Challenges in enacting occupation-based social transformative practices: A critical dialogical study

Abstract

Background. Globally, occupational therapists are taking up the transformative potential of occupation to mobilize the profession’s commitment to social change. Purpose. This study examined ideal constructions of occupation-based social transformative practices and challenges that may arise when enacting these practices. Method. Five participants with experiences developing practices aligned with social transformative goals in diverse locations were recruited. In this critical dialogical study, three dialogical interviews were conducted with each participant. Critical reflexivity was enacted through the exchange of transcripts and critical reflections with participants. A critical discourse analysis was conducted to examine how such practices are shaped within discourses and other contextual features. Findings. The findings address constructions of ideal practice and three threads that provide critical insights into ways discourses shape possibilities to enact social transformation through occupation. Implications. This study brings together experiential and theoretical knowledge to advance social transformative practices by problematizing underexamined discourses in occupational therapy.

Occupational Therapists as Street-Level Bureaucrats: Leveraging the Political Nature of Everyday Practice

“…It is well documented that many occupational therapists experience high caseloads, challenging productivity standards, and resource-poor work contexts (Bushby, Chan, Druif, Ho, & Kinsella, 2015). Occupational therapists also respond to accountability measures in dynamic, contextually situated ways (Freeman, McWilliam, MacKinnon, DeLuca, & Rappolt, 2009) and navigate various discourses, such as neoliberalism, healthism, and managerialism (Farias & Laliberte Rudman, 2019), which often bring pressure to “be more about enacting [system] restriction[s] than facilitating the patient” (Pollard, Sakellariou, & Lawson-Porter, 2010, p. 42). There is also evidence of systemic practice conditions, such as risk management priorities or productivity and reimbursement requirements, working against occupation-based, client-centered practice (Carrier, Freeman, Lavasseur, & Desrosiers, 2014; Hammell, 2007; Murray, Turpin, Edwards, & Jones, 2015; Walker, 2001), leading to occupational alienation among occupational therapists (Durocher, Kinsella, McCorquodale, & Phelan, 2016) and perpetuating “underground” practices (Mattingly & Fleming, 1994).…”

Combatting occupational deprivation and advancing occupational justice in institutional settings: Using a practice-based enquiry approach for service transformation

“…This has been observed in a number of different treatment contexts, including the reductionist biomedical approaches of hand therapy (Robinson et al, 2016); a large acute hospital in a large Australian city (Wilding and Whiteford, 2008) and the Australian university sector (Di Tommaso et al, 2019), where eight educators had differing opinions on the extent to which occupation should be used in educational curricula (as the basis for all teaching versus including impairment-based techniques). Such inconsistency and the lack of an overt commitment to occupation, as well as the institutional, economic and political forces that centralise an individualist orientation (Farias and Rudman, 2019), prevent the delivery of truly occupation-centred practice.…”

Practice analysis: Critical reflexivity on discourses constraining socially transformative occupational therapy practices

“…For example, occupational therapists working with groups affected by marginalizing conditions, with diverse contexts within and outside health care systems, are being pressured by funding/governmental agencies to demonstrate that their interventions have an impact in these communities, yet transformative process can have an 'incubation' period of awareness and discussion that cannot be measured by numbers. In this way, people's experiences of transformation and the new insights/knowledge developed during the process seem irrelevant or illegitimate from an NPM perspective that focuses on measurable impact (Farias and Rudman, 2019).…”