Constructions of Disability: A Call for Critical Reflexivity in Occupational Therapy

Aims: The occupational therapy profession has long proclaimed its commitment to a client-centred philosophy of practice and the assumption that occupational therapists consistently practice in a client-centred manner has become central to the profession's self-image and public rhetoric. However, client-centred practice has been subjected to little critical reflection within the occupational therapy profession. The aim of this paper is to foster critical reflection concerning the authenticity and veracity of the profession's commitment to client-centred practices. Major findings: Client-centred practice is defined without evident reference to clients' perspectives. Few occupational therapy researchers have sought clients' perceptions of the client-centred nature of their occupational therapy services. Occupational therapy research is neither consistently undertaken in a collaborative manner, nor are the profession's theories developed through explicit reference to a diversity of clients' perspectives. Professional practices and service evaluations do not consistently seek clients' viewpoints. Client-centred rhetoric is politically expedient and may be a professionalizing strategy employed to increase status and entrench power. Practice conclusion: Although exemplary client-centred occupational therapy practices exist, evidence suggests that the profession does not adhere consistently to its espoused client-centred principle in all its practices. The client-centred practice of occupational therapy should be subjected to assiduous critical reflection.

Social and political contexts are known to influence people's opportunities to engage in occupations. Occupational therapy in the domain of community development practice addresses the social determinants of health by contributing towards social transformation. Socially IH transformative practice refers to occupational therapy practice that strives to and addresses the social determinants of health and social Π I injustice through drawing on critical perspectives. Educators applied an autobiographical form of study, data were generated firstly through keeping a written reflective journal and audio recorded reflections on practice. Secondly, written comments and feedback to students ~\ during their community development practice placements were also included in the data set. Data were thematically analysed, yielding (/) I a theme and two categories. The theme: Towards socially responsive practice revealed the value of adopting a critical and collaborative approach to practicing occupational therapy in various domains of practice. Working towards social transformation was demonstrated as possible through the categories of being able to See and Feel the invisible and enabled as Equals working for change. The findings suggest that critical reflexivity together with implementation of participatory practices are necessary requirements towards addressing the conditions of people's health and occupational well-being. Key words: Occupational therapy practice; social transformation; participatory practice; Occupation-based community development

In Canada, the guidelines for the practice of occupational therapy are named and framed as client-centred. Two in-depth interviews were conducted with clients of mental health services about their experiences with a hospital-based occupational therapy service. These occupational therapy clients described their experiences as prescriptive, and as less than client-centred. With the publication of Enabling occupation: A Canadian occupational therapy perspective (Canadian Association of Occupational Therapists [CAOT], 1997) and an increasingly refined focus on being client-centred, these interviews highlight the challenges of a client-centred practice within the current health care environment. These occupational therapy clients raise issues of importance for occupational therapy. The participants stated that the prescription of 'activity', a lack of choice, and a focus upon the illness as opposed to the individual, served to diminish any collaborative partnership with the client and eliminate the client from any decision-making process. This distancing from the client, in their opinion, served to greatly diminish any therapeutic value of occupation. The participants recommended a greater focus upon occupational choice, consideration of the individual within the client, providing accepting, supportive environments, and using professional expertise on occupation to guide the client towards participation in meaningful occupation. These recommendations are strikingly similar to the most recent guidelines for the client-centred practice of occupational therapy in Canada. A discussion of the implications of these findings for the client-centred practice of occupational therapy is offered.

Evidence-based practice creates practice that integrates research-driven evidence with clinical expertise and patients' preferences in clinical decision-making. Aim: The aim of this study was to investigate and evaluate the quality and applicability of scientific research in occupational therapy intervention related to the use of everyday life occupations and client-centred practice within stroke rehabilitation. Design: Systematic searches of research studies published in English during 2000–2007 in peer-reviewed journals were undertaken. Thirty-nine articles and one Cochrane review were appraised and the quality evaluated using an evidence taxonomy and an evidence hierarchy. Results: Evidence arose providing support for a client-centred approach, entailing outcome related to better ability to recall goals, the patients feeling more involved and able to manage more everyday life occupations after rehabilitation. There is also considerable evidence for the use of everyday life occupations in occupational therapy. Occupational therapy was evaluated as an important aspect of stroke rehabilitation improving outcomes in everyday life occupations including activities of daily living (ADL) and participation. Discussion: As research of relevance for the profession to a large extent includes qualitative research it gives rise to reflection on including more tools than the evidence hierarchy while evaluating evidence within occupational therapy.

This study examined the viewpoints of occupational therapy educators in higher education regarding ableism and its impact on occupational therapy practice. It forms part of a wider study which also explored occupational therapy student perspectives, published separately. An online survey involved the administration of Likert-scales and open-ended survey questions, enabling a comprehensive examination of occupational therapy educators' perspectives on ableism in occupational therapy. The sample comprised 32 teaching staff actively engaged in occupational therapy degree-level education. Most participants (72%) perceived occupational therapy as inherently ableist. Content analysis showed variations in how respondents understood the term 'ableism', and this appeared to be a compounding factor in respondents' views as to whether the profession is ableist. Most (89%) respondents agreed that the profession focuses on independence, affirming past critiques. Themes, including cultural sensitivity, challenges with engaging in disability studies, and power dynamics within occupational therapy education, emerged. This study provides insight into educators' opinions of occupational therapy practices and their promotion of ableism. Future qualitative research should aim to unravel additional understanding of ableism within occupational therapy, including its origins, so future systemic changes required to address the harm of ableism can begin to be addressed.

Social and political contexts are known to influence people's' opportunities to engage in occupations. Occupational therapy in the domain of community development practice addresses the social determinants of health through practice that contributes towards social transformation. Applying an autobiographical form of self-study, data was generated firstly through keeping a written reflective journal and audio recorded reflections on practice and secondly, written comments and feedback that the first author, as a clinical educator, gave students during their community development practice placements, was captured. This data was thematically analysed, yielding a theme and two categories. The theme, "Towards socially transformative practice" revealed the value of adopting a critical and collaborative approach to practicing occupational therapy. This was demonstrated as possible through the categories of being able to "See and feel the invisible" and enabled as "Equals working for change". The findings suggest that critical reflexivity together with implementation of participatory practice is a necessary requirement towards addressing the conditions of people's health and occupational well-being.

To explore occupational therapy students' perspectives on ableism and its implications for occupational therapy practice. This formed part of a wider study that also explored occupational therapy educators' perspectives. An online survey was used to collect students' perspectives, using a mixture of Likert scales and open-ended questions. The sample comprised 56 occupational therapy students from the United Kingdom (n = 36), United States of America (n = 16) and Canada (n = 4) enrolled in a mixture of undergraduate (n = 13) and postgraduate (n = 43) pre-registration degree programmes. Thirty-four percent of respondents perceived occupational therapy as inherently ableist. This rose to 50% after respondents were presented with a comprehensive definition of ableism. Students reported witnessing and/or experiencing ableism within education (63%) and practice placements (55%). Eighty-six percent of students recognised they may hold unconscious ableist views, and 96% agreed they would like more support to engage in disability studies. Findings indicated a potential link between understanding of ableism and students' views that occupational therapy is ableist. Most students were aware of the potential they hold unconscious biases and welcomed support to engage further with disability studies. Further qualitative research is needed. Following this, systemic changes to address the harm of ableism can begin to be addressed.

The sustainability of health services globally is under increasing pressure with a rise in chronic conditions, an ageing population, ageing workforce and increased fiscal, safety and quality issues. One important strategy acknowledged to address these pressures is greater collaboration between health professions, often described as interprofessional practice (IPP) or collaborative practice. While many health professionals believe they already engage in IPP, in reality they are working alongside each other within their own professional silo (World Health Organization, 2010). The continuation of this siloed way of working impacts the occupational therapy profession, particularly evident in the lack of understanding of how occupational therapy contributes to the health of individuals, communities and the health system. Few people, including those with whom we work, understand what constitutes occupational therapy (Alotaibi, Shayea, Nadar & Tariah, 2015). Without that understanding, members of the health professional team are not able to appropriately refer to our services, or include occupational therapy in the delivery of care. An evident lack of understanding of the role of occupational therapy frustrates occupational therapists and denies clients access to services and achievement of their occupational goals (Britton, Rosenwax & McNamara, 2015; Keesing & Rosenwax, 2013). It also impacts the status of the profession, job satisfaction and retention (Moore, Cruickshank & Haas, 2006). Limited understanding of other professions not only impacts occupational therapy; health professionals generally do not fully understand the scope of practice, knowledge, skills and core values of other professions (Aguilar, Stupans, Scutter & King, 2014). Without this understanding, effective IPP is not possible. IPP does not just happen. It is widely recognised that interprofessional education (IPE) is needed to build staff capacity/capabilities for IPP. The World Health Organization defines IPE as ‘occurring when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes’ (World Health Organization, 2010). Many Universities have embedded IPE into health curriculum including two-thirds of Universities in the UK (Barr, Helme & D'Avray, 2014) and 85% of Universities in the USA (Greer, Clay, Blue, Evan & Garr, 2014). Unfortunately the same cannot be said for Australia and New Zealand. A recent review indicated that while 80% of the universities stated they had IPE in the curriculum, only 24% met the definition of IPE (Lapkin, Levett-Jones & Gilligan, 2012). This lack of IPE and IPP extends beyond universities and into student fieldwork placements. Even when IPP experiences are reported to occur during placements, the majority of these entail tutorials and education sessions (Davidson, Smith, Dodd, Smith & O'Loughlan, 2008) rather than structured learning experiences where students are facilitated to learn about, from and with other health professionals, clients and carers. Health students need to be provided with opportunities for IPP, particularly as it happens rarely within Australian health settings. Based on our experiences, students provided with such opportunities demonstrate increased valuing of teamwork, confidence in sharing expertise, trust and respect for other professions, altered stereotypical views and appropriate referrals. Additionally, having experienced IPP, clients cite high satisfaction with their care (Brewer & Stewart-Wynne, 2013). Our experiences include a training ward, dementia unit, primary schools, integrated primary care health facility, aged care, rehabilitation, mental health and an international service learning programme running for the past decade. While barriers exist to imbedding IPE and IPP, they should not be accepted as an excuse to persist with our current siloed approach to health education and practice. Universities have a responsibility to prepare our graduates to be leaders and agents of change to better meet the needs of the community (Frenk et al., 2010). Based on our experiences, we believe that IPP can help address the vexing question of ‘What is occupational therapy?’ By learning about, from and with each other, there is the opportunity to understand and experience the breadth, depth, values and scope of occupational therapy and other professions. With IPP as the norm, health professionals, clients and carers will be much better situated to work in partnership with occupational therapy.

Competence approach in the training of future occupational therapists makes it possible to determine the degree of readiness of students for purposeful professional activity. Assessment of the acquisition of competencies by university students remains a serious problem that requires discussion after the application of various assessment methods in the educational process. The purpose coverage of the component of professional competencies and criteria for their evaluation in the teaching of occupational therapy based on the French experience. Material and methods. In this paper we studied professional competencies of a French occupational therapist to obtain a state diploma "Occupational Therapist". We used the following methods: analysis, generalization and systematization of information of scientific and methodical literature. Results and discussion. Training in occupational therapy is carried out at the departments of physical therapy in the specialty 227 – "Physical Therapy, Occupational Therapy", which provides two specializations: 227.1 – "Physical Therapy" and 227.2 – "Occupational Therapy". Thus, the component of professional competence is a structural component of the educational program for the training of competent professionals who are able to use the acquired knowledge, skills and abilities in practice. In 2019, the Commission of Specialists at the Ministry of Education and Science of Ukraine developed a draft educational and professional training program for occupational therapists. In this project, professional competencies are divided into 5 professional competencies of the specialty and 14 professional competencies of the specialization. In order to receive a state diploma in occupational therapy, the Decree of the Ministry of Social Affairs and Health of France prescribes ten professional competencies that must be mastered by a future specialist. At the same time, this document contains criteria for assessing the student's acquisition of these competencies. This Decree contains the following criteria for assessing professional competencies: “What allows us to say that the skill has been mastered? What exactly do we want to check? What visible signs of a student's acquisition of competence can be observed? What are the signs of good results?” Conclusion. Professional competencies and criteria for their evaluation, which form the basis of training occupational therapists in France, can be considered a complex multidimensional education, which was formed in the process of acquiring professional education and is a powerful motivating factor for training competitive professionals, which direct the perception of goals, values, content, results and features of this activity. This experience of the French school can be useful for the preparation of educational and professional, syllabus and work programs in occupational therapy

Viewed from a critical disability perspective, criminal responsibility requires both formal and substantive equality. This article examines criminal responsibility using provisions of the Convention on the Rights on Persons with Disabilities (CRPD) on equal recognition before the law, access to justice, liberty and security of the person, and equality and non-discrimination. In light of the CRPD, declarations of unfitness to plead, the negation of criminal responsibility based on disability or alleged incapacity, as well as commitment to psychiatric institutions in either a civil or criminal context, are discriminatory measures contrary to the rights of persons with disabilities, and must be abolished. Beyond abolition, which will achieve formal equality, this article proposes an inclusively designed framework that may meet the need for substantive equality between persons with disabilities and others in the adjudication of criminal responsibility.

Background. Metacognitive Reflection and Insight Therapy (MERIT) is a manualized, evidence-based approach that supports occupational participation through its focus on the inter-related constructs of meaning making, positionality, and self-definition (Lysaker et al., 2020). MERIT's core tenets parallel the fundamentals of occupational therapy, making it an ideal guiding methodology for mental health occupational therapy practice. Purpose. We outline key constructs of MERIT and detail how occupational therapy practitioners can apply MERIT to support occupational engagement. Key Issues. Few manualized, evidence-based interventions exist to guide occupational therapy mental health practice (Kirsch et al., 2019). Detailing MERIT and its application in occupational therapy is an important first step in future studies of its feasibility, acceptability, and effectiveness in this context. Implications. MERIT provides a clear methodology for delivering mental health occupational therapy services that is amenable to large-scale hybrid implementation and effectiveness studies, thereby supporting practice and rigour in research.

Occupation is central to occupational therapy. Although occupation is a universal experience, occupational therapists need to consider the risks and opportunities of exploring new roles and maintaining existing services. I propose three questions to guide the optimal positioning of occupational therapy services. First, how proximal is occupation in the role? Second, how strong is the evidence to support occupational therapy in the role? Third, is the timing right for change? These questions are applied to the role of occupational therapy in primary health care. Occupation is proximal and the evidence is emerging to support an occupational therapy role in primary health care. Reforms make timing ideal. If we focus on the underlying principles of primary health care reform, the potential for an emerging role in primary health care is optimal. The same three questions can be used to transform and optimally position occupational therapy.

Aliki ThomasOccupational therapy has long drawn strength from its ability to integrate diverse forms of knowledge, scientific evidence, clinical expertise, patient narratives, and embodied wisdom. This lectureship explores the profession's epistemic identity: how we develop, validate, and apply knowledge in practice, and how this identity enables us to respond to complex health and social challenges. Drawing on historical and contemporary case examples, the author examines the evolution of occupational therapy knowledge, tracing shifts from intuitive, relational care to evidence-based models and toward today's epistemically pluralistic landscape. She argues that occupational therapy is not only shaped by multiple forms of knowledge but also functions as an epistemic community, one that holds authoritative, policy-relevant knowledge and contributes meaningfully to interdisciplinary networks. This identity positions occupational therapists to influence care models, policy directions, and systems transformation. However, our influence depends on epistemic humility, strategic collaboration, and a commitment to bridging research, practice, and lived experience. The author then outlines three key calls to action: (1) strengthening our knowledge base through pluralism and reflexivity; (2) amplifying our collective voice by clarifying professional identity and reducing fragmentation; and (3) increasing our policy influence through purposeful collaboration and leadership. In rapidly evolving healthcare environments, occupational therapy must assert its role not only in delivering services, but in stewarding integrated, context-sensitive knowledge that drives equity, participation, and justice.

Background. Occupational therapy and occupational science literature include growing attention to issues of justice, marginalization, and rights. In contrast, the concept of oppression has scarcely been employed. Purpose. This paper investigates how adding the concept of oppression may enhance occupational therapy approaches to injustice, prioritizing a focus on structural causes, and facilitating conscientious action. Method. A critical interpretive synthesis explored insights from authors who name oppressions in occupational therapy and occupational science literature. In total, a sample of 28 papers addressing oppression, ableism, ageism, classism, colonialism, heterosexism, racism, and/or sexism was selected for inclusion. Findings. Four themes were identified: oppression and everyday doing; effects of structures and power; responding and resisting; and oppression within occupational therapy. Implications. Incorporating oppression within the plurality of social discourse may help occupational therapists to avoid individualistic explanations, attend to relationships between social structures and constrained occupations, frame intersectional analysis, and engage in praxis.

Voluntary work is seen as a key component of promoting mental health through social inclusion. For many years, occupational therapists have worked in partnership with voluntary organisations to facilitate access for service users to voluntary placements. Yet there is little published evidence to support this aspect of occupational therapy or to indicate specific successful strategies, especially in establishing successful placements beyond mental health services. This review examined the existing evidence, discussing the implications for occupational therapy. The findings indicate a need for further research to ascertain the benefits of volunteering, the barriers and the ways to improve access for people with mental health problems. Occupational therapists, with their unique synthesis of knowledge and skills concerning occupation, enabling and client-centred practice (Townsend and Wilcock 2004), should be well placed to be able to respond to these issues, yet the literature does not provide evidence that they have risen to the challenge.