A call to resist occupational therapy's promotion of ableism.

BACKGROUND: Critical occupational therapists have exhorted their profession to engage with disability studies' scholarship, curtail occupational therapy's promotion of ableism and amend its disabling practices. These appeals have largely been ignored despite their importance for a profession that researches, theorizes, assesses, and intervenes in the lives of disabled people. AIMS AND OBJECTIVES: To interrogate occupational therapy's collusion with an ableist neoliberal agenda; and call for occupational therapists to resist their profession's disabling practices. MATERIAL AND METHODS: This paper draws from critical disability scholarship to expose, critique and contest the ableist ideology underpinning occupational therapy. RESULTS: Interlinked with racism, heteronormativity and gender binarism, ableism upholds certain bodies as normal and appropriate. Ableist values shape occupational therapy, with clients classified according to their proximity to 'normality', and exhorted to minimize their occupational performance deviations from dominant norms. CONCLUSIONS: Collusion with colonialism's binary classificatory systems and neoliberal ableist norms, and avowed aspirations to improve bodies, 'normalize' performances, promote individualism, self-reliance, independence, self-care, and productivity contribute to the perception that ours is a disabling profession. SIGNIFICANCE: This paper calls for occupational therapists to resist their profession's promotion of ableism, and refuse to collude with colonial practices that contribute to the oppression of disabled people.

Focusing on "what matters": the Occupation, Capability and Wellbeing Framework for Occupational Therapy / Focando no "que importa": a Estrutura de Ocupação, Capacidade e Bem-estar para terapia ocupacional

Abstract Introduction Critical occupational therapists have challenged models from the Global North that have dominated occupational therapy and informed ableist practices focused on appraising dysfunctions, classifying deviations from bodily "norms", and remedying individuals' "deficits" in performing three occupations (self-care, productive, leisure). This indicated the need for a new conceptual framework; one grounded in research evidence derived from a diversity of people and contexts. Objectives To outline the imperative for, and genesis and features of an evidence-informed conceptual framework for occupational therapy, centred on occupations, capabilities and wellbeing. Methods This paper draws from the work of critical occupational therapists; outlining the conception and process of building a flexible framework by linking concepts identified through extensive review of multidisciplinary research from both the Global South and North. Results Building on evidence that occupation is a determinant of wellbeing, the Occupation, Capability and Wellbeing Framework for Occupational Therapy (OCWFOT, Hammell, 2020a) encourages a strengths-based approach to occupational therapy: assessing and building on individual, collective and community assets, abilities and resources; focusing on occupations that "matter most"; and fostering a relational view of people as interdependent and embedded within families and communities. Conclusion Focused unequivocally on the wellbeing needs and aspirations of individuals, families, groups, communities and populations that are met or unmet by current patterns of occupational engagement; on both abilities and opportunities; and on occupation as a human right, the OCWFOT is theoretically defensible, provides conceptual clarity, and has utility as an evidence-informed structure around which future research and practices may be oriented.

Resumo Introdução Terapeutas ocupacionais críticos têm desafiado modelos do Norte Global que dominaram a terapia ocupacional e informaram práticas capacitistas focadas em avaliar disfunções, classificar desvios das "normas" corporais e remediar os "déficits" dos indivíduos no desempenho de três ocupações (autocuidado, produtividade e lazer). Isso indicou a necessidade de uma nova estrutura conceitual, fundamentada em evidências de pesquisa derivadas de uma diversidade de pessoas e contextos. Objetivos: Descrever o imperativo, a gênese e as características de uma estrutura conceitual baseada em evidências para a terapia ocupacional, centrada nas ocupações, capacidades e bem-estar. Métodos: Baseado no trabalho de terapeutas ocupacionais críticos, delinea-se a concepção e o processo de construção de uma estrutura flexível, vinculando conceitos identificados por meio de extensa revisão de pesquisas multidisciplinares do Sul e do Norte globais. Resultados Com base nas evidências de que a ocupação é um determinante do bem-estar, a Ocupação, Capacidade e Bem-Estar para Terapia Ocupacional (OCWFOT, Hammell, 2020a) incentiva uma abordagem baseada em pontos fortes para a terapia ocupacional: avaliar e construir ativos individuais, coletivos e comunitários, habilidades e recursos; focar nas ocupações que "mais importam"; e promover uma visão relacional das pessoas como interdependentes e inseridas em famílias e comunidades. Conclusão Focado inequivocamente nas necessidades e aspirações de bem-estar de indivíduos, famílias, grupos, comunidades e populações que são atendidas ou não pelos padrões atuais de engajamento ocupacional; em habilidades e oportunidades; e sobre a ocupação como um direito humano, o OCWFOT é teoricamente defensável, fornece clareza conceitual e é útil como estrutura baseada em evidências em torno da qual futuras pesquisas e práticas podem ser orientadas.

Securing occupational rights by addressing capabilities: A professional obligation.

BACKGROUND: The World Federation of Occupational Therapists asserts that all occupational therapists are obligated to promote occupational rights, and has highlighted the importance of Amartya Sen's concept of 'capabilities' to the work of securing the occupational rights to which all are equally entitled. AIMS: To outline the capabilities approach and highlight its relevance and importance for the occupational therapy profession. MATERIAL & METHODS: Drawing from Sen's work, and that of other scholars who have critiqued and adapted his capabilities approach, this paper describes the foundational components of the capabilities approach and identifies important overlaps with issues of concern to occupational therapy. RESULTS: Sen's capabilities approach employs a contextualised view of human wellbeing; attending to whether people have the abilities to do the things they would value doing, and whether their circumstances actually provide the real opportunities to choose to do what they would value doing. CONCLUSIONS: The capabilities approach, with its attention to abilities and actions, options and opportunities, empowerment and choice, justice and participation, has clear relevance for occupational therapists. SIGNIFICANCE: A capabilities perspective provides a valuable framework for occupational therapists striving towards equalising people's opportunities, possibilities and choices - their capabilities - to secure their occupational rights.

Social and Structural Determinants of Health: Exploring Occupational Therapy's Structural (In)competence.

Background: In high-income countries, such as Canada, 50% of health outcomes are attributable to social determinants. Occupational opportunities are also structurally determined, yet these inequities are obscured by the White, Western assumptions and ableist neoliberal ideology in which the profession is deeply rooted. Purpose. To highlight the impact of structural injustices and other social determinants of health and occupation; explore the occupational therapy profession's structural competence; and build on existing knowledge to advance an agenda for action on injustice and inequity for the occupational therapy profession. Key issues. Occupational therapy's failure to prioritize education, research and action on systemic injustices and other social determinants of health and occupation reflects a lack of commitment to achieving the World Federation of Occupational Therapists' Minimal Standards. Implications. If occupational therapy is to advance knowledge and practices that address inequities in the social and structural determinants of health and occupation, we must strive towards structural competence.

Occupation in Natural Environments; Health Equity and Environmental Justice.

Background. Occupations undertaken in natural environments can positively impact physical and mental health, improve cognitive functioning, contribute spiritual and cultural benefits, and increase belonging, self-worth, and the meaningfulness of occupations. However, occupational opportunities in healthy natural spaces are inequitably distributed; and the deleterious effects of climate change and environmental degradation are borne disproportionately by socioeconomically disadvantaged people. Purposes. To highlight evidence that occupational engagement in nature is a determinant of health, foreground environmental injustices and identify some implications for occupational therapy. Key issues. Cross-disciplinary, cross-cultural research and critical environmental justice scholarship indicate that healthy nature is an inequitably distributed determinant of occupation, wellbeing, and human health. This merits critical attention from occupational therapy. Implications. By researching, identifying, and addressing occupational and health inequities arising from environmental degradation, climate change and inequitable access to health-promoting natural environments occupational therapists could contribute valuable, occupational perspectives to initiatives addressing human rights and environmental justice.

'Choice' in occupational therapy theory: A critique from the situation of patriarchy in India.

Background: Dominant occupational therapy theories assert that people choose their daily occupations, and participate in occupations as autonomous agents; yet scholars insist that choices are socially-structured and inequitably available.Aim: To critically review the concept of choice in occupational therapy theory through an exploration of patriarchy in India.Material and methods: Drawing from scholarly work that addresses patriarchy in India, we employ the commonly-used occupational categories of self-care, productivity and leisure as a framework to explore the real availability of occupational choices for women.Results: Patriarchal ideology perpetuates inequitable power dynamics within Indian society. As a consequence, women, children and non-dominant men have few opportunities to make or enact occupational choices that impact their wellbeing and their lives.Conclusions: The examples provided in this paper challenge those occupational therapy theories that portray occupational engagement as the product of individual volition and unconstrained choice.Significance: Dominant occupational therapy theories are informed by specific Western assumptions that may have little relevance to people in other contexts. Critical approaches to professional assumptions are essential to avoid the imperialistic imposition of irrelevant theories, and the development and delivery of services that may be oppressive for clients who have few opportunities to make occupational choices.

Making Choices from the Choices we have: The Contextual-Embeddedness of Occupational Choice.

BACKGROUND.: "Choice" is central to occupational therapy's theoretical tradition, which maintains that individuals can impact their well-being through wisely choosing their occupations. However, the assumption that opportunities to choose are universally available is negated by research evidence. PURPOSE.: To review the ideology of "choice" in occupational therapy theory, and to encourage more critical approaches toward determinants of occupational opportunity and choice. KEY ISSUES.: Evidence indicates that within Canada, and throughout the world, opportunities to make occupational choices are inequitably distributed among people of different socioeconomic classes, castes, genders, races, abilities, sexualities, citizenship statuses, and experiences of colonialism. IMPLICATIONS.: Because occupation is a determinant of health and well-being, social injustices that create inequitable occupational choices are unfair violations of occupational rights. The occupational therapy profession's espoused aim of enhancing well-being through occupation demands theories that explicitly recognize the socially structured and inequitable shaping of choice, and consequent impact on people's occupational rights.

Ações nos determinantes sociais de saúde: avançando na equidade ocupacional e nos direitos ocupacionais 1 Texto traduzido pelo Prof. Dr. Vagner dos Santos, da Charles Sturt University, Austrália, em contribuição com os Cadernos Brasileiros de Terapia Ocupacional. / Action on the social determinants of health: Advancing occupational equity and occupational rights

Resumo Epidemiologistas vêm buscando focar a atenção global nos "determinantes sociais de saúde" - as condições nas quais as pessoas nascem, crescem, vivem, trabalham e envelhecem - e no impacto da distribuição desigual desses determinantes nas oportunidades de as pessoas serem saudáveis. As evidências demonstram, inequivocamente, que a ocupação é um determinante da saúde e bem-estar humano. Devido ao modelamento da disponibilidade de oportunidades ocupacionais de promoção à saúde feito pelos determinantes sociais desiguais, terapeutas ocupacionais vêm valorizando a importância de abordar as injustiças ocupacionais. No entanto, os estudos relativos à justiça ocupacional e à injustiça ocupacional têm sido desproporcionalmente dominados pelas perspectivas culturalmente específicas de teóricos anglófonos do Hemisfério Norte. Destacar alguns dos problemas e confusões feitos a partir de estudos anglófonos sobre as injustiças ocupacionais e destacar a importância de ações voltadas para os determinantes sociais da saúde por meio da ocupação. Definições confusas de várias injustiças ocupacionais são inúteis para os profissionais. A terapia ocupacional poderia ativamente abordar os determinantes sociais de ocupação por meio do foco na equidade ocupacional e nos direitos ocupacionais, informados por estudos teóricos existentes sobre as capabilidades humanas. Problemas de direitos ocupacionais, negação dos direitos ocupacionais (injustiças ocupacionais) e de iniquidade/equidade de oportunidades ocupacionais devem ser questões fundamentais para a terapia ocupacional, cuja preocupação maior deveria ser: como terapeutas ocupacionais, efetivamente, abordam os determinantes sociais de ocupação de tal modo que todas as pessoas tenham capabilidades para se envolverem em ocupações significativas que contribuam positivamente para o seu bem-estar e o bem-estar de sua comunidade, uma vez que é direito todos.

Abstract Epidemiologists have sought to focus global attention on the "social determinants of health" - the conditions in which people are born, grow, live, work and age - and on the impact of the inequitable distribution of these determinants on people's opportunities to be healthy. Evidence demonstrates, unequivocally, that occupation is a determinant of human health and wellbeing. Because inequitable social determinants shape the availability of health-promoting occupational opportunities, occupational therapists have raised the importance of addressing occupational injustices. However, theoretical scholarship pertaining to occupational justice and occupational injustice has been disproportionately dominated by the culturally-specific perspectives of Anglophone theorists from the Global North. The purpose of this paper is to highlight some of the problems and confusions arising from Anglophone scholarship on occupational injustices; and to highlight the importance of action on the social determinants of health through occupation. Confused definitions of various occupational injustices are unhelpful to practitioners. The occupational therapy profession could actively address the social determinants of occupation through focusing on occupational equity and occupational rights, informed by existing scholarship on human capabilities. Issues of occupational rights, denial of occupational rights (occupational injustices), and of in/equities of occupational opportunities ought to be fundamental issues for the occupational therapy profession, whose most pressing concern should surely be: how can occupational therapists most effectively address the social determinants of occupation such that all people have the capabilities to engage in meaningful occupations that contribute positively to their own well-being and the well-being of their communities, as is their right.

Opportunities for well-being: The right to occupational engagement.

BACKGROUND: The Canadian Association of Occupational Therapists' 2017 conference theme prompted thoughts about shaping our profession's future. PURPOSE: This Muriel Driver Memorial Lecture explores how occupational therapy's future might be shaped to become more important, relevant, and valuable to society. KEY ISSUES: Because occupational engagement is integral to human well-being and because well-being is integral to human rights, occupational therapy could usefully advance the right of all people to engage in occupations that contribute positively to their own well-being and the well-being of their communities. IMPLICATIONS: Occupational therapy's importance to society will be manifested when we focus unambiguously on well-being; extend our efforts beyond enhancing the abilities of individuals whose lives are already impacted by illness, injury, or impairment; and address the opportunities for achieving well-being through occupational engagement of all those whose capabilities-their opportunities to do what they have the abilities to do-are inequitably constrained.

Précis - Discours commémoratif Muriel Driver 2017 Possibilités en matière de bien-être: Le droit à la participation occupationnelle.

Le thème du Congrès 2017 de l'Association canadienne des ergothérapeutes a suscité des réflexions sur les différentes manières d'orienter l'avenir de notre profession. But. Ce discours commémoratif Muriel Driver examine comment nous pourrions façonner l'avenir de l'ergothérapie afin qu'elle devienne plus importante, plus pertinente et plus avantageuse pour la société. Questions clés. Comme la participation occupationnelle est essentielle au bien-être humain et comme le bien-être fait partie intégrante des droits de la personne, l'ergothérapie pourrait promouvoir le droit de toute personne de participer à des occupations qui contribuent positivement à son propre bien-être et à celui de sa communauté. Conséquences. L'importance de l'ergothérapie pour la société sera manifeste lorsque nous nous concentrerons sans ambiguïté sur le bien-être, lorsque nous déploierons nos efforts au-delà de l'amélioration des capacités des individus dont la vie est déjà touchée par la maladie, les blessures ou les handicaps et lorsque nous aborderons les différents moyens d'atteindre le bien-être par la participation occupationnelle de toutes les personnes dont les possibilités-les occasions de faire ce que leurs capacités leur permettent de faire-sont contraintes de manière inéquitable.

Quality of life, participation and occupational rights: A capabilities perspective.

BACKGROUND: Research suggests that perceptions of diminished quality of life among people with a severe physical impairment might be a consequence of environmental barriers and inequity of opportunity rather than the impairment itself. However, occupational therapists remain preoccupied with assessing and addressing individual dysfunctions and have directed little attention to assessing and challenging inequitable environmental constraints on people's occupational opportunities. PURPOSE: To highlight briefly what is known about environmental impacts on quality of life among people with impairments; to outline the relationship between occupational rights and human rights; to explore the concept of 'participation' and thereafter to outline the relevance of the Capabilities Approach for occupational therapists who seek to address inequalities of occupational opportunity and inequities in participation. MAIN FINDINGS: Sen's Capabilities Approach focuses on equality of the opportunity to 'do', and is relevant to occupational therapy in the context of the World Health Organisation's construct of 'participation', the United Nations' Convention on the Rights of Persons with Disabilities, and the World Federation of Occupational Therapists' (WFOT) Position Statement on Human Rights. PRINCIPAL CONCLUSIONS: Adoption of Sen's Capabilities Approach might facilitate critical occupational therapy practices focussed on equality of occupational opportunities and on the fulfilment of occupational rights, in accordance with the standards of rights-based practices advocated by disability scholars, WFOT and the UN.

Self-care, productivity, and leisure, or dimensions of occupational experience? Rethinking occupational "categories".

BACKGROUND: Critics contend that occupational therapy's theories of occupation are culturally specific, class-bound, and ableist, and that the division of all occupations into three simplistic categories of self-care, productivity, and leisure is arbitrary, lacks supportive evidence, and promotes a doctrine of individualism. PURPOSE: To add to the work of critics who advocate a fundamental rethinking of occupational therapy's conceptualizations of occupation in terms of subjective qualities of experience that address intrinsic needs. KEY ISSUES: This paper suggests that if categories of occupation were informed by the ways in which people experience their occupations, these might be labelled as restorative, as ways to connect and contribute, as engagement in doing, and as ways to connect the past and present to a hopeful future. IMPLICATIONS: If occupational therapists enabled diverse clients'perspectives to inform occupational categories, perhaps relationships between occupations and well-being might more easily be identified in theory and addressed in practice.

Sacred texts: a sceptical exploration of the assumptions underpinning theories of occupation.

BACKGROUND: Occupational therapists share some basic assumptions about occupation that are rarely challenged and are held to be true. These assumptions underpin our theories of human occupation. PURPOSE: To probe some of the core assumptions that inform current occupational therapy theory and to determine whether these are culturally specific or have supporting evidence. KEY ISSUES: Evidence suggests that some of occupational therapy's entrenched assumptions reflect specific rather than universal perspectives; that many meaningful occupations cannot be categorized as self-care, productivity or leisure; that the concept of leisure is an ableist, class-bound, and culturally specific concept; that current models of occupation overlook activities motivated by connections to others; that productivity is not universally perceived to be central to life's meaning nor universally experienced as a positive contributor to health; and that independence is not universally prized. IMPLICATIONS: Occupational therapy's theories of occupation would benefit from a sound evidence base derived from diverse cultural perspectives.

Reflections on...well-being and occupational rights.

BACKGROUND: Although claiming that engagement in occupations influences well-being, the occupational therapy profession has largely failed to acknowledge and address the relationships between well-being, occupation, and human rights. PURPOSE: This paper supports the premise that the focus of occupational therapy should be on the right of all people to participate in meaningful occupations, and proposes allegiance to occupational rights: the right of all people to engage in meaningful occupations that contribute positively to their own well-being and the well-being of their communities. PRACTICE IMPLICATIONS: The connection between well-being and human rights would be made explicit, occupational rights would be recognized as a political issue and the profession's confinement within health-care services would end. This commitment to occupational rights would bring our practice into line with our espoused belief in the relationship between occupation and well-being, and enable us to state, unequivocally, what occupational therapy contributes to humanity.

Reflections on...a disability methodology for the client-centred practice of occupational therapy research.

BACKGROUND: Occupational therapists' stated commitments to client-centred practice and to enabling participation in the occupations of daily life are not universally reflected in either the practice or the occupation of occupational therapy research. Nor have the profession's researchers generally engaged with those critiques of their endeavours that have been articulated by disability theorists. PURPOSE: Because no guidelines exist for the client-centred practice of occupational therapy research this paper draws from the work of disability theorists to sketch a disability methodology: a specific philosophical, political and ethical approach to developing knowledge that is fundamentally concerned with realigning power within the research relationship and throughout the research process. PRACTICE IMPLICATIONS: The proposed disability methodology attempts to align the practice of occupational therapy research with the client-centred philosophy underpinning occupational therapy practice and aspires to enable clients' meaningful participation in the occupation of research.

Dimensions of meaning in the occupations of daily life.

BACKGROUND: According to the existential philosophers, meaning, purpose and choice are necessary for quality of life. Qualitative researchers exploring the perspectives of people who have experienced health crises have also identified the need for meaning, purpose and choice following life disruptions. Although espousing the importance of meaning in occupation, occupational therapy theory has been primarily preoccupied with purposeful occupations and thus appears inadequate to address issues of meaning within people's lives. PURPOSE: This paper proposes that the fundamental orientation of occupational therapy should be the contributions that occupation makes to meaning in people's lives, furthering the suggestion that occupation might be viewed as comprising dimensions of meaning: doing, being, belonging and becoming. Drawing upon perspectives and research from philosophers, social scientists and occupational therapists, this paper will argue for a renewed understanding of occupation in terms of dimensions of meaning rather than as divisible activities of self-care, productivity and leisure. PRACTICE IMPLICATIONS: Focusing on meaningful, rather than purposeful occupations more closely aligns the profession with its espoused aspiration to enable the enhancement of quality of life.