Diversity, Equity, Inclusion, Justice, Accessibility, and Belonging in Occupational Therapy Practice and Education Open Access

The lived experiences of nondominant groups are often overlooked and underreported in educational and health care organizations in the United States (Plaisime et al., 2023), yet the ethical foundations of most health care professions call for veracious, equitable, and just treatment that honors the full spectrum of human experiences. These experiences permeate research, education, and clinical practice, shaping how care is delivered and received (Johnson et al., 2024; Stanford, 2020). This special issue on Diversity, Equity, Inclusion, Justice, Accessibility, and Belonging (DEIJAB) in Occupational Therapy Practice and Education brings together a collection of studies and theoretical arguments designed to illuminate neglected and underexamined areas within occupational therapy with the intent of advancing a more ethically grounded, inclusive profession. Equitable and affirming treatment necessitates the intentional application of inclusive education and training of practitioners, the careful selection of assessment tools and intervention pathways that align with the diverse needs of communities, and the design and implementation of research that strengthens best practice (Johnson et al., 2024). Rather than alienating or elevating any particular group, the articles in this issue seek to expose gaps, challenge assumptions, and inspire reflection on how the profession can uphold DEIJAB in daily practice.

The articles included in this special issue span five broad categories: (1) occupational therapy practice with diverse client populations, (2) occupational therapy student education and training, (3) theories and frameworks to address DEIJAB-related issues in the profession, (4) leadership, and (5) policy and advocacy. Populations highlighted in this special issue include, but are not limited to, people who identify as Black; Latino; disabled; and members of the lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and two-spirit (LGBTQIA2S+) community. Participants and informants include students, practitioners, educators, and clients who span various age ranges and socioeconomic groups. It is also important to note that this issue encompasses research conducted by occupational therapy scholars in international contexts, including Australia, Turkey, and Israel.

The occupational therapy scholars who have contributed to this issue call on practitioners to identify and apply culturally relevant interventions when working with Black, Latino, and disabled clients. For example, Dumont et al. (2025) demonstrate processes for adapting occupational therapy interventions for Black families of autistic children. Ramirez and Magasi (2025) offer familismo as a framework to facilitate culturally tailored care, encourage open communication, and address mental health, with the intent of improving access to services for Latino families. The articles in this special issue not only identify cultural considerations when providing services to families with diverse backgrounds but also describe considerations that affirm the needs of disabled children and older adults. More specifically, Day et al. (2025) characterize values-centered and tailored approaches, coupled with a nuanced understanding of services, as key to supporting inclusive occupational therapy interventions for aging adults with dementia, and Khourieh et al. (2025) outline the structural factors that influence differences in participation and quality of life for Arab and Jewish community-dwelling older adults. Washington et al.’s (2025) findings indicate significant improvements in activities of daily living and home safety after implementation of a home modification program for low-income older adults; their study emphasized the program’s role in promoting aging in place, reducing fall risks, and fostering equitable home interventions. Rios-Vega et al.’s (2025) article demonstrates the effectiveness of advisory boards in addressing barriers to accessing culturally sensitive occupational therapy for children with autism.

The occupational therapy research teams contributing to this special issue also highlight the need to develop reliable and valid measures suitable for refugees, such as the Occupational Justice Scale for Refugees, a 30-item instrument structured around five key dimensions of occupational injustice: (1) occupational deprivation, (2) occupational alienation, (3) occupational marginalization, (4) occupational imbalance, and (5) occupational apartheid (Yazici & Akyürek, 2025). Although other specific measurements are not included in the issue, several authors call for the need for culturally sensitive measurement tools to adequately assess occupational performance areas and measure change in response to occupation-based interventions.

This issue also includes four scoping reviews that take stock of the ways the profession can challenge and transform systems of care. Serrano-Diaz et al. (2025) point to deficiencies in the representation of cultural groups (e.g., First Nations peoples, transgender individuals) in research and the lack of available funding to sufficiently address these gaps as critical factors for improving inclusive occupational therapy education and practice. They recommend intentional and sustained efforts to address structural inequities by developing DEI-focused curricula, diversifying research and leadership, and fostering a culture of belonging in the profession. Another group of scholars, Smith et al. (2025), examined the role of intersectionality in education, practice, and research and advocate the integration of intersectionality into curricula, clinical approaches, and research methodologies to promote equity and culturally responsive care. Stugart et al. (2025) specifically examined the state of gender- affirming care and identify practice gaps and areas for improvement, and Kokorelias et al. (2025) explored how cultural humility is applied in therapeutic processes by using the Canadian Practice Process Framework, which focuses on client-centered and culturally responsive care.

Articles in this special issue address topics such as student belonging, target-based interventions for student learning, inclusive learning supports for disabled students, and mental health stigma in academic programs. In particular, the scholars report that cultivating belonging (Corcoran et al., 2025) and fostering intentional diversity and inclusivity within cohorts enhances educational experiences, notably for first-generation students, who face unique challenges that affect their academic performance (Ham, 2025). Banks and Cameres-Foley (2025) suggest that target-based interventions can improve students' cultural awareness, knowledge, and skills for working with Hispanic families, and Gregg et al. (2025) champion faculty training and incorporating disability frameworks throughout occupational therapy curricula to better support students with disabilities. Ramirez and VanPuymbrouck (2025) highlight how community outreach programs foster cultural humility, clinical skills, and diversity awareness, inspiring underrepresented students to explore occupational therapy careers while supporting DEI and workforce diversity goals.

Tomar et al. (2025) investigated the intersectional stigma of mental illness and race/ethnicity among students from nondominant groups. Their findings reveal that stigma influences identity negotiation, mental health care engagement, and occupational participation. Furthermore, their study underscores the need for culturally sensitive mental health interventions and greater inclusivity in educational and clinical settings.

Parallel to the experiences and needs of students are those of faculty from nondominant groups. Occupational therapy scholars contributing to this special issue call for a more nuanced understanding of the experiences of people who identify as Black, Indigenous, or People of Color to attract, recruit, and retain them in academic programs (Camacho & Bolden, 2025). Camacho and Bolden (2025) contend that this requires intentionality at all levels and access points in academic institutions as well as the profession at large.

Four articles introduce guideposts that help scholars critically examine structural inequities, bridge gaps in disciplinary conceptualizations of occupation, and disrupt problematic applications of DEIJAB. Akrofi et al. (2025) use postcolonial theory to critique the adaptation and application of DEIJAB principles in occupational therapy scholarship and practice and to outline the need for a broader praxis that values multiple philosophical orientations for a more transformative occupational therapy practice. Taff et al. (2025) use Derrida’s (2000) concept of hos[ti]pitality to interrogate the limitations of DEIJAB efforts in the profession; propose strategies to disrupt these dynamics; and promote antiracist and inclusive practices across education, research, and practice. Smet and Andrion (2025) argue for implementation of intersectionality theory to examine the overlapping systems of oppression experienced by occupational therapy academics and practitioners with multiple minoritized identities, and Major et al. (2025) advocate integrating the Public Health Critical Race Praxis framework into practice to address racial disparities in maternal health, in particular for Black mothers and birthing individuals who are disproportionately affected by systemic racism. These papers collectively provide structures from which occupational therapy practitioners can frame existing issues, critically examine barriers to progress, and explore possible solutions.

Leadership development of women of color in the profession is mediated by systemic racism, cultural assimilation, and the undervaluation of non-White identities, manifesting as workplace discrimination, tokenism, and limited opportunities for mentorship and sponsorship (Nirmul & Cabrejo, 2025). To confront these structural facilitators and systems of oppression, Nirmul and Cabrejo (2025) petition the profession to transform workplace culture; diversify mentorship and sponsorship; and implement antiracist, equity-driven DEIJAB initiatives to foster authentic inclusion and equitable pathways to leadership. Similarly, Banks et al.’s (2025) study of Black practitioners who pursued leadership opportunities highlights the importance of social networks. It also reveals how institutional racism sustains inequalities in the leadership journeys of Black occupational therapy practitioners.

A necessary point of discussion on accessibility in the profession concerns aspiring practitioners who are underdocumented. O’Brien and Kuhaneck (2025) examine state licensure requirements, workforce shortages, and educational barriers for underdocumented individuals and note critical needs for advocacy for policy reform, transparent licensure processes, and innovative educational solutions to create a more equitable and inclusive profession. Although this is the only article in this special issue to specifically focus on policy and advocacy, many of the contributions note the importance of advocacy and policy change as key to making progress in the field.

In 2020, the American Journal of Occupational Therapy began to recognize the strong need to increase evidence substantiating the value of diversity, equity, inclusion, justice, accessibility, and belonging in health care education and practice. This special issue is one of many salient steps undertaken to provide this evidence base, yet more work in this area is of vital importance (Zephyrin et al., 2023). As a profession, occupational therapy must hold true to the claim that “a standard application of DEI principles inherently promotes justice and accessibility for all. … Centering DEI in research[, education, and practice] moves the profession beyond obligatory, performative, and surface-level practices toward a DEI praxis” (Johnson et al., 2024, p. 2). What remains at stake are the individuals and communities with different lived experiences who are caught in the crosshairs and the potential of the profession to inadvertently perpetuate practices that cause harm. As occupational therapy scholars continue to build a knowledge base that better informs and prepares practitioners, educators, and researchers to enter into relationships with nondominant groups, we challenge the profession to remain steadfast in its efforts to ameliorate any remaining conceptual, theoretical, and methodological gaps. We can do this by

• ▪ developing research processes that disentangle race and other identities of difference, including disability, as risk factors versus risk markers of occupational outcomes;

• ▪ addressing ableism in research processes and reporting by establishing new, and expanding existing, frameworks that center disability; and

• ▪ preparing emerging occupational scientists and occupational therapy scholar practitioners to take up and apply antiracist and intersectional approaches in their work (Johnson et al., 2024).

In addition, we encourage research that bridges emancipatory action to quantitative and qualitative designs to mitigate disparities in occupational therapy practice, as well as the targeted inclusion of First Nations peoples, disabled individuals, LGBTQIA2S+ individuals, linguistically diverse individuals, and individuals experiencing war and conflict.

This special issue underscores the vital role of DEIJAB in occupational therapy research, education, and practice. By illuminating gaps, challenging dominant paradigms, and advocating culturally responsive approaches, these articles call for intentional action. As a profession, we must critically reflect, embrace intersectionality, and integrate inclusive frameworks to ensure ethical, just, and effective care for all communities. Change begins with awareness, commitment, and sustained action.

We extend our sincerest appreciation to Stacey Reynolds, PhD, OTR/L, FAOTA, Editor-in-Chief of the American Journal of Occupational Therapy, for her leadership and allyship in elevating research and scholarship with diverse communities in our professional discourse, and to Seth Mitchell, PhD candidate in occupational science at the University of North Carolina at Chapel Hill, for his technical support.