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Understanding Patient and Client Expectations

Understanding Patient and Client Expectations

The Competencies for Occupational Therapists in Canada (2021) includes a distinct section to address culture, equity, and justice in occupational therapy practice. To help registrants understand this, and to know what is expected of them, the College has developed a practice document called Culture Equity and Justice in Occupational Therapy Practice.

We recognize that the practice document contains complex concepts. Some of the language is not familiar to many people, including the public and registrants. This primer aims to provide a very high level and plain-language overview of the main practice document, as follows:


In the document, Intersectionality is the guiding framework. It explains that everyone has a collection of identities. They include, for example, race, ethnicity, gender, sexuality, class, age, dis/ability, and religion. These identities overlap in us to create “social locations” (also called “social positions” or “positionalities”). Each of us views and experiences the world from this social position. Yet, much of our position is determined at birth and is outside of our control. Then, this becomes impacted by systems, laws, and policies that don’t always manage our positions fairly or equally. Asking occupational therapists to understand their “social location,” and how this intersects with their services, starts their process of learning about culture, equity, and justice.

What can the public expect?  That occupational therapists have reflected their own social location and worldviews while supporting and engaging clients to communicate theirs as well.

What do occupational therapists need to know

Oppression means the ways that systems prevent certain groups from having rights and privileges because of their social identities. Systems cause oppression through social, economic, cultural, and political structures which lead to laws, policies, and institutional practices. Occupational therapists work in different systems and need to know that oppression exists where they practice.

What can the public expect?  That occupational therapists recognize and take steps to address oppression as it presents in everyday practice.

As healthcare professionals, occupational therapists are in positions of power. Their decisions and actions have an impact on clients’ lives. Yet the profession, like most of Western healthcare, was not developed for, or tested with, diverse groups. Therefore, occupational therapists need to recognize that not all of what they have been taught or know applies to all clients.

What can the public expect?  That occupational therapists recognize their inherent positions of power and take steps to adapt their practice to the unique needs of each client they work with.

Biases refer to the views and assumptions people have about diverse groups of people. We all have biases – some we know of, and some we don’t. Yet biases impact our actions, behaviours, and judgements.

What can the public expect?  That occupational therapists can take steps to identify and challenge their biases to reduce the impact they may have on clients and others.

Just because services or opportunities are available, that does not mean everyone can access them.

What can the public expect?  That occupational therapists to consider the barriers that clients may face -- like affordability, scheduling, and location -- and to take steps to minimize them.

Occupational therapists in Ontario must be aware that trauma is prevalent and that people in of equity-deserving groups are more likely to experience this. This can impact the services they need and receive.

What can the public expect?  That occupational therapists have a basic understanding of trauma and its impacts and know how to properly manage client trauma experiences and responses.

Occupational therapists have the human right to work in environments that are not racist or discriminatory.

What can the public expect?  That if an occupational therapist needs to stop working with a client who is putting them in an unsafe situation, that they will take steps to transfer the client’s care to another provider.

What occupational therapists can do

Critical reflexivity involves questioning the assumptions and beliefs one holds.

What can the public expect?  That occupational therapists reflect on how their values, beliefs, preferences, and worldviews impact their practice and those around them.

Employ relational accountability

Relational accountability is an ethical Indigenous research principle. It states that people are dependent on, and related to, everyone else. All people have a responsibility to nurture and maintain relationships and to be accountable to the communities they work in.

What can the public expect?  That occupational therapists practise the four Rs of relational accountability: respect, relevance, reciprocity, and responsibility.

Occupational therapists are expected to use tools and approaches that are effective, usually meaning they are grounded in science or evidence. While “evidence” often refers to research, occupational therapists should remember that there are other types of “evidence” to consider. This may include perspectives, experiences, and different ways of doing that they learn from others.

What can the public expect? That occupational therapists provide services informed by evidence from various sources.

Cultural humility is a lifelong commitment to being aware of our own positionality while also being open to others’ preferences, experiences, and worldviews. Culturally safer practice involves recognizing one’s position of power and creating safe and trusting spaces. It also means acknowledging that clients will ultimately determine what “safe” means to them.

What can the public expect? That occupational therapists to try to provide culturally safer experiences for their clients.

Learning about culturally safer practice does not start or stop with this document.

What can the public expect? That occupational therapists must make an ongoing commitment to removing the gaps in their knowledge and addressing the gaps in their practice.

Download the full document and provide your feedback

Download the Culture, Equity & Justice in Occupational Therapy Practice PDF

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