18. Occupational science
genesis, evolution and future contribution
Matthew Molineux and Gail E. Whiteford
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Throughout its history, occupational therapy has had distinct periods of conceptual and theoretical development that had an impact on the emergence of subsequent models of practice and the implementation of distinct intervention strategies. Considered retrospectively, some of these developments may now be regarded as having had net negative outcomes, such as the influence of reductionist medicine, which led to instrumentally focused occupational therapy.
In this chapter, the authors chart the development of occupational science as one of the most distinct developments the profession has witnessed. The chapter presents an overview of the genesis of occupational science alongside a discussion of some of the attendant issues and tensions associated with its subsequent development. Consideration of the value and contribution of occupational science in informing both the epistemological and practice foundations of the profession is covered, prior to a presentation of a research agenda for occupational science in the future. In essence, it is hoped that the reader will gain a clearer sense of how and why occupational science developed; what it has meant to the profession to date; and, finally, what it may contribute to understandings of the complex phenomenon of human occupation through a coherent and focused research agenda.
• Effective occupational therapy practice is founded on an understanding of occupation and its impact on health.
• Occupational therapists must have a thorough understanding of humans as occupational beings and of the relationship between occupation and health.
• Occupational science has been one of the most significant developments in the history of occupational therapy.
• The future of occupational science rests on its ability to generate new and useful knowledge, as judged by its stakeholders.
• A research agenda for occupational science, which covers all the levels at which occupation is organized, is one way to ensure appropriate knowledge generation and application.
How new knowledge is generated, tested and then infused into practice is a key concern in all disciplines. Whilst information is abundant in our age, how we make sense of it is especially challenging. Like other disciplines, then, occupational therapy finds itself in a historic moment in which the need to develop the epistemological foundations upon which it is based is of central concern. Unlike other disciplines, though, occupational therapy has experienced particular tensions with respect to the relationship between its central philosophical premise: that is, there is a dynamic interaction between occupation and health, and how this is addressed in practice. Specifically, this tension may be attributed to the conceptual and methodological inconsistencies between the biomedical and human/social science paradigms, which both inform occupational therapy curricula, practice and research.
To this end, the development of occupational science may be seen as a cogent response, one that has already had significant positive impacts on the practice terrain of occupational therapy and promises to play an even more important role in the next several decades. In this chapter, we chart the genesis, or development, of occupational science and how it has evolved over time. We also posit some suggestions as to how its research agenda can inform the contribution of occupational therapy in a range of practice contexts in the future.
History and development
Occupational science was first named by Yerxa and colleagues (1989, p.6) as ‘the study of the human as an occupational being including the need for and capacity to engage in and orchestrate daily occupations in the environment over the lifespan’. The naming of occupational science in the late 1980s was the culmination of a period of work by occupational therapy academics at the University of Southern California, who were developing a proposal for a doctoral programme. In doing so, they gave much thought to the focus of that programme, and felt that the profession of occupational therapy would be usefully served by scholars in a science of occupation. The commencement of that PhD programme and the publication of the first paper that proposed occupational science marked the formal recognition of the new discipline. However, examination of the history of occupational therapy reveals that the naming of occupational science was merely the climax of a slow but steady movement within the profession. For this reason, it has been said that occupational science is not merely a chance happening (Clark & Larson 1993).
A science of occupation was first mooted by the National Society for the Promotion of Occupational Therapy in 1917 (Wilcock, 2001 and Larson et al., 2003). The initial objectives of that organization, which later became the American Occupational Therapy Association, proposed that it should concentrate on ‘the advancement of occupation as a therapeutic measure, the study of the effects of occupation upon the human being, and the dissemination of scientific knowledge of this subject’ (Dunton et al 1917). As the profession grew, only the therapeutic use of occupation received much attention (Wilcock 2003), despite continued calls for theoretical unity within the profession, which was consistent with the history and philosophy of early occupational therapy (Clark & Larson 1993). Prominent figures such as Meyer, Slagle, Reilly and Ayres had proposed that such unity would be provided by a basic science that focused on occupation (Yerxa et al 1989).
Although occupational science grew out of occupational therapy, when it was formally proposed in the late 1980s it was represented as a distinct entity. The difference between the two, as outlined at that time, rested in the type of science they embodied. Occupational science was seen as a basic science: that is, one that dealt with ‘universal issues about occupation without concern for their immediate application’ (Yerxa et al 1989, p.4). Occupational therapy, on the other hand, was seen as being concerned with the application of knowledge about occupation for therapeutic ends (Clark et al 1991). Furthermore, it has been stressed throughout the history of occupational science that it is not a model or frame of reference, but a social science or field of enquiry (Clark and Larson, 1993, Clark, 1997, Wilcock, 2001 and Larson et al., 2003). Given the complexity of occupation and its relationship with health, occupational science has always been seen as an interdisciplinary field (Yerxa et al 1989).
The history of occupational science has been characterized by simultaneous acceptance and controversy. No overview of occupational science would be complete without an acknowledgement of this paradox. Although occupational science is still developing, it has made significant steps towards becoming a well-established discipline (Clark 2006). Some of the milestones and achievements include regular occupational science symposia in countries around the world, including the USA, UK, Canada, Australasia and Japan. A research conference dedicated to occupational science is now well established in the USA. The Journal of Occupational Science has been in publication since 1993, and a growing number of books exist that focus explicitly on occupational science, on occupation or on understanding humans as occupational beings (Zemke and Clark, 1996, Wilcock, 1998, Kramer et al., 2003, Pierce, 2003, Molineux, 2004, Watson and Swartz, 2004, Whiteford and Wright-St Clair, 2005 and Christiansen and Townsend, 2010). Occupational science has also featured in occupational therapy journals for several decades now, and many journals have published entire issues devoted specifically to the field (see, for example, Clark, 2001, Johnson and Yerxa, 1990, Molineux, 2000b and Zemke, 2000). Furthermore, occupational science is now embedded in the international standards for occupational therapy education (World Federation of Occupational Therapists 2002).
The emergence and continued development of occupational science has been a cause of concern for some occupational therapists. While Mosey (1992) saw that occupational science might prove useful for occupational therapy, she did argue for complete partition of the two. She proposed that separation would allow for a clear distinction to be made regarding the focus and form of enquiry in each field. Her suggestion was that occupational science should concentrate on theory development (focus) through basic research (form), while occupational therapy should concern itself with the testing and refinement of frames of reference through applied research. Her concerns were that, if complete partition did not occur, then an unhealthy co-dependence would develop, it would be unclear what was a discipline and what was a profession, and the research which took place would be poorly focused. Given that she viewed both forms of enquiry as valuable, she encouraged each field to concentrate on the type of research most applicable to its domain of concern (Mosey 1993). In response, Clark and colleagues (1993) from the University of Southern California argued that the differentiation between basic and applied research was not dichotomous, as Mosey (1992) proposed, and so to categorize occupational science and occupational therapy was inappropriate. This was an interesting assertion, given that only a few years earlier the same authors, with others, had proposed occupational science as a basic science (Yerxa et al 1989). Clark and colleagues now saw that such rigid categorization would unnecessarily limit research and stifle potentially useful work (Carlson and Dunlea, 1995 and Clark et al., 1993).
Issues of basic and applied sciences have featured heavily in other debates about occupational science. There has been some question, for example, as to whether or not a basic science of occupation is necessary at all, given that an abundance of knowledge about occupation exists in other disciplines (Kielhofner 2002). What is clear, however, is that, while other fields may address issues that might usefully inform an understanding of occupation, these fields do not use the concept of occupation as the focus of enquiry (Clark et al., 1993, Carlson and Dunlea, 1995, Zemke and Clark, 1996, Haggard, 2002 and Polatajko, 2004). As a result, ‘the concept of occupation as an organiser of theory and research falls outside the domain of traditional disciplines’ (Clark et al 1991, p.305). The relationship between basic and applied forms of research has also stimulated wider debates around approaches to knowledge generation. Although this was first raised by Mosey (1992), it has been more fully examined recently, in particular by proponents of the Model of Human Occupation. Their concern is with the way that knowledge informs practice. They contrast approaches to knowledge generation, which include, from the outset, concern for how that knowledge can be used by practitioners, and those whose concern is knowledge generation without guidance on how to use that in practice. It is argued that using a conceptual model of practice (as defined by Kielhofner, 1992 and Kielhofner, 1997) and related methods, such as the scholarship of practice (Braveman et al., 2001 and Kielhofner, 2005), ensures that the dialectic which exists between theory and practice is preserved. This ensures that any knowledge generated not only addresses the concerns of practitioners but also has clear guidance on how that knowledge can be used in practice (Kielhofner, 1997, Kielhofner, 2002 and Taylor et al., 2002). This approach can be contrasted with occupational science, which informs practice but may not necessarily provide specific tools or methods to be utilized by occupational therapy practitioners (Clark, 1997, Forsyth, 2001a, Forsyth, 2001b and Molineux, 2001).
It can be seen, then, that occupational science and occupational therapy are closely linked, and that in fact the former emerged from the latter. Indeed, it could be said that they were not initially two distinct entities, as the National Society for the Promotion of Occupational Therapy recognized the need to understand occupation and the dynamic relationship between occupation and health, and that this sat comfortably alongside the therapeutic use of occupation. However, it is worth noting that occupational science was formally labelled just over 20 years ago and it continues to develop and negotiate relationships with occupational therapy and other fields. Despite its youth, occupational science has much to offer and this will be discussed in the next section of this chapter.
The value and contribution of occupational science
Although there has been much debate about occupational science and related issues, such as approaches to knowledge generation and the relationship between theory and practice, even those who have raised concerns about the new discipline have also seen its potential (Forsyth, 2001a, Hinojosa, 2003, Kielhofner, 1997, Mosey, 1992, Mosey, 1993 and Rey, 2001). The value of occupational science has been well documented and includes (Carlson and Dunlea, 1995, Clark, 2004, Clark and Larson, 1993, Clark et al., 1991, Clark et al., 1998, Larson et al., 2003, Molineux, 2000a, Wilcock, 2003, Yerxa, 2000, Yerxa et al., 1989 and Zemke and Clark, 1996):
• providing support for what occupational therapists do in practice
• improving current services to clients and developing new approaches for therapy
• understanding humans as occupational beings
• explicating the relationship between occupation and health
• differentiating occupational therapy from other professions
• enhancing services outside of traditional health and social care boundaries
Of course, the real test of occupational science will be whether or not it stands the test of time and can make a place for itself alongside other academic disciplines. There is little doubt that the debates and discussion will continue and it will be worth examining those debates in order to understand their foundation. One such examination (Molke et al 2004) has noted that, while the number of occupational science publications in 2000 was much greater than in 1990, the articles were still being published in the occupational therapy or occupational science literature and not in other fields. While not growing outside of occupational therapy, that same analysis revealed that occupational science has grown within the international occupational therapy community.
It is this growing base of evidence as to both the power and the potential of occupation that has been one of the most significant contributions of occupational science to date. Whereas generations of occupational therapy researchers had been focusing on the efficacy of specific treatment regimes aimed at reducing impairment, occupational science has re-focused attention on the more fundamental concern of the relationship between doing and well-being. Significantly, there has been a very important outcome of this focus on doing and well-being that has subsequently had a subtle but profound impact on occupational therapy practice. This has been the centralization of the person.
Centralization of the person refers to a conceptual and philosophical shift to an appreciation of the client of occupational therapy services as being both the expert with respect to their own occupational history and the most significant agent of change. Correspondingly, the role of the professional is re-cast as a facilitator, coach, resource conduit and advocate, hence equalizing the power relationship. Viewed thus, we can see that this has represented a shift away from the dominance of biomedicine as a guiding paradigm: a paradigm in which the locus of expertise and authority (and, some would argue, meaning) resided with the professional. Inevitably, such a shift has created some tensions. Specifically, these tensions are experienced most overtly by occupational therapists working in acute care settings where the milieu is one in which a truly person-centred approach becomes not just philosophically challenging but pragmatically almost untenable (Wilding & Whiteford 2009).
Whilst a full examination of this particular issue is beyond the scope of this chapter, a paradigm tension such as that described above does have implications for what sorts of research question should become prioritized in occupational science. Accordingly, the next section presents an exploration of what should be incorporated into a coherent research agenda for the future, alongside a critical examination of some of the philosophical underpinnings of what constitutes valid research.
The research agenda of occupational science
As has been suggested in the previous section, one of the features that characterizes occupation is complexity; indeed, some authors have advocated that complexity theory itself should be the basis for developing understandings of occupation as a multi-dimensional human phenomenon (Creek, 2003, Molineux and Rickard, 2003 and Whiteford, 2005). Such complexity represents a two-edged sword when it comes to research, however. On the one hand, the complex features of occupation make it a rich field of enquiry. On the other hand, the complexity of occupation requires careful consideration of methodological strategies employed to comprehend it best.
Methodologically, discussions and developments in occupational science research to date have highlighted the importance of narrative approaches in understanding occupation. As numerous authors have argued over time, the dynamism of occupation cannot be captured through traditional experimental means. Indeed, because of its context dependence, occupation cannot be reduced to sets of variables that are controlled or manipulated. It is precisely the random and sometimes chaotic environmental interactions that are the everyday fabric of occupational engagement as lived experience. Narrative approaches have been identified as being a more ontologically appropriate means through which to understand how meaning through occupation is developed over a life course (Frank, 1996, Molineux and Rickard, 2003 and Wicks and Whiteford, 2003), the significance of occupational ‘motifs’ (Clark et al 1996), the relationship between occupation and gender (Wicks & Whiteford 2005), and that between occupation and identity (Christiansen 2004). Additionally, and very importantly for the future, a narrative approach to understanding occupation or ‘doing’ has also been identified as being more consistent with indigenous knowledge paradigms (Yalmambirra, 2000 and Ratima and Ratima, 2004).
As may be evident, the case for narrative ways of knowing and understanding occupation as a situated phenomenon have been well argued and are generally well accepted. There is, however, a broader methodological discussion that still needs to take place with respect to diversity. Understanding occupation in different contexts and at the different levels at which it occurs (micro though macro) requires a conscious adoption of methodological pluralism. Such pluralism allows diverse research methods and approaches to be utilized, depending on the nature of the research focus or question. For example, understanding the impacts of living with a chronic illness on patterns and meanings of occupational engagement may predicate a narrative approach, whilst understanding patterns of occupational engagement nationally would require population-level statistical information. Alternatively, attempting to illuminate impacts of, for example, a new industrial development on the occupations of a specific community would require a multi-method orientation utilizing approaches such as focus groups, surveys, time use instruments and individual interviews. Clearly, whilst this is an arena in which there is still much debate and dialogue to be had, it is of central importance to the ongoing development of occupational science and its research foci. But what are these foci and how do they relate to an overarching research agenda? Whilst we do not have the space in this chapter to discuss these in any great depth, we will start with a brief description of the current and future research agenda of occupation science as a segue into a presentation of what we, the authors, consider to be the specific foci for future enquiry.
In essence, the future of occupational science, and indeed its potential to inform and guide occupational therapy, lie in its ability to generate new and useful knowledge as judged by its stakeholders. Relevancy has overwhelmingly become the concern of not just stakeholders but funders, academics and practitioners alike when they discuss research. This represents a timely and appropriate response when, at worst, many abuses of intellectual and human rights have historically occurred in the name of research and, at best, research has been compromised in its usefulness by a lack of regard for application in real-world contexts. The notion of research as praxis, eloquently argued some time ago by feminist Patti Lather (1986), is based on a requirement for research to be focused on generating knowledge that leads to changes in practice in order to empower people. And that is exactly what a research agenda in occupational science needs to do. When we consider occupation and its centrality not only in people’s lives but in society per se, a research agenda to understand it further must necessarily address those structural issues that enable or preclude people from engaging in occupation, as well as individual ones. This means including consideration of the historic, political and economic factors shaping access and participation for whole groups of people and the discursive traditions that influence policy development. As described, then, it is an ambitious agenda. Accordingly, and in order to stand as a discipline alongside others, the enactment of this pluralistic research agenda must also be systematic, rigorous and defensible.
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