Professional Issues Forum: First Nation, Metis & Inuit Peoples’ Health & Community Development

1. Professional Issues Forum:First Nation, Metis & Inuit Peoples’ Health & Community Development Alison Gerlach, MSc, OT(C) CAOT Conference Whitehorse, June 2008

2. Where am ‘I Speaking From’? ~Transforming My Occupational Therapy Practice….. Post- Colonialism

3. Diversity~ ‘many different paths’ • Aboriginal peoples “do not see themselves as a pan-Aboriginal population - they come from diverse Nations, heterogeneous cultures, linguistic groups and geographies where there is no ‘One Perspective’ (Monture-Angus 1999 in NAHO, 2001b). • “Models of health care must reflect and be adapted to the realities of different communities. This may involve taking many different paths” (NAHO, 2001a).

4. “Program delivery models which reflect predominately western European concepts of health and illness have been identified as largely ineffective in responding to the needs of First Nation’s people” (Smye & Browne, 2002).

5. “A simple invocation of a return to culture” is not enough”(Adelson, 2005) Traditional Discourse in Health: Cultural Sensitivity/Competency (Adapted from Black, 2005).

6. An Alternative Discourse:Postcolonialism… • Postcolonial theories share “a social, political, and moral concern about the history and legacy of colonialism – how it continues to shape people’s lives, well-being, and life opportunities” (Young, 2001 in Browne, Smye & Varcoe, 2005, p. 19). • A postcolonial perspective critically analyzes healthcare discourses for their potential to “both mask and perpetuate neocolonial practices in health care for indigenous people”(Browne & Smye, 2002, p. 31).

7. Colonialism:A Determinant of Health for Aboriginal Peoples…. (NAHO, 2001a) Colonialism

8. Health & Social Justice in Community Development… • “A commitment to equity, social justice, participation and empowerment that enables people to identify common concerns and that supports them in taking action related to them” (WHO, 1999). • “Common good or communal well-being is a fundamental tenet of Aboriginal world views ..This translates into a requirement that the community participate in decisions concerning the health system”(NAHO, 2001a,b). • An ‘enabling occupational’ perspective promotes and guides greater engagement in social change (Townsend & Polatajko, 2007).

9. Canadian Model of Client-Centred Enablement (CMCE) • “Best practice in occupational therapy seeks to offer effective, client-centred, occupation-based enablement for health, well-being, and justice”. • Foundations of ‘enablement’: • Choice, risk, and responsibility • Client participation • Vision of possibility • Change • Justice: diversity & equity • Power sharing (Townsend & Polatajko, 2007)

10. Occupational Therapy Enablement Skills….

11. Community Development – Informed by Postcolonialism & Enabling Occupation Partnerships Culturally Safe Community Development Empowerment Asset Based

12. Community Development – Informed by Postcolonialism & Enabling Occupation Partnerships Culturally Safe Community Development Authentic equality in partnerships shifts power….

13. Genuine Partnerships….. • “Mainstream agencies and services need to re-imagine health systems by removing any racist implications from policy and practice and by welcoming Aboriginal people as partners”(Highlights of RCAP,1996:61 in NAHO, 2001b). • Establishing trust needs to be understood within the realities of historical and contemporary social relations between Aboriginal people and members of the dominant group – which may play out in everyday healthcare encounters and contribute towards avoidance of healthcare services (Browne & Smye, 2002).

14. Partnerships & Co-Creation of Knowledge • “Getting the right mix between Aboriginal evidence of health and well-being and medical and scientific based-evidence - both need to be seen as valuable and relevant to the improvement of Aboriginal Peoples’ health” (NAHO, 2001a). • The dominant culture is “deliberately decentred so that the perspectives of those who have been marginalized become starting points for knowledge construction” (Browne, et al, 2005).

15. Community Development – Informed by Postcolonialism & Enabling Occupation Partnerships Culturally Safe Community Development Empowerment Postcolonial theories “shed light on the unequal relations of power that are the legacy of the colonial past and the neocolonial present” (Browne, et al 2005).

16. Empowerment & Self-Determination • Occupational enablement and postcolonial theories - critical perspectives for understanding power and power relations in health care. • A determinant of health: “Aboriginal people regard self-determination as necessary to sustained improvements in health status” (NAHO, 2001a).

17. Postcolonialism & Enabling Occupation in Community Development… Trust Culturally Safe Community Development Empowerment Asset Based “Strengths represent potential pathways to wellness” (Van Uchelen et al, 1997).

18. Asset Based…. • Individual and collective strengths are found in the “activities, places, people, values, beliefs and traditions that are working well in the life of the individual and/or community” (Van Uchelen, et al, 1997). • Asset-based enablement:“aims to stimulate positive growth, insight, rapport, and energy” (Townsend & Polatajko, 2007).

19. Asset Based…. • Community assets & capacity (Frank & Smith, 1999) • Human resources • Environmental resources • Economic opportunities • Cultural and recreational resources • Communication processes • Infrastructure • Cultural knowledge & pride • Reclaiming of traditional approaches to health & healing

20. Community Development – Informed by Postcolonialism & Enabling Occupation Partnerships Culturally Safe Community Development Empowerment Capacity Building Asset Based

21. Capacity Building ~ Self-Determination & Empowerment • Builds on a community’s assets & potential • Shifts power & knowledge • Promotes empowerment & sustainable self-determination

22. Community Development – Informed by Postcolonialism & Enabling Occupation Partnerships Culturally Safe Community Development Empowerment Asset Based

23. Social Action: Mobilization…. • “Both indigenous and non-indigenous participants have a role to play in the process of decolonization … and must share the burden of social transformation” (McConaghy, 1997; LaRocque, 1993; Young, 1990 in Browne, et al, 2005). • “Enabling social change is based on collective participation and visions of possibility to promote occupational rights”(Townsend & Polatajko, 2007)

24. Social Action: Occupational Justice? • How can occupational enablement promote social and occupational equity and justice for, and in partnership with, Aboriginal communities?

25. Evidence?

26. Research: “Only if it is going to mean something” (Warry, 2007) • “Those closest to the consequences of research should be the most involved in decision-making”(McConaghy, 1997 in Browne, et al,2005). • In Canada, “Dion Stout et al call for more partnership-based research and indigenization of the research process” (NAHO, 2001a). • P.A.R. - “a form of social action with the goal of political or social change” (WHO, 2002) that contributes “to the decolonization of Aboriginal research”(Warry, 2007).

27. In closing … • “Occupational therapists are encouraged to generate the courage and supports to enable individual and social change, thereby advancing opportunities for client empowerment and participation in society” (Townsend & Polatajko, 2007).

28. Thank you …. I welcome any opportunity to continue this dialogue… Alison Gerlach agerlach@hawaii.rr.com

29. Readings related to this presentation Ball, J. & Pence, A. (2006). Supporting Indigenous Children’s Development. British Columbia: UBC Press Black, S. (2005). Cultural Sensitivity in Occupational Therapy. CAOT preconference workshop. Vancouver. Browne, A. & Smye, V. (2002). A post-colonial analysis of healthcare discourses addressing Aboriginal women. Nurse Researcher, 9:3, 28-41. Browne, A., Smye, V. & Varcoe, C. (2005). The relevance of postcolonial theoretical perspectives to research in Aboriginal health. Canadian Journal of Nursing Research, 37:4, 16-37. Dyck, I. & Kearns, (1995). Transforming the relations of research: towards culturally safe geographies of health and healing. Health & Place, 1:3, 137-147. Gerlach, A. (2003). Cultural issues and Canadian First Nations Families. Unpublished MSc Thesis, San Jose University, California. Hammel, K. (2008). Reflections on … well-being and occupational rights. Canadian Journal of Occupational Therapy, 75:1, 61-64. Howarth, A. & Jones, D. (1999). Transcultural occupational therapy in the United Kingdom: Concepts and research. British Journal of Occupational Therapy, 62:10, 451-458. Lauckner, H., Pentland, W., & Paterson, M. (2007). Exploring Canadian occupational therapists’ understanding of and experiences in community development. Canadian Journal of Occupational Therapy, 74:4, 314-325. National Aboriginal Health Organization. (n.d.) Access and integration. Retrieved April 2007 from: www.naho.ca/english/documents/health_sectoral_AC.pdf National Aboriginal Health Organization, (2001a). Strategic Directions for an Evidence-Based Decision Making Framework at NAHO. Retrieved April 2007 from: http://www.naho.ca/english/pdf/research_strategic.pdf National Aboriginal Health Organization, (2001b). Making a difference: Submission to the Commission on the Future of Health Care in Canada. Retrieved April 2007 from: http://www.hc-sc.gc.ca/francais/pdf/romanow/National%20Aboriginal%20Health%20Organization.pdfCont’d…..

30. Readings related to this presentation National Aboriginal Health Organization, (2003). Winds of Change: A Strategy for Health Policy Research and Analysis. Ottawa: National Aboriginal Health Organization National Aboriginal Health Organization. (2008). An Overview of Traditional Knowledge and Medicine and Public Health in Canada. Ottawa: Author. Ramsden, I. (1993). Cultural safety in nursing education in Aotearoa (New Zealand). Nursing Praxis in New Zealand, 8:3, 4-10). Restall, G., Ripat, J., & Stern, M. (2003). A framework of strategies for client-centred practice. Canadian Journal of Occupational Therapy, 70, 103-112. Smye, V. & Browne, A. (2002). ‘Cultural safety’ and the analysis of health policy affecting aboriginal people. Nurse Researcher,9:3, 42-56. Townsend, E.A., & Polatajko, H.J. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being, & justice through occupation. Ottawa, ON: CAOT Publications ACE. Warry, W. (2007) Ending Denial: Understanding Aboriginal Issues. Ontario: Broadview Press Wood, P. J., Schwass, M. (1993). Cultural safety: A framework for changing attitudes. Nursing Praxis in New Zealand, 8:1, 4-14. World Health Organization (WHO). (1999). Community participation in local health and sustainable development: a working document on approaches and techniques. Geneva: Author 1999, 10. World Health Organization. (2002). Community-based rehabilitation as we have experienced it: Voices of persons with disabilities. Geneva: Author. World Health Organization. (2003). Community development for health and empowerment. Geneva: Author.