Where can an occupation-focussed philosophy take occupational therapy?

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1 Parnell, T. & Wilding, C. (2010) Where can an occupation-focused philosophy take occupational therapy? Australian Occupational Therapy Journal, 57, This is the accepted-for-publication version of this article. The definitive version is available at The Australian Occupational Therapy Journal is copyright of the Australian Association of Occupational Therapists Inc. and published by Blackwell Publishing. Where can an occupation-focussed philosophy take occupational therapy? Authors: Tracey Parnell and Clare Wilding Introduction The profession of occupational therapy aspires to enable engagement in occupation and recognises the fundamental link between occupation, health and wellbeing (Townsend & Polatajko, 2007). As occupational therapy is still a developing profession, it is important to consider the ways in which it can be of service to society and to envisage the potential for innovation in providing services (Kronenberg, Algado & Pollard, 2005). In this viewpoint, we will argue that many contemporary societal problems may be well addressed by considering how occupation-focussed philosophy and theory illuminate the issue and thus leading to novel solutions previously considered. Considering an issue through the lens of occupation-focussed philosophy and theory may be described as taking an occupational perspective. One example of applying this vision will be discussed. During her recent research consultancy for the Roads and Traffic Authority (RTA) of New South Wales, the first author identified the need for an occupational perspective (Parnell & Pope, 2008a, 2008b). The focus of the RTA research was on exploring the experiences of key stakeholders in developing, actioning and reviewing plans to create and enhance pedestrian and bike pathways in a number of regional and rural communities. Throughout the course of the evaluation, it became apparent that there was a limited appreciation by many of the key stakeholders of the potential impact and benefit of well-planned built pathways beyond being more than just a means of transport. Many government bodies are interested in and are investigating community environments and how these impact on access, safety, economic viability, environmental sustainability, participation and health. For example, the RTA has initiated a programme of funding for local councils to implement Pedestrian Access and Mobility Plans (PAMPs) and Bike Plans. The purpose of these programmes is to provide a structured and coordinated framework for the planning and development of

2 pedestrian and cyclist infrastructures. Through the development and implementation of these plans, it is anticipated that local councils will build more appropriate and coherent pedestrian and cyclist facilities, provide safer and more convenient pathways and improve access for mobility-impaired groups in the community (New South Wales Roads and Traffic Authority, 2002). Despite the benefits offered to individuals and communities by programmes like the PAMPs, such strategies do not always achieve their full potential; they may fall short in enabling full and equitable community participation. The aforementioned research found that in some communities, sections of pathways had been built that did not link to existing pathways or to community facilities and resources. Although the long-term plan (5 10 years) was to link these pathways, in the interim, these communities effectively had pathways that lead nowhere. Consequently, the pathways were deemed to be of little benefit to the community, were not well utilised, and in some cases, were not maintained. This outcome made it difficult for some councils to convince the community that continuing to spend money on the ongoing development of pathways was worthwhile. Value in an occupational perspective Occupational therapists have something unique and important to offer those who plan and develop our shared built environments. Occupational therapists distinctive perspective is that occupations and environments are interdependent and that engaging in occupation has considerable potential to either enhance or decrease health and wellness. Occupational therapists have long been aware of the significance of the interdependent relationship between person, environment and occupation, and the impact of this transaction on occupational choice and engagement (Christiansen & Baum, 1997; Kielhofner, 2008; Law et al., 1996). Occupational therapists understand that the environment is a complex and multifaceted phenomenon that extends beyond physical components. Within the profession, it is well recognised that the environment has the potential to either facilitate or constrain choice and engagement in occupation (Brown, 2009). With this knowledge, it would appear that occupational therapists are well placed to provide valuable and insightful input to the policies, planning and development of the constructed aspects of the physical environment within communities. Need to expand to non-traditional roles Occupational therapy s core business is in enabling occupational engagement and performance for individuals, families, communities and populations (Townsend & Polatajko, 2007). Traditional occupational therapy roles have often concentrated on working with individuals and families and have frequently been located within healthcare services. However, clearly, there is also a critical need for the profession to broaden its view and apply an occupational perspective to many of the challenges that plague contemporary life. Examples of relevant issues include the increasing incidence of obesity, those who work too much and those who have no work at all, keeping pace with technological changes and their effects upon everyday doing, and how to live a meaningful life in the midst of war, poverty, terrorism and racism. Through the exploration and examination of community, social and political issues from an occupational perspective, occupational therapists can advocate for equity and social justice and can facilitate change to ensure the inclusion of all people in community life (Townsend & Polatajko).

3 Moving forward: occupational therapy tools to enable occupation What are the tools available to occupational therapists to assist them in improving the health, wellbeing and quality of experience of individuals, families, communities and populations? We consider that the most important means by which occupational therapists can intervene in these concerns is through promoting the message that occupation is intimately linked to survival, health and wellbeing. Wilcock (2006, p. 53) asserted that occupation, health and survival are inextricably linked and that deleterious effects to individual, community, population, and ecological health can only be redressed by seriously considering the implications or requirements of [people s] occupational nature[s]. When people reflect upon their experiences of everyday doing, many understand that what they do can contribute to their health. For example, if people consider how they feel when they are doing their favourite occupations, it quickly becomes apparent to them that performing these occupations enhances their lives). However, it is rare for people to make this link automatically. Occupational therapists should promote the concept that occupation and health are linked and that enhancing occupational engagement can improve wellbeing and quality of life. In addition, occupational therapists can use occupation theory and the occupational therapy reasoning process to develop ways to address occupational needs. There are many relevant and useful occupation models from which to choose, such as the Canadian Model of Occupational Performance and Engagement (Townsend & Polatajko, 2007) or the Model of Human Occupation (Kielhofner, 2008). Models for assisting occupationcentred reasoning and intervention planning include the Canadian Model of Client- Centred Enablement (Townsend & Polatajko) and the Occupational Therapy Intervention Process Model (Fisher, 1998). Example of taking an occupational perspective in practice The involvement of an occupational therapist at the policy development and planning stages of project development might assist in facilitating organisations to consider the occupational purposes of their ventures. Involvement in the previously mentioned research revealed that local councils and the RTA were experts in developing pathways that met the RTA guidelines. However, there was frequently little consideration of how people were going to access and use the newly created built facilities and what they might do in these spaces. Although not all councils experienced difficulty in creating meaningful pathways, some appeared to find it challenging to create a vision for long-term utility of these pathways. Rather than considering how the pathways might be used, creating the pathways was the primary focus. This example demonstrates how planning can become the wrong way around. Without a champion for an occupational perspective, the purposes of path structures can easily become subsumed by the desire to have and build a pathway, and thus the public spaces and structures can become empty and useless symbols of civic responsibility, rather than real and useful means for enabling healthful doing. If occupational therapists were to be more involved in these types of council and government committees, they could be the champions for occupation; they could provide explanations and expertise about how occupation influences and is influenced by environments, and thus they could ensure that occupational needs did not go unmet. This idea echoes that outlined by Fortune, Farnworth and McInstry (2006)

4 who acknowledged that although many organisations unknowingly enable occupation, the outcomes they achieve would be further enhanced by input from occupational therapists. In further considering this example, if an occupational therapist had been a consultant to the councils and or had participated in the community consultation process, this therapist would have been able to enhance these projects and assist them in being more relevant to the communities they were designed to serve. In particular, an occupational therapist could contribute to: an understanding of the environment that encompasses more than just the physical dimensions; consideration of the complex interplay between person, occupation and environment; knowledge of universal design and a consideration of impacts on whole systems; a pragmatic and solutionoriented approach; and, a person-centred philosophy. Occupational therapists also have knowledge of the challenges affecting more vulnerable persons in the community, such as those with disabilities and older persons, and as such, they offer a more inclusive approach that considers the diverse needs of individuals who comprise communities. Most importantly, the core occupational therapy knowledge of occupation is the unique perspective that an occupational therapist would bring to this particular issue. It is this knowledge and perspective that facilitates occupational therapists to take up positions in diverse workplaces (Fortune et al., 2006). Path to health: realising a community s occupational needs An example of the value and impact that an occupational therapist could provide when taking an occupational perspective to contemporary issues is presented in the following allegorical story. This story presents a hypothetical scenario but it is extrapolated from the research experiences of the first author. Occupationville Council heard that the RTA was offering funding for developing town pathways and thought they would like to develop a bike path. The council had recently employed a Community Liaison Officer, Emma Smith (who happened to be an occupational therapist by professional background), and they asked Emma to take charge of the project. Emma decided that her starting point would be to undertake a comprehensive review of current pathway networks and to consider the current and future occupational needs of residents. Together with the engineering department and the access committee (including community representatives), Emma conducted an audit of existing pathways and facilities. Next, she hosted a town meeting to which all residents and council workers were invited. During this meeting, Emma facilitated discussion to identify the occupations that residents needed and wanted to do, and to determine the enablers, barriers and priorities for engagement and performance in these occupations. Following the town meeting, stakeholder representatives met to advance the plans and develop a proposal further. Emma and her team developed a 15-year plan to construct a series of interconnected circular loops of shared pathways that complemented the existing pathway networks and that connected community services and facilities to residential areas and to the central business district. Each loop was self-contained and also linked to the whole network. Stage 1 was a loop between the school and the local sporting facility. Additional funding from the education department was sought to complement council

5 and RTA funding to ensure that the loop was completed in an appropriate timeframe. Stage 2 was a loop that linked the new multi-purpose health facility to residential areas, and in particular, to the number of aged care residences within the town. Emma s team proposed seeking additional funding for this stage from the health department. Stage 3 linked the aquatic centre to the pathway of Stage 1. Stage 4 linked to the business district. A longer-term proposal aimed to link the pathways to local tourist destinations. Alf Green, a long-term resident of Occupationville said about the new pathways: In our town, the railway was closed and we felt very isolated from other locations; it felt like we were stigmatised and that the town had little to offer. These new pathways have helped our community heal and have re-connected neighbours to neighbours. Conclusion We propose that the profession of occupational therapy needs to look beyond historical and traditional understandings of the role and purpose of occupational therapy to one that encompasses more contemporary and expansive perspectives for our current society. The world has changed since occupational therapy first emerged at the beginning of the twentieth century and so too, occupational therapy needs to consider new ways in which it can be of service to a changed society. To be of benefit and value to society, occupational therapists need to step forward and explain their unique occupational perspective of the world and promote how occupational therapy has a new and different view to add. Therapists might need to be prepared to take up positions that are not called occupational therapy, but yet, the therapist can bring with him her the occupational perspective that is so urgently needed in many contemporary organisations. References Brown, C. (2009). Ecological models in occupational therapy. In: E. B. Crepeau, E. S. Cohn & B. A. Boyt Schell (Eds.), Willard & Spackman s occupational therapy (11th ed., pp ). Philadelphia, PA: Lippincott Williams & Wilkins. Christiansen, C. & Baum, C. (1997). Occupational therapy: Enabling function and well-being (2nd ed.). Thorofare, NJ: Slack. Fisher, A. G. (1998). Uniting practice and theory in an occupational framework. American Journal of Occupational Therapy, 52, Fortune, T., Farnworth, L. & McInstry, C. (2006). Projectfocussed fieldwork: Core business or fieldwork fillers? Australian Occupational Therapy Journal, 53, Kielhofner, G. (2008). Model of human occupation: Theory and application (4th ed.). Baltimore, MD: Lippincott, Williams & Wilkins. Kronenberg, F., Algado, S. S. & Pollard, N. (2005). Occupational therapy without borders: Learning from the spirit of survivors. Edinburgh, UK: Elsevier Churchill Livingstone.

6 Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P. & Letts, L. (1996). The person environment occupation model: A transactive approach to occupational performance. Canadian Journal of Occupational Therapy, 63, New South Wales Roads and Traffic Authority. (2002). How to prepare a pedestrian access and mobility plan: An easy three stage guide. Retrieved 19 February 2009, from mobility-plan_how-to.pdf Parnell, T. & Pope, R. (2008a). An evaluation of the Pedestrian Access and Mobility Plan Program from the Roads and Traffic Authority of NSW as implemented by local councils in the South West Region of New South Wales. Retrieved 18 August 2009, from ps.pdf Parnell, T. & Pope, R. (2008b). An evaluation of the Bike Plan Program from the Roads and Traffic Authority of NSW as implemented by local councils in the South West Region of New South Wales. Retrieved 18 August 2009, from southwest/final_bike_plans.pdf Townsend, E. A. & Polatajko, H. J. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, and justice through occupation. Ottawa, ON: Canadian Association of Occupational Therapists. Wilcock, A. A. (2006). An occupational perspective of health (2nd ed.). Thorofare, NJ: Slack.