Research Connections: Racial equity in occupational science and occupational therapy

Khalilah R. Johnson, PhD, MS, OTR/L

The Researcher Dr. Khalilah Johnson is an Assistant Professor in the Division of Occupational Science and Occupational Therapy at the University of North Carolina School of Medicine in Chapel Hill, North Carolina. She also serves as an affiliate research faculty member at the Virginia Commonwealth University Center for Cultural Experiences in Prevention in Richmond, Virginia. Broadly, Dr. Johnson's research focuses on health service access and participation with racially minoritized adults with intellectual and developmental disabilities, as well as developing culturally affirming interventions that support their community engagement. Additionally, she is involved in national and local initiatives aimed to address structural racism in occupational therapy practice, pathways to occupational therapy education for minoritized students, and racial equity in occupational science and occupational therapy curricula. Her work is informed by nearly 15 years of experience spanning the states of Georgia, North Carolina, and Virginia.

Dr. Johnson serves on the leadership boards of the Coalition of Occupational Therapy Advocates for Diversity, the Society for the Study of Occupation: USA, and is the immediate past Advocacy and Policy Coordinator for the Developmental Disabilities Special Interest Section of the American Occupational Therapy Association. In addition to those memberships, Dr. Johnson is a member of the World Federation of Occupational Therapists, the National Black Occupational Therapy Caucus, the American Association on Intellectual and Developmental Disabilities, the Brenau University Heritage Society, the Carolina Black Caucus, and Delta Sigma Theta Sorority, Inc. She also serves on the Autism in Adulthood editorial board, and a host of other advisory boards and scholarly committees.

She is a proud alumna of Brenau University Women’s College (‘05 and ‘06) and the University of North Carolina at Chapel Hill (‘16).

The Research Racial equity is the core of Dr. Johnson’s work in occupational science research and occupational therapy education. She believes in the liberation of minoritized disabled people to be able to thrive at the intersections of all aspects of their identities, and therefore, challenges occupational scientists and occupational therapy practitioners to dismantle the false narrative that one’s race is a predictor of their outcomes and successes and frame those consequences as being mediated by structural racism, racial biases and ideologies. Further, Dr. Johnson calls on researchers, practitioners, and students to confront the dominant sociocultural paradigm that proliferates in the literature as legitimate evidence of disparities and inequities and the cultural practices and narratives that coordinate those processes.

The Challenge of Dual Disadvantage: Employment According to African American Adults with IDD Dr. Johnson’s program of research in intellectual and developmental disabilities (IDD) is concerned with people with IDD achieving social and economic mobility and voice in naming their realities. Her current pilot project highlights how structures and systems impact the distribution of resources and opportunities to access and participate in vocational services for African Americans with IDD.

Despite federal policies and incentive programs intended to increase employment of people with disabilities, there is a discouraging lack of improvement in employment of adults with ID (Siperstein, Heyman, & Stokes, 2014). Their unemployment rate is more than twice that of adults without disabilities, with only 44% of adults with ID aged 21 to 64 participating in the labor force compared to 83% of the general population (Siperstein, Heyman, & Stokes, 2014). Among those unemployed, the percentage of African Americans is nearly twice as high as Whites (Bureau of Labor Statistics, 2017).

Barriers to employment for this population (e.g., restricted aspirations, limited access to training, lack of supports and accommodations, discrimination) have been well-document (Lindstrom, Kahn, & Lindsey, 2013). Extant literature offers strategies to enhance work readiness including developing individual skills, broadening the range of employment opportunities explored, obtaining postsecondary training, providing customized supports to facilitate advancement, and advocacy (Wehman et al., 2015). In addition to individual characteristics and disability specific challenges or facilitators of employment success, interventions should be targeted and reflect cultural and contextual considerations specific to the consumer group (Hasnain & Balcazar, 2009). Without sociocultural context, it is problematic or even impossible to understand the intersections of race, disability, and employment (McDonald, Keys, & Balcazar, 2007).

This study is the first step to addressing the injustice of underemployment for racial/ethnic minorities from a community-based, culture-centered, and occupational approach. Knowledge gleaned from this study will inform the development of a multi-component culturally affirming intervention to increase employment and promote social justice within this community. Recruitment for this study remains open.

Understanding Minority Paths to Careers in Occupational Therapy A collaborative project with Dr. Linn Wakeford (Associate Professor and Principal Investigator), Kierra Peak (UNC occupational science doctoral student, and Breonna Caldwell (UNC occupational therapy student), this study explores pathways to occupational therapy educational programs for 50 African American women.

Discussions around diversity in occupational science and occupational therapy academic programs, and consequently, diversity in the occupational therapy workforce have been at the forefront of our professional discourse for some time. These discussions were further underscored by the 2019 American Occupational Therapy Association Workforce and Salary Survey which revealed 83.7% of occupational therapy practitioners identify as White and 3.0% identify as African American, with the number of African American practitioners decreasing over time. Although strategies to address these issues are represented in the literature, few address the specific concerns of occupational therapy or other rehabilitation professions (Simone et al., 2018; Varner et al., 2018); therefore, educators and practitioners may not have a nuanced understanding of the myriad of factors impacting how minoritized individual pursue and enter into occupational therapy. Dr. Linn Wakeford sought to tackle this persistent issue head on as a collaborative effort by making visible the paths taken by African American women to the profession. Better understanding the supports and barriers experienced when considering and entering occupational therapy academic programs can provide key insights to enhance strategies for recruitment and retention of students from minoritized groups.

Understanding Minority Paths to Careers in Occupational Therapy was accepted for presentation for the 2021 AOTA Inspire virtual conference.

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