structural competency

Page 1: Introduction to Structural Competence

• Course Title: Structural Competence OCCU 5003: Dimensions of Professional Practice

• Institution: Dalhousie University

Page 2: Course Outline

• Main Topics:

  • Structural Competence

  • Social Determinants of Health

  • Core Competencies

  • TRC Calls to Action

  • Implications for Practice© Crystal Dieleman 2024

Page 3: Culture, Equity & Justice (COTC C1)

• Objective: Promote equity in practice

• Key Strategies:

  • Identify ongoing effects of colonization on Indigenous Peoples' occupational opportunities.

  • Analyze systemic and historical factors affecting occupational possibilities.

  • Challenge societal biases and structures that marginalize communities.

  • Address social determinants of health that affect well-being and occupational opportunities.

  • Reduce effects of unequal power distribution on occupational therapy services.

  • Support factors that foster health and well-being. © Crystal Dieleman 2024

Page 4: Culture, Equity & Justice (COTC C2)

• Objective: Promote anti-oppressive behaviour and inclusive relationships

• Key Strategies:

  • Cultivate a culturally safer and anti-racist practice environment.

  • Practice self-awareness to mitigate personal biases.

  • Engage with respect and humility, integrating clients' health understandings into service plans.

  • Pursue resources for culturally safer approaches.

  • Collaborate with local interpreters and community leaders. © Crystal Dieleman 2024

Page 5: Culture, Equity & Justice (COTC C3)

• Objective: Contribute to equitable access in occupational therapy

• Key Strategies:

  • Enhance clients' awareness of their rights to occupational participation.

  • Facilitate client participation in health-promoting occupations.

  • Assist clients with accessing support networks and resources.

  • Navigate systemic barriers to enhance client support.

  • Engage in critical dialogue on social injustices affecting occupational opportunities.

  • Advocate for sustainable environments and policies.

  • Be aware of data biases in occupational therapy practice. © Crystal Dieleman 2024

Page 6: Cultural vs. Structural Competency

• Cultural Competency: Focus on clinician bias and communication during clinical interactions.

• Structural Competency: Recognizes the socio-political conditions that underpin health inequalities.

  • Calls for understanding how institutions shape healthcare experiences and advocating for systemic change. © Crystal Dieleman 2024

Page 7: Definition of Structural Competence

• Concept: The ability to see how clinical symptoms reflect broader social decisions and structures.

  • Focus: Understanding how institutional structures produce health inequities.

  • Goal: To address the social determinants of health through active engagement and advocacy. © Crystal Dieleman 2024

Page 8: Five Core Competencies of Structural Competence

1. Recognizing Structures: Awareness of factors influencing clinical interactions.

2. Extra-clinical Language: Ability to relate clinical presentations to social and institutional contexts.

3. Cultural Re-articulation: Framing clinical issues through cultural and structural lenses to acknowledge disparities.

4. Structural Interventions: Identifying and influencing decisions for structural change.

5. Structural Humility: Recognizing personal limits and valuing clients' lived experiences. © Crystal Dieleman 2024

Page 9: Engaging with TRC Calls to Action

• Quote: Importance of critical engagement with occupational theories in relation to Indigenous health inequities.

  • Reflection: Occupational therapists must be aware of their values and the societal structures that sustain inequities. © Crystal Dieleman 2024

Page 10: Interpersonal and Systemic Racism

• Issues: Myths of accessible services (healthcare, housing) versus reality of inequities.

  • Anticipation of racism by Indigenous people in healthcare settings.

  • Concept of racial fatigue: Stress from continual discrimination leading to mental and physical exhaustion. © Crystal Dieleman 2024

Page 11: Implications for Practice

• Advocation: Responsibility to address systemic issues affecting health outcomes.

• Shift in Perspective: From individual client blame to societal accountability for inequities.

• Critical Inquiry: Questions to consider regarding structural influences on health and clinical interactions. © Crystal Dieleman 2024

Page 12: Examples of Structural Issues

• Service Access: Centralization of services in urban areas limits access for rural populations.

• Primary Care Limitations: Insufficient mental health resources in rural communities.

• Myths of Free Services: Perpetuation of stereotypes affecting minorities. © Crystal Dieleman 2024

Page 13: Case Scenario 1

• Situation: A client with hemiplegia can’t be supported at a local nursing station due to resource shortcomings.

  • Care Recommendations: Discussion on the disconnect between urban and rural service provision. © Crystal Dieleman 2024

Page 14: Case Scenario 2

• Situation: Cultural discomfort faced by an Indigenous client in an inpatient rehabilitation setting.

  • Reflection on Practice: Need for sensitivity and respect in clinical observations and assessments. © Crystal Dieleman 2024

Page 15: References

• A compilation of literature related to truth and reconciliation and structural competency in occupational therapy. © Crystal Dieleman 2024

Page 16: Upcoming Class

• Next Topic: Advocacy in occupational therapy practices at Dalhousie University. © Crystal Dieleman 2024