Transforming Occupational Therapy for the 21st Century PAIRE: Recognize Privilege, Acknowledge Injustice, and Reframe Perspective to Reach Equity

Abstract

Theories, models, and frameworks provide the foundation for occupational therapy education, research, and clinical practice. While most have a systems approach focus, other factors, such as societal influences and structural inequities, also contribute to health. Using a cross-sectional design, this study identified the gaps in occupational therapy models of practice and presents a novel approach, the PAIRE (Recognize Privilege, Acknowledge Injustice, and Reframe Perspective to Reach Equity) Model. PAIRE is focused on achieving occupational equity through the reciprocal and intersectional impact of the provider/team, the person/people seeking occupational therapy, and the occupation-in-context, with continuous influences of access, context, and justice. We describe the components of PAIRE and illustrate its functionality in education, research, and clinical practice contexts as well as case examples.

Keywords:

• Framework
• model
• occupational equity
• occupational therapy
• theory

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the ­content and writing of this paper.

Additional information

Funding

This publication was supported in part by a Washington University in St. Louis Center for the Study of Race, Ethnicity & Equity Small Grant. It was also supported by the National Institutes of Health, National Heart Lung and Blood Institute awards K12HL137942 and K23HL161328-01A1. Additionally, we would like to thank Tara Han, Megen Devine, our participants, and colleagues for their feedback and support.

Notes on contributors

Catherine R. Hoyt

Catherine R. Hoyt, PhD, OTD, OTR/L (she/her); Dr. Hoyt is an Assistant Professor at Washington University School of Medicine, member of the inaugural American Occupational Therapy Association Diversity, Equity and Inclusion Committee and cofounder and inaugural Chair of the Coalition of Occupational Therapy Advocates for Diversity. Her research is focused on early identification of developmental delay.

Maribeth Clifton

Maribeth Clifton, OTD, OTR/L (she/her): Dr. Clifton is an Assistant Professor in the Occupational Therapy Program at the University of Nebraska Medical Center, and research affiliate of the Race and Opportunity Lab at Washington University in St. Louis. Her research interests relate to inclusion in higher education, and mental health among children from marginalized communities.

Cristina Reyes Smith

Cristina Reyes Smith, OTD, OTR/L, FAOTA (she/her): Dr. Smith is an Associate Professor and Director of Admissions in the Division of Occupational Therapy at the Medical University of South Carolina. She is a co-founder of the Coalition of Occupational Therapy Advocates for Diversity and has served on the Board of Directors for the American Occupational Therapy Association.

Lamar Woods

Lamar Woods (he/his): Mr. Woods is the CEO of Woods&Tech, a HealthCare Marketing Agency that focuses on connecting people with doctors to increase economic opportunity and access to healthcare for families and communities.

Steven D. Taff

Steven D. Taff, PhD, OTR/L, FNAP, FAOTA (he/his) is Professor of Occupational Therapy and Medicine and Director of the Teaching Scholars Program at Washington University School of Medicine in St. Louis. His scholarly interests include building and evaluating inclusive learning environments, curriculum design, critical learning theories, and applied educational philosophy.