Abstract
This study explored the impact of an evidence-based development workshop led by an occupational therapist to improve knowledge of, skills in, and attitudes toward implementing disability-inclusive workplace practices.
The United States has a long history of work discrimination against people with disabilities, even initially making able-bodiedness a requirement to immigrate to the new nation (Nielsen, 2012). Despite the inception of disability advocacy in the 1960s and the passing of the Americans With Disabilities Act of 1990 (Pub. L. 101-336), adults with disabilities remain vastly underrepresented in work roles today (U.S. Bureau of Labor Statistics, 2025). Adults with disabilities, who represent more than one-quarter of the U.S. population, are more than twice as likely to be unemployed compared with their nondisabled peers (Centers for Disease Control and Prevention [CDC], National Center on Birth Defects and Developmental Disabilities, 2024; Taylor, 2018; U.S. Bureau of Labor Statistics, 2025). Disabled adults who do secure work are typically underemployed in part-time, underpaid, and service-related roles rather than career-oriented, long-term positions (Lidz & Smith, 2016; U.S. Bureau of Labor Statistics, 2025). A lack of equitable work contributes to additional financial, health, well-being, and social outcome disparities (Hiersteiner & Butterworth, 2018; Okoro et al., 2018; Petroutsou et al., 2018).
Approximately 22% of all employed persons in the United States with a disability engage in paid work, earning an average of $9/hr (Hiersteiner & Butterworth, 2018; U.S. Bureau of Labor Statistics, 2025). At $9/hr, a full-time job (40 hr/wk) would earn $18,720/yr. That amount is approximately one-third of the average U.S. annual salary (U.S. Bureau of Labor Statistics, 2020) and is barely above the poverty level of $14,580 (Office of the Assistant Secretary for Planning and Evaluation, 2023). These average earnings apply only to disabled persons who secure full-time employment, which is often not the case. Although other researchers have estimated the average annual earnings of disabled people to be closer to $21,509, that figure still falls more than $10,000 below the average income of nondisabled persons (MediSked & The Arc, 2018).
Disability employment disparities, including inadequate wages, contribute to the unmet basic needs of the disability community. At least 400,000 disabled adults experience homelessness at a given time; they are 2 times as likely to live in poverty (30%–45% of people with disabilities) and 4 times more likely to experience food insecurity than their nondisabled peers (MediSked & The Arc, 2018; Taylor, 2018). Limited access to employment also limits access to health care and health-related activities, even despite recent legislation to expand insurance coverage (Creedon et al., 2021). Data also suggest that one-quarter to one-third of disabled adults do not have a usual care provider and are unable to seek adequate health care because of costs (CDC, National Center on Birth Defects and Developmental Disabilities, 2024; Okoro et al., 2018). In contrast, disabled adults with paid community-based jobs are more likely to live in their own homes, have increased community participation, and report having friends outside of paid acquaintances or family members (Hiersteiner & Butterworth, 2018).
Current solutions for disability employment disparities include policy reform, direct training for persons with disabilities, and emerging disability studies best practices scholarship. These solutions typically operate asynchronously or in parallel, with limited interdisciplinary partnerships. Therefore, the success and key features of these approaches are variable and difficult to replicate across contexts (Pranksy et al., 2016). This is the case despite business leaders’ calls for better collaboration with respect to communicating disability policy and best practices (Baker et al., 2018).
In addition, many current solutions focus on addressing the performance of disabled employees rather than addressing the knowledge and skill gaps of nondisabled peers and leaders in work environments. Programs that intentionally embed disability justice principles are few or nonexistent. Disability justice perspectives critically examine and challenge exclusionary systems by centering intersectionality, valuing lived disability experiences and expertise, presenting strengths-based views of disability, and rejecting ableist participation norms (Berne et al., 2018). The shortcomings of current solutions, and the data on persisting work disparities between disabled and nondisabled people, suggest that existing interventions are insufficient for long-term positive change.
There is a clear need for innovative theory-driven approaches to bridge research, policy, and practice. Intentionally designing solutions with disability justice frameworks is important to if we are to fill existing gaps, address persisting barriers, and enhance meaningful disability inclusion in the workplace. In this article, we describe the piloting of a 60-min occupational therapist–led disability-inclusion workshop aimed at increasing working professionals’ and leaders’ knowledge, skills, and application of inclusive workplace practices at a partnering global corporate organization.
Occupational Therapy’s Role in Disability Employment and Professional Education for Nondisabled Peers
Addressing disability employment equity involves foundational occupational therapy roles and outcomes outlined in the Occupational Therapy Practice Framework: Domain and Process (OTPF–4; American Occupational Therapy Association [AOTA], 2020): client advocacy, participation, well-being, and occupational justice. Occupational therapy practitioners are particularly suited to create solutions for work participation because they are trained to holistically analyze the complex contexts, activities, and client needs at the person, group, and population levels to inform nuanced recommendations for enhancing engagement (AOTA, 2020).
Occupational therapy practitioners also address the “variety of factors that disrupt or empower those occupations and influence clients’ engagement and participation” (AOTA, 2020, p. 8). Therefore, it is appropriate and important for occupational therapy practitioners to create and lead innovative solutions that address peers and leaders in the work environment. In response, we created Everybody Works, a disability justice and occupational therapy–informed disability-inclusion curriculum for business professionals. We conducted a quality-improvement program evaluation to understand the impact of a pilot workshop from this curriculum.
Disability Language, Identity, and Positionality
Disability identity language has been debated for decades (Wooldridge, 2023). Person-first language is a familiar approach that recommends using person terms before a disability or diagnostic label (e.g., person with a disability). In contrast, many disability community members prefer identity-first language, which centers the diagnosis or disability group as the primary label (e.g., disabled adult). Ultimately, disability community members are calling for (1) a reclaiming of the terms disability and disabled as sources of pride and (2) acknowledgment of individual preferences (Setzer, 2022; Wooldridge, 2023). This call to action means that multiple forms of disability language and identity are accepted and celebrated.
We ourselves identify as nondisabled with relational disability roles, including family members, friends, and colleagues of persons with disabilities. With these perspectives in mind, in this article we use both person-first and identity-first language to represent a small variety of how people in the disability community may identify.
Guiding Theories
Critical Disability Theory
Critical disability theory (CDT) is the foundational theoretical perspective that informed the curriculum and implementation of the curriculum we describe in this article. CDT is an action-oriented methodological approach rooted in disability justice that is used to empower disabled persons by analyzing and addressing the societal context of disability (Hall, 2019; Meekosha & Shuttleworth, 2009). This framework asserts that (1) qualitative research is vital to describing disability experiences rather than reducing those experiences to numerical data; (2) autonomy rejects normative values of participation that emphasize personal independence only; (3) understanding the historical, systemic, and social context of disability is paramount; and (4) communication among diverse cultures is vital for equity and inclusion (Meekosha & Shuttleworth, 2009).
CDT rejects the medical model’s pathologizing of disability and expands on the social model of disability (Hall, 2019; Lawson & Beckett, 2021). CDT principles were embedded throughout course development, content, and implementation. Examples include highlighting resources created by disability community members, educating participants on disability history and politics, identifying and challenging common disability stereotypes and latent biases, and adopting a strengths-based perspective of disability employment throughout learning activities and resources.
Adult Learning Theory
Adult learning theory (ALT) is a well-known pedagogical framework for informing adult learner education practices (Knowles, 1978). Because the theory values lived experiences and individual motivations for learning it is well suited for working professionals and leaders with unique perspectives, roles, and reasons for attending the workshop. ALT principles informed the curriculum content, including self-directed learning, problem-oriented tasks, and incorporating learners’ life experiences to promote learning. Examples include self-selecting case study prompts, flexible guided reflections, and creative problem-solving opportunities in learning assessments. These features allow participants to consider their personal lenses when encountering, applying, and internalizing disability-inclusion content.
Method
This quality improvement project was conducted as a mixed-methods pre- and post-assessment design. We partnered with leaders from a large global corporate entity that employs more than 10,000 people, seeking disability-inclusion professional development content. This pilot workshop used one module from a larger seven-module curriculum we created called Everybody Works. The Everybody Works curriculum is informed by disability justice and occupational therapy frameworks. The module for this pilot workshop was collaboratively selected to match stakeholder interests and learner levels.
Workshop content introduced and applied knowledge and skills in performance skill analysis to enhance workplace disability inclusion. Disability-inclusion strategies to support attendee participation included providing a live American Sign Language interpreter, encouraging individual preferences to have one’s web camera on or off, offering multimodal participation options, and enabling closed captioning. The platform also allows users to adjust individual accessibility settings for visual contrast, screen readers, reducing distractors, and more (Roussey, 2023).
This project is considered a quality-improvement program and was deemed nonhuman subjects research by Massachusetts General Brigham Human Research Office policies and its Health and Human Services department.
Participants
Participants were recruited via nonprobability convenience sampling. All employees of a partnering global corporate entity were invited to attend this event. In partnership with the company’s disability-inclusion interest group, marketing and invitation materials were disseminated via internal communications, email, and informational flyers posted to the organization’s home page.
Participants completed a brief disability-specific demographics survey to identify their relationships with disability. They were asked to select one or more of the following: identifying as a disabled adult, family member, friend, coworker, or peer; no relationship; or other relation to someone with a disability. No other demographic information was gathered because of the global partner’s concerns regarding participant survey burnout.
Procedure and Design
Attendees engaged in a 60-min virtual workshop via an online video communication platform. Because centering disabled voices and lived disabled experiences is crucial to genuine inclusion, this session was cofacilitated with an employee with a disability who shared her personal and professional perspectives. We also used a mixed-methods approach because qualitative data provide a richer, contextualized understanding of disability-related perspectives than quantitative data alone (Meekosha & Shuttleworth, 2009).
Measuring Changes in Attitudes, Knowledge, and Skills
Adapted Theoretical Domains Framework Survey
We developed a six-item pre- and postsurvey, informed by the Theoretical Domains Framework (TDF; Huijg et al., 2014), to evaluate changes in perceived knowledge of, skills in, and attitudes toward disability-inclusive workplace practices. The TDF was designed as a comprehensive context for evaluating behavior implementation factors (e.g., the likelihood of individuals applying specific approaches to practice). Initially studied in physical therapists, the TDF’s fill-in-the-blank style questionnaire items can and were intended to accommodate other professions, including business professionals. Acceptable-to-strong internal validity and discriminant validity were noted for all domains of interest, with Cronbach’s α values ranging from .74 to .93 (Huijg et al., 2014, p. 11). The TDF instrument was selected over more recent disability perception measures because of its (1) focus on capturing behavior implementation factors to predict real-world behavior change, (2) adaptability for interprofessional evaluation, and (3) strong psychometric properties.
Informed by the workshop learning objectives and CDT principles, the adapted TDF domains regarding implementing disability-inclusive practices in the workplace that were addressed in this adapted survey included Knowledge, Skills, Social/Professional Role and Identity, Patient (Disabled Peer, for this project), Positive Emotions, and Negative Emotions. Responses were scored on a 7-point ordinal scale that ranged from 0 (strongly disagree) to 7 (strongly agree). Higher scores indicated greater self-perceptions regarding the use of disability-inclusive workplace practices (Huijg et al., 2014). One item was included as a balancing measure to monitor for unintended change effects regarding negative emotions toward persons with disabilities. Therefore, this item was reverse scored. This survey was administered immediately before and after the workshop.
Defining Disability Survey
To measure changes in understanding of disability, participants were asked to define disability immediately before and after the session. Inclusive definitions of disability acknowledge interactions between persons; their environment, including social contexts and influencing norms; and their functioning and views of disability as the result of those interactions (Hall, 2019; World Health Organization, 2011). After assessing this holistic understanding of disability, client responses were scored on a 3-point scale with 1 point awarded for each aspect: person factors, environmental factors, or functional performance factors. Higher scores were indicative of more holistic, inclusive definitions of disability.
For both the adapted TDF and defining disability surveys, group means were compared at pre- and post time points. IBM SPSS Statistics (Version 28) was used for data analysis. Because all variables were considered ordinal or continuous without normal distribution, nonparametric tests were used. Mann–Whitney U tests were used to compare differences in median scores among pre- and postsession responses, with statistical significance of a two-tailed test set at .05. The mean, standard deviation, and 95% confidence intervals were also calculated for each variable.
OTPF–4–Informed Performance Skills Survey
We developed a three-item, open-ended, OTPF–4–informed survey that asked participants to describe a workplace activity and its related motor, process, and social skill as defined during the workshop and the OTPF–4 (AOTA, 2020, pp. 43–50). Each item was scored on an ordinal scale with a minimum score of 0 (response is absent or completely irrelevant to workplace topics) and a maximum score of 3 (response includes an appropriate workplace example and related performance skill), for a total of 9 possible points. Higher scores indicated greater accuracy in applying workplace performance skills analysis.
This survey was administered once during the workshop as a learning activity; therefore, only descriptive statistical analyses were indicated to understand general trends and outliers in learner performance. Microsoft Excel was used for descriptive data analysis. Files were stored on a password-protected computer and Microsoft Teams platform.
Qualitative Survey of Workshop Experience
A qualitative postsession survey was administered that included one open-ended item that asked attendees to share their impressions of workshop learning resources, activities, and experiences. Informed by Vaismoradi et al. (2016), an inductive thematic analysis was conducted to identify themes in participant responses to this workshop. During the initialization and construction phases of analysis, initial conceptual labels that closely reflected the participants’ own words were assigned to each response (Vaismoradi et al., 2016). Initial labels were then reviewed for emerging commonalities and further organized into major themes to reflect those relationships. To enhance trustworthiness, we maintained and discussed reflective analysis notes and the organization of responses and themes (Vaismoradi et al., 2016).
Results
Participant Demographic Characteristics
A total of 97 unique respondents participated across all survey opportunities. As a voluntary professional development event, attendees were free to enter and exit the event as needed to accommodate varying work schedules and survey participation was optional. As a result, the number of respondents across each survey opportunity varied.
For 67.5% of respondents, this was their first time attending an Everybody Works curriculum-based workshop. Nearly 21% of the respondents identified as being disabled. Other identity types included being a parent (12.0%), child (6.0%), sibling (8.4%), friend (42.2%), caregiver (3.6%), or some other relation (9.6%) to a person with a disability. Just over 18% reported not knowing anyone with a disability, and 13.3% reported having multiple relationships with disability.
Changes in Perceived Knowledge of, Skills in, Attitudes Toward, and Understandings of Disability
Analyses of responses to the adapted TDF survey (n = 52) revealed notable changes in perceived knowledge, skills, and attitudes after workshop participation. Total score averages increased from 31.56 to 36.28 (p = .000, 95% confidence interval [CI] [32.21, 34.77]), meaning participants reported higher confidence in their knowledge, skills, and positive attitudes regarding the implementation of inclusive workplace strategies (Table 1). Statically significant improvements were noted on four of the six items, including the following: knowledge of how to implement strategies (p = .000, 95% CI [5.17, 5.82]), skills in implementing strategies (p = .000, 95% CI [5.15, 5.84]), positive emotions toward implementing strategies (p = .015, 95% CI [5.59, 6.25]), and perception of disabled peers as positive allies for creating strategies (p = .018, 95% CI [6.19, 6.69]; Table 1).
Pre and Post Changes on the Adapted TDF Survey: Self-Perceived Knowledge, Skills, and Confidence
Note. N = 61. TDF = Theoretical Domains Framework; CI = confidence interval.
*p < .05. **p < .01.
With respect to holistic understandings of disability (n = 32), no significant changes in the thoroughness of disability definitions were noted on the disability definition survey.
Response to Performance Skill Analysis Application Activity
Thirty-nine (39) attendees completed the OTPF–4–informed performance skills survey. The total average of response scores was 4.72 out of 9 points, with a wide range of totals noted (range = 2–8). Relative strengths in analyzing and identifying motor skills in the workplace were noted (2.03), with lower performances noted on processing (1.26) and social skill items (1.44; Table 2).
Scores on the Performance-Based Learning Activity
Note. N = 39.
Qualitative Responses
The thematic analysis of qualitative responses (n = 12) yielded four major themes: (1) Empathy and Expanded Perspectives, (2) Knowledge and Skill Building, (3) Engaging Content, and (4) Community of Understanding (Table 3). Empathy and Expanded Perspectives responses described shifts in perspectives or new insights regarding disability experience, and Knowledge and Skill Building answers demonstrated self-perceived changes in abilities to apply disability-inclusive workplace strategies. Engaging Content included impressions of program content. Finally, Community of Inclusion responses referred to finding social connectedness to like-minded peers interested in fostering disability inclusion.
Sample Items From the Thematic Analysis of Post-Session Feedback
Three of the major themes (Empathy and Expanded Perspectives, Knowledge and Skill Building, and Community of Inclusion) qualitatively reinforced the significant improvements in knowledge, skills, and attitudes observed on the adapted TDF survey; specifically, learning about performance skills, disability perspectives, and key definitions were cited in participant responses and aligned with findings captured by other measures (Table 3).
Discussion
The findings from this quality-improvement project suggest that engagement in an occupational therapist– led disability inclusion curriculum, such as Everybody Works, may improve business professionals’ and leaders’ perceived knowledge of, skills in, and comfort with implementing inclusive workplace practices. Such programs may also encourage increased positive feelings toward disabled peers as allies and experts in the workplace.
The adapted TDF survey conceptualized beliefs and attitudes as the way individuals perceive their relationships with disabled peers, their ability to support inclusion, and the potential effects of workplace inclusion. Although the observations from this pilot workshop reflect participants’ self-perceptions of abilities rather than performance-based findings, beliefs and attitudes are commonly cited as major barriers to disabled people’s work participation (Butzer et al., 2021; Rashid et al., 2017). In addition, a person’s beliefs and attitudes are considered foundational, influential components of their actions according to cognitive behavioral and disability justice frameworks.
Qualitative feedback regarding Engaging Content also suggests the effective embedding of ALT principles to facilitate learner buy-in. Therefore, improving self-perceptions of, beliefs about, and attitudes toward disability employment and disabled peers, rather than performance alone, may be foundational to improving the behaviors of nondisabled peers and increasing supportive disability employment equity.
Next steps include continued, large-scale implementation and evaluation of the complete Everybody Works curriculum to further understand potential benefits for enhancing disability-inclusive workplaces. Follow-up evaluations will also help provide insight into the long-term impacts of this inclusive programming. In addition, disseminating the findings and key disability-inclusion features of this curriculum may encourage stakeholders to adopt similar approaches in other industries, professional development and education, corporate policies, and inclusive workplace practices. Education leaders and accrediting bodies may consider including similar approaches in postsecondary curricula to proactively prepare future workplace professionals.
Limitations
Some limitations of this quality-improvement project should be noted. First, the workshop had an open-group format, meaning participants could join or exit the event at any time. This made it difficult to standardize survey participation and content engagement and may have contributed to the limited changes in performance-based measures, especially given the novelty of, and relatively brief exposure to, this content. In addition, the corporate partner’s organizational policies disallowed the sending of follow-up surveys that would have helped us understand any long-term effects of this program.
However, these barriers reflect real-world workplace programming obstacles. It is important to also understand whether and how changes occur within a natural environment to support generalizable and replicable solutions. Therefore, these limitations, though challenging, provide valuable insight into how this curriculum readily translates to practice. These observations also reflect just one module from a seven-part curriculum. It is possible that participation in additional modules would reinforce the learning objectives.
Implications for Occupational Therapy Practice
The program evaluation of this pilot workshop suggests that occupational therapy and disability justice–informed solutions can play a major role in supporting disabled people’s work participation. Focusing interventions on business professionals and leaders to build inclusivity champions is nontraditional and may positively influence the social and systemic contexts of work. Thus, the following are potential applications to occupational therapy practice: ▪ Embedding occupational therapy strategies and frameworks into disability-inclusion content may increase peers’ knowledge of, skills in, and attitudes toward supporting inclusive workplaces. ▪ Incorporating disability justice principles into solutions may support improved inclusion outcomes per disability community best practices. ▪ Addressing nondisabled persons in occupational therapy interventions may yield innovative approaches for improving social contexts of participation across multiple settings to maximize inclusion. ▪ Advocating for occupational therapy’s role in corporate settings may further disability workplace equity.
Conclusion
Implementing the Everybody Works curriculum and applying disability justice principles to other occupational therapist–led solutions may improve social contexts. Preparing peers to be better allies of, advocates for, and innovators of disability-inclusive workplace practices may secondarily support increased access to and participation in employment for disabled adults. This increase in occupational access and participation in work may ultimately improve the quality of life and long-sought-after rights of the disability community.
Footnotes
Acknowledgments
We thank John Wong, PhD, for his expertise and contribution to the statistical analyses for this project.