Friday, December 07, 2012

Environmental sustainability and occupational therapy practice

I like ideas.  I even like big ideas.  That would include big ideas that are created simply for academic purposes.  However, as my bio indicates, I am a pragmatic guy who is sometimes at odds with his transcendent training.  Or something like that.

So in other words, I thought I liked ideas.  Maybe sometimes I don't.  I am starting to wonder.

The latest barrage of ideas that I got hit with this week has to do with sustainability and its application to occupational therapy.  I have some opinions about this that are probably a logical extension of these ideas that I blogged about in 2009 that relate to developing lexicon related to social or occupational justice constructs.  Please go read that information first if this is a topic that interests you.

OK so this week I saw a student spam posting the OT Connections site trying to get people to answer some survey about the role of occupational therapy with sustainability.  I normally just ignore spam posting but I went to the survey anyway simply out of academic curiosity on the topic - mostly because in my wildest imaginings I could not understand why this would be a legitimate domain of inquiry for an occupational therapist.  The survey was interesting but chock-full of assumptions that I didn't necessarily agree with.  I started answering the questions and then decided to scrap my answers because I didn't have anything constructive to add to the survey, and also because I thought this would be a more effective format for exercising my thoughts on the topic.

For a day or so I just shelved my puzzlement about why someone would think that OT had a role in sustainability but then the barrage of ideas continued.  First there was a message thread passing around the faculty where I teach about the concept of sustainability and how the college should make some movements toward more responsible efforts regarding the environment.  On its surface I don't mind when people promote recycling efforts and turn off lights and consider ways to be more efficient and environmentally mindful but then I started to get a little uncomfortable when there was a call for endowment divestment from big energy companies.  I expressed some concern about conflating methodologies for local sustainability initiatives with methodologies for "sustainability" of an endowment.  I don't know how many academics have had fiduciary responsibility for a large endowment or reserve fund like that so who knows if my cautionary opinions resonate in those halls.  Oh well.

Then a colleague sent me an opinion piece that appeared in the British Journal of Occupational Therapy in September (Whittaker, 2012).  And then someone else sent me a link to the WFOT website and they also have a position paper on environmental sustainability and sustainable practice within occupational therapy.  So there was a barrage of information about this topic this week and I guess I want to talk about it.

I don't want to have a global warming or global cooling or any kind of climate debate.  That would be boring and people are stuck in camps on the issue.  Instead I want to focus on the WFOT call for occupational therapists to "use their expertise and knowledge about occupations and occupational performance to participate in the resolution of these global problems."  According to the WFOT position paper the global problems include human driven global climate change, overuse of finite natural resources, decreasing biodiversity, overpopulation, and inequitable wealth distribution.  That is a pretty big list of problems to address in my little occupational therapy intervention plans here at ABC Therapeutics.  Still, I like to think that I am a cutting-edge kind of guy, so I figured I might have some work in front of me.

I needed some ideas, and since there is no one on the continuing education circuit peddling sustainable occupational therapy I figured I could just read some journal articles.  Whittaker talks about exploring cooking in more sustainable forms by having clients reflect on ecological context and cooking mindfully - which in turn might deepen the meaning of the cooking experience for the client.  His article goes on to explain that livestock farming accounts for 80% of greenhouse gas emissions from all food production.  This got me thinking.  Maybe we are supposed to promote "green" cooking by making peanut butter and jelly sandwiches instead of a ham sandwich during our ADL assessments.  If we stop eating meat and dairy then there will be fewer pigs and cows and chickens expelling their methane into the atmosphere.  I guess.

In the middle of these very deep thoughts I realized that my 8:30am appointment had arrived.  I started thinking that it really wasn't fair of me to even see this family because they have private insurance and are seeking private therapy to address some gross motor delays that their 8 month old daughter is experiencing.  The income inequality allows them to stay away from the municipal early intervention system which is seismically shifting and changing because of constricted funding.  Maybe it isn't fair to see people outside of the municipal system.  Based on these things that I am reading I am now considering the possibility that I am crushing the planet by reinforcing medical consumerism and wasteful spending in an unequal fashion.  Interesting.  Somehow I am not that certain that the parent looks at it all this way.  I wonder if they will mind if I just discharge them and tell them to call for County services?

After the appointment was over I decided to pick up my phone messages.  I thought I was saving some money by managing my own messages and cutting down on support staff but now I am thinking that I should reconsider my profit motive in the interest of more equitable wealth distribution on the planet.  Anyway, there was a message from a mom who was crying.  Her child has severe behavioral feeding difficulties and she was experiencing some moments of concern, crisis, and even depression about the whole situation.  Her child has made incredible improvements, and the mom has also made incredible improvements - but the whole situation remains extraordinarily acute.  I tried to call the mom back but only got to leave her a message.  I tried my best to be upbeat and positive and supportive and helpful.  I hope it will be enough until I get to see them again.

As I hung up from leaving the message I started thinking about sustainability again.  Maybe I could tell the family that chicken nuggets and hot dogs are not part of a sustainable diet.  Constricted food choices is a real problem for this child but maybe if I approach if from the angle that he can save the planet by eating more veggies that I can make a dent in his behaviors.  Maybe this is the kind of reflection that Whittaker was suggesting.  Just think: my counseling about the evils of chicken nuggets and hot dogs might enable this family to experience a deeper meaning about their mealtime routines.  I started getting excited about these new intervention strategies!!

Then I thought that maybe I could change his food-throwing behaviors by pointing out that there are hungry children in the world and that it is not sustainable to waste food when there is such an inequitable distribution of nutrition around the globe.

He is only three though.  I don't know if he will understand. 

I guess I am still struggling with how to apply these ideas about sustainability.  Maybe I will get better at it with a little practice.  I really don't want to be small-minded and I want to be an informed and globally connected practitioner.


I would like to see some of the sustainability promoters out on the lecture circuit telling us street-level practitioners how to make this happen.  I would like them to tell us all their real life case studies.  Is there a CPT code that we should be using for 'ecological occupational therapy??'  Can we reduce our carbon footprint by going back to the days of low tech craft work - and then our patients can take their tile trivets home and actually use them!  But should we only do handwork and should we avoid using a kiln?  Kilns consume an awful lot of electricity.  Maybe we can do more leather work as we pare down our farm animal populations?  There are so many exciting possibilities here on how we can be sustainable!!

We all have tremendous responsibility for stewardship.  I actually agree that we should be environmentally mindful.  I think we also have a tremendous responsibility for stewardship of our profession's scope of practice and what actually constitutes occupational therapy.

The halting and sobbing between words in that mom's message today keeps snapping me back to reality.

I think it is the pragmatic voice inside my head.  Maybe this is all just nonsense. 



References:

Whittaker, B. (2012). Sustainable global wellbeing: A proposed expansion of the occupational therapy paradigm.  British Journal of Occupational Therapy, 75(9), 436-439.

4 comments:

Anonymous said...

Dr. Alterio,
Sustainability is the newest fad in academia. Before this it was social justice. Before that it was diversity. A mindless string of pretty words are great on a college campus - who will be against them: only the mean, bad people, of course, just like the mean, bad people are the ones who are against social justice and diversity.

I am willing to wager that the Ethics Commission will try to put in a sustainability requirement in the Code of Ethics next time around.

The National Association of Scholars has criticized this movement - here are a couple of articles you may find interesting
take care
Alex

http://www.nas.org/articles/Critiquing_Sustainability

http://www.nas.org/articles/abundance_on_trial_the_cultural_significance_of_sustainability

Carol Gauper OT said...

I recently attended a weeklong sustainability /aging in place institute fo community colleges instructors. I was the only OT in the group. The rest were engineers, architects and interior designers. I came away confused after seeing a few lectures on green bathroom design featuring curb less showers, wet rooms and institutional bars ( often installed at a height that necessitated awkward shoulder abduction for the user to reach the bar). I came away with the strong notion that as OTs we can do a small bit for the planet ( and people's pocketbooks and safety) by getting out of the medical world and into the greater community and communicationg low tech/ relatively inexpensive solutions to home accessibility. Of course this is a "drop in the bucket" but I am concerned about people making massive remodels unnecessarily...in the interest of progress and hauling loads of their house to the dump in the name of sustainability and progress.









Amber Elhard said...

Christopher, I find your blog on the ecological occupational therapist intriguing. I am an active OT and am currently researching effective lower carbon treatment options and would like to know whether sustainable health and well-being in OT is increasing in value. It's been three years since you wrote this blog. Has your implementation of interventions evolved towards sustainable practice? If not, would you still consider it? If so, what information would you need to help you successfully implement sustainable practice into your interventions and daily work regimen? Thank you, I appreciate your response.

Christopher Alterio said...

Hi Amber,

I am afraid that my ideas about sustainability within an occupational therapy context are unchanged. I am not personally opposed to science-based interest in conservation related to the environment in general, but I remain deeply opposed to using concepts like 'sustainability' to advance world socialism and partisan economic philosophies that restrict human freedom.

In either case, neither has much of a place in occupational therapy practice, in my opinion. The proper role of occupational therapy is to help people who have problems that impede their ability to live their lives. It is not the role of occupational therapy to be a vehicle for social justice warriors who may want to save the planet.

I understand that some folk are misleading students and even older practitioners into some new definition of the profession that involves OT as a force for leveling the planetary playing field through control of resources - and I am sorry if you have been exposed to or accidentally swayed by that line of very incorrect thinking.

A couple articles were linked above from the National Association of Scholars. They are a good place to begin if you have been accidentally exposed to this content in your academic training.

Chris