Occupational therapists play an important role in helping people develop skills for daily living. Nancy Curci is a psychiatric occupational therapist. She has dedicated her practice to helping people experiencing homelessness and mental illness. She talks with the HRC’s Wendy Grace Evans about her approach as an occupational therapist and member of a multidisciplinary team.

Q: What is your approach for working with a new client?

I always start with the client. I believe it is important to understand the person first and the diagnosis second. I conduct a battery of assessments to understand how a person processes new information. The assessments give me a sense of the person’s baseline skills. This helps me to understand what skills we need to focus on. I also need to understand a person’s level of motivation for working with me. This helps me share detailed information about the whole person with the multidisciplinary treatment team.

Q: How can multidisciplinary teams work together to help individuals experiencing homelessness and mental illness?

I believe that each discipline brings unique expertise to the team. The psychiatrist provides a diagnosis and an understanding of psychiatric medications. The nurse knows how to address physical ailments. The social worker can provide input on the family background, and an understanding of program availability. The case manager offers a daily report on how the individual is working on goals. The occupational therapist presents the team with a baseline of concrete information about the individual’s capabilities. The therapist also helps the team to work with the individual to define and set goals.

Q: Can you tell me about “The Road Back,” the rehabilitation model you developed?

The Road Back describes the de-socialization process experienced by people who are disenfranchised. It offers a path back to help people find their place in the community again. This model is unique because it accomplishes four things:

• It uses play, fun, and laughter in physical, sensory, and emotional areas.
• It is a flexible model that can be used on the streets, in housing, or in hospitals.
• It provides a transitional bridge between providers. This ensures consistency in treatment and philosophy.
• It offers a holistic basis for assessment. This allows tracking of progress in levels of daily living skills, such as independence, autonomy, control, and functions of daily living.

Q: Can you share any success stories about people you have worked with?

I was working with a woman who was diagnosed with bipolar disorder and who had been homeless. She had a hard time relating to other people. Her husband had left her and she lost her children in the court system to their father. She was having trouble listening to people in the shelter. She had no job and she was angry, and shelter staff had difficulty understanding her.

I met with her and we went out for coffee to assess her social skills. From working with her, I learned that before she would participate in groups at the shelter she needed to feel respected. So, she was given the task of reading the weather to the group once she had her coffee. While she started very slowly, eventually people began to see her differently, as a whole person. As she felt respected, she felt more comfortable participating. Since her progress at the shelter, she has moved out of homelessness and into an apartment. She feels comfortable there and is able to manage her life quite well.