Shared Perspective

Our Dual Lens: Valuing Service-Using Occupational Therapists

Meredith Brison-Brown & Armita Amiri

As such, our focus is on our dual lens of occupational therapy professional and service user. In this article we aim to use our dual lenses to examine and dispel the constructed dichotomy of consumer and clinician that influences the ways we interact with our colleagues and clients. In doing so, we hope to highlight the value of SUOT and advocate for their inclusion in academic and professional spheres.

VALUE OF SUOT
The experiential knowledge that service users possess, combined with core occupational therapy competencies, make SUOT an asset to the field. Occupational therapists who are intimately familiar with the health care system from a user perspective can enhance care by using professional expertise deepened by first-hand experiences (e.g., Bevan, 2014; Chang et al., 2014). A systematic review of literature between 2002-2022 proposed that occupational therapists with disabilities build empathetic rapport, reduce implicit biases, and expand the professional knowledge base which contributes to better health outcomes (Lindsay et al., 2023).

Student occupational therapists, like ourselves, with experience as service users can enrich our colleagues’ learning by offering critical perspectives on, and alternatives to, established theories and practices. The dual lens we offer can make overt what may otherwise remain covert and help advance curricula and institutional policy (Beagan et al., 2022). As Beagan and colleagues (2022) articulate, SUOT challenge norms and power dynamics by bringing to view our “transgressive knowledges and skills that are not only helpful to working with a wide range of clients but also key to transforming institutions and social structures” (p.13). Thus, SUOT and students are key stakeholders with expertise in advancing individual client-care and the profession overall.

SUOT: PROFESSIONAL LEGITIMACY
Despite considerable expertise and value, service-using health professionals are often not meaningfully included in educational and professional spheres due, in part, to doubts regarding their legitimacy as professionals (Jarus et al., 2023). Within health care, service users find that the legitimacy of their accounts is questioned or dismissed (e.g., Costa et al., 2012; Kitchen, 2023). Disabled occupational therapists and scholars have described experiences of bringing critical and experiential knowledge into academia and having its legitimacy questioned when this knowledge does not conform to the normative ways that academic environments work and think (Mahipaul, personal communication, June 26, 2023). In addition, legitimacy is challenged when experiential knowledge is interpreted through existing models that leave the intended message silenced or misunderstood (LeBlanc-Omstead & Mahipaul, 2022). As authors, we resonate with these experiences.

The pursuit of professional belonging in occupational therapy is gatekept at learning institutions and workplaces by professional norms, rooted in ableism, that assume inclusivity undermines the core competencies (Easterbrook et al., 2015). Messages that are embedded in individual and institutional interactions in this environment emphasize the feel- ing that service users are not the intend- ed recipients of professional designation in occupational therapy (Beagan et al., 2022). However, guiding occupational therapy documents suggest that the profession is being challenged to disrupt this status quo. For example, the Joint Position Statement on Inclusive Occupational Therapy Education for Persons with Disabilities, published by the Canadian Association of Occupational Therapists (CAOT; 2018), recommends building awareness of “ableist assumptions within the design of competency documents and assessment of competency” (p.1). Similarly, the revised Competencies for Occupational Therapists in Canada (ACOTRO, ACOTUP, & CAOT, 2021) promote equity in practice through the analysis of biases and collaboration with stakeholders.

SUOT: STUDENT PERSPECTIVES
Clinicians and students with disabilities and/or disabling health conditions can deepen our understanding of equity in health professional education and practice. Yet, it can be challenging for SUOT students to incorporate the benefits of our dual lens while seeking legitimacy, in both classrooms and during fieldwork. Students, including ourselves, must balance the benefits of bringing our whole selves to occupational therapy with the potential consequences of self-disclosure. Easterbrook et al. (2015) found that “Students felt a conflict between acknowledging the disability and being treated as a whole person” (p.1510).

Much of the landscape of occupational therapy education programs is built on paradigms that assume the service user as the “other” (Sibbald & Beagan, 2022)." As students living with health conditions who are learning in health profes- sions, we often feel unseen because it is not explicitly recognized that we can be both. By failing to explicitly recognize that service users are our colleagues, this “othering” perpetuates stigmatization and exclusion, and limits opportunities for service-using individuals to contribute their expertise and lived experience.  In addition, visibility can be experienced as an internal tug-of-war because the requisite of disclosure to ensure a more equitable experience in academia and workplaces for service users incurs the risk of discriminatory and exclusionary consequences (Easterbrook et al., 2015; Sibbald & Beagan, 2022).

Research evidence suggests ableist dis- crimination by student colleagues, faculty, and university policies (Davis, 2020; Lindsay et al., 2022), though it is rarely acknowledged within the occupational therapy profession ( Jung et al., 2014). Fieldwork placement experiences are implicated specifically, noting resistance and concern from preceptors questioning service-using students’ fitness to practice (Davis, 2020; Easterbrook et al., 2015). As Davis (2020), observed, “. . . what is missing from these and all other studies is actual evidence to support this belief ” (p.33). The literature reveals a paucity of evidence that SUOT and students are more of a potential client safety risk than any other student or occupational therapist (Davis, 2020). Therefore, the perception of incompetence may arise from unchecked assumptions and biases perpetuated by occupational therapy professionals.

MOVING FORWARD
Given that professional norms in occupational therapy can result in discriminatory exclusion of occupational therapists with disabilities, and given the value of the perspectives of SUOT, occupational therapy is missing out on needed expertise under the guise of concern for client care. Instead, the profession needs to recognize the value of SUOT and to promote critical reflexivity regarding the false binary of service user and occupational therapist. So, what is the way forward?

To broaden the profession’s access to this dual lens, and meet the expecta- tions within our national documents,
occupational therapists need to challenge the binary thinking that leads to doubts about the professional legitimacy of their service-using colleagues, and meaning- fully include these colleagues within all aspects of the profession.

INCLUDE US, MEANINGFULLY
SUOT and students should be in positions of influence to improve policies, systems, and curricula. By centring this group of clinicians and students as legitimate, competent members of the field, it is possible to “resist the equation of disability with inability” (Sibbald & Beagan, 2022, p.14). Care must be taken to avoid the exploitation of SUOT and students as free resources to legitimize claims to advancement in equity. Crediting, compensating, and appreciating the complexities of our experience are key toward meaningful inclusion.

PRACTICE ALLYSHIP
Allyship can challenge the “us and them” dichotomy by advocating for SUOT as capable colleagues and leaders in the field. Chacala et al. (2014) point to the importance of practicing allyship for service-using colleagues, since “The responsibility for bridging the disabled/ non-disabled cultural divide rested with the disabled therapists, exacerbating inequity.” (p.107).

EXPAND THE LENSES THROUGH WHICH THE PROFESSION VIEWS LEGITIMACY
Part of dismantling ableism in health care and health care education is the recognition that being consumers of health care services and being clinicians/students in health care professions are not his change there must be recognition of this binary lens through which the construct of professionalism is applied to the occupational therapy field. Easterbrook et al. (2015) found that “Students felt a conflict between acknowledging the disability and being treated as a whole person” (p.1510). Therefore, learning institutions that train occupational therapists should actively pursue an evolving understanding of the complex dimensions of disability experiences.

TOWARD A MORE INCLUSIVE FUTURE
The narrow lens through which occupational therapists often conceptualize legitimacy within the profession must  be broadened to include an expansive appreciation of the ways of knowing and being that occupational therapists profess to enable. Instead of questioning the legitimacy of colleagues who possess a dual lens, occupational therapists would be better served by appreciating the potential added value to client care. The ableist foundations of occupational therapy must be viewed critically to invite reflection not only where we’ve been and why, but what is the way forward, and how can we get there? As the profession works to imagine a more inclusive future, will the status-quo continue to be perpetuated, or will rhetoric turn into reality and lead the way toward making occupational therapy a more inclusive health care profession?

References
ACOTRO, ACOTUP, & CAOT. (2021). Competencies for occupational therapists in Canada. https://acotro-acore.org/wp-content/ uploads/2021/11/OT-Competency-Document-EN-HiRes.pdf

Beagan, B. L., Sibbald, K. R., Pride, T. M., & Bizzeth, S. R. (2022).
Professional misfits: “You’re having to perform. . . all week long.” The Open Journal of Occupational Therapy, 10(4), 1–14. https:// doi.org/10.15453/2168-6408.1933

Bevan, J. (2014). Disabled occupational therapists—Asset, liability
... or “watering down” the profession? Disability & Society, 29(4), 583–596. https://doi.org/10.1080/09687599.2013.831747

Canadian Association of Occupational Therapists. (2018). Joint Position Statement on Inclusive Occupational Therapy Education for Persons with Disabilities. https://caot.ca/document/6362/ PS_InclusiveOTEd_PersonsWithDisabilities_2018.pdf

Chacala, A., Mccormack, C., Collins, B., & Beagan, B. L. (2014). “My view that disability is okay sometimes clashes”: Experiences of two disabled occupational therapists. Scandinavian Journal of Occupational Therapy, 21(2), 107-115. https://doi.org/10.3109/1
1038128.2013.861016

Costa, L., Voronka, J., Landry, D., Reid, J., McFarlane, B., Reville, D., & Church, K. (2012). Recovering our stories: A small act of resistance. Studies in Social Justice, 6(1), 85–101. https://doi. org/10.26522/ssj.v6i1.1070

Davis, J. (2020). The lived experience of occupational therapists who supervise students with disabilities. [Unpublished master’s thesis]. Dalhousie University,

Easterbrook, A., Bulk, L., Ghanouni, P., Lee, M., Opini, B., Roberts, E., Parhar, G., & Jarus, T. (2015). The legitimization process  of students with disabilities in Health and Human Service educational programs in Canada. Disability & Society, 30(10),1505–1520. https://doi.org/10.1080/09687599.2015.1108183

Jarus, T., Krupa, T., Mayer, Y., Battalova, A., Bulk, L., Lee, M., Nimmon, L., & Roberts, E. (2023). Negotiating legitimacy and
d practitioners’ experience. al Education, 57(6), 535–547. https://doi.org/10.1111/medu.15002

Jung, B., Baptiste, S., Dhillon, S., Kravchenko, T., Stewart, D., & Vanderkaay, S. (2014). The experience of student occupational therapists with disabilities in Canadian universities. International Journal of Higher Education, 3(1), 146–154. https://doi. org/10.5430/ijhe.v3n1p146

Kitchen, K. (2023). A strange tightrope: Unravelling the dichotomy between giving and receiving care after COVID-19. Occupational Therapy Now, 26(4), 14–16.

Leblanc-Omstead, S., & Mahipaul, S. (2022). Toward more socially- accountable service user involvement in education: Embracing Critical Disability Studies. Occupational Therapy Now, 25(2), 24–26.

Lindsay, S., Fuentes, K., Ragunathan, S., Lamaj, L., & Dyson, J. (2023). Ableism within health care professions: A systematic review of the experiences and impact of discrimination against health care providers with disabilities. Disability and Rehabilitation, 45(17), 2715–2731. https://doi.org/10.1080/09638288.2022.2107086

Sibbald, K. R., & Beagan, B. L. (2022). Disabled healthcare professionals’ experiences of altruism: Identity, professionalism, competence, and disclosure. Disability & Society. Advance online publication. https://doi.org/10.1080/09687599.2022.2061333

This article first appeared in OCCUPATIONAL THERAPY NOW July/August 2023 VOL 26.4. Permission for posting was granted by CAOT. CAOT holds the article copyright.