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: https://ir.lib.uwo.ca/cgi/viewcontent.cgi?article=7650&context=etd

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.

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