The city of Seattle is ranked as the third-largest homeless population in the US with approximately 11,751 homeless individuals in 2020 (Public Health-Seattle & King County, 2020). Angeline’s is a former day center that now provides longer term, 24-hour housing for homeless women in Seattle and aims to help them find and maintain safe, stable housing. Their services include meals, laundry, showers, lockers, and connections to community resources. After completing a windshield survey and interview with two of the residents at Angeline’s, our group identified an impaired social interaction due to a lack of organized activities and mental health condition as evidenced by the resident’s expressed interest in diversional activities. Homelessness encapsulates complex challenges beyond just the need for a physical shelter. As mental health is one of the leading causes of homelessness (Perry & Craig, 2015), we aimed to evaluate activities that could improve mental health in homeless women. COVID-19 protocols provided a unique challenge; support groups and organized activities were no longer taking place. This decreased the womens’ connections and interactions throughout the day, which led to impaired mental health. In our interview, a few women desired to play games together such as bingo. This led to us organizing bingo sessions and incorporating educational themes to each bingo card such as exercise, self-care, and coping. With this project, we hoped to engage the women in a joyful and interactive game while also providing education and encouragement through activities in order to improve their mental, physical, and emotional wellbeing.
According to the U.S. Census Bureau, women make up approximately 47% of the homeless population in King County (Public Health-Seattle & King County, 2019). The rate of women experiencing homelessness in King County has increased since 2018 (Public Health-Seattle & King County, 2019). Upon meeting and collaborating with the women at Angeline's Day Center, we determined that the most commonly expressed concerns were related to a lack of stimulation and socialization. As a result of COVID-19, Angeline’s had implemented protocols including the restriction of visitors and volunteers from entering the facility, and limited outdoor access to one time per day. A nationwide consequence of these types of protocols is increased depression, especially in the homeless community (Honor et al., 2021). Obstacles faced by many homeless individuals include impaired access to mental health resources, social isolation, social role deprivation, and lack of income to participate in recreational activities (Kerman and Sylvestre, 2020). For example, women at Angeline’s discussed that in order to cope with their depression and boredom, many resorted to increased smoking.
The bingo activities consisted of three interactive self help educational games on the topics of physical exercise, coping skills, and self-care. The goal of our program was to increase socialization and interaction between the women at Angeline’s along with increasing the physical, mental, and emotional wellbeing of the participants. To accomplish these goals, the program used diversion coupled with educational tools to encourage the incorporation of physical exercise, coping mechanisms, and self-care into the daily lives of the participants. Throughout the four weeks of interventions, the women were provided education (see Appendix A) on the chosen topic and then engaged in low intensity exercises during physical fitness bingo and learned about/discussed self-care and coping strategies in the other two bingo games. The bingo game had squares with these different exercises, coping mechanisms, or self-care ideas on them (see Appendix B). As the players marked their spots on the bingo card, they would either physically engage in the exercise or have discussion about the strategy. Each of these sessions lasted about one hour consisting of two rounds, and offered prize incentives as motivational factors to increase participation. As a result, this allowed them to learn new health promotion tools while being social and having fun.
We chose to use diversional activities as research shows that diversional activities act as a buffer, reducing stress in the lives of women living in homeless shelters (Klitzing et al., 2004). Klitzing et al. (2004) observed that activities, regardless of what they were, assisted women to cope and provided motivation to continue. Furthermore, Klitzing et al. noticed that activities promoted socialization, connection with others, and were shown to be self-restorative.
According to Marshall et al. (2020), boredom is a prominent feature of the experience of being homeless. To combat boredom, this population often uses ineffective or detrimental coping strategies such as substance abuse, smoking, or oversleeping (Marshall et al., 2020). As previously noted, the women at Angelines reported an increase in smoking due to boredom. Though boredom may seem small in comparison to other challenges that affect the homeless population, it has been shown to have a profound effect on their lives (Marshall et al., 2020).
Our goals were to increase the physical, mental and emotional wellbeing of participants along with increasing social interaction. Through our interventions we gathered both qualitative and quantitative data to measure these goals. Prior to determining an intervention, we used interviews and surveys (see Appendix C) to determine that the women felt they lacked diversion and socialization. Our presurvey results showed that though 75% of women were aware of coping skills, only 41% actively used these coping skills. Moreover, 25% of participants were satisfied with their current self-care and exercise practices which varied among participants.
Following each bingo session, we had participants fill out a survey to evaluate the impact of our intervention and make improvements. Through the data gathered and feedback from the staff at Angeline’s, we found that the intervention positively impacted the participants by increasing socialization, knowledge, mood, and the use of self-care and coping mechanisms. In the post-intervention surveys, 70-88% of participants reported an increase in knowledge regarding coping and self-care, and 64%-72% reported that they are likely to use skills learned. In addition, in our final survey, 60% of participants reported that these interventions provided an opportunity for social interaction and increased mood.
The limitations of this research include a small number of interventions, incomplete surveys, and lack of continuity of participants at each event. The participation fluctuated due to schedule conflicts and engagement may have fluctuated due to language and mental health barriers of participants. A further limitation was due to the inability to build stronger relationships due to COVID-19 isolation protocol and time restraints. Part of the COVID-19 protocols was wearing masks at all times, which prevented the women from seeing the faces of others and forming a more trusting relationship.
Future recommendations for this program include ensuring that the bingo interventions have clear easy to follow rules and facilitators use simple language to reduce barriers. Facilitators should encourage participation by asking questions during implementation. A further way to maximize impact is for future facilitators to build trust by forming relationships with the participants. Another recommendation would be to include music during interventions to allow time for free movement and exercise. Overall, implementation of these bingo activities provided an opportunity for diversion, socialization, and education which had a positive impact on the mental and emotional wellbeing of the participants.
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Kerman, N, Sylvestre, J. Surviving versus living life: Capabilities and service use among adults with mental health problems and histories of homelessness. (2020). Health & Social Care in the Community, 28(1), 414–422. https://doi.org/10.1111/hsc.12873
Public Health-Seattle & King County. (2019). Data and reports. https://kingcounty.gov/depts/health/locations/homeless-health/healthcare-for-the-homeless/data-reports.aspx
Public Health-Seattle & King County. (2020). Point-in-time count estimates a 5 percent increase in people experiencing homelessness, newly updated data dashboards reveal more people receiving shelter and services. https://kingcounty.gov/elected/executive/constantine/news/release/2020/July/01-homeless-count.aspx
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Marshall, C. A., Roy, L., Becker, A., Nguyen, M., Barbic, S., Tjörnstrand, C., Boland L., Westover L. A., Mace, J., Gewurtz, R., Kirsh, B., & Wickett, S. (2020). Boredom and homelessness: A scoping review. Journal of Occupational Science, 27(1), 107-124. https://doi.org/10.1080/14427591.2019.1595095
Perry, J., & Craig, T. K. J. (2015). Homelessness and mental health. Trends in Urology & Men's Health, 6(2), 19–21. https://doi.org/10.1002/tre.445
Greene, Alora Mae; Hoag, Jennifer; Hwynn, Kiana; Johnson, Jana; Skinner, Sophie; and Wong, Jacob, "Implementation of Interactive Self-Help Bingo Activities to Promote Social Interaction within Angeline’s Women's Shelter" (2022). Nursing Leadership in Community Engagement Projects. 10.
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