Decolonising person-centred care approaches
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There is a disconnect between occupational therapy and occupational science ways of knowing, being and doing and Indigenous people’s ways of knowing, being and doing. In a decolonising and anti-racist model of care, integral in all occupational therapy and discipline work is being aware of social, historical and political contexts that perpetuate racism and other forms of oppression. And once aware of these contexts, take affirmative actions to shift the oppression. Generally that shift needs to be with your own critical reflection of self and doing anti-colonial work (Ryall et al., 2020Ryall, J., Ritchie, T., Butler, C., Ryan, A., & Gibson, C. (2020). Decolonising occupational therapy through a strengths-based approach. In T. Brown, H.M. Bourke-Taylor, S. Isbel, R. Cordier, & L. Gustafsson (Eds.),Occupational therapy in Australia: professional and practice issues (2nd ed.) (pp. 130-142). New York: Routledge.). Implement a healing approach, which not only recognises past traumatic events but also how to take active steps not to cause further harm via your own therapeutic practice. Collaborate with communities, take time to build genuine rapport with Elders and hear stories (Gibson et al., 2020bGibson, C., Crockett, J., Dudgeon, P., Bernoth, M., & Lincoln, M. (2020b). Sharing and valuing older Aboriginal people’s voices about social and emotional wellbeing services: a strength-based approach for service providers. Aging & Mental Health, 24(3), 481-488.). Once you understand your own role in contexts, like colonisation and healing, it will be easy to work with Indigenous communities and do so where truth-telling and self-determination and Indigenous culture are at the centre of your work (Gibson et al., 2020bGibson, C., Crockett, J., Dudgeon, P., Bernoth, M., & Lincoln, M. (2020b). Sharing and valuing older Aboriginal people’s voices about social and emotional wellbeing services: a strength-based approach for service providers. Aging & Mental Health, 24(3), 481-488.). |
Social occupational therapy
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Social occupational therapy is a field in occupational therapy with expertise, knowledge and methods to mediate social participation of people who have socioeconomic factors hampering their social participation. Social occupational therapy was centred on the process of connecting with people where they are and through what they value, while also resisting the urge or push to follow a technical, mechanistic approach (Lopes & Malfitano, 2021Lopes, R. E., & Malfitano, A. P. S. (2021). Social occupational therapy: theoretical and practical designs. Philadelphia: Elsevier.). |
Occupation-based Community Development
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The Occupation-based Community Development framework (Galvaan & Peters, 2017Galvaan, R., & Peters, L. (2017). Occupation-based community development: a critical approach to occupational therapy. In S. Dsouza, R. Galvaan, & E. Ramugondo (Eds.), Concepts in occupational therapy: understanding southern perspectives (pp. 172-187). India: Manupal University Press.) provides a process and guidance to rethink what is known and to create spaces where new ways of knowing, being, and doing could be co-constructed and hegemony could be challenged on a daily basis. |
Canadian Community Development Practice Process
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Within a Canadian context, occupational therapists engaging in community development acknowledge the complexity of communities, with a greater focus on the social determinants of health. Their community development practices adapted the typical practice process to include: i) Getting to know the community, with a focus on building the relationships, exploring resources and prioritising together; ii) Getting the ball rolling and planning together, which involved co-planning, respecting culture and acting as catalysts; iii) Building upon occupational opportunities including occupations that build skills; iv) Revisiting the approach to monitor and recognising the difficulty of measuring change; and v) Striving for sustainability which involves identifying local community, having champions from community, finding funding and being involved over a longer term. (Leclair et al., 2019Leclair, L. L., Lauckner, H., & Yamamoto, C. (2019). An occupational therapy community development practice process. Canadian Journal of Occupational Therapy, 86(5), 345-356.) |
Community Centred Practice Framework
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The Community-Centred Practice Framework identifies four main features to conceptualize occupational therapists practice with communities drawing upon occupational therapy and science concepts and critical theory: community identity, community occupations, community resources/barriers, and participation enablement (Hyett et al., 2018Hyett, N., Kenny, A., & Dickson-Swift, V. (2018). Re-imagining occupational therapy clients as communities: Presenting the community-centred practice framework. Scandinavian Journal of Occupational Therapy, 26(4), 246-260.) |
Yarning
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Yarning provides a way of connecting with Aboriginal culture and does so in many ways, like sharing Aboriginal people’s voices, sharing knowledges, connecting with each other, caring for each other, problem-solving and setting priorities Yarning may influence how you see yourself and the world you live in, as well as set the parameters for how you connect with each other. Importantly, in the research and health contexts, yarning principles may be applied, with the aim of establishing connections with yarning members, a shared understanding of the issue at hand and more. In yarning, it is important to have the right community members involved, be that Elders, Traditional Owners of Country, and other community members who may be the knowledge bearers of the yarning topic (See Gibson et al., 2020aGibson, C., Dudgeon, P., & Crockett, J. (2020a). Listen, look & learn: exploring cultural obligations of Elders and older Aboriginal people. Journal of Occupational Science, 27(2), 193-203., 2020bGibson, C., Crockett, J., Dudgeon, P., Bernoth, M., & Lincoln, M. (2020b). Sharing and valuing older Aboriginal people’s voices about social and emotional wellbeing services: a strength-based approach for service providers. Aging & Mental Health, 24(3), 481-488.; Bessarab & Ng'Andu, 2010Bessarab, D., & Ng'Andu, B. (2010). Yarning about yarning as a legitimate method in Indigenous research. International Journal of Critical Indigenous Studies, 3(1), 37-50.; Emery-Whittington et al., 2023Emery-Whittington, I., Draper, L., & Gibson, C. (2023) Connections, disruptions and transformations: Decolonising qualitative research. In S. Nayar & M. Stanley (Eds.), Qualitative research methodologies for occupational therapy and occupational science. Abingdon: Routledge. (in publication).). |
Territorial actions
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The concept of territory suggests a combination of space, process, and relationship that surpasses the delimitation of physical space, whereas the concept of community suggests the idea of collectivity and the construction of networks, belongings and identities. Addressing territory and community jointly indicates reflection on the understanding of the ways of life and modes of appropriation of the material, social, cultural and relational resources that are established in a place, from a collective perspective of life, that centrally influences the occupations, doings, and the ‘everyday lives’ of different people, groups and communities (Bianchi & Malfitano, 2022Bianchi, P. C., & Malfitano, A. P. S. (2022). Professional practice of occupational therapists in Latin American countries: what characterizes a territorial-community action? Cadernos Brasileiros de Terapia Ocupacional, 30, e3053.). |
Campaign
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“A campaign involves the design of strategies to counter the hegemonies associated with the participation of marginalised social groups that result in exclusion and injustice. It is implemented in collaboration with this group, as well as with different combinations of key role players and stakeholders, depending on the issue at hand and the direction the community decides to take.” (Peters & Galvaan, 2018, pPeters, L., & Galvaan, R. (2018). Critical occupational therapy in the margins: parent participation in under-resourced schools. In P. Silbert, R. Galvaan, & J. Clark (Eds.), Partnerships in Action. University-school-community (pp. 131-145). Cape Town: HSRC Press.. 143) |
Community organising
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Choosing to practice outside of public healthcare system in order to engage with community and increase accessibility of health and social services for marginalised groups, using a five-stage model of community organization (Bracht & Kingsbury, 1990Bracht, N., & Kingsbury, L. (1990). Community organization principles in health promotion: a five-stage model. In N. Bracht (Ed.), Health promotion at the community level (pp. 66-88). Thousand Oaks: Sage.) |
Continuum of Community Development
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A continuum from developmental casework to social and political movements illustrates a continuum of community development (Jackson et al., 1989Jackson, T., Mitchell, S., & Wright, M. (1989). The community development continuum. Community Health Studies, 13(1), 66-73.) that moves towards multi-layered work with communities that is informed by social and systems change. This continuum of community development involves the following points along which individuals or communities could enter the continuum: addressing individual struggles (developmental case work); bringing people with similar experiences together with other social groups to counter act feelings of isolation (mutual support); generating opportunities for shorter-term involvement in events around shared interests that aim to create social change (Issue identification and campaigns); involving people in the decision-making processes at local levels (participation and control of services); and ongoing commitment to social change (Jackson et al., 1989Jackson, T., Mitchell, S., & Wright, M. (1989). The community development continuum. Community Health Studies, 13(1), 66-73.). |