Liderança e inovação na construção de conhecimento na terapia ocupacional brasileira: um estudo biográfico-documental da trajetória profissional de Jô Benetton

Is Occupational Therapy Adequately Meeting the Needs of People With Chronic Pain?

History, Current Practice, and the Future of Wound Care for Occupational and Physical Therapists.

Occupational Therapy Is a Vital Member of the Interprofessional Team-Based Approach for the Management of Rheumatoid Arthritis: Applying the 2022 American College of Rheumatology Guideline for Exercise, Rehabilitation, Diet, and Additional Integrative Interventions for Rheumatoid Arthritis.

Commemorative Editorial: The Legacy of Franklin Stein, PhD, OTR/L, FAOTA.

More Than Good Intentions: Advancing Adherence to Therapy Recommendations

Editorial: How many courses for how many jobs? Enduring questions in need of research-based answers.

There is a continued need to build research capacity within the allied health professions (Council for Allied Health Professions Research, 2016). As one of the larger allied health professions, this is also the case for occupational therapy. Each year there are approximately 1,000 graduate occupational therapists entering the health and social care workforce, joining what is a current UK community of 38,183 qualified occupational therapists (HCPC, 2018). One requirement of being a professional occupational therapist is adherence to professional standards, including a commitment to advancement of the evidence base through engagement with research activity (COT, 2015). This study provides in-depth understanding of the research capacity experiences of early career occupational therapists. The study aims to contribute to the UK Occupational Therapy profession’s knowledge about research capacity in practice and to use the research findings to inform the development of local Occupational Therapy undergraduate programme provision. This study used Interpretive Phenomenological Analysis as the discrete research approach. Through purposive homogenous sampling, eight early career first class (Hons) occupational therapists who graduated from one UK University, participated in this study. Data were collected using semi-structured interviews and a ‘participant profile’, and analysed using the interpretative phenomenological analysis step guide (Smith, Flowers and Larkin, 2009). Findings suggest that the early career occupational therapists in this study face professional challenges that have an impact on their current and future contribution to research capacity. These challenges are discussed using three topic areas:- professional identity of early career occupational therapists, professional socialisation of early career occupational therapists, and research capacity and how it is defined. Contributing to research capacity is not fully integrated into the professional identity of early career first class (Honours) occupational therapists. Professional socialisation within the workplace appears to have an impact on the research capacity contribution of early career occupational therapists. Occupational therapy undergraduate students should be better prepared for research utilisation and research production during their undergraduate learning. Strategies to further embed research capacity contribution within the occupational therapy curriculum are identified. This study suggests that acknowledging a continuum of research activities would be helpful to promote a more inclusive perspective on research capacity contribution.

Objective Moral distress may occur when people are unable to follow professional standards and ethical values in their profession. It is a significant issue in the healthcare profession and has negative consequences. In addition, there is a concern that it may adversely affect clinical performance and, in some cases, patient outcomes. Based on the evidence, occupational therapists experience moral distress, Therefore, there is a need for a tool that enables researchers to identify the extent of moral distress in each individual and to measure the effectiveness of strategies designed to reduce distress and prevent employee burnout. The aim of this study was to develop and evaluate the face and content validity of the Moral Distress Questionnaire in occupational therapists. Materials & Methods This psychometric study was performed in two stages. The first stage involved preparing a pool of questionnaire items, and the second stage examined the face and content validity of the questionnaire. First, texts and related studies were reviewed to extract the questionnaire items. Searching various databases was done to find any conditions that create moral distress in occupational therapy. Three qualitative studies conducted in the field of ethical issues of occupational therapists in the field of psychiatry, children and adults were fully studied. The codes extracted from these studies and the quotations of the interviewees were read. Then the questionnaire items were extracted from the codes, sentences and phrases of the studies. The items were read several times and edited in terms of content clarity, grammar and concept comprehension, and duplicate topics were removed. After preparing the pool of items for the preliminary questionnaire, the scientific stages of face and content validity of the questionnaire were completed. The face validity of the questionnaire was measured qualitatively and quantitatively by 30 occupational therapists who were selected by available sampling from clinics, hospitals and public and private centers. Inclusion criteria were at least one year of work experience in various fields of occupational therapy. Quantitative face validity was performed by determining the impact score of the item. In order to perform qualitative content validity, experts in the field of teaching ethics in occupational therapy and familiar with tool development were invited to review the questionnaire and exchange views in a face-to-face meeting. Seven people participated in the panel of experts. Participants were told that the tool would be an Evaluative tool designed to assess the extent of moral distress among occupational therapists working in clinical settings. After carefully studying the tool, they were asked to consider and comment on the four criteria of clarity, simplicity, transparency, and relevance of items to moral distress. To assess the quantitative content validity of the questionnaire, 20 occupational therapists with doctoral degrees were asked to complete the relevant forms for assessing Content Validity Ratio (CVR) and Content Validity Index (CVI). Results After reviewing the texts and related studies and analyzing the findings and concepts, a preliminary questionnaire with 50 items was extracted. The items of the questionnaire reached 22 items after completing qualitative and quantitative face and content validity. The impact score of the item was between 2.85 to 4.83. The CVR was in the acceptable range of 0.5 to 1 with an average of 0.7. The CVI of the questionnaire was 0.93. Conclusion The Moral Distress Questionnaire in Occupational Therapists with 22 items on a four-point scoring scale has appropriate content validity and can be used to measure moral distress in occupational therapists after completing the validity and reliability steps.

IntroductionAutistic children commonly receive simultaneous services from various health‐care and other professionals, including occupational therapy, throughout their journey of diagnosis and consequent therapeutic support. Current best practice guidelines for supporting autistic youth emphasise the importance of interprofessional collaboration. Despite this, collaboration among health‐care professionals does not always occur, and little is understood about clinicians' experiences of collaborative care. The aim of this study was to explore Australian paediatric occupational therapists' experiences of interprofessional collaboration and their perception of factors influencing collaboration when supporting autistic children.MethodsThis study employed an exploratory qualitative descriptive design. Semi‐structured interviews were conducted with 13 Australian paediatric occupational therapists involved in service provision to autistic children. Questions explored clinicians' experiences and perceptions of interprofessional collaboration. Reflexive thematic analysis was used to inductively analyse data.Consumer and Community ConsultationThis study was conceptualised and conducted by a team of researchers with a range of personal and professional experiences with the autistic community. The research design was strongly informed by the Autism CRC'S research guidelines.FindingsThree themes were generated highlighting factors that influence collaboration between occupational therapists and other professionals. The first emphasised that ‘clinicians' capacity to collaborate’ at both organisational and individual levels was understood to be greatly influenced by funding structures. The second emphasised that ‘relationships are key to collaboration’ with these often established through shared workplaces or clients. The third, ‘shared perceptions make collaboration easier’ described how shared perceptions of collaboration, the occupational therapy role, and autism‐related frames of reference were perceived to influence interprofessional collaboration.ConclusionFindings indicate that, while occupational therapists perceive interprofessional collaboration as valuable in the support of autistic children, there are barriers to effective collaboration, particularly in the context of a marketised service delivery model.PLAIN LANGUAGE SUMMARYThis study looked at how Australian occupational therapists work with other professionals to support autistic children. Even though it is recommended that professionals work together to support autistic children and their families, this does not always happen. In this study, researchers interviewed 13 occupational therapists and asked what it is like working with other professionals, what is helpful, and what makes working together difficult. From these interviews, it was found that many things affect how well occupational therapists can work with other health professionals and teachers to support autistic children. Factors like funding and workplace rules affect how professionals work together. Having someone take on the role of leader and having good relationships between professionals made it easier to work together. It was also helpful when occupational therapists and other professionals shared similar ideas on how to support autistic children. The study could be improved if it had gathered more information about the occupational therapists' education and what they have learnt about working with other professionals. Overall, the therapists in this study believed that working together to support autistic children and their families was important, but that there are many challenges to making this happen. More research on this topic would be helpful.

The purposes of this study are to investigate perceptions of occupational therapy (OT) among medical, nursing, and OT undergraduates and to survey their collaborative status with occupational therapists in the fieldwork. Three groups of participants were surveyed: medical students (N=60), nursing students (N=67), and OT students (N=87). The students completed a questionnaire examining (1) knowledge about the profession of OT; (2) appraisal of OT; (3) service needs from occupational therapists; and (4) the current status of teamwork practices. All students indicated that academic education was their main source of knowledge about the profession of OT. Thirty-five percent of medical students and 40% of nursing students reported that they could not distinguish between the professions of OT and physical therapy (PT). Both medical and nursing students appreciated OT for improving patients’ function in activities of daily living (ADL). They also reported that the most service needed from occupational therapists is ”ADL evaluation and training.” Most medical students (77%) and nursing students (84%) reported that they rarely collaborated with OT staff in teamwork training for patient care. Ninety-five percent of medical students and 76% of nursing students agreed that working with occupational therapists during fieldwork could enhance their understanding of the OT profession. The findings indicated that a large proportion of medical and nursing students have inadequate knowledge about the role and function of occupational therapists and few opportunities to collaborate with occupational therapists. However, they also showed specific needs for OT in patient care. Therefore, the development of a clinical collaborative education program to facilitate teamwork between occupational therapists and other medical professionals is necessary.

Despite occupational therapists having strong historical ties to the Canadian military, there are currently no uniformed occupational therapists and only a few permanent occupational therapists employed by Canadian Forces. Occupational therapy is provided, in the main, through civilian occupational therapists. Occupational therapists have unique skills that can contribute to the existing Canadian Forces Physical Medicine and Rehabilitation Services Department. To establish the depth and scope of their work, this article explains the theoretical underpinnings of occupational therapy. Examples are provided of possible occupational therapy for populations of Canadian Forces members: (1) those with transient, intermittent injuries; (2) those returning from overseas missions with very serious injuries or severe injuries; and (3) those with permanent injuries who are transitioning from the Canadian Forces into the civilian workforce. Interventions for mental health issues are interwoven with those targeting physical issues. The article suggests that occupational therapists employed on a permanent basis by the Canadian Forces can contribute in a more comprehensive manner to the wider rehabilitation of Canadian Forces members. The article has applicability to occupational therapy military services in other countries.

This study regards the experience of implementing a professional internship intended to students of Occupational Therapy in Primary Health Care in a Federal University located in São Paulo State, Brazil. Occupational therapist profession in Brazil was inserted in this level of care to offer specialised support to teams, mainly concerning qualification of care to vulnerable and invisible populations (community, family and cultural aspects), health promotion, encouragement of team work, humanisation in health. Such curricular internship occurs since 2017 to students of the 4th and 5th years of undergraduate course, completing 240 hours. How is the practice programme in Primary Health Care organised in the pedagogic project? Which are the strengths and fragilities of this field, as far as education is concerned? Among the practice scenarios, there are Basic Health Unit, Family Health Strategy teams, Family Health Support Centre, Street Clinic and University Basic Health Unit, with tutors who establish the collaboration. The interns follow individual and group cases, take part in team meetings and actions for team qualification and are also supervised weekly by a professor. Among their strengths, we can list a diversified education, based on the most recent public policies for the level of care that represents the stepping stone to the health system. As well as the access to the occupational therapy professional in this first contact, if the team identifies such necessity. Regarding challenges, there is unawareness about professional practice, difficulty to access work instruments and resources, as well as physical space. We hope this experience can help other educational institutions to implement their practice programmes in and for the health system. Egresses report that enables learning to work in a team in different scenarios. Such strategy aims to form a generalist professional, with criticality regarding challenges and potentialities of Brazilian public health. Key messages This study reports the experience of a professional internship of Occupational Therapy in Primary Health Care, understanding the health system as a scenario for practice, teaching and learning. Educating occupational therapists to this level of care is necessary, in agreement with the attributes of Primary Care.

Knowledge translation in the context of the Asia Pacific region.

The Universal Declaration of Human Rights ratified by the UN in 1948 encompasses the concepts of creating and enabling occupational opportunities including work, leisure, education and community participation (United Nations, 1948). The UN Declaration supports occupational therapists to act on behalf of our clients and our communities as well as diverse populations of vulnerable people. The World Health Organization (WHO) defines vulnerable people as children, pregnant women, elderly people, malnourished people, and people who are ill or immune-compromised (WHO, 2013). People with disabilities are included in this group and tend to be among the poorest of the poor (WHO, 2011). Poverty – and its common consequences such as malnutrition, homelessness, poor housing and destitution – is a major contributor to vulnerability. Natural and manmade disasters are affecting more and more people around the world. People are displaced from their homes and their lives, making them vulnerable. They may lose everything or be able to take only the basics with them. Livelihood opportunities may be destroyed. With lost roles and changed circumstances, survivors live perhaps in temporary housing in tiny rooms which take little time to clean, where there is no work, nothing to do, no occupational opportunities, a loss of daily structure, leading to boredom and despair (Wilson, 2011). With their support systems removed, displaced people are often unable to access basic health, welfare and education services. They experience severe socio-economic loss and impoverishment. How is the global community responding to this global crisis of displacement and vulnerability? What can we do as communities of professionals and as individuals? As a profession concerned with promoting health and well being through occupation, occupational therapists should be addressing issues that truly affect people's lives. In translating international policy into local action, we can fulfill many of the goals set out by the UN in their seminal document The Millennium Development Goals (United Nations, n.d.). Why do I comment on the MDGs, which were established in 2000 with goals set for 2015? How does this relate to the subject of this editorial – vulnerable populations and human displacement? I feel it is important for occupational therapists to understand global policy development so that we can better apply international principles to our own health systems and direct practices in order to effect change for our clients and communities. Much has been written in the international literature (now online) that supports the ongoing thrust of the MDGs to achieve global health and reduce poverty, partly because national and international organisations have to report to the UN regularly on their actions related to the MDGs and future goals (United Nations, n.d.), but also because there is increased interest worldwide among the general population. With easy access to online media, we are made instantly aware of the aftermath of disasters. Huge strides have been made so far in meeting the MDGs (United Nations, 2013). For instance, according to the Millennium Development Goals Report 2013, there have been visible global improvements in all health areas as well as in primary education. This includes halving the number of people living in extreme poverty. Some of this has been accomplished through financial input from major development organisations to reduce country debt. With continual global monitoring and evaluation, positive accomplishments can be tracked and supported. Now, UN agencies are looking to post-2015 actions for sustainable development goals to support and continue the actions already started. With the realisation that there must be policy and financial support from higher levels of government to effect change at community level, better coordination, better methods of monitoring, and improved policy at all levels are required to achieve the sustainable development goals. Another thrust at global level has been in direct relation to disaster mitigation. Global agencies have moved from talking about disaster relief and response to realising that disasters will happen but humans can reduce their impact through preparedness and changed ways of thinking. Change of thinking can lead to change in actions. One agency, the UN-based Global Network for Disaster Reduction (GNDR), started an online discussion to gain a clearer perception of the actions for change required at all levels from global to local. I was fortunate to be part of these discussions. One action undertaken by the group was to go to communities and community leaders to find examples of effective actions (Global Network for Disaster Reduction, 2011). Twenty thousand people from 69 countries responded to a GNDR survey and the results were compiled into Views from the Frontline. From this material, 90 case studies were produced, called Action from the Frontline, which share ideas and spur creative thinking. These case studies can be viewed at www.globalnetwork-dr.org. The GNDR research team found that different communities have different perspectives on their own needs (Global Network for Disaster Reduction, 2011). These case studies promote ways for communities to realise possibilities for reducing the effects of disaster – famine, epidemics, flooding – and make change to mitigate disaster risk. Based on their research results, GNDR brought community leaders together in regional workshops to share their ideas. With the authority of this agency, these ideas were conveyed to national and international levels through regional and world conference and online sharing which include community leaders, national and international NGO's. The 2012 World Disasters Report (International Federation of Red Cross and Red Crescent Societies, 2012) focused on forced migration and displacement. The work of the international community on reducing disaster risk and mitigating the impact of disaster is built on the knowledge and experience developed by countries and other stakeholders over the past several decades. Milestones include: in 1987, the 1990s was declared the international decade for natural disaster reduction (A/RES/42/169) by the United Nations General Assembly; in 1989, the United Nations General Assembly adopted the International Framework for Action for the International Decade for Natural Disaster Reduction (A/RES/44/236); in 1994, the Yokohama Strategy and Plan of Action for a Safer World was adopted by the 1st World Conference on Natural Disaster Reduction; in 1999, the United Nations General Assembly endorsed the International Strategy for Disaster Reduction (A/RES/54/219); and in 2005, in Kobe, Japan, the 2nd World Conference on Disaster Reduction adopted the Hyogo Framework for Action 2005–2015: Building the Resilience of Nations and Communities to Disasters (HFA) (International Federation of Red Cross and Red Crescent Societies, 2012). The Hyogo Framework for Action (HFA), a 10-year plan to make the world safer from natural hazards, will end its term in 2015. Thinking forward to post-2015 action has generated much discussion among stakeholders. Since the adoption of the HFA, the promotion of resilience has gained significant attention and investment, but there is disagreement about what resilience means and how it should be incorporated into the post-2015 development framework. Is the promotion of resilience a new approach that will bridge the divide between providing relief and promoting development, or is it a concept developed in the international aid arena to cover the real need for humanitarian response? Measuring resilience may be a way to determine its influence (Levine, Pain, Bailey & Fan, 2012). The proposed elements of a post-2015 disaster risk reduction framework include ways of fostering accountability so that responses are practical, specific and focused, measurable in progress, conform to agreed standards and certification and stimulate commitment by stakeholders. According to the United Nations Office for Disaster Risk Reduction (2013), the framework should enhance risk governance with public-private partnerships and support scientifically informed decision making. It should address the underlying cause of increasing loss from disaster and reduce vulnerability through the development of insurance schemes, training and information, social protection schemes and safety nets. Thus, disaster risk management would become a part of sustainable development. In these Frameworks for Action to reduce disaster risk, there should be particular note of the needs of people with disabilities as it has been found that, in developing countries, people with disabilities tend to be among the most vulnerable. People with disability account for between 15% and 20% of the global community and this figure is higher in a developing country context (WHO, 2011). The circumstances that people with disability consistently face include lower educational enrolment and attainment; limited employment opportunities; limited access to information, services and resources, and an increased likelihood of a life in poverty (Robinson, Scherrer & Gormally, 2013). People with disability may be placed at increased disaster risk due to cognitive, intellectual or physical impairments. These factors may limit the ability of a person to access information and/or to act on that information. For example, information on disaster preparedness may not be available in accessible formats so people with disabilities are less aware and less prepared for a disaster. Including people with disabilities into disaster planning and decision making processes should help to protect the dignity and rights of the most vulnerable members of the community. It will ensure that the skills and capacities of all community members are utilised in relief, recovery and reconstruction. It will also contribute to meeting the need created by increased numbers of people with disability in the community as a result of disaster. The World Federation of Occupational Therapists (WFOT) is the international representative of occupational therapists worldwide. Its objectives are to promote health, occupation and participation within a worldwide perspective; to increase and maintain the awareness, understanding and use of services of occupational therapists by government, employers and the wider community through collaborative action; to develop and promote a standard of excellence in occupational therapy practice; to ensure the ongoing development and accessibility of high quality education and research for occupational therapists worldwide; and to present the diversity of international or cross-cultural issues. WFOT is collaborating with multiple international organisations and contributing to the international discussion on areas of direct relevance to its objectives. The partnership with WHO's Disability and Rehabilitation Team (DAR), for example, provides an avenue for contribution, involvement, and forward planning on specific issues of disability, vulnerable groups, and disaster management. These issues have been noted in a number of occupational therapy papers. The WFOT Position Paper on Human Displacement, the WFOT Position Paper on Human Rights, the WFOT Position Paper on Cultural Diversity all refer to the problems which ensue from forced migration and consequent vulnerabilities. WFOT, through its position papers, offers support for occupational therapists to inform governments and strategic organisations of the role of occupational therapy in working with vulnerable and culturally diverse groups. The WFOT Guiding Principles on Diversity and Culture (Kinebanian & Stomph, 2009) offers suggestions and approaches to understanding cultural needs and human rights. The WFOT Position Paper on Human Displacement (2012) notes that occupational therapists respect occupational strengths by valuing previous life roles, occupational adaptation, and existing occupational participation. It affirms “reciprocity with displaced persons, partners, and host communities as normal means of reducing the impact of displacement for people and host communities affected.” The WFOT Position Paper on Human Rights (2006a) also supports occupational justice. The WFOT Position Paper on Community Based Rehabilitation (2004) notes, “Occupational therapists are committed to advance certain core principles, one of which is the right of all people – including people with disabilities – to develop their capacity and power to construct their own destiny through occupation”. The WFOT Minimum Standards for the Education of Occupational Therapists (2002) emphasise client-centered occupation-based practice. They offer an occupation-centred framework for students to work in novel practice areas, with diverse and vulnerable populations. The WFOT Disaster Preparedness and Response (DP&R) Information Package (2006b) is available to occupational therapists in countries affected by disaster or where DP&R training is taking place. This package was updated in 2012 with revised website and databases and a second edition is being considered. Regional and national workshops have been conducted by WFOT, or by national OT associations with the support of WFOT, to raise awareness and build capacity to work with vulnerable groups affected by disaster. These workshops have addressed prevention and risk reduction issues incorporating occupation-based principles. Workshops have been held at regional occupational therapy congresses, including the Asia Pacific OT Congress 2012, as well as World Congresses. Out of a workshop held after the WFOT World Congress in Chile in 2010, a regional group called TO en alert (Occupational therapists on Alert) was formed in South America. Members have shared information, research and actions for improved response to disaster related situations. Disaster Preparedness, Response and Recovery is one themes of the coming WFOT World Congress in Japan in June 2014. There will be a great deal of sharing related to the occupational therapy role in disaster management and risk reduction. Discussions will include concerns for human displacement and occupational justice issues. These exchanges will further inform the global occupational therapy community about working in this important field of practice. Occupational therapists are working with survivors of disaster, refugees and migrants around the world at the initial stages of natural disaster as well as at the stage when people become migrants and must adjust to new and sometimes frightening circumstances. In many situations OTs are supporting people and communities to help each other. OT intervention may include life skills training on an individual level or in groups, or provide train the trainer situations where skills can be passed on. As noted in this journal, OT students and practitioners work with diverse populations with multicultural backgrounds and needs. Examples of good practice in this area abound although they are not often written up in journals. It is often only at conferences – and now more often in online social media and blogs – that we learn of innovative practice. Seeking out opportunities to observe innovative practice in different countries, I have found excellent examples of approaches to mitigating vulnerabilities through ‘self-help’ and community practice. After the OTARG Congress two years ago in Zambia, I had the privilege of visiting a remote village to observe a feedback meeting of a local NGO self-help group. The discussion centred on abuse of women and girls. The meeting started with a drama put up by the local school children. It carried through the day with small group discussion and feedback. Some 40 villagers had come from a 10 mile radius to attend the meeting. They live in arid farmland and eke out a subsistence living. The Response Network in Zambia is an excellent example of local action. Though it does not have an occupational therapist directly involved in their activities, it embodies many of the principles of occupational therapists working in community development and is based on international policy. It is a rights-based organisation which is involved in helping people to know their rights with regards to education and living with dignity. Focused on facilitating village self-help programs, they use a structured method of encouragement and information delivered by skilled facilitators to motivate villagers to start and run self-help activities to improve their life situation. Locally developed manuals provide information on how to start and run self-help clubs within a variety of thematic areas, including community schools, adult literacy, skills training, know your rights, women's rights, health and nutrition, organic growing, HIV/AIDS, children with special needs and sports. By helping villagers to understand that they have many skills and resources themselves, facilitators help villages realise that they can solve most of their own problems without depending on outside donors. From 2005 to 2012, the Response Network has facilitated village programs in more than 600 villages. These villages have started over 3000 self-help clubs with over 60,000 members, building confidence, knowledge and skills and improving their life situation (Response Network, http://responsenetwork.org/). This self-help approach could easily be translated into other situations working with vulnerable groups. This year, after another very successful OTARG Congress, this time in Zimbawe, I had the opportunity to stay in Cape Town in South Africa and visit the Grandmothers Against Poverty and AIDS (GAPA), an NGO started by occupational therapist Kathleen Brodrick (2004). GAPA is a community-based support programme for grandmothers of small children and teenagers who have lost their parents to the long-term epidemic AIDS. The project, in a township near Cape Town, brought together depressed, distressed and frustrated women through a familiar occupation – patchwork quilting. Today all over South Africa there are grandmothers holding together families affected by HIV/AIDS and poverty. Often these women are the sole bread winners in a household. They may also be nursing the dying and bringing up orphaned grandchildren on their own. Research shows that these grandmothers suffer from a lack of information, stigmatisation and overriding poverty (GAPA, http://www.gapa.org.za/). Four-day workshops are held each month for grandmothers who are new to the project where they learn about HIV infection and AIDS. Practical skills to overcome effects of the pandemic on households are taught. The workshops cover topics such as HIV/AIDS and cancer awareness, vegetable gardening, human rights, elder abuse, death and bereavement, drawing up a will and business skills. Grandmothers are also invited to attend support groups held in the homes of area representatives once a week. GAPA's motto is ‘together we are stronger’ and the aim is to draw on the inherent strength of the grandmothers in the community to bring lasting change and hope. This NGO, which started with a small group of women and a vision, has now grown to become international. The UN is assertively addressing global issues of poverty and inequity while identifying specific goals and monitoring progress toward meeting those goals at an international and national level. Using the documents and reports of international policy already established in high level meetings, occupational therapists can translate these principles into local action. Occupational therapists need to be aware of global issues and documented strategies in order to devise better approaches to increasing individual occupations and removing societal barriers that inhibit participation. Occupational therapists must work collaboratively with vulnerable people, whether they are migrants, survivors of natural disasters or epidemics, or living at subsistence level in difficult situations. Occupational therapists need to have an understanding of their needs and cultural perspectives to assist in promoting occupational engagement and participation. WFOT documents are useful to support such actions. The articles in this journal offer further examples of local action incorporating international policy.

The World Health Organisation has designated 2021 as the International Year of Health and Care Workers (YHCW) under the theme: Protect. Invest. Together. (WHO, 2021). This acknowledges and expresses appreciation for the work of health-care workers, particularly during the COVID-19 pandemic. The WHO has also called for investment in our health workforce to ensure that they are always supported, protected, and equipped to do their work. The 2021 WHO campaign has a range of objectives including ensuring that health-care workers are prioritised to receive a COVID-19 vaccine and that there is political, social, and community support for caring and advocating for health-care workers. There has been global recognition and outward displays of gratitude towards health-care workers during 2020 and 2021. We have seen people standing at their front doors during lockdown to applaud health-care workers, murals painted on city buildings and frequent heartful thanks expressed by politicians and leaders to health-care workers, particularly those at the frontline. We have also been saddened to hear of health-care workers, including occupational therapists who have contracted COVID-19 and lost their lives. The working circumstances of occupational therapists have changed due to COVID-19, utilising more technology to deliver services via telehealth or having to don personal protective equipment in their routine practice. While occupational therapists have been attempting to maintain service provision during the pandemic, there has also been a noticeable increase in demand for occupational therapy services. There have been frequent reports of an inability to service demand and in particular, the private sector unable to recruit occupational therapists (Occupational Therapy Australia, 2021). Although there has been a long-standing maldistribution of workforce creating a chronic shortage of occupational therapists in rural and remote areas, not just due to recruitment issues but also retention (Mills & Millsteed, 2002), we are now experiencing workforce shortages across the nation. It is strange how things can change relatively quickly. In 2014, Dr Tracy Fortune and I wrote a provocative viewpoint published in this journal (McKinstry & Fortune, 2014) proposing that the increase in the number of occupational therapists graduating could provide the profession with opportunities to push into new and emerging areas of practice such as health promotion and increase entrepreneurial endeavours. Future growth for the Australian occupational therapy profession has been predicted to remain very strong (Australian Government Department of Education, Skills, & Employment, 2021). This was also the case in 1999 when Millsteed (1999) stated that workforce modelling expected an 79.9% increase in demand for occupational therapists by 2005 as a highly skilled profession. Millsteed also reported that in 1994, 481 occupational therapy students were graduating. The Occupational Therapy Board of Australia (2020) reported that in 2019/2020, there were 9,843 occupational therapy students (AHPRA, 2020) studying in 42 occupational therapy courses and there were 24,303 registered occupational therapists, a 7.1% increase in registered Australian occupational therapists from the previous year. Interestingly, Millsteed also highlighted the lack of workforce data to inform workforce planning which is unfortunately still the case today with only superficial data publicly available from the Australian Health Practitioners Regulation Authority. The National Rural Health Commissioner also recommended that a National Allied Health Data Strategy using geospatial workforce data, be established to inform rural and remote workforce planning and policy (National Rural Health Commissioner, 2020). With the installation of the Commonwealth Chief Allied Health Officer in July 2020, this recommendation will hopefully be implemented very soon (Australian Department of Health, 2020). Has there been an increase in the awareness and recognition of the role of occupational therapists or have new or expanded funding systems lead to the increase in demand, or both? The roll out of the National Disability Insurance Scheme has certainly created opportunities for people with enduring disabilities to access occupational therapy services to increase involvement in their daily activities, community, employment, education, and improve health and wellbeing which has had a marked impact on demand for occupational therapy services. The recommendations from recent Royal Commissions have also indicated the need for more services from health professionals such as occupational therapists (Commonwealth Royal Commission, 2021; Victorian Royal Commission, 202). While it is comforting to know that occupational therapists are valued members of the Australian health workforce, meeting the current and expected future demands will be a significant challenge. It will require input and commitment from all areas of the profession to increase recruitment and retention to ensure a strong high-quality profession with work informed by accurate data. Celebrate our significant achievements and professional standing during this International Year of the Health and Care Worker for we do make a significant contribution to the health and wellbeing of all who we work.