Full Inclusion Position Paper
The American Occupation Therapy Association

OCCUPATIONAL THERAPY:

A PROFESSION IN SUPPORT OF FULL INCLUSION


Full inclusion means that all individuals, regardless of ethnicity, race, age, religion, gender, sexual orientation, or disability, should be able to be a part of the naturally occurring activities of society.  Full inclusion addresses the need for all individuals to have the same opportunities.  It also recognizes the benefits to everyone of being with individuals who are different from themselves.

Occupational therapy supports full inclusion throughout all practice areas of the profession.  Occupational therapy practitioners provide adaptive and compensatory strategies to increase an individual's performance in activities of daily living, work, play, or leisure.  Interventions include the use of activities designed to improve performance, as well as the identification of adaptive equipment, environmental modifications, and alternative methods necessary to support improved function.  Occupational therapy practitioners assume a collaborative partnership with persons served and their significant others to support the individual's rights to self-direction.  Also, occupational therapy practitioners work collaboratively with other professionals to help ensure access to interventions and services in support of full inclusion.

Occupational therapy advocates that society has an obligation to provide reasonable accommodations necessary to allow individuals to access social, vocational, educational, and recreational opportunities.  By embracing an attitude of full inclusion, all individuals will benefit from the opportunities afforded by a diverse society.


Authors:

     Winifred Dunn, PhD, OTR, FAOTA
     Mary Foto, OTR, FAOTA
     Jim Hinojosa, PhD, OTR, FAOTA
     Barbara A. Boyt Schell, PhD, OTR, FAOTA
     Linda Kohlman Thomson, MOT, OTR, OT(C), FAOTA
     Sarah D. Hertfelder, MEd, MOT, OTR, FAOTA - Staff Liaison

                                     for

     The Commission on Practice
     Jim Hinojosa, PhD, OTR, FAOTA - Chairperson


                                                            Adopted by the Representative Assembly 4/95

NOTE:  To be distributed in conjunction with the white paper entitled, The Role of the Occupational Therapy Practitioner in the Implementation of Full Inclusion

Full Inclusion White Paper
The American Occupational Therapy Association


WHITE PAPER

THE ROLE OF THE OCCUPATIONAL THERAPY PRACTITIONER IN THE IMPLEMENTATION OF FULL INCLUSION

The American Occupational Therapy Association has adopted a position in support of full inclusion, confirming the profession's belief that all persons deserve equal opportunity to participate in society's daily activities (AOTA, in press).  This paper in intended to clarify the concept of full inclusion as it applies to occupational therapy practitioners working in a variety of settings with infants, children, and adults with disabilities.  In addition, it advocates roles for occupational therapy practitioners as we support full inclusion in practice.

Inclusive environments enable persons with disabilities to belong and participate in varied activities, engaging in meaningful interactions from which they derive self-satisfaction (Grady, 1995).  Full inclusion addresses an individual's inherent right to participate in an accepting and supportive society and the creation of opportunities which realize that goal (Stainback et al., 1994).  The objective of full inclusion is not simply to move individuals with disabilities to a non-specialized place or location, such as the general education classroom in a neighborhood school.  Nor does it focus on the placement of all persons with disabilities in any given environment without accommodations or supportive services at the ultimate goal.

The ideals that are espoused in an inclusive community relate to many of the basic tenets of occupational therapy.  The profession's founding principles are based upon belief in human dignity and equality.  Further, individual choice and participation in meaningful activity are primary human needs that lead to essential feelings of self-direction and belonging (AOTA, 1993).  The promotion of independence in daily life tasks across environments has been valued and embraced throughout the profession's evolution.

As occupational therapy practitioners strive to implement full inclusion into reality, we maintain a commitment to the profession's core body of knowledge and skills gained through entry-level preparation.  We recognize and accept the need for professional development and experience leading to competency in working with human diversities in a variety of environments and cultures.

The components and characteristics of inclusion discussed in this paper help define the concept and provide the basis for the occupational therapy practitioner's role in its implementation.  Full inclusion addresses both human and non-human elements of access and support in society.  However, beyond merely integrating people and services into any activities or environments, the concept of full inclusion also incorporates perceptions, values, attitudes, expectations, and behaviors of all persons, those with and without disabilities.

Recognizing and accepting differences is essential as we approach the goal of inclusive environments which promote human diversity and individual choice, rather than creating segregated communities based on homogeneity.  Individuals with differing abilities may require accommodation and/or support services in order to exercise their right to belong and participate in environments of their choice.  Accordingly, the belief in full inclusion requires an accompanying commitment to those accommodations, strategies, and services which may be necessary to promote individuals' access to desired environments, and subsequently, to enable and sustain their performance.

Full inclusion requires contribution and participation from many parties.  The individual seeking services, their family and/or caregiver(s), medical and health care professionals, education and social service providers, legislators, business and community members, and others may work together to achieve full inclusion in any given situation.  Recognizing the importance of self-direction in the human experience, occupational therapy practitioners encourage individuals with disabilities and their families to fully participate in decision-making that concerns their work, play or leisure, self-help, and other daily life roles.  We believe that the consumer perspective is a vital component of the therapeutic process to be respected and incorporated into mutually agreed-upon actions and strategies.

Building inclusive environments provides an opportunity to create meaningful connections between occupational therapy practice and a variety of activities and events, both for the benefit of consumers who seek these services and for society as a whole.  Occupational therapy practitioners are dedicated to a team approach which utilizes nondiscriminatory evaluations and includes all relevant viewpoints so that recommendations are made on an individual basis.  We encourage the use of innovative and flexible plans that may be required to address new and unique situations.  The occupational therapy profession supports accountability in all aspects of service delivery and promotes inquiry and research to document outcomes of inclusion efforts.

Members of the occupational therapy profession advocate inclusive placement and program decisions which are made with careful consideration of the nature and extent of incremental steps and supports needed to realize inclusion's ultimate goal.  These supportive efforts may be directed to both human and non-human elements.  They include remedial and compensatory interventions and approaches, the use of adaptive equipment, and environmental and activity adaptations, all available in a variety of settings and locations.  As this assistance may come from multiple sources, occupational therapy practitioners collaborate with others to identify and provide the supports and services which enable an individual's participation in chosen life tasks across desired environments.

Continual reevaluation of performance, of progress, and of the individual's continuing needs and desires are essential in creation and maintenance of inclusive communities and environments. These concerns become especially critical during transition in the life span, such as a child's advancement from home to school, a young adult's entry into the work world, or a mature adult's progression from work to retirement.

Occupational therapy practitioners offer consultation to families, caregivers and others, and to the system itself, in order to secure an individual's right to participation and to enable performance within the chosen environment. This consultation may be related to a need for information, the development of specific skills, adaption of the social or physical environment, or other support interventions.

In summary, full inclusion is compatible with the philosophies and ideals of occupational therapy. The implementation of full inclusion challenges occupational therapy practitioners. It offers opportunities for members of the profession and benefits for all society as well. As the diversity of human existence is recognized and differences are embraced through interaction and interdependence, all individuals have an opportunity to expand perceptions, expectations, and understanding.

Now, and into the next century, we anticipate societal challenges related to changing views of health, technological advances, and the implications of disability in an increasingly complex environment (Yerxa, 1994). In response, the occupational therapy profession is poised to accept the responsibility to provide choices, equal opportunities, and benefits for persons with disabilities. The profession supports inclusion efforts for all persons to encourage the removal of physical, legal, and attitudinal barriers to opportunities within society and to improve an individual's ability to realize his or her potential and achieve self-satisfaction.

References

American Occupational Therapy Association. (1993). Core values and attitudes of 									occupational therapy practice. American Journal of Occupational Therapy, 47, 		1085-1086.

American Occupational Therapy Association. (in press). Occupational therapy: A profession in support of full inclusion. American Journal of Occupational Therapy.

Grady, A. (1995). Eleanor Clarke Slagle lecture - Building inclusive community: A challenge for occupational therapy. American Journal of Occupational Therapy, 49, 300-310.

Stainback, S., Stainback, W., East, K., & Sapin-Shevin, M. (1994). A commentary on inclusion and the development of a positive self-identity by people with disabilities. Exceptional Children, 60, 486-490.

Yerxa, E. (1994). Dreams, Dilemmas, and decisions for occupational therapy practice in 
millennium: An American perspective. American Journal of Occupational Therapy, 48, 586-589.		


Author:

Mary Muhlenhaupt, OTR, FAOTA

for

The Commission on Practice
Linda Kohlman Thomson, MOT, OTR, OT(C), FAOTA - Chairperson


Adopted by the Executive Board 1/96

NOTE: This document accompanies the 1995 position paper entitled, Occupational Therapy: A Profession in Support of Full Inclusion