1. The Empire strikes back: learning from practice on the margins
Jennifer Creek

2. Contents of paper Terminology and key features of the margins
The influence of the British Empire on occupational therapy
Traffic between the centre and the margins
Integration of occupational therapy into the mainstream
What can be learned from occupational therapy theory and practice on the margins
Improving mainstream services

3. Social movements of the late 19th and early 20th centuries
Improving the lives of marginalised people: urban poor, immigrants, women, those with mental illness
Women’s professions in the social sector
Compulsory education
Contributing to the war effort
Career as an alternative to marriage for women
Better housing for the poor
The settlement movement

5. The settlement movement
1884 Toynbee Hall – London
To offer amenities, education and guidance to people living in impoverished urban areas
1889 Women’s University Settlement – London
To promote the welfare of the poorer districts of London, especially women and children
1889 Hull House – Chicago
To integrate new immigrants into American society and to improve the conditions in the industrial districts of Chicago

6. Occupational therapy in the USA
1889 Hull House Settlement 1903 Chicago School of Civics and Philanthropy 1908 Course in Occupations for attendants in mental institutions 1915 Favell School of Occupational Therapy

7. Occupational therapy in Britain
Elizabeth Casson:
1908 Housing manager for Octavia Hill
1913 Medical student
1919 Qualified as a doctor
1929 Opened Dorset House residential clinic in Bristol
1930 Opened Dorset House School of Occupational
Therapy

8. Terminology
Marginalised Situated on the edge, physically or socially; not fully integrated into the mainstream Marginal On or close to the margin below which something ceases to be possible or desirable Margin A physical place, a social space or a personal experience on the periphery of the social mainstream or dominant order. For every margin there is a centre or core that represents some form or position of authority, power and privilege.

9. Marginalisation
The process of moving something or someone from the centre to the periphery, impoverish, depreciate or undervalue The process of marginalisation can be progressive and cumulative

11. British Empire at the beginning of the 20th century

12. 1900 Campaign poster for the American Republican Party

13. Theoretical imperialism
A process by which theorists develop and perpetuate theories that privilege their own perspectives while overlooking, ignoring or silencing the perspective of others (Hammell 2011)

19. The Standard Rules on the Equalization of Opportunities for Persons with Disabilities
Adopted by the United Nations General Assembly, forty-eighth session, resolution 48/96, annex, of 20 December 1993

22. Occupational therapy on the margins
The process is different from that described in textbooks
Practice on the margins is qualitatively different from mainstream practice
Practitioners on the margins share a particular set of characteristics

23. Occupational therapy process
Perception of an unmet occupational need
Recognition of how that need might be met
Awareness that something can be done to improve the situation
Awareness that the therapist has the skills and knowledge to bring about positive change
Action by the therapist, with and on behalf of the people in need

24. Grandmothers Against Poverty and AIDS
PERCEPTION OF NEED: When one or more parents dies from AIDS the grandmother may become the sole provider and supporter of the grandchildren RECOGNITION OF HOW TO MEET NEED: Provide useful information about such matters as HIV/AIDS, nutrition, bereavement and business skills ACTION: Organise a series of workshops

25. Qualities of occupational therapy practice
Driven by particular ways of doing things, including models and procedures
Focussed on the individual, who is seen as the locus of the issue
Controlled by external forces, such as managers, employers and contracts
Based in an institution, such as a hospital or prison

26. Qualities of occupational therapy practice on the margins
Responsive to local conditions and needs
Focussed on the collective, that is, on the community, family or work group
Delivered by a professional who is able to make autonomous decisions about what to do and how to do it
Based in the communities where people live and work

28. Enabling characteristics
Agency is the capacity to take action towards an end
Openness involves trying to understand what is there on its own terms
Responsiveness means being willing to react in ways appropriate to the circumstances
Commitment is the stamina to persist despite challenges and setbacks
Resourcefulness is imagination and creativity in finding and making use of available resources

30. Conclusion
The features and characteristics of practice on the margins make it more effective than institutionalised occupational therapy practice for people living with long-term, complex conditions As health and social care services struggle to deal with increasing numbers of such people, it is time for us to let go of established ways of thinking and practising and allow ourselves to learn new and more successful approaches from practitioners on the margins