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Proposing possibilities for an international debate in occupational therapy

机译：为职业治疗的国际辩论提出可能性

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Occupation is now recognised as a human need and inextricably linked to the social determinants of health. From its beginnings where it was considered merely a concept of diversional activity, occupational engagement and its many facets is now embedded in global health delivery (WORLD…, 2019). The focus on community provision reflects the contextual philosophy of occupational therapy. The individualised targeting of care reflects the person centred philosophy and the focus on self management and readiness for change reflects the empowerment which is core to our profession. It is therefore of no surprise to the global profession of occupational therapy that health and social care determinants are now speaking our professions language.Between countries, we share the same philosophical assumptions but our translation of the delivery of our practice varies. We are therefore a global profession with similar values and beliefs but with differences in its political, cultural, historical background, and interpretation. Such differences have been recently echoed by Marilyn Pattison, President of World Federation of Occupational Therapists (WFOT). In her editorial she compares a country with a dominant medical model to a country with a dominant social model of disability. She recognises the success of each model of delivery for the service users resident in that country and the flexibility which the occupational therapy philosophy enables. She recognises that occupational therapists have adapted to each countries health system (PATTISON, 2018). These adaptations were likely aided by the common theories that guide our occupational therapy practice.The effects of the Bologna Declaration, signed in 1999 by the ministers of education of 45 European countries, point to the establishment of common standards and guidelines that can give parameters to the global processes of qualification and unification of curricula, double diplomacy, exchanges and cooperation among universities, international student and professional mobility (MANGIA; BREGALDA, 2018). In Occupational Therapy, this process has been coordinated by European institutions and organizations such as the Council of Occupational Therapists for the European Countries (COTEC) and the European Network of Occupational Therapy in Higher Education (ENOTHE). It seeks to build flexible and quality training proposals that are comparable across countries and capable of responding to global needs and changes. It also aims to develop local and international partnerships that promote and give visibility to Occupational Therapy (COUNCIL..., 2008; MANGIA; BREGALDA, 2018). The World Federation of Occupational Therapists similarly provides a key function in ensuring quality pre-registration occupational therapy programmes globally by producing Minimum Standards for the Education of Occupational Therapists and an important accreditation function (WORLD…., 2018a).The three authors of this editorial have had the privilege to critically analyse each others occupational therapy delivery in the context of their country’s’ health and social care provision (CAREY; CRUZ; LAYNE, 2019). Brazil, the United States of America-USA, and the United Kingdom have significant differences in their political structure and hence significant differences in their organisation of health, education, and social care provision. There are therefore differences in the translation of the occupational therapy philosophy.Practice differences are evident in the focus of employment settings for occupational therapy. Whilst a high percentage of occupational therapists are employed within mental health in the UK and Brazil, it is significantly less so in the USA, whereas paediatrics is significantly higher an employment setting in the United States of America than for the UK. Occupational therapy in the United States is historically rooted in mental health, however currently less than 3% of occupational therapists work in mental health in the USA (AMERICAN…, 2015). Over half of Occupational Therapists in the USA work within the primarily private medical model (AMERICAN…, 2015). Whereas in Brazil and UK it is more a health delivery (DRUMMOND; CRUZ, 2018). Particularly in Brazil, occupational therapists are becoming more engaged in addressing issues of social injustice through the field of social care and education to promote social changes. These occupational therapists understand occupation as a collective, influencing life through historical and social contexts (MUNGUBA; MALFITANO; LOPES, 2018). Galheigo et al. (2018) defines this proposed direction as a movement towards fields of knowledge and intervention of occupational therapy based in the sociopolitical context, the theoretical-conceptual discussion, and the goal for emancipatory actions.In education there are significant differences in the entry level qualification and also the regulation of assistants. Education standards vary from country to country (WESCOTT;
机译：现在，职业被认为是人类的需要，与健康的社会决定因素密不可分。从一开始就被认为只是一种转移活动，职业参与及其许多方面的概念，如今已融入全球卫生服务中（WORLD…，2019年）。对社区提供的关注反映了职业治疗的背景哲学。个性化的护理目标体现了以人为本的理念，而对自我管理和变革的准备的关注则反映了我们专业的核心能力。因此，对于全球职业治疗专业来说，健康和社会护理决定因素现在正在说出我们的专业语言也就不足为奇了。在各国之间，我们有着相同的哲学假设，但是我们对实践的翻译却有所不同。因此，我们是一个具有相似价值观和信念，但在政治，文化，历史背景和解释上却有所不同的全球性专业。世界职业治疗师联合会（WFOT）主席玛丽莲·帕蒂森（Marilyn Pattison）最近也回应了这种差异。在她的社论中，她将医学模式占主导地位的国家与残疾社会模式占主导地位的国家进行了比较。她认识到每种交付模式对于该国居民的服务用户的成功以及职业治疗理念所带来的灵活性。她认识到职业治疗师已经适应了每个国家的卫生系统（PATTISON，2018）。这些适应措施可能受到指导我们职业治疗实践的共同理论的帮助.1999年，由45个欧洲国家的教育部长签署的《博洛尼亚宣言》的影响指出，可以建立共同的标准和指南，以为课程资格和统一，双重外交，大学之间的交流与合作，国际学生和专业流动性的全球过程（MANGIA; BREGALDA，2018）。在职业治疗中，该过程已由欧洲机构和组织（例如，欧洲国家职业治疗师理事会（COTEC）和欧洲高等教育职业治疗网络（ENOTHE））进行协调。它力求制定灵活而优质的培训建议，使其在各国之间具有可比性，并能够应对全球需求和变化。它还旨在发展本地和国际合作伙伴关系，以促进职业治疗并提高其知名度（理事会...，2008年;孟买;布雷加达，2018年）。世界职业治疗师联合会还通过制定《职业治疗师教育最低标准》和重要的鉴定职能，在确保全球高质量的注册前职业治疗计划方面发挥了关键作用（WORLD…。，2018a）。本社论的三位作者他们有幸根据自己国家的健康和社会护理条款对彼此的职业治疗进行严格分析（CAREY; CRUZ; LAYNE，2019）。巴西，美利坚合众国-美国和英国在政治结构上存在重大差异，因此在卫生，教育和社会护理提供的组织方面也存在重大差异。因此，职业治疗哲学的翻译存在差异。在职业治疗就业环境的重点上，实践差异是显而易见的。在英国和巴西，虽然心理治疗领域聘用的职业治疗师的比例很高，但在美国却要少得多，而在美国，儿科的就业条件要比英国高得多。历史上，美国的职业疗法植根于心理健康，但是目前，在美国，不到3％的职业治疗师从事精神卫生工作（AMERICAN…，2015）。美国一半以上的职业治疗师采用的是私人医疗模式（AMERICAN…，2015年）。而在巴西和英国，这更是一种卫生保健服务（DRUMMOND; CRUZ，2018）。特别是在巴西，职业治疗师正在通过社会护理和教育领域促进社会变革，越来越多地致力于解决社会不公问题。这些职业治疗师将职业理解为一个集体，通过历史和社会环境影响生活（MUNGUBA; MALFITANO; LOPES，2018年）。 Galheigo等。 （2018）将这个提议的方向定义为基于社会政治背景，理论概念讨论以及解放行动的目标向知识和职业治疗干预领域的运动。在教育领域，入门级资格和还有助手的规矩。教育标准因国家而异（WESCOTT;

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