CAOT Position Statement:
Healthy occupations for children and youth (2009)

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The Canadian Association of Occupational Therapists (CAOT) recognizes that children and youth (boys and girls from birth to 18) have the right for opportunities to develop healthy patterns of occupations. CAOT supports a rights-based approach for advocacy to protect and fulfill this right. With a rights-based approach, an improvement in outcomes for people occurs through the realization of rights under the law. This approach works toward a guarantee of sustained protection and fulfillment of the rights of children and youth to participate in health-building occupations (United Nations, 2000). It focuses attention on broad-based collaboration among consumers, legislative process, the development of public policy and programs and services. A rights-based approach is dependent on a multi-sectoral and multi-level approach where there is potential to influence long-term social, economic and legal change (National Children’s Alliance, 2002).

Recommendations:

1. Occupational therapists collaborate with stakeholder groups to develop and promote social policies that support children and youth’s engagement in active and healthy occupations.

2. Occupational therapists address barriers to participation in active and healthy occupations by advocating for safe and accessible environments that support the occupations for Canadian children and youth.

3. Occupational therapists educate Canadians regarding the value of engaging in healthy and active occupations, in maintaining and promoting health and well-being for children and youth.

4. Occupational therapists support diversity in their practices as populations increase in diversity.

5. Occupational therapists support injury prevention practices that promote safe, active engagement in healthy occupations (programs to prevent obesity in children, promote helmet use, advance anti-smoking campaigns).

6. Occupational therapists support services and programs that enable parents to meet workplace and family responsibilities.

7. Occupational therapists conduct and promote research to understand children and youth’s engagement in healthy occupations.

CAOT Initiatives

To facilitate opportunities for children and youth to develop healthy patterns of occupations, CAOT will:

1. Monitor government initiatives that impact upon the right of children and youth.

2. Create an advocacy strategy for broader legislative and policy changes that will advance opportunities and resources for children and youth to engage in and develop healthy occupations.

3. Support and facilitate collaborative research strategies with CAOT stakeholders and key coalitions to inform new policy or policy reform.

4. Support members and stakeholders in their advocacy efforts through continuing professional education products, services, and communications.

5. Work in collaboration with national groups, organizations, and governments to address barriers and promote safe and supportive environments that enable active healthy occupation in children and youth.

Background

1. Occupational therapists enable all persons of Canada to have opportunities and resources to engage in occupations for their health and well being (CAOT, 2008).

2. Occupations are everything that people do during the course of everyday life and throughout their lifetime. These include the occupations through which people look after themselves, work, play, learn, and participate as members of their community and cultural group (CAOT, 2002).

3. Engagement in meaningful occupations is a determinant of health (Law, Steinwender, & Leclair, 1998). The complex interaction of physical, psychological, spiritual, social, cultural, and political factors influences occupational function and dysfunction (Whiteford, Townsend, & Hocking, 2000; Wilcock, 1998). Throughout a person’s lifecycle, withdrawal or changes in occupations can lead to increased dependency, lack of confidence, or depression. To be healthy, people need choice over their patterns of occupations. Health flourishes when people have access to occupations that hold personal meaning, are publicly valued by the society in which they live, and lead to productive and satisfying lifestyles.

4. Childhood is comprised of a series of highly sensitive developmental periods that are unique to each child. A missed opportunity to support a child’s occupational development at any stage in the cycle will have negative impacts across the life span. Early detection of developmental problems coupled with an immediate intervention is critical to a healthy future.

5. There are inequities, or occupational injustices that limit opportunities for Canadian children and youth to engage in healthy occupations. According to the Health Canada publication, Toward a healthy future: Second report on the health of Canadians (1999), Canada is ranked highly for indicators of a healthy population. However, children and youth who are marginalized and disadvantaged have fewer opportunities to develop healthy patterns of occupation. The maximum survival and development of many children is not assured. Children who are First Nation, Metis or Inuit, immigrants, disabled, and/or living in the care of the state, or in poverty, have been disproportionately disadvantaged in Canada on a sustained basis. “Injustices persist when participation in occupations is barred, confined, restricted, segregated, prohibited, undeveloped, disrupted, alienated, marginalized, exploited, excluded or otherwise restricted” (Townsend & Wilcock, 2004).

6. Increasingly, occupational therapists, clients, and consumer groups are taking collective action to address the systemic barriers and issues that affect health and occupation in children and youth. CAOT is well-positioned to provide leadership to this initiative by proposing and setting an agenda for children and youth to monitor, communicate, advocate, and research. Outdoor air quality is deteriorating, respiratory illnesses, mental health illnesses, and the rate of obesity in children is rising, childhood hunger persists and homelessness among families is a growing problem (Canadian Council of Social Development [CCSD], 2006).

7. Traditionally publicly-funded services for children and youth are driven by a needs-based approach administered by individual programs or one delivery system. Occupational therapists and their clients have come to realize that a needs-based program does not achieve sustainable occupational engagement for children and youth who are marginalized or disadvantaged.

8. The Progress of Canada’s Children & Youth (CCSD, 2006) noted that mothers of young children are increasingly in the workforce. Families are having difficulty balancing work and family life. The majority of children under age six are in some form of child care. The number of regulated child care spaces has increased – but there are still only enough spaces for a small proportion of children.

9. According to calculations by the CCSD, children with disabilities have challenges accessing child care as one in five children under age five with disabilities has been refused child care, 12% of whom have been refused child care at a child care centre or nursery school (Statistics Canada, 2001). Furthermore, children with disabilities also report difficulties participating in social or recreational activities in because of their disability (Statistics Canada, 2001).

10. Canadian children are ethnically, culturally, and linguistically diverse. The vast majority of Canadian children and youth live in urban areas. It is expected that the number of children and youth under age 25 will decline from 32% of the population (10 million) in 2004 to 26% of the population in 2020. The number of First Nation children and youth is projected to increase 20% by 2017 (CCSD, 2006).

11. In January 1997, the federal, provincial and territorial governments agreed to work together to develop the National Children’s Agenda which would provide a timely and established mechanism for addressing children’s rights. The National Action Plan was released in 2004 and represents a major step in renewing Canada’s public commitment to enhancing the well-being of children and youth. Nevertheless it still needs to address the following issues: sustaining families through income support; building healthy families and communities through services and supports; and, ensuring accountability through the development of sustainable third-party monitoring mechanisms with time bound and measurable goals (National Children’s Alliance, 2004).

12. In May 2002, the United Nations adopted A World Fit for Children (WFFC), which is an ambitious plan of action that includes 21 specific goals and targets for the next decade. Canada, as a signatory country to the WFFC, has agreed to develop a National Plan of Action as outlined in the WFFC agreement (United Nations, 2002).

Glossary of Terms

Enabling (verb) – Enablement (noun): Focused on occupation, is the core competency of occupational therapy – what occupational therapists actually do – and draws on an interwoven spectrum of key and related enablement skills, which are value-based, collaborative, attentive to power inequities and diversity, and charged with visions of possibility for individual and/or social change.

Enabling occupation: Refers to enabling people to ‘choose, organize, and perform those occupations they find useful and meaningful in their environment’ (CAOT 1997, 2002, p. 180).

Occupations: Groups of activities and tasks of everyday life, named, organized, and given value and meaning by individuals and a culture; everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure) and contributing to the social and economic fabric of their communities (productivity); the domain of concern and the therapeutic medium of occupational therapy (CAOT, 1997, 2002); a set of activities that is performed with some consistency and regularity; bring structure and are given meaning by individuals and a culture (adapted from Polatajko et al., 2004 and Zimmerman et al., 2006).

Occupational therapy: The art and science of enabling engagement in everyday living through occupation; enables people to perform the occupations that foster health and well-being; enable a just and inclusive society so that all people may participate to their potential in the daily occupations in life.

References

Canadian Association of Occupational Therapists (2002). Enabling occupation: An occupational therapy perspective (Rev. ed.). Ottawa, ON: CAOT Publications ACE.

Canadian Association of Occupational Therapists. (2008). Position statement on occupations and health. Retrieved from http://www.caot.ca/default.asp?pageid=2326.

Canadian Council of Social Development (2006). The Progress of Canada’s Children & Youth. Retrieved from http://www.ccsd.ca/pccy/2006/tools.htm.

Health Canada (1999). Second Report on the Health of Canadians. Ottawa, ON: Health Canada Publications.

Law, M., Steinwender, S., & Leclair, L. (1998). Occupation, health and well-being. Canadian Journal of Occupational Therapy, 65, 241-242.

National Children’s Alliance (2002). The National Children’s Alliance and a rights-based approach: Setting the context for discussion and action. Retrieved from http://www.nationalchildrensalliance.com/nca/pubs/2003/National_Plan_of_Action.pdf.

National Children’s Alliance (2004). Letter to Senator Langdon Pearson. Ottawa, ON:National Children’s Alliance.

Polatajko, H. J., Davis, J. A., Hobson, S., Landry, J. E., Mandich, A. D., Street, S.L. et al. (2004). Meeting the responsibility that comes with the privilege: Introducing a taxonomic code for understanding occupation. Canadian Journal of Occupational Therapy, 71(5), 261-264.

Statistics Canada. (2001). Participation and Activity Limitation Survey, Retrieved from http://www.statcan.gc.ca/pub/89-578-x/89-578-x2002001-eng.pdf.

Townsend, E.A. & Polatajko, H. J. (2007). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being & Justice through Occupation. Ottawa, ON: CAOT Publications ACE

Townsend, E., & Wilcock, A. (2004). Occupational justice and client-centred practice: A dialogue-in-progress. Canadian Journal of Occupational Therapy, 71, 75-87.

United Nations. (2000). Convention on the rights of the child. Retrieved from www.unicef.org/crc/crc.htm.

United Nations. (2002). World Fit for Children. New York: United Nations Children’s Fund.

Whiteford, G., Townsend, E., & Hocking, C. (2000). Reflections on a renaissance of occupation. Canadian Journal of Occupational Therapy, 67, 61-69.

Wilcock, A. (1998). Reflections on doing, being and becoming. Canadian Journal of Occupational Therapy, 65, 248-256.

Zimmerman, D., Purdie, L., Davis, J., et Polatajko, H. (2006). Examining the face validity of the taxonomic code of occupational performance. Presented at the Thelma Cardwell research day, Faculty of Medicine, University of Toronto, ON, Canada. Retrieved from: http://www.ot.utoronto.ca/research/research_day/documents/rd_06_proceedings.pdf.

Position statements are on political, ethical and social issues that impact on client welfare, the profession of occupational therapy or CAOT. If they are to be distributed past two years of the publication date, please contact the Director of Professional Practice, CAOT National Office, CTTC Building, 3400-1125 Colonel By Drive, Ottawa, ON. K1S 5R1. Tel. (613) 523-2268 or e-mail: practice@caot.ca .