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 Gallew (2016) 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

Gallew, H. A. (2016). Evidence-based practice: Critiques and contextual applications. In H. M. Hagedorn (Ed.), Occupation in context: A reflective practice approach (3rd ed., pp. 51–68). F. A. Davis.

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

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit josiejarvisot.substack.com

This month, I’m inviting occupational therapists, assistants, students, and allies to join a special conversation and art-making circle:

🌿 “Reclaiming the Roots of Care: Witches, Midwives, and Nurses—Reviving the Feminine Lineage of Healing through Occupation.”

Together we’ll trace the story of how our field—and the U.S. medical system itself—was built on both the wisdom and the erasure of women, craftspeople, and community healers.

🔥 A Forgotten Lineage of Occupation

Before “occupational therapy” was a profession, it was a practice of communal survival.

Herbalists, weavers, potters, midwives, and caregivers used occupation—the everyday work of hands, heart, and imagination—to restore rhythm and balance in their communities. These were the first practitioners of holistic health. Their medicine was relational, cyclical, and often communal.

But as Barbara Ehrenreich and Deirdre English so sharply remind us in Witches, Midwives, and Nurses, the rise of industrialized medicine and patriarchal institutions criminalized and professionalized care—pushing women, poor people, and folk practitioners out of authority.That legacy persists today in how our systems undervalue both the crafts of care and those who carry them.

🩺 The Occupational Therapy Connection

Occupational therapy was born from the same soil as these folk practices:the moral treatment movement, the arts and crafts movement, and the belief that doing—making, creating, and belonging—heals.

Yet, in today’s medical hierarchies, OT remains one of the most undervalued disciplines—our relational, craft-based, and psychosocial roots often sidelined in favor of “productivity metrics” and “efficiency scores.”We see it in the divestment from community programs, the burnout of first responders, and the shrinking access to care.

Just as women healers were once pushed out of medicine, today OTs, PTs, and nurses face systemic devaluation.It’s the same story—different century.

🌾 Why This Matters Now

We’re living through an era of healthcare collapse and collective burnout.Medicare cuts, staffing shortages, and inaccessible insurance structures are leaving entire communities without care.

When institutional medicine retracts, folk medicine revives.We’re already seeing this—through herbalism, creative arts, community mutual aid, and occupation-based micro-healing collectives.

Occupational therapists have the power to become the bridge between regulated healthcare and ancestral care:to hold dignity, skill, and accessibility where the system no longer reaches.

🌙 What We’ll Explore in This Gathering

In this 90-minute virtual reflection and collective art-making session, we’ll:

🕯️ Read and reflect on excerpts from Witches, Midwives, and Nurses (Ehrenreich & English, 1973).🎨 Create simple symbolic art—our “Window Between Worlds”—to honor the silenced healers in our lineages.🪶 Explore how OT’s founders carried forward folk-craft medicine under the language of “occupation.”💬 Share reflections on how today’s clinicians can reclaim and protect those roots amid healthcare divestment.🌱 Discuss how reviving folk practices—community weaving, kitchen herbalism, neighborhood arts—can complement and extend our scope of meaningful care.

💌 An Invitation to Remember

If you’ve ever felt the ache of doing too much in systems that care too little,or if you’re yearning to reconnect your professional role with your deeper lineage as a healer, maker, and witness—this space is for you.

Join us as we remember that the future of care may not lie in the systems we built, but in the occupations that built us.

On Sunday, November 2 (2:30–4:00 PM PT), I’m hosting a free virtual book circle exploring these roots through the lens of Witches, Midwives & Nurses — a short, powerful feminist classic that uncovers the haunting origins of U.S. healthcare and what they reveal about our present.

You can join live via Skool:

👉 Event link: https://www.skool.com/live/dJLMncrh6hX

🕯️ When: Sunday, Nov 2 | 2:30–4:00 PM PT

🇦🇺 Monday, Nov 3 | 9:30–11:00 AM AEDT

💻 Virtual on Skool

📖 Access the book (quick + free):

• Free PDF

* Text Without Pictures:

• Independent Publisher → https://www.feministpress.org/books-n-z/witches-midwives-nurses-second-edition

• Kindle/Audiobook → https://a.co/d/1oZu9zO

Come as you are — even if you haven’t read it all. Presence matters more than perfection.

Want to learn more about weaving intergenerational occupational histories! Make sure to check out this podcast episode!

Weaving the Threads of Our Occupational Histories: An Intergenerational Conversation with the Jarvis Family by Dr. Josie Jarvis OT

Read on Substack

References & Further Reading

* Ehrenreich, B., & English, D. (1973). Witches, Midwives, and Nurses: A History of Women Healers. Feminist Press.

✨ Closing Reflection

When systems collapse, it’s not the sterile rooms that survive—it’s the kitchens, the gardens, the song circles, and the hands that remember how to make.Occupational therapy has always been a revival movement disguised as a profession.Now is our time to remember.

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit josiejarvisot.substack.com

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

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit josiejarvisot.substack.com

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)

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit josiejarvisot.substack.com

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).

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit josiejarvisot.substack.com

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

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit josiejarvisot.substack.com

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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

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit josiejarvisot.substack.com

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

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit josiejarvisot.substack.com

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

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit josiejarvisot.substack.com

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

This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit josiejarvisot.substack.com