Occupational Justice Alterio ot24 vx final

Occupational Justice: Occupational Justice: Appraising Occupational Therapy's Fourth ParadigmAppraising Occupational Therapy's Fourth Paradigm

Christopher J. Alterio, Dr.OT, OTRABC Therapeutics

East Amherst, New York

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.

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.

CaveatsCaveats

Paradigm ChangeParadigm Change

Do our ideas stay the same over time, or should they change?

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

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

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

The Derailment of OTThe Derailment of OT

•Phillip Shannon (1977)

–Student of Reilly

• ‘A discipline that forgets its founders may be lost’

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

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.

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


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).


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.

General Systems HierarchyGeneral Systems Hierarchy

Organs and Organ systems

Person (Levels of conduct and experience)

Families

Communities

Genetics

Cells and Tissues

Focus

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)

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

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

General Systems HierarchyGeneral Systems Hierarchy

Families

Communities

Societies

Cultures

Cells and Tissues

Person

Focus?

But how do these concepts But 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.

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)

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).

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’

Core Values & Attitudes of Core 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).

Context at the Founding of OTContext at the Founding of OT

Contributing Core ValuesContributing Core Values

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

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


• 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

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.

Characteristics of a Good Model Characteristics of a Good Model

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.


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.


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 ed. Thorofare, NJ.: Slack, Inc.

Yerxa, E. J. (1985). Authentic occupational therapy: 1966 Eleanor Clarke Slagle Lecture. in AOTA (Ed.), A Professional Legacy: The Eleanor Clarke Slagle Lectures in Occupational Therapy, 1955-1984, (pp. 155-174). Rockville: AOTA.

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Occupational Justice Alterio ot24 vx final

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