Nick Pollard

Operationalizing community participation in community-based rehabilitation: exploring the factors.

Purpose. The purpose of this article is to critically discuss issues that pertain to the operationalization of community participation in community-based rehabilitation (CBR). Method. Data were drawn from an international, questionnaire-based survey of occupational therapists involved in CBR conducted through the World Federation of Occupational Therapists. A search of CINAHL. PsychInfo and Medline databases for articles on CBR was performed and both descriptive articles and analytical ones were included. Results. Although there are guidelines on the nature of CBR these do not always match its application in practice. Active involvement of local communities in CBR projects is often limited, threatening the sustainability of CBR programmes. Furthermore, the failure to acknowledge the sociopolitical underpinnings and the cultural nature of disability is likely to compromise the nature of disabled peoples involvement in CBR. Conclusions. There is confusion and lack of clarity about the nature of CBR. Educational modules on CBR should be made available to professionals. These should consider the importance of community involvement and context-specific and culture-sensitive programmes in practice.

Occupational Therapy, Gender and Mental Health: An Inclusive Perspective?

This article offers an understanding of how the gendered nature of occupational therapy has an impact on relationships between therapist and client, qualified staff and support workers, and occupational therapy managers and workers. It analyses the development of occupational therapy from its early, mainly female and middle-class, origins and explores how the profession has struggled to define its status and role to fit structures determined by the medical profession. The tensions that these pressures have exerted on occupational therapys original concerns with domestic and creative activities are considered, drawing on feminist theories and sociological interpretations of gender and professional development in the context of mental health. It is argued that in trying to meet medicines demand for a more scientific occupational therapy as well as orientate rehabilitation to returning clients to work, occupational therapists risk, first, losing sight of their core domestic activities and traditional caring roles and, secondly, devaluing the skills and abilities of their support worker colleagues. The article suggests that occupational therapists should claim domestic activities as central to practice and reconsider the feminine principles of caring, connectedness and the importance of relationships to produce a wholly inclusive and reflective practice.

Reconceptualising occupational therapy

This opinion piece describes central issues arising from discussions at a recent conference exploring the implications of global poverty for the occupational therapy profession. The connection between poverty, disability and the marginalisation that these problems produce presents an opportunity for occupational therapists to realise their potential for facilitating social change. To do so, however, entails some reconceptualising of the profession. In some areas of intervention, the struggle to obtain a clear definition for occupational therapy has both arisen from and contributed to a marginal status, linked to difficulties in developing capacity for research. The social questions around occupation suggest both challenges and opportunities for the profession.

Participatory citizenship: Critical perspectives on client-centred occupational therapy

Abstract Background/aims: This article aims to discuss client-centred practice, the current dominant approach within occupational therapy, in relation to participatory citizenship. Occupational therapists work within structures and policies that set boundaries on their engagement with clients, while working with complex, multidimensional social realities. Methods: The authors present a critical discussion shaped by their research, including a survey, discussions at workshops at international conferences, and critical engagement with the literature on occupational therapy, occupation, and citizenship. Conclusion: A focus on citizenship suggests reframing professional development based on the participation in public life of people as citizens of their society. While occupational therapists often refer to clients in the context of communities, groups, families, and wider society, the term client-centred practice typically represents a particular view of the individual and may sometimes be too limited in application for a more systemic and societal approach. Significance: The authors question the individual focus which has, until recently, been typical of client-centred occupational therapy. Placing citizenship at the core of intervention is a transformative process that assumes all people are citizens and conceives of health as a collective issue, influencing the way we educate, do research, and practise.

A commentary on the social responsibility of occupational therapy education

As one of the allied health professions, occupational therapy has adopted a primarily clinical focus on human occupation (or the process of daily life) and this is reflected in education, which has until recently tended to overlook contextual social factors such as poverty, marginalisation, exclusion, unemployment, incarceration and immigration. However, daily life is enabled, and potentially dis-abled, along the axes of several cultural and political constructs, such as gender, employment status and ethnicity. This article presents a critical commentary of the social responsibility of occupational therapy education. Furthermore, it discusses the need for educational practices that can enact an integration of personal and professional perspectives so as to lead to a more holistic understanding of occupation, incorporating not only clinical but also social and political factors. This article argues for the development of a political approach to occupational therapy education that can lead to an awareness of the cultural influences that they bring to their workplace, and a critical consideration of concepts such as ‘justice’ and ‘occupation’. The development of a political practice of occupational therapy calls for an appreciation of the diversity of human occupation and the circumstances that enable it and can be realised through the establishment of innovative educational partnerships, such as community–university collaborations.

Meaning Making through Occupations and Occupational Roles: A Heuristic Study of Worker-Writer Histories

Introduction: Occupations are recognised in occupational therapy and occupational science literature as vehicles to meaning and wellbeing. Yet, the question of how they are used to create meaning has not been investigated exhaustively. In this study, the researchers explored the life histories of worker-writers in the United Kingdom. These writers considered themselves as representatives of the most numerous but marginalised social class. The researchers considered how the worker-writers derived life meaning from their occupations and occupational roles. Method: Using heuristic research methods, 34 published autobiographies were analysed to elicit themes illuminating how meaning was created by the worker-writers through occupations and occupational roles. Results: Five themes emerged from the analysis. Worker-writers created meaning by engaging in occupations and occupational roles that fostered family life and other meaningful relationships; a sense of control over their lives; meaningful leisure pursuits; a contribution to or connection to greater causes; and a sense of wellbeing. Conclusion: No claims are being made in this study about the generalisability of the findings to clinical practice. However, occupational therapists may consider exploring ways of helping clients engage in occupations reflecting themes that emerged from the study, as a way of helping them to reconstruct their lives following life-changing events or conditions.

Occupation, Education and Community-Based Rehabilitation

Occupational therapy is rethinking its paradigm of human occupation to take account of the social, political, economic and environmental influences on communities and the effects that these have on opportunities for being and doing. One way of bringing this element into undergraduate curricula may be to develop programmes around community-based rehabilitation (CBR) and human rights. Recent position papers from the World Federation of Occupational Therapists, in combination with occupational justice arguments, may support an orientation of professional thinking towards community needs. Some suggestions are made for the accommodation of CBR perspectives in education, particularly through the development of practice placement opportunities.

Rehabilitation: In the Community or with the Community?

Community-based rehabilitation (CBR) is an approach that could usefully be applied by occupational therapists working towards access to occupation for all. CBR happens with, rather than in, the community. It allows communities to identify their problems and the causes, including the sociopolitical underpinnings of disability, to locate their needs and to take control of strategies that address those needs. A recent subproject of the World Federation of Occupational Therapists revealed a lack of consensus as to what constitutes CBR and a perceived overlap with community rehabilitation. This opinion piece aims to clarify the connection between the two approaches and to explore the implications for occupational therapists.

Reporting on the WFOT-CBR master project plan: the data collection subproject

Abstract This data collection subproject is part of the WFOT-CBR master project plan and serves as evidence of the commitment of the World Federation of Occupational Therapists (WFOT) to promote community-based rehabilitation (CBR) as an approach to promote access to occupation for all. This subproject aimed to collect data on the contributions of occupational therapists in CBR with the purpose to promote awareness on CBR within the profession and also to facilitate the development of relevant educational programmes. Responses were received by occupational therapists from the five continents. Findings revealed a polyphony regarding the conceptualisations of CBR and a perceived goodness of fit between occupational therapy and CBR. However, most respondents reported inadequate university education on CBR. It is suggested that CBR should be considered as part of the professional role of occupational therapists and that the profession should develop rigorous guidelines for its practice. Given the inherently dialectical nature of CBR it is also important to network with disabled people’s organisations and communities involved in CBR.

Voices talk, hands write: sustaining community publishing with people with learning difficulties

People with learning difficulties are generally a marginalised section of the community whose care environment often segregates them from other people. One way of broaching this invisibility is by developing a writing and publishing group which can present at community events and may be a means of educating others. However, such groups can be difficult to sustain. This article, based in part on a keynote address at the 2006 Groupwork Symposium (Pollard, 2006a), explores the origin and continuing development of a community publishing project with people with learning difficulties in Grimsby. Taking account of the difficulties of recording community based action, it reviews the outcomes 3 years after the initial set up project ceased.