Connections,Renewal,and Inspiration

Alyson

Thank you. As I often say, the occupational therapy community is my family, and INSPIRE is our Thanksgiving celebration. I am thankful to be here, and I am thankful for each one of you here with me. This year, I have spent a lot of time traveling to different state conferences and occupational therapy events. Some of you have heard me speak about a book I have read: WALK: Slow Down, Wake Up, and Connect at 1–3 Miles Per Hour. In this book, Jonathon Stalls examines how a cross-country community opens new avenues for renewal, connection, and change. I realize my journey this past year has been similar, except I found connections, renewal, and inspiration that propelled my own occupational therapy journey in new ways.

And I am changed. Thank you. I have the honor of introducing you all to my own unique occupational therapy journey at AOTA INSPIRE 2023. Now I want to share with you some of the incredible people and stories who reignited my passion to expand my understanding of occupational therapy. So, let us take a look.

Sophia

My name is Sophia, and I am a third-year Doctor of Occupational Therapy student at Boston University. I’m on my first Level II fieldwork rotation. I have worked at a summer camp. It was just a day camp. I worked with 3- and 4-year-olds, and there was one kid who stood out to me. She had some sensory aversion, not always getting along with the other kids, so I tried to support her and get her the environmental adaptation she needed. I did not really know what I was doing at the time, but it made sense to me. Then, at the end of the summer I got an email from her dad saying, “She is doing so much better in school; she talks about you all the time.” It was just such a meaningful experience that I made an impact in this child’s life, you know? It is for the summer or beyond that, but it was really cool.

I will remember that forever. And then, working with the young adults at the school, I felt that was the coolest thing because I had the experience to go to class with them and help them in their internship experiences to gain employer skills. They offered such a unique perspective on a lot of things. I made great friends with a lot of the students. And I just loved that the program, you know, did not just focus on one thing. Of course, there was the educational aspect where they went to classes, and it is kind of my responsibility to adapt the material as needed. But there was also the social aspect. It was, you know, building a college experience for these individuals—if there was an event on campus, organizing who they will go with, how they will get there. So that was meaningful as well, to be a part of a meaningful experience for them.

It was not just in the classroom, outside of it as well.

Alyson

My conversation with Sophia reminded me that we all have that memory of discovering occupational therapy. But how often do we pause and reminisce about that? How often do we keep our eyes open to additional opportunities to wake up to our discovery of occupational therapy? How often do we know what the stories are for our peers and our colleagues? So I give you an action, a challenge: What was your “Aha!” moment, where you knew you were intended to be part of the occupational therapy community? Write it down, share it with somebody this week that you meet, and then share it with somebody at home. Remember it, and share how you woke up to occupational therapy. While in Arizona I had the privilege of meeting a force in public health: a woman who inspired me to wake up to how the most necessary ADLs [activities of daily living] are truly fundamental to occupational practice. She did this through her “Aha” story that also taught me about the immense importance of occupational therapy practice in health care. Here is a part of our conversation.

Leslie

My name is Leslie, and I just relocated to Arizona. So my father was diagnosed with prostate and bladder cancer, and I saw this very gregarious, outspoken leader in his community literally go from that role and level of participation to a very withdrawn, almost depressed person. Because he was experiencing incontinence, I did some research and there was a specialty, pelvic floor therapy. So I took my dad to it. He was a good student, and I literally saw my dad get his life back. I got my dad back, and the community got an incredible leader back. So this was such a transformative experience for me, and it planted the seeds for where I am today. There is nothing more ADLs than a pelvic floor and if we look at it through that lens and look at it for participation activities just like I saw my dad, we will realize that when we look at it through that lens the quality of life we are able to give back to our clients, and it will take advocacy, that everyone knows that OTs [occupational therapists] can do this. But when we step into that and realize how fulfilling it is, how it is the things nobody is talking about, when we start to talk about them you will hear, “Yeah, I pee when I live a little bit.”

Alyson

In that brief [video] clip, she shared how her experience with her father and functional participation in basic occupations formed the foundation of her innovative practice in pelvic health. And she mentioned advocacy.

If we are committed to representing the distinct value of occupational therapy in all the places we deserve to be recognized, we must articulate our own wake-up narrative. The connection of this narrative to functional participation and functional participations links to human dignity. I have another challenge for you all. Jonathon Stalls says in his book, “Movement with a group, when nurtured and cared for, can be an incredible pathway to human dignity.” We must then challenge ourselves to explore the narratives of our colleagues, our peers, consumers, family, friends, neighbors, and then seek to identify the ways we can encourage functional participation to elevate the experience of human dignity for all.

Which brings me to a woman who became one of my most treasured friends in a very short time. I met Ashley in Arizona as well, an innovative occupational therapy assistant practicing at the top of her license who reminded me about the link between human dignity and vulnerability. Let us take a look at just a part of our conversation.

Ashley

My name is Ashley. I am an occupational therapy assistant, and I work in home health with adults. I was raised in a multiracial family, and you know, there were a lot of different diagnoses that my siblings and my parents had. I got to see firsthand how some of us were treated different based on our race or our appearance or what diagnosis we might carry. That was very unfortunate. I had come from kind of an upper–middle-class, I was born into an upper–middle-class family in a White suburb of Chicago, very well-to-do. My grandparents were business owners, and so I saw what it was like to have private insurance. Then I moved with my mom, who was a single mom, out in Arizona. I got to see the difference in how you were treated when you had that insurance versus when you had, you know, state insurance or something like this. And when you are a Brown person with state insurance, or you are a person with autism with state insurance, something like this.

So when I witnessed disparities, as far as how we are treated, I decided early that I want to work in health care so I could make sure nobody was ever treated that way. I could be that kind of a change and create a safe space for people like me. People like my mom and my siblings, like my great-grandmother, who had a stroke and was in rehabilitation, to put her makeup back on. She was the kind of person who always had her makeup on; you never know who you will meet or who will come to the door. So the way she put her lipstick on was important to her, and the occupational therapist focused on things like that, and that was intriguing to me and meant something to me. We shared a room after she had her stroke, so I got to really see how she progressed as far as her independence was concerned. My dad suggested I look into occupational therapy. When he became a speech pathologist, I did. And I really liked the idea of supporting people and their independence on their terms.

When I went into the field, I found that when I went into the rehab department a lot of people looked like me. It was predominantly White women. So we are in a helping profession and are doing good as or whatever, but behind closed doors I witnessed a lot of prejudice and a lot of biases. They were expressed in certain spaces with people who just look like us. So here I thought I had come from this place of, “OK, I will be the change I wish to see in the world, and now I have my credentials and now I can go and do this.” But behind closed doors I am seeing that the people around me still hold these values. The way the worldview still is influenced by certain biases in a way that shows me they are not able to connect with their clients as human beings, as individuals. They are not able to see that.

Alyson

Thank you for sharing this part of your journey and having the courage to do so, Ashley.

I love when she says, how can we be the change we want to see? I believe that to achieve authentic, meaningful, and sustainable change we must be vulnerable first. What do we know? What do we not know? How can we learn more? Where are our weaknesses? I am eternally grateful to Dr. Shanice Hamilton and Ms. Natalie Chang-Mason and the AOTA DEI Committee for being authentic and vulnerable and brave in the sustainable change we are all desperate to see.

I am thankful for their willingness to teach me, hold me accountable, and also offer me patience and grace and acceptance. I am honored to have the privilege to learn from Dr. Arameh Anvarizadeh, AOTA’s vice president, every day. I am eager and hopeful to propel her visions of connecting community and belonging into the reality of occupational therapy and the core of our culture. And when I hear of tragic events like a story of Ralph Yarl, a brilliant 16-year-old, young Black man, recently shot in Kansas City after ringing the wrong doorbell, I am saddened and motivated. Motivated to live AOTA’s societal statement on gun action in actionable ways.

Remember this statement says that practitioners, researchers, we all must recognize areas of occupational and social injustices to support, inform, and advocate for actions and laws that aim to improve the quality of life through interventions and policies aimed at addressing the occupational nature of gun violence occurrences in society.

How will we, the occupational therapy community, advocate support for Ralph Yarl and his family? How will we support and advocate for the many victims, some of us knowing this experience within our own community? Many of you have already begun to donate to the charity that has been announced yesterday. If you have and if you have not had a chance to give in appreciation and support for Ralph Yarl, it will be available on the app later today.

Now the action, the challenge to you all: Share your pain and nurture your wounds. And then intentionally create space to hear the pain and nurture the wounds of others. As I think about simple, daily occupations affected and the lives of so many, I must acknowledge that we each need to take time to learn about the needs of individuals from their experiences. Lisa reminded me what it is like to walk with creative wonder while learning about the many occupations of individuals. Let us take a look at a part of the conversation.

Lisa

I am Lisa, and I’m here at St. Louis, Missouri. In college, I traveled to 12 countries around the world and I was fascinated by people, and little did I know at the time that I was entranced by their daily activities, their daily occupations. And things like them going to work, cooking meals with one another, the way they clean their homes, all of these things. And I visited a school for children with disabilities in China.

I stayed overnight sleeping on a dirt floor in a Dalit village and went to an orphanage visited by Mother Teresa. What I saw made me question the world around me, the things people do, and it made me want to learn more. I attended my first AOTA conference, and it was in Seattle, Washington. So my friends from Missouri, we all traveled there. We slept in one hotel room [laughs]. We bunked in the same room so it was more cost-effective for us, and we had a blast. That conference was the most energizing thing we had ever experienced in the OT world at that point. So at that conference I went to a session by Dr. Karen Jacobs, and she talked about ergonomics in injury prevention and I was completely sold: I am like, “I have to do this.”

So I decided I would find my first job as an OT practicing ergonomics. After an intensive search—at that time it was Monster.com, and I had to look at different job titles because OT did not exist in that space—I had to look at manufacturing, engineering, you name it, and I had to look at any kind of job that might look for ergonomic services. I landed my first job as a contractor at a manufacturing plant, absolutely loved it, and I also began thinking—treating workers in industrial plants, so industrial rehabilitation.

Alyson

My conversation with Lisa reminded me to be in wonder. Wonder about the daily experiences of others across the globe. Wonder about how to invest occupational therapy into all the places where occupations are happening. Where are occupations happening that we need to elevate the value of occupational therapy as a support, as an intervention, and as an advocate in performing occupations? I have seen motions that recommend defining our role in gender-affirming care, sustainability and climate change, and critical care in therapy practice across the lifespan. I have heard of an incredible group who has started a school of occupational therapy in Haiti, each individual teaching volunteering their time.

I see with each of these occupational therapy practices that occupational therapy itself continues to dominate as a profession, a profession that can work in mental and community health, environmental interventions, and person-first biomechanical treatment across the world. Because occupation happens for all people in all different places. I am reminded that I may not be an occupational therapist who can practice in all places, but occupational therapy does exist in all places. We may differ in where we practice, or the style of practice, but we all share a core foundational connection to occupation. That is distinct, and that is powerful, and that is this community.

Another action for you all: Name what puts you in a state of art; name it out loud, allow it to be your own achievements, healing experiences. Investigate how you nourish your spark and intentionally build it into your daily routine. As I reflect on all the ways our incredible profession puts me in art, I think about my conversation with Arianna. Here is just part of our conversation.

Arianna

My name is Arianna. After two years of practicing, I decided to go back to school to get my doctorate in OT with a focus on program development for underserved populations so I can figure out my own program, figure out ways to provide services I believe people deserve and to get to people who sometimes fall through our systems. I piloted these programs for those postincarceration when they are getting back into the community. I developed it, piloted it out in Missouri, in a correctional facility. After that, I moved back to Michigan and pitched it to a local jail, and I was lucky enough they heard me out, because I was not expecting that.

But they did, and now that is where I give the majority of my services. After I did that program as part of my doctoral research, the pilot, I knew that this is exactly what I want to be doing and I cannot settle for anything else. I have had to learn the hard way about developing a business and what to do for that, so yes. Wearing multiple hats, but now the business, it has been a little over two years that it has been officially business. But right before I did my pilot, working with people experiencing homelessness and seeing that overlap‚ I think in general one of the “Aha” moments was not a client story but realizing how much of what is expected of somebody out on parole or probation has to do with executive functioning and all those kinds of skills required for that. And how much this population has, or such a high incidence of mental health issues, substance use, which all affect executive functioning.

When I found that out and found out how many people were going back to prison because of technical violations, usually related to not showing up on time for something or not reporting to the parole officer, like that are not really clients. That shocked me and I was like, “This is the perfect place for OTs.” That was an “Aha” moment going into it.

Alyson

I love the places where Arianna sees occupational therapy fits. She further challenged me later as she began to discuss the barriers consumers face every day. Currently, we have laws and United States Supreme Court decisions that state that jails and prisons must provide health services to justice-involved individuals who are incarcerated. However, we also have laws that prohibit these individuals from receiving coverage for Medicaid. It was stated in 2009 that approximately 14% of individuals in federal prison, 20% of individuals in state prison, and 60% of individuals in local jails did not even receive a medical examination while incarcerated.

Arianna reminded me that these barriers can exist even in our own profession—barriers for justice-involved individuals to pursue meaningful employment within the community. As she said to me, “Background checks are standard for programs. But if we say we are looking to make a field more diverse, we need to be cognizant of the kind of barriers we are putting up with requirements.” This is just one population. I am sure each of you can think of shared barriers and injustices that other populations are experiencing as well. The unhoused, veterans—there are so many. So my action is now: Create an advocacy plan and advocate. That brings me to an expansive humility and my part in an occupation that is life changing and powerful. In my conversation with Bobby, he exemplified how coming from a place of humility in occupational therapy practices can change not just the life of consumers but system-wide practices and our own lives as well. Let us take a look.

Bobby

Hi, I am Bobby; I am an occupational therapist working in Baltimore, Maryland, at Johns Hopkins. I have two roles here: I’m a manager for the occupational therapists and treat people in the Department of Psychology. I am also the director of the AOTA mental health fellowship here at Johns Hopkins. There is one individual who had been in and out of the hospital multiple times and was really focused on, “I do not need to be here, I am just being labeled as a bad kid.” And so kind of working with that patient to understand—they did not understand the concept of stigma—and kind of educating them at their level of what it meant in getting it back to them so we can show the family just how they were describing their child and how that was impactful to them. So being able to do that with younger kids was a unique experience that I was not used to before. Sometimes you have to ask a patient how they are feeling today, and that one simple question is so impactful to people.

We have been able to reduce the use of restraints, the use of medication, the use of security with a lot of our interventions and stuff. Seeing that happen across the enterprise has been very powerful.

Alyson

As Bobby and I continued our conversation, I was brought back to a final challenge from Jonathon Stalls. Jonathon calls us to “Walk barefoot” and ask yourself these questions: “Do I feel connected? Connected to the earth below my feet?” “What am I thinking about?” “What am I feeling?” And then, once in this place of humility, transition to awareness. Awareness of mistakes and missteps, awareness of work well done and successes. Which brought me back to exactly where I am in my own occupational therapy journey now. I want to pause to acknowledge the six members who opened the doors to their daily lives to enhance my journey, make my journey better.

I would like the five who are here today to be recognized.

Thank you. I hope you take the time to view their full interviews, available to watch now on the AOTA website [https://aota.org]. They are incredible. My clinic, Capable Kids, has always been a way for me to carry out good work, God’s work, in my community. But as I went through this journey and I got to a place of humility, becoming aware of my own missteps and mistakes, I saw the outpouring of support and the opportunity to learn from amazing individuals that I get to share this place of employment with. As I became aware of work well done and successes, I recognized that this only happens with the collaboration of my Capable Kids family. Just as I brought up my board family to be celebrated last year, I would like to bring up my Capable Kids family.

Help me celebrate them, the good work they do, which is a reflection of the good work you do. And the necessary and brilliant parts that each of you plan in the journey of occupational therapy. You are occupational therapy. You are AOTA. We are the best community there is. Thank you so very much.