Question 1

In order to advocate for marginalized communities and populations, occupational therapy practitioners must be:&#10;A) Apolitical&#10;B) Politically active&#10;C) Discriminatory&#10;D) Selective

Accepted Answer

Occupational therapy as a profession has historically advocated for certain marginalized populations, most often people and groups with disabilities or in specific age groups (e.g., vulnerable youth and older adults). Internationally, the profession's concerns have broadened beyond these groups to include displaced people (World Federation of Occupational Therapists [WFOT], 2014). The ability of the profession "to respond to the occupational needs of displaced people demands that the profession engage the socio-political context of displacement. The profession's approach must be critical as well as constructive" (WFOT, 2014, p. 2). The profession cannot be apolitical in addressing the occupational rights of displaced persons and other marginalized communities and populations. The WFOT Position Statement on Human Rights (WFOT, 2018) further supports this belief and upholds the United Nations' Universal Declaration of Human Rights (United Nations, 1948).

Question 2

A neighborhood association advocates and is successful in getting the local school board to agree to put a bond for a new neighborhood school on the ballot. The neighborhood association's advocacy is an example of a community:

A) Asset
B) Culture
C) Need
D) Occupation

Asset

Accepted Answer

The majority of theoretical approaches to community organization are need- or problem-based, and involve identification and remediation of deficits in a community. However, Kretzmann and McKnight (2005) propose a strengths-based approach that involves identifying and mobilizing all of the existing and potential, but often unrecognized, assets in a community. This approach is very much in alignment with the profession's values. Community assets include personal attributes and skills, relationships among people, local associations, and informal networks. Connecting community assets and strengths creates a synergy and multiplies their power and efficacy.

Question 3

In the Participatory Occupational Justice Framework, the first step is:&#10;A) Engaging collaboratively with partners&#10;B) Mediating agreement on a plan&#10;C) Supporting implementation and continuous evaluation of the plan&#10;D) Recognizing and raising consciousness about an injustice

Accepted Answer

While the Participatory Occupational Justice Framework (POJF) was developed by occupational therapists as a "conceptual tool for doing justice" (Whiteford & Townsend, 2011, p. 65), it is intended for use by a variety of people in partnership who are interested in promoting action to address meaningful change to eradicate occupational injustice (Whiteford & Townsend, 2011). This theoretical approach is also discussed in Chapters 3 and 4. The POJF promotes the value of an occupational lens to adequately identify, describe, and address specific impacts of occupational injustice. Similar to community organization approaches, recognizing and raising consciousness about an injustice is the first meaningful step toward action and, ultimately, transformational change. The next steps include:
• Engaging collaboratively with partners,
• Mediating agreement on a plan,
• Strategizing resource-finding actions,
• Supporting implementation and continuous evaluation of the plan, and
• Inspiring advocacy for sustainability or closure (Whiteford & Townsend, 2011, pp.73-74).

Question 4

The majority of displaced people (i.e., refugees, asylum-seekers, and stateless people) are&#10;A) Resettled&#10;B) Remaining close to home&#10;C) From Syria&#10;D) Seeking new identities

Accepted Answer

Migration is the movement of people from one place to another. Throughout history, there have always been migratory populations-some by personal choice, and others who are displaced or forced to leave their countries of origin. The majority of the latter migratory population are displaced people (i.e., refugees, asylum-seekers, and stateless people) who remain close to home, with only a small proportion seeking resettlement to another country. According to the United Nations High Commission for Refugees, the global population of forcibly displaced people reached 68.5 million people in 2017 (UNHCR, 2018). "While the Syrian conflict contributed significantly to this increase, there have been other major displacements throughout the world over the last five years, notably in and from Burundi, Central African Republic, the Democratic Republic of the Congo, Iraq, Myanmar, South Sudan, Sudan, Ukraine, and Yemen" (UNHCR, 2018, p. 4). As a result of armed and unarmed internal conflicts and shifting political environments, the trend in human migration does not seem to be slowing. The UNHCR reported that at the end of 2017 the global refugee population was 20 million people. This figure represents the highest known total to date (UNHCR, 2018). Table 22-1 provides examples of the definitions that have been developed to differentiate the types of displaced persons (see Table 22-1).

Question 5

A common major factor in the mental health status of refugees is:&#10;A) Language barrier&#10;B) Poverty&#10;C) Hunger&#10;D) Trauma

Accepted Answer

Trauma is a common experience for many refugees and asylum seekers. Unfortunately, it can occur multiple times during their migration experience: in their home countries, on their journey to resettlement, and during resettlement (Jani & Reisch, 2018). While many people focus on the trauma that occurred in their home countries, it has been found that stressors occurring after resettlement can have as much of an impact on the mental health of refugees (Copley, Turpin, Gordon, & McLaren, 2011; Heptinstall, Sethna, & Taylor, 2004).

Question 6

Policies of uncertainty-those intended to create systematic insecurity by constantly changing the terms of daily life and targeting what matters most to people-are exemplified in which example?&#10;A) Affordable Care Act&#10;B) Resettlement&#10;C) Systematic separation of immigrant children from their parents&#10;D) Sex trafficking

Accepted Answer

Farmer (1996) introduced to the health disparities literature the concept of "structural violence," which recognizes the harm and suffering inherent in health disparities that are both caused and obscured by inequality. Grace et al. (2018) reported on the "violence of uncertainty" in which violence is inflicted on these groups, through "systematic personal, social, and institutional instability that exacerbates inequality and injects fear into the most basic of daily interactions" (p. 904). Grace et al. (2018) report that these policies harm people's mental and physical health. They state that "taken together, the two crises create a vicious cycle that plays out partly in the health care system; policies of uncertainty enact the violence of uncertainty" (p. 379). They further state that violence of uncertainty is perpetuated by policies of uncertainty that are intended to create systematic insecurity by constantly changing the terms of daily life and targeting what matters most to people. Policies to separate immigrant children from their parents, for instance, or end the reunification of refugee families are recent examples of the process of systematic insecurity. This violence, along with the stress experienced by these populations as a result of posttraumatic stress, depression, and substance use, further exacerbates their health status and negatively affects participation in everyday, culturally sanctioned daily occupations.

Question 7

Which of the following is a form of occupational injustice?&#10;A) Occupational marginalization&#10;B) Occupational profile&#10;C) Health disparity&#10;D) Trauma

Accepted Answer

The concept of occupational justice, which first emerged in professional discourse in the late 1990s, is still being developed and debated in occupational therapy and occupational science (Whalley Hammell, 2016). An early description of occupational justice was asserted by Wilcock and Townsend (2000) as "equitable opportunity and resources to enable people's engagement in meaningful occupations" (p. 85). Occupational justice recognizes that "individuals are different and have different needs" (Stadnyk, Townsend, & Wilcock, 2010, p. 334). Because all people have different needs, occupational justice requires the ability to access and engage in occupations that one finds personally meaningful. The ability to engage in individually meaningful occupations is inherently linked to both the health and quality of life of the individual (Stadnyk et al., 2010). Therefore, when individuals are prevented from engaging in occupations they find meaningful, their health and quality of life will be negatively impacted. Forms of occupational injustice have been identified and categorized as occupational deprivation, occupational marginalization, occupational imbalance, and occupational apartheid (Kronenberg & Pollard, 2005; Townsend & Wilcock, 2004; Whiteford, 2005), and they are frequently experienced by marginalized populations.

Question 8

Refugee populations often experience isolation due to:&#10;A) Language barriers&#10;B) Resettlement&#10;C) Migration&#10;D) Trauma

Accepted Answer

Marginalized populations have many risk factors that can increase their chances of experiencing occupational injustice and its attendant physical and mental health conditions. Chief among them are deprivation and isolation and the effects of these risk factors before, during, and after extended migration experiences. Refugee populations often experience isolation due to the language barriers and technology barriers caused by settling in a new country, as well as social isolation because of participating in an underrepresented group or population, and the effects of mental health issues (McAllister et al., 2010; Smith et al., 2014).

Question 9

For refugees, the total time from displacement from home to resettlement is on average:&#10;A) 24 months&#10;B) 26 years&#10;C) 12 months&#10;D) 14 years

Accepted Answer

Once approved for resettlement to the United States, the individual goes through additional security checks and clearances, which can take an additional 12 to 24 months. The U.S. Department of State (USDOS, n.d.-a) reports that the total time from displacement from home to resettlement is on average 26 years (USDOS, n.d.). These marginalized individuals or populations experience prolonged environmental barriers to health promotion, education, employment, and occupational justice. When seeking asylum or migrating as a refugee, individuals' lack of citizenship in their current environment often leads to segregation, isolation, and a reduction in the number of occupations available to them (Crawford, Turpin, Nayar, Steel, & Durand, 2016).

Question 10

Maria is a 19-year-old who has been rescued from sex trafficking. Due to her experience, she is at high risk for which health condition?&#10;A) Headache&#10;B) Memory problems&#10;C) Posttraumatic stress disorder&#10;D) Weight loss

Accepted Answer

The mix of physical and mental health issues of marginalized populations is oftentimes complex and not easily resolved. Because of this complexity and the severity of trauma suffered by individuals in recovery from being trafficked, these individuals' health conditions are frequently long-term (George & Stanley, 2018). Oram et al. (2012) found that 88% of women in a sample of individuals in recovery from human trafficking "met ICD-10 criteria for a mental disorder" (p. 4). Women who had received six months of post-trafficking support services still reported high levels of symptoms such as headache, memory problems, stomach and back pain, loss of appetite, tooth pain, weight loss, chest pain, and breathing difficulties (Oram et al., 2012). Posttraumatic stress disorder (PTSD) is also a large concern with this population, with high levels of hyperarousal, feelings of hopelessness, and the re-experiencing of traumatic events (Turner-Moss et al., 2014).

Question 11

An occupation-based community program targeted at preventing young women from being entered into sex trafficking should focus on:&#10;A) Building self-esteem&#10;B) Promoting healthy weight&#10;C) Life skills training&#10;D) Parenting skills

Accepted Answer

The answer of An occupation-based community program targeted at preventing...

Question 12

An occupation-based community program supporting young women rescued from sex trafficking should focus on:&#10;A) Building self-esteem&#10;B) Promoting healthy weight&#10;C) Life skills training&#10;D) Parenting skills

Accepted Answer

The answer of An occupation-based community program supporting young women...

Question 13

A person assigned male at birth (i.e., the presence of a penis) and who identifies as being of the male gender would be referred to as a:&#10;A) Transgender male&#10;B) Bisexual male&#10;C) Pansexual male&#10;D) Cisgender male

Accepted Answer

The answer of A person assigned male at birth (i.e.,...

Question 14

Edgar is a 42-year-old male who reports he does not experience or act on sexual attraction to others but desires an intimate relationship nonsexual in nature. He identifies as:&#10;A) Asexual&#10;B) Bisexual&#10;C) Pansexual&#10;D) Intersex

Accepted Answer

The answer of Edgar is a 42-year-old male who reports...

Question 15

One strategy to increase inclusivity for marginalized individuals like those who identify as LGBTQ+ is to:&#10;A) Expand beyond binary gender language&#10;B) Restrict bathroom access&#10;C) Identify who can serve in the military&#10;D) Clearly define genders

Accepted Answer

The answer of One strategy to increase inclusivity for marginalized...

Question 16

Programs offered to individuals who have been incarcerated that have been mandated or designed based on state or federally funded programs and offer little opportunity for choice regarding topic or content often lead to:

A) Occupational disruption
B) Occupational deprivation
C) Occupational apartheid
D) Occupational isolation

Accepted Answer

The answer of Programs offered to individuals who have been...

Question 17

When working with a marginalized group due to resettlement, the most appropriate occupational therapy assessment would be:&#10;A) Sensory profile&#10;B) Role checklist&#10;C) COPM&#10;D) Skilled observation

Accepted Answer

The answer of When working with a marginalized group due...

Question 18

Marginalized populations would most benefit from interventions that include:&#10;A) Occupational therapy&#10;B) Mental health&#10;C) Interprofessional team&#10;D) Social work

Accepted Answer

The answer of Marginalized populations would most benefit from interventions...

Deck 22: Promoting Occupational Participation in Marginalized Populations Introduction