Occupational Justice Lecture 7 PDF

Enabling Health & Wellbeing Through Occupation Josh Campbell M.Sc.OT, OT Reg, (Ont.), RVP, CVRP, CCLCP Occupational Therapist, Vocational Professional, & Life Care Planner Lecturer, School of Occupational Therapy Western University, Elborn College...

Enabling Health & Wellbeing Through Occupation Josh Campbell M.Sc.OT, OT Reg, (Ont.), RVP, CVRP, CCLCP Occupational Therapist, Vocational Professional, & Life Care Planner Lecturer, School of Occupational Therapy Western University, Elborn College Rm 2529 RS 3125A – Lecture #7 1 iiiieiiattiiia.ro startbroad1st context  Overview for Today Questions about the group Project Occupational Justice 2  wanttopromoteit Occupational justice requires occupational rights for all to:  Participate in a range of occupations that support survival, health and well-being so that populations, communities, families and individuals can flourish and realize their potential, consistent with Occupational theoccupations they choosetoparticipate in Rights  Choose occupations without pressure, force, coercion, or threats but with acknowledgement that with choice comes responsibility for other people, lifeforms and the planet  Freely engage in necessary and chosen occupations without risk to safety, human dignity or equity. Ii is 3   Occupational deprivation - the result of individuals being denied the opportunity and resource is to participate in occupations outsittthi  Occupational imbalance - and occur when an individual is under employed or unemployed or has too little to do underemployedinworkorotheroccupant  Or the individual may be involved in too many occupations such hEEET É as the case of a single parent with multiple family and work Occupational for of of demands unique all us thereisapoint balance me  Occupational marginalization - when individuals lack the power Justice Terms to exercise occupational choice as can occur when persons are stigmatized by illness or disability racereligioncultureetc  Occupational alienation - when people are required to participate in occupations they find meaningless with little recognition or reward contextinnaturaldisasters nosufficientmeaningtherewasnobenefit cyclone 4   Occupational rights are secured by identifying and addressing the Occupational capabilities, opportunities, and freedom of choice for individuals, communities and populations to participate in society. alllevels Rights  Legal Justice vs Occupational Justice stilites Notthesamething great inglesethings 5  Using a Justice  Critically evaluating how practice contexts and our own practice Equity and processes promote or create barriers to the justice, equity, and rights of the individuals and collectives we work with and taking Rights-Based action to reduce or remove barriers to occupational participation Lens promoteoccupationaljustice evolvingconcept canbeidealicon one end 6  More Micro, Meso, Macro Terms to remember 7  factors Impersonal Fore heart IRmodify Ihesengqld approach compensatory adapt occur personallu  Personal level Micro Level  Therapist-Client Relationship Injustices  Implicit biases iiiniiiiiEE.E.is understandthese try to justdoingwhattheywantworkw̅ them unconsious hiddenbiaseswe not of aren'tconciouslyaware jigs Eutera grewup you media socialcircles 8 beawareofthembyidentifying thingsthatdo exist  Meso Level  Practice Environment Injustices men EiiiiiEiii look waysof barriersyouare not conciouslyaware of 9   Systems and structures that have created gradients of health for Macro Level people based on race, sex, ability, disability, sexual orientation, social class, age, geography, and social position Injustices issues Bigpicturesystemic long process happened todevelopoveryears decades structuralfactors individuals for createinequities groups addressingthisrequires 10 politicalaction advocacy  Preventing and estoneremediate stablisheducate Reducing Occupational Deprivation & Injustice Iiiii whatapproachescan weuse toprevent occupationaljustice Micro educateaboutpotentialinjustice megiggglish whatinequitiesmaypeopleexperiences geographicalbarriers Createpromoteto potentialinequities 11 Macro opportunities new towardsthatgroup catered Terinequality genÑ occupationalparticipation createawareness healthcare inclusiveenvironments typesof notcovered PT SES whatcanyouafford flyfi ipations wanttoparticipate thatyou curriculars sportstravelextra stigma whatis outthere knowledge ofinternet somedon't Instilacies  collaborative body improving  Occupational justice practice stretches beyond technical or instrumental goals to address the local, national or international restrictions that limit Micro Level possibilities for some populations or communities to participate Occupational  At the micro level, it is necessary for practitioners to Justice gain an awareness of their own positioning in health care systems, including how systems create Interventions situations that disempower and limit a persons occupational participation.  Professional status carries power ghettepethetherinsurancewillcoverit referrals eE.gefePyEouit all 12 powersharingis key collab   Being client-centred  Collaborating with clients and using the client as an expert in their own lives Power Sharing  Listening to and validating a client’s experience when they report & feeling unheard. Collaboration  Avoid imposing your own occupational norms on others  Recognizing that occupations have widely divergent meanings and values to different people, and that most occupations are performed differently from person to person. t.EE EiEn Yistenforlanguagethatgives them a voice 13  whataremybiases ftp.otegtgtaggressionthatmightnotseem  Become aware of Micro-aggressions mail.taffkacommentssee.se  Engage in critical self-reflection to identify biases Addressing badway  Engage in reflective practices with colleagues Micro-  Reflexive practices are strengthened by incorporating the voice of Occupational marginalized and stigmatized groups Injustices  Develop and implement preemptive strategies that mitigate the impact of implicit bias and that focus on their clients’ rights to live dignified lives where they can be and do what they value. advocating for clients of part power sharingapproac 14  Managing  Equipping a client with strategies to manage negative social stigma is a micro-level justice-oriented practice broader social  Advocating for a client’s rights within an institution or social forces system. key 15  htinju.itiei fostering discussion  Support the occupational rights of clients through intra-organizational transformation. Meso Level  include activities such as creating community-level occupational therapy programs to target the Occupational occupational needs of groups or modifying organizational policies and processes to increase Justice their sensitivity to the occupational rights of the Interventions people they affect.  Can also target the culture of clinical practice for occupational therapists in institutions. 16  Macro Level HE ftp.E iisnti tmnitis Occupational framework  POJF Justice  COTIPP Interventions dothings individual lul toenact change systemic Irl 17  Power Participatory Occupational Justice Framework (POJF) 18   Social Inclusion - this is focussed on ensuring people have opportunities, resources, and capabilities to fully participate in life and that they are supported to be contributing citizens in the Participatory society in which they live Occupational  CORE  Capabilities Justice  Opportunities Framework  Resources  Environments 19   While the process of the POJF is nonlinear, the typical starting point for a professional is to become conscious and raise consciousness in others of occupational injustice  The typical closing process for professionals is to inspire advocacy POJF Process for collaborative decision making about sustainability or closure of professional relationships or programs and services  Processes may be repeated or adjusted as needed depending on statiats where practice starts, partner readiness, resource conditions, and other factors collaborativedecisionmaking advocacy 20  Step 1 Raising Consciousness  Involves becoming aware of occupational injustice as a concern for of social inclusion in everyday life startingpoint  May include documenting awareness officially Occupational raiseconsiousness inself others Injustices areparticularpopulationspeopleexcluded unconsciousbiases of forms concious diverseperspectives needotherstoo 21  Step2  What Population or community is of central concern?  How ready are all partners to participate, and how resilience do they hope to be for the process? Engage  What conflicting beliefs, values, cultural, and power issues need attention? ensureeffectivecollab Collaboratively  What education, mediation, or negotiations will actively show with Partners respect for the worth, dignity and rights for all?  How will the designated partners participate?  What documentation is being created? convoisn't enough  How will knowledge be exchanged? themallinvolved keep formprorelationships accountability Includepartnershipsinbig policychanges 22 peopleitactuallyimpacts stakeholders ofthebiggest one municipalgovernment attemptedchangebefore policy experts   What goals, objectives and outcomes will be targeted and how will the underlying occupational justice issues be communicated? Step 3  What programs or services would have the greatest collective impact to reduce occupational injustice for a group, community, or buick foryour population? biggestbang Mediate a Plan  What education regarding occupational injustice needs to be included to engage the population, public, or government in Based on recognizing occupational injustice as a serious issue? Collaborative  What evaluation and documentation is needed to demonstrate program or service accountability to the public or to funders? Partnerships  Who advocate for human and financial resources and what are the funding options? Eeprom  What forum, method, database or other documentation will identify potential resource is? 23  Step 4  What occasion is needed to identify and confirm resources? Mediating and  What are priority occupational performance, spiritual and agreeing on a environmental issues, strengths, resource is an challenges for the population or social group of concern? plan  What enabling processes have been used? 24  Step 5  How are the partners enabling change in occupations through occupational engagement? Support  How are occupations being simulated? implementation  How does population collaborate in decision making about and continuous strategies for continuous evaluation? evaluation of the  How is a learning through doing philosophy used? trial error  How will the impact of services be monitored throughout? plan  What summative evaluative data will display whether or not the goals are being met for enabling occupational justice? 25  Step 6 Inspire  How might professionals inspire advocacy with or for partners?  What decisions would guide advocacy for sustainability or closure? advocacy with  What is the perception of success and lessons learned for each or for partners partner? to sustain or  What empowerment strategies might professionals inspire to positively conclude professional involvement and end the end the plan professional relationship? 26  191styodelers focusonmeso macro Canadian Occupational Therapy Inter- Relational Practice Process Framework (COTIPP) 27  Connect Seek Understanding and Define Purpose Explore Occupational Participation Six Action Domains Co-Design Priorities, Goals, Outcomes, and Plans Trial the plan, Explore Change, Refine the Plan Plan for Tranisiton 28  Relativelynon linear relationship connect w̅people buildcollab  The first meeting between individual, family, or group, community or population  Start to build a collaborative relationship titter  Facilitating an equitable entry point for initiation of services Connect by diverse individuals or groups, while considering potential systemic and structural barriers  Determine equity barriers  Learn Expectations for occupation from multiple perspectives 29  KeyQ's connect stage  What processes, rules, or structural factors are creating barriers?  What can you do to help (what knowledge and skills do you have)? Considerations  What constraints do you have ?  What are the conditions under which the individual or group wishes to engage? collabrelationship 30  validateexperiences Seek  Continue to build a collaborative relationship Understanding  Create a situation where the individual or group can share their stories , desires, and priorities regarding occupational and Define participation Purpose The holder  Listen to the ideas of the individual or group 31  KeyQ's individualmediation  What approaches will maximize our understanding?  How can we create conditions for interpersonal and physical safety? Considerations  Are there any practice models or frameworks that apply?  Are there any alternatives?  What approaches are most appropriate? howtogetinfo talktothem igtiifugelsst.tw survey best waytoreachpopulation 32   Co-create the conditions for exploring occupational participation concerns, aspirations, possibilities, desire for change, etc. Explore  Evaluate occupational participation including occupational personal/group factors and environmental contexts that impact occupational possibilities Participation  Develop priorities regarding concerns expectedoutcomes enablementapproaches 33   What formal and informal exploratory approaches will maximize understanding of the induvial/group story, while promoting and supporting conditions for interpersonal cultural, spiritual, and physical safety? Considerations  What are the most appropriate communications approaches  What strategies can potentially address structural and systemic barriers to occupations? 34   Co-create the conditions for collaboratively developing and or all of these through mutual sharing of perspectives about Co-Design occupational participation concerns priorities, goals,  Co-design plans while carefully supporting autonomy and self-determination outcomes, and  Co-create conditions for sharing of perspectives plans  Explore justice and equity barriers to achieving goals 35   What communication approaches will encourage rights-based self-determination?  What empirical, experiential, and theoretical knowledge might be important to consider? academicperspective Considerations  What are the most effective and appropriate strategies that are acceptable to the individual or group and are likely to have maximum benefit for the individual or group, considering the constraints and possibilities within the environment?  What justice and equity barriers to occupational participation need to be addressed? 36   Collaborate with the individual or group to trial the plan for promoting or sustaining occupational participation  obtain the individuals or the groups perspectives of their Trial the plan, experiences working with the plan, particularly how it did or Explore did not promote occupational participation Change, Refine  continuously monitor shared understanding and perspectives of progress and safety, and collaboratively the plan adjust the plan when needed  Co create the conditions for sharing perspectives about outcomes 37   How does your role and relationship with the individual or group need to evolve as you progress?  What are the most appropriate methods to collaboratively monitor progress and the individuals or groups personal, relational, and contextual factors that may be affecting progress? Considerations  What are the most appropriate approaches to discussing potential changes in the plan?  What are the most appropriate methods for exploring outcomes?  What was the effectiveness including any unintended consequences? 38   Listen to and seek to understand the individuals or the groups perspectives on the transition following your Plan for involvement Transition  Intentionally Co create a transition plan with the individual or the group transition tooccur goalsneededfor nosurpriseseveryoneisinvolved 39   What are the implications of transition for the individual or the group? inlongterm Considerations  How can any gains be maintained?  What additional resources can the individual or group access? 40  Sumintomainpoints Reduce or remove environmental barriers saidthandone easier Designing programs that enable engagement Providing information to policy makers What can we maynotbetheonesmakingthechangeyoucandriveit topushinto direction right do specifically? Increasing social inclusion Continued research to understand barriers and occupational injustice Adjusting social thinking of canalsoadjustthinking others 41  particularenvironmental ones  Physical Barriers Removing  Institutional Barriers Environmental  Social Barriers Barriers  Cultural Barriers 42  Removing  Universal Design accessibledesign Physical  Barrier free design Barriers  Barrier free language and signage usebroaderframeworks to drive create changesinpolicies 43  Removing  Advocating for individuals and groups Institutional  Creating or changing policies Barriers 44  Designing or  Identify a potential occupational issue of interest or concern for Finding you and the people you work with  explore which community agencies and existing groups might Programs that have some shared interests and aims Enable  consider which ones you might want to reach out to for a partnership and how you might do that Engagement makers influencepolicy In'texist terupsinspecificorgs cantryto adjustsocialthinking make itexist 45   Speaking with municipal, provincial, and federal government Influencing representatives Policy Makers  Speaking with policy makers at specific organizations 46   Public and population health  health promotion Adjusting  prevention of disease, injury, and disability Social Thinking  community development  Primary Health care and primary care 47  Case Examples 48  Aftermath terroristattack of Muslimindividuals of significantdiscrimination Muslimwomenweresociallyisolated avoidedgoingout  Context: Community based program in Sydney, Australia 1. Cycling  Focus: Strategizing and mobilizing of resources alltypesofwomen included Sisters  Group: Muslim Women injustice deprivation experiencingoccupational Groupsetting environment safe 49   With assistance of an OT formed a cycling group  Included non-Muslim women as well impetiantiagniccupation  Cycling Sisters now has several “chapters” in other parts of New South Wales in Australia, and has attracted sponsorship for cycling jerseys and t-shirts. Cycling Sisters  They have a social media presence and are fully self-sufficient.  They routinely participate in fundraiser rides raising money for other causes like MS research  Most recently, new groups have formed of women who swim and bushwalk together under the same banner 50  2. Occupation  Context: Non-Government Organisation (NGO) leading a state- wide refugee resettlement collaboration in Queensland, Australia focused  Focus: Raise consciousness of occupational injustice life skills  Group: Newly arrived people from refugee/ forced migration program backgrounds lackoffamiliarityw̅ AustralianLaw HCsystemtransportwelfare try negotiate new life 51   Based on stakeholder experiences and feedback, with colleagues Suleman developed the Life Skills Program aimed at providing new arrivals with a toolkit to not only survive, but to ultimately flourish, in their new environments.  Supported by use of interpreters if needed, and cultural support Occupation workers  The program runs over 3 days and covers core skills and facilitates focused connectedness with others through community building events life skills such as barbecues and picnics  Participants have their knowledge tested in informal non- program threatening ways checkingin betterreceived retained info  Has received funding from federal resources and grants  Now includes individual case management, skill development and training, community engagement, youth support and soft employment. 52 way  3. Occupation  Context: State Government funded forensic mental health service focussed  Focus: Support implementation and continuous evaluation practice  Group: Patients and OTS in a forensic hospital in New South Wales Australia initiative mentalhealth in criminalfacilities carerated 57 haveadiagnosable mentalhealthcondition ofthose in healthcapacitywasnot Notcriminallynegligentb c mental inrightplace intocommunity reintegrate committed crime 53 mentalhealthsobadthat Rehabunitwaspurposebuilt rehabilatiativeaspectdiminished modelrather driftto a prison thanrehab   The OT team engaged in practice-based inquiry  Goal of “reclaiming occupation” in their service in order to better meet the occupational needs of their patients Occupation  Through this initiative the Ots have:  Provided more occupation focused opportunities for patients focussed including a café, recycled clothing shop and market garden practice Tiffin  Are more confident in using occupation focused language to describe their work p initiative  Are more effective in their communications with other team members and with management  Have become practice scholars within the public domain, disseminating and discussing their work through publications and conference presentations. betteradvocates forclients model OT'shavebecome better shiftback torehab towards their clients 54  Next Guest Speakers 55