Diversity and Justice in OT, OTalk

#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

Diversity and Justice in OT, OTalk

#OTalk 21st July 2020 – Improving BAME Representation in OT – #OTalk Diversity in OT Series (UK Focus)

With the #BlackLivesMatter movement sending ripples around the world on top of the #COVID-19 pandemic, efforts to adjust to the ‘new normal’ are underway and the #OccupationalTherapy profession is no exception. Over the years there has been repeating and intermittent awareness of the need to increase inclusive representation within the profession. Talk needs to be followed by action, and more needs to be done in order to lead to sustainable change. We need to address the systems and processes that make real lasting change difficult. It is not just about making people who don’t usually represent the typical presentation of an #occupational therapist, fit the mould, but about embracing the diversity and strengths that widening access and participation has to offer our profession, and more importantly the people we serve. Moving forward we need to continue to build alliances within the professional membership, regardless of skin colour and ethnicity, to have a depth of impact in change. We can do this as a profession with the help of local activity, diverse local champions, diverse local leaders and @theRCOT.

 

This #OTalk presents an opportunity to share our thoughts on this subject, in light of the recent #BlackLivesMatter events and the public health report highlighting that #BAME (Black Asian Minority Ethnic) communities are disproportionately affected by the COVID-19 pandemic.

 

We would like to emphasise (and for the RCOT to take note) that focus on the BAME community should be regularly reviewed and discussed. This will keep the subject an explicitly ever present agenda for the profession in order to challenge and change structural based inequality. We also acknowledge that while the term BAME can be problematic, it can be helpful for exploring issues of representation. If in doubt ask the person their preferred term of reference.

 

This discussion on occupational therapy and UK-based BAME communities is part of an #OTalk series on topics of diversity. Other topics to be explored later include: Disability (including Neurodiversity), LGBTQIA+ and Gender Issues.

 

Some preliminary groundwork in preparation for this series is encouraged:

 

  • Look Deep. Acknowledge any privileges you may have. This resource on Privilege and Intersectionality may help: https://guides.rider.edu/privilege
  • Come to the chats with an open mind and heart and be prepared to feel uncomfortable – it is through discomfort that we can begin to make the necessary changes.
  • We need to unite to be actively against (anti) any forms of prejudice / oppression.
  • As always, respect each others’ views and acknowledge that there will undoubtedly be differences of opinion.
  • Develop an awareness of microaggressions and be mindful of how they may impact the colleagues you are interacting with on this topic: https://www.vox.com/2015/2/16/8031073/what-are-microaggressions
  • Accept that you will make mistakes and if these are pointed out, reflect on them and make the necessary changes.
  • Be clear about the differences between Inequality, Equality, Equity, and Justice. Check out this graphic created by @lunchbreath based on Shel Silverstein’s The Giving Tree.

Questions for the #OTalk chat will be as follows:

 

1 A) How ethnically diverse do you perceive our profession to be now? B) Has this changed over the course of your time as an OT? (Q Hosted by @Occ4LifeLtd)

2 A) Why would we want to encourage more people from BAME backgrounds to enter the profession? B) Does the OT staff group in your area represent the population you serve? (Q Hosted by @sherriikapp)

3 A) What racial / cultural discrimination have you experienced, seen or even perpetrated (even unconsciously)? B) What did you do about it? (Q Hosted by @KwakuOT)

4 A) What barriers do BAME occupational therapists face for progression into roles in leadership, academia and research? Please refer to the list of questions prepared by @HannahtheOT https://twitter.com/HannahtheOT/status/1267852336443150341 (How many Black lecturers / placement educators / managers have you had? Can you name 10 Black OTs you’ve worked with throughout your career? Can you name 10 white OTs? Name an OT theory, model or standardised assessment developed by a Black OT? How many articles/books have you read that were written by a Black OT?) (Q Hosted by @MwelaSihle)

5 A) What responsibility do you / will you take for exploring and educating yourself on issues of race and culture? B) What is one change you can make tomorrow? (Q Hosted by @LecturerMish)

 

Some useful resources: 

 

*Will COVID-19 be a watershed moment for health inequalities: https://www.health.org.uk/publications/long-reads/will-covid-19-be-a-watershed-moment-for-health-inequalities

 

*AHP Leaders Podcast: Changing the Culture of Conversations (featuring AHP leaders from across the UK)

https://www.youtube.com/channel/UCb722uXf9XJpegA_d-ApBUg

 

*The OT & Chill @ot_chill podcast, Episode 11 – L . O . V . E – Let’s Talk About Race #BLACKLIVESMATTER: https://open.spotify.com/episode/4sPh0qghwAiozaXLSM0re2

 

Akala deconstructs race, class, and Britain’s modern myths | Unfiltered with James O’Brien #32 https://www.youtube.com/watch?v=atfVUgyEIOI

 

Dr Karen Whalley Hammell WFOT Congress 2018 keynote ‘Building globally relevant occupational therapy from the strength of our diversity’ https://www.youtube.com/watch?v=9WipUPXx_Kk&t=7s

 

*George Floyd, Minneapolis Protests, Ahmaud Arbery & Amy Cooper | The Daily Social Distancing Show https://www.youtube.com/watch?v=v4amCfVbA_c

 

Hey White Therapist! Here’s where we start! https://courses.clearlyclinical.com/courses/free-ceu-racial-awareness

 

Why I am no Longer Talking to White People About Race by Renni Eddo Lodge: https://www.theguardian.com/world/2017/may/30/why-im-no-longer-talking-to-white-people-about-race (this is the preview article for the book)

 

Guidance for white allies who are trying to help https://ladders4action.org/news-blogs-videos/blog/do-no-harm/

 

Why “I’m not racist” is only half the story by Robin DiAngelo https://www.youtube.com/watch?v=kzLT54QjclA (a good summary of her book ‘White Fragility’)

 

 

 

A few real life scenarios to get you thinking:

 

In one occupational therapist’s work place it was identified that approximately 50% of inmates in a prison setting are from BAME backgrounds, with only 10% accessing occupational therapy services. Many reported discomfort in accessing services as they felt that the staff body was not representative of their backgrounds and lacked understanding of where they were coming from.

 

A Black occupational therapist received comments from a supervisor which suggested that they were perceived as lazy and uneducated. This Black colleague felt they had to work ten times as hard as white counterparts and also sees white colleagues get away with things they are reprimanded for.

 

A white Muslim occupational therapist who wears a hijab went to an interview and saw visible shock on the interviewer’s face. Feedback suggests that she couldn’t have answered the questions differently but she wasn’t offered the job.

 

A Black student turns up to a university admissions interview wearing jeans – they demonstrate more knowledge and insight than a white student who comes wearing a suit or smart attire. Which applicant gets awarded a place on the programme?

 

This #OTalk session and blogpost was made possible through the contributions of:

 

Sihle Mwela @MwelaSihle

Kwaku Agyemang @KwakuOT

Jo Bresi-Ando @otStones

Musharrat Ahmed-Landeryou @LecturerMish

Elaine Rutherford @Cariad_OT

Jou Yin, Teoh @teohjouyin

Grace Chikelu Amamilo (not on Twitter)

Kirsty Stanley @Occ4LifeLtd or @kirstyes

Somia Jan @SomiaOT

Carolyn Connage @CarolynOT

Nichole Yam @nicholeyam

Ed Sum @musedNeuroOT

Sophia Awan @Sophia OT

Yasmin Anisuddin Ward @Yazz_OT

Geraldine Kinkead-Richards @GeriLKR

Hannah Daisy @HannahtheOT

Simone Welch @Simzy_x

Ally Plusii @Ally56642911

Sheri Braimah @sheriefeb

 

One change our group thought was that RCOT could easily introduce is to appoint an Equality and Diversity Officer dedicated to organising research, study, networking and publicity events, and for influencing policy. A diversity mentorship / support scheme was also suggested to provide opportunities for people to discuss common issues. It would also be useful to have some dedicated webpage resources similar to those on the CSP website – https://www.csp.org.uk/workplace/equality-diversity. Do keep informed on the RCOT progress following the RCOT BAME Big Conversation – a summary of which will be posted on their new Equality, Diversity and Inclusion pages here – https://www.rcot.co.uk/equality-diversity-and-inclusion

 

Some immediate actions you can take: 

Vote for Dr Kee Hean, Lim @lim_hean to be member of the RCOT Council. He is the sole candidate to represent the BAME population and has a long, consistent track record of enabling equitable student recruitment and retention at Brunel University London. The Brunel University London student body has 30-50% BAME representation thanks to the efforts of Kee Hean and his fellow admissions tutor Dr Ayana Ifekoya. The Brunel University London occupational therapy team have a tweet thread documenting their recent efforts contributing towards Racial and Cultural Equity: https://twitter.com/OTatBrunel/status/1281145935502942209

Please consider answering the call for stories, poems, comics, etc for an eBook “We Are OT: a brief history and personal accounts of diversity in the profession of occupational therapy within the UK” to be published on World Occupational Therapy Day 2020. https://occupation4life.co.uk/2020/06/05/we-are-ot/