Occupational therapist practices in inclusive higher education

Abstract

The article presents experiences of occupational therapists in inclusive higher education, carried out at the National University of Colombia, and systematized from records that document them, in dialogue with the author's experience. Four areas of practice are identified: in administrative management, in student follow-up, in university policies and in the Inclusion Observatory. The Vice-Deanship of Welfare in the Faculty of Medicine in National University of Colombia is an administrative and management position that since the late 1980s has been assumed in some periods by occupational therapists. Since 2004, there has been significant professional participation in programs aimed, especially, at the follow-up of applicants and students with disabilities, and which over time have resulted in an institutional policy. The creation of the Inclusion Observatory has been a scenario for the development of occupational therapist functions and a key strategy to influence the daily life of different groups that demanded that their voices and feelings be welcomed at the university. Some approaches in relation to occupation in the university context are also synthesized, a topic to which several occupational therapists have given relevance.

Keywords:
Inclusive Education; Universities; Occupational Therapy

Resumen

El artículo presenta experiencias de terapeutas ocupacionales en la educación superior inclusiva, realizadas en la Universidad Nacional de Colombia y sistematizadas a partir de registros que las documentan, en diálogo con la experiencia de la autora. Se identifican cuatro ámbitos de prácticas: en la dirección administrativa, en acompañamiento a estudiantes, en políticas universitarias y en el observatorio de inclusión. La Vicedecanatura de Bienestar en la Facultad de Medicina en la Universidad Nacional de Colombia es un cargo administrativo y de gestión que desde finales de la década de 1980 ha sido asumido en algunos periodos por terapeutas ocupacionales. A partir de 2004, se registra una importante participación profesional en programas dirigidos, especialmente, al acompañamiento de aspirantes y estudiantes con discapacidad y que derivaron con el tiempo en una política institucional. La creación del Observatorio de Inclusión ha sido un escenario de desarrollo de funciones de terapeutas ocupacionales y una estrategia clave para incidir en la cotidianidad de diferentes colectivos que reclamaban que sus voces y sentires fueran acogidas en la universidad. Se sintetizan además algunas aproximaciones en relación con la ocupación en el contexto universitario, tema al que varias terapeutas ocupacionales le han dado relevancia.

Palabras clave:
Educación Inclusiva; Universidad; Terapia Ocupacional

Resumo

O artigo apresenta experiências de terapeutas ocupacionais no ensino superior inclusivo, realizadas na Universidade Nacional da Colômbia e sistematizadas a partir de registros que as documentam, em diálogo com a experiência da autora. Identificam-se quatro áreas de atuação: na gestão administrativa, no acompanhamento dos estudantes, nas políticas universitárias e no observatório da inclusão. A Vice-Diretoria de Bem-Estar da Faculdade de Medicina da Universidade Nacional da Colômbia é um cargo administrativo e de gestão que desde o final da década de 1980 foi assumido em alguns períodos por terapeutas ocupacionais. Desde 2004, tem havido significativa participação profissional em programas voltados, especialmente, para o acompanhamento de candidatos e alunos com deficiência, e que ao longo do tempo resultaram em uma política institucional. A criação do Observatório da Inclusão tem sido um cenário para o desenvolvimento das funções do terapeuta ocupacional e uma estratégia fundamental para influenciar o cotidiano de diferentes grupos que demandavam que suas vozes e sentimentos fossem acolhidos na universidade. São também sintetizadas algumas abordagens em relação à ocupação no contexto universitário, tema a que várias terapeutas ocupacionais atribuem relevância.

Palavras-chave:
Educação Inclusiva; Universidade; Terapia Ocupacional

Presentation

During the 1950s, violence in Colombia intensified in the countryside, while conditions were created that were conducive to the emergence of guerrilla groups on the political scene. Faced with the rehabilitation needs caused by the effects on the civilian population, among other circumstances, the National University of Colombia decided to create three technical training programs in 1966: Physical Therapy, Speech Therapy and Occupational Therapy (Agreement 4/1966) (Consejo Superior Universitario, 1966), which would later become professionalized.

In the following decades, far from being resolved, the conflicts became more intense and complex, so that by the end of the 1980s a complex context was presented where armed confrontation, narcoterrorism and the economic crisis¹ prevailed, accompanied by great inequalities and injustices that demanded action by the State and society. As the main public institution of a national character, the National University of Colombia creates “special admission programs” to promote access to higher education, on an equal basis, for young people from indigenous communities and the poorest municipalities in the country. These programs, instituted through agreements 22/1986 and 93/1989 of the Superior University Council (Consejo Superior Universitario (1986, 1989), respectively, are gradually expanded and, over time, give space to other populations and to the professional participation of occupational therapists within the university welfare actions arranged to follow them.

By 2008, the Ministry of National Education recognized the leadership of the National University of Colombia in the educational inclusion of people with disabilities (Pérez-Acevedo, 2015). Thus, in 2009, together with more than fifty higher education institutions from countries in the region, it participated in the formation of the Latin American and Caribbean Interuniversity Network on Disability and Human Rights. Likewise, as a result of the advice provided by the University to the Ministry of Education, the Guidelines for Inclusive Higher Education were derived (Bogotá, 2013).

Thus, in the field of inclusion in higher education, the National University of Colombia has been a reference for other institutions in the country. In this journey, the participation of occupational therapists has been relevant, which is why it is important to systematize and share this experience.

As a relevant reflection for this systematization, Cohen (2001, p. 314) affirms that “Colombian women have been part of history and have helped to shape it; they have made an active contribution to transform Colombian universities and to professionalize occupations”. In this political key, I highlight the work of occupational therapists who ventured into a public university as a field of professional action and social transformation; however, their important work rarely received any recognition.

Approach to the Practices of Occupational Therapists in Inclusive Higher Education at the National University of Colombia

Systematization, according to Jara (2018, p. 150), allows to reconstruct the history of an experience, where the first thing is the recovery of the lived process; it is like letting the experience speak. “It is about having a vision […] of the main events that were happening in the course of the experience, usually presented chronologically”.

In this systematization, the first phase, which is developed in this article, serves to thematize and locate in time the experiences of occupational therapists related to inclusion at the National University of Colombia; in this case, to identify the key themes around which, since the late 1980s, professional practices have moved in this context, based on the dialogue between some records that document them and my own journey, because as Fernández et al. (2020, p. 27) state, “[…] thematization appears as a crucial step to strengthen the value chain of experiences […], it involves turning an idea into the central theme of a speech, story, text, work of art, object, etc.”.

In the future, in a second stage, we can continue with a critical and interpretive analysis of the experiences, to later advance in a propositional approach, which can be developed in later publications.

The first text I had access to, which documents professional practices with university students in Colombia, was published in 2001, the last in 2023. Even so, these documents cover experiences since 1988; therefore, the systematization addresses that time window. Articles, books, and reports were identified and organized chronologically; then, I carried out several intratextual and intertextual readings to preliminarily examine some convergences and divergences. With this, I obtained a first thematization that I discussed with a colleague and, based on that dialogue, I adjusted it by identifying four areas of practice in higher education: in administrative management, in student follow-up, in university policies, and in the Inclusion Observatory.

On the other hand, unlike what was proposed by Marchant Castillo (2023), who addresses the “teaching role” of occupational therapists in Chile, this analysis excludes this area of professional action.

Practices in administrative management

Since the end of the 1980s, occupational therapists began to be called to assume the Vice-Deanship of Welfare at the Faculty of Medicine of the National University, the academic unit where the Occupational Therapy Program is located. The first to assume the position were professors Rosario Laserna (1988-1990) and Alicia Trujillo (1990-1992) (Fernández-Moreno et al., 2018). In this way, a first milestone is established in the positioning of occupational therapy in management positions at said faculty, which is also a precursor to the follow-up of students in inclusion logics in higher education, as part of this responsibility falls to university welfare bodies.

Although no documents were available regarding her administration, speech therapist Ethel Acero (cited by Fernández-Moreno et al., 2018, p. 275) reports: “the Vice-Deanship of Welfare, the secretariat and the departmental directorships themselves were the only ones that could be given to a woman; from there on up, little”. With this, she alludes to the link with feminine care that was reproduced in the welfare departments, in addition to the underlying subordination, which implies that these academics “had to wage struggles and bridge gaps not only because of the fact of being women, but also, and perhaps more strongly, because of the positioning of their professions” (Fernández-Moreno et al., 2018, p. 262).

More recently, occupational therapist Sylvia Duarte Torres has been appointed director of Welfare at the Faculty of Medicine for two consecutive terms (2018 - 2020 and 2020 - 2022). In the complex times of the pandemic, the work fronts and demands to provide relevant support to the university community are increasing. Among other initiatives, under the leadership of Professor Sylvia, the “padrinos (Godfathers)” plan is created to support students with economic and food needs and the “mental health route”, in conjunction with the Student Health Care Center and the University Hospital, aimed especially at internship and medical residency students and including suicide prevention activities. For 2021, within the framework of the “Healthy, inclusive, diverse, dialoguing and transformative university community” program, alternative communication channels are implemented for the follow-up and monitoring of students (Duarte-Torres, 2020, 2021).

Practices in the Student Follow-up

In the historical perspective in the educational sector that Professor Laura Álvarez de Bello traces in 1994, although she states that in Colombia occupational therapy actions at the university level had not begun, she already considers it as a projection (Álvarez, 1994). Similarly, the World Federation of Occupational Therapists (Federación Mundial de Terapeutas Ocupacionales, 2016) refers to the work of the profession at all educational levels.

In Colombia, the reviewed literature gives an account of formal practices in higher education that have been carried out since the late 1990s. Based on her professional practice in the Student Health Division, occupational therapist Duarte-Cuervo (2001, p. 94) outlines an understanding of the schooling of young university students as an occupational. In this sense, she describes “the dysfunctionality in the performance of their role and identifies the characteristics of the university environment and the demands of academic activity that determine the quality of occupational performance at this age and particular context”. Based on this, she proposes a range of professional actions in this area, including, among others, “the integration, reintegration and orientation of students with disabilities” (Duarte-Cuervo, 2001, p. 100). This work takes as references the developments that were taking place at the time –also at the National University– around the “model of occupational performance” and that considered personal capacities, occupational demands and interaction with the environment, assuming a transformative dynamic.

It should be added that the professional actions of Clara Duarte, as part of the interdisciplinary team of the Student Health Division, at the time, included the follow-up of students entering the University through special admission programs (Mayorga & Bautista, 2009).

On the other hand, in the Faculty of Medicine, on the initiative of three physiotherapy students and under the guidance of occupational therapist Lida Pérez Acevedo, in 2004 the project “Equalization of opportunities in the admission process of applicants with disabilities at the National University of Colombia” was presented (Pérez-Acevedo et al., 2015).

Pérez-Acevedo et al. (2015) state that the use of the term “equalization” and other similar terms in these initiatives was at the time a response to a historical, political and social project, while recognizing the expectation that they would be questioned and transformed, as occurred over the years. In this regard, they point out that “equalization” arises as a result of three dimensions: the recognition of the characteristics of people with limitations, the environment and the specificities of the admission process of the National University. It should be noted that the equalization actions carried out in the institution are consistent with what was established in the World Forum on Education held in 2015 in Incheon, Korea, which sought to guarantee inclusive and equitable quality education, as well as lifelong learning opportunities for all people (Organización de las Naciones Unidas para la Educación, la Ciencia y la Cultura, 2015).

Although this work was originally aimed at making adjustments and providing support for taking the admission test, in 2007 efforts were initiated to support the permanence and graduation of students with disabilities with the participation of the National Admissions Directorate, the National Directorate of University Welfare and the corresponding directorates of each campus, the Master's Degree in Disability and Social Inclusion² and other university bodies, constituting the Educational Inclusion System (SIE in Spanish). Thus, the initiative encourages subsequent developments that have a strong and permanent participation of occupational therapists for their implementation (Pérez-Acevedo, 2015; Murillo-Quiñones et al., 2023).

In 2013, together with the occupational therapist Aida Becerra, we presented a series of reflections and lessons learned from the follow-up of students with disabilities at the National University (Becerra-Becerra & Fernández-Moreno, 2013). These reflections arose from dialogue with members of the university community interested in continuing to promote changes in this regard. In this exercise, we reviewed the foundations and methods with the participants, in order to clarify the epistemological and methodological assumptions, the representations and the social practices regarding disability and inclusion, seeking to advance towards a paradigm shift focused on diversity as a broader horizon.

Practices in University Policies

Since the founding of the Latin American and Caribbean Interuniversity Network on Disability and Human Rights, the participating institutions have committed to the goal of “promoting the creation in higher education institutions of an institution that has the resources to develop effective and sustained actions that respond to the needs of people with disabilities” (Katz, 2015, p. 14).

In this sense, the participation of occupational therapists in the formulation of inclusive university policies at the National University of Colombia dates back to early 2008, with the work that Lida Pérez had been leading in the Educational Inclusion System and which resulted in Agreement 036/2012 (Consejo Superior Universitario, 2012), “By which the institutional policy for the educational inclusion of people with disabilities is established³ .” The Agreement promotes, among other issues, physical accessibility, the design, adaptation and implementation of resources for mobility, the acquisition and use of information and communication technologies, pedagogical preparation, the strengthening of institutional co-responsibility and the creation of an inclusion observatory. With varying degrees of success, occupational therapists have been committed to the actions agreed upon in the Agreement.

Practices at the Inclusion Observatory

As indicated, Agreement 036/2012 (Consejo Superior Universitario, 2012) creates a space called the Inclusion Observatory, whose objective is set out in 2016 as:

Monitor the implementation of the regulated measures and actions, provide advice and support to the academic, administrative and University Welfare areas at the National, Headquarters and Faculty levels, suggest the support required to facilitate the process of inclusion in the university environment of people with disabilities. (Universidad Nacional de Colombia – Rectoría, 2016).⁴

When it was created in 2017, it was directed by Lida Pérez; then, since 2018, it has been in charge of the occupational therapist Leyla Sanabria. The Observatory has counted on the participation of other colleagues in its team, some of whom claim to follow the approaches of Pérez-Acevedo (2015), with three useful guidelines in inclusive education processes: the approach to students with the purpose of discussing their interests, potentialities and requirements; the recognition of institutional capacity, and promoting the construction of a plural university, which recognizes differences, for everyone (Murillo-Quiñones et al., 2023).

These therapists recognize that the University itself reproduces models of inequality and exclusion from the admission processes, so it is relevant to work not only

around equitable and equal admission, but also to problematize, stress and propose, with the guidance of the populations themselves, mechanisms and practices that aim to transform the ways in which relationships are formed in university spaces [...] it is necessary to support the participation in conditions of equity of those underrepresented populations in these academic, research and social projection spaces. (Murillo-Quiñones et al., 2023, p. 131).

For the above, the follow-up processes from the Observatory have generated care routes that involve students, teachers, officials, and directors, as they require reasonable adjustments and affirmative actions, but, above all, permanent identification of physical, informational, and attitudinal barriers. At the University, equity continues to be a challenge, especially for students with disabilities, from indigenous and Afro-descendant populations, also those disconnected from the armed conflict, overage, border dwellers, among other groups. These populations have demanded not only the formulation of policies, but also constant monitoring and feedback to promote inclusive practices⁵ .

In this regard, Murillo-Quiñones et al. (2023, p. 201) point out:

As occupational therapists in higher education, the views on disability, gender, ethnicity, rural origin, among others, always demand contextualizing the power relations and political logics that are intertwined in these processes that we accompany.

Thus, I find a work that is based on respect for the dignity of those who participate, especially if they are at a disadvantage. To achieve this, it has started from permanent dialogue and collective construction that makes it possible, based on the follow-ups, to be who they want to be at university. The projection then goes towards the creation of university spaces that transcend the discourse of inclusion and are truly designed for everyone.

In Terms of Occupation

Duarte-Cuervo (2001) states that, in Colombia, “traditionally, when speaking of human occupation as an object of study in occupational therapy, there is a tendency to ignore the occupational role of the university student and the occupational behavior of adolescents and young people” (p. 95). It is hoped that this text will encourage writing about this topic and recover the voice of the protagonists in enriched dialogues with their peers.

According to the author, entering university

implies drastic changes in lifestyle that demand an adjustment or adaptation, the experience of a new role with different occupational, environmental and social demands and exposure to specific risk factors; consequently, it leads to the transformation of behaviors, habits and occupational actions. (Duarte-Cuervo, 2001, p. 96)

Of the range of professional actions that this colleague proposes, what is particularly relevant is what relates to the reorganization of performance, which clearly impacts students, especially those with disabilities, migrants and those belonging to other so-called minorities.

Of the texts reviewed to support this article, one of those published by Professor Pérez-Acevedo (2011) was of special interest. She records the actions to follow in occupational therapy for educational inclusion as an encounter, a way of relating. Thus, she presents three approaches: the first is related to understanding the occupation experienced by people who seek to make the university accessible, who are committed to advancing the right that we all have to enjoy university life. The second corresponds to the various activities of applicants, students and graduates with disabilities, who are stressed by their passage through university life; occupations that are restricted, denied or limited due to the characteristics of a university made for some, not for all. Finally, occupation understood as a scenario of encounter, cooperation and coexistence, planned with specific purposes.

These approaches constitute powerful clues for the work of occupational therapists in universities, particularly when these occupations can be bridges for encounter and coexistence, because, as stated by Murillo-Quiñones et al. (2023, p. 198): “[…] our lens of occupation has allowed us to understand and analyze, from a holistic perspective, the occupational work of students throughout their journey through university life, as well as the factors that determine it”.

Final Considerations

From the work of the Vice-Dean of Welfare of the Faculty of Medicine and in equal opportunity programs for applicants and students of the National University to the creation of institutional policies and the implementation of the Disability Observatory, these have been, as Murillo-Quiñones et al. (2023) suggest, strategies to influence the daily lives of different groups who demanded that their voices and feelings be welcomed in the institution. This emerging field in inclusive higher education, while showing direct actions by occupational therapists with people and groups, also presents an emphasis on administrative and management functions.

In the texts revised, there is a constant follow-up based on dialogic, relational and respect for diversity, aimed at generating spaces for meeting and co-construction with interprofessional teams that facilitate the genuine participation of the university community and manage to take what is stated in institutional policies to transformative actions and possible worlds.

The documents also reveal ethical-political reflections that emerge from professional performance in knowledge-power scenarios that need to be transformed to make room for diversity, they lead to questioning the ideal of inclusion and they outline an intersectional key that is only just beginning to be glimpsed. Other challenges for a university that embraces the diversity and plurality of the student body and, consequently, for occupational therapy in higher education, are social justice, equity and the confrontation of ableist challenges; issues that we are then called to address.

• 1
  A panoramic view of the armed conflict in Colombia can be found in Franco (2023).
• 2
  Postgraduate program also offered by the Faculty of Medicine and which, since its creation, has been led by the departments of Occupational Therapy, Physiotherapy and Speech Therapy.
• 3
  The National Directorate of University Welfare called the Master's Degree in Disability and Social Inclusion to a working table in which two occupational therapists participated as experts in the interprofessional team that consolidated the draft agreement to be later reviewed and approved by the University Superior Council.
• 4
  Subsequently, the Observatory is regulated by Rector's Resolution 289/2022 (Universidad Nacional de Colombia – Rectoría, 2022).
• 5
  The “Global Education Monitoring Report” (Organización de las Naciones Unidas para la Educación, la Ciencia y la Cultura, 2020) highlights as a key message that in Latin America and the Caribbean it is necessary to adopt broader concepts of inclusion, which consider various groups marginalized from education, not only children with disabilities.
• How to cite:
  Fernández-Moreno, C. A. (2024). Occupational therapist practices in inclusive higher education. Cadernos Brasileiros de Terapia Ocupacional, 32(spe), e3827. https://doi.org/10.1590/2526-8910.ctoRE394638272
• Funding Source
  (Universidad Nacional de Colombia) National University of Colombia.

References

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• Pérez-Acevedo, L., Bravo, M. F., & Forero-Usma, Ó. D. (2015). Proceso de réplica y socialización de la experiencia: equiparación de oportunidades en el proceso de admisión de aspirantes en situación de discapacidad en la Universidad Nacional de Colombia. In L. O. Pérez (Ed.), En el camino de construir una universidad para todas y todos: acciones y reflexiones en discapacidad (pp. 51-99). Bogotá: Universidad Nacional de Colombia.
• Universidad Nacional de Colombia – Rectoría. (2016, 2 de agosto). Resolución 779 de 2016, de 2 de agosto. Por la cual se reglamenta el Observatorio de Inclusión Educativa para Personas con Discapacidad en la Universidad Nacional de Colombia. Universidad Nacional de Colombia, Bogotá.
• Universidad Nacional de Colombia – Rectoría. (2022, 4 de abril). Resolución 289 de 2022, de 4 de abril. Por la cual se reglamenta el Observatorio de Inclusión Educativa para Personas con Discapacidad en la Universidad Nacional de Colombia y se deroga la Resolución 779 de 2016 de Rectoría. Universidad Nacional de Colombia, Bogotá.

Edited by

• Section editor
  Prof. Dr. Lívia Celegati Pan

Publication Dates

• Publication in this collection
  06 Dec 2024
• Date of issue
  2024

History

• Received
  11 Apr 2024
• Accepted
  20 Aug 2024