Collaboration within a curriculum of support in the classroom: occupational therapists' and educators' perceptions and experiences

Introduction: According to South Africa's key education policies, all children can learn and need support, necessitating collaboration between occupational therapists and educators. Collaboration between occupational therapists and educators within the classroom is however a relatively new practice in South Africa and there is a dearth of literature that report on studies in this regard. The aim of this study was thus to explore occupational therapists' and educators' experiences in adopting a classroom approach in three primary mainstream schools in the Metro North education district in the Western Cape. Methodology: A qualitative research approach andexploratory descriptive design was utilised. Data collection included semi-structured interviews and focus groups with educators and occupational therapists who participated in the curriculum of support in the classroom programme. Thematic data analysis was conducted. Findings: Three themes highlighting the meaning and value the participants assigned to classroom collaboration, andfactors that facilitate or limit the implementation of the curriculum of support emerged from the analysis. Conclusion: The study is useful in expanding the understanding of the changing role of occupational therapists within the context of inclusive education and contributes to the development of educator support strategies utilising the whole classroom approach. This approach entails the educator and occupational therapist working together in implementing activities in the classroom to all learners. These learning activities are based on curriculum themes and occupational therapy principles and components. IMPLICATIONS FOR PRACTICE Occupational therapists' roles in the education practice context are expanding from traditionally working in special school settings to providing support to educators within public mainstream schools. The role of the occupational therapist within public mainstream schools is evolving from a consultative role and providing input into the individual support of learners to providing hands-on support to educators and collaborating with them within the classroom

Occupational therapy graduates’ conceptualisations of occupational justice in community service practice in South Africa: a uwc case study

Philosophiae Doctor - PhDThe purpose of this qualitative study was to identify ways in which the University of the Western Cape (UWC) occupational therapy (OT) curriculum could be developed to prepare its graduates to advance occupational justice in community service practice. The background to the study is the development of occupational therapy practice and education within a policy context of health reform that gave momentum to the shift in emphasis from a bio-medical to a more socio-political approach to health in South Africa. Underpinning this study was the assumption that OT education informs professional practice and that uncovering new graduates’ practice experiences can inform the development of the UWC OT curriculum. The aim of the studyn was to examine how UWC OT graduates conceptualised occupational justice and how it manifested in their daily practice of community service in three provinces in South Africa. The study is framed within the theories of occupational justice and critical curriculum theory, in particular, critical pedagogy. A literature review pertaining to the application of occupational justice in OT practice and education is presented. This includes the background values that inform the practice of occupational justice, the application of occupational justice as it relates to OT practice and the relationship between OT education and occupational justice. The research design that was adopted is that of a single, interpretive case study. Through purposive sampling seven occupational therapy graduates from UWC who graduated in 2009, and who practiced in under-resourced, rural community service settings in 2010, were selected to participate in the study. The methods of data collection that were utilised were participant observation, a reflective journal, semi-structured paired or dyadic interviews and document review. The findings revealed that occupational justice held considerable value for the participants. They conceptualised occupational justice as enhanced health and well-being, and broader social change as an outcome of the facilitation of occupational enablement. The nature of their community service practice settings, however, posed several challenges for the participants. From the perspective of the participants, the dominance of the medical model, lack of resources and system of bureaucracy appeared to be the biggest challenges they encountered. While the participants’ education was geared towards equipping them to provide appropriate services as indicated by local needs, the health system was not ready tob accommodate their practice. Consequently, the participants appeared to encounter hegemony in practice. In encountering hegemony, however, they displayed an attitude of defeatism, leaving them with feelings of guilt, despondency and powerlessness. They lacked the skills to respond to power dynamics and to interact with people in positions of power. The main conclusion drawn from the study findings is that for OT graduates to impact the contexts in which they practice in South Africa, OT education must ensure that students develop competence to deal with the complexities of community service practice. This implies that transformational learning as pedagogical practice is of the essence, as it frames student preparation not just as learning but as a process of critical reflexivity that equips them to respond to power dynamics and intervene in matters related to occupational justice as active agents of change. The role and practice of occupational justice are subjects of debate in the context of OT education as they are for the profession broadly. This study contributed to this conversation through its examination of UWC OT graduates’ actual practice and the transmission of occupational justice-promoting practice through UWC OT education. The study highlighted that it is imperative that OT curricula in South Africa provide opportunities for students to engage in critical reflection on ways in which indigenous knowledge and a local understanding of occupational justice, as it relates to collective agency and critical consciousness, can be made more explicit in everyday practices. To this end, recommendations for the development of the UWC OT curriculum are made in respect of curriculum structure, content and approach; interdisciplinary education and practice, support for community service graduates and occupational therapy continued professional development

Curriculum transformation: a proposed route to reflect a political consciousness in occupational therapy education

Introduction: Curriculum review is an ongoing, dynamic, long-term process that forms part of occupational therapy education. The Department of Occupational Therapy, University of the Western Cape (UWC) recently responded to the challenge of becoming socially responsive and politically relevant by engaging in curriculum review. The review revealed that political reasoning was not clearly delineated previously in the curriculum. In response to this problem, over a period of several years we engaged in a process of curriculum transformation so that students become politically conscious. Methods: The process entailed environmental scanning, feedback from teaching staff and clinicians, students’ evaluations, regular curriculum revision meetings, academic development meetings, workshops and seminars. A qualitative study using a cooperative enquiry approach was conducted to analyse the data. Findings: From the analysis the following themes emerged: (1) identifying the essence of occupational therapy education at UWC, (2) understanding political practice on a theoretical and then a personal level, (3) integrating and operationalising political consciousness into the curriculum. We discuss the debates and critical questions raised in our efforts to develop a curriculum that prepares graduates to be politically conscious and socially responsive. Finally, we present key strategies for the way forward. Conclusion: Curriculum transformation around a political practice of occupational therapy does not merely mean just a change in curriculum content, but requires the internalisation of a political consciousness by educators individually and collectively.Department of HE and Training approved lis

Occupation-based practice in a tertiary hospital setting: occupational therapists’ perceptions and experiences

Occupation-based practice is an important feature of occupational therapy. There is however limited research regarding occupational therapists’ experiences with occupation-based practice. This study aimed to explore occupational therapists’ perceptions and experiences regarding occupation-based practice in a tertiary hospital setting in the Western Cape, South Africa. An explorative and descriptive research design within a qualitative research approach was utilised. Purposive sampling allowed the selection of four participants with a minimum of 2 years practice experience. Semi-structured interviews were conducted to gain an understanding of how they perceived and implemented occupation-based practice. Data were analysed using thematic analysis. Four themes emerged: occupation-based practice expresses professional identity; occupation-based practice necessitates relevance; constraints to occupation-based practice; and facilitators of occupation-based practice. The findings revealed that the participants’ perceived the implementation of occupation-based practice as an expression of their professional identity and that in adopting an occupation-based approach they perceived their roles as being diverse and transformational. It was however highlighted that the nature of the service context posed several constraints that influenced the implementation of occupation-based practice. Thus, occupational therapists may need to generate practice-based evidence to advocate for the service conditions necessary to implement occupation-based practice and deliver relevant occupational therapy services.DHE

Understandings and practices: Towards socially responsive curricula for the health professions

Global health inequities have created an urgency for health professions education to transition towards responsive and contextually relevant curricula. Such transformation and renewal processes hold significant implications for those educators responsible for implementing the curriculum. Currently little is known about how health professions educators across disciplines understand a responsive curriculum and how this understanding might influence their practice. We looked at curricula that aim to deliver future health care professionals who are not only clinically competent but also critically conscious of the contexts in which they serve and the health care systems within which they practice

Exploring occupational therapy graduates’ conceptualisations of occupational justice in practice: Curriculum implications

BACKGROUND. The concept of occupational justice was derived from a social justice perspective in response to a renewed commitment by the occupational therapy profession to address the occupational needs of individuals, groups and communities who experience social injustice. Accordingly, it is acknowledged that education with regard to occupational justice has the deliberate intention of preparing graduates, who would be change agents as critical practitioners. Nonetheless, while occupational therapy education programmes may seek to instil broader professional values, theory covered in the curriculum may not always assure congruent practice. OBJECTIVE. To explore how occupational therapy graduates’ conceptualisations of occupational justice, as instilled by the occupational therapy curriculum of the University of the Western Cape, South Africa, manifested in their practice while undergoing community service. METHODS. Seven occupational therapy graduates were selected to participate in the study through purposive sampling. A descriptive case study of their practice was generated through qualitative methods. Semi-structured interviews, document review and participant observation were used as data collection methods, analysed through a process of inductive thematic analysis. RESULTS. The findings revealed that while the participants conceptualised occupational justice as broader social change through occupational enablement, they encountered several constraints related to structural and systemic power issues in their practice contexts. CONCLUSION. The study supports the utilisation of transformative learning and inter-professional education in developing critical competencies such as agency and political proficiency to assist graduates in dealing with the complexities of practice during community service.DHE

A situational mapping overview of training programmes for community-based rehabilitation workers in Southern Africa: strategies for strengthening accessible rural rehabilitation practice

In 2018, the United Nations global report showed that people with disabilities, who make up 15% of the worlds’ population, have poorer health and rehabilitation access (SDG 3). Without improving the needed person-centered health and rehabilitation services at household level, SDG 3 cannot be achieved. This includes addressing human resource shortages through training multi-skilled community based rehabilitation workers (CRWs) to build rural workforce capacity and enhance the lives of people with disabilities, particularly in LMICs where the need is higher but resources are lower. However, to date, there is no documentation and analysis of existing training and its scope for this workforce in LMICs. A situational mapping overview was undertaken to review the current status of rural rehabilitation training programs offered in Southern Africa for CRWs. CRWs are rehabilitation personnel, based in the home/community, who are not professionals (without a bachelor qualification) but render non-institutional rehabilitation and inclusive development in communities, under the supervision of rehabilitation practitioners. Information on these programs was obtained using a two-step process. Firstly, a descriptive list of university courses for rehabilitation workers offered in the Southern African countries was collected via an internet and literature search. Secondly, detailed information about the disability and rural rehabilitation courses was collected from the respective institutions and their designated websites. There are six training courses targeted at CRWs or disability practitioners with a disability focus being offered at universities in Southern Africa, five of these in South Africa and one in Zimbabwe. Additionally, four training courses are offered as online/open resources by global organizations and are self-directed with no accreditation. While other key competencies feature, none of these programmes’ learning outcomes make direct reference to the rural practice context and its complexities in relation to disability and poverty. The situational mapping overview shows limited training targeted at CRWs in Southern Africa, to effectively facilitate rural rehabilitation, poverty reduction and social inclusion. There is a need for an articulated community-orientated rural training to respond to the unmet needs. This may require a different set of competencies and assessment standards for trainees as well as additional competencies for their supervisors and mentors

Academics’ knowledge and experiences of interprofessional education and practice

BACKGROUND. Interprofessional education (IPE) can be seen as the vehicle to address the health and social problems of society through collaborative approaches. Since IPE should be facilitated by educators who are skilled in this area, faculty development initiatives should be based on the principles of IPE and collaborative practice (IPECP). OBJECTIVE. To explore academics’ knowledge and experiences of IPECP. METHODS. The study used an exploratory descriptive design and the appreciative inquiry framework underpinned data gathering and analysis. The data were collected using workshops, and the participants of the workshops shared their knowledge and experiences of IPECP, which were audio-recorded and analysed using thematic analysis. Ethical clearance was obtained from the University of the Western Cape, Cape Town, South Africa. RESULTS. The analysis revealed three themes: knowledge of IPE; experiences of IPECP; and enablers of IPECP aligned to the dream and discovery phases of appreciative inquiry. The findings revealed that academics were knowledgeable about the concept of IPE and that their experiences with IPECP ranged from clinical supervision to research. Regarding enablers of IPECP, they provided important input, which could facilitate IPECP in a university faculty. These included competencies for IPECP, professional development and a common practice framework. CONCLUSION. The academics who attended the faculty development workshops were knowledgeable about the concepts of IPECP. They concluded that for IPE to be effective, a common practice framework should be adopted in the faculty to inform specific teaching and learning strategies and outcomes.DHE