AOTA’s Be Heard, We’re Listening Sessions: Reflections, Recommendations, and Actions

The year 2020 prompted the American Occupational Therapy Association (AOTA) to commit to transformation, unite through our shared values, and act broadly and for impact. To that end AOTA staff partnered with the AOTA Board of Directors to hold the first “Be Heard, We’re Listening” Sessions to provide a safe space for our profession’s Black and Brown occupational therapy professionals and students to voice their experiences, concerns, and recommendations.

Since then, AOTA staff have followed up with participants to ensure the commitment to transformation remains at the forefront. As staff focus on evolving toward the future, the listening sessions emphasized the importance of gaining an understanding of the historical past. To that end, exploring our occupational therapy history led to an opportunity to illuminate some little-known details about work to address diversity, equity, and inclusion (DEI) throughout occupational therapy’s 104-year history.

Before continuing to read this article, please take a moment to research a couple of simple questions: “What year were Black Americans allowed to study to become an occupational therapy practitioner?” and “Who were the first Black Americans to enter into the field?”

Take time to reflect on your search. Were you able to locate the information in a textbook or in a web search? Including such crucial information in this article presented its challenges. Hence, we felt it was important to invite the reader to endeavor upon a similar investigation. Despite such obstacles, we attempt to include some of the not-so-far-removed historical data leading to present day. The following is not intended to be a comprehensive historical overview. Rather, these facts help frame the stories shared during the listening sessions.

• The Mississippi School of Occupational Therapy was the first school to offer courses in occupational therapy for African Americans. After the school relocated to Louisiana, courses were discontinued in 1939 when the state’s segregation laws required a separate department to educate the African American students, causing overcrowding in the program (www.otcentennial.org/100-events/1920). Information regarding graduates and those practicing occupational therapy remains limited. AOTA membership records indicate two Black women as members in 1946, Naomi Wright and Ruth Coleman Denard (DeLany, 1999). Such records are void of any additional information.
• In 1953, Lela Llorens, PhD, OTR/Ret, FAOTA, who lived most of her life during the Jim Crow era, graduated from Western Michigan University’s Occupational Therapy Program. Llorens is nationally recognized as a practitioner, educator, scholar, researcher, author, and leader as an administrator in higher education (www.otcentennial.org/100-events/1953). In 1954, the U.S. Supreme Court ruled unanimously in Brown v. Board of Education that racial segregation in public schools violated the 14th amendment’s mandate of equal protection (Skyberg & Grubb, 2019). After segregation laws lifted, more schools began to allow Black and Brown students into their programs. In 1969, Llorens was the first person of color to be awarded the Eleanor Clarke Slagle Lectureship, an award for therapists who are making a significant contribution to the profession. (She is the only Black American to receive the award since its inception.) While Llorens delivered her Slagle lecture, the waitstaff lined a balcony in Texas to watch, as they had seldom seen a black person address a segregated audience made up primarily of white people.

By the early to mid 1970s, many universities were seeking to increase the presence of minority and woman faculty and students on campuses (Skyberg & Grubb, 2019). The journey for DEI did not end as a result of programs increasing such efforts. The demographics of the occupational therapy profession continue to remain mostly unchanged.

Therefore, the need to address DEI in the field of occupational therapy is ever present. This past year highlighted the already existing hurt and pain of Black and indigenous people of color (BIPOC), including the deaths of Ahmaud Arbery, George Floyd, and Breonna Taylor, further raising need to acknowledge the trauma and unveil the stories of our Black and Brown occupational therapy practitioners, educators, and students.

Frank Gainer, MHS, OTR/L, FAOTA, CMP, CAE, AOTA’s Vice President of Events and Meetings, discussed his perception of the 2020 “Be Heard, We’re Listening” sessions, echoing the resounding theme heard from so many: “These listening sessions were a good start. But only a start. Very painful stories were shared and now the Association needs to commit to being part of the solution. Listening is a good first step. Now it is time to implement measurable actions.”

Several actions have been taken since the sessions. This article highlights some of the efforts.

Addressing DEI in Occupational Therapy Practice

Jerry Bentley, MS, OTR, FAOTA, has been an active participant in issues related to social justice for decades. Her work as a student activist led her to cofound the Black Occupational Therapy Caucus (1974) while completing her Level II fieldwork. As a Black woman, Jerry endured racism and expressed the hurt that remains unchanged since that time in 1974. She states, “I had a fieldwork student who had similar experiences 30 years later in 2017.” During the session, Jerry emphasized the number of years that Black and Brown occupational therapy practitioners have struggled. She shared her satisfaction with the current steps AOTA is taking.

“I think if the profession wants to survive, we have to embrace students of color, and I think that all the individual efforts that have been identified are wonderful, but we also need a national effort,” Jerry said.

Jerry’s story of traumatizing experiences echoed that of generations of Black and Brown occupational therapy practitioners. The following demonstrates emerging themes from the 2020 AOTA “Be Heard, We’re Listening” Sessions.

Suggested Initiatives (Addressing the Needs of Occupational Therapy Practitioners)

Short Term

• Refer to the AOTA 2020 Code of Ethics (AOTA, 2020) to address enforceable standards of conduct
• Develop a system for reporting racism and/or discrimination
• Establish procedures for holding practitioners and educators accountable
• Provide ways to share strategies for coping with racism
• Create education and practice toolkits, including learning activities
• Review and revise policies and procedures for practitioners
• Mandate implicit bias staff training
• Develop a national initiative to increase awareness of the profession and recruitment of BIPOC
• Survey the occupational therapy community on issues related to DEI
• Create an anonymous anti-bias reporting form for tracking/research

Long Term

• Provide mentorship and development support for BIPOC by BIPOC
• Increase representation to increase the DEI of the profession (including BIPOC and Black males)
• Approach editors of textbooks to discuss inclusivity
• Incorporate DEI modules within AOTA CE resources
• Incorporate anti-racist/social justice language into AOTA’s Vision 2025 (AOTA, 2017), Code of Ethics, Core Values, etc.
• Develop DEI training

Addressing DEI in Professional Development and Academia

The listening sessions also made evident the need to focus on professional development, academic institutions, and students. Authors Cheryl Lucas and Selena Washington, in collaboration with AOTA’s Academic Education Special Interest Section, created a continuing education (CE) article called “Understanding Systematic Racism in the United States: Understanding Our Students and Ourselves.”

Debbie Amini, EdD, OTR/L, FAOTA, AOTA’s Director of Professional Development and CE, was pleased with the participation, stating, “Data reveals that several members continue to read the article and complete the CE credits. Multiple learners reported that the article was timely and necessary!”

One learner wrote, “I felt that I was quite current on the subject of systematic racism, but this course opened my eyes to some new ways of thinking about and defining the subject.”

Others recommended continuation of like topics that provide detail related to how to include them into occupational therapy curricula.

Another learner wrote, “As an OTA educator, this article provided me with many ideas on introducing topics of occupational justice and systematic racism, and being an agent for change to promote health in our communities.”

The response to the course has been overwhelmingly positive, further reflecting the need for support and training.

As efforts to understand our academic institutions’ and students’ needs continued, AOTA asked follow-up questions to Diarra Webb, an occupational therapy student at Florida A&M University, who attended the “Be Heard, We’re Listening” sessions. Diarra primarily attended the sessions to listen but felt the desire to expound her perspectives as an occupational therapy program applicant and student. She asserted, “Students need to be at the forefront of these conversations” and “deserve a seat at the table.”

Diarra thought the sessions shed light on the long journey ahead of the occupational therapy profession to become more equitable, transparent, and supportive of marginalized communities. Her biggest takeaway was that “there exists a community of people willing to put in the work to make OT a better field.”

It appears that the listening sessions did act as a catalyst for change and transformation in Diarra’s case. She reports, “This was the spark I needed to invest in equity-based work for myself and others.”

The sessions inspired Diarra to connect with occupational therapy students across the United States who have the same shared interests and values. Diarra participated in events such as the Florida Occupational Therapy Association’s summer session, dedicated to addressing racism and other oppressive issues, and the Coalition of Occupational Therapy Advocates for Diversity (COTAD) Ignite Series. Diarra also started a COTAD chapter at her university that she chairs.

She told AOTA about her recent experiences: “This fall, I created a student panel discussion-based series titled, ‘Decolonize your Mind,’ through which I collaborated with OT students from five other universities. We were able to bring together 76 participants to engage in a conversation related to race, colonization, occupational justice, and advocacy.”

Diarra’s goal is to “create a community of solidarity rooted in progressive, equitable, and culturally relevant change in OT.” When asked what next steps may be most promising and impactful, Diarra reports, “Any changes that are embedded within educational frameworks will be impactful. I noticed that unless DEI work is mandatory, many students [who are not marginalized] will not willingly engage.” Although Diarra notes, “The exposure these sessions provide can help bring awareness to inequities, as well as motivate us all to do our part in support of marginalized communities through an occupational justice-based lens,” she also acknowledges the challenges ahead.

Diarra worries that this collective energy around change will be short term, describing DEI as a “trendy” topic now, due to the political and social climate of our time, and that people may lose interest in prioritizing transformation.

Suggested Initiatives (Addressing the Needs of Occupational Therapy Academic Programs)

Along with Diarra’s insight, attendees offered recommendations for occupational therapy and occupational therapy assistant academic programs. Educational programs should consider immediate evaluation and implementation of the following as they pertain to their student community. (This content is also included in a March/April 2021 American Journal of Occupational Therapy article.):

• Offer fieldwork educator bias training
• Review procedures to report ethical concerns
• Provide faculty bias training
• Re-evaluate the admissions process to implement holistic admissions
• Reconsider the use of standardized measures like the GREs as cutoffs for admissions
• Include questions about social justice in student candidate interviews
• Evaluate bias during the admissions process (e.g., socioeconomic status bias in volunteer hour requirement)
• Develop outreach programs for disadvantaged AND non-disadvantaged groups/locations
• Provide resources to BIPOC students, including:

• A place to share experiences of racism in the program
• Ways for faculty to actively act as a voice for BIPOC students and actively work to integrate DEI into all actions
• Communications with allies to help them understand the experience of BIPOC students’ pressures (e.g., micro-aggressions, collective trauma)
  • Developing related capstone projects and research
  • Having student occupational therapy associations and Assembly of Student Delegates (ASD) chapters
• Call for anti-racist language in statements, vision; lobby nationally for related legislation
• Provide guidance and resources for educational institutions to adopt anti-racist practices
• Develop opportunities for BIPOC students to become involved (e.g., AOTA & NBCOT Launch Pad 2021, ASD, micro-opportunities for involvement, Summer Institute, mentorships)

• Have AOTA’s Commission on Education develop education resources for programs related to DEI and implicit bias

• Encourage occupational therapy and occupational therapy assistant programs to develop and support BIPOC issues through:

• Promote diversity and inclusivity in AOTA products, services, and resources

• Teach students self-advocacy—to ask for what they need
• Train faculty to inquire about issues that affect BIPOC students. This practice should probably be incorporated into the standard operating procedures for all the students as part of advisement
• Provide additional supports/resources for all students to address the impact of current/societal events
• Ask all students about what resources they will need to support them during the crisis
• Learn what hardships/struggles they have

Actions: AOTA Staff Initiatives

The impact on practitioner well-being rang evident during the AOTA “Be Heard, We’re Listening” sessions. Although this was a platform for the occupational therapy community, the Board of Directors and AOTA staff members also attended the sessions, listening intently to the heartfelt stories from the occupational therapy community, which sparked a united effort to address the needs of AOTA members across every division of the Association.

As stated by AOTA Executive Director Sherry Keramidas, PhD, FASAE, CAE, “Success will require efforts that are interwoven throughout the entire organization rather than siloed approaches. I hope it reflects AOTA’s commitment to initiate a meaningful transformation process. The listening sessions, in my opinion, are an important first step, with the intent to better understand the past and the present in order to reshape the future.”

Sherry further states: “The comments about feeling excluded from actively engaging in AOTA reinforce the critical need for AOTA to create a plan to consciously and effectively transform governance and engagement. Finally, I appreciated the bravery of those who spoke up to share their experiences and feelings. This courage is essential if we are going to create a path forward.”

With Sherry’s leadership, the AOTA staff included the following initiatives as a start to addressing DEI with a multifaceted approach (see Figure 1).

Conferences and Events Including Content and Dedicated Sessions on DEI

Attending the listening sessions expanded Frank Gainer’s considerations in his role as the Vice President of Events & Meetings.

“People need to be given an opportunity to share. From there you can begin to form an action plan,” he says. “The shared stories drove home the reality that systemic racism is real. I can’t speak for others, but for me it caused me to pause, listen, and do self-reflection on my behavior and beliefs. I was never tuned into micro aggressions. I am now. These sessions created awareness—for me. I assume it created awareness in others. I have certain things I am involved in personally, and they made me redouble those efforts.”

Frank, along with support of AOTA staff across divisions, dedicated event sessions and panel discussion on DEI for the AOTA + NBCOT StudentCon 2020, 2020 AOTA Education Summit, and the upcoming AOTA INSPIRE 2021.

Staff also facilitated the Academic Leadership Council Meeting dedicating a full day to the topic of DEI within academia. Members of the ASD participated in a robust panel discussion. Other student influence ignited discussion among faculty members during breakout sessions.

Additional Continuing Education and Practitioner Resource Development

Along with a member volunteer, staff are publishing an article in the March/April 2021 American Journal of Occupational Therapy identifying short- and long-term recommendations to address DEI in occupational therapy.

Staff also gave several DEI presentations to occupational therapy academic programs and are actively working to develop resources to address the needs of those in academia. Additionally, an AOTA website Toolkit will be available to members this year.

AOTA also developed the following decision guides:

• AOTA’s Guide to Acknowledging the Impact of Discrimination, Stigma, and Implicit Bias on Provision of Services
• Discrimination and Stigma

Staff Collaboration With Governance Groups

AOTA staff continue to support the 20-member DEI Task Force along with AOTA President Wendy Hildenbrand, PhD, MPH, OTR/L, FAOTA, and members of the AOTA Board of Directors. Alison Bondurant, CAPM, joined AOTA as the Executive Office Manager in 2020. Her role includes supporting the DEI Task Force in their efforts. With her assistance, the task force is collecting data to further guide their analysis and recommendations to the AOTA Board.

“We are actively reaching out to stakeholders including staff, members, and volunteer leadership to gather data from throughout the OT community,” Alison says.

The following are additional staff-supported DEI activities in collaboration with AOTA volunteer leadership:

• The Special Interest Sections (SIS) continue to host virtual events on various DEI topics. Staff have supported planning and organizational efforts as well as participation on panel discussions.
• The ASD saw the importance of partnering with AOTA staff to share the voice of students and identify methods to support. The ASD members worked with staff liaisons to participate in the “Be Heard, We’re” Listening Sessions and Academic Leadership Council meetings panels, and they developed a message on racism. Currently, the ASD steering committee, AOTA staff, and student volunteers are working to develop additional resources and enhance the DEI-focused decision guides.

Advocacy and Policy

There is a need to advocate to expand the occupational therapy workforce to diverse groups. Hence, AOTA will continue to promote the Allied Health Workforce Diversity Act, which passed in the House of Representatives in 2019. Such legislation would support the creation of a grant program to recruit a more diverse body of allied health professionals, including occupational therapy.

“As our nation grows in diversity, so should our occupational therapy workforce in order to maximize the potential of each and every client we serve,” Wendy Hildenbrand notes.

Conclusion

The history of the profession spans more than a century, and change takes time. Yet, the evolution certainly has begun. The AOTA staff meet regularly to share and identify new opportunities to address the needs of the OT community. These efforts illustrate the dynamic approach across AOTA, and staff will continue to:

• Commit to transformation. DEI efforts will reshape and strengthen the occupational therapy profession, as we strive to meet the changing occupational needs of society’s diverse populations.
• Unite through our shared values. Interprofessional dialogue and collaboration will spark the changes that will increase DEI in all aspects of occupational therapy.
• Act broadly, and for impact. We face complex challenges in achieving our DEI vision, which demands multifaceted action. We are building on existing initiatives and developing a new DEI strategic plan, led by the AOTA DEI Task Force, which will guide AOTA’s efforts for the Association and the profession.

References

American Occupational Therapy Association. (2020). AOTA 2020 Occupational therapy code of ethics. American Journal of Occupational Therapy, 74(Suppl. 3), 7413410005. https://doi.org/10.5014/ajot.2020.74S3006

American Occupational Therapy Association. (2017). Vision 2025. American Journal of Occupational Therapy, 71, 7103420010. https://doi.org/10.5014/ajot.2017.713002

DeLany, J. V (1999): African-American women in a predominantly Caucasian female profession: Learning paths to positions of prominence (Dissertation). Pennsylvania State University.

Skyberg, R., & Grubb, R. (2019). Evolution of occupational therapy practice: Life history of Lela Llorens, PhD, OTR/Ret, FAOTA. University of North Dakota. https://commons.und.edu/cgi/viewcontent.cgi?article=1056&context=ot-oral-histories-papers Lucas, C., & Washington, S. (2020). Understanding systemic racism in the United States: Educating our students and ourselves. https://www.aota.org/-/media/Corporate/Files/Publications/CE-Articles/CEA_October_2020.pdf

Varleisha D. Gibbs, PhD, OTD, OTR/L, is AOTA’s Vice President of Practice Engagement and Capacity Building.

Hope Caracci, OTR/L, OTD, is the AOTA Program Manager, Approved Provider Program.