BLACK REHABILITATION MANIFESTO
WE, AS BLACK REHABILITATION PRACTITIONERS, STUDENTS, AND PATIENTS/CLIENTS of occupational therapy, physical therapy, and speech language pathology, in order to establish the value of our lives and contributions to society, ensure equity for Black practitioners and consumers, promote solidarity on issues pertaining to professional practice, and provide a collective voice on societal issues, do ordain this Black Rehabilitation Manifesto.
The Black Rehabilitation Manifesto serves as a collaborative effort of leaders in our professions to provide guidance on needed actions to address advocacy, community engagement, practice, and education as we expound on best practices rooted in research and informed by lived experiences. We stand before you as individuals representing the Black diaspora asking to be seen for our individuality and giving of our time, talents, and efforts to serve our professions and communities. We unite to establish tenets integral to promoting contexts that acknowledge and honor individual, interpersonal, organizational, community, and policy factors that afford a cultural climate conducive to inclusion, diversity, and equity. We promote social justice and its factors and drivers for Black rehabilitation practitioners, students, and consumers. Social justice includes, but is not limited to equitable rights, economic, political, and professional opportunities. We challenge all to move beyond the unattainable aim of cultural competence. We demand accountability in personal, professional, and societal practices and initiatives to promote cultural humility and safety.
The tenets presented in this Black Rehabilitation Manifesto are more than mere words to digest, providing points to ponder and put into action. Throughout this document, we identify pervasive and current concerns, while also positing demands and proposing solutions to call attention to and address the social injustices faced by Black practitioners and consumers. The Black Rehabilitation Manifesto is a resource acknowledging the experiences of Black rehabilitation practitioners, students, and consumers in the United States and presents mandates to confront professional practice and consumer concerns. It exists as a tool for those of other races and ethnicities to learn the plight of the Black rehabilitation practitioner and serve as allies to move forward the initiatives set forth in this manifesto and others affecting professional practice. It identifies the need for organizations, institutions, and other societal entities to establish a qualified workforce of Black rehabilitation practitioners through intentional recruitment, retention, and registration/licensure practices. The overall aim is to establish and enact a professional and community culture that addresses interpersonal and structural inequalities and ensures an equitable society for Black rehabilitation practitioners, students, and consumers.
THE STATE OF BLACK REHABILITATION ADVOCACY ENDEAVOR
Advocacy has a complex history of personal gain and altruism, but regardless of the intention of the advocate, it can be a powerful tool to uplift the voices of the silenced. We outline real and perceived experiences as it relates to the lack of advancement of the complex Black voice and potential solutions to overcome barriers to advancement and recognition of the Black individual, culture, and community.
WHEREAS, there is a lack of visible and consistent Black leadership in roles including, but not limited to, Board of Directors and executive positions in rehabilitation membership organizations (e.g. American Physical Therapy Association [APTA], American Occupational Therapy Association [AOTA], American Speech-Language-Hearing Association [ASHA]), academic/education programs and institutions, clinic/hospital/facility administration and ownership, and local, state, regional, and national agencies;
WHEREAS, there exists no targeted programs or strategic initiatives to increase Black representation in leadership positions in any field of rehabilitation;
WHEREAS, all rehabilitation professions recognize Diversity, but lack meaningful and objective outcome measures to track the implementation and impact of “Diversity” initiatives;
WHEREAS, efforts to address issues specific to Black rehabilitation practitioners are absent from the professional organizations’ advocacy initiatives and professional documents;
WHEREAS, current advocacy efforts related to “access” falls short of directly addressing access and issues associated with Black practitioners, patients, clients, and consumers;
WHEREAS, advocacy efforts fall short of addressing social determinants of health associated with Black consumers of rehabilitation services;
WHEREAS, there continues to be a known “minority tax” on Black practitioners to shoulder the burden of educating colleagues and coworkers without adequate training or support;
WHEREAS, there is no commonly agreed-upon advocacy agenda or cross-discipline organization to address disparities in wage, hiring, and admission practices and how this is affected by the intersectionality of the Black rehabilitation practitioner; now, therefore be it
WE call for intentional and ongoing advocacy efforts germane to the Black experience in rehabilitation professions by actively pursuing the following:
1. Development of a National Black Rehabilitation Advocacy strategic plan that includes deliverable outcomes at all systemic levels to increase Black representation in leadership across rehabilitation, education, practice, and administration settings.
2. Creation of objective outcome measures for Diversity, Equity, and Inclusion that can determine whether the planned advocacy interventions are successful.
3. Achievement of a systemic rehabilitation culture in which Black voices, ideas, experiences, and expertise are valued and implemented.
4.Fostering a culture that respects Black individuality, complexity, history, and diversity and does not promote acculturation to a majority standard.
5. Establishment of governing and advisory entities to ensure that data collection and analysis is performed regarding advocacy efforts to improve the rehabilitation experience within the Black community.
6. Formally gathering and assessing data in order to systematically dismantle structures and processes that generate wage gaps and contribute to intersectionality across the spectrum of rehabilitation.
THE STATE OF BLACK REHABILITATION EDUCATION ENDEAVOR
Black people have historically been and are currently underrepresented in rehabilitation careers. We have identified problems and solutions at the individual, community, organizational, and national levels for sustained educational change. Representation matters; intentional engagement with Black people throughout the lifespan about the variety of opportunities in rehabilitation careers will result in a sustained workforce of Black practitioners to narrow the gap in representation.
WHEREAS, there is a lack of STEM/STEAM programming and representation of Black students from elementary schools through higher education aimed at rehabilitation professions;
WHEREAS, there is low visibility of rehabilitative career opportunities and providers to Black students;
WHEREAS, there is diminished support for Black prospective health profession students towards future career choices;
WHEREAS, there is decreased preparation of Black students for higher education in regards to educational requirements, financial responsibilities and institutional culture, leading to the potential for racial marginalization;
WHEREAS, there is limited use of needs assessments, mentoring, and guidance of Black students to advocate for and address their needs and concerns as it relates to discrimination, acculturation, and marginalization within health professions’ academic programs;
WHEREAS, there is an underrepresentation of Black faculty and associated support to promote recruitment, retention, and professional development within academia;
WHEREAS, there is inconsistent pedagogical and andragogical training for all faculty to meet the needs of Black students and provide culturally safe environments for didactic and clinical education opportunities;
WHEREAS, there are limited outcome measures to identify and address deficiencies within program development, accreditation/re-accreditation, and curriculum design;
WHEREAS, there is bias in many rehabilitation programs’ admissions policies including, but not limited to the required standardized tests that are discriminatory against Black students; WHEREAS, there is excessive emotional labor put on Black students when they are asked to educate other students and professors about social justice to compensate for the inadequacies inherent in the curriculum;
WHEREAS, Black students experience discrimination at clinical education sites that are not vetted for discriminatory practices or racial bias to ensure safe learning environments for Black students;
WHEREAS, Black students are not offered alternate clinical sites when they experience racial discrimination from their clinical instructors, peers or patients;
WHEREAS, there is insufficient coordination, communication, and resource sharing within and between Historically Black Colleges and Universities (HBCUs), Black serving professional organizations, and other programs/affinity groups for research, education, and program development of rehabilitation professionals; now, therefore be it
WE, call for intentional approaches to increase educational engagement of Black students throughout the lifespan. Approaches to increase educational engagement needs to address the different domains of learning and expose Black students to rehabilitation careers. To that end, consistent programming and funding is required in the following primary areas:
1. Creation of a strategic plan to educate Black students on rehabilitation careers beginning when they are as young as four years old-this is when their math and science identity begins; it will continue to develop throughout their primary and secondary education.
2. Funding evidence-based programming for Black students to receive age-appropriate information on rehabilitation careers.
3. Providing financial assistance to Black high school and college students for application fees and standardized tests for admission.
4. Training and financially supporting mentors to provide age-appropriate academic guidance for Black students to enter rehabilitation health careers.
5. Providing Black students with preparation for attending and completing higher education in order to pursue career paths in rehabilitation.
6. Utilizing holistic admissions processes for rehabilitation programs to promote increased inclusion and equity for Black students.
7. Creating and supporting programs that enhance the education, coordination, and promotion of Black faculty and students in education, program development, leadership training, and research at Historically Black Colleges and Universities as well as predominantly white institutions.
8. Increasing Black faculty and establishing a career pipeline path to academia geared towards former Black students of rehabilitation programs.
9.Tracking faculty appointments by race and ethnicity to identify patterns that support or negatively impact Black faculty.
10. Requiring and continually assessing culturally responsive pedagogy and andragogy knowledge and skills of all faculty to ensure equitable learning opportunities for all students.
11. Developing an anonymous form for students and faculty to report discriminatory practices experienced in academia and clinical education to their respective national rehabilitation membership organizations with a plan to mandate changes as needed.
12. Requiring cultural responsiveness training for all academic and clinical education sites to create a safe environment for Black students.
13. Tracking individual student clinical affiliation outcomes by race and ethnicity to identify negative patterns that adversely impact Black students.
14. The provision of resources and directories of minority- based organizations by academic institutions to all students entering rehabilitation programs.
15. Recruiting Black practitioners to write items for board examinations.
16. Modifying the current curriculum of academic institutions to ensure that diversity, equity and inclusion are interwoven throughout the educational materials.
THE STATE OF BLACK REHABILITATION COMMUNITY ENGAGEMENT ENDEAVOR
Addressing the needs of any community at individual, societal, and systemic levels requires a comprehensive, yet careful approach. The complex and diverse Black community requires special attention to fully understand how the nuances of its history as well as the formation of positive partnerships can impact health, wellness, research, and rehabilitation services.
WHEREAS, continuation of status quo disengagement with minoritized communities is a known harm to underserved and vulnerable health populations;
WHEREAS, there is inconsistent intentional engagement of the Black community across the lifespan to optimize individual and societal health outcomes, advocacy, and quality of life;
WHEREAS, there is inadequate representation of Black practitioners to facilitate culturally responsive care and research;
WHEREAS, there is a lack of acknowledgment of the history, current climate, and role of systemic racism and its impact on the social determinants of health and well-being of the Black individual and community;
WHEREAS, there is a lack of connectivity between Black communities and rehabilitation practitioners resulting in decreased access to treatment and poor therapeutic alliances;
WHEREAS, efforts to address social determinants of health do not include a pathway for individual clinicians to engage;
WHEREAS, efforts and funding to conduct community-participatory research and address barriers within Black communities are limited;
WHEREAS, data are collected and utilized inappropriately to support policy initiatives by local, national, and government organizations and associations;
WHEREAS, there is lack of clear guidance and clarity regarding the knowledge base, support or allowance for rehabilitation practitioners and students to participate in social justice initiatives; now, therefore be it
WE, call for intentional approaches and accountability aimed at community engagement to promote best practice, address health disparities, expand representation of Black practitioners, and increase access to quality rehabilitation services for Black consumers. These efforts will be achieved through the following:
1. Increased intentional efforts to engage the community and address health disparities to establish culturally responsive care and services for Black consumers.
2. Targeted priorities and funding for community participatory research to address pertinent issues identified in and by the Black community.
3. Intentional education of all rehabilitation practitioners on identifying the social determinants of health in community and professional organizations to provide resources and support that address the needs of the community.
4. Broadening the educational experience to include the history of racial injustices in the development of the healthcare ecosystem in the United States of America and its impact on Black community engagement in research.
5. Development of community-driven initiatives to explore and address rehabilitation deserts, as defined as inadequate access to rehabilitative care, and any other unmet rehabilitative needs through the emancipation and liberation of ideas and action plans from within the community.
6. Identifying or developing policies that designate rehabilitation clinics located in underserved communities eligible for the funding that is received by Federally Qualified Health Centers.
THE STATE OF BLACK REHABILITATION PRACTICE ENDEAVOR
Black people exhibit medical mistrust as a result of multigenerational health care abuse. Racial discordance between a patient/client and the healthcare provider predicts inadequate quality of care. The lack of Black representation among rehabilitation providers further exacerbates health disparities within Black communities.
WHEREAS, there is underrepresentation of Black rehabilitation practitioners in occupational therapy, physical therapy, and speech language pathology;
WHEREAS, there is underrepresentation of Black rehabilitation practice owners, administrators, researchers, and leaders;
WHEREAS, there is underrepresentation of Black practitioners and students trained and engaged in research;
WHEREAS, there is decreased knowledge of the perceived and actual impact of bias and health disparities in the delivery of rehabilitation services;
WHEREAS, there is decreased knowledge of cultural responsiveness and the needed skills to improve cross-cultural interactions;
WHEREAS, there is lack of acknowledgement of racial and cultural trauma as a public health concern within the rehabilitation fields;
WHEREAS, there are limited opportunities to continually assess racial and cultural safety concerns and competencies in educational and practice settings; now, therefore be it
HARM, whether intentional or unintentional, is being done to the Black community as a result of the lack of Black rehabilitation representation, poor quality care, and barriers to healthcare access. Since practice is driven by educational training, post-professional training, licensing rules, and policies, immediate and consistent action and funding is required in the following primary areas:
1. Developing outcome measures of inclusivity for all practice settings and educational programs.
2. Ensuring inclusive climates within all practice settings and educational programs through routine climate scans, action plans, and other surveillance measures and implementation to address threats to inclusivity.
3. Increasing funding, training, and partnerships with Black practitioners and students to build capacity for conduction, translation, and dissemination of equitable community-based research.
4. Mandating cultural awareness, humility, and responsiveness education/training as a requirement for initial licensure and renewal.
5. Requiring the inclusion of cultural responsiveness measures in performance evaluations/reviews and mandating that someone who is qualified to evaluate cultural responsiveness be responsible for the assessment of this area for competence.
6. Documenting micro- and macroaggressions and requiring professional development plans and action to protect rehabilitation practitioners and the public.
7. Requiring systematic evaluations to include questions about experiences related to cultural bias and trauma.
8. Employing an ombudsman at each professional organization to collect event data, assist with the identification of resources, and provide guidance to the organizations.
9. Partner with key stakeholders to address areas in rehabilitation practice that increase the disease or condition burden for consumers due to health and healthcare access and quality.
SUMMARY
The Black Rehabilitation Manifesto requires the acknowledgement of the harmful nature of the status quo in rehabilitative advocacy, education, practice, and community engagement. The status quo has resulted in increased healthcare costs, widening of the gap in individualized care, and increased disability and premature deaths in Black communities.
The Manifesto represents a collaborative effort of Black practitioners, students, and consumers to verbalize our expectations of stakeholders involved in rehabilitation advocacy, community engagement, practice, research, and education. Although the recommendations do not include overly detailed events, activities, or funding amounts, these omissions are not to be misinterpreted as current or potential acceptance of superficial or performative activities.
We collectively believe that each stakeholder has a moral and social obligation to partner with us to diversify the workforce, mandate inclusion within educational, research, and practice settings, and improve the health and wellness conditions of Black communities. We expect these recommendations to be considered and implemented intentionally and immediately with the Black community being actively involved in the decision-making process and the implementation of those decisions.
IN SOLIDARITY,
Tahira Collier, PT, DPT, CSCS, NCPT
Aaron Embry, PT, DPT, PhD Candidate, MSCR
Efosa Erhunmwunse, DPT
Victoria Gaugis, PT, DPT
Douglene Jackson, PhD, OTR/L, LMT, ATP, BCTS
Mica Mitchell, PT, DPT, C/NDT, Board-Certified Pediatric Clinical Specialist
Lisa VanHoose, PhD, MPH, PT, Board-Certified Oncologic Clinical Specialist
Tiffany Adams, PT, DPT, MBA, Board-Certified Geriatric Clinical Specialist
Onyekachim Amauwah, DPT
Drew E. Anderson, SPT
DeAndrea Bullock, PT, DPT, CCI
Garrison P. Cherry, SPT
Imani L. Coles, SPT
Marcia Darbouze, PT, DPT, FMS, CYT
Jennifer D. Hutton, PT, DPT
Candace Johnson, MOTS
Khalilah R. Johnson, PhD, MS, OTR/L
Victoria Junious, SPT
Cherie LeDoux, PT, DPT, PhD candidate
Tyra N. Mitchell, PT, DPT, MHA, CLT
Raveenn S. Smith Mowbray, SPT
Oluremi Onifade, PT, DPT, M.Ed, CCI, CCVT
Margaret Pittman, PT, DPT, Board-Certified Orthopedic Clinical Specialist
Katherine Sylvester, PT, DPT
Kimberly Varnado, PT, DPT, DHSc, Board-Certified Orthopedic Clinical Specialist
Briana L. Partee, PT, DPT
We had over 100 practitioners, students, and customers from Occupational Therapy, Physical Therapy, and Speech Language Pathology domains participate in the development of the Manifesto. Thank you to ALL for this labor of LOVE, CONVICTION, AND HIGHER EXPECTATIONS!