Advocating? Agitating? Activism? Anti-Oppressive Change-Making in Occupational Therapy.

The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. The demand for occupational therapists in Canada is expected to grow sharply at an annual growth rate of 3.2%, compared to 0.7% for all occupations. At the same time, it is believed by occupational therapists in Canada that the Canadian public does not understand the role of occupational therapy. Occupational science is an emerging basic science field that supports the practice of occupational therapy. Given that newspapers are one source the public uses to obtain information and that newspapers are seen to shape public opinions, the purpose of this study is to investigate how “occupational therapy” is covered in Canadian newspapers from the term’s first appearance in 1917 until 2016 and how “occupational science” is covered from the term’s first appearance in 1989 to 2016. We interrogated the findings through the lens of three non-newspaper sources—two academic journals: Canadian Journal of Occupational Therapy (CJOT) and Journal of Occupational Science (JOS); and one Canadian magazine: Occupational Therapy Now (OTN). We found that medical terms were prevalent in the newspaper articles covering occupational therapy similar to the presence of medical terms in the CJOT and OTN. However, the newspapers missed contemporary shifts in occupational therapy as evident in the CJOT, OTN and JOS—such as the increased engagement with enablement, occupational justice and other occupational concepts. The newspapers also failed to portray the societal issues that occupational therapy engages with on behalf of and with their clients, and the newspapers did not cover many of the client groups of occupational therapy. Occupational science was only mentioned in n = 26 articles of the nearly 300 Canadian newspapers covered with no concrete content linked to occupational science. The scope of occupational therapy presented in Canadian newspapers may be one contributing factor to a situation where occupational therapists in Canada think that there is lack of public understanding around their role, as readers are not getting the full picture and as such approach occupational therapy with different expectations. Given the lack of coverage of occupational science, readers will likely obtain limited knowledge about occupational science and its focus.

Background. National and provincial professional associations and regulatory bodies for occupational therapists (OTs) in Canada emphasize culture, equity, and justice as essential competencies. This study investigates the diversity within the occupational therapy profession and explores OTs' perspectives on providing culturally responsive care to members of equity-deserving groups, with a particular focus on cultural competence and agility. Method. OTs were administered a cross-sectional mixed-methods survey that included demographics, the Cultural Competence Assessment Instrument (Two subscales: Awareness and Sensitivity and Competence Behaviour), and an open-ended question examining their perceived cultural competence. Quantitative data were analyzed using descriptive statistics, and qualitative themes were determined through content analysis. Findings. A total of 240 OTs participated in this survey, with an average age of 45.3 (22.5), identifying primarily as females/women (90.7%). Less than half of respondents (41%) identified their race; of those who did, they were primarily of Southeast Asian descent (21.3%). OTs had lower scores for Cultural Awareness and Sensitivity (3.17/7 [3.11, 3.23]) and for Cultural Competence Behavior (3.22/7 [3.08, 3.37]). While highlighting the healthcare system distrust and barriers to culturally responsive care, most felt confident addressing them. OTs reported that greater awareness and inclusivity at individual and systemic levels are needed. Conclusion. Our sample of OTs suggests little diversity related to gender, race, and ethnicity. OTs in Canada vary in their perceptions of health disparities, barriers for patients in accessing and receiving health care, and efficacy in addressing barriers.

Occupational therapy is a predominantly female profession with, for example, only 5.8% of the occupational therapists in Canada being men. Traditionally, there has been limited success in recruiting men into occupational therapy education programmes and those men who do qualify as occupational therapists tend to work in the profession for only short periods of time. The purpose of this study was to examine the demographic characteristics of a group of male occupational therapists. A questionnaire was posted to all male therapists who were members of the Canadian Association of Occupational Therapists (n = 199). Eighty-three per cent of the sample responded. The survey results indicated several significant findings. Seventy-four per cent of the respondents said that they would end up leaving the profession within 10 years. The top four features of the profession that influenced respondents' choice of an occupational therapy career were the opportunity to work with people, job security and availability, feelings of accomplishment and diversity. On the other hand, the top four factors that contributed to respondents' feelings of job dissatisfaction were limited earning potential, limited upward mobility and opportunities for advancement, lack of awareness by other professionals of occupational therapy's role in health care and the lack of understanding the general public have about occupational therapy. In terms of demographics, the majority of male occupational therapists were around 33 years old, worked with an adult client caseload in a general hospital setting and spent 50% of their work time in direct client care. Overall, the male occupational therapists in this study were job dissatisfied. If means are not implemented to address this issue, many male clinicians are likely to leave the occupational therapy profession at some point.

The purposes of this study were to identify both the role development of the occupational therapist and the factors which have influenced and directed the role changes. It was assumed that these identifications would assist both the profession and educators of occupational therapists to evaluate the trends as to how and why the profession is developing and to plan for appropriate professional and educational changes for the future. The role of the occupational therapist, an allied health professional, has changed from that of a craft-oriented medical technician to that of a professional clinician, researcher, educator and consultant. This contemporary therapist was found to be practicing in a number of areas both within and outside of the medical model of practice. The development of these new roles has resulted in considerable concern, both outside of and within the profession, as to whether or not the traditional craft-oriented medical model of practice is still valid. As well, occupational therapists in both the United States and Canada have expressed the need to re-evaluate their roles, their responsibilities, and their education in order to meet the needs of changing patterns in the organization and delivery of contemporary health services. The study of the role development and identification of factors influencing the role changes was carried out through a review of literature published between 1922 and 1972 plus a minimal number of unpublished papers related to the topic. A brief review of the 1970-1971 Canadian occupational therapy curricula was included in an attempt to indicate the influences educational programs had on the role development of the occupational therapist. It was found that new roles developed in response to present and proposed government legislation, changing needs and demands of society in general, and changing emphases in medical education and health care delivery. It was also found that the educational influences of occupational therapy programs were minimal, if not inhibitory, to the role development of the occupational therapist. Conclusions drawn from the review of the literature resulted in the establishing of eighteen recommendations concerned with the role development, research needs, and educational needs of future occupational therapists in Canada. It was felt that these recommendations represented guidelines for change which must be implemented by the individual therapists, professional associations, and educators if occupational therapy is to remain a viable health profession.

During the past 15 years, occupational therapists in Canada, through the Canadian Association of Occupational Therapists, have worked to develop and implement guidelines for practice of a client-centred approach to occupational therapy. One of the difficulties with the current Guidelines for the Client-Centred Practice of Occupational Therapy is the lack of a definition and discussion of the concepts and issues fundamental to client-centred practice. In this paper, key concepts of client-centred practice: individual autonomy and choice, partnership, therapist and client responsibility, enablement, contextual congruence, accessibility and respect for diversity are discussed. Two practice examples are used to illustrate these ideas and raise issues about obstacles to the practice of client-centred occupational therapy. Research evidence about the effectiveness of client-centred concepts in enhancing client satisfaction, functional outcomes and adherence to health service programmes is reviewed.

The current impact of the International Classification of Functioning, Disability and Health (ICF) on the field of occupational therapy within Canada is unknown. To survey occupational therapists in Canada about their knowledge, use of and suggestions for education about the ICF. Mixed methods design included (i) an online survey, with data analyzed using quantitative methods; and (ii) semi-structured interviews with a purposeful sample of 10 therapists, using content analysis. The online survey was completed by 587 occupational therapists (17.6% return). Four hundred and ten respondents (70.0%) indicated some ICF knowledge, and 121 of those individuals (29.5%) reported using it in practice. Interview participants suggested resources, perceived meaning and investment factors impact ICF knowledge. Suggested uses include frameworks and interprofessional collaboration, while ideas for education involve meaningful and accessible formats. The ICF may be useful to occupational therapists in different settings if it fulfills a meaningful purpose and fits with practice models.

The Canadian Journal of Occupational therapy (CJOT) is the only Canadian refereed professional publication reflecting the views and professional development of occupational therapists in Canada. A study of all issues of CJOT published during three five-year periods was carried out to see if CJOT could be said to be improving in terms of reflecting professional trends. Some areas examined were quantity of articles, type of articles, references, authors and citations. It was found that although CJOT did reflect professional growth in many areas, there were a number of areas needing improvement before CJOT could be considered to be the primary professional publication for occupational therapists in Canada.

Occupational therapy is a female‐dominated profession with only 4% of all clinicians in Canada being men. Traditionally, occupational therapy training programmes have had limited success recruiting men into their educational programmes and those men who do qualify as therapists tend to work only in the profession for short periods of time. The purpose of this study was to identify work‐related factors that impact on male occupational therapists. Specifically, five job satisfaction factors (work, pay, co‐workers, supervision and promotional opportunities), work environment traits and the demographic characteristics of male occupational therapists in Canada were examined. A mailed survey questionnaire was sent to all male therapists who were members of the Canadian Association of Occupational Therapists (n = 199) during the 1990–1991 membership year; 83% of the sample responded. In terms of job satisfaction, male occupational therapists indicated that they were relatively dissatisfied with their work, pay, promotional opportunities, supervision and co‐workers as a group. However, they characterised their work environments as being above average in terms of supervisor support, autonomy and physical comfort, whereas they obtained a well below‐average score for the control dimension. Further research is needed to explore the issue of job satisfaction among occupational therapy personnel and to identify what factors impact on the job retention of male occupational practitioners.

Occupational therapy is a female-dominated profession with only 5.8% of all clinicians being men. Traditionally, occupational therapy education programmes have had limited success in recruiting men and those men who do become therapists tend to work in the profession for only short periods of time. The purpose of this study was to identify the factors that have an impact on male occupational therapists. Specifically, role strain due to community, colleagues and patients, three types of role stress (role ambiguity, role conflict and role overload) and the demographic characteristics of male occupational therapists in Canada were examined. Role strain is a subjective state of emotional arousal (such as increased level of awareness, general emotional arousal, distress, anxiety or frustration) in response to the external conditions of social stress. Community role strain was considered to arise from the negative attitudes of people outside the immediate work environment. Colleague role strain was considered to arise from the attitudes and behaviours of co-workers and others employed in the work environment. Patient role strain was considered to arise from the acts and attitudes of patients and their families. Role stress is a social structural condition in which role obligations are vague, irritating, difficult, conflicting or impossible to meet. Role ambiguity was defined as vagueness or a lack of clarity of role expectation. Role conflict was defined as role expectations that are incompatible. Role overload was defined as too much expected in the time available. A questionnaire was posted to all male therapists who were members of the Canadian Association of Occupational Therapists (n = 199). Eighty-three per cent of the sample responded. The survey instruments consisted of a demographic questionnaire, the Egeland and Brown Rating Scale, the Rizzo, House and Lirtzman Scale and the Beehr, Walsh and Taber Scale. As a group, male occupational therapists reported a moderate level of community role strain, colleague role strain and patient role strain. Similarly, male occupational therapists also reported a moderate degree of role conflict and role overload, but had a low level of role ambiguity.

Introduction As a response to the Truth and Reconciliation Commission of Canadas Calls to Action, Indigenous students are increasingly being recruited into occupational therapy programs. However, the occupational therapy profession relies almost exclusively on western worldviews and does not sufficiently consider the value of multiple ways of knowing and doing. How Indigenous students fare in these western educational systems is largely unexplored and undocumented. This work is part of a larger study exploring the experiences of Indigenous occupational therapists in Canada. Objective This manuscript explores the retrospective educational experiences of Indigenous occupational therapists. Methods This study was collaborative in nature with Indigenous occupational therapists across the country, using both Indigenous and western methods of inquiry. Stage 1 used individual storytelling sessions (n=13) to hear about participants everyday experiences. Stage 2 consisted of an in-person sharing circle gathering (n=8) to build relationships and community, and to refine data from Stage 1. Results Indigenous occupational therapists experienced imposed isolation, lack of support, exclusion, a devaluing of merit and skill, and ‘jagged worldviews colliding’ in their programs. These experiences are underpinned by the cultural imperialism perpetuated by the profession. Conclusion To truly fulfill our commitment to reconciliation, the occupational therapy profession must move beyond Indigenous inclusion in programs towards decolonial Indigenization, which asks for a divesting of colonial privilege and ideologies towards something dynamic and new. Deeply considering the value of, and need for, multiple perspectives (Two-Eyed Seeing (Etuaptmumk)) and drawing on the expertise and experiences of Indigenous students, occupational therapists, researchers, and educators for this work is urgently needed.

Purpose. The purpose of this study was to understand how the term independence is used in rehabilitation. In particular, we asked occupational therapists in Canada and Japan to interpret the term independence in terms of people with disabilities. In rehabilitation, independence has long been a key concept. A review of the literature shows that the term's meaning has shifted throughout the past century. However, despite its significance, the word's meaning has never been deeply analysed, and it is left to the interpretation of the individual practitioner; consequently, there is a conceptual confusion surrounding the term. Furthermore, no studies have been conducted from an inter-cultural viewpoint that included non-Western societies.Method. A qualitative interpretive study was conducted, based on semi-structured interviews with 18 occupational therapists. Nine Canadian and nine Japanese therapists were interviewed in depth and their perspectives analysed for themes and categories corresponding to their working definition of independence.Results. Therapists' interpretation of the term independence consisted of three perspectives: “Independence as competence,”“Independence as autonomy,” and “Independence as psychological qualities”. These perspectives were typically combined into two patterns of dealing with independence in practice. Differences between Canadian and Japanese perspectives were explored.Conclusions. The study's findings confirm some ideas about independence that have been pointed out in the professional literature, but they also add several important ideas – the idea of psychological characteristics as key to independence, and the notion of a cultural overlay on the definition and application of the concept independence. This study's findings should contribute to the ongoing discussion in the professional literature about the virtues and limitations of pursuing independence as the ultimate goal in rehabilitation.

Combining methods in a single study is becoming a more common practice because of the limitations of using only one approach to fully address all aspects of a research question. Hermeneutics in this paper is discussed in relation to a large national study that investigated issues influencing the ability of international graduates to work as occupational therapists in Canada. Using methods that reflect different ontological and epistemological beliefs was necessary to attain a comprehensive view of enablers and barriers that influence workforce integration. Hermeneutics proved to be a credible and flexible strategy for combining methods to create a deep understanding of acculturation issues for international occupational therapy graduates wishing to work in Canada.

There is an increasing number of occupational therapists in Canada who are involved in bidding for contracts to deliver occupational therapy services. Occupational therapists working in an institutional or community-based setting may not have had the responsibility of developing a proposal or a marketing plan for bidding purposes. However, the responsibility of developing a bid to compete for a service delivery contract often rests on occupational therapists who are sole practitioners in a private practice setting. The purpose of this paper is to highlight issues in the literature such as service delivery plans, marketing strategies and costing of services that can assist the occupational therapist in the development of a contractual bid. A specific clinical example, school therapy services, has been used to illustrate how these strategies can be applied to practice. Success in contractual bids appears to be primarily influenced by cost of the service, the expertise of the service provider, ability to provide coordinated care, ease of access for clients, and inclusion of methods to measure client outcome.

Occupational therapists in Canada play a central role in wheelchair service provision. Inadequate entry-to-practice professional education has been identified as a major concern in the delivery of wheelchair related services. The goal of this study was to describe the current education provided in Canadian occupational therapy programs and to map this content against the recommended WHO 8-step wheelchair service provision process. The study used a descriptive cross-sectional online survey design. Educators were recruited from accredited occupational therapy programs in Canada. Participants completed a short sociodemographic questionnaire and a survey with 97 closed- and open-ended questions regarding the wheelchair service provision education provided in their curriculum. Survey data was then mapped according to the WHO 8-step wheelchair service provision process. Twenty-nine educators from all Canadian occupational therapy programs (n = 14) were enrolled. Most participants (55.2%) were full-time faculty members that had been teaching in occupational therapy programs for an average time of 10.9 years. All programs covered at least 4 of the WHO recommended steps, but only 5 programs covered all steps. Assessment and Prescription steps were covered in every program while the Referral & Appointment, Funding & Ordering, Fitting and User Training steps were covered in most programs. The pedagogic approach, the amount of time dedicated to wheelchair-related content, and the type of evaluation used varied greatly between programs. This study is the first to provide a detailed description of wheelchair service provision education across all Canadian occupational therapy programs according to the WHO 8 steps and provides a foundation for collaborative efforts to promote best practice in entry-to-practice professional education.

Occupational therapists in Canada play a central role in wheelchair service provision. Inadequate entry-to-practice professional education has been identified as a major concern in the delivery of wheelchair related services. The goal of this study was to describe the current education provided in Canadian occupational therapy programs and to map this content against the recommended WHO 8-step wheelchair service provision process. The study used a descriptive cross-sectional online survey design. Educators were recruited from accredited occupational therapy programs in Canada. Participants completed a short sociodemographic questionnaire and a survey with 97 closed- and open-ended questions regarding the wheelchair service provision education provided in their curriculum. Survey data was then mapped according to the WHO 8-step wheelchair service provision process. Twenty-nine educators from all Canadian occupational therapy programs (n = 14) were enrolled. Most participants (55.2%) were full-time faculty members that had been teaching in occupational therapy programs for an average time of 10.9 years. All programs covered at least 4 of the WHO recommended steps, but only 5 programs covered all steps. Assessment and Prescription steps were covered in every program while the Referral & Appointment, Funding & Ordering, Fitting and User Training steps were covered in most programs. The pedagogic approach, the amount of time dedicated to wheelchair-related content, and the type of evaluation used varied greatly between programs. This study is the first to provide a detailed description of wheelchair service provision education across all Canadian occupational therapy programs according to the WHO 8 steps and provides a foundation for collaborative efforts to promote best practice in entry-to-practice professional education.