62.2 finlayson
TRANSCRIPT
-
8/9/2019 62.2 Finlayson
1/6
CJOT VOLUME 62 NO 2
KEY WORDS
Community occupational
therapy
Health promotion
Occupational
therapy
services
MARCIA FINLAYSON JEANETTE EDWARDS
ntegrating
the concepts
health
promotion nd
community into occupational
therapy practice
ABSTRACT
ealth reform activities in Canada have encouraged health
care professionals to examine new and innovative ways to share their skills, not
only with other professionals, but
with
the public. Historically, occupational
therapists have been encouraged by
leaders in the profession
to expand their
practice and
to share their skills through
active participation with their
communities. Health
promotion
has been identified
as a
process through which
this expansion can be pursued. In order for occupational therapists to
contribute to their communities
in a
meaningful
way, the concepts of health
promotion and
community require definition, development
and
reflection
within their model of practice. Through a discussion of
these
concepts,
this
paper encourages
occupational therapists to develop, expand
and
integrate
new practice roles within
the
community by integrating health
promotion
into
their practice.
RSUM
entreprise de la rforme de la sant au Canada a
encourag les professionnels de la sant examiner de nouvelles faon de
partager leurs comptences, non seulement avec d'autres professionnels, mais
aussi avec le public. Historiquement, les ergothrapeutes ont t encourags
par les leaders de leur profession tendre leur pratique et partager leurs
comptences par le biais de leur participation active au sein de leur milieu. La
promotion de la sant a t dfinie comme un processus par lequel cette
expansion peut tre envisage. Afin que les ergothrapeutes puissent contribuer
leur milieu de faon significative, des concepts relatifs la promotion de la
sant et de l'environnement communautaire ont besoin d'tre dfinis, dvelopps
et penss en fonction de leur modle de pratique. Par une discussion de ces
concepts, cette tude encourage les ergothrapeutes dvelopper et adopter
de nouveaux rles au sein de leur pratique communautaire en intgrant la
promotion de la sant dans leur pratique.
Mania Finlayson, BMR, OTM,
0.T. (C)
was
the Project Coordinator
Manitoba for the
CAOT Seniors
ealth
Promotion
Project upon initiation of this
paper.
She is cu rrently a ful l
time graduate
student in the
Department
of Community
Health
Sciences
at
the University of
Manitoba. Direct
correspondence to 1240
Wolseley Avenue, Winnipeg, Manitoba,
R3G 1H4.
Jeanette Edwards,
MHA, CHE,
BOT,
OTL1, 0.T. (C) was a member
of
the CAOT
Seniors Health
Promotion
Project s
Manitoba
Resource Group upon
the initiation of this paper. She is
the
Executive Director
of the
Health Action
Centre, 425
Elgin Avenue, Winnipeg,
Manitoba.
70 JUIN 1995
-
8/9/2019 62.2 Finlayson
2/6
CJOT * VOLUME 62 * NO 2
Health
promotion
has become one of the most signifi-
cant concepts
within health care reform currently
underway
in all
provincial
jurisdictions and in Canada
as a nation.
Is occupational therapy prepared to grasp
this concept and
integrate it into practice?
The
Cana-
dian Association of
Occupational Therapists (CAOT)
Seniors' Health Promotion
Project has demonstrated
that the profession has
the
potential to assume these
new roles (Letts,
Fraser, Finlayson & Walls, 1993).
In
January of 1992,
the C A O T Seniors' Health
Promotion
Project introduced
a
series
of
Health Pro-
motion Issue Papers.
In the
first
issue paper, the
authors introduced
a conceptual model of
occupa-
tional therapy
and
health
promotion
(Finlayson &
Edwards, 1992). This
current paper is intended to
expand on
those ideas, to provide further understand-
ing of the
history behind occupational therapy
and
health
promotion, and to
explore the concepts of
health promotion and
community for future inclusion
in the
client-centred
model.
Further, this paper is intended to encourage occu-
pational therapists to develop, expand and integrate
new practice roles within
the community by integrat-
ing health promotion into their practice. It is not
the
intention of this paper to prescribe practice roles,
but
rather to challenge
occupational therapists to reflect
on
the
history
of the profession, and to apply this knowl-
edge to their current practice realities.
BACKGROUND AND
HISTORY
Maurer
and
Teske
(1989)
state that one of the barriers
to occupational therapists engaging in health promo-
tion
and
wellness activities is the lack
of a
meaningful
model of practice which enables understanding
and
development in
these areas. The authors
of this paper
feel that it is not the lack of a model
per se, but
it is
rather
the lack
of articulation of
health promotion
and
community concepts
within the
current practice model
(CAOT, 1991) that
pose the barrier to the
profession's
exploration of these areas
and the potential roles
within them.
Although the terminology used today in health
promotion is relatively new, its
basic concepts can be
traced back to ancient Greek and Oriental writings.
Early civilizations recognized that health
and
well-
being were affected by social interactions
between
individuals,
as well
as the interactions
between indi-
viduals
and
their environments (Johnson, 1986).
These core beliefs
about health continued up until
the
mid-19th century, when health was valued
as a
process and an aspiration of
life itself, rather than
an
outcome. Consequently, individuals were concerned
with their daily and
community activities.
(Johnson,
1986, p.755).
With
the invention of microscopes, and the mass of
technology which followed, health became
the do-
main of the professionals rather than the
domain
of
individuals
and of communities.
As technology has
grown, health has evolved from
a process of living to
an outcome to be achieved (Rachlis Kushner,
1989).
Meyer, an early advocate for
occupational therapy,
recognized the potential breadth
of the profession
when he stated: Our special work, which
tries
to do
justice
to special human needs, I feel is destined to
serve again as the centre of a
great
gain for the normal
as well [as
the
sick]. (1922, 1977, p.642)
Although
the
early writings in
occupational therapy
recognized
the value of occupation in the overall
health of people, the profession
did little in the
area
of
preventive health practices between
the 1920's and
1960's
but
rather concentrated solely
on curative
approaches, abandoning the philosophy
of
preventive
health (Reitz, 1992, p.51). Reilly (1962) reminded
the
profession of
its philosophy and roots - that occupa-
tional therapy believes that health can be influenced by
engagement in
meaningful activity.
Brunyate (1967)
stated that occupational therapy
had a vital, distinct and
elsewhere unattainable con-
tribution to make to restorative, preventive and main-
tenance health
(Brunyate, 1967, p.262).
Later,
she
encouraged occupational therapists to take
a more
active role in
community
and
preventive health (Wiemer,
1972).
Finn (1972)
challenged occupational therapists to
learn
more about the
political,
social and
economic
factors of a
community and
their
influence on health.
In the inaugural Canadian
Association of Occupational
Therapists'
Muriel Driver
Memorial
Lecture in 1975,
Bassett noted that occupational therapists
must re-
spond to the need
for research in
health promotion and
determine effective
ways
of helping persons
bridge the
gap between hospital
and the
community.
Finn
(1977)
later challenged therapists to consider
the
development of
alternative models
ofpractice,
and
to investigate
a role expansion
from therapist to health
agent.
Ten years
later,
Stan reiterated this
challenge
stating, We must
ask where we can
use
our
talents and
take our skills beyond
the
boundaries of
currently
subsidized health care to provide
services
not
met
by
institutions,
private practices
or public health.
As
individuals, we need to be prepared to take
the
risks
of
operating outside
of the
system (Stan,
1987, p.169).
Now,
71
years after Meyer's first
suggestion
that
occupational therapy could
serve the
well
population
in addition
to
the disabled
population, the profession
is faced with
a political
and economic
situation
that
requires
a
response. The
cost of providing
the
present
illness care system has stretched
the
financial resources
of the provincial and
federal governments.
The
pre-
dicted escalation
in
costs
of the
present system will be
beyond the
resources of the present tax
base (Carswell-
Opzoomer, 1990, p.199).
In addition,
although health
JUNE 1995 71
-
8/9/2019 62.2 Finlayson
3/6
CJOT
VOLUME 62 NO 2
care costs have
been escalating at alarming
rates, the
overall health
of populations
has not drastically im-
proved (Johnson, 1986; Rachlis Kushner, 1989). In a
landmark
document on health and
health care in
Canada, Lalonde (1974) reintroduced
the concept
that
health was influenced by a variety of determinants
including human biology, lifestyles, environment and
the organization of medical
care. de
Leeuw (1989)
identified
the
Lalonde
report as the
overall roots of
health
promotion as a concept.
Within the
next de-
cade, the
World Health Organization also broadened
its definition of health to a resource for
everyday life,
not the objective of living (WHO,
1984).
Between
1974
and 1984, the World Health Organi-
zation defined primary health care
as
essential health
care made
universally accessible
to individuals and
families in the
community by means
acceptable to
them, through their
full participation and
at a
cost that
the
community and country
can afford.
(WHO,
1978).
Canada
continued
in its development of health
promotion concepts and principles with the release of
the publication
Achieving Health for All
(Epp, 1986).
This document
outlined
the challenges to health
for all,
and
identified mechanisms and
strategies by which
health promotion should be pursued. Later that same
year, the
Canadian
Public
Health
Association, in
con-
junction with the
World Health Organization, hosted
the first international conference
on
health
promotion.
The result of this event was
the
Ottawa Charter
on
Health Promotion
(WHO, Health
&
Welfare Canada &
CPHA, 1986).
CORE
CONCEPTS OF
HEALTH
PROMOTION
Health promotion
has been defined by the
World
Health Organization as the process of enabling
people
to increase control over, and to improve, their health
(Epp,
1986).
Enabling, mediating
and
advocating
are
means through which health
promotion activities are
pursued. These terms
are
defined
as:
Enable: Involves providing
people and
com-
munities with information and support
to
identify
and address health issues...
Mediate: Involves linking the
many sectors
that influence
health...
Advocate: Involves supporting and
fighting
for favourable
conditions for
health
...
(Letts et
al,
1993,
p.
9)
It is through these essential means that actions
to
develop personal skills, create supportive environ-
ments, reorient health services and strengthen commu-
nity actions are pursued. These means and actions are
the
critical foundations
in the building of healthy
public policy and therefore of health
promotion (WHO
et al,
1986).
Ultimately, health
promotion is helping
people
help
themselves. Within health
promotion,
people identify
their health needs,
and
utilize available tools/informa-
tion to elicit
change in
their own lives. It is
the
responsibility therefore,
for the
professionals working
within the scope
of health promotion to provide
the
necessary tools/information which promotes
the em-
powerment
or
enablement for change.
Professionals
cannot empower
or enable clients, but
can provide
information in
order that people
may go through
the
process of empowering themselves, of
taking control
over their own health
as they see fit.
Health
promotion
therefore, is
a
continuous process
of
development
and change
that involves many
people
working together in
collaborative ways. It is a
process
that requires one to listen and
understand what is
important
to both individuals
and
communities,
and
then to facilitate action
to satisfy these self-identified
needs. A commitment to health
promotion
means
a
commitment to change
(Letts
et al, 1993, p.10).
If
activities
are
to
support the
health promotion
process,
they
must
be guided
and owned by the
recipients of the information
(individuals
and
commu-
nities). Effective
health
promotion must have grass
roots ownership. Health
promotion is a mechanism
through which a continuum between
the
individual
and the
environment is created. Within this continuum
the
individual effects
the environment to make change
and the environmental response enhances the
individual's health
and
well-being.
The manual, For
the Health of It: Occupational
Therapy Within
a
Health
Promotion
Framework, (Letts
et al,
1993)
summarizes these ideas by identifying that
the health promotion process is participatory,
intersectoral,
integrative and
continuous.
Raeburn (1992)
and Green and Raeburn (1988) state
that health promotion is one of the first and
few truly
interdisciplinary enterprises, with
the consumer
being
critical to
the process.
Within the health
promotion
concept, experts do not exist as each person makes
contributions
to
the process. This new health paradigm
integrates health
and
health care into community life
with consumers
and citizens playing
an active role
(Carswell-Opzoomer, 1990, p.201).
CORE CONCEPTS
OF
OCCUPATIONAL
THERAPY
Occupational therapy has been described
as a
blend
of art and science
(Peloquin, 1989). The art of occupa-
tional therapy utilizes
the
therapeutic use of self,
human relationships
and emphasizes
the dignity
and
rights
of the
individual regardless
of the
individual's
past
or present circumstances or future potential
(Mosey,
1981, p.23).
Occupational therapists believe that individuals
need to be engaged,
and
that
engagement in
purpose-
72
JUIN 1995
-
8/9/2019 62.2 Finlayson
4/6
CJOT
VOLUME 62 NO 2
ful activity can contribute to well-being
and
quality
of
life. Occupational therapists also believe that
a balance
of occupations
(self-care,
productivity, leisure) con-
tributes to a
sense of well-being
(CAOT, 1991).
Within
the
practice of occupational therapy,
the
environment, both human
and non-human, is integral
to
the functioning
of an individual. The
environment
influences
all aspects of
daily functioning, from
the
values that one holds, to the ability to
interact,
to
the
reactions
one has to
stress and stressors.
The
environment is
a
tool which creates change,
as
well
as a
tool that can be adapted to facilitate function
(Reed & Sanderson,
1983).
In
achieving occupational
performance,
each individual both
influences and is
influenced by his/her environment (Townsend,
Brintnell & Staisey, 1990, p.71).
With this in mind,
occupational therapists need to consider
the different
components of the
environment i.e. physical, social,
cultural,
economic
and institutional
(Law,
1991),
in
order to truly understand
clients and their
past,
present
and future
functional abilities
and
potentials.
Law (1991)
offered a taxonomy
of the environment
which places
these components
on a
matrix with levels
of
the environment
-
individual, household,
neighbourhood, community and
province/country.
Slae
suggested that these components
and
levels were
interlocking,
and
challenged occupational therapists
to use
this interlocking matrix to consider
the broader
systems operating within
the
environment,
and how
they impacted
on
health
and
occupational perfor-
mance.
Through this broad review of the core concepts
of
occupational therapy,
one can see that although sci-
ence is an
integral
part of the
profession, it is the
process
and
approach to
a client
that makes it
a unique
profession. The
Occupational
nerapy Guidelines for
Client-Centred Practice
state: Thus
the
occupational
therapy approach is
unique
rather than
the
specific
skills used by
the
therapist. It is this that constitutes the
art
of therapy
(CAOT, 1991, p.6).
Mosey adds With-
out
art, the
occupational therapy process is only
the
application
of scientific knowledge
in a
sterile v acuum
(1981, p.25).
OCCUPATIONAL THERAPY
AND
HEALTH
PROMOTION: A NATURAL PARTNERSHIP
Health promotion is
a
process of
integration and
partnership between individuals
and communities.
The authors
of
this paper
have
chosen to use the
definition of
community
as
noted
in the
Manitoba
Department of H ealth, Health Advisory Network, Pri-
mary Health C are Task Force's Interim Report
(1993).
A community is
an interactive group of people (who
may live in a
geographical location)
who cooperate
in
common activities and/or solve mutual concerns.
Articulation of
this context enables occupational
therapists to be involved in
integrating individuals into
their environments,
and subsequently into
the
larger
context of
their community.
The
authors feel that this process requires
a
broader
exploration and
understanding
of the
community and
how it interacts with occupational performance. Un-
fortunately,
the Occupational Therapy Guidelines for
Client
Centred Practice
(1991)
neglects to define
com-
munity or related
concepts such
as
community mobi-
lization or
community development.
By expanding the
conceptualization of the
environ-
ment within
the
client-centred practice model to delin-
eate
the importance
of the community
and the
need
for
kinship and
relatedness to others
and the need for a
sense
of individuality
and
selfness,
the
process of
exploration
and
understanding can begin (Cassidy,
1962).
Community implies fellowship,
a
state
of
shar-
ing
and joint
ownership. It implies
a
group
of
people
whose members hold something
in
common such as,
but
not
exclusive to, religion,
geography and/or cul-
tural similarity.
The processes which
are critical
in
ensuring
the
integration
of an
individual within communities
have
been previously described in this
paper, and are
based
on the means
and actions outlined
in the Ottawa
Charter
for Health
Promotion (WHO et al,
1986).
The
conceptual expansion
of the
environment to articulate
the
concepts
of
community provide
the means
for the
role expansion
from therapist to health
agent
encour-
aged by Finn
(1977). More
importantly, it focuses
on
the community as the agent of change and
recognizes
the capacity
of
individuals, and collections of individu-
als within communities, to articulate problems
and
to
set priorities for
their resolution (Hoffman & Dupont,
1992).
INTEGRATION INTO PRACTICE
How can occupational therapists expand their roles
and
enable communities to be agents of change? Many
examples currently exist
in Canada,
and each demon-
strates
the possible
ways that this
expansion
can
occur.
For the Health of It
(Letts et al,
1993)
identifies five
critical activities which are
necessary to integrate
health promotion and community into occupational
therapy practice. These activities include networking,
consulting, collaborating,
planning and
reflecting.
The
CAOT Seniors' Health Promotion Project is
a
good
example of how these five activities were applied by
occupational therapists
in
Manitoba and
Newfound-
land.
Specific
initiatives
undertaken during this Project,
and described
in
detail by Letts
et al
(1993),
include:
0
advocating for accessible transportation together
with seniors;
JUNE 995 73
-
8/9/2019 62.2 Finlayson
5/6
CJOT * VOLUME 62 NO 2
0
collaborating with
a seniors' organization to de-
velop health-related educational video-tapes;
publishing a
health column in a provincial seniors'
newspaper; and
0 facilitating
the
development
of a seniors' writing
group and
newsletter committee within a seniors'
organization.
Although formal funding for
this Project -ended in
March
of
1993,
the commitment to health promotion
has continued. In Manitoba, a
voluntary group known
as the
'Partners
for
Health
Promotion'
has acted as a
catalyst to bring together
seniors'
groups
and occupa-
tional therapists
for
mutual learning. To
date
this group
has successfully linked practicing therapists with urban
and rural seniors'
groups to share health
information
both
in
person and
through written materials.
By acting as
resource
people,
occupational thera-
pists
in Manitoba have
also been working with a
core
area community
for the
past three years within various
community development
initiatives
(Health Action
Centre,
1992).
This
voluntary involvement has lead to
the
formal development
and funding
of a
neighbourhood
seniors'
council.
The purpose
of this
council is to identify gaps
in services, issues
related to
independent
living, and
to coordinate volunteers
and
programmes
to meet these needs.
Other examples
of the
ways in
which Canadian
occupational therapists
have
engaged
in the health
promotion
process with their communities
are
de-
scribed
in the May
1993
volume of
he
National Clark
Green,
1993).
The articles in
this publication
describe
partnerships, change
processes and
co-enterprises in
which occupational therapists
have
engaged across
the country.
In
each of the
above examples, it can be seen that
legitimate and
practical roles exist
for occupational
therapists who integrate health
promotion and com-
munity
concepts
into their practice. These roles can be
described
as
being enablers, mediators
and advocates.
CONCLUSION
Occupational therapists working with individuals
within
the
context
of a
community and
within a health
promotion
framework
must
be prepared to respond to
the needs of the
consumers in
practical yet creative
ways,
and focus
on collaboration. The
response needs
to be grounded
in a
belief
of
wellness, and a
belief that
the skills of
an .occupational
therapist are
equally
as
valuable to healthy persons
as to ill persons
as sug-
gested by Meyer (1922).
When working with individuals,
an
occupational
therapist
must view
the client
holistically,
and
this is
also the case
when working with a
community. Health
promotion
is integrative. Health
promotion
activities
must
be meaningful,
acceptable and
responsive to the
community
and
its needs. Health
promotion
is partici-
patory
and
continuous. Health
promotion
activities
must
also recognize all
of the
key players
and
stake-
holders
the individual, the people of the
neighbourhood,
the
politicians,
the
professionals,
the
community agencies,
the local
churches and
industry.
Health
promotion
is
intersectoral.
Occupational therapy has much to offer
in the area
of
health
promotion and
considering
the current
economics of health
care, and the
ever increasing
ethno-cultural
mix of the
Canadian
population,
it is
imperative that
the profession
make its skills available
to communities.
Health
promotion,
like occupational therapy, can
be considered
a
blend
of art and science.
Like occupa-
tional therapy, loss
of the art in
health promotion
means a failure in the process. The
true
art of health
promotion
is learning to
accept, and
then to endorse,
a
community's desire to establish its own course
of
action.
With
the
belief occupational therapists
have in
client-centred practice, and the experiences from which
they have learned,
the profession
is poised to link the
individual with
the community
in a manner that
promotes health
for all. As
Brockett
stressed, it is
important for the profession of
occupational therapy
to act immediately to
assume leadership for the
con-
tinuing legitimization
and maintenance of
health pro-
motion within occupational therapy practice
(1993,
p.19).
ACKNOWLEDGEMENTS
The
authors wish to acknowledge
the staff
of the CAOT
Seniors'
Health Promotion
Project for
assisting
in
integrating the ideas presented
in this paper -
Brenda
Fraser (National
Coordinator), Lori
Letts (Assistant
National
Coordinator), June Walls (Project Coordinator
- Newfoundland),
and Margaret
Brockett (Project Con-
sultant).
The
first author would also like to acknowledge
COTF
(Part-time scholarship - 1993;
Royal
Canadian
Legion fellowship
- 1994)
and the National Health
Research and
Development Program (M.Sc. fellow-
ship- 1993-1995) for
their financial support of her
graduate studies
and research.
REFERENCES
Bassett, J. (1975).
Muriel Driver M emorial
Lecture.
Canadian Journal of Occupational Therapy.
42,
91
96.
Brockett, M.
(1993).
Effecting change. The National,
10
(3),
18-19.
Bruyante, R.W. (1967).
After
50 years, what stature do w e
hold? American Journal of Occupational Therapy,
21,
262-267.
Canadian Association of
Occupational Therapists. (1991).
Occupational therapy guidelines for client-centred practice.
Toronto:
CAOT
Publications
ACE.
74 JUIN
1995
-
8/9/2019 62.2 Finlayson
6/6
CJOT
VOLUME 62 NO 2
Carswell-Opzoomer, A.
(1990). Muriel D river
Memorial
Lecture.
Occupational therapy - Our
time has
come.
Canadian
Journal of Occupational Therapy. 57, 197-203.
Cassidy,
H.G. (1962).
The sciences and the arts: A
new
alliance. New York:
Harper
and Brothers.
Clark-Green,
M.
(Ed.) (1993). PartnershiPs:
A strategy
for
managing
change in the
90's.
(Special
issue).
The National,
10
(3).
de
Leeuw, E.J.J. (1989).
The sane revolution. Health
promotion: backgrounds,
scope
prospects.
The Netherlands:
Van
Gorcum,
Assen/Maastricht.
Epp, J.
(1986).
Achieving health for all: A framework for
health promotion.
Ottawa: Health
and
Welfare,
Canada.
Finlayson,
M. & Edwards, J.
(1992).
Occupational therapy
and
health
promotion: A
natural partnership.
The
National.,
9
(1),
Centrefold.
Finn,
G.L. (1972). 1971
Eleanor Clarke
Slagle
Lecture. The
occupational therapist
in
prevention programs.
American
Journal of Occupational Therapy. 26,
59-66.
Finn,
G.L. (1977).
Update of Eleanor
Clarke
Slagle
Lecture. The
occupational therapist
in prevention programs.
American Journal of Occupational Therapy. 31,
658-659.
Green,
L.W . & Raeburn,
J.M. (1988).
Health
promotion:
What is i t ?
What will it become?
Health
Promotion.
3,
151-159.
Health
Action C entre.
(1992).
Friendly neighbour
workers:
A
community development
project.
Unpublished
Report.
Hoffman, K.
&
Dupont,
J-M. (1992).
Community health
centres and
community development.
(Cat.# H3N-261/1992E.)
Ottawa:
Health &
Welfare
Canada.
Johnson,
J.A. (1986).
Wellness and
occupational therapy.
American Journal of Occupational Therapy. 40,
753-758.
Lalonde,
M. (1974).
A
new perspective on
the health
of
Canadians.
Ottawa: Information Canada.
Law, M.
(1991).
Muriel D river
Memorial
Lecture. The
environment:
A
focus for
occupational therapy.
Canadian
Journal of Occupational Therapy, 58,
171-179.
Letts, L., Fraser, B.,
Finlayson,
M. & Walls, J.
(1993). For
the health of it: Occupational therapy within
a
health promotion
framework.
Toronto:
CAOT
Publications ACE .
Manitoba
Health, Health Advisory Network.
(1993).
Primary health care interim
report.
Unpublished Report.
Maurer,
K.E. & Teske, Y.R. (1989).
Barriers to occupa-
tional therapy
in
wellness.
Occupational Therapy
in Health
Care.
5
57 -67.
Meyer, A.
(1922, 1977). The philosophy
of
occupational
therapy (reprinted).
American Journal of Occupational Therapy.
31,
639-642.
Mosey, A.C. (1981).
Occupational therapy:
Configuration
of a profession.
New Y ork:
Raven Press.
Peloquin, S.M. (1989).
Sustaining the art of
practice in
occupational therapy.
American Journal of Occupational
Therapy. 43,
219-226.
Rachlis,
M.
& Kushner,
C.
(1989).
Second opinion:
What s
wrong with Canada s health-care system
and
how to fix it.
Toronto: C ollins
Publishers.
Raeburn,
J. (1992).
Health
promotion research
with heart:
Keeping
a people perspective.
Canadian Journal of Public
Health, 83 (Supplement 1),
S20-24.
Reed,
K.L. &
Sanderson,
S.R. (1983).
Concepts
of occupa-
tional therapy (2nd ed.).
Baltimore: Williams and W ilkins.
Reitz,
S.M.
(1992). A
historical review
of.occupational
therapy's role
in
preventive health
and wellness. American
Journal of Occupational Therapy. 46,
50-55.
Reilly,
M. (1962). Occupational therapy can be one of the
greatest ideas of
20th
century medicine.
American Journal of
Occupational Therapy, 16,
1-9.
Stan,
14. (1987). Muriel D river
Memorial Lecture. Making
our mark in the
marketplace.
Canadian Journal of Occupa-
tional Therapy. 54,
165-171.
Townsend,
E.,
Brintnell,
S.,
& Staisey,
N.
(1990).
Develop-
ing guidelines
for
client-centred occupational therapy practice.
Canadian Journal of Occupational Therapy. 57,
69-76.
Weimer, R.B. (1972). Some concepts of
prevention as an
aspect of
community health.
American Journal of Occupational
Therapy, 26,
1-9.
World Health Organization, Health and
Welfare
Canada
& Canadian
Public Health
Association.
(1986).
Ottawa C harter
on Health
Promotion.
Canadian Journal of Public Health,
77,
425-427.
World Health Organization. (1984). Health
promotion: A
discussion document
of the concepts
and principles.
Geneva:
Author.
World Health Organization. (1978).
Declaration of Alma-
Ata. Geneva: Author.
JUNE 1995 * 75