Occupational therapy: what does this look like practised in very remote Indigenous areas?
BACKGROUND
Occupational therapy in very remote, predominantly Indigenous, settings requires therapists to modify traditional models of practice to make practice applicable, culturally relevant and culturally safe. This article describes some of the author's observations of similarities and differences in what occupational therapy 'does' and 'is' in four different, but in many ways similar, very remote contexts. A Churchill Fellowship allowed the author to travel to visit teams in three very remote regions of Canada and the USA, allowing comparison to practice in the Top End of the Northern Territory in Australia.


OBJECTIVE
These very remote settings are unable to support onsite therapy services resulting in fly/drive-in visits from hub towns, influencing service models and extending professional tasks and roles. In many of these remote contexts populations are predominantly Indigenous, which requires therapists to work cross-culturally. This requires occupational therapists to adapt therapy assessments and interventions to make these appropriate to the contexts.


CONCLUSIONS
Therapists perceived a range of therapeutic adaptations and resources as useful in their practice and some barriers to implementing these. These included supports to practice such as cultural liaisons or interpreters; being open and respectful to differences in beliefs around health, wellbeing, desired occupational pursuits and function; using a client/family-directed approach in care planning, goal setting and development of therapeutic strategies; being selective around use of standardised assessment tools; and taking time and developing relationships with family and clients. Therapists in these areas also reported their scope of practice as being broader in remote settings, requiring skills in a greater range of areas. Therapists also reported the increased use of technology to supplement and support remote practice.
Remote Disability Services, NT Department of Health, Darwin, Northern Territory, Australia. felicity.pidgeon@nt.gov.au.
F
F
Pidgeon
D002170:Canada; D002983:Clinical Competence; D003150:Community Health Workers / Q000592:standards; D003431:Cross-Cultural Comparison; D054521:Cultural Competency; D004059:Diffusion of Innovation; D005194:Family Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006303:Health Services, Indigenous; D006801:Humans; D008297:Male; D015876:Northern Territory; D009788:Occupational Therapy / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care / Q000379:methods; D018802:Patient-Centered Care / Q000379:methods; D010817:Physician-Patient Relations; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards; D012424:Rural Population / Q000706:statistics & numerical data; D012923:Social Class; D012944:Social Support; D014186:Transportation; D014481:United States
Allied Health; Cross-cultural Safety; Occupational Health; Practice Tips