#87: Community-based OT with Ryan Lavalley

[ryan_lavalley]

Community-based OT: OT CEU Course with Ryan Lavalley

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Learn more about our guest: Ryan Lavalley, PhD, OTR/L

In our OT work with individuals, there can be a feeling of futility.

As there is a growing collective consciousness around what we, as OT professionals, experience day in and day out:

The communities in which we live have such a profound impact on our health.

And, we can fail individuals by focusing only on their individual choices—and not the larger driving forces of their lives.

I think this expanding view of health is why we see so much interest in community practice from students, new grads, and tired clinicians. Community practice does have a long history in occupational therapy, but currently very few clinicians find full-time work in this practice area. The authors of this course’s featured article, believe this may be in part to a lack of frameworks for community-based OT. So, today we’ll explore the framework they put forth and their call to “reimagine occupational therapy clients as communities.”

Next week on the podcast, we will welcome Ryan Lavalley, PhD, OTR/L. Dr. Lavalley is the founder and primary lead of the Community Practice Lab at UNC School of Medicine.

Agenda

Intro and breakdown and analysis of journal article

• 00:00:00 Intro
• 00:03:06 Intro to OT’s role in community
• 00:03:44 Why the focus on community practice now?
• 00:04:34 What has already been written about community practice OT?
• 00:05:54 What was the intent of this paper?
• 00:06:03 What were their methods?
• 00:07:02 Presenting the Community Practice Framework
• 00:11:35 Intro to Ryan Lavalley

Discussion on practical implications for OTs

• 00:13:48 How did Ryan became interested in community-based OT
• 00:21:17 What is the community practice lab?
• 00:26:43 What other community practice jobs exist?
• 00:30:14 Why should all OTs be thinking about the community-level?
• 00:34:35 Article impressions
• 00:38:38 How do you describe community-based OT?
• 00:44:11 What are the magic tools that community practice OTs bring to the table?
• 00:48:39 What future full-time jobs do you see for community-based OTs?

Supplemental Resources

Supporting Research and Journal Articles

• The Effectiveness of Community Occupational Therapy Interventions: A Scoping Review.
• An overview of occupational therapy community practices in Latin America.

Article Review

Read Full Text: Re-imagining occupational therapy clients as communities: Presenting the community-centred practice framework (This is a paid article, but we still thought it was important to cover.)
Journal: Scandinavian journal of occupational therapy
Year Published: 2019
Ranked 97th on our 2019-2023 list of the 100 Most Influential OT Journal Articles

In our OT work with individuals, there can be a feeling of futility.

Especially as there is a growing societal-level consciousness around what we, as OT professionals, already experience day in and day out:

That the communities in which we live have a profound impact on our health.

And, we can fail individuals by focusing only on their individual choices—and not the larger driving forces of their lives.

I think this expanding view of health is why we are seeing a surge of interest in community practice from students, new grads, and tired clinicians.

Community practice actually has a long history in occupational therapy, but very few clinicians find full-time work in this practice area today. According to the authors of this week’s featured article, this may be due to a lack of frameworks for community-based OT. Today, we’ll explore the framework the authors put forth and their call to “reimagine occupational therapy clients as communities.”

Next week, to help us unpack this topic, we will welcome to the podcast Ryan Lavalley, PhD, OTR/L. Dr. Lavalley is the founder and primary lead of the Community Practice Lab at UNC School of Medicine.

Let’s dive in.

Intro to OT’s role in community

While OT professionals are commonly viewed as person-centered, individually focused providers, the authors of this article argue that OT professionals have worked in community-based settings and contributed to community practice for over 100 years.

But, despite this long history, our work with communities remains limited.

(Per my own research, only 0.7% of respondents to the 2023 AOTA Workforce Survey reported working in community-based private practice, and only 0.4% said they worked in Community Mental Health and Behavioral Settings.)

Why the focus on community practice now?

The authors argue that in light of an increased emphasis on community practice expansion in government-driven health policy, there is a need for increased support of community practice OT.

Case in point: This Guide to Community-Centered Approaches from Public Health England advocates for improved uptake of community-centered interventions to:

1. Strengthen and build community.
2. Create and support volunteer and peer communities.
3. Involve collaborations and partnerships.
4. Enable access to community resources.

What has already been written about community practice OT?

As OTs, we already have a solid foundation for stepping into community work and meeting the rising demand for community-based practice. The authors highlight 3 strengths we bring to this area:

1. Occupational therapy’s work with communities is well-established in our overarching practice frameworks. For example, the WFOT defines occupational therapy clients as both “people and communities.”

2. Past research also demonstrates the breadth of community-based occupational therapy practice, including our involvement with:

• Health and policy in indigenous communities
• Urban planning projects and environmental design of age-friendly communities
• Environmental sustainability
• Natural disaster preparedness

3. Our training equips us with knowledge, skills, and abilities that are valuable to community clients.

But even with this background, the authors posit that knowledge gaps in literature—including the lack of a framework for community-centered practice—are likely to hold OTs back from confidently pursuing this practice area.

Which leads us to this paper…

Intent of this paper

The intent of this article is to present a conceptual framework for community-centered practice in OT.

Methods

To develop their conceptual framework, the authors selected two cases for cross-analysis of themes.

To be included in this analysis, the cases had to be:

1. Located in a “Western, high-income/developed country”
2. English speaking
3. Identified as an exemplar of community participation
4. Located somewhere accessible for fieldwork

Cases chosen for analysis

2 cases were chosen for analysis (please note, these are not occupational therapy-specific):

1. A network of Canadian food security programs
2. A rural Australian banking initiative

The researchers visited both sites and performed semi-structured interviews, observation, and document analysis. In the article, they go into detail on both cases and their analysis, but for the sake of this review, I’m going to focus on the framework that was developed as a result.

Community Practice Framework

The developed framework has 4 components, each with guiding questions for the occupational therapy professional. I’ll go through each one briefly:

1. Community Identity

In this section, the OT professional is prompted to consider:

Who is the community client?

Two primary considerations are:

1. Who are the social actors (including individuals, groups, organizations, and networks), and what is the makeup of the social field? (A community’s “social field” includes the diverse range of clients who move in, out, and through the social space.)
2. What factors related to the place/setting should also be considered (for example, the natural and built environment)? Place attachment may be a helpful theory to consider.

2. Community Occupations

In this section, the OT professional is prompted to consider:

What occupations are important? And, what is the occupational goal?

Two potentially useful considerations are:

1. What co-occupations or collective occupations are being performed?
2. Given the heterogeneity of communities, how is community diversity being explored and understood?

3. Community Resources and Barriers

In this section, the OT professional is prompted to consider:

What resources are needed by the community? And, what barriers prevent participation?

Occupational therapy professionals are encouraged to consider both economic and non-economic resources, as well power distribution.

4. Participation Enablement

In this section, the OT professional is prompted to consider:

What processes are being used for community participation? And, what is the occupational therapist’s role in enablement?

When examining the process being used for participation, it may be helpful to consider Pretty’s typology of participation. The 7 stages are:

1. Manipulative participation
2. Passive participation
3. Participation by consultation
4. Participation for material incentives
5. Functional participation
6. Interactive participation
7. Self-mobilization

Community enablement strategies that could be considered include:

• Providing leadership development
• Leveraging partnerships and capacity building
• Facilitating online participation via social media
• Employing multi-method strategies that are socially and culturally diverse

Conclusion

The authors encourage OT professionals and students to trial this framework. Future research is needed to trial and evaluate the framework, with the goal of ensuring that OT practice with communities is informed by a robust evidence base.

Takeaways and Questions for OT practitioners

(Note: These are my own takeaways; they were not mentioned directly in the article.)

My takeaway: This article asked the right question, but ultimately left me wanting more.

This article represents the early stages of conceptualizing a community practice framework, but the limited nature of the case studies left me wondering what else is out there—and what, exactly, our work in the community already looks like (see my questions below).

I do agree that we are at a unique point in history where the world is more ready than ever for community-based interventions. I would like to see our national organizations (e.g., AOTA) partner with entities like The American College of Lifestyle Medicine to help OTs really step into our role in public health initiatives.

My 2 questions for you:

1.) What examples do you know of OT professionals working with communities?
2.) What societal shifts do you see as evidence that there is more demand for community practice?

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Please share any other feedback below! Including, ideas for future programming, and most importantly, how you feel this podcast will impact your practice!

[SarahLyon]

I wanted to be the first to jump in here first, because so much has been written about community practice since this article was written and it has been fun to dive into some of the writings.

@nerida (who was the lead author on our featured article) shared this new article with me on some of the updates in thinking! Nerida, it is so great to have you here in our Club.

International community of practice: learning from experiences of community...

[ryan_lavalley]

Really grateful for this conversation and excited to dive deeper through the podcast next week. This article brings up so many good directions for OTPs to be exploring how and why we think about communities and occupation, and our role as practitioners in those spaces.

[SarahLyon]

@ryan_lavalley something, I keep thinking about is the relation of this community practice movement to two other episodes I’ve done on:

1.) Social Determinants of Health
2.) and the Path Program for Kids with Emotional Disability (which seems to be my really be about changing culture.)

If you ever have a chance to listen to these episodes, I’d love to know if you see common threads in them. And, maybe we can talk about it in a “What is OT in 2025” episode?

[sherry (Sherry Stancliff)]

Sarah,
Hello! I enjoyed the Podcast Path Program for Kids with Emotional Disability. I appreciated that the collaborative program allowed occupational therapy practitioners to use their skills of understanding emotions and self-regulation to support the community of educators.
My OT journey has included several adult settings and school-based settings, and presently, I am practicing as a full-time faculty member. The community practice topic piqued my interest. As you stated, the Occupational Therapy Practice Framework, 4th edition, supports our role in community practice. This week’s article provides additional information on how community practice can be formed and what it might entail.
I would like to add another element to the community practice lens: that community practice ‘needs,’ for lack of a better term, an occupational therapy practitioner’s passion or desire to create change based on identifying the need. ( Step 1).

Who We Are | Elder Orphan Care

In Concord, NC, there is a strong example of community practice. The organization, which served Romania without occupational therapy for years, expanded to serve their local elders in need. They have an OTA and OT on staff. Their support is not traditional health monies but grants, donations, and fundraisers. My takeaway here is that passion has to lead to thinking outside of the traditional box to create partnerships and grants to support the dream.

Other occupational therapy practitioners serving our area’s pediatric populations are holding camps, family game nights, and supporting community experts to educate the individuals and families in their communities to support occupations and engagement. The beginning of the community lens is occupational therapy practitioners who have a passion for their communities, identify a need, and find creative ways to meet the needs. Here is a link to Restored Hope Therapy; check out their ‘Outreach’ section: https://www.restoredhopetherapyservices.com/services.

My questions are: Is this where the occupational scientist comes in to document and gather data and stories to establish the science behind community practice? Your example of a community of practice highlights the individual’s stories and lens. Occupational therapy practitioners are doing community practice, but most do not advertise their practice or ‘see’ it as anything special because they decided to serve their communities, and that is what they are doing.

This is a great topic, and I believe many occupational therapy practitioners are doing community practice, but we are missing the data to support the effects.

[SarahLyon]

@sherry

I would like to add another element to the community practice lens: that community practice ‘needs,’ for lack of a better term, an occupational therapy practitioner’s passion or desire to create change based on identifying the need. ( Step 1).

Oh, @sherry so good to hear from you! I hope you are well!

I totally agree with you! I think each every OT framework should include the OT professional, because we bring our own strengths (and weaknesses) to every OT encounter.

I also love seeing concrete examples of OTs who have found a home in the non-profit world, like you shared! I also love seeing community-level approaches integrated into a traditional clinic, again like you shared. I think the more concrete examples we can see, the more OTs can see themselves exploring what community practice could look like for them!

[sherry (Sherry Stancliff)]

OT practitioners are creative and are expanding their thoughts about what our services look like and include. We can limit our boundaries but at the same time each of us has responsiblities that require payment to others so finding the middle ground (like some of my pediatric friends have done) or going non-traditional with grants, fund raisers, and partnerships remaind viable options for those who want to explore community practice.
Oh one more to share: https://www.backtoindependencerehab.com/ Darci also write grants and finds partnerships for her clients.

[SarahLyon]

Wow, I love seeing examples of innovative practices! Our podcast guest, @ryan_lavalley is from NC as well! (Ryan, I need to remember to tell you how much Sherry—and faculty from Winston Salem—have supported me and OT Potential. I’m always so thankful for NC OTs…)

[ryan_lavalley]

Ooohhh yes. I listened to both of these and think there are some great connections. That preventative work at the community level is so important and can be done in so many ways!

[ryan_lavalley]

Sherry! I love your questions! As an occupational scientist, these questions are exactly what drew me into the science and the need to document how an occupational perspective can be helpful in these settings. Many of my publications are me trying to think through this! For example:

Lavalley, R. (2021). New Frontiers: Occupational Therapy’s Role in Coordinated Community Coalitioning. OT Practice, 2021(January), 18–21.

I think, as I you will hear on the podcast, there are many disciplines who work in this field and so we have to really consider what our perspective brings to the table but we have some great processes and lenses to offer!

[SarahLyon]

Ryan, I’ve also been thinking about community health and informatics a lot lately. We didn’t really touch on this on the podcast, but I want to know what you think about it.

I’ve been wondering if we got trapped focusing on individuals too much in healthcare because individual health is easier to track than community health.

But as the field of informatics develops and more large data sets become available and digestible (thank you AI!), will that give us the metrics we need to support community intervention?

(@Renee_Towne I want to talk with you about what this could look like in reality. And, @joy1 I’d love to catch up with you soon to talk about informatics and community practice!)

[SarahLyon]

(@ryan_lavalley I’m asking this because I’m working on getting an informatics OT on the podcast, and I’m day-dreaming about what to ask her!)

[hanan (Hanan Hanna)]

This great way to increase social skills and get our patients together in the community through fun , functional and therapeutic activities. It is important to be around people and do not isolate from the society specially for older adult .

[adeena (Adeena Hall)]

To question #2: I think that community based OT has always been necessary, however, the culture of today makes it so much more needed. People in general are less connected to each other and have less support systems with family and friends, etc. Also, the generations coming of age are less prepared for life and will continue to be this way as long as the cycle is not broken. Because of these things and more that I haven’t listed, people need more support. OT is an asset to help meet the needs of communities, because we help with the practical everyday things of life that are necessary for independence, function, and quality of life.

[Renee_Towne]

Thanks for tagging me, @SarahLyon ! I love the concept of community-level or population-level care as it encompasses both the medical side as well as the community/social side that OTs are so well positioned to address with our proficiencies. I am curious to learn if any others have been involved in the Community Health Assessment and Intervention process typically led by the local Public Health Departments? I feel this would be a natural venue for our unique profession.

I have quite a few SDOH resources if anyone is interested, I’m happy to share more but one common one in my analytics world is the publicly available CDC Social Vulnerability Index (SVI) Census Tracts: CDC/ATSDR Social Vulnerability Index (CDC/ATSDR SVI)

[SarahLyon]

@Renee_Towne

Community Health Assessment and Intervention process typically led by the local Public Health Departments

This is something I would love to learn more about and be a part of! @ryan_lavalley do you know any OTs doing this work?

And, thank you for sharing that SVI map, @Renee_Towne, I had never seen it before and I am going to add it to this post that Joy Doll and I wrote to go with her episode!

How OTs can address Social Determinants of Health • OT Potential

[ryan_lavalley]

Raises hand I actually partner with our School of Public Health often to work with MPH students in their practicum and try to integrate an occupation-oriented perspective in those projects. Another example would be @adam2 Pearson who I’m sure leverages his OT perspectives in his role of Director of Human Services and likely engages with the Public Health Department in St. Louis quite a bit. I think there is a lot to develop when it comes to relationships with Public Health departments and really finding where our lens can be helpful in those sorts of community assessments. But it requires OT practitioners learn how to assess the occupation of a community rather than the amalgamation of the individual occupations of its residents. I think the article is really engaging with this important question.

[ryan_lavalley]

Big data is powerful! My biggest concern is losing sight of our unit of analysis, occupation, and allowing our scope to drift into work that we are not well trained to do as OTPs. There is complex and layered ways to look at community health outcomes, and there are degrees and disciplines specifically looking at that, but we need to consider how looking at community occupational outcomes/practices may require specific situating of that data or lens through which it needs to be understood. This may sound blasphemous, but I think we often get distracted by “health” and leave “occupation” behind as our area of expertise.

[sherry (Sherry Stancliff)]

@SarahLyon, Our students at Rowan Cabarrus Community College partner yearly to do wellness checks for the local senior center and the Car Fit assessment. These opportunities provide our students with an understanding of the diversity of community-dwelling older adults. @ryan_lavalley, they also find that these adults have stories to share during the assessments, which allows the students to see the value of therapeutic relationships, occupations, and the desire to stay independent.