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Pre-Assignment MOUNT ST. JOSEPH UNIVERSITY

Spring 2016 SCHOOL OF BEHAVIORAL & NATURAL SCIENCES

CLASS TITLE: SOC/SWK 377 - R8, Evaluation Research

& Grantsmanship

PREREQUISITE: SOC/SWK 375

INSTRUCTOR: Judy Singleton, Ph.D.

PHONE: 244-3269

OFFICE CL 13, Administration Building

EMAIL: judy.singleton@msj.edu

CLASS MEETS: 1/14; 1/28; 2/11; 2/25; 3/17; 3/31, 4/14; & 4/28 in CL 113;

Thursdays; 6:30 – 9:20 p.m.

REQUIRED TEXTS: *Program Evaluation: An Introduction by David Royse,

Bruce A. Thyer, Deborah K. Padgett, and T.K. Logan., 6th

edition, 2016, Publisher: Cengage Learning.

*The Royse et al. textbook is also available as an

ebook. The price is considerably lower than the print

version. If you are interested in the ebook, please either

visit the MSJ bookstore or go to the bookstore website at:

http://www.bkstr.com/mtsaintjosephstore/home/en?cm_mm

c=Redirect-_-VanityURL-_-shopmsj.com-_-10531

. Winning Grants Step by Step by Tori O’Neal-

McElrath. 2013, 4th edition. Jossey-Bass, Inc., Publishers.

PRE-ASSIGNMENT: (worth 30 points) I will not accept preassignments submitted after January 14,

2016, 6:30 p.m., nor will I accept handwritten assignments. However, you still need to complete the preassignment even if it is

late (without points being given) in order to move forward in the

class. Please note that partial preassignments are not accepted for

points. The assignment is to be completed in full. Number 5 in the

instructions below gives the outline of what you are to submit

(typed) for this preassignment. Print your preassignment and bring

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it to class (to turn in) as we will be discussing the preassignments

in class on January 14, 2016.

Preassignment Directions

1. For the pre-assignment, read chapter 3 in the Royse et al. text and the following pages

in the O’Neal-McGrath book: 1-11, 31-37, and 85-90. Be prepared for in-class

discussions and exercises related to these readings.

2. Locate a human service agency [with a tax-exempt IRS status, 501 (c) (3) – a

government agency is not suitable for this assignment] that will work with you to:

a) help you understand what are some very basic needs facing the clients with whom the

agency works; and,

b) help you as you prepare a grant proposal for the final project for this class.

Some of you are in field placements for social work. That field placement agency would

be ideal. If you are unfamiliar with a human service agency for which you can write

about for this class project, please contact me as soon as possible. I will give you

suggestions of agencies to contact. Three agencies have agreed to work with students in

this class.

3. With the agency, identify a “need” of the clients served by the agency. This may

entail something specific that clients ‘need’ in order to improve (for example, recreation

equipment for youth sports), or it may entail something that the agency ‘needs’ in order

to better serve clients (for example, laptops for home health care workers to enter client

notes as soon as possible after making visits). This particular ‘need’ is what you will

use to write a grant proposal for in this class (the major project of this class). Be sure

to discuss this with the agency. Please see the attached Appendix A for some ideas for

this discussion. I suggest you collect brochures, handouts, etc. from the agency. You can

learn more about the agency this way, particularly as some small agencies may not have a

website.

4. Read the article on a needs assessment at a homeless shelter that is attached at the end

of this preassignment. Using the Royse et al. text, chapter 3 (section on ‘selecting a

needs assessment approach), thoroughly discuss how the data was collected for the needs

assessment in this article.

5. This is what you submit as your preassignment on January 14,

2016: Submit in writing (that is, typed and double-spaced) both A & B below:

A. for the agency:

agency name

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agency address

agency contact name with whom you will be working for this class project

agency phone number

agency mission

identified ‘need’ (which you will use to write a grant proposal)

B. for the needs assessment article

Answer what was requested in #4 above (typed and doubled-spaced). There is

not a ‘length requirement’ on this; however, provide enough detail for me to see

that you understand and can clearly discuss the approaches

*Just for your information - you will be preparing a full grant proposal for the

major class project. That is the reason I want you to be connected to an agency for the

preassignment. Do not hesitate to call/email me if you are having difficulty linking up

with an agency, but remember…I’m just a resource. It is your responsibility to locate an

appropriate agency. I can help you with this process during the break so that you can

begin class with an agency for which you can write a proposal. The agency is not

required, nor are you for that matter, to submit any proposal written in this class for

actual funding. However, you do need to submit your class project (proposal) based on

an actual non-profit agency. Additionally, this class is preparing you to write proposals

for private foundations, not government ‘requests for proposals’ (RFPs). There is a big

difference.

Call me for help if you are stuck on selecting an agency. If you are late in finding

an appropriate agency, this class will become very difficult for you to stay on schedule,

and you will be strongly encouraged to drop the course. In fact, if you do not have the

preassignment completed on/by January 14, 2016 you will be asked to drop the class.

We meet only 8 times; you cannot fall behind and complete this class with a passing

grade. I will work with you, but you must get the work done on time and give me enough

time to help you (hint: don't call me after January 7, 2016 to tell me you need help

finding an agency. At that point, you will be requested to drop the course as you very

likely won’t be able to connect to any agency at such a late date). I really don't like being

so 'hard-nosed' about this, but I speak from experience. It is not an easy class when you

fall behind.

Please feel free to call me at MSJ at 244-3269, my cell at 513/520-1282, or e-mail

me at judy.singleton@msj.edu if you have questions. I look forward to seeing you in

class on January 14, 2016 and working with you before class as needed to get this

preassignment completed!

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Appendix A

The information below may help you begin thinking about needs that could be met

by the agency you choose to work with for this assignment. This is merely a guide.

Client Needs, Community Needs, Organizational Needs

Most funders (foundations, corporations, government) want to provide funds to

meet “client needs” and “community needs”, such as those listed in the chart below.

However, some funders will provide funds for “organizational needs”, sometimes called

“general operating costs” or “core support”. Listed below are some examples of all of

these types of ‘needs.’

CLIENT COMMUNITY

NEEDS NEEDS Food Safety, Protection

Housing, Shelter Jobs

Education Economic Growth

Mental Health, Counseling Social Justice

Healthcare Arts & Culture

Literacy Animal Welfare

Youth Development Clean Environment

ORGANIZATIONAL NEEDS

Executive Director

Fund Development Staff

Accountant

Office Manager

Furniture

Copy Machine

Insurance

Audit

Needs Assessment

Funders frequently ask:

Have you conducted a needs assessment?

How do you know that the problem/need exists in the community?

What is your evidence?

Sometimes you can find published evidence that supports your contention that a

need in the community exists.

In other cases, you need to conduct your own needs assessment.

You are not conducting a needs assessment for this project, but you do need to

discuss ‘a need’ with the agency in order to write the proposal based on that need.

The American Journal of Occupational Therapy 313

The Process and Outcomes of a Multimethod Needs Assessment at a Homeless Shelter

Marcia Finlayson, Michelle Baker, Lisa Rodman, Georgiana Herzberg

KEY WORDS • homelessness • occupational performance • program development

Marcia Finlayson, PhD, OT(C), OTR/L, is Assistant Professor, Department of Occupational Therapy,University of Illinois at Chicago, 1919 West Taylor Avenue(MC 811), Chicago, Illinois 60304; marciaf@uic.edu.

Michelle Baker, MOT, OTR/L, is Occupational Therapist,School System, Weehawken, New Jersey.

Lisa Rodman, MOT, OTR/L, is Occupational Therapist,ARC Broward, Sunrise, Florida.

Georgiana Herzberg, PhD, OTR/L, is Associate Professor,Occupational Therapy Program, Nova SoutheasternUniversity, Ft. Lauderdale, Florida.

Many factors contribute to homelessness, including extreme poverty, extended periods of unemployment,shortages of low-income housing, deinstitutionalization, and substance abuse. As a result, the needs of peo-ple who are homeless are broad and complex. This needs assessment used literature reviews, review of localdocuments and reports, participant observation, focus groups, and reflective journals to guide the developmentof an occupational performance skills program at one homeless shelter in south Florida. Through these meth-ods, the role of occupational therapy was extended beyond direct service to include program and resourcedevelopment, staff education, advocacy, and staff–resident mediation. The findings of the needs assessmentand the actions taken as a result of this work point to the huge potential for occupational therapists and stu-dents to work together with staff and residents of homeless shelters.

Finlayson, M., Baker, M., Rodman, L., & Herzberg, G. (2002). The process and outcomes of a multimethod needs assess-ment at a homeless shelter. American Journal of Occupational Therapy, 56, 313–321.

Over the past decade, occupational therapists have witnessed dramatic shifts inthe structure of the health, social, and educational systems. These shifts, com-

bined with an increase in communication among occupational therapists world-wide, have had a strong influence on the development of the profession, theoreti-cally and practically. The development of occupational science (Zemke & Clark,1996), the development or modification of practice models (Kielhofner, 1997; Lawet al., 1997; Townsend, 1997), and the growing focus on health promotion andwellness (Finlayson & Edwards, 1995, 1997) have encouraged occupational ther-apists to consider the application of their skills and knowledge to the broader socialand systematic issues that influence occupational performance.

The everyday practice of many occupational therapists has expanded toinclude work with people who would have been unlikely to have contacted anoccupational therapist in the past. Healthy older adults, children attending after-school programs, members of consumer advocate groups, and people who arehomeless are a few examples. Many occupational therapists have reported that col-laborative work with these populations can dramatically and positively influencetheir quality of life (Finlayson & Edwards, 1997).

The purpose of this article is to describe a needs assessment that was conduct-ed in the spring of 1999 at one homeless shelter in south Florida. The primary pur-pose of the needs assessment was to guide a developing occupational performanceskills program at the shelter that had resulted from a collaborative relationshipbetween the fourth author and the shelter’s director of social services. A secondarypurpose for the needs assessment was to guide the selection of fieldwork activitiesfor occupational therapy students working at the shelter.

Needs assessment is a type of applied research that focuses on gathering andanalyzing information to identify and describe gaps between real and ideal condi-tions that are amenable to change and then acting to make those changes. As a

result, needs assessment goes beyond collecting and analyz-ing information to using that information to improve thelives of people in the target population (Reviere, Berkowitz,Carter, & Ferguson, 1996). According to Altschuld andWitkin (2000), a needs assessment consists of three phases:preassessment, assessment, and postassessment. The focusand methods of the assessment are determined in the firstphase. The second phase involves data collection, analysis,and interpretation, and the final phase involves developing,implementing, and evaluating an action plan. This articleuses these three phases as an organizing framework, ratherthan the typical structure of a research article, to betterreflect the developmental nature of the process and out-comes of our work.

Preassessment: Determining Focus and MethodAs noted, the primary purpose of the needs assessment wasto guide a developing occupational performance skills pro-gram at the shelter. This program was, and continues to be,a collaborative venture between the faculty members andstudents of an occupational therapy education program atone university and the staff and residents of the shelter. Thecollaboration began after a chance meeting between theshelter’s director of social services and the fourth author ofthis article in the spring of 1998. By January of 1999, shel-ter administrators had decided to purchase 10 hours perweek of occupational therapy services from the universityon a contractual basis. These services were provided by alicensed occupational therapist engaged in postprofessionaltraining at the university.

At the time the contract was put in place, it was antic-ipated that the occupational therapy services would focuson assisting residents at the shelter to develop skills neededto enter the workforce and to obtain and maintain inde-pendent living arrangements. After the contract was in

place, though, more specific attention was given to definingand focusing the roles and activities of the occupationaltherapist and to selecting fieldwork activities for occupa-tional therapy students who would be coming to the shel-ter in April of that year. Through a series of meetingsamong the shelter’s director of social services, the occupa-tional therapist, and the first and fourth authors of this arti-cle, the specifics of the needs assessment were negotiated.Objectives were determined to be as follows: 1. Obtain background information on the overall context

of homelessness in the United States and on the needs ofpeople who are homeless.

2. Identify and describe the social and environmental con-text (e.g., rules, routines, culture) of the shelter and itsneighborhood.

3. Identify the primary issues and concerns of the residentsliving in the shelter.

4. Identify the primary issues and concerns of the staffmembers who worked at the shelter.

5. Identify the challenges and potential barriers that wouldbe faced in developing an occupational performanceskills program and having occupational therapy studentsat the shelter.

Methods to address these objectives also were determinedduring these meetings (see Table 1).

Assessment: Collecting, Analyzing, and Interpreting DataMultiple methods were used to collect the data for theneeds assessment (see Table 1). The university’s InstitutionalReview Board and the administrators of the agency thatoperated the shelter approved the assessment and its meth-ods and consent documents. The timeline shown in Figure1 illustrates when these methods were used during the pro-cess. Each method and the key findings are explained in thefollowing sections.

314 May/June 2002, Volume 56, Number 3

Table 1. Methods Used To Address Needs Assessment ObjectivesObjective Information Sources and Methods Selected

Obtain background information on the overall context of homelessness in the United States and on the Literature review of peer-reviewed and indexed articlesneeds of people who are homeless.

Describe the social and environmental context (e.g., rules, routines, culture) of the shelter and its Review of local reports, Web sites, and news reports neighborhood. Four periods of participant observation at the shelter

Reflective journals completed by students

Identify the primary issues and concerns of the residents living in the shelter. Focus group with residentsFour periods of participant observation at the shelterReflective journals completed by students

Identify the primary issues and concerns of the staff members who worked at the shelter. Focus group with staffFour periods of participant observation at the shelterReflective journals completed by students

Identify the challenges and potential barriers that would be faced in developing an occupational Four periods of participant observation at the shelterperformance skills program at the shelter. Reflective journals completed by students

Method 1: Literature Review

Information to address the first objective of the needs assess-ment was gathered through a literature search of articlesindexed in the following electronic bibliographic databases:MEDLINE, PsychLit, Sociofile, CINAHL, HealthStar, andERIC. Search terms included homeless, homelessness, andhomeless shelter. Through a review of the identified articles,we discovered that “homelessness continues to be amongthe most visible and most troubling social problems con-fronting our nation” (Herman, Struening, & Barrow, 1994,p. 249). According to the National Coalition for theHomeless (1999), approximately 700,000 people are home-less in the United States on any given night. Historically,the majority of people who were homeless were young ormiddle-aged men, but this situation is rapidly changing.The proportions of women, children, and families amongthe homeless population are steadily increasing.

Poverty is a major contributing cause of homelessness.Other factors associated with homelessness include short-ages of low-income housing, deinstitutionalization, physicaldisability, and a decline in local and state income assistanceprograms. In addition, extended periods of unemploymentor, alternatively, employment in menial jobs with low wageshave been found to be associated with the risk of becominghomeless (Applewaite, 1997).

The factors associated with homelessness mean thatpeople who are homeless have a complex array of practicalneeds, such as adequate nutrition, safe and affordable hous-ing, adequate education, suitable employment, and generallife skills. For many of these individuals, meeting theseneeds is complicated by the fact that an estimated 15% to30% of them have a serious mental disorder, and as manyas 70% also struggle with substance abuse and dependence(Toro et al., 1997). Persons given dual diagnoses (i.e., sub-stance abuse and psychiatric disorder) comprise about 20%of the overall homeless population (Toro & Warren, 1999).

In Florida, an estimated 23% of the homeless population isreported to have a mental illness, and 27% have histories ofboth substance abuse and mental illness (Broward Coalitionfor the Homeless, Inc., 1998).

Employment, housing, and income frequently havebeen identified as common needs among people who arehomeless, along with assistance for health and substanceabuse problems (Herman et al., 1994; Tryssenaar, Jones, &Lee, 1999). Job training and placement, child care, trans-portation, family counseling, and legal help have been iden-tified as additional problems and needs of people who arehomeless (Toro & Warren, 1999). It has been argued thatthe services that do exist do not match the needs reportedby people who are homeless (Herman et al., 1994), and thisargument points to the need to be client-centered whenconsidering the development of new programs and servicesfor this population.

Studies using focus groups (Applewaite, 1997),semistructured interviews (Herman et al., 1994), and theCanadian Occupational Performance Measure (Tryssenaaret al., 1999) have identified a range of client-centered prob-lems and needs of people who are homeless. Health andmental health problems, resource-related problems (e.g.,lack of decent, affordable housing), and public perceptionproblems all have been identified. Specific needs includefinding a place to live, finding a job to obtain a steadyincome, improving job skills, learning how to managemoney, learning how to get along better with other people,handling legal issues, and using resources. Participants inApplewaite’s (1997) study noted many barriers to their useof services, including insensitive service providers; negativepolicies and procedures; and problems with inaccessibility,inadequate services, and a generally discouraging social ser-vices system.

From the literature review, we became much moreaware of the incredible complexity of homelessness; we alsorealized that occupational therapists have knowledge andskills that could be used to address the needs, issues, andbarriers faced by people who are homeless (Heubner &Tryssenaar, 1996; Tryssenaar et al., 1999). Nevertheless,staff members and residents of homeless shelters are largelyunaware of the profession of occupational therapy. Thisfinding highlighted that we would have to constantlyexplain our approach and activities, their focus, and theirrationale to shelter staff and clients. Students would have tobe well-prepared to explain their presence and activities.

Method 2: Review of Local Reports

A review of local reports and newspaper articles contribut-ed to our understanding of the social and environmentalcontext of the shelter. Local information was identified

The American Journal of Occupational Therapy 315

January February March April May June

Objective 1: Literature Review

Objective 2: Review local reports

Objectives 2–5: Participant Observation

Objectives 2–5: Journals

Objectives 3 & 4: Focus Groups

Figure 1. Data collection timeline.

316 May/June 2002, Volume 56, Number 3

through networking with shelter staff and other agenciesworking with people who are homeless and through onlinesearches for Florida government reports and local newspa-per articles about homelessness.

Through these sources, we discovered that in BrowardCounty (where the needs assessment was conducted), thereare approximately 6,400 people who are homeless, andapproximately 1,300 of these people are children (BrowardCoalition for the Homeless, Inc., 2000). On any givennight, 5,000 people compete for 650 emergency shelterbeds (Huriash, 1999). In 1999, the Broward Coalition forthe Homeless reported to the Florida governor that 70% ofthe people who were homeless in the county were between18 and 59 years of age, 49% were Caucasian, 39% wereAfrican American, and 8% were Hispanic. Sixty-seven per-cent had been homeless for 1 year or more, and the major-ity (70%) were residents of Florida. A large proportion ofthe homeless population had acute or chronic health con-cerns: 36% had substance abuse issues, 33% had an acuteor chronic mental illness, 17% had HIV/AIDS, and 48%had a disability or chronic medical condition. Thirty per-cent were employed (Broward Coalition for the HomelessInc., 2000).

Countywide, approximately 200 agencies provide mul-tiple services to people who are homeless. Of these agencies,35 provide emergency and transitional shelter beds (L.Hansen, personal communication, August 15, 2001). In1998 and 1999, none of these agencies included occupa-tional therapy in their array of services. The shelter that wasthe focus of the needs assessment provided 164 of the 2,150beds available in the county in 1999. The same agency thatruns the shelter also operates a transitional housing facilityfor families who are trying to reestablish themselves after aperiod of homelessness.

Overall, this local review helped us to identify potentialresources in the community for future networking and torealize the scope of homelessness in our region. It helped usto realize that the population at the shelter would be turn-ing over quickly, would be very diverse in terms of age andethnicity, and would have complex needs. We would haveto be fluid in our programming and prepared to changeplans quickly to address the needs of whomever was at theshelter on any given night.

Method 3: Participant Observation

We decided to use participant observation as one method toget to know the residents, listen to their issues and con-cerns, learn about their backgrounds and visions for thefuture, and learn about the setting of the shelter and itsrules and routines. Spradley (1980) described moderateparticipant observation as a method in which the researcher

watches what is going on around him or her and begins toparticipate but does not become an insider. Four observa-tion periods ranging from 1 to 3 hours were completed over4 weeks by an occupational therapist hired to fulfill theoccupational therapy services contract. The observationperiods included an early morning time, an afternoon time,and two evening times. These times were selected to ensurethat a broad perspective was obtained on the routine of theshelter’s residents and staff and to ensure that the times per-mitted participation in regular shelter activities (e.g., mealtime, morning check-out, evening check-in).

After each period of observation, the occupational ther-apist recorded in a journal her observations of the shelteractivities and her insights and feelings about what she saw.She also shared this information verbally with the first andfourth authors, and the first author reviewed the writtenjournal. The discussions and journal review focused onidentifying contextual issues specific to the shelter, apparentgaps in the existing programming and services, and overar-ching issues and concerns of the residents and staff.Following is a summary from the journal, the discussions,and the reviews.

The building is two stories high and occupies approxi-mately one quarter of a city block. Two entrances are avail-able for residents. Only men live on the “transitional side,”where many of the residents have jobs and are saving forsecurity deposits to live independently. Families with chil-dren, women, and some of the unemployed men live on the“social services side.” A sense of community was apparenton the transitional side, with the men supporting eachother’s efforts to improve their own lives by sharing infor-mation, helping with tasks, or asking for and giving advice.The 8-ft wrought iron fence surrounding the building isintended to deter the local drug traffickers from using theagency parking lot for business. The ease of obtaining illic-it drugs, together with the fact that many of the residentshave a history of substance abuse, affect the rules and activ-ities of the shelter.

Persons staying at the shelter on any given night canbegin “checking in” at 5 p.m. They must be free from theinfluence of drugs or alcohol and can be required to passrandom breathalyzer and urinalysis checks to remain at theshelter. Anyone found to have drugs or alcohol in his or herpossession is immediately removed from the shelter with thehelp of local police, if necessary. The check-in process wasdescribed in the occupational therapist’s journal as follows:

The clients started to gather by the door around 4:15 forthe 5:00 opening. Clients were checked in by monitors;this was very informal (reminiscent of cattle call). Someclients seemed to have difficulty with organizing themselvesduring this task and understanding what was expected of

them, while others took it all in stride. Clients receive eithera towel or a meal ticket, which they return the next day.This does not seem to be working well as most towels weremisplaced as clients frequently forget to return them…thisresults in less towels the next night, and some clients didnot get one. Some clients demonstrated difficulty locatingtheir rooms (some because they were new). Staff redirectedsome clients but without eye contact or greeting...

The beds are in dormitory-style rooms, with each roomaccommodating 4 to 10 individuals. This arrangement cancreate problems for both staff and residents:

[Staff member] described an incident the night beforewhere two clients got angry because one snores and theother plays his radio to drown out the noise. He was ableto resolve the conflict and reestablish peace, but this morn-ing the man who played the radio asked for a room switch.[Staff member] said he tries to move people if he has thespace, but did not on that particular night. When I askedwhat happens if there is a big problem, he said he calls911…we need to have an emergency management plan...

Families stay together in a single room, regardless of thenumber of persons in the family. Dinner is served at 5 p.m.for families and at 5:30 p.m. and 6 p.m. for adults withoutchildren. Any programming offered to residents must occurafter dinner and be completed in enough time to accom-modate “lights out” at 10 p.m. In addition, time must beavailable for residents to complete laundry, phone calls, orother daily activities. At the time the participant observa-tion was conducted, a bible study was being led once a weekby one of the residents. In addition, a social work studentwas running a group on job skills. Rules of the shelterrequire that parents at the shelter do not leave their childrenunder the supervision of another resident so, as a result, areeither unable to attend evening programs or must bringtheir children to the program.

Residents are expected to leave the shelter no later than7 a.m. each morning, unless the resident works nights orhas a physical or mental illness or disability that puts him orher at risk for injury in the community. Approximately 24individuals remain in the shelter each day for these reasons.At the time of the needs assessment, no programming wasprovided for these persons, and few resources or materialswere available to help them fill their days (e.g., books, puz-zles, magazines). Of the residents who leave the shelter eachmorning, many go to day labor jobs. These jobs allow themto remain at the shelter for longer periods (up to 9 months).Individuals who are unable to secure work can only remainat the shelter for 8 days.

Upon completion of the participant observation expe-rience, we noted that many residents were frequent users ofthe shelter or others in the area. Many remained unem-ployed or employed in odd jobs or day labor that did not

provide adequate income to obtain a place to live. Manyhad difficulty with organization and social skills, had sub-stance use issues, and could not remember or maintain therules of the shelter. Space at the shelter was tight, and it wasnot clear where the occupational therapy programs weregoing to be held or what options would be available forchild care for those residents who wanted to come to pro-grams. It was also clear that students doing fieldwork at theshelter were going to have to work primarily in the eveningsto have contact with residents, and they were going to haveto be available at some time in the day to liaise with manyof the staff members.

Method 4: Focus Groups

Two focus groups were held as part of this needs assessment,one with residents and one with staff members who wereprimarily case managers. Participants for the staff focusgroup were identified in collaboration with the shelter’sdirector of social services. No attempt was made to obtain arepresentative sample of staff members; rather, the goal wasto obtain staff members who were articulate and had shownwillingness in their daily work to explore new ideas ormethods for improving the quality of life of people usingthe shelter. Although the involvement of the director ofsocial services in selecting staff focus group participants mayhave restricted our findings, it was more important toactively involve him as part of overall efforts to build rap-port and trust with the organization.

The staff focus group included 8 staff members, 5 ofwhom were women. Five participants identified themselvesas being African American, 2 as White, and 1 as “other.”The staff member with the least experience had been work-ing at the shelter for 6 months, whereas the one with thelongest experience had been there for 7 years. Examples ofquestions during the staff focus group included: What arethe needs your clients demonstrate? What are the factorsaffecting these needs? What goals have your clientsexpressed to you? What are the barriers that you think yourclients will face in meeting these goals?

For the same reasons that the director of social serviceswas involved in identifying staff members for the focusgroup, staff members were involved in identifying residentsfor participation in the client focus group. Selection of clientparticipants focused on individuals who had been living atthe shelter for at least 5 days but not more than 20 days, whowere able to communicate appropriately with other residentsand staff, and who had expressed personal issues or concernsin occupational performance areas. The client focus groupinvolved 11 residents of whom 9 were men. Six participantsidentified themselves as being African American, 4 as White,and 1 as “other.” Seven had been homeless less than 3

The American Journal of Occupational Therapy 317

months. Six indicated that this was their first time beinghomeless, whereas 2 others had been homeless more thanfive times in their past. Nine had at least a high school edu-cation, with 3 of them having some college or universityeducation. Examples of questions asked at the client focusgroup included: What are the strengths you believe that youpossess? What goals do you have for yourself? What are yourneeds in terms of trying to meet these goals? What can wedo to help you meet your goals?

The focus groups were conducted on site at the shelterby two different doctorally trained occupational therapists,each with extensive experience conducting needs assess-ments, focus groups, and developing new working relation-ships with community agencies. Both focus groups wereaudiotaped and attended by the same observer-recorder.The audiotapes from both focus groups were fully tran-scribed and then reviewed and discussed by the authors.Transcripts were then hand-coded by each author, with afocus on identifying the main issues that could inform thedevelopment of the occupational performance skills pro-gram or that had the potential to influence how the pro-gram or student fieldwork opportunities developed.Additional discussions were held after the coding process tocompare and contrast our findings and to discuss them inthe context of the needs assessment.

Four main issues emerged from the focus groups. First,perceptions of what it meant to be homeless differed. Someresidents argued that they were not “homeless” becausethey, having made the decision to remove themselves fromthe street, were living at the shelter. Staff members wereincredulous at this perspective because of the lack of per-sonal control residents had over their lives at the shelter.Staff members focused on the fact that residents have noinput into what will be served for meals, when to go to bed,or when to get up. Second, the staff and the residents didnot share the same priorities. The focus for the residents wason finding some meaning and direction in their lives,whereas the focus of the staff members was on finding jobsfor the residents and moving them out of the shelter. Third,the staff and residents had fundamentally different perspec-tives on getting and keeping a job. Residents wanted todevelop skills and seek jobs that would pay well, enablethem to reengage with mainstream society, and make a con-tribution: “[I want to] become a responsible, productivesource in society.” In comparison, staff members seemed toview all jobs as being equal and as a means to end a resi-dent’s experience with homelessness: “[They need] betteremployment. Skills, skills. Basically jobs and houses.” Thefinal issue that emerged from the focus groups was theextent to which the organization and mission of the shelterinfluenced the ability of both staff members and residents

to end the cycle of homelessness. Both staff members andresidents seemed to appreciate that many small steps wererequired to move from the shelter to independent living,but they were limited in their ability to set up, practice, andtake those steps. The rules and routines of the shelter andits focus on being primarily for emergency use limiteddevelopment of programs emphasizing graded levels ofresponsibility. Both groups were clearly frustrated with thesituation. As one resident explained, “This is just a revolv-ing door. The labor pool, and a hot [meal], and a cot.”

These findings highlighted that occupational therapyclients at the shelter were not going to be only the residents,as we had initially assumed. We also were going to have towork with staff members to identify ways of helping clientstake small steps toward their goals within the confines ofthe shelter environment. We were going to have to workwith both staff members and residents to advocate toadministrators for changes to the environment that wouldmake it easier for clients to experience success.

Method 5: Reflective Journals

The final method used to collect information for this needsassessment was a review of journal entries completed dailyby the first two occupational therapy students completingtheir Level I fieldwork at the shelter. The full-time fieldworkplacement was 3.5 weeks. The students completed 38 jour-nal entries. The primary purpose of the journals was to pro-vide communication between the students and the super-vising therapists (the occupational therapist providingservice at the shelter and two faculty members) and to pro-mote critical thinking and reflection. Although the journalswere not originally considered to be part of the needs assess-ment, the contents were found, over time, to provide fur-ther information about the context and activities of theshelter, and the needs and concerns of the residents andstaff. The reflections contained in the journals raised issuesfor our program and future student placements. Therefore,with the permission and participation of the students, thejournals were added to the available needs assessment dataafter the completion of the placement.

The analysis of the journals was conducted in the sameway as the analysis of the focus group transcripts. As a group,all the authors reviewed and discussed the contents of thejournals and the reflections of the students. The journals werethen hand-coded to identify issues that could inform thefuture development of the program or the student fieldworkopportunities. Additional discussions were held after the cod-ing process to compare and contrast our findings and to dis-cuss these findings in the context of the needs assessment.

What we found in the journals reinforced our findingsfrom our other data collection methods. First, the staff had

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a very limited view of our potential role at the shelter and,overall, did not have a clear understanding of what occupa-tional therapy was about. This finding was consistent withwhat we found in the literature. Second, the students notedthat they were constantly seeing new clients each day. Onestudent made the following entries in her journal: “We onlyhad two repeat members, the rest were new to the group.”“Due to the transient population each group gets new mem-bers. With new members come new ideas and concerns.”These and other entries reinforced our findings from ourreview of local documents and reports about homelessness inBroward County. We had anticipated that residents wouldbe changing rapidly and would be diverse in their needs andconcerns. The student journals supported this expectation.

Third, the student journals reinforced the discordancebetween the staff and the residents and the need for us tomediate between these two groups and help them to shareinformation with each other. After attending a job skillsgroup run by a social work student, one of our studentswrote:

The clients brought up so many issues that their case man-agers aren’t addressing. It is important that we inform thecase managers of what is going on and try to introducesome type of community meeting that could bring every-one together.

A few days later, one of the journal entries included this:As far as educating the staff members, I think bringingclient concerns to meetings each week can help us get ourpoint across in a nonthreatening way....I introduced theidea of a suggestion box for the clients. We could gather upall of the suggestions each week and bring them to the casemanagers at the meetings.

Again, the student journal entries reinforced what we hadfound in the literature review, the participant observations,and the focus groups about the differences in staff and resi-dent priorities and expectations for action.

Besides reinforcing our previous findings, the studentjournals pointed to some important considerations forfuture fieldwork placements. The students noted the impor-tance of spending informal time with residents, particularlyby joining them for meals. Similarly, helping staff memberswith routine activities was important for building rapportwith them. The journal entries also pointed to the need forfuture students to think on their feet and be prepared forthe unexpected.

Postassessment: Developing, Implementing,and Evaluating an Action PlanThis needs assessment was initiated to guide a developingoccupational performance skills program and the selectionof fieldwork activities of occupational therapy students

working at the shelter. As a result of our data collection pro-cess, we realized that our initial thoughts about what ourwork at the shelter would entail were incomplete. Althoughwe had initially assumed that the residents of the shelterwere going to be our clients, the discordance between staffand resident priorities and the negative influences of theorganizational structure of the shelter on staff and residentsuccess pointed to the need for us to be involved in theagency in a variety of roles. Clients could not only be limit-ed to the residents, but also include the case managers andadministrators of the shelter. People in these latter twogroups perform occupations that have a direct and pro-found influence on the lives of people who are homeless.

Our needs assessment identified that we were going tobe not only direct service providers, but also consultants,educators, mediators, and advocates. We realized that wewere going be involved in mediating discussions betweenstaff and residents, educating and mentoring staff aboutwriting realistic and achievable goals in partnership withresidents, and educating everyone about resources in thecommunity and how to access them. We also realized thatwe were going to be involved in suggesting changes to neg-ative policies and procedures. Ultimately, the findings fromour needs assessment demonstrated that we needed to thinkmore broadly about our roles and whom we were serving.

Based on our needs assessment, we initiated a clientadvisory board meeting once a month and had clients buildand set up suggestion boxes for the shelter. We also set up astudent volunteer program through which occupationaltherapy students provide programs for children so that par-ents can attend resident programs. The nature and contentof the resident programs are based on the issues identified atthe client advisory board meetings. The programs have var-ied over time but frequently focus on communication skills,job finding and interviewing skills, exploring inexpensiveleisure activities, and finding and maintaining a home.Over time, we have become more and more involved inplanning, organizing, and bringing in programs and ser-vices that we are either unable to provide ourselves or thatother individuals can provide more easily or effectively. Forexample, developing computer skills has been a consistentdesire of clients. As a result, together with residents, weworked to have space at the shelter renovated into a com-puter room and to obtain computers. Now a computerroom exists, and computer training programs are being runby outside volunteers.

Through our work with residents and staff, it becameapparent that additional professional services would bevaluable at the shelter, particularly optometry, audiology,and dispute resolution. Clients were having difficulty withjob-related tasks because of vision and hearing loss. Staff

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members needed further training and education on disputeresolution strategies. As a result, we contacted these otherdepartments at the university, found collaborators, anddeveloped and submitted an Allied Health Training GrantProposal to the Health Resources and ServicesAdministration of the Department of Health and HumanServices. This project was funded in July 2000 and will con-tinue until June 2003.

Evaluation of our work continues. Ongoing processevaluation has been used to modify how we provide ser-vices, what we provide, and to whom the program is tar-geted. We have been challenged in our efforts to determinethe extent to which our direct services help residents breakthe cycle of homelessness. Residents come and go, and it isdifficult to track people over time.

Other outcomes have been tracked more easily. Staffmembers now know what we do and view our work as partof what happens at the shelter. We have been invited toextend our work and provide services at the transitionalhousing facility. In addition, two other local shelters arenow negotiating to obtain their own occupational therapyservices. Occupational therapy students complete Level Iand II fieldwork placements at the shelter, and other oppor-tunities are available for them to gain experience in workingin both the shelter and the transitional housing facility. Theshelter hired its own occupational therapist in the spring of2000 but continued to contract with the university.Although the occupational therapist the shelter hired hasmoved to another position, the administration is commit-ted to filling the position.

ConclusionThe primary purpose of the needs assessment was to guidea developing occupational performance skills program atone homeless shelter in south Florida. We achieved this goaland have been able to develop a strong and currently sus-tainable program at the shelter. The needs assessmentincreased our awareness of the complexities of developingservices in a shelter setting and of the range of roles that anoccupational therapist can fulfill in this type of environ-ment. The strength of our approach was the use of multiplemethods of information gathering and our process orienta-tion. By learning from scientific and local literature, watch-ing and learning from residents and staff, and reflecting onwhat we were doing and learning, we have been able tobuild the strength of the shelter, its staff members, and theresidents who are served. s

AcknowledgmentsWe thank Amy Russell, MA, OTR/L, and ElisaHoneyman, OTR/L, for their assistance in collecting datafor this study and for their involvement in the initial con-ceptualization and development of the program at the shel-ter. This project was and continues to be financially sup-ported in part by the Occupational Therapy Program ofNova Southeastern University. M. Finlayson and M. Bakerpresented an earlier version of this article at the 2000American Occupational Therapy Association AnnualConference in Seattle, Washington.

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