Chapter 1
Introduction to Occupation-centred Practice for Children

Sylvia Rodger and Ann Kennedy-Behr

If we don't stand up for children, then we don't stand for much.

Marian Wright Edelman

Preliminary questions

1. Why a book on occupation-centred practice for children?
2. Think about your childhood: what did you most like doing?
3. Think about your childhood: what did you least like doing?
4. What were the environments that you engaged in (e.g. home, park, school, neighbourhood)? How did they afford opportunities for occupation?
5. Did you play sports, learn an instrument or go to clubs or organised activities?
6. How might your childhood be different to those of children today?
7. How might living in the city vs country, suburb vs. high rise impact on children's occupations?

Introduction

The primary aim of this chapter is to set the scene for this book and in doing so to fulfil the following objectives:

1. Briefly describe the resurgence of occupation within the occupational therapy profession.
2. Outline some global trends that have occurred in parallel with the refocusing of the profession.
3. Describe some of the challenges to traditional developmental theory that has historically informed occupational therapy practice with children, as well as emerging views and theories of occupational development that have the potential to better inform our practice with children and their families.
4. Identify the impact of these professional and global trends on occupational therapy practice with children.

Children engage in many social and occupational roles every day. They are variously grandchildren, children, nieces/nephews, siblings, friends, peers and playmates. In addition, they are school or kindergarten students, players or self-carers/maintainers, albeit they are developing independence and autonomy in these latter roles (Rodger, 2010; Rodger and Ziviani, 2006). Healthy active children engage in occupations relevant to these roles all the time: they play, dress, eat, manage their personal care needs, engage in household chores and schoolwork tasks and extra-curricular activities, such as soccer, ballet, scouts, tae kwon do and playing musical instruments. Children engage in these occupations in a range of environments, such as with their families at home, friends at school and in their communities (e.g. church, neighbourhoods, local parks, sports clubs) (Rodger and Ziviani, 2006).

The children's artwork in Figure 1.1 and Figure 1.2 illustrates the daily occupations of two boys, one growing up in metropolitan Brisbane, Australia and the other in a village in East Timor. Figure 1.1 illustrates the boy's daily life with family, friends and his occupations of schoolwork, playing sports, ball games, listening to music and the importance of school. By contrast, Figure 1.2 illustrates the outdoor environment in which this Timorese boy lives, his home, the hills, his village and his role in tending crops. These drawings demonstrate some of the many cultural differences in children's occupations and daily lives.

Figure 1.1 Daily life and occupations of a boy aged 11 years in metropolitan Brisbane.

Source: Courtesy of Thomas Beirne (2008).

Figure 1.2 Daily life and occupations of a boy aged 15 years in East Timorese village.

Source: Courtesy of Jorge do Rosario (2008).

Typically, occupational therapists come into contact with children when there are concerns about their occupational performance (e.g. ability to engage fully in their roles, issues with performance of tasks or activities associated with various occupations, or environmental hindrances to their performance and participation). However, it has been proposed (Rodger and Ziviani, 2006) that as a profession we also have a role in advocating for children's place and rights in society, their need for health-promoting occupations and for safe, supportive, healthy environments that can optimise their occupational performance and participation. This may be through supporting campaigns promoting healthy lifestyle choices such as: having smoking banned in children's playgrounds, lobbying for traffic calming and pedestrian footpaths/pavements to enable safe walking to school, advocating for more green spaces, such as parks, and raising awareness about excessive involvement in virtual environments (e.g. computers and handheld games) which may lead to decreased engagement in physical activity and social isolation. In recent times, issues of children's health and well-being in detention centres have been raised in Australia, and elsewhere in conflict zones and refugee camps. From an occupational perspective, these environments lead to significant occupational deprivation for detainees, and impact negatively on children's development and mental health (Australian Human Rights Commission, 2014). In essence, occupational deprivation is caused by the lack of access to the typical activities, routines and objects (toys, books, games, outdoor recreation spaces) that support children's development and skill acquisition due to the restrictive institutional environment of detention centres.

There are many advocacy and professional groups whose websites provide information for parents about children's health and well-being issues such as the American Academy of Pediatrics (http://www2.aap.org/obesity/community_advocacy.html?technology=2) and Play Australia, which promotes the value of children's play (https://www.playaustralia.org.au/).

In addition, we have a role as individuals, health professionals and occupational therapists to advocate for children whose lives are deprived of health-giving occupations and safe environments as a result of war, natural disasters, dislocation, social disadvantage, poverty or neglect/abuse, for example the World Federation of Occupational Therapists Position Statement on Human Rights (WFOT, 2006) and the Occupational Opportunities for Refugees and Asylum Seekers (OOFRAS, 2016). The WFOT (2006, p. 1) Position Statement declares occupation a human right. Specifically it espouses a series of principles:

• People have the right to participate in a range of occupations that enable them to flourish, fulfil their potential and experience satisfaction in a way consistent with their culture and beliefs.
• People have the right to be supported to participate in occupation, through engaging in occupation, to become valued members of their family, community and society.
• People have the right to choose for themselves, to be free from pressure, force or coercion, in participating in occupations that may threaten safety, survival and health, and those occupations that are de-humanising, degrading or illegal.
• The right to occupation encompasses civic, educative, productive, social, creative, spiritual and restorative occupations.
• At a societal level the right to occupation is underpinned by the valuing of each person's unique contribution to the valued and meaningful occupations of society and is ensured by equitable access to participation regardless of difference.
• Abuses to the right to occupation may take the form of economic, social or physical exclusion through attitudinal or physical barriers, or through control of access to necessary knowledge, skills, and resources, or venues where occupation takes place.
• Global conditions that threaten the right to occupation include poverty, disease, social discrimination, displacement, natural and man-made disasters, and armed conflict.

While this book focuses primarily on the occupational therapy practitioner engaging with children and their families at an individual, group or family level, it also addresses occupation-centred practice in school environments (Chapter 11) and in the context of community-based leisure pursuits (Chapter 13). The broader benefits of occupational engagement for children who are deprived of occupations is not specifically addressed; however, readers are encouraged to consider the opportunities they may have for advocacy and engagement at a societal and political level in instances where children experience poor health (Spencer, 2008) or occupational deprivation, alienation and injustice (Kronenberg et al., 2005; Whiteford and Wright St-Clair, 2005).

Re-affirming occupation: The core of occupational therapy

Over the past several decades, there has been a major focus within occupational therapy on the provision of client-centred services, with its counterparts in child- and family-centred practice. Emanating from Canada, the emphasis on guidelines for enabling occupation- and client-centred practice has spread throughout the occupational therapy profession internationally (CAOT, 1991; Sumsion, 1996). This is discussed at length in Chapters 2 and 3.

There has also been a resurgence of interest in occupation at the core of occupational therapy. This occurred in response to critical reflection by a number of occupational therapy theorists and researchers (e.g. Clark, 1993; Fisher, 1998; Kielhofner, 2007; Molineux, 2004; Pierce, 2001; Yerxa, 1998). This has led to the reclamation of occupation as the defining feature of our profession and practice focused on occupation, its meaning for individuals, its importance for health...