Tuesday, July 16, 2013

'Occupation' or 'function' as best descriptors for OT practice?

It is too hot to go outside and do anything and I had to shut down my office as we lost power in a (presumed) brownout so I came to my home office and have been trolling around the Internet all afternoon.  That rarely ends productively, but I was really happy to run across some comments from today's #occhat where there was a debate about use of terminology in the profession.

I want to strongly encourage people to go read the Letter from the Editor in the Spring 2013 Open Journal of Occupational Therapy written by Diane Powers Dirette. In this letter she discusses issues related to terminology in the field related to use of the words 'occupation' and 'function.'

Powers Dirette states that historically OTs have used the word 'function' but this word was replaced with the word 'occupation' in the mid-1990s.  Perhaps not coincidentally, this is the time period when we saw the creation of 'occupational science' as an academic discipline, something I recently discussed in my 'Fourth of July' message.  Powers Dirette states that as the occupational therapy profession embraced a new term, other professions were quick to use the word 'function' in describing their services.  I was very interested and surprised at her report that "An ArticleFirst search for the keyword “function” for the year 2012 results in 3,105 articles. Only seven of those articles are from OT sources, and those seven are from the British Journal of Occupational Therapy."

A search of the word "occupation" in the same time period yielded 88 articles, of which it is reported that only ONE as it is defined in our profession, and all the others referring to "work or the taking over of land or space."

That sure is surprising to me.  I am not personally very familiar with the ArticleFirst database so I don't know if that has anything to do with the search results.  I tried to use a similar search strategy in Ebscohost and using the Medline and CINAHL databases specifically but was overwhelmed with the number of articles - it would take a rather substantial effort to sift through the results of that search within the Medline or CINAHL databases.

The premise that Powers Dirette raises is still interesting though, particularly because there was some rather lively debate on the OT Connections site back in 2009 related to the AOTA 'branding' campaign.  At that time the new OT 'brand' was rolled out with the tagline 'Living Life to Its Fullest' and there was some measure of disagreement if this was the proper way to describe the essential nature of our services.

At that time I made these comments about the concept of 'branding:'

Brands are symbols and experiences used for recognition - and as such the poster that was unveiled was a collection of symbols and (presumably) representative consumers who were 'happy' with their OT experience/interactions.  Images are unpredictably evocative and I think you have already received a wide sampling of responses to the images.  Some like them - others don't.  Perhaps that isn't the bottom line problem.

I hear people saying that although the poster might convey a feeling that is positive, it still leaves people with a sense of "OK, I feel good, but what do I feel good about?  Do I feel good about a Blackberry?  Or will that glass of water be refreshing?  Or am I glad that I have a full tank of gas?"

So if the purpose of branding is to generate recognition based on symbols or collected feelings/experiences, one of the problems here is that there may be only a weak connection between these images and occupational therapy - and it that sense, at this stage, it 'feels' a little lacking.

First stage or not, as occupational therapists we all know about the importance of understanding within context.  Context, in this instance, supplies fuel to the initial fiery response of "What does that poster mean anyway!"  There are some contextual accelerating factors to keep in mind.

1. If we are embarking on a branding campaign, it seems reasonable to believe that we should have a common 'product' upon which we can agree to develop symbols, etc. around.  Do we have such a common product?

2. Questions about the commonality of our 'product' are significant.  Some have commented about their perspective that the Practice Framework doesn't translate to practice.  Others have commented about 'elephants' in the room regarding intervention modalities.  Others have commented on the concept of "who wants to define 'full' for another human being??'  Others have commented that maybe OT is less about 'feeling good' and more about 'hard work and achievement.'

I have blogged about apparent disconnects between our professional journal and everyday practice.  This was underscored in President Moyer's comments that OT literature "is not really about simple engagement back into doing."  What are practitioners left to think OT is when the AJOT is full of articles about water quality and factors associated with obesity - and the OT Practice is about Disaster Relief - and the President is asking us if our universities and state associations are doing enough to combat hunger?  All of these issues are important, and require attention, and in all reality do impact people's occupations... but everyday practitioners may be finding it difficult to relate to this 'brand' of OT that seems to be slightly off focus from what most people are actually experiencing in their OT careers each day.

So we can pick any of these as a jumping off point - there is so much rich data in those comments that I think we could start anywhere.

None of this means that we need to change anything with the branding campaign necessarily.  However, it doesn't make sense to have a branding campaign unless we are all standing on the same ship that we are trying to brand.  Developing that sense of commonality and having conversations about some of these concerns might go a long way in building consensus and support around a branding strategy.

The process for the re-branding campaign reportedly included a guided process by 'BreakWhiteLight' which was the public relations firm that AOTA contracted with.  It was reported that they surveyed a large number of OT leaders, practitioners, and other constituents and by the debates that ensued on the OT Connections site I believe that AOTA leadership was taken a little off guard by the negative response to the branding campaign by some members.  It is difficult to provide all of the direct references on these debates because of the organization of the OT Connections site, but if you go to that site and type in 'branding' in the search box you will be able to view quite a bit of representative conversation in blogs, discussion posts, etc.

All of this is relevant because I expect that after several years of a branding campaign where we are supposed to be rallying practitioners around common definitions of 'what we do' that it seems that we are just not 'there' yet.  That is a problem.

The reason why I went back and quoted myself about the branding issue is because the problem that I pointed to back in 2009 is something that we apparently need to continue to attend to, particularly if the Powers Dirette argument that we are not self-defining in a clear fashion is true and has merit.  The question remains: Do we have a common product?  Is it occupation - or is it function???  Or something else???

Whatever our product is, I am not certain that we have done enough to capture and communicate 'what we do' correctly.  Powers Dirette states that a review of 'OT definitions' on hospital websites indicates that more are using the word 'function' as compared to 'occupation' in a rather lopsided distribution.  The AOTA branding campaign has not served any purpose of promoting 'occupation' which has been so heavily favored in our academic literature and conferences.  She states, "there is a disconnection between the published literature from the academic arenas and the language used in clinical practice."  That is a rather powerful statement to make.  Powers Dirette goes on to advocate for the use of the word 'function' as it represents 'plain language' that is easily understood by the public.  She states that the word 'occupation' is professional jargon that is not particularly clear to consumers.

In fairness, it is important to note that it does not seem that the branding campaign was intended to promote a single word as a descriptor, but it was supposed to rally us around a concept.  Did we choose the correct concept?

So here we have a reflection point:  Does Powers Dirette make a legitimate argument?  Has our branding campaign been effective or ineffective?   Do we need to make course adjustments?

I want to thank Powers Dirette for an excellent Letter for us all to consider, and also thank the #occhat folks for bringing it to broader attention.  I hope that this blog entry will also spur some additional conversation about the issue.



References:

Powers Dirette, Diane Ph.D., OTL (2013) "Letter from the Editor: Let’s Talk about Function," The Open Journal of Occupational Therapy: Vol. 1: Iss. 3, Article 1. Available at: http://scholarworks.wmich.edu/ojot/vol1/iss3/1

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