American Journal of Occupational Therapy

In this editorial, AJOT Editor-in-Chief Stacey Reynolds shares how the special issue on Diversity, Equity, Inclusion, Justice, Accessibility, and Belonging in Occupational Therapy Practice and Education was developed. From the establishment of the journal’s first-ever Diversity, Equity, and Inclusion (DEI) Committee to the creation of a robust collection of research focused on DEI, Dr. Reynolds reflects on lessons learned and how the process of developing the special issue has helped shape the future of the American Journal of Occupational Therapy.

In this editorial, AJOT Editor-in-Chief Stacey Reynolds shares how the special issue on Diversity, Equity, Inclusion, Justice, Accessibility, and Belonging in Occupational Therapy Practice and Education was developed.

Importance: Although occupational justice is an important construct for occupational therapy, the Occupational Justice Scale for Refugees (OJS–R) is, to our knowledge, the first of such scales developed in this field.

Objective: To develop an occupational justice scale designed specifically for refugees and to evaluate its psychometric properties.

Design: This study was conducted as face-to-face interviews and self-report surveys with refugees. The Davis technique was applied twice to 12 expert panelists, and the test form was administered to 603 individuals. Item analysis was conducted to evaluate the internal consistency of the scale. An exploratory factor analysis and confirmatory factor analysis were also performed to examine the construct validity of the scale.

Setting: Four different provinces in Turkey: Istanbul, Ankara, Elazig, and Bingöl.

Participants: Data from 603 Syrian refugees were included in the analyses.

Outcomes and Measures: Information from completed informed consent forms, the OJS–R, and the Occupational Balance Questionnaire–11, Turkish version (OBQ11–T).

Results: The OJS–R explained 70.179% of the variance and revealed a five-factor structure (occupational deprivation, alienation, marginalization, apartheid, and imbalance). The scale demonstrated high reliability, with an interclass correlation of .989 and Cronbach’s α of .993. Test–retest correlation coefficients were robust, and the correlation between the OJS–R and OBQ11–T were statistically significant (r = .987, p < .001). These results validate the 30-item scale structure consisting of five dimensions.

Conclusions and Relevance: The OJS–R may be a reliable and valid measure of occupational justice and appropriate for populations such as refugees.

Plain-Language Summary: Occupational justice is a critical perspective of social structures that promote social, political, and economic changes to enable individuals to meet their occupational potential and experience well-being. Refugees often experience occupational injustice, even though there is no scale to evaluate occupational justice. This study is a scale development study. We developed the Occupational Justice Scale for Refugees (OJS–R), which, to our knowledge, is the first scale designed specifically to measure the levels of occupational justice experienced by refugees. This study’s results may simplify greater consideration and evaluation of occupational justice by occupational therapists. Furthermore, the OJS–R may encourage occupational therapists to include occupational justice in their refugee intervention programs.

This is a scale development study of the Occupational Justice Scale for Refugees, which was developed by the authors and is the first scale designed specifically to measure the levels of occupational justice experienced by refugees.

Importance: Research on the factors contributing to low academic performance of first-generation students studying occupational therapy is limited, and how these factors affect the students’ academic performance is insufficiently described.

Objective: To explore how first-generation students in occupational therapy perceive their academic self-efficacy, academic engagement, and social integration.

Design: Explanatory sequential mixed-methods design.

Setting: Occupational therapy program on the East Coast of the United States.

Participants: The total sample included 18 first-generation students in occupational therapy through purposeful sampling. Eighteen participants completed the survey, and 5 participants participated in the interview.

Outcomes and Measures: Measures included a demographic questionnaire, the Self-Efficacy for Learning Form–Abridged, the Survey of Student Engagement, the Social Integration Scale, and semistructured interviews.

Results: Participants reported a low level of academic self-efficacy, academic engagement, and social integration.

Conclusions and Relevance: This study fills the gap in research regarding factors contributing to low academic performance of first-generation students in occupational therapy and how the identified barriers of academic self-efficacy, academic engagement, and social integration can be addressed for these students.

Plain-Language Summary: This study explored how first-generation occupational therapy students think about their academic performance, engagement, and social integration. Students reported a low level of academic performance, engagement, and social integration. Identifying and understanding the factors that affect the academic performance of first-generation students can improve the support and services provided by occupational therapy programs to first-generation students.

Positionality Statement: Positionality is described as the location of the researcher in their research (Milner, 2007). It influences the researcher’s assumptions, findings, and interpretations (Banks, 2015). As a first-generation doctoral student, I identify with the unique challenges faced by many first-generation students. As Milner (2007) suggested, it is important to be introspective during research and acknowledge any internal biases to maintain objectivity during the research process. I aimed to be reflexive by taking notes about my thoughts throughout the study to actively reflect on my understanding of how my positionality may affect my data collection and analysis.

This study explored how first-generation occupational therapy students think about their academic performance, engagement, and social integration.

Importance: A reflection of the experiences of faculty from underrepresented backgrounds who have been recruited into academia and retained may enhance diversity, equity, inclusion, justice, accessibility, and belonging initiatives, such as pipeline programs, mentorship programs, and outreach.

Objective: To explore the experiences and perceptions of occupational therapy educators who self-identify as Black, Indigenous, or people of color (BIPOC) as they navigated the path that led them to academia.

Design: A phenomenological descriptive study with semistructured interviews and a demographic survey.

Setting: Academia.

Participants: A purposive sample of occupational therapy faculty (N = 17) in the United States who self-identify as BIPOC.

Results: Three themes emerged. The first, the journey to academia, describes experiences that sparked the pursuit of a career in occupational therapy and then the transition to academia. This encompasses the subthemes of defining moments, opportunities to engage in teaching, influential factors, and formal and informal mentorship. The second theme, the journey through academia, captures factors that influence job satisfaction, job performance, and retention in academia, with subthemes of belonging and academic culture. The third theme, the role of representation in the profession, describes the impact of racial and ethnic representation experienced on the paths to and through academia.

Conclusions and Relevance: The respondents described distinct experiences of academic culture. These experiences can be applied to initiatives intended to attract more diverse perspectives and ways of knowing into the field of occupational therapy.

Plain-Language Summary: The findings of this study add nuance to the discussion of the recruitment and retention of occupational therapy practitioners who self-identify as Black, Indigenous, or people of color (BIPOC). Despite strategic diversity, equity, and inclusion efforts, the profession of occupational therapy has failed to recruit and retain a racially and ethnically diverse pool of practitioners that is reflective of the U.S. population. The evidence that explores diversification of occupational therapy excludes the lens of BIPOC occupational therapy faculty. This study explored the reasons that inspired faculty from underrepresented backgrounds to enter the field and led them to work in academia. The findings indicate that these educators were motivated by a desire to influence change in the profession and the wider world and that they were affected by the lack of diverse representation in the field. The social, academic, and financial support experienced by these educators adds culturally responsive nuances to further diversifying the occupational therapy workforce.

Positionality Statement: Victor Camacho (he/him/el) identifies as a GenXer, urban dweller, South American Latino male. LaMar Bolden (she/her) identifies as a Black, cisgender, female Xennial with Christian spiritual beliefs. Both are full-time faculty members in occupational therapy departments; hold postprofessional clinical doctorates; and lead and serve on various diversity, equity, and inclusion committees at the department, university, and state levels. The genesis of this research stemmed from their conversations about the paucity of occupational therapy academician representation reported in the American Occupational Therapy Association’s (2023) workforce survey and experienced in their circles of higher education. They intentionally focus on Black, Indigenous, and people of color to acknowledge the history of this conversation in the United States and the occupational therapy profession.

The study findings show that occupational therapy educators are motivated by a desire to influence change in the profession and are affected by the lack of diverse representation in the field.

Importance: Belonging is a dynamic contextual construct valued within occupational therapy and connected with students’ academic success and career transitions. Although belonging has been measured in higher education, there is no specific tool to measure it in occupational therapy education.

Objective: To create the Professional Belonging Scale for Occupational Therapy Students (PBSOTS) and assess its validity and internal consistency reliability for measuring belonging among occupational therapy and occupational therapy assistant students.

Design: Scale development and preliminary psychometric study.

Setting: Academic programs.

Participants: The study took place in three phases from 2022 to 2023. Phases 1 and 2 involved occupational therapy experts in diversity, equity, inclusion, belonging, and assessment. Phase 3 included 162 students from accredited occupational therapy education programs in the United States.

Outcomes and Measures: Scale items were developed on the basis of the literature, expert interviews, and a student focus group and were revised based on calculated content validity index ratings (cutoff = .78) and expert feedback. Next, student data were analyzed for an exploratory factor analysis and to determine internal consistency reliability.

Results: Of an initial 24 items, 5 were removed, 5 were revised, and 1 was added, resulting in a 20-item scale with an α value of .92. Four factors had eigenvalues greater than Kaiser’s criteria of 1 and explained 61.13% of the variance.

Conclusions and Relevance: On the basis of preliminary validity and internal consistency reliability testing, the authors suggest further developing and researching the PBSOTS.

Plain-Language Summary: Belonging is valued within occupational therapy and is connected to students’ academic success and career transitions. However, there is no specific tool to measure belonging in occupational therapy education. This study used the Professional Belonging Scale for Occupational Therapy Students (PBSOTS), a self-assessment that was created by the authors to measure students’ sense of belonging in occupational therapy education programs. The authors recommend further developing and researching the PBSOTS so that the self-assessment can be used to inform occupational therapy education programs about students’ sense of belonging.

This study assesses the Professional Belonging Scale for Occupational Therapy Students, a self-assessment that was created by the authors to measure students’ sense of belonging in occupational therapy education programs.

Importance: The transgender and gender-diverse (TGD) community faces significant health care disparities, including elevated rates of mental health issues, poverty, and barriers to accessing affirming care. Occupational therapy practitioners are ethically obligated to provide gender-affirming care, yet there are no practice guidelines for such care.

Objective: To examine the landscape of gender-affirming care within occupational therapy practice, aiming to identify gaps for future research and guidelines.

Data Sources: Six databases (MEDLINE, EMBASE, Scopus, PsycINFO, CINAHL, Web of Science). Search dates ranged from database inception to September 19, 2023.

Study Selection and Data Collection: We followed Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute guidelines for all methodologies. Studies were included if they described gender-affirming care, included language related to the transgender and gender-diverse community, and mentioned occupational therapy. Studies were excluded if they were not peer-reviewed or did not include an intervention.

Findings: A total of 614 studies were identified, and 17 were included. Of the included studies, the majority were qualitative (n = 9) and from the United States or Canada. Published research highlighted clinicians’ need for more training in gender-affirming care and suggested diverse modalities to bridge gaps in working with TGD individuals.

Conclusions and Relevance: This review underscores the urgent need for targeted research to address TGD individuals’ specific needs in occupational therapy practice. Future efforts should focus on developing and evaluating gender-affirming care interventions, expanding training modalities, and promoting inclusive care within occupational therapy.

Plain-Language Summary: The transgender and gender-diverse (TGD) community often encounters obstacles in accessing health care, including mental health issues and barriers to affirming care. Occupational therapy practitioners play a crucial role in providing gender-affirming care, yet there is a lack of clear guidelines for doing so. This study aimed to examine the current state of gender-affirming care in occupational therapy and identify areas for improvement, ultimately benefiting both practitioners and clients. Future research should focus on developing and evaluating gender-affirming care interventions, expanding training modalities, and promoting inclusive care within occupational therapy.

Positionality Statement: The authorship team represents one individual who identifies as nonbinary and four who identify as cisgender. Most of the authors identify as White. Three authors identify as LGBTQ+. Two authors have prior experience writing scoping reviews.

This review examined the current state of gender-affirming care in occupational therapy and identifies areas for improvement.

Importance: Cultural humility may improve the quality of occupational therapy services, but how occupational therapy practitioners apply this approach in their practice contexts has not been clearly described in the literature.

Objective: To describe peer-reviewed rehabilitation literature on the practice of cultural humility and align the findings with occupational therapy practice using the Canadian Practice Process Framework (CPPF).

Data Sources: Nine databases were searched, using the term cultural humility to identify relevant peer-reviewed rehabilitation literature. Google Scholar and six journals were hand-searched to identify additional studies.

Study Selection and Data Collection: This substudy of a larger knowledge synthesis was guided by Arksey and O’Malley’s (2005) scoping review methodology. Titles, abstracts, and full texts of studies were screened using Covidence. Study descriptors, context, population, and cultural humility elements defined by Tervalon and Murray-García (1998), and recommendations were extracted, analyzed, and mapped onto the CPPF.

Findings: In total, 11 studies were included. Cultural humility elements of self-reflection and critique (n = 7; 63.6%), self-awareness and egolessness (n = 8; 72.7%), and supportive interaction (n = 5; 45.4%) were identified. Most cultural humility elements aligned with the societal (n = 11; 100%) and practice (n = 10; 90.9%) contexts of the CPPF.

Conclusions and Relevance: Findings highlight how occupational therapists could integrate cultural humility at each stage and in each context of their practice. Additionally, these insights can inform occupational therapy education on integrating cultural humility into training programs and guiding practitioners in applying cultural humility principles to enhance their practice.

Plain-Language Summary: Cultural humility may improve the quality of occupational therapy services. How occupational therapy practitioners apply cultural humility has not been clearly described in the literature. This review describes literature on the practice of cultural humility. The findings were aligned with occupational therapy practice using the Canadian Practice Process Framework. The findings highlight how occupational therapists could integrate a cultural humility approach at each stage, in each practice process and context, and into training programs. The findings also provide a foundation for future research on how to apply cultural humility principles to improve occupational therapy services.

This scoping review describes literature on the practice of cultural humility in occupational therapy services.

Importance: Despite the importance of diversifying the occupational therapy workforce and fostering inclusive learning environments, disabled occupational therapy students face many barriers throughout their education.

Objective: To better understand the lived experience of disabled students regarding external barriers influencing their occupational therapy education.

Design: A qualitative study with thematic analysis of focus group sessions and individual interviews. Trustworthiness was ensured through participant and researcher triangulation and practicing reflexivity.

Setting: Focus group sessions were conducted remotely.

Participants: Convenience sampling was used to recruit participants who met the following criteria: current enrollment in the university entry-level Master of Occupational Therapy program or having graduated within the past 18 mo; identification as disabled/a person with a disability, neurodivergent, d/Deaf, and/or having a chronic health condition; and having engaged in the process of exploring or obtaining accommodations through the Disability Resources for Students department.

Outcomes and Measures: A semistructured interview guide.

Results: Four focus group sessions and one interview were completed with 14 participants. Three main themes emerged that describe how faculty support, peer support, and the culture of the profession matter to disabled occupational therapy students.

Conclusions and Relevance: Themes describe the varied experiences of students, including barriers they faced and opportunities for systematic change to support them better. Implications include opportunities for faculty training, incorporating disability frameworks throughout the curriculum, and creating a culture of inclusion in occupational therapy education.

Plain-Language Summary: This study explored factors that affect disabled occupational therapy students. The results describe what helps and hinders them throughout their education. These include faculty support, peer support, and program culture. Providing faculty training, reframing disability in coursework, and creating a more inclusive culture could better support students.

Positionality Statement: Throughout this article, identity-first (e.g., disabled students) and person-first (e.g., students with disabilities) language is used interchangeably, following the guidance of disabled self-advocates who indicate a preference for flexible language styles (Dwyer, 2022). The research team presented different identities, including one team member who identified as having a chronic health condition. At the time of the study, all team members were interacting or had interacted with all or some participants in their teaching roles (i.e., as faculty member or teaching assistant). The faculty members have actively integrated disability studies and anti-ableist perspectives in their teaching.

This study explored factors that affect disabled occupational therapy students and describes what helps and hinders them throughout their education.

Importance: Occupational therapy interventions are a crucial part of dementia care and have been shown to be effective in research trials. However, the acceptability and inclusivity of occupational therapy interventions to treat dementia for people from diverse groups are unclear.

Objective: To explore factors contributing to the delivery of acceptable and inclusive community-based occupational therapy interventions for people with dementia from diverse groups in Australia.

Design: Exploratory qualitative study in which interviews and focus groups were used. Data were analyzed with reflexive thematic analysis.

Setting: Community-based occupational therapy in Australia.

Participants: Purposive sampling was used to recruit 26 participants. Eight people with experience of dementia from diverse groups (ethnic minority, sexual minority, and socially or economically disadvantaged groups) participated in individual interviews; occupational therapists participated in focus groups (n = 10) and interviews (n = 8).

Results: Three key themes were developed to support inclusivity: (1) knowing the person at the center of the care, (2) collaboration, and (3) perception of occupational therapy for people with dementia. Acceptable and inclusive occupational therapy interventions for dementia occurred when people from diverse groups felt valued and received tailored interventions, were confident in and partnered with the therapist, and understood the purpose of therapy.

Conclusions and Relevance: Therapists require support to apply cultural humility and to build skills to overcome barriers to providing culturally safe and acceptable care.

Plain-Language Summary: People from diverse groups include ethnic minority, sexual minority, and socially or economically disadvantaged groups as well as Indigenous populations. We know community-based occupational therapy interventions improve function and quality of life for people with dementia and their families, but we do not know whether they work for people from diverse groups. We asked people with experience of dementia from diverse groups and occupational therapists in Australia what they thought. We found that occupational therapy interventions for dementia are acceptable to diverse groups when the therapist works in partnership, providing an intervention that is meaningful to them. To be inclusive, therapists need to empower people from diverse groups to participate equally in the intervention. They need to make sure families understand the purpose of the intervention. Some occupational therapists may need training to build skills and knowledge as well as support to overcome barriers and to provide acceptable and inclusive interventions.

The authors found that occupational therapy interventions for people with dementia are acceptable to diverse groups when the therapist works in partnership and provides an intervention that is meaningful and purposeful for the client.

Importance: Participation is a central determinant of older adults’ health and quality of life (QoL). Examining participation and QoL among older adults from different ethnic groups through an occupational justice lens is vital in occupational therapy.

Objective: To compare participation (objective and subjective) and QoL among older adults from two ethnic populations (Arab and Jewish) and to examine the relationships between sociodemographics, health-related variables, and participation with QoL in both groups.

Design: Cross-sectional quantitative and comparative.

Setting: Community-dwelling older adults in Israel.

Participants: A total of 190 adults ages 65 yr and older (90 Arabs, 100 Jews) who had not been hospitalized in the past month.

Outcomes and Measures: We used a background questionnaire, the four-item Patient Health Questionnaire for Anxiety and Depression, the Experiencing Day-to-Day Life Questionnaire, and the World Health Organization Quality of Life–Brief Version.

Results: The minority group reported lower education, poorer health, and lower participation and QoL scores compared with the majority group. Making ends meet, education, health-related variables, and participation were significantly correlated with QoL in both groups, with a higher correlation between subjective participation and QoL in the Arab group.

Conclusions and Relevance: Participation and QoL vary among older adults from different ethnic groups, with sociodemographics and health-related variables interconnected in both groups. The findings support the study hypotheses, highlighting the potential role of social factors on participation and the importance of encouraging subjective participation to enhance QoL, especially among minority groups. Further studies among diverse minority groups are recommended.

Plain-Language Summary Participation, or involvement in purposeful and meaningful daily activities, is a central determinant of older adults’ health and quality of life. This study examined differences in sociodemographics, health, participation, and quality of life among older adults from ethnic majority versus minority groups. The study emphasizes the potential impact of social aspects on participation and the importance of encouraging subjective participation to improve quality of life, especially among minority groups. Developing and tailoring occupational therapy intervention programs that address inequities through the lens of occupational justice can promote participation in meaningful activities and enhance older adults’ quality of life, especially among minority groups.

This study examined differences in sociodemographics, health, participation, and quality of life among older adults from ethnic majority versus minority groups.

Importance: Occupational therapy students need preparation to provide culturally effective pediatric care that addresses the needs of Hispanic families.

Objective: To implement and evaluate a curriculum module aimed at improving occupational therapy students’ cultural awareness, cultural knowledge, and cultural skills for working with Hispanic families.

Design: Mixed-methods, pre–post interventional study.

Setting: An entry-level occupational therapy master’s program.

Participants: Convenience sample of 30 occupational therapy master’s students.

Intervention: A 2-hr cognitive behavioral–based intervention module on culturally effective care for Hispanic families.

Outcomes and Measures: Cultural Competence Self-Assessment Checklist–Revised (CCSACR) administered pre- and postintervention as well as a qualitative questionnaire on self-perceived changes.

Results: Significant improvements were found in cultural awareness (p = .013) and cultural skills (p = .038) on the CCSACR. Qualitative data indicated self-perceived improvements in awareness, knowledge, and preparedness for culturally effective practice.

Conclusions and Relevance: A brief educational module can significantly improve occupational therapy students’ cultural awareness and skills for working with Hispanic families. Curriculum-based cultural training can help prepare students to provide more equitable care.

Plain-Language Summary: This study demonstrates the effectiveness of a targeted educational module for improving culturally effective care for occupational therapy students working with Hispanic families. The study found significant improvements in students’ cultural awareness and cultural skills. Curriculum-based cultural training can help prepare students to provide more equitable and culturally effective care.

Positionality Statement: The authors’ perspectives are rooted in their social positions, which shape their approach to this research. They both identify as female; one identifies as Black, and one identifies as Hispanic. The authors’ experiences have instilled a deep understanding of the systemic barriers and historical injustices that have shaped health care access and outcomes for marginalized communities.

This pilot study demonstrates the effectiveness of using a targeted educational module to significantly improve occupational therapy students’ cultural awareness and skills when working with Hispanic families.

Importance: Ayres Sensory Integration^® is an evidence-based intervention for autistic children, but there is no culturally responsive adaptation to support Black American autistic children and their families.

Objective: To culturally adapt an occupational therapy intervention for Black American families.

Design: Qualitative study involving focus groups and interviews, using researcher triangulation and member-checking surveys for the trustworthiness of findings.

Setting: Zoom focus groups and interviews.

Participants: Convenience sampling resulted in 12 participants, including Black American parents and caregivers, cultural experts, and occupational therapy practitioners who provide services to Black American autistic children.

Outcomes and Measures: Interviews and focus group discussions.

Results: Four parents and caregivers, two cultural experts, and six practitioners participated. Five themes emerged regarding barriers and eight for supports in accessing and utilizing occupational therapy services, including cultural humility knowledge and practices by practitioners and strategies for engaging and incorporating families’ culture.

Conclusions and Relevance: This study demonstrates the process of culturally adapting an occupational therapy intervention according to relevant literature and the insight and expertise of parents and caregivers, cultural experts, and occupational therapy practitioners.

Plain-Language Summary: This project identified challenges and supports for Black American families of autistic children regarding access to and engagement in occupational therapy services. We adapted an occupational therapy intervention to address these challenges and to include recommended supports to guide occupational therapy practitioners to be more culturally responsive and collaborative with Black American families of autistic children throughout the therapeutic process.

Positionality Statement: The inclusive term Black American is used to engage people from all cultural and ethnic backgrounds who are a part of the Black and African-American community throughout the United States (Rivera-Figueroa et al., 2022). Also, identity-first terminology and the term autistic are used according to autistic adults’ preferences for embracing one’s identity (Taboas et al., 2023). The research team consisted of female occupational therapists (Rachel Dumont, Roseann Schaaf, Lady Rios-Vega, and Taylor Sivori, who self-identified as White, White, Latina, and White, respectively); female and male occupational therapy students (Allison Barrett, Emily Knell, and Joshua Njoroge, who self-identified as Asian, White, and Black and White, respectively); and a male focus group facilitator (Levone Cannady, who self-identified as Black). The principal investigator (PI) for this study, Rachel Dumont, and co-PI, Roseann Schaaf, have 16 yr and more than 30 yr of research experience, respectively. The co-PI has extensive experience with occupational therapy using Ayres Sensory Integration and was the director of the Jefferson Autism Center of Excellence. The focus group facilitator had over 8 yr of experience in leading groups and workshops.

This project identified challenges and supports for Black American families of autistic children regarding access to and engagement in occupational therapy services.

Importance: Stakeholder engagement in research is essential to assure that the perspectives of diverse populations studied are represented.

Objective: To describe the process and experiences of engaging Hispanic and Latino stakeholders in research.

Design: A mixed-methods prospective design was used to plan, prepare, and evaluate stakeholder engagement.

Setting: Online, via Zoom.

Participants: Twenty-two stakeholder partners, including 7 Spanish-speaking Hispanic and Latino parents and caregivers of autistic children, 3 Hispanic and Latino autistic individuals, 3 teachers, 3 occupational therapists, 3 Hispanic and Latino cultural experts, and 3 autism experts working with Hispanic and Latino autistic populations were recruited via snowball sampling and engaged in various project activities.

Intervention: Activities for each engagement phase were implemented in Spanish and English. Stakeholder advisory boards were formed following the Patient-Centered Outcomes Research Institute’s engagement principles. Training modules were provided to the stakeholders to support engagement.

Outcomes and Measures: Stakeholder partners’ feedback was collected. The Acceptability of Intervention Measure (AIM) assessed stakeholders’ perceptions of the training modules. Additionally, two surveys were developed to evaluate the accessibility of and satisfaction with the modules.

Results: Three advisory boards were created, each comprising culturally diverse, multilingual stakeholders dedicated to a particular project area. The stakeholder partners found the training modules acceptable and accessible as a learning strategy with high satisfaction levels.

Conclusions and Relevance: Partnerships and capacity building are essential for fostering genuine engagement. Implementing and evaluating training and its acceptability is crucial for effective stakeholder participation. Meaningful engagement of culturally diverse populations is necessary for inclusive and equitable occupational therapy research.

Plain-Language Summary: Occupational therapists use evidence-based interventions. There is a need for culturally sensitive interventions, but many autism treatments are based on research with mostly White participants, which may not be effective for people from other cultures. To make the interventions more culturally relevant, occupational therapists must include the communities they serve. In this study, we formed three stakeholder advisory boards with Hispanic and Latino parents and caregivers of autistic children, autistic adults, occupational therapists, cultural experts, teachers, and autism experts. The purpose of the stakeholder advisory boards is to help us guide a project that will culturally adapt an evidence-based intervention for autistic children and improve access to and the use of occupational therapy services for Hispanic and Latino autistic communities. The authors share the engagement process they used and the feedback they received on the training modules.

Positionality Statement: The term Hispanic has historically been applied to individuals with ancestry from Spain or those whose primary language is Spanish. Although some embrace the term, others find it problematic because of its association with the Spanish colonization and its inability to reflect the identities of many people from Central and South America (Martínez & Gonzalez, 2020). The term Latino and its variations are used for individuals with origins in Latin America, including Central America, South America, and the Caribbean (Martínez & Gonzalez, 2020); this term is preferred by many. Research reveals varying preferences for these terms across populations (Martínez & Gonzalez, 2020). Given the diverse preferences, and to promote inclusivity, we use Hispanic and Latino throughout this article. Furthermore, we implement the identity-first terminology for autistic persons based on autistic individuals’ preferences for using identity-first language (Taboas et al., 2023). The first author, Lady Rios-Vega, identifies as a Latina. She has served minoritized families in early intervention, which revealed the disparities and inequities in access to and utilization of occupational therapy services within the Hispanic and Latino autistic communities. Her experiences have strengthened her commitment to prioritizing the voices and needs of marginalized groups in occupational therapy interventions and research. We acknowledge that her perspectives may influence how data are presented. In addition, the diverse backgrounds and experiences of all contributing authors shape our work, guiding us to pursue our objectives with a strong focus on equity and inclusivity. The senior author, Roseann Schaaf, identifies as a White Caucasian woman from a middle-class background. She is an occupational therapist, neuroscientist, and an experienced autism researcher. She acknowledges the potential impact of her privileged positionality when studying the experiences of marginalized communities, and she is committed to mitigating any biases that may arise from her own perspective.

This review describes the process and experiences of engaging Hispanic and Latino stakeholders in occupational therapy research.

Importance: Occupational therapy lacks workforce diversity. Academic programs (APs) are uniquely positioned to create learning experiences that align with diversity, equity, and inclusion (DEI) efforts within occupational therapy.

Objective: To examine the acceptability of a student-led outreach program from the perspectives of occupational therapy students.

Design: Qualitative, cross-sectional study that used occupational therapy students’ reflections as part of routine educational assessments. Thematic analysis was used to identify and define themes within reflections. Reflexivity and prolonged engagement in the field enhanced trustworthiness.

Setting: Urban, Midwestern OTD program.

Participants: Sixty-eight occupational therapy students enrolled in their second semester.

Intervention: Occupational therapy student–led outreach presentations in middle and high schools in which most students had Black, Indigenous, or People of Color backgrounds. Presentations lasted 45 to 60 min.

Outcomes and Measures: After their presentations, occupational therapy students completed an open-ended reflection on their outreach experience of at least 250 words.

Results: Participants were primarily women (n = 63; 92.65%) and White (n = 50; 73.53%). Three themes emerged in the analysis of students’ reflections: knowledge translation, opportunity versus assignment, and practical insights.

Conclusions and Relevance: Occupational therapy APs are positioned to craft learning opportunities that can meet accreditation requirements, benefit students’ professional development, and contribute to DEI efforts. To make these efforts sustainable, occupational therapy APs must cultivate meaningful relationships with local and diverse community partners while also evaluating opportunities to integrate DEI into their own curricula. Additional research is needed to examine the long-term impact of outreach efforts between occupational therapy students and recipients.

Plain-Language Summary: Occupational therapy academic programs are uniquely situated to promote diversity, equity, and inclusion (DEI) in the profession. Focusing on racial and ethnic diversity, in this study we sought to capture the perspectives of first-year occupational therapy students who participated in a student-led outreach initiative embedded within their curriculum. We found that occupational therapy students benefited from participating in this educational experience because they were challenged to share their knowledge of occupational therapy with middle and high school students from underrepresented communities. Viewing this experience as an opportunity instead of an assignment, occupational therapy students felt that they contributed to DEI efforts while growing as future practitioners. Occupational therapy academic programs can create synergies between student learning objectives and DEI efforts to make transformative change.

Positionality Statement: Diversity encompasses several identities such as race, ethnicity, gender, disability, and many more. We acknowledge all these aspects of diversity. For the purposes of this article, we focus on the diversity related to race and ethnicity.

Focusing on racial and ethnic diversity, this study captures the perspectives of first-year occupational therapy students who participated in a student-led outreach initiative.

Importance: Latino/a cancer survivors (LCSs) and their family caregivers (FCs) experience barriers to participation. The occupational therapy literature centered on Latinos affected by cancer is limited, including the examination of cultural values such as familismo.

Objective: To explore the impact of familismo on LCSs and their FCs during treatment and survivorship from the perspectives of several stakeholders.

Design: Qualitative, cross-sectional study using semistructured interviews with various stakeholders recruited via purposive sampling. A detailed audit trail and peer examination were used to enhance rigor. Thematic analysis was used to identify, analyze, and report major themes.

Setting: Urban Midwestern city.

Participants: Diverse stakeholders in cancer survivorship among Latino families—LCSs living in survivorship (n = 8) and FCs (n = 5)—and cancer care providers (n = 5).

Results: LCSs were primarily female breast cancer survivors (75%), and most FCs were men (60%); only 1 LCS received occupational therapy services. Providers were 2 occupational therapists and 3 social workers. Participants described familismo as facilitating the multilevel support needed for everyday participation. Despite these tight family bonds, survivors and caregivers felt emotionally distant and were disappointed when cultural expectations were not met.

Conclusions and Relevance: Familismo plays a complex and nuanced role among Latino families affected by cancer because it is a strength that many families can draw from; however, it can also create a cycle of unexpressed needs and inadequate support. Future implications include examining culturally tailored occupational therapy services that infuse prominent cultural values and embrace cultural humility.

Plain-Language Summary: The occupational therapy cancer research base primarily focuses on White survivors. The profession needs to learn from diverse populations how best to support them. Focusing on Latino families affected by cancer, this study showed that familismo, which prioritizes family needs over individual needs, is a cultural value that plays out in many ways. Both survivors and caregivers were supported by many biological and chosen family members. Because of the collectivistic nature of familismo, individuals often put their family’s needs before their own. Despite close family relationships, survivors and caregivers felt distant and unsupported. We provide suggestions for how to incorporate familismo in practice. As occupational therapy’s role in cancer care grows, it must put diverse communities at the forefront and intentionally put effort into developing culturally tailored services.

Positionality Statements: Ricardo Ramirez is a first-generation, bilingual, and Latino occupational therapist with family experience of cancer. Susan Magasi is a White occupational therapy educator and scholar with family experience of cancer. She is a qualitative methodologist and cancer health equity researcher. In this article, the term Latino/a is used to honor the chosen language of participants with this background. We recognize that terms such as Latinx are considered to be gender-neutral, however, only 4% of the community uses this term (Noe-Bustamante et al., 2024). The term survivor is used throughout this article because it reflects the language that participants used to refer to themselves.

Focusing on Latino families affected by cancer, this study showed that familismo, which prioritizes family needs over individual needs, is a cultural value that plays out in many ways.

Importance: Historical and contemporary social structures in the United States profoundly shape leadership development for women of color in occupational therapy, revealing systemic inequities.

Objective: To understand how social structures have shaped the leadership development of women of color leaders in occupational therapy in the United States.

Design: Building on Nirmul et al. (2023), the authors conducted a secondary qualitative analysis using Winker and Degele’s (2011) multilevel intersectional approach, examining organizational culture, mentorship, sponsorship, and professional organizations through eight narrative interviews.

Setting: Virtual multiregional interviews.

Participants: Eight English-speaking women of color self-identified as leaders in occupational therapy in the United States were included, representing diverse professional roles and career stages.

Outcomes and Measure: Steps 5 through 8 of Winker and Degele’s (2011) multilevel intersectional approach were used to analyze participants’ narratives, exposing social structures and their effects on mentorship, professional organizations, organizational culture, and sponsorship experiences.

Results: The analysis revealed that American White supremacy profoundly affects leadership development for women of color in occupational therapy. Key challenges included racialized social structures, institutional barriers, discrimination, anti-Blackness, patriarchy, performative diversity efforts, mentorship hierarchies, and financial constraints, highlighting structural inequalities within professional organizations, mentorship, sponsorship, and organizational culture.

Conclusions and Relevance: Diversity, equity, inclusion, justice, accessibility, and belonging initiatives must address social structural barriers by transforming organizational culture, diversifying mentorship and sponsorship, and fostering authentic inclusion through ongoing professional development to support leadership development for women of color.

Plain-Language Summary: This study investigated how social structures in the United States have influenced the leadership development of women of color in occupational therapy. Using data from a prior study, the authors analyzed the personal narratives of eight self-identified women of color leaders. Analysis revealed that American White supremacy profoundly affected the participants’ leadership journeys; this impact was evident in organizational culture, professional organizations, mentorship, and sponsorship. Key issues identified include anti-Blackness, institutionalized patriarchy, performative diversity initiatives, racial hierarchies in mentorship, and financial constraints. The study concluded that while diversity, equity, inclusion, and justice initiatives are essential, they are insufficient to overcome these social structural barriers. The authors advocate for intentional action to transform organizational culture, prioritize diversity in mentorship and sponsorship, and provide continuous professional development opportunities.

Positionality Statement: As described in Nirmul et al. (2023), both authors are immigrants from postcolonial countries and have been racialized in the United States as an Asian American (Ushentha Nirmul) and a White Latina (Pamela Talero Cabrejo). Their privileges have allowed them to engage in leadership development work, and they believe that an intersectional analysis is crucial for understanding both leadership development and daily living occupations.

This study investigated how social structures in the United States have influenced the leadership development of women of color in occupational therapy.

Importance: This article illuminates the unique challenges Black occupational therapy practitioners face on their leadership paths. Amplifying minoritized voices and raising awareness of systemic racism serve as catalysts for fostering equity and inclusivity in the occupational therapy profession.

Objective: To explore the journey and lived experience of Black occupational therapy practitioners currently holding or who had previously held leadership positions.

Methods: An interpretive phenomenological method was used to explore, identify, and analyze the supports and barriers participants encountered while pursuing leadership roles. Participants completed a demographic survey and a 60-min virtual interview. Reflexive thematic analysis was used to identify themes, and theory triangulation ensured validity and rigor in the analysis.

Findings: Five themes emerged: (1) sociocultural context can nurture the potential for leadership, (2) responsibility to build a legacy of representation, (3) micro- and macroaggressions: stereotyped and underestimated, (4) networking as a necessary process, and (5) creating inclusive spaces expands professional identities.

Conclusions and Relevance: Findings were examined and triangulated through the lens of critical race theory and social network theory, providing valuable context for understanding social structures, power dynamics, and their impact on developing Black occupational therapy practitioner leaders. The data support the importance of networks and the role of institutional racism in perpetuating social inequalities that persist in the leadership journey of Black occupational therapy practitioners.

Plain-Language Summary: This manuscript illuminates the unique challenges Black occupational therapy practitioners face in their leadership paths. Researchers used an interpretive phenomenological research design to explore the journeys and lived experiences of seven Black occupational therapy practitioners currently holding or who had previously held leadership positions within the past 5 yr. Five themes emerged: (1) sociocultural context can nurture the potential for leadership, (2) responsibility to build a legacy of representation, (3) micro- and macroaggressions: stereotyped and underestimated, (4) networking as a necessary process, and (5) creating inclusive spaces expands professional identities. The findings were examined and triangulated through the lens of critical race theory and social network theory, providing context for understanding social structures, power dynamics, and the impact of these structures on developing Black occupational therapy practitioner leaders. The data support the importance of networks and the role of institutional racism in maintaining the social inequalities persisting on the leadership journey of Black occupational therapy practitioners.

Positionality Statement: The authors all identify as cis women of color and advocate for the impact of the intersection of race and gender on the occupational therapy profession. Tyra M. Banks is a Black woman, educator, scholar, and first-generation college educated. Karen Park is a Korean American, neurodivergent woman, occupational therapist, educator, scholar, and child of immigrants. Kayla Gibson is a Black woman, athlete, occupational therapist, and first-generation college educated. Their combined identities and lived experiences in a predominantly White profession allow them to hold an intersectional lens for critically analyzing the profession and amplifying voices historically excluded from occupational therapy narratives.

This article highlights the unique challenges Black occupational therapy practitioners face in their leadership paths.

Importance: Intersectional stigma of mental illness and race/ethnicity is a persistent determinant of the growing mental health care disparities among students in the United States. It is also the foundation on which concerns of inclusion and belonging are experienced, warranting scholarship on intersectional stigma and occupational engagement.

Objective: To examine intersectional stigma and its relationship with occupational engagement among racialized higher education students.

Design: This study used a qualitative descriptive design with interview methodology, and thematic analysis was used for data analysis. Transcript checks, peer debriefings, and multiple analysts helped strengthen the rigor of the study. Theoretical frameworks included the principle of gradient rationality to examine stigma and the moral economics of occupations framework to examine occupational engagement.

Setting: Higher education institution.

Participants Thirteen racialized students with mental illness were recruited via purposive sampling.

Results: Four themes emerged: identities and their negotiations, mental health journey, intersectional stigma of mental illness and race/ethnicity, and occupational engagement (mental health care and community participation).

Conclusions and Relevance: Findings highlight that intersectional stigma and racial/ethnic identity construction are fluid processes instead of fixed attributes and guide occupational engagement. Future research will help occupational therapy practitioners and leaders in efforts to address the growing public mental health crisis.

Plain-Language Summary: This study highlights that concerns related to belonging and inclusion among racialized students with mental illness are experienced through the intersectional stigma of mental illness and race/ethnicity. Understanding intersectional stigma also allows practitioners and scholars to better inform and implement culturally sensitive care within mental health care settings.

Positionality Statement: This research was conducted by a team of interdisciplinary multiracial researchers. This research was initiated by Nikhil Tomar, an immigrant scholar of color with a professional background in occupational therapy. The team included researchers from clinical psychology, social work, and sociology. The team included a Black scholar with expertise in race/ethnic identity, a Biracial scholar with expertise in stigma and global mental health, and a White scholar with expertise in children and adolescent mental health. The interdisciplinary nature of this research allowed the authors to challenge conventional wisdom in their respective fields and conduct research in a critical manner. Tomar has expertise in interview methodology and mental health research, which helped him conduct interviews by balancing the needs for participant safety and data collection.

This study examines concerns related to belonging and inclusion among racialized students with mental illness.

Importance: Lack of consideration of intersectionality by occupational therapy practitioners, faculty, and researchers can result in inequities experienced by students and clients served.

Objective: To determine how intersectionality is represented in the scholarly literature used to inform occupational therapy practice, research, and education.

Data Sources: A comprehensive database that includes CINAHL, MEDLINE, and PsycINFO.

Study Selection and Data Collection: Inclusion criteria were peer-reviewed articles published between 2013 and 2023, written in English, and pertinent to the research question. The review used Covidence database and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, resulting in 36 articles identified as meeting all criteria. Any discrepancies were resolved through discussion among the authors.

Findings: A data abstraction chart was developed, and analysis resulted in themes of education, practice, and research with specific subthemes. Findings revealed that the lack of an intersectional approach in education is often viewed negatively by diverse students, who experience a lack of belonging. Suggested strategies focused on reducing isolation and revising curricula to reflect student diversity. Intersectional issues in practice showed access disparities and a lack of occupational participation for diverse clients. Suggested strategies included consideration of the multilayered identities of clients using cultural humility and consideration of context. Strategies for research focused on using a collaborative approach to represent the intersectional lived experience of diverse populations.

Conclusions and Relevance: Despite limited studies, intersectionality was identified as a lens for occupational therapy educators, practitioners, and researchers and as an important strategy to address issues faced by diverse students, resulting in more effective client-centered care.

Plain-Language Summary: This study reviewed literature from occupational therapy and other health professions to determine how the concept of intersectionality is used to inform practice, education, and research. The study is needed because common Western-based practice is based on an individual, White, upper-middle class, able-bodied, cisgender perspective, which does not match the demographics or needs of clients. Results show that the intersectional identities of students and clients are often not being considered. Literature is emerging to provide educational, practice, and research strategies to address the diverse needs of occupational therapy students and clients by identifying and considering multiple and intersectional identities and the effect of context. The results challenge occupational therapy educators, practitioners, and researchers to consider the use of intersectionality moving forward to provide holistic, client-centered care.

Positionality Statement: Diane Smith is a cisgender, White, able-bodied occupational therapy professor with a graduate degree and numerous publications regarding disability rights and intersectionality. Alesia Ford is a cisgender, Black, neurodivergent occupational therapy practitioner with a graduate degree and publications focused on increased diversity within the profession. Helina Samson is a cisgender, Black, able-bodied occupational therapy practitioner with a graduate degree. These lenses influence and may potentially bias our interpretation regarding critique of current strategies in education, practice, and research. For the purposes of this review, please note that LGBTQIA+ is not a standardized term, and the term used by the original researchers will be used (e.g., LGBTQ, LGBT).

This study reviewed literature from occupational therapy and other health professions literature to determine how the concept of intersectionality is used to inform practice, education, and research.

Importance: As the aging population expands, the need to develop home modification programs that effectively support older adults living in low-income households is increasing.

Objective: To examine how an interprofessional team implemented the Older Adult Home Modification Program (OAHMP) at a specific urban site and integrated functional interventions and home modifications to address the safety, accessibility, and functional needs of older adults in low-income households.

Design: This program evaluation study used descriptive analysis to evaluate sociodemographic characteristics, pre- and postimplementation data, and home modifications.

Setting: An urban city environment.

Participants: Sixty-five participants completed the program. The average age was 72 yr (SD = 7.3); participants were predominantly women (95.4%), Black or African American (87.7%), and living alone (81.5%).

Intervention: Three in-home visits by an occupational therapist, a home modification team, and a social worker.

Outcomes and Measures: A paired-samples t test was conducted to compare pre- and postimplementation functional scores on the assessments used, and Pearson’s r correlation analysis was used to assess relationships between functional measures.

Results: The OAHMP implementation led to significant improvements in self-care activities of daily living (ADLs) and home safety; significant positive relationships were found between health status and improved independence in ADLs and instrumental ADLs.

Conclusions and Relevance: The OAHMP enhances ADL independence and home safety for older adults in low-income, diverse communities. By addressing environmental barriers through client-centered modifications and interprofessional collaboration, the program supports aging in place. Its cost-effective approach fosters autonomy, occupational engagement, and health equity, highlighting occupational therapy's key role in safe, sustainable community living.

Plain-Language Summary: This study evaluated the Older Adult Home Modification Program (OAHMP), which aims to help older adults in low-income communities age safely in place by addressing home safety, accessibility, and ADLs. Findings showed that participants experienced increased independence in ADLs and reduced home safety hazards, with 91% of personal goals met or partially met. The average cost of home modifications was significantly lower than national averages, making the program a cost-effective alternative to nursing home placement. The results highlight how tailored home modifications, combined with interprofessional collaboration, can promote ADL independence and safety in the home. This study emphasizes the essential role of occupational therapy in developing equitable, client-centered interventions that address environmental barriers, contributing valuable insights to occupational therapy research, practice, and education.

Positionality Statement: The authors are one Black female therapist, one White female therapist, and two White female occupational therapy students. We acknowledge that our economic, educational, and cultural backgrounds may influence our perspectives and potential biases in this analysis.

This study emphasizes the essential role of occupational therapy in developing equitable, client-centered interventions that address environmental barriers for older adults in low-income households.

Inclusion and belonging are fundamental human needs and key to the engagement and well-being of occupational therapy practitioners, scientists, educators, and learners. Despite this, the profession has struggled throughout its history to act on its values as focused on wide-ranging perspectives of occupational engagement in diverse cultural contexts. Issues of diversity, equity, inclusion, justice, and accessibility (DEIJA) innervate contemporary discourse, but there is a real danger that these conversations remain at a superficial level and stop short of attempts at genuine disruption of the deeply rooted colonial systems that exist in the profession. In this column, we use Jacques Derrida’s concept of hos[ti]pitality to problematize DEIJA initiatives by asking whether occupational therapy can be genuinely inclusive or if minoritized persons will always be “guests” who are expected to reciprocate their presence. We then extend this theoretical approach to inform practical ideas to disrupt hos[ti]pitality in education, practice, and research, promoting antiracist and inclusive educational settings and deconstructing barriers to more authentic inclusion of marginalized identities. Although occupational therapy cannot be fully and unconditionally hospitable, we suggest that generative disruption at both the micro and macro levels can lead to a sense of solidarity that benefits the profession and the people and communities we serve.

In this column, the authors use Jacques Derrida’s concept of “hos[ti]pitality” to problematize DEIJA initiatives by asking whether occupational therapy can be genuinely inclusive or if minoritized persons will always be “guests” who are expected to reciprocate their presence.

This column explores the integration of the Public Health Critical Race Praxis (PHCRP) framework into maternal health occupational therapy to address racial disparities and enhance health care outcomes. The PHCRP framework provides a race-conscious methodology for examining the intersection of race, health, and systemic inequities, making its application in occupational therapy research and practice essential amid the U.S. maternal health crisis, which disproportionately affects Black birthing individuals. We highlight occupational therapy practitioners’ responsibilities, emphasizing race-conscious research, culturally informed and responsive interventions, and advocacy for equitable maternal health care policies. By leveraging the PHCRP framework, occupational therapy can take a transformative approach to address the root causes of maternal health disparities, dismantle systemic health care barriers, and improve Black maternal health outcomes. This column intentionally adopts inclusive language to recognize the diverse identities of those who give birth. We use terms such as birthing individuals and mothering to acknowledge the diverse identities, pregnancy, and childbirth experiences of all birthing individuals. Research indicates that these individuals navigate distinct experiences and may prefer gender-affirming terminology, such as transman, nonbinary, or parent, to mitigate gender dysphoria (Kukura, 2022). This inclusive approach is essential for promoting equitable, culturally affirming care because it acknowledges the additional layers of bias, discrimination, and racial inequity often experienced by non-female–identified birthing individuals. Through this lens, we aim to center diverse experiences and advocate for an occupational therapy practice that actively challenges systemic inequities and fosters equitable maternal health care.

Positionality Statement (Jordan C. W. Major): As a biracial Black–White, English-speaking, cisgender, heterosexual female with an invisible disability who was born and raised in the United States, my intersectional identity profoundly shapes my perspective, allowing me to uniquely address the nuances of racial, health, and maternal issues in health care. I am an occupational therapy practitioner currently pursuing a PhD in rehabilitation science, studying the impact of type 1 diabetes on Black maternal health. My lived experiences and academic background afford me the opportunity to center the experiences of Black mothers and birthing people through a race-conscious lens and call on my occupational therapy colleagues to do the same.

This column explores the integration of the Public Health Critical Race Praxis (PHCRP) framework into maternal health occupational therapy to address racial disparities and enhance health care outcomes.

The philosophical foundations of occupational therapy, originating in North America, primarily align with American philosophy, which leads to challenges when occupational therapy is applied in diverse cultural contexts. The occupational therapy profession needs to embrace multiple philosophical orientations to enhance cultural sensitivity. In this column, the authors use postcolonial theory to analyze colonial legacies and power dynamics within communities, highlighting the limitations of current Western-based adaptations in promoting diversity, equity, inclusion, justice, and accessibility. They argue that incorporating diverse philosophical orientations into occupational therapy can enrich the field by fostering adaptability and inclusivity. They also outline steps to integrate multiple philosophical orientations, including acknowledging historical influences and adopting practices that resonate with diverse values. Embracing multiple philosophical orientations signifies the profession’s commitment to evolving and responding effectively to the complex needs of individuals and communities, thereby promoting more equitable and just outcomes in occupational therapy practice.

Positionality Statement: The authors of this column include a Ghanaian nondisabled occupational therapist who studied and practiced occupational therapy in Ghana, West Africa, and the United States; a White, nondisabled, female Canadian occupational therapy scholar with practice experience across numerous international contexts; and an Asian, nondisabled, female occupational therapy scholar who has occupational therapy practice experience in both Asia and the United States. All three authors currently live and work in the United States. They drew from their personal experiences, knowledge of the profession, research evidence, and critical reasoning to conceptualize this column.

In this column, the authors analyze colonial legacies and power dynamics within communities and highlight the limitations of current Western-based adaptations in promoting diversity, equity, inclusion, justice, and accessibility.

The occupational therapy profession faces critical workforce shortages, and the demand for services to meet the needs of diverse communities continues to rise. Underdocumented individuals represent a diverse pool of potential practitioners who face barriers to licensure if they pursue a career in occupational therapy. Despite being eligible for occupational therapy education and the National Board for Certification in Occupational Therapy exam, inconsistent state licensure requirements, which often mandate a Social Security number (SSN), pose a significant barrier to licensure and employment. We examine the challenges underdocumented individuals encounter in pursuing occupational therapy education and careers and argue for removing such barriers to enable them to become licensed practitioners. Addressing these barriers could diversify the workforce, enhance access to culturally responsive care, and alleviate shortages in underserved areas. We propose six actionable steps for the profession: (1) investigating and clarifying state licensure requirements; (2) ensuring accurate information dissemination to the public and students; (3) advocating for inclusive licensure policies, such as accepting Individual Taxpayer Identification Numbers instead of SSNs; (4) addressing inconsistencies in reciprocity agreements across states; (5) funding research to better understand workforce demographics and needs; and (6) advocating for increased tuition equity and scholarship opportunities. By fostering an inclusive pathway to licensure and embracing diversity in cultural backgrounds, languages, and life experiences, the occupational therapy profession can become a meaningful career option for underdocumented individuals who can contribute to the development of a more resilient and representative workforce to effectively serve diverse populations and address health disparities.

The authors examine the challenges underdocumented individuals face in pursuing occupational therapy education and careers.