Historical and Philosophical Perspectives of Community and Population Health Practice

What are some of the benefits of community and population health practice?

• expands OT practice

• enhances understanding of OT

• Increases recognition of OT

• Influences health and social policy

• Provides opportunity for new leadership roles

Examples in history of community-based practice:

• Prevention of tuberculosis and blindness (kids of parents with TB were essentially “orphaned”

• Consolation House (1914) opened in NY by George Barton (engage people in meaningful activities)

• Hull House (1915) opened in Chicago by Jane Adams and Eleanor Clark Slagle for immigrants

• WW2: military personnel with shell shock

• Well Elderly Study of 1997 (preventative treatment program for older community dwelling adults)

What is a Paradigm and a Paradigm shift?

• Paradigm: conceptual framework that allows the explanation and investigation of phenomena

• Paradigm shift: when a discipline abandons one view of the world for another, undergoing a revolution/radical conceptual restructuring

Paradigm shifts in OT

• Pre-paradigm 18th-19th century: Moral Treatment (do away with insane asylums)

• Paradigm 1940s-1950s: Occupation (hung our hats in occupation)

• Crisis- medicine: Medical Model Paradigm (highly biomechanical)

• Crisis- identity: Community Practice (wait, what about mental health?)

Differences between medical model and community model:

Medical model:

• profressional is responsible, has the power, makes decisions, and is the “expert”

• planning is fragmented

• culture is denied

• so many referrals, you’re just a #

• professionals answer to the agency

Community model:

• community member is responsible, has power, makes decisions and is the “expert”

• professionals answers to the consumer

• planning is coordinated

• culture is appreciated

What is the community and population health paradigm?

• client-centered

• occupation-based

• supported with evidence

• based on dynamic systems theory

• ecologically sound

• strengths-based

What is health?

• health is not simply access to medical care (just cause you have a doctor doesn’t mean you’re healthy)

• health and well-being are dependent upon where we live, our social connections, our occupations, and our communities

What is a community?

a specific group of people, often living in the same geographical area, who share a common culture, value, and norms, are arranged in a social structure according to relationships, which the community has developed over a period of time

What is community-based practice?

health-related services like prevention and health promotion, acute and chronic medical care, habilitation and rehabilitation, and direct and indirect service provision

What is a population?

a mix of people who may or may not know each other but share at least one common characteristic such as age, race, ethnicity, gender, health habit, or condition, geographic location, cultural identity, socioeconomic status, or education level

What is population health?

the health outcome of a group of individuals, including the distribution of such outcomes within the group

• collaborative, interdisciplinary approach that includes advocacy; program development, implementation, and evaluation

Example of community practice areas:

• adult day program

• low vision program (easter seals)

• driving program

• fall prevention program

• wellness program

• lifestyle redesign

Roles for OT in communities:

• community health advocate

• case manager

• primary care provider

• program manager

• entrepreneur

• consultant

Characteristics of effective community-based OTP:

• Standards for continuing competence (AOTA)

  • ethical reasoning, performance skills and proficiencies, interpersonal abilities to establish effective relationships, critical reasoning for decision-making, knowledge for multiple roles

• Attributes and skills

  • comfort with indirect service provision

  • grant-writing skills

  • networking skills

  • organizational skills

  • professoinal autonomy

  • program- planning and evaluation skills

  • public relations skills

Language is different in community setting:

• client rather than patient

• intervention rather than treatment

• funding rather than reimbursement

Broaden your perspective:

• move beyond individual client to the community and or population

• your role may be community agency rather than patient population

• base your approach on dynamic systems theory

• appreciation for culture and diversity will enhance service delivery

Moving OT forward:

• gain knowledge about community organizations and institutions and how they operate

• understand unique services and what they offer and how to communicate these services clearly

• develop strategies to translate knowledge into actual programs that are responsive to community needs

• take risks when faced with challenges in unfamiliar environments

• communicate with nonmedical personnel and avoid the use of professional jargon