(AOTA) Diversity in the Workforce

Perspectives from Emerging Leaders

Contributing Authors Cristina Reyes Smith, OTD, OTR/L

o Medical University of South Carolina (Charleston, SC)

Arameh Anvarizadeh, OTD, OTR/Lo California Children’s Services (Los Angeles, CA)

D’Andre Holland, OTD, OTR/Lo Every Child Achieves (Los Angeles, CA)

Catherine Hoyt Drazen, OTD, OTR/Lo Washington University in St. Louis (St. Louis, MO)

Nadine Kwebetchou, MS, OTR/Lo VA Palo Alto (Palo Alto, CA)

Stacy Wilson, MS, OTR/Lo WakeMed Health and Hospital (Raleigh, NC)

Presentation Learning Outcomes

Rationale and Background Focus Group Results and Discussion Personal Perspectives Moving Toward the Diverse Workforce

of the Centennial Vision

Rationale and Background

AOTA Centennial Vision

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)

Defining Diversity 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.)

Diversity can include…

Diversity

Age

Education

Gender

Nationality

Race/ Ethnicity

Religion

Sexual orientati

on

Socio-economic status

Current Demographics in the United States

Population (2012): 313, 873, 685o 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)

Current Demographics in the United States

(U.S. Department of Commerce, 2014)

Male Students in OT Academic Programs

AOTA Academic Programs Annual Data Report: 2011-2012

(AOTA, 2012)

Faculty Gender in OT Academic Programs

AOTA Faculty Workforce Survey (December 2010)

(AOTA, 2010)

Projected Percent Distribution by Projection Series, Race,

and Hispanic Origin: 2012 to 2060

Whi

te

Blac

kAI

ANAs

ian

NHPI

Two

or M

ore

Races

Hispa

nic

0

10

20

30

40

50

60

70

201220352060

(As cited by U.S. Census Bureau, Population Division in Census.gov, n.d., p. 45)

AIAN=American Indian and Alaska Native; NHPI=Native Hawaiians and Other Pacific Islanders

Student Race in OT Academic Programs

AOTA Academic Programs Annual Data Report: 2011-2012

(AOTA, 2012)

Student Ethnicity in OT Academic Programs

AOTA Academic Programs Annual Data Report: 2011-2012

(AOTA, 2012)

Faculty Ethnicity in OT Academic Programs

AOTA Faculty Workforce Survey (December 2010)

(AOTA, 2010)

ACOTE Standards 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)

ACOTE Standards 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)

AOTA’s Societal Statement on Health Disparities

“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)

Literature on Diversity in the Workforce

Benefits and drawbacks to diversity:o Pros: Increased creativity and innovationo Con: increased conflict through a variety of ideas and

beliefs presentso Mediating factors to negative effects of diversity are:

1. Leadership2. 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)

Literature on Diversity in the Workforce

“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)

Literature on Diversity in the Workforce

“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)

Literature on Diversity in the Workforce

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)

Models of Cultural Sensitivity

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-reflectiono Integrating culture in the occupational therapy processo Developing organizational support for change

Dass and Parker, 1999:o Resistance to organizational support for change

Cultural Competence vs. Cultural Humility

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-critiqueo Addressing power imbalances in the provider/client dynamico Developing partnerships with communities

Focus on student education to examine individual patterns of unintentional and intentional racism, classism, homophobia

(Tervalon & Murray-Garcia, 1998)

New Recommendations for Competence

…transculturally competent therapists are skilled at working with the client to: o identify how meanings are created and/or expressed

through occupationo acknowledge systemic barriers to inclusion and are able

to advocate for their ameliorationo 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)

Developing Terminology 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

Strategies for Clinical Implementation

“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)

Strategies for Clinical Implementation

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)

Focus Group Results & Discussion

Focus Group Discussion Questions

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?

Focus Group Results

17 (23%) 21 (28%)

Participants by region (n=75): 32 (43%)

1 (1%)

Not reported 3 (4%)

Focus Group Survey Responses (n=75)

Yes 33%No 67%

20-29 41%30-39 23%40-49 17%50-59 13%60-69 5%

Student33%OTR/L 49%COTA 3%Research 7%Educator 8%

Focus Group Survey Responses (n=75)

Focus Group Survey Responses (n=75)

Sample Qualitative Responses

“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.

Sample Qualitative Responses

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.

Focus Group Discussion Themes

Politically-correct

Phenomenon vs.

Problem

Changing terminolog

y

Personal Perspectives

Lived Experiences of Emerging Leaders

Arameh

Catherine

Cristina

D’Andre

Nadine

Stacy

Moving Toward the Diverse Workforce of the Centennial Vision

Small Group Discussion

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?

Large Group Discussion

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?

Recommendations for the Future

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

Be strategic about recruitment and have high expectations

Recommendations for the Future

Move BeyondCultural

Competence

Questions?

Contact Information 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

References 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

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American Occupational Therapy Association. (2007). AOTA’s centennial vision and executive summary. American Journal of Occupational Therapy, 61, 613–614.

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