OT24Vx 2015. Occupational Justice: Appraising OT's Fourth Paradigm

1. Occupational Justice:Occupational Justice:
Appraising Occupational Therapy's Fourth ParadigmAppraising Occupational Therapy's Fourth Paradigm
Christopher J. Alterio, Dr.OT, OTR
ABC Therapeutics
East Amherst, New York

2. PurposePurpose
This presentation explores the history of
paradigmatic change in OT theory.
Use a 'goodness of fit' analytic method to critically
appraise the changes in theory associated with the
globalization of occupational therapy and the new
occupational justice orientation.

3. ObjectivesObjectives
Define the core values of the First, Second, and
Third OT paradigms.
Compare and contrast Justice concepts with OT core
values.
Appraise and discuss internal consistency of OT
theory over time.

4. CaveatsCaveats

5. Paradigm ChangeParadigm Change
Do our ideas stay the same over time, or
should they change?

6. Where we wereWhere we were
The First Paradigm:
•Occupational therapy identified itself as a field that
appreciated the importance of occupation in human life,
addressed problems of occupational disengagement, and
used occupation as a therapeutic measure

7. Where we wereWhere we were
The Second Paradigm:
 Occupational therapy identified itself as a field that considered
human performance as intact biomedical functions and operated
at the level of remediating those dysfunctional ‘inner workings’
that were impeding function

8. Paradigm crisisParadigm crisis
Thomas Kuhn (1962)
Structure of Scientific Revolutions
 A Paradigm crisis occurs when questions emerge about the
shared values and beliefs of a scientific community or
professional group

9. The Derailment of OTThe Derailment of OT
•Phillip Shannon (1977)
–Student of Reilly
• ‘A discipline that forgets its founders may be lost’

10. The Derailment of OTThe Derailment of OT
•Phillip Shannon (1977)
–Derailment occurred by losing focus on founding principles
of Meyer and Slagle
–While searching for scientific rationale, OT embraced the
medical model
–Epistemological shift from social sciences to physical
sciences

11. The Occupational Behavior ModelThe Occupational Behavior Model
The Third Paradigm:
 Occupational therapy identified itself as a field that returns to a
concern for occupation, originally articulated in context of
occupational behavior theory.

12. Reilly’s 1961 Slagle LectureReilly’s 1961 Slagle Lecture
The first premise:
•“That man, through the use of his hands as they are
energized by mind and will, can influence the state of
his own health.”
– She believed that this was an idea that could advance civilization
– Concerned if our culture was ‘ready’ for this concept

13. Reilly’s 1961 Slagle LectureReilly’s 1961 Slagle Lecture
A place and time to test the hypothesis
•Reilly perceived that the United States was the
correct place to test this hypothesis
– A drive toward action is part of the American character (Lerner) reflected as ‘the self
reliant craftsman’
– The American context/environment is inextricably a part of the American character
– “I believe, therefore, that the occupational therapy hypothesis is a natural one to be
advanced in America.” (Reilly, 1961).

14. Reilly’s 1961 Slagle LectureReilly’s 1961 Slagle Lecture
What vital need does occupational therapy serve?
Premise: Work and production are physiologically
conditioned needs
What is the unique service?
Premise: man has a need to master his environment, to
alter and improve it.

15. General Systems HierarchyGeneral Systems Hierarchy
Organs and Organ systems
Person (Levels of conduct and experience)
Families
Communities
Genetics
Cells and Tissues
F
o
c
u
s

16. Occupation based modelsOccupation based models
 The ‘occupation based models’
◦ Model of Human Occupation: Theory and application
◦ The Ecology of Human Performance
◦ The Person-Environment-Occupation Model
◦ Theory of Occupational Adaptation
◦ The Person—Environment—Occupational Performance Model
◦ Canadian Model of Occupational Performance and Engagement (CMOP-E)

17. Paradigm crisis, againParadigm crisis, again
Thomas Kuhn (1962)
Structure of Scientific Revolutions
 A Paradigm crisis occurs when questions emerge about the
shared values and beliefs of a scientific community or
professional group

18. A new resolution?A new resolution?
 A new paradigm: Occupational Justice?
 Explicit exploration of applying social justice concepts to occupational
therapy (Townsend and Wilcock, 2004).
 Approaching therapy from a ‘rights’ and ‘justice’ perspective is a radical
departure from traditional occupational therapy Core Values

19. General Systems HierarchyGeneral Systems Hierarchy
Families
Communities
Societies
Cultures
Cells and Tissues
Person
F
o
c
u
s
?

20. But how do these conceptsBut how do these concepts
translate?translate?
 These ideas were subsumed wholly into the thinking of many American
scholars, who in turn began infusing these concepts into AOTA official
documents, including the Code of Ethics and Practice Framework.

21. Definition of OTDefinition of OT
First Practice Framework
Occupational therapists and occupational therapy assistants
focus on assisting people to engage in daily life activities that
they find meaningful and purposeful. Occupational therapy's
domain stems from the profession's interest in human
beings' ability to engage in everyday life activities.
◦ (AOTA Practice Framework 2002)

22. Definition of OTDefinition of OT
• Third Practice Framework
• Occupational therapy is defined as the therapeutic use of everyday life activities
(occupations) with individuals or groups for the purpose of enhancing or enabling
participation in roles, habits, and routines in home, school, workplace, community,
and other settings. Additionally, “the clients of occupational therapy are typically
classified as persons (including those involved in care of a client), groups
(collectives of individuals, e.g., families, workers, students, communities), and
populations (collectives of groups of individuals living in a similar locale—e.g.,
city, state, or country—or sharing the same or like characteristics or concerns).
Services are provided directly to clients using a collaborative approach or
indirectly on behalf of clients through advocacy or consultation processes.
• (AOTA Practice Framework 3rd
ed., 2014).

23. Social Justice in other documentsSocial Justice in other documents
Social Justice was added to the 2010 Code of Ethics.
As definitions were still developing, the Social Justice
construct was populated with all of the definitions under the
2005 Beneficence section
Thus, anything that was considered ‘promoting good’ was re-
defined as ‘social justice’

24. Core Values & Attitudes ofCore Values & Attitudes of
Occupational Therapy PracticeOccupational Therapy Practice
•Social Justice is not mentioned in Dr. Reed's 'Values and
Beliefs' series
•Justice itself is barely mentioned in these documents; there
was no focus on justice.
•Simply stated, this was not a driving philosophical point for the
profession (American context).

25. Context at the Founding of OTContext at the Founding of OT

26. Contributing Core ValuesContributing Core Values

27. Misinterpreting Core ValuesMisinterpreting Core Values
• Why is it that occupational therapists have come to
label social/distributive/occupational justice as a
way of understanding the philosophy and ethic
behind these efforts?
• Early philosophy of Christian philanthropy has been
re-labeled as a social justice narrative

28. Core ValuesCore Values
There is necessarily a limit to the amount which the normal
man can do for his unfortunate brother. There is necessarily
a limit to the number of members of a community who can
remain in idleness, no matter how distressing their condition.
More than that — to support in idleness, even though in
distress or pain, if not the worst, is not the best means of
assisting the unfortunate.
◦ Barton, 1917

29. Core ValuesCore Values
• Indeed, so thoroughly have our so-called charitable
impulses undermined the self-respect of the people
that a new medical term has been introduced in
Europe to cover those cases who, through fear of
not being supported for nothing, refuse to endeavor
to return to work. This condition is known as
"pension hysteria.”
–Barton, 1917

30. Core ValuesCore Values

31. Goodness of fitGoodness of fit
• Global transference of occupational therapy
models needs to be more carefully considered
• Applies to transference in any and all directions.

32. Characteristics of a Good ModelCharacteristics of a Good Model

33. Characteristics of a Good ModelCharacteristics of a Good Model

34. Characteristics of a Good ModelCharacteristics of a Good Model

35. ReferencesReferences
 American Occupational Therapy Association. (2010). Occupational therapy code of ethics and ethics standards. American Journal of Occupational Therapy, 64, 17-26.
 American Occupational Therapy. Association. (2002). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, 609-639
 American Occupational Therapy Association. (2008). Occupational therapy practice framework: Domain and process, 2nd ed. American Journal of Occupational Therapy, 62, 625-683.
 American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process, 3rd ed. American Journal of Occupational Therapy, 68(Suppl. 1).
 American Occupational Therapy Association. (1993). Core values and attitudes of occupational therapy practice. American Journal of Occupational Therapy, 47, 1085–1086.
 Barton, G.E. (1917). Re-education: An analysis of the institutional system of the United States. Boston: Houghton Mifflin Co.
 Beauchamp, T.L. & Childress, J.F. (2009). Principles of bioethics, 6th ed. New York: Oxford University Press.
 Christiansen, C., Baum, C.M., & Bass, J. The Person—Environment—Occupational Performance Model. (2011). In E.A.S. Duncan (Ed.), Foundations for Practice in Occupational Therapy
(93—104). 5th ed. London: Elsevier.
 Bowyer, P., Belanger, R., Briand, C., de las Heras, C. G., Kinebanian, A., Launiainen, H., Marcoux, C., Mentrup, C., Morel-Bracq, M.C., Nakamura-Thomas, H., Pan, A.W., Tigchelaar, E.,
Yamada, T., Ziv, N., & Keilhofner, G. (2008). International efforts to disseminate and develop the Model of Human Occupation. Occupational Therapy in Health Care, (22) , 1-24.
 Durocher, E., Gibson, B.E., & Rappolt, S. (2014). Occupational justice: A conceptual review. Journal of Occupational Science, 21(4), 418-430.
 Durocher, E., Rappolt, S , & Gibson, B.E. (2014). Occupational justice: Future directions. Journal of Occupational Science, 21(4), 431-442.
 Dunn, W., Brown, C. & McGuigan, A. 1994. The Ecology of Human Performance: A Framework for considering the effect of context. The American Journal of Occupational Therapy.
48(7):595-607.

36. ReferencesReferences
 Gray, J.M. (1998). Putting Occupation into Practice: Occupation as Ends, Occupation as Means. American Journal of Occupational Therapy, 52, 354-365.
 Hammell, K.W. (2009). Sacred texts: A sceptical exploration of the assumptions underpinning theories of occupation. Canadian Journal of Occupational Therapy, 76(1), 6-13.
 Hammell, K.W. (2011). Resisting theoretical imperialism in the disciplines of occupational science and occupational therapy. British Journal of Occupational Therapy, 74(1), 27-33.
 Kielhofner, G. (2008). Model of Human Occupation: Theory and application. (4th Ed.) Baltimore, MD: Lippincott Williams & Wilkins
 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(1):9-23
 Meyer, A. (1977). The philosophy of occupational therapy. American Journal of Occupational Therapy, 51, 639-642.
 Mocellin, G. (1992). An overview of occupational therapy in the context of the American influence on the profession, Parts 1 &2, British Journal of Occupational Therapy, 55(1), 7-12;
55(2), 55-60.
 Mocellin, G. (1995). Occupational therapy: A critical overview, Part 1. British Journal of Occupational Therapy, 58(12), 502-506.
 Mocellin, G. (1996). Occupational therapy: A critical overview, Part 2. British Journal of Occupational Therapy, 59(1), 11-16.
 Nillson, I. & Townsend, E. (2010). Occupational justice – Bridging theory and practice. Scandinavian Journal of Occupational Therapy, 17, 57-63.
 Polatajko, H.J., Townsend, E.A. & Craik, J. 2007. Canadian Model of Occupational Performance and Engagement (CMOP-E). In Enabling Occupation II: Advancing an Occupational
Therapy Vision of Health, Well-being, & Justice through Occupation. E.A. Townsend & H.J. Polatajko, Eds. Ottawa, ON: CAOT Publications ACE. 22-36.
 Reed, K. (1984). Models of practice in occupational therapy. Baltimore: Williams and Wilkins.
 Reilly, M. (1962). Occupational therapy can be one of the great ideas of 20th Century medicine. American Journal of Occupational Therapy, 16, 2-9.

37. ReferencesReferences
 Schultz, 2009. Theory of Occupational Adaptation. In Crepeau, E.B, Cohn, E.S. & Schell. B.A. 2009. Willard's & Spackman's Occupational Therapy. 11th Edition. Philadelphia: Lippincott
Williams & Wilkins.
 Shannon, P. (1977). The derailment of occupational therapy. American Journal of Occupational Therapy, 31(4), 229-234.
 Trombly, C.A. (1995). The 1995 Eleanor Clarke Slagle Lecture: Occupation: Purposefulness and Meaningfulness as Therapeutic Mechanisms. American Journal of Occupational Therapy,
49, 960-972.
 Townsend, E., Langille, L., Ripley, D. (2003). Professional tensions in client-centered practice: Using institutional ethnography to generate understanding and transformation. American
Journal of Occupational Therapy, 57, 17–28
Townsend, E. and Wilcock, A. (2004). Occupational justice and client centered practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71, 75-87.
 Wilcock, A.A. and Hocking, C.H. (2015). An occupational perspective of health, 3rd
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 Yerxa, E.J. (2009). Infinite distance between the I and the It. American Journal of Occupational Therapy, 63, 490-497.