Defending occupation in paediatric practice.
Occupational therapy (Methods)
Occupational therapy (Patient outcomes)
|Publication:||Name: British Journal of Occupational Therapy Publisher: College of Occupational Therapists Ltd. Audience: Academic Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2010 College of Occupational Therapists Ltd. ISSN: 0308-0226|
|Issue:||Date: August, 2010 Source Volume: 73 Source Issue: 8|
|Topic:||Event Code: 310 Science & research|
|Geographic:||Geographic Scope: United Kingdom Geographic Code: 4EUUK United Kingdom|
Influenced by the global financial crisis, the climate in health
and social care in the United Kingdom is altering (Care Quality
Commission 2010), with legislative and policy changes that are likely to
be detrimental to occupational therapy and other health-related
professions. At the same time, occupational therapists working with
children are often active in fields using primarily and exclusively
therapeutic conceptual approaches (such as Bobath or sensory
integration), which are shared with other health professions. These
approaches are not necessarily committed to the basic tenets of the
occupational therapy philosophy. Viewed against this background,
occupation, the concept to which we owe our distinct professional
identity, appears to be absent from much of paediatric practice.
Currently, the framework of holistic paediatric occupational therapy assessment and intervention tends to centre on occupation and occupational performance. However, debate continues about the use of approaches based on a reductionist perspective, which still dominates the biomedical view of health. The focus of this perspective is on performance components, which only indirectly influence positively the occupational performance (known as the bottom-up approach; Trombly 1993, Brown and Chien 2010).
The difficulty of interpreting the concepts of meaningful and chosen in children's occupation because of their age and the influence of caregivers, as well as the lack of appreciation of the benefits of occupation, may lead occupational therapists to abandon occupation in paediatric practice. A further contributing factor to this course of action may be that, contrary to the use of a single model, an occupational perspective does not provide a prescriptive programme of therapy. The focus of therapists' education and training on a bottom-up approach and the alignment of the working environment with the medical model may be additional reasons for the neglect of occupation.
Discussion about the place of occupation in the occupational therapy process resonates with a related debate regarding the contribution of occupational science to occupational therapy. The evolution of occupational science (Yerxa 1990) led some people to believe that it would supply occupational therapy with a solid foundation. However, the nature of their relationship has provoked intense dispute among occupational therapists.
Regardless of the relationship of occupational science to occupational therapy and of the role and place of occupation within occupational therapy, the need for an occupation-informed, if not occupation-centred, paediatric clinical practice is affirmed. It is urgent to make occupation obvious in our practice, even in the context of approaches not entirely compatible with occupation. We should highlight occupation when we articulate our clinical reasoning and justify our therapeutic actions to colleagues, managers, commissioners, service users and others.
By arresting this neglect of occupation in paediatric practice, we put ourselves in a stronger position. Our unique and distinctive perspective will be demonstrated, making us an asset to any multidisciplinary team.
Key words: Paediatric, occupation, philosophy.
Brown T, Chien C-W (2010) Top-down or bottom-up occupational therapy assessment: which way do we go? British Journal of Occupational Therapy, 73(3), 95.
Care Quality Commission (2010) Focused on better care: annual report and accounts 2009/10. Available at: http://www.cqc.org.uk/_db/_documents/CQC_Annual_Report_2009-10_WEB.pdf Accessed on 03.08.10.
Trombly C (1993) Anticipating the future: assessment of occupational function. American Journal of Occupational Therapy, 47(3), 253-57.
Yerxa EJ (1990) An introduction to occupational science, a foundation for occupational therapy in the 21st century. Occupational Therapy in Health Care, 6(4), 1-17.
Correspondence to: Andreas Diamantis, 'Ergotherapeutiki Paremvasi Paidiou' ('Occupational Therapy Intervention for Children'), Mpoumpoulinas 78a, Patras 26222, Greece. Email: firstname.lastname@example.org
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