Incorporating an Occupational Perspective in Refugee Resettlement
Incorporating an Occupational Perspective in Refugee Resettlement Sarah Jamieson, BS, OTS Thomas Jefferson University August 7, 2014
Overview ● Introduction to OT ● Occupational perspective of the refugee experience ● Occupational deprivation versus occupational justice ● Occupation-based refugee work ● Case studies ● Closing thoughts
A question... What are some of your favorite things (occupations) to do?
So...what is occupational therapy? ● “Occupational therapists help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations).” (AOTA, 2014) ● Work with people of all ages, abilities, and conditions
The “Core” of OT ● Humans are inherently occupational beings ● Engaging in valued occupations promotes and sustains health and wellbeing ● The environment is paramount to practice ● The client is a valued member of the therapy team ● The habits, routines, roles, and rituals of clients inform our therapy
The “OT Process” ● ● ● ●
Evaluation Goal planning with client Intervention Outcomes evaluation
Flow
Csikszentmihalyi, M. (1990). Flow: the psychology of optimal experience. New York: Harper & Row.
The Refugee Process as seen from a Case Manager:
The Refugee Process as seen from an Occupational Therapist:
Occupational Deprivation ● “A state of preclusion from engagement in occupations of necessity and/or meaning due to factors that stand outside the immediate control of the individual” (Whiteford, 2000) ● Who is most susceptible to occupational deprivation? ● What results from occupational deprivation? ● lack of meaningful use of time ● lack of awareness of local resources ● lack of confidence in accessing resources
Occupational Justice ● “Access to and participation in the full range of meaningful activities afforded to others” (Townsend and Wilcock, 2004) ● A recognition of occupational rights, regardless of age, ability, gender, class, or other differences (Nilsson and Townsend, 2010)
Occupation-based refugee work: Re:new Project
http://www.renewproject.org/
Occupation-based refugee work: OT 562, Environmental Competence in Action
Occupation-based refugee work: University of Utah ● Initiated in 2004 ● OT students on fieldwork provide “life skills training” to assist newly arrived refugees in transition o Individual and group sessions Public transportation Pre-driving Home safety and maintenance Employment skills Classes for high school students who desire higher education o Programs PAR FORE Karen weaving program Gardening projects
When could you refer an OT? ● Isolation ● Not venturing into community ● Not following through with plans/appointments (medical care, employment, ESL classes) ● Difficulty with daily activities *If it appears a client is reducing their environment, an OT would work to create an environment where they can succeed
Case Study 1 S.T. is a 36 year-old female from Bhutan with a 9 year-old son who has cerebral palsy. Her son is unable to mobilize independently and spends most of his time in a large stroller. They live on the third floor of their apartment building. Because of her son’s condition, S.T. must make frequent doctor’s appointments and visits. However, she is unable to read and understand the numbers on a phone and speaks little English. She is uncomfortable calling the doctor on her own and states that the commute is challenging. The stroller is large and heavy to carry down the stairs and the doctor’s office is a far commute from home. How do you enable S.T. to take care of herself and her son in the safest and most satisfying way possible?
Case Study 2 H. A., a 72 year-old male from Sudan, is in the fourth month of his resettlement in Philadelphia. He currently lives with three other men from Sudan. He presents with low vision, rheumatoid arthritis, and hypertension. He is also pre-literate in both his native language and in English. Recently, H.A. received four different kinds of medication for his various conditions. Upon meeting with the case manager to review his medication, H.A expressed that due to Ramadan, he will not be able to swallow anything for the next month from sunrise to sunset. All of his medication is taken at least twice daily, some more often. Furthermore, H.A. is unable to distinguish between pills and the directions/side effects that accompany them. How do you ensure that H.A. safely takes his medication while maintaining his ability to observe his religion?
Case Study 3 I.A. is a 29 year-old male from Iraq where he worked as a mechanical engineer. However, he has been unable to find an engineering job in Philadelphia with his current credentials. He is near the completion of his third month in the US and shows little interest in obtaining a job. He has already missed one interview and is reluctant to explore job options with you, his case manager. How do you find a way to engage I.A. in obtaining and maintaining a job?
Adopting an Occupational Perspective in Your Casework ● Consider the natural environment in which an activity occurs and try to adapt the environment ● After initial resettlement phase, assess how they are spending their time ● Show & tell & do
Closing Thoughts “In helping we see weakness; in serving we see wholeness.” Rachel Thibeault, OTR/L, OTD, Ph.D
Questions? Contact information: Sarah Jamieson [email protected]
Thank you to Stephen Kern, Ph.D, OTR/L and Bobby Walsh, OTR/L for their ideas and assistance.
References About Occupational Therapy. Retrieved July 10, 2014, from http://www.aota.org/en/About-Occupational-Therapy.aspx Csikszentmihalyi, M. (1990). Flow: the psychology of optimal experience. New York: Harper & Row. Immigration and refugee resettlement programming. Retrieved August 1, 2014 from http://www.health.utah.edu/occupationaltherapy/fieldwork/outreach/immigration-resettlement.php Nilsson, I., & Townsend, E. (2010). Occupational justice-bridging theory and practice. Scandinavian Journal of Occupational Therapy, 17(1), 57-63. Townsend, E., & Wilcock, A. A. (2004). Occupational justice and client-centred practice: A dialogue in progress. Canadian Journal of Occupational Therapy,71(2), 75-87. Whiteford, G. (2000). Occupational deprivation: Global challenge in the new millennium. The British Journal of Occupational Therapy, 63(5), 200-204.
Overview ● Introduction to OT ● Occupational perspective of the refugee experience ● Occupational deprivation versus occupational justice ● Occupation-based refugee work ● Case studies ● Closing thoughts
A question... What are some of your favorite things (occupations) to do?
So...what is occupational therapy? ● “Occupational therapists help people across the lifespan participate in the things they want and need to do through the therapeutic use of everyday activities (occupations).” (AOTA, 2014) ● Work with people of all ages, abilities, and conditions
The “Core” of OT ● Humans are inherently occupational beings ● Engaging in valued occupations promotes and sustains health and wellbeing ● The environment is paramount to practice ● The client is a valued member of the therapy team ● The habits, routines, roles, and rituals of clients inform our therapy
The “OT Process” ● ● ● ●
Evaluation Goal planning with client Intervention Outcomes evaluation
Flow
Csikszentmihalyi, M. (1990). Flow: the psychology of optimal experience. New York: Harper & Row.
The Refugee Process as seen from a Case Manager:
The Refugee Process as seen from an Occupational Therapist:
Occupational Deprivation ● “A state of preclusion from engagement in occupations of necessity and/or meaning due to factors that stand outside the immediate control of the individual” (Whiteford, 2000) ● Who is most susceptible to occupational deprivation? ● What results from occupational deprivation? ● lack of meaningful use of time ● lack of awareness of local resources ● lack of confidence in accessing resources
Occupational Justice ● “Access to and participation in the full range of meaningful activities afforded to others” (Townsend and Wilcock, 2004) ● A recognition of occupational rights, regardless of age, ability, gender, class, or other differences (Nilsson and Townsend, 2010)
Occupation-based refugee work: Re:new Project
http://www.renewproject.org/
Occupation-based refugee work: OT 562, Environmental Competence in Action
Occupation-based refugee work: University of Utah ● Initiated in 2004 ● OT students on fieldwork provide “life skills training” to assist newly arrived refugees in transition o Individual and group sessions Public transportation Pre-driving Home safety and maintenance Employment skills Classes for high school students who desire higher education o Programs PAR FORE Karen weaving program Gardening projects
When could you refer an OT? ● Isolation ● Not venturing into community ● Not following through with plans/appointments (medical care, employment, ESL classes) ● Difficulty with daily activities *If it appears a client is reducing their environment, an OT would work to create an environment where they can succeed
Case Study 1 S.T. is a 36 year-old female from Bhutan with a 9 year-old son who has cerebral palsy. Her son is unable to mobilize independently and spends most of his time in a large stroller. They live on the third floor of their apartment building. Because of her son’s condition, S.T. must make frequent doctor’s appointments and visits. However, she is unable to read and understand the numbers on a phone and speaks little English. She is uncomfortable calling the doctor on her own and states that the commute is challenging. The stroller is large and heavy to carry down the stairs and the doctor’s office is a far commute from home. How do you enable S.T. to take care of herself and her son in the safest and most satisfying way possible?
Case Study 2 H. A., a 72 year-old male from Sudan, is in the fourth month of his resettlement in Philadelphia. He currently lives with three other men from Sudan. He presents with low vision, rheumatoid arthritis, and hypertension. He is also pre-literate in both his native language and in English. Recently, H.A. received four different kinds of medication for his various conditions. Upon meeting with the case manager to review his medication, H.A expressed that due to Ramadan, he will not be able to swallow anything for the next month from sunrise to sunset. All of his medication is taken at least twice daily, some more often. Furthermore, H.A. is unable to distinguish between pills and the directions/side effects that accompany them. How do you ensure that H.A. safely takes his medication while maintaining his ability to observe his religion?
Case Study 3 I.A. is a 29 year-old male from Iraq where he worked as a mechanical engineer. However, he has been unable to find an engineering job in Philadelphia with his current credentials. He is near the completion of his third month in the US and shows little interest in obtaining a job. He has already missed one interview and is reluctant to explore job options with you, his case manager. How do you find a way to engage I.A. in obtaining and maintaining a job?
Adopting an Occupational Perspective in Your Casework ● Consider the natural environment in which an activity occurs and try to adapt the environment ● After initial resettlement phase, assess how they are spending their time ● Show & tell & do
Closing Thoughts “In helping we see weakness; in serving we see wholeness.” Rachel Thibeault, OTR/L, OTD, Ph.D
Questions? Contact information: Sarah Jamieson [email protected]
Thank you to Stephen Kern, Ph.D, OTR/L and Bobby Walsh, OTR/L for their ideas and assistance.
References About Occupational Therapy. Retrieved July 10, 2014, from http://www.aota.org/en/About-Occupational-Therapy.aspx Csikszentmihalyi, M. (1990). Flow: the psychology of optimal experience. New York: Harper & Row. Immigration and refugee resettlement programming. Retrieved August 1, 2014 from http://www.health.utah.edu/occupationaltherapy/fieldwork/outreach/immigration-resettlement.php Nilsson, I., & Townsend, E. (2010). Occupational justice-bridging theory and practice. Scandinavian Journal of Occupational Therapy, 17(1), 57-63. Townsend, E., & Wilcock, A. A. (2004). Occupational justice and client-centred practice: A dialogue in progress. Canadian Journal of Occupational Therapy,71(2), 75-87. Whiteford, G. (2000). Occupational deprivation: Global challenge in the new millennium. The British Journal of Occupational Therapy, 63(5), 200-204.
