Uncharted: My first year as a role-emerging occupational therapist.

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Photo description: The author stands, hands on her waist carrying a hiking backpack on a trail after the rain in Algonquin park.

By Naomi Hazlett, BSc., MScOT, OT Reg. (Ont.)

“I conceptualize my life as a series of constraints and circumstances. The constraints often frustrate me, and the circumstances often intrigue me.”

In 2017, I wrote those words at the end of my masters program in occupational therapy. In the year since, they have often rung true. As I begin my second year of practice as a registered OT, I believe it necessary to add a third “c”: these series of constraints and circumstances have lead to great creativity.

As you can see in the above picture, pushing my limits is something I do in my personal time, but is also the foundation of my professional work. The idea of role-emerging practice is straightforward: create an OT role in place where there was none. To do so requires an understanding of system and practice constraints, an eagerness to pursue opportune circumstances, and a great deal of creativity in problem-solving along the way.

Over the past twelve months, I established or enhanced the occupational therapy role at three locations, in three different areas of practice: ADHD, blindness and low vision, and long-term care. Coming into each of these three practice locations, I started from square one, and went from there, one small step at a time.

How did I become interested in role-emerging practice? What has this experience been like? What’s next for me? To answer these questions, I want to first look back, then to the present, then to what the future ahead holds.

Pushing the bounds of what a profession could be first piqued my interest when I stepped into my first cognitive science course at the University of Toronto. Much like occupational therapy, cognitive science is one of those words that almost inevitably has people asking you “what is it you do, exactly”?

Let me begin by telling you, then: cognitive science is the interdisciplinary study of the mind. I studied english and computer science, linguistics and latin american history, artificial intelligence and philosophy, all through the lens of understanding what a human mind is. And psychology, of course… Ultimately, I fell in love with the idea that you could stand in the centre of these incredible pillars of knowledge and connect them to create something better than the sum of its parts.

I feel the same way when it comes to occupational therapy. Rather than the lens of mind, though, occupational therapy sees the world through the lens of meaningful activity.

We speak often in healthcare about silos. As science and technology expand the frontiers of our knowledge and abilities, we often have to narrow our focus in order to understand something at an adequate level of depth to make a difference. Like cogsci, occupational therapy is situated in the centre of a number of pillars of knowledge in medicine, and arguably, social justice and disability theory. Whether it is truly as interprofessional/interdisciplinary as cognitive science is an ongoing debate, one for another day. What is undebatable is OT’s potential to address the gaps caused by the narrowed perspective of specialization.

First graduating in 2013 with a bachelor of science in psychology and cognitive science, I spent some time reflecting on what I wanted to do next. I had spent the past five years believing I would be a teacher, until I realized I didn’t have the time to wait – the supply was, and still is, much greater than the demand in Toronto. Lost and unsure, I thought about what I really loved to do. Teaching was there, but also helping others. Critically, I thought about all the other things I loved to do. At the time, I worked in a bike mechanic shop and taught knitting to women at CAMH. I had a plethora of hobbies and passions: composing music, writing, camping, rock climbing, roleplaying, meditation…was there a profession that had a focus every bit as wide as in my first degree?

It was 2015 when I entered my masters program in occupational therapy. I had found a program with that wide scope. At the time, I didn’t know I was going to be in a position to make that scope even wider.

With this history in mind, here are the lessons I’ve learned from role-emerging practice so far:

  1. Occupation is our bedrock.

This may seem obvious at first, but it is clear with every elevator pitch I do, it isn’t to those we work with. Each time I have entered a new setting, I’ve heard a different story of what occupational therapy can do. “You prescribe wheelchairs!” “You teach handwriting!” “You teach cooking and cleaning!” Why doesn’t anybody ever say what we want them to? “You help people do activities.” When beginning a new position, I’m often asked if I can help, but the challenge is framed in terms of a problem or an impairment. In forging new paths, it has been vitally important for me to reframe that challenge in terms of occupation. “Can you help my son with his executive dysfunction?” “Can you help this resident with her falls risk?” To these questions, I pose another: “What is the activity that is being challenged by this concern?”

  1. Occupational therapy is about addressing the complex to enable the simple.

OT is an iceberg. The part that rests above the surface, the performance of mundane, everyday activities, is dwarfed by the amount of assessing, analyzing and planning that goes on under the surface. It’s one of the reasons, I believe, that OT is not given the credit it deserves, as it is often appraised by those who do not (or think that they do not) have difficulty with doing what they want or need to do in life. Inevitably, though, when those people have an opportunity to spend some time with an OT, they realize the power of our profession.

  1. Emerging roles can sometimes be returning roles.

As I mentioned before, OT is about enabling meaningful occupation. In starting new roles for myself and the profession, I have always come back to our old roots.  As much as I respect our expertise in areas of speciality, such as wheelchairs and mobility, hand therapy and sensory integration, one of the things I love most about role-emerging OT is how close I can return to our profession’s founding vision. In the course of one week, I might rock-climb with one client, go on the bus with another, and do laundry with a third.

Looking forward to the future, I can’t wait to continue to chart new territory as an OT. With the support of my colleagues, there are so many possibilities to consider, and new paths to forge.