2017 CAOT CONFERENCE 

Mathieu Carignan

Symptoms of low vision may be confused for cognitive impairment!

- 40% of hip fractures correlates with low vision

- lack of interest: 30% of depression in low vision populations

​

Challenges with magnifiers:

- small diameter, fixed distance from lens to object, varying distance of lens to eye may impact posture

Benefits of magnifiers: 

- low cost

- low tech

​

Objective of project: 

- identify strategies to help clients with low vision and cognitive deficits use low tech

​

Methods:

- 15 participants

- mean age: 87 yo

- cognitive impairments

- 5 excluded due to health concerns

​

Strategies:

1. Organizational:

- reading corner with optimal environment (e.g. lighting)

2. Cognitive:

- provide clear, explicit instructions on how to use low tech devices

- enlarged pictograms of sequence

- provide repetition of instructions  

​

Please click on the button for a link to the Occupational Therapy and Low Vision Rehabilitation Network (OTLVRN) and for more information Mathieu Carignan and his colleagues' research. 

​

​

Skye Barbic, Stephanie Gillingham, Lyn Heinemann, Dan Huang-Taylor, Sarh Blackmore, Steve Mathias, Catherine Backman, & Jasmit Sumra

This paper presentation described a community intervention created to support youth with mental illness in obtaining and maintaining meaningful employment and education in Vancouver, British Columbia. The Youth Breakthrough to Employment and Training (Y-BEAT) is a 16-week supported employment/education program offered through the YMCA, in partnership with the Inner City Youth Clinic. Overall, the study provided preliminary evidence that a community-based intervention can support the employment, education, and health goals of Canadian youth with mental illness. 

​

For more information about this study and Y-BEAT, click the button below.

Rebecca Renwick, Debra Cameron, & Denise Dubois

The authors of this paper presentation used inclusive community-based methodology to describe belonging from the perspective of youth with intellectual/developmental disabilities. Occupations that fostered belonging and barriers to belonging were also highlighted.

​

Click the button below to watch a video of Denise Dubois describe this research.

Presenters: Ivonne Montgomery & Jill Zwicker

This presentation discussed teachers' perceptions of using "Printing Like a Pro!" which is a free printing resource developed by occupational therapists. It consists of worksheets that teachers can use to help students work on their handwriting. It is based on motor learning theory and uses cognitive strategies to assist children in developing handwriting skills. 

Kerry Fraser

Complex trauma: repeated abuse, witness of physical abuse or prolonged neglect

- occurs during crucial periods of development, which causes structural changes in the brain

- individuals with complex trauma may experience challenges with aggression, self-regulation, emotion regulation, attachment, depression, anxiety, trust

​

Impact on Occupational Performance:

- ability to play and interact with peers

- participation in leisure, school and community

- family relationships

​

The author conducted a scoping review to explore complex trauma in children 5 - 18 years of age.

Inclusion criteria:

- 2000 - 2015

- 5 - 18 year old

​

Results:

- 16 articles (2004 - 2015)

- 6 articles used OT lens or framework

- sensory integration used to increase emotion regulation, self-regulation, promotion of attachment behaviours and increased participation 

​

Interventions categorized by PEO model:

P: sensorimotor framework, sensory diets, mindfulness

E: calming/sensory rooms, decreased seclusion & restraints in inpatient & residential settings, more play based treatment settings

O: use of play to self-regulate, use of art or movement activities, structured sensory therapy

​

Discussion:

- research more focused on symptomology or performance components, not much on occupational components

- evidence is limited, but promising

​

Conclusion:

- sensory-based interventions are varied and need to be part of an overall treatment program, instead of separate, stand alone interventions (e.g. sensory interventions may be used to address symptoms of trauma in order to facilitate use of additional interventions such as CBT to address trauma itself).

- OT has potential to uniquely contribute, especially when utilizing the PEO lens. 

​

Contact Kerry at kerry.fraser@dal.ca

Erika Katzman, Stephanie Leblanc

Introduces the concept of "epistemic justice" as a means to critically examine the potential of prioritizing evidence-based practice to marginalize other forms of knowledge such as clinician's experiential knowledge and client's experiential knowledge. Encourages clinicians to reflect on practices in which client knowledges are routinely (though unintentionally/unknowingly) subjugated. The presenters use two studies on disabled persons' autonomy in attendant services and on mental health service user involvement in OT education. 

​

The presenters brought attendees' attention to instances of epistemic injustice (a wrong done to someone specifically in their capacity as a knower) in order to push beyond tokenistic inclusion of client knowledges toward incorporating client knowledges as legitimate and valuable forms of expertise. Doing so not only provides you as a clinician with valuable information, but respects the client as rational beings. Failure to do so can lead to clients withdrawing from health care services, and generall happens to members of marginalized groups. The presenters argued that overemphasis on codified professional knowledge may overshadow core principles of client-centredness in which client knowledges are truly considered in OT practice.  Barriers to doing so include: time pressure, dominance of biomedical approaches to health care, pressure to meet performance indicators, standardized protocols, and asymmetric power relations between therapists and clients. Tools OTs can use to increase epistemic justice include: advocacy on various levels for just practices, use spaces where we can listen to client knowledge and their narrative, practice reflexively, and practice epistemic humility by acknowledging the limits of our knowledge.

​

Additional Resources:

Fricker, M. (2007). Epistemic injustice, Power and the ethics of knowing. Oxford, Oxford University Press.

Heidi Cramm, Casandra Boushey, Jackie Rowe, Deborah Norris, & Linna Tam-Seto

Dr. Heidi Cramm presented this scoping review at the conference, which examined how post-traumatic growth (PTG) is understood in the context of Posttraumatic Stress Disorder (PTSD) experienced by military personnel and Veterans. PTSD was found to be a predictor of PTG, which is an important component of recovery. The authors conclude that occupational therapists can assist with the life disruptions caused by PTSD to create conditions that optimize the likelihood of PTG. Some of these recommendations include: facilitating a sense of belonging, purposefulness, and meaning, and developing problem-focused coping strategies. 

​

Click below for a link to learn more about Dr. Heidi Cramm's and her research.

Suzette Bremault-Phillips

Aim of model:

- improve quality of DMCA

- create a process that is least intrusive, problem solving based

​

Mixed methods study conducted, with health care professionals and key stakeholder engagement 

​

3 Components to the DMCA Model:

1. Systems level

2. Health care provider level

3. Client level

​

Overview of the DMCA Model Care Map:

3 Steps:

1. initial ax: identify reasons for ax, domains and risks

2. pre-ax: in depth ax and problem solving using cognitive and functional testing

3. formal capacity ax: when problems cannot be solved by less intrusive means

​

Results:

- 92% of participants reported that they were reducing risks to clients when following the model

- 59% of participants indicated the DMCA process improved the efficiency and effectiveness of DMCAs

​

Click the button below for an open-access copy of this article. 

Yani Hamdani, Barbara E. Gibson, Cameron Norman, & Rebecca Renwick

This critical qualitative study examined how transition to adulthood is problematized for youth with developmental disabilities (DD) and their parents within policies and practices. Policy documents in the realm of rehabilitation, education, and developmental services were analysed and interviews were conducted with parents of youth with DD in Ontario. The authors found policies and practices focused on underlying assumptions about "normal" ways of being, becoming and participating as an adult for youth with disabilities. For example, transitional goals for youth with DD traditionally focus on employment, independent living, and daily living skills for independence. Although there are some beneficial effects of these policies, both parents and youth experienced  harmful effects, such as feeing devalued and socially excluded, when the youth was unable to participate in occupations associated with independence and productivity.  The authors suggest that "normal" ways of being and doing be rethought, so that a wider range of occupations are valued and considered in transition policies and practices. For example, independence may focus more on shifting dependence from being on parents to other people and supports. Other goals may include: making/maintaining relationships, working as an end in itself, and fostering a positive disability identity. The presenters emphasized that there may be push back from parents on this shift. Not focusing interventions on independence requires social change, but we as OTs can work on this discourse through the clinical encounter and engaging parents in challenging it. Ultimately, what are traditionally considered "adult" occupations, may not be accessible or desired by everyone and the assumption that they are can result in marginalization of youth with DD. 

​

Click the button below for a featured article about Dr. Yani Hamdani and her research.

Ginette Aubin and Maude Lallemande

This poster presentation explored the OT role in working with clients with Hoarding Disorder (HD). HD impacts the functionality of people's environments and therefore their occupational performance. Often therapists are not referred due to HD and discover the hoarding while on home visits. This preliminary study provided a glimpse into the assessment and intervention of clients with HD and is an interesting emerging area of practice, particularly for clinicians who conduct home visits. Please click on the link for a copy of the poster that was presented at the conference. 

Helen Smith

Nicolas is currently 20 years old an has a diagnosis of CP

The family has 4 children in total.

​

Challenges:

1. "we don't know what we don't know"

- family cannot advocate for something that they don't know about

2. families can be unaware of difference directions and services available

3. families can be ready for different things at different stages

- introduce ideas to plant the seed, but respect and support each family's decisions 

- e.g. Nicholas was advised to use a wheelchair at 3 years old, but family was not ready for that until he turned 6 years old

4. Families need access to services in a timely manner

- OT services are limited, but OTs should advocate and think outside the box to ensure all children have access to therapy

5. Navigating the system is hard 

- finding out what's available in services is the biggest challenge for families, especially during transition periods

- OTs are needed for advocacy of services!

​

The ripple effect of OT is major!

- e.g. Nicholas learning to eat with a fork has major implications for other things in his life. The skills he developed from learning to use a fork carries forward to other skills he needs in life. 

Dana Anaby, Mary Law, Debbie Feldman, Annette Majnemer, Laura Turner, Rachel Teplicky, & Lisa Avery

This paper presentation examined the effectiveness of PREP in a 12-week intervention in 28 youth (12 - 19 years old) with moderate to physical disabilities. PREP (Pathways and Resources for Engagement and Participation) is an evidence-based approach to therapy developed by CanChild, which focuses on enhancing participation by modifying the natural environment. Together, the occupational therapist works with the client and caregiver to identify strengths and barriers to participation within the environment. The occupational therapist, client, and caregiver then work together to minimize or remove barriers within the environment and build on supports, so that the client may engage in their chosen activities. Goal performance was measured using the COPM at baselines, intervention, and follow-up. Improvement for goal performance was found at intervention and maintained at follow-up. The authors concluded that changing the environment only can help to improve participation.

​

5 M's:

• Make goals

  • Introduce prep and get consent

  • Use COPM

  • Use other measures or questions if client has difficulty identifying participation issues

• Map out a plan

  • Identify strengths and skills

  • Identify challenges and barriers

  • Learn about activity, including equipment and rules

  • Examine environment in which activity will take place

  • Build a participation team

• Make it happen

  • Decide which modifications to try first

  • Be prepared for some trial and error, be flexible

  • Record what works and what doesn't

  • Length and intensity of intervention at this stage varies

• Measure the process and outcomes

  • Happens throughout intervention

  • Performance and satisfaction initially and at end

  • Performance ratings continue during baseline period and throughout the intervention (2 times a week - could do this over text)

  • May complete the PEM-CY before and after

• Move forward

  • Checking in:

    • Is client still participating?

    • Did client generalize learning to new activities?

    • Has experience changed perspective?

  • Sharing knowledge with others

​

Click the buttons below for a link to the Participation Knowledge Hub for resources on participation; and a link to the PREP intervention protocol. 

Cori Schmitz, Michele Moon, Shaniff Esmail, & Susan Mulholland

​In response to the national OT Position Statement on Diversity (2014) and the publication of the Truth and Reconciliation Commission (TRC) Calls to Action (2015), the OT department at University of Alberta completed an internal curriculum evaluation to assess how human diversity and culture are addressed in their entry-level program. Their objectives were: (1) Enhance curriculum content to support students' awareness of diversity and build cultural responsivity, (2) Deliberately incorporate a greater breadth of cultural "lived experience" and Indigenous ways of knowing into their curriculum. Data collection occurred via a survey of (a) faculty and instructors, (b) current students and graduands to "map" how they were currently addressing these topics without their multi-faceted curriculum.  Findings are now being used to facilitate a workshop at an annual curriculum retreat and have caused the program to forge more comprehensive partnerships with local minority and marginalized cultural groups to redevelop curriculum content.  

​

Survey respondents identified a need for the following to be incorporated in the U of A's OT program: 

• Awareness of diversity

• Cultural safety, humility, reflexivity

• Increased awareness of Indigenous ways of knowing

• Consistency re: cultural competency vs. cultural safety/humility

• Exploration of understanding re: power and oppression

• Experiential activities in the community

• More culturally diverse student body

• Fieldwork placements with marginalized populations for everyone

• Track exposure/engagement with diversity during placements, including resources accessed//used

• Cases/examples from diverse populations

• Reflective activities: place emphasis on understanding relationship between themselves, culturally diverse clients, organizations and where they fit with the implications for OT

• More information/training for instructors before they could incorporate cultural diversity into their courses

• More information on:

  • Social justice

  • Harm reduction

  • Narratives

  • Advocacy

  • Being an ally 

  • TRC

  • Intersectionality

• Support critical thinking, appropriate and consistent language and appropriate modelling by faculty and instructors​

​

So far, the University of Alberta has made the following changes:

• Diversity and culture curriculum stream established

• Indigenous ways of knowing module

• Lunch and learn sessions for faculty focused on indigenous health

• Repository created for curriculum resources and media pieces

• Encourage instructors to include:

  • Alternative worldviews

  • Cultural safety

  • Social determinants of health

  • Media

• Indigenous focus stream:

  • Participate in current professional program focus assignments on Indigenous peoples

  • Enrol in modules with content

  • Participate in fieldwork focused on people and communities

  • Create opportunities to partner with knowledge keepers and people with lived experience

​

Additional Resources

• Beagan, B. (2015) Approaches to culture and diversity: A critical synthesis of occupational therapy literature, CJOT, 82(5), 272-282

Bill Wong

In his presentation, Bill Wong shared some of the background research about employment in adults with autism as well as his own experience as an OT with autism. Bill has also shared his experiences on social media and at other conferences including a Ted Talk, facebook page, and twitter account.

​

Click on the button for a link to his presentation. 

Raphael Lencucha, Keiko Shikako-Thomas, Katherine Tousignant

We know that policy is critical for OT practice and that policy decisions can serve to structure clinical practice. It is also integral to understanding the environments in which our clients live.  The objective of this paper was to present results about the OT-policy intersection, as this can then help OTs move toward a more enabling policy environment in the future.  Of 64 articles which met the inclusion criteria, the majority of papers addressed public policies at the national level. These included papers on health policy, but also economic and education policies as they relate to health. Only 37% of papers addressed policy process.

The following themes emerged:

• Awareness of how policy shapes the lives of clients

  • E.g. How disability employment policy affects lives of women with MS and their ability to participate in employment --> barrier

  • Can help therapists advocate, highlight areas for reform

• Awareness of how policy shapes practice

  • Health care system in constant flux (Bill 10 in Quebec)

  • Don't know how Ots adapt to policy shifts

  • Within workplace, public policy

• Call to action to get involved at policy level

  • Tend to look at interpersonal relationship at individual level and structural features of client

  • Absence from policy table equates to absence from policy itself

  • 0.003% of health care budget goes to OT

  • Often tied to budgets and how resources are allocated

• Call to Action to embed OT in policy

  • Address social injustices through policy change (bringing philosophical frameworks to practice)

  • Identifying value of OT services

The presenter identified a strong potential for OT in public policy in the following domains:

• Research: using other disciplines to study unique contributions that Ots can have in policy process

• Practice: understanding of health-wellbeing-occupation nexus and social and political contexts informing this can be key assets to inform policy

• Education and training: can begin to explore if and how policy action and awareness can be brought systematically into the OT curriculum

​

Laurence Roy, Sofia Salsi, Tammy Duong, Marie-Lyse Breault, Aurelie B. Leclair, & Yara Awadallah

This paper presentation examined the time use, occupational engagement, and occupational performance of 21 women experiencing sheltered homelessness. The participants described spending most of their time on sleep and passive leisure, and described occupational performance issues and goals surrounding active leisure and employment. The women in this study also described their occupational lives while living at the shelter. The authors recommend that occupational therapists use trauma-informed and strengths-based approaches when working with this population.

​

Laurence Roy is also involved in a project called Development of a Research and Practice Agenda on Homelessness and Occupational Therapy in Canada, which aims to build capacity for occupational therapists, researchers, and educators working with individuals who are at risk of, experiencing, or transitioning from homelessness. Contact Laurence Roy at laurence.roy@mcgill.ca, or the project coordinator at alissa.low@mail.mcgill.ca to join the group and mailing list.

​

Click the button below for a link to Laurence Roy's profile on the McGill University website.

Dominique Fijal

An integrative literature review to assess the potential to incorporate Indigenous perspectives on health and wellness formally into the CMOP-E framework in order to enhance the capacity of this OT model to serve all peoples in Canada. Results revealed that while there are numerous Indigenous approaches to wellness, they typically start from commitment to balance, wholeness and interconnectedness.

​

• Health as balance:

  • Physical

    • Food

    • Physical activity

    • Physical needs

  • Emotional

  • Mental

    • resilience

  • Spiritual

    • Indigenous knowledge and way of life

    • Culture

    • Identity

• Importance of community

  • Increased opportunities for sharing, practicing, and preserving Indigenous knowledge

• Importance of land

  • Contributes to balance and social cohesion

  • Cornerstone of culture, knowledge and identity

  • Place to pass on traditional knowledge

Though both the CMOP-E and Indigenous perspectives reject the biomedical model of health, the CMOP-E emphasizes individual ability to engage in occupation, while Indigenous perspectives emphasize the balance between the individual and community with the land. The author then used this information to broaden the CMOP-E model:

• Medicine wheel in the centre

• Environment: community, land, Canadian context

• Community and land same colour as person, but part of the environment

• Occupation as a way to maintain balance and connect with the community and the land

The author hoped these changes what to the CMOP-E could help OTs take a broader focus with all clients.

Betty Tran, Serena Lu, & Kevin Reel

Study aimed to qualitatively explore the perspectives of OTs and Student OTs in Canada on Medical Assistance in Dying (MAiD). This may suggest possible emerging OT roles in response to its implementation as both independent practitioners and as members of the healthcare team. 

​

The following themes emerged from the results of an anonymous online survey which collected both quantitative (presented in another paper) and qualitative answers:

• OT values and philosophies

  • Autonomy of client

  • Context

    • Moral dilemmas

    • Degree of physician involvement

    • Conflict between personal values and practice

• Terminal Illness

  • Capacity

  • Mental health: ho w to determine capacity with mental illness

    • Depression as temporary

  • Alternatives

  • Last resort

  • Autonomy of client

• ALS:

  • Lack of experience/more training needed

  • Need for clear legislation/practice guidelines

  • Interprofessional role present

• Life threatening illness or functional decline

  • Autonomy of client, however context dependent

• Potential roles

  • Providing meaning for client's remaining life

  • Psychosocial support

  • Comfort care

• Final comments

  • Value of life

    • Life should be preserved

  • Pleased MAiD is being discussed

• Overarching themes of capacity and autonomy were woven throughout the above themes

Implications for these results include a focus on enabling clients to self-administer their own life-ending methods and promoting independence, and changing curriculum to promote sill attainment in effectively managing client cases related to MAiD

Aislinn Lalor

90% of people will suffer from some form of sleep impairment at some stage in life.

​

Authors asked 3 questions to patients, at 3 months and 6 months post discharge from hospital. 

Q1: What are the main reasons why sleep was not addressed during your consultation?

Q2: What was discussed if consultations occurred?

Q3: What was done or decided to address sleep?

​

Results:

- Over 80% of older adults with sleep impairments were did not discuss the issue with any health professional

- If sleep was addressed, it was mostly pharmacological interventions (despite evidence for non-pharmacological interventions)

Limitations:

- client (older adults) report, no healthcare professionals involved in study

Implications:

- Unclear if sleep is not being discussed or if patient had difficulty recalling 

- OT scope: daily occupational performance of sleep, providing non-pharmacological interventions 

​

Contact aislinn.lalor@monash.edu for more information!

Josie Lui, Satmeen Nagra, & Setareh Ghahari

OTs are well positioned to play a leadership role in addressing the ongoing challenges and barriers in refugees' lives. The objective of this paper was to identify the prominent themes in the life experiences of refugees in Canada and to explicate the possible roles of OTs to enhance refugees' lives in Canada.

The following themes emerged:

• Loss or change of identity

  • More prominent in refugees

  • Lack of continuity and constant relocation

    • Difficult to identify with origin country and new country, especially if they had relocated all over the world between the two

  • Loss of professional and social life

  • Concerns with losing culture

    • Common fear of parents that their children would lose their culture

• Discrimination in new country

  • Accents and language barriers leading to discrimination

  • Lack of respect and recognition of profession

  • Difficulty finding permanent employment and housing

  • LGBT report "double discrimination"

  • Subtle and elusive

    • Deprivation rather than outright discrimination

• Perceived lack of support

  • Report inadequate support from UN, leaders in community, child care, LGBT organizations

  • Need for more inter culturally competent ethnic and religious leaders

    • Wanted their own culturally leaders to understand the other cultures represented in Canada to allow for more integration

  • Culturally inappropriate services

    • Not given interpreters, HCPs didn't understand their background, trauma/mental health not acknowledged

• Importance of close bonds

  • With support of family and friends, negative effects of stressful experience of migrating can be mitigated

  • Connectivity decreases feelings of fear and loneliness

Discussion: Refugees can experience subtle forms of discrimination when seeking support from healthcare providers and their identities are often disrupted due to changes in work and social roles within Canadian culture. Therefore, healthcare providers (including OTs) need more cultural competency education in order to be involved with resettling refugees. 

Rachel Thibeault, Wadih Beheit, Natalie Gagne, Sophia Raytchev, Maude Le Bouthillier Shaughnessy, & Stephanie Berube

2000 government sponsored refugees arrived in Ottawa.

They faced slow processing, physical and mental health concerns, lack of employment and lack of housing. 

- increased anxiety, depression, PTSD

- isolation within communities 

- lack of routine

​

A peer support program was created to address these problems. 

- 20 peer supporters paired with 20 refugees in need

- project funded through Ottawa Community Foundation

- 12 hour peer support training program provided to Arabic speaking volunteers (e.g. communication strategies, resources and how to access them, meaningful activities for resilience and integration)

​

Main objectives:

1. Peer Navigator: Help refugees familiarize with and use the institutions & facilities that shape daily life 

2. Peer Screening: Screen for disabilities & mental health issues

3. Peer Support: provide emotional support 

4. Peer Networker: connect the refugees quickly to local communities and resources

​

Cyclic Process:

Select participants --> Peer training program --> Matching --> Ongoing monitoring of activities --> Community practice --> Final evaluation --> Select new participants 

​

The Role for OT:

• Change agent:

  • Design of unique PS program for psych well-being

  • Developing an open source manual to reproduce program with other vulnerable groups

• Enabling occupation:

  • Pairing regufees with PS with shared lived experience with intentional meaningful activities

• Scholarly practitioner

  • Lit review to understand challenges of refugees and material on:

    • Intentional meaningful activities

    • Attitudes

    • Emotional regulation

• Practice manager:

  • Data collection and analysis

• Professional

  • Client-centred program by understanding cultures, religion attitudes

• Communication:

  • Training

  • Ensuring cultural sensitivity (e.g. Well-being vs. Mental health(

• Collaborator:

  • Between key stakeholders

​

Results:

- Quantitative and qualitative results indicate the program has been beneficial for peers and peer supporters!

- Monitoring, evaluation, and learning has been done using "Empowerment Evaluation", which asks participants to define success in their own terms.

​

Challenges:

- logistics: program wanted to recruit supports that spoke Arabic, but not Syrian because refugees were fearful of different populations. It was challenging to read the target population as a Westerner despite consulting relevant experts due to the ethnic, language, religious, and political layers involved.

- ethics with participatory action research is difficult to obtain because communicating with participants prior to program development is not common, however, the program development needed refugee input

​

Next Steps:

- Program for immigrant women 

- Program for immigrant youth at risk

- Greater focus on grief and bereavement

- Development of step-by-step manual for implementing program in other sites

​

Examples of resilience-building occupations:

- physical activity or ordering activities to address anxiety

- mindfulness

- activities that promote connectedness

- create activities

- activities that allow you to give back to the community

Presenter: Sandy Escobar

This presentation explored the literature on transgender people's experiences in the healthcare system. Sandy was a student presenter from Dalhousie University and had a great presentation and handout that she agreed to share with our classes. This presentation gave some interesting ideas about OPIs that can be faced by transgender people and changes we can make to create a more inclusive space for this demographic.

Please click on the buttons below for copy's of the presentation and an informative handout. 

Presenters: Angie Phenix, Kaarina Valavaara, Gayle Restall, & Havelin Anand

In this session, a panel of Occupational Therapists led a discussion about the Truth and Reconciliation Commission (TRC) and strategies to promote an understanding of indigenous healthcare in the Occupational Therapy community from an anti-oppressive lens. We participated in an interesting exercise that was designed to emphasize the social positions that exist in Canada and how various groups can be marginalized in our society. This session led to an interesting discussion where an occupational therapist who practices in the Yukon shared some of her experiences and insights into how the healthcare system can be incompatible with culturally appropriate practices in certain communities. The speakers discussed colonization as a social determinant of health, and discussed how being unprepared to deal with structural racism and barriers that impact the health of Indigenous clients can reproduce inequity. Through use of a case study, small groups discussed the following relevant issues:

• Systemic barriers:

  • Individualized focus

  • Acute focus of care

  • Standardized approach inappropriate for culture

  • Understanding the history: perception of someone coming in to the home to take someone back to the hospital (power imbalances)

  • Regulated health profession: ethical standards about socializing with clients/being involved outside formal interaction (example of how our codes are written from Western perspective)

  • Coming in with a student (entourage of power)

  • Value that OTs value

• Research/program evaluation:

  • Participatory action research methodology

  • More ethnographic focus; immersion in the community

  • No one talks about what to do when things go poorly

• Education:

  • Model of preceptor/student

  • Content on Indigenous worldviews and ways of knowing

  • Building elders into their classroom

  • System constrains our knowledge

• Cultural safety:

  • Appropriateness of care (e.g. Going hunting with a male)

  • Not appropriate to talk to an elder the way most cognitive assessments are structured

• Clinical:

  • Culture of making it okay to make mistakes and move forward

  • Who are you walking into my house? Sharing personal information about your name, your parents, where you're from (important in many cultures)

For more ways to get involved, the presenters shared the following resources and ideas: 

• Partner with Indigenous peoples in your communities

• Create a local reading and discussion group

• Join the CAOT Occupational Therapy Aboriginal Network

• Watch this CBC series: 8th Fire Dispatches from a team of Aboriginal storytellers

​

Other readings:

• Bishop, A. (2015). Becoming and ally: Breaking the cycle of oppression in people. Halifax: Fernwood Publishing.

• Phenix, A. & Valavaara, K. (2016). Reflections on the Truth and Reconciliation Commission: Calls to action in occupational therapy, Occupational Therapy Now, 18, 17-18. 

• Restall, G., Gerlach, A., Valavaara, K., & Phenix, A. (2016). The Truth and Reconciliation Commussion's calls to action: How will occupational therapists respond? (Guest Editorial), Canadian Journal of Occupational Therapy, 83, 264-268. 

• First Peoples, Second Class Treatment: The Racism in Health and Wellbeing of Indigenous peoples in Canada