An interactive process for recognizing and responding to inequity
This project was funded by the Social Sciences and Humanities Research Council of Canada.
For more information about this Praxis Toolkit, use this QR code or visit: https://www minorpraxis com/praxis toolkit
The Praxis Toolkit was co-created by the following contributors (listed in reverse alphabetical order): Diana van der Stoel, Erin Tichenor, Jennifer Sadowski, Amanda Mah, Monica Hoang, Sarah Hamill, Gayla Grinde, Frankie Chan, Eduan Breedt, Tim Barlott, and Rebecca Alley
The Praxis Toolkit is licensed under the Creative Commons CC BY-NC-SA 4 0 license. This means others may use, share, print, adapt, or translate the toolkit provided that: 1) credit is given to Minor Praxis Lab and Praxis Toolkit Co-Creators; 2) the toolkit is not used for commercial purposes; and 3) any adaptations are shared under the same license.
Hello! So glad you picked up this Praxis Toolkit. We can’t wait to explore with you.
The Praxis Toolkit supports clinicians addressing social inequities and health injustices to engage in ethical reasoning processes around tricky and complex situations they encounter in practice The toolkit helps clinicians:
Reconceptualize practice conditions
Recognize the variety of forces impacting them and the individuals and communities they work with
Surface underling causes of inequities
Generate strategies for intervening in inequity
Mobilize values towards health justice through drawing on different knowledges and practices
What do we mean by ‘Praxis’?
Praxis is the relationship between theory (how we conceptualize things) and practice (what we do). This relationship between theory and practice is continuous and iterative Said another way, how we think about things informs and gets modified by our actions, practices, and vice versa.
Some Assumptions that Anchor the Praxis Toolkit
Our individual and collective values, assumptions, principles, and knowledge are always in process
We are consciously and unconsciously informed by these values, assumptions, principles, and knowledge
We use these values, assumptions, principles, and knowledge differently in different contexts, depending on the situations we encounter Dominant social, economic, and political systems (such as capitalism, racism, colonialism, cisheteropatriarchy, etc.) are harmful and produce and shape social and health inequities
Who made this toolkit?
This toolkit was collaboratively developed by a group of eight occupational therapists, three occupational therapy researchers, and two interdisciplinary researchers in amiskwaciwâskahikan (Edmonton, Alberta, Canada) in Treaty 6 territory.
IMPORTANT!
This is a tool for exploration, not a rigid guide that produces a ‘right’ answer
While this toolkit may offer some pathways for navigating complex situations and developing strategies for intervening in inequity, it is, not meant to become a rigid guide for practice. There is not necessarily a ‘correct’ answer to discover. Instead, the toolkit creates space to explore, compare, contrast, and ‘try on ’ multiple different actions, opportunities, and interventions at different levels.
How to Use the Toolkit
Who can use the toolkit?
The toolkit can be used by individual clinicians or by a clinician in collaboration with others (e g with colleagues, teams, or service users). We think it is best done in pairs, groups, or teams.
When might it be helpful to use the toolkit?
The toolkit can be helpful in a variety of contexts and situations such as an incident management meeting, team debrief, case management session, collaborative session with service user(s), reflective activity, retreat or professional development program, or an interdisciplinary meeting. It can be used to discuss a specific person, situation, or incident, but you could also use it more abstractly, for example, to develop your own or your team’s in-process ethical approach to decision making or care.
A Note on Language
Some of the language and phrases in this toolkit (such as ‘loopholes’ and ‘soft spots’) emerged from conversations with the clinicians that helped create the toolkit and might feel unfamiliar or strange to those outside of this group. We encourage you to use, make sense of, or pass over these words in whatever way is useful for your particular context.
Toolkit Parts
Whiteboard
Whiteboard Marker
Guidebook
Magnets
A set of magnets for each prompt
A set of shapes
Steps to Using the Toolkit
1 Place the board in front of you/ the group
2. Place the Shape Magnets beside the board
3. Place the Magnets beside the board, sorted into their respective colours
4. Grab the keyring of Prompt Cards and start to move through the prompts one by one
As you move through the steps, try to remain relatively fluid in your sense making. No need to get too bogged down with ‘accurately’ representing the situation or even coming to a final ‘decision’ or ‘conclusion’. Add or remove components and allow the relationship between things to change as needed. You may not find the ‘perfect’ word you ’ re looking for - and that’s OK! Be flexible with your definitions, and use the blank pieces to add in concepts, names, and phrases that you need for your context.
List of Prompts
Each of the prompts below appears as a Prompt Card in the Toolkit Here they are collected in one place for quick reference:
Prompt 1: What are we hoping to achieve with this activity?
Prompt 2: How are you showing up to this activity today?
Prompt 3: Reflect on the implicit and/or explicit assumptions that we and/or others bring to this situation.
Prompt 4: Who is involved in this situation and who is missing?
Prompt 5A: What are the experiences (at micro, meso, and macro levels) that we are responding to?
Prompt 5B: What are the conditions (at micro, meso, and macro levels) that we are responding to?
Prompt 6: What parts of people’s everyday life are impacted and how?
Prompt 7: What values are being prioritized and overlooked in this situation?
Prompt 8: What knowledges are being prioritized and overlooked in this situation?
Prompt 9: What tensions between barriers and desired goals do we have to balance?
Prompt 10: Are there other factors to consider when reflecting on this situation?
Prompt 11: Using the shapes, consider how these components interact and relate with one another.
Prompt 12: Revisit your answers to Prompt 1 and Prompt 2. What has changed in your aims, expectations, and/or emotions since starting this sense making process?
Prompt 13: Reflect on what opportunities for action this sense-making process may offer
Prompt 14: What actions feel in and/or out of our control as individuals or as a group, and who do we need to connect with to increase our capacity for action?
What Are We Hoping to Achieve With This Activity?
Write down your goal or expectation at the top of the board
How Are You Showing up to This Activity Today?
1. Grab the yellow Emotion Magnets and Shape Magnets and spread them out and look at them.
2. Choose any Emotions and/or shapes that resonate.
3. Write additional emotions that are not already on a magnet on a blank magnet. You can come up with them on your own or use the “Starting List” on the back of this card to help you identify others.
4. Place your chosen Emotions on the board.
5. If working with others, have a conversation together about what emotions you chose and why.
6 Continually revisit the emotions you named throughout the process - feel free to add, take away, and/or adjust the emotions as you continue the exploration.
Prompt category
Example Emotion Magnets
Starting List of Emotions
The emotions magnets capture some, but certainly not all, of the potential feelings that we, our colleagues, our service users, and other partners and relations may be feeling with regards to a given situation. Reflecting on the emotions circulating in the situation may support us to conceptualize and discern a mode of action differently than if we only focus on rationality and facts
Thinking of something that’s not in the list? Write it on a blank magnet!
Joy Love Nervous Optimistic Overcome Rage Powerless Proud Relieved Sad Scared Shame Shocked Sorrow Trusting Worried
Reflect on the Implicit and/or Explicit Assumptions That We and/or Others Bring to This Situation
1. Grab the green Assumption magnets and spread them out and look at them
2. Choose any Assumptions that resonate.
3. Write additional Assumptions that are not already on a magnet on a blank magnet. You can come up with them on your own or use the “Starting List” on the back of this card to help you identify others.
4. Place your chosen Assumptions on the board.
5. If working with others, have a conversation together about what assumptions you chose and why.
6. Continually revisit the assumptions you named throughout the process - feel free to add, take away, and/or adjust the assumptions as you continue the exploration.
Starting List of Assumptions
This is a starting list of assumptions, developed by the diverse group that created the toolkit. Collectively we determined that we all come into practice with these base beliefs and principles, which informs our sense-making and approaches to action
Dominant social structures produce inequity
We do not accept the systems as they are, even as we work within them. We are often part of systems that do harm. We can be complicit in reproducing systemic harm.
Our duty is to mitigate and intervene in the harmful systems we work in My social location, assumptions/biases, and values impact my practice. Mistakes happen - our practices are always iterative.
Our work involves risk Systems are deficit-based.
Community is required for individuals to thrive.
We (service users and clinicians) are always doing the best they/we can with what they/we have available to them/us We do not always know what we do not know.
Thinking of something that’s not in the list?
Write it on a blank magnet!
Who Is Involved in This Situation and Who Is Missing?
1. Grab the blue Partnerships/ Relationships Magnets and spread them out and look at them.
2. Choose any that resonate.
3 Write additional Partnerships/ Relationships that are not already on a magnet on a blank magnet. You can come up with them on your own or use the “Starting List” on the back of this card to help you identify others
4. Place your chosen Partnerships/ Relationships on the board in relation to this situation.
5. If working with others, have a conversation together about what Partnerships/Relationships you chose and why.
6. Look at the Shape Magnets and see if any of them can help you further illustrate the Partnerships/Relationships
7. Continually revisit the Partnerships/ Relationships you named throughout the process - feel free to add, take away, and/or adjust the Partnerships/Relationships as you continue the exploration.
Prompt category
Example Partnership/ Relationship Magnets
Starting List of Partnerships and Relations
These terms refer to the people, groups, and institutions that you and your service users may interact with, which can be used for (re)thinking and contextualizing a situation at hand and the variety of actors shaping and affected by it.
Academics
Allied Health
Child and family services
City Community
Community leader
Court
Cultural practitioner
Dentist
Detox
Dietician
Elder
Family
Friends
Funder
Government assistance
Healthcare system (private)
Healthcare system (public)
Hospital Housing Indigenous practitioner
Jail ‘Justice’ system
Knowledge holder
Lawyer Leadership
Loved Ones
Manager
Medicine
Mentor
Neighborhood
Thinking of something that’s not in the list? Write it on a blank magnet!
Nurse
Occupational therapist
Paramedic
Peace officers
Permanent supportive housing
Pharmacist
Physician
Physiotherapist
Policy makers
Police
Practitioner
Prison
Probation
Private housing
Province
Psychologist
Public housing
Rehabilitation
Role
Roles
Security Service user
Shelter
Speech therapist
Staff
Students
Support worker
Team
What Are the Experiences (At Micro, Meso, and Macro Levels) That We Are Responding To?
1 Grab the pink Individual Experience Magnets and spread them out and look at them.
2. Write additional Individual Experiences that are not already on a magnet on a blank magnet. You can come up with them on your own or use the “Starting List” on the back of this card to help you identify others.
3. Choose 3–5 Individual Experiences and place them on the board in relation to this situation
4 Look at the Shape Magnets and see if any of them can help you further illustrate the conditions.
5. If working with others, have a conversation together about which Individual Experiences you chose and why.
6. Continually revisit the Individual Experiences you named throughout the process - feel free to add, take away, and/or adjust them as you continue the exploration.
Example Individual Experience Magnets Prompt category
Starting List of Individual Experiences
These terms refer to the specific experiences, challenges, strengths, and goals of a service user or community you ’ re working with. Taking these factors into consideration is often central to clinical practice, and the goal of this activity is to contextualize these experiences within the frames offered by the other magnets you ’ ve selected.
Thinking of something that’s not in the list? Write it on a blank magnet!
Houselessness
Identity Immigration
Impairment
Indigeneity
Language
Leisure
Literacy
Loneliness
Medication
Mental health
Mobility
Money/income
Nation
Neighborhood
Pain
Pets
Physical health
Pregnancy
Punishment
Religion
Sexual health
Spouse(s)
Spirituality
Substance use
Supplies
Transportation
Trauma Values
Victimization
Vulnerability
What Are the Conditions (At Micro, Meso, and Macro Levels) That We Are Responding To?
1. Grab the orange Constraining Conditions Magnets and spread them out and look at them.
2. Write additional Constraining Conditions that are not already on a magnet on a blank magnet You can come up with them on your own or use the “Starting List” on the back of this card to help you identify others.
3 Choose 3–5 Constraining Conditions and place them on the board in relation to this situation.
4. Look at the Shape Magnets and see if any of them can help you further illustrate the conditions.
5 If working with others, have a conversation together about which Constraining Conditions you chose and why.
6. Continually revisit the Constraining Conditions you named throughout the process - feel free to add, take away, and/or adjust them as you continue the exploration.
Prompt category
Example Constraining Conditions Magnets
Starting List of Constraining Conditions
These terms refer to the micro, meso, and macro factors that may be posing challenges for individuals and groups and increasing inequity.
Ableism
Ageism
Bias
Biomedical
Capitalism
Caseload
Cisheteronormativity
Climate
Coercion
Colonialism
Crime
Crisis
Defunding
Disconnection
Discrimination
Economy
English language
supremacy
Environment
Eugenics
Exclusion
Finances / funding
Gender expectations
Gender roles
Genocide
Harm
Homophobia
Housing crisis
Iatrogenic
Immigration
Individualism
Inequity
Thinking of something that’s not in the list? Write it on a blank magnet!
Insurance
Intolerance
Mandates
Migration
Misogyny
Nativism
Non-insured health benefits program
Occupation
Oppression
Policies
Politics
Precarity
Privilege
Procedures
Punishment
Racism
Regulations
Risk tolerance
Sanism
Separation
Sexism
Stigma
Time
Transphobia
Violence
Weather
Workload
Xenophobia
What Parts of People’s Everyday Life Are Impacted and How?
1. Grab the blank mauve Occupations Magnets
2. Write on the magnets any Occupations that are implicated in this situation. You can come up with them on your own or use the “Starting List” on the back of this card to help you identify others.
3. Place your chosen Occupations on the board in relation to this situation
4. Look at the Shape Magnets and see if any of them can help you further illustrate the Occupations.
5. If working with others, have a conversation together about what Occupations you chose and why.
6. Continually revisit the Occupations you named throughout the process - feel free to add, take away, and/or adjust the Occupations as you continue the exploration.
Prompt category
Blank magnets for writing in occupations
Starting List of Occupations
According to the World Federation of Occupational Therapy, “occupations refer to the everyday activities that people do as individuals, in families and with communities to occupy time and bring meaning and purpose to life. Occupations include things people need to, want to and are expected to do.” Below is a list of categories informed by the fourth edition of the Occupational Therapy Practice Framework published by the American Occupational Therapy Association To explore a full list of categories and occupations, you can scan the QR code at the bottom of the card
Activities of Daily Living (ADLs)
Instrumental Activities of Daily Living (IADLs)
Health Management
Rest & Sleep Education Work Play Leisure & Recreation
Thinking of something that’s not in the list? Write it on a blank magnet!
Social Participation & Relationships
Spiritual, Cultural, & Identity-related Occupations Environmental or Survival-related Occupations
Political & Economic Participation
Scan the QR code to see a full list of occupations.
Exploring Values and Principles
1. Grab the blue-grey Values Magnets and spread them out and look at them
2. Reflect:
a. What values are being prioritized in this situation?
b. Which Values do you want to prioritize in this situation and in your reflection and responses?
c. Which Values are influencing your priorities, goals, or agendas?
3. Write additional Values that are not already on a magnet on a blank magnet. You can come up with them on your own or use the “Starting List” on the back of this card to help you identify others.
4. Choose 3–5 Values and place them on the board in relation to this situation.
5. Look at the Shape Magnets and see if any of them can help you further illustrate the values.
6. If working with others, have a conversation together about what Values you chose and why.
7. Continually revisit the Values you named throughout the process - feel free to add, take away, and/or adjust the Values as you continue the exploration.
Prompt category
Example Values Magnets
Starting List of Values
Values refer to principles or beliefs regarding what is good and important
Recognizing the values we - and other people and institutions - hold can guide us to challenge biases, navigate tensions, and engage in actions toward values that support well-being and reduce inequity
Accountability
Adaptability
Affordability
Alignment
Assent
Aspiration
Belonging
Capabilities-based
Collaboration
Comfort
Community Connection
Consent
Courage
Cultural safety
Dignity
Dignity of risk
Efficiency
Equity Family Flexibility
Harm reduction
Healing Health
Hope
Human needs
Human rights
Humility
Independence
Individualism
Interdependence
Justice
Thinking of something that’s not in the list?
Write it on a blank magnet!
Learning Life Love Meaning
Money
Mutuality
Occupational
justice
Optimism
Productivity
Profitability
Power
Recovery
Relationality
Representation
Reputation
Respect Responsibility
Resilience
Risk-Management
Safety
Self-determination
Strengths-based
Transparency
Trauma-informed
Trust
Wealth
Well-being
Exploring Knowledges
1. Grab the beige Knowledges Magnets and spread them out and look at them
2. Reflect:
a. What Knowledges are being valued and prioritized, or passed over and ignored?
b. Which Knowledges do we want to draw from to help inform our reflection and action?
3. Write additional Knowledges that are not already on a magnet on a blank magnet. You can come up with them on your own or use the “Starting List” on the back of this card to help you identify others.
4. Choose 3–5 Knowledges and place them on the board in relation to this situation.
5. Look at the Shape Magnets and see if any of them can help you further illustrate the conditions
6. If working with others, have a conversation together about what Knowledges you chose and why.
7. Continually revisit the Knowledges you named throughout the process - feel free to add, take away, and/or adjust the Knowledges as you continue the exploration.
Prompt category
Example Knowledges Magnets
Starting List of Knowledges
In everyday practice, we consciously and unconsciously draw on learnings and teachings from a variety of people, places, things, experiences, and so on. That is, we do not only use the knowledge taught in clinical education or what is regarded as “knowledge” in clinical contexts. Reflecting on which knowledges we are mobilizing and which we would like to prioritize can enable us to think and act differently in clinical situations.
Thinking of something that’s not in the list? Write it on a blank magnet!
Memory
Past
Policy Principles
Protocol
Regulation
Religion
Research
Scope
Sensation
Societal values
Spirituality
Stories
Teachings
Theory
Unconscious
Values
What Tensions Between Barriers and Desired Goals Do We Have to Balance?
1. Grab the teal turqoise Tensions Magnets and spread them out.
2. Write additional Tensions that are not already on a magnet on a blank magnet. You can come up with them on your own or use the “Starting List” on the back of this card to help you identify others.
3. Choose 3–5 Tensions and place them on the board in relation to this situation.
4. Look at the Shape Magnets and see if any of them can help you further illustrate the Tensions
5. If working with others, have a conversation together about what Tensions you chose and why.
6. Continually revisit the Tensions you named throughout the process - feel free to add, take away, and/or adjust the Tensions as you continue the exploration
Example Tension Magnets Prompt category
Starting List of Tensions
In our work, we often encounter tensions between our own values, priorities, and goals, and those that the system promotes or offers. For example, the healthcare system may prioritize efficiency, whereas we may want to take our time to develop relationships Navigating these tensions –whether by communicating differently, negotiation, making compromises, or circumventing challenges – is crucial for developing praxis that supports service users and attends to inequity
Appropriation
Balance
Benefit
Boundaries
Burnout
Capture
Caseload
Code of conduct
Co-optation
Consequences
Cost
Discretion Efficiency
Expectations
Externalities
Failure
Flexibility
Judgment
Legality
Legibility
Legitimacy
Mandate
Thinking of something that’s not in the list? Write it on a blank magnet!
Moral injury
Outcome Policy
Profit
Protocol
Reactivity
Regulation
Relationships
Resources
Risk Safety Scope Speed Success
Therapeutic relationship Time Unknown Unsanctioned
Are There Other Factors to Consider When Reflecting on This Situation?
Move, add, or remove magnets as necessary
Using the Shapes, Consider How These Components Interact and Relate With One Another.
1. Pull out the black Shape Magnets and start to spread them out
2. Place shapes and (re)arrange the other Magnets accordingly.
3 You might also use the whiteboard marker to draw arrows or other shapes on the board to connect the different building blocks and further illustrate the situation.
4. Explore the Miscellaneous Add-Ons listed on the back of this card. What might change if you added these to the situation you are exploring using a whiteboard marker?
Example Shape Magnets
Miscellaneous Add-Ons
These terms are meant to support you to contextualize the other Magnets and make them versatile for you - without having to deal with too many magnets! For example, if you want decolonization to be an action mode, you can add “de” to colonization
Micro Meso Macro And... But Or... AntiDeLack of... NonUnIndividual
Revisit Your Answers to Prompt One and Prompt Two. What Has Changed in Your Aims, Expectations, And/or Emotions Since Starting This Sense Making Process?
Add, remove, or rearrange Magnets as necessary. Feel free to revisit, make changes, or reference your situation. Praxis is always in process.
Reflect on What Opportunities for Action This Sense-Making Process May Offer.
1. Grab the brown Modes of Action Magnets and spread them out and look at them.
2. Write additional Modes of Action that are not already on a magnet on a blank magnet You can come up with them on your own or use the “Starting List” on the back of this card to help you identify others.
3 Place your chosen Modes of Action on the board in relation to this situation.
4. Look at the Shape Magnets and see if any of them can help you further illustrate the Modes of Action
5. If working with others, have a conversation together about what Modes of Action you chose and why.
6. Continually revisit the Modes of Action you named throughout the processfeel free to add, take away, and/or adjust the Modes of Action as you continue the exploration
Prompt category
Example Modes of Action Magnets
Starting List of Modes of Action
With these terms, we invite you to think beyond clinical “interventions” as action points, and consider what other forms of micro, meso, and macro actions you may take to address the situation - or the broader conditions shaping it.
Access Acceptance Accommodation
Activism Advocacy Assessment Communication Connect with… Coordination
Coping
Look for cracks Decision
Disagreement Discharge Documentation Do nothing Equipment Gaps
Goal setting Inclusion Intervention Look for loopholes Long-term Mistakes
Thinking of something that’s not in the list? Write it on a blank magnet!
Motivation Network Options Possibilities Prevention Professional development Questions Referral Refusal Rehabilitation Resist Short-term Look for soft spots Subvert Support Therapy Tools Training Translate Treatment
What actions feel in and/or out of our control as individuals or as a group, and who do we need to connect with to increase our capacity for action?
