CAOT Position Statement
Access to Occupational Therapy (2008)

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The Canadian Association of Occupational Therapists (CAOT) advocates for equitable access to quality occupational therapy services for the health and well-being of the people of Canada. CAOT recognizes engagement in meaningful occupations is an important determinant of health. Through occupational therapy, Canadians are enabled to maximize their productivity, reduce lifestyle restrictions and avoid unnecessary dependency.

CAOT Initiatives
To advance access to quality occupational therapy services, CAOT will:

1. Promote the development and dissemination of research evidence and economic data that demonstrates the value of occupational therapy.
2. Develop and promote standards that advance excellence in occupational therapy education and practice in Canada.
3. Develop capacity of members for management and leadership positions and for innovative and cost-effective delivery of programs.
4. Work with university occupational therapy education programs in Canada to increase occupational therapy workforce supply and research capacity.
5. Participate in innovative projects to support inclusion of international graduates within the Canadian workforce.
6. Promote retention of the professional identity of occupational therapy leaders in sectors including management, policy development, education, research as well as clinical service.
7. Develop tools and resources and participate in advocacy activities to ensure optimal utilization of the occupational therapy workforce.
8. Partner with consumers, policy makers, researchers and other stakeholders to identify innovative solutions to address the barriers to accessing publicly and privately funded health services. For example, advocate for the repositioning of current policy priorities on wait times for medical procedures to perspectives more inclusive of other health issues; continue to develop and implement strategies to lobby insurance companies to include and expand coverage for occupational therapy services; work with provincial/territorial associations to target policy decision-makers at the provincial/territorial, regional and local levels to promote access to occupational therapy services; and promote workplace environments that foster interprofessional collaboration.

Recommendations for occupational therapists:

1. Articulate the costs and benefits of occupational therapy services in rational ways to be recognized as an essential and necessary health service in all Canadian communities.
2. Develop innovative models of service delivery and create powerful and reciprocal relationships and partnerships with public and private sector organizations that allow Canadians increased access to occupational therapy services.
3. Advocate for adequate funding, resources and support to allow occupational therapists to comply with professional standards for the practice of occupational therapy and the delivery of quality occupational therapy services to the Canadian public.
4. Utilize effective strategies to recruit and retain occupational therapy practitioners, particularly in under-serviced areas.
5. Educate the public regarding the role of occupational therapy in positively influencing occupational engagement.

Background
Research by the Canadian Policy Research Network identified vulnerable, at-risk and marginalized populations throughout Canada with health needs that go unmet (Hay, Varga-Toth & Hines, 2006). Health is largely dependent on how we work, learn, live, and play (Canadian Institute for Health Information [CIHI], 2006), in other words, by our participation in occupations of life. Many populations in Canada have limited or no access to opportunities to engage in meaningful occupations.

Occupational therapy services enable people to have the opportunities and resources to engage in occupations for their health, well-being and justice. Occupational therapists are the primary service providers for occupational therapy. Occupational therapists are regulated health professionals and university educated at the master’s degree level in Canada. The education of occupational therapists is devoted to the study of occupation and occupational engagement. As an expert in occupation, they understand the effects of factors such as disease and injury on the ability of individuals, groups and communities to engage in the occupations of life. Occupational therapists use evidence–based processes that focus on their clients goals to participate in valued activities (CAOT, 2007a; Townsend & Polatajko, 2007).

Current debate and dialogue in Canada on access to health care is primarily restricted to consideration of waiting times for access to certain diagnostic tests and medical interventions (e.g. joint replacements, cancer treatments). However people of all ages who are unable to access occupational therapy services may face unnecessary medical treatment, re-hospitalization, permanent unemployment, premature placement in long-term care facilities and even death. The costs to the individual and their families are great; the costs to society are felt in our already burdened health care system as well as in the social and economic fabric of our country.

Access to occupational therapy services is strongly shaped by Medicare coverage in Canada, as articulated in the Canada Health Act (Government of Canada, 1985). This act provides only for “medically necessary services” which are primarily physician-based.  Under this act, occupational therapy services may be provided as optional services in health facilities. With demand for health services continuing to exceed available funding now and in the future, the occupational therapy profession is challenged to reflect on how to finance service delivery in new and creative ways (Casey & Jongbloed, 2007). A 2007 CAOT Professional Issue Forum on Access to Occupational Therapy was therefore used to identify a number of strategies that could facilitate access to occupational therapy services by the Canadian people (CAOT, 2007b).
Access to needed health services is an issue for Canadians (Health Council of Canada, 2007). The research paper Towards a Broader Framework for Understanding Accessibility in Canadian Health Care attempts to broaden the definition of health care accessibility beyond wait times for medical interventions and procedures. It provides a preliminary framework for understanding the host of factors that affect Canadians’ ability to obtain a complete range of essential health services. It requires policy makers to address real problems with access to a range of services and service providers that are not part of current debate about wait times (Torgerson, Wortsman & McIntosh, 2006).

Primary health care renewal has focused on the redesign of the of the health delivery model from a single first-provider to an interprofessional team which would provide more comprehensive and client-centred care. While variations of team-based care are being introduced throughout Canada, most Canadians still do not receive health services in a team setting. Teamwork continues to be primarily a voluntary process throughout Canada (Health Council of Canada, 2007).

Canada is facing a skilled occupational therapy workforce shortage in both private and public services in several regions. For example, a recent report advises that the number of annual occupational therapy graduates should be doubled to 80 in order to address the current generalized shortage of occupational therapists in British Columbia (CAOT & British Columbia Society of Occupational Therapists, 2007). Increases in education capacity are also under consideration in provinces such as Alberta and Saskatchewan.  Quebec recently initiated two new university education programs to supplement the existing supply of occupational therapists. Governments have placed high priority on promoting workforce integration for international graduates that wish to practice occupational therapy in Canada.  CAOT has responded by undertaking a number of initiatives to work with occupational therapy partners to address barriers experienced by international graduates.

In 2007 the Canadian Institute for Health Information (CIHI) published the first annual version of Workforce Trends of Occupational Therapists in Canada that summarizes information from the Occupational Therapy Database (OTDB).  The OTDB is a comprehensive data source on the supply of the occupational therapy workforce in Canada and is intended for the use of all levels of government, researchers, stakeholders and occupational therapists. The presentation of clear, objective data and data analysis enables informed decision-making and supports policy formulation. In an analysis of this document and other recent occupational therapy workforce research, von Zweck (2008) confirms shortages currently exist throughout the country despite apparent underutilization of occupational therapists in Canada when compared with countries with similar health systems. CAOT, the Canadian Physiotherapy Association, and the Canadian Association of Speech-language Pathologists and Audiologists have been working together to obtain funding for the development of a caseload management framework. Ultimately, the outcomes generated by the application of the framework can be used for evidence-informed occupational therapy utilization and human resource planning (Management Dimensions & D. Parker Taillon and Associates, 2005).

The increasing lifespan of Canadians and the rise in numbers of people with disabilities will result in higher demand for occupational therapy services to enable people to do the activities that are important for them, or their occupations. The number of healthy seniors will increase by 2.6 million between 2001 and 2021 (Casey & Jongbloed, 2007). People 65 years and older are expected to seek health care services earlier and remain in care longer thereby utilizing a large proportion of the health care budget. Consumers of services will be increasingly egocentric, demand better timelines, choice and quality regarding service delivery, and be more open to trying complementary non-western approaches to health care (Pierre, Pollack & Fafard, 2007).

A study of Canadian health policies for Aboriginals, Canadian Forces, veterans, persons with disabilities, and policies addressing the growing incidence of obesity, reveals a number of current or emerging gaps in health programs such as occupational therapy services (Pierre, Pollack & Fafard, 2007). There appear to be opportunities to increase the number Aboriginal and non-Aboriginal health care providers in Aboriginal communities on reserves and to improve health care for urban Aboriginal populations; to make an economic case to the Canadian Forces to play a more central role in the delivery of health services to the Forces; to assist in facilitating the integration of veterans into society after service; to conduct research on the prevention of obesity and the optimum coping strategies for obese persons for every segment of the population across the entire lifespan; and to address the unmet needs of Canadians with disabilities regarding assistive devices and supports in the home, education and work spheres.

Occupational therapists may serve their clients by looking at how they can ethically and safely collaborate with various stakeholders (both public and private) in new ways to create powerful, reciprocal relationships that allow Canadians increased access to occupational therapy services (Casey and Jongbloed, 2007; Varga-Toth, 2007).  Increasingly such partnerships are dependent on demonstration of the economic value of occupational therapy service delivery. Documenting the costs and benefits of occupational therapy services requires articulating service outcomes in terms of cost and value-added components such as quality of life, increase in role contribution and or satisfaction, decrease caregiver stress, and effects on the Canadian economy (MacDonald, 2006).

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 (1997; 2002).  Enabling occupation: An occupational therapy perspective (Rev. ed.). Ottawa, ON: CAOT Publications ACE.

Canadian Association of Occupational Therapists (2007a). Report of the professional issue forum on Access to Occupational Therapy.  Retrieved on April 28, 2008 from http://www.caot.ca/default.asp?pageid=2159.

Canadian Association of Occupational Therapists (2007b). The Profile of Occupational Therapy Practice in Occupational Therapy: Occupational Therapists. Retrieved on April 16, 2008 from http://www.caot.ca/default.asp?pageid=36

Canadian Association of Occupational Therapists and British Columbia Society of Occupational Therapists. (2007). Addressing the occupational therapy shortage in British Columbia. Ottawa/Vancouver: Authors. Retrieved April 27, 2008 from http://www.caot.ca/pdfs/shortage%20of%20Ots.pdf

Canadian Institute for Health Information (2007). Workforce trends of occupational therapists in Canada, 2006. Retrieved on April 28, 2008 from http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_1809_E&cw_topic=1809

Canadian Institute for Health Information (2006). Canadian population health initiative action plan 2007-2010. Ottawa, ON: Canadian Institute for Health Information.  Retrieved on April 28, 2008 from http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=GR_1608_E

Casey, R. & Jongbloed, L. (2007). Access to occupational therapy services in Canada. Retrieved on April 27, 2008 from http://www.caot.ca/default.asp?pageid=2152

Government of Canada (1985). Canada Health Act. Retrieved April 16, 2008 from http://www.hc-sc.gc.ca/ahc-asc/media/nr-cp/2002/2002_care-soinsbk4_e.html

Hay, D., Varga-Toth, J., & Hines, E. (2006). Frontline health care in Canada: Innovations in delivering services to vulnerable populations. Ottawa, ON: Canadian Policy Research Networks. Retrieved on April 27, 2008 from www.CPRN.org.

Health Council of Canada (2007). Health renewal in Canada: Measuring up. Retrieved on April 28, 2008 from http://www.healthcouncilcanada.ca/en/index.php?option=com_content&task=view&id=136&Itemid=115

MacDonald, D. (2006). Economic evaluation of occupational therapy. Retrieved on April 27, 2008 from http://www.caot.ca/default.asp?pageid=2150.

Management Dimensions & D. Parker Taillon and Associates (2005). Toward best practices for caseload assignment and management for occupational therapy in Canada: Final report. Ottawa: CAOT Publications ACE. Retrieved on April 27, 2008 from http://www.caot.ca/pdfs/CAOT_CASELOAD_MANAGEMENT_REPORT.pdf

Pierre, N., Pollack, N., & Fafard, P. (2007). Health policies and trends for selected target groups in Canada: An overview report for the Canadian Association of Occupational Therapists. Retrieved on April 28, 2008 from http://www.caot.ca/default.asp?pageid=2203

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.

Torgerson, R., Wortsman A., & McIntosh, T. (2006).  Towards a broader framework for understanding accessibility in Canadian health care. Prepared for the Canadian Nurses Association. Ottawa: Canadian Policy Research Network. Retrieved on April 28, 2008 from http://www.cprn.org/doc.cfm?doc=1434&l=en

Townsend, E., & Polatajko, H. (2007). Enabling occupation II: Advancing an occupational therapy vision for health, well-being & justice through occupation. Ottawa, ON: CAOT Publications ACE.

Varga-Toth, J. (2007). Frontline health care in Canada: Innovations in delivering services to vulnerable populations. Presentation to the Canadian Association of Occupational Therapist Professional Issue Forum on Access to Occupational Therapy. Retrieved on April 27, 2008 from http://www.caot.ca/default.asp?pageid=2159

von Zweck, C. (2008). The occupational therapy workforce in Canada: A review of available data. Occupational Therapy Now, 10(2), 3-6.

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 March 28, 2007 at: 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.

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