Discrimination of Care Services

With more than 83% of occupational therapists being white, it is clear there is a lack of diversity within the field (Data USA). This is also obvious when looking at the demographics of occupational therapy clients. Because occupational therapy is often not seen as essential health care which basic insurance and medicaid would cover, only those who can afford it or have better insurance have access to it. This leads to marginalized populations and minorities not having access to occupational therapy. This is dangerous as it perpetuates the cycle of expected occupations within these communities. Occupations look different within impoverished, marginalized, and urban settings. Working with children and adolescents in these areas makes these differences apparent because adolescence is when habits such as drug use, study skills, and violence are solidified. Having occupational therapists who specialize in working with these communities and populations could improve positive outcomes, lower incarceration rates, and break cycles of unhealthy occupations such as drug and alcohol abuse.

I chose this topic because my major is in Occupational Sciences and Occupational Therapy. I have an interest in social justice issues which stems from my hometown being St. Louis, Missouri. In St. Louis, discrimination and systemic marginalization are prevalent issues in daily life, especially within the city and impoverished areas. St. Louis is a very segregated city, both racially and socioeconomically, which leads to distinct and polarized lifestyles. These different lifestyles result in different occupations and activities of daily living based on need and habits.

Through this literature review, equity of care across diverse and marginalized groups will be examined. It will look at not only how occupational therapists working in marginalized populations and communities can embrace the differences in the communities, but also how the differences in their clients' occupations will change their jobs. It will go over six articles from various occupational therapy journals and newsletters that have to do with social justice within health care disparities and resource allocation as well as the meaning of occupation within lower-income and marginalized populations.

Drs. Suzanne M. Peloquin and Beatriz C. Abreu wrote the first article, "Embracing Diversity in Our Profession", for the American Journal of Occupational Therapy in June 2004. Both doctors are professors and researchers at the University of Texas-Galveston and Dr. Peloquin was named one of the Top 100 Most Influential People in Occupational Therapy(AOTA). They have both been cited hundreds of times, making them qualified and trusted within their field.

This article looks at diversity within occupational therapy in a unique way because of its subjective and personal nature. The authors use both personal experiences and professional observations to examine the construction of prejudices against other people and populations who are different from their own environment. This allows them to offer better ways to value uniqueness and support diversity. They introduce the idea of "other-isms" as a social construct that leads to problems with stereotyping marginalized minorities. It also discusses the effects of cultural diversity on occupational therapy and occupations specifically rather than its effects on health-based practices overall which is not frequently examined.

"Embracing Diversity in Our Profession" is important because of how specific it is to occupational therapy. Because the authors are both practicing, experienced occupational therapists, they are able to give a unique perspective on a topic that is complex, misunderstood, and often forgotten.

The article is written with substantial sections being quotes and experiences of the authors' which means there is a lot of text based on opinion rather than objective facts and research. However, because Peloquin and Abreau acknowledge this, the bias is less significant and problematic. They wrote to occupational therapists who are practicing in the field and working with more marginalized populations. This allows them to attempt to avoid making assumptions based on the various -isms described in the text.

Dr. Susan Bazyk and Mr. John Bazyk are the coauthors of "Meaning of Occupation-Based Groups for Low-Income Urban Youths Attending After-School Care." Dr. and Mr. Bazyk are both registered and licensed occupational therapists. They have been associate professors in the occupational therapy program at Cleveland State University in Ohio. They are both highly regarded in their field and combined have been quoted and cited in over 60 other articles, making their work credible and reliable.

This article focuses on occupation and occupational sciences rather than occupational therapy. Children and adolescents in low-income, urban areas often participate in different occupations than children in higher income, suburban, or rural areas resulting in life-long changes in social and emotional development. During their research, the authors conducted a study in which they had children and adolescents from marginalized communities participate in creative activities intended to improve mood and engage them. Dr. and Mr. Bazyk found that the children enjoyed the activities which opened them up to talking and learning strategies for dealing with anger. These results showed that allowing children to take part in occupations they enjoy enhances them as therapeutic tools.

The research primarily focuses on the unique needs and occupations of children and adolescents in poor areas of cities which are neglected populations in both treatment and research. It focuses on how differing occupations change emotional, academic, and social development and how occupation can be used to improve academic achievement, sense of personal identity, emotional self-regulation, social interaction, and teamwork.

This article was written by adults in higher socioeconomic classes about lower income youths. This means that while it is objective, it is also susceptible to being out of touch with the results and which may be skewed based on prejudice and assumptions. Dr. and Mr. Bazyk wrote to occupational therapists working with children in impoverished neighborhoods in an after-care setting. This is because they are the professionals who could make the most direct and significant changes in the field.

"Social Justice and Resource Utilization in a Community-Based Organization: A Case Illustration of the Role of the Occupational Therapist" was written by Drs. Brent Braveman and Yolanda Suarez-Balcazar for the American Journal of Occupational Therapy. Dr. Braveman is a clinical professor in the Department of Occupational Therapy at the University of Illinois at Chicago and Dr. Suarez-Balcazar is a professor and the department head in the Department of Occupational Therapy at the University of Illinois at Chicago. They are both highly qualified within the occupational therapy community and have been referenced many times by other authors. Dr. Braveman specializes in social justice and equity surrounding occupational therapy and has written over fifteen published articles on similar topics.

The text discusses social justice theories, human rights, medical empowerment, and occupational justice and how they tie together. It explains the responsibility of the health care systems to provide access to care, even within more marginalized areas. The authors explain that by prioritizing human rights, medical empowerment, and occupational justice, over time, individuals will be more self-sufficient and require less treatment. The text discusses two cases in which occupational therapy was used to facilitate social justice. By assessing and addressing individuals' levels of self-sufficiency and environmental limitations, marginalized people will be more capable of getting the proper amounts and types of care.

The research is important because it looks at the past of occupational therapy and how it has affected the present. It also explains what the future currently holds for occupational therapy and what occupational therapists, as health professionals, can do to make more positive outcomes about occupational identities, competence, and behavior settings. Some problems with the writing are that it makes assumptions about not only occupational therapists, but also their patients. Though the authors have done their research, they could have skewed writing based on personal prejudices about occupational therapists and patients.
Drs. Braveman and Suarez-Balcazar are writing to practicing occupational therapists who have the power to implement changes in the way they practice. Changes in practice would result in an improvement in patient outcomes which is the primary goal of health care.

The article, "Justice and U.S. Occupational Therapy Practice: A Relationship 100 Years in the Making" was written by Drs. Rebecca M Aldrich, Tessa L. Boston, and Claire E. Daaleman. They all have their doctorates in occupational therapy and are professors at various universities across the United States. Although this article has not been referenced or cited yet, this is the result of it being published in February of 2017. The authors have been cited in other documents over 150 times for their other articles which makes them, and their work, credible.

The text was chosen because of its focus on social justice within occupational therapy in the United States. This was difficult to find as a majority of the research on this topic has been done in Canada. It is unique because it brought research in from fields outside of occupational therapy and health care such as law, international justice, and medical care across international borders. The authors mention not only that occupational therapy is very helpful in adjusting to a new culture, but also why and how it can help immigrants adjust.

The way so many diverse topics were brought together made this an uncommon source. How it combines the socio-economic biases of medicine with the immigration policies of the United States provides a new way to use and look at the old research.

This article was written by three caucasian women who are United States citizens which means that though they can research and empathize with these problems and biases, they cannot sympathize which makes the article impersonal but accurate and objective.

While it was written by three caucasian women, the audience for "Justice and U.S. Occupational Therapy Practice" is broader than most articles written on this topic. The audience is not only practicing occupational therapists but also policy makers in the American Occupational Therapy Association. It is written to the occupational therapists because, since they are interacting directly with the clients, their services are what changes the dispersal of services. However, the policy makers are also an audience because they are the professionals who can change accessibility and availability of the services. If these two groups were to change how they were providing care, more people with less privilege would have access to occupational therapy.

"Sharpening Our Critical Edge: Occupational Therapy in the Context of Marginalized Populations" by Alison J. Gerlach was published in the Canadian Journal of Occupational Therapy in 2015. Gerlach has her doctorate of occupational therapy from the University of British Columbia where she now teaches and does research. She has been published 15 times and her articles have been referenced nearly 60 times.

This research looks at the importance of intersectional analysis of occupational therapy within marginalized populations. Gerlach found that what primarily shapes health is not medical treatments or lifestyle choices, but rather where individuals live, work, and play. She proposed that intersectional care would enhance occupational therapy and promote an increase in treatment of marginalized patients who otherwise would not receive care. It also looks at the idea of occupation within different socioeconomic classes that are rarely mentioned in other articles. It discusses value and context of occupational while discussing social order and privilege within health care goals.

Dr. Gerlach is a caucasian, upper-middle class female who, although she has done research and empathizes with her patients, can never truly sympathize with them which results in impersonal conclusions based on her data and research. Although this distance makes her conclusions impersonal, it also makes them less biased and subjective. She wrote this to occupational therapists who are practicing in less privileged areas with people who are more marginalized and overlooked when it comes to health care.

Drs. Brent Braveman and Julie Bass-Haugen are coauthors of "Social Justice and Health Disparities: An Evolving Discourse in Occupational Therapy Research and Intervention". This, along with some of their other articles, was published in the American Journal of Occupational Therapy in 2009. Because of where and how many times they have been published, Drs. Braveman and Bass-Haugen evidently are trusted within the occupational therapy community.

This article not only discusses social justice and health disparities within occupational therapy, but also how they relate to each other. It focuses on the medical implications of health inequities and inequalities and the differences in care that are present between people of different genders, races, ethnicities, educational backgrounds, socioeconomic statuses, abilities, geographic locations, and sexual orientations. Because of the differences in incidence, prevalence, and mortality that are a direct result of different occupations within these backgrounds, according to Braveman and Bass-Haugen, this is an issue for occupational therapists. The research they did specifically names the causes of health disparities, develops intervention strategies, explores the human causes of disparities, and recognizes systemic problems and how those problems can be changed.

This information is important because it looks at what occupational therapy is and what it is meant to do. It encourages practicing therapists to promote justice and improve health by allowing people with diverse and marginalized backgrounds to have access to their services.

The article does not use any new information or research. It looks at old information in a new way which brings all the bias from its referenced articles to the new article. The old information could also be misused or misinterpreted in the new article, resulting in skewed facts.

The audiences for this article are occupational therapists practicing in diverse and marginalized communities as well as the professionals making the laws that make care available.

These six articles show how social justice issues such as racial and socioeconomic backgrounds create a hierarchy in which the white and wealthy receive better care than those who are minorities and poor. This creates a system where people who have been oppressed and denied care continue to be forgotten.
Equity of care, occupational justice, and health disparities across diverse and marginalized groups were major themes throughout the articles. In "Social Justice and Resource Utilization in a Community-Based Organization: A Case Illustration of the Role of the Occupational Therapist" the idea of occupational justice is introduced. Occupational justice involves inequities that are present when participation in occupations is prohibited, undeveloped, disrupted, alienated, marginalized, exploited, excluded, or otherwise restricted (Braveman and Bass-Haugen). Occupational justice is often impaired when policies that cause health inequities in different populations are changed (Gerlach). These inequities often have three primary features; it has systematic, consistent patterns across populations, is socially produced and easily changed, and is unfair from a perspective of basic human rights (Braveman and Bass-Haugen).

The second major point of all the articles has to do with the repercussions of these inequalities. Occupational therapists have to change how they do their jobs to embrace different occupations across diverse communities. Occupation looks different within different social groups and are often seen as other and therefore lesser (Peloquin and Abreau). Occupations such as panhandling on the street, lining up to get a hot meal, or getting a fix for an addiction are under acknowledged occupations. Because most theories are based on middle-class views and norms, many treatments lack meaning for clients who live in very different social conditions (Gerlach). This means that occupational therapists must adapt to the needs and wants of individuals outside of their usual clientele demographics. By embracing the complexities of peoples' lives rather than expecting them to conform to our practice models and tools, we can avoid the use of occupations such as vandalism, drug use, and gang activity to meet social, physical, and relaxation needs(Bazyk and Bazyk). This will promote a more complex and contextualized understanding of health and occupation in relation to varying forms of marginalization and social exclusion (Gerlach), therefore enhancing occupational therapy as a tool.

As in all aspects of life, people have experienced discrimination and marginalization in health care. Because of this, marginalized people do not have access to occupational therapy and when they do, it is not pertinent to their needs and occupations. The texts looked at in this review discuss how adapting occupational therapy and making it available would benefit many lives. However, these texts are very unique in their content.

Not many articles have been written about occupational and social justice. More research needs to be done in this area of occupational therapy. Many of the studies did not have research and data and were lacking scientific evidence. As research continues, there need to be more longitudinal studies done looking at the effects of occupational therapy on individuals in marginalized, underprivileged populations.

With social justice and equity of healthcare being such popular topics, occupational therapy in this area will be further scrutinized and critiqued. If occupational therapists were to start implementing intersectional techniques, occupational equity would improve and quality of life would most likely improve in impoverished areas. If this were to happen, there would most likely be an improvement in positive outcomes, a decrease in incarceration rates, and a decrease in use of unhealthy occupations, resulting in overall better health for americans.

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