Comunidade internacional de práticas: aprendendo com experiências de desenvolvimento comunitário e de terapia ocupacional social

Hyett, Nerida; Peters, Liesl; Gibson, Chontel; Malfitano, Ana Paula Serrata; Lauckner, Heidi; Leclair, Leanne; Galvaan, Roshan

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Sumário

Original Article • Cad. Bras. Ter. Ocup. 31 • 2023 • https://doi.org/10.1590/2526-8910.ctoAO272435512 copiar

Comunidade internacional de práticas: aprendendo com experiências de desenvolvimento comunitário e de terapia ocupacional social

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Introdução

De modo crescente, terapeutas ocupacionais mundialmente estão discutindo mudanças das abordagens médicas ocidentais individualizadas para o trabalho com comunidades, coletivos e no campo social. Isto sinaliza uma motivação crescente para se engajar em práticas socialmente responsivas e transformadoras que abordem estruturas políticas e sistemas coloniais opressores.

Objetivo

Explorar e descrever epistemologias, vocabulários e entendimentos que sustentam a teoria de desenvolvimento de comunidades e da terapia ocupacional social, em diversos contextos globais para avançar em perspectivas teóricas e práticas.

Método

A partir de uma Comunidade de Prática de terapeutas ocupacionais e acadêmicos situados em quatro países (Austrália, Brasil, Canadá e África do Sul), nos reunimos virtualmente bimestralmente de março de 2020 até janeiro de 2023. Nosso trabalho envolveu revisões narrativas críticas da literatura, apresentações reflexivas, diálogos em grupo e reflexões e análises individuais e coletivas.

Resultados

Foram escolhidos quatro fios temáticos e uma seleção de vocabulários e epistemologias: Conectando e abrindo espaço para a práxis decolonial, Questionando a desconexão entre a prática da terapia ocupacional e os contextos, Examinando vocabulários que moldam a prática contextualmente relevante e Engajando uma postura reflexiva para trabalhar em direção à equidade, justiça e direitos sociais.

Conclusões

A geração de conhecimento reflexivo que sustente formas de saber, ser e fazer requer múltiplas linguagens, ciências e contextos que fortalecem a terapia ocupacional. É essencial manter a pluriversalidade e resistir a abordagens únicas para trabalhar com a ocupação humana/vida cotidiana. Este artigo oferece um catalisador para iniciar uma práxis descolonizadora de aprendizado em contextos globais.

Palavras-chave:
Colonialismo; Justiça Social; Direitos Sociais; Troca de Conhecimentos; Equidade

Individual questions for reflecting on group discussions - “where did I start?”
Q. What vocabularies are used to describe practice? Terms, language, concepts, ways of talking about and communicating our occupational perspective of community development and social occupational therapy?
Q. What epistemologies inform our practice? What is the nature of our practice knowledge, where does this come from, what informs this knowledge of occupational perspectives of community development and social occupational therapy?
Q. What is the value of this practice, how does/can this practice contribute to/influence health equity, social rights, access, and justice within our local and global contexts?
Q. What are unique and common aspects/understandings across context and what are gaps and future directions?
Individual questions for reflecting on self - “what changed?”
Q. What have we learned?
Q. How have we changed? What has helped shift thinking/practice/praxis?
Q. How has what I have learned from others/practice influenced my own understandings of self/practice?
Q. How did our understanding of power influence and shift through these conversations?
Collective question about our process/”container” - “what about the process contributed to these shifts?”
Q. What about the space we created allowed us to have these conversations? How did we set up the space?

Ana
The community of practice is a great opportunity to share discussion about occupational therapy practices, its fundamentals and possibilities of actions. Coming from South America, the English language is a barrier to dialogue with the “occupational therapy world”, but, at the same time, part of our tasks as academic scholars. I am part of a collective group in Brazil, who has been working on Social Occupational Therapy, and, as a member of this collective, I have been trying to spread our ideas on an international level, trying to identify partners and dialogue about different ways of professional actions in occupational therapy. I am an academic, living in Brazil. Latin America is an unequal place, related to our colonial history, challenging different professionals to be involved with the social reality.
*Chontel*
I am a Kamilaroi woman with cultural and family connections to the Collarenebri area in Australia. I currently live and work on Kamilaroi country. I grew up with a familial understanding about the impact of advocacy, racism and many different forms of oppression. I understood how the broader contexts, like political and social contexts, influence individual lives. For example, in the early to mid-1900s a time when the Australian Government's policies supported segregation, my grandmother, many of her brothers and sisters, and other families in our community were not allowed to attend the government school because their Aboriginal identities. Following leadership from my great grandmother and other community members, Aboriginal children were eventually allowed to attend the government school. My Gran and other students' experiences then reflected another government policy era of assimilation, which included the belief that Aboriginal people were viewed as inferior to non-Aboriginal children. For example, my Gran was expected to perform at a lower level in her exams, when compared to the non-Aboriginal children. My work now centres on more than just inclusion of Aboriginal and Torres Strait Islander people, in that it now promotes and facilitates the implementation of Indigenous ways of knowing, being and doing. I grew up valuing all forms of education and feel that having both the cultural and socio-political context provided me with a framework to navigate the western world, including that of education and health systems. I pay my respects for Elders, past and present, many of whom have had a profound impact on my life, including my professional work. I acknowledge fellow Aboriginal and Torres Strait Islander people in Australia and Indigenous people across the globe. There are significantly diverse cultural ways of knowing, being and doing for each Indigenous nation, and even within an Indigenous nation. There are also commonalities across the nations, including some responses to imperialism and colonisation. It is important to understand that the term Indigenous is not a term that I generally use, unless I'm speaking in an international context. I generally use terms like Kamilaroi and Aboriginal, as these terms make sense and have meaning for me and where I currently live. My starting point for the community of practice, was twofold. The first was from a place for supporting occupational therapy allies to implement community development in a way which would be of benefit for Indigenous people. The second was to better understand colonisation, which is one of many expressions of imperialism, and the impact this has on the occupational therapy profession and occupational science discipline across the globe.
*Heidi*
When I shared my personal narrative with our community of practice, I inserted my positionality statement part way through my presentation in order to illustrate my evolving recognition of the implications of my positionality overtime. I was honest that I was much less aware of my positionality over 20 years ago when I was first introduced to community development in the context of international development in post-apartheid Namibia after working as an occupational therapist in the USA for a few years. Those international experiences not only raised questions for me about occupational therapy’s role in community development locally and internationally, but also raised many questions for me regarding my own power and privilege loally and internationally as a white, cis-gender, settler-colonizer descendent of european refugees who settled in Canada after WWII. This critical examination of my positionality that began many years ago when I was afforded the opportunity to look at my own experiences within and from the perspective of another context has continued in my current work as an occupational therapy educator, researcher and international fieldwork coordinator at DalhousieUniversity in Mi’kma’ki (in Eastern Canada), the ancestral and unceded territory of the Mi’kmaw People. I viewed involvement in this CoP as an opportunity to learn with and from those with experiences within other contexts to deepen our collective understanding of how coloniality impacts what we do and how we might do things differently with each other and the communities with whom we work. For me, such a journey requires engagement with those multiple perspectives to assist me in understanding myself within my own context more fully and more critically.
*Leanne*
As a white Canadian settler, occupational therapy educator, researcher and academic administrator at the University of Manitoba, located on Treaty 1 territory in central Canada, the ancestral lands of Anishinaabeg, Cree, Oji-Cree, Dakota and Dene Peoples and the homeland of the Red River Metis, acknowledging that white, western, eurocentric perspectives have predominated my understanding of occupational therapy and many of my life experiences, this group offered me new learnings and perspectives on teaching, research, scholarship and practice related to community development and social occupational therapy. The community of practice allowed me to learn with, from, and about colleagues living in different geopolitical contexts around the globe. It provided me with an opportunity for critical reflexivity on my positionality and taken for granted ways of thinking through collective dialogue about our experiences and perspectives that contributed to my life-long work of de-linking, undoing, unlearning, and unpacking colonial knowledge, power and practices and relearning truth.
*Liesl*
I am an Afrikan OT and educator, who is also a white middle-class womxn. I am a lecturer in the Division of Occupational Therapy at the University of Cape Town and, since the inception of my teaching career, I have been working to understand how we might practice in and with communities. These are only some of my identities that have various and multiple meanings in my own local context and show up intersectionally across different spaces in different ways. In our community of practice, I was struck by the ways in which we ‘located’ ourselves and understood this ‘location’ differently dependent on so many different aspects, but a large part of this was our geopolitical positions and the unique histories and current realities of the contexts we found ourselves in. I was particularly interested in how these facets shaped our thinking and use of knowledges in practice. It felt like there was a ‘coming to know’ throughout my experience of engaging with the community of practice - this was shaped by who I am but also what I could come to know through learning alongside and with others.
*Nerida*
My starting point for beginning this community of practice was from a place of seeing and uncovering the limitations of my praxis that relate to my whiteness and colonial upbringing and worldview where I had been undoing the layers as a process of decolonising praxis. I selected two main themes for my presentation which were community-centred practice and complex population health issues - this also reflected the vocabularies I chose to discuss. I am a colonial settler, a 5th generation white Australian with European and Chinese ancestry. I live on the unceded lands of the Dja Dja Wurrung people in a rural town in central Victoria, Australia. Rural place is important to me and a central part of my identity, and my family have lived in this place since european invasion.
This identity and context inform my practice, research, and knowledge construction, and part of my process of decolonising praxis has started with decolonising my mind by seeing and dismantling the myths, lies, and untruths I have lived and breathed all of my life here, and in my profession and discipline of occupational therapy. The importance of community comes from who I am and my rural upbringing, and this is why it is central in my research and community practice. I’m motivated to understand how occupational therapists practice with communities can be more respectful, reciprocal, equitable, and just.
*Roshan*
I saw the community of practice as an opportunity for dialogue, introspection and collective reflection that provided a space to delve deeper into the different ways that community development and human occupation was seen in different contexts. Context matters, but how context is interpreted is political. Coming from our political history of unjust race relations in South Africa and given the continued social inequality that we live with, equity as a principle for engaging is paramount. Rather than only declaring my positionality, working out how it constrained and assisted with being open to different ways of knowing mattered to me.

Vocabularies	Epistemologies
Decolonising person-centred care approaches	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	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	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	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	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	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	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	“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	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	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.).

Universidade Federal de São Carlos, Departamento de Terapia Ocupacional Rodovia Washington Luis, Km 235, Caixa Postal 676, CEP: , 13565-905, São Carlos, SP - Brasil, Tel.: 55-16-3361-8749 - São Carlos - SP - Brazil
E-mail: cadto@ufscar.br

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[1] Nerida Hyett e-mail: n.hyett@latrobe.edu.au