Beyond inclusion: collective social spaces of safety, communion, and recognition

This paper unsettles taken-for-granted understandings of social inclusion in the field of occupational therapy and links with the concept of radical inclusion developed in social occupational therapy. It traces the ways that, over time, inclusion has been reduced to a position within the inclusion/exclusion binary. Pierre Bourdieu’s reflexive theory of practice is introduced to expand understandings of how the negative value accorded to disability is reproduced through exclusionary social conditions and relations. Drawing on the results of a qualitative study that examined the everyday lives, practices and occupations of 13 Canadian youth who used augmentative and alternative communication (AAC) modes as a result of physical impairments, three elements of more inclusive social spaces – safety, communion, and recognition – are presented alongside implications of each for occupational therapy. These alternative approaches for thinking beyond inclusion are grounded by narratives illustrating elements of social spaces that can foster a sense of belonging and connection. The perspectives shared by youth in the study add complex insights into how they made ‘practical sense’ of prevailing calls for social inclusion. Their stories show how even as they struggled for inclusion, they were subject to and internalized negative valuations of disability. Importantly, the paper highlights strategies employed by youth to reformulate inclusion on their own terms. These reformulations go beyond over-simplified conceptions of inclusion and hold potential to inform the ways that occupational therapists work alongside individuals and collectives to improve life chances, expand occupational possibilities, and support flourishing for disabled children and youth

Working the Limits of “Giving Voice” to Children: A Critical Conceptual Review

Although claims to “give voice” to children through qualitative inquiry seem morally just and have been largely framed by good intentions, critical scholarship has called for reflexive reconsiderations of such claims. Re/presentations of voice permeate published accounts of qualitative research with children; similarly, voice is a term invoked frequently in qualitative research with informants of all ages. In this article, we follow Spyrou’s notion of “troubling” to review, critique, and synthesize key works by critical child-focused scholars who have reflexively queried and worked with the epistemological and methodological limits of “giving voice” to children through qualitative inquiry. Building on the reviewed literature, as well as poststructural approaches to framing voice in research more generally, we briefly discuss how we have built on these critiques in our own research. In so doing, we join ongoing dialogues aimed at generating alternative approaches to theorizing and re/presenting children’s perspectives in qualitative inquiry more justly

Problematizing ‘productive citizenship’ within rehabilitation services: insights from three studies

Background: The idea that everyone should strive to be a ‘productive citizen’ is a dominant societal discourse. However, critiques highlight that common definitions of productive citizenship focus on forms of participation and contribution that many people experiencing disability find difficult or impossible to realize, resulting in marginalization. Since rehabilitation services strive for enablement, social participation, and inclusiveness, it is important to question whether these things are achieved within the realities of practice. Our aim was to do this by examining specific examples of how ‘productive citizenship’ appears in rehabilitation services. Methods: This article draws examples from three research studies in two countries to highlight instances in which narrow understandings of productive citizenship employed in rehabilitation services can have unintended marginalizing effects. Each example is presented as a vignette. Discussion: The vignettes help us reflect on marginalization at the level of individual, community and society that arises from narrow interpretations of ‘productive citizenship’ in rehabilitation services. They also provide clues as to how productive citizenship could be envisaged differently. We argue that rehabilitation services, because of their influence at critical junctures in peoples’ lives, could be an effective site of social change regarding how productive citizenship is understood in wider society.Implications for rehabilitation ‘Productive citizenship’, or the interpretation of which activities count as contributions to society, has a very restrictive definition within rehabilitation services. This restrictive definition is reflected in both policy and practices, and influences what counts as ‘legitimate’ rehabilitation and support, marginalizing options for a ‘good life’ that fall outside of it. Rehabilitation can be a site for social change; one way forward involves advocating for broader understandings of what counts as ‘productive citizenship’

Assembling activity/setting participation with disabled young people

Rehabilitation research investigating activity participation has been largely conducted in a realist tradition that under-theorises the relationship between persons, technologies, and socio-material places. In this Canadian study we used a post-critical approach to explore activity/setting participation with 19 young people aged 14 to 23 years with complex communication and/or mobility impairments. Methods included integrated photo-elicitation, interviews, and participant observations of community-based activities. We present our results using the conceptual lens of assemblages to surface how different combinations of bodies, social meanings, and technologies enabled or constrained particular activities. Assemblages were analysed in terms of how they organised what was possible and practical for participants and their families in different contexts. The results illuminate how young people negotiated activity needs and desires in particular ‘spacings’ each with its own material, temporal, and social constraints and affordances. The focus on assemblages provides a dynamic analysis of how dis/abilities are enacted in and across geotemporal spaces, and avoids a reductive focus on evaluating the accessibility of static environmental features. In doing so the study reveals possible ‘lines of flight’ for healthcare, rehabilitation, and social care practices

Mindfulness and therapeutic relationships: insights from a phenomenological study of occupational therapists' practices

Background A well-established body of literature highlights the importance of the therapeutic relationship when working with children and youth. A growing body of literature points to the potential of mindfulness to enhance the quality of relationships, including the therapeutic relationship. To date, little attention has been paid to this topic within the profession of occupational therapy. Aim The aim of this study was to inquire into paediatric occupational therapists’ experiences of mindfulness in the therapeutic relationship with children and youth.  Methods Heideggerian-informed hermeneutic phenomenology was employed as the methodological approach. Two key Heideggerian concepts of being-with and care served as theoretical underpinnings of the study. Semi-structured interviews were completed with eight North American occupational therapists to elicit their first-hand accounts of mindfulness in the therapeutic relationship with their paediatric clients. Interviews were transcribed verbatim and analyzed using a phenomenological approach. Results Four key themes were identified and include: fostering a safe space, enhancing presence, being authentic, and cultivating acceptance. Conclusions The findings offer insights regarding the potential affordances of mindfulness to support clinicians as they form of therapeutic relationships with children and youth. This study highlights research priorities for future inquiry.&nbsp

Critiquing representations of intellectual disability in occupation-based literature

Background: Within and beyond occupation-based scholarship, concerns abound regarding the pervasiveness of discourses that promote a negative, deficit-based view of intellectual disability and associated consequences for disabled people’s lives. Such representations risk reducing the complexities of human doing and being and can limit the occupational possibilities of this group. Yet, there is a lack of critically reflexive research exploring how disability is discursively constructed in occupation-based literature. Aims/Objectives: This paper critically analyses representations of intellectual disability within occupation-based literature. It considers the influence of such representations on the occupational possibilities of people labelled intellectually disabled. Methods: This review employed a critical interpretive synthesis of 21 peer-reviewed articles from occupational therapy and occupational science that focused on intellectual disability. Results: Three analytic threads were identified as contributing to how intellectual disability was represented across the reviewed literature: habilitating expected doings, becoming productive citizens, and activated, but insufficient. Conclusion & significance: Occupation-based discourses have powerful influence within society, particularly within occupational therapy, regarding understandings of intellectual disability and how these shape occupational possibilities for persons labelled intellectually disabled. Drawing attention to taken-for-granted representations of intellectual disability is essential to promote transformative occupational therapy practice and enhance occupational possibilities for this population

Expanding beyond individualism: Engaging critical perspectives on occupation.

BACKGROUND: Perspectives that individualize occupation are poorly aligned with socially responsive and transformative occupation-focused research, education, and practice. Their predominant use in occupational therapy risks the perpetuation, rather than resolution, of occupational inequities. AIM: In this paper, we problematize taken-for-granted individualistic analyses of occupation and illustrate how critical theoretical perspectives can reveal the ways in which structural factors beyond an individual\u27s immediate control and environment shape occupational possibilities and occupational engagement. METHOD: Using a critically reflexive approach, we draw on three distinct qualitative research studies to examine the potential of critical theorizing for expanding beyond a reliance on individualistic analyses and practices. RESULTS: Our studies highlight the importance of addressing the socio-historical and political contexts of occupation and demonstrate the contribution of critical perspectives to socially responsive occupational therapy. CONCLUSION AND SIGNIFICANCE: In expanding beyond individualistic analyses of occupation, critical perspectives advance research and practices towards addressing socio-political mediators of occupational engagement and equity

An integrated methods study of the experiences of youth with severe disabilities in leisure activity settings: The importance of belonging, fun, and control and choice

Purpose: The aim was to examine the leisure activity setting experiences of two groups of youth with severe disabilities-those with complex continuing care (CCC) needs and those who have little functional speech and communicate using augmentative and alternative communication (AAC). Method: Twelve youth took part in a mixed methods study, in which their experiences were ascertained using qualitative methods (observations, photo elicitation and interviews) and the measure of Self-Reported Experiences of Activity Settings (SEAS). Data integration occurred using a following a thread technique and case-by-case analysis. Results: The analysis revealed several highly valued aspects of leisure activity setting experiences for youth, including engagement with others, enjoying the moment, and control and choice in selection and participation in activity settings. Conclusions: The findings provide preliminary insights into the nature of optimal activity settings for youth with severe disabilities, and the mediators of these experiences. Compared to other youth, the data illustrate both the commonalities of experiences and differences in the ways in which these experiences are attained. Implications for research concern the utility of mixed methods approaches in understanding the complex nature of participation experiences. Implications for clinical practice concern the importance of not assuming the nature of youths\u27 experiences.Implications for RehabilitationService providers can lose sight of the importance of broader concepts of belonging, fun, and control and choice when providing interventions that focus on participating in an activity to build specific skills.In addition to the skill-based outcomes for youth with disabilities that are valued by the rehabilitation system, we suggest that consideration needs to be given to other types of outcomes that matter to youth, such as participating in a leisure activity for the sake of belonging or having fun.It is important not to assume that youth with severe disabilities are not enjoying their participation or are not benefiting from their leisure experiences.It is important not to over-therapize youth with disabilities and promote a balanced approach to therapy and leisure participation, by discussing with youth and families the beneficial developmental outcomes that can accrue from leisure activities

Interrogating Inclusion: Critical Research with Disabled Youth who use Augmentative and Alternative Communication

This dissertation provides a critical exploration of the notion of inclusion, applied to the ‘case’ of disabled youth who use augmentative and alternative communication (AAC). Oriented by Bourdieu’s theory of practice, this study examined the lives and practices of youth who use AAC to better understand how they make ‘practical sense’ of inclusion and locate their place in the world. The objective was to illuminate the extent to which the constraints of social arrangements and conditions delimited the social interactions of youth who use AAC and shaped their understandings of inclusion. Using a novel critical dialogical methodology developed for the study, data were generated with 13 Canadian youth who use AAC by combining participant-generated photographs and a graphic elicitation technique termed Belonging Circles with interviews and observations. The study results make three substantive contributions to existing research on disabled children’s lives and children’s rehabilitation. First, the participants’ narratives reflected habitus - socially constituted sets of dispositions - that predisposed them to accommodate the devalued social positions and constricted conditions of existence imposed on them. From the points of view made possible to them, the youths’ practices represent logical and practical strategies for claiming inclusion that, paradoxically, reproduce and resist the systems of categorization that constrain them. Second, by illuminating the life circumstances and delimited life trajectories of youth in the study, the research vividly demonstrates that some forms of ‘inclusion’ perpetuate symbolic violence by keeping disabled youth ‘in their place’ through the oppressive effects of misrecognised social norms, beliefs and values that privilege ‘normal’ bodies. All study participants claimed inclusion but under constricted conditions of possibility that were not of their choosing. Finally, while the youths’ practices primarily reproduced the status quo, they also worked at the margins to curate locally produced forms of inclusion that attempted to transform the ‘rules of the game’. These results make visible the mechanisms involved in reproducing significant social inequities which constrain youth who use AAC. The research suggests a need for systemic shifts past reified notions of inclusion toward fostering social spaces where alternative ways of being in the world are positively valued.Ph.D

Integrating Visual Methods With Dialogical Interviews in Research With Youth Who Use Augmentative and Alternative Communication

Scant information is available to guide the selection and modification of methods for doing research with people with communication impairments. In this article, we describe and illustrate a novel combination of methods used to optimize data generation in research with 13 disabled youth who use augmentative and alternative communication (AAC). Using a critical dialogical methodology developed for the study, we explored links between dominant calls for social inclusion, disabled youths’ social relations and life circumstances, and their position-takings in relation to inclusion. Building on emergent methodologies, we selected and integrated complementary methods: photo-elicitation, a graphic elicitation method termed “Belonging Circles,” observations, and interviews. The interview methods were modified to recognize all AAC modes used by participants and to acknowledge the relational, situated and thus, dialogical nature of all communication in interviews. Each method is described, and rationales for their selection and modification are discussed. Processes used to combine the methods, generate data, and guide analysis are illustrated using a case example from the study. The integrated methods helped illuminate the lives and practices of youth who use AAC and the strategies they used to negotiate inclusion across the social spaces that they traversed. We conclude with reflections on the strengths and limitations of our approach, future directions for development of the methodology, and its potential use in research with a broad range of persons experiencing communication impairments