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A Here- and- Now Challenge for Occupational Therapists

By Imasha Perera and Kate-Lin Douglas

The Queen’s Occupational Therapy Class of 2021 has finally finished our first year of graduate school. Over the past few months, we have adjusted to a new way of life, including how we learned. Making it through these past few months was a huge accomplishment and we should be proud. The death of George Floyd and The Black Lives Matter movement took on full force as we were finishing our first year of grad school, and now that we are done with exams, it seems fitting that we should further examine our own profession and how we can combat institutional racism in facilities we work and study in.

Occupational Therapists (OTs) work with people to enable them to live meaningful lives. We do this by engaging and collaborating with our clients and assisting them in daily activities that are important to them - for instance, being able to get ready for the day, engage fully in school or work, and participate in hobbies and leisure activities. We also play a large role in advocating for our clients in the institutional environments that surround them. A term we use as OTs is “occupational justice”. Occupational justice refers to the notion that every individual has a right to meet their basic needs and have equal opportunity to reach their potential. It focuses on looking at the environmental barriers that prevent an individual from engaging in their daily activities. Essentially, according to occupational justice, WE ALL have a right to take part in activities that are meaningful to us and engage us in our society. However, for Black people there are environmental barriers such as institutional racism that disable them from fully engaging and enacting their rights. As students and future clinicians, we went into our profession wanting to make meaningful changes in people’s lives and the communities we live in. However, can we do that without exploring the biases embedded in our profession and the privilege we have as healthcare workers?

Occupational Therapy was founded by white men and women. The first OTs were actually referred to as “good girls from good families” meaning they were white women who came from upper middle-class families helping the “less fortunate”. The theoretical foundations of the profession are rooted in ideology that support a white, western, and middle-class population even though many who are in need of OT services identify themselves as a minority.  Iwama (2003) states that theories that idolize western values can be counterproductive and even oppressive to clients who experience reality through different beliefs. Sadly, we cannot change the past. But we can work at making the present and the future better for our clients and our profession.

This is a time for us to examine our own personal biases. As individual therapists, we need to think critically about the ideologies we practice within, especially when we apply them to our racialized clients. It also means letting go of our egos, being more vulnerable and practicing with a beginner’s mindset when working with our racialized colleagues and clients. This means leaving our assumptions at the door, being present, listening, asking questions, and understanding that people experience reality differently from ourselves. Learning about the experience of Black people and acknowledging our own biases is not enough. We need to be accountable and look for ways to change the way we practice by taking more training on practicing from anti-racist, LGBTQ+ friendly, womanist and anti-oppressive lenses. 

The challenge of racial injustice is an institutional problem.  It is not enough for individual therapists to hold themselves accountable. We must be willing to interact with leaders in charge of the institutions that train us, hire us, and govern us. However, the relationship between the individual and the institution is a reciprocal one. Leaders must be open to listening and creating meaningful change based off of suggestions they receive by examining current policies and procedures, consulting minorities, and changing the operations of the institution accordingly to create more diversity and inclusion.

We need to make changes on both the micro and macro levels to truly practice what we preach as OTs. We need to do better for our clients, regardless of colour of skin, age, gender, sexuality, cultural and ethnic beliefs. We all have our role to play in this issue and so to do better, we must first begin with ourselves.


Iwama, M. (2003). Toward culturally relevant epistemologies in occupational therapy. American Journal of Occupational Therapy, 57(5), 582-588.

Further reading for healthcare workers 


  • Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet Washington
  • The Power to Heal: Civil Rights, Medicare, and the struggle to transform America's Healthcare system by David Barton Smith
  • Killing the Black Body by Dorothy Roberts
  • Why are the Black Kids Sitting Together In the Cafeteria: and other conversations about race by Beverly Daniel Tatum


  • The cost of racism for people of color: Contextualizing experiences of discrimination, American Psychological Association
  • Perception of Racial discrimination and psychopathy across three US ethnic minority groups, Cultural Diversity and Ethnic Minority
  • Race and Trust in the Healthcare System, Public Health Reports


1) "let's get to  the root of racial injustice" Megan Ming Francis

2) " The Dangers of Whitewashing Black History" David Ikard

3) " The Symbols of Systemic Racism and how to take away their power" Paul Rucker


Into the Fold: The Past Does Matter Post Traumatic Slave Syndrome

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