OTalk 21st July 2020 – Improving BAME Representation in OT – #OTalk Diversity in OT Series (UK Focus)

With the #BlackLivesMatter movement sending ripples around the world on top of the #COVID-19 pandemic, efforts to adjust to the ‘new normal’ are underway and the #OccupationalTherapy profession is no exception. Over the years there has been repeating and intermittent awareness of the need to increase inclusive representation within the profession. Talk needs to be followed by action, and more needs to be done in order to lead to sustainable change. We need to address the systems and processes that make real lasting change difficult. It is not just about making people who don’t usually represent the typical presentation of an #occupational therapist, fit the mould, but about embracing the diversity and strengths that widening access and participation has to offer our profession, and more importantly the people we serve. Moving forward we need to continue to build alliances within the professional membership, regardless of skin colour and ethnicity, to have a depth of impact in change. We can do this as a profession with the help of local activity, diverse local champions, diverse local leaders and @theRCOT.

This #OTalk presents an opportunity to share our thoughts on this subject, in light of the recent #BlackLivesMatter events and the public health report highlighting that #BAME (Black Asian Minority Ethnic) communities are disproportionately affected by the COVID-19 pandemic. We would like to emphasise (and for the RCOT to take note) that focus on the BAME community should be regularly reviewed and discussed. This will keep the subject an explicitly ever present agenda for the profession in order to challenge and change structural based inequality. We also acknowledge that while the term BAME can be problematic, it can be helpful for exploring issues of representation. If in doubt ask the person their preferred term of reference.

This discussion on occupational therapy and UK-based BAME communities is part of an #OTalk series on topics of diversity. Other topics to be explored later include: Disability (including Neurodiversity), LGBTQIA+ and Gender Issues.

Some preliminary groundwork in preparation for this series is encouraged:

  • Look Deep. Acknowledge any privileges you may have. This resource on Privilege and Intersectionality may help: https://guides.rider.edu/privilege
  • Come to the chats with an open mind and heart and be prepared to feel uncomfortable – it is through discomfort that we can begin to make the necessary changes.
  • We need to unite to be actively against (anti) any forms of prejudice / oppression.
  • As always, respect each others’ views and acknowledge that there will undoubtedly be differences of opinion.
  • Develop an awareness of microaggressions and be mindful of how they may impact the colleagues you are interacting with on this topic: https://www.vox.com/2015/2/16/8031073/what-are-microaggressions
  • Accept that you will make mistakes and if these are pointed out, reflect on them and make the necessary changes.
  • Be clear about the differences between Inequality, Equality, Equity, and Justice. Check out this graphic created by @lunchbreath based on Shel Silverstein’s The Giving Tree.

Questions for the #OTalk chat will be as follows:

1 A) How ethnically diverse do you perceive our profession to be now? B) Has this changed over the course of your time as an OT? (Q Hosted by @Occ4LifeLtd)

2 A) Why would we want to encourage more people from BAME backgrounds to enter the profession? B) Does the OT staff group in your area represent the population you serve? (Q Hosted by @sherriikapp)

3 A) What racial / cultural discrimination have you experienced, seen or even perpetrated (even unconsciously)? B) What did you do about it? (Q Hosted by @KwakuOT)

4 A) What barriers do BAME occupational therapists face for progression into roles in leadership, academia and research? Please refer to the list of questions prepared by @HannahtheOT https://twitter.com/HannahtheOT/status/1267852336443150341 (How many Black lecturers / placement educators / managers have you had? Can you name 10 Black OTs you’ve worked with throughout your career? Can you name 10 white OTs? Name an OT theory, model or standardised assessment developed by a Black OT? How many articles/books have you read that were written by a Black OT?) (Q Hosted by @MwelaSihle)

5 A) What responsibility do you / will you take for exploring and educating yourself on issues of race and culture? B) What is one change you can make tomorrow? (Q Hosted by @LecturerMish)

Some useful resources:

*Will COVID-19 be a watershed moment for health inequalities: https://www.health.org.uk/publications/long-reads/will-covid-19-be-a-watershed-moment-for-health-inequalities

*AHP Leaders Podcast: Changing the Culture of Conversations (featuring AHP leaders from across the UK) https://www.youtube.com/channel/UCb722uXf9XJpegA_d-ApBUg

*The OT & Chill @ot_chill podcast, Episode 11 – L . O . V . E – Let’s Talk About Race #BLACKLIVESMATTER: https://open.spotify.com/episode/4sPh0qghwAiozaXLSM0re2

Akala deconstructs race, class, and Britain’s modern myths | Unfiltered with James O’Brien #32 https://www.youtube.com/watch?v=atfVUgyEIOI

Dr Karen Whalley Hammell WFOT Congress 2018 keynote ‘Building globally relevant occupational therapy from the strength of our diversity’ https://www.youtube.com/watch?v=9WipUPXx_Kk&t=7s

*George Floyd, Minneapolis Protests, Ahmaud Arbery & Amy Cooper | The Daily Social Distancing Show https://www.youtube.com/watch?v=v4amCfVbA_c

Hey White Therapist! Here’s where we start! https://courses.clearlyclinical.com/courses/free-ceu-racial-awareness

Why I am no Longer Talking to White People About Race by Renni Eddo Lodge: https://www.theguardian.com/world/2017/may/30/why-im-no-longer-talking-to-white-people-about-race (this is the preview article for the book)

Guidance for white allies who are trying to help https://ladders4action.org/news-blogs-videos/blog/do-no-harm/

Why “I’m not racist” is only half the story by Robin DiAngelo https://www.youtube.com/watch?v=kzLT54QjclA (a good summary of her book ‘White Fragility’)

A few real life scenarios to get you thinking:

In one occupational therapist’s work place it was identified that approximately 50% of inmates in a prison setting are from BAME backgrounds, with only 10% accessing occupational therapy services. Many reported discomfort in accessing services as they felt that the staff body was not representative of their backgrounds and lacked understanding of where they were coming from.

A Black occupational therapist received comments from a supervisor which suggested that they were perceived as lazy and uneducated. This Black colleague felt they had to work ten times as hard as white counterparts and also sees white colleagues get away with things they are reprimanded for.

A white Muslim occupational therapist who wears a hijab went to an interview and saw visible shock on the interviewer’s face. Feedback suggests that she couldn’t have answered the questions differently but she wasn’t offered the job.

A Black student turns up to a university admissions interview wearing jeans – they demonstrate more knowledge and insight than a white student who comes wearing a suit or smart attire. Which applicant gets awarded a place on the programme?

This #OTalk session and blogpost was made possible through the contributions of: Sihle Mwela @MwelaSihle Kwaku Agyemang @KwakuOT Jo Bresi-Ando @otStones Musharrat Ahmed-Landeryou @LecturerMish Elaine Rutherford @Cariad_OT Jou Yin, Teoh @teohjouyin Grace Chikelu Amamilo (not on Twitter) Kirsty Stanley @Occ4LifeLtd or @kirstyes Somia Jan @SomiaOT Carolyn Connage @CarolynOT Nichole Yam @nicholeyam Ed Sum @musedNeuroOT Sophia Awan @Sophia OT Yasmin Anisuddin Ward @Yazz_OT Geraldine Kinkead-Richards @GeriLKR Hannah Daisy @HannahtheOT Simone Welch @Simzy_x Ally Plusii @Ally56642911 Sheri Braimah @sheriefeb

One change our group thought was that RCOT could easily introduce is to appoint an Equality and Diversity Officer dedicated to organising research, study, networking and publicity events, and for influencing policy. A diversity mentorship / support scheme was also suggested to provide opportunities for people to discuss common issues. It would also be useful to have some dedicated webpage resources similar to those on the CSP website – https://www.csp.org.uk/workplace/equality-diversity. Do keep informed on the RCOT progress following the RCOT BAME Big Conversation – a summary of which will be posted on their new Equality, Diversity and Inclusion pages here – https://www.rcot.co.uk/equality-diversity-and-inclusion

Some immediate actions you can take:

Vote for Dr Kee Hean, Lim @lim_hean to be member of the RCOT Council. He is the sole candidate to represent the BAME population and has a long, consistent track record of enabling equitable student recruitment and retention at Brunel University London. The Brunel University London student body has 30-50% BAME representation thanks to the efforts of Kee Hean and his fellow admissions tutor Dr Ayana Ifekoya. The Brunel University London occupational therapy team have a tweet thread documenting their recent efforts contributing towards Racial and Cultural Equity: https://twitter.com/OTatBrunel/status/1281145935502942209

Please consider answering the call for stories, poems, comics, etc for an eBook “We Are OT: a brief history and personal accounts of diversity in the profession of occupational therapy within the UK” to be published on World Occupational Therapy Day 2020. https://occupation4life.co.uk/2020/06/05/we-are-ot/

The Lives of #BAME OTs in 2020 explored via CMOP-E – Canadian Model of Occupational Performance and Engagement

I was invited by @LecturerMish to follow @DLafayette411‘s example and conceptualise BAME (Black and Minority Ethnic – UK Term) lives through an OT Model. Now being unable to stick to one tweet and not go overboard I’ve written this.

CMOP-E – Canadian Model of Occupational Performance and Engagement

This model describes the relationship and influences between these elements (Spirituality, Person, Occupation and Environment) which enables occupational performance. That is the ability of a person to perform occupations and daily engagements.

Analysis

Spirituality

Entered the profession to make a difference. Core identity as a member of a BAME community, family and the OT Profession. May feel incongruity with core values and beliefs and current situation.

Person

Cognitive – Mind can’t switch off, memories of past injustice mix with current situation. Need space to process. Emotional reasoning does not equal illogical reasoning.

Physical – Added concern about the increased physical health risk of covid to BAME populations. Bombarded by sensory images of racism.

Affective – Tired and worn down, frustrated and angry, upset by being asked to relive past trauma. May also be energised by the momentum for change. Additional anxiety created by pandemic.

Occupation

Self-Care – Possibly neglected or may not be being prioritised. Need to focus on mental health and safety.

Leisure – I would imagine fairly limited especially in terms of enjoyment. Constantly engaging in debate, reading news/social media. Favoured occupations may be sidelined.

Productivity – If still working the form of this will have changed placing extra demands on the person to work in different ways. Engagement in activism as a productive co-occupation.

Environment

Physical – Lockdown has removed access to certain parts of society where people may have sought support. May feel like there is no sanctuary as home has become where everything takes place.

Institutional (includes Economic, Legal, Political) Possibly feeling unheard by professional and regulatory bodies and workplaces. Wanting to affect change but having little power to do so within current structure. Finance may be difficult at the current time meaning less able to act on needs. Political environment is a mess compounded by Brexit – feels unsupportive. People also appear to be conflating politics with human rights. #BLM movement driving impetus for change.

Cultural – Conflicting cultures. Family, ethnicity, professional. May struggle with the professional or overarching British cultural attitude of stiff upper lip, keep calm and carry on. Focus is on connecting more to culture around ethnicity at present – that’s where attention is needed. Family may or may not support this depending on familial make-up – do family members share BAME backgrounds and understand concern?

Social – Usual support groups not as accessible, experiencing tone policing online from those who aren’t used to discussing racism. Seeking social support from allies to take on some of the load. Co-workers may not ‘get it’ especially where you are the lone OT from a BAME background.

In this model the environment is recognised as an underused resource and one that we need to capitalise on.

Not included in the model but I’d add in the Historical environment here too. This isn’t about what has just happened. It’s about all the things that have come before, all the personal microagressions, all the injustices. They aren’t blaming others for the past environment but it still impacts massively on the present and needs acknowledgement (and yes even if you/they weren’t alive when it all happened).

Synthesis and action

Spirituality

Reaffirm core belief of self and validation of the person as a their member of their BAME heritage. Help articulation of goals and desires for this period.

Person

Support strategies to manage stress and switch off. Prioritise sleep, nutrition etc. Person needs to be healthy to be most effective. Examine reasoning and explore thoughts and feelings. Risk assessment re physical well-being in workplaces. Recognise that everyone is individual. Some BAME OTs may not want to/feel able to engage at the moment and that is their right.

Occupation

Refocus on self care and restorative leisure occupations. Recognise that energy will need to be spent differently during this time though. Respect that activism is a valid occupation – explore different forms of activism. Possibly reduce demands of some occupational areas to compensate at this time, eg. Housework. That’s always the first thing to go with me at least!

Environment

Locate a safe space, a place or time where can just be themselves.

Find a social support network of like minded individuals to bounce ideas off and share the load. Include white allies to support this.

Challenge structural and institutional inequalities and demand change. Allies need to do this too. Professional body/workplace could take more responsibility for leading change allowing BAME OTs to contribute as able without feeling burdened.

As a white OT I have aimed to use the model to empathise with the lived experience of my BAME colleagues. Any mistakes are entirely my own. Do feel free to comment if you agree or disagree with anything I’ve written. I will listen.

An OT CPD Activity A Day – Preorder Your Creative CPD Journal Now

An OT CPD Activity A Day by Kirsty Stanley is a Creative CPD Journal for occupational therapists to use to: re-invigorate their Continuing Professional Development, try a range of creative methods of reflection, reconnect with the philosophy of our wonderful profession, imagine its future, and to explore their own occupational wellbeing.

The 366 activities included are not dated so they can be completed in any order, and started on any day of any year. If you do join me in using the journal in 2021 share your activities with everyone on social media using #OTCPD21.

From clinical reasoning to your favourite occupation, anti-racist practice to risk management, reflective art and poetry to basket weaving. There will be something in here to spark new insights in even the most experienced of OTs. You can see some example pages here: https://www.instagram.com/p/CCshVE4DBoN/?igshid=u5x5tb4s0m7i.

Cover Image

Kirsty Stanley, via Occupation4Life Ltd, will be writing and designing this journal which will be shipped worldwide in December 2020. Books will be square coil bound 210x210cm with matte cover. Pages will be mostly black and white with some colour inserts.

The journal is priced at £20 (£25 inc UK P&P, £35 inc International P&P). Use my Paypal me link to pay the relevant amount.

Preorders will close on 20th November 2020 after which you will be sent an email asking you to confirm your shipping address. I cannot guarantee a reprint or stock after this date. It will depend entirely on demand.

For combined shipping on multiple orders for teams contact me via Occupation4Life@gmail.com for a quote. I’m based in Dorset so can deliver within the county for free.