Promoting Justice, Diversity, Equity, and Inclusion Through Caring Communities: Why It Matters to Occupational Therapy.

The global challenges humanity faces today, such as social and economic inequalities, occupational deprivation, racism, exclusion, displacement and migration crises, violence, wars, and political oppression, all contribute to health and participation inequities (Powell & Toppin, 2021). The depth and breadth of these inequities became strikingly evident and were exacerbated with the coronavirus 2019 pandemic (Khanijahani et al., 2021). More than ever before, we need to apply an occupational perspective to create caring communities that strengthen each person's sense of belonging (Beagan, 2015; Lavalley & Johnson, 2020; Mahoney & Kiraly-Alvarez, 2019). In this column, we argue that occupational therapy academic programs have a unique role in advancing justice, equity, diversity, and inclusion through the creation of caring communities.

Multicultural training in the United States: a survey of occupational therapy programs.

ABSTRACT This study was designed to describe multicultural training practices in occupational therapy programs. A survey was sent to occupational therapy programs in the United States to gather information on multicultural content, skills, and teaching methods as well as diversity context and challenges. The response rate was 54%. The most frequently covered multicultural content was related to cultural background and sociopolitical factors. Multicultural skills covered most often were practice oriented and interpersonal skills. Teaching methods reported as used most often differed from the methods thought by the respondents to be most effective. Programs reported multiple challenges to multicultural training including lack of time and lack of diversity in the student body, faculty, and environment. Results suggest that educators may need to expand multicultural content and skills to prepare occupational therapy students for providing care in increasingly diverse practice settings. In addition, increased use of teaching methods that focus on exposure to diverse populations and reflection may be needed to improve the effectiveness of multicultural training in occupational therapy programs.

Culturally responsive caring in occupational therapy.

The present study examined how practitioners conceptualized culture and used their understanding of a client's culture to provide culturally responsive caring. Descriptions of practice were elicited from experienced practitioners serving culturally diverse clients. Twelve practitioners completed a written questionnaire and participated in a telephone interview. Half of these same participants also participated in a follow-up interview, which was confirmatory in nature. Grounded theory methodologies were used to identify and conceptualize key processes inherent in these practitioners' descriptions of providing culturally competent care. Practitioners' perceptions of providing culturally responsive care were categorized into five interrelated constructs: building cultural awareness; generating cultural knowledge; applying cultural skills; engaging culturally diverse others; and exploring multiculturalism. One environmental construct, the diversity context was also defined in the data. Culturally responsive caring is described as a process of actively developing a synergistic relationship grounded in mutuality and an intentional respect for a person's cultures. The findings add to the discourse on cultural competency in occupational therapy and may help to examine conceptual models of cultural competency for the profession. Possible implications for culturally responsive professional development, education, practice and research are presented.

The community reintegration project: occupational therapy at work in a county jail.

The incarcerated population in U.S jails has more than doubled in the last thirty years while prison populations have quintupled. Over half of those released from incarceration return to correctional systems within one year of release. One of the reasons for these high rates of recidivism is that many inmates lack the community living skills necessary for community reintegration. Successful community reintegration for ex-offenders requires a skill set that occupational therapists have long addressed in their domain of practice. Compared to practitioners in the United Kingdom and Australia, U.S. practitioners have been slow to develop occupational therapy programming in correctional settings. This article describes a community reintegration program for jail inmates built through a collaborative partnership between a university occupational therapy program, community non-profit organizations and a county jail.

Assessing the occupational performance priorities of people who are homeless.

SUMMARY This study examined retrospective data for 65 participants enrolled in an occupational therapy supportive employment program. The Canadian Occupational Performance Measure (COPM) was used to identify self-perceived occupational performance problems specific to this population. Over half of the identified problems fell in the self-care domain (59%), about one-third (31%) were in the productivity domain and the final 10% were in the leisure domain. Narrative analysis of verbatim goals suggests that these individuals identified different types of self-care and productivity problems than samples in previous studies. The results of this study indicate that the COPM can facilitate person-centered, culturally responsive assessment with individuals who are homeless.

Building productive roles: occupational therapy in a homeless shelter.

SUMMARY Project Employ is a grant-funded program providing occupational therapy services to persons who are homeless. At Project Employ productive role involvement is the primary program outcome. Choices for productive role involvement are keyed by the person's interests and preferences, assessment is an ongoing process, prevocational training and rapid job placement are both available, and support and work-place interventions, while not unlimited, can continue for up to two years. This article describes the process of assessing factors that act as supports or barriers to productive role functioning and shares intervention methods that support role competence and adaptation in this vulnerable population.

Project Employ: engineering hope and breaking down barriers to homelessness.

The homeless population in the US has dramatically increased in the past two decades. People who are homeless often lack skills sets such as stress management and social skills, independent living skills, and skills for vocational and leisure engagement. Best practice vocational education and training programs for individuals who are homeless recognize that success in the worker role often hinges on a person's capacity to manage day-to-day living. Life skills and pre-employment training are essential components of vocational programs but no more important than interpersonal skill development including anger management, developing self esteem and motivation, building goal setting capacity, and skills for money management, personal budgeting and self-advocacy. These areas of performance have all been traditionally included in occupational therapy's domain of practice. This article describes Project Employ, a grant funded supportive employment program that has grown out of collaboration between Duquesne University's Department of Occupational Therapy and Bethlehem Haven, an emergency shelter and residential recovery program and primary service provider for homeless people in Pittsburgh, Pennsylvania. The purpose of this article is to describe the history, structure and outcomes of Project Employ.

The practice-scholar program: an academic-practice partnership to promote the scholarship of "best practices".

SUMMARY Faculty-practitioner partnerships that address mutually established, practice-relevant priorities have great potential to bridge academy and practice. Each partner has a different purpose or mission but together embracing mutually beneficial opportunities through sustainable partnerships, exponentially increases the outcomes that could result. The purpose of this paper is to report the evolution of a new program, called the Practice-Scholar Program at Duquesne University. The goal was to develop new partnerships between practice and our Department to support mutual interests in teaching, research and service focusing on the scholarship of occupational therapy 'best practices' in a variety of settings. These 'best practice' sites are to develop model programs in occupational therapy stressing occupation-based practice, application of evidence in clinical decision-making and embed scholarship activities into their every day practice. The selection, development and sustenance of our Practice-Scholar program and our first four partnership sites are described in this paper. Our Practice-Scholars sites have been at a collaborative speech-language/occupational therapy pediatric clinic, and at three community sites: three day-care sites in a marginalized underserved community; a homeless shelter for women; and the county jail. This paper describes how faculty have woven the Practice-Scholar program into our teaching, research and service responsibilities while helping our Practice-Scholars develop 'best practices.' Faculty, practitioner, and students benefits are described. Both the funding and outcomes from the Practice-Scholar program will be presented. Finally, new developments, modifications and challenges in sustaining these Practice Scholar partnerships and scholarship of practice activities are discussed.

Education and practice collaborations: a pilot case study between a university faculty and county jail practitioners.

SUMMARY The purpose of this case study is to present a partnership between faculty and practitioners that initiated a systematic evaluation data collection approach to support program development and study practice in a newly developing occupational therapy program. The Department of Occupational Therapy at Duquesne University collaborated with Goodwill Industries of Pittsburgh to introduce occupational therapy as part of a grant-supported community re-integration program at the Allegheny County Jail. In developing the program, the absence of published data regarding the occupational needs among jail inmates was evident. This paper is presented as a case study to demonstrate that faculty-practitioner collaborations can promote the implementation of a viable, systematic evaluation process when implemented as soon as possible in the practice setting. The community-university partnership ensured that a wide variety of knowledge and resource applied to the development of an evaluation process that generated relevant data for each of the partners. The intent of providing systematic evidence for practice can enhance the intervention process and provide valuable professional information. This paper also presents pilot descriptive results from the Occupational Self Assessment (2002) from the initial 67 (61 men & 6 women) inmates in the local Allegheny County Jail Community regarding perceptions of their own occupational competence and of the impact of their environment on their overall occupational adaptation. Using OSA responses, a difference score between reported occupational competence in an activity (rated low) and the correlated importance of the occupation (rated high), the top eight occupational performance areas of concern were identified for the total group, men only and women only. Caution in using the woman data due to the small n is advised. The top eight occupational performance areas of concern for this population included managing my finances, handling my responsibilities, working towards my goals, accomplishing what I set out to do, a place to live and take care of myself, basic things I need to live and take care of myself, things I need to be productive, and a place where I can be productive. Notably, four of these eight items captured the inmates' perceptions of the impact of the environment on their occupational adaptation. This study demonstrates the viability of the academic-practice partnership to support the scholarship of practice and provide a model to embed evidence-gathering through systematic evaluation processes.

Educating for community-based practice: a collaborative strategy.

SUMMARY This paper describes creative instruction strategies that prepare students for community-based practice. These educational innovations are designed to prepare graduates to understand occupation-based service delivery in community settings, to develop community-built programs that are responsive to community needs, and to understand how to both secure funding for and market occupational therapy services in the community. The process and products of collaboration between instructors in an administration and a community-based practice course are described. Outcome data from students and community partners are presented. Strategies for successful community partnerships and recommendations for continued development of these educational approaches are presented based on these data.