Language and Occupation

For our April 2020 Occupational Justice for Newcomers Network (OJNN) meeting, we decided to focus on language and occupation. Amidst the COVID-19 pandemic, OJNN has been compiling accurate and accessible multi-lingual resources. While resources in multiple languages are but one small part of just and equitable healthcare, we feel it is a necessary social determinant of health to address. We recognize that the complexities of language and occupational engagement warrant further attention. For this reason, we focused on three areas in our last meeting: 1) updating and expanding multi-lingual COVID-19 resources, 2) delving into occupational science research on the topic, and 3) reviewing best practices when working with interpreters in healthcare settings.

1. Multi-lingual COVID-19 resources

We continue to gather and organize COVID-19 resources in multiple languages on this website. OJNN member Eliza Garland Quinn, an Occupational Therapist working with newcomers with low literacy levels in English as an Additional Language (EAL) programming, raised some important points and strategies to consider when developing and sharing multi-lingual resources. She recommends taking into account the person’s literacy level and whether the languages they speak have a written form, as some languages are predominantly oral. In these situations, creating resources with real-life images (e.g., photographs) can be more helpful.

In the future, OJNN plans to compile multi-lingual resources specific to occupational therapy.  We would love to hear from you if you have suggestions and ideas of OT resources that would be most supportive for your practice.

2. The power of language: Exploring the relationship between linguistic capital and occupation for immigrants to Canada (Huot et al., 2020)

We were lucky enough to have Dr. Suzanne Huot, Assistant Professor in the Department of Occupational Science & Occupational Therapy at the University of British Columbia join us for the meeting. We read and discussed the paper she wrote with Ana Can, Jiwon Kim, Milad Shajari and Tamara Zimonjic on the ways language can facilitate or bar occupational engagement. The authors draw on Bourdieu’s work to conceptualize language as a form of (social) “capital that is mediated through social power relations” (Huot et al., 2020, p. 95). Grounded in their qualitative secondary analysis of 20 interview transcripts of newcomers in London, Ontario, the authors find that ‘learning English’ is an overarching theme connected to four sub-themes: 1) accessing resources during settlement, 2) economic integration, 3) social and cultural integration, and 4) family.

Ultimately, integration, occupational engagement and language are not just about newcomers solely bearing the responsibility of  ‘learning English’ as an isolated skill. It is more holistic. Huot et al.’s (2020) work shows us the importance of considering broader system level barriers, such as  lack of access to interpreters and inflexible language instruction formats or schedules. Further, we must consider the ways cultural practices in Canada create barriers for effective communication, such as use of jargon and colloquialisms, and speaking too quickly. Underlying these practices and systemic barriers are cultural attitudes that pass judgment on accents and devalue proficiencies in minority or unofficial languages. In this way, the unquestioned dominance of English in Canada is a gatekeeper to occupational access, participation and engagement.

Be sure to read the article! We had a fascinating conversation where members shared their insights about the importance of occupation-based language learning. More resources and discussion to come in this important area!

3. Best practices for working with interpreters in healthcare settings 

We encourage you to look up the recent webinar by the Centre for Addiction and Mental Health (CAMH) Immigrant and Refugee Mental Health Project called: Working effectively with interpreters – working together to improve mental health outcomes across language barriers. Some of the highlights to emerge include:

  • Work with a trained interpreter
  • Know whether you need a cultural interpreter, community interpreter, or Over the Phone (OPI) / Video Remote Interpreter (VRI)
  • Respect the interpreter’s role, standards of practice and ethical principles

You can access an overview with more tips on preparing for sessions and debriefing by viewing the OJNN April 20, 2020 Meeting Presentation. Additionally, you may be interested in the Mental Health Interpreting Guidelines for Interpreters by Jim Hlavac at Monash University, Australia (2017).

Wishing you all well,

Refugee Rights Day: April 4th and Updates

We hope you’re keeping healthy and well. A quick update and information on upcoming events. Please let us know of additional resources, trainings, and research you think members will be interested in. We’re always happy to hear from you!
Refugee Rights Day: April 4th
The Canadian Council for Refugees (CCR) is hosting an online event at 2:00pm  EST on April 4, 2020 to honour Refugee Rights Day. With the closing of the Canadian border to asylum seekers and uncertainties for those with precarious work permits, this is an especially important time to gather.
Webinar: Support the mental health of refugees and immigrants during COVID 19

The Immigrant and Refugee Mental Health Project is inviting you to an “Ask the Expert” online session on how to support the mental health of immigrants and refugees during COVID 19.

Wednesday, April 8th 2020, 2:30 -3:30p.m. EST

Register and learn more about the webinar. 

OTs making a difference in the lives of refugees through research and writing

OJNN member Sarah Klaas brought our attention to the excellent article written by Karen Whalley Hammell (2020) called Engagement in Living During the COVID 19 Pandemic and Ensuing Occupational Disruption. Drawing on Dr. Rachel Thibeault’s (2002, 2011) exceptional international work with people who have experienced trauma, violence and displacement, she outlines occupations that support resilience reconstructing a meaningful life during times of uncertainty and disruption:

  • Centre – engaging in routine occupations that help to ground
  • Contemplate – paying attention to the everyday by engaging in mindfulness activities, formal meditation or immersive experiences in the natural world
  • Create – nourishing occupations that explore creativity such as art, drama, singing, music, baking, writing and imaginative play
  • Connect – participating in occupations that foster belonging within families, groups of friends, and communities
  • Contribute – giving occupations that support the wellbeing of those near and far
Stay well,

Carla Giddings OT Reg. (Ont.) & Sara Abdo Reg. OT (NS)

Occupational Justice for Newcomers Network Co-Chairs

Advocating for health care for all in the context of COVID-19

So much has changed in a short period of time with the COVID-19 pandemic. As Occupational Therapists, we are searching for ways to stay informed and engage in meaningful forms of advocacy that reflect our commitment to occupational justice for newcomers. Please see our March 2020 Newsletter for additional information. Below are some highlights specific to health care coverage and multi-lingual resources.

Provincial Health Care coverage: Due to ongoing advocacy work, some provincial health care coverage has been extended to cover individuals who are without health care coverage for COVID-19 related care. I note context of migrants, resettled refugees and refugee claimants, this can be due to wait periods before provincial insurance begins or because they have precarious status within Canada. See the Migrant Rights Network petition and website for additional advocacy tools and resources.

Québec:Most recently, the Government of Québec has agreed to cover the cost of COVID-19 health care expenses for all people without healthcare insurance, including those without status. Read the article in French.

Ontario: “To ensure that anyone in need of care can receive it, Ontario is waiving the three-month waiting period for Ontario Health Insurance Plan (OHIP) coverage. Additionally, the province will cover the cost of COVID-19 services for uninsured people who do not meet the criteria for OHIP coverage. Together, these measures will ensure that no one will be discouraged from seeking screening or treatment for COVID-19 for financial reasons”.

Ontario expands coverage for care – newsroom report

British Columbia: Temporary coverage for Medical Services Plan available for BC residents. The waiting period has been waived. Read the Medical Services Plan for BC residents new brief for specific details.

Multi-lingual resources: Support the efforts of health care providers and advocates in your community to increase access to current, accurate, and place-specific health information on COVID-19. Contact OJNN at to add new resources to the list.

    • RSTP – List of COVID-19 resources in multiple languages
    •  COVID-19 Printable Project for Self Isolation and Self Management handouts in 26 languages. The Self Isolation handout is for the general public on what self isolation entails. The Self Management handout is for people who have been assessed by a health care professional and testing results are pending results or have been confirmed as positive for COVID-19. The resources will be updated regularly and are based on best practice guidelines.
    • World Health Organization – resources in English, French, Arabic, Chinese, Russian, and Spanish
    • Ontario Ministry of Health – scroll to the bottom to access information in 33 languages
    • Alberta Health Services – posters and signs in English, French, Arabic, Simplified Chinese, Traditional Chinese, Punjabi, Tigrinya, Vietnamese
    • Advocate for your local Public Health Agency and workplace to translate necessary resources into all languages required in your area. Click here for COVID-19 backgrounders in Tigrinya and Amharic
    • Advocates and scholars at the Centre for Refugee Studies at York University engaged crowdsourcing to translate and update health care and financial resources specific to Canada, Ontario and Toronto in Amharic. They are looking for community translators to assist with Tigrinya translations.

CAOT Conference 2019: Sessions on Newcomers and People with Refugee Backgrounds

This overview summary has been assembled by Carla Giddings, with permission of the presenters.

For many Canadian Occupational Therapists, attending the Canadian Association of Occupational Therapists’ (CAOT) Conference is an opportunity to re-set, re-charge, and re-connect with OTs across the country.

The 2019 CAOT Conference in Niagara Falls (May 29 – June 1, 2019) was bursting with exciting research, clinical skill development opportunities and networking. Of the 320 poster presentations, paper presentations, extended discussions, panels, and special events, four of them focused specifically on the experiences of newcomers. Student Occupational Therapists and OTs completing Doctoral research with newcomers led the way in research and practice in this emerging field.

This overview offers a re-cap of these poster presentations, paper presentation, and panel discussion with links to additional resources.


Supporting immigrants’ and refugees’ occupational engagement in minority community spaces, by Anne-Cécile Delaisse, Suzanne Huot, and Luisa Veronis 

Dr. Suzanne Huot, Assistant Professor (Department of Occupational Science & Occupational Therapy, University of British Columbia) presented the preliminary findings of research conducted with MSc student Anne-Cécile Delaisse (Rehabilitation Sciences, University of British Columbia), and Dr. Luisa Veronis (Department of Geography, Environment and Geomatics, University of Ottawa) in the Occupational Science. The findings are based on critical ethnographic research with Francophone minority communities in Metro Vancouver through partnerships with community sites.

The research question was: “How do spaces that support occupations for migrants from minority groups influence their integration into Canadian society?”

To answer the research question, they engaged in on-site observations at three (3) community locations (a community centre, church, and provincial association). They also had personal, and follow-up “go-along” interviews with 20 French-speaking immigrants and refugees from the Democratic Republic of the Congo (DRC) (7), France (6), Burundi (2), Mauritius (2), Belgium (1), Haiti (1), and Switzerland (1), as well as six (6) key informant interviews. Their main findings are:

1) French-speaking newcomers engage in identity negotiation through occupations and spaces: Within the Anglo-dominant province of British Columbia, French-speaking newcomers often have different occupations associated with specific linguistic spaces. For example, work occupations tend to be in English, and leisure occupations in French. “Free time” in ethno-cultural spaces also intersects with multiple linguistic identities. For example, some participants from DRC indicated that Lingala was their first language and preferred to speak this language while at church on the weekend.

2) Spatializing the power of language: Research participants explained that the way French is valued impacts their attachment to their identities as French-speakers within Anglophone environments. For example, an environment where English is most valued makes it both important and difficult to maintain French linguistic identities.

3) Supporting everyday occupations:  Everyday occupations were structured by funding sources. For example, government-funded spaces (e.g., those offering employment training) may have restrictions on the types of French activities offered, whereas privately-funded spaces (e.g., churches and community events) may have a wider range of French and/or multilingual activities but are based on community members’ contributions and goals.

4) Occupational segregation: Unintended exclusion can occur within Francophone communities and spaces when socioeconomic class and cultural factors are overlooked. For example, French-inspired cooking classes geared toward middle-income participants may not take into account barriers to participation such as transportation, childcare, timing, location, and food preferences.

Drawing on a transactional perspective, Delaisse, Huot and Veronis conclude that Francophone spaces have the potential to offer a sense of continuity with their country of origin while fostering belonging in their new home. This may include education (for self and children) and religious activities in their first language or financial support. Further, Francophone community spaces can support transitions to Canada. This research encourages OTs to carefully consider the linguistic identities of clients and communities we are working with. For more information on this exciting research, check out their poster (PDF).


Panel Discussion: Reclaiming the occupational lens in the aging well discourse. Panelists included: Dr. Barry Trentham (Assistant Professor, University of Toronto), Josephine Grayson (Senior Policy and Program Advisor), Dick Moore (LGBTQ+ Seniors’ Advocate), and Dr. Sachi Wijekoon (Postdoctoral Fellow, University of Toronto)

Throughout the Panel Discussion, panelists offered their responses to Atul Gawande’s best-selling book, Being Mortal. Gawande critiques health care’s current approaches to aging characterized by a biomedical lens, hyper-vigilance of safety, and privileging of “independence”. While each of the panelists offered thoughtful reflections on how OT can address the “ADL independence rut” and diversify their perspectives on aging, we focus here on the contributions of Dr. Sachindri Wijekoon.

Dr. Wijekoon’s work offers important insights into the experiences of newcomers and aging through her focus on how late-life migration and displacement creates experiences of aging “out of place”. Drawing on her Doctoral research, Wijekoon described the ways that the ethnocultural experiences of aging can be erased within OT, and health care more broadly, through assumptions of a “normal” aging pathway associated with White, Western, middle-class, long-standing Canadian citizens. In this way, the prevailing aging-in-place approaches can erase or misrepresent the lived experiences of late-life immigrants.

For a full overview of the research, see Dr. Sachi Wijekoon’s PhD Dissertation: “We were Meant to go Down One Road, but Now We Have Rerouted”: A Phenomenological Inquiry into the Experience of Aging Out-of-place (2018). Electronic Thesis and Dissertation Repository. 5569. Available from:

Wijekoon grounds her research in her grandparents’ experiences of late-life immigration as well as her own immigration story. Her PhD research engaged specifically with Sinhalese older adults who migrated from Sri Lanka later in life to the Greater Toronto Area (GTA) through in-depth interviews. One of her main findings was the ways that participants’ spiritual (Buddhist) occupations took precedence. This demonstrated a transition in occupations from “doing” to being and becoming. Environmental factors were also significant, both within family spaces and beyond. For example, sponsorship power dynamics can challenge grandparents’ roles and positions in family structures. She also explains how OTs with similar life experiences, cultural connections, and language may have increased understanding of the socio-cultural and environmental factors of clients aging “out of place”. This can facilitate relationship-building and effective OT interventions through culturally safe care.

Due to time limitations and the specific focus of the panel, Dr. Wijekoon was not able to fully discuss the complexities experienced by this group. In conversation with Carla Gidding for OJNN, she explained that late-life immigrants have distinct vulnerabilities compared to those who migrated earlier in life. With fewer opportunities to adapt to the social, economic, and physical environment of their new home, late-life immigrants may experience financial insecurity, language barriers, weather-related challenges, loneliness, discrimination, and deficits in skills specific to living in Canada (e.g., driving and navigating healthcare systems). These factors can increase isolation and dependency on family members. Taken together, these distinct vulnerabilities and experiences must be addressed in OT practice and research.

As the Project Coordinator for En-AGE through Ontario Society of Occupational Therapists (OSOT), Dr. Wijekoon offers strategies for all OTs to engage diverse seniors: 1) shift priorities from solely doing, to being and becoming, 2) facilitate and grow a diverse healthcare workforce, 3) build trust and relationships, and 4) support a platform for participation. To find out more about Dr. Wijekoon’s current work, visit the AGE-WELL and En-AGE projects through OSOT.


Poster Presentation: Intergenerational trauma in second generation refugees: An occupational perspective, by Janany Jeyasundaram, Luisa Yao Dan Cao, and Barry Trentham (University of Toronto)

Janany Jeyasundaram and Luisa Yao Dan Cao from the University of Toronto presented their MSc(OT) research on intergenerational trauma in second generation refugees. In this research, intergenerational trauma is understood as negative effects of historical oppression and violence from one family generation to the next. Jeyasundaram and Cao focus specifically on the experiences of Vietnamese and Sri Lankan Tamil adult children whose parents resettled in Canada after the end of the Vietnam War (1975) and the start of the armed conflict in Sri Lanka (1983).

Using qualitative narrative inquiry, the authors explored the research question: “How do second-generation Sri Lankan Tamil and Vietnamese refugees in the Greater Toronto Area (GTA) experience intergenerational trauma in their occupational lives?”

To answer this question, the authors engaged in twelve (12) in-depth semi-structured interviews with Tamil and Vietnamese adults (aged 22 to 33 years with equal representation regarding gender and ethnicity) whose parents migrated to Canada as refugees.

Jeyasundaram and Cao found that intergenerational trauma in second-generation refugees can be influenced by factors within sociohistorical, cultural, and familial contexts. These contextual factors can influence how second-generation refugees come to view what they can and should do in everyday life. Socially constructed discourse can shape occupation and undermine the needs of those who fall within or outside of these constructs. Interactions between contextual factors and individual agency can impact how occupation is negotiated and for some participants, have led to active engagement in a variety of individual and communal healing occupations.

Due to the exploratory nature of the research, the authors pose critical questions for continued inquiry and application to occupational therapy practice:

  • What occupations does mainstream discourse idealize and what are the consequences for individuals and groups who don’t live out these ideals?
  • In what ways may the occupational therapy literature and practice contribute to marginalizing discourse?
  • How can occupational therapists work to identify the limits and inequities of current discourse that marginalizes second-generation refugees and their occupations?

You can view their conference poster here (PDF).


Paper Presentation: Understanding barriers to employment for female refugees with physical disabilities, by Perdita Elliott1, Leanne Fells1, Suzanne Huot1, Mary Kam2, and Sandra Almeida2(1University of British Columbia, S.U.C.C.E.S.S.)

Student Occupational Therapists Perdita Elliott and Leanne Fells (University of British Colombia) presented a paper presentation on their qualitative research on employment experiences of newcomer women with refugee backgrounds who live with physical disabilities in Metro Vancouver. This research is important and timely, as between 2015 and 2018, approximately 6,300 refugees were resettled to Metro Vancouver. Women with physical disabilities resettling in the city face additional barriers to accessing paid employment. This can exacerbate factors of vulnerability, such as poverty, barriers to adequate housing, food insecurity, health effects, and increased exposure to crime.

They explore the topic through the lenses of critical theory with a focus on intersectionality (e.g., intersect of ableism, sexism, racism and xenophobia) and occupational justice paradigms that focus on structural and institutional elements. As such, the researchers explored the research question: “What are the barriers and facilitators to employment for newcomer women with refugee backgrounds who live with physical disabilities in Metro Vancouver?”

The authors interviewed a total of five (5) women with lived experiences of forced displacement and physical disability as well as four (4) caregivers. The exploratory research uncovered five (5) themes through participant interviews:

1) stigma and discrimination: Participants experienced discrimination from service providers through ableist assumptions that they were not capable of performing certain occupations. Similarly, participants felt at times stigmatized by their families and cultural communities due to their disabilities. Further, participants discussed xenophobia and racism in wider Canadian society based on language and (former) refugee status. These systemic forms of discrimination meant participants’ skillsets were not fully recognized.

2) Traditional labour market: Participants faced barriers to accessing the traditional labour market due to lack of recognition of international credentials and requirements for “Canadian work experience”. At the same time, traditional supports such as Employment Services were ineffective in supporting participants to match their skillsets with work opportunities. Looking outside traditional labour structures, participants encountered financial barriers to pursuing self-employment.

3) Housing:  Housing presented a complex challenge for participants through a lack of accessible housing, pressure to accept housing options that did not meet the accessibility needs of participants, being isolated from social supports and/or living in physically inaccessible neighbourhoods.

4) System cohesion: Participants noted that the employment supports system is at capacity (e.g., long wait times and time-limited), generic (e.g., not individualized or taking complex needs into account), and fragmented (e.g., lack of effective referral systems) without efforts to build the capacities of clients to seek out employment independently. This meant participants could not easily navigate the system and often turned to informal supports instead.

5) English language: Employment Services, transportation to work, and jobs are offered predominantly in English, creating an obstacle for many participants. While it is possible to arrange interpreters and translators, they were not always available and were often expensive. Further, English language classes are offered infrequently and are not learner-centred.

The authors conclude with preliminary recommendations focused on formal supports and employers. First, they encourage education for policy-makers, service providers, and employers to reduce discrimination. Second, they advocate for more language-related supports to decrease barriers to services, transportation, and workplaces. Third, they suggest Employment Services enhance cohesion across supports. Finally, the authors recommend that Employment Services adopt a client-centred approach that prioritizes individual work goals.

Their PowerPoint presentation is available to view here.

Newcomers in the News, April 2019

  • Proposed Government Policy Changes Affecting Asylum-Seekers

The Canadian Council for Refugees recently spoke out against proposed changes to refugee policies that were buried in the recent budget implementation bill with a letter to the Prime Minister. The proposed changes would prevent asylum seekers who have already filed a refugee claim in one of five countries deemed “safe” (U.K., Australia, New Zealand and the U.S.), from accessing a full and independent refugee hearing in Canada.

These changes do not change the Safe Third Country Agreement with the U.S. (discussed in previous blog posts), which prevents asylum-seekers from applying for refugee status if they crossed the border at an “official port of entry”. Because of the Safe Third Country Agreement about 40,000 asylum-seekers have crossed at “non-official” ports of entry since early 2017 (this is a so-called “loop-hole” that excludes them from the stipulations of the Agreement).

The proposed changes would apply to a small portion of the number of asylum-seekers from the U.S.

CBC News (April 10th, 2019) reports: “Since April 2017, only 3,150 people claiming asylum in Canada had applied previously for asylum in the U.S., according to statistics provided by the government.”

Therefore, these statistics indicate that the vast majority of people arriving from the U.S. to apply for refugee status in Canada, have not previously filed a refugee claim in the U.S. and therefore would not be directly affected by these recent policy changes. Nevertheless, everyone should have a fair hearing. As the Canadian Council for Refugees states“Significant changes to our refugee determination system impacting Canada’s international human rights obligations have no place buried in a budget bill.”

  • Increase in Unaccompanied Minors Arriving in Canada to Claim Refugee Status, & the Integral Role of Transitional Refugee Housing & Support

Matthew House Toronto is one of a few extremely valuable organizations that offer transitional housing to refugees who find themselves in limbo without a confirmed status, or in the process of beginning their new lives here. Anne Woolger, the founder of Matthew House, has noticed an increase in unaccompanied refugee minors arriving at their doorstep, and statistics confirm this trend.

According to a CBC article (Dec. 30, 2018), at Matthew House young refugee claimants “have guidance from what Woolger refers to as “house parents” — one or two volunteers who live in the home at any given time. “They’re not telling them what to do, but they’re being resources for them, kind of helping to steer them in wise directions.”

“Paul Zurbrigg is a longtime volunteer and fill-in ‘house parent’ at Matthew House. It’s something they might not otherwise get as asylum-seekers, says longtime volunteer and fill-in house parent Paul Zurbrigg. “Some night it might be sitting helping a kid with biology homework. Some night it might be talking over an issue that’s happening in somebody’s life. Some night it might be watching a movie together or playing PlayStation. It’s just hanging with these kids.” The retired teacher of 31 years knows connecting with the kids is key and has seen the difference Matthew House is making in their lives.”


After fleeing Afghanistan at the age of 17, “now 20, Sadiqi has graduated high school, secured a full-time job at a restaurant and has plans to go back to study technology in college. He’s also transitioned out of Matthew House into an apartment with roommates.” (CBC, Dec. 30, 2018)

Organizations like Mathew House and those who volunteer with them, are supporting the occupational re-engagement of some of society’s most vulnerable newcomers.

  • An Example of how Occupational Continuity can Facilitate an Easier Settlement Experience

Many of you may have heard of Peace by Chocolate, a huge newcomer (occupational) success story out of Nova Scotia. The Hadhads, (former) Syrian refugees, arrived in Antigonish in January 2016 and very quickly were able to launch a chocolate company in August 2016. Now, only three years later, Peace by Chocolate is distributing their products to major stores and wholesalers across Canada and employing up to 45 people during peak production periods. It grew much more quickly than even they anticipated.

Tareq Hadhad, family member and CEO of Peace by Chocolate, spoke to the CBC News (Feb. 19, 2019) about their plans to expand and to “give back and pay it forward”. The company is pledging to work with 50 refugees and mentor 10 Canadian startups run by refugees over the next few years.

“Tareq’s father, Assam Hadhad, was a chocolate maker in Damascus for two decades — employing 30 people in his factory. Before the country was ravaged by war and the factory was bombed, the company used to ship specialty treats across the Middle East.”  (CBC News, Feb. 19, 2019)

This is a great example of occupational continuity creating a bridge from one environment to another – sustained and meaningful engagement in a familiar and fulfilling occupation that maintains similar identity roles, despite the settlement disruption. This provides a lot of stability during a transition that can feel very destabilizing.

Of course, this type of occupational continuity is not always possible to this extent and at this scale. However, there are likely still many occupational patterns and rituals that can be supported in continuing on a smaller scale – even in more difficult circumstances.

  • In Contrast, Many Newcomers Experience more Significant Challenges with their Settlement Process

In an article published by The Star (February 8, 2019), Syrian newcomers (former refugees) in Calgary shared a more difficult experience adjusting to Canada while facing greater challenges:

“The Star talked to families that use child benefits to pay the rent, parents who can’t leave the house to learn English because they can’t afford child care, refugees who can’t get a job because of the language barrier, victims of torture triggered by the stress of settlement and, in almost every city, people struggling to navigate the bureaucracy to try to sponsor family members left behind in refugee camps.”

“Alsaleh knows it could be years, even decades, before she sees her family again. The future is bright for her children, but as a single mother who left school at the age of 12 and married at 18, family is all she knows. Calgary volunteer Sam Namourra, who has worked with Alsaleh for a year and a half, said she is one of his most difficult settlement cases. “So many times, she has asked me to go (back) to the camps.”

“The despair lodged in Alsaleh’s heart, the feeling of living in one place and belonging to another, is at the crux of integration. Canada can offer shelter and food and education and medical care, but some refugees will never be able to call this country home. “You still feel like you’re in a strange land,” Alsaleh said. “Like you’re in a country that isn’t yours.” (The Star, February 8th, 2019)

These quotes also speak to the common experience of “emotional ambivalence” among newcomers – the key theme found by Grounded Space’s ethnographic research in Toronto and Surrey, discussed earlier.

In another Star article (February 8th, 2019) a former Syrian refugee who has settled in Toronto, is haunted by the torture he experienced in prison during the war. Thankfully he is able to access counselling sessions and support at the Canadian Centre for Victims of Torture.

“Once the initial euphoria of settlement dissipates, newcomers face new stressors like finding a place to live, learning a new language and finding a job. When they have time to reflect on their new reality, it can awaken the trauma they tried to bury.

“They arrive here with a sense of relief after fleeing war and conflicts. Then they try to acquire the skills and tools to adjust to a new life. This stage is task-focused,” explained Ben Kuo, a clinical psychology professor at the University of Windsor in Ontario. “After one or two years of settlement, the adults start to question the purpose of their new life.

Oftentimes post-traumatic stress symptoms can be triggered years later after the traumatic event. Nevertheless, effectively addressing the basic settlement and occupational needs of newcomers provides significant support to the healing process. People are better able to heal the impact of the past when they are safe and secure in their bodies and environments, in their present-daysituation.

“Because of their suffering during the war and conflicts, if their immediate settlement needs are not met, it makes them that much more vulnerable to mental health illnesses,” Ahmed said. “Their mental health improves, lapses and relapses. But most of them do overcome their mental health issues and are able to settle.”

“Some refugees, however, are reluctant to seek professional help, said Reham Abazid, a translator at the YMCA of Greater Saint John and a Syrian refugee who arrived in New Brunswick in 2016. It is uncommon to talk about emotions, so refugees don’t realize the value of therapy or counselling.”

These newcomers need to feel they are welcomed and belong. Social support and prevention work is key. We need public education to remove the stigma associated with mental health needs,” said Pietropaolo, who heads a 13-member clinical team. “We have to get them when they come to us for help, or they are gone forever.” (The Star, February 8th, 2019)

CBC News (December 8,2018) reported on the high rate of pseudoseizures among Yazidi refugees in Canada which are attributed to the severe psychological stress they experienced while captured by ISIS as sex slaves. Canada has welcomed about 1,400 former captives and survivors of ISIS.

“Support groups and doctors working with the Yazidi population here say they need mental health treatment in their first language and the ability to reunite with their families, who may be left behind in refugee camps.”

The manager of the community wellness program at Mount Carmel Clinic in Winnipeg wants to see Canada extend the definition of “family” especially in the Yazidi case to include a larger network of support, and to make it easier for family members to be reunited in Canada. Family support and family reunification is particularly vital for those who have experienced severe trauma.  (CBC News, December 8,2018) 

  • Occupational Therapy References in the News in a Newcomer Context

Every now and then I do a news search to pick up any new articles that mention OTs working in a newcomer context in Canada.

In a CBC article from December 16th, 2018, it was stated: “Now, occupational therapists are also working with immigrant and refugee children suffering from trauma.” There is no further elaboration on this point – the article is about occupational therapists working on primary care teams providing mental health treatment in general. However, it was still interesting to read this mention.

I also came across an older article in the Vancouver Sun, from June 22nd, 2016 that mentioned occupational therapy. It is particularly worth quoting an excerpt here in light of our recent discussion about IFHP (Interim Federal Health Program) during the network’s last annual general meeting in December 2018:

“The Al-Sidawi family of six arrived in Vancouver in January and moved into their apartment in May. They had a safe place to call home, but with their arrival in Canada came a new set of challenges.”

“The apartment they were placed in is not accessible, which means it is almost impossible for the women to get into the bathroom. Because there is a bathtub, it is hard for their mother and older sister to give them showers, so this only happens once every two or three weeks. On one occasion they went to the house of a friend with a mobility impairment in order to shower.”

“Abbotsford-based occupational therapist Jeff Mah, who works with about a dozen Syrian refugee clients, says modifications can be made to most homes to make them accessible.”

However, he has run into roadblocks with the Interim Federal Health Program (IFHP), which funds refugee health care, which prevent him from getting equipment to clients as quickly as possibleMany refugee health centres are staffed by nurse practitioners, but the health program that funds the equipment requires a doctor to sign off, he explained.

This is problematic because many refugees — and established Canadians — don’t have a family doctor and rely on walk-in clinics.”

Other funders, such ICBC or WorkSafeBC, pre-approve clients in desperate situations, Mah said.

“It makes things a lot easier for everyone,” Mah said. “You have a certain budget to work with, you just order it right away and there’s no … delay in getting that client the equipment they need. It’s for clients with higher needs who are not mobile.”

“The IFHP also does not pay for translators, except for psychiatric or counselling appointments, he said, which has left him having to rely on Arabic-speaking volunteers.” (Vancouver Sun, June 22nd, 2016)

Check out the Canadian Council for Refugee’s webpage, ‘Refugee and immigration issues in Canadian media’, for a continually updated list of recent news headlines and articles, which provides an overview of the national public dialogue on relevant issues.


Questions for Reflection & Action:

  • How can OTs come alongside and contribute to organizations like Matthew House, which provide essential transitional housing and occupational supports to newcomers?
  • How can OTs partner with former refugees to amplify their efforts to “pay it forward” like the Hadhad family want to do with the success of their business?
  • How can OTs facilitate occupational continuity for newcomers during their settlement process – on both large and small scales, wherever possible?
  • What might it look like to be an OT supporting occupational continuity wherever possible, while also supporting newcomers with learning and acquiring the resources and skills to engage in new occupations?
  • How can OTs support newcomers with cultivating ‘occupations of belonging‘ in order to ease feelings of alienation and exclusion… while also making environments more welcoming to newcomers?
  • How could OTs be better equipped and resourced to navigate the challenges of the IFHP and advocate for equipment and changes to the program when necessary, on behalf of their newcomer clients?

Relevant OT/OS Research Updates, April 2019

Once again, we want to highlight the North American Refugee Health conference June 14-16 at the Sheraton Centre Toronto Hotel, Toronto, Canada where one of the network’s co-chairs, Sara Abdo, will be presenting! Register in advance in order to attend.

Many of the network’s members are researchers; either through a faculty or student role.

In our last newsletter we highlighted the recently published study by network member and OT Nadine Blankvoort, who is a PhD Researcher in the area of Refugee Integration programs in the Netherlands.

In this newsletter we would like to highlight a current project being undertaken by Network member Heidi Lauckner (project lead, Dalhousie University), and recent publications by Network member Suzanne Huot (UBC).

Heidi Lauckner’s multi-phase two-year community development project (2019-2020), titled Empowering Newcomers for Recreation Leadership, “will engage newcomers in identifying ways to integrate into, adapt, or initiate recreation programming that is created by and for them. This initiative focuses on leadership development, and provides a sustainable means of introducing newcomers to community recreation by putting newcomers themselves at the centre of program development and facilitation.”

Project methods and approaches will include multi-member stakeholder collaboration, a peer support model, a photo project/exhibit, and train-the-trainers leadership programming. We look forward to hearing more about this very innovative and exciting project as it continues!

Suzanne Huot, an occupational scientist on faculty with UBC’s OT school, has contributed to a number of recently published studies and articles relevant to the occupational engagement of newcomers. Six of these articles are listed below. Thank you so much for your important continued work in this area, Suzanne!

Six Relevant Newcomer-Related Research Publications authored by Suzanne Huot (Occupational Scientist):


Abstract excerpt: “Refugee populations are particularly vulnerable to marginalization and have reduced social networks. In the present study we explored whether, how, and why participation in choir singing, as an example of an everyday occupation, could be of significance for refugees in their transition to a new daily life in a Norwegian municipality… Staying occupied and meeting with people were found to be two key strategies to develop a sense of belonging…Their choir participation was thus a part of their experience of searching for identity within their new context.”

Abstract excerpt: “Our study examines the power of language in shaping immigrants’ engagement in occupations during their integration into a host society. Beyond serving as a means of communication, language is understood as a form of capital that is mediated through social power relations. We used a qualitative secondary analysis methodology that adopted an occupation-focused perspective to study 20 transcripts generated through narrative and semi-structured interviews with 10 immigrants in a mid-sized Canadian city. ‘Learning English’ was identified as the overarching theme that connected to the sub-themes of accessing resources during settlement, economic integration, social and cultural integration and isolation, and family. Findings illustrate specific ways that the mediation of engagement in occupations through the host society’s dominant language creates challenges for immigrants’ integration experiences. Ultimately, the dominance of English in Canada poses barriers to engagement in needed and wanted occupations for immigrants who do not possess this valued linguistic capital.”

Abstract excerpt: “The purpose of this paper is to illustrate how the differential value of immigrants’ symbolic capital within the host societies’ fields influenced their engagement in daily occupations and shaped their socio-economic integration. It is argued that the misrecognition of capital contributes to symbolic violence experienced by immigrants who must subsequently engage in a range of occupations in order to regain forms of symbolic capital that are lost and devalued following immigration. A study was conducted with a multinational group of immigrants in London, Ontario, Canada and Auckland, New Zealand, using narrative and visual methods… Results illustrate a reciprocal relationship between occupation and symbolic capital, whereby recognition of the latter facilitated immigrants’ everyday ‘doing’.

Abstract excerpt: “We examined the role of minority community spaces (e.g. schools, places of worship, community centres) for supporting participation in occupations among French-speaking immigrants and refugees in Canada who settled in two Anglophone dominant cities. Fifty six people from diverse countries participated in eight focus groups (four in each city) conducted as part of a larger, four stage comparative case study… We contend that community spaces can provide important opportunities for linguistic minority community members to engage in meaningful occupations, but these must attend to the heterogeneity of the populations they serve.”

Abstract excerpt: The participants’ employment related occupations were characterized by the overarching theme of ‘making difficult decisions’. This main theme was connected to four related sub-themes: 1) mechanisms of exclusion, 2) learning the host country’s culture, 3) the influence of one’s outlook on the decisions made, and 4) accessing support… ‘Making difficult decisions’ was faced by all participants throughout the process of becoming part of the Canadian workforce and, ultimately, society at large.

Abstract excerpt: “International or internal migration as a result of unexpected circumstances, such as that experienced by forced migrants (i.e. refugees, asylum seekers and internally displaced persons), can disrupt established occupations. Occupational therapists have the potential to improve quality of life by re-establishing lost occupations. Research on forced migrants has been increasing within the occupation-based literature and has the potential to inform practice with this population. Our aim was to identify and synthesize current knowledge of the occupational experiences of forced migrants…Based on a total of 320 studies that were identified, 24 met the inclusion criteria. Six themes emerged as a result of the data extraction and synthesis process:occupational deprivation, occupational imbalance, occupational adaptation, occupational change, efforts to maintain and re-establish identity, and outlook for the future.”

OT Now Article – Making the Connection: Why refugee and asylum seekers need occupational therapy services:

In the last month we were contacted by an OT in Quebec, who brought the following OT Now article to our attention: Making the Connection: Why refugee and asylum seekers need occupational therapy services (July/August 2017, open access), by Kara Winlaw, a community OT working in BC at the time of publication. We highly recommend the article!

It is a great read with a strong call to action for OTs in Canada. Here is an excerpt:

“Many professions and organizations within Canada are dedicated to addressing the challenges faced by refugees and asylum seekers. However, by and large, occupational therapists appear to be missing from this landscape… Our lack of professional input with refugees and asylum seekers is not simply a missed opportunity; it fundamentally represents a failure to uphold our professional values… Now, more than ever, is the time to show support for refugees and asylum seekers by ensuring they have access to the same health care services as the rest of the Canadian population.

By devoting our time to this cause, we would be confronting one of the biggest challenges in the global community while honouring our historical commitment to social justice (Trimboli & Taylor, 2016)”.
~ Kara Winlaw (2017)

Recent Ethnographic Newcomer Research by Grounded Space in Toronto, ON & Surrey, BC – “Emotional Ambivalence” as key finding:

I have been following the work of In With Forward, a “social design organization” for a few years now, and I have been so impressed with the innovative work that they have been doing in Canada since 2014 – primarily operating in Toronto, Ontario and Surrey, British Colombia. Their aim is to change social services through ethnographic research, collaboration and experimentation, in order to make social support systems more like trampolines, and less like safety nets.

In the last couple years IWF received funding to build Grounded Space, “Canada’s first Social Research & Development Collective”, to continue building capacity and developing effective change-making services that meet the needs of Canada’s most marginalized folks.

Bottom-up, ethnographic, grounded theory research is the backbone of most of their work as they build upward toward prototyping solutions and implementing service shifts with community partners.

But what does this have to do with occupation?

Since October 2018, with funding from Immigration, Refugees, and Citizenship Canada, In With Forward in their iteration as Grounded Space, has been “partnering with North York Community House in Toronto and Options Community Services in Surrey to capture the experiences of newcomers and re-imagine parts of their journey.” Their process up to now, which involved ethnographic research with 65 newcomers in Toronto and Surrey, is presented in an engaging and insightful publication called “The Sense Maker” (March 2019); a beautiful example of accessible knowledge translation.

I think there are a lot of insights in their research process that are relevant to occupational engagement and the potential role of an OT in supporting newcomers with navigating “emotional ambivalence” as they transition to their new home (their key finding/theme).

Here’s a brief introduction to their findings and the exploratory questions they present related to the emotional ambivalence of migration (a phenomenon I have personally witnessed repeatedly with many newcomers):

“Eros, who moved to Canada from the Philippines to reunite with his mother, feels both lost and found. Maria and Sal, who came to Canada from Mexico to reunite with their kids, experience both peace and disappointment. Nandeep, who immigrated to Canada from Punjab state, holds both acceptance and sadness.

So often when we talk of migration, we go big picture, describing international currents, economic drivers, and security situations. So often when talk of resettlement, we go practical, focusing on housing, jobs, and English classes. And yet beneath the politics and the pragmatics, emotions percolate.Migration, as Professors Paulo Boccagni and Loretta Baldassar remind us, entails the renegotiation of self and others in new and old places. That re-negotiation process is laden with feelings. And those feelings are experienced internally, within bodies, and externally, within social contexts, through our words, expressions, customs, and interactions. Moving to a new country means constantly moving emotions.

And yet, emotions are too often marginalized throughout the migration process, only to later be cordoned off as mental health issues, requiring specialist mental health supports.

What if we recognized and embraced ambivalent emotions throughout the resettlement process — from pre-arrival, to month 13 (when initial supports come to an end) to year three (when Canadian citizenship becomes a possibility)? What if we understood that anticipation, relief, gratitude, and hope is often mixed with disappointment, worry, sadness, and humiliation?

How might we create new kinds of spaces and supports to move through ambivalence — and not silo emotions to clinical spaces or filter them through Western conceptions of mental health? This is the opportunity space Grounded Space will explore over the next three months.”

Check out their publication “The Sense Maker” (March 2019) for more of their insightful, Canadian-based research!

OOFRAS Announcement – A Documentary Film about OT work with Refugees:

As a final announcement regarding research related initiatives, OOFRAS has shared the following with the co-chairs to forward on:

The World Federation of Occupational Therapists (WFOT) has partnered with Reality Learning to create a documentary film about occupational therapy work with refugees. It will be used in online professional development modules about working with refugees. Please consider donating to support the creation the film and learning modules.”

The Synopsis of the 15-minute educational and awareness-raising film reads as follows: “Theo is a committed, occupational therapist managing human rights for the influx of over 60,000 people displaced from around the world to refugee camps in Greece. Taking personal and professional risks, he works with teenager Sohail and artist Nakam, to unravel the secrets of working and living in ‘limbo’, of building meaningful lives and thriving communities.”


Questions for Reflection & Action:

  • What are current OT/OS research gaps in the Canadian newcomer field that need to be addressed?
  • How might occupational therapists/scientists collaborate with a partnership initiative like Grounded Space?
  • How could OTs more effectively support newcomers with navigating emotional ambivalence and difficult emotional experiences, regardless of whether or not they qualify for a mental health diagnosis?
  • How can the Occupational Justice for Newcomers Network collaborate and network effectively with larger international networks like OOFRAS?
  • How can OTs respond to Kara Winlaw’s (2017) call-to-action: “Our lack of professional input with refugees and asylum seekers is not simply a missed opportunity; it fundamentally represents a failure to uphold our professional values… Now, more than ever, is the time to show support for refugees and asylum seekers by ensuring they have access to the same health care services as the rest of the Canadian population. By devoting our time to this cause, we would be confronting one of the biggest challenges in the global community while honouring our historical commitment to social justice (Trimboli & Taylor, 2016)”.

Newcomers in the News, November 2018

[we welcome submissions for future newsletters and blog posts regarding the OT role in responding to newcomer concerns – please email us at]

  • Policy Change: Greater inclusivity for newcomers with disabilities

Before the policy changes to the Immigration and Refugee Protection Act in April 2018, immigrant applicants could be found inadmissible to Canada, based on their medical/health condition, thereby potentially excluding newcomers with disabilities. This policy has been amended to be more inclusive.

“The changes we are announcing today are a major step forward in ensuring our immigration system is more inclusive of persons with disabilities, and reflects the values of Canadians.” ~ The Honourable Ahmed Hussen, Minister of Immigration, Refugees and Citizenship

You can read the full details of this policy change, here.

  • Unlawful Immigration Detention Case

In a previous blog post, we discussed the issue of immigration detention and how this impacts the occupational engagement, health and wellbeing of newcomers – especially when they are held for a long, indeterminate amount of time without legal recourse or other supports.

As we reported previously, in July 2018, the Canadian Government released a highly critical external audit of the Immigration and Refugee Board (which assesses refugee claims) and the Canada Border Service Agency (CBSA). The federal audit, which can be read in full here, calls for major reforms regarding how Canada works with refugee claimants who are detained.

As an update to the developments previous discussed, most recently on November 14th, 2018, a number of refugee advocate groups were interveners in a Supreme Court of Canada case involving Pakistani immigration detainee Tusif Ur Rehman Chhina. The situation is summarized by Nicholas Keung in The Star, as follows:

Should an immigration detainee have the same right to challenge their ongoing detention as their criminally convicted peers? That’s the quandary at the centre of a Supreme Court of Canada case opening on Wednesday in Ottawa.”

“While Canadian citizens serving a jail sentence are entitled to argue their case before a judge, foreign nationals held for immigration violations must appear before a federal tribunal, which has been criticized for rubber-stamping their continued incarceration.”

“Canada’s highest court is being asked to clarify if immigration detainees are protected by the Charter of Rights and Freedoms and can access what is legally known as habeas corpus — a legal recourse that allows anyone held by the state to challenge the lawfulness of their detention.

“Until now, immigration detention has been a murky area of law between two levels of authority — the federal government, which is responsible for immigration matters and runs the tribunal, and the provinces, which are in charge of detention facilities.”

For more information, you can read the case summary on the Supreme Court of Canada website, a thorough legal review and explanation of the case by Alice Pan, and the media release by the Canadian Council for Refugees regarding their involvement.

There has also been a recent lawsuit launched against the Canadian government by Prosper Niyonzima. This was an individual with PTSD who had experienced horrific trauma in Rwanda and Burundi before being accepted to Canada. He then lost his permanent resident status after being convicted of a number of crimes and spent four years in immigration detention (including over two years in solitary confinement), which had a further detrimental impact on his mental health, as described by Lorenda Reddekopp for CBC News.

  • Continued Developments Pertaining to the Increase of Asylum Seekers Crossing the US-Canada Border at Non-Official Border Points

As discussed previously, Canada (specifically Toronto and Montreal) have been tasked with providing basic supports to the large number of asylum seekers who have crossed the US-Canada border at non-official port of entry border points in the past couple of years.

More than 34,000 asylum-seekers have crossed at “non-official” ports of entry since early 2017, because this excludes them from the Safe Third Country Agreement that Canada has with the United States. The Safe Third Country Agreement would otherwise prevent them from applying for refugee status if they crossed the border at an “official port of entry”. Although refugee advocates have been calling for a suspension of the Safe Third Country Agreement with the U.S., post-Trump’s election to presidency, this has not occurred.

In response to protests around using the derogatory terminology of “illegals” or “illegal border-crossers” to describe newcomers seeking entry at non-official border crossings, the Canadian Government updated their online information to refer to these newcomers as crossing at “irregular” entry points, instead of at “illegal” border-crossings.

Around the same time this year, however, Canada also established a new Minister of Border Security and Organized Crime Reduction. The Canadian Council for Refugees takes issue with this in an open letter to the Canadian Government (August 2018) because of the way that it risks “conflating migration and crime in the name of the new Ministry”, and could continue to feed public fears about the increased number of asylum seekers entering Canada from the United States.

The Canada Border Services Agency has indicated that they will be increasing the deportation of asylum seekers who have failed refugee claims, with a target of 10,000 completed deportations per year, while the Canadian Council for Refugees argues that an arbitrary annual target and quota, may erode a commitment to a just and compassionate case review.

Meanwhile, the tension between the federal and provincial/municipal levels of government continues as the city of Toronto struggles to provide for the large number of refugee claimants using their shelters and, this past summer, occupying the college dorms in the city before many of them were relocated to hotels.

The City of Toronto has statistics that indicate about 40 percent of those using Toronto’s shelter system, describe themselves as asylum-seekers (i.e. refugee claimants) and/or confirmed refugees. The refugee population have unique needs that need to be taken into consideration in this context.

In a recent article for The Tyee (25 Oct., 2018), summarizing the situation in Toronto, Seila Rizvic interviews Shaban, a refugee settlement counsellor who states: “The number one checkpoint that we have on our list is the housing… Because once you have a stable address then you can locate the schools. Then you can start searching for a job… if you are a permanent resident, you can apply for your health card, and the Social Insurance Number and the rest.”

Of course, the need for more affordable housing is a hot topic in many places in Canada, particularly Toronto. It is an issue that affects many people. However, a lack of credit history, language barriers, and an unfamiliarity with the rental system, can be additional hindrances for newcomers searching for a safe home.

There are a few organizations that offer transitional housing and other supports tailored to the needs of refugees and refugee claimants, such as Mathew House, Sojourn House, and Christie Refugee Welcome Centre.

As quoted by Seila Rizvic, Ann Woolger (the founding director of Matthew House) and others, “have been in talks with the city to come up with better solutions, including buying properties to use as refugee shelters rather than shelling out millions of dollars in hotel costs per year.”

“Unfortunately, there’s a dilemma between dealing with the emergency at hand and long-term planning. And we kind of want to say, hold on, step back,” she says.

Increasing the number of refugee shelters to provide a transition between arrival and finding long-term housing would be a meaningful first step…To address the refugee housing issue the city will have to improve overall housing affordability and availability.”

Safe housing is often a foundational need that must be addressed before other meaningful occupational engagement can be pursued.

  • Trudeau Apologizes for Canada’s 1939 Refusal of the Ship of Jewish Refugees

On November 7th, 2018, Prime Minister Justin Trudeau delivered a public apology for Canada’s refusal to welcome more than 900 German Jewish refugees, on board the St. Louis ship, when they requested asylum in 1939. They were turned back to Europe and tragically, many died in the Holocaust.

A CTV News article covering the public apology, reports:

“The Liberals’ new immigration plan calls for accepting up to 16,500 protected persons in 2019, a category that includes refugees, growing to 20,000 in 2021. Critics say the figures are far too low while debate rages about “irregular” border crossers walking over from the United States.

The Canadian Council for Refugees said many refugees trying to get into Canada are often fleeing persecution just like the St. Louis passengers. ‘History will judge us by whether we respond in ways that respect the rights and dignity of refugee claimants, just as we today judge those who turned away the St. Louis and other Jewish refugees,’ the council said.”

The Canadian Council for Refugees warns that “we must guard against rising anti-Semitism, Islamophobia and xenophobia. When we welcome newcomers and ensure that they can fully contribute here, we all gain.”

  • Newcomers Engaging in Meaningful Occupations in Canada

There are many stories of newcomers engaging in meaningful occupation in Canada, but most recently the following examples came to our attention.

Musician Sari Alesh fled the nightmare in his war-torn home in Syria and found refuge in Victoria where he has had new opportunities to share his healing love of violin with the public, amid resettlement challenges and racial discrimination.

Marwa Harb, Praise Mugisho, and Rupesh Dhungana, are three young newcomers who have established a new home in Canada. ISANS, the Immigrant Services Association of Nova Scotia, recently featured their stories in a short video, called “I am Today” The importance of meaningful occupational engagement stands out in their stories. Praise Mugisho says: “I will not let my obstacles be bigger than my dreams.”

Check out the Canadian Council for Refugee’s webpage, ‘Refugee and immigration issues in Canadian media’, for a continually updated list of recent news headlines and articles, which provides an overview of the national public dialogue on relevant issues.


Questions for Reflection & Action:

  • What OT language and discourse might be discriminatory and inappropriate among newcomer clients? What underlying messages are being communicated through our terminology that might be misinterpreted or cause harm among this population?
  • How can OTs contribute to improving access to appropriate mental health services for newcomer youth?
  • How can OTs, especially in cities such as Montreal and Toronto where the majority of refugee claimants are currently residing, support these newcomers while they live with uncertainty in a precarious situation?
  • How can OTs collaborate with organizations offering transitional housing to refugees and refugee claimants in order to support newcomers with meeting their basic needs and establishing meaningful occupational engagement and stabilizing occupational rhythms?
  • How can OTs provide helpful health and occupation-based knowledge and expertise to policy-makers and decision-makers in their cities and communities, as to how to best support newcomers without status, or with transitional status?


Selected References:

Global Dentention Project. (2008). Immigration Detention in Canada: Important Reforms, Ongoing Concerns. Retrieved from

Immigration and Refugee Board of Canada. (2018). Report of the 2017/2018 External Audit (Detention Review). Retrieved from

Relevant OT/OS Research Updates, November 2018

We are thrilled to announce the recent publication of a study by one of the network’s members, Nadine Blankvoort, along with their co-authors!

Nadine is a CAOT-registered OT and PhD Researcher in the area of Refugee Integration programs in the Netherlands.

This qualitative study is quite innovative and unique in that the four co-authors in addition to Nadine, are individuals with a refugee background. We have not seen any similar OT or OS studies as of yet, that were so inclusive of participants with a refugee background. Although there are a number of studies that explore the meaning of occupational engagement to newcomers, it is relatively rare in the literature to find studies that specifically investigate the OT role and OT-specific interventions among refugee populations. We are so pleased to see this valuable contribution to the literature. Thank you Nadine, for your work and for the work of your co-authors! The citation and abstract is as follows:

Abstract: Theoretical works in occupational therapy and occupational science have explored the refugee experience through an occupational lens, and explored the potential for occupational therapy in this field. Currently, there exists a lack of literature which includes refugees in these explorations. Recognising the western-bias present within occupational therapy, it is important that refugees are part of a co-produced response. This article presents findings of a workshop held in the Netherlands, where four co-authors with a refugee background and one occupational therapist explored the definition of occupational therapy, the role it could have with refugees, and what is required from the profession to take on this role. Reflections suggest that occupational therapy has the potential to be a connector, matchmaker and translator, working towards societal participation. To do this, occupational therapists must critically reflect on assumptions embedded in occupational therapy, and must be aware of how structural systems influence participation of refugees.

Nadine Blankvoort was also very recently a speaker at a TedX event with a presentation titled: Two migrants: one is an expat and the other a criminal refugee. Nadine’s presentation is an excellent critical examination of the terminology, discourse, and social messages embedded in Netherlands’ mandatory integration program. You can watch the 8-minute TedX video on YouTube below…

We also want to highlight the publication of a recent quantitative study undertaken by OT Connie Trimboli and co-author. Connie is active with OOFRAS (Occupational Opportunities for Refugees and Asylum Seekers), an international OT network with its roots in Australia.

Connie recently co-authored an article documenting the results of a recent study that involved interviewing 29 OTs and OT students, regarding their interventions with newcomers. Again, it is great to see this type of contribution to the literature!

  • Trimboli, C. & Halliwell, V. (2018). A survey to explore the interventions used by occupational therapists and occupational therapy students with refugees and asylum seekers. World Federation of Occupational Therapists Bulletin, 2, 106-113. You can review a PowerPoint summary of the study online here.

Abstract: The analysis of 29 completed surveys found that respondents spent most time on: documentation, education, and leisure integration. Respondents were also engaging in: education, mental health/counselling, research, community development, mentoring, recreation, and nontraditional occupational therapy interventions. Interventions respondents were not using, but which they thought would be useful were: addressing sexuality, forming support groups, driving assessment and practice, home visits, and self care. Findings from this study shed light on an emerging area of occupational therapy and identifies some of the interventions currently being used with refugees and asylum seekers.


Finally, although it is not OT-specific research, we wanted to bring to your attention a recent Ontario-based study that was recently published in October 2018:

The article’s conclusion indicates that “rates of first contact in the emergency department for youth mental health conditions in Ontario were highest among refugees and recent immigrants to Canada. This reflects poor access to timely mental health care that may be delivered in outpatient settings. Our findings suggest that immigrants face barriers using mental health services from a physician on an outpatient basis, but there is variability within immigrant groups. Better understanding of the barriers and enabling factors that contribute to use of mental health services and access to care are needed, including focusing efforts to reduce stigma and identify mental health problems early, before crises, in particular among refugee and newcomer youth and immigrants from Africa and Central America.”

This study was further highlighted in mainstream media with this Global News article – Immigrant, refugee youth end up in ER for mental health care more than others.


Mental health issues, especially when they reach a crisis point, can cause a significant disruption to meaningful occupational engagement and ultimately, the entire resettlement process and the person’s overall state of well-being. Refugees and recent immigrants may be more vulnerable in these states of crisis, in contrast to other non-newcomer youth, for a variety of reasons.

OTs can contribute to research that investigates barriers and enablers that newcomer youth encounter when in need of outpatient mental health services. OTs can be part of efforts to reduce stigma and identify mental health problems early-on among newcomer youth, and they can also join efforts to support their self-management and recovery process.

An Occupational Therapy response to immigration detention & family separation in Canada

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As many of you are likely aware, recently there has been a huge outcry regarding the separation of families at the Mexico and U.S. border, and the horrific imprisonment of children in cages while their parents are detained under criminal charges for crossing the border ‘illegally’ – because they have no other options.

The attention directed toward this issue in the United States has prompted a closer scrutiny of Canada’s policies toward asylum seekers who claim refugee status once within our borders.

This blog post will provide some context and an overview of current issues relevant to occupational therapists in Canada.

Is there anything similar occurring in Canada?

Yes. Although arguably not to the same degree, migrating people are frequently detained in immigration holding centres (as well as in prisons), unaccompanied minors are regularly detained, and the separation of migrating families does occasionally occur in Canada.

The Sherpa Research Centre reports that “over the past 6 years, Canada has held approximately 45,000 people in immigration detention, and [2018] is projected to reach the highest number of immigration detainees since 2012.” In 2017, the Toronto Star produced a 3-part series called “Caged by Canada”, which highlights a few of the troubling stories of refugee claimants who have found themselves behind bars for years. It is reported that “since 2000, at least 16 people have died while incarcerated in Canada’s system of immigration detention.”

Very recently (~July 20th, 2018), the Canadian Government released a highly critical external audit of the Immigration and Refugee Board (which assesses refugee claims) and the Canada Border Service Agency (CBSA), conducted in 2017/2018.

Josh Paterson, executive director of the BC Civil Liberties Association, is quoted by the CBC as saying:

“The audit reveals alarming misconduct on the part of CBSA, including misleading the immigration tribunal, some CBSA officers conducting themselves in a way that intimidates tribunal members, and failing in their duty to ensure that people are treated fairly and are deprived of their freedom only as a very last resort.”

The federal audit, which can be read in full here, calls for major reforms regarding the ways that Canada works with refugee claimants who are detained.


What is an appropriate occupational therapy response to immigration detention and family separation?

The profession of Occupational Therapy is founded on the understanding that human beings are occupational beings whose health and wellbeing is dependent on their occupational engagement. When the broader social, political and physical environments restrict people’s capacity to participate and engage in life-giving activities that are meaningful to them, this is an occupational justice issue that occupational therapists have a professional obligation to respond to.

Wilcock and Townsend (2009) define occupational justice as “the right of every individual to be able to meet basic needs and to have equal opportunities and life chances to reach toward her or his potential but specific to the individual’s engagement in diverse and meaningful occupation.” (p. 193)

Immigration detention and the separation of migrating families is an occupational justice issue where basic needs for autonomy and attachment are denied, and families do not have access to equal opportunities and life chances to reach toward their potential through the conduit of meaningful occupation.

People can be detained under Canada’s Immigration and Refugee Protection Act by CBSA (Canada Border Services Agency) officials if the person is believed to be a flight risk, a danger to the public, or if they are unable to sufficiently prove their identity (Red Cross). This broad policy leads to many innocent people and families being put behind bars – sometimes in actual prisons when space in an immigration holding centre is not available. Parents can choose to have their children put into foster care when faced with detention, or children may be removed from their care if there is a perceived safety risk.

Canada’s three immigration holding centres are located in Vancouver, Montreal, and Toronto, and closely resemble medium-security prisons.

On June 27th, 2018, Catherine Solyom reported for the Montreal Gazette:

“Between April and Dec. 31, 2017, about 155 minors were detained with their parents in Canada, including 102 in Quebec. Eighty-seven were under five years old, and 35 were between six and 11. They were kept in detention for an average of 16 days. Six children were kept as long as 90 days in detention, and another eight were kept up to 180 days.”


On June 27th, 2018, a diverse group of over 2,000 Canadian healthcare providers joined advocacy efforts by Canadian Doctors for Refugee Care by signing an open letter to the Government of Canada, requesting that it end immigration detention (including child detention and family separation). They are also requesting that the Government of Canada end the Safe Third Country Agreement, and apply pressure to the United States to end their practice of child and family detention.

The following is an excerpt from their open letter (which can be read in full here).

“In Canada, immigration detention of both adults and children, and family separation, have been a long-standing and grave concern. Canadian research and reports have repeatedly shown the severe mental health impacts of even short-term detention on both adults and children, including elevated rates of depression, anxiety and PTSD symptoms in adults. Children also suffer severe symptoms such as regression of developmental milestones, sleep disruption, anxiety and depression.”

“As healthcare providers we urge our federal leaders to take action on this issue and consider how history will look back on what we as a country choose to do right now. While Canada’s practice of detaining migrant children is not new, the general public is now rapidly becoming more aware of it. It is hypocrisy to criticize the United States when children are being detained and separated from their families here in Canada, causing similar severe psychological trauma that physicians and other mental health experts are now speaking out about.”


Immigration concerns are only going to become increasingly urgent and pressing as more and more people flee the United States due to its new immigration policies under President Trump. The Pew Research Center indicates that “more people sought asylum in Canada in 2017 than at any point in at least a quarter-century,” and this is largely credited to people crossing the Canadian border from the U.S. to apply for refugee status.

A significant barrier to people securing refuge in Canada via the U.S. – Canadian border, is the Safe Third Country Agreement.

The Canadian Government explicates the Safe Third Country Agreement as follows:

“The Safe Third Country Agreement between Canada and the United States (U.S.) is part of the U.S.–Canada Smart Border Action Plan. Under the Agreement, refugee claimants are required to request refugee protection in the first safe country they arrive in, unless they qualify for an exception to the Agreement.”

“…To date, the U.S. is the only country that is designated as a safe third country by Canada under the Immigration and Refugee Protection Act.”

At the time of this writing, the website for the Canadian Government states: “The United States continues to meet the requirements for designation as a safe third country.”

The Canadian Council for Refugees (CCR) disagrees with this continued designation because of the changes that have taken place since Trump’s presidency making it unsafe for many people (particularly undocumented people) to continue living there; causing upward of 20,000 people to flee the United States into Canada via the Quebec and Manitoba borders (The Globe & Mail, March 19, 2018). It is estimated that about 150 per day, for example, are crossing the border from the U.S. into Quebec (CTV News, April 5, 2018).

While the CCR  – along with Amnesty International, the Canadian Civil Liberties Association, and the many healthcare providers previously mentioned – are strongly advocating for a suspension of the Safe Third Country Agreement with the U.S. Most recently on July 3rd, the CCR, Amnesty International, and the Canadian Council for Churches, filed extensive evidence to support their legal challenge of the Safe Third Country agreement, initially launched in 2017. You can read their media press release here.

It should also be noted that other political representatives have asked for the government to secure Canada’s borders by making the Safe Third Country Agreement stronger (Global News, March 14th, 2017; Global News, July 24th, 2018). Currently there is a so-called ‘loophole’ in the legislation that allows people entering Canada from the U.S. via unofficial border crossing points, to file an application for refugee status after they are detained – rather than being turned away from the border immediately (which is what can occur at official port of entry points on the border).

Providing they are released from detention, these refugee claimants then have access to (or at least are entitled to) legal aid, a temporary work permit, public education and healthcare services, while they wait for their claim to be processed and assessed.


While this access to services is positive, more resources are need to support the cities that are currently hosting the majority of refugee claimants, such as Montreal and Toronto. According to an article by The Star (June 27, 2018):

“…there are now about 3,300 refugee claimants housed in Toronto’s already-strained shelter system… Toronto needs support and money from higher levels of government to deal with all this. But so far it’s been left to cope on its own.”

“…Meanwhile, the clock is ticking. About 800 migrants are housed temporarily in dormitories at two Toronto colleges, Centennial and Humber, but students start returning on Aug. 9 and the colleges will need the spaces back.”

This situation is creating some increasing tension between the Ontario Provincial Government and the Federal Government, in regards to the need for additional funds and housing options (see the Ottawa Citizen July 12th, and July 21st 2018 for more on this). It is complicated because, while housing is primarily considered a provincial responsibility to manage, immigration is primarily a federal matter.

The risk that the increase in refugee claimants arriving in Canada from the U.S. will further inflame anti-immigrant sentiment in the country, is a real possibility. It is a risk that should be warded against through effective management of the situation in ways that simultaneously supports claimants in feeling safe and able to participate in meaningful occupations.


It has been acknowledged that occupational therapists may have difficulty directly connecting the aims of their profession to matters of justice. The following excerpts, written by those at the forefront of developing the concept of occupational justice, seek to further establish the professional obligation of OTs to respond to occupational injustices and mobilize around a health advocacy agenda based on global thinking” (Nilsson & Townsend, 2010, p. 58)…

“The central point is that occupational injustice is an outcome of social policies and other forms of governance that structure how power is exerted to restrict participation in the everyday occupations of populations and individuals.” (Nilsson & Townsend, 2010, p. 58)


[Migrating people] may be disadvantaged by refugee protocols, even to the extent of being segregated in detention centers while seeking right of entry. During formal immigration processes, most people will have access to a very restricted range of occupations. They continue to experience occupations that are far from health giving and that are unjust in terms of either human rights or health needs. Quality of life, empowerment, and social inclusion in occupations are matters of justice and of health. (Wilcock & Townsend, 2009, p. 197)


Questions for Reflection:

  • What is an appropriate occupational therapy response to immigration detention, family separation, and the Safe Third Country Agreement?
  • How can OTs effectively advocate against immigration detention and family separation policies that deny basic needs, as well as access to meaningful occupational engagement?
  • How can OTs, especially in cities such as Montreal and Toronto where the majority of refugee claimants are currently residing, support these newcomers while they live with uncertainty in a precarious situation?
  • How can OTs provide helpful health and occupation-based knowledge and expertise to policy-makers and decision-makers in their cities and communities, as to how to best support newcomers without status, or with transitional status?


Selected References

Global Dentention Project. (2008). Immigration Detention in Canada: Important Reforms, Ongoing Concerns. Retrieved from

Immigration and Refugee Board of Canada. (2018). Report of the 2017/2018 External Audit (Detention Review). Retrieved from

Nilsson, I., & Townsend, E. (2010). Occupational Justice – Bridging Theory and Practice. Scandinavian Journal of Occupational Therapy, 17, 57-63.

Wilcock, A.A. & Townsend, E.A. (2009). Occupational justice. In E.B. Crepeau, E.S. Cohn & B.A. Boyt Schell (Eds.), Willard & Spackman’s Occupational Therapy (11th ed., pp. 192-199). Baltimore: Lippincott Williams & Wilkins.