Occupational Therapy / Social Justice

International Fieldwork: At a Crossroads

I attended the AOTA (American Occupational Therapy Association) Conference in Baltimore last Thursday, which was my first AOTA Conference experience. It was invigorating to see and hear from many OTs interested in topics that I too am interested in, like international and cross-cultural work, social justice, community-based practices, and work with underserved populations like refugees etc. I often feel like an outlier in my school OT program because there aren’t many of us that are as inclined towards working within these areas of OT, as they are less defined in the OT practice scope and also severely less funded. This blog has been a great way to connect with other OTs and OT students though who are passionate about these issues too – in fact I got to meet one fellow OT student from MD who had found my blog!

International Breakfast on “International Fieldwork: Where in the world can we go from here?” by Gelya Frank, PhD

Gelya y Yo

Dr. Frank y Yo

I attended this special breakfast to hear from Dr. Frank, who is the Director of the NAPA-OT Field School in Guatemala that I attended last summer and is also a professor at USC (she is actually an anthropologist – USC’s occupational science dept. is affiliated with the school of anthropology). She spoke about the differences between the Reimbursement Model that is mostly used in OT practice here in the U.S. (based on clinical practice, outcomes research, evidence based practice, and insurance reimbursement) vs. the Occupational Justice Model (community-based practice, social determinants of health, gov’t/NGO collaborations, and empowerment) which is the model used at the field school. These two models are obviously at odds and this, she said, creates a “double-vision” as occupational therapists look at the world.

Image Credit: Alternative World Vision from vector.me (by dado9ch)

Image Credit: Alternative World Vision from vector.me (by dado9ch)


This leads us to many questions – many that I myself have pondered as I have encountered difficulty with reconciling these two viewpoints – questions regarding the efficacy of international fieldwork in preparing students to pass the NBCOT exam and become competent entry-level therapists practicing here in the states under a reimbursement model and if studying abroad has become just a rite of passage of all college students/young adults, and many more questions.


She continued to describe how anthropologists view the world, and how that connects to social and occupational justice ideas in OT by looking at how people are able to deal with living in unjust situations, riddled with disparities and inequalities. She mentioned the connection of looking at the context of Guatemala’s problems and issues to OTs’ concern for understanding their clients’ narratives, trying to understand where they have come from and how that impacts them. She included quotes from several former field school students (myself included!) about our field school experiences as related to occupational justice and our careers in OT. Some of her suggestions for actions AOTA could take to cater to this emerging area of OT in the U.S. and to help develop the careers of students interested in pursuing these avenues:

  • offering funding for research
  • development of consortia with other countries using non-reimbursement models
  • a directory of opportunities/resources
  • targeted/structured placements through existing organizations like the Red Cross, UN, etc.
  • a task force to look at transdisciplinary practice models
  • research/recognition for community-based model

I’d love to see any of these ideas come to fruition!



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