Occupational Consciousness

"Listen with your ears and eyes and heart and your minds and your soul": Implications for decolonising consultation and occupational therapy from case studies on "Closing the Gap" policy implementation

BACKGROUND

Including Aboriginal and Torres Strait Islander people and communities through consultation has been a key feature of policy implementation throughout the Australian Government's "Closing the Gap" (CTG) strategy. However, consultation often reinforces power imbalances between government and local community and can undervalue or marginalise Indigenous knowledge and leadership. Occupational therapy has a short history of examining colonial power structures within the profession, but there has been limited progress to decolonise consultation and practice.

METHODS

Drawing on decolonising research methodology and positioned at the interface of knowledge, comparative case studies were used to understand policy implementation in two regions. In Shepparton, Victoria, CTG policy was implemented predominately through an Aboriginal Community Controlled Health Organisation, and in Southern Adelaide, South Australia, CTG policy was implemented through mainstream state government and non-government providers in the absence of a local Aboriginal-controlled organisation. Findings were examined critically to identify implications for occupational therapy.

RESULTS

Our case studies showed that policy stakeholders perceived consultation to be tokenistic and partnerships were viewed differently by Aboriginal and non-Indigenous participants. Participants identified the need to move beyond a rhetoric of "working with" Aboriginal and Torres Strait Islander people, to promote Aboriginal leadership and really listen to community so that policy can respond to local need. The findings of this research show that Aboriginal-controlled services are best positioned to conduct and respond to community consultation.

CONCLUSION

A decolonising approach to consultation would shift the status quo in policy implementation in ways that realign power away from colonial structures towards collaboration with Indigenous leadership and the promotion of Aboriginal-controlled services. There are lessons for occupational therapy from this research on policy implementation on authentic, decolonised consultation as a key feature of policy implementation. Shifting power imbalances through prioritising Indigenous leadership and honouring what is shared can drive change in CTG policy implementation processes and outcomes.

'Finding the play' - exploring with occupational therapists practice possibilities in the context of Irish schoolyards

BACKGROUND

Research has identified diverse constraints to the adoption of school-based occupational therapy approaches and a lack of attention to addressing the barriers to children's play opportunities. Critical contextualised research is advocated to inform practice possibilities.

AIMS/OBJECTIVES

This inquiry aimed to explore with occupational therapists their existing practices in Irish schoolyards to generate practice possibilities concerned with play, as an issue of occupational justice.

MATERIALS AND METHODS

Using the theory of practice architectures, six occupational therapists from diverse sites of practice participated in the first phase of a critical action research process using dialogical focus group and occupational mapping methods.

RESULTS

Three themes were generated (1) Existing practices as situated (2) (Re)mattering play and practices as occupations and (3) Practice possibilities - 'Finding the play' between responsiveness and responsibilities. A further interrelated dimension was how the research methods provided mechanisms of raising consciousness.

CONCLUSIONS, AND SIGNIFICANCE

Alongside constructing knowledges on existing practices in an Irish context, this inquiry contributes to understandings of practices as socially embedded generative processes of 'finding the play', highlighting ethical responsibilities to make visible inequities reproduced in habitual practices and engage in relationships of solidarity to (re)construct alternative shared practices.

The shadow side of occupational therapy: Necropower, state racism and colonialism

BACKGROUND

In the Global North, advances in occupational therapy benefitted unduly from the oppression, disablement and suffering of thousands of people in the South (and beyond). To prevent the recurrence of these injustices, history must be unveiled and occupational therapists urged to come to terms with their own involvement and responsibility.

OBJECTIVE AND METHOD

Utilising Achille Mbembe's concept of necropolitics, this academic essay blends select historical and philosophical perspectives to explore occupational therapy's concealed role in manifestations of institutionalised violence.

RESULTS

By examining its roles in World War II and France's colonisation of Algeria, we make visible the development of occupational therapy's distinct 'shadow side'. In Nazi Germany's Euthanasia Programme, it became a tool for identifying which lives were deemed 'worthy of living' and which were not, which indirectly contributed to the killing of 200,000 disabled persons. Under France's colonial medical system, occupational therapy imposed Western standards that alienated and completely depersonalised Algerian patients.

CONCLUSION AND SIGNIFICANCE

Entrenched in a (bio)economy that has endured beyond these events, occupational therapists must exercise vigilance, remaining mindful of the potential to unintentionally overlook individuals labelled as 'unproductive'. This requires confronting the profession's assumptions of inherent 'goodness' and acknowledging and addressing its shadow side.

Promoting Justice, Diversity, Equity, and Inclusion Through Caring Communities: Why It Matters to Occupational Therapy

The global challenges humanity faces today, such as social and economic inequalities, occupational deprivation, racism, exclusion, displacement and migration crises, violence, wars, and political oppression, all contribute to health and participation inequities (Powell & Toppin, 2021). The depth and breadth of these inequities became strikingly evident and were exacerbated with the coronavirus 2019 pandemic (Khanijahani et al., 2021). More than ever before, we need to apply an occupational perspective to create caring communities that strengthen each person's sense of belonging (Beagan, 2015; Lavalley & Johnson, 2020; Mahoney & Kiraly-Alvarez, 2019). In this column, we argue that occupational therapy academic programs have a unique role in advancing justice, equity, diversity, and inclusion through the creation of caring communities.

First-Generation Palestinian Refugees in Jordan: Experiences of Occupational Disruption From an Occupational Justice Perspective

IMPORTANCE

Only a limited amount of research has investigated the impact of prolonged refugee status of Palestinian refugees who have been displaced for more than 70 yr.

OBJECTIVE

To explore lived experiences of Palestinian refugees in Jordan and understand their occupational disruption.

DESIGN

Thematic analysis guided by descriptive phenomenology with one-on-one and group interviews.

SETTING

An AlBaqa'a community-based rehabilitation center or participants' homes.

PARTICIPANTS

First-generation Palestinian refugees who fled Palestine and live in Jordan.

RESULTS

Fifteen Palestinians, mainly widowed women in their 70s, participated in this study. Ten completed interviews, and five participated in two group interviews. Four themes emerged: (1) Palestinian pride, (2) trauma leaving one's home country, (3) challenges of living in a host country, and (4) internalized prejudice.

CONCLUSIONS AND RELEVANCE

After 70 yr, prolonged refugeeism has led to occupational disruption and negative implications for occupational justice, especially in the absence of social justice. The area most negatively affected was social participation; however, participants still had a great sense of pride about their homeland and their heritage. What This Article Adds: This foundational research explores the occupational injustices of the protracted refugee status of first-generation Palestinians in Jordan and identifies meaningful interventions to promote the alleviation of occupational disruption.

Rethinking professional identity formation amidst protests and social upheaval: a journey in Africa

The under-representation of minoritized or previously oppressed groups in research challenges the current universal understanding of professional identity formation (PIF). To date, there has been no recognition of an African influence on PIF, which is crucial for understanding this phenomenon in places like South Africa, a society in which the inequity of the apartheid era still prevails. In addition, there is little data examining how social upheaval could impact PIF. This study uses interviews with medical students to explore PIF within the context of social upheaval during the 2015-2016 protests that rocked South Africa when students challenged asymmetries of power and privilege that persisted long after the country's democratic transition. The combination of the primary author's autoethnographic story, weaved into the South African sociohistorical context and ubuntu philosophy, contributes to this study of PIF in the South African context. The use of an African metaphor allowed the reorientation of PIF to reflect the influence of an ubuntu-based value system. Using the calabash as a metaphor, participants' experiences were framed and organized in two ways: a calabash worldview and the campus calabash. The calabash worldview is a multidimensional mixture of values that include ubuntu, reflections of traditional childhoods, and the image of women as igneous rocks, which recognizes the power and influence on PIF of the women who raised the participants. Introducing an African ubuntu-based perspective into the PIF discourse may redirect the acknowledgement of context and local reality in developing professional identity.

Narrative Theater to Examine and Mitigate Anti-Black Racism Within Occupational Therapy

Theater has long-standing roots in social justice and holds promise for reducing racist attitudes and behaviors. Objectives of this study were to (a) collect and theatrically portray narratives from Black occupational therapy students and practitioners to a national audience and (b) examine the impact of the theatrical performance on anti-Black racism among attendees. The Identity Development Evolution and Sharing (IDEAS) model guided translation of narratives into a filmed performance. Paired t-test of pre/post administration of the Acceptance and Action Questionnaire-Stigma (AAQ-S) measured changes in stigma beliefs. Qualitative thematic analysis of an open-ended post-survey question elucidated experiences of the performance. The performance engendered significant decreases in stigma; qualitative data elucidated potential mechanisms of change. This study provides insight into experiences of anti-Black racism within occupational therapy and offers a promising means for occupational therapists to engage in anti-Black racism.

Development of a capability maturity model for the establishment of children's nursing training programmes in southern and eastern Africa

Establishing sustainable training to strengthen human resources for health for children's nursing in Africa requires stakeholders to navigate complex pathways spanning multiple regulatory systems and sectors. Incomplete stakeholder insight threatens long-term sustainability of new training programmes. We drew on collective experiential knowledge of capacity building for children's nursing in southern and eastern Africa to articulate a Capability Maturity Model (CMM), using a six-stage process to: identify necessary supportive conditions; specify levels of process maturity; develop domains; characterise levels of capability; consult with stakeholders; and finalise the model. We articulated a comprehensive CMM describing five levels of process maturity in relation to education, clinical and regulatory systems, human resources for health systems, and requirements related to overall stakeholder collaboration. The model makes visible the range of regulatory and associated processes involved in developing a new educational programme for specialist nurses, including educational standards, quality assurance, scopes of practice, and systems for licensing and registering specialist children's nurses. Stakeholders can use the model as a map to identify where they are in the process, and establish the resources and actions needed to make further progress.

Exploring the Role of Occupational Therapy and Forced Migration in Canada

BACKGROUND.

In response to increasing forced migration across the globe, Canadian occupational therapists are returning to the profession's social justice roots by exploring this emergent area of practice. Purpose. This research explores occupational therapy practices with forced migrants in a Canadian context. Method. Grounded in critical epistemologies, the researchers conducted 12 semi-structured interviews with occupational therapists, students, and researchers connected to displacement. Data were analyzed using thematic analysis. Findings. Four themes describe current occupational therapy practices related to forced migration: 1) engaging clients in new environments, 2) translating the everyday, 3) connecting and networking, and 4) advocating for occupational justice. Implications. This research contributes to the advancement of occupational therapy and forced migration by documenting the diverse and fluid nature of occupational therapy roles. Further, the paper outlines promising reflexive practices while forwarding advocacy priorities for (occupational) justice.

“I was raped inside, being in a place where I was supposed to be taken care of”: Experiences of oppression and violence in health contexts towards women with disabilities and approaches from feminist occupational therapy

Abstract Introduction The practices of violence in health contexts constitute one of the multiple manifestations of violence against women with disabilities. In Chile, as in the rest of the world, the development of studies on this violence is still incipient. Objectives To characterize practices of violence against women with disabilities in health contexts, and to characterize experiences of vindication of human rights of this group of women in Chile, from the voices of activists and professional occupational therapists. Method A secondary analysis of qualitative data from a study executed between 2015 and 2020 was conducted. From a qualitative approach and collective case study, a secondary thematic analysis of the data obtained from 8 interviewees was performed. Results From the perspective of the informants, women with disabilities experience structural violence in a systematic and transversal way, which crosses other various forms of violence: physical, psychological, sexual, obstetric, and symbolic-institutional. The experiences of this group in claiming their human rights reflect processes of emancipation, resistance, and construction of practices that transform these violations. Conclusion The practices of violence in health contexts toward women with disabilities in Chile is a situation visualized as manifestations of domination and oppression against them, which perpetuate their social exclusion and inequalities in health. Faced with this situation of social injustice, women activists and professional occupational therapists propose the need to implement strategies for the vindication of human rights, together with practices of collective resistance.

Organizações sociais civis em tempos de pandemia: um relato a partir do conceito de reconstrução ocupacional coletiva

RESUMO Introdução Este artigo relata ações coletivas desenvolvidas por participantes de duas Organizações Sociais Civis representantes de pessoas com diagnóstico de esclerose múltipla, localizadas na região Sul do Brasil, durante o período da pandemia de COVID-19. Objetivo Evidenciar as estratégias e ações que constituíram parte do processo de reconstrução ocupacional coletiva das Organizações Sociais Civis. Portanto, descreve os resultados de processos coletivos a partir da reflexão sobre os fenômenos observados pelas autoras. Método Trata-se de um trabalho descritivo, do tipo relato de experiência, com a abordagem qualitativa. As práticas ocorreram de forma remota durante o período da pandemia (entre março e dezembro de 2020). Resultados Verificou-se que os dispositivos de mídias sociais contribuíram para a manutenção das ocupações coletivas do grupo, facilitando o processo de reconstrução ocupacional coletiva das Organizações Sociais Civis. Entre os dispositivos utilizados, destaca-se os aplicativos de mensagens e de videochamadas, que facilitaram o desenvolvimento das práticas coletivas, minimizando os impactos negativos do distanciamento físico. Conclusão Os dispositivos de mídias sociais apresentam-se como recursos potentes para a manutenção do fazer coletivo e nos processos de reconstrução ocupacional.

“Yo fui violentada adentro, estando en un lugar que me tenían que cuidar”: Experiencias de opresión y violencias en contextos de salud hacia mujeres con discapacidad y abordajes desde la terapia ocupacional feminista

Resumen Introducción Las prácticas de violencia en contextos de salud constituyen una de las múltiples manifestaciones de la violencia contra las mujeres con discapacidad. En Chile, como en el resto del mundo, el desarrollo de estudios sobre estas violencias aun es incipiente. Objetivos Caracterizar prácticas de violencia hacia mujeres con discapacidad en contextos de salud, y caracterizar experiencias de reivindicación de derechos humanos de este colectivo de mujeres en Chile, desde las voces de activistas y profesionales terapeutas ocupacionales. Método Se realizó un análisis secundario de datos cualitativos de un estudio ejecutado entre los años 2015 y 2020. Desde un enfoque cualitativo y estudio colectivo de casos, se realizó un análisis temático secundario de los datos obtenidos de 8 entrevistadas. Resultados Desde la perspectiva de las informantes, las mujeres con discapacidad experimentan violencia estructural de forma sistemática y transversal, la que atraviesa otras diversas formas de violencia: física, psicológica, sexual, obstétrica y simbólica-institucional. Las experiencias de reivindicación de derechos humanos de este colectivo reflejan procesos de emancipación, resistencia y construcción de prácticas transformadoras de estas vulneraciones. Conclusión Las prácticas de violencia en contextos de salud hacia mujeres con discapacidad en Chile es una situación visualizada como manifestaciones de dominación y opresión contra ellas, que perpetúan su exclusión social y desigualdades en salud. Frente a esta situación de injusticia social, mujeres activistas y profesionales terapeutas ocupacionales plantean la necesidad de implementar estrategias de reivindicación de derechos humanos, junto a prácticas de resistencia colectiva.

Pedagogies within occupational therapy curriculum: centering a decolonial praxis in community development practice

Abstract Introduction Critical occupational therapy aims to promote occupational justice through addressing the social determinants of health and the socio-political structures that affect peoples’ occupational engagement. Objective This paper reports on two objectives from a case study, namely: To describe the teaching and learning practices in South Africa, University of Cape Town Occupational Therapy, Community Development Practice curriculum, and the pedagogy informing it. Method Multiple methods were used as data in the construction of the case. These included the review of curriculum documents and a focus group discussion with academics who teach on the programme. These academics also wrote reflective journal entries which were included in our analysis. Data was analysed using a critical interpretive synthesis. Results An overarching theme emerged, namely “Modelling a development processes in a teaching and learning alliance”. This theme identified our key pedagogical approach, illustrating how a decolonial praxis that involves consciously resisting coloniality in the design and implementation of the curriculum occurred. This was made possible through pedagogical actions embedded in the approach and reflected in three categories: “Partnering to bring our critically reflexive and authentic selves”; “The labour of working with individual and systemic processes of struggle” and “Being committed to facing uncertainty together”. Conclusion Our interpretation of our pedagogical approach within the curriculum demonstrates how decolonial pedagogies open up pathways that promote the kind of dialogic and transformative learning that is important for critical occupational therapy. These decolonial pedagogies hold significance for addressing health inequities and developing a justice-oriented profession.

Feminismo decolonial e terapia ocupacional: relato de experiência de um estágio curricular no contexto da pandemia

Resumo Este relato é um aprofundamento teórico a partir das práticas de estágio remoto de terapia ocupacional junto ao Centro de Referência de Assistência Social (CRAS) de um território do município de Pelotas, Rio Grande do Sul, Brasil. As práticas estão referenciadas pelas terapias ocupacionais do sul e pelas perspectivas feministas decoloniais. Durante o estágio, foram realizados acompanhamentos singulares, um grupo virtual com usuárias do CRAS e um grupo formativo voltado para trabalhadoras dessa instituição. Por meio das intervenções, tivemos acesso às histórias de vida marcadas por opressões de gênero. Com o auxílio de Patrícia Hill Collins, entendemos como as imagens de controle operavam nas atividades cotidianas das mulheres, sobretudo atividades relacionadas ao cuidado. As intervenções encontraram suporte no paradigma ameríndio da tradução, sublinhando o equívoco como fundamento do cuidado em terapia ocupacional. Propusemos as Atividades de Tradução Cultural como método de intervenção terapêutico-ocupacional, que prevê e se utiliza da diferença cultural em prol de novas formas de experimentação, conscientização, coletivização e incitamento ao enfrentamento das opressões.

Civil society organizations in times of pandemic: a report from the concept of collective occupational reconstruction

ABSTRACT Introduction This article reports collective actions developed by participants of two Civil Society Organizations representing people diagnosed with multiple sclerosis, located in southern Brazil, during the period of the COVID-19 pandemic. Objective To highlight the strategies and actions that comprised part of the collective occupational reconstruction process of the Civil Society Organizations. Therefore, it describes the results of collective processes, based on reflection on the phenomena observed by the authors. Method This is a descriptive, qualitative research based on an experience report. The practices occurred remotely during the pandemic period (March to December 2020). Results It was found that social media platforms contributed to maintain the collective occupations of the group, facilitating the process of collective occupational reconstruction of Civil Society Organizations. Among the used tools, instant messaging and video calling applications stood out, which facilitated the development of collective practices, thus minimizing the impacts of physical distance. Conclusion Social media platforms are powerful resources to maintain collective action and occupational reconstruction processes.

Decolonial feminism and Occupational Therapy: an experience report of a curricular internship in the context of the COVID-19 pandemic

Abstract This experience report is a theoretical deepening of the practices of remote internship in Occupational Therapy (OT) at the Social Assistance Reference Center (CRAS) of territory in the municipality of Pelotas, State of Rio Grande do Sul, Brazil. The practices are based on the Occupational Therapy of the South and decolonial feminist perspectives. During the internship, individual interventions, a virtual group with women users of the CRAS, and a training group focused on workers from the same institution were carried out. Through these interventions, we had access to life stories marked by gender oppression. Supported by Patricia Hill Collins’s theory, we understood how the images of control impacted those women’s daily activities, especially those related to care. The interventions found support in the Amerindian paradigm of translation, underlining misunderstanding as the foundation of care in OT. We proposed Cultural Translation Activities as a method of occupational-therapeutic intervention that foresees and uses the cultural difference in favor of new forms of experimentation, awareness, collectivization, and incitement to face oppression.

The Concept of Oppression and Occupational Therapy: A Critical Interpretive Synthesis

Background. Occupational therapy and occupational science literature include growing attention to issues of justice, marginalization, and rights. In contrast, the concept of oppression has scarcely been employed. Purpose. This paper investigates how adding the concept of oppression may enhance occupational therapy approaches to injustice, prioritizing a focus on structural causes, and facilitating conscientious action. Method. A critical interpretive synthesis explored insights from authors who name oppressions in occupational therapy and occupational science literature. In total, a sample of 28 papers addressing oppression, ableism, ageism, classism, colonialism, heterosexism, racism, and/or sexism was selected for inclusion. Findings. Four themes were identified: oppression and everyday doing; effects of structures and power; responding and resisting; and oppression within occupational therapy. Implications. Incorporating oppression within the plurality of social discourse may help occupational therapists to avoid individualistic explanations, attend to relationships between social structures and constrained occupations, frame intersectional analysis, and engage in praxis.

The power struggle: exploring the reality of clinical reasoning

PURPOSE

Historically, clinical reasoning has largely been considered from an empirical, biomedical standpoint. This epistemology, rooted in imperial rule, is influential in how healthcare practitioners practice. An empirical approach to healthcare often oversimplifies the complex nature of clinical reasoning by obscuring the influence of imperial ideologies on decision-making. This can perpetuate inequitable approaches to healthcare delivery which deepen social, political and economic divides globally. This paper aims to explore and challenge this standpoint by exploring how power, imperialism and performativity influences healthcare provision and decision-making amongst healthcare practitioners in dysphagia rehabilitation.

METHODS

Qualitative exploratory interviews were undertaken with seven South African trained SLPs with experience working in dysphagia. To allow for participation and collaboration from participants, three data collection tools were employed within the interviews: oral histories, cognitive mapping and arts-based tasks. An initial modified thematic analysis followed by a further ideological analysis were undertaken to analyse the data collected.

RESULTS

The results suggest that the participants felt influenced by several manifestations of power within healthcare. We argue that this demonstrates that imperial practices can influence knowledge, interaction and context and therefore affect how healthcare practitioners make decisions.

CONCLUSION

By acknowledging the impact of imperialism and power dynamics on healthcare provision and clinical reasoning we can potentially begin to transform the epistemology from which we approach healthcare provision in favour of one which is better suited to the current realities of healthcare to allow for equitable service provision.

Play of children living with HIV/AIDS in a low-resourced setting: Perspectives of caregivers

Background

Although play is viewed as a childhood occupation that is spontaneous, it can be limited in children with HIV/AIDS. This study explored the perspectives of caregivers from Zimbabwe on the play of children with HIV/AIDS.

Methodology

A descriptive qualitative research approach was used to explore the perceptions of caregivers on play of children living with HIV/AIDS. Fifteen caregivers of children aged 4–9 years diagnosed with HIV/AIDS were purposively sampled. Two interviews were carried out with each of the caregivers. Findings were analysed thematically.

Findings

Four major themes were generated from the study: ‘Ubuntu is no more’, ‘Survival is primary (chikuru kurarama)’, ‘Play affirms that my child is still like other children’ and ‘More is required for this child’. Although issues of survival were paramount, caregivers were able to highlight the importance of play in affirming childhood, identifying the specific needs for play of children with HIV/AIDS.

Conclusion and Significance

Play, like all other human occupation, is contextually situated. Poverty and health status are key in shaping how families prioritise play. However, the ability to play for a child with HIV/AIDS also seems to mitigate stigma and may disrupt the ‘HIV is death’ narrative.

Decoloniality in physiotherapy education, research and practice in South Africa

Background

Historically, the profession of physiotherapy in South Africa has closely aligned itself with our former colonial master, the United Kingdom. Whilst efforts have been made in recent years to transform our profession, numerous challenges remain. An improved understanding of the topic of decoloniality is a useful and necessary way of beginning to address these challenges.

Objectives

The aim of this opinion piece is to encourage further dialogue amongst South African physiotherapists working in all sectors – a dialogue that must focus on genuinely transforming our profession to be better suited to serving the majority of South Africans.

Method

Global and local literature related to decoloniality is summarised for readers, followed by a closer scrutiny of how this topic relates to some of the challenges faced by the profession of physiotherapy in South Africa.

Results

The evidence presented demonstrates that whilst some efforts have been made to transform South African physiotherapy, significant work and dialogue is required to bring about a true transformation of the profession.

Conclusion

An honest and transparent conversation about decoloniality and transformation can assist in realising the potential of our profession, thereby improving the health and well-being of all South Africans.

Clinical implications

Real engagement with this topic can assist in transforming who enters our profession, what we teach, where and why we conduct research and how we can ensure that physiotherapy practice contributes to real social justice by benefitting the majority of our population.

How prepared is Australian occupational therapy to decolonise its practice?

INTRODUCTION

Being culturally secure, respectful and responsive can mean occupational therapists can contribute to improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples. New culturally responsive accreditation and competency standards provide an opportunity to decolonise the profession to enhance the cultural capabilities of graduates. The purpose of this study was to explore how well-prepared Australian occupational therapy courses are to implement the new standards.

METHODS

The principles of participatory action research were applied. An initial survey with occupational therapy academic staff was used to inform questions for semi-structured interviews. Semi-structured interviews were conducted with 10 occupational therapy academics and occupational therapy accreditors. Interview data were thematically analysed.

FINDINGS

The four themes identified from the interviews were: occupational therapy profession drivers, effective leadership, community and Elder involvement, and course design and delivery.

CONCLUSION

The new accreditation and competency standards are a promising step forward for the profession. However, the profession needs to be better prepared to decolonise Australian occupational therapy. A positive and culturally secure way forward is to engage Elders and other community members in learning experiences to build student, academic and practicing occupational therapist's cultural capability. Non-Aboriginal and Torres Strait Islander leadership at all levels of the profession and within universities is crucial to establishing trusting, reciprocal relationships to support deep knowledge exchange. These relationships lay the foundation to build cultural capabilities and decolonise processes in the profession.

Intersectorialidad y reducción del estigma en salud mental: la necesidad de avanzar hacia una descolonización de la institucionalidad, desde una perspectiva intercultural

Resumen El objetivo de este estudio es analizar las implicancias en la subjetividad y los cambios en la vida cotidiana, de quienes participaron en calidad de asistentes a las Jornadas Anti-estigma en la ciudad de Concepción en Chile, una práctica socioeducativa, de carácter interinstitucional e interdisciplinar, cuyo propósito es generar un cambio cultural sobre la estigmatización en el campo de la salud mental. Se desarrolla una sistematización de esta experiencia, enfatizando en la historia y las metodologías aplicadas en ella. La información para el análisis se produce a través de un grupo de discusión con 14 participantes. Los resultados muestran que existe un impacto en la subjetividad de quienes asisten dado que se propicia el contacto con los sujetos estigmatizados y con sus experiencias de vida en torno a éste. Sin embargo, se presenta como un desafío la transformación de prácticas en los espacios cotidianos, aspectos que requieren de esfuerzos intersectoriales y una institucionalidad que genere las bases y desarrollo de políticas públicas adecuadas para ello. En este sentido resulta imperativo incluir perspectivas y prácticas decoloniales e interculturales en el campo de la salud mental.

Using Occupational Justice as a Linchpin of International Educational Collaborations

When designing international educational collaborations, occupational science and occupational therapy educators must consider how occupational justice can be a linchpin for students' learning. This article describes an international collaboration involving 52 undergraduate occupational science students in the United States and 41 undergraduate occupational therapy students in South Africa. The students participated in six synchronous video conferences in 2016, during which they gave group presentations about four occupational science constructs and engaged in general question-and-answer sessions. Forty percent of the students provided feedback about the interactions using a six-item open-ended electronic questionnaire, which we analyzed using directed content analysis. Our findings suggest that the collaboration helped the students develop more nuanced understandings of disciplinary constructs, international peers, and themselves, providing a platform from which to engage with the big idea of occupational justice. Refinements to this collaboration are aimed at drawing on students' increased critical consciousness to further develop their knowledge about occupational justice.

Walking up hills, through history and in-between disciplines: MHH and Health Sciences Education at the tip of Africa

Celebration, frustration, contestation and imagination all manifest themselves when examining the evolution of the field of Medical and Health Humanities (MHH) at the University of Cape Town (UCT). That this field has been growing at the same time as access to, inclusion in, and social justice issues linked to higher education have come under the spotlight has the potential to shape how we think and plan for the future of the field. Doing this will require treks up hills, journeys through difficult histories and dynamic dances in-between disciplines.This article examines MHH at UCT broadly, referring to projects and programmes that are underway primarily in the humanities and health sciences faculties. From this overview, the article specifically examines the curricula changes introduced in the Faculty of Health Sciences inspired by MHH and the author's interest in historical consciousness. It describes current points of intervention in physiotherapy and MBChB undergraduate curricula; and through short-term special study modules that have allowed those interested in MHH to explore relationships between health and healing and art, music, writing, yoga, PhotoVoice, drama, drawing and complex histories.It discusses some of the challenges of introducing humanities teaching into health sciences curricula; and some of the tensions that result from the meeting of divergent epistemologies and pedagogies. The article considers if, and how, MHH might engage with social (in)justice, and inclusions and exclusions and potentially offer a balm to soothe the bruising effects of oppressive histories and a hegemonically hierarchical present.