Module 1: Client-Centred Practice & Professional Reasoning

Question 1

What is Professional Reasoning?

Answer 1

The process that practitioners use to plan, direct, perform, and reflect on client care.

It is a FAST and COMPLEX process.

Question 2

What does “embodied process” mean?

Answer 2

Using our senses (touch, smell, sight, and experience) to understand & experience something.

Question 3

Where do we get KNOWLEDGE from to inform our REASONING?

Answer 3

1. straightforward knowledge
2. whole-body experience
3. tacit knowledge

All 3 above are influenced by our values, beliefs, assumptions, and biases.

Question 4

Why is professional reasoning important?

Answer 4

Understanding and being able to explain our professional reasoning makes the complexities and expertise of our work visible and tangible.

It also facilitates professional development by highlighting any gaps

Question 5

6 MODES of REASONING

Answer 5

1. scientific
2. narrative
3. pragmatic
4. ethical
5. interactive
6. conditional

Question 6

What is scientific reasoning?

Answer 6

Diagnostic: understand condition, OPI’s
Procedural: determine treatment plan
informed by scientific methods: hypothesis generation & testing, pattern-recognition, theory-based decision-making, evidence-informed

Question 7

What is narrative reasoning?

Answer 7

Using client perspectives, values, and meanings to make decisions. Focuses on understanding the client’s experience and the meaning they attach to their experiences (past, present, and future).

Question 8

What is Pragmatic Reasoning?

Answer 8

Practical considerations.
Practice: scheduling, equipment availability, management directives
personal: OT’s competency, preference, values, life demands

Question 9

What is ethical reasoning?

Answer 9

Reasoning used in response to an ethical dilemma, i.e., “what should be done?”
Generating options, to determine a defensible, ethical course of action
Systematic approach that uses available resources: ethics board, COTBC code of conduct, risk assessment frameworks

Question 10

What is interactive reasoning?

Answer 10

Intentional and intuitive processes used with the goal of fostering effective therapeutic relationships

Question 11

What is conditional reasoning?

Answer 11

Using multiple modes of reasoning in conjunction with each other to determine a variety of potential outcomes.
Capacity to engage in this kind of reasoning builds with experience.

Question 12

Describe the Ecological view of professional reasoning

Answer 12

Using information from the practice context, and perspectives and experiences from the client and the therapist to inform professional reasoning.

Question 13

How to develop professional Reasoning

Answer 13

Be a reflective, life-long learner: think about thinking, reflect ON action, and reflect IN action, be reflexive.
examples: how did that go? why did I make that decision? what went well? what needs to change?

Question 14

Developing professional reasoning: timeline for progression (what are the stages?)

Answer 14

1. Novice (0 years)
2. Advanced beginner (<1 year)
3. Competent (1-3 years)
4. Proficient (3-5 years)
5. Expert (5-10 years)

Question 15

What are some BARRIERS to effective professional reasoning?

Answer 15

1. Early hypothesis generation (not collecting all information first)
2. Unchecked assumptions
3. Over-reliance on standard techniques (not being reflective on technique usage)
4. Time pressures
5. Workload demands (becoming robotic/automatic)
6. Practice expectations

Question 16

Occupational Engagement

Answer 16

Concept of occupational engagement broadens the scope of OT practice to help characterise people’s social participation in occupation REGARDLESS of their capacity to perform an occupation.

Engagement includes consideration of the nature (active vs passive), intensity, degree, etc.

Question 17

Describe the concept of engagement

Answer 17

1. strong cognitive-affective dimension - it is the inward facing component of occupation
2. DOING may not be required for engagement
3. subjective experience of doing

ex: mental activities when engaging in a specific occupation may vary from context to context, over time, etc.

Question 18

What are the 4 modes of engagement along the disengagement-engagement continuum?

Answer 18

1. disengagement
2. partial engagement
3. everyday engagement
4. full engagement

Question 19

Disengagement

Answer 19

fully disengaged from occupation
lack of agency
feeling “numb and heavy”
may hold a protective function

Question 20

Partial engagement

Answer 20

Engagement with immediate environment

Can be used as an escape from business of life

Question 21

Everyday engagement

Answer 21

Direction, commitment, shared experiences, attuned

Question 22

Full engagement

Answer 22

Transcendent, engrossed, can be compared to “flow”

Question 23

How do we find out about occupational engagement?

Answer 23

Interviewing: life history, interests, motivation, and passion; assess capabilities; determine what is meaningful for them; provide them with choice

Understand their foundational values and beliefs

Question 24

Enablement as a Core Competency

Answer 24

Drawing on enablement skills that are value-based, collaborative, attentive to power inequities and diversity and charged with visions of possibility for individual and/or social change

CLIENT CENTRED, occupation-based

Question 25

CCP & Indigenous Knowledge: Indigenous Health Characteristics

Answer 25

Indigenous Health Characteristics: diverse medical and healing traditions

• surgical & community-based responses to illness and injury
• holistic understanding of health & wellbeing

Question 26

CCP & Indigenous Knowledge

Answer 26

Generally, knowledge is contextual: built from the land and environment, experience, given & not necessarily for everyone

Western science does not need to validate indigenous knowledge

As OT’s: advocate for indigenous knowledge for clients, connect them

Question 27

CCP & Indigenous Knowledge: Wise Practices

Answer 27

“Locally-appropriate actions, tools, principles, or decisions that contribute significantly to the development of sustainable and equitable conditions”

Less dogmatic than “best practice” guiding principles
- make space for multiple ways of knowing

Assume indigenous peoples & communities have the wisdom, strength, and abilities to create their own solutions

Implement reconciliation into healthcare

Question 28

Colonialism

Answer 28

Process that employs modes of control to manage a population and/or expropriate land, resources, and people

purpose is to secure wealth and/or privilege and power for colonizers.

Often enacted through policies and laws

Is a KEY DETERMINANT OF HEALTH for Indigenous Peoples.

Question 29

Colonialism & OT: understanding “occupations”

Answer 29

Benefits of occupation understood from a white perspective 
 - focused on reintegrating back into white, middle-class society

Daily occupations experienced through a filter of british colonialism

• “occupy” the land = removal of indigenous people from their land and is built into how Indigenous land rights are understood and upheld in canada
• consequence: limits opportunities for Indigenous people

Question 30

Core assumptions about Occupation

Answer 30

Not necessarily shared by Indigenous People - but our models, assessments, and research are shaped by these assumptions

ex:
1. evidence-based practice and best-practice guidelines are appropriate for ALL clients
2. the approach and values of our services are beneficial and wanted by ALL clients
3. clients can/will tell us when our services are not a good fit for them

Question 31

How can we practically move forward? Self Reflection

Answer 31

understanding of own identities and social positions
birthplace, language, culture
community and safety
govt systems working for or against us (ex: child welfare, police)
family belief systems and histories
adherence to colonial narratives

Question 32

How can we practically move forward? Cultivate cultural humility

Answer 32

Express humility - recognize your own social positions, assumptions, and biases and respectfully acknowledge and build space for diverse worldviews and experiences

Week diverse perspectives and ask whose voices are missing? How can they be included?

Looks different for everyone - based on history, indigeneity, relationships

Listen to and prioritize indigenous experiences and knowledge (94 calls to action, MMIWG calls to justice, include indigenous resources and scholarship.

Question 33

Learn and Respect Indigenous Rights

Answer 33

Right to self-determination
right to be actively involved in developing and determining health, housing and other economic and social programmes affecting them

Question 34

What are the critiques of CCP?

Answer 34

• negates the real differences in power and types of knowledge held between a person seeking health care and a health care provider and focuses on an individualistic perspective.
• relatively silent on therapists’ acknowledgment of their own social positionality and how their social positions affect therapy relationships.
• limited acknowledgement of oppressive structures and practices.