Professional Issues Forum:
First Nation, Metis & Inuit Peoples’
Health & Community Development
Enabling
Occupation
First Nations,
Metis & Inuit
Peoples’
Health
Community
Development
Alison Gerlach, MSc, OT(C)
CAOT Conference
Whitehorse, June 2008
Where am ‘I Speaking From’?
~Transforming My Occupational Therapy
Practice…..
Client-Centred
O.T.
PostColonialism
Community
Development
Justice &
Equity
Diversity ~ ‘many different paths’
• Aboriginal peoples “do not see themselves as
a pan-Aboriginal population - they come from
diverse Nations, heterogeneous cultures,
linguistic groups and geographies where there
is no ‘One Perspective’ (Monture-Angus 1999 in NAHO, 2001b).
• “Models of health care must reflect and be
adapted to the realities of different
communities. This may involve taking many
different paths” (NAHO, 2001a).
“Program delivery models which reflect
predominately western European concepts of
health and illness have been identified as
largely ineffective in responding to the needs
of First Nation’s people”
(Smye & Browne, 2002).
“A simple invocation of a return to
culture” is not enough” (Adelson, 2005)
Self-
Cultural
Awareness
Knowledge
Practice
Skills
Traditional Discourse in Health: Cultural Sensitivity/Competency (Adapted from
Black, 2005).
An Alternative Discourse:
Postcolonialism…
• Postcolonial theories share “a social, political, and
moral concern about the history and legacy of
colonialism – how it continues to shape people’s
lives, well-being, and life opportunities” (Young, 2001 in
Browne, Smye & Varcoe, 2005, p. 19).
• A postcolonial perspective critically analyzes
healthcare discourses for their potential to “both
mask and perpetuate neocolonial practices in health
care for indigenous people” (Browne & Smye, 2002, p. 31).
Colonialism: A Determinant of Health for
Aboriginal Peoples…. (NAHO, 2001a)
Poverty
Health
Disparities
Trauma
Colonialism
Oppression
‘Invisibility’
Health & Social Justice in
Community Development…
• “A commitment to equity, social justice, participation
and empowerment that enables people to identify
common concerns and that supports them in taking
action related to them” (WHO, 1999).
• “Common good or communal well-being is a
fundamental tenet of Aboriginal world views ..This
translates into a requirement that the community
participate in decisions concerning the health system”
(NAHO, 2001a,b).
• An ‘enabling occupational’ perspective promotes and
guides greater engagement in social change (Townsend &
Polatajko, 2007).
Canadian Model of Client-Centred
Enablement (CMCE)
• “Best practice in occupational therapy seeks to
offer effective, client-centred, occupation-based
enablement for health, well-being, and justice”.
• Foundations of ‘enablement’:
–
–
–
–
–
–
Choice, risk, and responsibility
Client participation
Vision of possibility
Change
Justice: diversity & equity
Power sharing
(Townsend & Polatajko, 2007)
Occupational Therapy Enablement Skills….
Community Development – Informed by
Postcolonialism & Enabling Occupation
Partnerships
Social
Action
Culturally
Safe
Community
Development
Capacity
Building
Empowerment
Asset Based
Community Development – Informed by
Postcolonialism & Enabling Occupation
Partnerships
Culturally
Safe
Community
Development
Authentic equality in partnerships shifts power….
Genuine Partnerships…..
• “Mainstream agencies and services need to reimagine health systems by removing any racist
implications from policy and practice and by
welcoming Aboriginal people as partners” (Highlights of
RCAP,1996:61 in NAHO, 2001b).
• Establishing trust needs to be understood within the
realities of historical and contemporary social
relations between Aboriginal people and members of
the dominant group – which may play out in
everyday healthcare encounters and contribute
towards avoidance of healthcare services (Browne & Smye,
2002).
Partnerships & Co-Creation of
Knowledge
• “Getting the right mix between Aboriginal evidence
of health and well-being and medical and scientific
based-evidence - both need to be seen as valuable
and relevant to the improvement of Aboriginal
Peoples’ health” (NAHO, 2001a).
• The dominant culture is “deliberately decentred so
that the perspectives of those who have been
marginalized become starting points for knowledge
construction” (Browne, et al, 2005).
Community Development – Informed by
Postcolonialism & Enabling Occupation
Partnerships
Culturally
Safe
Community
Development
Empowerment
Postcolonial theories “shed light on the unequal
relations of power that are the legacy of the colonial
past and the neocolonial present” (Browne, et al 2005).
Empowerment & Self-Determination
• Occupational enablement and postcolonial theories critical perspectives for understanding power and
power relations in health care.
• A determinant of health: “Aboriginal people regard
self-determination as necessary to sustained
improvements in health status” (NAHO, 2001a).
Postcolonialism & Enabling Occupation in
Community Development…
Trust
Culturally
Safe
Community
Development
Empowerment
Asset Based
“Strengths represent potential pathways to wellness”
(Van Uchelen et al, 1997).
Asset Based….
• Individual and collective strengths are found in the
“activities, places, people, values, beliefs and
traditions that are working well in the life of the
individual and/or community” (Van Uchelen, et al, 1997).
• Asset-based enablement:“aims to stimulate positive
growth, insight, rapport, and energy” (Townsend & Polatajko,
2007).
Asset Based….
• Community assets & capacity (Frank & Smith, 1999)
–
–
–
–
–
–
Human resources
Environmental resources
Economic opportunities
Cultural and recreational resources
Communication processes
Infrastructure
• Cultural knowledge & pride
• Reclaiming of traditional approaches to health &
healing
Community Development – Informed by
Postcolonialism & Enabling Occupation
Partnerships
Culturally
Safe
Community
Development
Capacity
Building
Empowerment
Asset Based
Capacity Building ~
Self-Determination & Empowerment
• Builds on a community’s assets & potential
• Shifts power & knowledge
• Promotes empowerment & sustainable selfdetermination
Community Development – Informed by
Postcolonialism & Enabling Occupation
Partnerships
Social
Action
Culturally
Safe
Community
Development
Capacity
Building
Empowerment
Asset Based
Social Action: Mobilization….
• “Both indigenous and non-indigenous
participants have a role to play in the process
of decolonization … and must share the
burden of social transformation”
(McConaghy, 1997; LaRocque, 1993; Young, 1990 in Browne, et al, 2005).
• “Enabling social change is based on collective
participation and visions of possibility to
promote occupational rights”(Townsend & Polatajko, 2007)
Social Action: Occupational Justice?
• How can occupational enablement promote
social and occupational equity and justice for,
and in partnership with, Aboriginal
communities?
Enabling
Occupation
First Nations,
Metis & Inuit
Peoples’ Health
Evidence?
Community
Development
Research: “Only if it is going to
mean something” (Warry, 2007)
• “Those closest to the consequences of research
should be the most involved in decision-making”
(McConaghy, 1997 in Browne, et al,2005).
• In Canada, “Dion Stout et al call for more
partnership-based research and indigenization of the
research process” (NAHO, 2001a).
• P.A.R. - “a form of social action with the goal of
political or social change” (WHO, 2002) that contributes
“to the decolonization of Aboriginal research” (Warry,
2007).
In closing …
• “Occupational therapists are encouraged to
generate the courage and supports to enable
individual and social change, thereby
advancing opportunities for client
empowerment and participation in society”
(Townsend & Polatajko, 2007).
Thank you ….
I welcome any opportunity to continue this
dialogue…
Alison Gerlach
agerlach@hawaii.rr.com
Readings related to this presentation
Ball, J. & Pence, A. (2006). Supporting Indigenous Children’s Development. British Columbia: UBC Press
Black, S. (2005). Cultural Sensitivity in Occupational Therapy. CAOT preconference workshop. Vancouver.
Browne, A. & Smye, V. (2002). A post-colonial analysis of healthcare discourses addressing Aboriginal
women. Nurse Researcher, 9:3, 28-41.
Browne, A., Smye, V. & Varcoe, C. (2005). The relevance of postcolonial theoretical perspectives to research
in Aboriginal health. Canadian Journal of Nursing Research, 37:4, 16-37.
Dyck, I. & Kearns, (1995). Transforming the relations of research: towards culturally safe geographies of health
and healing. Health & Place, 1:3, 137-147.
Gerlach, A. (2003). Cultural issues and Canadian First Nations Families. Unpublished MSc Thesis, San Jose
University, California.
Hammel, K. (2008). Reflections on … well-being and occupational rights. Canadian Journal of Occupational
Therapy, 75:1, 61-64.
Howarth, A. & Jones, D. (1999). Transcultural occupational therapy in the United Kingdom: Concepts and research.
British Journal of Occupational Therapy, 62:10, 451-458.
Lauckner, H., Pentland, W., & Paterson, M. (2007). Exploring Canadian occupational therapists’ understanding
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National Aboriginal Health Organization. (n.d.) Access and integration. Retrieved April 2007 from:
www.naho.ca/english/documents/health_sectoral_AC.pdf
National Aboriginal Health Organization, (2001a). Strategic Directions for an Evidence-Based Decision
Making Framework at NAHO. Retrieved April 2007 from:
http://www.naho.ca/english/pdf/research_strategic.pdf
National Aboriginal Health Organization, (2001b). Making a difference: Submission to the Commission on the
Future of Health Care in Canada. Retrieved April 2007 from: http://www.hcsc.gc.ca/francais/pdf/romanow/National%20Aboriginal%20Health%20Organization.pdf
Cont’d…..
Readings related to this presentation
National Aboriginal Health Organization, (2003). Winds of Change: A Strategy for Health Policy Research and Analysis.
Ottawa: National Aboriginal Health Organization
National Aboriginal Health Organization. (2008). An Overview of Traditional Knowledge and Medicine and
Public Health in Canada. Ottawa: Author.
Ramsden, I. (1993). Cultural safety in nursing education in Aotearoa (New Zealand). Nursing Praxis in New
Zealand, 8:3, 4-10).
Restall, G., Ripat, J., & Stern, M. (2003). A framework of strategies for client-centred practice. Canadian
Journal of Occupational Therapy, 70, 103-112.
Smye, V. & Browne, A. (2002). ‘Cultural safety’ and the analysis of health policy affecting aboriginal people.
Nurse Researcher,9:3, 42-56.
Townsend, E.A., & Polatajko, H.J. (2007). Enabling occupation II: Advancing an occupational therapy vision for health,
well-being, & justice through occupation. Ottawa, ON: CAOT Publications ACE.
Warry, W. (2007) Ending Denial: Understanding Aboriginal Issues. Ontario: Broadview Press
Wood, P. J., Schwass, M. (1993). Cultural safety: A framework for changing attitudes. Nursing Praxis in New
Zealand, 8:1, 4-14.
World Health Organization (WHO). (1999). Community participation in local health and sustainable
development: a working document on approaches and techniques. Geneva: Author 1999, 10.
World Health Organization. (2002). Community-based rehabilitation as we have experienced it: Voices of
persons with disabilities. Geneva: Author.
World Health Organization. (2003). Community development for health and empowerment. Geneva: Author.