Occupational therapy: Depth, innovation and courage

Abstract

‘We make our world significant by the courage of our questions and by the depth of our answers’ . . . Carl Sagan (1973, p. 193). Over the past two decades, occupational therapy has grown and developed rapidly. Changes include expansion in practice focus and location, increased emphasis on occupation and occupational performance, and a greater importance of accountability and measurement of therapy outcomes. Worldwide, there is substantial agreement that client-centredness, use of evidence, and occupation-based practices embody the fundamental principles of reflective occupational therapy. There are, however, significant challenges to meet such expectations. As practitioners, students, educators, researchers, and managers, how can we address these challenges? I believe that such change is grounded as much in the way we approach practice as in what we actually do. I wish to share with you some thoughts about characteristics that our profession can apply as we move forward — the ideas of depth, innovation and courage. The depth of the occupational therapy discipline reflects our ability to appreciate and understand the complexity of daily living. In times of turmoil, cultural change, globalisation, societal ageing, and increasing disability, our comprehension of the nature of people doing occupations within varied environments is fundamentally important (McColl, 2002). For effective occupational therapy, it is necessary to guide education, practice and research by broad, conceptual models. Examples include currently developed and contemporary occupational therapy models (Dunn, Brown & McGuigan, 1994; Law et al., 1996; Canadian Association of Occupational Therapists, 1997; Gibson & Strong, 2003; Strong, 2003) as well as interdisciplinary models such as the International Classification of Functioning, Disability and Health (World Health Organization, 2001). While conceptual models are not enough, they provide the foundation for occupational therapists to understand the complex relationships between persons, occupation and environment. Such models form the basis for the development of a deep appreciation of the ways in which people find meaning in their lives through occupation. As occupational therapists develop ‘best’ practice, we would be wise to seek inventive methods of assessment and intervention strategies. We are leaders in client-centred practice and forming effective partnerships with clients, families, colleagues, service providers, agencies, and government. Expanding the range of interventions and populations with whom we work will enable occupational therapy to truly explore the relationship between occupation, health and well-being for individuals and populations. In doing so, occupational therapists can bring hope to those who suffer through lack of satisfactory occupations. We also have the potential to forge a new understanding of evidence-based practice. Our profession will move forward in this way if we recognise that evidence-based practice, in its most innovative way, represents a confluence between research evidence, practice wisdom, and client values and preferences. Australian occupational therapy is one of the leaders in the world in moving evidence into practice. Resources such as OT Seeker, and Critically Appraised Papers in the Australian Occupational Therapy Journal are models for other countries to follow. Courage is not typically considered in a discussion centred on the development of a profession. However, think about the definition of courage, as ‘the state or quality of mind or spirit that enables one to face danger, fear, or vicissitudes with self-possession, confidence, and resolution’ (American Heritage Dictionary, 2000). How better to describe an occupational therapy practice centred on the needs, values and wishes of those we serve? Facing the future in developing effective practice inevitably leads us to concentrate on how we can enable change in occupation and environments rather than simply change people. In this way, we define occupational therapy in ways that are not limiting, but which are potentially more effective. We must have the courage to measure the outcomes of what we do, and to stop carrying out interventions that we learn are not effective. Occupational Therapy, whether practised in Australia, in Canada, or elsewhere, will be known by what we do to make a difference in the world. Some years ago, a parent said to me during an interview: ‘You spend their young lives trying to get them ready for the world and when the time comes, the world isn't ready for them. So we have to find a way to do it.’ Depth, innovation, and courage — these values can help us in this journey. My thanks to Linsey Howie from La Trobe University for her helpful review of this editorial.