Occupational therapists must consider the unique needs of transgender clients to create an inclusive healthcare environment that respects individual identities. Several recent legislation restrict various liberties, including medical treatments, bathroom usage, and preferred pronoun recognition. Transgender individuals often face distinct challenges related to mental health, social support, and healthcare access.  Occupational therapists play a vital role in addressing these challenges by tailoring intervention plans to meet the specific needs of transgender clients, which may include assistance with daily activities and serving as advocates. By embracing cultural humility and gender-affirming care, occupational therapists contribute to the well-being and empowerment of transgender clients, promoting healthier and more fulfilling lives.

Resources

• Philadelphia Trans Wellness Conference
• Fenway Health & Harvard University “Advancing Excellence in Sexual Minority Healthcare”
• Harvard online course “LGBTQ Health Issues” 

References

Gender identity and expression. (2016, April 16). [PowerPoint slides]. Retrieved from personal email from PFLAG Health Disparities. (2015, September 1). [blog post]. Retrieved from https://www.cdc.gov/healthyyouth/disparities/index.htm

Human Rights Campaign & Trans People of Color Coalition. (2017). A time to act: Fatal violence against transgender people in America 2017. San Francisco, CA: Lee, M. 

Lynn, M. (2017). Here’s what transgender people with disabilities want you to know. BuzzFeed, Retrieved from https://www.buzzfeed.com/mahdialynn/heres-what-disabled-transgender-people-want-you-to-know? utm_term=.fdrrNNQX5m#.jbdx00AzGX

National Center for Transgender Equality and the National Gay and Lesbian Task Force. (2011). National transgender discrimination survey. Washington, DC: Grant, J. M., Mottet, L. A., Tanis, J., Herman, J. L., Harrison, J., & Keisling, M. 

National LGBTQ Health Education Center: Fenway Health. (2016). Affirmative care for transgender and gender non-conforming: Best practice for front-line health care staff. Boston, MA

Occupational Therapy’s Commitment to Nondiscrimination and Inclusion. (2014). American Journal of Occupational Therapy, 68(Supplement_3), S23-4. 

Pan, L. & Moore, A. (n.d.). The gender unicorn. [blog post]. Retrieved from http://www.transstudent.org/gender

Parekh, R., (2016, February). What is gender dysphoria? [blog post]. Retrieved from https://www.psychiatry.org/patients-families/gender-dysphoria/what-is-gender-dysphoria

Singular ‘they’. (2018). [blog post]. Retrieved from https://www.merriam-webster.com/words-at-play/singular-nonbinary-they

State Maps of Laws and Policies. (2019). [blog post]. Retrieved from https://www.hrc.org/state-maps/transgender-healthcare

Understanding the transgender community. (2018). [blog post]. Retrieved from https://www.hrc.org/resources/understanding-the-transgender-community

Violence against the transgender community in 2018 (n.d.). Retrieved from https://www.hrc.org/resources/violence-against-the-transgender-community-in-2018

Occupational therapy can provide services in many different areas within the prison system. From providing transitional services to inmates getting ready to be released, to focusing on occupational deprivation, to leading groups for an infinite number of topics.  This episode features Ariana Gonzalez, an occupational therapist, executive director, and founder of Life After Incarceration: Transition & Reentry (LAITR), an occupational therapy community-based program focused on reentry for individuals after incarceration.

To learn more about Ariana Gonzalez and LAITR visit https://www.lifeafterincarceration.com/

References 

Criminal justice data. The Sentencing Project. (2023, January 25). Retrieved July 29, 2023, from https://www.sentencingproject.org/research/us-criminal-justice-data/

Dillon, M. B., Dillon, T. H., Griffiths, T., Prusnek, L., & Tippie, M. (2020). The distinct value of occupational therapy in corrections: Implementation of a life skills program in a county jail. Annals of International Occupational Therapy, 3(4), 185. https://doi.org/10.3928/24761222-20200309-01

Gonzalez, A., & Tyminski, Q. (2020). Sleep deprivation in an American homeless population. Sleep Health: Journal of the National Sleep Foundation, 6(4), 489–494. https://doi.org/10.1016/j.sleh.2020.01.002

Jaegers, L. A., Dieleman, C., Dillon, M. B., Rogers, S., Muñoz, J. P., & Barney, K. F. (2020). Justice-based occupational therapy initiative: Advancing occupational justice in criminal justice systems. Annals of International Occupational Therapy, 3(4), 200+. https://link.gale.com/apps/doc/A676585517/AONE?u=mlin_m_regis&sid=ebsco&xid=ed5dd4db

Muñoz, J. P., Moreton, E. M., & Sitterly, A. M. (2016). The scope of practice of occupational therapy in U.S. criminal justice settings. Occupational Therapy International, 23(3), 241–254. https://doi.org/10.1002/oti.1427

Tucker, S. (2020). Access to OT in the prison system: Assessing attitudes of OT students and practitioners...2020 American occupational therapy association annual conference & expo. American Journal of Occupational Therapy, 74(Sup1), 1. https://doi.org/10.5014/ajot.2020.74S1-PO1510

Tyminski, Q., Gonzalez, A., & Synovec, C. E. (2020). The importance of health management and maintenance occupations while homeless: A case study. Work, 65(2), 297–301. https://doi.org/10.3233/WOR-203081

Special thanks to Parker Sheridan for the background research!

By the end of 2022, a record-breaking number of people — 108.4 million — have been forced to flee their homes.  

Refugees are people who are forced to flee from their country of origin due to violence, oppression, or substantiated fear of persecution based on sexual orientation, gender identity, race, religion, nationality, membership in a group, or expression of certain political opinions.

Refugees experience occupational deprivation which is defined as a condition where an individual is unable to engage in meaningful occupations due to enforced contextual factors such as a lack of sources of sustenance, support, and services, diminished safety, and separation/loss of family members.  

When occupational injustice occurs, humans as occupational beings are hindered from their right to have equal opportunities to participate in meaningful occupations that meet their occupational needs. 

Jill Maglio, an occupational therapist, is currently working with refugees in Greece on a CircusAid project.  She is the founding Director, Educator, and Occupational Therapist of both Holistic Circus Therapy and CircusAid, which are social circus programs that utilize circus activities as a therapeutic tool to increase occupational participation. 

Her work is nuanced with all the shifting barriers and bureaucracies in place but instills joy and laughter.  Her work promotes social connectedness and efficacy, as well as a possible reprieve from their distressing circumstances.

• For more information on Jill Maglio's work with refugees - https://www.circusaid.com/
•  Follow CircusAid on Instagram - https://www.instagram.com/circusaid/?igshid=OGQ5ZDc2ODk2ZA%3D%3D
• For more information about circus as a therapeutic tool - https://www.holisticcircustherapy.com/

References

Darawsheh, W. B., Bewernitz, M., Tabbaa, S., & Justiss, M. (2022). Factors Shaping Occupational Injustice among Resettled Syrian Refugees in the United States. Occupational Therapy International, vol. 2022, Article ID 2846896. https://doi.org/10.1155/2022/2846896

Maglio, J. & McKinstry, C. (2008). Occupational therapy and circus: Potential partners in enhancing the health and well-being of today’s youth. Australian Occupational Therapy Journal, 55, 287–290. https://doi.org/10.1111/j.1440-1630.2007.00713.x

R. El-Bialy and S. Mulay, (2015). Two sides of the same coin: factors that support and challenge the wellbeing of refugees resettled in a small urban center. Health & Place, 35, 52–59. https://doi.org/10.1016/j.healthplace.2015.06.009

The UN Refugee Agency. (14 June, 2023) Refugee data finder. UNHCR. https://www.unhcr.org/refugee-statistics/

In June 2022, the Supreme Court's decision on Dobbs v. Jackson Women's Health Organization turned the right to obtain or not obtain an abortion over to the states, which is very nuanced.  It is more than just a restriction of women’s rights but in some states, there is an aspect of criminalization.  This presents complications for occupational therapy practitioners in terms of how we practice with our Occupational Therapy Practice Framework, how we address occupational risk factors, and how it obscures our Occupational Therapy Code of Ethics.  Darya Nemati and Delany McKee, Boston University Occupational Therapy Doctoral Candidates, share their emerging research on recent changes in abortion laws and how these laws might influence occupational therapy practice.

References

Abdelfatah, R. & Araboluei, R. (Hosts). (2022, June 16). After Roe: A new battlefield [Audio podcast episode]. In Throughline. NPR. https://www.npr.org/2022/06/15/1105245445/after-roe-a-new-battlefield

Abdelfatah, R. & Araboluei, R. (Hosts). (2022, May 19). Before Roe: The physician’s crusade [Audio podcast episode]. In Throughline. NPR. https://www.npr.org/2022/05/18/1099795225/before-roe-the-physicians-crusade

American Occupational Therapy Association. (2020). AOTA 2020 Occupational Therapy Code of Ethics. American Journal of Occupational Therapy, 74(Suppl. 3), 7413410005.  https://doi.org/10.5014/ajot.2020.74S3006

American Occupational Therapy Association. (2020). Occupational therapy practice framework: Domain and process (4th ed.). American Journal of Occupational Therapy, 74(Suppl. 2), 7412410010. https://doi.org/10.5014/ajot.2020.74S2001

Beddoe, L. (2022). Reproductive justice, abortion rights, and social work, Critical and Radical Social Work, 10(1), 7-22. Retrieved June 15, 2023, from https://doi.org/10.1332/204986021X16355170868404

Levenson, M. (2023, June 24). Five things to know one year after the Dobbs decision. The New York Times. https://www.nytimes.com/2023/06/24/us/politics/roe-wade-anniversary-dobbs.html

Reagan, L. (2018, January 22). Roe made abortions legal, but it doesn't keep women and providers safe. HuffPost. https://www.huffpost.com/entry/reagan-opinion-roe-wade-harassment_n_5a63d88ee4b0dc592a096aa1?section=us_opinion

Toni Solaru OT, OTD, OTR talks about the unknown history of occupational therapy.  Dr. Solaru is a community-based mental health OT and the co-founder and Chair of Diverse-OT National, an organization dedicated to advancing the cultural climate within the OT profession and strives to create a community of critically reflexive OT(A)s and students. 

To follow Diverse-OT National on Instagram - https://www.instagram.com/diverseot_national/?hl=en

To access the full interview on YouTube – https://youtu.be/Au8sreLe8IE

References

American Occupational Therapy Association. (1953, November). Report of the Subcommittee on Schools and Curriculum. (Available from the Wilma L. West Library, 4720 Montgomery Lane, Bethesda, Maryland 20814)

Black, R. M. (2002). Occupational therapy’s dance with diversity. American Journal of Occupational Therapy, 56, 140–148.

Black History Milestones. (2019). LifeHistory.com. Retrieved from https://www.history.com /topics/black-history/black-history-milestones

Bolden, J. A. (1993). Differential occupational outcomes among African American and white women in female-dominated professions: The case of occupational therapy. Unpublished doctoral dissertation, Boston University.

Robinson, L. (2000). The Black occupational therapy caucus: The first 25 Years. Black Occupational Therapy Caucus.

Skyberg, R., Grubb, Rachel. (2019). Evolution of occupational therapy practice: Life history of Lela Llorens, Ph.D., OTR/Ret, FAOTA.. Oral History Student Papers. 54.

Wells, S. A., & Whiting, F. (1998, March). A celebration of diversity: Reviewing AOTA’s progress toward creating a more diverse profession. OT Practice, 2, 31–34.

http://www.otcentennial.org/

https://www.cleveland.com/news/2022/10/ex-cleveland-schools-therapist-who-rioted-at-us-capitol-on-jan-6-seeks-mercy-from-court.html

Victor Calise has had a diverse career path—he has gone from plumber to Paralympian to Policymaker.  He competed in sled hockey in the 1998 Paralympics in Nagano, Japan.  He worked for the NYC Department of Parks and Recreation.  He was appointed the Commissioner of the Mayor's Office for People with Disabilities by Mayor Michael Bloomberg, and then reappointed by Mayor Bill De Blasio, and reappointed again by Mayor Eric Adams.  He recently took on a new role as Director of Global Culture, Diversity, Equity and Inclusion at Walmart’s newly formed Accessibility Center of Excellence.

Here are some additional links for the accessible accomplishments in NYC - Accessible NYC and Judy Heumann's #ManCrushMonday about Victor Calise.

As occupational therapy practitioners, we understand disability within the context of diversity, equity, and inclusion. In this two-part episode, occupational therapy student Meaghan Lawrence discusses the program, Empower Spinal Cord Injury (SCI) which supports individuals who have had an injury to their spinal cord. In the traditional rehabilitation model in the United States, rehabilitation stops a few months after injury. Often after discharge is when true rehabilitation needs to occur because the initial shock and comorbid conditions have diminished.  Through Empower SCI, the participants have the opportunity to take part in a more meaningful rehabilitation.

Special Thanks to Meaghan Lawrence for writing and interviewing and special thanks to Michael Manhardt for sharing the Empower SCI story. 

For more information about Empower SCI, please visit their website.

As occupational therapy practitioners, we understand disability within the context of diversity, equity, and inclusion. In this two-part episode, occupational therapy student Meaghan Lawrence discusses the program, Empower Spinal Cord Injury (SCI) which supports individuals who have had an injury to their spinal cord. In the traditional rehabilitation model in the United States, rehabilitation stops a few months after injury. Often after discharge is when true rehabilitation needs to occur because the initial shock and comorbid conditions have diminished.  Through Empower SCI, the participants have the opportunity to take part in a more meaningful rehabilitation.

Special Thanks to Meaghan Lawrence for writing and interviewing and special thanks to Elizabeth Lima Remillard for sharing the Empower SCI story.  In our next episode Meaghan will interview, Michael Manhardt, who was a participant and peer mentor at Empower SCI.

For more information about Empower SCI, please visit their website.