The Canadian Association of Occupational Therapists (CAOT) acknowledges and respects the importance of collaboration, partnership and relationship building in working with Indigenous groups. Occupational therapists (OTs) work hand-in-hand with Indigenous communities to identify and develop programs that take a compassionate, culturally safe, holistic and client-centred approach to client care. OTs address barriers to participation in daily activities and help promote positive health outcomes as part of inter-professional primary care teams in Indigenous communities.
Indigenous people are the youngest and fastest growing segment of the Canadian population, with a median age of 23 for Inuit, 26 for First Nations, followed by Métis at 31. Currently, there are 1,400,684 Indigenous people in Canada, representing approximately 4.4% of the total Canadian population (Statistics Canada, 2017) Across the country, there are more than 600 distinct first nations and over 60 indigenous language groups.
Ongoing and multi-faceted colonial and structural inequities continue to impact the social conditions in which many Indigenous peoples live, work and play. Despite improvements in recent years, Indigenous peoples continue to experience remedial health inequities, including higher rates of infant mortality, chronic diseases such as diabetes and arthritis, mental illness and substance abuse, as well as a suicide rate that is 11 times the national average(Public Health Agency of Canada).
Indigenous health and well-being is a priority of the Government of Canada, with $1.5 billion over five years committed in Budget 2018 to help close the gaps in the health outcomes between Indigenous and non-Indigenous people. The Government of Canada is also committed to advancing reconciliation with Inuit, First Nations and the Métis Nation, and partnering with them to fully implement the calls to action of the Truth and Reconciliation Commission of Canada (TRCC).
The Truth and Reconciliation Commission of Canada: Calls to Action (Commission de vérité et réconciliation (CVR)) has prompted the occupational therapy profession in Canada to reflect more intensely on the practice of occupational therapy with Indigenous peoples. Individual OTs are increasingly questioning their role within the broader national discourse of the TRC and the social injustices and health inequities experienced by Indigenous peoples and are beginning to take action in small but meaningful ways.
- CAOT struck up a TRC Task Force to explore ways that the profession of occupational therapy could most effectively contribute to the TRC.
- CAOT completed a position paper on Occupational therapy and Indigenous peoples (2018).
- CAOT is developing a role paper on suicide prevention.
- As part of the Coalition for Safe and Effective Pain Management, CAOT is releasing the final CSEPM report early 2019 that provides recommendations for non-pharmacological pain management to tackle the opioid crisis. The CSEPM Interim report (2017) outlined provided three specific non-pharmacological occupational therapy interventions:
- Occupational Therapy Using the Biopsychosocial Approach;
- Occupational Therapy to Support Relapse Prevention; and
- Splinting to Reduce Upper Extremity Pain.
- The Assembly of First Nations and the Government of Canada have been conducting a Non-Insured Health Benefits (NIHB) program review since 2015. With the aim of enhancing the NIHB program, CAOT participated in several meetings to date, providing the occupational therapy perspective regarding key issues affecting care for Indigenous peoples in Canada.
- For the last two years, CAOT has dedicated OT Canada, the day before CAOT’s national conference, to educating OTs and leaders in the profession about the historical and contemporary contexts of colonization in Canada and its direct and indirect impact on disparate health care and social service delivery.
- During CAOT Conference 2017 and 2018, CAOT hosted numerous sessions centred on Indigenous health issues including:
- 2018: Professional Issue Forum: Inspiring Actions: Occupational Therapy Paths to Truth and Reconciliation with Indigenous Peoples. Experts discussed how OTs have a unique role in delivering culturally-safe and effective client care in collaboration with Indigenous peoples.
- 2017: Truth and Reconciliation: A call to action for occupational therapy.
- CAOT met with Dr. Valerie Gideon, Senior Assistant Deputy Minister of Indigenous Services Canada and her team to consider breaking barriers to availability and access to much needed occupational therapy services in Indigenous communities in Canada. CAOT’s efforts to bring to life some of the TRC calls to action were highlighted and areas of potential collaboration and support from Indigenous Services Canada were explored.
- CAOT attended a Forum on Indigenous Health that featured several panelists, including Dr. Carolyn Bennett, Minister of Crown-Indigenous Relations and Northern Affairs in Canada. The discussion centred on how to narrow the gap between health and wellness outcomes between non-Indigenous and Indigenous Canadians.
- To enable OTs to provide collaborative services with Inuit, Metis, and First Nations in the provision of low-cost, high-impact occupational therapy solutions in Indigenous communities.
- To promote the inclusion of OTs on primary health care and community-based teams that provide direct access to health care services to Indigenous peoples including chronic disease and pain management, mental health and addiction support, suicide prevention and managing the opioid crisis.
- To pursue the calls for action by the Truth & Reconciliation Commission of Canada, including the training of OTs in cultural safety and humility, tackling the opioid crisis and supporting distinctions-based housing in Indigenous communities.
- To provide the occupational therapy perspective on NIHB.
- To advance non-pharmacological solutions to chronic pain management such as splinting, biopsychosocial support, and relapse prevention.
Occupational Therapy Value Proposition
- OTs recognize and attend to the historical and current structural influences on Indigenous people’s health and work to reduce barriers and to recognize the strengths and resiliency of Indigenous people and communities (CAOT, 2018).
- Occupational therapy services can influence the health, well-being and occupational justice of First Nations, Métis and Inuit people through their unique focus on the relationship between a person, their daily activities, and their environment (Brown, 2012).
- Opioid Crisis & substance abuse:
- Involving occupational therapists early in the pain management treatment process has the potential to prevent reliance on opioids and/or development of opioid dependence (CAOT,
- By understanding an individual’s pain experience, occupational therapists can implement an appropriate combination of treatment strategies to address the physiological, psychological and social aspects of pain. Occupational therapy provides low cost, high impact solutions to many physical and mental health-related issues and can prevent problems before they occur.
- A distinct role for occupational therapy is to identify the desirable aspects of substance use, and support clients to achieve those same effects through re-organizing their daily routines to incorporate activities that do not involve opioid use (Kiepek, 2016; Chang 2008).
- Occupational therapists work to support clients with chronic pain who wish to reduce substance use to engage in a variety of activities, including paid employment (Darko-Mensah, 2011), securing housing, accessing transportation, and completing education.
- Within primary care, occupational therapists provide services that extend beyond those of physicians, nurse practitioners, and physician assistants, focusing on identifying how symptoms, such as disease or chronic pain, can impact function and participation in everyday activities (Muir, 2012).
- OTs work in a wide range of settings and are unique in their dual focus on prevention as well as treatment and their bias towards a non-pharmacological approach. Occupational therapists help individuals implement strategies to manage their symptoms, reduce the incidence of acute care situations and promote productivity.
- OTs on primary health care teams improve effectiveness of patient care outcomes. (CAOT Pre-budget consultation, 2018.
- OTs develop policies, procedures, and resources (e.g., models, assessment tools) in collaboration with Indigenous peoples that are specifically relevant to Indigenous peoples in Canada, therefore allowing a targeted and effective approach to health care delivery.