Question 1

In order to advocate for marginalized communities and populations, occupational therapy practitioners must be:

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:

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:

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

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:

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?

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?

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:

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:

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?

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:

Accepted Answer

Current prevention programs specifically focus on young girls. An occupation-based approach to develop prevention programs can be extended to other at-risk populations, including boys, men, women, and the LGBTQ+ communities. Martinez and Kelle (2013) and Shigekane (2007) have identified the need for dedicated services to address the distinct needs of these populations. Prevention includes both organized and informal efforts directed at vulnerable persons for decreasing their recruitment into trafficking activities (USDOS, n.d.-b). Informal prevention efforts can include information sessions about trafficking, technical training, educational programs, and micro-lending services (Kaufman & Crawford, 2011). Prevention program components include awareness of traffickers' recruitment techniques, trafficker identification, techniques to avoid entry into trafficking, and methods to enhance self-esteem. Gorman and Hatkevich (2016) described the potential value of occupational therapy in developing evidence-based programs and conducting and publishing research on prevention programs and education efforts. Occupational therapy practitioners have opportunities to play pivotal roles in developing awareness campaigns, educating medical and law enforcement personnel, and evaluating novel prevention efforts.

Question 12

An occupation-based community program supporting young women rescued from sex trafficking should focus on:

Accepted Answer

Active participation in meaningful occupations offers a distraction from negative patterns of thinking and promotes feelings of confidence and control while learning new skills (Gorman & Hatkevich, 2016, p. 3). Using a variety of sensory, musculoskeletal, and other occupation-based approaches, occupational therapy practitioners can provide immediate life skills training in basic self-care, emotional regulation, sleep, and physical stability. Intervention can focus on improving skills in education, employment, social participation, budgeting, home management, and executive function to assist survivors in achieving constructive personal roles, functional performance patterns, and a positive quality of life on a long-term basis. A growing need exists for programs to empower and educate survivors in maneuvering complex national and international legal processes.

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:

Accepted Answer

In order to understand the lived experience of the LGBTQ+ communities, a discussion of language and meaning is first needed, as well as a review of long-standing societal norms and beliefs. Heteronormativity is the belief in a binary system of gender; it assumes heterosexuality is the only sexual norm and that marriage is only acceptable for two persons of opposite sexes. Heteronormativity is linked to heterosexism, homophobia, and transphobia (Leap, 2007). Cisgender persons are those whose assigned sex (i.e., genitalia) and gender identity correlate; for example, a person assigned male at birth (i.e., the presence of a penis) and who identifies as of the male gender would be referred to as a cisgender male. Therefore, a cisgender woman who is attracted to men would be referred to as a heterosexual, cisgender woman, and conversely, a cisgender man who is attracted to other men would be a cisgender, gay man. Cisnormative is the assumption that all human beings are cisgender (Crethar & Vargas, 2007). Lesbian women and gay men are those individuals who have romantic and sexual attraction to others of the same gender; gay, lesbian, or same-gender- loving couples is a term coined by activist Cleo Manago (Black Men's Xchange National, 2012). Bisexual persons are attracted to both men and women. Transgender is an umbrella term for people whose gender identity and/or gender expression differs from what is typically associated with the sex they were assigned at birth. Pansexual persons are those who are open to romantic attachments with cisgender men and women as well as transgender men and transgender women.

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:

Accepted Answer

Some individuals within the LGBTQ+ communities may identify as gender nonconforming, gender queer, and/or drag queens. Drag queens, typically, are gay men who wear clothing, makeup, and wigs to simulate a female or fantasy appearance, most often in the context of being a celebrity or performance artist within the LGBTQ+ community. In recent years, the drag community has come to be more accepted by the general population thanks to the rise of weekly reality competition television shows and the popularity of restaurants that offer weekend brunches with drag performances as entertainment in major cities nationwide. Drag stars are making appearances at major awards events, including the 2019 Academy Awards, earning roles in movies such as Hairspray and the Academy Award-nominated A Star is Born, and being featured in television shows such as Netflix's Dancing Queen. Other persons within the LGBTQ+ communities may identify as gender queer or gender nonconforming. These individuals may present variously in attire that is a mix of masculine and feminine; this may be an aspect of personal expression, a reflection of undetermined gender-as is the case with some intersex individuals-or it may be an act of social rebellion and consciousness raising. Intersex is a general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that does not seem to fit the typical definitions of female or male. Asexual persons are those individuals who do not experience or act on sexual attraction to others but desire and likely seek intimate relationships that are of a nonsexual nature (Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual [LGBTQIA] Resource Center, n.d.).

Question 15

One strategy to increase inclusivity for marginalized individuals like those who identify as LGBTQ+ is to:

Accepted Answer

Multiple studies have shown that the LGBTQ+ communities have experienced, continue to experience, and fear experiencing discriminatory practices from health-care providers. This can lead to hiding their identities due to fear; this is of concern especially for LGBTQ+ seniors (Swiatek & Jewell, 2018). Suggested approaches to support ethical practice include the following (Swiatek & Jewel, 2018, pp. 17-18):
• Eliminating "heterosexist assumptions," or the assumption that heterosexuality is the only sexual norm and that marriage is only acceptable for two persons of opposite sexes;
• "Encouraging sensitivity trainings for health care and social service providers to promote safe environments";
• Selecting updated assessment tools that avoid the use of binary exclusionary language;
• Using inclusive language;
• Developing "outreach programs and services that cater to" seniors in LGBTQ+ communities; and
• Creating an open and welcoming environment (e.g., post a rainbow or other LGBTQ+ symbol, acknowledge LGBTQ+ Awareness Day).

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:

Accepted Answer

One of the primary purposes of prisons is punishment (Zoukis, 2014). Some justice systems include rehabilitation as a mission of their institutions, although there are minimal opportunities provided to those incarcerated, and of those provided, they are often not client- or occupation-centered. Decisions regarding time allocation and the way in which time is spent are dictated by prison resources. Programs offered to individuals are those that have been mandated or designed based on state or federally funded programs and offer little opportunity for choice regarding topic or content. This leads to occupational deprivation, which has been linked to prison violence, suicides, and psychosis (Molineux & Whiteford, 1999).

Question 17

When working with a marginalized group due to resettlement, the most appropriate occupational therapy assessment would be:

Accepted Answer

Evidence is lacking regarding the best interventions to use with clients during the resettlement period. In addition to absent or severely limited English literacy, many clients seen are preliterate in their native language as well. Assessment tools and methods that have been adapted are utilized in practice; however, the degree of diagnostic accuracy following subsequent administration may not be as high as one would typically observe in the absence of those adaptations. Occupational profiles, along with skilled observation of the individual performing the activities/occupations, are utilized to obtain the best assessment data.

Question 18

Marginalized populations would most benefit from interventions that include:

Accepted Answer

Most policies and programs designed to assist marginalized populations have focused solely on physical health needs, and have not addressed all the issues that are impacting the health and quality of life of marginalized populations (Cerny, 2016; Hom & Woods, 2013; Konstantopoulos et al., 2013). However, as has been described, their needs are complex and may require an interprofessional team involving physical medical care, psychosocial support, and counseling in order to enable holistic services that can facilitate full participation in meaningful occupation (Oram et al., 2012).

Quiz 22: Promoting Occupational Participation in Marginalized Populations Introduction