Liz We can celebrate and be proud of a century of development that is ongoing today. Long history of working in the community as well as hospitals and other places, and working on many issues to enable participation in occupations e.g., Jessie Luther (Rhode Island OT at Grenfell Mission) engaged in community development to enable healthy & disabled workers engage in productive occupations
Liz I am proud to look back at my good fortune. I was attracted to join the first national 'Guidelines' Task Force in 1979 at the invitation of Hilary Jarvis, then CAOT President from Nova Scotia. At the time, I was enrolled in a Masters of Adult Education program. This privileged position of being an outsider-insider helped me to see the importance for me - and I believe for all occupational therapists and other professionals - to learn to articulate what we do, what we know, how we work, and why societies might benefit from and want to use the knowledge. Thelma Sumsion, the first Task Force Chair and CAOT President, took introduced the nation to national occupational therapy guidelines funded by the Department of National Health & Welfare. Our review of the literature convinced us that what we have been doing for the last century is what Carl Rogers called client-centred practice.
As a profession in Canada, we can be proud to have almost 30 years of national guidelines development. This history of examining, questioning, and articulating what a profession does from a national perspective appears to be a precedent amongst Canadian professional groups, and unique around the world. While practice guidelines are well known in most professions, Canada can be proud of developing generic, conceptual guidelines for any practice. While they are not as directive as many practice guidelines, they have helped us to uncover and describe the foundations that make it possible to practice occupational therapy in so many different ways & places. CAOT formed a Client-Centred Practice Committee that integrated three original1980s Guidelines into a single volume published by CAOT in 1991. The Committee was based in Nova Scotia and included Lori Multari, our CAOT Board Member. These were adventurous times… including working to publication deadlines despite the weather and power outages! “ 8:00 p.m. Meeting convened at the home of Lori (Multari, NS CAOT Board Member, using candles in power outage] Light beamed steadily on the editorial work of the 1991 Edition… Tea and muffins were served” Shedding Light on the Work of CAOT (NATIONAL, July 1991, p. 6)
I think this should go here and say when it was published we added a second emphasis Occupation Ergo a new model and an dual focus and a change in persective -then over to Helene Liz When Enabling Occupation I was published by CAOT in 1997 with the help of Geraldine Moore then Editor of the Canadian Journal of Occupational Therapy
Helen Start with a clearer articulation of occupation in the then new enabling
I am thinking this doesn’t work well here and would be better as a segway from client-centred to CMOP
Liz The 1990s were exciting times in Canadian occupational therapy circles as our Canadian perspective evolved from the early 20 th century post-World War I idea of ‘divergent therapy’ to keep wounded soldiers and people with tuberculosis and other diseases ‘occupied’. A physician, Dunton (1919) already recognized the power of occupational engagement to promote health!
Liz Occupational therapy’s evolution from divergent therapy had a fascinating stage in which occupational therapists learned to adapt ‘occupations’ for therapeutic uses for the body, such as using a bicycle saw for exercise, coordination, and work tolerance. A multitude of assistive devices came on the market as aids to daily living. Fred Sammons became a familiar name as an inventor and business man in assistive devices. Muriel Driver, for whom Canada’s premier lectureship is named, wrote in 1968 about occupational therapists’ fascination with technical sciences and the need to understand the profession’s philosophic foundations.
Liz Enabling Occupation emerged as a new framing of client-centred practice. The focus returned to the profession’s origins in addressing occupation beyond technical interests in body parts. At this point, the emphasis was largely on individual occupational performance.
Suggestion – put the “I just pilled….” quote on the slide and say the other quote Used intermationally
Quote from Sara Crepinsek
Speak about # translations, # countries, # research articles on COPM
Mary I thought this might be a good way to show how the ‘impact’ of the guidelines has been considered – both in terms of sales and the impact on practice Helen: maybe this could go at the end of be proud since it has all three bits
Transition - Helene
Liz ENOTHE view from Europe of the emphasis on working too often only with the individual … when we have much to contribute on the societal level
Liz With occupation being articulated as the domain of concern, Canadian occupational therapists were daring in creating a new model to capture the profession’s implicit, taken-for-granted understanding about HOW occupational therapists actually work. With informal testing to name ‘enablement skills’, we found resonance and support to dare to name 10 enablement skills in an Enablement Continuum in Enabling Occupation II. to name the core competency that distinguishes occupational therapy as ‘enablement’. With this new language, stories have begun to be articulated. For example where occupational therapists have felt restricted by being labelled and locked into a job as the ‘equipment person’, stories are emerging about using enablement skills to educate people about their occupational issues and the potential for them to realize occupational dreams with technical assistance, or to coach them in using particular technologies, and to collaborate with the client – who may be an architect firm to design and actually test the building of inventive technologies that make daily living possible.
Liz International colleagues join us in daring to use the power of ideas, models, and practice process guidelines for enabling occupation. Being able to see what occupational therapy is really about is being examined in different cultures and systems such as Japan
Liz The idea of being daring is catching around the world. An Australian group of occupational therapy researchers and practitioners in various settings has created a Community of Practice to examine what it means for occupational therapists to try enabling occupation in their particular situations. They ‘road tested’ the Enabling Occupation guidelines and dared to raise important critical perspectives about the struggles and the great breakthroughs practitioners reported on their practices, using the latest guidelines for Enabling Occupation II
Liz The Australian project was an important one for daring occupational therapists – some of whom like Lauren felt they were drifting away from the core beliefs and values of occupational therapy – to reassert their interests in enabling occupation
Transition - Mary
Speak briefly about the impact of occupation on person’s lives and our communities; need to create knowledge to carry our discipline forward; stretch our boundaries beyond health services
Justice with interests in social inclusion Injustice lies in denial or restrictions on the different capabilities that people can actually develop Accommodations need to support the realization of actual potential
Imagine if………………occupational therapists are leaders in the creation of environments that truly support the participation of all persons Imagine if……………..occupational therapists enable occupation at points in transition in person’s lives (e.g. school entry, retirement, first job)
- With a quiet background – e.g. looking off to horizon in future
- With a quiet background – e.g. looking off to horizon in future
Liz Imagine if WE pooled our energies as practitioners, students, and faculty as in the photo of such a group at Dalhousie? Imagine if our pooled energies was focused on changing the cities and towns of Canada, like Halifax and a Newfoundland fishing village in the photos, to make them more inclusive for living a meaningful life Imagine if we were enabling change from the use of technology to health practices to homelessness and social inclusion in schools and workplaces around the world
Liz contemplation on developing awareness and the ability to both describe and critique our profession, our work, and our world
ALL – or Liz briefly as continuity from the last Imagine if? We hope that you’ll be proud, be daring & be the difference in your individual practice, and as a professional community in Canada and the world.
From ‘C’ to ‘C’ to ‘C’: An Ocean of Possibilities Dr. Mary Law Dr. Helene Polatajko Dr. Elizabeth Townsend
Celebrate: our client centred guidelines <ul><li>13 Important Ways to Use the Guidelines for the Client-Centred Practice of Occupational Therapy by Thelma Gill </li></ul><ul><li>#1. The guidelines provide </li></ul><ul><li>a clear outline of the process </li></ul><ul><li>of O.T. which can be useful </li></ul><ul><li>in discussions with the </li></ul><ul><li>administrator of your </li></ul><ul><li>facility. ……….… #13. </li></ul><ul><li>From Thelma Sumsion’s 1982 & 1983 Series on “Getting our Act Together and Putting it on the Road … or Handling the Challenge of Change” , NATIONAL, September 1984 , p. 12) </li></ul>
Celebrate: our Client-Centred Practice of Enabling Occupation “ What is this important publication and valuable addition to your professional library?” Angela Naugle, Member, CAOT Client-Centred Practice Committee. National, The Newsletter of the Canadian Association of Occupational Therapists, May / June 1997 , 14 (6), p. 1
Celebrate: our Client-centred occupational focus <ul><li>The occupational imperative </li></ul><ul><li>Regardless of the perspective </li></ul>Client-centred Human Occupation
Celebrate: our Canadian Model of Occupational Performance (CMOP) Original Occupational Performance Model (Adapted from Reed and Sanderson, 1980) Performance components Areas of occupational performance Adapted from Reed and Sanderson, 1980 THE INDIVIDUAL spiritual physical mental socio-cultural SOCIAL ENVIRON-MENT productivity self care leisure ENVIRONMENT (social, physical, cultural) CULTURAL ENVIRON-MENT PHYSICAL ENVIRONMENT
<ul><li>to enabling occupation … </li></ul><ul><li>At the level of … the individual </li></ul>
Celebrate and be proud: CMOP Now used to frame our practice <ul><li>Debbie Hebert of the Toronto Rehabilitation Institute writes… </li></ul><ul><li>Prior to the Enabling I publication, our OT documentation reflected a very medical model, impairment based type of assessment process…t here was nothing really occupation based about this form! Other professions such as nursing and physiotherapy might have filled out this assessment form as well as us. </li></ul><ul><li>One day, we were reflecting on how documentation both dictates and reflects practice. Our documentation was dictating something that did not reflect how occupational therapists work with clients </li></ul><ul><li>We renovated the initial assessment document and called it the “Occupational Performance Module”. </li></ul>
Celebrate and be proud: CMOP Now used to frame our practice <ul><li>Debbie Hebert continues… </li></ul><ul><li>This change was transformative … </li></ul><ul><ul><li>with respect to how we were practicing and how our teams regarded our input. </li></ul></ul><ul><li>The Enabling Occupation document gave us the guidance and validation to be the leaders in patient centred goal setting at our hospital </li></ul><ul><li>Now we are mostly considered as an invaluable profession for our knowledge of helping our clients articulate their goals and evaluating how safely our clients perform their needed and desired occupations. </li></ul><ul><li>It is nice to now hear our colleagues say… </li></ul><ul><li>“ I wish I were an OT” rather than “What do OTs do?” </li></ul>
Celebrate and Be proud – CMOP Internationally lauded Your work has such international significance, it has such professional significance and to me it has such personal significance as it gave me the structure to build my science that has always had the focus to improve the lives of those with or threatened with disabling conditions. … it has involved and it has influenced so many therapists, scientists, educators and clients that have been served. Congratulations to all Canadians for your vision, your work and your commitment. Dr. C Baum, 2010 AOTA Past President
Celebrate: our Canadian Occupational Performance Measure (COPM) <ul><li>Enables meaningful participation in the occupational therapy process through: </li></ul><ul><ul><ul><li>identifying occupational performance problems </li></ul></ul></ul><ul><ul><ul><li>evaluating performance and satisfaction in these occupations </li></ul></ul></ul><ul><ul><ul><li>measuring change in perception of occupational performance </li></ul></ul></ul>
Celebrate and Be proud COPM around the world Countries where the COPM is used
Celebrate and Be Proud <ul><li>Highest Uses of CMOP (1993 Canadian Survey) </li></ul><ul><ul><li>Assessing </li></ul></ul><ul><ul><li>Educating others </li></ul></ul><ul><ul><li>Explaining the profession to others </li></ul></ul><ul><li>Sales over 10 years (1999 – Sep. 2009) </li></ul><ul><li>COPM manuals: 11,542 </li></ul><ul><li>Enabling I (1997, 2002): 13,623 (French and English) </li></ul><ul><li>Enabling II (2007): 4186 (French and English) </li></ul>
Celebrate -> Be proud Challenge Each other to go further
Challenge the Present: go further <ul><li>Enabling II: Advancing OT vision for health, well-being & justice through occupation </li></ul><ul><li>Occupation-based practice </li></ul><ul><li>Beyond performance </li></ul><ul><li>Beyond disability </li></ul>
Challenge: Canadian Model of Occupational Performance AND Engagement - occupation as our focus
Challenge: our scope and go further <ul><li>Individuals with impairments </li></ul><ul><li>Individuals with occupational performance issues (OPIs) </li></ul><ul><li>Individuals, families, groups, organizations, communities or populations with OPIs or potential OPIs </li></ul><ul><li>The human population </li></ul><ul><li>Impairment reduction </li></ul><ul><li>Adaptation (P, O, E) </li></ul><ul><li>Accommodation (E) </li></ul><ul><li>Skill acquisition (P) </li></ul><ul><li>Social reconstruction (O,E) </li></ul><ul><li>Health and well-being </li></ul><ul><li>Occupational enablement </li></ul>1 2 3 4 7 2 3 1 6 4 5
Challenge: our practice and go further <ul><li>Sunnybrook Health Sciences Centre OT’s journey toward occupation-based practice: </li></ul><ul><li>Initiated in 2003 and kept alive by the professional practice leader – Fran Aiken </li></ul>
Challenge: our practice and go further <ul><li>Sunnybrook Health Sciences Centre OT’s journey toward occupation-based practice: </li></ul><ul><li>Fran Aiken writes… </li></ul><ul><li>I have always felt rooted to occupation as the basis of practice. BUT - I experienced first-hand the move to increasingly ‘disease-oriented’ health care and found that even my OT colleagues devalued activity-oriented interventions. THUS, it was with open arms that I welcomed the 1997 Enabling Occupation guidelines </li></ul>
Challenge: our practice and go further <ul><li>Fran —as the Centre’s Professional Leader—used occupation-based practice as a unifying concept for the newly amalgamated Occupational Therapy service </li></ul><ul><li>Over the years, Fran and her colleagues incorporated a series of knowledge building exercises (through large professional group workshops and retreats), as well as one-on-one individual reflective practice exercises—all related to occupation-based practice . </li></ul><ul><li>And then they studied the effect </li></ul>
Challenge: Be Daring Occupation-based practice <ul><li>The Question : How do OT’s at S&W incorporate an occupational view of health in the context of their clinical practice on a day-to-day basis? </li></ul><ul><li>Our Long-term goal : To contribute to the understanding of occupation and thus develop methods of helping people </li></ul><ul><li>Interesting findings : The meaning GAP </li></ul>
Challenge: Be Daring <ul><li>The meaning GAP </li></ul><ul><li>When there is incongruence between how therapists believe occupational therapy should be practiced in an ideal world and how they actually do practice in the real world, they experience a “ meaning gap. ” </li></ul><ul><li>“ Well, again I think we always struggle with being true to our profession and yet being true to the programme that we work in. And very often I think it's hard to say that I've been able to balance both in my clinical practice.” </li></ul>
Be Daring: Occupation-based practice <ul><li>The meaning GAP </li></ul><ul><li>The process of resolving the meaning gap between ideal and actual practice is a personal journey . The search for meaning facilitates a personal sense of occupation that guides practice . </li></ul><ul><li>Those who bridge the gap have specific stories about co-creating meaning and how that meaning transforms their practice . </li></ul><ul><li>“ it’s your individual sense of occupation that sort of guides you. ” </li></ul>
Be Daring: Occupation-based practice <ul><li>The meaning GAP </li></ul><ul><li>Therapists who highly value occupation and see the potential for client occupational engagement in their daily roles are enthusiastic therapists, who derive personal meaning and satisfaction within their own occupation, despite other challenges in their work environment. </li></ul><ul><li>it’s your individual sense of occupation that sort of guides you.” </li></ul>
Be daring: Contribute to society <ul><li>The Canadian guidelines for client-centred practice and enabling occupation have had a great impact in Europe because these concepts match very well with the European values like freedom, democracy, equality, human dignity and solidarity and with European Social Policy … clients say : OT works too often only with the individual and this is a pity since they have much to contribute on society level. </li></ul><ul><li>Hanneke van Bruggen, Executive Director, ENOTHE (European Network of Occupational Therapy Educators) re European Values Study (EVS), 2004, & Tuning Project, 2008 </li></ul>
<ul><li>to enabling occupation </li></ul><ul><li>At the level of … the group </li></ul>
to enabling occupation At the level of … society
Be daring: Naming Enablement in Enabling Occupation <ul><li>“ theory in enabling occupation helped me to see what occupational therapy is really about” </li></ul>Photo & quote courtesy of Hiromi Yosikawa, November 2009
Be daring: Enable our own occupation <ul><li>Members came from diverse practice contexts - including in an indigenous community in the central desert, to a youth focussed mental health outreach service in a large city. (G. Whiteford) </li></ul>Australian Practice Scholar Group 2008 by permission G. Whiteford … we created a community of practice scholars who "road tested" the Enabling Occupation guidelines over the course of a year.
Be daring: Enable our own occupation My inclusion in this practice scholars research came at a time I felt I was drifting away from the core beliefs and values of Occupational Therapy. (Lauren, co researcher in the Australian project)
Be Daring: Building New Partnerships for Practice <ul><li>Family Health Teams </li></ul><ul><li>Legal services </li></ul><ul><li>Municipalities </li></ul><ul><li>School Boards </li></ul>
Be Daring: Building Evidence-based Practice in Partnership <ul><li>Occupational therapists from three Vancouver region health districts </li></ul><ul><li>Worked with a knowledge broker and developed strategies to change practice in three areas: </li></ul><ul><ul><ul><li>cognitive screening </li></ul></ul></ul><ul><ul><ul><li>assessment of risk for skin breakdown </li></ul></ul></ul><ul><ul><ul><li>provision of wheeled mobility and seating equipment </li></ul></ul></ul>
Be Daring: Building Evidence in Partnership <ul><li>A resource to assist families in giving, getting, and organizing information about their child/youth with special needs </li></ul>
Celebrate -> Be proud Challenge -> Be daring Create An occupational future for all
Create: An occupational future for all <ul><li>“ Occupational therapists are in the business of helping people to transform their lives through enabling them to do and to be. We are part of their process of becoming and we should constantly bear in mind the importance of this task.” </li></ul><ul><li>Wilcock, 1998 </li></ul>
Create: Be the difference ‘ We make our world significant by the courage of our questions and by the depth of our answers’ . . . Sagan, C. (1973). The cosmic connection. New York: Anchor Press, p. 193.
Martha Nussbaum American Philosopher “ The capabilities approach … simply specifies some necessary conditions for a decently just society, in the form of a set of fundamental entitlements of all citizens” (2006)
<ul><li>"You spend their young lives trying to get them ready for the world and when the time comes, the world isn't ready for them. So we have to find a way to do it." </li></ul><ul><li>- parent of a child with a disability </li></ul>