Does Racially Informed Care Offer the Promise of Better Treatment for Occupational Therapy Clients?

When Charae McConnell, OTD ’19, read that 84% of occupational therapists (OTs) are white, she knew it was more than an abstract statistic in her class textbook. As an African American, she’d seen the lack of diversity impact mental health therapy while an intern at the Occupational Therapy Training Program (OTTP) in San Francisco. At OTTP, where 90% of clients are young people of color, Charae heard from clients and therapists alike that opportunities for important conversations about race and racism were being missed. She sensed an opportunity.

“A person’s racial identity and how they are perceived, because of it impacts their lives, can bring on stress, and may exacerbate existing mental health symptoms,” says Charae, a mental health OT, a lesser-known specialization in the field. “Still, sometimes race is left out of OTs’ conversations with their clients because they don’t always understand its significance to the work we do. Therapists may not know how to bring it up or clients think OTs can’t relate."

Just as there are OTs who work to address physical challenges that impact a client’s ability to function independently, there are a growing number of mental health OTs who work with clients diagnosed with psychological conditions. For clients with diagnoses such as depression, anxiety, bipolar disorder, personality disorders, and emotional regulation issues, OTs can help them manage their daily lives and become more self-sufficient.

To address the issue of missed conversations, Charae interviewed clients and OTs about their personal experiences with race and counseling about race for her capstone graduation project for the Doctor of Occupational Therapy program. Based on her first-of-its-kind research findings, she created the Racially Informed Care (RIC) Model to help mental health OTs acknowledge, understand, and address various forms of racism that may impact their clients. Charae’s research was published in the Open Journal of Occupational Therapy. She is also writing a chapter about it for Psychosocial Occupational Therapy: An Evolving Practice, a seminal textbook frequently referenced in the national OT licensing exam.

New tools in the toolbox

RIC includes three tools for OT clinicians to use with clients. The Racial Impact Questionnaire examines exposures and reactions to race-based stressors, across school, community, society, peer group, and behavioral contexts. The “What Would You Do?” conversation starter poses scenarios that help clients explore coping strategies for responding to adverse racial events. And “The Visitors” game prompts discussions about bias and discrimination and helps reveal any biases the clients themselves might have.

Two years on, OTTP has adopted Charae’s RIC model and it’s changing the care their clients receive as well as how the organization approaches race in their hiring, according to Raymond Nubla OTR/L, OTTP’s outpatient services manager.

RIC gives OTTP a new framework to sharpen their awareness about how their race impacts their interactions with the youth they serve. “The RIC model provides language, awareness, and direction to support the life-long process of recognizing how race impacts our quality of care, and the way we interact with the world,” Raymond says.

Charae credits her academic mentor, Professor Chi-Kwan Shea, with helping her write her first research article and supporting her through the publishing process. She is also grateful to Anne MacRae for choosing to include RIC in her textbook.

“Professor Shea really encouraged me to pursue this work beyond my capstone project and put myself out there, which felt daunting,” says Charae, now an OT working with students with learning differences and special needs in Manteca public schools. “It’s so much more than a job for her, and as a result, my work has gone so much farther than I thought it would.”

“People may be afraid of being ridiculed or saying the wrong thing when discussing race-related issues, so it can be scary to even address race. But if we don’t go there, when necessary, we’re failing to fully serve the people we’re supposed to be helping,” Charae explains.