https://ebookmass.com/product/program-development-and-grantwriting-in-occupational-therapy-making-the/
Instant digital products (PDF, ePub, MOBI) ready for you
Download now and discover formats that fit your needs...
The Intentional Relationship Occupational Therapy and Use of Self: Occupational Therapy and the Use of Self 1st Edition, (Ebook PDF)
https://ebookmass.com/product/the-intentional-relationshipoccupational-therapy-and-use-of-self-occupational-therapy-and-the-useof-self-1st-edition-ebook-pdf/ ebookmass.com
Conditions in Occupational Therapy: Effect on Occupational Performance 5th Edition, (Ebook PDF)
https://ebookmass.com/product/conditions-in-occupational-therapyeffect-on-occupational-performance-5th-edition-ebook-pdf/
ebookmass.com
The Everything Grant Writing Book Nancy Burke
https://ebookmass.com/product/the-everything-grant-writing-book-nancyburke/ ebookmass.com
Tratado de Fisiologia Médica, 13ª Edição John E. Hall & Arthur C. Guyton
https://ebookmass.com/product/tratado-de-fisiologia-medica-13a-edicaojohn-e-hall-arthur-c-guyton/
ebookmass.com
Hope Behind Bars: Notes from Indian Prisons Sanjoy Hazarika (Editor)
https://ebookmass.com/product/hope-behind-bars-notes-from-indianprisons-sanjoy-hazarika-editor/
ebookmass.com
Fundamentals of Body MRI 2nd Edition Christopher G. Roth
https://ebookmass.com/product/fundamentals-of-body-mri-2nd-editionchristopher-g-roth/
ebookmass.com
50 Years of Central Banking in Kenya Patrick Njoroge
https://ebookmass.com/product/50-years-of-central-banking-in-kenyapatrick-njoroge/
ebookmass.com
Bunka Fashion Series Garment Design Textbook 1Fundamentals of Garment Design Bunka Publishing Bureau
https://ebookmass.com/product/bunka-fashion-series-garment-designtextbook-1-fundamentals-of-garment-design-bunka-publishing-bureau/
ebookmass.com
Liquid-Gas and Solid-Gas Separators 1st Edition Jean-Paul Duroudier
https://ebookmass.com/product/liquid-gas-and-solid-gas-separators-1stedition-jean-paul-duroudier/
ebookmass.com
Lo que nadie nos dijo de Jerry Hancock Alexander Wickner
https://ebookmass.com/product/lo-que-nadie-nos-dijo-de-jerry-hancockalexander-wickner/
ebookmass.com
Foreword
ThisisthefirsttimeIhavebeenaskedtowriteaforewordforabook,andI amdelightedforthreemainreasons.First,thebookiswrittenbyoneofmy formeroccupationaltherapystudentsattheUniversityofSouthAlabama.I knewherthenasJoyVoltz,andIhavefollowedhercareerinoccupational therapywithgreatinterest,pride,andadmiration.
Secondly,Iamevenmorepleasedbecauseshehaschosentowriteabout communitypracticeinoccupationaltherapy,atopicnearanddeartomy heart.WhenIwasanoccupationaltherapystudentatVirginiaCommonwealthUniversity,Dr.GaryKielhofnernurturedmyinterestincommunity practice.NowIamthrilledtopassthetorchtoJoy.IfinsomesmallwayI enhancedherattractionandcommitmenttocommunitypractice,Iam honored.
Finally,thebookitselfiswonderful,academic,andwellresearched,aswell aspracticalanduseful.Thebookcoversthenutsandboltsofcommunity assessment,programdevelopment,grantwriting,andprogramevaluation. Thecontentreflectstheauthor’sextensiveexperienceincommunity-based practiceandtheavailableevidenceintheliterature.Itprovidespractitioners andstudentsalikewiththeknowledgeandskillstodevelop,fund,andevaluatecommunity-basedoccupation-basedprograms.Thisisimportantasthe shiftfromhospital-basedcaretocommunity-basedcarecontinuestogrow. Thefederalgovernment’shealthagenda, HealthyPeople2020, isdesignedto enhancethehealthandwellbeingofAmericans,andthistextprovidesablueprintforoccupationaltherapyinvolvementincommunityandpublichealth efforts.
Thebookisbothscholarlyandpragmatic,adifficultsynthesistoachieve. IcommendJoyDollforherworkonthistext.Itnodoubtwillfurther enhancetheroleandskillsofcurrentandfutureoccupationaltherapypractitionersincommunity-basedsettings.
MarjorieE.Scaffa,PhD,OTR/L,FAOTA
Acknowledgments
Iwouldliketothankmyparentsfortheirongoingsupportandbeliefinme nomatterwhat.IalsohavetothankMikeforalwaysbelievinginmenomatterwhathappensandenduringmydesiretobewithpeopletobetterthe world.
IwouldliketodedicatethisbooktotheOmahaTribeofNebraska,which hastaughtmethetruemeaningofcommunityworkandwhatitmeansto becomepartofacommunity.IalsodedicatethisbooktoJohnPenn,who taughtmesomuchaboutgrantwritingandletmebeapartofhisteam.
Introduction
Inrecentyears,theprofessionofoccupationaltherapyhasdevelopedan interestincommunitypractice,andalthoughthisareaofpracticeisnotwell defined,itdeservestobesupportedandrecognized.Foroccupationaltherapypractitionersworkingincommunitysettingsratherthaninclinicalcare, thedemandsaredifferentanduniqueskillsarerequiredforsuccessfulpractice.Thepurposeofthisbookistobeatoolforcommunitypractitionersor foranypractitionersorstudentsinterestedincommunitywork,whetherfull timeorasasideproject.
Toolsforcommunitypracticeincludeprogramdevelopmentandgrant writing.Butbeyondthese,therearechallengesinmatchingaprogramwitha communityfortruesuccess.Thisbooknotonlyaddressestheskillsneeded forprogramdevelopmentandgrantwritingbutalsoexploressuccessfuland sustainableprogrammingincommunitysettings.Successandsustainability arenotonlytiedtograntfundingbuttrulyrequirecreativestrategies,buildingoncommunitycapacityandbuy-infromthepeopleactuallybenefiting fromtheservices.Thecomponentsofprogramdevelopmentandgrantwritingarenotonlyfornontraditionalpractice,anditismyhopethatclinicians inallsettingswillfindthisbookrelevanttopractice,despitethecontext.
Itisofimportancetonotethatthisbookoutlinesstrategiesforsuccessin communitypractice,butthateachcommunityandprogramisunique.What leadstosuccessinonecommunitymaynotdosoinanother.Occupational therapypractitionersworkinginthecommunitymustutilizetheirclinicalreasoningskillstodeterminewhichstrategiestoapplytotheircommunitysetting.Strategiesforutilizingclinicalreasoninginacommunitypracticesetting areemphasizedthroughoutthetextwithcasestudiesandprocessworksheets. Theseprocessworksheetsaremeanttohelpreadersthinkthroughthe processesforprogramdevelopmentandgrantwritinginordertolayafoundationfordevelopmentofoccupationaltherapypracticeintheseareas.
Anotherimportantnotetoconsideristhatcommunitypracticeisan ongoinglesson.Occupationaltherapypractitionersworkingincommunity settingshavetobeboldandcreativeindesigningstrategies.Theymustconstantlyreflectcriticallyontheuniquecommunityneedstobeabletomodify theprogramasnecessary.Criticalself-reflectionandprogramevaluationare
keycomponents.Similartothemodeltheyuseintraditionalclinicalsettings,occupationaltherapypractitionersmustbeinconstantevaluationmodeandableto modifytheprogramaccordingly.Reflectionandevaluationprocessesareemphasizedthroughoutthisbooktofacilitatethedevelopmentofthesetoolsforsuccessfulcommunity-basedpractice.
Thisbookfocusesoncapacitybuildingasanapproachtosuccessincommunity practice.Incommunitypractice,needs—especiallyhealth-relatedones—areoften grosslyevidentandcannotbefullyaddressed.Inthecaseofworkingwithanunderservedorhealthdisparatecommunity,needscanbeoverwhelmingandleaveone feelinghelplesstoaddressthem.However,anycommunitythatfaceschallenges alsohasstrengthsthatcanbeutilizedtotacklecommunityneeds.Someexamples includestrongculturalties,apowerfulcollectivefaith,anddependableleadership. Thesefactorsarethekeystoasuccessfulprogram,andthisbookfocuseson approachesforbuildingandusingcapacitytodevelopsuccessfulprograms.
Healthcareprofessionalsaregenerallyviewedasexpertsintheirpracticearea. However,incommunitypractice,successreliesonapartnershipapproachinstead ofanexpertapproach.Thismeansthatforoccupationaltherapypractitionerssuccessoftenresultsfrombeingapartofthecommunityandnotviewedasoutsider consultants.Thisbooktakestheapproachofcommunitypartnershipandpromotescommunityimmersionasatacticforsuccess.Itistheauthor’sbeliefand experiencethatthisapproachensuresthatprogramsmeetauthenticneedsand facilitatecommunitychange.
Foroccupationaltherapypractitionersworkingincommunitysettings,programdevelopmentandgrantwritingareahappycouple.Grantwritingcannot occurwithouttheprocessofcomprehensiveprogramdevelopment,andprograms incommunitysettingsusuallyrequireexternalfunding.Incommunitysettings, mostgrantsaregearedtowardprogramimplementationandprogramdevelopmentistypicallynotsupportedbyexternalfunders.Althoughtherearemany resourcesavailableongrantwritingtechniquesandstrategies,foroccupational therapypractitionersincommunitysettingsgrantproposalsareusuallyirrelevant withoutastrongprogram.Therefore,thepurposeofthisbookistoprovidea resourcefortheintegrationofgrantwritingandprogramdevelopment.Formany communitypractitioners,thesetwoaspectsofcommunitypracticeprovidesignificantchallengesandthisbookprovidestoolsandstrategiesforsuccess.
ReviewerRecognition
JosephCipriani,EdD,OTR/L Professor,DepartmentofOccupationalTherapy MisericordiaUniversity Dallas,Pennsylvania
SandraBarkerDunbar,DPA,OTR/L,FAOTA Professor,OccupationalTherapyDepartment HealthProfessionsDivision,CollegeofAlliedHealthandNursing NovaSoutheasternUniversity FortLauderdale–Davie,Florida
SueCoppola,MS,OTR/L,BCG,FAOTA
AssociateProfessor,DivisionofOccupationalScience UniversityofNorthCarolina ChapelHill,NorthCarolina
CristyDaniel,MS,OTR/L CollegeofSaintMary Omaha,Nebraska
DeniseDonica,DHS,OTR/L AssistantProfessor,OccupationalTherapyDepartment EastCarolinaUniversity Greenville,NorthCarolina
AnneM.Haskins,PhD,OTR/L OccupationalTherapyDepartment UniversityofNorthDakota GrandForks,NorthDakota
LianeHewitt,DrPH,OTR/L
AssociateProfessorChair,DepartmentofOccupationalTherapy LomaLindaUniversity LomaLinda,California
HeatherJavaherian,OTD,OTR/L LomaLindaUniversity LomaLinda,California
PamelaKasyan-Itzkowitz,MS,OTR/L,CHT OccupationalTherapyDepartment NovaSoutheasternUniversity FortLauderdale–Davie,Florida
JanePainter,EdD,OTR/L AssociateProfessor,Director,ClinicalEducation CollegeofAlliedHealthSciences,OccupationalTherapyDepartment EastCarolinaUniversity Greenville,NorthCarolina
AmyPaul-Ward,PhD,MSOT AssistantProfessor,DepartmentofOccupationalTherapy CollegeofNursingandHealthSciences FloridaInternationalUniversity Miami,Florida
GreshundriaM.Raines,OTD,MPA,OTR/L AssistantProfessorandAcademicFieldworkCoordinator DepartmentofOccupationalTherapy AlabamaStateUniversity Montgomery,Alabama
JaneeneSibla,OTD,MS,OTR/L UniversityofMary Bismarck,NorthDakota
StacySmallfield,DrOT,OTR/L UniversityofSouthDakota Vermillion,SouthDakota
TheresaSmith,PhD,OTR,CLVT TexasWoman’sUniversity Houston,Texas
BethP.Velde,OTR/L,PhD
Professor,OccupationalTherapyDepartment
AssistantDean,CollegeofAlliedHealthSciences
EastCarolinaUniversity
Greenville,NorthCarolina
CallieWatson,OTD,OT/L
CollegeofSaintMary
Omaha,Nebraska
LEARNINGOBJECTIVES
CommunityPracticein OccupationalTherapy: WhatIsIt?
Bytheendofthischapter,thereaderwillbeabletocompletethe following:
1.Describetheroleoftheoccupationaltherapypractitionerin communitypractice.
2.Compareandcontrasttheoreticalapproachestocommunitypractice inoccupationaltherapy.
3.Reflectontheskillsrequiredtoengageincommunitypracticeasan occupationaltherapypractitioner.
Overview
Thischapterprovidesabasicintroductiontocommunitypracticeasafoundationforprogramdevelopmentandgrantwritingforoccupationaltherapy practitioners.Thepremiseofthisbookisthatsuccessfulgrantproposalsare basedonsoundprogramdevelopment.Throughoutthisbook,manyofthe conceptsintroducedinthischapterarediscussedingreaterdetailincluding applicationandexamples.Inthischapter,modelsofcommunityoccupationaltherapypracticearedefinedanddescribedalongwithskillsandchallengesrelatedtocommunitypractice.Importantconceptsofcommunity
KeyTerms
•Community
•Community-based participatory research(CBPR)
•Community-based practice
•Community-built practice
•Communitycapacity building
•Communitycentered
•Community partnership
•Communitypractice
•Health
•Primaryhealth promotion
•Secondaryhealth promotion
•Tertiaryhealth promotion
practicearedescribedasaremethodsandstrategiesforbuildingevidenceincommunitypractice.
Introduction
Occupationsdonotoccurinavacuumand,asoutlinedintheOccupationalTherapyPracticeFramework(OTPF),occupationsareaffectedbythecontextinwhich peoplelive(AmericanOccupationalTherapyAssociation[AOTA],2008). Community isanimportantcontextthatinfluencespeoples’abilitytoengageinoccupations.Communitiescanfacilitateorinhibitoccupationalengagementofthose withandwithoutdisabilities.Inthisbook,theskillsofgrantwritingarethoroughly discussedasappliedtocommunityoccupationaltherapypractice.Occupational therapy communitypractice canbeinitiatedandsupportedbyexternalfunding, includinggrants(Brownson,1998).Priortodelvingintothetopicofgrantwriting, thequestionmustbeasked:Whatiscommunitypracticeforoccupationaltherapy practitioners?
WhatIsCommunity?
LET’SSTOPANDTHINK
Howdoyoudefinecommunity?
Whatcommunitiesdoyoubelong to?Takesometimetowritedown answerstothesequestionsand reflectonyourdefinitionandthe communitiesofimportancetoyou.
Communitiesprovideauniquesettingforoccupationaltherapypractice.“Everydaylifeofacommunity,itsmixofpeople,theirneeds,concerns,joysandstruggles,offersanunparalleledopportunitytodefine[theoccupationaltherapy] discipline,researchitspotential”(Fidler,2001,p.8).Communitiesareindividualstiedtogetherbyoccupationalengagementandacollective senseofmeaning.Communitiesarenotsimplydefinedby geographiclocationbutrefertoa“person’snaturalenvironment,thatis,wherethepersonworks,plays,andperforms otherdailyactivities”(Brownson,1998).Communitiesare thesettingswherepeoplereside,buildrelationships,and engageinhealthpractices(Brownson,1998;Scaffa,2001; Grady,1995).Communitiesexistasacontextinwhichpeopledefinetheirlives.Forsomepeople,identifyingmembershipinacommunitymaybechallenging,yeteveryone belongstomultiplecommunities.
Theimportanceandrelevanceofcommunitypracticeinoccupationaltherapy havebeendiscussedthroughouttheprofession’shistory(McColl,1998).Inoccupationaltherapy,anessentialconceptionofcommunityisonethatconsiders groupsofpeopleengagedinacollectiveoccupation.Inotherwords,justasindividualshaveuniqueoccupations,sodocommunities.Thebasisofacommunityis relationships,andcommunitiesofpeoplecometogether“todosomethingthat cannotbeeasilydoneinisolation”(Scaffa,2001,p.8).Basedonthispremise,communitieshaveuniquecultures,relationships,viewsofhealth,andoccupations.
HealthintheContextofCommunity
TheWorldHealthOrganizationdefines health as“astateofcompletephysical, mentalandsocialwell-beingandnotmerelytheabsenceofdiseaseorinfirmity” (WorldHealthOrganization[WHO],1998).Healthhasbeencomprehensively definedintheprofessionofoccupationaltherapyas
theabsenceofillness,butnotnecessarilydisability;abalanceofphysical, mental,andsocialwell-beingattainedthroughsociallyvaluedandindividuallymeaningfuloccupation;enhancementofcapacityandopportunityto striveforindividualpotential;communitycohesionandopportunity;social integration,support,andjustice,allwithinandaspartofasustainableecology.(Wilcock,2006,p.110)
Bothdefinitionsacknowledgethathealthisnotonlyaboutdiseasestate.These definitionsincorporateaholisticviewofwell-beingandtheimportanceofquality oflifeasasignificantcomponentofhealth.Incommunitypractice,occupational therapypractitionersmustretainabroadviewofhealthinordertoimplementsuccessfulhealth-relatedprogramsbecausetheextrinsicfactorsofhealthcannotbe denied.Forexample,whenconductinganoccupationaltherapyevaluationinthe home,thepractitionercanexploretheimpactthattheenvironmenthasonthe client’soccupationalengagementandeasilyvisualizethebarrierstotransfersor mobilitythattheclientmayfaceinthehome.
Inthecommunitycontextofoccupationaltherapypractice,thedefinitionof healthmovesawayfromthemedicaldefinition.Healthisviewedastheabilityto engageinoccupation(Baum&Law,1998;Wilcock,2006).Occupations“demonstrateacommunity’sandanindividual’sculturallysanctionedintellectual,moral, socialandphysicalattributes.Itisonlybywhattheydothatpeoplecandemonstratewhattheyareorwhattheyhopetobe”(Wilcock,2006,p.9).Theinabilityto engageinoccupation,whethercausedbyphysical,mental,social,orenvironmentalchallenges,leadstomanyproblemswithmaintenanceofhealthandwell-being.
Wilcock(2006)saysitbest:“Healthisremarkablysimpleandremarkablycomplex”(p.3).Perhapsthisperceptionofhealthcanactasanappropriatemantrafor occupationaltherapypractitionersworkinginthecommunity.Healthcanbe affectedbysimplefactors,suchasriskfactors,inwhichpeoplemakeconscious choicestoengageinhealthyandunhealthybehaviorsthatpreventorleadtodisease.Ontheotherhand,thehealthstatusofanindividualandacommunitymay beaffectedbyforcesbeyondindividualorgroupbehaviors.Externalforces,such astransportation,socioeconomicstatus,andhealthdisparities,greatlyaffectthe healthofacommunity.
Dr.PaulFarmer(2003),physicianandmedicalanthropologist,discussesthe impactsofsocialandpoliticaldecisionsonpublichealth,acknowledgingthatthese
largersystemsaffectthehealthofcommunitiesandentirecountries.Manyofthe factorsthataffectthehealthofgroupsandcommunitiesareoutoftheautonomous controlofthepeopleaffected.Forexample,manyunderservedcommunitiesfind theirhealthstatusaffectedbyoppressiveforcesoutsideoftheircontrol(Farmer, 2003).Healthdisparities,unequaltreatmentofpatients,andaccesstohealthinsurance(includingboththeuninsuredandunderinsured)aresociopoliticalfactors thataffectpeoples’abilitytoaccessandrespondtohealthcareregimensandhow communitymembersdefineandengageinhealthybehaviors.
Forexample,communitymembersmaynotwalkinthecommunityforexercisebecausetherearenosidewalksandresidentsfearfortheirsafetywhentheyhave towalkinthestreets.Althoughthismaysoundlikeanoversimplifiedproblem, manytimesinfrastructureandcityplanningissues,suchasalackofsidewalks, makecommunitymembersfeelliketheyareunabletopracticehealthybehaviors, likewalking.Inthisexample,thehealthdeterminantactuallyhasnothingtodo withthecommunitymembers’physicalabilitytoengageinhealthmaintenance activitiesbutdemonstratesasimplebarriertohealthandwell-beinginacommunitysetting.Byconsideringfactorssuchasthese,occupationaltherapypractitionerscanexplorealternativemethodsforengagingcommunitymembersinhealth maintenancebecausetheyunderstandthecomplexityofthehumanexperience.
Asexpertsinoccupation,occupationaltherapypractitionerseasilyidentifyfactorsthatpreventapersonfromhealing.Skillsinactivityanalysisprovideoccupationaltherapypractitionerswithabasisforunderstandingengagementandhow activitiesandoccupationsareimpededbyphysicalfactors.Inacommunitypracticesetting,occupationaltherapypractitionersusethesesameclinicalskillsto explorethedeterminantsofhealthbeyondthephysicalbytakingasystems approachtounderstandinghealthanddisease(Wilcock,2006;McColl,1998; Scriven&Atwal,2004).Theroleoftheoccupationaltherapypractitionerincommunitypracticeistoexploreoccupationalengagementinabroadsense.Practitionersmustapplytothecommunitysettingthesameclinicalskillstheyuseto analyzeanactivityandhowanindividualcanaccomplishitdespiteadisability (McColl,1998).
Occupationaltherapypractitionersmustunderstandthecontextandconditionsbeyondphysiologicproblemsthataffecthealthstatus.Communitycharacteristics,includingbutnotlimitedtosocioeconomicstatus,culture,political infrastructure,publictransportation,availabilityofhealthcareservices,andgeographiclocation,affectcommunityhealthstatus.Occupationaltherapypractitionerspracticinginthecommunitysettingneednotfullyunderstandallthe factorsthatcreatecommunitycontextbutmustacknowledgetheirexistenceand impactonthehealthstatusandwell-beingofthecommunityanditsmembers. Basedonthiscomplexityandinterdependenceofexternalfactorsonhealthstatus, occupationaltherapypractitionersarecalledtoviewhealthinabroadersense (Wilcock,2006).
TheNeedforCommunityPractice
Occupationaltherapypractitionersrecognizethat“stayingwithinthemedical modeldeprivessocietyofthefullbenefitsofanoccupationalapproach”(Miller& Nelson,2004,p.138).Communitypracticeopensthedoorfortheprofessionof occupationaltherapytogrowandapplyoccupationinitsnaturalsettings.Yetcommunitiesarecomplexanddynamic,andaddressinghealthissuesincommunities iscomplicatedbyfactorssuchasreimbursement,community-definedneeds,and healthdisparities.Currenthealthcaresystemslacktheabilitytoadequatelyaddress communityhealthissues,healthdisparities,healthpromotion,andhealthbehaviors,whichlaysthegroundworkforoccupationaltherapypractitionerstoactively exploreanddefinerolesincommunitypractice(Scaffa,2001;Fazio,2008).Because ofthesechallengesinthehealthcaresystem,occupationaltherapypractitionerscan adopt
aclient-centered,communityapproachthatrequirespractitionerstohave theskillstoworkeffectivelyinindividual,dyadic,group,andcommunity interactionstoimplementrestorativeaswellaspreventiveandhealthmaintenanceprogramsthatenhancethefunctionandwell-beingofclients.(Baum &Law,1998,p.9)
Withthedrasticchangesinhealthcareservices,therisingcostsofhealthcare, andthetimeconstraintsonprovidinghealthcarecausedbyfundinglimitations, anincreasingdemandforcommunityhealthprogramshasdevelopedacrossthe disciplines(Merryman,2002;Fazio,2008).Tomeetthesedemands,communities areturningtohealthcareprovidersforassistancetomeettheneedsofcommunity members(Baum&Law,1998;Suarez-Balcazar,2005).Furthermore,insurance costshaverisendrastically,forcingindividualsandemployersthatprovidehealth insurancetoexploretheroleofhealthmaintenanceandwellnessasamethodfor reducingcosts(CovertheUninsured,2008).Allofthesefactorsjustifytheneedfor occupationaltherapypracticeincommunitysettings.
Theprofessionofoccupationaltherapyisbecomingmoreproactiveinaddressinghealthneedsthatarise,expandingoutsidearehabilitationapproach.Examples ofthisincludefallpreventionprogramsanddrivingprograms(Dorne&Kurfuerst, 2008).Programssuchasthesedemonstrateashiftintheprofessionfromrehabilitatingthosewhoareillordisabledtofacilitatinghealthyliving,aginginplace,and qualityoflifeforall.Mostoftheseprogramsoccurinacommunitysetting.
UnderstandingCommunityPracticeinOccupational Therapy
Definingcommunitypracticeinoccupationaltherapyischallengingbecauseofits encompassingnatureanditsdifferencesfromtraditionalpractice.Inthecommunitysetting,occupationaltherapypractitioners“havenorecipeforsuccessinthis
realmofpractice,nostandardtreatmentplanstofollow,noscheduledtimestoperformactivitiesofdailylivingtreatments”(Loukas,2000).Occupationaltherapy practiceincommunitysettingsisbroad,andprogramsareuniquetoeachcommunityandpractitionerworkinginthecommunity.Occupationaltherapyinterventionsmove“beyondtheindividualtreatmentofaclienttoworkingwith systemsthataffecttheabilityofanindividualorgrouptoachievework,leisure,and socialgoals”(Brownson,1998,p.61).AccordingtotheOccupationalTherapy PracticeFramework(OTPF),occupationaltherapypractitionersmustconsider clientsnotonlyasindividualsbutalsoasbothorganizationsandpopulations withinacommunity(AOTA,2008).Becausecommunitiesarecollectiveinnature, occupationaltherapypractitionersincommunitypracticemustexploreinnovative waysofpracticing,notjustnewvenuesforpractice(Brownson,1998).
Communitypracticeinoccupationaltherapyexplores“theroleofoccupation intheshapingofasocietyandadailylife”(Fidler,2001,p.7).McColl(1998)proposesthatoccupationaltherapypractitionersincommunitysettings“needbasic knowledgeaboutthenatureanddistributionofdisabilityandoccupationand aboutthedeterminantsofsuccessfulcommunitylivingwithadisability”(p.11). Butbeyondunderstandingtheexperienceofindividualswithadisabilitylivingin thecommunity,communitypracticeinvolvesunderstandingthecollectivewhole. Asdiscussedpreviously,communitiesareuniqueandexhibitcollectiveoccupations.Evenwhenaddressingindividualclients,theimpactofthecommunityand relationshipswithinitareinstrumentaltooccupationalengagement(Fazio,2008). Wilcock(2006)suggeststhat“occupationprovidesamechanismforsocialinteractionandsocietaldevelopmentandgrowth,formingthefoundationofcommunity”(p.9).Asindividualsexperiencechallengestooccupationalengagement,so docommunities.Occupationaltherapypractitionersmustunderstandtheseconceptstoapplytheminacommunitysetting.
Communitypracticeprovidesaclearpictureofthedynamicsthataffectaperson’s abilitytopracticehealthyoccupations.Thedifferencebetweencommunitypractice andtraditionalmedicalpracticeissimple:“Communitypracticeexistsintheclient’s ‘reallife’and‘realworld’”(Siebert,2003,p.2).Infact,alltheaspectsthataffecthealth andoccupationalengagementmustbeconsideredinthecommunitysettingbecause thismakestherapymoreapplicableandclient-centered(Brownson,1998).For example,whenanoccupationaltherapistcompletesahomesafetyassessment,the practitionercaneasilyviewbarriersandaccessibilityissues.Obviously,thisapproach hasanadvantageoversimplyinterviewingtheclientinaninpatientsettingabouthis orherperceivedbarriersandaccessibilityissuesinthehome.Clientperceptionsare validandimportant,yetadiscussionabouthomesafetythatisconductedintheinpatientsettingisremovedfromthedynamicenvironmentandcommunitycontextin whichthepersonengagesdaily.Practicingincommunitysettingsprovidespractitionerswitharealisticviewoftheclient’slifeandpromotesbettertreatmentoutcomesbecausesuggestionsandtherapyoccurincontext.
Fazio(2008)suggeststhattoengageincommunitypracticesuccessfully,the occupationaltherapypractitionermustadoptasystemsapproach(Gray,Kennedy, &Zemke,1996a;Gray,Kennedy,&Zemke,1996b).Occupationaltherapypractitionersareinterestedinoccupationrelatedto“thedynamicsofthisprocesswithin thelargersystemofenvironment/community”(Fazio,2008,p.25).Communities arecomplex,withmultipledynamicsallinteractingandinterconnected.Occupationaltherapypractitionersmustfindarolethatcanfacilitatepositivehealth changesinthissystem(Fazio,2008).
Bybeinginacommunity,practitionerscanperceivecommunitymembers’barriersandchallengestohealthyliving.Manyfactorsthataffecthealtharenotvisibleinclinicalsettingsbecausetheenvironmentiscontrolledbythehealthcare system.Inthecommunity,manyfactorsaffectanindividual’sabilitytolivehealthily.Forexample,AmericanIndianslivingonareservationtypicallyreceivefederal foodcommodities,whichdictatefoodavailability.Tellingaclienttoeathealthyis simple,butobviouslyreservation-basedAmericanIndiansmayfinditdifficultto complywiththissuggestionbecauseofthelimitedfoodchoicesavailable.Clients arechallengedbyissuessuchasnutritionalaccess,andpractitionersmusttakeinto accounttheseissueswhenworkingwithcommunities.Whenprovidingservicesin communitysettings,practitionersmustknowthecommunityinordertoimplementhealthcarerecommendationsandtreatmentsthatmeettheneedsofthecommunitymembersandthatacknowledgechallengestobasichealthmaintenance (Fazio,2008).Factorssuchasfoodaccessaffecttheoverallhealthofacommunity andimplytheneedforhealthcarepractitionerstounderstandthecommunitycontexttofacilitatehealthyliving.
Communitiescanbecollectivelyhealthyorunhealthyasaresultofmanyfactors.Forexample,incitieswithreliableandaccessibletransportationsystems,individualswithphysicaldisabilitiescangettoworkontime.Becauseoftheaccessible andreliabletransportationsystem,thesecommunitymemberscanmakeasocietal contributionandareabletosustainalivingincome,whichimprovesqualityoflife forallmembersofthecommunity.Incommunitieswheretransportationisnot reliableoraccessible,individualswithphysicaldisabilitiesmaynotbeabletomaintainajobandcannotmakealivingwage.Becauseoflackoftransportationservices, individualswithphysicaldisabilitiesarealienatedandmayexperienceadecreased qualityoflife.Thisexamplehighlightstheimpactunderstandingtherolecommunityplaysinoccupationalengagement.
Theoccupationaltherapyprofessionhasidentifiedpracticesettingsinwhich occupationaltherapypractitionerscanprovideoccupationaltherapy–relatedservices(Scaffa,2001);however,theconceptsandframeworkofcommunitypractice inoccupationaltherapyhavenotbeenformallyoutlinedoracceptedintheprofession.Becauseofthislackofacollectiveprofessionaldefinitionofcommunity practice,occupationaltherapypractitionersmustbegintodefinecommunitypractice.Occupationaltherapypractitionershavetheopportunitytoexploretheimpact
ofoccupationaltherapypracticeincommunitiesanddefinethespecificrolethe professionwillplayincommunityhealth.
TheRolesofOccupationalTherapyPractitioners intheCommunity
Itisimportantforreaderstohaveabasicunderstandingoftherolesofoccupationaltherapypractitionersincommunitysettings.Asmentioned,nospecificstandardsforcommunitypracticeexist;however,becauseofthenatureofcommunity practice,specificrolesandresponsibilitieshaveemergedandarediscussedinthe literature.Theserolesareoftennotpractice-basedbutdescribethegeneralcharacteristicsapractitionerneedstobesuccessfulincommunitysettings.These includeadvocacy,assessmentskills,capacitybuildingskills,andtheabilitytoapply theprinciplesofoccupationinacommunitycontext.Obviously,theserolesand responsibilitiesarebroadandeachcommunitypractitionerwillfinddifferent activitiesassociatedwitheachofthesegeneralizedroles.Thefollowingsubsections describethesecharacteristicsfurther.
Advocacy
LET’SSTOPANDTHINK
Thinkofacommunityyoubelongto thatisimportanttoyou.Brainstorm waysinwhichyouwouldengagein advocacyforthatcommunity.Think ofspecificwaysyoucouldadvocate bothasamemberofthat communityandasanoccupational therapypractitioner.
Incommunitypractice,occupationaltherapypractitionersarerequiredtoadvocatefor clientsformultiplereasons.Advocacyispartoftheprinciplesandvaluesoftheprofession(AOTA,1993).Althoughadvocacyisimportantinalloccupationaltherapypracticesettings,ittakesonauniqueroleincommunitysettings(Jensen&Royeen,2002) wherepractitionersaddresshealthissuesnottypicallycoveredby insuranceprovidersandmayworkwithanunderservedpopulationthatcannotaffordservices.Thepractitionermustdiscover andexplorefeasibleapproachestoaddresshealthissuesinthe community,whichrequiresadvocacyonmanylevels,fromeducatingcommunitymembersontheroleofoccupationaltherapy practitionerstoadvocatingfortheneedsofunderservedcommunities(Herzberg&Finlayson,2001).Forexample,identifyinga healthproblemanddevelopingaprogramtoaddressthisproblemisaformofadvocacy(Kingetal.,2002;Scaletti,1999).Writingagranttofundservicesisalsoaformofadvocacy.
Practitionersmustalsoadvocateforpromotionofinclusionofallinthecommunity(Grady,1995)becausecommunityinvolvementisan importantcomponentofqualityoflifeandself-esteemforindividuals.Practitionersmightsometimesneedtoadvocateinregardtograntfunding,especiallywhen fundingstreamsareeliminatedorthreatenedasaresultofpoliticaldebate,economics,trends,orchangesinadministration(Jensen&Royeen,2002).Incommunitypractice,anoccupationaltherapypractitionermaybecalledtocontactor communicatewithpoliticalofficialstovoicesupportforinitiatives.
TABLE1-1OCCUPATIONALTHERAPYROLESINADVOCACY
•Education
•Addressingunmethealthneeds
•Servingtheunderservedthroughhealth-relatedprograms
•Promotinginclusion
•Politicaladvocacy
AssessmentSkills
Occupationaltherapypractitionersincommunitypracticerequireuniqueassessmentskills.Incommunityprogramdevelopment,mostinterventionsarefora groupandnotforanindividual;thereforeoccupationaltherapypractitionersin communitypracticemustlearnhowtoassessgroupsofpeopleregardingoccupationalengagementandperformance(Brownson,1998;Fazio,2008).Somepractitionersmayfindthisachallengebecauseitdeviatesfromthetraditional therapist–clientrelationshipanddeliverymodel.Furthermore,communityassessmentrequiresskillsinmultipledatacollectionmethodsanddataanalysis.It requiresanunderstandingofepidemiologyandhowcommunitydatacanbeused inprogramdevelopmentandgrantwriting(Fazio,2008;Wilcock,2006).
Inadditiontogatheringinitialassessmentdata,occupationaltherapypractitionersinthecommunitymustcollectongoingevaluationdata.Knowledgeand understandingofprogramevaluationmethodsarecrucialtothesuccessofany program(Suarez-Balcazar&Harper,2003).Evaluationmethodsarevitalto improvecommunityprogramsandensurethatprogramsaddresstheirintended purposes.Assessmentalsohelpstobuildevidenceandsciencedrivenapproachesthatarenecessarytojustifyfundingand developmentofcommunitypracticeinthefieldofoccupationaltherapy.
Gainingskillsinassessmentcanbechallengingtonovice practitioners.Methodsandstrategiesfordevelopingthese skillsarediscussedlaterinthetext.Assessmentnotonlyprovidesfeedbackonaprogram’soutcomesbutcanleadtoexternalfundingsupportandpotentialpolicydevelopment (Suarez-Balcazar,2005).
BuildingCommunityCapacity
BESTPRACTICEHINT
Outcomedatafromassessmentcan beusedinadvocacyby demonstratinganeedand justifyinghowaprogramcan affectacommunity’shealthina positiveandeffectiveway.
Communitycapacitybuilding canbedefinedasexploringandunderstandinga community’spotentialorabilitytoaddresshealthproblems(Chino&DeBruyn, 2006;Goodmanetal.,1998).Althoughallcommunitieshaveneeds,inunderserved
communitieswhereseverehealthdisparitiesexistandissuessuchasaccesstocare permeate,itcanbechallengingtoexplorecommunitycapacity.Althoughoccupationaltherapypractitionershavebeentrainedtoidentifyproblemsorneeds,in everycommunity,theymustlookbeyondneedtoidentifycapacityandassetsfor addressinghealthissues(Fazio,2008).
LET’SSTOPANDTHINK
Thinkofacommunityyoubelong tothatisimportanttoyou.What doesthecommunityhavetooffer thatisuniqueorbeneficial?Write downwhatyouidentifyand reflectonhowthesecapacities couldbeusedinthecontextof communityoccupationaltherapy practice.
Toengagecommunitycapacitybuilding,occupationaltherapypractitioners mustbe community-centered andapplyclient-centeredpracticetothecommunity.Inclient-centeredpractice,practitionersseektounderstandthegoalsofthecommunitymembersin asimilarwayastohowtheyseektounderstandtheindividual clientintraditionaltherapist–clientinteractions(McColl, 1998).Communityinterventionsthatarebasedonanddevelopedusingcommunity-identifiedneedsbuilduponcommunitystrengthsandhavebeensuccessful(Kretzmann& McKnight,1993;Elliott,O’Neal,&Velde,2001).Occupational therapypractitionersmustunderstandtheoccupationalprofileofthecommunitytodevelopmeaningfulinterventions thatarebasedonoccupationalpreferences(Brownson,1998).
ApplyingOccupationintheCommunityContext
Occupationaltherapypractitionersinthecommunitymustunderstandoccupationinacommunitycontext(Fazio,2008).Occupationaltherapypractitionersare expertsonoccupationandhavearguedthatoccupationisa“fundamentalprerequisiteofwellbeingandlinkedittoanindividual’sstateofhappiness,self-esteem andphysicalandmentalhealth”(Scriven&Atwal,2004,p.427;Wilcock,2006). However,incommunitypractice,practitionersmustunderstandoccupationsboth ontheindividualandcommunitylevels.Becauseillnessandhealthareaffectedby diseaseaswellasexternalcontextandhealthinfrastructure,occupationaltherapy practitionersmusttransformtraditionalbeliefsaboutoccupationtoapplyoccupationonmultiplelevels.Occupationcanbeappliedinthecommunitycontext throughprogramdevelopmentandgrantwriting,thefocusofthistext.
SkillsRequiredforCommunityPractice
Occupationaltherapypractitionersinthearenasofcommunityhealth,public health,community-basedpractice,andcommunity-builtpracticerequireaunique setofskillstoachievesuccess.Fidler(2001)statesthat“respondingtothevaried needs,interestsandwelfareofacommunitywilldifferinorientation,attitudinal andknowledgebasefromtheonethatcurrentlyguidesoureducationandpractice”(p.8).Despitethisfact,someskillsrequiredforcommunitypracticetransfer easilyfromtheclinicalsettingtoacommunitypracticesetting,whereasothers requiredevelopmentandexperience.
TABLE1-2COMMUNITYOCCUPATIONALTHERAPYPRACTITIONER SKILLS
•Consultancy
•Education
•Autonomy
•Client-centeredpractice
•Clinicalreasoning
•Healthpromotion
•Networking
•Managementskills
•Programevaluationskills
•Culturalawareness
•Teamskills
Accordingtoasurveyofcommunityoccupationaltherapistsconductedby MitchellandUnsworth(2004),communityoccupationaltherapistsneedtopossess thefollowingskillsandcharacteristics:consultancy,education,autonomy,clientcenteredpractice,clinicalreasoning,andhealthpromotion.AstudybyLemorieand Paul(2001)indicatesthatcommunityoccupationaltherapy practitionersneedtoknowhowtodothefollowing:network, navigatecommunityresources,managevolunteers,evaluate programs,healthpromotion/diseaseprevention,andaddress multiculturalpracticeissues.Fazio(2008)discussesskills requiredofoccupationaltherapypractitionersincludingcommunicationskills,abilitytodevelopcollaborativerelationships, managementskills,andleadershipskills.Furthermore,occupationaltherapypractitionersincommunitysettingsneedtobe abletointeractwithaninterprofessionalteamthatincludes bothprofessionalsandvaluedcommunitymembers(Baum& Law,1998;Paul&Peterson,2001;Miller&Nelson,2004).
BESTPRACTICEHINT
Manypractitionersfeelintimidated bycommunitypractice.Abest practicehintistoseekoutamentor orsupportgroupofpractitioners thatworkinthecommunity.By participatinginanetwork, practitionerscandevelopskills importanttocommunitypractice.
Occupationaltherapypractitionersincommunitysettingscanfindaroleinconsultancy(Mitchell&Unsworth,2004;Lysack,Stadnyk,Krefting,Paterson,& McLeod,1995).Forexample,anoccupationaltherapypractitionercanserveonthe boardofdirectorsforahealth-relatednonprofitorbeanactive memberofacommunitycoalition.Intheseroles,theoccupationaltherapypractitionerprovidesadviceasanexpertinoccupationorsomeothercomponentoftheprofession.Even thoughtheoccupationaltherapypractitionerdoesnotprovide directserviceorengageindirectprogramdevelopment,heor sheactsasanadvisortotheseprocesses,whichleadstoprofessionaldevelopmentandknowledgeaboutcommunitypractice. Educationisakeycomponentofcommunitypractice.Occupationaltherapypractitionersusuallytakeonaneducatorrole. AccordingtoBrownson(2001),community“programsare
BESTPRACTICEHINT
Toexplorecommunitypractice occupationaltherapypractitioners canjoinaboardofdirectorsor advisoryboardofacommunity organization.Servinginthis capacityhelpsthepractitioner learnabouttheprocessesof communityorganizations.
Considerthemultipletheoretical approachesthatoccupational therapypractitionersincommunity settingsmustemploy(public health,epidemiology,systems theory,sociology,organizational psychology,andsociology).Identify whichaspectsfromeach theoreticalapproachoccupational therapypractitionersmightusein communitypractice.
distinguishedfromclinicalservicesinthatprogramsareprimarilyeducational”(p. 96).Providingeducationisasignificantcomponentofcommunitypracticewhen practitionersexplorehealthpromotionandlifestylemodification.Occupationaltherapypractitionersincommunitysettings needtohavestrongeducativeskills(Scaffa,2001).Perhapstheir mostsignificantchallengeistotackleeducationinamannerthat fitstheneedsofthecommunity,gearingeducationtothecultureandhealthliteracylevelsofthecommunitymembers.
Thetenetsofcommunitypracticedrawfromavarietyof socialsciencesincludingpublichealth,epidemiology,systems theory,sociology,organizationalpsychology,andsociology (Munoz,Provident,&Hansen,2004).Occupationaltherapy practitionerscanuseelementsfromeachsourceastoolsfor communitypractice.Practitionersincommunitypractice mustcommittolifelonglearningandmakeongoingeffortsto experimentandstrategizeforsuccess.
ModelsofPracticeintheCommunity
Inoccupationaltherapy,therearetwomainapproachestopractice:community-based practiceandcommunity-builtpractice.Occupationaltherapypractitionersmust decidewhichapproachworksbestfortheneedsoftheirpracticeandthecommunity. Inthissection,eachapproachisexploredanddescribedasavaluableframework.
Community-BasedPractice
Community-basedpractice isthelocationinwhichoccupationaltherapyservicesareprovided.Inthismodel,specificlocationswithinthecommunitycontext areidentifiedandtheskillsofandrolesthatoccupationaltherapypractitionerscan playinthesettingaredescribed.Examplesincludeadultdaycareprograms,driving rehabilitationprograms,andhealthpromotionprograms(Scaffa,2001;McColl, 1998).AccordingtoWittmanandVelde(2001),community-basedpractice“refers toskilledservicesdeliveredbyhealthpractitionersusinganinteractivemodelwith clients”(p.3).
Forcommunity-basedpractice,occupationaltherapypractitionersmustmove awayfromthemedicalmodelandfocusonahealthpromotionanddiseasepreventionapproachtohealthcaredelivery(Scaffa,2001).Scaffa,Desmond,and Brownson(2001)encourageoccupationaltherapypractitionerstoadoptarolein healthpromotionprogramdevelopmentbyprovidinganoccupation-basedperspectiveordevelopingoccupation-basedprogrammingtocomplementcurrent healthpromotionprograms.
Programdevelopmentisasignificantcomponentofcommunitypractice.Itcan becomparedtotheoccupationaltherapyprocessandincludesthefollowingsteps:
TABLE1-3THEORETICALFRAMEWORKSUTILIZEDINCOMMUNITYBASEDPRACTICE
OccupationalTherapyTheoriesTheoriesOutsideOccupationalTherapy ModelofHumanOccupationSocialLearningTheory EcologyofHumanPerformanceHealthBeliefModel
OccupationalAdaptationPrecede-ProceedModel
Person-Environment-OccupationalTranstheoreticalModelofHealthBehavior PerformanceModel Change
Source: Scaffa,M.(Ed.).(2001). Occupationaltherapyincommunity-basedpractice settings. Philadelphia:F.A.Davis.
preplanning,needsassessment,plandevelopment,implementation,evaluation,and institutionalization(Brownson,2001).Programdevelopmentwillbediscussedin furtherdetailinChapter2.Community-basedpracticehasbeenwidelyacceptedin occupationaltherapy.Thecommunity-basedpracticeapproachtransferspractice skillsfromtheclinicalsettingtoapopulation-basedprogramdevelopmentmodel.
Community-BuiltPractice
Community-builtoccupationaltherapyprogramsare“opensystemsinconstant interactionwiththeirphysical,natural,temporal,socialandpoliticalenvironment” (Elliottetal.,2001,p.106).Thebasisofthe community-builtpractice modeliscollaborationwithastrength-basedapproachand“endswhentheclient-definedcommunityhaseffectivelybuiltthecapacityforempowerment”(Wittman&Velde, 2001,p.3).Community-builtpracticeisfoundedonthefollowingprinciples:
1. Eachcommunitymemberandcommunityhasstrengths. Inthecommunitybuiltpracticemodel,eachcommunitymemberandcommunityisevaluated forstrengths.Practicefocusesonhealthpromotionandwellnessandrecognizestheabilityofeachindividualandcommunitytobuildcapacityforsuccess.Itisassumedthatthecommunitywillembracethepracticeand,atsome self-definedpoint,nolongerneedtheoccupationaltherapyservices.
2. Communitymembersareequalpartnersinprogramdevelopment, implementation, andevaluation. Accordingtothecommunity-builtpractice model,communityprogramscanbesuccessfulonlyiftheyreceivethebuyinofcommunitymembersandinvolvethemintheprogramplanningand implementation.Communitymembersaretheexpertsinthecommunity’s culture,dynamics,politics,andhealthissuesandarethestrongestresource ofanycommunityprogram.Thecommunity-builtpracticemodelrecognizesthisfactandusesitasastrategyforsuccess(Wittman&Velde,2001).
