Publication Date

Winter 3-8-2023

Item Type

Text

Executive Summary

Introduction

This women’s day and overnight center has over fifty-five beds for single adult women experiencing homelessness and provides two meals a day. Residents also have access to bathrooms, showers, laundry, personal storage lockers, and group activities. Other services provided are community resources, such as housing assistance, and a clinic next door.

Seattle Pacific University (SPU) students were able to get to know these ladies and observe their attitudes and behaviors, and they discovered the need for coping strategies and community. In their observation the students noticed that most women seem to keep to themselves. To address this need, SPU nursing students implemented exercise classes and art therapy with the hope of giving multiple coping options and gathering the ladies together to foster community. The students’ nursing diagnosis is ineffective coping strategies related to housing insecurity and lack of access to resources as evidenced by observable behavior reported by residents (i.e. isolation from others) and the project manager. The students' goal is that the women enjoy conversing and participating in the activities and that their interventions would leave the women with a greater community at the shelter and more coping options.

Background

Women have different needs from other populations in homeless communities. A study conducted in 2020 that investigated the experiences of homeless women found that “Women have greater mental health concerns, higher rates of diagnosed mental health issues, suicidal thoughts and attempts, and adverse childhood trauma” (Milaney, 2020). Homeless women are more vulnerable than men to trauma situations, which is why the article indicated a need for women-targeted trauma-informed care. The students interviewed the program manager at the agency, and she expressed that more residents have experienced an increase in mental health issues, more than ever before. She explained that the residents needed more interaction, another human necessity that was limited by COVID-19. According to the program manager, ‘“Understandably, many women who have experienced chronic homelessness have trust issues”’ (Rodriguez-Knutsen, 2022). With this in mind, the agency and their advocacy team take a different approach to healing and helping than most: community building. “A lot of women that have come in just need someone to listen to how they’re feeling”’ (Rodriguez-Knutsen, 2022). To the program manager, social interaction and being with the residents was more important than creating an activity without first engaging with the population.

Activities

The SPU students created activities that would allow the residents to enhance coping mechanisms, with the hope the residents would continue them at their leisure. Their first activity is low impact exercises consisting of seated hip marching, arm extensions, leg extensions, and back stretches. They moved chairs to the front of the room to form a circle, so they were visible for the residents to follow instructions. This intervention lasted 20 minutes. The other activity is self-directed painting on paper or canvases. Paintbrushes, watercolor, acrylic paint, and pictures of nature to serve as inspiration were provided for residents to choose from. This activity lasts 60 to 90 minutes. These two activities allow the residents to establish new healthy coping mechanisms while building a community.

Research has shown exercise to be a significant coping strategy, “AE [aerobic exercise] brought about a large or moderate to large improvement in depression in a wide range of delivery formats” (Morres, 2018). The students created an exercise routine that was simple, and increased heart rate to improve cardiovascular health. The residents also expressed that they were experiencing back pain. A study found static stretching helped relieve back pain and increase range of motion in their participants (Hatefi et al., 2021). With this information, the group implemented static back stretches into the routine. The exercise routine was targeted towards mental health, but the students also added stretches requested by the residents. The students wanted to foster an opportunity for the residents to interact with students and other residents.

Another coping strategy implemented into the program was art therapy. A study was done to evaluate the effectiveness of art therapy as a structured activity in fostering social inclusion and found that art projects and activities are good starting points for socialization and engagement. They also found that, “art provides an alternative from the problems associated with homelessness, mental health and substance abuse and allows for public recognition and social inclusion.” (Thomas, 2011). Many residents are seen using the designated smoking area as a form of coping. The students decided that art therapy would be an excellent coping strategy to implement for the residents, especially those who turn to substance abuse. The students provided paints and canvas for the residents to express their creativity through painting. Images of scenery were also provided to give inspiration.

Outcomes

On the first week of implementing the project, three students led 5-6 participants in the group exercise program. There were several residents participating from their seats in different spots of the room as well. Many residents who participated in the exercise program also completed art projects on various mediums. After each art and exercise session, the students asked residents to complete a post-activity survey that asked them how much they enjoyed the activity and whether they had any comments or suggestions to improve the project. During the second week of implementation, there were the same number of participants for exercise and art as the first week. The third week of implementation had fewer residents for exercise and only one member in the art group. Based on the feedback surveys, 100% of residents who participated in art, exercise, or both said they really enjoyed the activities, and 100% said they would do it again. The residents provided us with valuable suggestions, such as requesting the students bring a speaker to play music and to incorporate more back focused exercises, which the students implemented to improve the project.

Conclusion

The students were successful in implementing the interventions and survey results were unanimously positive. The surveys asked the residents to rate the activity on a scale of one to five. Besides one score of four, the surveys all gave a rating of five. While this shows success of the interventions, it also points out the flaw. The surveys were not handed out until week five and the data would have been stronger if the students had started the surveys on the first visit to Angelines.

The students observed that residents wanted to continue working on their art projects after the students left the site. Two residents reported continuing the exercises independently in the interval between visits. The students see this as an indicator that the residents are likely to continue using these coping strategies in the future. Additionally, the surveys asked if the residents would like to do this activity again, and all the residents indicated that they would do these activities again.

A limitation of the project is that the students cannot follow up with the residents to see if they have continued using these coping strategies outside of the project's timeline. An idea for improving this project would be to add a section to the survey asking how the residents expect to continue these activities. Another limitation was the thirty-dollar budget, which the students used to purchase art supplies. They found that this budget was not sufficient to purchase enough canvases to last throughout the project. This led to cardstock paper being used by week eight instead. Additionally, the students were unable to control external factors that affected the success of the project such as illness of residents and community events coinciding with their visits, which negatively affected how many residents participated in the activities.

References

Haeyen, S., van Hooren, S., van der Veld, W. M., & Hutschemaekers, G. (2018). Promoting mental health versus reducing mental illness in art therapy with patients with personality disorders: A quantitative study. The Arts in Psychotherapy, 58, 11–16. https://doi.org/10.1016/j.aip.2017.12.009

Hardy, Kendyl. “A Closer Look at Volunteering: Angeline's Day Center for Women.” YWCA Works, 24 May 2018, https://www.ywcaworks.org/blogs/ywca/thu-05242018-1158/closer-look-volunteering-angelines-day-center-women

Hatefi, M., Babakhani, F., & Ashrafizadeh, M. (2021). The effect of static stretching exercises on hip range of motion, pain, and disability in patients with non-specific low back pain. Journal of Experimental Orthopaedics, 8(1), 55. https://doi.org/10.1186/s40634-021-00371-w

Mikkelsen, K., Stojanovska, L., Polenakovic, M., Bosevski, M., & Apostolopoulos, V. (2017). Exercise and mental health. Maturitas, 106, 48–56. https://doi.org/10.1016/j.maturitas.2017.09.003

Milaney, K., Williams, N., Lockerbie, S. L., Dutton, D. J., & Hyshka, E. (2020). Recognizing and responding to women experiencing homelessness with gendered and trauma-informed care. BMC Public Health, 20(1), 397. https://doi.org/10.1186/s12889-020-8353-1

Morres, I. D., Hatzigeorgiadis, A., Stathi, A., Comoutos, N., Arpin-Cribbie, C., Krommidas, C., & Theodorakis, Y. (2019). Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis. Depression and Anxiety, 36(1), 39–53. https://doi.org/10.1002/da.22842

Rodriguez-Knutsen, A. (2022). Rebuilding homeless services in Seattle. YWCA Seattle | King | Snohomish. (2022, October 4). https://www.ywcaworks.org/blogs/ywca/homeless-services-seattle#:~:text=%E2%80%9CA%20lot%20of%20women%20that,BNBuilders%20refreshing%20Angeline's%20Day%20Center

Thomas, Y., Gray, M., McGinty, S., & Ebringer, S. (2011). Homeless adults engagement in art: First steps towards identity, recovery and social inclusion. Australian Occupational Therapy Journal, 58(6), 429–436. https://doi.org/10.1111/j.1440-1630.2011.00977.x

Uttley, L., Stevenson, M., Scope, A., Rawdin, A., & Sutton, A. (2015). The clinical and cost effectiveness of group art therapy for people with non-psychotic mental health disorders: A systematic review and cost-effectiveness analysis. BMC Psychiatry, 15(1), 151. https://doi.org/10.1186/s12888-015-0528-4

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