Inclusive and emancipatory approaches to occupational therapy practice in substance-use contexts

Abstract

French

Background.

Occupational therapy practice is enhanced through clear understanding of its epistemological foundations. In the area of substance use, practices are strongly functionalist.

Purpose.

This study unearths epistemologies through analyzing practices addressing the social needs of clients with problematic substance use.

Method.

This study used an exploratory qualitative approach and was based on Marxist philosophies. Qualitative interviews were conducted with nine occupational therapists experienced in working with substance users. Data were analyzed through a dialectic approach to content analysis based on the Marxist theory of labour process.

Findings.

The occupational therapy practices were found to follow common principles: clients are agents of transformation in health processes; creativity is a strong element of practice and underlies the whole therapeutic process; and conditions of social reproduction compose the object of occupational therapy (i.e., what is transformed through occupational therapy practices). Two different approaches using these principles were uncovered according to the labour-process purposes: inclusive and emancipatory.

Implications.

Systematization of practices based on epistemological foundations strengthens occupational therapists’ ability to link actions to theories.

Keywords

Epistemology Health care systems Marxism Social class Work

Get full access to this article

View all access options for this article.

References

Aiken

F. E.

Fourt

A. M.

Cheng

I. K.

Polatajko

H. J.

(2011). The meaning gap in occupational therapy: Finding meaning in our own occupation. Canadian Journal of Occupational Therapy, 78, 294–302. doi:10.2182/cjot.2011.78.5.4

AlHeresh

Bryant

Holm

(2013). Community-based rehabilitation in Jordan: Challenges to achieving occupational justice. Disability and Rehabilitation, 35, 1848–1852. doi:10.3109/09638288.2012.756944

Antunes

(2013). The meanings of work: Essay on the affirmation and negation of work (2nd ed.; Molinari

, Trans.). Brill, UK: Leiden.

Baratta

(1994). Introdução a uma sociologia da droga [Introduction to a drug sociology]. In Mesquita

Bastos

F. I.

(Eds.), Drogas e AIDS: Estratégias de redução de danos [Drugs and AIDS: Harm reduction strategies] (pp. 21–43). São Paulo, Brazil: Hucitec.

Beagan

B. L.

(2007). Experiences of social class: Learning from occupational therapy students. Canadian Journal of Occupational Therapy, 74, 125–133. doi:10.2182/cjot.06.012x

Becker

H. S.

(1999). Métodos de pesquisa em ciências sociais [Methods in social sciences]. São Paulo, Brazil: Hucitec.

Brasil. (2004). Saúde mental no SUS: Os centros de atenção psicossocial [Mental health in the Unified Health System: The psychosocial health care centers]. Brasília, Brazil: Ministério da Saúde. Retrieved from http://www.ccs.saude.gov.br/saude_mental/pdf/sm_sus.pdf

Campos

C. M. S.

Soares

C. B.

(2003). A produção de serviços de saúde mental: A concepção de trabalhadores [The mental health services production: Workers conceptions]. Ciência & Saúde Coletiva, 8(2), 621–628. doi:10.1590/S1413-81232003000200022

Conselho Nacional de Saúde (Brasil) (2013). Resolução no. 466, de 12 de dezembro de 2012: Diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos [Resolution No. 466, of December 12, 2012: Regulatory guidelines and standards of research involving human beings]. Diário Oficial da União, June 13, 2013; Section 1, p. 59.

10.

Cordeiro

Godoy

Soares

C. B.

(2014). A supervisão como processo educativo: Construindo o paradigma de redução de danos emancipatória com uma equipe de CAPS-AD [Supervision as educative process: Building the emancipatory harm reduction paradigm with a CAPS-AD team]. Cadernos de Terapia Ocupacional da UFSCar, 22, 153–159. doi:10.4322/cto.2014.040

11.

Córdova

A. G.

(2012) Enfoque y práxis em terapia ocupacional. Reflexiones desde uma perspectiva de uma terapia ocupacional crítica [Approach and praxis in occupational therapy: thoughts from a critical perspective of occupational therapy]. Terapia ocupacional Galícia (A Coruña), 9(5), 18–29. Retrieved from http://www.revistatog.com/mono/num5/prologo.pdf ISSN 1885-527X

12.

Donnangelo

M. C. F.

(1975). Medicina e sociedade: O médico e seu mercado de trabalho [Medicin and society: The physician and the labour market]. São Paulo, Brazil: Livraria Pioneira.

13.

Freire

(1997). Professora sim, tia não: Cartas a quem ousa ensinar [Teacher yes, aunt no: Letters to those who dare to teach]. São Paulo, Brazil: Olho d’água.

14.

Galheigo

S. M.

(2005). Occupational therapy and the social field: Clarifying concepts and ideas. In Kronenberg

Algado

S. S.

Pollard

(Eds.), Occupational therapy without borders: Learning from the spirit of survivors (pp. 87–98). London, UK: Elsevier Churchill Livingstone.

15.

Galheigo

S. M

. (2011). What needs to be done? Occupational therapy responsibilities and challenges regarding human rights. Australian Occupational Therapy Journal, 58, 60–66. doi:10.1111/j.1440-1630.2011.00922.x

16.

Guajardo

Kronenberg

Ramugondo

(2015). Southern occupational therapies: Emerging identities, epistemologies and practices. South African Journal of Occupational Therapy, 45, 3–10. doi:10.17159/2310-3833/2015/v45no1a2

17.

Hammell

K. W.

(2015). Quality of life, participation and occupational rights: A capabilities perspective. Australian Occupational Therapy Journal, 62, 78–85.doi:10.111/1440-1630.12183

18.

Hammell

K. W.

(2017). Critical reflections on occupational justice: Toward a rights-based approach to occupational opportunities. Canadian Journal of Occupational Therapy, 84, 47–57. doi:10.1177/0008417416654501

19.

Hammell

K. W.

Beagan

(2017). Occupational injustice: A critique. Canadian Journal of Occupational Therapy, 84, 58–68. doi:10.1177/0008417416638858

20.

Hammell

K. W.

Iwama

M. K.

(2012). Well-being and occupational rights: An imperative for critical occupational therapy. Scandinavian Journal of Occupational Therapy, 19, 385–394. doi:10.3109/11038128.2011.611821

21.

Hart

(2013). High price: A neuroscientist’s journey of self-discovery that challenges everything you know about drugs and society. New York, NY: HarperCollins.

22.

Ikiugu

Pollard

(2015). Meaningful living through occupation. London, UK: Whiting and Birch.

23.

Kronenberg

Algado

S. S.

Pollard

(2005). Introduction to second section. In Kronenberg

Algado

S. S.

Pollard

(Eds.), Occupational therapy without borders: Learning from the spirit of survivors (pp. 56–57). London, UK: Elsevier Churchill Livingstone.

24.

Laurell

A. C.

(1989). Social analysis of collective health in Latin America. Social Science Medicine, 28, 1183–1191.

25.

Laurell

A. C.

(1991). Trabajo y salud: Estado del conocimiento [Work and health: State of art]. In Franco

Nunes

E. D.

Breihl

Laurell

A. C.

(Eds.), Debates en medicina social [Debates in social medicine] (pp. 249–339). Quito, Ecuador: OPAS.

26.

Lukács

(1980). The ontology of social being: 3. Labour ( Fernbach

, Trans.). London, UK: Merlin Press.

27.

Marx

(1982). Capital (Vol. 1). São Paulo, Brazil: Difel.

28.

Medeiros

M. H. R.

(2003). Terapia ocupacional: Um enfoque epistemológico e social [Occupational therapy: An epistemologic and social approach]. São Paulo, Brazil: Editora Hucitec.

29.

Mendes Gonçalves

R. B.

(1992). Práticas de saúde: Processos de trabalho e necessidades [Health practices: Labour processes and needs]. São Paulo, Brazil: Cadernos Cefor.

30.

Mészáros

(2005). A educação para além do capital. São Paulo, Brazil: Boitempo.

31.

Navarro

V. L.

(1982). The labor process and health: A historical materialist interpretation. International Journal of Health Services, 12, 5–25. doi:10.2190/MVRB-XD8G-RTM6-05KP

32.

Parsons

(1951). The social system. New York, NY: Free Press.

33.

Peduzzi

Schraiber

L. B.

(2012). Processo de trabalho em saúde [Health labour process]. In Dicionário da educação profissional em saúde [Dictionary of health professional education]. Rio de Janeiro, Brazil: ENSP/FIOCRUZ. Retrieved from http://www.epsjv.fiocruz.br/dicionario/verbetes/protrasau.html

34.

Pollard

Kronenberg

Sakellariou

(2008). The political practice of occupational therapy. Edinburgh, UK: Elsevier.

35.

Pollard

Smart

, & the Voices Talk and Hands Write Group. (2005). Voices Talk and Hands Write. In Kronenberg

Algado

S. S.

Pollard

(Eds.), Occupational therapy without borders: Learning from the spirit of survivors (pp. 287–301). London, UK: Elsevier Churchill Livingstone.

36.

Roe

(2005) Harm reduction as paradigm: Is better than bad good enough? The origins of harm reduction. Critical Public Health, 15, 243–250. doi:10.1080/09581590500372188

37.

Santos

V. C.

Soares

C. B.

Campos

C. M. S.

(2007). A relação trabalho-saúde de enfermeiros do PSF no município de São Paulo [The relation between work and health in nurses of family health programmes in the city of São Paulo]. Revista da Escola de Enfermagem da USP, 41, 777–781. doi:10.1590/S0080-62342007000500006

38.

Schmid

(2004). Meanings of creativity within occupational therapy practice. Australian Occupational Therapy Journal, 51, 80–85. doi:10.1111/j.1440-1630.2004.00434.x

39.

Soares

C. B

. (2007). Consumo contemporâneo de drogas e juventude: A construção do objeto na perspectiva da Saúde Coletiva [Contemporary consume of drugs and youth: The construction of the object of study under the perspective of the collective health]. Unpublished thesis, Escola de Enfermagem da Universidade de São Paulo, Brazil. Retrieved from http://www.teses.usp.br/teses/disponiveis/livredocencia/7/tde-26112007-161151/

40.

Soares

C. B.

(2015). The challenges of critical epidemiology and responses of capitalism to their reproductive difficulties: The cybersphere case. Revista Brasileira de Epidemiologia, 18, 990–994. doi:10.1590/1980-5497201500040028

41.

Soares

C. B.

Campos

C. M. S.

Yonekura

(2013). Marxism as a theoretical and methodological framework in collective health: Implications for systematic review and synthesis of evidence. Revista da Escola de Enfermagem da USP, 47, 1403–1409. doi:10.1590/S0080-623420130000600022

42.

Soares

(1991). Terapia ocupacional: Lógica do capital ou do trabalho? [Occupational therapy: Capital or labour logics?]. São Paulo, Brazil: Editora Hucitec.

43.

Spiegel

J. M.

Breilh

Yassi

(2015). Why language matters: Insights and challenges in applying a social determination of health approach in a North-South collaborative research program. Globalization and Health, 11, Article 9. doi:10.1186/s12992-015-0091-2

44.

Townsend

Wilcock

A. A.

(2004). Occupational justice and client-centred practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71, 75–87. doi:10.1177/000841740407100203

45.

Triviños

A. N. S.

(1987). Introdução à pesquisa em ciências sociais: a pesquisa qualitativa em educação [Introduction to research in social sciences: Qualitative research in education]. São Paulo, Brazil: Atlas.

46.

United Nations Office on Drugs and Crime. (2016). World drug report 2016 (United Nations publication, Sales No. E. 16. XI.7). New York, NY: United Nations.

47.

Waitzkin

Iriart

Estrada

Lamadrid

(2001). Social medicine then and now: Lessons from Latin America. American Journal of Public Health, 91, 1592–1601. doi:10.2105/AJPH.91.10.1592

48.

World Federation of Occupational Therapists. (2006). Position statement on human rights. Retrieved from http://www.wfot.org/ResourceCentre.aspx