Community

• Cultural Competence


  Have knowledge about specific cultures
• Cultural humility


  A life-long, learning-oriented approach to working with people with diverse cultural backgrounds... openness, self-awareness, egolessness, supportive interaction, self-reflection, and critique
• Cultural Sensitivity


  The ability to recognize but not judge the difference and similarities between people
• Power dynamics in health care - You will be in a position of perceived power over your clients. Others will be in a position of perceived power over you.
• Culture is complex, contradictory and evolving
• Differences between Cultural Humility and Cultural Competence


  • Cultural humility: Emphasizes consistent process of learning, Recognizes gaps in knowledge without shame, Provides opportunities for deeper engagement with clients, Acknowledges implicit and explicit bias and prejudice as a part of being human, Promotes positive change, Recognizes power dynamics in health care
  • Cultural competence: Emphasizes knowing about cultures, Expects providers to be adept and knowledgeable, Focuses on differences between cultures, Emphasizes personal culture and how it differs from others but does not delve in to implicit bias, Generally silent on issues of power
• Community health promotion


  Any combination of educational and social supports for people taking greater control of, and improving their own or the health of a geographically defined area
• Community interventions


  Attempt to modify the environmental context of the community to achieve health goals
• Community health promotion includes


  • Prevention and promotion, Acute and chronic medical care, Habilitation and rehabilitation, Direct and public health
• Population health


  A collaborative, interdisciplinary approach that includes advocacy, program development, etc. to maximize health equity and occupational justice based on the social determinants of health

  
• Participation


  Involvement in a life situation
• Community participation

  Involvement in the community
• Community participation is a key factor in health as a human right
• Meaningful community engagement

  Must be a collaborative effort through those who share similar situations, concerns, or challenges
• Elements of meaningful community engagement


  • Define what the community needs and make sure you can measure it, Allow the community to see itself in the language and context, Present a range of outcome options for the stake holders, Embed equity into your model
• Strengthening partnerships through


  • Diversity and inclusivity, Partnerships and opportunities, Acknowledgment, visibility, and recognition, Sustained relationships, Mutual value, Trust, Shared power, Structural supports for community engagement
• The paradigm shift for how the medical community thinks is a work in progress
• New social disability model


  Disability is in society, not the body

  
• Old medical model


  Disability is in the body
• A paradigm shift is when a discipline abandons one view of the world for another
• A conceptual restructuring (or for OT getting back to our roots) often has resistance
• Examples of medical vs community models

  • Medical: Professional is responsible, Professional has power, Professional makes the decisions
  • Community: Community member is responsible, Community member has the power, Community member makes the decisions
• OT theoretical frameworks for community-based practice and community participation


  • Model of Human Occupation (MOHO), Person-Environment-Occupation (PEO), Transactional perspective of occupation (TPO), Problematic Situations, functional Coordination, creativity and growth, Wilcock Doing, Being, Belonging, Becoming, Transtheoretical Model of Health Behavior Change
• OT's role in community health

  • Adult day program, Agency on aging, Community residential care facility, Environmental mod program, Group home, Independent-living center, Low vision program, Wellness program, Supervised housing, Home health, Community outreach, Primary care clinic
• Other OT roles in community health

  • Community health advocate, Consultant, Case management
• Occupation connects the past with the present with the future
• Without occupations you don't exist
• Traditional OT roles


  • Evaluator, Consultant, Supervisor, Researcher
• Emerging OT roles


  • Community health advocate, Consultant, Case manager, Private practice owner/entrepreneur, Supervisor, Program manager
• Classical Epidemiology


  A branch of medicine which deals with the incidence, distribution and possible control of diseases and other factors relating to health. The triangle of Host-agent-environment
• Population health


  The health outcomes of a group of individuals, including the distribution of such outcomes within the group; outcomes are the product of medical care, public health, genetics, behaviors, social factors, and environmental factors
• Basic population health principles

  • Health outcomes are more than the absence of disease, Outcomes are produced by complex interactions of multiple determinates, Resources to achieve wellness for populations is limited therefore cost effectiveness is critical
• Must look at cost to appeal to masses
• Sociopolitical factors influencing health

  Problems that involve both social and political factors
• Health disparities

  Differences in health outcomes that are closely linked with social, economic, and/or environmental disadvantage
• Interventions provided to groups and populations are directed to all members collectively rather than individualized to specific people within the group
• OT focuses on current group occupational performance but also prevention through environmental, policy, healthy habit formation, etc.
• Community-based development practices


  The agency or health professional identifies the issues and then links the community with a predetermined, planned program
• Community-centered development practices


  Support the community in identifying its own concerns and developing solutions and strategies to overcome the issues
• Action points of the Canadian Practice Process Framework (CPPF) to occupational therapists' work in community development

  • Enter/initiate, Set the stage, Assess/evaluate, Agree on objectives and plan, Implement plan, Monitor/modify, Evaluate outcome, Conclude/exit