Author’s Note: It’s a time of unrest in America. In order to help with my personal coping, I’m taking this opportunity to turn to something productive: to turn my awareness into action. Some of these suggestions are pulled from the great resources being shared right now, and would be a great place to start for anyone trying to improve their awareness of systemic racism and how it persists in this country. I’m going to try to align them specifically to occupational therapy and give you practical things you can do in the pursuit of being anti-racist in your OT practice. My lens is that of a privileged and graduate-level educated white cis-woman. My intention is to create space for us to comprehend our role in this inherently racist system and take steps to improve occupational therapy care for people of color. I believe it is our duty as health care providers to understand the system in which we operate and how the systematic issues impact our clients. In the words of Dr. Brittany Conners, OT, “If the world is unsafe for our non-white clients to do basic occupations… it is exactly our duty to do the work to change that.” Thank you for taking a step in the right direction today by showing up here and doing the work.

Brittany Behrendt, Occupational Therapist
Portland, Oregon

[Image description: Pile of books creating a non-fiction anti-racist reading list. Image by Jane Mount and accessible from: https://www.instagram.com/p/CAdw65UHtwJ/?igshid=b6cnemxxzfi9]

AWARENESS

Become familiar with the literature and terminology. You have likely seen a lot of suggestions circulating online for decolonizing your bookshelf. If not, a quick google search can give you some ideas. There are also links available in our March newsletter. You can also find reading lists for anti-racism or white privilege. Buy some books, read them, and sit with the discomfort. Join others to do a book club with you. There will be many missteps moving forward, no matter how deep you dive into these resources, but this is a critical first step.

Self-assess. There are many surveys and racial equity tools to help gain a personal understanding of your own biases. Begin to recognize your own triggers around race, ethnicity, language, sociopolitical factors, etc. You can test yourself for hidden biases here. While some cultural competency tools may help with self-assessment, it does not necessarily equate to being anti-racist in your work.

INDIVIDUAL FOCUS/ACTION ITEMS

Be a collaborative health care provider and educator. One of the best ways research shows to support clients who are of a different race than providers is to open the lines of communication and share decision making (Meghani et al, 2009). It comes very naturally to those in our profession to support and encourage clients towards their goals, versus trying to “dissuade” or “prescribe.” Look to improve and repair your relationships with the families of your students and clients. Honor them as “first teacher” or the true “primary care provider” and work with them as partners. Make space for the client's voice and agency in your practice.

Remember therapeutic use of self. Shallow and deep cultural considerations include concepts of time, use of touch and personal space, eye contact, communication styles - verbal and nonverbal, how we talk about theories of wellness and disease, how we present decisions and decision making during care, and how we acknowledge power dynamics (Hammond, 2015). Remember that we can consider these cultural factors and how they influence our practice, and adjust our own practices in order to better serve our clients.

Be visibly anti-racist as a reminder to yourself and to others to stay accountable. Post your commitments to equity. Use checklists and schedule time for you to reflect on your day to day actions. Mark your therapy spaces as “safe spaces” so marginalized persons know they can come to you. Here is a sticker you can post. Lastly, don’t be a bystander. If you hear someone stereotyping or notice patterns of marginalization, challenge them.

SYSTEMS FOCUS/ACTION ITEMS

Bring more diversity to your workforce. While research shows race-concordance between clients and providers does not necessarily impact health outcomes, it can only help your organization to have more diverse experiences contributing to important conversations (Meghani et al, 2009). But beware of tokenism. An anti-racist organization has a diverse group of individuals participating in decision making and allocation of budgets (Olcese, L., 2005). Work on hiring OTs who are black and indigenous people of color (BIPOC). Your company can recruit from Historically Black Colleges & Universities. Here is a list of HBCUs with OT programs. Here is a template for conversations with your employer. If you’ve exhausted all options and can’t find enough applicants of color, include interview questions that address the cultural competency of applicants like these. Ask questions that elicit responses that reflect awareness of one’s own cultural beliefs and attitudes, and hire people who care about reducing harm to people of color.

Advocate for your company/organization to bring in professional development related to equity. Hire people of color to deliver that PD and pay people of color for the materials they create.

Conduct a needs assessment for your organization. Research trends related to race in your place of practice. If you work in schools, how does the provision of OT services compare among races in your district? Is it comparable across races and aligned with district statistics? Is there a discrepancy in services minutes? Higher caseload numbers at schools with more affluent families? In other settings, is the outcome data of non-white clients comparable to white clients? How satisfied are your non-white clients with OT care compared to white clients? Lean into uncovering factors that are impacting equity in care. Take a deeper look into the use of culturally sensitive practices at your place of employment. You can start with your evaluation process. Are clients engaged to the fullest extent possible in the process because the service is provided in their language? Are the assessment tools available to you reliable and valid for the population you’re using it for? Are questions such as, “any cultural factors that would influence treatment?” often left blank or reported as ‘no’? Dig into how often that type of open-ended question elicits input from clients in their care. Can we do better? Here are some organizational assessment tools and resources:

The strengths-weaknesses-opportunities-threats (SWOT) analysis format may help highlight strengths as well as opportunities for growth.

Develop an action plan based on your needs assessment. It’s perfectly acceptable to start with simple steps that seem achievable, non-threatening, and have buy-in across stakeholders, in addition to having more long-term goals. Just like intrapersonal anti-racist work, it’s a continual growth process for organizations as well. An anti-racist organization is motivated by a quest for justice versus a sense of guilt, and invites challenge by learning from mistakes without retreating (Olcese, L., 2005). Lean in!

There is no one correct way to be anti-racist. OTsForAction is committed to helping others along their journey for providing more equitable occupational therapy services and to actively diminish occupational injustices for BIPOC. Please feel free to reach out for support along the way, or to share stories of success or tribulation, on our blog page.

REFERENCES

Hammond, Z. (2015). Culturally responsive teaching and the brain: Promoting authentic engagement and rigor among culturally and linguistically diverse students. Thousand Oaks, CA: Corwin
Meghani, S., Brooks, J., Gipson-Jones, T., Waite, R., Whitfield-Harris, L., & Deatrick, J. (2009). Patient–provider race-concordance: does it matter in improving minority patients’ health outcomes?. Ethnicity & Health, 14(1), 107-130. doi: 10.1080/13557850802227031
Olcese, L. (2005). Building a Multi-Ethnic, Inclusive & Antiracist Organization Tools for Liberation Packet [Ebook] (1st ed., p.12). Boulder, CO: Safehouse Progressive Alliance for Nonviolence (SPAN). Retrieved from https://www.racialequitytools.org/resourcefiles/olcese.pdf