CanMops RAPS

when was CanMop created?

in 2022 by the Canadian Association of Occupational Therapists (CAOT)

what theoretical guidelines for did the CAOT publish?

the Canadian Model of Occupational Participation (CanMop), the Collaborative Relationship-Focused Occupational Therapy approach, and the Canadian Occupational Therapy Inter-Relational Practice Process Framework

what does CanMop aim to do?

to provide guidance to OT’s in their reflection, reasoning, and analysis about occupational participation

how does CanMop define occupational participation?

having access to, initiating, and sustaining valued occupations within meaningful relationships and contexts

when promoting occupational participation what else do OT’s consider?

occupational performance and occupational engagement

occupational performance

choosing, organizing, and performing meaningful occupations

occupational engagement

refers to performance in the moment

why is occupational participation important?

allows the OT to look beyond occupational performance; must be considered for both individuals and collectives (families, groups, communities, and populations)

what is the core of CanMop?

occupational participation

what are the two central considerations of CanMop?

1) meaning and purpose influenced by history and relationships

2)occupational possibilities shaped by context at the micro, meso, and macro levels

what does CanMop emphasize about meaning and purpose?

that meaning and purpose of occupational participation is specific to individuals and collectives; it should be understood from their perspectives rather than the OT’s

what encompasses meaning and purpose?

• relationships

• history

• stories

• hopes and dreams

• experiences

how should the OT understand purpose?

should be guided by the individuals or collectives perspective regarding their four basic needs of survival, safety, autonomy, relatedness, and competence

autonomy

occurs when a person feels their actions are consistent with their own values and community standards

relatedness

involves a sense of being connected with, supporting, and being supported by others

competence

occurs when a person feels they have been effective in occupations that are important to them

relationships and history

the context that shapes meaning and purpose

relationships

play a central role in shaping the meaning and purpose of occupational participation; often provide the fundamental purpose for engaging in occupation

how does CanMop explore history?

at the individual and collective level. at the individual level uses Life Course perspective and uses the community history approach at the collective level

principle one of Life Course perspective

lifelong development, which acknowledges that life unfolds over time and that past experiences influence the present

principle two of Life Course perspective

historical time and place, which emphasizes that people’s lives are shaped by the historical times and geographical contexts in which they live

principle three of Life Course perspective

timing in lives, which stresses that the impact of life events depends on when they occur in a person’s life, with earlier events affecting later experiences

principle four of Life Course perspective

linked lives, in which people are understood to exist within affecting later experiences

principle five of Life Course perspective

agency, whereby people are seen to be able to take action within the context of the opportunities and constraints afforded by their situation

community histories

can include historic experience of cohesion and thriving, as well as experiences of trauma, such as genocide, colonization, or forced displacement; patterns of relationships with governments and various adjacent communities; and changes over time within the community related to size, geographic location, demographics, health, well-being, values, and priorities

occupational possibilities

ways and types of doing that come to be viewed as ideal and possible with a specific socio-historical context, and that come to be promoted and made available within that context

what does the notion of occupational possibilities emphasize?

that context powerfully determines expectations, barriers, and affordances regarding occupational participation

how are OT’s experts in expanding occupational possibilities?

1) addressing unexamined assumptions about what certain people who have differences in body structures and functions and social identities can and should do

2) collaboratively identifying and supporting needed changes to contexts at the micro, meso, and macro levels

characteristics to consider occupational possibilities at the individual level

their physical, affective, and cognitive structures and function, as well as their values, beliefs, sense of spirituality, and social identities

characteristics to consider occupational possibilities at the collective level

the values, beliefs, and inter-relationships of families and communities, their shared histories, and the resources they have available to them and how they use those resources

micro context

includes people’s direct interactions such as those with family members, friends, teachers, and peers from school, co-workers, and providers of health and social services, as well as direct interactions with the physical environment

community micro context also includes…

the interactions that members have with one another

meso context

the level of social systems, including organizations and their respective programs and neighborhood and community infrastructure systems such as the built environment

how is occupational participation affected at the meso level?

by factors largely beyond the individual’s control

macro context

the broader socioeconomic and political context and includes social and cultural values and beliefs that are reinforced by policy and legislation

macro and meso context relation

the macro context regulates the meso context by determining what is allowed or prevented and what is funded

hoiw does the macro context influence OT?

influences OT’s work and the occupational possibilities of clients by creating a framework that designates what will be developed and provided by both public services and private enterprises

How do these three levels of context affect the possibilities for occupational participation?

by promoting or limiting possibilities for accessing, initiating, and sustaining occupation

access

OTs can promote occupational participation by improving access to occupations at community and population levels. involves addressing barriers at the meso and macro levels.

types of interventions to improve access

ask people about the barriers they have experienced, advocate with municipal bodies, and intervene to reduce stigma, discrimination, and oppression in private and public spaces

initiate

occupational participation often requires the initiation or reinitiation of valued occupation. factors that impede can be concrete or abstract.

concrete challenges to initiation

can relate to cost, time, insufficient skill or confidence, and limited public services such as transport

abstract challenge to inititation

social attitudes that reduce acceptance of new people

sustain

people need to be able to sustain occupational performance over time. factors that influence the ability to sustain occur at the micro, meso, and macro levels and can be implicit or explicit.

example of a sustain challenge

a child is unable to sustain participation in sport because the coach is unable to accommodate the child's needs (micro)

the coach has a lack of training on facilitating participation with disabled children (meso)

limited policies and funding to support training for the coach (macro)

what is the purpose of the Collaborative Relationship-Focused Occupational Therapy

to broaden the focus on client-centeredness to relationships developed with people and collectives

relational context

includes diversity in the relationships forged between individuals and collectives and their physical, social, cultural, historical, and financial environments.

also includes interpersonal and systemic biases and discrimination that oppress individuals and communities and how OT’s may be complicit in such discrimination

what is the core of this approach?

collaborative relationship-focused OT

what are the four key relational characteristics of this approach?

• contextually relevant relationships

• nuanced relationships

• strives for safety in therapeutic relationships

• promotes rights-based self-determination

contextually relevant relationships

emphasizes that the relationships developed between OT’s and the people they work with need to be founded on mutual respect and an appreciation that worldviews, values, and beliefs are varied among people

what is imperative for OT’s so they can develop contextually relevant relationships

they must understand their own biases and stereotypical assumptions, and also need to recognize that the structures in which they work influence what they do and are historically shaped

cultural humility

life-long critical reflexivity by healthcare providers regarding social positioning, bias, and structural sources of privilege and oppression

nuanced relationships

therapeutic relationships need to be contextually nuanced, OT’s need to be able to respond to the needs of the people they are working with from those people’s own perspectives. they must not impose their own therapy priorities on the relationships

temporally nuanced therapeutic relationships

relationships take time to build and depending on the context OT’s can have a long period of time to build relationships or may have to build them quickly

strives for safety in therapeutic relationships

OT’s need to ensure they create relationships in which client’s feel safe including physical, emotional, spiritual, and cultural safety. OT’s must minimize risk and prevent physical harm

emotional safety

requires trust and respect for people’s cultural and spiritual beliefs and practices

culturally safe care

involves therapist’s consideration, analysis, and reduction of systemic power imbalances, discrimination, and colonization. OT’s have a duty to address these systemic issues that create barriers to safe OT practices.

promotes rights-based self determination

a relationship that acknowledges people’s entitlement to make decisions that affect their lives and their communities. involves acknowledging individuals and communities capacities and strengths, listening to, acknowledging, and understanding their world views, values, and priorities and engaging them in a shared-decision making process that provides information required for making informed choices

two values of the Collaborative Relationship-Focused Occupational Therapy approach

1) places the people OT’s work with at the center of the approach

2) OT’s aspirations of achieving equity and justice are embedded throughout the approach

component one of structural competency

developing an awareness of how society’s structures contribute to the health, behaviors, choices, and occupational possibilities of people

component two of structural competency

understanding how OT’s clinical actions and decisions are shaped by their social positions and other economic and sociopolitical forces

component three of structural competency

remembering that the societal structures that create and reinforce inequities should be conflated with the notion of culture

component four of structural competency

using interventions such as advocacy to address structural violence

what is the aim of the Canadian Occupational Therapy Inter-Relational Practice Process (COTIPP) Framework>

to outline an OT practice that is collaborative, inter-relational, and rights based

what does COTIPP recognize?

international and national human rights conventions and declarations particularly those advocating for vulnerable groups such as children, Indigenous people, and people with disabilities

what is the center of COTIPP?

the essential underlying process to build and sustain relationships

what are the three-foundational processes of COTIPP?

• seek understanding about context

• reflect, critically reflect, and reason

• use justice, equity, and rights-based lens

what are the six action domains of COTIPP?

1) connect

2) seek understanding and define purpose

3) explore occupational participation

4) co-design priorities, goals, outcomes and plans

5) trial the plan, explore change, and refine the plan

6) plan for transition

assumption one of COTIPP

occupational therapy is different in every context

assumption two of COTIPP

OT often (but not always) has a defined beginning and end

assumption three of COTIPP

OT is most often an iterative process that is responsive to context and relationships (but can follow a step-by-step process if that is most appropriate)

seek understanding about context

COTIPPS conceptualizes contexts in which people live and participate as mutually influencing

context in COTIPP

understood broadly and includes "history geographic location, the natural and built environment, social and economic 1aws, legislation and policies, organizational policies and rules, social and cultural norms and expectations, social identities, secular and religious beliefs, prevailing societal attitudes and behaviors, networks, and power relations within and among collectives

what aspects of context does COTIPP attend to

the therapist context, the practice context, and the individual’s and collective context

reflect, critically reflect, and reason

includes reflection-in-action (conscious in the moment reflection) & reflection-on-action (reflection after the action has taken place)

occupational consciousness

the everyday actions people use to resist and challenge dominant practices that sustain unequal power relations

the justice-,equity-, and rights-based lens

The imperative for OT’s to uphold the rights of people to justice and equal access to occupational participation. OT’s have a moral and ethical responsibility to promote equity and justice and preserve the rights of the people with whom they work.

1st action domain: Connect (COTIPP)

the OT’s first meeting with individuals and collectives

2nd action domain: Seek understanding and define purpose (COTIPP)

characterized by deep listening to the individual’s and collective’s concerns, priorities, goals, beliefs, dreams, and aspirations regarding occupational participation

3rd action domain: Explore occupational participation (COTIPP)

conditions for exploring occupational participation are co-created by therapists and the individuals/collectives with whom they are working

4th action domain: co-design priorities, goals, outcomes, and plans (COTIPP)

OT’s must understand their clients’ concerns and aspirations as well as work with them to understand their priorities for occupational participation and jointly identify goals and outcomes

5th action domain: trial the plan, explore change, and refine the plan (COTIPP)

bringing the plan to life, trialing the action that has been planned with assistance from the client to determine it’s effect on occupational participation

6th action domain: plan for transition (COTIPP)

transitioning from OT services

which part is the model?

CanMop

what part is the approach

Collaborative Relationship-Focused Occupational Therapy

what is the framework?

COTIPP