Where is the diversity?

Recently a photo of a past AOTA Board of Directors (the Board) was reposted on social media. The picture was taken at the AOTA Vision 2025 Summit in 2015. The photo includes all elected members of the Board at that time and two appointed members. Because the photo was “shared” a second time, it was not immediately evident that the picture was of the Board or where, when, and why it was taken.

The photo received several comments including two that asked (I'm paraphrasing)
“Where is the diversity?” One of the comments pointed out that there was no one included in the photo who had an obvious disability. Looking at the photo (which I am in) it seems apparent that the members of the Board at that time all or mostly outwardly appeared Caucasian. There seemed to be a range of ages and four of the 14 persons in the photo appear to be male. I think it is accurate to say that there is no one in the photo who appears to have an obvious disability (although we know of course that many disabling conditions are not outwardly visible).

I was a participant in both the Centennial Vision retreats and the 2025 Summit. For this reason these comments immediately drew my thought to where we stand with diversity as a profession. It is a complex issue that I cannot fully address in one Blog post. I am sure that I will leave out some important information to consider in the big picture, but I want to share my perspective as a Candidate for AOTA Vice-President. This is meant as continuing the conversation, not wrapping everything up with a neat bow.

First a few comments about the concept of diversity in the Centennial Vision driven from my personal experience. From my experience I remember that while the idea of becoming a diverse workforce most certainly included increasing racial, ethnic and gender diversity the concept was much broader. The concept of diversity in the Centennial Vision was meant to include all types of diversity including issues such as broadening the types of work settings in which occupational therapy practitioners work and/or recognizing the diversity that second career professionals bring to the workforce. It included diversity in terms of disability status. There were also mentions of recognizing other forms of diversity that are not immediately outwardly identifiable and becoming a profession that is fully welcoming of types of diversity such as sexual orientation or gender identification. This explanation is not intended to lessen the importance or the challenge of increasing racial, ethnic and/or gender diversity, it is simply an explanation of the origin of the concept of diversity in the Centennial Vision based on my participation in the Centennial Vision retreats and on the Board.

I also want to state that the participants at both the Centennial Vision retreats and the Vision 2025 Summit (both groups near 100) were in fact diverse in many ways.

So how have we done in becoming a more diverse workforce? We have made some identifiable strides forward, but clearly not the type of changes we saw in other areas of the Centennial Vision such as “widely-recognized” or “evidence-based.”

In terms of diversity of practice settings we maintain strong footing in established areas of practice such as hospitals, schools and long-term care and in fact the percent of the OT workforce in hospitals and LTC/SNFS increased from 37.5% in 2010 to 46% in 2015. This graph is taken from the 2015 AOTA Salary and Workforce Survey (Online at https://www.aota.org/~/media/Corporate/Files/Secure/Educations-Careers/Salary-Survey/2015-AOTA-Workforce-Salary-Survey-LOW-RES.pdf).

We have made forays into emerging areas such as primary care, population health and notably focused areas of practice such as oncology rehabilitation where I work. We certainly see many examples of creative practice with population such as refugees or the homeless. I continue to worry that we do not adequately support occupational therapy entrepreneurs and that private practice and business ownership receives less attention than it could. I am sure that many other examples of positives and areas for improvement could be mentioned.

What about diversity in our students and new practitioners? I retrieved data through a search of AOTA Website on 12/6/17 and found a PowerPoint presentation with load date of 6/7/17 for a presentation given by Heather Stagliano (Director of Accreditation) and Neil Harvison (Chief Officer, Academic and Scientific Affairs) at the 2017 Annual Conference & Exposition in Philadelphia March 30-April 2, 2017.

From 2000 to 2016 the number of occupational therapist students (including OTD) increased from 17,296 in 2000 to 20,627 in 2016 and the number of occupational therapy assistant students increased from 6,459 to 10,160 over the same time period.

This next slide presents self-identified race according to the 2016 Annual Data Report from ACOTE. We can see that the percentage of students reported as white is approximately 75% overall. This is compared to 61.3% of people identified by the U.S. Census bureau in a population estimate for 2016 as “White alone, not Hispanic or Latino” (Retrieved Online 12/6/17 at: https://www.census.gov/quickfacts/fact/table/US/PST045216).

The next three slides show comparisons in percentages from 2010 to 2016 in those self-identifying as Hispanic, White, and Male.

The next slide shows that the percentage of students self-identifying as Hispanic increased from 2010 to 2016.

The next slide shows that the percentage of students self-identifying as White dropped from 2010 to 2016. . It is possible that some of this change could be explained by any changes in the categories included for self-identification (note that 5% of OTD students, 9% of Master’s students, and 9% of OTA students are identified as “other” in the slide on race from this report).

The next slide shows that the percentage of students self-identifying as male increased from 2010 to 2016 for OTD students, stayed the same for OTM students and dropped one percentage point for OTA students

A full discussion of these statistics requires a deep dive far beyond the scope of this Blog post but I will summarize generally by saying that while we have made some improvements in these areas of diversity, I would characterize them as far from significant and leaving much room for improvement.

Before turning to some “so what” comments, I would like to comment on the issue of “obvious” or outwardly recognizable diversity and its complexity. Because I am included in the picture of the Board mentioned earlier and because I got to know my colleagues fairly well, I am positive that there are elements of diversity that are not outwardly apparent. These types of diversity are very important and should not be overlooked or undervalued. I want to avoid one of my pet peeves which is a “what about” response, meaning the tendency we have sometimes to respond to a concern about “A” with a response of “Yeah, but what about “B?” Still, diversity such as sexual orientation, gender identification, non-visible disability, ethnic diversity that may not be immediately outwardly recognizable ALL contribute in critical ways to making our workforce more diverse and more like the population in general. In this regard the answer to the question, “Where is diversity?” might be, “You’ll have to consider what you don’t see to see it.”

So this Blog post has likely already run on too long, so let me get to the take-home, “so what?” messages that reflect some of my thinking as a candidate for AOTA Vice-President.

1. We’ve made some improvements in diversity since we established the Centennial Vision but nowhere near as much as we should and it must remain a top priority of the Board of Directors and other bodies of the AOTA.
2. We must be careful that taking an operational approach of “diversity is integrated in everything we do” does not result in it being frequently an afterthought as we put together Ad Hoc groups or as we recruit volunteers for elected office or other opportunities.
3. Making a real change in the diversity of our students may require a totally different approach. As we have moved to post-baccalaureate education for the occupational therapist, we need to consider when (at what age and in what grades) do many or most students make decisions that would steer them toward or away from graduate education and toward or away from undergraduate education that would lend toward applying for an occupational therapy program.
   
4. We must consider what the impact could be of moving to a single point of entry at the baccalaureate degree for the OTA on the diversity of our OTA students.
5. We must examine in a respectful but honest manner if there are unrecognized barriers to increased diversity in our professional leadership such as elected positions but also in areas such as academic leadership.
6. We all can benefit from continued discussion, education and reeducation about the complex nature of diversity. We should all recognize that not all forms of diversity may be impacted by the same set of strategies. We need to be creative and conceptually flexible.

As a candidate for AOTA Vice-President I am committed to continuing attention and reinvestment of the efforts of the Board and the paid staff of AOTA in making our workforce more diverse.

I would love to hear your ideas.

Please contact me at [email protected], friend me or message me on Facebook or let me know if you would like to set a time to have an Online chat or phone call.

Thank you.