The 2008 Frances Rutherford lecture taking a stand for inclusion: seeing beyond impairment!Mihi
Nga mihi hoki ki te Atua, i manaaki i te hokianga o tenei whenua tapu, nana nei nga mea katoa i hanga, tena koe, tena koe, tena koe, e te Atua.
Nga Maunga, nga Awa, e nga Mana, e nga Reo, e nga Iwi, e nga Hapu, e nga Tipuna Matua o tenei whenua tapu, me kii te Iwi nei a Rangitane o Palmerston North (Papaoia), tena koutou, tena koutou, tena koutou katoa.
Me hoki ano a tatou whakaaro ki a ratou, kua wehe atu ra ki te wahi o Hinenuitepo, haere koutou, haere, haere, ki Hawaiiki Nui, te hono ki wairua moemoe ra. Apiti hono tatai hono, te hunga mate ki te hunga mate. Te hunga ora ki te hunga ora, tena koutou, tena koutou, haere atu ra.
Kia ora ano. Me mihi ki nga tini Kaihaumanu Turoro, i takoto nga tikanga whakahekea mai, i tetahi whakatipuranga ki tetahi, tae noa mai, ki to tatou e hui, tena koutou.
Nga mihi hoki ki a Yvonne Thomas, korua ko Karen Rebeiro Gruhl, i tae pamamao hei kaikorero matua mai, ki to tatou Hui Nui.
Kua tae mai tatou ki tenei whenua tapu ki te korero tahi, ki te kawe mai i nga whakaaro, nga tumanakohanga mo tenei kaupapa (Kaihaumanu Turoro) New Zealand Association o Occupational Therapists o Aotearoa, whanui he mihi mahana ki a koutou katoa ra hoki.
He tino honore tenei maku, ki te korero atu ki a koutou, i te rangi nei.
Greetings to the gods who care for people (Hokianga/host tribe) of this sacred land, the god who created everything, greetings, and thank you. The mountains, the rivers, the mana, the voices of the iwi/people, the sub tribe, the ancestors of this sacred land, and to the iwi/tribe here, Rangitane guardians of this area Palmerston North, thank you, greetings to you all. We should return our thoughts and acknowledge those who have passed on before us, who have crossed over into Hinenuitepo, farewell, go to Hawaiiki; who are linked to the spirit world, rest in peace, farewell to you in the spirit world farewell! To us all here in the world of the living, greetings to you all. Greetings to the generations of occupational therapists (Kaihaumanu Turoro) that have come before us, guided us to where we are now. Greetings to Yvonne Thomas and Karen Rebeiro Gruhl, keynote speakers who have come from afar to be with us. Warm greetings to the New Zealand Association of Occupational Therapists. This is indeed an honour to stand before you and give this presentation today.
To arrive at the point of the title of this paper, it is important that I begin by acknowledging what has come before. I will then discuss the notion of a stand for inclusion through the lens of occupational justice, sprinkled with questions for take-home reflection. School-based practice is offered as an exemplar, alongside findings from the author's research in the schooling sector (Simmons Carlsson, 2006; Simmons Carlsson, Hocking, & Wright-St Clair, 2007). Whilst not all occupational therapists work with children and young people whose occupations fall within the roles of student, learner, peer, friend, and player, the hope is that as you read this korero (discourse), you will be able to draw parallels from your own self, where the challenges of inclusion, inclusive practice, and occupational injustices may be similar. Readers are also invited to use this time to reflect on ways in which occupational therapy practice has evolved over time to go forward in one's occupational thinking. First, let me stand and look to past.
The Frances Rutherford Lecture Award
The Frances Rutherford Lecture Award (FRLA) honours the contribution made by Miss Frances Rutherford to the profession of occupational therapy in Aotearoa/New Zealand (Wright-St Claire, Gordon & Wilson, 2007). Born and educated in Wairarapa, Rutherford, described by Boyd, (1984) as a caring and warm person with vision, energy, and commitment, was by all accounts an amazing woman. Her educational achievements included diplomas in the field of fine arts, teaching, and occupational therapy.
Five decades ago, Rutherford was deputy principal of the Auckland-based school of occupational therapy, located in the grounds of old Carrington Hospital. In 1959 she was appointed the third and last principal of the Auckland school (Rutherford, 1998; Hocking, 2005; Penman, 2007) and in 1972, the last batch of Auckland students graduated. Rutherford played a large role in fostering students' enthusiasm for the study of occupational therapy alongside envisioning the future of our profession (Penman, 2007). She also advocated the profession's need for higher learning, a factor realised in the late eighties at the Central Institute of Technology, Heretaunga, Wellington (Hocking, 2005).
As the New Zealand Association of Occupational Therapists (NZAOT) most prestigious award, the FRLA is an acknowledgement of one's contribution to the profession. This award brings with it the solemn responsibility of a gift back to the profession; to share something in return. In doing so, one is always hopeful, if not a tad apprehensive, that what is offered in the presentation will be of consequence, be it small or great. In searching for a pertinent theme, I revisited the previously acknowledged giant's of the profession, all of whom have contributed in some formative way to my own journey thus far. This includes: Merrolee Penman, friend, peer, scholar, and reflective partner; my post-graduate masters thesis supervisors, mentors, and learned scholars Clare Hocking and Valerie Wright-St Claire; my undergraduate coaches Linda Wilson, Beth Gordon, Katy Austen and Mary-Anne Boyd, as well as Diane Henare, Anne Christie, Jill Gooder, and Lyn Shooter. These are some of the profession's national heroes and guiding lights for the profession's journey in Aotearoa/New Zealand.
Of note, Penman (2007) transformed our views of learning, throwing down the gauntlet for us to recognise and value forms of learning other than "listening to an expert" and charging us to place higher value on our own, home-grown experts. Hocking (2005) invited us to look for, foster, celebrate, and reflect on the romance in our everyday practice, revealing how evidence from the past holds the philosophical assumptions that have guided us over time and what this means for the present. Henare (2002) shared how occupational therapists can partner clients in identity building through occupation. Wright-St Claire (2000) challenged us to stop neglecting the notion of caring and to embrace a philosophy of care for motivating good and ethical occupational practice. Shooter (1987) advocated making progress towards a clear definition of occupational therapy as well as defined standards of practice, New Zealand-generated evidence knowledge-base for practice, retention of more home-grown graduates in the workforce, and our becoming a true profession. And as the first recipient, Boyd (1984) cautioned that we each have a responsibility to plan for the future and establish quality assurance in the work setting. As an occupational therapist, I am proud to stand beside these inspirational, energetic, and accomplished women, for they have woven a rich tapestry for our profession. This legacy continues today, ever welcoming of those who are inspired enough to sit beside them at the loom, for however long one may wish to tarry and chat.
For me personally, being the twelfth FRLA recipient is not only a great pleasure, privilege, and honour, it is also a humbling experience to stand before the audience of the biennial NZAOT conference and mark the 12th Frances Rutherford Lecture. This award, however, is not mine to claim alone. The FRLA belongs to all who have mentored, shaped, challenged, and nurtured me along this career path that I and all occupational therapists have chosen: occupational therapy. It also belongs to the many clients whom I have encountered along the way. In reality clients and their families have been my best teachers through allowing me to partner them in mastering their own personal journeys in life. In retrospection, some of the partnering I did well and got right, some perhaps not so well. Lastly, it goes without saying that the award belongs to my family and my early beginnings, without which I would not have shaped into the occupational therapist that I am today.
So, like Penman (2007) in September 2008 it became my turn to add to the profession's rich tapestry, to look forward to welcoming the future, whilst acknowledging the past, and to stand on the shoulders of those who had come before, just as Rutherford saw that each generation of students would stand on the shoulders of those previous. Ironically, I stood to present the FRLA in the very township, or rather city, where I had spread my fledgling wings as a novice occupational therapist in the early 80s.
[FIGURE 1 OMITTED]
It took me six months post-graduation to 'get' what this chosen profession was about. The memory of that day still fresh as I recall the excitement which bubbled up inside of me, whilst walking back to the occupational therapy department along the long corridors of Palmerston North Hospital. That was the day it dawned on me that I was truly "an occupational therapist". This realization came despite the blunders and the uncertainties of the usual 'coming to grips' phase of being a new graduate.
For those who recall, those were still the days of moccasins and basketry, remedial therapy, slow-stream acute-hospital stays, clinic-based rehabilitation, and diversional therapy on orthopaedic wards for young men who really only wanted to be out on the rooftop garden, having a smoke, and swapping stories about their 'spectacular' crashes. They were also times that included Anne Cronin Mosey's 'activity analysis' and 'conscious use of self ', macrame, collage, and even the bicycle fretsaw, as well as the early editions of 'Willard and Spackman's Occupational Therapy' and, not to mention the big shoulder pads, 80's music, and whacky hairdo's.
Occupational therapy today
As a profession, we have come a long way since then, have we not? Particularly with our ability to articulate who we are and what we do. However, what is it that we say about occupational therapy today? Moreover do we stand by what we say? From where I stand, I see that we still have far to go to articulate our professional identity, as we continue to break free of the biomedical shackles that practice seemingly remains embedded. Anne Wilcock (1999) likened this to a medical model-linked 'rut'; the rut being that same old way of doing things: our traditional practice. This rut is all too often hard to break out of because we so know the way of it; frequently cemented because people expect us to be in that rut. Perhaps for some of us, even our own expectations of practice are driven by this rut. For example, people wait in hospital for occupational therapy equipment assessments over the weekend in acute care settings when they could be at home, yet weekend services are still not the norm, nor do we yet hand over the prescription of some equipment to others. Do we not aspire to returning people back to their homes and communities so that they may re-engage with their lives, and if we do, what are we doing about it that is creative and different? Furthermore, we say we see the link between occupation, health, and well-being (more so than anyone else) and yet, do we sit complacent when it comes to primary health care, do we continue to still bemoan our perceived invisibility, rather than act?
The ethnography I conducted two years ago (Simmons Carlsson, 2006) provides many examples of this rut, labelled the 'fix-it' factor:
That 'fix-it' factor ... that traditional model of bringing the client or the patient to you [therapist], you do something to him, and when you are finished doing what you are supposed to be doing to him with your expertise, you will just send him back along [to class] (Simmons Carlsson, 2006, p. 159). [T] referrals to treat the child, to remediate, to 'fix' their hands, to assess visual perceptual problems every year, or every six months for a student's entire schooling period, you know. We need to respond to problems which are functional and occupational and which relate to the child's access to the curriculum and the school environment (Simmons Carlsson, 2006, p. 153).
The notion of 'fixing' conjures up the image of that which is considered 'broken'; of impairment being the primary focus:
I think that [/fixing] has some covert messages in it to the child, and I think those messages are about 'you need fixing' and 'you are not quite right'. It doesn't give a message that 'you will be learning with the other kids, and we will give you things that you can learn, and then you will learn, and then you will feel pleased with your progress, just like everybody else does' ... it's that message to the child and family 'try hard and the deficits will come right'. If I had to go back to doing only remedial work, I would have in the back of my mind, "What's the message for this child about who they are?" (Simmons Carlsson, 2006, p. 153).
The 'bind' of impairment-focussed practice
Such metaphor as the fix-it factor seems so far from where we have come and where we are going as a profession, that is, into "an era of occupational enablement for both occupational therapists and clients, where our future is focused on occupation-based enablement" (Townsend & Polatajko, 2007, p.11). So, I am excited by what our Canadian counterparts offer today in defining the profession:
Occupational therapy is the art and science of enabling engagement in everyday living through occupation; of enabling people to perform the occupations that foster health and well-being; and of enabling a just and inclusive society so that all people may participate to their potential in the daily occupations of life (Polatajko, et al. 2007, p. 27).
Here, enablement is defined as being "the positive form of the term disablement; the creation of the opportunity to participate in life's tasks and occupations irrespective of physical or mental impairment or environmental challenges" (Christiansen & Townsend, 2004, p. 276). Moreover, Townsend and Polatajko (2007) assert that enabling is the core competency of our profession; enabling is what we actually do!
When we engage in the process of enabling we are meant to use skills which are "value-based, collaborative, attentive to power inequities and diversity, and charged with visions of possibility for individual and social change, or both" (Townsend & Polatajko, 2007, p. 367). My question to the profession, however, is: "Do such attitudes as the 'fix-it' factor persist in our profession?" I assert that they do and we must listen and watch for these attitudes. In today's climate of practice, with today's theories to support our practice, we may be cautioned by words as above to see beyond impairment. What are we really saying in our actions as we go about our practice? Moreover, do we, as a profession in Aotearoa/New Zealand, take the same stance about enabling as our Canadian counterparts? Or have we a different stance? As individual occupational therapists do we actually engage in enabling processes, or do we prefer to focus on impairment? Similarly, how do we reflect such notions in our own work settings?
Taking a stand for inclusion: Seeing beyond impairment
In the last decade, or so, much of my own reflexive thinking has been influenced by the settings in which I have worked, which has involved a sometimes contradictory combination of previously ingrained medical model notions with the education model and aspects of environmental, or to be more precise, ecologically-driven practice. Unlike many, I chose to simultaneously straddle both the health sector and the education, compulsory schooling sector. This brought many rich experiences for genuine phenomena of action and conversation; from naive questioning of 'what's it like?' to opinionated perspectives of 'what it should be like' from both sectors.
For the purposes of the paper one can imagine the sectors on a continuum of impairment, activity, and participation (World Health Organisation, 2001) where the health sector frequently starts its focus from the impairment and activity levels. In contrast the education sector starts from the participation and activity levels (personal observation). However, both sectors may slide along the continuum depending on the focus of the individual's worldview, the organizational culture, and the service parameters. To illustrate, from a biomedical perspective, the student with a disability is in 'need of therapy' to address impairments (performance components) that may hinder occupational performance. However, from an education perspective the student is in 'need of education', to be present, participating, and achieving at relationships and learning objectives at school. Nonetheless, whichever end of the continuum one prefers, from an occupational perspective the student has the right to be included, to be a full citizen of the school community, and to participate and engage in school-based occupations to his or her full potential.
Sounds simple, yet therein lays the challenge. Often our take on what is right in practice may be driven by what we unconsciously value as practitioners, despite what our professional body of knowledge may be telling us. If one places high value on remediating impairments then practice may focus on 'fixing' albeit to the detriment of participation. Similarly, if one values interventions that are participation-focussed, the consequence of not tending to the impact of impairment during one's clinical reasoning may be detrimental to the client's life journey. Nonetheless, I am pleased to report that the emerging New Zealand-generated evidence knowledge-base for school-based practice is calling for inclusive practice (Simmons Carlsson, 2006; Hasselbusch & Penman, 2008), and more poignantly, for practice that is occupationally just. And so it should be if we take note of current trends in our practice discourse. For instance, earlier this year, our professional association clearly acknowledged its stand for justice by posing the question in OT Insight: Is our health system fair? Inviting occupational therapists in Aotearoa/New Zealand to "stand up for occupational justice and be heard" (Molloy & Rowland, 2008, p. 4). Whilst there has been some discussion by the profession on the topic, I question whether it has been enough.
Founded on beliefs that recognize humans as occupational beings who participate in occupations as autonomous agents, the term 'occupational justice' was coined by Dr Elizabeth Townsend. Accordingly, the notion asks occupational therapists to consider the inequities which arise when participation in occupations is barred, confined, restricted, segregated, prohibited, undeveloped, disrupted, alienated, marginalized, exploited, excluded or otherwise restricted (Townsend & Wilcock, 2006). As a profession, we are indebted to Townsend and Wilcock (2004a; 2004b; Wilcock & Townsend, 2000; Townsend 2003; Wilcock 2006; 2007a; 2007b), whose thoughtful and endless contributions enlighten us on occupational justice so that we do not become complacent about such issues. In hindsight, ten years ago, when I commenced practising in the compulsory schooling sector, I should have articulated my practice simply as: righting occupational injustice.
Townsend & Wilcock, (2004) assert that occupational justice is based on the following principles: Empowerment through occupation, an inclusive classification of occupations, and enablement of occupational potential, diversity, inclusion, and shared advantage in occupational participation. Moreover, they urge that dialogue about occupational justice is timely as the profession seeks to globally articulate what distinguishes the profession and its contributions to individuals, populations, and societies. As occupational therapists, our viewpoint should be that occupational participation is interdependent and contextual, indeed a determinant of health and quality of life.
Being occupationally just
To practice from an occupational justice framework is to enable clients the right to experience occupation as meaningful and enriching. Further, to develop through participation in occupations for health and social inclusion, to exert individual or population autonomy through choice in occupations, and to benefit from fair privileges for diverse participation in occupations. Lastly, and most importantly, that such right is interpreted in a cultural context (Polatajko, et al. 2007). For instance, in the schooling sector outcomes of occupational justice would be conceptualized as students having their occupational rights met. The occupational therapist's job will be to address outcomes of occupational injustice by enabling change at various levels. This includes from the level of the student through to advocating for change at a classroom and school community level and even a legislative level, and when necessary, to enabling occupational engagement issues at the level of impairment. This is what we are about as occupational therapists, and this is what we must stand for as both individual and as a profession. Today, I feel that we are only beginning to engage in this dialogue here in Aotearoa/ New Zealand. I trust that our collective voice on this issue will be strong. However, are we continuing to focus on impairment and performance components because that is the way we know?
Exemplar: Occupational injustice in the schooling system
It was not so long ago in this country, that students with disabilities had no real right of access to their local school which their peers had, or the national curriculum. One could say that these students were basically excluded and we supported this as a profession and as a society. In some instances, segregation is still supported. Consider the attitude for example, that underlies the statement, "that child should be in a special school, he'd get a better therapy service" (personal communication). Well he might, however, what are we really saying if we unpack these words. More importantly, is that what the child wants?
In Aotearoa/New Zealand the occupational injustice of exclusion was redressed with the 1989 Education Act Amendment (Ministry of Education, 1989), and further reinforced by implementation of Special Education 2000 (MoE, 1996) with its inherent policy focus on inclusion, affording the same right to education in state schools for all students. Sometimes governments do get it right! However, justice does not end with legislation. One must caution that simply placing a student with a disability in a school setting does not signal the achievement of inclusion (MacArthur, Kelly & Higgins, 2005). There must be action, such as working with schools to determine optimal opportunities for students' learning and participation, and at the simplest level ensuring that learning environments are accessible.
To this end, occupational therapists can model the way by enacting behaviours in schools that reflect several key objectives of the New Zealand Disability Strategy (Ministry of Disability Issues, 2001), including the following.
* Contributing to building a non-disabling school society that ensures the rights of disabled students
* Contributing to enabling the provision of quality education and long-term individually-focused support systems for students with disabilities, and
* Enabling disabled children and youth to lead full and active lives in their school and after school communities.
Whether we recognise it as such, or not, the Aotearoa/New Zealand special education policy is a stand for social justice.
Social justice and Aotearoa/New Zealand occupational therapy
Friesen (2007) explored how New Zealanders viewed the concept of social justice and what it meant for New Zealand society, finding that it was still an ambiguous concept. Overall, Friesen found the most basic principles were largely concerned with equality, tolerance, compassion, fairness and participation; the concept of equal worth.
In relation to inclusive practice, part of our job as members of society, and as a profession, is to make inclusion happen, rather than falling back on the age-old attitude of relying on the government to 'do it all', or supporting the status quo. After all as Porter (2007) stated, "community that values justice is built by small and ordinary things that grow into the big and the extraordinary" (p. 6). A socially just society is therefore one which allows everyone to flourish, where everyone is afforded the potential to achieve, to build and to grow, and in which everyone is reminded of the importance of the common good (Menzies, 2007). Perhaps the real question of social justice is, as put by Porter, "What kind of country do we want to live in?" (p. 6). Occupational therapists have a role to play in contributing to the answer ... are we, and is it enough? For instance, how aware is the profession that NZAOT provided a media release on the 'Removal of disparity needed to ensure occupational justice for all New Zealanders' in April this year, followed up by an interview on Close-Up this month? How often have we considered the social, political, economic, and cultural barriers that prevent children and adults with disabilities from becoming equal and fully participating members of society? Let alone extend such consideration beyond people with disability?
Little steps go a long way to realising such things and those occupational therapists who work in schools will attest to this.
I have found that as you work with a school and the team around the child to understand the child, and we put in the adaptations, there is a kind of magical quality, and the child makes very clear gains ... people around the child then stop with those messages of 'why don't you fix them?' They see that they are in a very powerful position; that they can enable occupation; that they can enable participation, and that's what occupational therapy is about. We can be really powerful in teaching other people to let that  happen (Simmons Carlsson, 2006, p. 160).
Key take-home question for reflection
Call me optimistic, I am inspired by the vision of where occupational therapists may potentially go on this path, and I know that NZAOT conference is the very place for signposting the way. However, we also need to do more than attend conference, beginning by staying up-to-date with where our profession is at. It remains to be seen how deeply embedded such notions as social justice and occupational justice are within our actual local practice. This may be of the take-home questions for reflection. Our challenge will be to articulate what such practice looks like in Aotearoa/New Zealand, alongside articulating what actions we may need to take in order to reflect this.
Building occupationally just schools for Aotearoa/New Zealand
Returning to the notion of inclusion and schools, there are of course many opinions and takes on the notion of inclusion in schooling and school-based therapy practice. Inclusion is a complex concept which continues to evolve, often based on personal values and beliefs, structures, policies, processes and practices (MacArthur, Kelly & Higgins, 2005). Indeed, achievement of inclusion in society and school communities will require people to overcome exclusive, disabling, and segregationist practices (Ballard, 1999; 2004; Booth, Ainscow, Black-Hawkins, Vaughan, & Shaw, 2000; Mitchell, 1999). As occupational therapists we have the opportunity to support schools to be inclusive and to enable student participation, the end result of inclusive practice being a student whom the school and the people in the school fully value as a learner, peer, and active participant in school life and community (MacArthur, Kelly & Higgins, 2005). That is, the student is an integral member, or citizen of his or her class and school community, learning and participating alongside their peers, like any other student, viewed as a person and learner first.
The process of inclusion is facilitated by asking not whether to include a child, but rather how to include a child (Service Leaders, Inclusive Services, 2001). On my part, my experiences with students in the compulsory school sector has taught me to stand for inclusion, moreover to act as an agent and negotiator, or broker, for inclusion in school settings, framed within the discourse of social justice and occupational justice. I am not alone in this standpoint, locally and globally (Cantin, 2007; Kramer-Roy, 2005). Not surprising therefore, one of the significant findings that emerged from my study revealed that the practice of the 13 participating therapists is strongly embedded in inclusion philosophy and collaborative practice; deeply imbued with the vision of building an inclusive society; and expressed through practice-based actions that enable building inclusive schools, occupational participation, and occupational achievement (Simmons Carlsson, 2006; Simmons Carlsson, Hocking & Wright-St Claire, 2007). Practice founded on such ethos goes far in realising the profession's movement towards a future focused on occupation-based enablement, alongside practice that aligns with the objectives of the Disability Strategy (MoDI, 2001) whilst pursuing social justice in New Zealand. I have long been inspired by the passion with which these therapists strive to assist students to do what they need and want to do in schools, their ethos (see Figure 2) and value system rings through the findings of the study as being organisationally embedded, situated within a greater discourse than that of 'doing therapy', and learnt through a process of acculturation (Simmons Carlsson, 2006).
I applaud these occupational therapists for it is not an easy task to stand against the wind and rain of traditional practice past, nor the expectations of those around them. Over time, and through experiences, these occupational therapists have shifted their practice towards the domain of occupational justice, for some brought about by the press of legislative policy for social justice, but equally because they took a stand to question historically established school-based practices. In doing so, they came to conclude that traditional practice did not best support occupational outcomes in school contexts. In coming to this realisation, so too did they realise that this could not happen unless environmental factors were addressed, including the social, cultural and political layers of school communities, the organisation of employment, and one could argue, society in general. Practice must pivot around enabling processes that allow students the right to access schooling, the right to participate in the curriculum, and the right to participate in the social structure of school life. The view is one of beyond impairment, injury, disease, or disorder and the focus is on intervention that enables the occupations that are important to students. Practice, is concerned with occupation, participation, meaning, social identity, health and well-being, supporting students' occupational goals and aspirations, and occupational achievement. So, is the key discourse for today's practice in schools and other settings addressing such issues as rights for children and young people with disabilities, including occupational rights?
[FIGURE 2 OMITTED]
Where to from here?
It is timely that we wake to questions such as these, regardless of practice setting and advocate for equality of citizenship, stand against discrimination, exclusion, and oppression of people with disabilities (Nielson, 2005) and without disabilities ... that we stand as a profession for inclusion.
Enabling occupational justice
Only five years ago in a presentation titled 'Occupational justice: Ethical, moral and civic principles for an inclusive world' Townsend (2003) asked her audience to consider some questions about occupational therapy processes of practice, and I believe we need to do this too, as these questions remain valid for our consideration:
What can we do? How can we work? and why are we practicing occupational therapy? With a global perspective on occupational justice, how can our local participation in daily life, our ordinary, taken-for granted processes of living in an environment, be used to change the world? How do occupational therapists work for justice? (Townsend, 2003, p. 14)
These are wise questions for us to consider in Aotearoa/New Zealand, evidenced by recent activity on the NZAOT Special Interest Group Listserves: the chats about inclusion on the Children & Young Persons SIG, the politically-imbued questions around changes within ACC. Mace's (2008) recent article in OT Insight on what we can offer primary health care, the issue of equity for illness; the plight of refugees settling into New Zealand, and not withstanding the complexity of issues surrounding the Treaty of Waitangi, to name but a few. And at a global level, the recent United Nations Development Programme (UNDP) blog on 'Inclusion and Disability' where questions raised included 'Are persons disabled or is society disabling?' We can no longer practice as occupational therapists without taking note of both local and global perspectives and of legislation that impacts on our reason for being.
Enabling human rights
In fact, this has been said not so long ago by Wilcock (2007b). To reiterate Wilcock's caveat ... as a profession we cannot continue to close our eyes to the United Nations Convention on Rights of Persons with Disabilities. Nor can we close our eyes to the World Federation of Occupational Therapy (WFOT) Position Statement on Human Rights (2006), or the New Zealand Disability Strategy. As occupational therapists I believe we need to up our game when it comes to social, cultural, and political awareness. We cannot ignore the building of a just and inclusive society, and we must see beyond impairment.
The World Federation of Occupational Therapists (WFOT) Position Statement on Human Rights (WFOT, 2006), endorses the Nations Declaration of Human Rights and clarifies the WFOT's stance on human occupation and participation. It is downloadable from the WFOT website ... but you will have to hunt for it and up until this presentation there was no direct link to the statement from the NZAOT website. Given where we are in defining our domain of concern today, with occupational justice and occupation at the heart, this is the very thing that needs to be brought to the forefront.
The WFOT stance recognises the rights of people to participate in a range of occupations, including civic, educative, productive, social, creative, spiritual, and restorative. The principles include the right for people to be supported to participate in occupation; to be included and valued as members of family, community, and society; and to have the right to choose for themselves. This is underpinned by the valuing of difference and diversity; acknowledging abuses of rights such as economic, social or physical exclusion through attitudinal or physical barriers, or control of access. The stance also acknowledges global conditions that threaten the right to occupation, such as poverty, diseases, social discrimination, displacement, disasters, armed conflict, as well as the impact from cultural beliefs and customs, local circumstances, and institutional power and practices. Furthermore, the WFOT assert that we as occupational therapists have a role and responsibility to: develop and synthesize knowledge to support participation, identify and raise issues of occupational barriers and injustices, and work with groups, communities and societies to enhance participation in occupation for all persons.
Tidying up our own back yard
My question to myself, and to you, is: Are we carrying out these roles and responsibilities? If we are, is it being articulated explicitly and consistently in our everyday practice, and to whom? For instance, what are we doing to work to the WFOT position paper? Where is our own home-grown position paper? How can we creatively embrace the role of occupation in social health? What are we doing about health promotion and enabling people to gain control over their personal wellbeing through meaningful activity? Are we lobbying managers and government sufficiently to recognise our expertise in occupation and enabling people to perform the occupations that foster health and well-being? Have we yet gone beyond the realms of impairment, disease processes, and physical rehabilitation? Or, have we still got one foot in the rut?
In conclusion, I believe such reflection as raised by the content and questions in this paper is vital and should become part of our everyday practice discourse and actions, not just the stuff of inservices, or notions reserved for the post-graduate student. As put by Wilcock (2007a), occupational therapists need only be true to their own rhetoric which embraces words and concepts such as occupation, participation, empowerment, sharing, choice, fulfilment, growth, satisfaction, opportunity through meaningful, purposeful and diverse occupations; and enabling the right to occupations that are specific to individual needs, with attention to the participatory and cultural nature of occupations. Do we truly focus on the everyday things people do so that they may live the life they want? Do we do so beyond our focus on disability?
If we are to reflect on the notion of occupational justice, it is not long before we see that as a profession this is what we stand for, couched within a bigger picture of social justice. We can no longer bury our heads in the sand. We must stand for building an inclusive society. That is we must each take a stand for inclusion, and see beyond impairment. The future of occupational therapy is in our hands. It is that simple. Take a stand for the society you want to live in. Our time to act is now.
To end, I offer this from Goethe:
Knowing is not enough; we must apply. Willing is not enough; we must do.
And from me, more questions:
* What will you apply from the twelfth Frances Rutherford Lecture?
* What will you do tomorrow, the next day, the next week, and the next year towards building an inclusive society?
* Are you ready? If not, why not? No reira, tena koutou, tena koutou, tena koutou katoa.
Kia Ora / Malo!
Therefore greetings to you all. Thank you.
Ballard, K. (Ed.). (1999). Inclusive education: International voices on disability and justice. London: Palmer Press.
Ballard, K. (2004). Children and disability: Special or included? Waikato Journal of Education, 10, 1-11.
Booth, T., Ainscow, M., Black-Hawkins, K., Vaughan, M., & Shaw, L. (2000). Index for inclusion: Developing learning and participation in schools. Bristol: Centre for Studies on Inclusive Education.
Boyd, M. (1984). The 1984 Frances Rutherford Lecture. Quality assurance in occupational therapy. New Zealand Journal of Occupational Therapy, 35(2), 3-11.
Cantin, N. (2007) Practice exemplar 7.1: Enabling school-based competence. In E. A. Townsend, & H. J. Polatajko (Eds.). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, and justice through occupation (pp. 191-193). Ottawa, Ontario: CAOT Publications.
Christiansen, C. H., & Townsend, E. A. (2004). Introduction to occupation: The art and science of living. NJ: Prentice Hall.
Friesen, M. (2007). Perceptions of social justice in New Zealand. In R Porter (Ed.). Pursuing social justice in New Zealand (pp. 145-161). Auckland: Maxim Institute.
Hasselbusch, A., & Penman, P. (2008). Working together: An occupational therapy perspective on collaborative consultation. Kairaranga, 9(2), 24-31.
Henare, D. (2003). The 2002 Frances Rutherford Lecture. "It just isn't me anymore". Moving forward to new identity. New Zealand Journal of Occupational Therapy, 50(1), 4-10.
Hocking, C. (2005). The 2004 Frances Rutherford Lecture. Evidence from the past. New Zealand Journal of Occupational Therapy, 52(1), 4-16.
Kielhofner, G. (2005). Rethinking disability and what to do about it: Disability studies and its implications for occupational therapy. American Journal of Occupational Therapy, 59(5), 487-96.
Kramer-Roy, D. (2005). Inclusive education in Pakistan: An occupational therapist's contribution to teacher education. In F. Kronenberg, S. S.
Algado, & N. Pollard, (Eds.). Occupational therapy without borders. Learning from the spirit of survivors (pp. 326-335). Edinburgh: Elsevier Churchill Livingstone.
MacArthur, J., Kelly, B., & Higgins, N. (2005). The learning and social experiences of students with disabilities: What does the research say? In D. Fraser, R. Moltzen, & K. Ryba (Eds.), Learners with special education needs in Aotearoa New Zealand (3rd ed., pp. 49-73). Southbank, Victoria: Thomson Dunmore Press.
Mace, J. (2008). Developing opportunities for occupational therapists in primary health organisations in New Zealand. OT Insight, 29(6), 1-5.
Menzies, P. (2007). Putting business in its place. In R. Porter (Ed.). Pursuing social justice in New Zealand (pp. 81-90). Auckland: Maxim Institute.
Ministry of Disability Issues. (2001). The New Zealand Disability Strategy: Making a world of difference. Whakanui Oranga. Wellington, NZ: Author.
Ministry of Education. (1989). Education Act 1989: Rights to primary and secondary education: Special education. Wellington, NZ: Author.
Ministry of Education. (1996). Special Education 2000. Wellington, NZ: Author.
Mitchell, M. (1999). Special education in New Zealand: A decade of change. Special issue: A decade of reform in New Zealand. Where to now? New Zealand Journal of Education Studies, 34(11), 199-210.
Molloy, S., & Rowland, E. (2008). Is our health system fair? OT Insight, 29(3), 1-4.
Neilson, W. (2005). Disability: Attitudes, history and discourses. In D. Fraser, R. Moltzen, & K. Ryba (Eds.), Learners with special education needs in Aotearoa New Zealand (3rd ed., pp. 9-21). Southbank, Victoria: Thomson Dunmore Press.
New Zealand Association of Occupational Therapists. (2008). Removal of disparity needed to ensure occupational justice for all New Zealanders. June 6, 2008 from http://www.nzaot.com/downloads/contribute/ NZAOTMediareleaseApril08OccupationalJusticeFINAL.pdf
Penman, M. (2007). The 2006 Frances Rutherford Lecture. Transforming views of learning: Connecting professional conversations. New Zealand Journal of Occupational Therapy, 54(2), 4-15.
Polatajko, H. J., Davis, J., Stewart, D., Cantin, N., Amoroso, B., Purdie, L., & Zimmerman, D. (2007). Specifying the domain of concern: Occupation as core. In E. A. Townsend & H. J. Polatajko (Eds.). Enabling occupation II: Advancing an occupational therapy vision for health, well being, & justice through occupation. Ottawa, ON: CAOT Publications.
Porter, R. (2007). Pursuing social justice in New Zealand. Auckland: Maxim Institute.
Rutherford, F. (1998). As the chrysalis becomes the butterfly. The Frances Rutherford Lecture Award. Retrieved August 12, 2008 from www. nzaot.com
Service Leaders, Inclusive Services, Specialist Education Services. (2001). Inclusion by design: Taking "special" out of education. Consultation Response. Wellington, New Zealand: Specialist Education Services.
Shooter, L. (1987). Our consumers, our practice, ourselves. New Zealand Journal of Occupational Therapy, 38(1), 3-10.
Simmons Carlsson, C. (2006). The 'culture of practice' of Ministry of Education, Special Education occupational therapists and physiotherapists. Unpublished master's thesis, Auckland University of Technology, Auckland, New Zealand.
Simmons Carlsson, C., Hocking, C, & Wright-St Clair, V. (2007). The "why" of who we are. Exploring the "culture of practice" of Ministry of Education, Special Education occupational therapists and physiotherapists. Kairaranga 8(2), 6-14.
Townsend, E. (2003). Occupational justice: Ethical, moral and civic principles for an inclusive world. Paper session presented at European Network of Occupational Therapy Educators Annual Meeting, Prague, Czech Republic.
Townsend, E. A., & Polatajko, H. J. (Eds.). (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, and justice through occupation. Ottawa, Ontario: CAOT Publications.
Townsend, E. A. & Wilcock, A. (2004). In C. H. Christiansen & E. A. Townsend (Eds.). Introduction to occupation. The art and science of living. NJ: Prentice Hall.
Townsend, E., & Wilcock A. A. (2004). Occupational justice and client-centred practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71(2), 75-87.
United Nations. (December 13, 2006). Convention on the rights of persons with disabilities. New York: Author.
Wilcock, A. A. (1999). Reflections on doing, being and becoming. Australian Occupational Therapy Journal, 46(1), 1-11.
Wilcock, A. A. (2006). Reflections as I contemplate retirement. OT Insight, 27(5), 1-4.
Wilcock, A. A. (2007a). Active ageing: Dream or reality? New Zealand Journal of Occupational Therapy, 54(1), 15-20.
Wilcock, A. A. (2007b). Why I can no longer think of myself as an occupational therapist. OT Insight, 28(1), 12-15.
Wilcock, A. A. & Townsend, E. (2000). Occupational justice. Journal of Occupational Science, 7(2), 84-86.
World Federation of Occupational Therapists. (2006). Position statement on human rights. Retrieved May 12, 2008 from http://www.wfot.org/ office_files/Human%20Rights%20Position%20Statement%20Final% 20NLH%281%29.pdf
World Health Organisation. (2001). International classification of functioning disability and health. Retrieved June 15, 2008 from http://www.who.int/classifications/icf
Wright-St Clair, V. (2001). The 2000 Frances Rutherford Lecture. Caring: The moral motivation for good occupational therapy practice.
Australian Occupational Therapy Journal, 48, 187-199 Wright-St Claire, V., Gordon, B., & Wilson, L. (2007). The occupational therapy profession pays tribute to Miss Frances Rutherford. OT Insight, 27(11), 1-4.
Carolyn Simmons Carlsson MHSc (Hons) NZROT
Professional Leader--Occupational Therapy
Allied Health, Physical Health Services
Auckland District Health Board
Address for Correspondence:
Allied Health Management--Physical Health Services
Level 11, Support Building
Auckland City Hospital
Private Bag 92024