Evolved Living Podcast

It’s Tuesday afternoon. You’re sitting in a care conference, IEP meeting, team meeting, or nursing station listening to someone explain why your client doesn’t need OT. You know what you have observed. You know what the client has told you. You know there is more happening here than what fits neatly into the criteria being used to make the decision. Maybe a discharge plan is being made and you weren’t included. Maybe someone in the district is telling you why a student no longer requires your involvement. Maybe someone in the nursing facility has already decided what happens next. Maybe the person making the decision simply has more organizational authority than you do. Your client wants something different. You see something that isn’t being discussed. And you can already feel the cost of being the person who says so. So you sit there doing the calculation. Do I say something? How hard do I push? Am I overstepping? Is this actually policy, or just how this organization does things? Will I be labeled difficult? Will speaking up change anything? What will it cost me if I do? What will it cost my client if I don’t? You want to be respected. You want to be collaborative. You also want to practice with integrity. And increasingly, those things can feel like they are pulling you in opposite directions. So you walk on eggshells. You notice how the system is affecting the client. You notice how it is affecting your colleagues. You notice how it is affecting you. But there is enormous pressure not to talk about any of it. Eventually, that constant calculation becomes exhausting. I think a lot of what we call burnout contains something more specific: Moral fatigue from seeing what is happening while feeling increasingly powerless to change it. I know that feeling. And I have been following the questions underneath it for a very long time. I didn’t find policy through occupational therapy Occupational therapy gave me language for questions I had been carrying much longer. I grew up in rural America with a mixed-race cousin who had a severe chromosomal disorder. I watched someone I loved encounter structural barriers to receiving care that recognized the fullness of her humanity. And somewhere inside that experience, I began imagining something different. I dreamed of a world where she and I could grow older together. Where disability did not automatically mean separation. Where the services someone needed could come to them. Where community, relationship, dignity, care, and belonging could be organized around a person’s life rather than requiring a person’s life to be organized around the limitations of a system. I didn’t have language like aging in place , community-based care , occupational justice , implementation science , or structural determinants yet. I just knew I wanted a world where we could age in place together. There was another story in my family, too. Before I was born, an uncle who was suspected of being autistic was institutionalized. He later died in circumstances my family understood in relation to neglect and the deterioration of social supports surrounding people like him. I inherited that story before I ever entered a policy classroom. Before I knew what an occupational therapist was. Before I knew how reimbursement worked. Before I understood that decisions made in legislatures, agencies, institutions, school districts, hospitals, insurance systems, and organizations could eventually determine extraordinarily intimate things: Where someone gets to live. Who gets to remain with their family. Who receives care. Whose needs are considered too complicated. Whose knowledge is believed. Who gets included in decisions. What support is considered worth paying for. And what kinds of lives our systems are willing to make possible. That is probably where my interest in policy actually began. Not in Washington, D.C. Not in a professional association. Not with CMS. At home. Eventually, I learned that these intimate experiences had structural dimensions As an undergraduate, I found student advocacy and lobbying alongside campaign and labor organizing work and study. Later came occupational therapy. School-based practice. Outpatient pediatrics. Acute care. Home health. Post-acute care. Mobile outpatient services. State and federal advocacy and policy work, including work related to shaping applied behavior analysis policy in Washington State, partnership with AOTA, AOTPAC-related involvement, and leadership development. Then occupational science, education, scholarship, and my growing inquiry into agency-centered, critical, and co-constructive implementation science. The settings changed. The scale changed. My language became more sophisticated. But I am not sure the underlying question ever changed: Who gets to participate in authoring what becomes possible for a human life? My clinical work kept giving me different views of that question. School-based practice showed me how policy, eligibility, institutional interpretation, educational priorities, and family realities shape participation. Outpatient pediatrics showed me children and families trying to integrate recommendations into lives much bigger than the clinic. Acute care showed me how quickly decisions about function, safety, discharge, and someone’s next stage of life are made inside complex institutional systems. Home health showed me what happens when those decisions arrive at someone’s front door. Post-acute practice made staffing, transitions, reimbursement, productivity, and interdisciplinary coordination impossible to separate from care. Mobile outpatient practice showed me what becomes visible when care moves closer to where occupation actually happens. Different settings. Different populations. Different payment structures. Same human lives. Same question: What becomes possible under these conditions? This Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber. Then I started asking what those conditions were doing to us Last year, I wrote Therapy Isn’t Just Biomechanical: Reclaiming the Psychosocial Heart of OT. It came out of a conversation about why occupational therapy practitioners can sometimes feel almost “naughty” for bringing psychosocial reasoning into supposedly traditional OT settings. That word stayed with me. Why would an occupational therapist feel as though practicing expansively requires permission? What happens when an organization’s operational version of OT becomes smaller than the occupational lens we were educated to use? And what happens when we adapt to that version for so long that we stop recognizing the adaptation? Later, writing about school-based practice pushed me further into the relationship between occupation and policy. I started putting language around something I had witnessed across settings: Policy mediates occupation. And then another realization followed. Practitioners are occupational beings, too. We spend our careers examining how environments shape someone else’s participation. But we have environments. Policy is part of our environment. Reimbursement is part of it. Productivity is part of it. Documentation systems are part of it. Staffing is part of it. Hierarchy is part of it. Organizational culture is part of it. Professional identity is part of it. The stories we’ve inherited about what “counts” as OT are part of it. This matters because I don’t want to individualize structural problems. You cannot mindset your way out of inadequate staffing. You cannot personally fix reimbursement. You cannot positive-think your way around an inaccessible service model. But I don’t think the only alternative is powerlessness. There is a territory between: “This is all my responsibility.” and “There is nothing I can do.” That territory has become increasingly important to me. This month, I wrote back On September 14, I submitted an 11-page public comment in response to the CY 2027 Medicare Physician Fee Schedule Proposed Rule. Listen to the CMS Comment here: This wasn’t my introduction to advocacy. It was another iteration of the question I have been carrying across my life and career: What kinds of care are our systems actually making possible? My comment addresses therapy coding and valuation, clinical reasoning, care coordination, interdisciplinary overlap, complexity, technology, mobile and home-based care, staffing and productivity pressures, access, and the risks of both overutilization and systematic underutilization of rehabilitation. But underneath the 12 recommendations is something larger. Some of the most consequential clinical work does not fit neatly inside the minutes spent performing a discrete intervention. We review records. We synthesize information. We recognize changes in function and risk. We communicate with caregivers and other clinicians. We modify plans. We coordinate transitions. We connect pieces of someone’s life that the healthcare system has separated into different disciplines, encounters, codes, and records. That work matters. And writing the comment brought me back to an idea that has become increasingly important in my scholarship: Payment systems are implementation systems. Payment policy eventually becomes staffing. Workflow. Caseload. Documentation. Technology. Service availability. Interdisciplinary communication. What clinicians have enough capacity to notice. And eventually: Policy becomes occupation. Because people don’t experience healthcare as a collection of codes. They experience a life. The question I ultimately asked CMS was: Does the payment system create the conditions for beneficiaries, caregivers, and clinicians to participate meaningfully in developing, coordinating, and adapting care around the realities of everyday life? I want you to read the comment. Not because you have to agree with me. Read it as a practitioner. What gives language to something you have experienced? Where do you disagree? What does your practice setting allow you to see that mine doesn’t? What assumptions have you been treating as policy? What would you have said differently? What do you know because you have actually been there? And notice if another question appears: Wait. Am I allowed to have an opinion about this? That question matters. Your experience doesn’t automatically make your interpretation correct. Authorship is not certainty. It is learning to understand what you know, how you know it, what you don’t know, what conditions are operating around you, and where you can responsibly participate. That is where From Adaptation to Authorship begins I created From Adaptation to Authorship for the practitioner sitting in that Tuesday afternoon meeting. I cannot make the administrator disappear. I cannot change your district for you. I cannot guarantee your facility will suddenly include you in discharge planning. I cannot eliminate hierarchy, reimbursement pressures, productivity expectations, or institutional politics in three months. What I want to help change is something different. I want you to be able to walk into the same Tuesday afternoon and locate yourself differently inside it. Someone says your client doesn’t need OT. Instead of immediately collapsing into anger, silence, self-doubt, or an exhausting internal argument, you have somewhere to stand. You can ask: What is actually happening here? What authority does this person hold? What is genuinely policy? What is interpretation? What is simply “how we’ve always done it”? What do I know? How do I know it? What does the client want? What can I document? What can I question? Who could I collaborate with? Where is there room for negotiation? What is genuinely immovable today? What am I willing to risk? What am I not willing to risk? And what is not mine to carry home? That is the transformation I care about. Discernment where there used to be diffuse powerlessness. Sometimes authorship is speaking. Sometimes it is documenting differently. Sometimes it is asking the question nobody has asked. Sometimes it is bringing the client back into a conversation happening around them. Sometimes it is reading the policy instead of accepting “that’s just how we do it.” Sometimes it is finding an ally. Sometimes it is trying a small experiment. Sometimes it is deciding: This is not the hill I am going to die on today. And sometimes: Actually, this one is. Sometimes authorship is staying. Sometimes it is leaving. But either way, I want you to understand the conditions and costs well enough that the decision feels more like yours . You do not have to abandon yourself in order to belong. And authorship does not require you to stop belonging. What we’ll actually do Over three months, we’ll investigate your real professional environment. You’ll create an Agency + Participation Map so the giant wall called “the system” starts becoming more legible. You’ll examine what is structural, what is policy, what is organizational culture, what belongs to someone else’s authority, where you have influence, where you need allies, and where you may need protection. Then we’ll create your Epistemic Quilt . We’ll examine the knowledge informing your practice: evidence, occupational science, professional expertise, clinical reasoning, lived and embodied experience, cultural knowledge, creativity, and other forms of knowing. Not because every form of knowledge is interchangeable. Because if you’re going to stand behind what you know, you need to understand how you know it and where it came from. Authorship requires provenance. Then you’ll design a 90-Day Authorship Experiment . Not a plan to fix healthcare. One meaningful way to participate differently in what becomes possible next. The founding cohort $777 for three months. We begin October 13. Space is intentionally limited (payment plans and sliding scale options available). I’m keeping this founding cohort small because I want room for actual inquiry, experimentation, conversation, and co-construction. This is not about escaping traditional OT. It isn’t a business program. It isn’t about everyone becoming a lobbyist or activist. And it is absolutely not another demand that exhausted practitioners work harder to compensate for systems that aren’t working. You might stay exactly where you are. But I want staying to feel different because you know where you stand. You know what you see. You know what you know and where that knowledge comes from. You know what you don’t know. You can better distinguish policy from interpretation, organizational norms from actual requirements, structural constraints from places where you have meaningful agency. And you have practiced making a move from that place. The system may still be there. There will be load-bearing pieces you cannot move alone. There will be places where you need protection. There will be people you can work with. There may be doors you didn’t recognize before. There may even be places where you can begin building something adjacent. But you don’t have to keep abandoning your own perception just to survive the room. This is happening around me, but I no longer have to let it author me. If that sentence landed somewhere deep, reply to this email. Tell me where you are in your practice right now. Tell me what you keep noticing. Tell me what feels constrained. Tell me what you wish could be different. No polished application. No sales performance. Just a conversation. We’ll start there. Josie Dr. Josephine Jarvis, PP-OTD, MA-OTR/L, BA, BS Occupational Therapist | Applied Occupational Scientist | Educator & Scholar-PractitionerEvolved Living From adaptation to authorship. This Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

What happens when the people delivering healthcare actually participate in deciding how that care is valued? Right now, we have an opportunity to do exactly that. CMS is accepting public comments on the CY 2027 Medicare Physician Fee Schedule proposed rule, and the deadline is September 14, 2026 . If you are a U.S.-based occupational therapist, physical therapist, speech-language pathologist, or another rehabilitation or allied health provider, this is a moment to pay attention and participate. Read the CMS CY 2027 Medicare Physician Fee Schedule proposed rule Submit a public comment through Regulations.gov Search for CMS-1848-P when submitting your comment. Why this matters Payment policy is about much more than reimbursement rates. It influences what healthcare systems prioritize, how services are structured, what work is considered valuable, and what kinds of care are realistically available to patients. For rehabilitation providers, there can be a significant gap between the work that actually produces meaningful outcomes and what can be easily represented through a billing code. Think about what goes into a complex rehabilitation encounter. There is the assessment itself, but also the clinical reasoning behind it. There is communication with caregivers and other providers, environmental analysis, education, risk management, adapting interventions to the individual, coordinating care, and making decisions based on information that may not be captured by a single diagnosis or procedure code. For many of us, these are not extras added onto the work. They are the work. That makes this comment period important. Rather than simply saying that reimbursement is too low, we have an opportunity to explain what current payment structures fail to capture and what that means for patients, providers, and the healthcare system. What is changing? The CY 2027 proposed rule includes changes and requests for input related to how Medicare services are coded and valued, including the Practice Expense methodology and aspects of care management and remote monitoring. These are technical policy issues, but the questions underneath them are surprisingly practical: What does it actually take to provide good care? What resources are required? What kinds of clinical work happen outside the most visible portion of an encounter? How should payment systems recognize complexity, coordination, clinical reasoning, and the resources required to manage patients over time? These are questions rehabilitation providers have direct experience answering. OT Potential’s Sarah Lyon and colleagues have been particularly active in bringing OT and PT perspectives into this conversation. Their proposed recommendations include better differentiation in reimbursement for evaluation complexity and consideration of non-time-based therapist management codes to recognize some of the ongoing clinical work that occurs throughout an episode of care. You do not have to agree with every recommendation to see the value in participating. In fact, this is one of the things I appreciate about the public comment process. It gives us an opportunity to respond to what is actually being proposed, identify what we think is missing, describe unintended consequences, and offer alternatives based on what we see in practice. Start with Sarah Lyon’s episode If you want some context before diving into the policy language, I recommend starting with Sarah Lyon’s recent OT Potential episode on this issue. Listen to the OT Potential episode on YouTube The episode provides a useful overview of the current opportunity and the work underway to bring rehabilitation perspectives into the Medicare payment conversation. OT Potential has also created a 2027 CMS Comment Template for OT and PT care , which makes the process considerably easier if you are staring at Regulations.gov wondering where to begin. Access the OT Potential CMS Comment Template The template provides language you can adapt, along with references and guidance for submitting your comment. I would encourage you to personalize it rather than simply submitting the exact same language as everyone else. Your own experience is what makes the comment valuable. What can you contribute? Start with the part of the system you know. Maybe you work with patients whose needs are more complex than the evaluation code adequately communicates. Maybe much of your clinical expertise involves adapting care to cognition, environment, caregiver capacity, health literacy, routines, transportation, safety, or other contextual factors. Maybe you spend substantial time coordinating with other disciplines and caregivers. Maybe your work involves preventing a problem rather than treating the consequences after it happens. Maybe you have watched a patient avoid an emergency department visit because someone identified a risk early. Maybe you have helped a family safely manage a transition home. Maybe your interdisciplinary team caught something that would have otherwise resulted in a complication or readmission. These experiences matter. They help illustrate something that can get lost when healthcare policy is discussed primarily through codes, utilization data, and reimbursement formulas: healthcare is delivered by people making decisions in complex environments with other people. If a payment methodology does not adequately account for the resources required to do that work well, policymakers need concrete examples of what is being missed. Don’t underestimate the value of your clinical perspective You do not need to be a healthcare economist to submit a meaningful comment. You do not need to write a 20-page policy analysis. You do not need to represent your entire profession. A useful comment can be fairly straightforward. Identify the issue you are responding to. Describe what you see in practice. Explain why it matters. Give a concrete example. Then tell CMS what you think should be considered. Instead of simply saying, “OTs need to be paid more,” you might explain how comprehensive occupational therapy assessment requires consideration of cognition, environment, routines, caregiver capacity, safety, equipment, participation, and other factors that may not be adequately represented by the existing valuation structure. Instead of simply saying, “care coordination should be reimbursed,” describe what happens when coordination does not occur. Explain who has to do the work, what information has to be exchanged, what decisions are made, and what can happen to the patient when that work is missing. The more concrete we are, the more useful our comments become. This conversation belongs to all of rehabilitation Although OT Potential’s template focuses on OT and PT, I think there is a larger opportunity here. OTs, PTs, SLPs, and other allied health professionals all see different pieces of the same system. We work across hospitals, outpatient clinics, home-based care, post-acute settings, schools, and community environments. We see where care coordination works and where it breaks down. We see the consequences when payment structures reward one part of the care process while making another part difficult to sustain. That perspective is worth bringing into the conversation. This does not have to become another debate about which profession deserves more. The more useful question is: What does the patient actually need, who has the expertise to provide it, and does the payment system support that care? That is a question worth asking across the healthcare continuum. We have until September 14 We spend a lot of time talking about healthcare payment. We talk about productivity. We talk about coding. We talk about documentation. We talk about access. We talk about burnout. We talk about care coordination. We talk about the disconnect between what patients need and what healthcare systems can realistically provide. This is an opportunity to move some of that conversation into the policymaking process. CMS is asking for public input. We have resources to help us understand the proposal. We have templates to help us get started. And we have our own professional experiences. So take an hour. Listen to the episode. Read the relevant sections of the proposed rule. Use the template if it helps. Add your own examples. Submit your comment. Comments are due September 14, 2026. Read the proposed rule Listen to the OT Potential episode Use the OT Potential comment template Submit your comment And then share this with another clinician. We cannot expect payment systems to recognize the complexity of our work if we never tell policymakers what that work actually involves. Now is the time to put our clinical experience on the record. Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

I wrote this piece in response to some discourse I was tagged in around OT’s role in sports medicine and supporting high performance athletes. The reflection is specifically in response to this three-part LinkedIn series: Part 1: What OT Adds to Sports Medicine Read the original post on LinkedIn Part 2: Collaboration and Professional Roles Read the original post on LinkedIn Part 3: Advocacy, Scope, and the Future Read the original post on LinkedIn Much of the discourse in the comments was centered on concerns of overlap with athletic trainers and presumptions that what OT is offering would be essentially duplicative and disrespectful to more traditionally prominent members of the sports medicine ecosystem. I had to modify my response on LinkedIn to match their character limit, so I thought I would publish the full response here. It covers content that feels relevant to much of the endless discourse that is largely driven by shorthand misinformation, presumptions, and various insecurities that get stirred when our focus is on eliminating rather than expanding possibilities for care and innovation. Why occupational science literacy matters A big part of why I am a proponent of increased occupational science literacy for OTPs worldwide is to encourage us to use our own distinct lens and concepts when communicating about the innovations, roots, and foundations of our practice so we can get out of this trap of being reduced to limited paradigms and understandings of other professions in bad faith. First, we tend to be undermined for possibly not having the same competencies as another discipline or profession. Then, when we reveal that we do have the same competencies, or we catch up, we are framed as essentially duplicative or redundant and not unique. This is why communicating about our identity and skills from our own foundations and core terminology, including our cosmological, philosophical, epistemic, and emerging practice developments, on our own terms, alongside the formal policy developments that have shaped our practice from the beginning, is so important. Especially if we do so with pride in our unique integrative foundations rather than shame or presumed incompetence, very often this pattern is deeply rooted in the internalization of structural sexism and misogyny as it relates to female-dominated health care professions and integrated care approaches overall. OTPs need to start recognizing that when we are met with such suspicion and accusation, it can actually be a sign of our strength and competence as a threat rather than a sign of our own incompetence or need to prove or defend ourselves where we typically already currently belong. We keep de-skilling each other It’s so interesting how often in this type of discourse we default to pigeonholing and limiting all skilled providers to the bare minimum of responsibilities in institutional settings. For example, often between OT and PT the discourse can reduce both professions down to upper extremity versus lower extremity, even though we all know both disciplines in the real world are full-body therapists. With the discourse around athletic trainers, it seems like we’re reducing all professions to the most basic elements of those responsibilities, rather than exploring nuanced conversations about strengths, weaknesses, opportunities, gaps, and intersections that could lead to more comprehensive care. Unlike competitive athletics, health and human services are not competitive sports. When providers compete, our clients are always the ones who lose out on comprehensive care. I also think this pattern of discourse has consequences beyond any single profession. When we continually reduce skilled professions to their bare foundations and then treat overlap at that level as evidence of duplication, we can inadvertently create conditions that discourage innovation and advancement across health and human services. The bare foundations are the floor of professional capacity, not necessarily the ceiling. If we treat the floor as the ceiling, then every advancement into an emerging specialty, every new application of foundational knowledge, and every development in professional reasoning has to first defend itself against the existence of something another profession already does. That creates a very different condition for professional development than asking what becomes possible when skilled professionals build beyond their foundations. Overlap is not duplication Overlap between providers is not new and never has been new. It’s actually essential to communication and efficiency for there to be essential overlap. One profession having a specific body area or modality in their scope does not mean that it is somehow unlawful or an automatic restriction or duplication for another provider to be skilled and competent in those areas. It simply means more than one profession has core competencies to perform a specific function. It means there are options rather than a basis for exclusion. For example, just about everyone in the hospital performs vitals, and we want it that way, to optimize saving everyone’s lives. The issue, then, is not simply whether competencies overlap. The more important question is what happens beyond those foundations. Nearly every skilled profession has foundational competencies that overlap with other professions. Those foundations establish what a profession is capable of doing. They do not necessarily define everything that profession can become. The floor is not the ceiling. This is also why I think it is important to distinguish overlapping competencies from professional identity . AOTA’s scope statement describes OT as a dynamic and evolving profession responsive to consumer and societal needs, system changes, and emerging knowledge and research. Its scope is organized around the domain and process of occupational therapy rather than around a single body region or a fixed list of procedures. Professional differentiation can therefore exist even when foundational services overlap. It can emerge through what a profession has developed beyond the foundation: its theories, epistemics, cosmology, professional reasoning, specialized knowledge, emerging practices, methods, populations, contexts, and approaches to delivering services. It can also emerge through the way even some of the same foundational services are understood and integrated into a person’s actual occupational life. Two professionals may provide something that looks similar on the surface while asking very different questions about the person, their environment, their goals, their occupations, their identity, their routines, and what meaningful participation looks like to them. That is not necessarily duplication. That is professional differentiation. And those differences can be meaningful to clients. A client may choose between qualified providers not simply because one profession possesses an activity that another profession is forbidden or unable to perform, but because of the way a practitioner understands their needs, the populations or contexts they specialize in, how they approach collaboration, how they conceptualize their goals, and how their services fit with the client’s preferences and priorities. Our clients are not choosing between completely separate universes of intervention. They are choosing people, approaches, relationships, areas of expertise, and ways of understanding and responding to their needs. The more generative question is therefore not simply whether another profession can perform the same foundational task. It is what each profession has developed beyond the foundation and how that development creates additional possibilities for care. OT has always been more than hands Much of what distinguishes occupational therapy exists in what is often regarded as largely unseen realms in physical medicine. Our internal, subjective experiences of navigating changes in body, mind, spirit, and environment are rarely fully appreciated through physical medicine methodologies alone. Occupational therapy emerged through the moral treatment and arts and crafts movements, advancing the right to engage in self-directed activity as restorative to body, mind, and spirit, and as foundational to human rights-affirming living for people wherever they live, work, and play. Occupational therapy is the belief that engagement in self-directed, integrative activity can regenerate health, integrating body, mind, spirit, and especially hands, but never reducing occupation simply to hands, because every occupation requires a full body to execute. This is where Elizabeth J. Yerxa’s work on occupational science becomes especially relevant. In her 2000 article, Occupational Science: A Renaissance of Service to Humankind Through Knowledge , Yerxa argued that occupational science could help occupational therapy develop and define its own knowledge base and scope through scholarship. She centered the human as an occupational being whose relationship with occupation unfolds across development, environment, culture, learning, and agency. That matters because our foundations are not simply historical ideas to preserve. They give us a way of knowing and reasoning that can continue to generate new possibilities for practice. That is also why I am excited that our September Evolved Living Collaborative Journal Club is returning to Yerxa’s article. More than 25 years later, her questions give us an opportunity to consider what occupational science can still contribute to how we understand occupation, knowledge, and the future of occupational therapy. Those foundations are still relevant, but they are also a starting point for what comes next. 📚 September Journal Club Saturday, September 26 at 1:00 PM Pacific Our first Journal Club was moved from August to September so we could give ourselves more time to read and engage with the article. This month we are returning to Elizabeth J. Yerxa’s 2000 article, Occupational Science: A Renaissance of Service to Humankind Through Knowledge. Article Freely Available Here More than 25 years later, Yerxa’s questions still give us plenty to think about. We will explore the emergence of occupational science, its relationship with occupational therapy, and what kinds of knowledge about occupation might continue to serve humanity. Inside the Collaborative, you will find an article summary, reflective prompts, and additional resources to help you engage with the reading. You do not have to read every word of the original article to participate. The Journal Club will be recorded for anyone who cannot attend live. Join Evolved Living Collaborative Here What could OT offer a high-performance athlete? With any client receiving occupational therapy services, which could include a high performance athlete, our services are determined by their unique occupational profile and disruptions. We receive the referral, either from a medical provider or, if not medically related, it could be pursued through a coaching model by a client themselves. We develop an occupational profile looking at activities, engagement, and development at different stages of life. I’ve characterized this as a person’s Pokemon card that looks at the ways in which occupational balance is experienced throughout days, weeks, months, years, and how routines can be optimized and adapted to accommodate different injuries and precautions, while still being able to have quality meaningful access and participation in one’s daily and weekly routine. This includes not just one’s role as a high performance sport athlete, but also as a mother, father, student. This is very consistent with the profession’s own contemporary description of practice. OTPF-4 defines occupational therapy as the therapeutic use of everyday life occupations with persons, groups, or populations to enhance or enable participation, emphasizing the transactional relationship among the client, their engagement in occupations, and context (AOTA, 2020). And there is now emerging literature specifically supporting this way of thinking about athletes. A 2025 scoping review of occupational therapy in athletics and sports identified OT contributions across physical, emotional, and social rehabilitation, participation, recovery, performance, quality of life, and psychosocial well-being. The authors explicitly describe sport as a meaningful occupation associated with identity, mastery, and well-being (Bulan et al., 2025). One of my colleagues is currently providing occupational therapy supports for neurodivergent medical students. In that work, they’re looking at how to adapt and relate to assignments and routine organization that is specific to accommodate neurodivergent medical students, which could be analogous to high performance athletes. I think the important point here is not that medical students and high performance athletes are interchangeable populations. It is that occupational therapy can look at how the demands of a person’s particular role interact with their cognitive, physical, emotional, environmental, and occupational needs. That kind of occupational lens is relevant to high performance athletes because the role of the athlete is not simply the performance of a physical skill. It exists within a network of routines, relationships, environments, expectations, recovery demands, identity, education or employment, family roles, sleep, leisure, and other occupations. And we have direct research demonstrating why this broader occupational lens matters in sports. Douglas et al. (2024) found that high school athletes recovering from concussion experienced disruptions not only in sport, but also in ADLs, school performance, sleep, mental health, driving, social participation, and identity. The authors concluded that occupational therapists can assist with individualized treatment plans supporting athletes’ return to meaningful occupations. The point is not that OT has to invent a completely different physical activity every time we work with someone. The distinction may be in what we are trying to understand, what we are trying to support, how we are reasoning about the person’s occupations and context, and how we integrate foundational services into the larger occupational life of the client. Tim Dionne’s work offers a useful example of this kind of occupationally grounded thinking. In The Neuroscience of Everyday Life: An Applied Guide for Health Sciences Students , Dionne contributed a chapter on ADHD and task completion that uses an everyday activity as the context for understanding how neurological differences affect participation. The book as a whole is explicitly organized around connecting neuroscience with people’s everyday activities and participation (Dionne, 2025). Tim also writes What Counts , where he shares contemporary OT perspectives and applied reflections. That kind of occupational lens is relevant to high performance athletes as well. The role of the athlete is not simply the performance of a physical skill. It exists within a network of routines, relationships, environments, expectations, recovery demands, identity, education or employment, family roles, sleep, leisure, and other occupations. The distinct psychology of a high performance athlete and the requirements of their role, similar to the role that occupational therapists play in the high-performance athletics of our military, focus on optimizing sleep routines and creating customized habits and life hacks that are particular to those soldiers and their various nuanced roles. Firefighters offer another example I have seen this same occupational science-informed approach emerge in work with another population whose demands can be remarkably analogous to those of high performance athletes: municipal firefighters. In 2023, I was involved in developing a capstone direction connected with the University of Washington that asked occupational therapy students to engage with community stakeholders and regional fire departments through an individual, micro, and mezzo lens informed by occupational science. The purpose was not simply to identify biomechanical injuries and then develop biomechanical interventions for the individual firefighter. The larger question was how occupational therapy could support wellness, recovery, and burnout prevention by examining the occupational ecology in which firefighting actually occurs. A firefighter’s performance does not happen in isolation from the fire station, shift structure, staffing patterns, routines, physical spaces, social culture, recovery opportunities, sleep, or the way activities are organized throughout a shift. A purely impairment-centered approach might identify the shoulder, back, knee, or other biomechanical problem affecting role performance and then treat the injured body part. An occupational science-informed approach can ask a different set of questions: What is happening in the environment that is contributing to this occupational disruption in the first place? How are activities being organized? What routines are making recovery easier or harder? How are the physical spaces of the fire station supporting or constraining wellness occupations? Where are there opportunities to reorganize activity, routines, environmental affordances, and social supports before an injury or burnout becomes an individual clinical problem? This is where the individual, micro, and mezzo levels become particularly important. Instead of isolating services to the individual and their biomechanical impairments and client factors, OT can also examine the organization of occupations within the team, the fire station, and the broader work environment. The University of Washington’s 2024 MOT capstone project, Sleep, Stress, and Shift Work: An Occupational Therapist’s Investigation into Firefighter Wellbeing and Culture , provides a concrete example of this emerging approach. The student team examined environmental, social, personal, and physical factors affecting firefighters’ occupational lives and identified intervention opportunities at individual, meso, and systemic levels. Their work included literature and media review, key informant interviews, six firefighter interviews, and two fire station visits. I was one of the community mentors for the project. This is exactly the kind of work I mean when I talk about occupational science creating possibilities for OT that cannot be reduced to biomechanical treatment. The project did not begin with the assumption that a standardized intervention already existed and simply needed to be delivered to firefighters. It engaged firefighters and community stakeholders in understanding the occupational ecology of their work and identifying where wellness and participation could be supported. And importantly, this does not mean OT needs to become the profession that treats every physical injury a firefighter experiences. A firefighter with a biomechanical injury may appropriately benefit from physical therapy, medicine, athletic training, occupational therapy, or other specialized services. The occupational therapy contribution can be understanding what that injury means within the person’s occupational life and what changes to routines, environments, roles, habits, recovery opportunities, and participation might support the person and the larger system. Occupational therapy’s involvement in this population is still an emerging area. We do not necessarily need to wait five decades for a fully mature literature base before occupational therapists are allowed to recognize an emerging occupational need and begin responsibly developing, evaluating, and refining services. We do need to distinguish between claiming that an intervention has been proven effective and responsibly engaging in program development, community-based inquiry, practice-based learning, and evaluation. Those are not the same claim. Occupati

Here is a voice-over of the article for those who prefer audio Hi everyone! I’m thrilled to share this episode with you today. If you’ve been following this podcast since it started in 2023, you might know it grew out of my doctoral capstone project during my time in the University of Utah’s Post-Professional Clinical Doctorate program from 2019 to 2023. This journey unfolded during the challenges of the COVID-19 pandemic, which highlighted the global impact that devaluing public health initiatives has had on collective on health and well-being, and made deeply evident the barriers and costs to humanity created by maintaining dynamics of scientific elitism, and the lack of accessible frameworks for translating impactful health interventions and knowledge from the academy to the field, especially frameworks informed by disability and occupational justice. After navigating two stalled capstone projects due to pandemic-related challenges, I shifted my focus to creating resources for field clinicians to develop occupational science literacy for direct practice. Over three years, I poured my heart and all my spare time into building a fully virtual introduction to occupational science, using innovative online learning tools and best practices in adult education. If you’re curious, you can explore this project at engage.evolvelivingnetwork.com , and just by subscribing to this Substack, you can get free access to the OS 101 guide, which includes a glossary of all foundational occupational science terminology. My journey back into occupational therapy higher education began after feeling disillusioned during my first two years of clinical and school-based practice as a travel therapist. I was searching for a space where I could thrive using holistic approaches that integrated mental and physical health. Initially, I hoped to work in pediatric and school-based settings, but I quickly encountered policy limitations that narrowed the focus of occupational therapy to handwriting and fine motor skills. This was disheartening, especially since my master’s research centered on executive dysfunction supports for adolescents and assistive technology in schools, areas that were largely controversial for occupational therapists in traditional settings at the time. These challenges revealed deeper issues within the field, including limited access to occupational science developments and foundational frameworks like the “Occupational Therapy Practice Framework Fourth Edition.” I realized through my my more in-depth study that these barriers were tied directly to historical inequities, such as structural sexism in higher education and healthcare leadership sourcing all the way back to the 1500s. This understanding fueled my passion for creative problem-solving and building community around these issues. I have a free training in the evolved living collaborative skool community on how Occupational Science is integrated with the Occupational Therapy Practice Framework Fourth Edition for anyone who is looking to get caught up on out latest practice guidence updates. After graduating, I launched this podcast to raise awareness about Occupational Science and my capstone course. Later, I collaborated on a textbook chapter proposal for the “Occupational Therapy Without Borders” third edition, exploring innovative ways to circulate knowledge beyond traditional academic institutions. While the chapter ultimately missed the publication deadline, the experience taught me valuable lessons about resilience and navigating academic challenges. Since then, however, I have been challenged in relation to this podcast by writer’s block, perfectionism, shame around missing the deadline, and a lack of direction without the structure of a prompt, deadline, or institutional affiliation to prove the value of my work to or rebel against. I’ve been on a personal journey of healing and rediscovery, exploring the roots of occupational therapy in the moral treatment and arts and crafts movements, and deepening my understanding of decolonial healthcare frameworks. This has included honoring the wisdom of indigenous and folk healers whose contributions have often been suppressed or commodified by modern healthcare systems. To support my own recovery, I created a podcast and community called “ Rewilding the Mythic Self, ” where I’ve been reconnecting with creativity, spirituality, and interdisciplinary collaboration outside of formal institutions. Over time, however, I have come to realize that fracturing out these parts of myself wasn’t really possible and was actually disconnecting me from the type of integrative work I am passionate about reviving in Occupational Therapy practice throughout the world and thank goodness I am not alone in this mission! One of the most transformative moments in this journey recently has been discovering the work of Libby Lamb an occupational therapist and poet (Author of the Acacia Project) based in UK and Australia who powerfully integrates spirituality and creativity into her personal life and practice. Participating in Libby’s writing workshop this past July has helped inspire me to revive this podcast and explore in community how occupational therapists can reconnect with their creative and spiritual selves while navigating the demands and restrictions of traditional practice settings. Her insights have been invaluable in addressing my own creative blocks and building confidence to embrace my full self in both my persional and professional practice. Together, Libby and I have been exploring themes around the “witch wound”, the historical legacy of suppression and violence against women healers, and its relevance to contemporary occupational therapy. In relation to our discussion, Libby wrote an incredible article on the complexities of navigating one’s identity as an OTP while also making space for one’s own spirituality and creative expression for our own wellbeing and holistic fulfillment. I highly recommend reading this article and subscribing to her work here: Libby Lamb Find Libby on instagram: @OTandbiscuits and @wordswithlibby and join her free facebook for OT’s Reclaiming Craft here: These conversations have deepened my appreciation for the power of occupational science in addressing systemic barriers and promoting inclusive healthcare practices. I encourage you to check out Libby’s work, including her poetry book and coaching program, “Duality,” which supports occupational therapists worldwide (US-based OTPs are invited to participate in her creative writing offerings through words with libby however she is currently unable to offer 1:1 coaching for OTPs in the USA at this time.) This past fall I also explored simliar themes in a reflexive intergenerational workshop on the concise classic text: Witches, Midwives, and Nurses by Barbra Enenrich and Deidre English on the historic orgins of the American Medical Association and the ties between imperial and colonial Western biomedical models and the formal exclusion and suppression of women, people of color, the global south, and criminalization of folk medicinal practices that are foundational to the fear and apprehension many of us continue to hold up into this day inspite of OT inseperable tie to the arts and crafts, mornal treatment, and spirutality through and self determined engagement in meaningful and purposeful activity in context. This powerful workshop is currently freely available in the Evolved Living Collaborative Skool Community Classroom. This legacy has persisted until this day in the podcast I referenced Drs. Vivian Tatiana Camacho Hinojosa and Bolivian midwife who trained in the west as surgeon before returning to ancestral practices and fighting with her community to protect and expand access to water, food, and traditional medicine world wide. Her powerful work has helped advance protections for folk medicinal practices and keep sacred midwifery practices alive with broad coalitions internationally. She is currently facing political persecution and encourages us to reconnect to honoring life and finding health in connection to life affirming community and protection and collaboration with nature as warriors for life and protection of its most tender expression. Quality outcomes from access to Midwives in childbirth: https://pmc.ncbi.nlm.nih.gov/articles/PMC9584105/ Here is the reference article on how weavers made Apollo Space Mission possible: https://www.sciencenews.org/article/core-memory-weavers-navajo-apollo-raytheon-computer-nasa Along with the powerful science of knitting: There are some amazing resources available that I plan to read and review on this Substack this year and possibly host discussions on in the Evolved Living Collaborative: I’ve come to realize that true liberation lies in integration, bringing together my creative, spiritual, and professional identities to build coalitions and navigate challenges collectively. This perspective has guided my recent collaborations, including sharing my folk arts and crafts experiments with the Canadian Society for Occupational Science and the American Occupational Therapy Association, and attending the Decolonizing Healthcare Knowledge Summer School Institute in Mexico City. For those interested in joining these conversations, I invite you to explore the Evolve Living Collaborative platform, where we host free workshops like “Witches, Midwives, and Nurses,” weekly craft nights, coffee and co-occupation sessions, and a monthly journal club focused on foundational occupational science articles and emerging interdisciplinary books. Together, we can revive the optimistic origins of occupational therapy, celebrate the power of meaningful activity, and create spaces for healing, creativity, and connection. Direct Link: https://www.skool.com/evolved-living-collaborative-6395/about Thank you for being here, and I hope you enjoy this episode! Thanks for reading! Subscribe for free to receive new posts and support my work. Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Why this Occupational Science series matters If you are an occupational therapy practitioner in the United States, chances are you are already using occupational science. You just might not have been given the words for it yet. That gap is part of why I created this Occupational Science Alphabet Series , a public learning series designed to make occupational science more accessible and more visible in everyday life and traditional practice settings. This first composite series begins with A for Occupational Apartheid . Recording Timestamps: 00:00 “Occupational Apartheid Analysis” 06:01 “Occupational Apartheid Challenges” 16:11 “Systemic Barriers in OT” 18:04 “Enhancing Accessibility through Advocacy” 25:20 “Defining Occupational Apartheid” 33:06 “Occupation and Systemic Inequality” 39:23 “Advocating Equity in OT Practice” 45:04 “Occupational Therapy for Healing” 48:04 “Advancing Occupational Justice” 54:55 “Occupational Ethics Evolution” 58:50 “Occupational Apartheid Ethics” 01:03:58 “Justice and Veracity” 01:10:17 Healthcare Bias and Scientific Integrity 01:15:59 “Addressing Maternal Health Disparities” The phrase can feel intense at first.It should. Because it names something real. It gives language to the ways people are systematically denied access to meaningful participation in everyday life, not simply because of individual impairment or diagnosis, but because of how social, economic, political, and cultural systems are organized. And that matters deeply for occupational therapy. Because when we only look at barriers inside individual bodies, we miss the wider context shaping participation. We miss the insurance policy.The school policy.The zoning code.The inaccessible architecture.The transportation gap.The labor condition.The funding cap. Occupational science helps us see those patterns clearly. And once we can see them, we can respond more ethically and more effectively. The Secret of Occupation One of the most powerful insights of occupational science is that occupation always transcends the individual . Yes, participation includes personal capacity, motivation, and health status. But occupation is also shaped by: environmentculturepolicyhistoryeconomicssocial relationships When occupational therapists work with clients, we are rarely working with bodies alone. We are working with people in systems . Occupational science simply gives us a language to describe those systems more clearly. Why Occupational Apartheid Matters The concept of occupational apartheid helps us name situations where social systems restrict access to meaningful participation in everyday life. Frank Kronenberg describes occupational apartheid as: “systematically enacted negations of humanity that divide and subjugate collectives of people to the benefit of some at the expense of others.” (Kronenberg, 2018) These restrictions can occur through intersecting social mechanisms such as: racismclassismsexismableismxenophobiaeconomic inequality These forces shape who has access to resources that sustain dignified living. They shape who can participate fully in everyday life. And they show up in everyday occupational therapy practice more often than we might initially realize. When Systems Become Habit One of the most profound insights connected to occupational apartheid comes from the concept of occupational consciousness , developed by Elelwani Ramugondo. Occupational consciousness invites us to examine how systems of power become embedded in everyday activity. Because the truth is: Systems do not reproduce themselves automatically. They reproduce themselves through what people do every day . Policies become habits.Beliefs become routines.Social hierarchies become normalized through everyday actions. Over time, these patterns become so familiar that they operate below the level of conscious awareness . This is where occupation becomes incredibly important. Occupation is the point where ideas turn into action. And when those actions become automated habits, they can quietly reproduce systems of inequality, even after the laws that created them have been formally abolished. When Systems End but Patterns Persist History shows us that oppressive systems rarely disappear completely when policies change. Segregation in the United States was formally dismantled decades ago. Apartheid in South Africa was officially abolished in the 1990s. And yet racial disparities, inequities in access to housing, healthcare, education, and safety persist in both societies today. Why? Because systems do not only exist in policy. They exist in everyday occupations . They exist in patterns of: where people livewho receives serviceswho gets referred to carewhose needs are believedwho feels welcome in public spaceswho has access to transportation, education, and healthcare These patterns often persist through habits and assumptions that operate subconsciously. Occupational consciousness asks us to notice those patterns. Occupational apartheid helps us name their structural origins. Rehumanizing the Collective After War Another important dimension of occupational apartheid is its relevance to collective recovery from war, violence, and social division . Many of the social systems that shape our institutions today were forged in contexts of conflict, colonial expansion, and geopolitical competition. Even when wars formally end, the habits, infrastructures, and relational patterns shaped by those conflicts often remain embedded in everyday life. Occupational apartheid helps illuminate how the aftermath of war can continue to shape participation in subtle ways, through segregation, displacement, institutional distrust, unequal resource distribution, and inherited patterns of fear or exclusion. If left unexamined, these patterns can reproduce division across generations. Occupation is where these patterns are maintained, but it is also where they can be transformed. Through shared activities, community participation, creative practice, caregiving, education, and everyday collaboration, people rebuild relational life. Occupational therapy historically emerged in part from this very context, helping individuals and communities reconstruct meaningful life after the disruptions of war and institutionalization . Engaging with occupational apartheid and occupational consciousness today invites us to continue that tradition. Not by reproducing new forms of division or tribal harm, but by helping cultivate conditions where people can participate in humanizing, compassionate, and sustainable forms of collective life . In this way, occupation becomes a pathway toward healing. Not only individual healing. But collective healing. Occupation as a Tool for Liberation If occupation can reproduce systems of injustice, it can also help dismantle them. Because occupation is also the place where change becomes possible. When we change everyday patterns of doing, we change systems. This is why occupational therapy has always been connected to movements for human dignity and social participation. From the moral treatment movement to disability rights advocacy, occupational therapy has been concerned with helping people return to meaningful life within their communities . Occupational science expands that mission. It invites us to see how everyday activities can either reinforce systems of harm or help create environments where people can live with dignity, belonging, and agency. Why This Perspective Strengthens Occupational Therapy Understanding occupational apartheid and occupational consciousness does not weaken clinical practice. It strengthens it. When therapists understand the systemic barriers affecting participation, they can: design more realistic interventionsadvocate for appropriate equipmentcollaborate with community resourcesidentify policy barriersdocument environmental constraints clearly It also helps us articulate what makes occupational therapy distinctive . Our profession studies human beings as occupational beings. That means we look not only at physical function, but at how environments and systems shape the possibilities for everyday life. This perspective integrates insights from: health sciencessocial sciencescritical social sciencescommunity knowledgedecolonial scholarship Together, these perspectives create a robust and integrated understanding of participation . What This Series Explores This Occupational Science Alphabet Series explores concepts that help illuminate the broader context of occupation, including: occupational apartheidoccupational consciousnessoccupational justicecollective occupationsecological approaches to health Each concept will be translated into examples from real-world practice contexts. The goal is simple: To help occupational therapists, students, and the public better understand the unique scientific foundation of our profession. Subscribe for OS 101 If this conversation resonates with you, I invite you to subscribe to this Substack . Here I share: Occupational Science 101 explanationspodcast conversationsinterdisciplinary scholarshipreflections on ethics and policyexamples from everyday clinical practice My hope is to make occupational science more accessible so that occupational therapy can be better understood both within our profession and by the broader public. Stay tuned for the Forthcoming Learning Community I am also building a forthcoming Skool community where free OS 101 content will be hosted. This space will include: introductory occupational science coursesa journal and book clubcommunity discussion forumsreflection spaces for practitioners and learners Together we will explore how occupational science can support: collective liberationecological balanceoccupational wellbeinghumanizing care across the lifespan Closing Reflection If you have ever felt that occupational therapy is bigger than the narrow boxes it is often placed in, you are not imagining that. If you have sensed that participation barriers often arise from systems rather than symptoms, you are not imagining that either. Occupational science gives us the language to understand those realities. And occupational therapy gives us the tools to transform them. This series is an invitation to explore that together. Primary Sources 📚 Ramugondo, E. L. (2015). Occupational consciousness. Journal of Occupational Science, 22 (4), 488–501.https://doi.org/10.1080/14427591.2015.1042516 https://www.tandfonline.com/doi/full/10.1080/14427591.2015.1042516 📚 Kronenberg, F. (2018). Everyday enactments of humanity affirmations in post-1994 apartheid South Africa: A phronetic case study of being human as occupation and health (Doctoral dissertation, University of Cape Town). https://open.uct.ac.za/handle/11427/29441 References Hammell, K. W. (2019). Building globally relevant occupational therapy from the strength of our diversity. World Federation of Occupational Therapists Bulletin, 75 (1), 13–26. https://doi.org/10.1080/14473828.2018.1529485 Kronenberg, F. (2018). Everyday enactments of humanity affirmations in post-1994 apartheid South Africa: A phronetic case study of being human as occupation and health (Doctoral dissertation, University of Cape Town). https://open.uct.ac.za/handle/11427/29441 Kronenberg, F., Pollard, N., & Sakellariou, D. (Eds.). (2011). Occupational therapies without borders: Towards an ecology of occupation-based practices (2nd ed.). Elsevier. Ramugondo, E. L. (2015). Occupational consciousness. Journal of Occupational Science, 22 (4), 488–501. https://doi.org/10.1080/14427591.2015.1042516 Wilcock, A. A., & Hocking, C. (2015). An occupational perspective of health (3rd ed.). SLACK Incorporated. Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Evolved Living Podcast with Dr. Josie Jarvis OT Global Conversations: Cross-Discipline Collaboration in Epidemiology, Occupational Science, Disability, and AIwith Emmanuel Ampomah Boadi --- Episode Overview In this episode of the Evolved Living Podcast, Dr. Josie Jarvis welcomes Emmanuel Ampomah Boadi, a Ghana-based researcher working at the intersection of occupational science, epidemiology, biostatistics, rehabilitation, and disability studies. Their thoughtful, wide-ranging conversation explores how participation in daily life is shaped by social, structural, and systemic forces far beyond individual clinical encounters. Dr. Josie Jarvis opens the episode by reflecting on her diverse clinical background, spanning home health, schools, memory care, and acute and orthopedic rehabilitation. Her journey—deepened by doctoral work amid the COVID-19 pandemic—led her to occupational science as a discipline uniquely equipped to investigate barriers to participation at the population (not just individual) level. --- Key Topics Discussed - What is Epidemiology? Emmanuel Ampomah Boadi grounds the discussion by defining epidemiology: the study of how health, disease, and disability are distributed across populations, and the factors influencing those outcomes. He emphasizes that "it is the backbone of public health," using stories from Ghana and references to public health icons like John Snow and John Graunt to illustrate epidemiology’s roots in mapping, measurement, and understanding the interplay between environment and human behavior. - Bridging Disability Studies and Occupational Science Emmanuel Ampomah Boadi describes how his academic journey—spanning disability/rehabilitation studies and biostatistics—inspired him to explore the overlap between occupational science and population health. He highlights the importance of looking not only at medical conditions but also at social and environmental context, power imbalances, and race—reminding us that “everybody has some form of disability” and that “there is nothing like normal.” - The Role of Data and AI The conversation explores the need to “quantify” our observations to strengthen advocacy. Emmanuel Ampomah Boadi sees artificial intelligence as an assistive technology—valuable, but ultimately limited. He urges clinicians and researchers to retain the clarity and accountability of human interpretation, using AI as a support rather than a replacement for nuanced judgment. - Ethics, Equity, and Systemic Barriers The episode doesn’t shy away from difficult truths. They discuss well-known ethical breaches in research history (Tuskegee Syphilis Study, Nuremberg Code violations) and highlight how, without active attention to equity and ethics, scientific progress can deepen injustice. Dr. Josie Jarvis and Emmanuel Ampomah Boadi both reflect on their lived experiences of systemic inequity—from global vaccine access to the design of research and public health interventions. - Cultural Humility and Community Engagement Emmanuel Ampomah Boadi shares a poignant research anecdote from Ghana: an infrastructure project failed because outsiders did not consult the community, ultimately building a water borehole atop a sacred space. The lesson: knowledge translation is only possible with true cultural humility and partnership, not top-down assumptions. --- Concepts Explained Occupational Science : A discipline that examines human participation (“occupation”) in everyday life, considering both individual and system-level factors—policy, environment, economics, and history—that enable or restrict engagement. Epidemiology & Biostatistics in Rehab : Not just tools for infectious disease, epidemiology provides frameworks for understanding disability, health disparities, and the structural determinants of participation. Biostatistics helps quantify these patterns and decipher root causes, moving advocacy from anecdote to evidence. Occupational Apartheid & Social Models of Disability : The episode contextualizes “occupational apartheid”—a situation where social, economic, or policy barriers systematically exclude groups from meaningful participation in everyday life. Emmanuel Ampomah Boadi distinguishes between the medical, social, and biopsychosocial (ICF) models of disability, urging listeners to see how “systemic barriers” create or intensify disability. --- Practical Wisdom for Listeners - Integration is Key: Solutions come from teamwork—integrating medical science, social science, community wisdom, and policy. “You need to involve the community—what you believe to be the best solution may not fit their real needs.” - You Belong in Science: Dr. Josie Jarvis and Emmanuel Ampomah Boadi both stress that occupational science and health advocacy are not reserved for those with doctorates or prestigious affiliations. Efforts—however imperfect—matter. - Share and Connect: The conversation encourages clinicians, students, and community members to participate, share ideas, question systems, and “be on LinkedIn” or join organizations like CSOS (Canadian Society for Occupational Scientists), which prioritize international access and virtual participation. - Respect, Humility, and Effort: Growth and social change depend on respecting all perspectives, continuous effort, and humility when things don’t go as planned. --- Why This Matters Occupational therapy and science are poised to lead in bridging the gap between STEM and social science, between evidence and ethics, between theory and grassroots reality. Episodes like this demonstrate—in clear, accessible language—why the work of linking occupation, policy, data, and advocacy is both urgent and hopeful. --- How to Engage Further - Resources Mentioned: - Occupational Science 101 Guide - OS Alphabet Series (on TikTok, Instagram, Facebook , and LinkedIn) - CSOS membership and virtual events - LinkedIn and Substack for new episodes and reflections - Get Involved: Bring occupational science ideas into your practice, classroom, or community—even if you’re new to the concepts. Connect for further conversations, share your efforts, and don’t wait for perfect conditions. --- Final Thought As Emmanuel Ampomah Boadi shares: "Don’t be afraid that you’ll get it wrong. If you don’t get it wrong, you never know what to do to make it right." Occupational science—and a just health system—needs all voices, including yours. Connect with Emmanuel on LinkedIn here: https://www.linkedin.com/in/emmanuel-ampomah-boadi-08b4241a4/ --- For more episodes, resources, and to keep the conversation going, follow the Evolved Living Podcast on Substack and connect on social media platforms. Let’s keep collaborating across borders, backgrounds, and disciplines—the future of well-being depends on it. Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

When I first learned about evidence-based practice, I remember staring at that glossy triangle, the research hierarchy pyramid , with meta-analyses gleaming at the top like sacred scripture. It was comforting at first. Finally, a clear map of what counts as truth.But once I entered practice, that tidy hierarchy started to crumble under the weight of real people’s lives.Human beings aren’t controlled variables, and occupation doesn’t fit neatly into double-blind trials. The Trouble with the Old Pyramid The traditional Evidence-Based Practice (EBP) pyramid was built for biomedical and pharmaceutical research , where the goal is to test isolated variables across large populations ( Duke University Medical Center Library, n.d. ). That works beautifully when you’re measuring how a medication lowers blood pressure.But occupation is not a pill… it’s a process.It’s meaning, context, motivation, and environment woven together. In OT, our “data set” is often one person at a time, a life lived in context.Trying to flatten that into a universal protocol often means losing what makes our work effective and human. The Tomlin & Borgetto Research Pyramid: A Model That Fits Our Field In 2011, George S. Tomlin and Brandon Borgetto published Research Pyramid: A New Evidence-Based Practice Model for Occupational Therapy in The American Journal of Occupational Therapy (Tomlin & Borgetto, 2011). They didn’t just redraw the pyramid, they reimagined what evidence could look like.Their four-sided model includes: * Descriptive research : defining and observing occupational phenomena (the foundation). * Experimental research : asking causal questions under controlled conditions. * Outcome research : measuring effectiveness and impact in practice settings. * Qualitative research : exploring lived experience, culture, and meaning. Each side contributes uniquely to a full picture of occupational reality.Rather than stacking these methods into a hierarchy, Tomlin and Borgetto framed them as mutually reinforcing , like the faces of a pyramid that meet at the top…where evidence becomes practice. “Rather than ranking designs by hierarchy, the research pyramid encourages practitioners to evaluate rigor based on the type of question being asked.”- Tomlin & Borgetto (2011, p. 190) Why This Matters in Practice In home health, I’ve seen firsthand how rigid hierarchies undervalue the evidence that actually drives change.An RCT can tell me which exercise statistically improves shoulder flexion …but not whether my client can now garden with her grandchildren , or return to painting without pain . Occupational therapy lives where biology meets biography .To serve people well, we need research frameworks that make room for both. The Critiques That Strengthen Us Scholars such as Whiteford and Wright-St Clair (2004) argue that the old hierarchy often silences the very forms of knowledge that make OT powerful- narrative, context, creativity.When we measure success only by quantitative control, we risk missing the human story. Occupational science reminds us that people are meaning-making beings.Our science must be capable of holding that complexity. How I Apply the Tomlin & Borgetto Pyramid * For mechanical reliability , I turn to experimental studies. * For real-world effectiveness , I consult outcome research. * For understanding experience , I value qualitative inquiry. * And at the root of it all, I rely on descriptive studies to ground my reasoning. Each approach has a place.Evidence becomes less about hierarchy and more about harmony, a dynamic ecosystem of knowing. Reclaiming Evidence as a Living Practice Embracing this model isn’t about lowering standards; it’s about broadening the lens .It validates community programs, arts-based methods, trauma-informed care, and culturally grounded interventions that might never fit into traditional RCTs. When we expand what counts as evidence, we expand what’s possible: for our clients, our profession, and the world we’re helping to rebuild. 🌿 Learn More: Foundations of Occupational Science for U.S.-Based OTPs If this conversation sparks something in you, the urge to better understand why occupational therapy feels different from other disciplines and how to ground that difference in research and policy… I invite you to join me inside Foundations of Occupational Science for U.S.-Based OTPs . This self-paced capstone learning experience bridges theory and practice, guiding practitioners and students to: * Decode the real meaning and application of the Tomlin & Borgetto Research Pyramid . * Integrate occupational science concepts into documentation, advocacy, and program design. * Reclaim OT’s creative and psychosocial roots while navigating contemporary U.S. systems. * Build confidence in articulating the full scope of practice, in language policymakers, payers, and interdisciplinary teams understand. You can explore the course and all current offerings here:👉 engage.evolvedlivingnetwork.com Together, we’re building a movement of practitioners who see evidence as a living, liberatory practice…one that honors both the science and the soul of occupation. References Duke University Medical Center Library. (n.d.). The evidence-based practice pyramid. Retrieved from https://guides.mclibrary.duke.edu/ebmtutorial/ebp_pyramid Tomlin, G. S., & Borgetto, B. (2011). Research pyramid: A new evidence-based practice model for occupational therapy. American Journal of Occupational Therapy, 65 (2), 189–196. https://doi.org/10.5014/ajot.2011.000828 Whiteford, G., & Wright-St Clair, V. (2004). Occupation and practice in context (1st ed.). Churchill Livingstone Australia. Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

I have been thinking a lot about the history of care and what becomes possible when we take the time to remember the people and practices that came before our modern healthcare systems. That was the focus of a recent book circle and art-making session inside the Evolved Living Collaborative , where we explored Witches, Midwives, and Nurses by Barbara Ehrenreich and Deirdre English through an occupational therapy and occupational science lens. The live gathering has already happened, but the recording and classroom materials are now available inside the community so you can explore the conversation at your own pace. This is one of those topics that I think deserves more than a single conversation. A Forgotten Lineage of Occupation Long before occupational therapy became a profession, people were using everyday occupations to care for themselves, their families, and their communities. Growing food, preparing remedies, weaving, sewing, making pottery, caring for children, attending births, preparing meals, and gathering around shared work were not necessarily separated into the categories we use today to describe healthcare, leisure, productivity, or self-care. They were simply part of living. These occupations helped people survive, connect with one another, pass knowledge between generations, and create meaning within their communities. Witches, Midwives, and Nurses gives us an opportunity to look at what happened when many of these community-based traditions of care came into conflict with increasingly professionalized and institutionalized systems of medicine. Women healers and midwives were not simply forgotten as modern medicine developed. Their knowledge and authority were challenged, restricted, and displaced in ways that were deeply connected to gender, class, and institutional power. That history raises questions that still feel relevant today. Who gets recognized as a legitimate knowledge holder? Whose knowledge becomes evidence? Who gets paid for care? What happens to forms of care that do not fit neatly into professional or institutional structures? These are not just historical questions. So What Does This Have to Do With Occupational Therapy? For me, this is where the conversation becomes especially interesting. Occupational therapy emerged alongside movements that recognized the therapeutic potential of meaningful activity, including the moral treatment movement and the arts and crafts movement. There was an understanding that doing matters. Making matters. Connection matters. The environments in which we live matter. Human beings are not simply bodies carrying diagnoses. We are people living through occupations, relationships, communities, environments, routines, and meaning. And yet, within modern healthcare, many of the things that make occupational therapy distinctive can become difficult to see. Our craft-based roots can become secondary to productivity metrics. Relational work can become difficult to quantify. Psychosocial and community-based occupations can be pushed aside when healthcare systems prioritize what is easiest to measure. Sometimes I think we have become so accustomed to explaining occupational therapy through the language of the medical system that we forget how unusual some of our roots actually are. That is one of the questions I wanted to create space for in this classroom session. What might happen if we became more familiar with the histories of care, craft, community knowledge, and everyday occupation that existed before our profession had a name? Why Revisit This Now? This feels particularly important at a time when so many people are experiencing burnout and disconnection from the systems that are supposed to support health. Clinicians are being asked to do more with less. Communities are struggling with access to care. Insurance structures can make meaningful services difficult to obtain. Healthcare workers are navigating staffing shortages, productivity expectations, and systems that do not always leave much room for relationship or creativity. At the same time, people continue to care for one another outside of formal institutions. People cook for their neighbors. They grow gardens. They make art together. They share skills and knowledge. They create mutual aid networks. They teach one another traditional practices. They gather around tables and find ways to make life a little more livable. None of this replaces regulated healthcare when regulated healthcare is needed. But I think it is worth paying attention to the fact that people have always created ways of caring for one another, particularly when formal systems have not been able to meet every need. Occupational therapy has an interesting place within this conversation because occupation connects individual health with the environments, relationships, communities, and everyday activities that make up a person’s actual life. What We Explored Together In the 90-minute classroom session, we used Witches, Midwives, and Nurses as a starting point for thinking about the relationships between women’s knowledge, folk practices, craft, community care, and the development of occupational therapy. We also created art together. The Window Between Worlds activity invited us to think symbolically about the people, practices, and forms of knowledge that may have been pushed outside of official histories of healthcare, while also considering what knowledge we might want to carry forward. The session includes reflections on selected passages from the book, connections to occupational therapy history, conversation about relational and community-based knowledge, and an opportunity to consider what reclaiming meaningful occupations might look like in our own communities. You do not need to have read the entire book to engage with the session. You also do not need to arrive with a particular interpretation or a perfect understanding of the history. The classroom is meant to be a place to think, question, make, and explore together. Access the Classroom Inside the Evolved Living Collaborative The recording and classroom materials from Reclaiming the Roots of Care are now available inside the Evolved Living Collaborative . Once you join, you can access the links to the text and audio versions of Witches, Midwives, and Nurses , along with the workshop recording and the creative activity we explored together. The community is also becoming a place for ongoing connection around occupational science, occupational therapy, creativity, and meaningful occupation. We are hosting weekly craft nights, Coffee & Co-Occupation gatherings, and a monthly Journal Club , along with other conversations, workshops, and opportunities to learn together. I created this community because I wanted a space where occupational therapists, students, educators, researchers, occupational scientists, creatives, and interdisciplinary collaborators could explore ideas together without everything having to become another formal course or professional development requirement. Sometimes we need to study something. Sometimes we need to talk about it. Sometimes we need to make something with our hands while we think. And sometimes we just need other people who are curious about the same questions. The Evolved Living Collaborative is free to join. You can join the community here. Want to Go Deeper? If you are interested in tracing the threads of occupation across generations, I also explored some of these ideas in my podcast episode, Weaving the Threads of Our Occupation . That conversation gets into why I have become so interested in intergenerational occupational histories and in looking beyond the official timelines we are often given when we learn the history of our profession. Because I do not think our professional history begins when someone first wrote down the words “occupational therapy.” The story is much older than that. There are threads connecting us to the people who made, cared, taught, gathered, adapted, and passed knowledge from one generation to another. I think there is something powerful about remembering those threads. A Closing Reflection The history of care is not only found in hospitals, universities, and professional textbooks. It can also be found in kitchens, gardens, workshops, homes, community gatherings, and in the hands of people teaching other people how to do something that matters. Occupational therapy has a complicated history, and I am not interested in romanticizing that history or pretending that everything that came before modern healthcare was inherently better. I am interested in asking what we might learn when we widen the story. What knowledge was preserved? What knowledge was lost? Who was allowed to become an expert? Who was excluded? And what might we want to reclaim without simply recreating the past? For me, that is where this conversation becomes exciting. Maybe remembering our roots is not about going backward. Maybe it gives us more possibilities for imagining what care could become. 🌿 The classroom session is available now inside the Evolved Living Collaborative, along with the book and audio resources and opportunities to keep exploring these questions together. Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Last week I reacted live to a powerful post shared by Bill Wong in our community. The article in question — “Occupational Therapy and the ‘Seat at the Table’ Fallacy” by ABC Therapeutics — suggests that the push for higher credentials in OT (e.g., mandatory OTD) has been mis-directed: “A degree doesn’t grant influence. Credentials open doors, but they don’t dictate what happens once you step through them … A ‘seat at the table’ means very little if the table itself was built by someone else.” ABC Therapeutics It’s a critique worth hearing. But it’s also an invitation—not to retreat—but to re-vision how we approach our profession. The core tension The article argues: * Many OTD programs replicate existing content under new credentials, without generating genuine contribution. ABC Therapeutics * Visibility campaigns (hashtags, social media posts) risk being “toothless” when they lack scalable frameworks or evidence. ABC Therapeutics * We have long sought a seat at others’ tables rather than designing our own tables. You’ll hear echoes of that critique in my video: I reflected on how OT education, biomechanics-dominated models, and reimbursement systems have siloed us—and how that matters for people with disabilities, for social justice, and for innovation. My take: Let’s build AND sit 1. Building our own tables Yes—the article is right: credentials alone don’t guarantee influence . But I take that as a call to action . We need to: * Design models where OT is not just invited , but indispensable (policy, systems, community, creative arts) * Co-create the future with interdisciplinary, cross-cultural, and justice-oriented partners * Use our degrees (OTD or otherwise) to contribute—not just credential-inflate 2. Recognizing the invisible tables people actually built OT’s lineage includes folks who built their own tables: moral treatment movement, arts & crafts interventions, community-based rehabilitation, disability justice activism. In my video I referenced how we’re responding to human rights crises, climate, trans / disability access barriers—these aren’t “outside” OT—they’re core. 3. Expanding practice beyond the “biomechanical king of the castle” The article critiques that OTD programs default to clever “hobbie” capstones (“OT in football”, hashtag activism) without rigor or depth. My sympathy to the students who poured their hearts and best work in to their first major OT project. Perhaps some encouragement and support for the potential of their future work is also in order. I can’t tell how much more difficult contributing to the advancement of one’s field without the support or encouragement or belief in possibilities from one’s elders also want to offer what depth and rigor can also look like : * Confronting systems of oppression (transphobia in toileting access, disability justice, policy literacy) * Measuring participation, identity, belonging—not just ROM, strength, task time * Using community arts, folk craft, cross-generation dialogue as legitimate knowledge translation pathways Why this matters—especially now * People with disabilities face occupational deprivation , systemic barriers , and need OT thinking that goes beyond physical rehab. * The U.S. health-human services system is stressed; OT’s value-add includes bridging discipline silos, addressing context, and enabling participation. * New generations (Gen Z, Gen Alpha) bring fresh epistemologies. If we insist on “sit at the table”, we risk boxing their potential. My mantra: “Make room for the next table-builders.” An invitation to you If you resonate with any of these questions: * How might OT design a new table rather than merely trying to sit at one? * What kind of praxis (not just theory) can we commit to that spans social justice, policy literacy, community arts, and cross-cultural collaboration? * Can we mentor and co-create with newer cohorts, rather than gate-keep? Then join me. Let’s build Evolved Living OT/OS Collaborative as a space for these conversations and creations. Reference ABC Therapeutics. (2025, October 17). Occupational Therapy and the ‘Seat at the Table’ Fallacy. Retrieved from https://abctherapeutics.blogspot.com/2025/10/occupational-therapy-and-seat-and-table.html Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Listen to the full episode → 🎧 Multigenerational Panel on Delayed Exposure to Occupational Science and Its Impact on OT Practice 🌎 Reclaiming Our Collective Voice When I think about the roots of occupational therapy and occupational science, I often imagine our profession as having lived under a kind of conservatorship — not unlike the cultural story of Britney Spears. For much of our history, OT in the United States was positioned under the American Medical Association , functioning almost like a dependent discipline. We began as “technicians” and “aides” before evolving into a profession with associate, bachelor’s, master’s, and now doctoral degrees. While this growth advanced professional credibility, it also created hierarchies and access barriers that have distanced many from the relational, creative, and community-driven roots of our work. That is why cross-cultural and intergenerational engagement with occupational science is so vital — it reconnects us to the shared experiment that science was always meant to be: interdisciplinary, context-sensitive, and liberatory. 🪶 Why Occupational Science Needs Many Voices Occupational science, in its truest expression, was designed to be: “An infinitely flexible and transparent experiment for discovering the meaning of doing, being, becoming, and belonging across contexts.” Globally, the field has diversified through multiple lenses: * Australia & New Zealand → Scholars such as Anne Wilcock , Gail Whiteford , and Claire Hocking have emphasized occupation as a determinant of health , linking individual activity to public-health systems and policy. * North America (University of Southern California) → The lineage of Elizabeth Yerxa , Mary Reilly , and later Gary Kielhofner rooted occupational science in clinical practice, volition, and systems of meaning. * Canada & Europe → Emerging work now centers occupational justice, sanctioned occupations, and community transformation. Each regional thread offers a unique epistemology — a way of producing and translating knowledge about what it means to live a meaningful life through occupation. 🧵 The Panel: Four Generations, Shared Purpose This Evolved Living Podcast episode brings together four occupational therapists from different generations — spanning Baby Boomer to Gen Z — to explore how exposure to occupational science transformed their thinking and practice. 🎙 Panelists * Dr. Susan Burwash (Baby Boomer) – LinkedIn | Portfolio | @subu_ot * Dissertation: Doing Occupation: A Narrative Inquiry into Occupational Therapists’ Stories of Occupation-Based Practice * Dr. Karen Dwire (Generation X) – LinkedIn * Capstone: Pets Alleviating Loneliness in Seniors (PALS) – An adjunct OT program addressing isolation in older adults. * Dr. Josie Jarvis (Millennial) – Host of the Evolved Living Podcast and founder of the Evolved Living Collective. * Anna Braunizer, Reg. OT (BC) (Gen Z / late Millennial) – LinkedIn * Referenced article: Silences around Occupations Framed as Unhealthy, Illegal, and Deviant (Kiepek et al., 2018, Journal of Occupational Science ). 🌍 What We Learned Across generations and borders — U.S. and Canada — similar patterns emerged: * Home Health & Community Mental Health share more overlap than we think.Dr. Karen Dwire’s U.S. home-health practice mirrors Anna Braunizer’s work in Canada’s community-mental-health model. * Occupational Science Vocabulary gives us a shared lens for inter-professional collaboration. * Exposure to Global OS Frameworks empowers clinicians to separate professional identity from restrictive payer systems. “OT exists in an incredibly vulnerable position if we do not allow ourselves to build an identity separate from the systems we work in.” — Josie Jarvis 💫 Why Intergenerational Literacy Matters When Baby Boomers, Gen Xers, Millennials, and Gen Z clinicians share dialogue, something shifts.We begin to see our own epistemological inheritance — and the blind spots that come with it. This is not about defining what OT is or isn’t in rigid terms.It’s about softening the limbic reflex that says “it’s either this or that.” Occupational science literacy helps us see possibility again — not through hierarchy, but through shared curiosity. 🩺 From Systems to Sovereignty One of the key takeaways from this panel is that understanding occupational science allows us to separate: * Policy systems (which define what’s reimbursed) * Professional identity (which defines what’s possible) Occupational therapy is always a negotiation between these two worlds. But when we ground ourselves in science — not just service codes — we begin to reclaim creative sovereignty and advocacy capacity within the system itself. As Dr. Jarvis noted: “Science is meant to be transparent and adaptable. When it becomes proprietary, it loses its soul.” 🌏 Building Bridges Across Borders This conversation also highlights the importance of global collaboration. The Canadian Society of Occupational Scientists (CSOS) is currently inviting submissions for their upcoming World Occupational Science Day Virtual Conference — an accessible, international gathering celebrating diverse applications of occupational science. 🌐 Submit a proposal or attend to see how community, justice, and policy perspectives are expanding OS worldwide. 💡 Supplementary Learning Topic Resource Foundations of Occupational Science A Capstone Course for U.S.-Based OTPs (Evolved Living Collective) History of U.S. Healthcare Systems Witches, Midwives & Nurses: A History of Women Healers — Barbara Ehrenreich & Deirdre English Sanctioned Occupations Kiepek et al., 2018 – Journal of Occupational Science Community OS Engagement Canadian Society of Occupational Scientists 🎧 Listen, Reflect, Share “Having an occupational lens informed by cross-cultural possibility enhances our ability to serve, adapt, and imagine.” Join the conversation by listening to the full episode here:🎙️ Multigenerational Panel on Delayed Exposure to Occupational Science And follow our guests: * Dr. Susan Burwash * Dr. Karen Dwire * Anna Braunizer, OT (BC) 📚 References * Ehrenreich, B., & English, D. (1973). Witches, Midwives & Nurses: A History of Women Healers. The Feminist Press . * Kiepek, N., Beagan, B., Laliberte Rudman, D., & Phelan, S. (2018). Silences around occupations framed as unhealthy, illegal, and deviant. Journal of Occupational Science, 26 (1), 1–13. https://doi.org/10.1080/14427591.2018.1499123 * Canadian Society of Occupational Scientists (CSOS) Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

I hopped on live this week after a rich conversation in the Practical OT Facebook group (hi Chris! 🙌).Chris shared The Intentional Relationship Model — Renee Taylor’s seminal text on therapeutic use of self and the relational core of practice (and yes, the IRM lineage connects to Gary Kielhofner and MOHO). That post opened a door I care deeply about: Why do so many of us still feel hesitant—or “naughty”—bringing the psychosocial domain into “traditional” OT settings? Short answer: our systems trained us to separate what OT was never meant to split. 🧠 Our Roots Were Never Split: OT = Psychobiological Integration Early psychiatrist Adolf Meyer , who co-founded the American Occupational Therapy Association alongside Eleanor Clarke Slagle , coined the term psychobiology — a framework for understanding human beings as integrated systems of mind, body, and environment (Meyer, 1922). He argued that disturbances in this balance—not isolated mental or physical “defects”—were the source of illness. The therapeutic goal was to restore rhythm and meaning in daily life through occupation. “It is the proper rhythm and balance of activity and rest, of work and play, of day and night, that constitute the very basis of health.” — Adolf Meyer, 1922 This psychobiological lens is the taproot of occupational therapy’s foundations in the moral treatment and arts and crafts movements — where engagement in creative, purposeful occupation supported emotional regulation, identity reconstruction, and social participation. Our profession was born as a psychosocial intervention , long before it became entrenched in the biomechanical model. That continuity remains explicit in the Occupational Therapy Practice Framework: Domain & Process, 4th Edition (AOTA, 2020) : occupation is not just biomechanical task performance. It is meaning- and purpose-laden activity shaped by volition, identity, roles, and context. If we leave out the psychosocial domain, we’re not fully addressing or assessing occupation — our primary protected and skilled domain across all U.S. practice settings. 📌 Fun fact: The 2020 revision of the OTPF-4 intentionally removed preparatory activities and exercise-centered approaches as stand-alone interventions to reaffirm that occupational therapy is grounded in occupation itself—not in isolated physical techniques. Even physical therapy is now shifting toward functional outcomes-based reimbursement per CMS guidance. 🩺 The Policy Playbook (So You Can Feel Confident) You don’t need permission to practice holistically — you already have it. Here’s language you can cite and stand on: “ Occupational therapy services are... medically prescribed treatment concerned with improving or restoring functions... or, where function has been permanently lost or reduced... to improve the individual’s ability to perform those tasks required for independent functioning. ”— Centers for Medicare & Medicaid Services, §230.2A Notice: this doesn’t say only when function is lost due to a physiologic cause . CMS explicitly recognizes psychosocially oriented activity as skilled occupational therapy. “ The planning, implementing, and supervising of individualized therapeutic activity programs as part of an overall active treatment program for a patient with a diagnosed psychiatric illness; e.g., the use of sewing activities which require following a pattern to reduce confusion and restore reality orientation in a schizophrenic patient. ”— (CMS, 2014, §230.2A) That’s not fringe OT — it’s federal definition of practice. 📎 Take-away: Skilled OT that restores or compensates for ADL/IADL performance — including interventions addressing motivation, affect, cognition, behavior, and role disruption — is squarely within coverage expectations . Psychosocial isn’t “extra”; it’s how independence is achieved — and how readmissions are prevented. 🖇️ Direct link to CMS formal guidelines for covered OT services ⚖️ Mental Health Parity and OT’s Expanding Role Since the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, federal law has required that insurance coverage for mental health and substance-use services be comparable to coverage for physical health conditions. This means psychosocial dysfunction cannot be treated as less legitimate than biomechanical dysfunction. However, implementation remains uneven. Many payers still reimburse only for “physical” goals — despite federal parity law and the CMS definition of OT practice. Parity isn’t optional—it’s our ethical mandate. It ensures that the mental, emotional, and social determinants of participation receive the same respect as physical rehabilitation. 🎥 Seeing It in Action Watch this short video:🎬 How Behavioral Health OT Can Be Integrated into Post-Acute Settings to Reduce Hospital Readmissions It shows how embedding occupational therapy into post-acute care reduces readmissions, enhances safety, and improves long-term outcomes. When OT is practiced through a psychobiological and psychosocial lens , it bridges the gap between physical and mental health care — just as our founders intended. This Bill to cover community behavioral health OT passed unanimously by the way! 💠 Integrating Trauma-Informed Care Principles Trauma-informed care (TIC) isn’t a specialty — it’s a lens for every setting. It re-centers safety, collaboration, and empowerment as therapeutic outcomes themselves. Core Principles (SAMHSA, 2014; AOTA, 2022): 1️⃣ Safety: Prioritize emotional and physical safety.2️⃣ Trustworthiness & Transparency: Explain procedures and expectations in plain language.3️⃣ Peer Support & Collaboration: Center co-regulation and shared decision-making.4️⃣ Empowerment, Voice, & Choice: Build agency and autonomy into every session.5️⃣ Cultural, Historical, & Gender Awareness: Acknowledge systemic trauma and intersectionality.6️⃣ Resilience & Recovery Orientation: Focus on strengths, regulation, and rhythm—not deficits. 📊 Tip: Download SAMHSA’s full framework and integrate it into your onboarding or staff education packets. Image placeholder suggestion: 🖼️ “Trauma-Informed Care Principles in OT Practice” infographic 🔧 How to Integrate Psychosocial—Anywhere You Practice * Begin with the Occupational Profile → Roles, routines, values, supports, identity, grief, neurodivergence, social determinants. * Use Quick Screens → GDS, anxiety scales, cognitive/attention checks. * Build Relational Skill → IRM, ACT-informed OT, trauma-informed micro-skills. * Document What Only OT Does → Connect psychosocial factors to function, safety, and GG outcomes. * Advocate Like a Clinician → Cite parity, CMS, and OTPF. 📄 Chart Example: “Psychosocial factors (grief, role loss, low activity drive, attentional dysregulation) are limiting safe, consistent engagement in ADL/IADL tasks. Skilled OT will address motivation, pacing, environmental fit, and compensatory routines to restore participation and reduce risk of decline/readmission.” 🪞 Why Many Clinicians Still Hesitate (and How We Move) A lot of OTPs graduated before our frameworks were widely taught— during times of mass systemic divestment from mental health supports in the U.S. Add decades of underfunded infrastructure, and it’s no wonder psychosocial practice gets sidelined. But we must also name the intersectional discrimination that continues to marginalize clients with mental-health diagnoses within physical-health systems. People with psychiatric disabilities often experience sanism — discrimination that pathologizes, dismisses, or silences those perceived as “mentally ill” — leading to diagnostic overshadowing, reduced access to care, and poorer health outcomes ( Poole et al., 2012 ; Faissner et al., 2024 ). Sanism compounds when layered with racism, ableism, sexism, classism, and ageism — shaping who receives empathy, time, and quality care.For example, Black, Indigenous, and LGBTQ+ clients with co-occurring mental-health and physical-health needs are still less likely to be referred for rehabilitation or receive equitable discharge planning (Faissner et al., 2024). The fix isn’t shame—it’s shared literacy and everyday translation. ✅ Talk OTPF-4 in plain language with your team.✅ Bring CMS §230.2A into in-services and appeals.✅ Connect psychosocial barriers → ADL/IADL limitations → utilization risk. ✅ Track and report outcomes that matter: falls, LOS, GG codes, readmissions. 🌱 Keep Learning (and Un-Gatekeep) 📘 The Intentional Relationship Model (Taylor)📘 Model of Human Occupation (Kielhofner)📘 ACT-informed OT (Carlyn Neek)🎨 Trauma-informed Creative Practices ( A Window Between Worlds )📜 CMS Pub. 100-02, Ch. 15, §230.2A – our shared evidence base 🌿 Final Word It doesn’t make us “better” clinicians to ignore neurodivergence, mood, trauma, identity, or role loss — it makes our work less effective . OT’s power is helping people rebuild lives that work , not just bodies that move . Let’s practice like the profession we are: psychobiological, trauma-informed, relational, creative, and policy-literate. 📚 References * American Occupational Therapy Association. (2020). Occupational Therapy Practice Framework: Domain and Process (4th ed.) * Centers for Medicare & Medicaid Services. (2014). Medicare Benefit Policy Manual, Chapter 15 – Covered Medical and Other Health Services, §230.2A – Occupational Therapy Services * Faissner, M., Stahmeyer, J. T., & Hoffmann, F. (2024). Intersectional discrimination and its health consequences: A systematic review. Frontiers in Public Health, 12 , 1350670. * Poole, J., Greaves, L., & Riach, L. (2012). Sanism, “mental health,” and social work education: A review of the literature. Intersectionalities, 1 (1), 20–36. * Substance Abuse and Mental Health Services Administration (SAMHSA). (2014). Concept of Trauma and Guidance for a Trauma-Informed Approach. * U.S. Department of Labor. (2022). Mental Health Parity and Addiction Equity Act (MHPAEA). Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Send us a text In this powerful episode of the Evolved Living Podcast, host Dr. Josephine Jarvis welcomes Lennée Reid a multi-talented Creole, queer, neurodiverse artist and healer, Lennée Reid. As the nation navigates the tumultuous aftermath of election week, they engage in a heartfelt conversation about art, activism, and the urgent need for unity in challenging times. Lennée opens up about Unity Henge, her visionary folk art project that aims to illuminate pressing social justice issues through striking art installations. Drawing parallels between ancient practices and contemporary struggles, Lennee explores how art can act as a catalyst for healing and dialogue amid societal discord. With roots in history, spirituality, and community, Unity Henge serves as a modern gathering place for diverse voices, echoing the principles of ancient monuments like Stonehenge. Dr. Jarvis and Lennée Reid discuss the importance of acknowledging and embracing our interconnectedness while shining a spotlight on the often-overlooked narratives of marginalized communities, particularly those affected by neurodiversity and disability. As they share their personal journeys and insights, they invite listeners to reflect on their roles in fostering creativity, empathy, and connection within their communities. Listeners will also learn how they can support the Unity Henge project, from participating in local events to contributing to its GoFundMe campaign. Through this conversation, Dr. Jarvis and Lennee illuminate the transformative potential of community art that prioritizes inclusivity, resilience, and mutual aid. Tune in for a thought-provoking episode filled with hope and inspiration, encouraging us all to gather around the symbols and stories that unite us. Together, we can ignite a movement that champions the voices of the diverse and intersectionally impacted. For more information on how to support Unity Henge, check the show notes for links to Lennee's art and fundraising initiatives. Join us as we forge connections, celebrate our heritage, and create a brighter future through the healing power of art! Don’t miss: Support Lennee's inspiring art project at: https://gofund.me/762fd338 Paypal.me/witchesmarch Cashapp $TheQueenMystic Venmo @TheQueenMystic https://awareni.wordpress.com/2022/06/23/what-is-unityhenge/ Discover Lennee's published works at: *Connect with Lennée:* - [Awareni Blog]( https://awareni.wordpress.com ) - Follow Lennee on social media under #UnityHenge Together, let’s keep the spark of hope alive—illuminated in black light, fueled by community and creativity! Ten Free Ebooks for Getting F Evolved Living Network Instragram @EvolvedLivingNetwork Free Occupational Science 101 Guidebook https://swiy.co/OS101GuidePodcast OS Empowered OT Facebook Group https://www.facebook.com/groups/1569824073462362/ Link to Full Podcast Disclaimer https://docs.google.com/document/d/13DI0RVawzWrsY-Gmj7qOLk5A6tH-V9150xETzAdd6MQ/edit Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Send us a text This multi-generational podcast discussion is brought to you by the occupational power of music linking the intersectional life paths of Miles Davis, Taylor Swift, Kendrick Lamar, John White, Josie Jarvis, Jian Jones, and Avery Geata with an invitation to explore music as a powerful medium for developing and expanding our collective Occupational Lens both within and outside of the Occupational Therapy Classroom & Clinic! This episode will provide powerful inspiration for exploring the ongoing evolution of Occupational Science and the power of music to heal and restore the collective human spirit across generational differences amid the landscape of historic and contemporary intergenerational challenges. Music and occupation link us all in our path toward meaning and wholeness. Support Those Impacted by Hurricane Helene SSO:USA 2024 Conference Oct 17-19 in Durham North Carolina: Art and Occupation: Creativity, Critical Theory, and Social Transformation Video/Text Summary of: Occupations in the Extreme, Life History, Theoretical Perspectives on the Life of Miles Davis by John White, PhD, MA, OTR/L Life History of Dr. John White, PhD, MA, OTR/L FAOTA 2021 Folk Ballard of SSO:USA Dr. Jian Joans, PhD, MA-OTR/L Two-Fifteens : The Podcast Where Hip-Hop, Occupation, and Identity Collide make connections related to Hip-Hop culture, the science of doing, and the shaping of the identity of people. Not Like Us by Kendrick Lamar Dr. Avery Gaeta, OTD All Too Well Taylor's Version Capstone Research: Exploring the Health Management of Neurodivergent College Students Evolved Living Network Instragram @EvolvedLivingNetwork Free Occupational Science 101 Guidebook https://swiy.co/OS101GuidePodcast OS Empowered OT Facebook Group https://www.facebook.com/groups/1569824073462362/ Link to Full Podcast Disclaimer https://docs.google.com/document/d/13DI0RVawzWrsY-Gmj7qOLk5A6tH-V9150xETzAdd6MQ/edit Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Send us a text The podcast interview discusses maternal health disparities, the importance of collaboration between occupational therapists and physical therapists, and the role of technology and personal experiences in empowering women and improving healthcare outcomes, with a focus on trauma-informed, individualized care and systemic change. Released in Tandem with AOTA SPECIALTY CONFERENCE: Women's Health https://www.aota.org/events/calendar/aota-specialty-conference-womens-health Trauma-Informed Collaboration Resource Compilation: https://qr.link/jgmFXO Katherine Sylvester is a mother of two, physical therapist, preeclampsia survivor, clinical assistant professor for women’s health, and VBAC-certified doula. She is the founder of Operation M.I.S.T. where she and her team teach women to use smart watches and blood pressure cuffs for safer pregnancies, smoother cycles, and better health. She and her team also host More than a Period Parties and Heart Harmony Seminars where they teach ladies about their bodies so they can trust, prepare and protect them throughout all phases of womanhood. Operation M.I.S.T. https://operationmist.org/ The poem (both written and read) is below: Written poem: From Racism to Remote Monitoring: https://docs.google.com/document/d/1H-3lGLBjORkkyhjOkAdTPxo2VLe2_npOV41-WQ8k3YE/edit Read: From Racism to Remote Monitoring Spoken Word: https://www.youtube.com/watch?si=5nXYRxPEqbGBk5H8&v=W1qrTFcVrC8&feature=youtu.be Kary Gillenwaters serves as a community-based OT and the SOLACE Foundation director of support and community engagement. Eeleven years ago, the birth of Kary's first child resulted in her becoming a member of a club no one signs up for or anticipates. At the time, little to no support was available online, health care teams had little experience with serious obstetrical tears, and the lack of understanding and meaningful support made an already difficult life transition even more challenging. But as many of the members of this club have learned, these experiences are more common than we think-it's just that it's all too painful (and sometimes embarrassing) to talk about, so we don't. The silence and isolation that so often follow a severe obstetric laceration exacerbate the physical, mental, emotional and spiritual challenges people face, overnight, not just to their body, but to their roles, their relationships, and their identity. SOLACE Foundation: https://www.solaceforwomen.org/ Raising awareness of severe obstetric lacerations by promoting prevention through maternal education and research, driving change toward a standard of care, and providing women with comprehensive support through their healing journeys. Kary's 4th Degree Care Story: https://solidagovc.com/blog/the-impact-of-birth-injuries-interprofessional-teaming-and-informed-consent-on-the-occupations-of-motherhood Evolved Living Network Instragram @EvolvedLivingNetwork Free Occupational Science 101 Guidebook https://swiy.co/OS101GuidePodcast OS Empowered OT Facebook Group https://www.facebook.com/groups/1569824073462362/ Link to Full Podcast Disclaimer https://docs.google.com/document/d/13DI0RVawzWrsY-Gmj7qOLk5A6tH-V9150xETzAdd6MQ/edit Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Send us a text This Podcast discusses a conversation with Angel, a Tacoma Area tattoo artist, about her journey into the tattoo industry, the skills required, the therapeutic aspect of her work, the need for more diversity and representation in the field, and her community work with the Hundredth Monkey art organization, with future steps including sharing resources on trauma-informed practices, promoting body art in professional spaces, and continuing the conversation about making art more accessible and inclusive. Check out and support Lil' Angel's Ink Artisty: https://m.facebook.com/lilangelink/?locale=hi_IN Support the 100th Monkey Tacoma Art Event: https://www.facebook.com/Tacoma100thMonkey/ https://www.facebook.com/events/6804563089672218/?ref=newsfeed Gender Diversity & Gatekeeping in Art Industries Josephine explores gender diversity within artistic communities while discussing gatekeeping practices that have historically affected women in various industries. Angel shares insights into challenges faced by women in male-dominated spaces like heavy metal music culture and traditional views within certain segments of the tattoo industry. Both hosts emphasize creating more inclusive environments by supporting diverse artists while addressing issues related to cultural appropriation. Evolution of the Tattoo Industry The interview discusses the evolution and growth of the tattoo industry, highlighting the increasing diversity and inclusivity within the community. Angel shares her experience as a female tattoo artist and emphasizes the importance of an open-minded approach to different artistic styles and artists. The conversation touches on historical aspects, acknowledging that tattooing has been a significant art form across various cultures for centuries. Trauma-Informed Tattooing and Personal Storytelling through Tattoos Angel’s experiences working with clients who have had traumatic medical experiences or seek to cover scars with meaningful tattoos. Josephine’s exploration of how tattoos can serve as a form of storytelling, reclaiming personal narratives, especially for marginalized communities. The role of trauma-informed care within occupational therapy paralleled with trauma-informed tattoo practices. Collaboration in Art Workshops There was a focus on trauma-informed community art workshops as a means to make different art forms accessible to people with disabilities while fostering collaboration between occupational therapists and tattoo artists. Occupational Therapy and Art The conversation delved into the historical connection between occupational therapy and the arts, exploring how creating art can be naturally therapeutic for individuals and communities. Evolved Living Network Instragram @EvolvedLivingNetwork Free Occupational Science 101 Guidebook https://swiy.co/OS101GuidePodcast OS Empowered OT Facebook Group https://www.facebook.com/groups/1569824073462362/ Link to Full Podcast Disclaimer https://docs.google.com/document/d/13DI0RVawzWrsY-Gmj7qOLk5A6tH-V9150xETzAdd6MQ/edit Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Send us a text Learn essentials to develop your own intergenerational Occupational Profile Informed by Occupational Science Here: https://eln.upcoach.com/organizations/i/x9V5a6WydwaVTsGBXqwfUon13Fewi4nHAj6QYPMyQl2fwmKkPL Dr. Josie Jarvis sits down with her parents, Julie and Wade Jarvis, to learn about their occupational histories and how their experiences have shaped Josie's own occupational path. Through conversation, they work to understand the threads that connect their lives across generations and cultural contexts. The discussion delves into textile manufacturing traditions in the family, gender roles and expectations through the decades, and how cultural roots in Iceland continue to influence identity. They also reflect on career influences, economic opportunities, and navigating norms within the Mormon church. Woven throughout are reflections on the power of quilting and fiber arts as artifacts preserving informal histories. Listeners are invited to gain insight into constructing their own intergenerational occupational profiles through family stories. This intimate dialogue models how deepening cultural understanding can evolve across the generations. Quotes "We're all more connected than we realize... especially through forces of occupation." "To move is about the only way that you can write your own story." "I think it's been occupationally helpful to me that I've had role models... women that have broken with some traditions." "There were just some people [in Utah] that were [racist], but it didn't feel like all people were that." "Everything to me from as long as I can remember was I wanted to be able to fix things... those were very appreciated skills." "There really always will always have to be some kind of a sewing machine because unless we stop wearing clothes... they can never make something that's just all-in-one piece that is a garment." "We're like such an honestly privileged cohort... we're holding these things [crafts] but it’s interesting... our ancestors cultivated that they had to do out of scarcity." "Quilting is one of the most embedded artifacts of informal publishing in United States history." "Your parents made a foundation for me to come into this world." "Even if you do look at things you don't like... find something unique... that you can be proud." Evolved Living Network Instragram @EvolvedLivingNetwork Free Occupational Science 101 Guidebook https://swiy.co/OS101GuidePodcast OS Empowered OT Facebook Group https://www.facebook.com/groups/1569824073462362/ Link to Full Podcast Disclaimer https://docs.google.com/document/d/13DI0RVawzWrsY-Gmj7qOLk5A6tH-V9150xETzAdd6MQ/edit Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Send us a text This thought-provoking podcast brought together Dr. Jian Jones, Dr. Josie Jarvis and special guest Dr. Arameh Anvarizadeh to discuss the power of hip hop culture in advancing occupational therapy. They explored how hip hop represents activism, creativity and driving positive change through storytelling and community. Dr. Arameh shared her vision of bringing more diverse voices into leadership conversations at AOTA to address gaps and decrease barriers. Her approach aligns with hip hop's focus on opportunity, access and mobilizing through activism. She aims to reconnect members to AOTA's core values through authentic, community-focused leadership. Check out our Hip Hop Pedagogy and AOTA Election Resource Compilation Here! Now also includes the Disorienting Dilemma Toolkit For Culturally Mindful Dysregulation Support with New Learning! Free! Dr. Jian Jones, PhD, OTR/L, ACSM-CEP , is the host of Two Fifteens: The Podcast Where Hip-Hop, Occupation, and Identity Collide where she and guests make connections related to Hip-Hop culture, the science of doing, and the shaping of the identity of people. She is an Occupational Therapist, life coach, 500-HR yoga teacher, professor, and scholar who offers culturally relevant mental, emotional, social, spiritual and physical well-being techniques that assist you in uncovering your potential to live your best life. Jian blended her passion for wellness, nature, purpose and Hip-Hop into a personal development company, Jian Jones, LLC with a mission to transform lives one mind, body, and soul at a time. Jian encourages you to Press+FLY™: 'press through your obstacles so that you can fly toward your destiny'. Jian uses her personal evolution to serve others and looks forward to their individual growth and success as they cross the bridges of life. Dr. Josie Jarvis, PP-OTD, MA-OTR/L, BA, BS is a part-time Occupational Therapist and full-time Open Science activist with a focus on translating Critical Occupational Science Literacy to the field through mechanisms of informal publishing and holistic and transparent implementation science that is inclusive to social, physical, and indigenous sciences in the field as well as in the academy. She is the host of the Evolved Living Podcast a podcast dedicated to coming together and sharing multidisciplinary and multicultural wisdom from diverse perspectives to support adapting to change holistically and ecologically together with honesty about the messy and imperfect process of ongoing growth, change, and adaptation to the contemporary world. Dr. Arameh Anvarizahdeh, OTD, OTR/L, FAOTA has already made history as the youngest and first African American/Iranian woman to become Vice President of the American Occupational Therapy Association (AOTA). She is also the youngest woman Evolved Living Network Instragram @EvolvedLivingNetwork Free Occupational Science 101 Guidebook https://swiy.co/OS101GuidePodcast OS Empowered OT Facebook Group https://www.facebook.com/groups/1569824073462362/ Link to Full Podcast Disclaimer https://docs.google.com/document/d/13DI0RVawzWrsY-Gmj7qOLk5A6tH-V9150xETzAdd6MQ/edit Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Send us a text Just in time to decolonize Thanksgiving, even in "progressive" Pacific Northwest Seattle Suburbs where exclusive and protective...does not always mean...safe...for everyone... Check our Hawaiian Artist and Indigenous Human Rights Activist Malialani Dullanty! Please consider following her work on instragram : https://www.instagram.com/malialani/ And supporting her Patreon ! https://www.patreon.com/malialanimade The podcast primarily involves Josephine Jarvis and Malialani Dullanty discussing their experiences in relation to cultural assimilation, systemic racism and the importance of decolonizing their mindsets and practices. -Both discuss their school experiences, highlighting the lack of accurate and comprehensive historical education regarding marginalized populations. -They delve into the topic of indigenous science, emphasizing its validity and the need to view it through a non-colonial lens. -A significant portion of the conversation revolves around the systemic abuse and sexualization of women, particularly women of mixed-race and native heritage. -The two express their shared experiences of growing up in white supremacist structures and discuss the need for systemic change and healing, rather than solely focusing on healing the victims. -Josephine Jarvis acknowledges the trauma and harm caused by her ancestors and commits to not letting that be her legacy. -The conversation touches upon the importance of acknowledging and understanding the harm caused by their ancestors, and the importance of healing together. -The participants discuss the need for critical thinking and challenging the established norms and systems. -The conversation ends with Josephine expressing her admiration for Malialani's authenticity and bravery. Disorienting Deliemma Toolkit to Help Navigate Challenging Emotions Available in the Onboarding Module of Foundations of Occupational Science 101 Course (free) Supplementary Learning: Occupational Consciousness [Free open access article] (helpful decolonizing lens contributed to OT and OS literature by 2023 Ruth Zemke Lecturship Recipient Dr. Elelwani L. Ramugondo , PhD, MSc, BSc(OT), Associate Professor) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606822/ The Devastating Effects of Colonization on Hawai'i https://storymaps.arcgis.com/stories/83474c5d6077492d990b961bab0bcd74 What is indigenous science? https://wisn.org/about/what-is-indigenous-science/ Resources to help with Decolonizing Whiteness for Settler Descendents: https://www.marybethbonfiglio.com/blood-and-belonging Context on Decolo Evolved Living Network Instragram @EvolvedLivingNetwork Free Occupational Science 101 Guidebook https://swiy.co/OS101GuidePodcast OS Empowered OT Facebook Group https://www.facebook.com/groups/1569824073462362/ Link to Full Podcast Disclaimer https://docs.google.com/document/d/13DI0RVawzWrsY-Gmj7qOLk5A6tH-V9150xETzAdd6MQ/edit Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Send us a text This is a very meaningful podcast discussion for me as I not only get to catch up with a dear college friend I also get to deeply explore the occupational impact of how one's life path can evolve after acquiring a profound neuro divergence early in life. Ashley and I's paths in our early twenties crossed quite a bit however I never would have guessed I would ever become a therapy colleague with her over a decade after moving away from Olympia, WA. When I last was actively connected to Ashley's life she was the most prolific fiction and play writer I had ever met. She was destined to become a professional editor and facilitator of creative wonder. Her momentum as a writer was however stunted as it is for many of us with the sudden acquisition of a disabling experience. At age 25 Ashley acquired a cerebral vascular accident impacting her left side. This occupational disruption ended up fueling Ashley's passion to go back to school. She not only regained her motor function, but she also regained her voice, and new gifts, however, she could not develop these ambitions on her own, it took a village including occupational therapy, physical therapy, speech therapy, brain injury support groups, vocational rehab, and the fight to self advocate for her educational accommodations. Connecting with Ashley I couldn't avoid the correlations between her life path and the challenges my friend Paul Johnson a leader in the WA disability rights movement in how hard he had to fight to access the ability to write in general and to access formal publishing in particular. His life story took over a decade to write and I was his support volunteer intern where it took over 2.5 years of active letter by letter word by word typing a revising. Because of Paul, I have learned to never take my voice and mobility for granted. I am so glad I was able to share Paul's work with Ashley with a new foundation of shared meaning as we all interconnected in our experiences of rare young adult neurodivergence and how that impacts and changes access to writing and our relationship to our own voice when you depend on supported communication to express yourself. Paul's family offered consent to continue sharing his story and our time together publically with the goal of inspiring others to tell their stories. Ashley's Request for community support for survivors of acquired brain injury! Please help save this wonderful organization through donations and volunteering. Sarah Bellum's Bakery launched in 2017 and officially opened its doors in Multnomah Village in SW Portland in 2018. They provide job training support for adults with acquired brain injuries. They also have volunteer opportunities in speech, occupational therapy, and rehabilitation psychology for students here at Pacific University. Check out the links below. Together we can save Sarah Bellum's! acquired brain injury workshop/community and nonprofit at risk of closing. Paul's Publically Published Writing in Evolved Living Network Instragram @EvolvedLivingNetwork Free Occupational Science 101 Guidebook https://swiy.co/OS101GuidePodcast OS Empowered OT Facebook Group https://www.facebook.com/groups/1569824073462362/ Link to Full Podcast Disclaimer https://docs.google.com/document/d/13DI0RVawzWrsY-Gmj7qOLk5A6tH-V9150xETzAdd6MQ/edit Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

Send us a text Announcements The first 3 modules of my Online Doctoral Capstone Course Foundations of Occupational Science is available now for free for a limited time: https://engage.evolvedlivingnetwork.com/ If you are in the Tacoma Area or are a fan of the Social Justice Sewing Academy and would like to be involved in supporting the adaptation of their workshops to focus on disability justice and to be accessible to people with disabilities in more heavily institutionalized spaces consider joining in our community event virtually or in person with AOTA President Alyson Stover on Monday, October 16 [6-8pm] Get details on how to register here: https://www.facebook.com/events/706895548119940/?ref=newsfeed In-person capacity: 60, Live virtual: 150, Recording: Unlimited Episode Show Notes In part two twe explore the costs of mental health neglect in and under investment in mental health infastructure in the United States and systemic patterns that contributed to adverse occupational outcomes and how all occupational beings access to proactive investment in mental health care for all. We also explore the benefits of building your own care village for lifespan occupational wellbeing. Jennifer Pearlstein, PhD, is a post-doctoral fellow in rehabilitation medicine at the University of Washington and completed her graduate work in clinical science at the University of California, Berkeley. Jen strives to improve the well-being of people with disabilities across her research, clinical work, and advocacy. She has received funding from the National Institute of Mental Health (NIMH) and National Science Foundation (NSF), published work related to disability and mental health and training, and has gained specialized clinical training in evidence-based practices for diverse psychological presentations, including how to support populations experiencing illness or disability. She also writes about her personal experiences navigating academia with a disability and strives to increase the representation, equity, and inclusion of people with disabilities in academia and in medicine. Connect with UW's Behavioral Health ECHO Project: (How Josie met Jennifer without expense of a fancy conference) https://bhinstitute.uw.edu/events/?trumbaEmbed=view%3Devent%26eventid%3D163336444 Accessible Mental Health Support Resources: https://openpathcollective.org/ As long as there is a financial need, our lifetime membership will allow you to see anyone in our network for the rates listed above. This is our guarantee. A lifetime membership to our nonprofit only costs $65. Employee Assitance Programs: https://www.insperity.com/blog/employee-assistance-programs/ Holistic Wellness for BIPOC OTs/Communities https://otbayarea.com/resources Support Group for Disabled OTP Evolved Living Network Instragram @EvolvedLivingNetwork Free Occupational Science 101 Guidebook https://swiy.co/OS101GuidePodcast OS Empowered OT Facebook Group https://www.facebook.com/groups/1569824073462362/ Link to Full Podcast Disclaimer https://docs.google.com/document/d/13DI0RVawzWrsY-Gmj7qOLk5A6tH-V9150xETzAdd6MQ/edit Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe