When Occupational Therapy Becomes Occupational Justice

Newswise — Lindsey Hoffman, a Tufts University alumna, is an occupational therapist with the National Health Service (NHS) in London, working at a hospital helping patients get back on their feet—sometimes quite literally. Most recently, she’s focused on geriatric patients, from helping them do the most basic things—getting out of bed and dressed—to creating discharge plans to make sure they have adequate services once they are home recuperating.

For each patient she works with, she tries to see the whole person and their life circumstances, with an eye particularly to what’s called occupational justice. That means “essentially the right to participate in anything that is meaningful to them,” she says. (Occupational therapy helps people do their day-to-day activities, not just on the job, but in all aspects of their personal lives.)

When there’s occupational injustice, people “don’t have access to opportunities to do things that are meaningful to them, to take care of themselves,” she says. In her job now, for example, that could mean being aware if a patient will have access to services regardless of their financial or other life circumstances.

When she was getting a graduate degree at Tufts, Hoffman used her occupational therapy lens at the domestic violence shelter Respond, in Boston. “It was very clear how social justice and OT were linked there, because those women were experiencing what we would call occupational deprivation,” she says. “They didn’t have access to a lot of things that they needed to take care of themselves or have things they enjoyed doing.”

She ran a health and wellness group with the women, among other efforts. They cooked together, made a backyard garden to grow food, and did yoga, meditation, and other wellness activities.

“It gave them an hour each week to take care of themselves and learn skills to carry into their day-to-day lives,” she says. “They were at an emergency shelter, so they didn’t have much of an opportunity to focus on anything but survival and a search for permanent housing. The OT groups also gave them access to meaningful occupations they were previously restricted from participating in including basic activities of daily living like getting rest or eating well.”

She also made efforts to mobilize the women and connect them with resources, especially because experiencing domestic violence and being in a shelter is a traumatic time and resources are limited.

Mary Barnes, one of her teachers in the OT program at Tufts, says that Hoffman has always had an ability to see and uncover disparities and to create ways to deal with them.

“She’s always had that courage to say something, and it’s helping the future generation of students see that it is part of their role as an occupational therapist, to notice when there are what we call occupational injustices,” she says. “Lindsey has a strong gift for hearing the person she’s working with, or the population she’s working with—what their needs are and designing something for that.”

One early fieldwork placement was at the Medford Senior Center. She and another OT graduate student designed and implemented a wellness group for elders who use the senior center. “They were a big hit,” Barnes says, noting that Hoffman wrote up the experience, which was published in OT Practice magazine.

Looking at Justice Through Different Lenses

In her current job at the hospital in London, the social justice aspect may not seem as obvious as when she was working at the domestic violence shelter, but it still is present. “We think a lot about social determinants of health and how maybe a patient’s socioeconomic status, their ethnicity, or the neighborhood they live in will affect what kind of care they have access to,” Hoffman says.

For instance, when making up discharge plans for elderly patients, she doesn’t have to worry so much about services for those who live in Westminster borough, where the hospital is located—it’s a prosperous neighborhood. But other neighboring boroughs have fewer resources to devote to adult social care. “For those patients, we have to really advocate for getting the things they need, because there’s just not a lot out there,” she says.

For OT professionals concerned with occupational justice, thinking about the economic and social determinants of health is important, because they affect the overall person, their health and health outcomes, she notes.

Settings like domestic violence shelters, prisons, homeless shelters—all of those are emerging practice areas where occupational justice can play a big part, Hoffman says.

As part of her work for the NHS, she is also doing research on discharge processes, looking at the neighborhood/borough they reside in, primary language, ethnicity, gender, and age to determine if those demographic factors are affecting the discharge outcome or the length of stay in the hospital, and if they are treating some types of patients more than others.

“OTs in many different settings can do a service evaluation where you’re looking into whether we are treating all of our patients fairly and equitably,” she says. “And that’s just another way to implement occupational justice as well.”

That’s what Barnes calls true advocacy for clients. “Justice-based OT is about having the courage to speak up and say, this is what I hear the client needs now,” she says.