systems & policy

Systems & Policy Overview

• Course: OCCU 5003 - Dimensions of Professional Practice

• Institution: DALHOUSIE UNIVERSITY

Outline

• Focus areas include:

  • Current key issues in health care in Canada

  • Locating Occupational Therapy (OT)

  • Engaging with policy

Competencies of OTs in Canada

• Strengths and Barriers: Ability to assess systems in health care affecting participation.

• Determinants of Health: Address social, structural, political, ecological factors.

• Power Dynamics: Work to alleviate unequal distribution of resources affecting OT services.

• System Navigation: Assist clients in overcoming systemic barriers.

• Data Awareness: Recognize limitations and biases within systems.

• Environmental Awareness: Stay informed regarding impacts of socio-economic factors on practice.

• Cost Consideration: Evaluate the costs associated with care at social, economic, and ecological levels.

• Ethical Practices: Adhere to organizational policies while aligning with professional standards and client values.

Canada Health Act

• Policy Objective: Aimed at ensuring that all Canadians can access health services without financial or other barriers while promoting physical and mental well-being (Canada Health Act, 1984: s.3).

Key Issues in Canada’s Health Care System

• Ongoing Injustices: Persistent systemic inequities.

• Demographics: Changing population dynamics with aging citizens.

• Service Fragmentation: Siloed health services leading to inefficiencies.

• Cost and Access: Rising healthcare costs, potential for privatization, and issues surrounding access to services.

• Quality of Care: Challenges in maintaining optimal care standards.

• Human Resources Integration: Resistance to restructuring human resource allocation in health care.

OT’s Role in the Canada Health Act

• OT practices are aligned with the objectives of promoting well-being while ensuring access to health services without financial barriers.

Health Care Spending Categories (Rogers et al, 2017)

• Breakdown includes:

  • Accommodations

  • Laboratory services

  • Pharmacy expenditures

  • Medical/surgical supplies

  • Specialized services (Cardiology, Radiology, Inhalation therapy)

  • Emergency and operating room services

  • Therapy and outpatient services

  • Occupational therapy and ancillary services (e.g., speech pathology, dialysis)

Findings on Occupational Therapy (Rogers et al, 2017)

• Increased OT spending is linked to lower readmission rates for conditions like heart disease and pneumonia.

• OT prioritizes addressing patients' functional and social needs, essential for reducing readmissions.

Social Determinants of Health (CPHA)

• Key factors influencing health outcomes include:

  • Income & income distribution

  • Education

  • Employment conditions

  • Early childhood development

  • Food insecurity

  • Housing and social networks

  • Access to health services

  • Cultural factors (Aboriginal status, gender, race, disability)

Social Determinants of Mental Health (WHO, 2014)

• Life Course Factors: Impacts across various life stages, shaped by gender and socioeconomic status.

• Family Context: Effects of parenting, material conditions, and support systems.

• Community Influence: Neighborhood conditions and participation impact mental health.

• Local Services: Availability and quality of early childhood education, health care, and support services.

• Nationwide Policies: Influence of human rights and governance on service access and social protections.

Health Determinants for Indigenous Communities (Greenwood et al, 2022)

• Colonial Impact: Effects of colonialism on economic and social inequities.

• Health Determinants: Self-determination, traditional practices, and environmental issues affecting health outcomes.

• Community Health Initiatives: Focus on cultural reclamation, vaccine trust, and disability rights.

Health Access Outside Formal Systems

• Most individuals engage with health and wellness beyond traditional health care systems.

• Many services are accessible only upon demonstration of illness or disability; health care access is a mere part of health determinants.

OT Presence Beyond Traditional Care

• Growing roles of OTs include:

  • Community health organizations (e.g., Tajikeimɨk for Mi’kmaw communities)

  • Supported housing initiatives (e.g., YWCA WISH program)

  • Specialized services (e.g., CNIB, CSC)

  • Corporate wellness programs and immigrant service organizations.

Future of OT Under Canada Health Act

• Continued alignment with Canada Health Act's objective of promoting well-being and ensuring access to services.

Policy’s Impact on Practice (Lencucha & Shikako-Thomas, 2019)

• Interaction between public and organizational policies creates tensions:

  • Colonial vs. Professional Values: Navigating differences in ethical frameworks.

  • Organizational vs. Client Values: Balancing institutional policies with client needs.

• Importance of evidence-informed practice and clinical reasoning in policy shaping.

Examples of System Navigation

• Mental Health in Incarceration: Addressing long-term incarceration impacts through organizational advocacy and targeted program design.

• Engaging Clients: Collaborative perspectives in program and business planning.

Understanding System Dynamics

• Policy Conflicts: How correctional policies overshadow mental health directives, affecting care.

• Ongoing negotiations among stakeholders reveal complexities in policy implementation and resource allocation, impacting service delivery.

Next Class Overview

• Upcoming Topic: Structural Competence & Cultural Humility

• Institution: DALHOUSIE UNIVERSITY