Packing Tips by Nava

Prior to leaving, one of the hottest topics of conversation was what to pack, what to buy, where do buy it etc. so I figure I’d share what made it into my bag and what got cut. I planned to continue on with travels after our time in Ghana so I packed light in a 40L REI backpack and found I was able to squeeze in everything I needed no problem. This did require doing laundry in the sink a few times but I had no problem drying clothing overnight on a line.

My clothing list included:

  • Bottoms (3 pants, 3 skirts, 1 shorts): 1 pair of linen pants, 1 pair of very light Northface pants, 1 pair of leggings (for travel days), 1 maxi skirt, 1 mid-calf Northface skirt, 1 nicer skirt (for church), and one pair of running shorts (for hiking and waterfalls)
  • Tops (6): 4 cotton target t’s, 2 Hanes cotton t’s (to be ruined and left behind
  • Shoes: One pair of runners and one pair of Teva flip-flops
  • Underwear: 5 pairs and 5 sports bras (much easier to wash and clean that regular bras)
  • 1 Rain jacket
  • 1 Bathing suit

Other things I brought along included:

  • Travel size bathroom stuff (deodorant, toothbrush/paste, REI travel shampoo/conditioner)
  • REI Travel detergent
  • Hand sanitizer
  • Mini medical kit and prescriptions – ibuprofen, antimalarial, anti-diarreals, band aids, neosporine, tums…
  • Sunscreen
  • Copies of insurance/passport/credit cards/tickets/immunization records
  • Passport/yellow fever card
  • Cash to convert at the airport – they had a good rate and if you’re heading to Volta, this is possibly your only opportunity to convert cash)
  • Electrical converter – we only encountered the two round prong kind (I’ve heard this referred to as British but not sure)
  • Travel towel
  • Baby wipes
  • Deet bug spray
  • Day bag
  • Journal & pens – I like small Field Notes, for portability and convenience
  • Kindle & charger
  • Phone & charger
  • Camera, charger, extra storage card
  • Cocoon Sack
  • Water bottle
  • Toilet paper/tissues

And food! I brought 16 bars and two bags of trail mix, chocolate and dried fruit.

All done it looked kinda like this:

2014-05-14 18.05.36

Tips and things I would change if I were doing it again:

  • Pants vs. Skirts: I’m really not a skirt person but found myself wearing skirts a lot because of the airflow they allow. The majority of our trip members shared a uniform of target t-shirts and old navy skirts which seemed to work really well and are very cheap. We also often unintentionally matched which was pretty funny.
  • Never needed any special shoes. Many people chose to bring older running shoes and leave them behind after our hike.
  • Bug spray: The wipes are awesome because they don’t count against your liquid amount and are easy to apply. If you’re going the liquid route, a normal size, normal deet content (like 35%) would have been fine for the bugs we encountered. I would recommend testing it before you go as Macy had a minor allergic reaction to using my bug spray! A few people went for the permethrin (spray for your clothing/sleep sack) but it turned out to not be necessary, at least for the time of year we were there.
  • Baby wipes and tissues came in handy often as you never know what/when/where your next bathroom will be and the wipes were helpful for wiping down your face or hands from the dirt. Hand sanny was nice as well but doesn’t do as much to help with the dirt.
  • Food: I really don’t love bars and luckily in the heat, we all just found that we were not that hungry until the sun went down. That said, there were often times during the day when I could just feel my energy crashing and then the dried fruit and trail mix was my go-to. If you’re going the bar route, I suggest mixing up the brands you’re bringing so that you don’t get burnt out on any one brand.
  • If you are a MasterCard user, we found that many ATMs were not accepting of MasterCard so be prepared with an alternative method or bring cash. Also maybe this will be different in a year?
  • If you’re going to Ghana through VCU OT’s program, ask people who went last year if you can borrow things such as sleep sacs, skirts, sink detergent etc. If you go the target/old navy route, you can really spent very little on what you’re packing.
  • Things I wish I’d brought: AFTER BITE! Only Rick had the foresight to pack this and oh man, did it come in handy. Also more dried fruit. And one old navy skirt
  • Things I wish I’d left at home: 1 pair of pants (traded for the skirt), 2 of the 4 little hand sanitizer (took up too much liquid room and didn’t use ’em)



Trip Reflections by Nava

Lauren helping Michael with his letters

Lauren helping Michael with his letters

1) Participating in this trip helped me think a lot about what kind of OT I want to be and what the role of OT (international or domestic practitioner) could or should be. Being back in North America, I am regularly reminded that one does not have to fly across an ocean or drive even 5 miles to find children growing up in difficult situations who need love and services. It only takes turning on the local news or opening up a web browser to come up with many ideas of how we could volunteer right at home to try and decrease the burden carried by our nations children and families. While it might not be as exciting as packing a bag and getting on a jet plane, regularly volunteering at a homeless shelter, shelter for victims of domestic violence, food bank, Ronald McDonald house, centre for immigrant services…these are all things that can be done here to promote occupational justice through use of the skills we have as OTs. They may not be in a different country but even local participation can provide personal growth opportunities like those we had in Ghana such as learning words in new languages, experiencing belief systems that are not your own, and practicing cultural competency. It is also a great way to learn more about our own communities and the parts of them that we may not see or know much about. These options allow for continued involvement which may allow the effect we have to be more long lasting and meaningful for us and for the people we work with. And we may even get to enjoy some sort of air conditioning while we’re at it.

Jo reading to Bright and Henrietta

Jo reading to Bright and Henrietta

2) I’m glad that occupational justice is a concept that is part of our curriculum and that it is regularly impressed upon us how important it is to practice in a client-centred manner. We could have headed in this unknown Ghana and tried to show them everything we know without listening and looking at what it is they need and want but I often heard myself and my trip-mates asking questions about what future trips to Volta could look like and how we could spend our time there in a way that we could actually help. No one had any easy answers but I think this trip was a great opportunity for each of us to really experience how valuable many of those general and obvious feeling concepts we talk about in class are. It can be challenging when you’re excited and have all these ideas of how to ‘fix’ things to remember the context and specific needs of the individual you are working with. This trip helped hit home the importance of these things for our future practice here in North America.

Girls dancing at Eugemont Orphanage

Girls dancing at Eugemont Orphanage

3) I’m really excited about the OT program that is being developed at the University of Ghana and what it hopefully means for the future of OT in Ghana. I hope that VCU is able to maintain a relationship with the program as is develops and grows. It seems like exchanges between our program and theirs could provide some wonderful cross-cultural learning experience and help to create a sustainable method of supporting the growth of OT in Ghana. The opportunity to do problem solving exercises with their students and get to know them over lunch was definitely one of my highlights of my trip. I was really impressed by their ability to explain to me what they feel their education is about and their fears and questions about what and how they will practicing in a few years.

4) Monkeys!


Tafi Atome Monkey Sanctuary

What to do now? by Nava

After the experiences had in Ghana, it was hard to just leave and move on to the rest of summer. In the Accra airport I shared these feelings with Lily when realized we felt the same way, we figured we should work together and do something. We wanted this ‘something’ to follow-up but our experiences at study abroad students and as OT student trying to deliver services in a rural area. We spoke to our professors and decided to gather a few ideas that we could put forth as poster proposals for the National AOTA (American Occupational Therapy Association) conference next spring. With the due date two weeks away, we brainstormed a list and rounded it down to two topics we feel we can present information on that might interest the AOTA crowd. We will not know if either topic has been accepted until sometime in September but I thought I’d write about them anyway as the process of submitting these proposals has helped me process a lot of what we did and saw over the course of our trip prep and travel. The concepts we submitted are:

1: Compare participant and leader pre-departure goals with post-trip feelings of what was gained from the experience in both Accra and Hohoe through a simple survey of trip participants and by examining blogs.

2: Investigate the issues faced in delivering OT services and carrying out projects in the rural setting. Explore what we understand of why these issues occurred, and possible solutions for future trips. (language/cultural differences, available resources, time, relationships, etc.)

Through the first topic, we hope to look into the different experiences had by each group to compare and contrast the outcomes and how each group feels their experience aligned with the goals of the trip as set out by the course syllabus. When we were all together for our last few days in Accra, it was clear that there were significant differences between the type of work done by each group. The Accra team completed very OT related tasks by working with students and teachers on things like positioning and wheelchair repairs in a school specifically for children with disabilities. They also completed a significant amount of Denver screenings at a school for typically developed children and helped write-up reports for those they had some concerns about. This experience (we expect) was likely very affirming for them in their choice of career and was a great experience for them to put to use the skills they’d learned in the classroom. For those of us in Volta, our time was primarily spent with children from the orphanage. While many of these children may have some psychological trauma in their pasts that contribute to behavioural or emotional concerns, with only two weeks in country, we were not able to focus on those areas. Our time was spent learning and absorbing the culture of rural Ghana life and its challenges. We developed relationships and asked many questions about what and how one could be an effective OT in this setting. From the survey results, we do know that participating in this trip was valuable for all members. We hope to find out more about which aspects were most valuable and most challenging and how they compare to the expectations of our professors to help provide insight for future OT study abroad trips.

Our second prompt touches on a topic that I’ve thought a lot about since our trip. There are many arguments for and against NGOs and ‘outsiders’ providing aid to developing nations. Regardless of what side you find yourself on, many practitioners are doing it. Just like we did, they choose to travel overseas, usually for a short period of time with the goal of delivering services and making a difference. Just as we did, many of them likely experience significant unanticipated  barriers to being able to provide the kind of care they imagined. When looking through literature to prepare this proposal, Lily and I found many articles regarding the systemic and structural barriers for delivering services in rural areas such as limitations to government funding and small numbers of practitioners, but nothing that touched on the face-to-face part of delivery. That’s kind of a lie. We found one article that touched on some of the language and religious concerns and got really excited and then realized it was by Stacey (our trip leader). But still, none of these articles proposed any suggestions for mitigating these barriers when in country or ways to prepare. This is likely because there is obviously no one-size-fits-all solution and the collection of formal research in this small area is likely difficult to acquire funding for. In this poster, Lily and I would like to share the knowledge we acquired through conversations with the Ghanaians we met, the reflections of our trip-mates, and consultation of literature across medical literature. We want to provide suggestions and ideas that we wish we had prior to our departure and hopefully help those interested in participating in this realm of OT seriously consider what they can do to prepare for such an experience.

As I said above, we wont know if we will actually have the opportunity to present either of these till September but regardless, the opportunity to go through the process of submitting was an interesting learning experience that will hopefully come in handy in again in the future.

Trials and Tribulation with Health Education by Nava

The lesson plan I was assigned to work on with Jouette was health education. Before leaving we planned a few different sessions that we hoped to be able to adapt for different age groups in different settings as we had no idea what age groups or in what setting we would be working with kids in before we left. We prepared these short sessions so that they could be grouped together in a variety of combinations with ice breakers and activities. As many others talked about in their posts, we did not anticipate the differences between American and Ghanaian culture in how classes are taught and how students are expected to behave. All of our plans involved student participation and that is where we experienced our biggest hurdles.

The classrooms for 7 and 8 year olds that we spent most of our time in had ample room with desks and chairs for each student and a large blackboard up front. The children mostly behaved according to the expectation that they would sit in their seats and perform rote memorization of the lesson.The lessons we observed consisted of the teacher explaining something and the students repeating it back. We didn’t see any examples of students being asked to provide answers demonstrating comprehension or critical analysis.

Kids at orphanage practicing handwriting

Kids at orphanage practicing handwriting

Jo and I created mini lesson plans on personal hygiene, basic emotions and coping skills, relationships and appropriate physical behaviour, smoking, and healthy eating/food pyramid. Most of it was geared towards the 7-9 year age range with the ability to simplify for younger kids or grade it up for 10-15 crowd. We also put together role playing and information on relationships and consent aimed at more of a teenage audience. We only had the opportunity to execute these lesson plans with the 7 and 8 year olds and decided, after teaching them the hokey pokey, to break them up into three groups. The groups rotated between three stations each lead by a pair of OT students that covered oral hygiene & taking care of your skin, emotion health and coping strategies, and how to stop germs.

After completing all the rotations, catching our breath, we headed back to our hostel on the way, had a little debrief of the experience. At each station, students had been responded with silence to simple open ended and we always eager to repeat a suggestion provided by us ‘teachers’. They appeared to listen and be somewhat engaged when learning about oral hygiene, skin care, and germs but were rather disengaged on the topics of emotions and coping strategies. The children to regularly perform teeth brushing of some sort and wound care but still struggled to tell me about it when prompted. Emotions seemed to be foreign concepts to them. The only responses they were able to provide were that they were sad when they “got beat” – a common parenting practice in Volta. Talking about putting names to feelings and the idea that one would discuss feelings with a confidant only brought blank stares and wiggly feet.

An interesting contrast to this experience was how the children behaved out of school. There was one 13 year old girl we met in the older classroom when some of my group-mates were teaching transitional skills who seems pretty quiet and disengaged. A day or two later when we visited a village to conduct interviews with mothers, she approached our tro tro (van) and chatted with us for probably about 30 minutes. She had so much to say and answered questions about what she wanted for her future, her favourite activities, her family, etc. She bounced around as she asked us tons of questions about our families, our favourite foods and shared her story. This was a drastic contrast to the personality she displayed in school. She was clearly bright, active, and inquisitive. Meeting her outside of the school context provided us with an interesting idea of how students adjust their behaviour and attitudes based on the expectations in the classroom.

Interviews and the Denver-II by Nava

A few posts here have mentioned the interviews we conducted with Ghanaian mothers as part of Kate’s PhD project and Carole Ivy and Stacey Reynold’s ongoing research. Carole and Stacey are in the process of adapting a developmental assessment used in the US and many other countries, the Denver Developmental Screening Test (Denver-II), to be used in Ghana.

The Denver-II is a screening administered typically by a pediatrician or other early childhood  professional to obtain information regarding a child’s overall performance in four categories: social, language, fine motor skill, and gross motor skill. Children are asked to perform a variety of age appropriate tasks such as stacking blocks, drawing shapes, or answering questions. How they perform is compared to national standard averages to determine if a child is developing as expected in these four areas.

In order to develop a Ghanaian Denver-II, it is necessary to gather information about the expectations timeline for development, what skills are important and expected for Ghanaian children, and how to structure and word screening items to ensure that they are accurately testing what it is you want to test. Gathering as much of this information as we could was a big goal of this trip and we did it primarily through two methods.

  1. The group in Accra completed the American Denver-II on over 50 children to see how they performed according to our norms. This also allowed screening administrators to observe which screening items were more difficult to test due to cultural differences, language barriers, or other factors.
  2. Kate in Accra and myself and others in Hohoe interviewed ~30 mothers by asking them each about 40 questions regarding parenting practices and child development. We recorded these interview and Kate is now reviewing and coding them to pick out important trends and information

All of this information will be complied over the following year and used to create a trial Ghana Denver which can be taken back to Ghana next year to be tested.

I interviewed two women at Eugemont Orphanage, four mothers in their homes, and one woman at our hostel with the help of Bless, our local interpreter, and another student to record. Each time, Bless had found these women a head of time and arranged a time for us to conduct the interview. This was necessary in Hohoe as the level of English varies significantly and thus walking around and soliciting women in the neighborhood can be very difficult (and moderately intrusive). In Accra, Kate used connections through the schools they visited and also wandered the area and approached women. We started each interview by explaining the procedure of recording and the confidentiality of the interviews. We then proceeded to ask questions about how children spend their time, types of play, expectations for chores, money management, potty-training, etc. At the end, we showed the women 15 images of children ages 3mo-5years doing things such as rolling over, running, or feeding themselves and asked the women to tell us at what age they think their children started to do these things.

Completing these interviews was a very interesting and informing experience for me. It was a learning process to figure out how to ask the questions and follow ups in a way that would get at the information I needed. Because of the language barrier and cultural differences, the mothers were not always sure what it was I was asking or how much detail I wanted and often seemed to want to provide a ‘correct’ answer. It was also interesting to go through an interpreter as I often felt as though details in the answers were lost either due to a limit in our interpreter’s vocabulary or judgment calls on his part as to what it was I wanted to hear. In addition to learning from the answers I received, it was also very educational to observe what was going around in the areas where these women lived. We inevitably had a bit of an audience at each home during the interviews. Most of the homes we visited were situated very close to other homes in a compound-like set up and kids or other mothers would gather around to listen and sometimes contribute their thoughts. Being able to meet these women and children in their homes made it easier to see and understand the skills they need to be able to perform in order to contribute to the home. There seems to be many physical requirements that I couldn’t imagine needing to complete everyday in the hot climate. During the interviews I was able to watch older boys crushing cassava root with very large mortar and pestle like tools, girl and boys of a wide age range walk with large buckets of water from the river and older girls preparing washing done at the river to be dried.

All of these are tasks that we, in North America, either complete with the click of a button or a purchase at the store. We can adapt the buttons and tools we use relatively easily for someone with a disability so that they can act independently and contribute to their household. Thinking about working with Ghanaians living in rural areas in a OT context puts a new spin on things. While many areas such as fitting wheelchairs or adapting utensils, might be very similar to how they are done in the states , many other aspects of OT such as role development/adaptation and social skills are a whole new ball game. It seems to me that the most valuable skills for OTs (and probably most professions) working in different areas of the world is cultural competency and patience . As we learned on this trip, there is only so much you can do to prepare but once you’re on the ground, it is so important to ask questions and observe and listen as much as possible to understand how and why things are done the way they are before you suggest adaptations and changes. As we learned, this is not always easy as you don’t always get answers that make sense to you or that tell you what you need to know but eventually things can mostly be pieced together, which is why you need to be patient. Being patient allows you to see more and hear more, which may give you the answers you need without you needing to ask questions.

What We Kinda Really did by Nava

Posting retrospectively is proving to be an interesting challange for me as I now have collective knowledge of the trip and find it difficult to go back and process events in isolation when really I’m now processing the whole of the experiance. I digress…

Ghana was quite the time. After doing all we could to prepare for the trip, every expectation I had for what it would be like was pretty much shredded and thrown aside once we arrived in Volta. Prior to arrival, I had expectations for how we would be recieved, how the food would taste, what Ghanaian accents would sound like etc. I also had prepared for how we would execute the lessons we had prepared for the students and how I would ask the questions in the research interviews. Being able to toss all my preconcieved notions out the window and begin to build a foundational understanding of life in rural Ghana was the overall highlight of my trip. I say begin, because while I learned more than I imagined I would, I am still left with so many questions as well as aspects of their culture and life that I don’t fully understand.

Prior to departure, I had an understanding that the goal of our trip was to provide services to disadvantaged children (due to either disability or loss of family support) and that we would be doing this through the methods we prepared. Very OT practice focused. Based on my understanding of Accra experiance, this sounds pretty on point. But my Volta experiance had little resemblence to that. Hohoe (the rural town we based out of) is in a very rural location where children who grow up in a family home have different experiances and requirements for success in life than those in the urban context. The children at the Eugemont Orphanage, where we spent most of our time, attended school with many of these other rural children. Both the orphanage and the school face a variety of challanges that we did not anticipate. Those challanges, along with cultural differences, affected our ability to work with the children in the way we’d imagined (to be explored in later posts). The focus of our trip shifted to developing relationships with the students, teachers, community members, and mothers and asking questions to better understand their challanges and needs. We in turn can then better understand how our role can best fit their needs. I’m pretty sure we didn’t get it all but the process was fun, educational, and hopefully will help provide a strong base for next years crew to work off of.

Akwaaba Ghana!

We made it! And just in time for a magnificent thundestorm. Eric, the head of the Grace International School, met us set the airport and we crammed into vans to head into the city. The whole group is hanging out in Accra tonight and tomorrow the Volta group will head east while the Accra group heads to the Grace International School (I think).

It’s humid but not too hot and everyone is excited to be here and no longer on planes!

Learning About Ghana by Nava

In this post, I (Nava) am hoping to build on what Sam posted about yesterday regarding Ghana being unfamiliar and unknown. I’m going to spend the morning doing some research and present a small window of whats going on in recent Ghanaian news and politics. As our trip approaches and we continue to work on our projects to prepare, many of us have been asking more detailed questions regarding the modernity of the locations we’re going to and what we should expect. We’ll be able to report more on that in approximately 6 days (whoa) but hopefully some factual info on the state of the country will help provide framework for my mind to build on once we land!


  • Government Overview: Ghana currently maintains a parliamentary democracy with a history of military and civilian rule. The executive branch is lead by current President: John Dramani MahamaThere are 40 political parties represented, the largest being The National Democratic Party, New Patriotic Party, and the Conventions People’s Party. Ghana is divided into 10 regions and there are 275 electoral constituencies. Ghana has yet to have a female leader.
  • Legal System: The Ghanaian legal system is based on the British Common law, traditional law, and the current constitution.
  • Foreign Relations: Ghana maintains non-alignment with any major power bloc and is an active member of the UN and African Union. They have had many representatives serve as international diplomates including former UN Secretary General, Kofi Annan.
  • Currency: Ghana uses the Cedi which has not been doing terribly well. As of today, the rate is $1USD = 2.8GHS (source)
  • Accountants: The Institute of Chartered Accountants, Ghana (ICAG) is currently celebrating National Accountants Week to celebrate and share the importance of the role of accountants as custodians of the economy of nations. Fun note: Their president is Mrs Angela Peasah. Her mission includes cutting down on government financial corruption (source, source)
  • Some Major Online News SourcesGhanaWeb, DailyGuideGhanaVibeGhanaGraphicOnline,

Sports: The first thing to pop up when one google news searches Ghana is WORLD CUP SOCCER! the GFA just announced the 26-man roster for the 2014 world cup line up being lead by Captain Asamoah Gyan. He and Sulley Muntari will be the most veteran players returning for their  third consecutive World Cup. Ghana, known as the Black Stars,  will compete in group G in the world cup along with Germany, Portugal and the U.S. Another cool piece of Ghanaian football trivia – Kwesi Appiah will be the first Ghanaian coach to coach the Ghanian team at a world cup. Sadly, we will just be missing the end of the local league season so we wont be able to attend any games but I’m sure we’ll be playing a lot of pick up (source).

There is little news to be found about other sports however I have found headlines regarding:

  • A new development training program for Ghanaian weightlifting coaches (source)
  • Preparations to send four tennis athletes to Europe to train for the Davies Cup as well as a new sponsor to help them with gear (source)
  • In honor of a football riot resulting in multiple deaths 13 years ago, a fund was created to support the families of those who died. This year the fund announced that although not part of their mandate, they decided to ensure each child of the deceased will be educated to the tertiary level. Currently, this means funding education for 90 students. (source)


  • Mobile Banking: Guarantee Trust Band (Ghana) just introduced online checking deposit to allow customers to deposit checks without visiting a branch location which is a first for Ghanaian banks (source)
  • Smart Farming: The NGO, TechnoServe,  has introduced its flagship Mobile Training Unit (MTU) to support and improve farm level productivity of smallholder farmers in Northern Ghana. (source)
  • Electronic Waste Dump: Very interesting slide show and article about Agbogbloshie, the world’s biggest e-waste dumpsite and is located close to Accra. Electronic waste – TVs, PCs, HiFi systems, refrigerators – now fill a former wetland and recreation area

So that certainly doesn’t cover everything. I haven’t gotten to healthcare, corruption, political history, education, rural vs. urban…but its a start towards seeing the bigger picture of what Ghana means. While I’ve only put links and headlines here, reading through these articles and the ones that didn’t make the posting cut, was really helpful in getting an idea of the political climate and news outlet priorities. I’m curious to see how these facts and headlines related to the realities of life once we land. If there are any questions you have about Ghana or areas you think might be good for me to research before we take off, feel free to comment!

Lisa Kristine’s Modern Day Slavery Photo Essay by Nava

My mother actually found this link to a woman who has done some amazing photo essays, Lisa Kristine. One of her photo essays is titled Modern Day Slavery and captures images of adults and children in Ghana, India, and Nepal who are currently indentured slaves or trapped in debt bondage. While this topic is not directly related to our trip, I feel it is a link worth sharing for the purpose of  bringing awareness to the issue. Many of her pictures are of  very young children forced to work in fishing boats on Lake Volta. They are deprived of basic necessities such as health care, proper nutrition, and education not to mention the psychological and emotional consequences this children may face. The Ghanaian government prohibits all forms of trafficking through its 2005 Human Trafficking Act however in 2012, the UN said that Ghana is not yet compliant with minimum standards for the elimination of trafficking. Enforcement occurs through the Anti-Human Trafficking Unit. Additionally, there are a few NGOs such as Challenging Heights and PACODEP that work to protect the rights of these children by withdrawing them from compromised living situations, educating local fishermen, and helping to support rescued children in developing healthy futures.

This issue of slavery can be related back to occupational therapy through the concept of occupational justice, a type of social justice. This is the idea that all individuals should  have the right of equal access to occupational opportunities. Occupations are defined as personally meaningful activities. This is a concept that we will be promoting on our trip by working to adapt tasks, modify tools, and teach children strategies to access and participate more independently in their occupations.