proceedings today so thank you honored colleagues and friends on behalf of the Canadian Association of occupational therapists it’s my privilege to welcome you to the mural driver lecture and the awards ceremony set the plumie Deal Association can at the end echo Triplett Underland is similar and tanka conference yeah dude this commemorative mural driver Supriya Cannella contribution exceptional the individual or sandela profession it only demands that de la rochelle de los animal and de la practica that a legal therapy the award was named in the memory of muriel driver a pioneer of occupational therapy who served in the Royal Canadian Army Medical Corps and was posted to Europe during the Second World War she was the first occupational therapist to work at the Hamilton military hospital and she organized the first department of occupational therapy at Runnymede Hospital in Toronto Muriel drivers outstanding contribution exemplifies the highest qualities of our profession this afternoon by awarding our highest distinction to a most esteemed colleague we hope to honor the memory of Muriel driver and her work to champion the occupational therapy profession today’s Muriel driver lecturer dr. Barney Kirsch walks not only in the footsteps of Muriel driver but also in the footsteps of the previous Award winners I invite the past Muriel driver lectures to join me on stage and be recognized please come on stage when I call your name from 2013 Claire Jean – blows 2012 Juliet Archie Cooper 2011 Lori let’s 2008 Terry Krupa 2007 Mary Aiken 2004 Katherine Bachman 2003 Judith friedlin 1994 hit get the car 1993 Liz Townsend 1992 Helen Politico 1989 Margaret Thompson we had a couple others who were with us but I’m not sure they’re here today 1988 sue Baptiste in 1985 Sharon Breton all please around applause for our Cinco I invite Judith friedlin and terry crouppen on the stage as they have done to introduce this year’s honoree well it’s with very great pleasure can you hear me with very great pleasure that terry crouppen and i introduce Bonnie Kirsch like Muriel Driver herself Bonnie’s enthusiasm for occupational therapy has inspired students and colleagues alike for over three decades bonnie has made an outstanding contribution to our profession through research education and the practice of occupational therapy particularly in the field of mental health her contribution comes at a time when the entire country is realizing the need for a better understanding of mental health and when we as a profession are seeing the strong role that occupational therapy can play so let me tell you a little bit about Bonnie and how she got to where she is now as a child as a child bonnie was undeniably cute even eager but you will agree that she showed very few signs at least in this photo of the scholar that she would later become bonnie attended elementary school and high school in

Toronto and in her teens she certainly seems to have known how to have fun however late blame your husband don’t blame me okay however she could also be a sullen teenager when that seemed more appropriate with those ten years ending it was time to settle down a little at least enough to get through the OT program at U of T and here she is in her charming uniform during those school years with Linda Cali oh and I want you to remember this uniform after graduating in 1977 Bonnie went directly into practice and mental health and if you ask her why she went into mental health she’ll tell you that she can pinpoint the moment she had intended as so many of us have to go and do Peas and I think we a lot of us started out that way myself included but well on a placement in the safe department at the Toronto General Hospital she had something of an epiphany her supervisor the late Joanne Fleagle Greenham asked her to interview a university student who had a significant mental health mental illness bonnie became fascinated then with the idea that her own life and that of her peers was so similar in so many ways and yet so significantly an unhappily different her first job after graduation was at the clark institute of psychiatry in toronto in general psychiatry and on the affective disorders unit after two years she moved to a position in the work adjustment program and it must have been there that she found her niche in the world of workplace accommodations for people with mental health issues she became aware then of the work that was waiting to be done and still waiting she knew that there was much more to be known meanwhile Barney the latent scholar was starting to show up and she returned to university for an M ed degree she took a summer course credit in Israel which included studying different cultures and part of the program was living with Bedouin in the desert you can see Barney there as you can see Bonnie enjoyed that experience too during that same summer romance was brewing and by 1983 Barney and John married jon hamm of it in the 25 years or so that I’ve known Bonnie I don’t ever remember seeing her with curly hair but there she is three amazing children followed thereafter Adam Maya and Emily and it’s wonderful for us to have the whole family here with us today from 1985 to 1989 Bonnie worked at Khoda that wonderful home that had appeared for the many oaties who wanted to work part-time she then began working at Queen Street mental health center and at the same time took on the role of clinical associate at U of T that role involved teaching in our department and Bonnie was likely warming up then to the idea that maybe being an academic might suit her well after serving for a year as the director of rehab at Queen Street she came to us at U of T full-time I think this is from about that time Barney but I’m not sure I was the director of our department then and I guess I must have hired her so I take some of them it was at that time that I felt I needed someone to take over what had been my teaching area in mental health and I must have thought I was dreaming when Bonnie agreed she had a perfect clinical background for us she had already been providing some teaching and group facilitation in her role as a clinical associate and she had an a med degree which in those days was big stuff she couldn’t have been more qualified for the position so my course was in good hands indeed but as anyone in our profession knows learning never ends and there seems to be a constant need for upgrading and bonnie was no different in that respect she wanted to enter a ph.d program but needed a qualifying research paper prior to acceptance I had the pleasure of supervising her work at that time and I remember being impressed with her knowledge and passion for her topic the topic for that paper was influences on the process of work reintegration the consumer perspective it was evident then that she was a hard worker and a critical thinker she could think conceptually while also thinking about the practical application of her work

and that is pretty much how bonnie is she identifies problems and rigorously seeks solutions the title of her doctoral dissertation is further evidence of that approach and also signaled the work to come the title was factors associated with work in two for mental health consumers bonnie completed her PhD in 1999 and that same year moved from the tutor stream into the professorial stream at U of T and in 2001 she was offered a tenure-track position she currently holds the rank of associate professor in OSN ot and has crossed a point that pointed to the department of psychiatry and the rehab Sciences Institute she is also an adjunct professor at Dalhousie and an adjunct scientist at the Institute for work in health through it all bonnie has maintained her pride in OT and I might add her sense of fashion more remarkable of course is that she could fit into the same that uniform and probably still could I’m afraid so well I’ve now brought you up to date from the beginning of for the beginning of the more serious stuff which Terry’s going to provide I will end my part by saying that Bonnie’s many friends and colleagues and her family I’m quite sure see her is quite an amazing individual she’s very down-to-earth compassionate and generous she gives everyone social support of all types instrumental informational emotional as needed she does her share of service work and then some at our school and in the community she lends her expertise to a great number of committees and is an exceptional citizen she provides countless hours to the Canadian Mental Health Association where she’s been a member for many years in the department we’ve also been the recipients of her great skill at hosting a party helped by John for sure everyone feels a very warm welcome and I’m going to end there and pass you over to Tara hi everybody so as Judy mentioned I get the honor of presenting the serious side of Bonnie the scholar always remembering there’s always with a hint of fun that we see there and you know just by a quick look at her CV it would be easy to convince you of her contributions to the knowledge base of our profession and also to the health and social sector more generally just using some typical metrics that anybody in the research field and the scholarly field knows so first of all she’s been the recipient of over 26 million dollars in research funding either as a PI or Co I I know I added it out 26 million sperm Arkell many of those grants are from very prestigious and competitive tri-council federal funding agencies like shirk and CIHR sort of the holy grail of research funding for researchers she is more than 70 publications and peer-reviewed journals a book that we joke about impress many book chapters and non peer-reviewed articles and well well over a hundred presentations or papers delivered at scientific meetings and conferences both nationally and internationally but those metrics impressive as they are they don’t really tell you the exact nature of her contributions and how she significantly advanced the knowledge base of our particular field and beyond so while her research and scholarly interests have spanned several topics the main focus of her work that I’m going to talk about today is her work on developing the knowledge base related to work workers and workplaces particularly as they apply to disability with a special but by no means exclusive focus on mental health and mental illness within that focus her work has covered an amazing amount of ground tackling this very challenging area from a variety of perspectives and providing us with an in-depth understanding of the range of factors and forces that have historically served to compromise and marginalize people with disabilities generally and people with mental illness very specifically compromising their ability to access sustain and enjoy the benefits of employment and work-related rules and just as important it’s contributed to I understand as how as occupational therapists we can move this forward to change that situation so in this presentation I want to give you just a little bit of an overview of some of these different areas the first and perhaps her earliest kind of interest was in the area of organizational culture and climate and other workplace factors that impact work experiences and outcomes in relation to disability and I would hazard a guess that she’s within the top two experts in

this area in the country she might argue with me but I’m convinced of it she’s explored policy oh I’m sorry I don’t know why that happened it didn’t happen on my computer policy level factors influencing the work-related activities of people with disability she’s well known for her work on the lived experiences of injured workers or those marginalized from workplace in the context of disability and if I could direct you to anything she’s written it would be this area because I think she showed us the empathy that’s needed to understand the situation that people find themselves in when they find themselves out of work at with injury or other areas she’s contributed to understanding about how stigma and discrimination evolves and is expressed in the work context an intervention approaches to improve inclusion she’s done a remarkable amount of work defining the characteristics of programs and services that improve employment prospects and outcomes and is is well known internationally for her work in this area in fact I’d say she’s within the top two and supported employment in our country she’s advanced the conceptual frameworks that can integrate a broad range of perspectives on work and disability and suggests potential intervention approaches and strategies and a blast but by no means least she’s shown us the relevance and contributions of occupational therapy in this field and suggested to us how we can contribute continue to contribute now Bonnie’s skill and acumen as a scholar and research in her own area of focus is well-known beyond our own discipline and in fact it’s interesting I was talking with Helen politic oh yes we were commenting and saying how she’s so well-known in other areas we’re not even sure that you know her as well in occupational therapy and in those fields she’s very highly recognized Judy mentioned that she’s had six years as an adjective with the Institute for health and work she was appointed by that organization as an educationally influenced influential member of a profession meaning that she was selected as an individual in recognition of her potential to apply research evidence into practice and to help other researchers and practitioners learn from that evidence she was appointed to the workplace Advisory Committee of the Mental Health Commission of Canada and it’s noteworthy she was the only ot in the country that was asked to contribute on any of the mental health Commission’s foundational structures she was a lead investigator in the Commission’s efforts to address the employment needs that people with serious mental illness who despite their aspirations to work are marginalised from the community work force she’s a one of their PI’s and the Commission’s opening minds initiative which focuses on workplace interventions to reduce stigma and discrimination nationally and overall this is work that has led her to being sought out as the public voice for workplace mental health and there she is with Steve Paikin I don’t know if you caught that but it was a proud moment now finally when I was preparing for telling you about her as a scholar I thought jeez I’d like to go back to some of the researchers outside of ot that have worked with her to hear from them in terms of what they would tell you about her qualities and here’s what I heard bonnie is brave she’s not afraid to pursue good ideas that may be difficult to achieve bonnie is an astute researcher always with a good understanding of a situation in Ackman for solutions never first full but firm and fair she’s the thoughtful approaches to issues and her sound judgment is good when we’re working on the fringes of new problems Barney brings some Sarah to everything she does the kindness that is always in her eyes and voice for colleagues and her students an incredible respect for students a dedicated approach to including them in all her work she’s sure to leave a legacy in our profession with this and my favorite quote that I think absolutely sums up with those of us who have worked with Barney no it’s the belief and hope she inspires in all of us who know her belief in hope that with the right amount and type of support people who face many challenges can live immensely fulfilling lives and with that it’s my honor to turn the podium over to this year’s Muriel Driver lecture Barney Kirsch well thank you doesn’t say it but thank

you so much Judy and Terry I’m so fortunate to be introduced by the two of you my very dear colleague and friends and of course mural driver recipients themselves they have set the bar very high for me and I count myself very lucky to have had them so close by my side all these years so thank you I’m very honored to be delivering this year’s Muriel driver lecture I would like to thank my colleagues at the University of Toronto and across the country who have inspired me as well as my current and former students from whom I have learned so much just sweets phazon okay to put on say the of Muriel driver should chant FMF ceated mate colleague to the University to Toronto it’s fair to payee team on SP Fame as Sica to may say to John actually ancien to Keyshia beaucoup Oakley and of course I could not have done this without the support of my family sitting in front of me here to cheer me on my wonderful husband John and my three fantastic kids out of Maya and Emily thank you all messia too for some time now occupational scientists and occupational therapists have been reflecting on how we can become a more socially and politically responsible discipline occupational scientists and therapists in Canada and globally have pointed to in Justice’s underlying occupational deprivation that are in need of our attention and action and have called for occupational therapy to take up politically informed transformative approaches this year’s conference themed occupational justice rising to the challenge is a perfect opportunity to reflect on how far we have come and where we might go in enacting our collective commitment to furthering social justice human rights and occupational opportunities for all it’s a chance to examine systemic advocacy as a way of expressing our moral identity I come to this topic after reflecting on my own work in the advocacy and policy arena for most of my career I was not particularly active in this area I simply wanted to help people who were marginalised from mainstream society find their place in the world and flourished through meaningful occupation I did not anticipate how this goal would grow into a larger calling as I witnessed the hardships confronting the people I worked with the barriers that needed to be overcome the issues that not only complicated their lives but challenged the work we did together I started to cast my gaze to the larger system and began stepping into new arenas that could influence how things worked boards of community mental health programs government Task Forces on mental health reform knowledge translation networks that aim to move research into practice and participatory action research most recently my work with the Mental Health Commission of Canada was an opportunity to influence policy and system development on a large scale culminating in the development of a national standard for psychological safety in the workplace and a desperately needed national strategy for mental health in our country with Canada being the last of all g8 nations to accept one I tell you all of this because I now realize that my mission as an occupational therapist and scientist to enable and enhance the occupational lives of people living with illness or disability did not start out with the social justice and advocacy agenda not on a system or policy level at least I grew into this set of activities rather slowly and quietly because it was necessary to do the things that I set out to do in my mind the goal of occupational fulfillment not only for the group I aim to help but for my own professional self could not be met in any other way I believe now that advocacy is a professional imperative for occupational therapy in this lecture I provide an arc argument for the need to integrate advocacy and social justice into ot identity and discuss why we should advocate at political and public levels I argue that the dominant individualist perspective is just too narrow and inadequate to meet our mission of meaningful occupation for all I begin by

looking at the challenges we face in moving beyond an individualist perspective I then discuss reasons for adopting a socio-political approach and I then examine advocacy as a professional imperative I provide a framework for advocacy and situate examples within it exemplifying how OTS can contribute to social justice through advocating for occupational rights and opportunities in developing our science and furthering our evidence-based practices we have focused primarily on individuals and their occupational performance perhaps it is our complete and undying commitment to client centeredness that has anchored us here at a place where individuals lives can be made meaningful through attending to their dreams and goals regarding what they do our emphasis on the subjective experience of the people we serve allows us to do the important work of finding meaning through doing but at the same time in large measure it maintains our science and our practice at the level of the individual and overshadows the social and structural roots of occupational injustice this is not to say that we and occupational therapy are not concerned with environments in which occupations are situated almost 25 years ago Mary law pointed to inequities of the opportunity posed by environmental barriers and called for OTS to change disabling environments while OTS have made considerable gains in addressing physical environments there’s been much less attention paid to the social economic political legal or institutional elements of the environment that afford or prohibit occupational possibilities only in the last few years have we started to show our concern for issues of inequitable environmental constraints of this nature my search of the last 10 years of the Canadian Journal of occupational therapy a journal that reflects our country’s most salient ot issues revealed several articles in recent years that targeted the social and cultural environment from pole gars called to enabling community mobility at a societal level two reads letter to the editor describing a culture that promotes risk in sport to began’s insights on the impact of racism on the occupations of African Canadian women these papers and others encourage us to expand our traditional conceptualizations of the environment beyond the physical and beyond the immediate context in which individuals carry out their daily occupations to address the larger social institutional and political ones that determine Occupational restrictions and possibilities the heightening sensibility around our commitment to social and occupational justice has fueled the dilemma of how to balance our work between helping individuals who are facing disruptions in their occupational lives and addressing systems and structures that prevent them from moving forward it has highlighted the schism between the theoretical commitment of occupational therapy which calls for increased work with communities and societies and its practice which grapples with how to enable occupation at these levels concomitant Lee the controversy over individual versus social responsibility for health productivity civic engagement and occupational fulfillment is playing out in our society and this furthers tensions around how and where to direct our efforts to best meet our goal of enabling occupation and social inclusion for all Minkler describes the same dilemma in the area of Public Health she refers to this tension as responsibility versus responsibility in other words she says the focus on personal behavior change and individual responsibility is often not accompanied by attention to challenges posed by the larger context that affect the capacity of individuals and communities to fulfill their needs and build on strengths here capacity refers not to the person’s abilities but rather the freedoms resources or opportunities to enact those abilities and strengths oftentimes oaties may feel trapped and helpless in dealing with the larger structural issues that affect the occupational lives of the people they serve recently I spent some time in the United States at a top tier University OT program and became familiar with the remarkable work that they do in the area

of homelessness the men’s shelter across the street from the OT school was a much sought after student placement and the important work done within it resulted in some impressive outcomes an increased sense of community amongst the residents a positive and hopeful climate that was almost palpable within the environment improvements in social skills optimism and self-esteem amongst the shelter’s residents but the OTS were unable they told me to provide what was really needed and that was an evidence-based housing first approach shown to be most effective in helping homeless individuals move on with their lives this recovery oriented approach quickly moves people experiencing homelessness into independent and permanent housing and then provides additional supports so they can engage in and succeed carrying out their chosen occupational roles but here’s the catch housing first relies on the availability of affordable and accessible housing and more often than not there is little to none available so o T’s do what they can within these constraints faced with the overwhelming and long-term task of advocating for more housing they work with individuals and groups within the context that comprise the current reality let me qualify this by saying that some wonderful work with housing first is being done by OTS here in Canada but the fact remains that the number of people on the streets and in shelters keeps growing and most people experiencing homelessness have no access to it at all a recent report the state of homelessness in Canada written by gates and colleagues put the problem right in our laps it said in a country as prosperous as Canada with a broadly shared and strong commitment to social justice there is no need to accept or tolerate the experiences of poverty hardship and homelessness here I interpret the meaning of the word poverty to be consistent with recent notions of social exclusion which see poverty not only as economic poverty but also poverty of aspiration poverty of participation or if you will poverty of occupation this quote causes us to question whether we have accepted the unacceptable whether we’ve been swept away by the dominant thinking and economic models of our time can we should we be doing more to combat such hardship the obvious answer would be yes but before we go down that road I’d like to explore some of the challenges we face with regard to advocacy inaction in the realm of social change so we’re aware of what we need to overcome one barrier that impedes our shift from an individual to a societal approach is the enormity of the issues that we must face if we decide to take on this calling poverty discrimination exploitation homelessness abuse powerlessness social exclusion inaccessible inequitable or underfunded services these are indeed daunting problems to address Australian occupational scientists Wix and Jamison referred to such complex social and environmental problems as wicked problems because they defy all the usual attempts to solve them and any seemingly clear solution could create more issues many in our field might argue that such wicked problems are beyond our scope of practice that we don’t have the power or political savvy to enact meaningful structural change that we weren’t trained to influence policy or politics that we will lose our focus on occupation and simply blend in with the ranks of others fighting for change that there is much work to do for individuals with illnesses and disabilities so how can we do it all in this talk I’ll be making the case that if we don’t attend to these wicked problems we really won’t be able to achieve our goals with the individuals or groups that we serve furthermore there is support to go forward with this mission the policies and position statements we have to guide us as OTS include a focus on social and occupational justice at a high level our national CA ot guidelines identify enabling social change as a collective form of occupational therapy and the World Federation of occupational therapists position statement on human rights identifies two of the major tasks to be taken up by occupational therapy as accepting professional responsibility to identify and address occupational in Justices and raising collective awareness of occupation and

participation in society as a right we need to decide if we as OTS wish to be agents of social transformation by expanding the boundaries of our professional practice in new and challenging areas a second challenge to becoming a more socially and politically engaged fashion has been noted by occupational science and occupational therapy scholars who have examined our practice from a critical lens they’ve pointed out that the social vision of ot has been narrowed by the need to comply with particular managerial approaches to the health professions and with medical approaches to health disability and well-being in particular in her text good intentions overruled Townsend highlighted how we as OTS on the one hand promote empowerment for marginalized people in groups and on the other hand have those efforts undermined by predominant institutional forces such as a concern for accountability budgeting and hierarchical decision-making external structures can narrow our focus as the overrule both personal and professional values and intentions and stifle advocacy objectives in our field power dynamics are organized in such a way that biomedical principles have long been privileged although the situation is changing we have been in the words of lomez colonized by the individualist ethics of medicine and economics and this is obstructed social and political change this theme has echoed through the last several decades across various practice contexts as far back as the late 80s Michaelis pointed out that conflicting power dynamics may push socially committed occupational therapists to the margins in the same way that the communities within which they work are disenfranchised a third force promoting an individualist Pro individualistic approach in our field as opposed to a social or structural one is our current political climate of neoliberalism within our neoliberal context social issues are configured as individual problems and responsibilities and independence and self-sufficiency are upheld as prime values our current government has conveyed the message that problems of oppression and exclusion are not social phenomena but rather individual acts take for example our prime minister’s comments in response to the death of Tina Fontaine a First Nations girl whose murder sparked calls for an inquiry into Canada’s missing and murdered Aboriginal women and girls harper argued that an inquiry was not needed because this is not a quote sociological phenomenon but simply a series of individual crimes in the absence of a broader sociological analysis structural and justices are not addressed and governments are allowed to recede from responsibility as problems and solutions are seen to lie outside the state’s domain while the impact of neoliberal values has been well explicate ‘add in the social policy literature it has only begun to gain attention in occupational science and therapy la liberté Redmond described the way in which we individualized the social and articulated her concerns that this obscures the economic political and other social factors that shape inequities in occupational opportunities Kurtz and colleagues demonstrated how neoliberal principles which valorize self-sufficiency become embedded into disability support programs and influencer service providers to intervene in ways that place responsibility for work and economic survival on the individual this neoliberal political frame shapes the institutions in which we practice the discourse in which we participate and the priorities we set by painting social problems as individual ones it minimizes the sense of social responsibility that we need to address structural barriers to occupation I argue that the dominant individualist perspective is too narrow and inadequate to meet our mission of meaningful occupation for all as it fails to promote an understanding of institutional and systemic inequality that governs people’s occupational lives we need to adopt a broader socio-political approach for at least three reasons one occupation is not an individual issue as occupational therapist Dicky and colleague state occupational science is

not served well by definitions of occupation that focus investigation and interpretation almost entirely on individual experience and indeed occupation rarely if ever is individual in nature occupation is not individual because it’s situated in communities institutions and societies and as such is governed by the policy systems and culture of which they are part our recent research with students experiencing mental health problems in the university setting points to how an meshed occupation is with prevailing discourses and institutional and social structures although the students worked hard to manage their mental health using evidence-based techniques such as mindfulness medication physical exercise and energy conservation they still faced poor academic outcomes often sacrificing hopes for their futures because of the institutional culture and policies that govern their work caught within a culture of intense competition these students simply by virtue of being University students were expected to do what they needed to do to succeed one of our doctoral students ruler mark lacus studied the social relations governing university students with mental health problems and revealed that although accommodations are available these accommodations are individual arrangements that provides solutions to problems for individual students but do not in and of themselves create an accessible institution indeed she found that the ablest assumptions underlying the complex accommodation system served to weed out the most mentally unwell the system actually created difficulties for the very students it was meant to assist this is one example that shows us how vulnerable individuals get cut off from their desired occupations by policies processes and cultures that are embedded into institutions it highlights that indeed occupations are not individual a second reason for adopting a more socially focused approach to enabling occupation is the importance at home holds for health and occupational well-being a useful framework to adopt in this regard is Lincoln falen’s fundamental cause theory which is rooted in the field of Public Health Lincoln Phelan critiqued epidemiological work for focusing too much on individual factors or what they called proximate causes of disease such as diet lack of exercise and other forms of self care and not attending enough to social factors or more distal causes they theorized that it’s these distal social factors that are the fundamental causes of ill health they come to this conclusion based on the persistent Association of such social factors as socioeconomic status with disease and mortality across time and contexts indeed as we know socio-economic inequalities in health and mortality are very large very robust and very well documented even when mechanisms to reduce health inequities are put into place universal health care for example the relationship between poverty and poor health persists Lincoln falen were determined to understand why conditions that should eliminate or reduce inequities seem not to their theory of fundamental causes explains that the reason for such persistent associations is that social causes involve access to resources that can be used to avoid risks or minimize negative consequences with many health conditions or vulnerabilities these resources include money knowledge power prestige and interpersonal resources that are embodied in social supports and social networks these social and economic resources offer advantage to health and well-being and can be used in different ways different situations they are transportable so the association between a social condition and health will endure while the fundamental causes explanation that Lincoln Phelan proposed has been used primarily to explain health outcomes it’s a useful framework to examine social and occupational process as well in my work I see that much of what we do is that what Lincoln Phelan determined the proximate level in the area of mental health we’ve worked hard to improve employment amongst people with mental illnesses and we have made progress in some areas we now think about work as a right and a possibility and we address it as a central focus of our work with people living with serious

mental illness but unemployment is still dismal ‘high for this group the highest of any disability group even newer evidence based models such as supported employment which have improved employment rates when and where they are used rarely pull people out of poverty our focus on proximate factors individual skill building vocational planning job training and connection to mental health treatment is not going far enough this is because there are much larger distal courses that play fundamental social causes as Lincoln falen would turn them research has shown that although there are individual level factors that affect employment the most pernicious impediments have been found to be rooted in stigma government policies that disincentivize work poverty and other social and economic realities these are the fundamental social causes that form the bedrock realities that undergird all else when we create programs that focus on individual capacity factors without accounting for social disadvantage social problems become erroneously constructed as individual problems and what results is the creation of overly simple interventions and prop and policies to address complex phenomena if we want to succeed at the individual level we will need to find innovative ways to address these fundamental causes a third argument for working at a social institutional and political level is based on rights rather than health Ignatieff in his Massey lecture the rights revolution argues that humans have a longing to live in a fair world and that rights give legal meaning to the values we care about dignity equality and respect the rights revolution as he calls it is about enhancing our right to be equal while protecting our right to be different the Canadian dream of social decency has positioned our country as one of the most distinctive rights cultures in the world and OTS hold an important place within it as OTS we believe in the right of all people to engage in meaningful occupations that contribute positively to their own well-being and the well-being of their communities but who benefits in society who has access to occupations that create the fabric of a good life has much to do with power power powerful members of society’s dominant group take for granted the social policies of which they are beneficiaries while rights are denied to millions of people who are marginalized based on their ability health status race sexual orientation age gender etc they experience discrimination on a daily basis with respect to education housing employment transportation and social participation engagement in occupation thus becomes a political issue occupational scientists Pereira whiteford and earlier this week Hawking for example have implored us to critically interrogate societal influences on occupation and participation to reveal inequities produced through the taken-for-granted ways in which institutions and society as a whole are structured scholarship in the field is growing around this issue but as occupational therapists Fleming Cottrell State’s occupational therapists have historically shown limited response to entrenched societal constraints and discriminatory policies I contend that if occupational justice and social inclusion are our goals we must not only analyze and critique the social institutional economic and political constraints that impede people’s ability to participate in their communities we must also take steps to dismantle them for occupational therapy to become a profession committed to attaining occupational rights we will require political engagement with those issues that limit people’s equitable opportunities and resources we must become more assertive about transforming our values and beliefs into action with this mission in mind advocacy takes center stage if we are to adopt a practice grounded in inclusiveness that promotes universal access and equity as a mode of thinking a therapeutic tool and an ethical responsibility then advocacy must be an essential component advocacy has the capacity to bridge the gap between social forces and individual experiences and between the world of policy makers and the lives of our clients advocacy work can take place at the level of cases or causes case

advocacy involves representing vulnerable individuals and groups with the aim of promoting the rights and opportunities cause advocacy acknowledges that structural factors need to be addressed to create occupational opportunities for all in OT we most often often operationalize advocacy at the level of cases Dylan and Kali studied how and why oh D s are involved in advocacy and found that most often occupational therapists advocate for individual clients on a case-by-case basis as part of their client-centered practice rather than creating change at the level of social policy and political action there is a CA ot definition of advocacy that moves us towards the level of causes it states that advocacy is a political process performed by an individual or group that aims to info public policy and resource allocation decisions within political economic social systems and institutions the very existence of a definition of this nature suggests that we are well positioned to be facilitating change at the level of organizations systems and society moving into the realm of advocacy in this larger sense involves speaking out against in inequity and inequality mobilizing evidence to influence policy and practice and participating directly and indirectly in political and institutional processes historically there is some fine examples of ot advocacy as a means of translating our core values into socio-political action in the u.s. occupational therapist Beatrice Wade worked with veterans groups to amend the 1920 Vocational Rehabilitation Act because it excluded persons with mental illnesses their efforts were finally successful over a decade later when President Franklin D Roosevelt signed an amendment to public law 113 extending vocational rehab benefits to veterans with mental illness American occupational therapist Flemming Cottrell writes about weight describing her as a classic example of an occupational therapist dedicated to our professions holistic roots and involved in social change however Flemming Cottrell goes on to lament that few in the profession have followed in her footsteps occupational therapists have the capacity to influence political and institutional agendas and chip away at the fundamental social causes of occupational deprivation but to do so we need to build our capacity to effectively navigate the challenging terrain of advocacy I turn now to a framework adapted from Dorfman and colleagues who developed it as part of an advocacy training program to help health practitioners and community leaders become active in local state and national policy the framework provides a way to visualize and understand and the components of advocacy and how they work together it shows us that there are many steps and strategies that can promote change as well as a variety of places where advocacy decisions are made ot is wishing to take up the role of advocate may employ some or all of the elements of the model the place to begin of course is identifying the problem and providing evidence of it this is what will establish its importance in the minds of the public and policy makers it’s important to become well-versed in few points on all sides of the issue in order to give a complete and accurate picture research stories and voices of those impacted by the problem are needed to substantiate it however experts in designing healthy public policy point out that while necessary evidence alone is rarely sufficient for influencing policy processes as policy decisions are often not based on research an important part of the advocacy process is building support community development and coalition building our discipline has cultivated a strong practice and research base in Community Development there are many examples and principles that focus on how occupational therapists can and do partner with communities in addressing their needs Lochner and colleagues describe community development as a multi-layered community driven process in which relationships are developed and the community’s capacity is strengthened in order to effect social change in Community Development power relationships are closely attended to so there is shared accountability and responsibility this approach is

consistent with oaties belief in participation and power sharing it’s important to have a plan with goals and strategies this will be the roadmap of the steps to be taken along the way the plan will need to develop a clear strategy based on the chosen forum and needs to consider the resources available the plan will inevitably change along the way another important component of advocacy is communicating the message well to inform the public and decision-makers the message needs to convey the importance of the issue based on accurate information and a well reasoned analysis it needs to reach the right audience tell a simple and compelling story and connect to the well beings of community and society sometimes direct group action for example protests can focus focus public attention on an issue in addition to deciding on these actions for change the place where changes to be made must be targeted it could be government agencies or the legislature health care institutions the courts profit or not-for-profit organizations voters or a combination of several these steps carefully considered can lead to solutions for change I’d like to share an example of advocacy by telling you about how of us work to change conditions for injured workers in Ontario for some time injured workers had been struggling to have their voices heard because they felt they were unjustly treated by the workers compensation system and by society at large they found themselves not only struggling with an injury that rendered them unemployed they often found themselves facing poverty poor physical health poor mental health and negative attitudes from others several years ago a group of injured worker representatives and researchers came together to explore the plight of injured workers in Ontario with the aim of creating some real change in the system we began as the model suggests by identifying the problem and gathering evidence the problem as told to us by injured workers was that widespread suspicion and stigma were embedded in workplaces the health care system and the work played Orcas compensation system this created anger a diminished sense of social status and barriers to health recovery and return to work as one injured worker put it they know how to instill fear in the person that’s injured you’re already injured so your defenses are down you’re now backed into a corner you feel like you’re alone and you have no recourse and it’s a rotten position to be in international research on the topic was consistent it pointed to stereotypes that painted all injured workers as fraud artists abusing the system as well as institutionally embedded expectations that injured workers will violate or abuse entitlements we went on to building support community development and forming coalition’s we were fortunate to receive funding and this enabled us to develop an infrastructure for research in action we called ourselves RAC we research Action Alliance on the consequences of work injury co-leading the project were an academic and a community member who was active in the injured worker community we recruited injured workers to become researchers on the project we partnered with injured worker organisations we engaged other stakeholders people heard about rock we and came with their stories their energy and their readiness to work hard on the cause as our work developed we communicated our messages to multiple audiences of course there were the usual academic articles and Conference presentations but there was so much more an injured workers speaker’s school was started where injured workers learned to convey their messages to the public or in the words of one of the organizers injured workers practice moving from venting to convincing they not only told their personal stories but learn to frame them in a larger political context in which they were able to express and defend their rights this is a photograph taken on one graduation evening of the speaker’s school it was a terrible snowstorm when everyone was off the streets except this group the speeches were gripping another way of communicating the message was a play titled easy money which was based on research by some of our team members Joe Nikken Ellen make–can and Judy Clarke as the title suggests the play took a satirical look at the misperception that injured workers prefer to rely on workers compensation as a source of easy money rather than to work for a living written and directed by Kate letting

ttan actors portrayed the frustration that many injured workers experienced we also held a symposium and invited the then Minister of Labour the Honourable Linda Jeffery to deliver closing remarks she did at the same time there was direct action for years there’s been an annual injured workers day during which there’s always a rally at Queen’s Park injured workers and others from our group attended we targeted the workers safety and insurance board as the specific place to make change the WSIB administers the provinces no-fault workplace insurance for employers and their workers providing disability benefits for workers injured or made ill on the job many of our participants and research partners had shared stories about the systemic discrimination they encounter there and the barriers they experienced in trying to return to work he can describe the discourse of abuse that pervaded the system and we had a pretty clear idea that this was in the words of Lincoln Phelan a fundamental social cause of occupational deprivation and in ill health many of us met with the WSIB president and other senior managers at the board to share our concerns and our findings about stigma and to talk about how we could work together the president picked ten people from her management team to explore the issue and we chose six comprised of researchers injured workers and injured worker advocates together we embarked on a set of sessions that were dubbed blue sky discussions the approach was respectful open democratic and honest I won’t ever forget the role-playing exercise where two injured worker advocates acted out what an ideal interaction between an injured worker and a WSIB adjudicator should look like this set the bar together we developed a framework describing how stigma becomes embedded into institutions and what changes are needed to address it we then developed an action plan with clear objectives and a set of deliverables it seemed that soon stigma was being discussed everywhere within the organization as managers took the messages back to their departments and senior executives conveyed that the problem was real we knew we were making an impact on raising awareness but we wanted to ensure some changes in policies and procedures as well and to the credit of the organization and its leadership we managed to see some concrete results the organization implemented a draft recruitment screen to identify negative attitudes towards workers with disabilities when recruiting internally and externally it also implemented a worker sensitivity check tool used during the development or updating of written communication to help identify if the communication might promote stigma a draft brochure on the stigma faced by injured worker injured workers was disseminated widely the brochure points out and correct some of the myths about injured worker in that brochure the president of WSIB takes a stand he wrote when someone is injured on the job they need our help not snap judgments about who they are just because they got hurt on the job we have to do everything we can to help them recover their lives dignity and health finally an e-learning course on stigma aimed at reducing negative attitudes and behaviors towards injured workers was embedded into the competency training that all WSIB staff complete as part of their performance evaluations these changes new policies on recruitment orientation and training of staff new systems for corporate communication within the organization and new tools and procedures for the creation and approval of documents were all put into place to shift the culture and social relations that governed how injured workers were treated by the system we knew that these changes had to go further the government’s needed a heightened consciousness in order for changes to infiltrate the public domain we were delighted that the message was carried forward by incoming WSIB president Dave David Marshall and Deputy Minister of Labour Cynthia Morton as they discussed stigma when they appeared before the Standing Committee of Public Accounts we were very proud of the changes in impacts of our advocacy work we engaged injured workers and other key stakeholders in a participatory process and then targeted institutions and systems to create change it resulted in new policies and procedures within the organisation and it reached the government level as well it was the beginning of some real social change we knew that it was just the beginning that advocating for social and occupational

justice demands vigilance to ensure a change is sustained over time and not undermined by shifting in social social and political trends in the words of Ignatieff the price of freedom is eternal vigilance there are many other Oats examples of advocacy to draw on as well from researchers and clinicians alike Barry Trenton and his work with care watch a senior citizen lead group advocating for adequate funding for supportive home care by working with policy makers and those who influence policy his interest in how social attitudes influence occupations of senior citizens has led him to examine the intersection of ageism and senior citizenship ads of advocacy together Barry and the senior citizens of care watch have shaped policy discourse on ageism and senior citizenship Karen Rivera girl in Northern Ontario recognized that policies and programs that are meant to help people with mental illness be successful in their employment goals are actually a barrier to those most needing support she created a groundswell of interest in the vocational service provider community throughout Northeastern Ontario she brought together important decision-makers from the Ministry of Community and social services the local health integration network and the Ontario Disability Support Programme to review employment issues of people with mental illnesses as a result there’s an elevated importance of employment for people with serious mental illness within Northeastern Ontario Karen has said that her organization has seen a significant increase in the numbers of individuals who seek work and who transition off of social assistance Robyn misunder an OT in Edmonton who uses social media to mobilize OTS and others to apply precious to government’s on issues of social justice for example his ot blog that you see here calls on the people of Edmonton to increase bike lanes for the health and well-being of the city and its people but also for people living in poverty struggling with the costs of transportation you can also see here his tweet about Bill 10 which if passed in its original form would have allowed the provinces School Boards to reject students requests to create a Gay Straight Alliance the bill was amended to protect gay youth and enable these peer support groups to form where to go from here in this talk I have argued for and demonstrated possibilities for increased involvement in political and systemic advocacy on the part of OTS promoting social change through advocacy is a collective responsibility and one that can be taken up by OTS in any research or practice role or capacity the time is ripe and the opportunities are many for expansion of our efforts in this realm enhancing our commitment to social change through advocacy must become part of the process of professional socialization by equipping ourselves with the analytic and practical tools necessary to undertake this calling we need to address and develop a new set of competencies in our educational programs and in our professional development we need to become knowledgeable in community and coalition development the structure and function of political systems policy analysis conflict resolution and systems change principles including how power distribution and decision-making processes unfold we need new platforms for communication we might want to become more astute in using the media especially social media for advocacy purposes we need conferences such as this one newsletters task forces and awards for work in the advocacy arena most of all we need to embrace a sense of self-confident idealism reflected in a strong belief that our investment in advocacy will make the world a better place occupational therapy is a visionary discipline occupational justice is our most ambitious enterprise and advocacy is one of its key strategies in closing I’ll return to a question I asked earlier in this talk have we accepted the unacceptable I propose our collective response could be a quote from political activist and Davis posted on Robins blog I am no longer accepting things I cannot change I’m changing things I cannot accept thank you thank you so much dr. Kirsch for that

inspirational talk not only did you pose to us a challenge and explored that in depth you also provided us with a model some suggestions and some very successful examples of how this can be done thank you so much