Evolved Living Podcast

Dr. Josie Jarvis OT
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  • Social Sciences
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🎙️ The Evolved Living Podcast with Dr. Josie Jarvis, PP-OTD, MA-OTR/L, BA, BS Hosted by occupational therapist, occupational scientist, and open citizen science advocate Dr. Josie Jarvis, The Evolved Living Podcast explores how we can bridge art, science, and wisdom to co-create more liberatory, ecological, and collaborative systems of care. Each episode invites critical yet compassionate dialogue across disciplines—connecting practitioners, educators, researchers, and community members who are working toward holistic, trauma-informed, and life-affirming change. Together, we translate occupational science into real-world practice and collective wellbeing through honest, inclusive, and transformative conversations. josiejarvisot.substack.com

  1. Sep 23

    Hearsay wearing a lab coat

    You asked a careful question about your scope and got an answer delivered with total certainty and no source. Maybe it came in a comment thread, maybe in a team meeting, and you felt yourself shrink a little inside a profession you spent years training for. If that has happened to you, this essay is for you, and so is the free journal club I’m hosting this Saturday. Details are at the end, or you can join the Evolved Living Collaborative here now and meet us there Saturday. I see some version of this exchange nearly every week, in practice groups, in team meetings and in hallways outside treatment rooms. I’ve de-identified it, since what matters is how it works and nobody in particular. A practitioner asks whether OTs can perform digital stimulation as part of a bowel program for a client with a spinal cord injury. She has already checked her state practice act and the AOTA materials, found nothing explicit either way, and is asking before she proceeds. That’s exactly what a careful clinician should do. Someone answers in two words. Absolutely not. They cite no statute, regulation or professional standard, and often give no sign that they hold the credential they’re ruling on. That answer will land on somebody’s practice. Maybe not hers, since she was already reading the source documents. Somebody watching, though, will absorb “OTs can’t do that” and carry it into a team meeting six months from now, where a person who no longer remembers where they heard it will repeat it as fact. A scope shrinks one confident, unsourced sentence at a time, repeated until it hardens into something that feels like law. The missing-sentence fallacy The reasoning under that two-word answer goes like this: I can’t find this intervention named in an OT document, so it must be prohibited. Our own professional resources ask for a much fuller process. That process includes checking whether applicable documents actually contain language prohibiting the practice (American Occupational Therapy Association [AOTA], n.d.-c), and I’ll lay out the whole sequence below. AOTA describes occupational therapy as a dynamic and evolving profession responsive to societal needs, system changes, emerging knowledge, research and technology. It also makes clear that professional documents do not supersede state laws and regulations governing practice (AOTA, 2021). Silence in a document tells you the document is finite, and by itself it proves nothing about prohibition. Sometimes that silence tells us something more hopeful. A practice that has not been extensively codified may simply be an area where the profession has not yet developed the evidence, competency infrastructure, educational resources or policy language practitioners need. People may already be doing pieces of that work in clinical programs and communities, while much of their knowledge stays in clinical reasoning, local outcomes and conversations with one another. That gap is an invitation to build, responsibly. When practitioners pool what they have learned, document outcomes, collaborate with researchers and communities, develop competencies, and bring that evidence into professional and regulatory conversations, today’s missing sentence can become tomorrow’s resource. I’m doing exactly that right now, working on a paper with Dr. Tim Dionne and Dr. Susan Burwash, and I’ll come back to it at the end. So when you can’t find a practice named anywhere, one question is absolutely whether you are permitted and competent to do this now. Another is who ought to be developing the evidence and infrastructure this area still needs, and sometimes the answer to that second question might include you. Where our certainty actually comes from I’ve been watching how scope gets argued online for a long time, and the pattern is remarkably consistent. People who answer scope questions with total conviction are often drawing on something far more local than they realize. They’re drawing on when and where they went to school, and on what the curriculum emphasized in that particular decade. A clinician trained twenty years ago and one trained last spring can hold very different pictures of the same profession, and each may describe theirs as simply “what OT is.” They’re also drawing on the traditions of the agencies they’ve worked in, meaning the way a department has always done things and the precedent nobody has questioned since the manager before last. Very often they’re drawing on their own personal boundaries as well. “I would never do that” is a legitimate thing for a clinician to feel, and “I have not developed competence to do that safely” is an important professional judgment. Delivered as a statement about an entire licensed profession, however, that individual boundary can become personal preference dressed up as policy. Six things we collapse into one Most scope arguments in our profession are really six different conversations wearing one label. Untangling them is the skill: * The profession-wide scope of occupational therapy * State practice-act regulation * Clinical guidelines and standards of care * Areas of natural overlap with other professions * Employer or facility policy * An individual practitioner’s scope of competence “I haven’t been trained in this and wouldn’t perform it” is a complete, honorable, professional sentence, and it belongs to the sixth category. Once it gets upgraded into “our profession isn’t allowed to do this,” it has quietly taken over the other five, usually without anyone in the room noticing. AOTA’s own decision process gives us a better sequence. Is this consistent with occupational therapy’s professional domain? What does state law permit or restrict? Do applicable professional documents or clinical guidelines prohibit it? What education, training, supervised practice or credentials are required? Has the practitioner demonstrated competency? What does the evidence support? What do the payer and the organization require? And can the practitioner articulate why this service belongs within occupational therapy for this client? (AOTA, n.d.-c). Answering those questions takes literacy. Answering in two words takes two seconds and can shape somebody’s access to comprehensive care. What this looks like in real questions Scope arguments sound abstract until you watch one land on an actual client. Here are four questions I see come up again and again, and each one sits on a different layer. Can OT address bowel and bladder management after a spinal cord injury? This is the question from the opening. Our own practice framework names toileting and toilet hygiene among the activities of daily living (AOTA, 2020b). For someone living with SCI, a bowel and bladder routine can decide whether they can hold a job, travel, date or sleep through the night, which makes it about as occupational as a need gets. I’ve still watched practitioners hand it off entirely because somebody once called it “a nursing thing.” Nursing has a real role here, and so do physicians, and so do we. That’s category four, natural overlap, being mistaken for category one. Whether a specific technique like digital stimulation is permitted in your state is a separate and legitimate question, and it deserves a sourced answer. Part 2 walks through how to get one. Can OT address addiction? Occupational therapists look at how substance use reshapes a person’s self-care, productivity and leisure, and help people rebuild daily routines that can hold (Ercan Doğu & Özkan, 2023). AOTA’s own practice publications describe OT’s role in return to work for people with substance use disorder (Wheeler et al., 2022). A national survey of practitioners found genuine interest in working with this population alongside real gaps in confidence and knowledge (Mattila et al., 2022). That’s a category-six gap in education and competence, and a profession can close that kind of gap. Can OT work in pelvic health? I’ve heard “pelvic floor is a PT specialty” stated as settled fact more times than I can count. Pelvic health covers bowel and bladder health, vaginal and uterine health, and sexual health, including the muscles and structures involved (Akselrud & Vestal, 2021). Our practice framework names toileting and sexual activity among the activities of daily living (AOTA, 2020b), and AOTA’s own clinical guidance says OT practitioners can address underlying body structures and functions, such as pelvic floor strengthening to reduce bowel and bladder leakage, to improve everyday performance (AOTA, n.d.-e). OTs are already practicing and publishing in this area. Specific techniques, including internal assessment, still depend on your jurisdiction and your training, so that question gets answered by your state’s rules and your own competence. What doesn’t hold up is the claim that the whole area belongs to one profession. That’s category four, natural overlap, being mistaken for category one again. Can OT perform dry needling? Here state law really is most of the conversation, and it shows how quickly that layer can move. At the professional level, AOTA’s policy on interventions to support occupations names dry needling among the techniques that may be used in preparation for, or alongside, occupation (AOTA, 2023). The states have gone very different ways. In 2023, Florida’s Board of Occupational Therapy declined to find dry needling within OT scope. The question then moved to the legislature, and since July 1, 2026, Florida law has authorized OTs to perform dry needling once they meet defined standards for experience, training and demonstrated competency (Florida House of Representatives, 2026; Laws of Florida, 2026). Alaska’s board concluded in 2023 that its OT statute didn’t support dry needling, then retracted that position after conflicting legal opinions and began work on clarifying language (Alaska Board of Physical

  2. Sep 16

    I wrote to CMS. But this is about more than policy.

    It’s Tuesday afternoon… You’re sitting in a care conference, IEP meeting, team meeting, or nursing station listening to someone explain why your client doesn’t need OT. You know what you have observed. You know what the client has told you. You know there is more happening here than what fits neatly into the criteria being used to make the decision. Maybe a discharge plan is being made and you weren’t included. Maybe someone in the district is telling you why a student no longer requires your involvement. Maybe someone in the nursing facility has already decided what happens next. Maybe the person making the decision simply has more organizational authority than you do. Your client wants something different. You see something that isn’t being discussed. And you can already feel the cost of being the person who says so. So you sit there doing the calculation. Do I say something? How hard do I push? Am I overstepping? Is this actually policy, or just how this organization does things? Will I be labeled difficult? Will speaking up change anything? What will it cost me if I do? What will it cost my client if I don’t? You want to be respected. You want to be collaborative. You also want to practice with integrity. And increasingly, those things can feel like they are pulling you in opposite directions. So you walk on eggshells. You notice how the system is affecting the client. You notice how it is affecting your colleagues. You notice how it is affecting you. But there is enormous pressure not to talk about any of it. Eventually, that constant calculation becomes exhausting. I think a lot of what we call burnout contains something more specific: Moral fatigue from seeing what is happening while feeling increasingly powerless to change it. I know that feeling. And I have been following the questions underneath it for a very long time. I didn’t find policy through occupational therapy Occupational therapy gave me language for questions I had been carrying much longer. I grew up in rural America with a mixed-race cousin who had a severe chromosomal disorder. I watched someone I loved encounter structural barriers to receiving care that recognized the fullness of her humanity. And somewhere inside that experience, I began imagining something different. I dreamed of a world where she and I could grow older together. Where disability did not automatically mean separation. Where the services someone needed could come to them. Where community, relationship, dignity, care, and belonging could be organized around a person’s life rather than requiring a person’s life to be organized around the limitations of a system. I didn’t have language like aging in place, community-based care, occupational justice, implementation science, or structural determinants yet. I just knew I wanted a world where we could age in place together. There was another story in my family, too. Before I was born, an uncle who was suspected of being autistic was institutionalized. He later died in circumstances my family understood in relation to neglect and the deterioration of social supports surrounding people like him. I inherited that story before I ever entered a policy classroom. Before I knew what an occupational therapist was. Before I knew how reimbursement worked. Before I understood that decisions made in legislatures, agencies, institutions, school districts, hospitals, insurance systems, and organizations could eventually determine extraordinarily intimate things: Where someone gets to live. Who gets to remain with their family. Who receives care. Whose needs are considered too complicated. Whose knowledge is believed. Who gets included in decisions. What support is considered worth paying for. And what kinds of lives our systems are willing to make possible. That is probably where my interest in policy actually began. Not in Washington, D.C. Not in a professional association. Not with CMS. At home. Eventually, I learned that these intimate experiences had structural dimensions As an undergraduate, I found student advocacy and lobbying alongside campaign and labor organizing work and study. Later came occupational therapy. School-based practice. Outpatient pediatrics. Acute care. Home health. Post-acute care. Mobile outpatient services. State and federal advocacy and policy work, including work related to shaping applied behavior analysis policy in Washington State, partnership with AOTA, AOTPAC-related involvement, and leadership development. Then occupational science, education, scholarship, and my growing inquiry into agency-centered, critical, and co-constructive implementation science. The settings changed. The scale changed. My language became more sophisticated. But I am not sure the underlying question ever changed: Who gets to participate in authoring what becomes possible for a human life? My clinical work kept giving me different views of that question. School-based practice showed me how policy, eligibility, institutional interpretation, educational priorities, and family realities shape participation. Outpatient pediatrics showed me children and families trying to integrate recommendations into lives much bigger than the clinic. Acute care showed me how quickly decisions about function, safety, discharge, and someone’s next stage of life are made inside complex institutional systems. Home health showed me what happens when those decisions arrive at someone’s front door. Post-acute practice made staffing, transitions, reimbursement, productivity, and interdisciplinary coordination impossible to separate from care. Mobile outpatient practice showed me what becomes visible when care moves closer to where occupation actually happens. Different settings. Different populations. Different payment structures. Same human lives. Same question: What becomes possible under these conditions? This Substack is reader-supported. To receive new posts and support my work, consider becoming a free or paid subscriber. Then I started asking what those conditions were doing to us Last year, I wrote Therapy Isn’t Just Biomechanical: Reclaiming the Psychosocial Heart of OT. It came out of a conversation about why occupational therapy practitioners can sometimes feel almost “naughty” for bringing psychosocial reasoning into supposedly traditional OT settings. That word stayed with me. Why would an occupational therapist feel as though practicing expansively requires permission? What happens when an organization’s operational version of OT becomes smaller than the occupational lens we were educated to use? And what happens when we adapt to that version for so long that we stop recognizing the adaptation? Later, writing about school-based practice pushed me further into the relationship between occupation and policy. I started putting language around something I had witnessed across settings: Policy mediates occupation. And then another realization followed. Practitioners are occupational beings, too. We spend our careers examining how environments shape someone else’s participation. But we have environments. Policy is part of our environment. Reimbursement is part of it. Productivity is part of it. Documentation systems are part of it. Staffing is part of it. Hierarchy is part of it. Organizational culture is part of it. Professional identity is part of it. The stories we’ve inherited about what “counts” as OT are part of it. This matters because I don’t want to individualize structural problems. You cannot mindset your way out of inadequate staffing. You cannot personally fix reimbursement. You cannot positive-think your way around an inaccessible service model. But I don’t think the only alternative is powerlessness. There is a territory between: “This is all my responsibility.” and “There is nothing I can do.” That territory has become increasingly important to me. This month, I wrote back On September 14, I submitted an 11-page public comment in response to the CY 2027 Medicare Physician Fee Schedule Proposed Rule. Listen to the CMS Comment here: This wasn’t my introduction to advocacy. It was another iteration of the question I have been carrying across my life and career: What kinds of care are our systems actually making possible? My comment addresses therapy coding and valuation, clinical reasoning, care coordination, interdisciplinary overlap, complexity, technology, mobile and home-based care, staffing and productivity pressures, access, and the risks of both overutilization and systematic underutilization of rehabilitation. But underneath the 12 recommendations is something larger. Some of the most consequential clinical work does not fit neatly inside the minutes spent performing a discrete intervention. We review records. We synthesize information. We recognize changes in function and risk. We communicate with caregivers and other clinicians. We modify plans. We coordinate transitions. We connect pieces of someone’s life that the healthcare system has separated into different disciplines, encounters, codes, and records. That work matters. And writing the comment brought me back to an idea that has become increasingly important in my scholarship: Payment systems are implementation systems. Payment policy eventually becomes staffing. Workflow. Caseload. Documentation. Technology. Service availability. Interdisciplinary communication. What clinicians have enough capacity to notice. And eventually: Policy becomes occupation. Because people don’t experience healthcare as a collection of codes. They experience a life. The question I ultimately asked CMS was: Does the payment system create the conditions for beneficiaries, caregivers, and clinicians to participate meaningfully in developing, coordinating, and adapting care around the realities of everyday life? I want you to read the comment. Not because you have to agree with me. Read it as a practitioner. What gives language to

  3. Sep 9

    CMS Payment Reform: Your Voice Is Needed by September 14

    What happens when the people delivering healthcare actually participate in deciding how that care is valued? Right now, we have an opportunity to do exactly that. CMS is accepting public comments on the CY 2027 Medicare Physician Fee Schedule proposed rule, and the deadline is September 14, 2026. If you are a U.S.-based occupational therapist, physical therapist, speech-language pathologist, or another rehabilitation or allied health provider, this is a moment to pay attention and participate. Read the CMS CY 2027 Medicare Physician Fee Schedule proposed rule Submit a public comment through Regulations.gov Search for CMS-1848-P when submitting your comment. Why this matters Payment policy is about much more than reimbursement rates. It influences what healthcare systems prioritize, how services are structured, what work is considered valuable, and what kinds of care are realistically available to patients. For rehabilitation providers, there can be a significant gap between the work that actually produces meaningful outcomes and what can be easily represented through a billing code. Think about what goes into a complex rehabilitation encounter. There is the assessment itself, but also the clinical reasoning behind it. There is communication with caregivers and other providers, environmental analysis, education, risk management, adapting interventions to the individual, coordinating care, and making decisions based on information that may not be captured by a single diagnosis or procedure code. For many of us, these are not extras added onto the work. They are the work. That makes this comment period important. Rather than simply saying that reimbursement is too low, we have an opportunity to explain what current payment structures fail to capture and what that means for patients, providers, and the healthcare system. What is changing? The CY 2027 proposed rule includes changes and requests for input related to how Medicare services are coded and valued, including the Practice Expense methodology and aspects of care management and remote monitoring. These are technical policy issues, but the questions underneath them are surprisingly practical: What does it actually take to provide good care? What resources are required? What kinds of clinical work happen outside the most visible portion of an encounter? How should payment systems recognize complexity, coordination, clinical reasoning, and the resources required to manage patients over time? These are questions rehabilitation providers have direct experience answering. OT Potential’s Sarah Lyon and colleagues have been particularly active in bringing OT and PT perspectives into this conversation. Their proposed recommendations include better differentiation in reimbursement for evaluation complexity and consideration of non-time-based therapist management codes to recognize some of the ongoing clinical work that occurs throughout an episode of care. You do not have to agree with every recommendation to see the value in participating. In fact, this is one of the things I appreciate about the public comment process. It gives us an opportunity to respond to what is actually being proposed, identify what we think is missing, describe unintended consequences, and offer alternatives based on what we see in practice. Start with Sarah Lyon’s episode If you want some context before diving into the policy language, I recommend starting with Sarah Lyon’s recent OT Potential episode on this issue. Listen to the OT Potential episode on YouTube The episode provides a useful overview of the current opportunity and the work underway to bring rehabilitation perspectives into the Medicare payment conversation. OT Potential has also created a 2027 CMS Comment Template for OT and PT care, which makes the process considerably easier if you are staring at Regulations.gov wondering where to begin. Access the OT Potential CMS Comment Template The template provides language you can adapt, along with references and guidance for submitting your comment. I would encourage you to personalize it rather than simply submitting the exact same language as everyone else. Your own experience is what makes the comment valuable. What can you contribute? Start with the part of the system you know. Maybe you work with patients whose needs are more complex than the evaluation code adequately communicates. Maybe much of your clinical expertise involves adapting care to cognition, environment, caregiver capacity, health literacy, routines, transportation, safety, or other contextual factors. Maybe you spend substantial time coordinating with other disciplines and caregivers. Maybe your work involves preventing a problem rather than treating the consequences after it happens. Maybe you have watched a patient avoid an emergency department visit because someone identified a risk early. Maybe you have helped a family safely manage a transition home. Maybe your interdisciplinary team caught something that would have otherwise resulted in a complication or readmission. These experiences matter. They help illustrate something that can get lost when healthcare policy is discussed primarily through codes, utilization data, and reimbursement formulas: healthcare is delivered by people making decisions in complex environments with other people. If a payment methodology does not adequately account for the resources required to do that work well, policymakers need concrete examples of what is being missed. Don’t underestimate the value of your clinical perspective You do not need to be a healthcare economist to submit a meaningful comment. You do not need to write a 20-page policy analysis. You do not need to represent your entire profession. A useful comment can be fairly straightforward. Identify the issue you are responding to. Describe what you see in practice. Explain why it matters. Give a concrete example. Then tell CMS what you think should be considered. Instead of simply saying, “OTs need to be paid more,” you might explain how comprehensive occupational therapy assessment requires consideration of cognition, environment, routines, caregiver capacity, safety, equipment, participation, and other factors that may not be adequately represented by the existing valuation structure. Instead of simply saying, “care coordination should be reimbursed,” describe what happens when coordination does not occur. Explain who has to do the work, what information has to be exchanged, what decisions are made, and what can happen to the patient when that work is missing. The more concrete we are, the more useful our comments become. This conversation belongs to all of rehabilitation Although OT Potential’s template focuses on OT and PT, I think there is a larger opportunity here. OTs, PTs, SLPs, and other allied health professionals all see different pieces of the same system. We work across hospitals, outpatient clinics, home-based care, post-acute settings, schools, and community environments. We see where care coordination works and where it breaks down. We see the consequences when payment structures reward one part of the care process while making another part difficult to sustain. That perspective is worth bringing into the conversation. This does not have to become another debate about which profession deserves more. The more useful question is: What does the patient actually need, who has the expertise to provide it, and does the payment system support that care? That is a question worth asking across the healthcare continuum. We have until September 14 We spend a lot of time talking about healthcare payment. We talk about productivity. We talk about coding. We talk about documentation. We talk about access. We talk about burnout. We talk about care coordination. We talk about the disconnect between what patients need and what healthcare systems can realistically provide. This is an opportunity to move some of that conversation into the policymaking process. CMS is asking for public input. We have resources to help us understand the proposal. We have templates to help us get started. And we have our own professional experiences. So take an hour. Listen to the episode. Read the relevant sections of the proposed rule. Use the template if it helps. Add your own examples. Submit your comment. Comments are due September 14, 2026. Read the proposed rule Listen to the OT Potential episode Use the OT Potential comment template Submit your comment And then share this with another clinician. We cannot expect payment systems to recognize the complexity of our work if we never tell policymakers what that work actually involves. Now is the time to put our clinical experience on the record. Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

  4. Sep 6

    Overlap Is Not Duplication: Making Space for Emerging OT Practice informed by Occupational Science

    I wrote this piece in response to some discourse I was tagged in around OT’s role in sports medicine and supporting high performance athletes. The reflection is specifically in response to this three-part LinkedIn series: Part 1: What OT Adds to Sports MedicineRead the original post on LinkedIn Part 2: Collaboration and Professional RolesRead the original post on LinkedIn Part 3: Advocacy, Scope, and the FutureRead the original post on LinkedIn Much of the discourse in the comments was centered on concerns of overlap with athletic trainers and presumptions that what OT is offering would be essentially duplicative and disrespectful to more traditionally prominent members of the sports medicine ecosystem. I had to modify my response on LinkedIn to match their character limit, so I thought I would publish the full response here. It covers content that feels relevant to much of the endless discourse that is largely driven by shorthand misinformation, presumptions, and various insecurities that get stirred when our focus is on eliminating rather than expanding possibilities for care and innovation. Why occupational science literacy matters A big part of why I am a proponent of increased occupational science literacy for OTPs worldwide is to encourage us to use our own distinct lens and concepts when communicating about the innovations, roots, and foundations of our practice so we can get out of this trap of being reduced to limited paradigms and understandings of other professions in bad faith. First, we tend to be undermined for possibly not having the same competencies as another discipline or profession. Then, when we reveal that we do have the same competencies, or we catch up, we are framed as essentially duplicative or redundant and not unique. This is why communicating about our identity and skills from our own foundations and core terminology, including our cosmological, philosophical, epistemic, and emerging practice developments, on our own terms, alongside the formal policy developments that have shaped our practice from the beginning, is so important. Especially if we do so with pride in our unique integrative foundations rather than shame or presumed incompetence, very often this pattern is deeply rooted in the internalization of structural sexism and misogyny as it relates to female-dominated health care professions and integrated care approaches overall. OTPs need to start recognizing that when we are met with such suspicion and accusation, it can actually be a sign of our strength and competence as a threat rather than a sign of our own incompetence or need to prove or defend ourselves where we typically already currently belong. We keep de-skilling each other It’s so interesting how often in this type of discourse we default to pigeonholing and limiting all skilled providers to the bare minimum of responsibilities in institutional settings. For example, often between OT and PT the discourse can reduce both professions down to upper extremity versus lower extremity, even though we all know both disciplines in the real world are full-body therapists. With the discourse around athletic trainers, it seems like we’re reducing all professions to the most basic elements of those responsibilities, rather than exploring nuanced conversations about strengths, weaknesses, opportunities, gaps, and intersections that could lead to more comprehensive care. Unlike competitive athletics, health and human services are not competitive sports. When providers compete, our clients are always the ones who lose out on comprehensive care. I also think this pattern of discourse has consequences beyond any single profession. When we continually reduce skilled professions to their bare foundations and then treat overlap at that level as evidence of duplication, we can inadvertently create conditions that discourage innovation and advancement across health and human services. The bare foundations are the floor of professional capacity, not necessarily the ceiling. If we treat the floor as the ceiling, then every advancement into an emerging specialty, every new application of foundational knowledge, and every development in professional reasoning has to first defend itself against the existence of something another profession already does. That creates a very different condition for professional development than asking what becomes possible when skilled professionals build beyond their foundations. Overlap is not duplication Overlap between providers is not new and never has been new. It’s actually essential to communication and efficiency for there to be essential overlap. One profession having a specific body area or modality in their scope does not mean that it is somehow unlawful or an automatic restriction or duplication for another provider to be skilled and competent in those areas. It simply means more than one profession has core competencies to perform a specific function. It means there are options rather than a basis for exclusion. For example, just about everyone in the hospital performs vitals, and we want it that way, to optimize saving everyone’s lives. The issue, then, is not simply whether competencies overlap. The more important question is what happens beyond those foundations. Nearly every skilled profession has foundational competencies that overlap with other professions. Those foundations establish what a profession is capable of doing. They do not necessarily define everything that profession can become. The floor is not the ceiling. This is also why I think it is important to distinguish overlapping competencies from professional identity. AOTA’s scope statement describes OT as a dynamic and evolving profession responsive to consumer and societal needs, system changes, and emerging knowledge and research. Its scope is organized around the domain and process of occupational therapy rather than around a single body region or a fixed list of procedures. Professional differentiation can therefore exist even when foundational services overlap. It can emerge through what a profession has developed beyond the foundation: its theories, epistemics, cosmology, professional reasoning, specialized knowledge, emerging practices, methods, populations, contexts, and approaches to delivering services. It can also emerge through the way even some of the same foundational services are understood and integrated into a person’s actual occupational life. Two professionals may provide something that looks similar on the surface while asking very different questions about the person, their environment, their goals, their occupations, their identity, their routines, and what meaningful participation looks like to them. That is not necessarily duplication. That is professional differentiation. And those differences can be meaningful to clients. A client may choose between qualified providers not simply because one profession possesses an activity that another profession is forbidden or unable to perform, but because of the way a practitioner understands their needs, the populations or contexts they specialize in, how they approach collaboration, how they conceptualize their goals, and how their services fit with the client’s preferences and priorities. Our clients are not choosing between completely separate universes of intervention. They are choosing people, approaches, relationships, areas of expertise, and ways of understanding and responding to their needs. The more generative question is therefore not simply whether another profession can perform the same foundational task. It is what each profession has developed beyond the foundation and how that development creates additional possibilities for care. OT has always been more than hands Much of what distinguishes occupational therapy exists in what is often regarded as largely unseen realms in physical medicine. Our internal, subjective experiences of navigating changes in body, mind, spirit, and environment are rarely fully appreciated through physical medicine methodologies alone. Occupational therapy emerged through the moral treatment and arts and crafts movements, advancing the right to engage in self-directed activity as restorative to body, mind, and spirit, and as foundational to human rights-affirming living for people wherever they live, work, and play. Occupational therapy is the belief that engagement in self-directed, integrative activity can regenerate health, integrating body, mind, spirit, and especially hands, but never reducing occupation simply to hands, because every occupation requires a full body to execute. This is where Elizabeth J. Yerxa’s work on occupational science becomes especially relevant. In her 2000 article, Occupational Science: A Renaissance of Service to Humankind Through Knowledge, Yerxa argued that occupational science could help occupational therapy develop and define its own knowledge base and scope through scholarship. She centered the human as an occupational being whose relationship with occupation unfolds across development, environment, culture, learning, and agency. That matters because our foundations are not simply historical ideas to preserve. They give us a way of knowing and reasoning that can continue to generate new possibilities for practice. That is also why I am excited that our September Evolved Living Collaborative Journal Club is returning to Yerxa’s article. More than 25 years later, her questions give us an opportunity to consider what occupational science can still contribute to how we understand occupation, knowledge, and the future of occupational therapy. Those foundations are still relevant, but they are also a starting point for what comes next. 📚 September Journal Club Saturday, September 26 at 1:00 PM Pacific Our first Journal Club was moved from August to September so we could give ourselves more time to read and engage with the article. This month we are returning to

  5. Aug 31

    Integrating Creativity and Spirituality in Occupational Therapy: Embracing Arts, Science, and Ancestral Wisdom with Libby Lamb OT, Poet, and Creativity & Spirituality Coach

    Here is a voice-over of the article for those who prefer audio Hi everyone! I’m thrilled to share this episode with you today. If you’ve been following this podcast since it started in 2023, you might know it grew out of my doctoral capstone project during my time in the University of Utah’s Post-Professional Clinical Doctorate program from 2019 to 2023. This journey unfolded during the challenges of the COVID-19 pandemic, which highlighted the global impact that devaluing public health initiatives has had on collective on health and well-being, and made deeply evident the barriers and costs to humanity created by maintaining dynamics of scientific elitism, and the lack of accessible frameworks for translating impactful health interventions and knowledge from the academy to the field, especially frameworks informed by disability and occupational justice. After navigating two stalled capstone projects due to pandemic-related challenges, I shifted my focus to creating resources for field clinicians to develop occupational science literacy for direct practice. Over three years, I poured my heart and all my spare time into building a fully virtual introduction to occupational science, using innovative online learning tools and best practices in adult education. If you’re curious, you can explore this project at engage.evolvelivingnetwork.com, and just by subscribing to this Substack, you can get free access to the OS 101 guide, which includes a glossary of all foundational occupational science terminology. My journey back into occupational therapy higher education began after feeling disillusioned during my first two years of clinical and school-based practice as a travel therapist. I was searching for a space where I could thrive using holistic approaches that integrated mental and physical health. Initially, I hoped to work in pediatric and school-based settings, but I quickly encountered policy limitations that narrowed the focus of occupational therapy to handwriting and fine motor skills. This was disheartening, especially since my master’s research centered on executive dysfunction supports for adolescents and assistive technology in schools, areas that were largely controversial for occupational therapists in traditional settings at the time. These challenges revealed deeper issues within the field, including limited access to occupational science developments and foundational frameworks like the “Occupational Therapy Practice Framework Fourth Edition.” I realized through my my more in-depth study that these barriers were tied directly to historical inequities, such as structural sexism in higher education and healthcare leadership sourcing all the way back to the 1500s. This understanding fueled my passion for creative problem-solving and building community around these issues. I have a free training in the evolved living collaborative skool community on how Occupational Science is integrated with the Occupational Therapy Practice Framework Fourth Edition for anyone who is looking to get caught up on out latest practice guidence updates. After graduating, I launched this podcast to raise awareness about Occupational Science and my capstone course. Later, I collaborated on a textbook chapter proposal for the “Occupational Therapy Without Borders” third edition, exploring innovative ways to circulate knowledge beyond traditional academic institutions. While the chapter ultimately missed the publication deadline, the experience taught me valuable lessons about resilience and navigating academic challenges. Since then, however, I have been challenged in relation to this podcast by writer’s block, perfectionism, shame around missing the deadline, and a lack of direction without the structure of a prompt, deadline, or institutional affiliation to prove the value of my work to or rebel against. I’ve been on a personal journey of healing and rediscovery, exploring the roots of occupational therapy in the moral treatment and arts and crafts movements, and deepening my understanding of decolonial healthcare frameworks. This has included honoring the wisdom of indigenous and folk healers whose contributions have often been suppressed or commodified by modern healthcare systems. To support my own recovery, I created a podcast and community called “Rewilding the Mythic Self,” where I’ve been reconnecting with creativity, spirituality, and interdisciplinary collaboration outside of formal institutions. Over time, however, I have come to realize that fracturing out these parts of myself wasn’t really possible and was actually disconnecting me from the type of integrative work I am passionate about reviving in Occupational Therapy practice throughout the world and thank goodness I am not alone in this mission! One of the most transformative moments in this journey recently has been discovering the work of Libby Lamb an occupational therapist and poet (Author of the Acacia Project) based in UK and Australia who powerfully integrates spirituality and creativity into her personal life and practice. Participating in Libby’s writing workshop this past July has helped inspire me to revive this podcast and explore in community how occupational therapists can reconnect with their creative and spiritual selves while navigating the demands and restrictions of traditional practice settings. Her insights have been invaluable in addressing my own creative blocks and building confidence to embrace my full self in both my persional and professional practice. Together, Libby and I have been exploring themes around the “witch wound”, the historical legacy of suppression and violence against women healers, and its relevance to contemporary occupational therapy. In relation to our discussion, Libby wrote an incredible article on the complexities of navigating one’s identity as an OTP while also making space for one’s own spirituality and creative expression for our own wellbeing and holistic fulfillment. I highly recommend reading this article and subscribing to her work here: Libby Lamb Find Libby on instagram: @OTandbiscuits and @wordswithlibby and join her free facebook for OT’s Reclaiming Craft here: These conversations have deepened my appreciation for the power of occupational science in addressing systemic barriers and promoting inclusive healthcare practices. I encourage you to check out Libby’s work, including her poetry book and coaching program, “Duality,” which supports occupational therapists worldwide (US-based OTPs are invited to participate in her creative writing offerings through words with libby however she is currently unable to offer 1:1 coaching for OTPs in the USA at this time.) This past fall I also explored simliar themes in a reflexive intergenerational workshop on the concise classic text: Witches, Midwives, and Nurses by Barbra Enenrich and Deidre English on the historic orgins of the American Medical Association and the ties between imperial and colonial Western biomedical models and the formal exclusion and suppression of women, people of color, the global south, and criminalization of folk medicinal practices that are foundational to the fear and apprehension many of us continue to hold up into this day inspite of OT inseperable tie to the arts and crafts, mornal treatment, and spirutality through and self determined engagement in meaningful and purposeful activity in context. This powerful workshop is currently freely available in the Evolved Living Collaborative Skool Community Classroom. This legacy has persisted until this day in the podcast I referenced Drs. Vivian Tatiana Camacho Hinojosa and Bolivian midwife who trained in the west as surgeon before returning to ancestral practices and fighting with her community to protect and expand access to water, food, and traditional medicine world wide. Her powerful work has helped advance protections for folk medicinal practices and keep sacred midwifery practices alive with broad coalitions internationally. She is currently facing political persecution and encourages us to reconnect to honoring life and finding health in connection to life affirming community and protection and collaboration with nature as warriors for life and protection of its most tender expression. Quality outcomes from access to Midwives in childbirth: https://pmc.ncbi.nlm.nih.gov/articles/PMC9584105/ Here is the reference article on how weavers made Apollo Space Mission possible: https://www.sciencenews.org/article/core-memory-weavers-navajo-apollo-raytheon-computer-nasa Along with the powerful science of knitting: There are some amazing resources available that I plan to read and review on this Substack this year and possibly host discussions on in the Evolved Living Collaborative: I’ve come to realize that true liberation lies in integration, bringing together my creative, spiritual, and professional identities to build coalitions and navigate challenges collectively. This perspective has guided my recent collaborations, including sharing my folk arts and crafts experiments with the Canadian Society for Occupational Science and the American Occupational Therapy Association, and attending the Decolonizing Healthcare Knowledge Summer School Institute in Mexico City. For those interested in joining these conversations, I invite you to explore the Evolve Living Collaborative platform, where we host free workshops like “Witches, Midwives, and Nurses,” weekly craft nights, coffee and co-occupation sessions, and a monthly journal club focused on foundational occupational science articles and emerging interdisciplinary books. Together, we can revive the optimistic origins of occupational therapy, celebrate the power of meaningful activity, and create spaces for healing, creativity, and connection. Direct Link: https://www.skool.com/evolved-living-collaborative-6395/about Thank you for being here, and I hope you enjoy th

  6. Mar 17

    Clinical Reflections on Occupational Apartheid: Ethics, Policy, and Systems Change in Occupational Therapy

    Why this Occupational Science series matters If you are an occupational therapy practitioner in the United States, chances are you are already using occupational science. You just might not have been given the words for it yet. That gap is part of why I created this Occupational Science Alphabet Series, a public learning series designed to make occupational science more accessible and more visible in everyday life and traditional practice settings. This first composite series begins with A for Occupational Apartheid. Recording Timestamps: 00:00 “Occupational Apartheid Analysis” 06:01 “Occupational Apartheid Challenges” 16:11 “Systemic Barriers in OT” 18:04 “Enhancing Accessibility through Advocacy” 25:20 “Defining Occupational Apartheid” 33:06 “Occupation and Systemic Inequality” 39:23 “Advocating Equity in OT Practice” 45:04 “Occupational Therapy for Healing” 48:04 “Advancing Occupational Justice” 54:55 “Occupational Ethics Evolution” 58:50 “Occupational Apartheid Ethics” 01:03:58 “Justice and Veracity” 01:10:17 Healthcare Bias and Scientific Integrity 01:15:59 “Addressing Maternal Health Disparities” The phrase can feel intense at first.It should. Because it names something real. It gives language to the ways people are systematically denied access to meaningful participation in everyday life, not simply because of individual impairment or diagnosis, but because of how social, economic, political, and cultural systems are organized. And that matters deeply for occupational therapy. Because when we only look at barriers inside individual bodies, we miss the wider context shaping participation. We miss the insurance policy.The school policy.The zoning code.The inaccessible architecture.The transportation gap.The labor condition.The funding cap. Occupational science helps us see those patterns clearly. And once we can see them, we can respond more ethically and more effectively. The Secret of Occupation One of the most powerful insights of occupational science is that occupation always transcends the individual. Yes, participation includes personal capacity, motivation, and health status. But occupation is also shaped by: environmentculturepolicyhistoryeconomicssocial relationships When occupational therapists work with clients, we are rarely working with bodies alone. We are working with people in systems. Occupational science simply gives us a language to describe those systems more clearly. Why Occupational Apartheid Matters The concept of occupational apartheid helps us name situations where social systems restrict access to meaningful participation in everyday life. Frank Kronenberg describes occupational apartheid as: “systematically enacted negations of humanity that divide and subjugate collectives of people to the benefit of some at the expense of others.”(Kronenberg, 2018) These restrictions can occur through intersecting social mechanisms such as: racismclassismsexismableismxenophobiaeconomic inequality These forces shape who has access to resources that sustain dignified living. They shape who can participate fully in everyday life. And they show up in everyday occupational therapy practice more often than we might initially realize. When Systems Become Habit One of the most profound insights connected to occupational apartheid comes from the concept of occupational consciousness, developed by Elelwani Ramugondo. Occupational consciousness invites us to examine how systems of power become embedded in everyday activity. Because the truth is: Systems do not reproduce themselves automatically. They reproduce themselves through what people do every day. Policies become habits.Beliefs become routines.Social hierarchies become normalized through everyday actions. Over time, these patterns become so familiar that they operate below the level of conscious awareness. This is where occupation becomes incredibly important. Occupation is the point where ideas turn into action. And when those actions become automated habits, they can quietly reproduce systems of inequality, even after the laws that created them have been formally abolished. When Systems End but Patterns Persist History shows us that oppressive systems rarely disappear completely when policies change. Segregation in the United States was formally dismantled decades ago. Apartheid in South Africa was officially abolished in the 1990s. And yet racial disparities, inequities in access to housing, healthcare, education, and safety persist in both societies today. Why? Because systems do not only exist in policy. They exist in everyday occupations. They exist in patterns of: where people livewho receives serviceswho gets referred to carewhose needs are believedwho feels welcome in public spaceswho has access to transportation, education, and healthcare These patterns often persist through habits and assumptions that operate subconsciously. Occupational consciousness asks us to notice those patterns. Occupational apartheid helps us name their structural origins. Rehumanizing the Collective After War Another important dimension of occupational apartheid is its relevance to collective recovery from war, violence, and social division. Many of the social systems that shape our institutions today were forged in contexts of conflict, colonial expansion, and geopolitical competition. Even when wars formally end, the habits, infrastructures, and relational patterns shaped by those conflicts often remain embedded in everyday life. Occupational apartheid helps illuminate how the aftermath of war can continue to shape participation in subtle ways, through segregation, displacement, institutional distrust, unequal resource distribution, and inherited patterns of fear or exclusion. If left unexamined, these patterns can reproduce division across generations. Occupation is where these patterns are maintained, but it is also where they can be transformed. Through shared activities, community participation, creative practice, caregiving, education, and everyday collaboration, people rebuild relational life. Occupational therapy historically emerged in part from this very context, helping individuals and communities reconstruct meaningful life after the disruptions of war and institutionalization. Engaging with occupational apartheid and occupational consciousness today invites us to continue that tradition. Not by reproducing new forms of division or tribal harm, but by helping cultivate conditions where people can participate in humanizing, compassionate, and sustainable forms of collective life. In this way, occupation becomes a pathway toward healing. Not only individual healing. But collective healing. Occupation as a Tool for Liberation If occupation can reproduce systems of injustice, it can also help dismantle them. Because occupation is also the place where change becomes possible. When we change everyday patterns of doing, we change systems. This is why occupational therapy has always been connected to movements for human dignity and social participation. From the moral treatment movement to disability rights advocacy, occupational therapy has been concerned with helping people return to meaningful life within their communities. Occupational science expands that mission. It invites us to see how everyday activities can either reinforce systems of harm or help create environments where people can live with dignity, belonging, and agency. Why This Perspective Strengthens Occupational Therapy Understanding occupational apartheid and occupational consciousness does not weaken clinical practice. It strengthens it. When therapists understand the systemic barriers affecting participation, they can: design more realistic interventionsadvocate for appropriate equipmentcollaborate with community resourcesidentify policy barriersdocument environmental constraints clearly It also helps us articulate what makes occupational therapy distinctive. Our profession studies human beings as occupational beings. That means we look not only at physical function, but at how environments and systems shape the possibilities for everyday life. This perspective integrates insights from: health sciencessocial sciencescritical social sciencescommunity knowledgedecolonial scholarship Together, these perspectives create a robust and integrated understanding of participation. What This Series Explores This Occupational Science Alphabet Series explores concepts that help illuminate the broader context of occupation, including: occupational apartheidoccupational consciousnessoccupational justicecollective occupationsecological approaches to health Each concept will be translated into examples from real-world practice contexts. The goal is simple: To help occupational therapists, students, and the public better understand the unique scientific foundation of our profession. Subscribe for OS 101 If this conversation resonates with you, I invite you to subscribe to this Substack. Here I share: Occupational Science 101 explanationspodcast conversationsinterdisciplinary scholarshipreflections on ethics and policyexamples from everyday clinical practice My hope is to make occupational science more accessible so that occupational therapy can be better understood both within our profession and by the broader public. Stay tuned for the Forthcoming Learning Community I am also building a forthcoming Skool community where free OS 101 content will be hosted. This space will include: introductory occupational science coursesa journal and book clubcommunity discussion forumsreflection spaces for practitioners and learners Together we will explore how occupational science can support: collective liberationecological balanceoccupational wellbeinghumanizing care across the lifespan Closing Reflection If you have ever felt that occupational therapy is bigger than the narrow boxes it is often placed in, you are not imagining that. If you have sensed th

  7. Mar 9

    Global Conversations: Cross-Discipline Collaboration in Epidemiology, Occupational Science, Disability, and AI with Emmanuel Ampomah Boadi

    Evolved Living Podcast with Dr. Josie Jarvis OT Global Conversations: Cross-Discipline Collaboration in Epidemiology, Occupational Science, Disability, and AIwith Emmanuel Ampomah Boadi --- Episode Overview In this episode of the Evolved Living Podcast, Dr. Josie Jarvis welcomes Emmanuel Ampomah Boadi, a Ghana-based researcher working at the intersection of occupational science, epidemiology, biostatistics, rehabilitation, and disability studies. Their thoughtful, wide-ranging conversation explores how participation in daily life is shaped by social, structural, and systemic forces far beyond individual clinical encounters. Dr. Josie Jarvis opens the episode by reflecting on her diverse clinical background, spanning home health, schools, memory care, and acute and orthopedic rehabilitation. Her journey—deepened by doctoral work amid the COVID-19 pandemic—led her to occupational science as a discipline uniquely equipped to investigate barriers to participation at the population (not just individual) level. --- Key Topics Discussed - What is Epidemiology? Emmanuel Ampomah Boadi grounds the discussion by defining epidemiology: the study of how health, disease, and disability are distributed across populations, and the factors influencing those outcomes. He emphasizes that "it is the backbone of public health," using stories from Ghana and references to public health icons like John Snow and John Graunt to illustrate epidemiology’s roots in mapping, measurement, and understanding the interplay between environment and human behavior. - Bridging Disability Studies and Occupational Science Emmanuel Ampomah Boadi describes how his academic journey—spanning disability/rehabilitation studies and biostatistics—inspired him to explore the overlap between occupational science and population health. He highlights the importance of looking not only at medical conditions but also at social and environmental context, power imbalances, and race—reminding us that “everybody has some form of disability” and that “there is nothing like normal.” - The Role of Data and AI The conversation explores the need to “quantify” our observations to strengthen advocacy. Emmanuel Ampomah Boadi sees artificial intelligence as an assistive technology—valuable, but ultimately limited. He urges clinicians and researchers to retain the clarity and accountability of human interpretation, using AI as a support rather than a replacement for nuanced judgment. - Ethics, Equity, and Systemic Barriers The episode doesn’t shy away from difficult truths. They discuss well-known ethical breaches in research history (Tuskegee Syphilis Study, Nuremberg Code violations) and highlight how, without active attention to equity and ethics, scientific progress can deepen injustice. Dr. Josie Jarvis and Emmanuel Ampomah Boadi both reflect on their lived experiences of systemic inequity—from global vaccine access to the design of research and public health interventions. - Cultural Humility and Community Engagement Emmanuel Ampomah Boadi shares a poignant research anecdote from Ghana: an infrastructure project failed because outsiders did not consult the community, ultimately building a water borehole atop a sacred space. The lesson: knowledge translation is only possible with true cultural humility and partnership, not top-down assumptions. --- Concepts Explained Occupational Science: A discipline that examines human participation (“occupation”) in everyday life, considering both individual and system-level factors—policy, environment, economics, and history—that enable or restrict engagement. Epidemiology & Biostatistics in Rehab: Not just tools for infectious disease, epidemiology provides frameworks for understanding disability, health disparities, and the structural determinants of participation. Biostatistics helps quantify these patterns and decipher root causes, moving advocacy from anecdote to evidence. Occupational Apartheid & Social Models of Disability: The episode contextualizes “occupational apartheid”—a situation where social, economic, or policy barriers systematically exclude groups from meaningful participation in everyday life. Emmanuel Ampomah Boadi distinguishes between the medical, social, and biopsychosocial (ICF) models of disability, urging listeners to see how “systemic barriers” create or intensify disability. --- Practical Wisdom for Listeners - Integration is Key: Solutions come from teamwork—integrating medical science, social science, community wisdom, and policy. “You need to involve the community—what you believe to be the best solution may not fit their real needs.” - You Belong in Science: Dr. Josie Jarvis and Emmanuel Ampomah Boadi both stress that occupational science and health advocacy are not reserved for those with doctorates or prestigious affiliations. Efforts—however imperfect—matter. - Share and Connect: The conversation encourages clinicians, students, and community members to participate, share ideas, question systems, and “be on LinkedIn” or join organizations like CSOS (Canadian Society for Occupational Scientists), which prioritize international access and virtual participation. - Respect, Humility, and Effort: Growth and social change depend on respecting all perspectives, continuous effort, and humility when things don’t go as planned. --- Why This Matters Occupational therapy and science are poised to lead in bridging the gap between STEM and social science, between evidence and ethics, between theory and grassroots reality. Episodes like this demonstrate—in clear, accessible language—why the work of linking occupation, policy, data, and advocacy is both urgent and hopeful. --- How to Engage Further - Resources Mentioned: - Occupational Science 101 Guide - OS Alphabet Series (on TikTok, Instagram, Facebook, and LinkedIn) - CSOS membership and virtual events - LinkedIn and Substack for new episodes and reflections - Get Involved: Bring occupational science ideas into your practice, classroom, or community—even if you’re new to the concepts. Connect for further conversations, share your efforts, and don’t wait for perfect conditions. --- Final Thought As Emmanuel Ampomah Boadi shares: "Don’t be afraid that you’ll get it wrong. If you don’t get it wrong, you never know what to do to make it right." Occupational science—and a just health system—needs all voices, including yours. Connect with Emmanuel on LinkedIn here: https://www.linkedin.com/in/emmanuel-ampomah-boadi-08b4241a4/ --- For more episodes, resources, and to keep the conversation going, follow the Evolved Living Podcast on Substack and connect on social media platforms. Let’s keep collaborating across borders, backgrounds, and disciplines—the future of well-being depends on it. Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

  8. 10/27/2025

    🌿 Beyond the Hierarchy: Rethinking Evidence in Occupational Therapy

    When I first learned about evidence-based practice, I remember staring at that glossy triangle, the research hierarchy pyramid, with meta-analyses gleaming at the top like sacred scripture. It was comforting at first. Finally, a clear map of what counts as truth.But once I entered practice, that tidy hierarchy started to crumble under the weight of real people’s lives.Human beings aren’t controlled variables, and occupation doesn’t fit neatly into double-blind trials. The Trouble with the Old Pyramid The traditional Evidence-Based Practice (EBP) pyramid was built for biomedical and pharmaceutical research, where the goal is to test isolated variables across large populations (Duke University Medical Center Library, n.d.). That works beautifully when you’re measuring how a medication lowers blood pressure.But occupation is not a pill… it’s a process.It’s meaning, context, motivation, and environment woven together. In OT, our “data set” is often one person at a time, a life lived in context.Trying to flatten that into a universal protocol often means losing what makes our work effective and human. The Tomlin & Borgetto Research Pyramid: A Model That Fits Our Field In 2011, George S. Tomlin and Brandon Borgetto published Research Pyramid: A New Evidence-Based Practice Model for Occupational Therapy in The American Journal of Occupational Therapy (Tomlin & Borgetto, 2011). They didn’t just redraw the pyramid, they reimagined what evidence could look like.Their four-sided model includes: * Descriptive research: defining and observing occupational phenomena (the foundation). * Experimental research: asking causal questions under controlled conditions. * Outcome research: measuring effectiveness and impact in practice settings. * Qualitative research: exploring lived experience, culture, and meaning. Each side contributes uniquely to a full picture of occupational reality.Rather than stacking these methods into a hierarchy, Tomlin and Borgetto framed them as mutually reinforcing, like the faces of a pyramid that meet at the top…where evidence becomes practice. “Rather than ranking designs by hierarchy, the research pyramid encourages practitioners to evaluate rigor based on the type of question being asked.”- Tomlin & Borgetto (2011, p. 190) Why This Matters in Practice In home health, I’ve seen firsthand how rigid hierarchies undervalue the evidence that actually drives change.An RCT can tell me which exercise statistically improves shoulder flexion …but not whether my client can now garden with her grandchildren, or return to painting without pain. Occupational therapy lives where biology meets biography.To serve people well, we need research frameworks that make room for both. The Critiques That Strengthen Us Scholars such as Whiteford and Wright-St Clair (2004) argue that the old hierarchy often silences the very forms of knowledge that make OT powerful- narrative, context, creativity.When we measure success only by quantitative control, we risk missing the human story. Occupational science reminds us that people are meaning-making beings.Our science must be capable of holding that complexity. How I Apply the Tomlin & Borgetto Pyramid * For mechanical reliability, I turn to experimental studies. * For real-world effectiveness, I consult outcome research. * For understanding experience, I value qualitative inquiry. * And at the root of it all, I rely on descriptive studies to ground my reasoning. Each approach has a place.Evidence becomes less about hierarchy and more about harmony, a dynamic ecosystem of knowing. Reclaiming Evidence as a Living Practice Embracing this model isn’t about lowering standards; it’s about broadening the lens.It validates community programs, arts-based methods, trauma-informed care, and culturally grounded interventions that might never fit into traditional RCTs. When we expand what counts as evidence, we expand what’s possible: for our clients, our profession, and the world we’re helping to rebuild. 🌿 Learn More: Foundations of Occupational Science for U.S.-Based OTPs If this conversation sparks something in you, the urge to better understand why occupational therapy feels different from other disciplines and how to ground that difference in research and policy… I invite you to join me inside Foundations of Occupational Science for U.S.-Based OTPs. This self-paced capstone learning experience bridges theory and practice, guiding practitioners and students to: * Decode the real meaning and application of the Tomlin & Borgetto Research Pyramid. * Integrate occupational science concepts into documentation, advocacy, and program design. * Reclaim OT’s creative and psychosocial roots while navigating contemporary U.S. systems. * Build confidence in articulating the full scope of practice, in language policymakers, payers, and interdisciplinary teams understand. You can explore the course and all current offerings here:👉 engage.evolvedlivingnetwork.com Together, we’re building a movement of practitioners who see evidence as a living, liberatory practice…one that honors both the science and the soul of occupation. References Duke University Medical Center Library. (n.d.). The evidence-based practice pyramid. Retrieved from https://guides.mclibrary.duke.edu/ebmtutorial/ebp_pyramid Tomlin, G. S., & Borgetto, B. (2011). Research pyramid: A new evidence-based practice model for occupational therapy. American Journal of Occupational Therapy, 65(2), 189–196. https://doi.org/10.5014/ajot.2011.000828 Whiteford, G., & Wright-St Clair, V. (2004). Occupation and practice in context (1st ed.). Churchill Livingstone Australia. Get full access to Dr. Josie Jarvis OT at josiejarvisot.substack.com/subscribe

    🌿 Beyond the Hierarchy: Rethinking Evidence in Occupational Therapy
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🎙️ The Evolved Living Podcast with Dr. Josie Jarvis, PP-OTD, MA-OTR/L, BA, BS Hosted by occupational therapist, occupational scientist, and open citizen science advocate Dr. Josie Jarvis, The Evolved Living Podcast explores how we can bridge art, science, and wisdom to co-create more liberatory, ecological, and collaborative systems of care. Each episode invites critical yet compassionate dialogue across disciplines—connecting practitioners, educators, researchers, and community members who are working toward holistic, trauma-informed, and life-affirming change. Together, we translate occupational science into real-world practice and collective wellbeing through honest, inclusive, and transformative conversations. josiejarvisot.substack.com

Information

  • Creator
    Dr. Josie Jarvis OT
  • Years Active
    2022 - 2026
  • Episodes
    34
  • Rating
    Clean
  • Copyright
    © Dr. Josie Jarvis OT
  • Show Website
    Evolved Living Podcast