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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).

3. Communitymembers“own”theprogram. Thecommunityprogram shouldnotdependonexpertsor“outsiders”tobesuccessfulbutshould becomeembodiedbythecommunity.Thisprocesstakestimeandisnotwell definedinthecommunity-builtmodelbecausecommunitiesvary;butthe ultimategoalofcommunity-builtpracticeisforthecommunitytoassume responsibilityfortheprogram.

4. Theoccupationaltherapypractitionermustbeculturallyawarefortheprogramtosucceed (Barnardetal.,2004;Wittman&Velde,2001).Inmostcases, theoccupationaltherapypractitionercomesfromaculturalbackgrounddifferentfromthecommunitymembers.Culturalawarenessandculturaldesire (Campinha-Bacote,2001)areskillsrequiredofthepractitionerfortheprogramactivitiestohaveanimpact.

Community-builtpracticeisanemergingmodelinoccupationaltherapypracticethatisbasedoncommunity-andcapacity-buildingmodelsinpopulationbasedandhealthpromotionpractice(Wittman&Velde,2001).

Community-BasedPracticeversusCommunity-BuiltPractice

Bothcommunity-basedpracticeandcommunity-builtpracticearemodelsusedas frameworksforcommunitypractice.Althoughbothmodelsfocusoncommunity practice,theydifferintheirapproachesandphilosophies.

Acommunity-basedoccupationaltherapyprogramtakesplaceinthecommunitycontext.Itfocusesonapplyingtheconceptsofoccupationaltherapypractice tocommunitysettingstodevelopprogramsthataddressoccupationalneeds. Braveman(2001)sharesanexampleofacommunity-basedprogramforaddressingtheworkrehabilitationneedsofindividualswithHIV/AIDS.Theprogram, basedontheModelofHumanOccupationandprovidedaspartoftheservices offeredbyacommunityorganization,providesfourphasesofintervention:Phase 1focusesonself-assessmentandexplorationofrolesandhabits,phase2focuses ondevelopingskillsrequiredforwork,phase3includesemploymentplacement withsupport,andphase4provideslong-termfollow-upandsupportinthenew workrole.Todeveloptheprogram,Braveman(2001)followedaprogramdevelopmentmodelproposedbyGrossmanandBortone(1986)andimplementedthe programwithinacommunitycontext.

Community-builtpracticeutilizesacollaborationmodelandfocusesonthe needsandcapacitiesofthecommunityanditsmembers.Thecommunity-built modelreferstothisaspectinitstitle: Community is built withtheoccupational therapypractitionerasfacilitator.Barnardandcolleagues(2004)in“Wellnessin Tillery”describeanexampleofacommunity-builtmodel.Tilleryisasmall,rural towninNorthCarolinawithalargeAfricanAmericanpopulation.Studentsinthe EastCarolinaUniversityOccupationalTherapyprogramwereassignedtodevelop programmingfollowingacommunity-builtmodel.Studentswereaskedto

immersethemselvesinthecommunitytolearnaboutthepeopleandtofacetheir ownbiasesaboutthecommunity.Throughbuildingrelationships,thestudents wereabletocollaboratewiththeolderAfricanAmericansinthecommunityto developtheOpen-MindedSeniorsWellnessProgram,aprogramfocusedonphysicalactivity,spirituality,nutritioneducation,andcognitionactivities.Through surveysandfeedback,theprogramwasabletoincreaseseniorwellnessand improveoverallqualityoflifeamongthecommunitymembersinvolved.Theprogram’ssuccessisattributedtotheconceptsofthecommunity-builtmodel,which includecollaborativeplanningandimplementation,equalpartnershipsinprogramimplementation,andasenseofcommunityownershipoftheprogram.

Bothmodelsofcommunitypracticeofferapproachesand methodsfortheoccupationaltherapypractitioner.The community-basedmodelfocusesonavarietyofhealthpromotionandprogramdevelopmentapproacheswhereasthe community-builtmodelprovidesastructuredwayofviewing thecommunityandprogramdevelopment.Occupational therapypractitionersmustdeterminewhichapproachbest suitstheirclinicalreasoningandthecommunitytheyplanto partnerwith.Examplesofcommunity-basedandcommunity-builtpracticeprogramsexistintheliteraturetoaidthepractitionerinpickingamodelbestsuited forpractice.

PublicHealthandOccupationalTherapy

AccordingtoHildenbrandandFroehlich(2002),theaimof publichealthisto“mobilizeresourcestoensurehealthsupportingconditionsforallpersons.”Wilcock(2006)argues thatoccupationaltherapistshavearoleinpublichealth.On theotherhand,ScrivenandAtwal(2004)question“whether theprofessionhasthecompetenciesandcapacitytojoinothersinthepublichealthworkforcewithupstreamremitsand responsibilities”(p.428;Scaffa,VanSlyke,&Brownson, 2008).Despitethedebate,theroleofoccupationaltherapy practitionersincommunitypracticefollowsatraditionalpublichealthmodel.

BESTPRACTICEHINT

Exploretheliteratureformodelsof community-basedpracticeand community-builtpracticeto identifywhichmodelbestsuitsyou.

BESTPRACTICEHINT

Manystateshavepublichealth organizationssimilartostate occupationaltherapyassociations. Exploremembershipinthepublic healthorganizationofyourstate tolearnmoreandtonetworkwith publichealthprofessionals.

Healthpromotionisakeycomponentofpublichealth.AccordingtotheWorld HealthOrganization(2008),healthpromotionis“theprocessofenablingpeopleto increasecontrolovertheirhealthanditsdeterminants,andtherebyimprovetheir health.”Ingeneral,theoccupationaltherapyliteratureacknowledgesthatpractitioners’rolesincommunitypracticeareto“workwithclientstopromotehealthand overcomearangeofphysical,socialandemotionalbarriersandproblemstomaximisetheclient’squalityoflife”(Mitchell&Unsworth,2004,pp.14–15).Formany

occupationaltherapypractitioners,practicemaydelveintohealthpromotion, whichtightlyalignswiththetenetsofpublichealth(Baum&Law,1998).

Practitionerswhoareunfamiliarwiththeconceptsofpublichealthmayfindit difficulttotransitiontoapublichealthframework.HildenbrandandFroehlich (2002)arguethatoccupationaltherapypractitionershaveafundamentalroleto playinpublichealth,includingthepromotionofhealthmaintenanceforindividualswithorwithoutdisabilities,developmentofoccupation-basedcommunity programs,andparticipationonteamsofpublichealthprofessionalsinvolvedin healthpromotionprogramming.Theyencourageoccupationaltherapypractitionerstoembracearoleinpublichealth,statingthat“publichealtharenasof healthmaintenance,diseaseprevention,andhealthpromotionofferanewvision ofopportunityforpersonalchallenge,professionaldevelopment,anddiscipline expansion.”

Accordingto ThePromotionofHealthStatementandthePreventionofDisease andDisability publishedbytheAmericanOccupationalTherapyAssociation, occupationaltherapypractitionerscanplayaroleinhealthpromotionthroughthe promotionofhealthyliving,useofoccupationasavehicleforhealingandhealth maintenance,andtheprovisionofinterventionsfocusedonbothindividualsand populations(Scaffaetal.,2008).Thedocumentgoesontostatethat“becauseof theinextricableandreciprocallinksbetweenpeopleandtheirenvironments,larger groups,organizations,communities,populations,andgovernmentpolicymakers mustalsobeconsideredforintervention”(p.420).

Incommunitypractice,therearethreemainareasofhealthpromotionasoutlinedbyScrivenandAtwal(2004):primaryhealthpromotion,secondaryhealth promotion,andtertiaryhealthpromotion.Followingtraditionaldefinitionsofprevention, primaryhealthpromotion isdefinedas“activitiesthattargetthewell populationandaimtopreventillhealthanddisabilitythrough,forexample,health educationand/orlegislation.” Secondaryhealthpromotion “isdirectedatindividualsorgroupsinordertochangehealth-damaginghabitsand/ortopreventill healthmovingtoachronicorirreversiblestageand,wherepossible,torestorepeopletotheirformerstateofhealth.” Tertiaryhealthpromotion occurs“withindividualswhohavechronicconditionsand/oraredisabledandisconcernedwith makingthemostoftheirpotentialforhealthyliving”(Scriven&Atwal,2004,p. 425).Eachlevelofprevention/promotionfocusesonadifferentsubsetofthepopulation.Primarypreventionexploreshealthforallindividualswhereassecondary preventionfocusesonworkingwithpeoplewhohaveidentifiedriskfactorsand tertiarypreventionfocusesonthosewhoalreadyhaveanexistingconditionaffectingtheirlives.

Occupationaltherapypracticeisfueledbythebeliefthatwellnessandhealth derivefromengagementinoccupation(Fazio,2008).Thisveryfundamentalprincipledefinestheroleofoccupationaltherapypractitionersinpublichealthandpreventionincommunitysettings.