Transitioning From Homelessness: The COTS Program
By Ashley Opp Hofmann
Photo at right: As part of the COTS programming, a woman in a shelter serving mothers and their children painted this picture of a home. She described it as illustration of her goal.
For many clients served by the Community Occupational Therapy Services (COTS) program, transitional housing facilities and their programs constitute a last-ditch effort to improve their quality of life. Occupational therapy students from across the country have completed fieldwork requirements through the COTS program at the University of Tennessee Health Science Center located in Memphis. COTS provides occupational therapy services to seven facilities serving persons transitioning from homelessness.
“We provide life skills training. Occupational therapy students and supervisors facilitate all of the activities,” says Lisa Tekell, MS, OTR/L, program director for COTS. Six facilities are transitional living shelters. Each shelter specializes in serving military veterans and other populations with issues such as alcohol and substance abuse, mental illness, dual diagnosis, and domestic violence. Clients may live in a shelter for up to 2 years, depending on their progress toward independence. A seventh facility provides permanent supportive housing for dually diagnosed veterans. The veterans pay some rent and may live at the facility indefinitely.
In 2000, a University of Tennessee Health Science Center (UTHSC) occupational therapy graduate, Debbie Follis, BS, OTR/L, envisioned the COTS program and procured the funding through the city of Memphis’s Continuum of Care application to Housing and Urban Development (HUD) Supportive Housing Program. She made the necessary connections with the housing facilities and obtained matching funds from the university before leaving to pursue her practice. Gretchen Stokes, MALS, OTR/L, launched the program in 2001 co-led the program with Tekell until Stokes moved to pursue her doctorate. Tekell has worked with the program for the past 4 years.
COTS has fieldwork contracts with 66 colleges and universities in the United States and one in England (Leeds University). The program can accommodate up to 12 students per rotation, or about 48 students per year. “There’s hardly a fieldwork experience I can think of where students would have the opportunity to work with so many students from other schools, hear ideas, and build off the differences in their backgrounds,” says Ann Nolen, PsyD, OTR, associate professor and chairperson of the Occupational Therapy Department at UTHSC,
Usually two students are placed in each facility, and each has a supervisor. “I do a phone interview with students and ask them to write a letter with information about themselves,” Tekell says. “With that information, I have a pretty good idea of where they would best be placed. I think about what their goals and personal objectives are, and I match them according to the site.”
At the transitional living facilities, occupational therapy students work with clients individually and in groups. COTS intervention can be grouped into four large categories: improving self-awareness; increasing performance in work and self-care; improving quality of life; and building healthy relationships.
“Each client has established a personal, individualized plan,” explains Tekell. With the students’ assistance, clients learn computer skills, parenting skills, résumé writing, anger management, basic activities of daily living, sewing, health awareness, relationship building, community reintegration, and sober leisure options. For example, a group of clients who are dually diagnosed worked on computers to create cookbooks that used rice as a basis for all of the recipes. Another group developed a personalized Monopoly game they use to help develop money management skills.
Community Within the Community
Community is central to the success of the program. “We do a lot of building beautification projects where clients bring in landscaping—filling in holes, putting in shrubs and rocks, making the facility nice,” Tekell notes. These projects are particularly significant for the veterans who reside at the permanent supported living facility. “It’s really important that we create community and homes in these apartments. We put a lot of energy into beautification. In this way, the residents are involved in giving back to their own community.”
When clients graduate from a facility—usually by way of securing a job and a safe place to live—they continue to have access to occupational therapy services for up to 6 months. “We let them know that the transition is a huge step and that there will be a lot of hurdles for which they may want assistance,” Tekell says. For example, a client who has graduated might call COTS for help with his résumé or interview skills, so a student and supervisor would meet with him and work on those tasks. “Right now, I have a client calling us who is dealing with a difficult relationship. She just wants resources, which we connect her to,” says Tekell.
“We’ve had amazing results,” Tekell continues. More than 50% of the clients met a goal related to improving their health, improving their productivity, or gaining a vocational skill to improve their income, which is quite high for this population. Perhaps more importantly, clients develop self-esteem and confidence. One project that proved especially beneficial was giving brownies to veterans on Veterans Day. Clients baked the brownies; wrapped them up in red, white, and blue; and created cards to thank the veterans living in the Memphis community.
“They came up with original things to say to show their appreciation,” Nolen said. “These are little things, but they’ve given the clients such self-respect and confidence. We watch them become comfortable with who they are; they just come alive.”
In another community project celebrating Mother’s Day, the clients decided to make flower pots, cards, and pictures for residents of a nearby nursing home. “They are able to give back and become an active community member,” Tekell says. “A lot of them feel like they have taken for so long, and they just blossom by being able to give back.”
Working and Learning
Experiences in COTS have shaped and developed students’ professional selves. “Students are given a wonderful opportunity to create their own structure in these facilities. A hospital is so structured and [practitioners’] roles are closely governed by reimbursement, whereas the community really gives students a chance to express who they are and be creative,” Nolen says. After working in COTS, “students have an appreciation for diversity and for what occupational therapy can do in the community,” she adds.
Weekly staff meetings are an important part of fostering creativity and idea exchange. Students and supervisors come together to discuss client and facility issues; their “aha! moments;” and topics related to students’ future job searches, including fieldwork experience, interviews, and ethical situations.
Looking to the Future With Hope
Unfortunately, HUD has cut funding for facilities’ support services so the occupational therapy services provided through HUD will end on February 29, 2008. Despite occupational therapy students on waitlists, who will likely not get to participate, the COTS staff is optimistic. “We’re sad to see it end, but 7 years on a grant is a good run,” Nolen says, and the program has significantly influenced hundreds of occupational therapy students and clients.
Tekell knows that the effects of COTS will continue as clients rebuild their lives and as students move on to develop their own careers. As she puts it, “Watching a shy student become an assertive, healthy occupational therapist who is ready to take on anything and is able to be creative with her clients, listen to them, and guide them through life—that’s pretty awesome.”
For more information, please contact Lisa Tekell at email@example.com or visit the COTS Web site at www.utmem.edu/cots.
Ashley Opp Hofmann is AOTA’s senior staff writer.