Re-Envisioning an Early Years System of Care towards Equity in Canada: A Critical, Rapid Review.

Background: Many children in high-income countries, including Canada, experience unjust and preventable health inequities as a result of social and structural forces that are beyond their families' immediate environment and control. In this context, early years programs, as a key population health initiative, have the potential to play a critical role in fostering family and child wellbeing. Methods: Informed by intersectionality, this rapid literature review captured a broad range of international, transdisciplinary literature in order to identify promising approaches for orienting early years systems of care towards equity in Canada. Results: Findings point to the need for a comprehensive, integrated and socially responsive early years system that has top-down political vision, leadership and accountability and bottom-up community-driven tailoring with an explicit focus on health promotion and maternal, family and community wellness using relational approaches. Conclusions: Advancing child health equity in wealthy countries requires structural government-level changes that support cross-ministerial and intersectoral alliances. Employing intersectionality in this rapid review promotes contextualized and nuanced understandings of what is needed in order to advance a responsive, comprehensive and quality early years system of equity-oriented care. Further research is needed to prevent child health inequities that are disproportionally experienced by Indigenous and racialized children in wealthy countries such as Canada. olicy and research recommendations that have relevance for high-income countries in diverse global contexts are discussed.

Orienting child- and family-centered care toward equity.

Child- and family-centered care (CFCC) is being increasingly adopted internationally as a fundamental philosophical approach to the design, delivery, and evaluation of children's services in diverse primary and acute health care contexts. CFCC has yet to be explored in the context of families and children whose health and health care is likely to be compromised by multifaceted social and structural factors, including racialization, material deprivation, and historically entrenched power imbalances. To date, an equity orientation for CFCC has not been examined or developed. This is a critical area of inquiry, given the increasing evidence that children in families who face such inequities have poor health outcomes. This article examines dominant discourses on CFCC in the context of families and children who are at greater risk of health inequities in wealthy countries, drawing on Canada as a useful example. It outlines an evidence-based approach to equity-oriented care that the authors contend has the potential to orient CFCC toward equity and provide greater clarity in the conceptualization, implementation, measurement, and evaluation of CFCC in ways that can benefit all families and children including those who have typically been excluded from research.

Community-Based Recreation Therapy and Mental Health Recovery: A Mixed-Media Participatory Action Research Study.

BACKGROUND: Personal recovery is an individualized process through which people develop a positive identity and live a meaningful life, with symptoms of mental illness. Few studies have explored the role of recreation therapy in the recovery process from the perspectives of individuals with lived experience of mental illness. OBJECTIVES: To understand how community-based recreation therapy can support mental health recovery, from the perspectives of people diagnosed with mental illness, and to guide the development, delivery and evaluation of recovery-oriented mental health services. METHODS: Guided by the principles of participatory action research (PAR) and photovoice, six participant researchers (PRs) generated arts-based media and narrative data in response to the research question: How can therapeutic recreation, in a community mental health center, support the recovery of individuals diagnosed with mental illness? The research group analyzed the qualitative data through a participatory data analysis process. RESULTS: The PRs produced and analyzed 24 pieces of arts-based media and 5 hours of transcribed narrative data describing their artworks' relationship to therapeutic recreation and recovery. The PRs identified seven salient themes through the participatory data analysis process: providing a safe place, promoting hope, finding balance, developing self-wisdom, increasing enjoyment, building confidence, and encouraging self-determination. CONCLUSIONS: Service recipients' unique preferences and perspectives must be integral to service development to deliver therapeutic recreation interventions that are truly recovery-oriented. The research findings will be used to guide the delivery of innovative, collaborative, person-centered programming in community-based mental health settings.

Expanding beyond individualism: Engaging critical perspectives on occupation.

BACKGROUND: Perspectives that individualize occupation are poorly aligned with socially responsive and transformative occupation-focused research, education, and practice. Their predominant use in occupational therapy risks the perpetuation, rather than resolution, of occupational inequities. AIM: In this paper, we problematize taken-for-granted individualistic analyses of occupation and illustrate how critical theoretical perspectives can reveal the ways in which structural factors beyond an individual's immediate control and environment shape occupational possibilities and occupational engagement. METHOD: Using a critically reflexive approach, we draw on three distinct qualitative research studies to examine the potential of critical theorizing for expanding beyond a reliance on individualistic analyses and practices. RESULTS: Our studies highlight the importance of addressing the socio-historical and political contexts of occupation and demonstrate the contribution of critical perspectives to socially responsive occupational therapy. CONCLUSION AND SIGNIFICANCE: In expanding beyond individualistic analyses of occupation, critical perspectives advance research and practices towards addressing socio-political mediators of occupational engagement and equity.

Engaging Indigenous families in a community-based Indigenous early childhood programme in British Columbia, Canada: A cultural safety perspective.

This article is part of a larger study that explored how an Indigenous early intervention programme in British Columbia (BC), Canada, known as the 'Aboriginal Infant Development Program' (AIDP), influenced family and children's health and well-being and was responsive to child health inequities. Postcolonial feminist and Indigenous feminist perspectives provided a critical analytical lens to this qualitative inquiry. The study was undertaken with AIDPs based in diverse community organisations located in off-reserve urban municipalities throughout the province of BC. From September 2013 to March 2014, in-depth, semi-structured interviews were undertaken with: Indigenous primary caregivers (n = 10), Indigenous Elders (n = 4), AIDP workers (n = 18) and administrative leaders (n = 3). The purpose of this article is to examine and analyse the findings that focus on how AIDP workers supported family and children's health and well-being by transforming their routine policies and practices in ways that fostered caregivers' active engagement in their programmes. Findings centre on three main themes: (i) overcoming mistrust; (ii) 'being willing to move a step forward' and (iii) resisting what's taken-for-granted. These inter-related themes are examined and discussed in relation to the concept of cultural safety. The findings have international relevancy for social and healthcare community-based programmes that are questioning how to engage with parents who may be hard to reach as a result of multi-faceted social and structural factors.

Sharpening our critical edge: Occupational therapy in the context of marginalized populations.

BACKGROUND: An emerging and important area of occupational therapy practice involves engaging with various individuals and population groups who live in marginalizing conditions that result in health inequities. PURPOSE: This paper calls for more critical and intersectional analyses of occupational therapy in the context of marginalized populations. KEY ISSUES: Intersectionality has the potential to reveal important and complex interactions among social systems that create and sustain marginalization and to inform more nuanced, contextualized, and socially responsive forms of occupational therapy. Central to this process is the co-construction of knowledge with people who experience marginalization. Engaging in this work requires occupational therapists to undertake ongoing critical reflexivity to attend to our sociohistorical positioning of power and privilege in relation to marginalized populations. IMPLICATION: Complicating our discourse on marginalized populations is imperative to enacting our critical potential in working toward social justice and health equity.

A critical reflection on the concept of cultural safety.

BACKGROUND: Cultural safety broadens and transforms the discourse on culture and health inequities as experienced by diverse populations. PURPOSE: To critically analyze cultural safety in terms of its clarity, simplicity, generality, accessibility, and importance. KEY ISSUES: Whilst the clarity and generality of cultural safety remain contentious, there is emerging evidence of its capacity to promote a more critical discourse on culture, health, and health care inequities and how they are shaped by historical, political, and socioeconomic circumstances. IMPLICATIONS: Cultural safety promotes a more critical and inclusive perspective of culture. As an analytical lens in occupational therapy practice and research, it has the potential to reveal and generate broader understandings of occupation and health from individuals or groups in society who are traditionally silenced or marginalized. In relation to Aboriginal peoples, it clearly situates health and health inequities within the context of their colonial, socioeconomic, and political past and present.

"Circle of caring": a First Nations worldview of child rearing.

BACKGROUND: For occupational therapy to be meaningful for all families who have a child with a developmental disability, the profession needs to consider and integrate into practice alternative and more inclusive epistemologies. A greater understanding and respect of a First Nations worldview may help reduce the risk of inadvertently perpetuating oppression and assimilation. PURPOSE: To describe raising a child with a developmental disability from the perspective of five members of the Lil'wat Nation. METHODS: Data were obtained from in-depth interviews and analysed using a constant comparative approach. FINDINGS: Within the category of family the subcategories identified were extensive support network, intergenerational learning and doing, and influence of the residential school system. Within the category of raising a child the subcategories identified were health and spirituality, causation beliefs, and a sense of knowing. IMPLICATIONS: Occupational therapists need to be cognizant of alternative worldviews on child rearing, family, and health that may differ significantly from their own personal and professional beliefs and practices.