A N OT C O M M U N I T Y D E V E LO P M E N T P R AC T I C E P R O C E S S

LE CLAIR Mr Mpanza’s Research group

INTRODUCTION AND
BACKGROUND
• The study was conducted in Canada with the purpose of expanding the very limited information available in
the Canadian Practice Process Framework (CPPF) with regards to community development

• Previously, authors theorized what processes COULD be practiced in the CD approach to improve the outcome
while this study focused on the experience of OTs within the field.

• OT practitioners who had at least 1 year of experience in CD and engaged with various communities were asked
to participate.

• The participants were subject to an initial and follow up interview, which was independently analyzed by 3
researchers.
5 KEY ELEMENTS
1. Getting to know the community.

2. Planning together

3. Building occupational opportunities

4. Revisiting the approach (and making necessary changes)

5. Ensuring sustainability.
REASON FOR THE STUDY
• The underlying driver of the study was the shift that was needed from institutional to community-
based practice in order to reach the individuals and communities that required the services of OT.
• Through Community Development (CD) approaches, the community spearheads the discussion of the
health issues within their context and the OT facilitates
• Not to be confused with Community-based programs in which the OT identifies the issues and involves
the community in predetermined and planned programs.
• The CD approach is often a longer-term project and is open ended in comparison
• an interpretive design was used as it is linked to referring to the experience of others in the field who
make use of existing knowledge to inform practice
FINDINGS
• 8 OTs who worked in the eastern and central regions of Canada participated in the study, with a minimum of 2
years of experience in CD – 32 years in the field.

• Even though OTs were often affiliated with community health centers or government offices, they worked at
various location which community members had access to. They were at most times, the sole OT with no clear
job description. However, they did present with shared interests and concerns that focused on the social
determinants of health (SDH) such as poverty, income, housing etc.

Not only did the community raise these subjects as their concerns but all of these were present within the
communities’ contexts.

• The therapists used the theories of health promotion, SDH, education, harm reduction and program
development to guide their work
• emphasized values that led to successful outcomes which included going into the community, learning about
the culture and mannerisms of the community and building trusting relationships with the members,
identifying the community strengths and breaking down the factors which limited empowering the community
CD OCCUPATIONAL THERAPY PRACTICE PROCESS

1. Getting to know the community

• Building relationships and networking - along with the formation of individual relationships, attending
community meetings, events and activities allows one to recognize the needs, strengths and priorities.
• Exploring available resources and opportunities - looking at programs that were already offered and
identifying gaps in providing the service to specific populations and potential opportunities for
partnerships that could help address occupational issues. Formal (environmental scans/research on
the community) and informal (phone calls) research was conducted by practitioners.
• Identifying shared needs and priorities -participants considered the common individual needs by
many and linked it to systemic issues such as lack of housing or inaccessible services. This occurred
through formal tools such as group surveys and focus groups. Barriers included, lack of time, chaotic
life circumstances and power structures which influenced the participation of certain members within
the community.
 2. Getting the ball rolling/planning together

• Being creative, taking action and “doing” – a trial-and-error approach was used to put the plan in
action and some evidence-based approaches were implemented during this time to ensure that the
OT remained involved in the action which would have an impact on the occupations of the community.

• Respecting and incorporating culture – this was achieved by consulting cultural representatives or
leaders to ensure that nothing is done to offend the community.

 Co-planning for occupational opportunities – focus was placed on meeting the needs of many in
the community. Either through community agencies or shared experiences from individuals and
groups in the community.

The OTs encouraged community members to be directly involved in the planning and would
sometimes initiate the plan or suggest ideas and let the community decide on a priority and
take it from that point onwards.
3. Building occupational opportunities

 Creating a safe space – community members were consulted about meeting in a comfortable place
in which to engage in occupations. This was to combat the populations who may feel marginalized
in public spaces and programs (e.g. People at risk of homelessness).

 Promoting opportunities for social connectedness – initiatives were created to perform meaningful
opportunities with others such as open mic nights for community members, a group for women
who will learn how to make jewellery, computer skills training and employment workshops at a local
community kitchen etc. to increase the awareness of participants, to start to take personal action
which will lead to sustaining these practices and becoming part of everyday life.

 Building skills – a link between skill building and community involvement and being an active
community member was recognized. This led to skill building relating to the community (lack of
access to transportation = bicycle cooperative run by community leaders) and personal
empowerment (employment skills – computer skills, financial literacy, leadership training etc.
4. Revisiting the approach – (turning point)

 Checking in – OTs would check in with the community about the sustainability of the project,
whether it was still meeting the needs of the people, overall satisfaction of program/services or
supports and modifying it based on the feedback.

 Looking for change – Evaluation was a complex process when the issues were so concerning (e.g.
Poverty) so therapists would use observation skills such as noting participation at community
events/meetings, focus groups or individuals’ stories to evaluate the project.

Evaluation was also based on the determinants of health such as maintenance of housing or
emergency room visits.
 5. Striving for sustainability

 Supporting local leaders and champions – finding a champion to take charge of the project from
the onset increases chance for sustainability. Some participants stated that the community would
appoint the OT as the leader which they would kindly decline and instead assume the role of a
guide to enable the community to take responsibility of the organization, evaluation and funding of
the projects.

 Committing long term – participants stated that one has to recognize that in order for a CD process
to be sustainable, they have to commit to working with the community over a longer period of time.

 Seeking ongoing funding – funding was seen to be the most challenging part of the process since
the CD process occurs over an amount of time, therefore, it is imperative to help funders to
understand this process.
CONCLUSION
The CPPF provides a generic framework from which OTs can practice, however, it was not largely used
in the community context. A similarity linked to the available frames of reference which were, at times,
not applicable to the communities within their context.

This was pinpointed to the fact that until recently, OT models did not theorize a link between individual
and community occupations which resulted in a lack of theoretical foundations for community
occupations.