What is anti-DEI legislation, and how can students get involved?

Over the last few years, there has been a notable increase in the quantity of legislation proposed and passed in the United States (U.S.) that restricts access to services, training, and education on diversity-related topics.

This article uses the phrase “anti-DEI (Diversity, Equity, and Inclusion) legislation.” We, the authors, acknowledge that the term DEI covers a broad range of topics affecting many individuals at varying levels and may mean different things to different people, with a nuance beyond the scope of this Op-Ed.

What is legislation?

Laws, rules, and regulations affect us in almost every aspect of life. However, the legislative process is not something we tend to think about daily. Legislation is when a new law is proposed and discussed at the state or national level.

Generally, state legislation and laws impact only those living in that state, and federal legislation affects all 56 states and territories, and Washington, DC. However, trends often occur across the country, so you may see similar or the same legislation proposed in multiple states.

How does legislation impact me?

The most challenging part of drafting and understanding legislation is anticipating the potential positive and negative outcomes, who benefits or is harmed by those outcomes, and whether there is a risk of abuse.

Legislation is assigned a bill number and then given a name that intends to imply a particular outcome. For example, some recent anti-DEI legislation titles are “Do No Harm Act,” “Protecting Youths Health Act,” and “Medical Ethics Defense Act.” While on the surface these bills sound like a good idea, the intent and implications become more evident after an in-depth reading of the text.

Supporters tout these bills as being anti-discriminatory because the language within the bill bans “special treatment” for specific groups. At the same time, we know that equal care is not automatically equitable, and by avoiding what some call special treatment, we can cause more harm—primarily to underrepresented groups with certain risk factors we refer to as social determinants/drivers of health (SDOH).

Advocacy in action—Missouri SB 410 “Do No Harm Act”

The Missouri Senate and House recently proposed legislation titled the “Do No Harm Act,” which used the threat of withholding state funds to effectively ban the teaching of diversity-related topics in education and health care systems.

It is difficult to summarize the full implications of this bill in this short essay. Succinctly, this bill would significantly restrict or eliminate the ability of higher education programs, state licensure boards, health systems, and practitioners to provide or require DEI education.

What could be done?

First, members alerted the Missouri Occupational Therapy Association (MOTA), which initiated internal discussions with leadership and their lobbyist to understand the bill’s implications. MOTA was able to prioritize action on this legislation because of its implications for occupational therapy programs, licensure requirements, and its workforce.

MOTA notified members, local health education, and organization leaders, and contacted the American Occupational Therapy Association (AOTA). They then created a grassroots advocacy letter-writing initiative, drafted a joint statement in support of DEI initiatives with AOTA, and several members made an in-person appearance at the Capitol to speak to senators and representatives about the potential harm should the bill pass.

And advocacy worked! Legislators removed the anti-DEI language from budget bills, and SB 410 did not move to a vote on the Senate floor. Nonetheless, students and practitioners are still encouraged to contact their legislators and remain vigilant about future issues.

Can students get involved in advocacy?

Students are vital to the advocacy process, and there are many ways to get involved at the national and state levels.

Clarice became involved in advocacy by pursuing a third Level II fieldwork experience with AOTA’s Federal Congressional Affairs team as an OT student at Columbia University. Inspired by this experience, she got involved with the MOTA advocacy committee, and 1 year later became Director of Practice for MOTA—a position that leads the legislative and advocacy agenda for MOTA. She now runs Amplify OT to support advocacy efforts around Medicare and reimbursement.

Mario is the current Director of Practice for MOTA, and the President of the Missouri Black OT Caucus, and he was involved in and led numerous grassroots student initiatives focusing on DEI and anti-racism as a student at Washington University in St. Louis. He later became involved in COTAD as a new practitioner.

If you want to get involved in a committee or a leadership position, contact your state association or look at AOTA’s website for volunteer opportunities. There is always a shortage of volunteers, so simply giving your time can significantly impact our profession and our clients. These volunteer positions are excellent low-risk ways for students to build understanding and capacity for advocacy from a legislative or organizational perspective.

7 Ways to Engage in Advocacy

1. Be a member of AOTA and your state association. Without membership, none of this work is possible. Your dues support lobbyists, the resources and systems associations use to keep you updated, volunteers, and so much more. So, if you are an AOTA and/or state association member, thank you! This work isn’t possible without you.
2. Spread the word! If you are aware of legislation related to OT, notify AOTA or your state association. State associations and AOTA closely monitor state and federal legislation, but, it is impossible to catch every issue that comes up across the country. If an issue isn’t explicitly related to OT, AOTA and state associations may be limited in their ability to take action due to funding, scope, or time. You can still take action by being part of other special-interest groups specializing in advocacy efforts around specific topics such as gender-affirming care, health equity, abortion, etc.
3. Vote. We cannot change who is in office or ensure that they represent our point of view if we don’t participate in all local and national elections.
4. Contact your legislator. It is your right as a private citizen to contact your legislators. They work for their constituents (you). Your voice matters! Use AOTA’s Take Action Page to easily contact your legislators on specific issues or find contact information for your local elected officials. Many legislators are not familiar with the health care perspective and can benefit immensely from your OT lens.
5. Get involved. Consider joining your state advocacy committee, being an AOTPAC ambassador, or volunteering for your state association, AOTA, or a special interest group.
6. Stay informed. You can utilize free resources like Fastdemocracy.com to stay up to date on legislation. Subscribing to email updates from organizations and following them on social media is another way to stay informed. Additionally, AOTA posts advocacy updates on Twitter, aota.org/advocacy, and in OT Practice.
7. Be an ally. Not everyone has the space or ability to take the lead, and that’s OK! Sometimes a simple email or text letting the person or group know you support them is the fuel they need to keep up their advocacy efforts.

Speak up and speak often

Remember, change cannot happen without passionate individuals like you who decide to speak up and speak often. You can use your OT skills to advocate effectively by identifying your initiative’s barriers, supports, and goals.

Progress will never be perfect, and advocacy may not always work the way we want, but it doesn’t mean the work isn’t worth doing. Advocacy DOES work—especially when we work together.

Clarice Grote, MS, OTR/L is an innovative advocate, Medicare specialist and founder of Amplify OT. Through Amplify OT and the Amplify OT Podcast, she educates and inspires practitioners to engage in advocacy and be the change they want to see in our healthcare system. Clarice is a current AOTPAC Ambassador for North Carolina and the North Carolina Occupational Therapy Association Advocacy co-chair. She can be reached at amplifyot.com or on social media @amplify_ot.

Rose McAndrew, OTD, OTR/L, CHT has been an OT for 20 years. While her clinical background is in hand and work rehabilitation, she feels called to help students and practitioners alike appreciate the importance of policy and how it directly impacts our ability to practice. She wants to help students and OTPs discover and learn more about the meaningful occupation of advocacy. She teaches at multiple OT programs as an adjunct instructor and volunteers in multiple capacities for the American Society of Hand Therapists.

Mario Millsap, MS, OTR/L is a Class of 2020 graduate from Washington University in Saint Louis, President of the Missouri Black OT Caucus, and Director of Practice for the Missouri Occupational Therapy Association. His professional interests include interprofessional partnership, DEI within academia, and empowering Black people through a holistic and occupation-based lens.