Community Occupational Therapy

Substance abuse is a public health concern in South Africa, and Western Cape Province in particular has been identified as having alarming rates of substance abuse. Substance abuse is the cause of some of the most pervasive and costly problems in society. Substance abuse is associated with various social problems such as crime, violence, unemployment, poverty, risky sexual behaviours, the escalation of chronic diseases such as AIDS and TB, and dysfunctional family life -and these problems are often interlinked. Furthermore, substance disorders place a huge strain on the health and welfare system of South Africa. In-and outpatient treatment facilities exist in communities to assist with alleviating the problem of substance abuse. Aftercare facilities are a form of outpatient service for substance abusers who have completed inpatient treatment. The primary aim of aftercare is to assist recovered substance abusers to maintain treatment gains by abstaining from substance use and to facilitate their reintegration with their families and communities. The purpose of the present study was to explore and obtain an in-depth understanding of the experiences of rehabilitated substance abusers in aftercare, following their completion of inpatient treatment. The sampling method for the study was purposive, and the sample consisted of two female and six male participants. Participants' attendance at the aftercare programme was verified with the aftercare co-ordinator. Semi-structured interviews were conducted and data were analysed using interpretative phenomenological analysis. Results of the study found that, overall, participants had a positive experience of aftercare. Furthermore, results indicated that aftercare played a vital role in assisting participants to maintain treatment gains.

Substance abuse is a public health concern in South Africa, and Western Cape Province in particular has been identified as having alarming rates of substance abuse. Substance abuse is the cause of some of the most pervasive and costly problems in society. Substance abuse is associated with various social problems such as crime, violence, unemployment, poverty, risky sexual behaviours, the escalation of chronic diseases such as AIDS and TB, and dysfunctional family life -and these problems are often interlinked. Furthermore, substance disorders place a huge strain on the health and welfare system of South Africa. In-and outpatient treatment facilities exist in communities to assist with alleviating the problem of substance abuse. Aftercare facilities are a form of outpatient service for substance abusers who have completed inpatient treatment. The primary aim of aftercare is to assist recovered substance abusers to maintain treatment gains by abstaining from substance use and to facilitate their reintegration with their families and communities. The purpose of the present study was to explore and obtain an in-depth understanding of the experiences of rehabilitated substance abusers in aftercare, following their completion of inpatient treatment. The sampling method for the study was purposive, and the sample consisted of two female and six male participants. Participants' attendance at the aftercare programme was verified with the aftercare co-ordinator. Semi-structured interviews were conducted and data were analysed using interpretative phenomenological analysis. Results of the study found that, overall, participants had a positive experience of aftercare. Furthermore, results indicated that aftercare played a vital role in assisting participants to maintain treatment gains.

Background Because the pattern of illnesses changes in an aging population and many people manage to live well with chronic diseases, a group of health care professionals (Huber et al., 2011) proposed reformulating the static WHO definition of Health towards a dynamic one based on the ability to physically, mentally and socially adapt and self-manage. This paper is the result of a collaborative action of the INTERDEM Social Health Taskforce to operationalize this new health concept for people with dementia, more specifically the social domain, and to formulate directions for research and practice to promote social health in dementia. Method Based on the expertise of the Social Health Taskforce members (N=54) three groups were formed that worked on operationalizing the three social health dimensions described by Huber et al.: 1) capacity to fulfil potential and obligations; 2) ability to manage life with some degree of independence; 3) participation in social activities. For each dimension also influencing factors, effective interventions and knowledge gaps were inventoried. After a consensus meeting, the operationalizations of the dimensions were reviewed by the European Working Group of People with Dementia (EWGPWD). Results The social health dimensions could be well operationalized for people with dementia and are assessed as very relevant according to the Social Health Taskforce and EWGPWD. Personal (e.g. sense of coherence, competencies), disease-related (e.g. severity of cognitive impairments, comorbidity), social (support from network, stigma) and environmental factors (e.g. enabling design, accessibility) that can influence the person with dementia's social health and many interventions promoting social health were identified. Conclusion A consensus-based operationalization of social health in dementia is proposed, and factors that can influence, and interventions that improve, social health in dementia identified. Recommendations are made for research and practice.

The findings of the study suggests that service providers experience challenges in service delivery in rural areas of South Africa. These include, culture (amarula festival and ancestral worship) that exacerbates the use of substances, high rate of unemployment and poverty such that people resort to home brewed substances for sustainable living, lack of resources within the respective work places (NGOs and governmental departments) of service providers (staff shortage and equipment/vehicles). The lack of resources is also exacerbated by the geographical isolation of rural areas, consequently, the treatment or rehabilitation is weak and disjointed among stakeholders. Furthermore poor monitoring and evaluation of services coupled with lack of research in rural areas was noted. Strengths included prevention programmes, good inter-sectoral collaboration including strong support from civil societies. Conclusion: The collective perceptions and experiences of rural substance abuse service providers were challenging in rendering the service in rural areas. However, there were strengths or enablers noted. Evidently, the South African acts and policies has overlooked rural areas and a lack of resources exacerbates the situation. It is recommended that protocol and service standard for Substance Abuse Occupational Therapy services for after care and community based rehabilitation should be developed for easier monitoring and evaluation for quality improvement rehabilitation services

Background Because the pattern of illnesses changes in an aging population and many people manage to live well with chronic diseases, a group of health care professionals (Huber et al., 2011) proposed reformulating the static WHO definition of Health towards a dynamic one based on the ability to physically, mentally and socially adapt and self-manage. This paper is the result of a collaborative action of the INTERDEM Social Health Taskforce to operationalize this new health concept for people with dementia, more specifically the social domain, and to formulate directions for research and practice to promote social health in dementia. Method Based on the expertise of the Social Health Taskforce members (N=54) three groups were formed that worked on operationalizing the three social health dimensions described by Huber et al.: 1) capacity to fulfil potential and obligations; 2) ability to manage life with some degree of independence; 3) participation in social activities. For each dimension also influencing factors, effective interventions and knowledge gaps were inventoried. After a consensus meeting, the operationalizations of the dimensions were reviewed by the European Working Group of People with Dementia (EWGPWD). Results The social health dimensions could be well operationalized for people with dementia and are assessed as very relevant according to the Social Health Taskforce and EWGPWD. Personal (e.g. sense of coherence, competencies), disease-related (e.g. severity of cognitive impairments, comorbidity), social (support from network, stigma) and environmental factors (e.g. enabling design, accessibility) that can influence the person with dementia's social health and many interventions promoting social health were identified. Conclusion A consensus-based operationalization of social health in dementia is proposed, and factors that can influence, and interventions that improve, social health in dementia identified. Recommendations are made for research and practice.

No occupational therapist can ignore the rapidly changing context of practice. Health policies are informed by many stakeholders, not only from the state sector and professional associations but also from service user organisations, the private sector and non-governmental organisations, among others. Accountability becomes harder to define in such a complex context: to whom are occupational therapists accountable and for what? In 2006, the World Federation of Occupational Therapists published a position statement on human rights. This statement endorsed access to occupation as a human right. If only a portion of people can access meaningful occupation, then this is a call for action for occupational therapy. As professionals who are concerned with facilitating occupational choices, occupational therapists are advocates for the right to meaningful occupation. In recognising and working for the right to do, be, become and belong, occupational therapists have a role in safeguarding equitable access to occupation and ensuring that situations of occupational injustice are brought to the surface. We believe that occupational therapists are primarily accountable to the individuals and communities that they work with towards an equitable access to occupation. Equitable access does not imply similar access: people have different wishes and needs. In addition, some factors that hinder access to occupation are not amenable to change, whereas others, like geographical features, apply to everybody. However, many of the factors that restrict access to occupation are due to preventable causes that go against the needs and desires of individuals or communities. When these occur over a long time, they can have a pervasive impact on the resources and opportunities available, presenting a potential violation of the right to occupation.

This data collection subproject is part of the WFOT-CBR master project plan and serves as evidence of the commitment of the World Federation of Occupational Therapists (WFOT) to promote community-based rehabilitation (CBR) as an approach to promote access to occupation for all. This subproject aimed to collect data on the contributions of occupational therapists in CBR with the purpose to promote awareness on CBR within the profession and also to facilitate the development of relevant educational programmes. Responses were received by occupational therapists from the five continents. Findings revealed a polyphony regarding the conceptualisations of CBR and a perceived goodness of fit between occupational therapy and CBR. However, most 2 respondents reported inadequate university education on CBR. It is suggested that CBR should be considered as part of the professional role of occupational therapists and that the profession should develop rigorous guidelines for its practice. Given the inherently dialectical nature of CBR it is also important to network with disabled people's organisations and communities involved in CBR.

The World Federation of Occupational Therapists' (WFOT's) position paper on community-based rehabilitation (CBR) was the first of the kind in its 52 year history, a significant indicator of the importance of CBR approaches with the increasing professional interest in social justice and socio-political barriers to participation in dignified and meaningful occupations as a human right. The authors describe the primary health care roots of CBR and critically discuss potential occupational therapy roles in the CBR strategies for inclusive community development. CBR enables the exposition of links between poverty, disability, and other hidden issues. The WFOT CBR project is presented as stemming from the perception that disability can be rethought as a social and development issue incorporating inclusion and individual needs based around occupation. The potential outcomes from the adoption of CBR are explored through the political Activities of Daily Living (pADL) tool, which is used to propose further strategic actions for WFOT, and occupational therapy practitioners, educators and researchers.

The issue of sex is often avoided in or excluded from occupational therapy. This opinion piece argues that the exclusion of sex contradicts the holistic and client-centred arguments of occupational therapy and can lead clients to the adoption of precarious occupations in order to pursue their sexual needs. It offers an overview of some of the reasons for the exclusion of sex discourses from occupational therapy and calls for an appreciation of clients’ sexual needs. By learning more about clients’ experiences, occupational therapists can establish priorities towards shared outcomes and facilitate the maintenance, development and re-establishment of meaningful occupational lives.

Occupational therapy is rethinking its paradigm of human occupation to take account of the social, political, economic and environmental influences on communities and the effects that these have on opportunities for being and doing. One way of bringing this element into undergraduate curricula may be to develop programmes around community-based rehabilitation (CBR) and human rights. Recent position papers from the World Federation of Occupational Therapists, in combination with occupational justice arguments, may support an orientation of professional thinking towards community needs. Some suggestions are made for the accommodation of CBR perspectives in education, particularly through the development of practice placement opportunities.

Occupational therapy is broadly about the experience of ‘doing’ as the basis of human participation. This requires access to the means of participation, space, facilities and resources for different forms of human action. People who have experienced disability are frequently prevented from engaging in activities which other people can access, and can benefit from. Their rights to social participation at all levels are restricted, and this is a political aspect of their impairment – something that is recognized in feminist discourse in the recognition of the relationship between the personal and the political. Consequently rehabilitation has a dimension which is not just about restoring or adapting function, but also about addressing the social and political circumstances which produce barriers to occupation.

This data collection subproject is part of the WFOT-CBR master project plan and serves as evidence of the commitment of the World Federation of Occupational Therapists (WFOT) to promote community-based rehabilitation (CBR) as an approach to promote access to occupation for all. This subproject aimed to collect data on the contributions of occupational therapists in CBR with the purpose to promote awareness on CBR within the profession and also to facilitate the development of relevant educational programmes. Responses were received by occupational therapists from the five continents. Findings revealed a polyphony regarding the conceptualisations of CBR and a perceived goodness of fit between occupational therapy and CBR. However, most 2 respondents reported inadequate university education on CBR. It is suggested that CBR should be considered as part of the professional role of occupational therapists and that the profession should develop rigorous guidelines for its practice. Given the inherently dialectical nature of CBR it is also important to network with disabled people's organisations and communities involved in CBR.

The World Federation of Occupational Therapists' (WFOT's) position paper on community-based rehabilitation (CBR) was the first of the kind in its 52 year history, a significant indicator of the importance of CBR approaches with the increasing professional interest in social justice and socio-political barriers to participation in dignified and meaningful occupations as a human right. The authors describe the primary health care roots of CBR and critically discuss potential occupational therapy roles in the CBR strategies for inclusive community development. CBR enables the exposition of links between poverty, disability, and other hidden issues. The WFOT CBR project is presented as stemming from the perception that disability can be rethought as a social and development issue incorporating inclusion and individual needs based around occupation. The potential outcomes from the adoption of CBR are explored through the political Activities of Daily Living (pADL) tool, which is used to propose further strategic actions for WFOT, and occupational therapy practitioners, educators and researchers.

The World Federation of Occupational Therapists' (WFOT’s) position paper on community-based rehabilitation (CBR) was the first of the kind in its 52 year history, a significant indicator of the importance of CBR approaches with the increasing professional interest in social justice and socio-political barriers to participation in dignified and meaningful occupations as a human right. The authors describe the primary health care roots of CBR and critically discuss potential occupational therapy roles in the CBR strategies for inclusive community development. CBR enables the exposition of links between poverty, disability, and other hidden issues. The WFOT CBR project is presented as stemming from the perception that disability can be rethought as a social and development issue incorporating inclusion and individual needs based around occupation. The potential outcomes from the adoption of CBR are explored through the political Activities of Daily Living (pADL) tool, which is used to propose further strategic actions for WFOT, and occupational therapy practitioners, educators and researchers. This is a reprint of the final submitted article, not the published version

Community-based rehabilitation (CBR) is an approach that could usefully be applied by occupational therapists working towards access to occupation for all. CBR happens with, rather than in, the community. It allows communities to identify their problems and the causes, including the sociopolitical underpinnings of disability, to locate their needs and to take control of strategies that address those needs. A recent subproject of the World Federation of Occupational Therapists revealed a lack of consensus as to what constitutes CBR and a perceived overlap with community rehabilitation. This opinion piece aims to clarify the connection between the two approaches and to explore the implications for occupational therapists.

This data collection subproject is part of the WFOT-CBR master project plan and serves as evidence of the commitment of the World Federation of Occupational Therapists (WFOT) to promote community-based rehabilitation (CBR) as an approach to promote access to occupation for all. This subproject aimed to collect data on the contributions of occupational therapists in CBR with the purpose to promote awareness on CBR within the profession and also to facilitate the development of relevant educational programmes. Responses were received by occupational therapists from the five continents. Findings revealed a polyphony regarding the conceptualisations of CBR and a perceived goodness of fit between occupational therapy and CBR. However, most respondents reported inadequate university education on CBR. It is suggested that CBR should be considered as part of the professional role of occupational therapists and that the profession should develop rigorous guidelines for its practice. Given the inherently dialectical nature of CBR it is also important to network with disabled people’s organisations and communities involved in CBR. This is the text of the submitted draft, not a pdf of the printed article.

This paper offers a critical discussion of the goodness of fit between professional motives and community needs in the field of community-based rehabilitation (CBR). Data were drawn from the authors’ involvement in a survey of occupational therapists involved in CBR and a search of CINAHL, PsychInfo and Medline online databases for related descriptive and analytical articles. Due to cultural differences and time constraints CBR professionals often are, and remain, ‘outsiders’ to the community they are working with. The focus of CBR is sometimes uncertain. Professional motives do not always meet community needs and good intentions do not necessarily transpire into sustainable, culturally appropriate action. The involvement of the community in all stages of programme development and implementation is important both to ensure relevancy and build alliances with the community. CBR needs to be approached and evaluated as a unique area of professional practice.

Multidisciplinary teams (MDTs) are conventionally recommended in mental health
care literature as an important way to offer holistic treatment provision to patients. This
study aims to explore multidisciplinary teamwork in contemporary mental health
settings, particularly what aids and hinders the process of multidisciplinary teamworking,
and the social work contribution in such teams. In order to attain an in-depth
exploration of these phenomena, a single case study design was employed. Within this
design, data were generated through semi-structured interviews and structured
observation of a mental health MDT in Ireland. These data were analysed using
interpretative phenomenological analysis. The research highlights how the concept of
mental illness is contested within this MDT, with the medical model dominant within
an environment of fluid working arrangements. Professional role blurring and
stereotyping were found to impact the division of labour on this team, with role
negotiation found to be an integral part of retaining a professional’s practice identity.
This research raises concerns for social work’s capacity to function within mental
health MDTs in Ireland, and highlights ways in which social work educators might
respond in order to empower Irish social workers to meet the challenges of mental
health multidisciplinary teamworking.

Due to cultural differences and time constraints CBR professionals often are, and remain, 'outsiders' to the community they are working with. The focus of CBR is sometimes uncertain. Professional motives do not always meet community needs and good intentions do not necessarily transpire into sustainable, culturally appropriate action.