REHABSCI 3125A: Enabling Health & Wellbeing Through Occupation PDF

REHABSCI 3125A: ENABLING HEALTH & WELLBEING THROUGH OCCUPATION LEC. 9 - OCCUPATIONAL JUSTICE OCCUPATIONAL JUSTICE TERMS ​ Occupational Deprivation: the result of individuals being denied the opportunity and resources to participate in occupations​ ​ Occupational Imbalanc...

REHABSCI 3125A: ENABLING HEALTH & WELLBEING THROUGH OCCUPATION LEC. 9 - OCCUPATIONAL JUSTICE OCCUPATIONAL JUSTICE TERMS ​ Occupational Deprivation: the result of individuals being denied the opportunity and resources to participate in occupations​ ​ Occupational Imbalance: occur when an individual is underemployed or unemployed or has too little to do ○​ Individual may be involved in too many occupations such as the case of a single parent with multiple family and work demands ​ Occupational Marginalization: when individuals lack the power to exercise occupational choice as can occur when persons are stigmatized by illness or disability ​ Occupational Alienation: when people are required to participate in occupations they find meaningless with little recognition or reward OCCUPATIONAL RIGHTS ​ Occupational rights are secured by identifying and addressing the capabilities, opportunities, and freedom of choice for individuals, communities, and populations to participate in society ​ Legal Justice vs. Occupational Justice USING A JUSTICE EQUITY AND RIGHTS-BASED LENS ​ Critically evaluating how practice contexts and our own practice processes promote or create barriers to the justice, equity, and rights of the individuals and collectives we work with, and taking action to reduce or remove barriers to occupational participation MACRO, MESO, MICRO TERMS MICRO-LEVEL INJUSTICES ​ Personal level ​ Therapist client relationship ​ Implicit biases MESO-LEVEL INJUSTICES ​ Practice environment MACRO-LEVEL INJUSTICES ​ Systems and structures that have created gradients of health for people based on race, sex, ability, disability, sexual orientation, social class, age, geography, and social position PREVENTING AND REDUCING OCCUPATIONAL DEPRIVATION AND INJUSTICE MICRO LEVEL OCCUPATIONAL JUSTICE INTERVENTIONS ​ Occupational justice practice stretches beyond technical or instrumental goals to address the local, national, or international restrictions that limit possibilities for some populations or communities to participate ​ At micro level: necessary for practitioners to gain an awareness of their own positioning in healthcare systems, including how systems create situations that disempower and limit a personal occupational participation ​ Professional status carries power POWER SHARING AND COLLABORATION ​ Client-Centered ​ Collaborating with clients and using the client as an expert in their own lives ​ Listening to and validating a clients experience when they report feeling unheard ​ 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 ADDRESSING MICRO-OCCUPATIONAL INJUSTICES ​ Become aware of Microaggressions ​ Engage in critical self-reflection to identity biases ​ Engage in reflective practices with colleagues ​ Reflective practices are strengthened by incorporating the voice of marginalized and stigmatized groups ​ Develop and implement preemptive strategies that mitigate the impact of implicit bias and that focus on their client’s rights to live dignified lives where they can be and do what they value MANAGING BROADER SOCIAL FORCES ​ Equipping a client withs strategies to manage negative social stigma is a micro-level justice-oriented practice ​ Advocating for a client’s rights within an institution or social system MESO LEVEL OCCUPATIONAL JUSTICE INTERVENTIONS ​ Support the occupational rights of clients through intra-organizational transformation ​ Include activities such as creating community-level occupational therapy programs to target the occupational needs of groups or modifying organizational policies and processes to increase their sensitivity to the occupational rights off the people the affect ​ Can also target the culture of clinical practice for occupational therapists in institutions ​ POJF: PARTICIPATORY OCCUPATIONAL JUSTICE FRAMEWORK ​ COTIPP: CANADIAN OCCUPATIONAL THERAPY INTER-RELATIONAL PRACTICE PROCESS FRAMEWORK PARTICIPATORY OCCUPATIONAL JUSTICE FRAMEWORK ​ Social Inclusion: 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 society in which they live ○​ CORE: Capabilities, Opportunities, Resources, Environment POJF PROCESS ​ While the PJOF Process is not linear, 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 in to inspire advocacy for collaborative decision making about sustainability orr closure of professional relationships or programs and services ​ Processes may be repeated or adjusted as needed depending on where practice starts, partner readiness, resource conditions, and other factors RAISING CONSCIOUSNESS OF OCCUPATIONAL INJUSTICES ​ Involves becoming aware of occupational injustices as a concern for social inclusion in everyday life ​ May include documenting awareness officially Engage Collaboratively with Partners (Questions to Ask) ​ What populations or communities are of central concern? ​ How ready are all partners to participate, and how resilient dot hey hope to be for the process? ​ What conflicting beliefs, values, cultural, and power issues needed attention? ​ What education, mediation, or negotiations will actively show respect for the worth, dignity, and rights for all? ​ How will the designated partners participate? ​ What documentation is being created? ​ How will knowledge be exchanged? Mediate a Plan Based on Collaborative Partnerships ​ What goals, objectives and outcomes will be targeted and how will the underlying occupational justice issues be communicated? ​ What programs or services would have the greatest collective impact to reduce occupational injustice for a group, community, or population?  ​ What education regarding occupational injustice needs to be included to engage the population, public, or government in recognizing occupational injustice as a serious issue? ​ What evaluation and documentation is needed to demonstrate program or service accountability to the public or to funders? ​ Who advocates for human and financial resources and what are the funding options? ​ What forum, method, database or other documentation will identify potential resources? Mediating and Agreeing on a Plan ​ What occasion is needed to identify and confirm resources? ​ What are priority occupational performance, spiritual and environmental issues, strengths, resources and challenges for the population or social group of concern? ​ What enabling processes have been used? Support Implementation And Continuous Evaluation of the Plan ​ How are the partners enabling change in occupations through occupational engagement? ​ How are occupations being simulated? ​ How does the population collaborate in decision making about strategies for continuous evaluation? ​ How is learning through doing philosophy used? ​ How will the impact of services be monitored throughout? ​ What summative evaluative data will display whether or not the goals are being met for enabling occupational justice? Inspire Advocacy with/for Partners to Sustain or End the Plan ​ How might professionals inspire advocacy with or for partners? ​ What decisions would guide advocacy for sustainability or closure? ​ What is the perception of success and lessons learned for each partner? ​ What empowerment strategies might professionals inspire to positively conclude professional involvement and end the professional relationship? CANADIAN OCCUPATIONAL THERAPY INTER-RELATIONAL PRACTICE PROCESS FRAMEWORK (COTIPP) Six Action Domains 1.​ Connect 2.​ Seek Understanding and Define Purpose 3.​ Explore Occupational Participation 4.​ Co-Design Priorities, Goals, Outcomes, and Plans 5.​ Trial the Plan, Explore, Change, and Refine the Plan 6.​ Plan for Transition 1.​ Connect ​ The first meeting between the individual, family, or group community or population ​ Start to build a collaborative relationship ​ Facilitating an equitable entry point for initiation of services by diverse individuals or groups, while considering potential systemtic and structural barriers ​ Determine equity barriers ​ Learn Expectations for occupation from multiple perspectives Considerations ​ What processes, rules, or structural factors are creating barriers? ​ What can you do to help (what knowledge and skills do you have)? ○​ What constraints do you have ? ​ What are the conditions under which the individual or group wishes to engage? 2.​ Seek Understanding and Define Purpose ​ Continue to build a collaborative relationship ​ Create a situation where the individual or group can share their stories, desires, and priorities regarding occupational participation ​ Listen to the ideas of the individual or group Considerations ​ What approaches will maximize our understanding? ​ How can we create conditions for interpersonal and physical safety? ​ Are there any practice models or frameworks that apply? ​ Are there any alternatives? ​ What approaches are most appropriate? 3.​ Explore Occupational Participation ​ Co-Create the conditions for exploring occupational participation, concerns, aspirations, possibilities, desire for change ​ Evaluate occupational participation including personal.gro9up factors and environmental contexts that impact occupational possibilities ​ Develop priorities regarding concerns Considerations ​ What formal and informal exploratory approaches will maximize understanding of the individual/group story, while promoting and supporting conditions for interpersonal cultural, spiritual, and physical safety? ​ What are the most appropriate communications approaches ​ What strategies can potentially address structural and systemic barriers to occupations? 4.​ Co-Design priorities, Goals, Outcomes, and Plans ​ Co-create the conditions for collaboratively developing and or all of these through mutual sharing of perspectives about occupational participation concerns ​ Co-Design plan while carefully supporting autonomy and self-determination ​ Co-Create conditions for sharing of perspectives ​ Explore justice and equity barriers to achieving goals Considerations ​ What communication approaches will encourage rights-based self-determination? ​ What empirical, experiential, and theoretical knowledge might be important to consider? ​ 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? 5.​ Trial the Plan, Explore Change, Refine the Plan ​ Collaborate with the individual or group to the trial the plan for promoting or sustaining occupational participation ​ Obtain the individuals or the groups perspectives of their experiences working with the plan, particularly how it did or did not promote occupational participation ​ Continuously monitor shared understanding and perspectives of progress and safety, and collaboratively adjust the plan when needed ​ Co-Create the conditions for sharing perspectives about outcomes Considerations ​ 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? ​ 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? 6.​ Plan for Transition ​ Listen to and seek to understand the individual or the groups perspectives on the transition following your involvement ​ Intentionally co-create a transition plan with the individual or the group Considerations  ​ What are the implications of transition for the individual or the group? ​ How can any gains be maintained? ​ What additional resources can the individual or group access? What Can We Do Specifically? ​ Reduce or Remove environmental barriers ​ Design programs that enable engagement ​ Providing information to policy makers ​ Increasing social inclusion ​ Continued research to understand barriers and occupational injustice ​ Adjusting social thinking Removing Environmental Barriers ​ Physical, institutional, cultural, social Removing Physical Barriers ​ Universal Design ​ Barrier-Free Design ​ Barrier-Free language and signage Removing Institutional Barriers ​ Advocating for individuals and groups ​ Creating or changing policies Designing or Finding Programs that Enable Engagement ​ Identify a potential occupational issue of interest or concern for you and they people you work with ​ Explore which community agencies and existing groups might have some shared interests and aims ​ Consider which ones you might want to reach out to for a partnership dn how you might do that Influencing Policy Makers ​ Speaking with municipal, provincial, and federal government representatives ​ Speaking with policy makers at specific organizations Adjusting Social Thinking ​ Public health and population ​ Health promotion ​ Prevention of disease, injury, and disability ​ Community development CASE EXAMPLES CASE 1: CYCLING SISTERS ​ Context: Community based program in Sydney, Australia ​ Focus: Strategizing and mobilizing of resources ​ Group: Muslim Women ​ OT-formed cycling group ​ Several “chapters” and sponsorships ​ Social media and fully self-sufficient ​ Routinely participate in fundraiser rides ​ Groups have formed of women who swim and bushwalk CASE 2: OCCUPATION FOCUSED LIFE SKILLS PROGRAM ​ Context: Non-Government Organisation (NGO) leading a statewide refugee resettlement collaboration in Queensland, Australia ​ Focus: Raise consciousness of occupational injustice ​ Group: Newly arrived people from refugee/ forced migration backgrounds ​ Based on stakeholder experiences and feedback, program developed aiming to provide new arrivals with toolkit to survive and flourish ​ Supported by use of interpreters if ended, and cultural support ​ 3 days and covers core skills and facilitates connectedness with others through community building events ○​ Such as barbecues and picnics ​ Participants have their knowledge tested in informal non threatening ways ​ Has received funding from federal resources and grants 3. OCCUPATION FOCUSED PRACTICE INITIATIVE ​ Context: State Government funded forensic mental health service ​ Focus: Support implementation and continuous evaluation ​ Group: Patients and OTS in a forensic hospital in New South Wale Australia ​ Practice-Based inquiry ​ Goal: “Reclaiming occupation” in their service to better meet needs of patients ​ OTs have: ○​ Provided more occupation focused opportunities for patients: cafes, recycled clothes shop, market garden ○​ Are more confident in using occupation focused language to describe their work ○​ 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 REHABSCI 3125A: ENABLING HEALTH & WELLBEING THROUGH OCCUPATION LEC. 10 - COURSE REVIEW DEFINING OCCUPATION ​ Anything people want to do, need to do, and are expected to do ​ Doing, Being, Becoming, and Belonging Basic Assumptions of Occupation we Started With ​ Occupations affect health and wellbeing ​ Occupations organize time and bing structure to living ​ Occupations bring meaning to life ​ Occupations are very personal Basic Assumptions of Occupation we Added Along the Way ​ Everyone has the right to participate in occupations that ○​ Support survival ○​ Support health and wellbeing ○​ Are meaningful ○​ Are freely chosen Key Concepts we Covered ​ PEO Model: ○​ Barriers and Facilitators ○​ Occupational fit: how well someone and their occupation align ​ Enablement Approaches: Designed to improve fit ○​ Create/Promote ○​ Restore/Remediate ○​ Establish/Educatie ○​ Maintain ○​ Modify/Adapt ○​ Prevent PEO with Enablement Approaches Person Factors Environmental Factors Occupational Factors ​ Restore/Remediate ​ Create/Promote ​ Create/Promote ​ Establish/Educate ​ Modify/Adapt ​ Establish/Educate ​ Prevent​ ​ Modify/Adapt ​ Maintain