Diversity and Social Inclusion : What is the best way to develop and implement the topics of diversity and social inclusion in the OT bachelor program?

(1)

0

Student

Chitra v. Aernsbergen

500661169

Franne Boer

500668772

Rolf Schaap

500642808

Anouk Verschoor

500666189

Class

DG_LE15-P8C

Bachelor

Occupational therapy

Coach

Soemitro Poerbodipoero

Clients

The Netherlands:

- Soemitro Poerbodipoero

England:

- Kee Hean Lim

- Debbie Kramer-Roy

Location

Amsterdam

Date

03-06-2016

Word count

Diversity and Social Inclusion

What is the best way to develop and implement the topics of diversity and social inclusion in the OT bachelor program?

(2)

1

Abstract

Aim: This project aims to get insight in the implementation of diversity and social inclusion in Brunel

U i e sit s O upatio al the ap OT u i ula, i the ulti ultu al it of Lo do , to o pa e this to the Hogeschool van Amsterdam (HvA) curriculum. This information is used to write an advice report for the HvA on how to better implement these topics.

Methods: Each group member answered part of the main question through literature studies.

Seminars and conferences regarding the topics were attended to get insight. Semi structured interviews were completed with 16 participants (students, teachers and placement educators) from both England and the Netherlands.

Results: Literature studies and conferences allowed knowledge and experiences on the topics.

Inquiries found 7 themes for students and teachers: definition, influences, awareness, OT views, personal views, current curriculum, wishes curriculum and importance to OT. Placement educators had one extra theme: the link between education and practice.

Conclusion: Diversity and social inclusion are dynamic and important topics for OT. Although implicit

in education and practice, they should be included. Awareness can be reached by reflections and discussions by OT and its OTs. The link between theory and practice should be more prevalent. More research has to be done to improve curricula and practice regarding these topics.

(3)

2

6.1.1 English ... 37 6.1.2 Dutch ... 38 7. Inquiries ... 40 7.1.1 Students ... 40 7.1.2 Teachers ... 64 7.1.3 Placement educators ... 83 8. Summary of inquiries ... 87 8.1.1 Students ... 87 8.1.2 Teachers ... 93 8.1.3 Placement educators ... 97 9. Results inquiries ... 99 9.1.1 Students ... 99 9.1.2 Teachers ... 103 9.1.3 Placement educators ... 106 10. Advice report ... 108 10.1.1 Diversity ... 108 10.1.2 Social inclusion ... 110 10.1.3 Occupational justice ... 111 10.1.4 Intercultural competences ... 112 10.1.5 General ... 114

(5)

4

1. Introduction and motivation

Diversity* and social inclusion* are relevant issues in occupational therapy (OT). Every individual has a particular manner of thinking and doing things that were taught to them in a certain social context. Culture impacts the understanding of health and determines a specific behaviour in relation to practices in health care. Over the last years, there has been an increase in critical thinking regarding OT culture. The main assumptions at the base of OT have been developed in urban areas of the (mainly English-speaking) nations of the Western world. Because of this, we have to acknowledge that the problematic culture of OT is based on the occupational therapist, instead of the client (Martín, Martos, Millares, & Björklund, 2015).

A recent study shows the need to implement diversity and inclusiveness in the advancement of teaching strategies in health-care education (Trentham, Cockburn, Cameron, & Iwama, 2007). Over the past few decades, several articles focused on the ethnocentrism in OTs ai o epts, assumptions and beliefs. The main assumptions underpinning OT are culturally specific. Most of them have been developed without sufficient concern for culturally different views around the world. Moreover, occupation is not a cross-cultural* universal concept, along with health, disease, ability, disability and therapeutic care. Fieldwork can be used for moving the theoretical knowledge of culture into practice and vice versa (Martín et al., 2015).

As for social inclusion, this is a concept that aims to ensure that all people have the same rights, services and benefits. Access to employment, income, economic, social and material resources, education, healthcare, housing and personal safety should be equal to all people. Social inclusion alues a d e og izes di e sit , fo usi g o people s se se of elo gi g, so ial equality and participation. Occupational therapists (OTs) can use their specific skills to identify factors that allow people to engage in daily activities. Their knowledge of how to remove barriers to participation can be of use when they strive to support enabling for every individual (Canadian Association of Occupational Therapists, 2016).

Currently the Amsterdam School of Health Professions (HvA) is working on the design of a new curriculum* starting next school year. Previous staff exchanges between OT schools of both HvA and Brunel University in London have resulted in the desire to implement diversity and social inclusion in the new OT curriculum. The latest screening of the current curriculum in Amsterdam identified some gaps in the education about the topics diversity and social inclusion (Kelting, 2015). If students want to learn more about these topics, there are options within the current curriculum of the OT bachelor at the HvA. However, these options mostly exist outside of the standard curriculum.

Examples of these are:

- The minor program, where a student can choose to follow different minors (e.g. Global Health, e-Health, Health Promotion).

- Another program focuses on community development and is initiated by the HvA itself. The University offers different projects from a district in Amsterdam that require special attention (e.g. illiteracy, diversity, social inclusion). Other projects require students to perform specific tasks by a certain client, such as developing innovative ways to work with specific instruments. Students will participate within project groups, sometimes together with students from other bachelors, to develop a final paper and / or product.

Both programs are distributed over one semester and students will have the opportunity to develop certain skills (Hogeschool van Amsterdam, 2016).

(6)

5

Unfortunately, the demand for these projects is low and not all students think of it as important or interesting. Therefore it would be useful and interesting for this project group to explore how much these bachelor programs, in the UK and in Amsterdam, actually contain about these topics. There is a challenge to develop new and smart didactic ways to incorporate these topics in the new curriculum - which is already quite fixed and filled up. This project can lead to recommendations for innovative approaches in the implementation of these topics within the OT curriculum to foster the intercultural competences of students.

It is important that key terms and concepts mentioned in the products are explained. These are included in a glossary, so that it is clear what the accompanying definitions are within this project (see appendix 1). References will be made in the text through asterisks.

To monitor the quality of the process, Aubèl (2014) was used as guideline. This book offers a framework with six steps to understand and improve quality care. This framework was used because our goal is an advice / implementation plan for the next curriculum at the HvA. This plan is meant to improve the quality of education for students. The steps give guidance on how to analyse and investigate the different aspects that play a part in, or will contribute to, the final product. The full advice report can be found in appendix 10.

(7)

6

2. Aim of the project

In the following headings we will describe the aim of the project, by describing the focused problem, the target group and the social relevance of the topics at hand.

2.1 Focused problem

As previously mentioned, the issue is the small amount of information on diversity and social inclusion in the current curriculum of the HvA. There is not a clear approach on how to implement these topics; therefore the question from our supervisors is to see how they implement these topics in the University of Brunel. The HvA can use this information to implement it in their curriculum.

2.2 Social relevance

Practitioners and users of OT services are becoming more aware of the issues of diversity. This is made possible through globalization* and the constant information stream. We can see this through the questions people ask occupational therapists, and also because our services must change to be able to help people on diversity level (Martín et al., 2015). As of recent, social demographic challenges, like the refugee crisis, also bring more diversity to Europe.

It is necessary, as occupational therapists, to be aware of these topics. Keeping social inclusion and diversity in mind, creates an innovative way of treating people in a community, and is implemented already in the United Kingdom (UK). As a university, it is important that the curriculum stays up to date. This gives students the latest information, which can be used in the field.

Another reason for the relevance of this project is to educate students in Amsterdam about these topics, so that they will have an equivalent amount of knowledge about them as a peer from England and vice versa. It coincides with the mission and beliefs of the world federation of OT (WFOT) (WFOT, 2016).

2.3 Primary objective

At the end of this semester we have set up an advice that fosters integration of the topics diversity and social inclusion within the curriculum of the current OT program at the HvA.

(8)

7

3. Methods

To educate ourselves about the topics diversity and social inclusion, and how they can be implemented in practice and education, a wide variety of sources were used. Different conferences were visited, a literature study was made by each project member, and data was collected from different participants.

3.1 Literature studies

In order to meet the primary objective, research had to be performed. A main question has been formulated with the clients, which was divided into four sub questions. Each project member answered one of the sub questions, by carrying out a literature study. The collective of these sub questions can be used to answer the main question. Each project member used the most relevant scientific articles, books and personal experiences to formulate an answer to their question.

Question Answered by:

Main What is the best way to develop and implement the topics of diversity and social inclusion in the OT bachelor program?

All

1. Which state of the art knowledge, skills and attitude regarding diversity need to be included in the OT bachelor program?

Rolf

2. Which state of the art knowledge, skills and attitude regarding social inclusion need to be included in the OT bachelor program?

Franne

3. Which state of the art knowledge, skills and attitude regarding occupational justice* need to be included in the OT bachelor program?

Anouk

4. What are the best practices to develop intercultural competences* in the OT bachelor program?

Chitra

Table 1: Literature questions

The literature studies support our bachelor thesis and will provide information for field research. All literature studies substantiate: introduction, research questions and -goal, relevance, databases used, search strategy, selection procedure, results, discussion and conclusion.

3.1 Moodle

HvA teachers can follow a new module on diversity in healthcare, improving knowledge, skills and attitude (incorporating intercultural competence). This can be taught to the students through classes and assignments. The module gives information on preparation for diverse clients, whether the differences are relevant and how to be open to people from different backgrounds. The module uses different kinds of approaches, such as: experience assignments, teaching assignment, videos, lectures and workshops. Different kinds of literature are recommended and reflection is required. This has been taken into account in the advice report.

3.2 Seminars and conferences

The fi st se i a as O gaa et di e siteit, ee Eu opese uitdagi g Deali g ith diversity, a Eu opea halle ge i De Haag, hi h as offe ed to us ou lie t. This o fe e e s ta get group was mainly political and economic students and professionals. Different workshops and lectures were given regarding diversity within society.

The first conference was the Brunel Student Conference on April 6th at Brunel, themed Buildi g skills fo futu e p a ti e . This as a o fe e e fo OT stude ts a d tea he s at B u el, a d fo internationals. We were asked to give a workshop of 60 minutes regarding our project, with a maximum of 24 participants. The o kshop s goal as to e a i e the opi io s a d e pe ie es of the students regarding diversity and social inclusion (SI). Another goal was to recruit Brunel students to involve them with our inquiries. Discussion groups would be a good way to achieve these goals,

(9)

8

because data can be gathered in-depth from multiple participants. The steps from Boston College (2011) were used to shape the workshop. The group would be equally divided in two: one would g oup ould dis uss di e sit , the othe so ial i lusio . Ea h g oup ould e led t o p oje t e e s, dis ussi g the ai topi s defi itio , u i ulu i ple e tatio a d ishes ega di g the curriculum. Flap-overs allowed students to write down thoughts and perspectives. Afterwards the results of both groups would be compared and discussed regarding similarities and differences. The preparation document can be found in appendix 3.

A total of 14 participants, equally and randomly divided over two groups, attended our workshop at the conference. Output of the workshop was used to compare and merge with other outcomes. The flap-overs can be found in appendix 4.

From the 11th until the 15th of April the COHERE conference was attended in Derby with the theme 'Diversity and social exclusion'. We participated in different workshops and lectures concerning the topics of diversity and social exclusion, which are relevant topics for the main question of this thesis project.

Afterwards we returned to London. Our client arranged that we could attend first year post-reg classes for two days, allowing insight in the education of students. It also created an opportunity to promote our project and recruit participants. Most students had their exam period, but most were available after the May 5th.

Through students we learned about a seminar in Brunel on April 20th, themed e ualit a d di e sit . Tha ks to this i fo atio e could enrol in this seminar, to see if we could get more information for the project. We also found that second year post-reg students would return to Brunel on April 27th, so we returned that day to recruit more participants.

3.3 Collection of data

Some questions could only be answered by performing research in the field:

- What are the experiences of OT students on the topics of diversity and SI in their OT curriculum?

- What are the experiences and best practices of teachers in implementing the topics of diversity and SI in the curriculum in OT?

- Which gaps can be identified in the mutual curricula and what could be innovative recommendation to face and solve these challenges?

Inquiries

The method inquiry was used to get opinions and experiences of students, teachers and placement educators. This gives insight in the curriculum and how the topics of diversity, SI, occupational justice (OJ) and intercultural competence (IC) are implemented. Semi-structured interviews were chosen to get as much in-depth information on their views as possible (Newton, 2010). Verbal confirmation was given before every inquiry for the use of data in our project.

Each inquiry was performed by two project members. Equal chances were given to work with each other and to switch tasks during inquiries (taking notes or questioning participants), to give each group member equal opportunities to learn. The data from inquiries was recorded in the topic lists; the answers were written down under each sub question. One of the project members took notes during the inquiry; the second peer gave feedback afterwards.

All sub questions were summarized and were categorized under the main questions of every inquiry (diversity, SI, OJ and IC). Tables were created for students, teachers and placement educators

(10)

9

respectively. This allowed data to be easily compared. Each inquiry was summarized by the person taking notes during the inquiry, the second person gave feedback. The summaries can be found in appendix 8.

Students were interviewed because of their experience with the curriculum and placements, and their ability to compare both of these contexts. Students were recruited through the given workshop at Brunel University (n=2), by following lectures at Brunel University (n=2), through email by our client (n=2) and through placements visits (n =3). We were not able to find participants through other students. We also tried to have a discussion group with Dutch students to compare the different data, by contacting the placement desk of the HvA. They sent out an overview of the project to the tea he s of pla e e t oa hi g g oups. We also asked ou lie t to put it o DLWO, the H A s intranet. No students replied.

Teachers at both universities were interviewed to see how they implemented the topics of diversity and SI in their curriculum. They could also tell us their opinion regarding the topics of diversity and SI and the relevance to society and the work field. One teacher was recruited through our client and the attended lessons at Brunel University. No other teachers at Brunel University were interviewed, due to a lack of response. Dutch teachers were recruited through our client at HvA (n=3).

Placement educators can compare how the students are developing their skills when it comes to the researched topics. They can compare education to practice. Placement visits were arranged through our client. Placement educators were reached through these placement visits (n=3). The students were also approached this way.

Participants Approached (n = 56) Participated (n = 16) Students 34 9 Teachers HvA 3 3 Teachers Brunel 3 1 Placement educators 16 3 Table 2: Participants

Characteristic Brunel student (n = 9) Brunel teachers (n=1) HvA Teachers (n=3) Placement educators (n=3) Mean age, yr. (NL/EN) 26,33 54 34 49,67

Women, n 7 1 2 3 Men, n 2 - 1 - Western background, n 7 1 2 1 Non-western background, n 2 - 1 2 Bachelor, n (1st-, 2nd-, 3rd year) 3 (0, 3, 0) Pre-reg*, n (1st-, 2nd year) 4 (1, 3) Post-reg*, n (1st-, 2nd year) 2 (0, 2)

Table 3: Participant demographics

Topic lists

A topic list was used for the inquiries with the students, teachers and placement educators. It was drafted by using the main questions of the literature studies. Boeije (2014) was used as guide to draft the first concept. During the project the list had three changes. The first concept was used for the first inquiry, and was later feed backed by our coach. The question Ho ould you … diversity in

relatio to your edu atio as OT? was deleted in the second version, since it was already covered by Ho is … i ple e ted i the curriculum? . After two student inquiries, the questions concerning

(11)

10

Ho ould you des ri e… were specified to What is your defi itio of …? . This was due to the

participants often making the connection to the curriculum, rather than giving their own views. We also decided, after the second interview, to prevent interfering and giving information during the inquiry, since this could influence answers. This also shortened interviews to about 45 minutes instead of an hour, which was beneficial for participants. The topic lists were available in Dutch and English. The final lists in both languages can be found in appendix 6.

Since there was no ethical approval for recording and transcribing formal interviews, interviews were informal. As an alternative reporting method, key phrases and -words were written down during the inquiries. These notes can be found in appendix 7.

3.4 Data analysis

Conclusions from the literature studies were used to support the topic lists and to get background information regarding our main question and sub questions.

Notes were taken during the conferences, and the presentations were used to summarize relevant data regarding the main question.

The summaries were used for coding, which gave different themes. To organize these results, fishbone models were used, as recommended by Aubèl (2014). This gives a clear overview of all main and sub themes. The themes, codes and their descriptions can be found in appendix 9.

Figure 2: fishbone model students

(12)

11

(13)

12

4. Results

Through the literature studies, seminars, conferences, and inquiries, results were gathered. These will be presented in a similar sequence below.

4.1 Literature studies

The lite atu e studies o lusio s ill e p ese ted elo thei espe ti e esea h uestion.

Which state of the art knowledge, skills and attitude regarding diversity need to be included in the OT bachelor program?

Diverse populations exist in all societies and are becoming increasingly diverse. Diversity and culture are intertwined. Everyone is part of a culture and vice versa. Culture and diversity are expressed as a key phenomenon in OT, considering their close relationship to occupation and expression in OT. Due to the dynamic nature of diversity and culture, IC will never be finished developing, including the knowledge, skills and attitude required. To acquire IC, it is necessary to critically reflect on both the experiences of clients with OT, and OT as a profession universally applying its Western way of thinking.

The articles on curricula scratch the surface of the ways that new knowledge, skills and attitude regarding diversity can be included in the OT bachelor program. However, more research has to be done, preferably by collaboration between educators and researchers, in order to adjust and develop new evidence based practices in regard to diversity.

Which state of the art knowledge, skills and attitude regarding SI need to be included in the OT bachelor program?

According to the articles, knowledge of including vulnerable- and excluded groups needs to be in the curriculum. OT students need skills to use meaningful occupation as an intervention to achieve SI. Additionally, the Western worldview needs to change from an individual perspective to a community perspective to attain SI. Regarding attitude, the students need to be aware of their responsibility, so they can ensure that excluded groups and vulnerable people have equal access in the society – especially in the health care system.

The articles included the following vulnerable and excluded groups: mental health problems, mental health problems in forensic service, homeless people, refugees on high schools, and students from a secondary primary school regarding classroom environment. Other vulnerable and excluded groups have not been researched at all, including: people with learning disabilities, the unemployed, disabled people, older people, pregnant teenagers and asylum seeker communities. However, it is necessary to do research on these target groups.

Which state of the art knowledge, skills and attitude in regarding to OJ need to be included in the OT bachelor program?

According to all the articles named in the literature study, occupational injustice is seen in different aspects and terminology, occupational deprivation, occupational imbalance, occupational marginalization and occupational alienation. Because this is mentioned in all the articles, this can be seen as valuable knowledge that should be included in the OT bachelor program. Two articles were reflections on OT curricula and what the students thought about these curricula. The topic OJ can be included in the curriculum through lectures regarding the definition of the topic, discussions in class regarding ethics and taught through fieldwork.

With the information from the articles, and the example of the two curricula, a program can be formed that can be included in the OT bachelor program at the HvA with OJ.

(14)

13

What are the best practices to develop IC in the OT bachelor program?

The importance of culture, diversity and being culturally competent within OT is a fact. Implementing these topics, supporting students in becoming culturally aware and to enhance their IC within the OT bachelor program, will prove to be a complex task for educational institutions. Future students and current practitioners should become aware of their role, and how multicultural situations provide significant opportunities to increase knowledge of the impact that cultural differences have on the experience of OT. Students experienced that the focus of faculties is more on preparations academically rather than increasing cultural awareness. Fieldwork experiences, supervision, obtaining relevant skills and attitudes, and gaining insight and understanding of how OT students perceive their international, cross- cultural learning experiences should give OT educational institutions advantage when enhancing their curricula. However, more research is necessary to form concrete ideas how to establish OT curricula which can support students in developing their IC.

4.2 Seminars and conferences

4.2.1 Den Haag conference

Coping with superdiversity

The city of the future is not multicultural but superdiverse*. Currently London has a population of people from 179 countries. Every national group is group has different races, ethnicities, gender, sexual identity, language, religion, age, socio economic status, political affinity, legal status, transnational etc. In our way of thinking in integration, social cohesion or good health care, the focus is solely in ethnicity or insufficient culture instead of the individual (personal communication, March 18, 2016).

The refugee crisis is also a current issue with long term consequences for the Dutch society. The pressure of integration will maintain in the future, because the Dutch policy integration staff from forecast that migration rates would increase. Refugees will most likely stay longer, even after the crisis. More results can be found in appendix 2.

4.2.2 Workshop Brunel OT student conference

Diversity

Students described diversity as customs, ethnicity, religion, beliefs, food, language, way to dress, sexual orientation, marital status, health conditions, disabilities, socio-economic status, different classes, and family background. The Equality act of 2010* was mentioned to prevent discrimination, which was quite recently introduced in the UK.

Culture was described as a collective group, encompassing different individuals. All individuals are different, having their own cultural identity. According to the students, this individual culture encompasses marital state, disabilities, health, well-being, socio-economic status amongst others. We should accept that everyone is different, but equal; equity in variety.

OT is predominantly female, which is reaffirmed in the Mary Seacole building of Brunel University; the e is o l o e ge ts toilet, hi h is also i ed ge de . The did, ho e e , st ess that OT is a a e of diversity and includes it in its approaches with clients.

The topi of OT as a ultu e as dis ussed. OTs te ds to spe ialize, a d the e is dis i i atio between these specializations. They concluded that OTs do this to strengthen their security, and to identify themselves more clearly as an OT.

Curriculum

Students mentioned that Brunel University is diverse, as is London. Diversity was included in different lectures, lessons, case studies, workshops and placements. An example was peer to peer learning: everyone came to a seminar to discuss case studies. Within placements there is also diversity. The

(15)

14

topic is more implicitly than explicitly mentioned in lectures, workshops and placements, but a certain level of awareness is expected when enrolling. According to the students, OTs must be

open-i ded; the e open-is o lea e open-ipe . OTs ha e to espe t theopen-i lopen-ie ts a d theopen-i a kg ou ds, a d require desire to learn about other cultures. These are core elements of person- and client centred practice. This is also described in the Code of Ethics, in which equality and policy are described. Not only is this seen as a core value in OT but in the area of London as well.

Wishes

The following ideas were proposed to improve the curriculum in regard to diversity:

- Explicit tips on how to deal with this topic in seminars.

- There needs to be more emphasis on diversity in seminars.

- Implement ethnicity into aspects of the curriculum. However, mainly teach to have an open mind. They should teach about the differences, individual ethnicities and cultural preferences.

- Using multimedia (e.g. YouTube) to show cultures from diverse ethnic backgrounds.

- There should be more emphasis on the wider aspects of diversity, not just cultural / ethnicity.

- More talks from service users.

In general, participants were all positive in regard to diversity in the curriculum. They feel lucky that Brunel is such a diverse and unique place. They learned about diversity from the university because of its students as well. Culture in Brunel, in particular OT, enables students to explore diversity in an experimental and meaningful way.

Social inclusion

Students described SI in different terms such as: adverts, political, culture, participation, relationship, accessibility, buzzword, loneliness, social media, cyber bullying, subjective, opportunity, class, diversity, isolation, connection, professionals , friends, outreach, language, gender, religion, acceptance, environment, groups, disabilities, life events, beliefs, location and values.

Students found it hard to define SI without first focusing on diversity. There were different thoughts about SI. A core definition was hard to describe. More terms followed, including diverse perspectives of students. SI is a uzz ord , as people keep talking about. SI was seen as such a broad term. This brought them to emphasize that SI is still a hot topic, concerning loneliness and cyber bullying; therefore also linking with social media.

Curriculum

OT students participated in community projects with older adults with dementia, to create SI in the form of a common group activity. In the placements there were different projects regarding SI, for example mental health settings and neurology placements. During lectures service users were invited, and there were also lectures about research concerning this topic.

Theoretical models mentioned:

- Occupation for health and wellbeing, including the topics culture and diversity. This model incorporated the following activities: social outing, gardening, cooking and photography.

- Theory of occupation, also including the topics culture and diversity.

- Social model of disability, which reflects the way of thinking how OTs could become aware of the social stigmatization of disabled people in communities.

- Professional practice module

(16)

15 Wishes

OT should become more international. OT journals should be available for anyone, also in non- Western countries. Students mentioned that, in their education, these journals were often used to suppl ele a t a ti les. “tude ts ish to de elop thei o ld ie as a OT , i ludi g: lea i g about other cultures, reading other sorts of journals, and learning about both Western and non-Western perspectives. However, most current journals are still only showing topics from their Western point of view. Students agree this should change.

A discussion on working evidence based practice ensued. The traditional way of theory based research is being challenged. Normally, theoretical data is gathered first. The new way lets OTs first gather data from practice, and afterwards finish their research based on their experiences. There was a need for more research and community projects with vulnerable groups, such as mental health, visual impairment and dementia.

4.2.3 Brunel OT student conference

One lecture was about empathizing with clients. It also encompassed that caregivers are also human. They should also deal with emotions during care, just like any other human, but sometimes this is forgotten. Another lecture was about connecting with refugees. It was recommended to find common ground, since refugees can have a lot of negative experiences. A good tip was to start a conversation about the personal items they brought with them. The conference was also an opportunity to introduce our project to the students of Brunel, in order to recruit participants.

4.2.4 COHEHRE conference

During the conference we learned about underlying difficulties of SI and diversity, such as emotional resilience. Becoming too emotionally resilient can be negative, and can be caused by social exclusion. We learned to work together with people from different backgrounds. We also experienced their different views on health care, SI and diversity. This conference was important for our main question, because it gave different views on diversity, SI, cultural views, and different teaching methods at different schools. More results from our experiences and the entire program from this conference can be found in appendix 2.1.3.

4.2.5 Equality and Diversity Research Conference: D i e s of Cha ge

This conference was organized by Brunel. However, during the conference the speakers appeared to be more research based, rather than going in-depth on the topics of diversity and SI. This resulted in a less informative conference regarding our main question.

4.3 Inquiries

Several themes surfaced during the coding of the inquiries. A short summary per topic was made about the themes we had found. For students and teachers we found the themes: definition, influences, awareness, OT views, personal views, current curriculum, wishes curriculum and importance to OT. Placement educators had one extra theme: the link between education and practice. Below is a summary of all our results, encompassing themes and descriptions.

4.3.1 Students

Diversity

Definition Diversity is about being multicultural (as in race, ethnicity, religion, beliefs, culture), moving in society and communities. It is about understanding how people do things and how they view things and having not just one set of ideology or one set of people.

Influences Diversity influences knowledge, skills, attitude and ability. It also has an impact on working client centred. Because the Western culture is being

(17)

16

projected on many other cultures, and this changes your own way of approaching clients. OTs should be mindful of cultural differences, learn from them and adapt, as one will never understand everything about everyone.

Awareness OTs work with clients from various ages, cultures and (socio-economic) backgrounds. To be aware of these differences is important, especially in multicultural societies. This helps OTs p ofessio all to e su e the e working client centred. We should be mindful about this, so we can learn and adapt. One can never really understand everything about everyone. OT Views OT has a Western bias, as it was created in the Western world and the

workforce is dominated by white women. This does not fit in well with diverse clients. Client centred practice requires awareness on diversity. We e goi g to e o ki g ith lie ts ith a diffe e t a kg ou ds a d views, which influence the profession. OT should be mindful of differences, to learn and adapt, because it works with what is known and adjusts it to something that fits the client. Therefore OTs need to be creative and open. Personal views Diversity is important for the OT practice, because we are not living

i di iduall ut i a o u it . It s i po ta t to t a sfe knowledge and skills and be open-minded. Narrow-mindedness will slow us down. To explore and mix with other people will help to be open minded as well. Importance to OT Having awareness of cultures is important in OT, especially in multicultural

societies and communities. OT can only work client centred if they take diversity into account and are aware of the diversity of the client. It is important to remember that we are not living individually, but in a community. OT should be mindful of cultural differences, learn and adapt. It is important to transfer this knowledge to skills and be open-minded. OT is supposed to be creative, we need to be open.

Current Curriculum It s i pli it. Most of the u i ulu ou ha e to e plo e fo ou self to access these topics, but it is accessible for everyone. Some lectures are about diversity and being cross-cultural. Also, journal clubs and seminars are part of the curriculum, where the topic is filtered through. Essays and case studies require justification of ethics, diversity, culture, and lifestyle. They describe different countries and faith, amongst others. Some are only available if the corresponding topic was chosen. Placements are usually early in the curriculum, which improves awareness early on. They add on the topic through exposure to different diseases, cultures et . It s ette lea i g like this than through models. Each peer / professional is a spokesperson for their own experiences, so discussions improve your own critical thinking. Wishes Curriculum Discussions should be implemented more, as most of them are not indebt

enough; more discussions are required on the meaning of health, well-being, culture, diversity etc. Another wish is to exchange experiences. It is important to transfer this knowledge to skills and be open-minded. Peers can help with this.

SI

Definition People feel socially included inside the community and are able to participate.

Influences It influences social-, physical- and personal factors are involved, and how people can help you feel included. different problems can affect each other (e.g. physical disabilities can cause mental health problems and vice versa) Awareness Awareness needs taken into account when working with a client to let them

(18)

17 feel more included.

OT Views OT focuses on the person rather than tackling the excluding group, and is about empowering clients.

Personal views Feel included, be open-minded without prejudice. See the difference you ake to a pe so s life he ou help the feel i luded.

Importance to OT A big part of OT is empowering people. That is ha d to do he the do t feel accepted in their environment.

Current Curriculum The ake esou es a essi le ut do t push us to follo up. We eed to make an effort ourselves. You have essays and case studies, but it is more implicit, no actual lectures. When working with different students, you learn about how to socially include a person, which also helps within the curriculum regarding SI.

Wishes Curriculum It s diffi ult to i ple e t, since it is not a clear cut topic which can be easily implemented in the curriculum.

OJ

Definition Everyone has a right to live and be who they want to be. OJ incorporates occupational alienation, seeing clients as individuals and the rights of a human being. It is about equal opportunities for everybody; equal members of society.

Influences Bad environment can cause occupational alienation and isolation, which is occupational injustice.

Awareness Awareness allows people to think about things that might be going on with people.

OT Views In OT it is kept in check by the OT Code of Ethics in the UK, the British Association of OT and the College of OT. These underlie the profession. It is about working client centred, and it is important in practice because of the person and the environment, alienation, isolation. OT looks at the entire picture, a d hat s i po ta t to lie t.

Personal views It is about benefiting the client, so people can do what they want to do; ou e the ediato . OJ is also part from your own occupational balance as a person.

Importance to OT It is important to see health benefit of occupation, and engage health through occupation. It links to health and OT.

Current Curriculum There have been few lectures. Essays require justification of what you do and why people benefit from OT. There were also reflections on placements. This created awareness. It does depend on the type of assignments you get. Wishes Curriculum OJ is used term rather than a discussion topic. There are no options to go

in-depth into this topic, like a discussion. Also, they should encourage students about these topics and write about it, reflect on it.

IC

Definition A lot of students were not aware that this was a thing. However, there was a

general awareness of what it meant.

It refers to the ability to navigate across different cultures, and could be seen as o e s a ilit to communicate effectively on a socially sensitive basis with people from different (cultural) backgrounds. It is about knowledge, awareness, interaction, understanding, open mindedness and acceptance of (cultural) differences, along with knowledge on what is acceptable and what is not. This includes compassion and empathy for other cultures, and an

(19)

18 understanding of that.

Awareness Although some have not heard of the term, there is awareness, because it is implemented in the criteria of assignments.

OT Views It is important being client centred, it makes a difference to what you can do as a person.

Personal views OT should adapt, e ause it s desig ed a d uild o Weste ultu e, to e more accessible for other cultures. Its lifelong learning: you always work on the competences, especially in a multicultural city like London, because you cannot know everything about everyone. These competences are required for OTs: other ise you are talki g to a ri k all . Being open minded and flexible is important in daily life and practice, to give and take as a person. Without a pe so centred e talit it s goi g to e diffi ult to e a OT. Importance to OT OT should adapt, e ause it s desig ed a d uild o Weste ultu e, to e

more accessible for other cultures. It is important being client centred, it makes a difference as what you can do for a person. Being open minded and flexible is important in daily life and practice, to give and take as a person. It is helpful for the occupational therapy practise: other ise you are talking to

a brick wall – espe ially i di ersity ity like Lo do

Current Curriculum If you have cultural drivers, you should be more dependent on yourself instead of what the school is providing. You have to choose for it and navigate yourself; your own motivation is important. The competences are imbedded in the curriculum. The information they give is subtle enough to create awareness. It is being mixed with the theory, but no clear lecture. It is included in case studies. It is more something that comes up as it happens, and highlighted on placements if the context allows it. In our course people a e uite di e se. We a lea f o ea h othe s pe spe ti es. The e a e opportunities for that.

Wishes Curriculum Students are unsure if this should be something to be graded on, since it is highly dependent on the context. They could create more awareness through discussion about this topic. A lot of issues arise because people just do not know. Currently there is no time for it. Some would like to see more of these kinds of topics in the lectures to be more aware before going on placements.

4.3.2 Teachers

Diversity

Definition In the interviews there were two main definitions: variety and identity. Variety was meant i the oadest se se, ot just people s a kg ou ds, differences, sexual orientation, gender, culture etcetera. Identity was defined as who you are, where you come from, how you personally experienced diversity. All individuals have their own identity through their roles. These constantly change and influence the approach to others.

Awareness Usually people think of cultural differences in regard to diversity. Students and placement educators mentioned that they do not always see diversity. Personal views Diversity could be seen as the origin and start of contact. Diversity is the

start and origin of the possibilities to learn. Without diversity, there would be little to learn about.

Importance to OT Diversity has everything to do with how people differ from each other, and it s e e he e.

(20)

19

studies, assignment and lectures. The lectures are about diversity and cultural sensitivity.

At the HvA it is implemented explicitly in international exchanges, lectures and assignments. The lectures are in the higher years, and focus on cultural diversity. The focus is on interaction with people with different languages and the use of interpreters. Some assignments incorporate cultural and countryside-city diversity, but it is unclear whether it will be further addressed during the curriculum.

Wishes Curriculum At the HvA is the wish to integrate diversity in assignments. They have been trying to achieve this for the last two years. It is still in progress, and it is a slow process.

SI

Definition Two definitions were mentioned: participating and inclusion despite difference. Participating was about everyone participating on their own level. Inclusion despite difference is fine as you want everyone to feel included in the community, despite differences between people.

Awareness It is important to take this into account and be aware of it when you are going into practice.

OT Views OTs help connect people to their environment. However, it is disappointing that OT would do a lot regarding this topic, but there is not done enough research about this topic and OT are not as inclusive as they think they are. Personal views You want to help your clients being able to participate in society.

Importance to OT An occupational therapist could bring people together through a shared o upatio that is i po ta t i people s life.

Current Curriculum At the HvA this topic is in development. There are some new theories which are implemented in the new literature and there are lectures, but not as much as there could be.

Brunel university has some lectures about this topic, but they should have more fieldwork about this topic. They also have a program called Widening Participation to promote the underrepresented to take part in higher education.

Wishes Curriculum The HvA wishes to have a more diverse student body, including a more diverse age range. Currently the student body consists of primarily white middle class students.

Brunel university has a wish to implement SI in fieldwork. OJ

Definition Participants mentioned that OJ is a fairly new concept about doing what you want to do. It is about everyone having the right to do and have an occupation.

OT Views As an OT you can support people who suffer from occupational injustice. Importance to OT The importance for an OT is to understand that it contributes as much as

eating for your own personal health and well-being.

Current Curriculum At the HvA two programs where there are projects implementing this topic. However, most students do not know the term OJ. There should be more lectures on it.

Brunel university has implements this topic in lectures and fieldwork, primarily throughout the first year. There is a lecture on OJ. In the BSc and MSc there are assignments about this topic. After this is shown in fieldwork

(21)

20 with OJ and more underlying.

Wishes Curriculum Both universities want to make the topic easier for students to understand and tell them more about it.

IC

Definition The participants saw dealing with diversity as a definition for IC. This means the knowledge, skills and attitude one possesses to contact, communicate and support diverse people, such as cultural sensitivity and empathy.

Personal views Everybody should have equal opportunities. International students bring different cultures with them, so it also impacts them. Without IC you could never help people. Everyone has them to some extent.

Current Curriculum The HvA implements IC through motivational interviewing, social- and conversation skills. However, Students and teachers do not pay enough attention to cultural diversity in Some assignments. It is noted, but there is no deepening of knowledge, skills and attitude. Also, the HvA is still "labelling" IC very explicitly. A more underlying tone might help increase the awareness of these topics.

Brunel has implemented these topics through lectures, assignments, and placements.

Wishes Curriculum The HvA has three wishes. There is a need for discussion about what IC actually is and that it involves cultural differences (1). The diversity model for teachers has to be perfected (2). This module helps teachers to assist students in developing IC. The e is a eed fo i easi g the stude ts le el of IC, as it is currently too low (3). The level depends on which projects the students choose to do in program six and seven. They need to figure out how all students could develop this competence.

Future The world is getting more diverse. More people with different backgrounds are coming to the United Kingdom and the Netherlands. Therefor is necessary to constantly develop knowledge, skills and attitude to help the people from different backgrounds.

4.3.3 Placement educators

Diversity

Definition Including people in society. Diversity involves: cultures, religions, ethnicity, age and gender, social set up, interests, and understanding of what people do. Differences in people, in a positive way.

Awareness People need to be aware and understand the concept.

OT Views It s i po ta t to lea f o people a d to e plo e diffe e es.

Personal views Students need to be prepared to work in different areas in different parts of the country. They need to be aware and understand the concept, which is part of the awareness as well.

Current Curriculum In the current curriculum there is no specific module. You do have the code of ethics and there are certain outcomes in placements, but nothing specific on diversity.

SI

Definition The definition of SI is: trying to include people from different backgrounds and illnesses.

OT Views The role of an OT is to prevent isolation. It is important to help people being included.

(22)

21

Personal views People want to feel included. As an OT all participants mentioned they want to help people feel included

Current Curriculum In the current curriculum there is not a real model for SI. OJ

Definition It is the highest level to achieve. Being able to do what you want. OT Views It is important to create awareness because you look at it as an OT. Current Curriculum It is not included in the current curriculum.

IC

Definition The definition of IC could be seen as understanding what people and cultures you work with, how competent you are, and training to develop these competences. Additionally, daily living could be seen as a definition of IC, because dealing with people from different backgrounds is something you do on a daily basis.

Awareness IC is about awareness of self in relationship with people, and awareness of IC. Additionally, it is all about having respect for people and come to terms with differences. You will learn more about this through the practice.

OT Views As an OT it is important to have a relationship with the people and be aware of your own IC.

Current Curriculum There is no module for this topic. 4.4 Summary of results

Diverse populations exist in all societies, and are part of communities. These are becoming increasingly diverse, as mentioned in both literature and the inquiries. Diversity is much broader than cultu al di e sit . The te di e sit ould e ha ged to supe di e sit : i di iduals a ha e several cultural backgrounds, along with an individual culture. Diversity is very important to OT, considering the close relationship between different backgrounds and occupation: it influences client centred practice. OT universally applies its Western way of thinking, which makes it less client centred. The inquiries show that there is awareness of the meaning and impact of diversity on practice. Most students considered it very beneficial to have discussions in class, to understand concepts better (e.g. health, well-being, diversity, culture). They approved of the implicit nature that diversity gets at school, as they consider it something that is learned in practice. IC is important to cope with diversity and to become culturally aware. It could increase knowledge of the impact that cultural differences have on the experience of OT. However, students experience that the focus of faculties is more on preparations academically rather than increasing cultural awareness. Some students think these competences are more context-based and should not always have to be taught at school. IC will never be finished developing, including the knowledge, skills and attitude required.

Political movements show that the refugee crisis is a long term issue. Literature shows vulnerable and excluded groups need to be addressed in education. SI closely related to community development. SI is defined as feeling socially included into a community and being able to participate. OT needs to prevent isolation and bring people together through a common occupation. A part of SI is OJ. This is defined as the right to do and have an occupation, what rights you have as a human and to have equal opportunities to prevent isolation, alienation, deprivation, imbalance and marginalization. Students had different levels knowledge regarding this topic, depending on the programs they followed. Most placement educators never heard of OJ, and just guessed what might

(23)

22

be the definition. However they all agreed that it is important in practice and upcoming in education. In the education they see OJ in journal clubs, but they wish there could be more discussions about this topic.

(24)

23

5. Discussion

Data was gathered through literature studies, seminars, conferences, workshops and inquiries. During this process limitations and biases might have influenced our outcomes. These will be discussed below.

Limitations

Several students, following different curricula at Brunel University (bachelor, pre-reg and post-reg), were interviewed. Some curricula require previous work experience, while others require a previous master degree. The HvA does not have the pre- and post-reg education. Due to these differences, we noticed that most people we interviewed were older and had different background, knowledge and experiences going into the program. This needs to be taken into account when making a new curriculum, in order to make it applicable at the HvA curriculum.

There is a contrast in the ultu e of studying between England and the Netherlands. Brunel students often have more experiences, as mentioned before, and therefore have more experience before they start working in the field. London offers a broad range of nationalities, which enha es the it s diverse reputation. Brunel takes advantage of this, by sending students to various placements throughout the city.

Bias

During the discussion groups, we summarized and confirmed the discussed topics to prevent bias. However, the discussion of similarities and differences could not be completed due to limited time. Therefore final conclusions regarding the discussed topics were made by our project group, which could have caused bias.

Due to our limitations in recording the data, most information was recorded by taking notes. This means that the information might be limited or filtered by what we deemed important, even though we tried to write down as much as possible. Sometimes verbal confirmation was asked to check if the notes were correct. There were no follow-ups verifying data. Member check is advised to increase validity.

We could have influenced results in the first two interviews. We asked questions and gave information that influenced the given answers. It also caused the interview to digress from the aim. We decided to follow the topic list and ask unbiased questions, relating to the aim.

One of our clients was interviewed and included in the collected data. Our client has more background information regarding the researched topics and is involvement in different parts of this project. It might cause bias for a favourable outcome. This could have influenced the given information in the inquiry, in turn affecting our results.

The main themes of the summaries have been used for coding. Summaries were made by examining the complete inquiries, after which the most relevant information was included. This means the themes were not derived from the original source, and might be biased. However, this was necessary to filter and structure usable information, since a large amount of data was collected. The summaries thus attain the most relevant information to the main question.

Data from students and teachers from Brunel University could only be compared to data from HvA teachers and our own vision. We also tried to organize a discussion group with Dutch students to compare different data. However, there was no response. This needs to be taken into account.

(25)

24

Personal experiences in curriculum

There was a lack of response from HvA students. In order to provide information on the Dutch curriculum and student experiences, we provide input from our own experiences and opinions, because we have followed our curricula for at least four years.

Knowledge, skills and attitude regarding the topics can be greatly influenced by the chosen programs and projects. Two project members followed the minor Global Health, and therefore know more about diversity and SI compared to the others. They think that these topics are important to be taught, due to their prevalence in all target groups of OT.

The HvA currently does not fully use the diversity it has. There is invisible diversity in the student body, which is not used to its full potential. We would like to see OT studies promoted in the Netherlands, to gather more students from minority groups to attain a diverse professional- and student body.

In lectures most teachers do not mingle with students; they teach in front of the class. We noticed that B u el U i e sit s teachers have more discussions and debates with students during lectures, and try to have a professional conversation. This will most likely lead to better and in-depth understanding of the topic.

The H A s OT placements last twenty weeks and we all agree that this is quite a long time. On top of that, the assignments are very demanding. Placements at Brunel University were shorter and full time, and there were no assignments on placement. This gave them a good focus on their placements. They considered twenty weeks very long, but 8 weeks was a bit too short.

(26)

25

6. Conclusion

What is the best way to develop and implement the topics of diversity and SI in the OT bachelor program?

All participants considered diversity and SI as important topics. They are dynamic concepts that constantly change. OTs and OT students require a desire to learn and an open mind throughout their career. Students and professionals constantly need to develop knowledge, skills and attitude to the needs of society. The topics are important, as they influence client centred practice and occupation. Even though the topics are implicit in education and practice, the general opinion is that they should be included in practice and theory. Awareness of these topics in required for client centred practice. In order to reach awareness, reflections and discussions on these topics were deemed very important. More time has to be created to do this according to participants. It also prevents a tunnel vision and a bias in the transfer of knowledge from person to person. Discussions and reflections allow OTs and OT students to get a clear conception on the different views of these topics, to develop their own view. To improve education even more, the link between theory and practice should be more prevalent. Students and placement educators state that placements are opportunities to learn about these topics and how to implement them. Community based placements prove to be highly educational to develop a professional enterprise attitude.

Overall, OTs should keep in mind that their work is mainly Western based and most of the theories and models which are used in education are Western based as well. However, more research has to be done, preferably by collaboration between researchers, educators, and students, in order to adjust and develop new evidence based practices in regard to diversity and SI to improve curricula and practice.

(27)

26

Bibliography

Aubèl, G. F. (2014). Zorgbasics Kwaliteitszorg. Den Haag: Boom Lemma.

Boeije, H. (2014). Analyseren in kwalitatief onderzoek. Den Haag: Boom Lemma uitgevers. Boston College. (2011). Focus group protocol. Retrieved March 2016, from Boston College:

http://baselinesupport.campuslabs.com/hc/en-us/article_attachments/201672135/BC_Focus_group_guide.docx.

Brunel University London. (2016). Occupational Therapy (Post-Registration) MSc. Retrieved May 2016, from Brunel University London:

http://www.brunel.ac.uk/courses/postgraduate/occupational-therapy-msc

Brunel University London. (2016). Occupational Therapy (Pre-Registration) MSc. Retrieved May 2016, from Brunel University London:

http://www.brunel.ac.uk/courses/postgraduate/occupational-therapy-pre-registration-msc Canadian Association of Occupational Therapists. (2016). Occupational Therapy and Social Inclusion.

Retrieved February 2016, from Canadian Association of Occupational Therapists: http://www.caot.ca/otmonth/OTandSI_FS.pdf

Gov.uk. (2015, June). Equality Act 2010: guidance. Retrieved May 2016, from Gov.uk: https://www.gov.uk/guidance/equality-act-2010-guidance

Hogeschool van Amsterdam. (2016). Minoren. Retrieved February 2016, from Hogeschool van Amsterdam:

https://minoren.mijnhva.nl/Paginas/default.aspx?wid=WebPartWPQ2&cb=Domein$Gezond heid

Hogeschool van Amsterdam. (2016). Studiehandleiding verdiepingsprogramma 6. Retrieved February 2016, from Hogeschool van Amsterdam: https://dlwo.ashp.hva.nl/studiedelen/Geen%20SIS-

nummer/1516-27/Documents/Studiehandleiding%20P6%20DEEL%201%20sem%202%202015-2016.pdf Kelting, M. (2015). Inventarisatie diversiteit in P1-P5 van het ET Curriculum. Amsterdam: Hogeschool

van Amsterdam.

Martín, I. Z., Martos, J. A., Millares, P. M., & Björklund, A. (2015). Occupational therapy culture seen th ough the ultifo al le s of ﬁeldwork in diverse rural areas. Scandinavian Journal of

Occupational Therapy, 22, 82-94.

Murden, R., Norman, A., Ross, J., Sturdivant, E., Kedia, M., & Shah, S. (2008). Occupational therapy students' perceptions of their cultural awareness and competency. Occupational Therapy

International, 15(3), 191-203.

Newton, N. (2010). The use of semi-structured interviews in qualitative research: strengths and

weaknesses. Retrieved March 2016, from Academia:

(28)

27

Townsend, E., & Wilcock, A. A. (2004). Occupational justice and client-centered practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71(2), 75-87.

Trentham, B., Cockburn, L., Cameron, D., & Iwama, M. (2007). Diversity and inclusion within an occupational therapy curriculum. Australian Occupational Therapy Journal, 54, S49 - S57. Vertovec, S. (2007). Super-diversity and its implications. Ethnic and Racial Studies, 30(6), 1024-1054. WFOT. (2009). Guiding Principles On Diversity And Culture. Retrieved March 2016, from WFOT:

www.wfot.org/ResourceCentre/tabid/132/did/306/Default.aspx

WFOT. (2016). Fundamental Beliefs. Retrieved February 2016, from World Federation of Occupational Therapy: http://www.wfot.org/AboutUs/FundamentalBeliefs.aspx

Diversity and Social Inclusion : What is the best way to develop and implement the topics of diversity and social inclusion in the OT bachelor program?

Student

Chitra v. Aernsbergen

500661169

Franne Boer

500668772

Rolf Schaap

500642808

Anouk Verschoor

500666189

Class

DG_LE15-P8C

Bachelor

Occupational therapy

Coach

Soemitro Poerbodipoero

Clients

The Netherlands:

- Soemitro Poerbodipoero

England:

- Kee Hean Lim

- Debbie Kramer-Roy

Location

Amsterdam

Date

03-06-2016

Word count

Diversity and Social Inclusion

Contents

1. Introduction and motivation

2. Aim of the project

3. Methods

4. Results

5. Discussion

6. Conclusion

Bibliography