Evolved Living Podcast

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 ruleSubmit a public comment through Regulations.govSearch for CMS-1848-P when submitting your comment.Why this mattersPayment 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 episodeIf 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 YouTubeThe 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 TemplateThe 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 perspectiveYou 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 rehabilitationAlthough 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 14We 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 ruleListen to the OT Potential episodeUse the OT Potential comment templateSubmit your commentAnd 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

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 LinkedInPart 2: Collaboration and Professional RolesRead the original post on LinkedInPart 3: Advocacy, Scope, and the FutureRead the original post on LinkedInMuch 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 mattersA 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 otherIt’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 duplicationOverlap 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 handsMuch 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 ClubSaturday, September 26 at 1:00 PM PacificOur 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 Elizabeth J. Yerxa’s 2000 article, Occupational Science: A Renaissance of Service to H

Here is a voice-over of the article for those who prefer audioHi 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-nasaAlong 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/aboutThank you for being here, and I hope you enjoy this episode!Thanks for reading! 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Why this Occupational Science series mattersIf 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 Integrity01:15:59 “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 OccupationOne 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 relationshipsWhen 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 MattersThe 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 inequalityThese 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 HabitOne 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 PersistHistory 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 healthcareThese 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 WarAnother 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 LiberationIf 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 TherapyUnderstanding 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 clearlyIt 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 scholarshipTogether, these perspectives create a robust and integrated understanding of participation.What This Series ExploresThis Occupational Science Alphabet Series explores concepts that help illuminate the broader context of occupation, including:occupational apartheidoccupational consciousnessoccupational justicecollective occupationsecological approaches to healthEach 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 101If 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 practiceMy 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 CommunityI 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 learnersTogether we will explore how occupational science can support:collective liberationecological balanceoccupational wellbeinghumanizing care across the lifespanClosing ReflectionIf 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 that participation barriers often arise from systems rather than symptoms, you are not imagining that either.Occupational science gives us the language to understand those realities.

Evolved Living Podcast with Dr. Josie Jarvis OT Global Conversations: Cross-Discipline Collaboration in Epidemiology, Occupational Science, Disability, and AIwith Emmanuel Ampomah Boadi---Episode OverviewIn 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 ExplainedOccupational 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 MattersOccupational 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