Sustainability in occupational therapy: A focus on human performance and well-being

In this blog and in my textbook I have expressed some concerns about application of occupational therapy theory into distal contexts that are only marginally related to the profession.  Specifically, I have stated that although concerns about topics including the climate and social justice are fine areas for people to be interested in, we are obligated to consider whether or not application of these concepts to the occupational therapy process is generative or distracting.

It is my opinion that these topics are frequently distracting, and that they confuse our stakeholders. I revisited this topic just last year when prompted by a colleague who was wondering if I 'revisited my thinking' on the topic.  At that time, I doubled down on my criticism.

One of my favorite quotes is from Konrad Lorenz, the renowned (and infamous, I suppose) ethologist, "It is a good morning exercise for a research scientist to discard a pet hypothesis every day before breakfast: it keeps him young." In my new context of developing an occupational therapy program at Rochester Institute of Technology I am awash in the messaging of engineers, computer scientists, and many others that I have not previously had continuous exposure to.  Accordingly, I am modifying my criticism of the role of occupational therapy and sustainability.  I don't expect that my modified position will satisfy those who are promoting a climate agenda or social justice role for the profession; however, perhaps these modified ideas can show how one might apply concepts of sustainability to occupational therapy without violating our founding principles and purpose as expressed in our social contract with stakeholders (aka licensing law and scope of practice).

For background, I encourage readers to thoroughly study the WFOT publication on the role of occupational therapy and sustainability.  I disagree with this document in its entirety, but it will serve as a basis to interpret my counterpoint.

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The WFOT proposal regarding the role of sustainability in occupational therapy does not apply to a traditional practice context and is confusing to stakeholders. I do not believe that sustainability ideas only need to be applied to the extended level of environment and ecological concern. Rather, occupational therapists interested in applying the concept to their field can consider the sustenance of human performance, particularly in the context of disease, disability, or illness. This approach aligns with the broader goals of occupational therapy, which aims to enhance individuals' ability to engage in meaningful occupations and to improve the quality of life. By integrating sustainability principles of circular economy, value retention, and life-cycle sustainment, occupational therapists can develop strategies that ensure the long-term well-being and functional independence of those under their care.

CIRCULAR ECONOMY and OCCUPATIONAL THERAPY
The idea of circular economy emphasizes the continual use of resources by creating a closed-loop system that minimizes waste and maximizes value. In occupational therapy, this can be translated into practice that focus on the sustenance of human participation under stress contexts. This is not a new concept in occupational therapy and actually was the core of George Barton's thinking.  Although he did not use the word 'sustainability' that I could find, his interest in this topic was driven by consideration of how to manage his loss of occupation due to his own infirmity - and his background as an architect and familiarity with the emergent science promoted by the Gilbreths related to time, motion, and efficiency. In Barton's own words, "I am going to raise the cry that it is time for humanity to cease regarding the hospital as a door closing upon a life which is 'past' and to regard it henceforth as a door opening upon a life that is yet to come. I do not mean heaven. I mean a job, a better job, or a job done better than it was before."  That is the occupational therapy application of circular economy.

VALUE RETENTION IN HUMAN PERFORMANCE
Value retention involves preserving the usefulness and effectiveness of products over time. In the context of occupational therapy, this means maintaining and enhancing the functional abilities of individuals through ongoing interventions and support. 'Value' is more broadly defined - and in our profession we have tended to call this 'Quality of Life.'  Again, hardly a new concept for the profession.

PRODUCT LIFE-CYCLE SUSTAINMENT
Product life-cycle sustainment in traditional engineering terms focuses on the entire lifespan of a product, from creation to disposal, ensuring its utility throughout.  In occupational therapy, this concept can be applied to the human life-cycle, emphasizing the maintenance of health and occupational participation at all stages of life.

Occupational therapists can design interventions that address the changing needs of individuals at different life stages, from childhood through old age and up until death. This holistic approach ensure that therapy is relevant and effective and meaningful to an individual.  This also includes proactive planning to sustain engagement (or maintenance of occupational participation) that again enhances the quality of life.

SUMMARY:
By incorporating principles of circular economy, value retention, and product (human) life-cycle sustainment into their practice, occupational therapists can define 'sustainability' to focus on the long term maintenance of human performance.  This approach not only aligns with the goals of enhancing occupational participation and quality of life, but also promotes a more efficient and effective use of resources applied to the therapeutic process.  Most importantly, defining sustainability in this way reflects the values and beliefs of the profession that have stood the test of time for over 100 years. This direct application of sustainability is more aligned with the social contract of the profession than any imagined role of occupational therapy's professional involvement with climate change.

This proposed perspective on sustainability can lead to improved outcomes. Unlike the more distal and abstract application of occupational therapy to climate change as proposed by WFOT, this model keeps the therapist's focus directly on the individual receiving occupational therapy services. This perspective is more aligned with the immediate, hands-on nature of traditional occupational therapy, where the primary goal is to address the functional and occupational needs of individuals, making the therapeutic process more impactful and relevant.

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