Critical reflections on occupational justice: Toward a rights-based approach to occupational opportunities

First-Generation Palestinian Refugees in Jordan: Experiences of Occupational Disruption From an Occupational Justice Perspective

IMPORTANCE

Only a limited amount of research has investigated the impact of prolonged refugee status of Palestinian refugees who have been displaced for more than 70 yr.

OBJECTIVE

To explore lived experiences of Palestinian refugees in Jordan and understand their occupational disruption.

DESIGN

Thematic analysis guided by descriptive phenomenology with one-on-one and group interviews.

SETTING

An AlBaqa'a community-based rehabilitation center or participants' homes.

PARTICIPANTS

First-generation Palestinian refugees who fled Palestine and live in Jordan.

RESULTS

Fifteen Palestinians, mainly widowed women in their 70s, participated in this study. Ten completed interviews, and five participated in two group interviews. Four themes emerged: (1) Palestinian pride, (2) trauma leaving one's home country, (3) challenges of living in a host country, and (4) internalized prejudice.

CONCLUSIONS AND RELEVANCE

After 70 yr, prolonged refugeeism has led to occupational disruption and negative implications for occupational justice, especially in the absence of social justice. The area most negatively affected was social participation; however, participants still had a great sense of pride about their homeland and their heritage. What This Article Adds: This foundational research explores the occupational injustices of the protracted refugee status of first-generation Palestinians in Jordan and identifies meaningful interventions to promote the alleviation of occupational disruption.

Float to grow: nurturing the roots of socially inclusive and just practice in occupational therapy students

Abstract Models of practice and theoretical frameworks that seek to deemphasize impairment and focus on the implications of societal attitudes, norms, and culture are significant and relevant to the practice of occupational therapy. As an underpinning of client-centered practice, there is a need to highlight and embrace the intersection of impairment-deemphasizing theories and move from conceptual understanding to true application of those theoretical models in practice. This article describes the inclusion of the Salamander Workshop; an experiential learning activity designed to facilitate the development of students’ therapeutic self-awareness and initiate a starting point for incorporating social frameworks into authentic practice. Student reflections conceptualize the discussion about professional growth and development against the backdrop of disability experiences, social change, and empowerment. The article begins with an introduction to how the profession of occupational therapy and disability studies interconnect. This is followed by a description of both the occupational therapy education program where the experiential learning activity took place, and details of the workshop itself. The final two sections of the article articulate and discuss student reflections of the experiential learning exercise and conclude by framing the discussion within the larger context of occupational therapy pedagogy. The Salamander Workshop facilitated an opportunity for students to immerse themselves in the lived experience of others, while enhancing their own self-awareness, which in turn may translate to their growth and development as inclusive practitioners.

A participação social como um caminho possível para a justiça social e ocupacional

Resumo Introdução Justiça social, justiça ocupacional e participação social são termos utilizados por terapeutas ocupacionais e cientistas ocupacionais para nortear, construir e informar suas práticas, formação profissional, pesquisas e produções teóricas. Objetivo Identificar e refletir sobre as possibilidades, limites e desafios da prática de terapeutas ocupacionais brasileiras na busca pela participação social e como isso pode ou não contribuir para construção da justiça social e ocupacional. Método Por meio de uma metodologia colaborativa, terapeutas ocupacionais docentes e da assistência, atuantes no estado de São Paulo, Brasil, foram convidadas a responderem um questionário. Com esse instrumento, buscou-se caracterizar as colaboradoras, conhecer o trabalho desenvolvido nos contextos de ensino, pesquisa, extensão e assistência e identificar como discutem e realizam a participação social nos campos teórico e prático. Resultados As 65 colaboradoras estavam inseridas em instituições públicas, privadas e filantrópicas, em diferentes campos de saber e de prática, e desenvolviam trabalhos e estudos com/para várias populações com demandas e necessidades específicas. Elas descreveram distintas possibilidades de participação social, algumas de natureza individual, focada no sujeito e na funcionalidade e outras orientadas para e com base no coletivo. Os limites e desafios estiveram relacionados às instituições de trabalho, aos aspectos individuais, coletivos e estruturais e ao próprio núcleo de saber e de prática da terapia ocupacional. Conclusão Com embasamento nas experiências das colaboradoras e na compreensão das profissionais sobre participação social, considera-se que esse pode ser um caminho teórico-conceitual e prático para refletir e buscar justiça social e ocupacional junto a indivíduos, grupos e comunidades.

Social participation as a possible way forward for social and occupational justice

Abstract Introduction Social justice, occupational justice, and social participation are terms used by occupational therapists and occupational scientists to guide, build, and inform their practices, professional training, research, and theoretical productions. Objective To identify and reflect on the possibilities, limits, and challenges of Brazilian occupational therapists' practice in the search for social participation and how this may or may not contribute to the construction of social and occupational justice. Method Through a collaborative methodology, academics, and assistance occupational therapists, working in the state of São Paulo, Brazil, were invited to answer a questionnaire. This instrument characterized the collaborators, and their work in teaching, research, and assistance, and identified how they discuss and carry out social participation in the theoretical and practical fields. Results The 65 collaborators were inserted in public, private and philanthropic institutions, in different fields of knowledge and practice, and developed work and studies with/for various populations with specific demands and needs. They described different possibilities of social participation, some of an individual nature, focused on the subject and functionality, and others oriented towards and from the collective. The limits and challenges were related to work institutions, individual, collective, and structural aspects, and the field of knowledge and practice of occupational therapy. Conclusion Based on the experiences of the collaborators and the professionals' understanding of social participation, it is considered that this may be a theoretical, conceptual, and practical path to reflect on and seek occupational and social justice with individuals, groups, and communities.

United Nations Convention on the Rights of Person with Disabilities (UNCRPD) Implementation: Perspectives of Persons with Disabilities in Namibia

The Namibian government ratified the UNCRPD and its optional protocol in 2007 raising expectations that such a convention would fundamentally improve the lives of persons with disabilities. However, persons with disabilities continue to experience inequalities and violation of dignity. This study explores the impact of the UNCRPD as reflected on the lives of persons with disabilities in Namibia. An exploratory qualitative study with the use of photovoice and in-depth interviews was conducted in Omusati and Khomas regions, Namibia. Persons with disabilities (n = 31) were recruited via purposive sampling, of which n = 25 participants were engaged in three focus group discussions. Participants employed in the disability sector (n = 6) were engaged in in-depth interviews. Data were thematically analysed. The study findings revealed the inadequacy of disability rights information dissemination and continued barriers to inclusivity of persons with disabilities. Stigma, discrimination, limited financial opportunities, weak political support, and limited accessibility to physical infrastructure caused barriers to inclusivity. However, opportunities to advance the UNCRPD were also identified. There is a need for the disability sector to build on identified institutional facilitators to advance disability rights through mobilisation of local resources, communities, and government to redress the challenges identified in Namibia.

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.

The (dis)obedient occupational therapist: A reflection on dissent against disciplinary propaganda

Abstract Introduction Despite struggling to establish itself as an autonomous profession, occupational therapy remains extensively regulated and controlled by discursive authorities inside and outside the discipline. After overcoming the profession’s reformist ideals, the military governance that supported its rapid expansion morphed into civil institutions but both were based on similar grounds: occupational therapists should obey a strict set of rules while disobedience and dissent are consistently repressed or silenced. Objective The objective of this article is to deconstruct dominant (consensual) discourses that shape the status quo in occupational therapy and envision alternative paths for the development of the discipline. Method Drawing on the work of Erich Fromm and Jacques Rancière, we propose a (critical) theoretical analysis of the concepts of disobedience and dissensus as they apply to occupational therapists. Results The concepts of disobedience (Fromm) and dissensus (Rancière) can be used to revisit the consensus shaped by discursive authorities inside and outside occupational therapy and expose the political nature of such processes. We argue that remaining oppressive forces similar to those of a warfare regime persist in regulating occupational therapy practice and knowledge by enacting a form of ‘disciplinary propaganda.’ Rather than threatening the development of the discipline, disobedience and dissensus constitute critical responses to disrupt dominant discourses and give rise to healthier concepts. Conclusion The use of politically charged terms such as disobedience or dissensus can be seen as controversial and unsettling for a profession like occupational therapy but we believe they are necessary for the future of our discipline.

Occupational justice health questionnaire: reflections on its application

ABSTRACT Introduction Occupational justice concept is defined as the equal access and participation in all occupations, including the resources required for participation and opportunities for social inclusion. Occupational justice not only remains conceptually ambiguous for occupational therapy practice but also lacks critical examination of its applicability to non-Western cultures. Objective This article describes the reflexive process exercised by the researchers during and after using the Occupational Justice Health Questionnaire (OJHQ) as an occupational therapy tool in a substance addiction rehabilitation setting in the Philippines. Method This qualitative study gathered transcriptions from field notes and focus group discussions of the authors. These transcriptions were characterized by the authors’ reflections on their experiences using the OJHQ on four distinct periods: 1) OJHQ translation, 2) pilot testing, 3) OJHQ-Filipino version administration, and 4) project conclusion. Data were analyzed through thematic analysis. Results Qualitative data revealed four themes: tool usefulness; administration guidelines; contextualized use of the tool; and nuances of occupational injustices in substance addiction and rehabilitation setting. Conclusion Findings expanded OJHQ’s purpose to enhance clinical reasoning, promote justice-oriented health care, activate reflective practice, and recognize the interweaving and evolving nature of injustices. This article offers an understanding of how reflections can facilitate cultural adaptation of practice tools used in occupational therapy and justice practice.

People with Disabilities and Other Forms of Vulnerability to the COVID-19 Pandemic: Study Protocol for a Scoping Review and Thematic Analysis

OBJECTIVES

To develop a protocol for a scoping review mapping as well as thematically analyzing the literature on the effect of, and responses to, the coronavirus disease 2019 (COVID-19) pandemic, focused on people with disabilities with other layers of individual vulnerability or social disadvantage.

METHODS

We will search scientific databases (Medline/PubMed, Web of Science, Scopus, AgeLine, PsycINFO, CINAHL, ERIC) and preprint servers (MedRxiv, SocArXiv, PsyArXiv). Google searches, snowballing, and key-informant strategies were also used, including a focus on the gray literature (eg, official reports). Peer-reviewed and preprint publications will be covered in 6 languages, and the gray literature in English. Publications will be included if they address individuals with disabilities; the COVID-19 pandemic or subsequent socioeconomic or occupational effects; and individual or social vulnerabilities, including any form of discrimination, marginalization, or social disadvantage. Two independent reviewers will perform eligibility decisions and key data extractions. Beyond mapping the literature, the results will thematically analyze any disproportionate risks people with disabilities and other forms of vulnerability experience in terms of being infected by COVID-19, having severe health consequences, and facing negative socioeconomic effects. Actions taken or recommended to reduce identified inequalities will also be synthesized. Our entire research team, with diverse backgrounds, will be involved in the synthesis.

CONCLUSIONS

This review, which we plan to expedite, aims to inform policy makers, health authorities, disability advocates, and other stakeholders regarding the needs and ways to promote equity and disability-inclusive responses to the COVID-19 pandemic and the resultant socioeconomic shockwaves.

Occupational Therapy for South Asian Older Adults in the United Kingdom: Cross-Cultural Issues

Introduction

There is limited understanding of the cultural needs of diverse Black and Minority Ethnic populations such as South Asian older adults, which may be perpetuating occupational injustices and health inequalities faced by these groups. Although cultural considerations are intrinsic to person-centred occupational therapy and increasingly relevant to the changing landscape of health and social care, the profession is criticised for its western-centric focus. This study aimed to gain understanding of the current cross-cultural issues in supporting South Asian older adults in the UK, as perceived by occupational therapists.

Method

A constructivist qualitative design supported by thematic analysis was used, involving seven occupational therapists in the United Kingdom who participated in semi-structured interviews via Skype/telephone.

Findings

Cross-cultural issues were illustrated through the following themes: ‘when the barriers go down’ – cultural mismatch in individualist vs. collectivist worldviews; ‘invasion of the family home’ – cultural inappropriateness of standard interventions; and ‘I go into every assessment assuming nothing’ – recognition of and response to challenges.

Conclusion

This study provides insight into cross-cultural issues in occupational therapy for South Asian older adults, revealing a gap between theory and practice in integrating cultural humility. It highlights the need for a more inclusive, person-centred approach to support culturally diverse populations.

Doing Occupational Justice: A Central Dimension of Everyday Occupational Therapy Practice

BACKGROUND.

The Canadian Association of Occupational Therapists (CAOT) and the American Occupational Therapy Association (AOTA) state that occupational justice is part of the domain of occupational therapy and that occupational justice is "an aspect of contexts and environments and an outcome of intervention" (AOTA, 2014, p. S9).

KEY ISSUES.

Despite the increasing focus on justice in the occupational therapy and the occupational science literature, many practitioners in traditional settings do not see its relevance to their everyday practice (Galvin, Wilding, & Whiteford, 2011) or have difficulty envisioning how to enact a justice-informed practice.

PURPOSE.

This paper demonstrates how occupational justice is germane to all settings of occupational therapy, and how it can be enacted at micro, meso, and macro levels of occupational therapy practice.

IMPLICATIONS.

We argue that occupational therapy is a justice-oriented profession at its core and will discuss how occupational justice can be enacted at all levels of practice.

Occupational Therapists as Street-Level Bureaucrats: Leveraging the Political Nature of Everyday Practice

Background.

As front-line service providers who often work in systems regulated by governmental bodies, occupational therapists can be conceptualized as “street-level bureaucrats” ( Lipsky, 1980/2010 ) who effect and are affected by policy.

Purpose.

Drawing on understandings from a study of long-term unemployment, this article proposes that occupational therapists, as street-level bureaucrats, respond to inter-related policies and systems in ways that can perpetuate, resist, or transform opportunities for doing and being.

Key Issues.

By highlighting practitioners’ everyday negotiation of governmental, organizational, and professional power relations, the notion of street-level bureaucracy illuminates the political nature of practice as well as the possibilities and boundaries that policy can place on ideal forms and outcomes of practice.

Implications.

Framing occupational therapists as street-level bureaucrats reinforces practitioners’ situatedness as political actors. Mobilizing this framing can enhance awareness of occupational therapists’ exercise of discretion, which can be investigated as a basis for occupation-focused and emancipatory forms of practice.

Inclusive and emancipatory approaches to occupational therapy practice in substance-use contexts

BACKGROUND.

Occupational therapy practice is enhanced through clear understanding of its epistemological foundations. In the area of substance use, practices are strongly functionalist.

PURPOSE.

This study unearths epistemologies through analyzing practices addressing the social needs of clients with problematic substance use.

METHOD.

This study used an exploratory qualitative approach and was based on Marxist philosophies. Qualitative interviews were conducted with nine occupational therapists experienced in working with substance users. Data were analyzed through a dialectic approach to content analysis based on the Marxist theory of labour process.

FINDINGS.

The occupational therapy practices were found to follow common principles: clients are agents of transformation in health processes; creativity is a strong element of practice and underlies the whole therapeutic process; and conditions of social reproduction compose the object of occupational therapy (i.e., what is transformed through occupational therapy practices). Two different approaches using these principles were uncovered according to the labour-process purposes: inclusive and emancipatory.

IMPLICATIONS.

Systematization of practices based on epistemological foundations strengthens occupational therapists' ability to link actions to theories.

Occupational injustice: A critique

Background.

Although the idea of occupational injustice pervades the occupational therapy literature, there has been little scholarly debate concerning this construct or the parameters of the five identified forms of occupational injustice.

Purpose.

The aims of this paper are to highlight conceptual confusions, foreground some inherent questions that have been neither acknowledged nor addressed, and question the theoretical and practical utility of five manifestations of occupational injustice.

Key Issues.

Few theorists have contributed to the occupational injustice literature. Significant definitional confusion exists concerning the five forms of occupational injustice with some forms described as subsets of others. The inherent problems of judging occupational injustice have not been addressed.

Implications.

If occupational injustice were understood as a violation of occupational rights—human rights to achieve well-being through occupation—many of the problems of identifying a situation of occupational justice or injustice would be resolved. Using the capabilities approach to human rights would facilitate this endeavour.