Globalization and occupation therapy - a continued musing.

I have been talking about the implications of globalization on the occupational therapy profession for quite some time - it started off with blog posts here and then a presentation at OT24VX in 2015.  Then I gave the topic a whole chapter in my theory textbook in 2019.  Then there were more blog posts here and here.

In sum, I am uncertain if occupational therapy is a unitary global profession, although I now add this caveat: at least as understood in the publications of academics.  I add this caveat now because I am uncertain if the things that people in academia write about truly reflects actual practice in other countries.  I know that in the United States there is some academic scholarship that is highly relevant to practice, and other scholarship that leaves me wondering if I am an occupational therapist according to the way some suggest that practice should be constructed.

So for example I read the Canadian Journal and wonder if everyday practitioners are functioning in 'change agent roles' as described or if I would be more likely to find someone providing traditional OT to a worker who injured their hand in the Alberta oil sands so they can resume their occupational roles.  I am unsure.  I know that in the US I am more likely to find practitioners doing very pragmatic and traditional things in traditional health and educational/community settings - and that social/occupational justice 'work' on a population level is actually quite rare (except for the seeming endless stream of doctoral capstone projects done in homeless shelters and soup kitchens - that rarely seem to translate into actual work settings).

Anyway, the point is that there is some scholarship that seems to promote OT in these new roles and that seems to have very little traction in reality.  A lot of the international scholarship is like this too - promoting OT as a political methodology or as a mechanism for understanding oppression (anti-Western, anti-Northern, anti-Capitalist, etc etc).  I suspect that OTs around the world understand and respect social and cultural dynamics and treat people with high levels of respect and care.  OTs in my opinion are a very accepting, kind, and sensitive lot of people.  I don't know how many practitioners outside of academia make it their lifework to be systems change agents though.

I suspect that more OTs help people put on their pants or learn how to write or do similar kinds of everyday tasks that they find meaningful.  I am not a world-traveler though, so I can't be certain.

Anyway, the disconnect between what some academics write about and what practitioners do is a problem in the United States.  That is particularly true when ideas from other countries are floated as potential models for practice in the United States.  I have tried to explain numerous times - colonial transfer of ideas is problematic in any direction.  That seems to be a point of sensitivity for people who have been on the receiving end of Western ideas/dominance for a long time, but you don't fix the problem by reversing the data flow.  You just create the same problem in the opposite direction.

The methodology for treating a broken bone is rather plain on a biomedical level and could probably transfer easily from country to country.  That is why we can state with greater surety that medicine and nursing and even physical therapy translates pretty easily around the globe.  But when we take it to the level of occupations then all kinds of cultural elements start to interfere - is independence valuable around the globe, or is that a Western construct?  

The OT profession has really taken the conversation into far-flung places along the 'general systems theory' hierarchy - to the point that some academics seem to consider social OT as a Freirian political movement, or that we should just abandon the medical model, and so on. Is this the way that OTs are actually practicing, or is this just the philosophical musing of some academics?  Reading the international journals is a journey into the unknown.

Here in the US the problem is that the professional association is overpopulated with academics and underpopulated with clinicians.  Policy papers, model practice acts, and many other forms of influential documents come flying out of the national office - and to be honest they have varying levels of applicability to what practicing OTs are doing.  This is a problem.  This is also why I always worry about what idea will come out of WFOT - because invariably some American OT academics who don't practice might think WFOT policy papers are the next great idea that we need to insert into our own Practice Framework.  That Practice Framework now is so expansive and out of touch with what many American OTs do - and it just gets more disconnected with each new edition.  Again, that is why globalization of ideas is a real problem in any direction when higher level social and cultural elements are in play.

Maybe the solution is to have more members of our Academy practice.  Is that how medicine remains grounded?

This all comes top of mind again because I see that the new Willard and Spackman text is being released.  I know the publisher; they published my text as well.  I was asked to make my text relevant for an international audience and I told them that it was not possible to make a theory textbook internationally relevant if it was going to be clinically focused.  I might not be asked to write another theory textbook because of that opinion, but it remains my position.  That hurts book sales, I know.  I get the objectives of the publisher that wants to have international sales - but how realistic is it to believe that we can create a global textbook?  Let's just take one example - nearly a third of OTs in America provide services in pediatric contexts, and practice is driven around specific American laws that dictate how early intervention, preschool, and school-based services are delivered.

How do we translate that and make it relevant in other countries that don't have those same systems and guidelines and restrictions?

Now we can criticize the American systems all day.  Goodness knows they are imperfect.  But as an American academic I have to teach American students how to practice in America.  And I have to hope they pass the American certification exam.  And those students have to be competent within the laws about occupational therapy delivery in those service contexts.

Do my American students need to be change agents to help move the American system into a Freirian political movement?  Do they need to be concerned about theoretical colonialism and if MOHO applies in other countries?  In American practice do those students have future roles in sustainability and climate change and social justice?

This is the disconnect.

I don't begrudge anyone's interest in these topics.  Actually I think that these are interesting topics to think about.  I am uncertain if they apply to American occupational therapy practice.

So I will order the new W&S text, and I will read it thoroughly.  

Whether or not I decide to encourage my students to read it is another story - that will depend on whether or not the content is relevant to their future careers as American occupational therapists.

I really wish more members of our Academy would think critically about this issue.  We need more honest dialogue on these things.


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