Promoting Justice, Diversity, Equity, and Inclusion Through Caring Communities: Why It Matters to Occupational Therapy

Caring communities—thriving environments that address humanitarian challenges and in which people care for one another (Ramugondo & Kronenberg, 2015)—foster a sense of belonging, an innate drive to form and maintain interpersonal connections that is fundamental to our identity (Kocaoğlu et al., 2022). Belonging makes us feel included: It’s not about fitting in, it’s about being accepted as we are (Allen et al., 2022). Belonging boosts our well-being and gives us a sense of shared identity; it helps us feel connected and acknowledged as a part of something, build on our common values, and appreciate our differences (Powell, 2012).

The concept of caring communities is prominent in community development, whereby people address significant challenges within their communities (Kocaoğlu et al., 2022). Activists, community developers, and advocates transform a community through collective work, making the community a place where everyone can grow and thrive (Hemminger, 2021). Caring communities are centered around shared values, support of one another, appreciation of our similarities, and celebration and acceptance of differences. In caring communities, everyone is accepted and cared for regardless of circumstances, beliefs, or the unique ways they may engage with the world (Powell, 2012). Most occupational therapy practitioners have lived experiences of working with a person who, facing new challenges, is graced with a caring community of people who surround them and connect with the person and each other to help that individual adjust and have the opportunity to thrive. If you scale this idea up, you will understand the potential power of caring communities in academia and in the occupational therapy profession.

Intentional efforts to advance and promote justice, equity, diversity, and inclusion (JEDI) are one way to develop caring communities. Such intentionality requires a commitment to move beyond rhetoric to specific, measurable actions that support justice and dismantle racism. Justice is foundational to developing caring communities. Caring communities can achieve justice by examining factors that affect an individual, addressing the challenges, and deconstructing systemic injustices affecting the larger community. Antiracist practice begins by naming and framing racism (Johnson & Lavalley, 2021) and making conscious decisions to practice critical reflexivity to unlearn White supremacy culture and foster belonging, in particular in academic settings (Beagan, 2015; Johnson et al., 2022).

Occupational therapists practice person- and family-centered care by acknowledging each individual’s values, beliefs, and strengths throughout the occupational therapy process (American Occupational Therapy Association [AOTA], 2020b). Practitioners acknowledge an individual’s experiences and understand desired outcomes for intervention through the development of collaborative relationships. Practitioners are well trained in analyzing the environment and cultivating participation that nurtures a person’s feelings of self-efficacy and safety. Practitioners promote health, well-being, and participation through occupation (AOTA, 2020b). Cultural humility is increasingly important in health care delivery, and practitioners recognize the need to critically analyze their practices and engage in realistic, ongoing self-appraisal (Agner, 2020; Lerner & Kim, 2022). Applying this unique skill set through an antiracist practice can allow occupational therapy to address the challenges of JEDI by developing caring communities in academic spaces.

Promoting JEDI is critical in today’s divided world. Advocacy can start by having meaningful conversations about what the terms justice, equity, diversity, and inclusion mean as values and, importantly, by delineating what it looks like when we put into practice JEDI values in occupational therapy. Taking action to promote JEDI through caring communities may require that we disrupt some current practices. Ramugondo (2015) coined the term occupational consciousness, which refers to a persistent awareness of how dominant practices sustain our doing. This concept, which is grounded in intentional mindfulness, can support mindful, conscious approaches to “doing JEDI” in ways that build caring communities.

Racial justice requires addressing the accumulated inequalities along racial lines in the United States, most importantly, systemic racism (Johnson & Lavalley, 2021). Systemic racism exists in our laws and regulations, resulting in discrimination in health care, housing, employment, and education. Although systemic racism harms people of color, we know that it also harms our society as a whole, affecting the well-being of all (McGhee, 2021).

Aligned with racial justice is social justice, which is based on the principle of fair equality—whereby all human beings have rights and responsibilities—and the principle of difference, which suggests that goods and opportunities should be redistributed and available in such a way as to ensure that all human beings have sufficient resources to enjoy a freely chosen life of dignity and respect (Braveman & Suarez-Balcazar, 2009). The dominant concept of social justice includes a procedural dimension—opportunities to freely decide on a life project and a choice of occupation—and a distributive dimension, which refers to access to the necessary resources to achieve this. Social justice encompasses occupational justice as well. It is important to speak of both racial and social justice, in part because, in our discourse about social justice, we often ignore racial justice.

In recent years, various global movements have brought people together from different disciplines, diverse ethnic and racial backgrounds, and distinct walks of life. They call for racial and social justice (e.g., Black Lives Matter), environmental justice (e.g., the Climate Justice Alliance), Indigenous Peoples justice (e.g., First Peoples Worldwide), justice for survivors of sexual abuse (e.g., the #MeToo movement), justice for people with disabilities (e.g., the People First movement), justice for individuals who are immigrants and refugees (e.g., Families Belong Together), and rights for individuals who identify as LGBTQIA+, among others. Growing inequalities that are affecting humanity demand an urgent search for new answers to problems affecting our communities and require a fervent search for new restorative frameworks and a questioning of modern colonialism in our ways of doing and thinking (Mahoney & Kiraly-Alvarez, 2019).

Global inequities require a conception of racial, social, and occupational justice that advances in at least four directions: (1) recognizing that racism and inequalities result from systematic and intersectional violations of human rights; (2) highlighting the proactive role of individuals, including those in a position of power as well as regular citizens, in pursuing justice and creating communities in which all people have opportunities to engage in occupations of their choice; (3) addressing social, economic, and environmental inequalities that affect marginalized communities’ capacity for occupational engagement and participation; and (4) empowering and supporting local communities to advocate for systemic transformative changes (Suarez-Balcazar et al., 2022). These four directions align well with AOTA’s (2017) Vision 2025: As an inclusive profession, “occupational therapy maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living” (p. 1).

A renewed social justice approach also requires an emphasis on community engagement and participatory community approaches to occupational therapy scholarship and practice. Community engagement and participatory scholarly approaches are underscored as a strengths-based and emancipatory process whereby the research and action components are driven by community concerns and carried out by scholars in partnership with the community (Hammel et al., 2015; Johnson & Lavalley, 2021). This involves promoting critical dialogue and meaningful engagement of communities in the co-creation of knowledge (Suarez-Balcazar, 2020) and an antiracist agenda (Johnson et al., 2022; Lerner & Kim, 2022). To contextualize this work, Hammel et al. (2015) proposed a revised Scholarship of Practice model that highlights the ongoing interaction among occupational therapy scholars, practitioners, community members, and leaders in the co-production of knowledge that is well informed by practice.

However, the groups that experience marginalization and social inequalities often are farthest removed from occupying roles in social and political participation, making it harder to involve them in partnership efforts. This is a challenge for occupational therapy scholars and practitioners alike. It requires reflective practice, intentional efforts, cultural humility, the putting aside of biases, and increasing critical awareness so that we can create spaces to give a voice to the most silent communities. Just as our vision of social and racial justice needs to be revised, so too do our strategies to promote it require advancing new ways of doing research (Suarez-Balcazar, 2020). These ways involve conducting occupational therapy scholarship that is participant centered, gives voice to community residents in meaningful ways, promotes the redistribution of resources, and facilitates gaining the power to make decisions about one’s life (Hammel et al., 2015; Johnson & Lavalley, 2021).

The terms equity and inclusion refer to how social groups are stratified across society. Inclusion is a concept that demands that institutions and communities open themselves to members of formerly excluded social groups (Taff & Blash, 2017). Equity moves beyond simple or formalistic notions of equal treatment. When groups are situated differently in society with respect to status, resources, and opportunities, then equal treatment can perpetuate rather than ameliorate health, social, economic, legal, or political inequality (Powell & Toppin, 2021). Equity is a concept that recognizes that sometimes fair treatment requires differential treatment according to people’s needs and conditions. Although they are important concepts, neither equity nor inclusion guarantees belonging.

Belonging and creating caring communities go hand in hand with diversity, equity, and inclusion; people’s voices are included, and their needs are considered and met. Diversity is not enough; inclusion and equity need to be underscored. McGarry and Agarin (2014) drew attention to the need to distinguish “presence, voice, and influence.” To strive toward inclusion and diversity, we must have diverse people present at the table who are welcome to share their views and thus to influence action toward equity and inclusion. Distinct voices have the power to influence policies, systems, practices, services, and programs.

From an ecological perspective, we need action at the individual, academic, community, and systemic levels. In the sections that follow, we supply recommendations for advancing JEDI by creating caring communities and a sense of belonging. We recognize that these recommendations are not exhaustive and that they build on others’ work, including AOTA’s Diversity, Equity, and Inclusion Resource Library (https://www.aota.org/practice/practice-essentials/dei/diversity-equity--inclusion-toolkit-resource-library; Suarez-Balcazar et al., 2020). Although the emphasis here is on action steps at the academic program level, we recognize that many, if not all, recommendations apply to practice settings as well.

This level applies to the individual student, practitioner, and academic occupational therapy unit:

1. Ensure your practice, scholarship, and occupational therapy education reflect AOTA’s (1993) core values of Altruism, Equality, Freedom, Justice, Dignity, Truth, and Prudence.

2. Intentionally practice cultural humility and engage in active listening. Reach out to others; engage in conversations that take you out of your comfort zone; and be open to new ways of thinking, believing, celebrating, and doing.

3. Make a habit of engaging in reflective practice by asking yourself questions such as “What did I learn from this?” and “How can I grow from here?” Realize that we all have the power to become better people; change starts within us.

4. Articulate a vision of the world you want to see and share it with others with the intent of creating shared values and visions. Hold brainstorming sessions on shared values at the departmental level including faculty, students, and staff. Realize that despite our differences, we may share similar values such as “equity,” “compassion and kindness,” and “justice,” just to highlight a few examples. Follow the identification of values with conversations on how to enact shared values. Communicate your shared values to others.

5. Make an effort to ensure your workspace is an emotionally safe learning, healing, and working environment.

6. Cultivate an inclusive curriculum of courses and in-services that integrate topics relevant to training practitioners to advocate for racial and social justice. Topics may include, but are not limited to, developing cultural humility, recognizing implicit bias, and understanding and addressing microaggressions, and understanding systemic racism, as well as education on social determinants of health, White privilege, racial and social justice frameworks, critical race theory, LGBTQIA+ rights, and disability rights, among others. Fink’s (2013) categories of significant learning (foundational learning, application, integration, human dimension, caring, and learning how to learn) are used at the University of Illinois Chicago as a framework to integrate JEDI throughout the curriculum. Fink’s framework is described in detail in AOTA’s (2020a) “Educator’s Guide for Addressing Cultural Awareness, Humility, and Dexterity in Occupational Therapy Curricula.”

7. Decolonize the curriculum and typical practice standards. Situate and illuminate histories and knowledges that do not originate from Western traditions and viewpoints and that have been marginalized in academic contexts and traditional practice settings. Bring the voices of Black, Brown, and Indigenous people; people with disabilities; and the LGBTQIA+ community to the forefront.

8. Integrate JEDI-related activities across committees and all academic efforts.

9. Initiate a Coalition of Occupational Therapy Advocates for Diversity (COTAD; https://www.cotad.org/) and Diverse-OT (https://diverse-ot.com/) chapter and support their efforts. Similar initiatives can also be established in occupational therapy practice settings. For example, a group of inpatient and outpatient occupational therapy practitioners established a diversity, equity, and inclusion media health literacy club for their hospital system to engage in reflective practice and discuss strategies for promoting culturally relevant and inclusive care.

10. Gather information from students and faculty to better understand their lived experiences and what is relevant to them. Survey students; be accountable and evaluate your efforts. This can also be done for individuals who receive occupational therapy services. Host an in-service, and invite patients who have been discharged to share their lived experiences navigating the health care system and life after hospitalization. Then engage in active reflection to implement changes to alleviate any challenges identified within your system.

11. Follow a holistic admissions model to enroll a diverse cohort of learners, one that considers diverse life experiences, overcoming challenges, volunteerism, leadership, service to the community, and other factors as pivotal admission considerations (see Barrett et al., 2022; Stoffel et al., 2021).

12. Considering other ways of doing and thinking also means moving beyond traditional Western values and knowledge. Reflect on what we can learn from collectivism, co-empowerment, collective well-being, cooperation, and spiritual growth, among other non-Western values.

13. Create safe spaces in academia for learners to have these conversations and listen. Create spaces for personal encounters—virtual or face to face—where people come together to mingle and get to know each other, being mindful of others, sharing values, celebrating their differences, and building on their shared values.

14. Develop guidelines and considerations for inclusive language and culturally sensitive and de-colonizing pedagogy to be shared with all instructors and guest speakers.

As citizens, we have the power to build caring communities. The following are some recommendations:

1. Be engaged: Volunteer, gift your time, your resources, your skills, and so on, and challenge practices that seem to perpetuate racial and social injustices.

2. Get involved in your community and society at large and promote discussions with others about instances of environmental, social, and occupational injustices; racism; disparities, and other topics.

Changes at this level are harder to achieve, yet not impossible:

1. Become active in the AOTA Political Action Committee. Attend AOTA’s Hill Day, and advocate for policy-level change with your congressional representatives.

2. Look for opportunities within the larger society to engage in advocacy. A group of occupational therapy practitioners saw the lack of awareness of occupational therapy in their community therefore they started a grassroots organization, the DiversOTy Chicago Collective (see, e.g., https://www.facebook.com/groups/2731476637135620/, https://www.instagram.com/diversoty_chicago/), which serves to empower growth and connections among occupational therapy practitioners and community members.

3. Become involved at your state-level organization and be a voice for JEDI. Create a subcommittee or host a town hall meeting to discuss issues, challenges, and solutions.

4. Vote, and make your voice heard by supporting candidates that share your values.

Advancing JEDI through caring communities is a lifelong journey that starts with us. Occupational therapy educators, practitioners, and scholars are perfectly positioned to support the efforts recommended in this column and strengthen the profession’s commitment to JEDI and caring communities. We need to be intentional and strategic and critically reflect on current policies and practices and how they are supporting and promoting JEDI and creating caring communities. Promoting JEDI through caring communities and a sense of belonging is a journey. We are all in this together.

An early version of this article was presented by Yolanda Suarez-Balcazar in a keynote address at Midwestern University’s Department of Occupational Therapy Leadership Series. We thank Celeste Januszewski for her feedback on an early version.