Aspire OT is honored to welcome Lauren Jones, MS, OTR/L as a guest blogger this week! Click here to check out her website.
Contrary to popular opinions about providing “colorblind” care, understanding the unique challenges that can impact Black clients’ ability to participate in occupational therapy is crucial to helping improve the quality of care across settings. In addition to having been historically excluded from the development of modern healthcare systems and treatments, many Black people continue to face barriers to healthcare access as a direct result of practitioners’ implicit biases, discriminatory practice policies, and historic systems of oppression.
Read on to learn how individual and systemic biases are causing harm to your Black clients and how you can take steps to disrupt these injustices.
Contributing to Adverse Physical and Psychological Health Outcomes
After experiencing ethnically based discrimination in the form of microaggressions, Black clients are at a greater risk of experiencing poor health outcomes. Specifically, one study indicated that individuals’ experiences of racial microaggressions predicted multiple types of physical health problems, including “pain, lower energy levels, and fatigue.” Thus, clients presenting for therapy to practitioners with low levels of cultural humility who make microaggressions or microassaults may have their health conditions compounded by these additional affronts. Black people who are victims of microaggressions in healthcare settings may also suffer from lasting emotional or psychological harm that can deepen mistrust in healthcare providers and make it more difficult for historically marginalized individuals or groups to receive care.
· First Steps: As a starting point, complete a self-assessment and learn about your own implicit biases and cultural “blind spots.” It can be a difficult process, but one that can make a huge difference in the care you are able to provide your Black and brown clients.
· Next Steps: After your initial assessment, ask for feedback from peers and managers who have seen you interacting with clients of diverse ethnic backgrounds. Do they notice a difference in the way you communicate with or treat Black clients? Finally, commit to taking a course or participating in a justice-focused intervention with colleagues to identify strengths and opportunities for growth at the individual, group, and systems levels.
Impaired Clinical Reasoning and Assessment
OT practitioners’ implicit biases can have a negative impact on the quality of care they provide for Black clients by distorting their clinical reasoning and treatment recommendations. Research has shown that healthcare providers are more likely to minimize or ignore reports of pain from people of color and make different treatment recommendations due to implicit and explicit biases, including false beliefs about the pain tolerance and other physical qualities of Black people. Despite having the knowledge to treat these clients effectively, the clinician dismisses their concerns and allows their bias to guide their clinical reasoning rather than responding to client concerns. These biases can result not only in damaged therapeutic rapport, but worse long- and short-term outcomes for clients of diverse ages and diagnoses. In the short-term, clients experience pain or other conditions that go untreated; in the future, the issues resulting from untreated health problems can contribute to unnecessary pain, permanent disability, or even early mortality.
· First Steps: Compare your plans of care and documentation for Black clients versus those who are White or of other ethnic backgrounds with similar diagnoses or health conditions. What type of language are you using to describe the clients or their family members? Do you notice a difference in your reactions, plans of care, treatment recommendations, or other outcomes?
· Next Steps: Familiarize yourself with standardized assessments that enable you to gather data about yourself and your organization and your clients to better inform your plans of care. The assessments can also provide an opportunity for you to identify and address client concerns related to their care as a Black individual.
Violating Ethical Principles of OT Practice
Per the AOTA 2020 Occupational Therapy Code of Ethics, “Exhibiting attitudes and actions of dignity requires occupational therapy personnel to act in ways consistent with cultural sensitivity, humility, and agility” (AOTA, 2020). When treating Black clients as a monolithic group rather than individuals, OT practitioners risk violating one of the ethical principles of our profession. The principle of Dignity asserts that clinicians must “value, promote, and preserve the inherent worth and uniqueness of each person,” including “respecting the person’s social and cultural heritage and life experiences.” This means challenging assumptions and unlearning myths about Black clients’ interests, motivation, means, and goals and providing client-centered care that prioritizes the dignity of each Black client as an individual.
· First Steps: Review the AOTA 2020 Code of Ethics. Consider how closely your own practice, implicit biases, and actions align with the profession’s stated goals and values. Journal or engage in a discussion with peers about how the Code of Ethics impacts your daily practice with Black and brown clients.
· Next Steps: Read or listen to media (see resources below) that explains the origin or development of cultural biases you are unaware you possess or are affected by. While engaging with the media, complete exercises independently or in a group to deepen your understanding of the ethical implications for OT practice and your personal life.
Perpetuating Systemic Practices of Discrimination
Biased practices that negatively impact Black clients are not just happening at the individual level. Consider how the historical practice of redlining – the discriminatory practice of denying services (typically financial) to residents of certain areas based on their race or ethnicity – has resulted in many Black individuals living in communities that are located further away from treatment facilities (hospitals, outpatient clinics) or in areas with inconsistent access to public transportation enabling them to participate in treatment.
Systemic discrimination also affects Black youths - it has been well-documented that Black students are subject to disciplinary actions in school at rates that are significantly higher than their White peers. This systemic bias – resulting from a combination of individuals’ implicit bias and historical cultural biases against Black children – results in significantly worse life outcomes, including higher rates of involvement with the criminal justice system.
Thus, one-size-fits-all policies that unfairly punish clients who struggle to attend appointments or children with behavioral concerns not only deny these people much-needed care, but serve to perpetuate historic systems of racism and discrimination that created health and educational disparities in the first place.
· First Steps: Conduct a review of clients who have been disciplined or dismissed in your setting. Are there noticeable trends regarding these clients’ ethnic background, home addresses, or insurance type (which may be an indicator of discriminatory financial practices based on race or financial means)?
· Next Steps: Review office policies using a lens of racial equity. Do your policies have the potential to discriminate against a specific cultural group that is under resourced or historically marginalized? If so, collaborate with leadership to revise discriminatory policies and find solutions that avoid further harm to Black and brown clients and perpetuation of historically unjust practices (ex. Flexible scheduling, transportation assistance, telehealth options, etc.)
Individual and systemic biases can have a huge impact on the experiences of Black OT clients in therapy and beyond. OT practitioners who are committed to anti-racist, culturally humble, and inclusive practices can have a positive impact on their clients, workplaces, and communities by
· Going beyond the book club and engaging with local programs and/or virtual communities that foster lifelong learning and a continuous commitment to being an anti-racist OT practitioner
· Conducting regular self-assessments and seeking feedback on implicit and explicit biases toward Black and brown clients
· Increasing knowledge on specific health issues facing Black clients and considering these concerns when developing plans of care
· Engaging in lifelong learning about the impact of systemic racism, discrimination, and bias and gaining skills to become an ally, accomplice, or interrupter
· Collaborating with leadership to develop systems-level policies to positively impact Black and brown clients and communities
Although the focus of this article is the harm done to Black clients by individual and systemic biases, it is worth noting that justice-focused practice benefits all clients who have experienced harm as a result of factors such as poverty, ethnicity, sexual orientation, and historic discrimination. While each client is an individual, it is important to understand how historic health and justice issues can impact historically marginalized client populations and include these considerations during the therapy evaluation, intervention, and discharge process.
Increasing your awareness of your own biases is not enough. Making the decision to challenge your biases, practice cultural humility daily, and continually work towards systems-level change not only honors OT values and ethical principles but also helps positively impact health outcomes for Black clients and communities today and in the future.
Be Heard—We’re Listening: Emerging Issues and Potential Solutions From the Voices of BIPOC Occupational Therapy Students, Practitioners, and Educators (Article)
Organizing Against Racism Groundwater Training (Training)
Getting Our Knees Off Black People’s Necks: An Anti-Racist Approach to Medical Care (Article)
How to provide anti-racist mental health care (Article)
Interrupting Microaggressions in Health Care Settings: A Guide for Teaching Medical Students (Article)
Dismantling Racism Web Workbook (Workbook)
NY Times article on myths about physical racial differences in times of slavery and still today (News Article)
The Myth of Innate Racial Differences Between White and Black People’s Bodies: Lessons From the 1793 Yellow Fever Epidemic in Philadelphia, Pennsylvania (Article)
Me and White Supremacy (Book)
USC Law Book List (Reading Resource List)
Culturally Connected (Website & Trainings)
About the Author
Lauren Jones, MS, OTR/L (she/her/hers) earned a B.S. in Psychology from the College of William and Mary and an M.S. in Occupational Therapy at the University of North Carolina at Chapel Hill. She has held many leadership positions throughout her career and is active in state and national occupational therapy associations, including NCOTA, AOTA, and COTAD. Ms. Jones is a faculty member of the Durham Technical Community College Occupational Therapy Assistant program and is dedicated to promoting justice in OT education and in her clinical practice.
Diversity, Equity, and Inclusion are important concepts for all OTs, OTAs, and students
Occupational therapy practitioners have to understand how to address these concepts in our clients, but we also need to understand how to promote DEI within our profession.
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