2. Cristina Reyes Smith, OTD, OTR/L
o Medical University of South Carolina (Charleston, SC)
Arameh Anvarizadeh, OTD, OTR/L
o California Children’s Services (Los Angeles, CA)
D’Andre Holland, OTD, OTR/L
o Every Child Achieves (Los Angeles, CA)
Catherine Hoyt Drazen, OTD, OTR/L
o Washington University in St. Louis (St. Louis, MO)
Nadine Kwebetchou, MS, OTR/L
o VA Palo Alto (Palo Alto, CA)
Stacy Wilson, MS, OTR/L
o WakeMed Health and Hospital (Raleigh, NC)
3. Rationale and Background
Focus Group Results and Discussion
Personal Perspectives
Moving Toward the Diverse Workforce of the
Centennial Vision
5. We envision that occupational therapy is a
powerful, widely recognized, science-driven, and
evidence-based profession with a globally connected
and diverse workforce meeting society's
occupational needs.
(AOTA, 2007)
6. di·ver·si·ty
noun də-ˈvər-sə-tē, dī-
: the quality or state of having many different
forms, types, ideas, etc.
: the state of having people who are different races or
who have different cultures in a group or organization
(Merriam Webster, Inc., n.d.)
8. Population (2012): 313, 873, 685
o Under 5 years: 6.4%
o Under 18 years: 23.5%
o 19 to 64 years: 62.8%
o 65 and over: 13.7%
o Female: 50.8%
o White, alone: 63.0%
o Black/African American, alone: 13.1%
o American Indian/Alaska: 1.2%
o Asian, alone: 5.1%
o Two or more races: 2.4%
o Hispanic/Latino: 16.9%
(U.S. Department of Commerce,
2014)
12. 0
10
20
30
40
50
60
70
White Black AIAN Asian NHPI Two or
More
Races
Hispanic
2012
2035
2060
(As cited by U.S. Census Bureau, Population Division in Census.gov, n.d., p. 4
AIAN=American Indian and Alaska Native; NHPI=Native Hawaiians and Other Pacific Islanders
16. B.1.3: Demonstrate knowledge and understanding of the concepts
of human behavior... including but not limited to introductory
sociology or introductory anthropology.
B.1.4: Apply knowledge of the role of the
sociocultural, socioeconomic and diversity factors and lifestyle
choices in contemporary society to meet the needs of individuals
and communities.
B.1.5: Demonstrate an understanding of the ethical and practical
considerations that affect the health and wellness needs of those
who are experiencing or are at risk for social injustice, occupational
deprivation and disparity in the receipt of services.
B.2.9: Express support for the QOL, well being and occupation of
the individual, group or population...considering the context
(cultural, personal, temporal, virtual).
(AOTA, 2011)
17. B.4.7: Consider factors that might bias assessment results, such as
culture, disability status, and situational variables related to the
individual and context.
B.5.20: Effectively interact through written, oral, and nonverbal
communications with the client, family, significant
others, communities, colleagues, other health providers and the
public.
B.5.33: Provide population-based occupational therapy intervention
that addresses occupational needs as identified by the community.
B.6.3: Integrate current social, economic, political, geographic and
demographic factors to promote policy development and the
provision of OT services.
B.7.9 (OTD only): Demonstrate knowledge of and the ability to write
program development plans for provision of services to individuals
and populations.
(AOTA, 2011)
18. ―Occupational therapy practitioners have the responsibility to
intervene with individuals and communities to limit the effects
of inequities that result in health disparities. Practitioners have
knowledge and skills in evaluating and intervening with
individuals and groups who face
physical, social, emotional, or cultural challenges to
participation. Further, the American Occupational Therapy
Association (AOTA) supports advocacy to increase access to
health services for persons in need, and efforts to lessen or
eliminate health disparities are consistent with the
Occupational Therapy Code of Ethics and Ethics Standards
(2010) (AOTA, 2010).‖
(AOTA, 2013)
19. Benefits and drawbacks to diversity:
o Pros: Increased creativity and innovation
o Con: increased conflict through a variety of ideas and
beliefs presents
o Mediating factors to negative effects of diversity are:
1. Leadership
2. Communication
(Dreachslin, Weech-Maldonado, & Dansky, 2004)
―Leaders who are able to validate alternative realities and
appreciate different perspectives appear to moderate the
potential negative effects of racial diversity on team
communication processes and strengthen the positive aspects
of diversity‖
(Dreachslin, Hunt, & Sprainer, 2000, p. 1403)
20. ―Minorities receiving care in hospitals with a less diverse
inpatient population may face greater barriers to health
care than those receiving care in hospitals with a more
diverse patient population.‖
(Weech-Maldonado et al., 2012, p. 821)
―There is a need for occupational therapy to deepen its
understanding of how the experience of being a minority
group client within a therapeutic relationship intersects with
the process and outcomes of occupational therapy.‖
(Kirsh, Trentham, & Cole, 2006)
21. ―Diversity will only be achieved if the primary focus is on:
what is happening within the pipeline…Emphasizing
talent development opens up many new approaches for
science training outside of traditional degree programs.‖
(McGee, Saran, & Krulwich, 2012)
Literature is scarce on the long-term benefits of
workplace diversity in OT:
o (Kirsh, Trentham, & Cole, 2006)
o (Trentham, Cockburn, Cameron, & Iwama, 2007)
22. Imbed cultural competency training into OT curriculums
(Nochajski, & Matteliano, 2008)
Fieldwork education with underserved populations and
international fieldwork opportunities (Kirsh et al., 2006)
Promote self-reflection into OT students’ own cultural
identities (Kirsh et al., 2006)
Explore qualitative literature which depicts the
experiences of minority groups who receive OT (Kirsh et
al., 2006)
Include discussions in academia of discrepancies in
Westernized versus non Westernized cultural values
(Iwama, 2003; Kinebanian & Stomph, 1992)
23. Podsiadlowski et al., 2013:
o Organizational paradigms to diversity
• Discrimination and fairness
• Access and legitimacy
• Learning and effectiveness
Suarez-Balcazar et al., 2011:
o Self-reflection
o Integrating culture in the occupational therapy process
o Developing organizational support for change
Dass and Parker, 1999:
o Resistance to organizational support for change
24. Dynamic between client and provider can be compromised by
sociocultural mismatches
Competence connotes a theory that can be mastered
Cultural humility indicates:
o Lifelong commitment to self-evaluation and self-critique
o Addressing power imbalances in the provider/client dynamic
o Developing partnerships with communities
Focus on student education to examine individual patterns of
unintentional and intentional racism, classism, homophobia
(Tervalon & Murray-Garcia, 1998)
25. …transculturally competent therapists are skilled at working
with the client to:
o identify how meanings are created and/or expressed
through occupation
o acknowledge systemic barriers to inclusion and are able to
advocate for their amelioration
o open to learning about the lived experience of their clients
o knowledgeable about their {clients} values and health
beliefs
o insightful about their own values and assumptions
regarding what are good and right and true
o can monitor their own tendency towards ethnocentricity
(Trentham, Cockburn, Cameron, & Iwama, 2007)
26. Cultural fluidity (Shippy, 2009):
o Able to adapt to different cultures--expert and learner
Cultural humility (Tervalon & Murray-Garcia, 1998):
o Every interaction is multicultural; must be aware of personal bias
Transcultural competence (Kirsh et al., 2006):
o Ability to function effectively within a given role with a diversity of
individuals whose cultural perspectives differ from one’s own
• Cultural sensitivity is viewed as one aspect of transcultural
competence.
Cultural proficiency (AAFP, n.d.):
o Knowledge, skills, and attitudes which enable people to work
well with, effectively respond, and support people in cross-
cultural settings
27. ―Another promising strategy might be to make use of
―influential‖ therapists….In our opinion, knowledge
brokers could be very important, especially in the last
stages of implementation—change and maintenance.‖
(Ketelaar, Russell, & Gorter, 2008)
―For research findings to effectively influence health
services’ delivery of care needs an intermediary…an
emerging role therefore exists for knowledge
brokers, supported by knowledge brokering resources
and agencies, to fill the gap.‖
(Lomas, 2007)
28. Therapists value interactive and hands-on continuing
education but rely most heavily on their peers when
accessing, evaluating, and implementing new
knowledge.
Trials involving educationally influential therapists are
indicated.
Continuing education research is needed to identify
organizational conditions conducive to therapists’
learning and knowledge translation.
(Rappolt & Tassone, 2002)
30. 1. What does diversity mean to you?
2. How do you define diversity?
3. What are 2-3 things that you have observed, done or
could do to promote diversity in the workforce?
4. What do you feel is the importance of diversity in the
workforce?
5. Is there anything else you would like to share?
31. Focus Group Results
17 (23%) 21 (28%)
Participants by region (n=75):
32 (43%)
1 (1%)
Not reported 3 (4%)
35. ―I am reminded that we as a profession need to keep our eyes
fresh to continually adjust our modes of operation. Only then
can we provide the best patient care and more fully promote a
richer QOL.‖
―Diversity tends to be boxed into groups, but it is a really
broad concept on more than race, gender, religion and
sexuality.‖
It is extremely important. No pt is the same meaning having
diversity in the workforce helps us as OTs provide more pt
centered practice and increases the comfort and relatability
pts feel with us.
36. Its important for patients of different cultures to see we have
employee diversity as well
―Equality does not equal diversity -> makes working together
interesting.‖
I realize there are many types of diversity, as we discussed.
Some areas, such as rural may only have 1 OT for hundreds
of miles. In these cases there is not a lot of opportunity for a
diverse professional pool. I feel the therapist needs to be
diverse in their understanding of cultures that they do not
belong to. There is such an opportunity to learn from our
clients too. Maybe this is considered cultural sensitivity, but
we also need to be diverse in our own self to be effective.
46. 1. What does ―diversity‖ mean to you? How does
diversity relate to your workplace?
2. What are some strategies that you have
observed, implemented, or could do to promote diversity
in the workforce?
3. Discuss the concepts of cultural competence, cultural
humility, cultural fluidity, and trans-cultural care. Why are
these different? Do they matter? Why or why not?
47. 1. What were some of the perspectives discussed
by your group? Were there any insights or
epiphanies you would like to share?
2. Are there any other supports or barriers to
promoting diversity in your workplace or
university that you have observed?
48. Invest in people—it can make all the difference
Tell people who you are and what you do. Advocate for
what you are doing, and look for teachable moments
Be an advocate in/for your community. Look for
volunteer opportunities to speak at local schools or
career fairs
Create volunteer/observation opportunities for youth
Do not underestimate the one minute elevator speech.
You can change a life in a minute
Provide opportunities for structured and unstructured
mentorship on multiple organizational levels
Provide financial support for Conference and/or
Conclave
Strategize inclusion of OT in career interest tools/events
51. Cristina Reyes Smith, OTD, OTR/L; Medical University of South
Carolina (Charleston, SC); (843) 814-7917; smithcris@musc.edu
Arameh Anvarizadeh, OTD, OTR/L; California Children’s Services
(Los Angeles, CA); (213) 820-3260; anvariza@gmail.com
D’Andre Holland, OTD, OTR/L; Every Child Achieves (Los
Angeles, CA); (317) 445-8573; deehollandOT1209@gmail.com
Catherine Hoyt Drazen, OTD, OTR/L; Washington University in St.
Louis (St. Louis, MO); (301) 467-0177; hoytc@wusm.wustl.edu
Nadine Kwebetchou, MS, OTR/L; VA Palo Alto (Palo Alto, CA);
(443) 562 -3774; nadine.kwebetchou@gmail.com
Stacy Wilson, MS, OTR/L; WakeMed Health and Hospital
(Raleigh, NC); (336) 847-0093; mrstacywilson@gmail.com
52. American Association of Family Physicians. (n.d.). Cultural Proficiency.
Retrieved from http://www.aafp.org/patient-care/public-health/cultural-
proficiency.html
American Occupational Therapy Association. (2013). AOTA’s societal
statement on health disparities. American Journal of Occupational
Therapy, November/December 67, 6 (Supplement), 57-58.
American Occupational Therapy Association. (2012). Academic Programs
Annual Data Report: Academic Year 2011-2012. Retrieved from
http://www.aota.org/-
/media/Corporate/Files/EducationCareers/Accredit/47682/2011-2012-
Annual-Data-Report.pdf
˜ American Occupational Therapy Association. (2011). ACOTE Standards.
Retrieved from http://www.aota.org/-
/media/Corporate/Files/EducationCareers/Accredit/Draft-Standards/2011-
Standards-and-Interpretive-Guide-August-2013.pdf
53. American Occupational Therapy Association. (2010). Faculty Workforce
Survey. Retrieved from http://www.aota.org/-
/media/Corporate/Files/EducationCareers/Educators/OTEdData/2010%20F
aculty%20Survey%20Report.pdf
American Occupational Therapy Association. (2007). AOTA’s centennial
vision and executive summary. American Journal of Occupational
Therapy, 61, 613–614.
˜ ˜ Census.gov. (n.d.). Methodology and Assumptions for the 2012 National
Projections. Retrieved from
http://www.census.gov/population/projections/files/methodology/methodstat
ement12.pdf
Dass, P., & Parker, B. (1999). Strategies for managing human resource
diversity: From resistance to learning. Academy of Management
Executive, 12, 68–80.
Dreachslin, J. L., Hunt, P. L., & Sprainer, E. (2000). Workforce diversity:
implications for the effectiveness of health care delivery teams. Social
Science & Medicine, 50, 1403-1414.
54. Dreachslin, J. L., Weech-Maldonado, R., & Dansky, K. H. (2004). Racial and
ethnic diversity and organizational behavior: a focused research agenda for
health services management. Social Science & Medicine, 59, 961-971.
˜ Gates, M. G., & Mark, B. A. (2012). Demographic diversity, value
congruence, and workplace outcomes in acute care. Research in Nursing
and Health, 35(3), 265-276.
Halime, C., Abma, T. A., Klinge, I., & Widdershoven, G. A. M. (2012).
Process evaluation of a diversity training program: The value of a mixed
method strategy. Evaluation and Program Planning, 35, 54-65.
˜ ˜ Hildebrand, K., Lewis, L.J., Pizur-
Barnekow, K., Schefkind, S., Stoffel, A., & Wilson, L.S. (2013). Frequently
asked questions: How can occupational therapy strive towards culturally
sensitive practices. Retrieved from
http://www.aota.org/media/Corporate/Files/Secure/Practice/Multicultural/FA
QCulturalSensitivity.pd1f
Iwama, M. (2003). Toward culturally relevant epistemologies in occupational
therapy. American Journal of Occupational Therapy, 57, 583–589.
55. Ketelaar, M., Russell, D.J., & Gorter, J.W. (2008). The challenging of moving
evidence-based measures into clinical practice: Lessons in knowledge
translation. Physical and Occupational Therapy in Pediatrics, 28(2), 191-
206.
Kinébanian, A. & Stomph, M. (1992). Cross-cultural occupational therapy: a
critical reflection. American Journal of Occupational Therapy, 46, 751–757.
Kirsh, B., Trentham, B., & Cole, S. (2006). Diversity in occupational therapy:
Experiences of consumers who identify themselves as minority group
members. Australian Occupational Therapy Journal, 53, 302-313.
˜ Lomas, J. (2007). The in-between world of knowledge brokering. British
Medical Journal, 334, 129–132.
McGee, R., Saran, S. & Krulwich, T. A. (2012). Diversity in the biomedical
research workforce: Developing talent. The Mount Sinai Journal of Medicine
New York, 79(3), 397-411.
˜ Merriam-Webster, Inc. (n.d.). Diversity. Retrieved from
http://www.merriam-webster.com/dictionary/diversity
56. Nkansah, N. T., Youmans, S. L., Agness, C. F., & Assemi, M. (2009).
Fostering and managing diversity in schools of pharmacy. American Journal
of Pharmaceutical Education, 7.
Nochajski, S., & Matteliano, M. (2008). A guide to cultural competence in the
curriculum: Occupational therapy. Retrieved from Center for International
Rehabilitation Research Information and Exhange (CIRRIE) website:
http://cirrie.buffalo,edu
Nunez-Smith, M., Pilgrim, N., Wynia, M., Desai, M. M., Jones, B.
A., Bright, C., Krumholz, H. M., & Bradley, E. H. (2009). Race/ethnicity and
workplace discrimination: results of a national survey of physicians. Journal
of General Internal Medicine, 11, 1198-1204.
˜ Rappolt, S., & Tassone, M. (2002). How rehabilitation therapists
gather, evaluate, and implement new knowledge. Journal of Continuing
Education in the Health Professions, 22, 170–180.
Shippy, M.A. (2009). Cultural Fluidity: How multicultural leaders adapt in the
US business environment. Verlag, Germany: VDM Verlag.
57. Suarez-Balcazar, Y., Balcazar, F., Taylor-
Ritzler, T., Portillo, N., Rodakowski, J., Garcia-Ramirez, M., & Willis, C.
(2011). Development and validation of the cultural competence assessment
instrument: A factorial analysis. Journal of Rehabilitation, 77, 4–13.
Tervalon, M. & Murray-Garcia, J. (1998). Cultural humility versus cultural
competence: A critical distinction in defining physician training outcomes in
multicultural education. Journal of Health Care for the Poor and
Underserved. 9(2).
Trentham , B., Cockburn, L., Cameron, D., & Iwama, M. (2007). Diversity
and inclusion within an occupational therapy curriculum. Australian
Occupational Therapy Journal, 54, S49-S57.
Weech-Maldonado, R., Elliott, M.
N., Pradhan, R., Schiller, C., Dreachslin, J., & Hays, R. D. (2012). Moving
towards culturally competent health systems: Organizational and market
Factors. Social Science & Medicine, 75, 815-822.
U.S. Department of Commerce. (2014). United states census bureau: State
and county quickfacts. Retrieved from:
http://quickfacts.census.gov/qfd/states/00000.html
Editor's Notes
The data on race were derived from answers to the question on race that was asked of individuals in the United States. The Census Bureau collects racial data in accordance with guidelines provided by the U.S. Office of Management and Budget (OMB), and these data are based on self-identification. The racial categories included in the census questionnaire generally reflect a social definition of race recognized in this country and not an attempt to define race biologically, anthropologically, or genetically. In addition, it is recognized that the categories of the race item include racial and national origin or sociocultural groups. People may choose to report more than one race to indicate their racial mixture, such as “American Indian” and “White.” People who identify their origin as Hispanic, Latino, or Spanish may be of any race. OMB requires five minimum categories: White, Black or African American, American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander.
The significance of age and sex data:Slide shows: Population by Sex and Selected Age Groups: 2000 and 2010 (SUMMARIZE CHART)Focusing on a population’s age and sex composition is one of the most basic ways to understand population change over time. In general, the U.S. population continues to grow older with a median age over 40 years old in many states. At the same time, increases in the number of men at older ages are apparent. Understanding a population’s age and sex composition yields insights into changing phenomena and highlights future social and economic challenges.
Not knowing lived experiences, health beliefInherent is the patient focused interview and client centered language