Why Anti-Racist Occupational Therapy Is the Current (And Forever) Work of OTs.
by Erin Carroll,OTR/L
Authors Note: As a white woman with a masters degree, my whiteness, education, and experiences in the world allow me to view and write about racism from a restricted and privileged perspective. My intention here is to create space for conversation within our community about racism, and to learn how to create and sustain equitable therapy practices within occupational therapy. People of color are the experts on racism and its systemic impacts on individuals, communities, and social and political structures. I encourage you to read, listen to, and follow women of color and people of color, as they are the leaders of anti-racist and racial equity, including Patrice Cullors, Ericka Hart, Dr. Ibram X. Kendi, Ijeoma Oluo , Kimberlé Williams Crenshaw and organizations such as the Equity Literacy Institute, SEA Center for Racial Equity, authors of Critical Race Theory and Dis-Crit, and the Racial Equity Tools community.
As an occupational therapist practicing in the school setting, I’ve had experiences that leave me with a stomach ache, a gut-sinking feeling of “oh no, not again”. My teammates and I share stories of students of color who are labeled with “behavior problems” in kindergarten and threatened with suspension or removal from the school, while their white peers with similar concerns are given support that seems to be offered quickly and without second guesses. We see when a student of color goes undiagnosed and their white peer has one, if not two or three diagnoses that increase their access to disability services and supports. We understand that when an advocate has the ability to be present at the student meeting or when the advocate can communicate in the language of the school and the education system, the child receiving services may have more access to the continuum of care simply because the system is structured to support folks who have the language, time, ability, or education to be advocates. When a parent who is a person of color sits silently in a meeting when white educators are telling them about their child, or when an interpretation only gives half of the story in a parent-teacher meeting… in any of these situations, we understand that we’re seeing racism in action.
When I witness these events or hear these stories, I know that as a white woman, my experience of racism doesn’t come close to the reality that people of color face on a daily basis. Critical race theory asserts that racism is a system of oppression and advantage based on race, or more simply, racial prejudice + social and institutional power = racism. “Racism involves one group having the power to carry out systematic discrimination through the institutional policies and practices of the society and by shaping the cultural beliefs and values that support those racist policies and practices.” (Dismantling Racism, 2020).
Throughout my almost six years as a school based occupational therapist, I’ve had learning opportunities guided by leaders in the work around racial equity and anti-racist education. I’ve learned a couple of things:
Occupational Therapy as a profession does not explicitly discuss or teach about racism or anti-racist work. As a health profession and providers within the school setting, OT upholds racially inequitable systems of healthcare, therapy and education when it does not explicitly teach, talk and disavow racism (Paradies, Truong, & Priest, 2014).
The systems and structures of the healthcare and education within the U.S. are inherently racist through their creation on the white supremacist cultural norms. (Kohli, Pizarro, & Nevarez, 2017)
We, my fellow white occupational therapists, have work to do and that work is our own (Oluo, 2019). Racism and its life-threatening effects are not new to people of color, and it is past time for us to make changes within our profession. There is an urgent responsibility for our profession to learn, develop and practice anti-racist occupational therapy.
When my colleagues in education, including school psychologists, speech language therapists and physical therapists share about the student of color who was suspended as a kindergartener for misbehavior, we are talking about racism. When we talk about the hoops that our families have to jump through to get resources, like having to call insurance multiple times to cover a diagnosis evaluation for your child, we know that there are more hoops and more lines to cross for our families of color. When my team shares about the students of color whose families have to push for threes years to get a diagnosis to allow for insurance to cover treatments, or to ensure educational supports, we’re talking about racism. When systems make it difficult to access daily life occupations such as access to your classroom, and when its made harder because you or your family don’t look, learn, act, or talk like non-disabled white students learn, look, act or talk… we’re talking about racism.
While racism isn’t explicitly in mainstream conversations within the occupational therapy profession, perhaps it would be untrue to say we avoid the conversation entirely. Our current OT practice guidelines use the language of multiculturalism and cultural (Bureau of Labor Statistics, 2020) competency, diversity and inclusion and occupational justice (American Occupational Therapy Association, 2014). This language, while not incorrect, is incomplete and shies away from the language of anti-racism and equity literacy. In using clear and explicit language of racial equity literacy, we can begin to break down the individual, institutional and systemic racism that causes implicit and explicit harm to our neighbors of color. The language we use, and the actions we must reflect the greatest truths of our world. It is our responsibility as a professional learning community to teach our students, colleagues, and ourselves about the structural, institutional and individual racism that effects the lives and occupations of our clients, and of occupational therapists.
Racism is a systematic, institutional and structural system of power that directly effects an individual’s experience and interpersonal relationships (SURJ, 2017). Critical Race Theory (CRT) underlines that racism is a social construct, so ordinary in the everyday of our world, that it is accepted as truth.[i] In Canada, Brenda Beagan and Josephine Etowa write specifically about the impact of racism on the occupations of African – Canadian women, and find that racism has direct effects an individual’s experience and participation in daily occupations, as well as negatively impacts women of color’s experiences with occupation in nuanced and subtle ways (Beagan & Etowa, 2009). Racial micro-aggressions have a detrimental impact on wellness and occupational independence of individuals of color (Grullon, Hunnicutt, Morrison, Langford, & Whaley, 2018). Our own students in occupational therapy have less access to academic equity if they are people of color (Burke Lucas, 2017).
Let’s call each other to be bold. We have to start talking more, teaching more, and sharing more about racism within our profession, so that we can start to break apart the tightly woven webs of white-normed systems that we work within. In the United States, 88% of occupational therapists are white (Bureau of Labor Statistics, 2020)[ii]. That means that the current field of OT practitioners is disproportionately representative of the populations, communities and individuals we serve. Eighty-eight percent also means that the majority of occupational therapists practicing within the United States have the privilege to never personally experience racism, micro-aggressions, or to enter the daily world working against structurally racist systems and individuals. It folks can be very tempting to avoid the discussion of racism within our work, but that avoidance or fear is leading us away from being bold with and for each other (DiAngelo, 2017).
Anti-racism is defined as “the work of actively opposing racism by advocating for changes in political, economic, and social life. Anti-racism tends to be an individualized approach, and set up in opposition to individual racist behaviors and impacts” (Race Forward, 2020). When we understand that our educational and healthcare systems currently reflect inequities in the care of our neighbors of color, we must do our own work to be anti-racist. More than that, we must know that being anti-racist is not a statement to name ourselves with, or a title to hold just because our white culture loves titles and saviorism. Being anti-racist means supporting and uplifting anti-racist policy, to push against the tides of injustice and inequity, and to repair and heal when there is harm, whether we have intended that harm or not. Being anti-racist means understanding that as white occupational therapists, racial groups are inherently equal and do not need to be developed to fit an idea of what white culture says is correct (Kendi, 2019). We don’t get to or need to save anyone to make them fit into our cultural ideas of what accepted, accessible, normative living and being looks like.
Racism is an environmental and contextual factor that impacts the lives of our clients and communities. Institutional and structural racism uphold medically racist practices that mean that 2/3 of children of color get diagnosed with ADHD later than their white peers (Morgan, Staff, Hillemeier, Farkas, & Maczuga, 2013). White children are 19% more likely to get a diagnosis of Autism than their Black peers and 65% greater than their peers of Hispanic and/or Latino descent (Furaro, 2017). My co-workers and I share stories of the parents we work with who have to work for years to get a diagnosis for their child when their white peers have medical diagnoses given to them for ADHD through private testing afforded by parents who can and will work within a system that is made for them.
We are the definers of occupational justice, occupational apartheid and occupational marginalization. If occupational injustice is “breaches of occupational justice [that] occur when participation in health enhancing occupations is inequitable across different groups in society, with some people unfairly benefiting and others subjected to patterns of occupation that are detrimental to health and well-being” we cannot ignore or deny that racism is a serious source of occupational injustice. As we continue to discuss and teach multi-culturalism, diversity and occupational justice, we are also called to discuss racism as an environmental factor within our clients lives and community that is influential in creating occupational deprivation, marginalization, alienation and apartheid[iii] (Hocking, 2017).
We hold the responsibility of our profession to listen to people of color and to identify antidotes to racism in occupational therapy. Occupational justice for and with our clients and the communities we serve means being able to name the injustice, to look it in the eye, and to call it out for what it is. We must call into our own OT communities, universities, programs and care practices to include:
Teachings on Critical Race Theory and individual, structural, and institutional racism (Dismantling Racism, 2020)
Teachings of equity literacy practices to recognize, respond, redress, and create and sustain racially equitable practitioners, structures and systems (Equity Literacy Institute, 2018)
Be accomplices to our communities, and to our neighbors and clients of color to create and sustain racially equitable occupational therapy practices, systems and structures
Name racism as a contextual and environmental factor within the Occupational Therapy Practice Framework
Create policies within our own programs to recruit, retain and respect occupational therapists of color (Burke Lucas, 2017)
Celebrate, uplift, and uphold current and future occupational therapists of color by making sure our table of power does not only include them, but puts their voices at the center of our profession
Our dominant white culture is very good at maintaining able-ism and racism through assimilation and meritocracy. As a practitioner, I need to be able to have honest conversations with myself, my colleagues, and the families and students I serve about racism, and its intersections with ableism for people with disabilities. It is our work currently and for the future of our profession as occupational therapists, to be able to change structures that continuously and consistently create gaps in care, wellness and occupations for those we serve. It is our work to be anti-racist therapists.
Erin is currently reading: How to Be an Anti-Racist by Ibram X. Kendi and just finished reading Children of Blood and Bone series by Tomi Adeyemi. Gratitude to Brittany Behrendt, Erin Whitley, and Dr. Brittany Conners as brilliant occupational therapists who I admire and who keep me going in this work, and to Megan Carroll, editor and sister extraordinaire.
What Can One Occupational Therapy Practitioner do? Join our OTs for Action Blog conversation on anti-racist occupational therapy here. I hope you’ll add what you are doing below in the comments, so we can continue this conversation, create and sustain anti-racist occupational therapy practices and build our community for occupational justice.
Footnotes:
[i] CRT was developed in the ‘70s and ‘80s by legal scholars, activists and legal scholars, and while started within the legal system, is used widely within several areas, including in education.
[ii] (Bureau of Labor Statistics, 2020) Unfortunately, that number does not include certified occupational therapy assistants, which were under-reported.
[iii] (Hocking, 2017) Occupational imbalance is due to occupational patterns of being over or under occupied, due to excessive work demands, enforced idleness, or burdensome responsibilities to care for the environment, dependants or oneself
Definitions:
Occupational alienation has been defined as “deep feelings of incompatibility with the occupations associated with a place, situation, or others to the extent that basic needs and wants appear impossible to attain or maintain” (Wilcock & Hocking, 2015, p. 258). It may manifest as aggressive occupations associated with social unrest or self-destructive behaviours
Occupational marginalisation is usually associated with discrimination, such that people are systematically relegated to occupational opportunities and resources that are less valued within a society (jlucido93, 2013)
Occupational apartheid refers to the systematic segregation of groups of people and deliberately denying them access to occupations such as quality education or well-paid work, or occupational contexts, based on prejudice about their capacities or entitlement to the benefits of culturally valued occupations (Wilcock & Hocking, 2015).
Works Cited:
American Occupational Therapy Association, A. (2014). Occupational Therapy Practice Framework, 3rd Edition. American Journal of Occupational Therapy .
Beagan, B., & Etowa, J. (2009, October 1). The Impact of Everyday Racism on the Occupations of African Canadian Women. Canadian Journal of Occupational Therapy .
BLS, U. (2019, January 19). U.S. Bureau of Labor Statistics. Retrieved January 4, 2020, from Labor Force Statistics from the Current Population Survey: https://www.bls.gov/cps/cpsaat11.htm
Burke Lucas, C. (2017). Occupational Therapists of Color: Perceptions of the Academic Experience (Vol. Dissertation). Johnson and Wales Unversity.
DiAngelo, D. R. (2017, 02 17). Deconstructing White Privelage with Dr. Robin DiAngelo. USA.
Dismantling Racism. (2020, January). Racism Defined: What is Racism. Retrieved from Dismantling Racism Works: http://www.dismantlingracism.org/racism-defined.html
Equity Literacy Institute. (2018). Equity Literacy : Definition and Abilities. Retrieved from Equity Literacy Institute: https://www.equityliteracy.org/equity-literacy-definition
Furaro, H. (2017, November 20). Race, class contribute to disparities in autism diagnoses. Retrieved from Spectrum : https://www.spectrumnews.org/news/race-class-contribute-disparities-autism-diagnoses/
Grullon, E., Hunnicutt, C., Morrison, M., Langford, O., & Whaley, M. M. (2018, Dec). A Need for Occupational Justice: The Impact of Racial Microaggression on Occupations, Wellness, and Health Promotion. OCCUPATION: A Medium of Inquiry for Students, Faculty & Other Practitioners Advocating for Health through Occupational Studies .
Hocking, C. (2017). Occupational Justice as social ustice: The moral claim for inclusion. . Journal of Occupational Science .
Kendi, I. X. (2019). How to Be Antiracist. Random House.
Kohli, R., Pizarro, M., & Nevarez, A. (2017). The “New Racism” of K–12 Schools: Centering Critical Research on Racism. Review of Research in Education, 41 .
Morgan, P. L., Staff, J., Hillemeier, M. M., Farkas, G., & Maczuga, S. (2013, Jul). Racial and Ethnic Disparities in ADHD Diagnosis From Kindergarten to Eighth Grade. Official Journal of American Academy of Pediatrics .
Oluo, I. (2019, March 28). Confronting racism is not about the needs and feelings of white people. Retrieved Feb 2020, from The Guardian: https://www.theguardian.com/commentisfree/2019/mar/28/confronting-racism-is-not-about-the-needs-and-feelings-of-white-people
Paradies, Y., Truong, M., & Priest, N. (2014). A Systematic Review of the Extent and Measurement of Healthcare Provider Racism. Journal of General Internal Medicine .
Race Forward. (2020). Racial Equity Tools Glossary. Retrieved from Racial Equity Tools: https://www.racialequitytools.org/glossary#anti-racism
Raj Chetty, N. H. (2018, March). Race and Economic Opportunity in the United States: An Intergenerational Perspective∗. Quarterly Journal of Economics .
SURJ, (. U. (2017, February). Understanding Racism. Retrieved from SURJ (Showing Up for Racial Justice) Political Education Site: https://surjpoliticaledsite.weebly.com/racism-101.html