Understanding Occupation in Community

Dylan North

Braun Award for Excellence in Writing in Graduate Programs

Nominated by Donald Earley, Professor of Occupational Therapy

Dylan North, of Flint, Michigan, is enrolled in SVSU’s M.S. in Occupational Therapy (MSOT) Program with an anticipated graduation date of December 2023. He has been involved with the Student Occupational Therapy Association since he entered the program in 2021. Dylan received his B.S. in exercise science in May 2017 through SVSU. He thanks former SVSU assistant professor of English Suzan Aiken for challenging him to become a better writer.

“Understanding Occupation in Community” was written for Community Integration (OT 610), instructed by Dr. Donald Earley in Spring 2021. This course explored the relationship between meaning and occupation as they exist within the community, emphasizing issues of participation and occupational performance. The Conceptual Framework of Therapeutic Occupation was integrated within the context of this course.

The description and concept of community and occupation have been thoroughly discussed through multidisciplinary literature on psychological and philosophical levels. The literature describes the past and current views of occupational therapy in relation to meaning, purpose, and the occupational nature of humans The research, as discussed below, delves into the topics of meaning and purpose in occupation, occupation regarding the concept of community, interwoven concepts of occupation in community, and the value of building occupational therapy’s knowledge base to better understand occupation in the context of community.

Meaning and Purpose in Occupation

Occupation can be described in many ways. In the past, the profession of occupational therapy has struggled to define the concept of occupation. It is with research and experience that these definitions of occupations were introduced. Betty R Hasselkus, Ph.D., OTR, FAOTA, (2011) used a metaphor to describe occupation as the essential current that propels us along on life’s journey. The occupations in our lives and the meanings of those occupations are critical contributors to the pace and direction of life. This is true in the sense that occupation provides meaning to our lives. Occupation and meaning contribute to one another throughout our lifespan. Occupation can encompass everything from self-care, leisure activities, and contributions to the social and economic aspects of community, Hasselkus continues, and is focused on the aspect of doing. It is everything that individuals do to occupy themselves. Engaging, participating, and performing activities and tasks ultimately define what occupation is. Practitioners can engage with their clients to explore what their occupations consist of. Hasselkus also noted practitioners should embrace the idea of assisting our clients on their journey back to meaningfulness. Practitioners need to understand how meaning comes from occupation and vice versa. Practitioners have the ability to discover meaning in occupations and have the opportunity to create new meaning. After all, occupation is the core concept of our profession; we are custodians of meaning and meaning-givers Donald W. Earley, OTD, MA, OTRL, (2003) discussed how community and occupation are two concepts that are separate but interrelated. To be effective in this profession practitioners must understand that community is crucial to one’s occupational performance and vice versa. This means that occupational therapy needs to be viewed as a process that addresses the individual as a whole. Occupational therapy is not always about achieving a greater sense of independence. Favorable outcomes should also include meaning-making; meaning-making and creating purpose result in a greater quality of life.

Earley (2003) provided an example of the importance of meaning-making. He mentioned “The Out & About Program” implemented at a senior living facility. Although no significant changes were noted in independence or function, improvements were noted in the community, and a profound sense of meaning was established. This example also focused on the importance of having face-to-face experiences and allowing clients to connect deeply on an emotional level. (This seems especially important today since these experiences are hard to come by due to the COVID19 pandemic.) Developing this sense of purpose and emotional connection is critical. Once this is fully achieved, clients will be more likely to sustain what they have experienced. They will become empowered and continue to build within their community on their terms.

Occupation with Regard to the Concept of Community

Community can be described as people within an area that share similar values and beliefs. Community is essentially a feeling of connectedness within a group or population. People within a community share a sense of caring for others and actively participate as community members. There must be participation from each member with a common purpose. John F. Freie (1998) stated that for a community to thrive, members must recognize their membership in it and develop an enlarged sense of self. Members of a community must be able to share meaningful experiences. Another important quality of a community is effectively managing conflict when it arises. Conflict within a community is inevitable but should be handled appropriately by respecting the dignity of each member when reaching decisions.

One quality that should not be expected of a community is sameness. Sameness is associated with counterfeit community Sameness does not allow members the freedom to express individuality. Freie (1998) stated that this could make community members feel like they need to conform to other opinions and beliefs besides their own. This can hinder an individual’s sense of self-expression and willingness to produce change. These are desired qualities in an ideal community and are taken away by feeling the need to “follow the norm” or come to the same agreement. Counterfeit community avoids addressing such social problems crime and racism. Avoiding these problems does not produce any psychological benefits for members. Communication within communities is also vitally important. Communication can be defined as formal or informal interactions that develop as an outgrowth of members’ interests within a community (Freie, 1998). Within these interactions, friendships are formed, and social skills are enhanced. For occupational therapists, it is thus important to have good communication skills. To develop trust and respect, we must create a special bond between the client and the occupational therapist. Freie (1998) discussed the idea of community, the sense of togetherness, and the qualities of a successful and unsuccessful community. Freie (1998) also stated that most people are capable of learning the rules of communication and are willing to follow them. It is important to note that the rules of communication can be taught and learned. Practitioners need to have a deep understanding of what community means and how it is related to the profession of occupational therapy. It is essential to be observant and have a sense of empathy when communicating with a client. Occupational therapists can learn through this experience and understand what it is like to be part of the community in which their clients are participants. Good communication is a fundamental principle of community building and the idea of togetherness

Interwoven Concepts of Occupation in Community

Ann A. Wilcock, Ph.D., (2001) explored the theme of utopias and emphasized the significance of how others have established opportunities for people to experience well-being through occupation. Wilcock described her vision of utopia as a world in which the occupational nature of people is recognized in a just and equitable way. The idea of occupational utopia was derived from Wilcock’s study of the evolution of an occupational perspective of health and wellbeing. Wilcock stated that to achieve maximal health and well-being, people need to appreciate their occupational needs and change the world to that end Although utopia may be unrealistic, practitioners can draw from these ideas about utopia and implement them into their practice Wilcock described three types of utopian communities and how they addressed people’s occupation needs. The first community emphasized that a healthy mind and body can only be achieved when life harmonizes with nature. The Amish community adopted this idea. They believed that simplicity and manual work were how to meet their occupational needs. The second community believed in the idea that change is inevitable and will lead to a more productive society. Wilcock mentioned that she favored promoting a holistic vision of the future in which people's occupational needs are recognized and met. This idea emphasized a proactive stance to raise awareness about what possibilities could arise if people were considered occupational beings. Occupational therapists should adopt this vision of utopia in their professional obligations as a practitioner. Practitioners need to be aware of occupational natures, positive or negative, to promote the best outcome. This will enable their clients to find meaning and purpose through their everyday occupations.

Practitioners also need to view individuals as meaning-making through participation and occupation. This will allow practitioners to “conceptualize ideas of wholeness and self-realization, which transcend the narrower view of function and independence” (Meyer, 1922, p. 45). Individuals make meaning in their lives despite their dependence and lack of function. For example, individuals with a disability might be viewed as less than whole, but this perception is changing in the sense that these individuals are advocating for themselves. It is important to consider these individuals as a whole and active community members. Participation and expressing meaning through occupation are instrumental to the idea of wholeness. The profession of occupational therapy is moving past the notion that views consciousness as separate. Jeffrey L. Crabtree, MS, OTR/L, FAOTA, (1998) stated that many health professionals continue to seek truths regarding function and independence exclusive to one’s values, judgments, intentions, and meanings. A broader view of human purpose transcends function and independence. The ideal human state, Crabtree noted, is “taking action of performing, or actualizing potentialities for a purpose beyond the action taken” (p. 207). Furthermore, function and independence have their place in the overall scheme of occupational therapy, but they are not adequate to explain the ideal state. The ideal state is one in which individuals make meaning through actions.

Concepts that Contribute to Meaning and Occupation

Shared experiences can influence the meaning of space and place in a relational community. Yi-Fu Tuan (2001) focused on human dispositions, capacities, and needs, and how culture affects them. Tuan stated that space and place are terms that describe common experiences, as individuals often attach meaning to space and place. Place can be described as a sense, whether it is a geographic location or a feeling of secureness. Individuals, for example, often associate home with a feeling of stability. Space, however, can be described as freedom, whether it is openness or a threat to the concept of space. The meaning of place often merges with the idea of space, but both are so much more, for these terms can be associated with experiences. Practitioners must thus consider what gives these terms their meaning and their identity. Tuan additionally stated that places are where biological needs are satisfied. Experiences directly influence knowledge regarding the concepts of space and place. These experiences can be direct and intimate or indirect and conceptual. Tuan also noted that individuals have different tendencies, and the meaning of place and space can differ based on shared experiences. An individual’s interpretation of these concepts is thus influenced by the community.

On the other hand, Deborah Tall (1996) described the concept of space and the notion of dwelling as a means to pause or delay. To dwell in place means to simply occupy the space. Tall stated that home used to be considered a place but is now viewed solely as property. It is described as something of monetary value rather than symbolic. Interestingly, Tall said that individuals usually do not stay in a house longer than five years. Changing locations is perceived as a way to change one’s life; staying in the same place is often viewed as unambitious, but a change in location ignores the meaning associated with home. It seems as though the familiarity of a home has lost its significance. Tall also said that frequent relocation could be disrupting It is not easy to become attached when the environment has no meaning or community.

Graham D. Rowles, Ph.D., (2000) offers other insights about space and place. He implied we develop a rhythm and a routine in our use of space and our relationships with the places in our lives. This rhythm and routine become part of our identity as we mature. Rowles also explored the habits and the events that disrupt our sense of normalcy. To understand an individual’s life and how that individual is affected by disability, we need to view the individual from a holistic perspective. Rowles, in fact, explored the idea of adaptation in relation to the setting of place, structured daily activity, and the environment. Examining regularity in the context of routines in time and space, Rowles referred to a specific example of Mary, her time and space rhythm, and how an unscheduled call disrupted her daily routine. Practitioners thus should move beyond the traditional role of providing skills training by exploring creative strategies that reinforce habits that can be sustained. Practitioners should also seek to understand the role of habits and routines when providing care. It is essential to develop recognition skills and the ability to observe these habits, rituals, and routines. This idea may lead to greater personal rewards and more substantial outcomes. Community also plays into the interactional model of disability. To fully understand an individual as a whole, practitioners must change their perception of disability. Joseph P. Shapiro (1994) stated that individuals with disabilities deserve respect and the opportunity to build bonds with their community as entirely accepted participants. Ann P. Grady, MA, OTR, FAOTA, (1995) described how disability has been seen as a medical problem with the expectation that individuals with disabilities should in all actuality be like those without said disability. This view is wrong. Individuals with a disability should be viewed as a whole with regard to their abilities; disability should not be a limiting factor. These perceptions are beginning to change because community is now involved. Practitioners have to consider the environment in which these individuals are present perhaps the environment is to blame for the failure to include these individuals. In other words, in the interactional model, disability is not a difference; contrary to the medical model, the interactional model views disability in a neutral light, and as Grady stated, “the remedy for disabledrelated problems is a change in the environmental interaction. Occupational therapists can be the remedy for change” (p. 303). These individuals merely need an advocate or someone who bridges the gap between the individual and the community. The notion of inclusion is evident: all individuals should be treated equally regardless of their abilities.

The Value of Building Occupational Therapists’ Knowledge Base

The profession of occupational therapy is based on client-centered care, and occupational therapists must possess other skills to provide the best quality of care. Occupational therapists must learn to use their client's perspectives as a guide in providing care. Occupational therapists can benefit from seeing how a client participates within their community. To understand the client, practitioners must understand what is valuable to them and where they draw meaning in their everyday occupations. Meaning-making is vitally important because it can lead to a sense of empowerment. Occupational therapists must thus engage with their clients to figure out what is meaningful to them. Occupational therapists must be able to figure out the roles and occupations with which the client is associated. To provide the client with the best possible outcome and to implement the best program to achieve a greater quality of life, it is imperative to make these connections To promote positive change, practitioners need to provide compassionate care. It is important to demonstrate compassion and understanding, a willingness to explore new ideas, and the skills to empower the client to maximize the outcome.

Cheryl L. Walter (2012) stated that the concept of community involves elements that we are not used to talking about. To create a framework for community-building practice, we must examine the idea of community and the associated strategies. We must shift the perspective to one that expands our concept of community to include other healthcare team members and develop a model for community building rooted in this concept. The idea of community building and how we conceptualize it influences our actions. As practitioners, we use our knowledge of community to guide our decisions. Often, we view the community as a neighborhood in which we participate. However, with this idea, we miss the notion of community as a multidimensional system. We need to shift our perspective of community by changing our actions, consciousness, and context. This enables us to take more information into account when familiarizing ourselves in practice and when making decisions. Walter emphasized the need to view community as a dynamic whole continually progressing. By adopting this idea and learning to engage with one another respectfully, community will become more of an exchange. As Walter noted, community building practice encompasses all the dimensions of community

Conclusion

The value of building occupational therapy’s knowledge base related to understanding occupation in the context of community is evident throughout the literature. It is through occupation and community that humans create meaning. Occupational therapists can draw from literature and incorporate these concepts of meaning and purpose in practice. The goal of occupational therapy is not just to provide therapy but also to help clients find meaning and purpose in their community. Occupation is the fundamental concept of our profession, and we are the curators of its meaning

References

Crabtree, J. L. (1998). The end of occupational therapy. American Journal of Occupational Therapy, 52(3), 205–214. https://doi.org/10.5014/ajot.52.3.205

Earley, D. (2003). The neuro-occupation framework: Meaning-making for contemporary clinical practice. Advance for Occupational Therapy Practitioners 34–35.

Freie, J. F. (1998). Counterfeit community: The exploitation of our longings for connectedness. Rowman & Littlefield Publishers, Inc.

Grady, A. P. (1995). Building inclusive community: A challenge for occupational therapy. American Journal of Occupational Therapy, 49(4), 300–310. https://doi.org/10.5014

Hasselkus, B. R. (2011). Meaning in everyday occupation (2nd ed.). Thorofare, NJ: Slack.

Meyer, A. (1922). The philosophy of occupation therapy. Archives of Occupational Therapy 1, 1–10

Rowles, G. D. (2000). Habituation and being in place. Occupational Therapy Journal of Research, 20, 5267.

Shapiro, J. (1994). No pity: People with disabilities forging a new civil rights movement. Three Rivers Press.

Tall, D. (1996). Dwelling: Making peace with space and place. In W. Vitek and W. Jackson (Eds.) Rooted in the land: Essays on community and place. Yale University Press.

Tuan, Y.-F. (2001). Introduction. In Yi-Fu Tuan (Ed.), Space and place: The perspective of experience. University of Minnesota Press.

Walter, C. L. (2012). Chapter 5. Community building practice. In M. Minkler (Ed.), Community organizing and community building for health and welfare (pp. 68–83). Rutgers University Press.

Wilcock, A. (2001). Occupational utopias: Back to the future. Journal of Occupational Science, 1 (1), 5–12. https://doi.org/10.1080/14427591.2001.9686479.