Driving Social Change: Occupational Therapists ...

Driving Social Change: Occupational Therapists’ Contributions to Occupational Justice Clare Hocking1 , Elizabeth Townsend 2 1

Auckland University of Technology, Auckland 1142, New Zealand, 2University of Prince Edward Island, Charlottetown, PE C1A 4P3, Canada The World Federation of Occupational Therapists Position Statement on Human Rights frames the contribution that occupational therapists make to society in terms of promoting participation and inclusion for all people. Reaching beyond accepted practice, where bodily concerns are often the focus, this commentary draws on accounts of practice shared in the literature and at human rights workshops internationally. It outlines proposed revisions to the Minimum Standards for the Education of Occupational Therapists to incorporate human rights, by having every curriculum address what occupational therapists will do to advance occupational justice. This will be achieved as each of us recognises that justice is fundamental to an occupational perspective of health, and take up a “can do” attitude to promoting human rights in everyday practice. Keywords: Human rights, Inclusion, Scope of practice, Critical reflection, Education

Introduction The World Federation of Occupational Therapists (WFOT) Position Statement on Human Rights (2006) is responding to and galvanizing occupational therapists’ interests in human and occupational rights and making connections with occupational justice (Durocher, Rappolt, & Gibson, 2014a, 2014b; Hammell, 2014, 2015; Stadnyk, Townsend, & Wilcock, 2010; Townsend & Sandiford, 2012). The position statement expresses concerns about the occupational restrictions that exclude some groups and populations from full citizenship participation in society, and excludes them from the potential benefits of occupational therapy practices. Following up on Wendy Bryant’s Guest Editorial on human rights and occupational therapy (Bryant, 2010), our commentary shares occupational therapists’ stories from workshops on human rights, occupational justice and social change around the world, including at the WFOT Congress 2014 in Yokohama. Our discussion is intended to be both an endorsement and a stimulus for occupational therapists to ‘see’ opportunities for driving social change when we encounter Correspondence to: Clare Hocking, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand. Email: [email protected] Beyond the scope of this Commentary, the authors encourage discussion of links and differences between concepts often used without critique as interchangeable: human rights, social change, occupational justice, and inclusion.

© World Federation of Occupational Therapists 2015 DOI 10.1179/2056607715Y.0000000002

human rights and occupational justice issues in any context. As co-chairs of the WFOT International Advisory Group (IAG) on Human Rights, we as authors have been encouraged by occupational therapists who believe ‘we can do it’ – that as a collective force this profession can do a lot to drive social change. Evidence for this social change ‘can do’ stance by some if not all occupational therapists seems to be growing in collective initiatives, such as the International OOFRAS Network (see Facebook and Twitter) and Occupational Therapy without Borders (see Facebook, website and more). Such initiatives show how to stretch beyond the work of individual occupational therapists who can offer positive attention to human rights and occupational justice in contexts where practice is individualized.

A ‘Can Do’ Attitude to Driving Social Change Although we believe that occupational therapists have potential to drive social change, the reality is that practice in some contexts has overlooked human and occupational rights, accepted body-based more than human rights concerns, or complied with a limited scope of practice (Hammell, 2014). Yet when societies (and professions, including occupational therapy) have the power to address problems that disadvantage particular groups, but fail to do so, that is a human rights issue in itself (Venkatapuram, 2011). With a caution for us all in occupational therapy to be critically

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therapy shows that social change is occurring, one hopes with encouragement from occupational therapists. It is no longer true, for example, that becoming an ‘invalid’ automatically relegates people to the edges of society (Marquand, 1951). Rather, marginalisation is now recognised as a dynamic state that can be addressed (Duncan & Creek, 2014). In addition, we no longer accept societal assumptions that after a stroke, people will be unable to do anything; life is over (Cooksey, 1954). Women ‘crippled’ with chronic heart disease or arthritis no longer face having their children placed in orphanages because they are thought incapable of caring for them (Cooksey, 1954). One person at a time and sometimes collectively, occupational therapists and others have set out to make a difference. In occupational therapy, there is an opportunity to work with excluded groups to remove practical barriers, discover creative options for participation, and otherwise create societies that are more occupationally and socially inclusive.

reflective, let us consider stories and a sampling of literature on what occupational therapists can do and what some occupational therapists are already doing. Readers are invited to reflect critically on these examples of a can do stance, individually and collectively exploring different perceptions of what it might mean in various practice contexts. • When occupational therapists enable people to be safe in their homes, and assist them to develop the capabilities to participate in education, work, shops, leisure pursuits and places of worship, we are driving social change to affirm human rights (Hammell, 2015). • With consciousness for attending to diversity, occupational therapists can be major players in counteracting social, economic and physical barriers to participation and inclusion (CAOT, 2014). • In the development of meaningful, long-standing, respectful partnerships with disability rights movements, mental health movements, movements to address addictions, homelessness, incarceration and more, occupational therapists can expand initiatives for social change (Galvaan, Mdlokolo, & Joubert, 2010). • Activist occupational therapists are inventing occupation-focused, human rights initiatives in primary health care, social support programming, employment preparation and more (Townsend & Marval, 2013). • Occupational therapists can enable social change by creating the conditions that prepare the way, ideally with not for people with disabilities, to come out of care homes and escape the institutions that, in previous eras, were established to look after them but segregated them from society (Venkatapuram, 2011). • Changing approaches from institutionalization to community integration means that occupational therapists can help people to realise and claim their capacity to live in the community, for instance by enabling home modifications and social integration (Thomas, Gray, & McGinty, 2010). • In workplaces around the world, occupational therapists have shown that people with disabilities and others who are questioned in the workforce can do paid work despite challenging health and social conditions (Rebeiro Gruhl, 2010). • Occupational therapists who are enlightened by an analysis of social difference can work with schools to make them more accessible, inclusive and welcoming for diverse students (Angell, 2014). • When addressing global concerns about what people do each day, occupational therapists link occupational therapy to the global, ecological crisis (Hocking & Kroksmark, 2013; Hudson & Aoyama, 2008; Ikiugu, 2008; Simó Algado & Townsend, 2015).

Occupation and Human Rights Occupational therapists can also look to global bodies with similar interests. The United Nations’ (UN) Universal Declaration of Human Rights (1948) points to realms of everyday life where occupational therapists actively work to secure the rights of people with disabilities and other challenges. The stories above and others told in workshops point to occupational therapists who are supporting freedom of movement (Article 13), the ability to express opinions (Article 19), access to education (Article 26), working in “favourable” conditions (Article 23), rest and leisure (Article 24) and the cultural life of the community (Article 27). Similarly, with reference to the UN’s Convention on the Rights of the Child (1989), occupational therapists who work with children and families have told stories of enabling survival and developmental needs (Article 6), giving the child’s views due weight (Article 12), supporting their access to information and ideas (Article 13), and supporting families to keep their children in the family environment (Article 20). Where human rights and occupational justice interests prevail, occupational therapists have told stories of practices to ‘recognize that a mentally or physically disabled child should enjoy a full and decent life, in conditions which ensure dignity, promote self-reliance and facilitate the child’s active participation in the community’ (Article 23) and to help make it possible for children to enact their right to education (Article 28). Critically reflective occupational therapists ‘can do’ that work ‘without discrimination of any kind, irrespective of the child’s or his or her parents’ or

Historical Contribution to Social Change Beyond occupational therapy stories and a growing body of literature, history outside occupational

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legal guardian’s race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, birth or other status’ (Article 2) and make ‘the best interests of the child … a primary consideration’ (Article 3).

Enacting a Human Rights Agenda In short, occupational therapists can and in some instances are already serving society by enacting a human rights agenda. Occupational therapy efforts have, historically speaking, been largely confined to health settings, working with people who have a diagnosed health condition. However, in many regions of the world, the profession’s scope is now expanding or being enacted to encompass more diverse needs and broader issues evident in society, including poverty, obesity, the challenges faced by immigrants and refugees, and the legacy of colonisation for aboriginal or indigenous populations. That work is supported by an expanding literature on occupational justice, which helps us to understand justice and human rights from our unique perspective and, ideally, is focused on occupations in collaborative practices that are ‘client-centred’ with communities, not only with individuals. The idea of occupational justice rests on the conviction that participation in culturally meaningful occupation is the foundation of health and well-being, and the knowledge that “odious and health-depleting occupations are unfairly apportioned across different groups in society” with some groups unfairly “excluded from beneficial occupations” (Wilcock & Hocking, 2015, p. 392). These ideas are embedded in the WFOT Position Paper on Human Rights (2006). The seven principles in the original Position Paper have now been refined into four succinct claims (Stadnyk, Townsend, & Wilcock, 2010): • Right 1: Participation in a range of occupations for health, development and social inclusion • Right 2: Choices for shared decision-making power in daily life • Right 3: Experiences with meaning and enrichment in one’s occupations • Right 4: Privileges enabling the opportunities and resources needed for diverse participation in a range of occupations.

Reflecting on these claims reveals how fundamental occupational justice is to human health, development and social inclusion. It reveals that occupational injustices are important, not least because like other social injustices they have “serious consequences for society as a whole, undermining social cohesion, a sense of personal safety, and economic well-being … occupational injustices waste human potential, create health burdens and, when perpetuated by entrenched attitudes,

institutional racism and the like, plant the seeds of social unrest” (Wilcock & Hocking, 2015, p. 392).

Reforming Occupational Therapy Education Occupational therapists’ widespread failure to conceptualise their work as enacting occupational justice is, at least in part, due to the profession’s educational curricula. Despite notable founders of the profession in the UK and USA being social activists, occupational therapy students have not been universally sensitised to occupational justice issues nor routinely taught about justice, activism and social change theories. Rather, the profession has tended to follow along, responding to new possibilities as they arise rather than identifying and asserting the need to challenge inequitable access to occupation. Occupational therapists who actually make change are to be congratulated, but how much more might we achieve if we bring knowledge of human rights to everyday occupational therapy practices? Acting upon our belief that occupational justice is an important piece of the dialogue about achieving health for all, we approached WFOT as the co-chairs of its International Advisory Group: Human Rights (IAG:HR). Our proposal was that the next revision of WFOT’s Minimum Standards for the Education of Occupational Therapists incorporates a human rights perspective. We argued that moving in that direction is consistent with documents published by the United Nations and the World Health Organization, which position health and well-being as human rights (WHO, 2002), emphasise health equity by addressing the social determinants of health (WHO, 2008), and declare that all educational programmes, from pre-school to higher education, must incorporate and teach about human rights (UN, 2012). We received funding to convene a working group in 2012, to sketch out what infusing human rights into the Minimum Standards might mean. Together with Sandra Galheigo and Jose Naum de Mesquita Chagas from Brazil, Lena-Karin Erlandsson from Sweden, and Samantha Shann from the UK, we considered how and where the standards should reflect the profession’s emerging commitment to human rights and occupational justice. The main outcome was identification of a new standard: that all occupational therapy educational programmes would state their commitment to societal change. Adopting that standard would mean that programmes would be required to identify key issues of human rights and occupational injustice in their context, set goals for change, give increased attention to human rights in all educational activities, orient educators to human rights education and diversity, and support fieldwork placements with a human rights focus (IAG:HR, 2012).


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Hammell, K. W. (2015). Quality of life, participation and occupational rights: A capabilities perspective. Australian Occupational Therapy Journal, 62(2), 78–85. doi:10.1111/ 1440-1630.12183. Hocking, C., & Kroksmark, U. (2013). Sustainable occupational responses to climate change through lifestyle choices. Scandinavian Journal of Occupational Therapy, 20, 111–117. doi:10.3109/11038128.2012.725183. Hudson, M. J., & Aoyama, M. (2008). Occupational therapy and the current ecological crisis. British Journal of Occupational Therapy, 71, 545–548. Ikiugu, M. N. (2008). Occupational science in the service of Gaia: An essay describing the possible contribution of occupational scientists to the solution of prevailing global problems. Baltimore: Publish America. International Advisory Group: Human Rights. (2012). Draft International Guidelines for the Education of Occupational Therapists – 2014. Auckland: Author. Marquand, H. Rt. Hon. (1951). Opening address. Occupational Therapy, 14(4), 190–196. Rebeiro Gruhl, K. (2010). The employment rights of people with serious mental illness in Ontario: Considering the influence of dominant ideology on marginalizing practices. WFOT Bulletin, 62, 33–39. Simó Algado, S., & Townsend, E. A. (2015). Eco-social occupational therapy. British Journal of Occupational Therapy, 78(3), 182–186. doi:10.1177/0308022614561239. Stadnyk, R. L., Townsend, E. A., & Wilcock, A. A. (2010). Occupational justice. In C. H. Christiansen & E. A. Townsend (Eds.), Introduction to occupation: The art and science of living (2nd ed., pp. 329–358). Upper Saddle River, NJ: Pearson Education. Thomas, Y., Gray, M., & Ginty, S. (2010). Homelessness and the right to occupation and inclusion: An Australian perspective. WFOT Bulletin, 61, 19–25. Townsend, E. A., & Marval, B. (2013). Can professionals enable occupational justice? Occupational Therapy Journal. Federal University of São Carlos (Cadernos de Terapia Ocupacional da Universidade Federal de São Carlos), 21, 215–228 (English; Portuguese: pp. 229–242). Townsend, E. A., & Sandiford, M. (2012). Reaching out: Today’s activist occupational therapy. Beachwalker Films, Inc. Full version: http://youtu.be/LIcfyQ3RwT0, Short version: http ://youtu.be/_RXL4V505Bw. United Nations. (1989). Convention on the Rights of the Child. Geneva: Office of the High Commissioner for Human Rights. Available from http://www.ohchr.org/EN/ProfessionalInter est/Pages/CRC.aspx. United Nations. (1948). Universal Declaration of Human Rights. Geneva: Office of the High Commissioner for Human Rights. Available from http://www.ohchr.org/en/udhr/pages/intro duction.aspx. United Nations. (2012). Declaration on Human Rights Education and Training. A/RES/66/137. Available from: http://www.un .org/documents/instruments/docs_en.asp. Venkatapuram, S. (2011). Health justice: An argument from the capabilities approach. Cambridge, UK: Polity. Wilcock, A. A. & Hocking, C. (2015). An occupational perspective of health. Thorofare, NJ: Slack. World Federation of Occupational Therapists. (2006). Position Paper: Human Rights. Available from http://www.wfot.org/ ResourceCentre.aspx. World Health Organization. (2002). 25 questions & answers on health and human rights. Health & Human Rights Publication Series, 1, 1–32. World Health Organization Commission on Social Determinants of Health. (2008). Closing the gap in a generation: Health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva: WHO.

Our vision, in championing this educational reform, is that clearly articulated occupational justice goals would inform graduates, employers, society and governments of the skills and capacities occupational therapists can bring to the workplace. More than that, it would position occupational therapists as champions of occupational justice. If the revisions drafted in 2012 are adopted, it will require a radical re-thinking of the drivers of occupational therapy education and practices. Fulfilling that potential will mean thinking beyond the severity of an individual’s bodily issues when decisions are made about whose needs to prioritise and what ought to be done. It will mean looking at the social conditions that determine which groups carry the burden of ill-health and who is likely to have a poor health outcome. Thinking about justice will also prompt occupational therapists to consider who we need to partner with to achieve change. Perhaps we will re-think how and where occupational therapy services need to be targeted and what those services will look like. Being conscious of human rights violations and occupational injustice as drivers of occupational therapy intervention might also prompt the profession to measure, in some way, its impact on creating inclusive and participatory societies.

References Angell, A. M. (2014). Occupation-centered analysis of social difference: Contributions to a socially responsive occupational science. Journal of Occupational Science, 21(2), 104–116. doi: 10.1080/14427591.2012.711230. Bryant, W. (2010). Global voices, local lives: Human rights and occupational therapy. WFOT Bulletin, 62, 5–6. Canadian Association of Occupational Therapists. (2014). Joint position statement on diversity. Ottawa: CAOT. Retrieved from http://www.caot.ca/default.asp?pageid=4294. August 24, 2014. Cooksey, F. S. (1954). Rehabilitation of the disabled housewife. Occupational Therapy, 17(4), 133–144. Duncan, E. M., & Creek, J. (2014). Working on the margins: Occupational therapy and social inclusion. In W. Bryant, J. Fieldhouse, & K. Bannigan (Eds.), Creek’s occupational therapy and mental health (5th ed.). London: Churchill Livingstone. Durocher, E., Gibson, B. E., & Rappolt, S. (2014a). Occupational justice: A conceptual review. Journal of Occupational Science, 21(4), 418–430. doi:10.1080/14427591.2013.775692. Durocher, E., Rappolt, S. & Gibson, B. E. (2014b). Occupational justice: Future directions. Journal of Occupational Science, 21(4), 431–442. doi:10.1080/14427591.2013.77569. Galvaan, R. L., Mdlokolo, P. M., & Joubert, R. J. (2010). Developing partnerships to privilege participation. In M. Curtin, M. Molineux & J. Supyk-Mellson (Eds.), Occupational therapy and physical dysfunction: Enabling occupation (6th ed., pp. 281–296). United Kingdom: Churchill Livingstone Elsevier. Hammell, K. W. (2014). [Editorial] Participation and occupation: The need for a human rights perspective. Canadian Journal of Occupational Therapy, 82(1), 4–5. doi:10.1177/ 0008417414567636.

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