Re-examining concepts of occupation and occupation-based models: Occupational therapy and community development

Key words. Communities. Occupational therapy. Occupations. Theoretical models. Mots clés. Communautés. Ergothérapie. Modèles théoriques. Occupations. Abstract. Background. A growing body of literature supports the role of occupational therapists in community development. Using a community development approach, occupational therapists respond to community-identified occupational needs. They work to build local resources and capacities and self-sustaining programs that foster change within the community and potentially beyond. Purpose. The purpose of this paper is to highlight some key issues related to occupational therapy practice in community development. Key Issues. The definitions and classifications of occupation focus primarily on the individual and fail to elaborate on the shared occupations of a community. As well, occupation-based models of practice are not easily applied to occupational therapy practice in community development. Implications. In order for occupational therapy to articulate its role in community development, greater heed needs to be given to the definition and categorization of occupation, occupation-based models of practice, and their application to communities. Résumé. Description. De plus en plus d'écrits appuient le rôle des ergothérapeutes dans le domaine du développement communautaire. En utilisant une approche de développement communautaire, les ergothérapeutes peuvent répondre aux besoins occupationnels de la communauté. Les ergothérapeutes travaillent en vue de développer des ressources locales, des compétences et des programmes autonomes qui favorisent le changement non seulement au sein de la communauté, mais bien au-delà. But. Le but de cet article est de mettre en évidence quelques-uns des principaux enjeux liés à la pratique de l'ergothérapie dans le domaine du développement communautaire. Questions clés. En matière d'occupation, les classifications et les définitions se concentrent à priori sur l'individu et ne permettent pas d'élaborer sur les occupations partagées au sein d'une communauté. De plus, les modèles de pratique fondés sur l'occupation ne s'appliquent pas facilement à la pratique de l'ergothérapie en développement communautaire. Conséquences. Afin de permettre aux ergothérapeutes d'affirmer leur rôle en développement communautaire, une plus grande attention doit être prêtée à la définition et à la catégorisation de l'occupation, ainsi qu'aux modèles de pratique fondés sur l'occupation et à leur application au sein des communautés.






Publication: The Canadian Journal of Occupational Therapy
Author: Leclair, Leanne L
Date published: February 1, 2010

Community development is "the process of organizing and/or supporting community groups in their identification of important concerns and issues, and in their ability to plan and implement strategies to mitigate their concerns and resolve their issues" (Labonte, 2007, p. 90). A community development approach responds to community-identified needs, building local resources and capacities and self-sustaining programs that foster change within the community and potentially beyond (Laverack & Labonte, 2000). Community development is different from community-based approaches. The distinction lies in who identifies the issues or concerns and who holds the decision-making power (Labonte). In a community-based approach, professionals or agencies define the problem and develop strategies to remedy the problem. The professionals or agencies may involve local community members and groups to assist in solving the problem; however, the decision-making power lies primarily with the professionals, agencies, and/or program funder. For example, home care programs and services use a community-based approach to provide specific services to individuals living in the community that meet criteria established by policy makers. Community-based approaches are important, but they are not community development, which attempts to support community groups in resolving concerns as group members define them. Community development, like community-based approaches, does not focus only on health issues; it may also focus on issues and initiatives that promote the social and economic development of a community.

The term community has been defined in many ways. However, according to Labonte (2007), when working in community development, the community must self-identify as a group with a common interest.

We all belong to multiple communities at any given time. The essence of being a community is that there is something that is "shared." We cannot really say that a community exists until a group with a shared identity exists (Toronto Department of Public Health, 1994, p. 2).

A growing body of literature supports the role of occupational therapists in community development (Algado & Cardona, 2005; Banks & Head, 2004; Bass-Haugen, Henderson, Larson, & Matuska, 2005; Christiansen & Townsend, 2004; Lauckner, Pentland, & Patterson, 2007; Restall & Ripat, 2008; Restall, Ripat, & Stern, 2003; Scaletti, 1999; Townsend, Cockburn, Letts, Thibeault, & Trentham, 2007; Trentham, Cockburn, & Shin, 2007; Wilcock, 2006). In the most recent guidelines for Canadian practice, Townsend, Beagen, et al. (2007) broadened occupational therapy client categories to include communities, recognizing that occupational therapists have a unique contribution to make to the health and wellbeing of communities. Townsend, Cockburn, et al. called on occupational therapists to engage in enabling social change at the macro-level using a community development approach. "Outcomes of interest to occupational therapists in enabling social change may be to advance occupational rights" (p. 155) through occupational justice.

Occupational justice is a term that has emerged in the occupational therapy literature over the past decade. It speaks to the occupational nature of all human beings and the right of all individuals to participate in meaningful and purposeful occupations (Townsend & Wilcock, 2004). However, if occupational therapists wish to pursue occupational justice at the macro-level, "they need to build on their abilities in working cooperatively and in partnership with communities" (Pollard, Sakellariou, & Kronenberg, 2008, p. 27), concepts that are in keeping with community development. The purpose of this paper is to explore the challenges that both the definitions and categorizations of occupation and the application of occupation- based models of practice pose to occupational therapy practice in community development.

Key Issues

Definitions and Categorizations of Occupation

It is important to acknowledge that while our professional title has included occupation from the beginning, the focus on occupation in practice has wavered over the years. For several decades, the profession lost sight of its roots in occupation, working within the reductionistic, biomedical paradigm (Dickie, 2008). However, in the late 1970s, the profession again began to acknowledge occupation as the foundation of occupational therapy, and discourse about the definition and nature of occupation persists today (Dickie). Definitions of core concepts are the foundation of a profession's research and practice and shape its traditions through their emphasis and values (Pierce, 2001). Currently, there is no consensus on a universal definition of occupation within the profession of occupational therapy. However, the literature is replete with richly textured and diverse explanations of the concept (Watson & Fourie, 2004).

Table 1 provides an overview of several definitions of occupation cited in the occupational therapy literature. Many definitions share the idea that occupation is experienced by the individual and is subjective. Some definitions assert the idea that value and meaning are also derived from cultural context and that participation in occupation benefits not only the individual but the communities in which they live, work, and play. Polatajko, Backman, et al. (2007) explored the characteristics of human occupation. They indicated that "the who of occupation may not only be a single person, but pairs, groups, communities, populations and even societies" (p. 40).

Shared or collective occupations?

Wilcock's (2006) definition of occupation in Table 1 supports the idea of shared occupation. Similarly, Doble and Caron (2008) suggested that individuals have the need "to engage in occupations with others who share common experiences, interests, values or goals" (p. 187). Eakman (2007) examined the social complexity of occupation, exploring occupation as a phenomenon that may be co-constructed by individuals who are mutually engaged. Zemke and Clark (1996) described the idea of co-occupations of social beings, which by definition are occupations that involve at least two active participants, for example, infant and caregiver interactions. Segal (1998, 1999) also studied the idea of shared occupations, focusing her work on families. Family occupations occur when the whole family is engaged in an occupation together, for example, partaking in a family meal. However, the level of engagement in the occupation may not be equal among family members and their purpose and experiences may differ (Segal, 1998).

The notion that occupations can be shared among individuals, groups, and communities is not widely recognized or developed in the occupational therapy literature. Trentham et al. (2007) discussed the use of community development strategies to enable engagement in shared occupations. They emphasized the importance of supporting individuals' engagement in shared occupations "such as planning, learning, and skill building in a group context" (p. 62) to influence individual and community health. Christiansen and Townsend (2004) discuss shared occupations as being central to successful community living. Polgar and Landry (2004) discussed community participation in occupation. They described communities as "groups of people acting collectively in a desired or needed occupation" (p. 210). The community comes together in the performance of a common or collective occupation. For example, an occupational therapist using a community development approach to promote the health of a community of older adults could facilitate the planning of a community forum to bring together community members to identify their concerns and priorities for action. Each individual may have a different reason for participation in the community occupation and a different approach to participation. However, by identifying and focusing on common issues, community members declare a shared purpose and work together when acting on a particular goal. At the community forum, community members may identify that an issue of central concern is that they lack a place to congregate outdoors in their community. The community members may decide that they would like to develop a green space where they can engage in meaningful activities and contribute to the community. They may express an interest in developing a community garden for all to enjoy. The community garden can serve various purposes for the community members. Some individuals may enjoy the occupation of gardening, while others would like to spend time in the garden socializing or exercising. For some, the planning and organization of the community garden provides them with meaningful occupation. However, all partake in the shared occupation of building a community garden. Participation as a collective enables groups of people to fulfill certain functions and meet needs that they would be unable to achieve individually. "Participation in collective doing and interconnected occupations provides members with a sense of purpose, with a source of motivation and drive, and with an appreciation of their ability to share in shaping their communities" (Polgar & Landry, p. 211).

When working within a community development approach, the idea of shared occupation becomes fundamental to the process. The occupational therapist supports engagement in shared occupations and may take on various roles in the process. He or she may assist in bringing together different organizations that can contribute to building the community garden. For example, the municipal government may be able to offer assistance with procuring land for the garden; a garden nursery in the community may be able to donate plants; another business may be able to donate benches. The role the occupational therapist plays in the community development process will vary depending on the needs and capacities of the community. At times, the occupational therapist may take on a leadership role and at other times, he or she may serve as a facilitator in the community development process while other community members take on a leadership role.

Categorization of occupation.

The Canadian Association of Occupational Therapists' (CAOT) definition, like other definitions of occupation, suggests that occupation can be categorized into three main areas: self-care, productivity, and leisure. However, the categorization of occupations is often problematic (Christiansen & Townsend, 2004; Dickie, 2008; Hammell, 2004, 2009). While it would seem that the categories fit some areas of practice, they do not appear to be universal. Occupational therapists working in community development may find categorizing occupations into self-care, productivity, and leisure does not fit with their practice; these categories and definitions may not be relevant to the collective occupations of a community. Christiansen and Townsend propose occupational categories that contribute to the success of communities, including social sanctions, cultural rituals, shared history, art, magic and religion, volunteerism, work, and sustainable practices. However, there has been very little discussion or debate in the occupational therapy literature about the occupational nature of communities. Without a greater understanding of the nature of community occupation, categorization is dubious. As occupational therapy continues to evolve and emerge in different areas of practice, such as community development, the profession needs to examine the categorization of occupation and its application to all clients (e.g., individuals, groups, communities).

Occupational Therapy Models of Practice

A core concept of occupational therapy models is client-centred practice. Townsend and Wilcock (2004) emphasized the link between the collaborative and inclusive nature of community development with "occupational therapy's social vision of client-centred approaches for enabling empowerment through occupations" (p. 77). Traditionally, the development of clientcentred practice in occupational therapy has focused primarily on working with individuals. However, efforts to frame clientcentred practice beyond the individual are emerging. For example, the Client-Centred Strategies Framework (Restall et al., 2003) provides strategies that occupational therapists can use when working in various contexts, including community organizing and coalition advocacy, both in keeping with a community development approach. Recently, Restall and Ripat (2008) explored occupational therapists' application of the strategies proposed in the Framework to their practice. A key finding of the study revealed that occupational therapists felt they lacked the knowledge and skills needed to practice community organizing and coalition advocacy. While the focus of their study was on the application of client-centred strategies in these areas, it speaks to the lack of exposure and experience therapists feel they have in community development approaches.

Occupational therapists working in community development may draw on several different models or approaches commonly used by other professionals working in this area of practice to inform their process. Table 2 provides an overview of the Community Development Continuum Model (Jackson, Mitchell, & Wright, 1989) and Rothman and Tropman's (1987) Taxonomy of Community Development. Occupational therapists have used the Community Development Continuum Model to frame practice in community development (Scaletti, 1999; Trentham et al., 2007). This model identifies five stages that link individual and social change (Townsend, Cockburn, et al., 2007). Scaletti proposed an approach that occupational therapists can use when working with this model in child and adolescent mental health. Another widely recognized community development framework used by occupational therapists is Rothman and Tropman's three models: locality development, social planning, and social action. "Each model is characterized by particular assumptions about where to start and where to focus in enabling change in micro- and macro-level structures" (Townsend, Cockburn, et al., p. 163). Trentham et al. used Rothman and Tropman's taxonomy and the Community Development Continuum Model "to link their work with individuals to broader community development objectives" (p. 57). They provided suggestions of how an occupational perspective might fit within these models.

The elements that distinguish occupational therapy's contributions from those of other professionals are our focus on occupation and our use of occupation-based models of practice when working with clients. Yet, many models in occupational therapy focus on individuals (Thibeault & Hebert, 1997). Hammell (2009) stated that "current theories of occupation provide little space for consideration of the importance of fostering interdependence or of contributing to the well-being of others" (p. 11). Lawlor (2003) suggested that theoretical and research models are needed to capture the essence of socially occupied beings doing something with someone else that matters.

Application of occupation-based models in community development.

The Canadian Model of Occupational Performance and Engagement (CMOP-E) (Polatajko, Davis, et al., 2007) and the Person-Environment-Occupation Model (PEO) (Law et al., 1996), like other occupation-based models of practice, pose a challenge for practitioners working in community development. The language and concepts of the CMOP-E are similar to those of the PEO. Like the PEO, the CMOP-E categorizes occupation into self-care, productivity, and leisure, a categorization that does not necessarily fit with the collective occupations that are the focus of a community development approach. The CMOP-E and the PEO address the cognitive, affective, and physical performance components of the person. These performance components are not easily translated to a community. For example, how would one describe or evaluate the cognitive, affective, or physical abilities of a community? The environmental components of the CMOP-E and the PEO are an important part of a community development approach because often the community is seeking to change environmental aspects; however, the physical, social, cultural, and institutional environments of a community can be quite different from those of an individual. Both models refer to the client's occupational performance, and, more recently, the CMOP-E has included occupational engagement. What are a community's occupational performance or engagement issues and how does an occupational therapist identify them?

There are very few examples of the application of occupation- based models of practice to communities in the occupational therapy literature.Watson and Wilson (2003) discuss the application of the concept of person-environment-occupation at a community level. They suggest that occupational therapists "offer a unique approach to assessing community needs, assets and resources by conducting task analysis of population characteristics (i.e., persons), environments (i.e., performance contexts), and community actions (i.e., tasks and activities) that support or hinder health" (Watson & Wilson, p. 158). While the constructs of person-environment-occupation may be applicable to community clients, occupational therapists must conceptualize the constructs in a different way than is outlined in the PEO or CMOP-E. However, thinking about the constructs in relation to communities is an important first step in developing occupation-based models of practice that will support occupational therapists work in community development.

Wilcock (1998) introduced the Ecological Sustainability Model of Health as a tool for occupational therapists to promote healthy relationships between people and their environments. She refers to it as an "occupation-focused ecosustainable community development approach" (2006, p. 222). This model requires a focus on eco-sustainability when participating in community development, which Wilcock (2006) argues should be part of all community development activities. Algado and Cardona (2005) applied the model in their work with Guatemalan refugees and suggested that occupational therapists can use human occupation to restore balance in the natural environment while also contributing to community development. While this model has some application for occupational therapists working in community development, it has not been widely used or cited in the occupational therapy literature.

Several authors have explored the gap that exists between theory and practice (Forsyth, Summerfield, & Kielhofner, 2005; Kielhofner, 2005; Lee, Taylor, Kielhofner, & Fisher, 2008). Kielhofner (2005) proposed that those who will ultimately use theory in practice should be involved in its generation. He emphasized cooperative efforts in which practitioners and academics work together to advance theory and practice. Therefore, future development of occupation-based models that pertain to community development practice should be "derived from the experiences of occupational therapists currently working in community development" (Lauckner et al., 2007, p. 323) in partnership with scholars who share an interest in this area. Occupational therapists are encouraged to participate in research that contributes to the evolution of existing occupation-based models that would allow for their broader application to community development.

Conclusion

In order for occupational therapy to articulate clearly its role in community development, greater heed needs to be given to our understanding of the application of our definitions and categorizations of occupation and occupation-based models of practice to community development. Given some of the current issues outlined in this paper, occupational therapists need to ask themselves about the nature of their work with communities. Are we enhancing participation in shared occupations? How might we categorize the community's occupations? Are we using occupation-based models of practice when working in community development? In an effort to advance the profession in community development, occupational therapy researchers and practitioners working with communities, along with their community partners, need to continue to explore and expand on the definition of shared occupation, categorizations of community occupations, and the development of occupation-based models of practice that can be used when working in community development.

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Author affiliation:

Leanne L. Leclair, MSc, PhD Candidate, OT Reg (MB) is Assistant Professor, Department of Occupational Therapy, University of Manitoba, R106-771 McDermot Avenue, Winnipeg, Manitoba, R3E 0T6. Telephone: 204-977-5631.

E-mail: leclairl@cc.umanitoba.ca

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