OT for individuals experiencing homelessness

Quinn Tyminski, OTD, OTR/L, BCMH, leads an emerging area of mental health practice

by Michele Berhorst • December 11, 2023

Tyminski (middle) engages with one of the clinic's regular clients from St. Patrick Center’s Women’s Night Program.

At St. Patrick Center (SPC), a St. Louis nonprofit organization that assists people experiencing homelessness, the occupational therapy (OT) clinic is held on Wednesdays at 10:30 a.m. The clinic is led by Quinn Tyminski, OTD, OTR/L, BCMH, and the students in her Community Independence Occupational Therapy lab. The students head upstairs to ask SPC clients who are in the day treatment program: “Are you coming to OT?”

Ten clients follow the students downstairs into the OT room, which was previously a child-care center with a bathroom, a small kitchen and a private meeting room. Also present is Kailin Lust, OTD ‘23, SPC’s future staff occupational therapist and Program alumna, to welcome clients to the clinic.

Everyone is dressed casually in jeans and collarless shirts, so there is no delineation between the clients and the students. It’s intentional to remove any health-care hierarchy or power dynamics. The clients take their seats as the session begins. Today’s focus is health promotion with an emphasis on prevention and management of seasonal illnesses and is led by second-year doctoral students Anna Brondyke and Mia Pearce. The students design and implement a series of group-based treatment sessions and activities based on client feedback regarding what they want to learn about that semester.

The students and clients sit together in small groups and discuss the differences between the flu, COVID, the common cold and allergies. The conversations are guided by a “comfort agreement,” where everyone agrees to be respectful, present and to actively listen to one another without judgment. Toward the session’s end, the group talks about the different illnesses and ways to take care of themselves and others when they are sick. Clients give input on what they would like to see on a follow-up resource flyer on the day’s topic and are invited to the next week’s session as they exit the room.

Tyminski and Lust discuss with the students how the session went, client engagement, and possible follow-up topics. They also discuss the clients themselves – many they have seen week after week – what concerns the clients have and how the students can support them in future OT sessions.

“We are not the experts here; the clients are. We recognize that we know about one thing and that’s OT. The clients know everything about being unhoused,” Tyminski explains. “We do not know what their lived experiences are, and we will never know unless we become homeless.”

Mental health OT

Before joining the faculty of the Program in Occupational Therapy in 2017, Tyminski worked for five years at Peter & Paul Community Services (PPCS) Labre Center, a transitional housing program for men experiencing severe and persistent mental illness and homelessness. It had been the site of her first week-long fieldwork I (FW1) experience as a master’s student in the Program. Jeanenne Dallas, MA, OTR/L, FAOTA, FW coordinator and mental health practitioner, became a mentor. “Jeanenne ran a lab with Catina O’Leary, PhD, focused on community-based mental health services. We would visit organizations that were serving various populations in the community to learn about the role of OT and mental health. I also completed a three-month FW2 rotation at an inpatient psychiatric hospital called Sheppard Pratt in Baltimore. I saw acutely ill clients and high-level cases. It helped me understand the prior trauma and the experience of my clients when they are most acutely ill,” Tyminski says.

Sarah Walsh, MOT, OTR/L, the occupational therapist at PPCS, hired Tyminski soon after graduation. Tyminski recalls: “I had been volunteering there throughout OT school. While mental health OT positions can be entry-level, this was not, because I was the only occupational therapist in the entire agency. There was no one to supervise me, so Sarah became my mentor. We met weekly for my entire first year and then monthly. I had so much to learn about my clients and myself.”

Early on, Tyminski acknowledged her privileges and that she did not have the same identities as her clients. She would have to adjust her approach if she wanted to earn their respect. “I had to change my communication style and learn to listen more. These were clients who needed encouragement to do things they didn’t want to do. I used motivational interviewing and other counseling approaches to encourage behavioral change,” she says.

There are specific challenges to working with the unhoused population for the therapist. “It’s not like acute or inpatient care where you know your clients for a short period of time. I have clients I have known for almost a decade. People can have histories of substance abuse, incarceration and chronic disease in addition to mental health conditions,” Tyminski explains. “It can be emotionally taxing when working with a client to stay clean, and then they relapse. There are calls in the middle of the night that a client didn’t come home or that law enforcement is involved. Many of our clients have short life expectancies due to lifestyle or comorbidities. I have been to numerous funerals as well.”

However, having such long-term relationships with clients can also be incredibly rewarding. “I get to see people change their lives, truly change their lives. Behavioral change is so slow, but over the course of several years, I see someone who couldn’t keep a job due to substance abuse live independently, modulating their emotions and caring about others,” Tyminski says.

After three years, Tyminski was promoted to PPCS’ clinic director. She was tasked with implementing a new billing system and training others on documentation. She hired and supervised two OT assistants and helped increase the organization’s capacity to take FW students. Working in community-based mental health OT in St. Louis is a niche area, and Tyminski was a frequent guest lecturer at several OT programs. She found she enjoyed teaching and mentoring. Walsh encouraged her to pursue a post-professional doctorate from Saint Louis University so she could move into academia.

“I could have stayed in mental health practice forever because I really do love it. However, I felt I would become a complacent practitioner if I stayed full-time in the role. I felt the doctoral degree was a step toward being able to impact the practice and the OT profession in a different way,” Tyminski explains.

The OT clinic was developed as part of her post-professional doctoral capstone project at Biddle Housing Opportunities Shelter, an emergency shelter for single men experiencing homelessness. It was operated through a contract between SPC, PPCS and the City of St. Louis. After a couple of years, agencies decided not to renew their contracts and continued to offer services at their facilities. SPC had a proposition for Tyminski that aligned with her new role as Program faculty.

“They told me that OT had been the most beneficial service they had ever provided for their clients and asked if I would bring the clinic to their main building,” she shares. “I told them I needed a clinic space. Once I saw the vacant child-care center, I knew it was the right place for their clients and my students.”

Mentoring students

Both master’s and doctoral students have the opportunity to work with Tyminski in the OT clinic starting in the summer semester and running a full year. She wants to take students interested in mental health who aren't going to get such an opportunity elsewhere. There is a recruitment process in place, but it is the current students who conduct the interviews and help select the next cohort. They know what to look for based on their client and clinic experiences at SPC.

“Being a specialized mental health practitioner actively working in community organizations with individuals who have serious mental illness takes a specific skill set,” Tyminski says. “You have to constantly manage your emotions, expressions, words and body language. Anything that you’re doing could be sending a message to that client. However, the important critical skill students develop is flexibility. Unexpected things happen in the clinic, and the students have to run with it. We often toss out the prepared session to focus on an immediate client need or concern.”

One of Tyminski’s long-term clients still comes to the clinic even though she is now in stable housing. “She was in the Women’s Night Program when she started coming to OT. She had a lot of emotional dysregulation and would become angry with other clients and leave the room. We worked on her coping and communication skills. Slowly, she started to change behaviors,” Tyminski recalls. “We now call her our peer support OT helper. Recently, a client with several mental health issues was having a crisis. To help him calm down, she gave him the fidget toy she used and encouraged him to come to OT. Later she told us she was really annoyed with him at first but then realized she had been in that situation and wanted to help.”

Emerging leader

Tyminski is an emerging leader in the area of mental health OT. She is a guest speaker, lecturer and presenter on the national level at conferences and events. “I found a niche practice area that I am passionate about, so that gives me a conversation space. There is not a lot out there about the role OT has in the homeless and the unhoused population. However, it only does me so much good to tell other occupational therapists about it through publications and presentations,” she says.

So she has taken an innovative approach to reach beyond the profession. Tyminski is a frequent guest on podcasts and presented a TEDx Talk in 2021 on OT for homeless individuals. “These opportunities are a chance to reach the people who are funding these needed services. If the general public is asking ‘If OT is an evidence-based way to address the unhoused crisis, then why are my federal dollars not funding OT services?’ The message needs to be broader, so organizations can receive funding to have an occupational therapist on staff,” Tyminski shares.

To meet that goal and further her career, Tyminski is pursuing a PhD degree in education. “In medicine, we focus heavily on quantitative research, but I find that, particularly in homelessness, it requires qualitative research to really see people’s perspectives. It’s important to me that I am doing research rigorously enough because the evidence can help organizations like SPC secure funding to hire occupational therapists. I also want to be in an administrative leadership position one day, and the PhD degree opens up more opportunities to create impactful mental health OT outcomes.”