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Re-imagining occupational therapy clients as communities: Presenting the Community-Centred Practice Framework
- 1. latrobe.edu.au CRICOS Provider 00115M Re-imagining occupational therapy clients as communities: Presenting the Community- Centred Practice Framework Dr Nerida Hyett PhD, MHSc, B.OT Prof Amanda Kenny, Dr Virginia Dickson-Swift, and Dr Carol McKinstry Occupational Therapy Australia 27th National Conference, Perth 2017 Twitter: @neridahyett
- 2. 2La Trobe University Rationale Increasing calls for occupational therapists to work with communities… • WFOT and many professional associations identify ‘community’ as a potential client of OT • Increasing calls from governments for community-focused practices that improve community/health service participation However, there is little guidance on how to shift or expand focus from working with individuals, to working with communities
- 3. 3La Trobe University Defining ‘community’ • No standard definition (Rifkin, 2014) • Different interpretations across disciplines and fields (Scaffa & Reitz, 2013) • Place AND social group A group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings (MacQueen et al., 2001, p. 1929)
- 4. 4La Trobe University Community-centred practice Working with communities, not just within community settings (Hyett, et al, 2015) Working with rather than for or on them, on goals that are identified by communities themselves (Minkler, 2012) Community-centred interventions follow the principles of client- centred practice, where the client is the entire community (Scaffa & Reitz, 2013 pp 5-6)
- 5. 5La Trobe University Methods • Qualitative case study methodology (Stake, 1995) • ‘Exemplar’ cases of highly regarded community participation initiatives • Canadian community food security network • Australian rural community banking initiative • Methods: key informant interviews, document analysis, social media analysis, fieldwork • Analysis: multi-case analysis to identify cross case findings and build theory (Stake, 2006) • Limitations: small sample size, limited by time/resources, preliminary conceptual findings to inform future research
- 6. 6La Trobe University Findings 1. Community Identity •Who is the community client? •Social actors and social field (people, groups, organisations, networks) •Place and/or setting 2. Community Occupations •What occupations are important? •What is the occupational goal? •Co-occupation •Community heterogeneity (diverse roles, skills, values, experiences, and expertise) 3. Community Resources and Barriers •What resources exist? •How can resources be used to overcome barriers? •Economic/noneconomic •Power redistribution 4. Participation Enablement •What processes are used for community participation •What is the occupational therapists enablement role? •Enabling strategies
- 7. 7La Trobe University 1. Community Identity The first component of the framework, directs the occupational therapist to question: • Who is the community client? This will support them to understand community identity, which is defined by social actors and social field, and place and setting.
- 8. 8La Trobe University 2. Community Occupations The second component of the framework, encourages occupational therapists to question: • What occupations are important to the community? • What joint action is taken by community members towards their shared goal? Theories of co-occupation and community heterogeneity are used to conceptualise community- level occupations.
- 9. 9La Trobe University 3. Community Resources and Barriers In the third component of the framework, occupational therapists are encouraged to question: • What resources are needed by the community? • What barriers prevent participation? It is important to audit resources with both economic value and noneconomic meaning. This is used to support a process of power redistribution.
- 10. 10La Trobe University 4. Participation Enablement In the fourth component of the framework the questions to be asked include: • What processes are used for community participation? • What is the occupational therapists enablement role? This process will enable occupation therapists to select and utilise enabling strategies, which will help the community to achieve their occupational goal.
- 11. 11La Trobe University Conclusion • Evidence is needed to strengthen occupational therapists’ practice with communities • The proposed conceptual framework can improve understanding of community clients, and utilisation of a community-centred practice approach • Further research is needed to trial and evaluate the CCPF across the wide range of socially and culturally diverse community contexts where occupational therapists currently and/or could potentially work
- 12. 12La Trobe University References Hyett, N., McKinstry, C., Kenny, A., & Dickson-Swift, V. (2015). Occupational therapists: improving the health and wellbeing of populations. Australian Journal of Occupational Therapy, Early view. doi: 10.1111/1440-1630.12222 Jewkes, R., & Murcott, A. (1996). Meanings of community. Social Science & Medicine, 43(4), 555- 563. doi: 10.1016/0277-9536(95)00439-4 Kaufman, H. F. (1959). Toward an interactional conception of community. Social Forces, 38, 8. MacQueen, K. M., McLellan, E., Metzger, D. S., Kegeles, S., & et al. (2001). What is community? An evidence-based definition for participatory public health. American Journal of Public Health, 91(12), 1929-1938. doi: 10.2105/AJPH.91.12.1929 Minkler, M. (2012). Community organizing and community building for health and welfare (3rd ed.). London: Rutgers University Press. Rifkin, S. B. (2014). Examining the links between community participation and health outcomes: a review of the literature. Health Policy and Planning, 29(suppl 2), ii98-ii106. doi: 10.1093/heapol/czu076 Scaffa, M. E., & Reitz, S. M. (2013). Occupational therapy in community-based practice settings Retrieved from http://www.eblib.com
- 13. 13La Trobe University Shaw, M. (2008). Community development and the politics of community. Community Development Journal, 43(1), 24-36. doi: 10.1093/cdj/bsl035 Stake, R. E. (1995). The art of case study research. Thousand Oaks: Sage Publications Inc. Taylor, J., Wilkinson, D., & Cheers, B. (2006). Is it consumer or community participation? Examining the links between 'community' and 'participation'. Health Sociology Review, 15(1), 38-47. doi: 10.5172/hesr.2006.15.1.38 Townsend, E. A., Polatajko, H. J., Craik, J., & Davis, J. (2007). Canadian Model of Client-Centred Enablement. In E. A. Townsend & H. J. Polatajko (Eds.), Enabling occupation II: Advancing an occupational therapy vision for health, well-being, and justice through occupation (pp. 110). Ottawa: Canadian Association of Occupational Therapists. Whiteford, G. E., & Townsend, E. A. (2011). Participatory Occupational Justice Framework (POJF 2010); enabling occupational participation and inclusion. In F. Kronenberg, N. Pollard, & D. Sakellariou (Eds.), Occupational therapies without borders-volume 2: Towards an ecology of occupation-based practices (Vol. 2, pp. 65-84). Philadelphia, PA: Churchill Livingstone/Elsevier Wilkinson, K. P. (1970). The community as a social field. Social Forces, 48(3), 311-322. References
- 14. Thank you latrobe.edu.au CRICOS Provider 00115M Dr Nerida Hyett Lecturer in Occupational Therapy La Trobe Rural Health School La Trobe University , Bendigo, Australia Email: n.hyett@latrobe.edu.au Phone: +61 3 5444 7432 Twitter: @neridahyett
Editor's Notes
- 1min Increasing calls for OTs to work with communities WFOT and many professional associations identify ‘Community’ as a potential client of OT services, Increasing calls from governments, particularly in England, Australia and Canada to reorient health services to communities and improve community-health service participation. However, there is little guidance for OTs to shift practice from individuals to communities - To understand how OTs can work with communities we must first understand who ‘community is and what this means for practice
- 1min In healthcare, community is often used to mean a setting for the delivery of healthcare programs, which is outside of or external to hospitals or secure institutional settings In OT, community is commonly broadly defined as an occupational environment, a setting in which occupational participation occurs In my literature reviews e.g. scoping and critical reviews Rifkin, established author in public health, research on community participation since 1983 in South East Asia, concludes there is no standard definition of ‘community’ OT authors Scaffa and Reitz argue that community is defined differently across disciplines and fields, and means different things in different contexts Generally ‘community’ is understood as a place that involves a group of people who are socially linked Best/highly cited definition in healthcare research is MacQueen et al developed with a group of healthcare consumers
- 2mins I expect that many OTs will be familiar with community-based practice (Scaffa & Reitz, 2013), however, the idea of community-centred practice has had relatively less discussion in the OT literature Community-centred practice is about working WITH not just within community settings e.g. working with individuals in community settings is community-based but not community-centred practice Minkler and other community development authors argue that community-centred practice is driven by communities, and practitioners must take on roles that enable them to work with them (not for them or on them) Scaffa and Reitz likens this to client-centred practice, where community is at the centre of practice, and the OT works with the community in a collaborative partnership. This is similar to Elizabeth Townsends definition in the Enabling Occupation textbook. However, there is little guidance of how to do this within the occupational therapy literature (and in the broader health literature) and a number of challenges are reported e.g. funding, workload demands, facilities, resources, and lack of understanding/confidence or evidence-based methodologies
- 2mins Very briefly outline of research methods We completed 2 qualitative case studies 1. Canadian food security network – 6 interviews, visited/toured 7 organisations in three cities (Toronto, Montreal and Halifax), social media Facebook and Twitter pages 2. Australian rural community bank initiative – in North West Victoria, Australia. Community owned banking business, 50% of profits go back into community groups and initiatives I presented the each of the case studies at the previous National OT conference in 2015. Today I am presenting the findings of the cross case analysis
- The findings from the cross case analysis were used to develop a four stage, conceptual model to guide community-centred practice in occupational therapy. We have called this the Community-Centred Practice Framework (CCPF). The model was developed by interpreting the descriptive case findings using occupational therapy and occupational science knowledge and social theory.
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