#OTalk 27th October 2020 – Improving LGBTQIA+ and Gender Representation in OT – #OTalk Series (UK Focus) –

Welcome to the third in this #OTalk Series on Improving Diversity in the OT Profession with this one taking part next week on #WorldOTDay.

Do check out the transcripts of our previous chats here – on BAME https://otalk.co.uk/2020/07/13/otalk-21st-july-2020-improving-bame-representation-in-ot-otalk-diversity-in-ot-series-uk-focus/ and Disability https://otalk.co.uk/2020/08/23/otalk-25th-august-2020-improving-disability-representation-in-ot-otalk-series-uk-focus/ Representation, and do also put the 15th December in your diary for an Update on where we are now and to take a look at what our key priorities for 2021 should be in order that we keep taking this forward.

In the UK-based context of societal assumptions of cisgender* and heterosexual ‘normatives’, this chat is actually exploring two different aspects of diversity – gender identity and sexual orientation, aspects of diversity which are commonly summarised and abbreviated under the umbrella of the LGBT+ acronym (lesbian, gay, bisexual, transgender and plus representative of additional diverse identities for example, queer or questioning, intersex and asexual). These two topics often get conflated and confused, and so they are combined not because they are one and the same, but to try and dispel some myths and misconceptions.

*cisgender (cis) is the word used to describe people whose gender identity, their personal experience of gender, is aligned with the sex with which they were assigned at birth.       

Transgender (trans), in its’ simplest and most encompassing sense, is the antonym of cisgender and, again in its’ most encompassing sense, is the term used to describe gender identity not congruent with sex assigned at birth.

Similarly, non-binary is an umberella term for people whose gender identity may sit outside of the polar binary of male or female. Non-binary people may or may not identify as trans and vice versa.

Please see AOTI’s excellent 2019 publication LGBT+ Awareness and Good Practice Guidelines for Occupational Therapists (available at: https://www.aoti.ie/news/AOTI-LGBT-Awareness-and-Good-Practice-Guidelines-for-Occupational-Therapists or refer to https://www.stonewall.org.uk/ for further consensus definition of terms.      


With huge thanks to @hspenceruk and @Hunter_2802 for their input in preparing this chat and accompanying blog post.

First up I think that when people think of gender representation in OT they, like me, have a tendency to think of the binary – i.e. that there are more female than male OTs. In thinking this, are we perpetuating societal binary ‘norms’ and overlooking the diversity of gender identity and expression beyond the commonly perceived binary? And what implication does this have in terms of diversity, wellbeing and accurate representation of our workforce? The image below is a helpful visual representation of how we may consider and understand gender beyond a polar binary, but do take a look at the link https://www.genderbread.org/resource/genderbread-person-v1 for the original image and a discussion about its limitations.

Genderbread Person Image  which features a gingerbread person and 4 'scales' which look at Gender Identity, Gender Expression, Biological Sex and Sexual Orientation.



Hannah (@hspenceruk) has particular interest in this topic area and completed their MSc research project around understandings of gender variance and relevance to occupational therapy practice from which they intend to publish in due course. In the meantime, they had this to add:

Acknowledgements of multiple-fold injustices (occupational, health and otherwise) experienced by trans, non-binary and gender diverse populations are plentiful alongside what are arguably longstanding societal assumptions of cisnormativity. With respect to healthcare settings in particular, a report recently published by the LGBT Foundation (2020) highlighted  that ‘80% of trans people experience anxiety before hospital treatment due to fears of insensitivity, mis-gendering and discrimination (LGBT Foundation, 2020, p.60)’. Though potential campaign agenda biases must be acknowledged, similar statistics are echoed through research by the likes of Stonewall and the Government Equalities Office, easily obtainable through a quick Google search.

A lack of understanding among multi-disciplinary healthcare professionals across general health care services is a dominant theme throughout research such as that cited above, though there is a relative absence of either occupational therapy-specific research or mention of occupational therapy elsewhere. This essentially reiterates that theme of lacking knowledge and understanding of the specific needs and experiences of trans, non-binary and gender diverse populations, particularly with respect to specific occupational needs as are the unique focus of our profession. Take, for example, our pre-chat challenge (see below).   

What does all of the above mean for us as occupational therapists, evidence-based professionals, working towards optimum health, participation and quality of life for our service users and as part of a diverse workforce?

With respect to sexual orientation, Hunter (@Hunter_2802) previously carried out a literature review around LGB (lesbian, gay and bisexual) identity disclosure as part of his research project and subsequent conference presentation entitled  ‘In Or Out?? Which is it to be? and What do OT’s need to know???’ from which, together with experience in practice, he draws below:

As a gay OT, I felt sexual identity disclosure has significant occupational impacts, as we are all occupational beings. I want to make a point, this research was done in 2015, so there may be more articles published since. However, at the time the following findings were identified and since this, in practice I have experienced and observed similar issues. And so,  a summary of key elements of my research that are most relevant for all OT students, OT’s and academics. The 8 themes were:
        1)       Disclosure and Non-Disclosure have negative and positive health and wellbeing implications.
            2)       Support systems have a significant impact on disclosure and are impacted by disclosure with both perceived and actual negative and positive implications.
            3)       Identity is significantly impacted by disclosure and non-disclosure or repression.
            4)       Demographical factors such as age, religion, culture, ethnicity and social economic status have impacts on individual disclosure/non-disclosure.
            5)       Disclosure is a process often beginning with self-identification/self-disclosure, disclosure to friends and then family; with different extents of disclosure.
            6)       Fear of perceptions, expectations and actual reactions has significant implications on occupation, health and wellbeing.
            7)       Occupational and activity based impacts emerged significantly as a result of both positive and negative disclosure experiences.
            8)       Heterosexism and Homophobia were commonly experienced which had implications on individuals occupations, health and wellbeing through disclosure and non-disclosure.

            I’m not going to go into the themes in details, but the key points involved were people would need to self-affirm and self-disclosure prior to disclosing to close friends, then if positive experiences were to happen they would disclose further, if not then they would not. However; the impacts of this was that where positive experiences and affirmation happened; internalised homophobia was diminished, yet where this was not the case it reduced future disclosure.

            More importantly, disclosure in itself was identified as a need. Disclosure had impacts on identity, where negative experiences and non-disclosure occurred it could fragment identifies; with development of heteronormative identities for self-preservation from stigma and threats   to traditional expectations of the individual. Disclosure also had impacts such as conflicting with cultural identifies, which as Occupational therapists, we know identity is core to activity  and vice versa.

            People with negative disclosure experiences had detrimental impacts on mental and physical health, occupational participation, engagement in detrimental occupations, increased risky sexual behavioural and detrimental impacts on vocational/academic performance. Conversely, positive experiences increased self-acceptance, and a core characteristic of positive disclosure experiences is the presence of positive relationships. On the other hand, there were fears of losing family, losing work, losing friends and impacts on occupational performance and satisfaction. Positive relationships are a key part of positive disclosure experiences; having an affirmative and positive LGB environment also led to positive experiences of disclosure, with increased occupational satisfaction and participation.

            Finally, in terms of demographics, due to what’s going on I am going to focus on Race and LGB identity. With Race, individuals experienced a dual level of discrimination; with experiences of racial and sexual identity disclosure also having negative impacts. So Race is a key factor, but also considering more people are coming out at a younger age another factor to consider is have their coping mechanisms to manage reactions to disclosure matured/developed enough, or do they need support with that.

            Implications
            Occupational Therapy emphasises dignity and equality, but to do this the profession needs to recognise and challenge the heteronormativity and heterosexism that exists. By doing this, positive LGB disclosure environments and interventions can be developed and facilitated. It is clear the therapist is responsible in providing the appropriate environment, tools and skills to facilitate this so as to enable optimal occupational satisfaction, fulfilment and participation. However, without knowledge about disclosure and its impacts, it is something that cannot be expected to be put into practice within Occupational Therapy.

            In the process of conducting my review, there was a significant lack of LGB identity disclosure literature within the Occupational Therapy/ Science fields. This lack of evidence indicates a lack of education is identified. Having knowledge about disclosure is important, not just to provide equitable and equal assessment/intervention, but also to provide a safe and inclusive profession where both therapists and students can be their authentic selves. Hence there is a key need for an education base surrounding disclosure and sexual identity which would enable our students, academics and practitioners to develop practices to be more      inclusive and person centred. Furthermore, the lack of research specific to this endeavour was concerning considering it is a topic which is so socially important and impacts on mental and physical health.


            While I have had some experiences myself which for now I will keep personal, the many experiences of other LGB OT practitioners I have spoken to have shown me that heteronormative practices and heterosexism being pervasive throughout teams, practices and places of employment. These can leave you feeling isolated, outcast and discriminated against, which is why the call for research, education and continued professional development is ever more important; not just to better ourselves and better serve our patients/clients/service users, but also so we can be that truly person-centred profession with positive affirmative environments in which we can work and also gain that occupational satisfaction, participation and enjoyment!


Chat Questions

We have a challenge for you before the chat. Pop the word Transgender and the acronym LGBT into any of the OT Professional Bodies web pages, RCOT, WFOT, AOTI etc. and try the Physiotherapy ones, e.g. CSP, too. What did you learn?

1. What did you learn from the pre-chat challenge? What is your reaction to this?

2. Do you perceive Occupational Therapy as a profession to be informed and inclusive with regards to specific needs of LGBT+ populations as service users and as part of the workforce? Do you think that it is necessary/relevant for OTs to have knowledge and understanding of LGBT+ identities? (Why/why not? If yes, how could this be best facilitated?)

3. Do you feel you provide colleagues and clients with safe spaces to live authentically? Are you aware of any commitment to LGBT+ needs within your workplace setting?


4. Having read the blog post and considered answers to the above, what does that mean for us as occupational therapists, evidence-based professionals, working towards optimum health, participation and quality of life for our service users and as part of a diverse workforce?


5. Are there any actions you have taken to increase knowledge and understanding regarding the specific and diverse needs and experiences of LGBT+ populations? What actions will you take forwards to make your workplace more inclusive with respect to gender and sexuality?

Releasing on the day of this chat, and World Occupational Therapy Day – 27th October 2020 is the e-book – ‘We Are OT’ that serves as a space to discuss the benefits and challenges of being a ‘diverse’ part of the OT workforce. It uses narratives to pose reflective questions to challenge your practice, and looks at how you support and uplift your colleagues.

The ebook will be priced at £1.99 with the option of adding an additional donation. All profits to go to a scholarship fund. The link to buy will be on my website on the 27th Occupation4Life.

Kirsty

#OTalk 20th October 2020 – Application of Theory to Occupational Therapy Practice, during Practice Placements – a current debate.

Hi, my name is Emma Spellman (OTEmmaS @EmmaspellmanOT) and I have been an occupational therapist for over 24 years. During my student years, practitioner years and now as an academic I have heard stories from students, practice educators and academics about the challenges occupational therapy students have when trying to apply theory to practice. This application is especially important for the purposes of preparing for, using during and reflecting upon post practice placements. Is this something that is commonly discussed within our occupational therapy profession?

Below I have outlined the questions constructed from both current related literature and golden threads from narratives I have heard, that I think are the most important ones for our discourse on Tuesday ../8/20 during OTalk at 8 pm. Can we as a community shed a modern light on this issue and find some common agreements? Please join us.


Questions

  1. Why is applying theory to practice important please?
  2. Please can you provide one example of a theory that you think is useful in occupational therapy practice?
  3. What do you think currently drives occupational therapy students to learn theory and use it in practice please?
  4. What do you think are the current barriers that occupational therapy students face learning and applying theory to practice please?
  5. How do you think student’s ability to both learn theory and apply it to practice be improved please?

#OTalk 13th October 2020 – Online groups: current occupational therapy practice

This weeks chat will be hosted by By Sam Pywell, @smileyfacehalo.

In the current world (due to COVID-19), it is possible that services where occupational therapists provide groupwork can face delivery restrictions due to social distancing, regional lockdown areas, shielding, and the personal choice a client has of wanting to engage in a group but not physically attend (perhaps due to caring for someone, or wanting to keep their bubble of exposure small).   Access to a physical space where the group and staff can socially distance may be a challenge.  Certain activities within a groupwork session e.g. messy crafts may not be possible due to difficulties with cleaning regimes.  Traditional face to face groups and groupwork may therefore not always be possible for a variety of reasons.   

Occupational therapists have the potential to deliver groupwork online depending on the individuals digital skills, access to training, equipment and access to platforms to name a few (NHS England, 2019; see @NESnmahp tweets on August 20 about “delivering digital groups”). Traditionally taught and delivered in a face to face setting, there is potential to mobilise occupational therapy groups either in part, as a whole or create a new group (e.g. to address the long covid population) online.  This could lead to additional innovate practice lead by occupational therapists for the benefit of our clients.  However, it cannot be assumed the client has the same digital access.  The clients digital skills, access to training equipment, platforms and reliable internet can all become barriers to access. It could be argued the therapists role is to explore this and enable access to the online group as well as providing the group itself. 

My interest in this area has come from delivering a module which contained groupwork, to include current practice due to COVID-19.  In order to connect pre-registration students, and colleagues who may have experienced F2F groupwork in the past, and to share best practice, the questions for this evening #OTalk are: 

1. what groups are occupational therapy staff running online now for which client groups (either as a result of COVID-19, prior to, or intend to run in the future)? 

2. what platforms are occupational therapy staff using and why? 

3. what are the barriers to running online groups? How can navigate these? 

4. what are the differences of a face to face group to a virtual group re: preparation and running? 

5. Under the NHS England (2020) and HEE (2020) definition of TECS: what would you define your group as (telehealth, telemedicine, teleconsultation etc) and why. 

6.What do you include in your risk assessment about the digital environment/ online groups (as if with F2F groupwork, you would have a risk assessment) 

By Sam Pywell, Lecturer in Occupational Therapy @ The University of Central Lancashire, Preston. #AHPsintoAction #digitalAHPs #mobilisethedigitalOT #UCLanOT @UCLanOT 

References 

NHS England (2019) A digital framework for allied health professionals https://www.england.nhs.uk/publication/a-digital-framework-for-allied-health-professionals/ 

HEE (2020) Rapid Expansion of AHP placements: Simulation and Technology Enabled Care Services (TECS) webinar  

NHS England (2020) Technology Enabled Care Services (TECS) https://www.eng

#OTalk Research 6th October 2020 – Reflexivity in Research

Welcome to this weeks #OTalk Research. I am Sarah Lawson, (@SLawsonOT) a PhD Candidate, Lecturer Practitioner at Wrexham Glyndwr University and co-author of TRAMmCPD. I am carrying out a qualitative study and one of the things I am grappling with is the concept of reflexivity. I am interested to explore the concept and hear your thoughts on this important aspect of research.

Being reflexive within our research is integral to the research process at any level. As researchers we are constructing and creating knowledge through a process of interpretation (Braun and Clarke 2019) which is based on our own values, assumptions, biases, social and cultural contexts (Creswell and Creswell 2018; Etherington 2004; Finlay and Gough 2003) . These aspects also influence our choice of research topic, paradigms, methodology and methods. Our reality is socially and personally
constructed and being reflexive is a crucial, ongoing and active process which may be challenging but is necessary to provide context, and tackle concepts such as validity, trustworthiness and reliability within our research (Clancy 2013) .

Within qualitative research researcher subjectivity through reflexivity may be considered as positive rather than negative although as with many areas within research this is often contested. To explore reflexivity further we would like to consider the following questions within this chat:

Q. 1 Can you share any experiences of reflexivity and/or the types of studies in which you have experienced reflexivity being used?
Q.2 What do you understand to be the difference between reflective practice and reflexivity?
Q. 3 How have you recorded or demonstrated reflexivity or observed it being demonstrated?
Q. 4 How has reflexivity added to your study or research you are familiar with?
Q.5 What do you find challenging about ‘reflexivity’?
Q. 6 What do you need to consider next? How will you use what you have learnt from this #OTalk?

References
Braun, V. & Clarke, V. (2019) Reflecting on Reflexive Thematic Analysis. Qualitative research in sport,
exercise and health. 11 (4) pp. 589-597.
Clancy, M. (2013) Is Reflexivity the Key to Minimising Problems of Interpretation in
Phenomenological Research? Nurse Researcher. 20 (6) pp. 12-16.
Creswell, J.W. & Creswell, D. (2018) Research Design: Qualitative, Quantitative & Mixed Methods
Approaches 5th Ed. London: Sage Publications.
Etherington, K. (2004) Becoming a Reflexive Researcher: Using Ourselves in Research. London: Jessica
Kingsley Publishers.
Finlay, L. & Gough, B. (2003) Reflexivity: A Practical Guide for Researchers in Health and Social
Sciences. Oxford: Blackwell.

#OTalk 29th September 2020 -Do OTs have a role in supporting resilience and wellbeing?

Occupational Therapists are skilled at looking at the person and a situation in a holistic manner in order to empower and support the individual to do what has meaning and purpose in their life. Through that occupation, their health and wellbeing can be improved. Terms like wellbeing gets thrown around without always having a clear sense of what we mean by them. Likewise in the last decade interest in the idea of resilience has grown- from fringe models of why some children are able to move on from difficult childhoods, to a sense of everyone’s ability to navigate life’s inevitable difficulties. 
There are a multitude of different understandings about what these terms mean. For some the idea of wellbeing and resilience can be seen as ways to put more responsibility on the individual and away from the environmental impact of struggles such as society responses to race, poverty and disability.  For this reason I use BoingBoing (see link below) definition for resilience: “Beating the odds, whilst also changing the odds”.   
It may be argued by some OTs that building resilience and wellbeing skills is the domain of psychology, but others like Dr Rachel Thibeault argue strongly that research shows that eudemonic or meaningful activities are one of the biggest influencers on an individual’s experience of whether they feel themselves to be resilient, so we can and should be within the remit of OTs. 
In addition to this I have noticed a rise in the number of OTs entering new roles that focus more on wellbeing including being part of employee wellbeing services and operating as OT coaches. In this OTalk we will explore the following questions; 
  1. – Are many OTs working in roles where they offer specific interventions around resilience or wellbeing? Are OTs supporting colleagues / workplace resilience and wellbeing?
  2. -Why do we struggle with these terms- are there better ways to describe this work?
  3. -Do OTs feel they should be doing more in this area / what is stopping them? 
  4. -What creative examples of practice are emerging? 
Boing Boing Resilience Training- source of definition above:
Dr Rachel Thibeault open access talks for CAOT on resilience:
Lyubomirsky and Porter 2010. study which explore the importance of meaningful activity in wellbeing.