Bringing occupational therapy to Maskwacis through student fieldwork placements

The University of Alberta and the Glenrose Rehabilitation Hospital are addressing the significant need for occupational therapy services within First Nations communities.

Rob Curtis - 15 November 2019

If you live in one of the four First Nations communities in Maskwacis, Alberta, the nearest hospital is 20 km away.

With no hospital in the community itself, residents have to travel to Wetaskiwin or Ponoka for many services-emergency room care, dialysis, medical imaging. The lack of a nearby hospital also creates a substantial need in domains such as home care, pain management, mental health care, and education and support around medical equipment.

"These are all areas that can be addressed through occupational therapy (OT), but in First Nations communities, it's rare to find an occupational therapist as part of the health-care team," says Randy Littlechild, executive director of Maskwacis Health Services.

The University of Alberta's Faculty of Rehabilitation Medicine and the Glenrose Rehabilitation Hospital are working to change that through a unique OT fieldwork placement. "With a population of 18,000, our people are getting older, there's a need for growth," he says. "The Maskwacis Health Services home care department serves 780 people every month, which is quite high when compared to other regions in the province."

UAlberta occupational therapy alumna Chelsea Krupa, '06 BPE, '09 MScOT, provides homecare three days a week in the rural Alberta community an hour south of Edmonton. Together with UAlberta fieldwork educator Loraine Kolber, '92 BSc, '95 BScOT, she has been working with OT graduands Lacey Cox and Adam McKenzie to expand the role of occupational therapists in local health care.

"Prior to starting the placement, I had some awareness of Indigenous peoples and cultures through the Truth and Reconciliation Commission, but being here, it really hits home," says McKenzie. "It's been really impactful for me in terms of gaining an understanding of their community and how you have to approach your work from a trauma-informed view."

The Department of Occupational Therapy had been looking for more role-emerging placement opportunities with Indigenous health services organizations, particularly since the creation of the elective Indigenous Focus in its program. The Glenrose Rehabilitation Hospital was seeking ways to be more involved in delivering accessible rehabilitation services to Indigenous populations. So when the national First Nations & Inuit Health Branch identified an unmet need for occupational therapy services to be provided to Alberta First Nations and approached the two institutions for help, they joined forces to provide the funding and support necessary to create this unique placement opportunity. Another critical piece of the puzzle was Krupa, who together with Kolber took on all professional responsibility for the students, without which the placement would have been impossible.

As part of her placement, Cox supported a mental health program, developing new resources and helping to facilitate an anxiety and depression group. McKenzie worked with a multidisciplinary pain clinic, raising awareness of the perspective occupational therapy brings to the team and his own client caseload. Both students also worked with Krupa in the delivery of home care services. Their work is raising awareness of the benefits of occupational therapy in First Nations communities such as Maskwacis.

"We've just begun to see how OT could become more involved in Maskwacis," says McKenzie. "Hopefully it can continue to grow; we offer a certain lens that is missing when there isn't an OT."

There was also much to be gained by the occupational therapy students themselves, being immersed in the culture and community. Cultural practice-how to respectfully enter someone's home and engage openly with individuals, for example-came into play in their work every day, and helped them to forge closer connections with their clients. A focus on a culturally safe approach to OT practice also leads to the development of more comprehensive client histories and to a better understanding of the generational trauma, living conditions and other substantial barriers faced by the community.

McKenzie has been struck by the strength of the people he's met: "Every client I've encountered has tremendous resiliency in terms of what they or their family members have experienced and continue to experience. Despite significant barriers, people continue to have a desire to change their circumstances."

Krupa recalls an elderly woman in her nineties, still living independently in her home, making and selling beadwork. "This is a traditional art that is slowly disappearing over time, but the presence of occupational therapy services in the community meant that this artist could be provided with a wheelchair and other supports to continue to live on her own and practice her craft," she says.

The placements ended recently, but Krupa and the OT students are optimistic that the knowledge gained from occupational therapy will continue to influence practice within Maskwacis Health Services.

"By way of the new resources that have been developed and the relationships that are being built within the community, there's a growing awareness of what occupational therapy can bring to health care in Maskwacis, and a hope that this first step will grow into increased and ongoing OT services in the long term," says Krupa.