Transforming Practice:
Occupational Therapy’s Role in Healing Racial Stress and Trauma in Youth of Color
A three-part learning series on cultural humility, identity, and trauma-informed OT practice
Welcome!
Our Duty as Occupational Therapists
As occupational therapy practitioners, it is our duty to promote health, well-being, and justice across diverse populations. This involves recognizing the differences among various sociocultural backgrounds that shape occupational engagement, especially among communities that have been historically marginalized. In particular, youth of color are in a unique position, as they must navigate the complexities of racial discrimination and trauma during critical developmental periods, often without support from the systems meant to serve them. As such, occupational therapy practitioners have an opportunity to be among the trailblazers of healthcare professionals to advance occupational justice and equitable care.
Welcome!
Our Duty as Occupational Therapists
These modules were created as part of a Doctoral Capstone Project in response to the growing need for culturally responsive, justice-informed OT practices that center the lived experiences of youth of color. While much has been done to advance trauma-informed care in occupational therapy, a gap remains in addressing the intersections of racial trauma and occupational participation. These modules aim to bridge that gap by offering a deeper understanding of racial stress and trauma (RST), cultural humility, and occupation-based interventions that support healing, resilience, and empowerment.
If you have any questions, comments, or technical difficulties while completing the modules, please reach out to jadehernandez.ot@gmail.com
Welcome!
What to Expect
Each module includes:
- Research-based educational content
- Interactive activities to support active engagement and application
- Short case studies with reflective prompts providing opportunities to consider real-worlds scenarios
- Comprehension questions at the end of each module to reinforce key concepts
The training modules consist of three self-paced learning modules, each designed to be completed in 20–30 minutes:
- Foundations of Racial Stress and Trauma (RST) in Youth
- Cultural Humility and Identity
- OT Interventions for Supporting Racial Stress and Trauma
Welcome!
After this training, you will:
- Have a clear understanding of RST and its impact on youth development and occupational engagement
- Strengthen your capacity for culturally responsive, trauma-informed care and clinical reasoning
- Be equipped with occupation-based strategies that support youth of color
- Strengthen your role in advancing equity and justice within occupational therapy
- Earn a certificate of completion that can be used towards CBOT PDU requirements to maintain licensure (1 PDU)*
Welcome!
Table of Contents
Module 2
Module 3
Module 1
Foundations of Racial Stress and Trauma in Youth
Cultural Humility and Identity in OT Practice
OT Interventions to Support Youth Experiencing RST
- Defining cultural humility and its importance in OT
- Understanding identity and belonging
- Exploring the Kawa model and it’s role in understanding cultural identity and trauma
- Case study #2 and reflection questions
- Comprehension check
- Trauma-informed, justice-based OT practice
- Applying the Kawa Model
- Anti-racist practice
- Promoting belonging and community healing with OT
- Acting as an Advocate and Ally as an OT
- Case study #3 and reflection questions
- Comprehension check
- Introduction to RST and its impact on health and occupational participation
- Neuroscience and stress mechanisms related to racial discrimination
- Occupational impacts of RST
- Case Study #1 and reflection questions
- Comprehension check
Important Information
- This training takes about 1 hour to complete, which meets CBOT’s requirement for earning 1 PDU. You will receive information on how to obtain your certificate of completion at the end of the modules.
- You may access these modules for free at any time via the OTAC website if you'd like to review content and reassess your knowledge of RST in OT practice. Please note that you may only submit completion of this training once to CBOT for 1 PDU.
- If you need to step away, make sure to use the same name or alias you entered at the beginning of the modules – this allows the system to save your progress and you will be able to resume where you left off. Entering a different name will restart the modules.
- At any point, you can use the menu icon (three lines in the top left corner) to navigate or revisit content.
- Throughout the modules, you'll complete short interactive activities. Your responses remain confidential and are collected only for internal data comparison, not shared with others.
Content Warning
These modules discuss topics such as racism, racial stress and trauma, discrimination, and lived experiences that may be emotionally difficult or triggering. Some case studies and reflection activities may bring up discomfort or personal memories. Please proceed at your own pace and take breaks as needed.
Before you start...
Please take a moment to grab a pen and paper or a notepad. You’ll be encouraged to use this during the reflective questions and case study prompts. Writing down your thoughts can help deepen reflection, support clinical reasoning, and connect the content to your practice.
Foundations of Racial Stress and Trauma in Youth
Understanding how racial stress and trauma impact participation, development, and well-being in children and adolescents.
Module 1: Foundations of RST in Youth
Estimated time of completion: 15 – 20 minutes
Learning objectives
Understand what RST is and why it matters for youth development.
Describe how chronic racial stress affects the brain, body, and behavior.
Identify the occupational impacts of RST on youth of color.
Reflect on your assumptions and begin shifting your clinical lens through transformative learning.
Section 1: What Is Racial Stress and Trauma (RST)?
Many times when we are working with new clients, we must zoom out and consider their lived experience. As occupational therapists, we are trained to use the occupational profile to gather a holistic view of our clients. A client’s experience of racial stress and trauma (RST) is a vital contextual factor that can impact their occupational engagement. Let’s look deeper into how RST plays a role.
Section 1: What Is Racial Stress and Trauma (RST)?
RST refers to the emotional and physiological toll that results from repeated exposure to racism. Individuals are particularly at risk for RST when these experiences of racism are chronic, unpredictable, and occur across developmental periods, like in childhood and adolescence.
- RST is not officially recognized as a diagnosis in the DSM-5, yet it has measurable impacts similar to PTSD (Williams et al., 2018).
- RST is developmentally contextualized, meaning it can uniquely disrupt identity formation, learning, and emotional regulation in youth (Saleem et al., 2019).
Click on the + to compare PTSD and RST Symptoms
Section 1: What Is Racial Stress and Trauma (RST)?
Racism is a system of beliefs, practices, and policies based on race that benefit those with historical power. Racism can exist on individual, insitutional, and structural levels (Haeny et al., 2021).
Click on each plus sign to learn more about the different levels of racism.
Structural Racism
Institutional Racism
Internalized Racism
Interpersonal Racism
"Discrimination is a chronic stressor that can dysregulate stress physiology in a way that contributes to poor health outcomes.” (Williams et al., 2019)
Section 1: What Is Racial Stress and Trauma (RST)?
What level of racism?
Drag and sort the example scenarios to match the level of racism on the left
Level of Racism
Interpersonal
Institutional
Structural
Internalized
Section 2: The Neuroscience of RST
Does racism really affect the brain? The answer is a clear and resounding “yes.” There is a growing body of literature from various fields (psychology, biology, social work, and even occupational therapy) that explores the neurobiological response to racism and how it can impact a person’s behavior.Repeated racialized stress activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to dysregulated cortisol patterns, sleep disruption, and heightened vigilance (Berger & Sarnyai, 2014; Grasser & Jovanovic, 2022). Over time, this “toxic stress” can impair executive functioning, emotion regulation, and learning (Woody et al., 2022).
Read more
Section 2: The Neuroscience of RST
These biological changes are compounded by environmental adversity (e.g., discrimination at school, over-policing, media representation), which can shape the developing brain. Racial discrimination is considered a culturally specific Adverse Childhood Experience (ACE) and research shows that the physiological impact of trauma due to ACEs can not only be genetic, but also begin to occur as early as infantry (Bernard et al., 2020; Kurbatfinski et al., 2024). Research shows:
- RST increases risk for depression, anxiety, and PTSD symptoms in youth (Bird et al., 2021; Woody et al., 2022).
- The brain’s response to discrimination mirrors traditional trauma responses (e.g., increased risk for depression, increased reactivity in the amygdala, hyervigilance) , even if the trauma is systemic rather than acute or interpersonal. This means systemic injustices that we may observe within systems like education, health care, or law enforcement hold just as much power as everyday experiences of discrimination or microaggressions.
“The stress response to racism mirrors responses to other traumatic events.” (Woody et al., 2022)
Section 2: The Neuroscience of RST
Pause and Reflect
Imagine you are 10 years old. Every day at school, you feel as though you’re looked down upon and treated differently before you even speak. What might that do to your sense of safety (i.e., feeling supported, protected, and not at risk of harm or judgment in your environment)? How do you think it may impact your ability to learn or play?
Section 3: Occupational Impacts of RST
Now that we’ve covered what RST is and how it can impact us physiologically, it is time to think about how RST can affect our daily occupations. RST manifests in occupational disruption through diminished participation, self-efficacy, and belonging. Youth of color may avoid settings that reinforce negative stereotypes or withdraw from school activities to protect their sense of safety (Grullón et al., 2018; Leung & Smith, 2010).
Section 3: Occupational Impacts of RST
In other words, RST can significantly impact how youth:
- Show up in school or disengage entirely.
- Navigate social interactions (especially if they feel unsafe).
- Develop a sense of identity (both occupational identity and cultural identity) and confidence in self-expression.
- Manage emotions during play, learning, or daily routines.
“Experiences of racism can diminish a child’s ability to fully engage in play, education, and self-expression.” ( Leung & Smith, 2010)
Case Study #1
In the next section, you’ll read a brief case study and respond to reflective prompts. Please take your time, and use your notes or notepad to support your thoughtful reflection.
Case Study #1: Lorenzo
Lorenzo is a 13‑year‑old boy who recently moved to a new middle school. He enters sixth grade excited, ready to make friends, and decides to join the football team. Soon, he begins noticing both subtle and not-so-subtle racial incidents. A math teacher tells him, “I bet when you look in the mirror, you see a monkey,” causing his peers to laugh at him. Over the next few months, Lorenzo endures repeated slurs, exclusion, and mocking social media posts about him. At home, he begins to avoid talking about school and complains of a stomachache every morning. At school, his grades are slipping, and he risks having to repeat the sixth grade. Socially, he begins to withdraw and no longer desires to participate in football. When he comes to OT, he says, “I just didn’t want to learn anymore.”
Inspired by real events. Learn more about Lorenzo’s story here.
Case Study #1: Lorenzo
Reflection
These questions are designed to support clinical reasoning through an RST-informed lens. Please take a moment to write your responses using pen and paper to add to your personal notes and reflection.
- What signs of racial stress and trauma do you observe in Lorenzo’s story? How might these be misinterpreted by educators or therapists unfamiliar with RST?
- What additional questions might you ask Lorenzo (or his family) to better understand the cultural context of his experience?
Module 1 Comprehension Quiz
The next 5 slides involve multiple choice questions that cover topics and themes discussed in this module. Please answer each question thoughtfully and to the best of your ability before moving onto Module 2. Good luck!
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Module 1 Summary
So far we have learned
- RST is a real form of trauma that disrupts youth development and occupational engagement.
- Chronic exposure to racism alters neurobiology and shapes emotional, behavioral, and social responses.
- As OTs, our role isn’t just to support development, but to validate lived experiences, recognize systemic barriers, and adapt our practices through a trauma- and justice-informed lens.
Cultural Humility and Identity in OT Practice
Exploring self-awareness and the role of cultural humility in fostering justice-informed practice.
Module 2: Cultural Humility and Identity in OT Practice
Estimated time of completion: 15 – 20 minutes
Learning objectives
Describe how identity and belonging shape occupational engagement.
Define cultural humility and explain how it differs from cultural competence.
Understand the Kawa Model as a culturally responsive framework for practice.
Recognize how systems of oppression influence identity formation and participation in youth of color.
Reflect on how cultural humility supports occupational justice in pediatric OT.
Section 1: What is Cultural Humility?
Unlike cultural competency, cultural humility is not a skill we achieve once — it’s a mindset and continuous process of learning, unlearning, and reflecting. Cultural humility emphasizes relational awareness and accountability. It asks practitioners to recognize their own identities and biases, and how those influence interactions and therapeutic decisions.
We often hear the term “culturally competent” when discussing the type of care to provide when working with clients from different cultural backgrounds. Cultural competence tends to focus on gaining knowledge about specific cultural groups and places an emphasis on mastery, which can seem daunting and unattainable, especially when working within diverse populations.
“Cultural humility requires a lifelong commitment to self-evaluation and self-critique.” — (Lerner & Kim, 2022)
Section 1: What is Cultural Humility?
Cultural humility involves a process of transformative learning and requires ongoing self-reflection, awareness of power imbalances, and an openness to learning from clients rather than assuming expertise about their experiences, which often times leads to feelings of invalidation (Lerner & Kim, 2022). Within the practice of OT, cultural humility centers the client as experts of their lived experience, which is essential when addressing RST. Each encounter with the client should invoke curiosity within the practitioner, prompting questions such as “What am I missing here?” or “How might my perspective limit what this client needs?” Through this reflective stance, OTs can promote justice-based care that validates the experiences of youth of color and empowers them to build positive identity and resilience.
“Cultural humility is an invitation to reflect not only on who our clients are, but on who we are—and how those two realities intersect in practice.” (Pooley & Beagan, 2021)
Section 1: What is Cultural Humility?
Competence vs. Humility
Section 2: Identity and Belonging
Occupations are at the center of identity formation in childhood and adolescence. It is a time where youth begin to develop a sense of who they are in school, play, and social routines. Additionally, one’s culture plays a large role in the formation of their identity, impacting the type of occupations they engage in and how. For youth of color, their sense of identity and belonging is shaped heavily by systems of power and exclusion. Experiences of discrimination, microaggressions, or stereotyping can lead to internalized messages about self-worth and belonging (Grullón et al., 2018).
Section 2: Identity and Belonging
Belonging is considered as:
- A psychological need that promotes well being amongst youth, and;
- A protective factor that buffers the negative effects of stressors (Allen et al., 2022)
When youth experience racialized discrimination or invalidation, it can fracture their sense of belonging and identity resulting in decreased occupational engagement.
Section 2: Identity and Belonging
Occupations and Occupational Therapists are inherently political.
Oppression occurs both systemically and within the “everyday doings” of life, i.e., our daily occupations (Pooley & Beagan, 2021). Thus, participation in occupations, especially for youth of color, is shaped by whose activities are supported, valued, or restricted. However, this also means that for marginilized youth of color, engagement in everyday occupations can become acts of advocacy, resistance, and social change (Pollard & Sakellariou, 2014). This is where the idea of OTs as agents of change comes in. When we support youth of color in developing strong, affirming identities, we are engaging in justice-oriented practice that challenges occupational inequities. The occupational therapist is then considered a political being (Pollard & Sakellariou, 2014).
Section 2: Identity and Belonging
Occupational barriers or supports?
Section 3: Practicing Cultural Humility in OT
Practicing cultural humility within the practice of OT goes hand-in-hand with engaging in the transformative learning process. One tool to promote critical self-reflection within OT education and practice was introduced by Muñoz et al. (2023): Generative Disruptive Questions (GDQs). GDQs challenge practitioners and educators to examine how structures of privilege and inequity shape their own work.
In practice, this may look like asking:
- How do I ensure my therapeutic approach validates this child’s lived experience?
- In what ways might my language or expectations reflect dominant cultural norms?
- How can I shift power dynamics so that collaboration feels safe and reciprocal?
Asking these questions allow OTs to begin challenge and dismantle systemic barriers embedded in service delivery. As such, cultural humility is not only interpersonal—it is also institutional and structural. It calls for examining policies and interventions through a justice lens.
“Educational programs are gateways to the profession and play a major role in whether marginalized individuals feel a sense of belonging.” (Muñoz et al., 2023)
Section 4: The Kawa Model
Iwama and colleagues (2009) developed the Kawa Model with the goal to offer a culturally responsive framework for understanding occupation and identity. For many clients, particularly those from collectivist or marginalized cultural backgrounds, this model resonates because it emphasizes interdependence and context rather than individual achievement. It recognizes that a person’s well-being and identity are intertwined with their social and cultural surroundings.
Section 4: The Kawa Model
Each element of the river in the Kawa Model represents a different aspect of an individuals life. The different elements can interact with each other and affect the flow of one's river.
Click on each + to learn more about the different elements of the river.
Rocks (Iwa)
Riverbanks (Kawa Zoko)
Driftwood (Ryuboku)
Water (Mizu)
Spaces in between the elements represent opportunities to enhance the river's flow through therapeutic intervention.
“The Kawa Model represents the flow of life through the metaphor of a river.” — Iwama et al. (2009)
Section 4: The Kawa Model
When supporting youth of color, OTs can use the Kawa Model to:
- Understand how cultural and systemic barriers (e.g., racism, exclusion) act as “rocks” in the river.
- Identify supports that can expand the river’s flow (e.g., family, community, spirituality, creativity).
- Work with clients to co-create interventions that honor cultural values and identity affirmation.
The Kawa Model can be a valuable resource for practitioners to align their practice with occupational justice by supporting not only participation but also identity, empowerment, and belonging. The model is versatile in use – it can be used during evaluation, treatment, and reflection in order to support a client's life flow.
Section 4: The Kawa Model
River Metaphor Match
Drag and sort the example scenarios to match the Kawa River elements on the left
Kawa River Element
Rock
Driftwood
Riverbank
Water
Case Study #2
In the next section, you’ll read a brief case study and respond to reflective prompts. Please take your time, and use your notes or notepad to support your thoughtful reflection.
Case Study #2: Lillian
Lillian, a 17-year-old Black high school student at a predominantly white private school, has been struggling with sleeplessness, academic pressure, and feeling she must work twice as hard to be seen as capable. Microaggressions (e.g. classmates touching her hair) have left her feeling isolated and overly self-conscious. Recently diagnosed with two anxiety disorders, Lillian volunteers with suicide prevention and mental health initiatives to support others. During a previous therapy experience, her white therapist commented that “Black families tend to not be open to receiving mental health services,” which left her feeling misunderstood and disconnected. She is now referred to OT to help rebuild balance, motivation, and a sense of belonging in her daily routines.
Inspired by real events. Learn more about Lillian’s story here.
Case Study #2: Lillian
Reflection
These questions are designed to support clinical reasoning through an RST-informed lens. Please take a moment to write your responses using pen and paper to add to your personal notes and reflection.
- How might the therapist’s comment about Black families have impacted Lilian’s sense of safety and trust in care?
- What steps can you take to ensure that your language and approach reflect genuine curiosity in Lillian’s lived experiences rather than assumption?
Module 2 Comprehension Quiz
The next 5 slides involve multiple choice questions that cover topics and themes discussed in this module. Please answer each question thoughtfully and to the best of your ability before moving onto Module 3. Good luck!
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Module 2 Summary
In this module we learned
- Cultural humility is a lifelong commitment to reflective, respectful, and partnership-based care.
- Tools like the Kawa model can help OTs explore their own biases and identities.
- Cultural humility fosters more inclusive, client-centered and justice-based occupational therapy.
OT Interventions for Supporting RST
Evidence based approaches to promote healing, belonging, and empowerment.
Module 3: OT Interventions for Supporting RST
Estimated time of completion: 20 – 30 minutes
Learning objectives
Integrate anti-racist, strengths-based, and empowerment-focused practices into your work.
Identify trauma-informed and justice-based OT approaches for youth experiencing RST.
Recognize the OT’s role in supporting resilience, belonging, and identity development.
Apply the principles of cultural humility and the Kawa Model in intervention planning.
Reflect on how systemic advocacy aligns with occupational justice.
Section 1: Awareness to Action
In the previous modules, you explored RST are and how cultural humility supports equity in OT practice. Now, it’s time to explore how to translate this awareness into meaningful, evidence-based intervention.
“Opportunities for well-being arise when individuals can engage in meaningful occupation without barriers.”
Hammell (2017)
Section 1: Awareness to Action
As you explore the ways in which RST can be addressed within practice, keep in mind that interventions are not one-size-fits-all. Experiences of RST are inherently unique to the individual, prompting interventions to be contextual, collaborative, and grounded in the child’s sense of belonging and identity. The focus of intervention should always be restoring the child’s well-being and supporting their right to well-being through occupation (Hammell, 2017).
Coping with RST involves both individual and systemic strategies( Holmes et al., 2024). For OTs, this means attending to both the internal experiences of clients (emotional regulation, self-efficacy, identity) and the external barriers that limit participation (discrimination, exclusion, systemic oppression).
“Occupational therapy is uniquely positioned to help individuals reconstruct a sense of agency, control, and coherence following experiences of injustice.” (Hammell, 2017)
Section 2: Trauma-Informed and Justice-Based OT Practice
Traditional trauma-informed care (TIC) recognizes the effects of trauma on health and behavior, and emphasizes safety, choice, collaboration and empowerment within treatment. Specifically within OT practice, TIC is a holistic, occupation-centered approach that involves awareness of trauma’s impact on occupational participation, while using occupation as a therapeutic means to healing (Gadkari & McMahan, 2025). When applied to RST, however, trauma-informed OT must also be justice-informed by acknowledging how systemic oppression perpetuates harm and *occupational deprivation.
*Occupational deprivation refers to a state of preclusion from
engagement in necessary and/or meaningful occupations due to factors that are outside the immediate control of the individual (Whiteford, 2000)
“Healing is not only about recovery from trauma—it is about reclaiming one’s humanity.” — Holmes et al. (2024)
Section 2: Trauma-Informed and Justice-Based OT Practice
Holmes et al. (2024) identify several evidence-based strategies for addressing racial trauma, such as validating racialized experiences, promoting racial socialization, and fostering community connection. For OTs, this translates into interventions that:
- Create a safe therapeutic space by validating the client’s emotions and experiences of racism.
- Support self-regulation through sensory, cognitive, and creative modalities (e.g., art, play, movement, storytelling).
- Incorporate cultural identity and values into meaningful activities, allowing youth to express pride and connection.
- Promote community engagement and mentorship with others who share lived experiences.
By integrating these principles into OT sessions, practitioners affirm the client’s sense of agency and belonging. The pathway to healing from RST is not just about coping, but about reclaiming a sense of identity and joy.
Section 2: Trauma-Informed and Justice-Based OT Practice
Match the principle
Drag and sort the example scenarios to match the Trama-Informed Principle on the left
TIC Principle
Safety
Choice
Collaboration
Empowerment
Section 3: Integrating Cultural Humility and the Kawa Model
“The Kawa Model views the self as inseparable from social context.” — Iwama et al. (2009)
Cultural humility and the Kawa Model are valuable tools in designing interventions for youth of color experiencing RST. The Kawa Model’s river metaphor reminds us that every person’s flow of life is shaped by their environment which can involve both supportive elements and barriers to engagement. For youth of color, rocks in the river might represent discrimination, microaggressions, or systemic barriers that impede participation.
Section 3: Integrating Cultural Humility and the Kawa Model
OTs can help youth identify different aspects of their river, such as their unique environmental contexts (social and physical), barriers, and personal attributes and resources. Interventions can then be designed to:
- Strenghten the river’s flow by addressing contextual stressors (e.g., advocating for inclusion at school).
- Remove or navigate rocks by teaching coping and self-advocacy strategies.
- Highlight driftwood (i.e., personal strengths, values, and supports that enhance resilience).
While the Kawa model can be used as a guiding framework to support healing and identity building, clients may benefit from creating their own river to help contextualize the different aspects of their life and how they intersect. The Kawa Model can also be used to support holistic evaluations and re-evaluations to assess progress. Integrating this model with cultural humility turns therapy into a collaborative journey, where the OT and client can work together to address goals. In other words, it encourages the therapist to ask, “how can I support your river’s flow, rather than redirect it?”
“Culturally responsive practice requires us to align interventions with the client’s worldview—not our own.” (Iwama et al., 2009)
Section 4: Anti-Racist Practice
Non-racist (passive) practice avoids causing or perpetuating harm, while anti-racist (active) practice actively seeks to dismantle systems that produce inequity (Lerner & Kim, 2022).
In occupational therapy, this means going beyond empathy and taking systemic action by:
- Challenging biased policies or referral practices that exclude youth of color.
- Redefining “appropriate behavior” through a culturally responsive lens.
- Ensuring treatment goals reflect the client’s self-identified values, not dominant cultural norms.
- Building partnerships with families and communities to sustain inclusion.
Section 4: Anti-Racist Practice
The focus in anti-racist practice is on empowering the client through occupation. For youth of color, this might look like using play to explore identity, adapting routines to include cultural practices, or designing group sessions that center community resilience and storytelling.
In Module 2, you were introduced to the idea of some occupations being valued above others. Oppression can exist subtly within occupational structures and deem certain activities as “normal,” “productive,” or “functional,” (Pooley & Beagan, 2021). Anti-racist interventions resist these norms and instead prioritize meaningful engagement and self-determination of the client.
“Occupation can be an act of resistance when it enables individuals to reassert agency within oppressive systems.” (Pooley & Beagan, 2021)
Section 4: Anti-Racist Practice
Passive or Active?
Section 5: Promoting Belonging and Community Healing
“When belonging is fostered, healing becomes communal rather than individual.” (Suarez-Balcazar et al., 2023)
In Module 2, you explored how belonging acts as a protective factor against racial stress. A key way to foster belonging involves the creation of or participation in caring communities (i.e., environments where individuals feel seen, valued, and supported; Suarez-Balcazar et al., 2023). When working with youth of color, this means designing spaces (i.e., clinics, classrooms, playgrounds) where youth of color can meaningfully engage in occupations and with their peers or families.
Section 5: Promoting Belonging and Community Healing
OTs can promote belonging by:
- Facilitating activities that celebrate diversity and collaboration.
- Incorporating group projects that allow shared storytelling or collective art-making.
- Partnering with families and schools to ensure inclusive representation in materials and routines.
- Using occupation as advocacy (e.g., co-creating art displays about identity or justice).
- Providing multicultural resources within the clinic (e.g., resources in different languages, community newsletters or bulletin boards)
These interventions can help to heal and empower youth impacted by RST. They help youth internalize a sense of worth and agency in spaces where they may otherwise feel excluded.
Section 5: Promoting Belonging and Community Healing
Designing a Caring Community
Section 6: The OT as an Advocate and Ally
“The occupational therapist is a political being.” — Pollard & Sakellariou (2014)
Occupational therapists hold both privilege and responsibility within systems of care. When occupational justice is at the forefront of our practice, advocacy becomes a necessity and is not optional. In order to be responsible practitioners, it is imperative for OTs to recognize their social positioning and use it to challenge injustice within institutions and communities (Pollard & Sakellariou, 2014).
Section 6: The OT as an Advocate and Ally
Advocacy can occur at multiple levels:
Creating culturally affirming interventions and validating clients’ experiences.
Micro
Influencing program policies and interdisciplinary discussions.
Meso
Supporting systemic changes that address inequity in healthcare and education.
Macro
By acting as advocates and allies, OTs directly promote the vision of occupational justice: a world where every person, regardless of race, can engage in meaningful occupation freely and fully.
Case Study #3
In the next section, you’ll read a brief case study and respond to reflective prompts. Please take your time, and use your notes or notepad to support your thoughtful reflection.
Case Study #3: Fatima
Fatima is a 17-year-old first generation Pakistani immigrant and ESL student. At school, Fatima has endured being called “terrorist” or racial slurs in the hallways, feeling unsafe due to the constant harassment and interogrations from her peers. She avoids eating lunch in the cafeteria and hesitates to speak in group settings, fearing ridicule or judgment. As Fatima’s OT, you notice how the trauma of discrimination has impacted her mental health and engagement in occupations she once enjoyed such as organizing events with her school’s cultural club. Fatima shares, “I just want to do the things I enjoy without feeling attacked.”
Inspired by real events. Learn more about Fatima’s story here.
Case Study #3: Fatima
Reflection
These questions are designed to support clinical reasoning through an RST-informed lens. Please take a moment to write your responses using pen and paper to add to your personal notes and reflection. After learning how cultural identity is often tied to participation in meaningful occupations, reflect on Fatima’s choice to withdraw from her club and school lunch.
- How might this avoidance affect her occupational identity and sense of belonging?
- Whata actions could you take as an OT to help restore a safe and affirming connection to these meaningful activities?
Module 3 Comprehension Quiz
The next 5 slides involve multiple choice questions that cover topics and themes discussed in this module. Please answer each question thoughtfully and to the best of your ability before completing the learning modules. Good luck!
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Module 3 Summary
In this module we learned
- Trauma-informed OT becomes justice-informed when it acknowledges systemic racism as a source of trauma.
- The Kawa Model and cultural humility guide OTs in creating culturally grounded, collaborative interventions.
- Anti-racist practice requires reflection and action—challenging bias and promoting equitable participation.
- Belonging and community are essential for healing racial stress in youth.
- OTs are not just clinicians—they are allies, educators, and advocates for occupational justice.
Thank you for taking the course!
Thank you for completing the Racial Stress and Trauma (RST) Learning Modules. Your engagement supports the growth of justice-informed occupational therapy practice for youth of color. We appreciate your time, reflection, and commitment to creating spaces of belonging, healing, and equity within our profession. Your participation helps shape the future of inclusive OT education and practice! To receive your certificate of completion, please fill out this Google Form.
Feedback is always welcome! Please reach out to jadehernandez.ot@gmail.com for any questions, comments, or concerns.
References
Scan or click the QR code for references
Rocks (Iwa)
Rocks in the river represent life challenges, difficulties, or barriers that impede flow. These can include illness, trauma, financial stress, discrimination, or other interpersonal conflicts. Rocks can vary in size and number, affecting the impact they may have on the flow. Some rocks may cause stagnation of the river while others create manageable ripples.
Driftwood (Ryuboku)
The driftwood represents an individual's personal attributes and resources such as values, personality traits, knowledge, experience, skills, and material assets. Driftwood can either help or hinder the river's flow. For example, traits of creativity and resilience may push rocks aside to improve flow, while negative self-beliefs may add to the blockage.
Water (Mizu)
Water represents one's life flow from beginning to end. It considers the person's occupations, energy and overall well being. The strength and smoothness of the water symbolizes the person's current life flow. A strong, unobstructed flow reflects well-being and balance, while disruptions from other elements may suggest barriers in occupational enagagement.
Williams et al. (2018)
Riverbank (Kawa Zoko)
The riverbank represents an individual's physical and social environment (i.e., family, culture, community, and physical surroundings). These boundaries can shape and contain the flow of the river, just as environmental and social factors can shape a person's life. Supportive environments can be reflected in stable flow, while a restrictive riverbank can constrain a person's flow.
Interpersonal Racism
Involves discriminatory interactions between individuals, including microagressions, exclusion and mistreatment based on race, and overt discrimination or acts of violence. Interpersonal racism can occur vicariously when a member from a marginalized community witnesses or learns of the targeting of another racialized person (Beagan et al., 2023).
HPA Axis Break-Down- Repeated experiences of racialized stress (e.g., discrimination, microaggressions) act as ongoing triggers.
- The hypothalamus detects the stress and releases CRH (corticotropin-releasing hormone)
- The pituitary gland responds by releasing ACTH (adrenocorticotropic hormone) into the bloodstream.
- The adrenal glands release cortisol, the body’s main stress hormone
- With repeated racial stress, the HPA axis stays overactive and becomes chronic stress, wearing down the body and brain.
Internalized Racism
Refers to the process by which individuals from marginalized racial groups internalize negative beliefs and attitudes about their own group’s perceived inferiority and the assumed superiority of dominant racial or ethnic groups (James et al, 2025).
Institutional Racism
Also referred to as systemic racism, this form involves the perpetuation of racial inequities through the policies, practices, and procedures of institutions such as schools, healthcare systems, governments, and the justice system. Although these organizational structures (i.e., standards, rules, and operating processes) are often presented as race-neutral, they consistently advantage white individuals while marginalizing or disadvantaging people of color. This form of racism frequently occurs through interpersonal interactions, as institutions function through the actions of individuals (Beagan et al., 2023).
Structural Racism
Refers to the social structures and systems that create unequal access to and benefits from a society’s economic, political, material, and social resources. Structural racism refers to the ways in which interconnected social systems and institutions (such as the media, education, health care, policing, law, and politics) work together to create and maintain racial hierarchies within a society (Beagan et al., 2023).
Transforming Practice:
Jade Hernandez
Created on October 22, 2025
Start designing with a free template
Discover more than 1500 professional designs like these:
View
Customer Service Course
View
Dynamic Visual Course
View
Dynamic Learning Course
View
Akihabara Course
Explore all templates
Transcript
Transforming Practice:
Occupational Therapy’s Role in Healing Racial Stress and Trauma in Youth of Color
A three-part learning series on cultural humility, identity, and trauma-informed OT practice
Welcome!
Our Duty as Occupational Therapists
As occupational therapy practitioners, it is our duty to promote health, well-being, and justice across diverse populations. This involves recognizing the differences among various sociocultural backgrounds that shape occupational engagement, especially among communities that have been historically marginalized. In particular, youth of color are in a unique position, as they must navigate the complexities of racial discrimination and trauma during critical developmental periods, often without support from the systems meant to serve them. As such, occupational therapy practitioners have an opportunity to be among the trailblazers of healthcare professionals to advance occupational justice and equitable care.
Welcome!
Our Duty as Occupational Therapists
These modules were created as part of a Doctoral Capstone Project in response to the growing need for culturally responsive, justice-informed OT practices that center the lived experiences of youth of color. While much has been done to advance trauma-informed care in occupational therapy, a gap remains in addressing the intersections of racial trauma and occupational participation. These modules aim to bridge that gap by offering a deeper understanding of racial stress and trauma (RST), cultural humility, and occupation-based interventions that support healing, resilience, and empowerment.
If you have any questions, comments, or technical difficulties while completing the modules, please reach out to jadehernandez.ot@gmail.com
Welcome!
What to Expect
Each module includes:
The training modules consist of three self-paced learning modules, each designed to be completed in 20–30 minutes:
Welcome!
After this training, you will:
Welcome!
Table of Contents
Module 2
Module 3
Module 1
Foundations of Racial Stress and Trauma in Youth
Cultural Humility and Identity in OT Practice
OT Interventions to Support Youth Experiencing RST
Important Information
Content Warning
These modules discuss topics such as racism, racial stress and trauma, discrimination, and lived experiences that may be emotionally difficult or triggering. Some case studies and reflection activities may bring up discomfort or personal memories. Please proceed at your own pace and take breaks as needed.
Before you start...
Please take a moment to grab a pen and paper or a notepad. You’ll be encouraged to use this during the reflective questions and case study prompts. Writing down your thoughts can help deepen reflection, support clinical reasoning, and connect the content to your practice.
Foundations of Racial Stress and Trauma in Youth
Understanding how racial stress and trauma impact participation, development, and well-being in children and adolescents.
Module 1: Foundations of RST in Youth
Estimated time of completion: 15 – 20 minutes
Learning objectives
Understand what RST is and why it matters for youth development.
Describe how chronic racial stress affects the brain, body, and behavior.
Identify the occupational impacts of RST on youth of color.
Reflect on your assumptions and begin shifting your clinical lens through transformative learning.
Section 1: What Is Racial Stress and Trauma (RST)?
Many times when we are working with new clients, we must zoom out and consider their lived experience. As occupational therapists, we are trained to use the occupational profile to gather a holistic view of our clients. A client’s experience of racial stress and trauma (RST) is a vital contextual factor that can impact their occupational engagement. Let’s look deeper into how RST plays a role.
Section 1: What Is Racial Stress and Trauma (RST)?
RST refers to the emotional and physiological toll that results from repeated exposure to racism. Individuals are particularly at risk for RST when these experiences of racism are chronic, unpredictable, and occur across developmental periods, like in childhood and adolescence.
Click on the + to compare PTSD and RST Symptoms
Section 1: What Is Racial Stress and Trauma (RST)?
Racism is a system of beliefs, practices, and policies based on race that benefit those with historical power. Racism can exist on individual, insitutional, and structural levels (Haeny et al., 2021).
Click on each plus sign to learn more about the different levels of racism.
Structural Racism
Institutional Racism
Internalized Racism
Interpersonal Racism
"Discrimination is a chronic stressor that can dysregulate stress physiology in a way that contributes to poor health outcomes.” (Williams et al., 2019)
Section 1: What Is Racial Stress and Trauma (RST)?
What level of racism?
Drag and sort the example scenarios to match the level of racism on the left
Level of Racism
Interpersonal
Institutional
Structural
Internalized
Section 2: The Neuroscience of RST
Does racism really affect the brain? The answer is a clear and resounding “yes.” There is a growing body of literature from various fields (psychology, biology, social work, and even occupational therapy) that explores the neurobiological response to racism and how it can impact a person’s behavior.Repeated racialized stress activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to dysregulated cortisol patterns, sleep disruption, and heightened vigilance (Berger & Sarnyai, 2014; Grasser & Jovanovic, 2022). Over time, this “toxic stress” can impair executive functioning, emotion regulation, and learning (Woody et al., 2022).
Read more
Section 2: The Neuroscience of RST
These biological changes are compounded by environmental adversity (e.g., discrimination at school, over-policing, media representation), which can shape the developing brain. Racial discrimination is considered a culturally specific Adverse Childhood Experience (ACE) and research shows that the physiological impact of trauma due to ACEs can not only be genetic, but also begin to occur as early as infantry (Bernard et al., 2020; Kurbatfinski et al., 2024). Research shows:
“The stress response to racism mirrors responses to other traumatic events.” (Woody et al., 2022)
Section 2: The Neuroscience of RST
Pause and Reflect
Imagine you are 10 years old. Every day at school, you feel as though you’re looked down upon and treated differently before you even speak. What might that do to your sense of safety (i.e., feeling supported, protected, and not at risk of harm or judgment in your environment)? How do you think it may impact your ability to learn or play?
Section 3: Occupational Impacts of RST
Now that we’ve covered what RST is and how it can impact us physiologically, it is time to think about how RST can affect our daily occupations. RST manifests in occupational disruption through diminished participation, self-efficacy, and belonging. Youth of color may avoid settings that reinforce negative stereotypes or withdraw from school activities to protect their sense of safety (Grullón et al., 2018; Leung & Smith, 2010).
Section 3: Occupational Impacts of RST
In other words, RST can significantly impact how youth:
“Experiences of racism can diminish a child’s ability to fully engage in play, education, and self-expression.” ( Leung & Smith, 2010)
Case Study #1
In the next section, you’ll read a brief case study and respond to reflective prompts. Please take your time, and use your notes or notepad to support your thoughtful reflection.
Case Study #1: Lorenzo
Lorenzo is a 13‑year‑old boy who recently moved to a new middle school. He enters sixth grade excited, ready to make friends, and decides to join the football team. Soon, he begins noticing both subtle and not-so-subtle racial incidents. A math teacher tells him, “I bet when you look in the mirror, you see a monkey,” causing his peers to laugh at him. Over the next few months, Lorenzo endures repeated slurs, exclusion, and mocking social media posts about him. At home, he begins to avoid talking about school and complains of a stomachache every morning. At school, his grades are slipping, and he risks having to repeat the sixth grade. Socially, he begins to withdraw and no longer desires to participate in football. When he comes to OT, he says, “I just didn’t want to learn anymore.”
Inspired by real events. Learn more about Lorenzo’s story here.
Case Study #1: Lorenzo
Reflection
These questions are designed to support clinical reasoning through an RST-informed lens. Please take a moment to write your responses using pen and paper to add to your personal notes and reflection.
Module 1 Comprehension Quiz
The next 5 slides involve multiple choice questions that cover topics and themes discussed in this module. Please answer each question thoughtfully and to the best of your ability before moving onto Module 2. Good luck!
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Module 1 Summary
So far we have learned
Cultural Humility and Identity in OT Practice
Exploring self-awareness and the role of cultural humility in fostering justice-informed practice.
Module 2: Cultural Humility and Identity in OT Practice
Estimated time of completion: 15 – 20 minutes
Learning objectives
Describe how identity and belonging shape occupational engagement.
Define cultural humility and explain how it differs from cultural competence.
Understand the Kawa Model as a culturally responsive framework for practice.
Recognize how systems of oppression influence identity formation and participation in youth of color.
Reflect on how cultural humility supports occupational justice in pediatric OT.
Section 1: What is Cultural Humility?
Unlike cultural competency, cultural humility is not a skill we achieve once — it’s a mindset and continuous process of learning, unlearning, and reflecting. Cultural humility emphasizes relational awareness and accountability. It asks practitioners to recognize their own identities and biases, and how those influence interactions and therapeutic decisions.
We often hear the term “culturally competent” when discussing the type of care to provide when working with clients from different cultural backgrounds. Cultural competence tends to focus on gaining knowledge about specific cultural groups and places an emphasis on mastery, which can seem daunting and unattainable, especially when working within diverse populations.
“Cultural humility requires a lifelong commitment to self-evaluation and self-critique.” — (Lerner & Kim, 2022)
Section 1: What is Cultural Humility?
Cultural humility involves a process of transformative learning and requires ongoing self-reflection, awareness of power imbalances, and an openness to learning from clients rather than assuming expertise about their experiences, which often times leads to feelings of invalidation (Lerner & Kim, 2022). Within the practice of OT, cultural humility centers the client as experts of their lived experience, which is essential when addressing RST. Each encounter with the client should invoke curiosity within the practitioner, prompting questions such as “What am I missing here?” or “How might my perspective limit what this client needs?” Through this reflective stance, OTs can promote justice-based care that validates the experiences of youth of color and empowers them to build positive identity and resilience.
“Cultural humility is an invitation to reflect not only on who our clients are, but on who we are—and how those two realities intersect in practice.” (Pooley & Beagan, 2021)
Section 1: What is Cultural Humility?
Competence vs. Humility
Section 2: Identity and Belonging
Occupations are at the center of identity formation in childhood and adolescence. It is a time where youth begin to develop a sense of who they are in school, play, and social routines. Additionally, one’s culture plays a large role in the formation of their identity, impacting the type of occupations they engage in and how. For youth of color, their sense of identity and belonging is shaped heavily by systems of power and exclusion. Experiences of discrimination, microaggressions, or stereotyping can lead to internalized messages about self-worth and belonging (Grullón et al., 2018).
Section 2: Identity and Belonging
Belonging is considered as:
- A psychological need that promotes well being amongst youth, and;
- A protective factor that buffers the negative effects of stressors (Allen et al., 2022)
When youth experience racialized discrimination or invalidation, it can fracture their sense of belonging and identity resulting in decreased occupational engagement.Section 2: Identity and Belonging
Occupations and Occupational Therapists are inherently political.
Oppression occurs both systemically and within the “everyday doings” of life, i.e., our daily occupations (Pooley & Beagan, 2021). Thus, participation in occupations, especially for youth of color, is shaped by whose activities are supported, valued, or restricted. However, this also means that for marginilized youth of color, engagement in everyday occupations can become acts of advocacy, resistance, and social change (Pollard & Sakellariou, 2014). This is where the idea of OTs as agents of change comes in. When we support youth of color in developing strong, affirming identities, we are engaging in justice-oriented practice that challenges occupational inequities. The occupational therapist is then considered a political being (Pollard & Sakellariou, 2014).
Section 2: Identity and Belonging
Occupational barriers or supports?
Section 3: Practicing Cultural Humility in OT
Practicing cultural humility within the practice of OT goes hand-in-hand with engaging in the transformative learning process. One tool to promote critical self-reflection within OT education and practice was introduced by Muñoz et al. (2023): Generative Disruptive Questions (GDQs). GDQs challenge practitioners and educators to examine how structures of privilege and inequity shape their own work.
In practice, this may look like asking:
Asking these questions allow OTs to begin challenge and dismantle systemic barriers embedded in service delivery. As such, cultural humility is not only interpersonal—it is also institutional and structural. It calls for examining policies and interventions through a justice lens.
“Educational programs are gateways to the profession and play a major role in whether marginalized individuals feel a sense of belonging.” (Muñoz et al., 2023)
Section 4: The Kawa Model
Iwama and colleagues (2009) developed the Kawa Model with the goal to offer a culturally responsive framework for understanding occupation and identity. For many clients, particularly those from collectivist or marginalized cultural backgrounds, this model resonates because it emphasizes interdependence and context rather than individual achievement. It recognizes that a person’s well-being and identity are intertwined with their social and cultural surroundings.
Section 4: The Kawa Model
Each element of the river in the Kawa Model represents a different aspect of an individuals life. The different elements can interact with each other and affect the flow of one's river.
Click on each + to learn more about the different elements of the river.
Rocks (Iwa)
Riverbanks (Kawa Zoko)
Driftwood (Ryuboku)
Water (Mizu)
Spaces in between the elements represent opportunities to enhance the river's flow through therapeutic intervention.
“The Kawa Model represents the flow of life through the metaphor of a river.” — Iwama et al. (2009)
Section 4: The Kawa Model
When supporting youth of color, OTs can use the Kawa Model to:
- Understand how cultural and systemic barriers (e.g., racism, exclusion) act as “rocks” in the river.
- Identify supports that can expand the river’s flow (e.g., family, community, spirituality, creativity).
- Work with clients to co-create interventions that honor cultural values and identity affirmation.
The Kawa Model can be a valuable resource for practitioners to align their practice with occupational justice by supporting not only participation but also identity, empowerment, and belonging. The model is versatile in use – it can be used during evaluation, treatment, and reflection in order to support a client's life flow.Section 4: The Kawa Model
River Metaphor Match
Drag and sort the example scenarios to match the Kawa River elements on the left
Kawa River Element
Rock
Driftwood
Riverbank
Water
Case Study #2
In the next section, you’ll read a brief case study and respond to reflective prompts. Please take your time, and use your notes or notepad to support your thoughtful reflection.
Case Study #2: Lillian
Lillian, a 17-year-old Black high school student at a predominantly white private school, has been struggling with sleeplessness, academic pressure, and feeling she must work twice as hard to be seen as capable. Microaggressions (e.g. classmates touching her hair) have left her feeling isolated and overly self-conscious. Recently diagnosed with two anxiety disorders, Lillian volunteers with suicide prevention and mental health initiatives to support others. During a previous therapy experience, her white therapist commented that “Black families tend to not be open to receiving mental health services,” which left her feeling misunderstood and disconnected. She is now referred to OT to help rebuild balance, motivation, and a sense of belonging in her daily routines.
Inspired by real events. Learn more about Lillian’s story here.
Case Study #2: Lillian
Reflection
These questions are designed to support clinical reasoning through an RST-informed lens. Please take a moment to write your responses using pen and paper to add to your personal notes and reflection.
Module 2 Comprehension Quiz
The next 5 slides involve multiple choice questions that cover topics and themes discussed in this module. Please answer each question thoughtfully and to the best of your ability before moving onto Module 3. Good luck!
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Module 2 Summary
In this module we learned
OT Interventions for Supporting RST
Evidence based approaches to promote healing, belonging, and empowerment.
Module 3: OT Interventions for Supporting RST
Estimated time of completion: 20 – 30 minutes
Learning objectives
Integrate anti-racist, strengths-based, and empowerment-focused practices into your work.
Identify trauma-informed and justice-based OT approaches for youth experiencing RST.
Recognize the OT’s role in supporting resilience, belonging, and identity development.
Apply the principles of cultural humility and the Kawa Model in intervention planning.
Reflect on how systemic advocacy aligns with occupational justice.
Section 1: Awareness to Action
In the previous modules, you explored RST are and how cultural humility supports equity in OT practice. Now, it’s time to explore how to translate this awareness into meaningful, evidence-based intervention.
“Opportunities for well-being arise when individuals can engage in meaningful occupation without barriers.”
Hammell (2017)
Section 1: Awareness to Action
As you explore the ways in which RST can be addressed within practice, keep in mind that interventions are not one-size-fits-all. Experiences of RST are inherently unique to the individual, prompting interventions to be contextual, collaborative, and grounded in the child’s sense of belonging and identity. The focus of intervention should always be restoring the child’s well-being and supporting their right to well-being through occupation (Hammell, 2017).
Coping with RST involves both individual and systemic strategies( Holmes et al., 2024). For OTs, this means attending to both the internal experiences of clients (emotional regulation, self-efficacy, identity) and the external barriers that limit participation (discrimination, exclusion, systemic oppression).
“Occupational therapy is uniquely positioned to help individuals reconstruct a sense of agency, control, and coherence following experiences of injustice.” (Hammell, 2017)
Section 2: Trauma-Informed and Justice-Based OT Practice
Traditional trauma-informed care (TIC) recognizes the effects of trauma on health and behavior, and emphasizes safety, choice, collaboration and empowerment within treatment. Specifically within OT practice, TIC is a holistic, occupation-centered approach that involves awareness of trauma’s impact on occupational participation, while using occupation as a therapeutic means to healing (Gadkari & McMahan, 2025). When applied to RST, however, trauma-informed OT must also be justice-informed by acknowledging how systemic oppression perpetuates harm and *occupational deprivation.
*Occupational deprivation refers to a state of preclusion from engagement in necessary and/or meaningful occupations due to factors that are outside the immediate control of the individual (Whiteford, 2000)
“Healing is not only about recovery from trauma—it is about reclaiming one’s humanity.” — Holmes et al. (2024)
Section 2: Trauma-Informed and Justice-Based OT Practice
Holmes et al. (2024) identify several evidence-based strategies for addressing racial trauma, such as validating racialized experiences, promoting racial socialization, and fostering community connection. For OTs, this translates into interventions that:
- Create a safe therapeutic space by validating the client’s emotions and experiences of racism.
- Support self-regulation through sensory, cognitive, and creative modalities (e.g., art, play, movement, storytelling).
- Incorporate cultural identity and values into meaningful activities, allowing youth to express pride and connection.
- Promote community engagement and mentorship with others who share lived experiences.
By integrating these principles into OT sessions, practitioners affirm the client’s sense of agency and belonging. The pathway to healing from RST is not just about coping, but about reclaiming a sense of identity and joy.Section 2: Trauma-Informed and Justice-Based OT Practice
Match the principle
Drag and sort the example scenarios to match the Trama-Informed Principle on the left
TIC Principle
Safety
Choice
Collaboration
Empowerment
Section 3: Integrating Cultural Humility and the Kawa Model
“The Kawa Model views the self as inseparable from social context.” — Iwama et al. (2009)
Cultural humility and the Kawa Model are valuable tools in designing interventions for youth of color experiencing RST. The Kawa Model’s river metaphor reminds us that every person’s flow of life is shaped by their environment which can involve both supportive elements and barriers to engagement. For youth of color, rocks in the river might represent discrimination, microaggressions, or systemic barriers that impede participation.
Section 3: Integrating Cultural Humility and the Kawa Model
OTs can help youth identify different aspects of their river, such as their unique environmental contexts (social and physical), barriers, and personal attributes and resources. Interventions can then be designed to:
- Strenghten the river’s flow by addressing contextual stressors (e.g., advocating for inclusion at school).
- Remove or navigate rocks by teaching coping and self-advocacy strategies.
- Highlight driftwood (i.e., personal strengths, values, and supports that enhance resilience).
While the Kawa model can be used as a guiding framework to support healing and identity building, clients may benefit from creating their own river to help contextualize the different aspects of their life and how they intersect. The Kawa Model can also be used to support holistic evaluations and re-evaluations to assess progress. Integrating this model with cultural humility turns therapy into a collaborative journey, where the OT and client can work together to address goals. In other words, it encourages the therapist to ask, “how can I support your river’s flow, rather than redirect it?”“Culturally responsive practice requires us to align interventions with the client’s worldview—not our own.” (Iwama et al., 2009)
Section 4: Anti-Racist Practice
Non-racist (passive) practice avoids causing or perpetuating harm, while anti-racist (active) practice actively seeks to dismantle systems that produce inequity (Lerner & Kim, 2022).
In occupational therapy, this means going beyond empathy and taking systemic action by:
Section 4: Anti-Racist Practice
The focus in anti-racist practice is on empowering the client through occupation. For youth of color, this might look like using play to explore identity, adapting routines to include cultural practices, or designing group sessions that center community resilience and storytelling.
In Module 2, you were introduced to the idea of some occupations being valued above others. Oppression can exist subtly within occupational structures and deem certain activities as “normal,” “productive,” or “functional,” (Pooley & Beagan, 2021). Anti-racist interventions resist these norms and instead prioritize meaningful engagement and self-determination of the client.
“Occupation can be an act of resistance when it enables individuals to reassert agency within oppressive systems.” (Pooley & Beagan, 2021)
Section 4: Anti-Racist Practice
Passive or Active?
Section 5: Promoting Belonging and Community Healing
“When belonging is fostered, healing becomes communal rather than individual.” (Suarez-Balcazar et al., 2023)
In Module 2, you explored how belonging acts as a protective factor against racial stress. A key way to foster belonging involves the creation of or participation in caring communities (i.e., environments where individuals feel seen, valued, and supported; Suarez-Balcazar et al., 2023). When working with youth of color, this means designing spaces (i.e., clinics, classrooms, playgrounds) where youth of color can meaningfully engage in occupations and with their peers or families.
Section 5: Promoting Belonging and Community Healing
OTs can promote belonging by:
- Facilitating activities that celebrate diversity and collaboration.
- Incorporating group projects that allow shared storytelling or collective art-making.
- Partnering with families and schools to ensure inclusive representation in materials and routines.
- Using occupation as advocacy (e.g., co-creating art displays about identity or justice).
- Providing multicultural resources within the clinic (e.g., resources in different languages, community newsletters or bulletin boards)
These interventions can help to heal and empower youth impacted by RST. They help youth internalize a sense of worth and agency in spaces where they may otherwise feel excluded.Section 5: Promoting Belonging and Community Healing
Designing a Caring Community
Section 6: The OT as an Advocate and Ally
“The occupational therapist is a political being.” — Pollard & Sakellariou (2014)
Occupational therapists hold both privilege and responsibility within systems of care. When occupational justice is at the forefront of our practice, advocacy becomes a necessity and is not optional. In order to be responsible practitioners, it is imperative for OTs to recognize their social positioning and use it to challenge injustice within institutions and communities (Pollard & Sakellariou, 2014).
Section 6: The OT as an Advocate and Ally
Advocacy can occur at multiple levels:
Creating culturally affirming interventions and validating clients’ experiences.
Micro
Influencing program policies and interdisciplinary discussions.
Meso
Supporting systemic changes that address inequity in healthcare and education.
Macro
By acting as advocates and allies, OTs directly promote the vision of occupational justice: a world where every person, regardless of race, can engage in meaningful occupation freely and fully.
Case Study #3
In the next section, you’ll read a brief case study and respond to reflective prompts. Please take your time, and use your notes or notepad to support your thoughtful reflection.
Case Study #3: Fatima
Fatima is a 17-year-old first generation Pakistani immigrant and ESL student. At school, Fatima has endured being called “terrorist” or racial slurs in the hallways, feeling unsafe due to the constant harassment and interogrations from her peers. She avoids eating lunch in the cafeteria and hesitates to speak in group settings, fearing ridicule or judgment. As Fatima’s OT, you notice how the trauma of discrimination has impacted her mental health and engagement in occupations she once enjoyed such as organizing events with her school’s cultural club. Fatima shares, “I just want to do the things I enjoy without feeling attacked.”
Inspired by real events. Learn more about Fatima’s story here.
Case Study #3: Fatima
Reflection
These questions are designed to support clinical reasoning through an RST-informed lens. Please take a moment to write your responses using pen and paper to add to your personal notes and reflection. After learning how cultural identity is often tied to participation in meaningful occupations, reflect on Fatima’s choice to withdraw from her club and school lunch.
Module 3 Comprehension Quiz
The next 5 slides involve multiple choice questions that cover topics and themes discussed in this module. Please answer each question thoughtfully and to the best of your ability before completing the learning modules. Good luck!
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Comprehension Quiz
Module 3 Summary
In this module we learned
Thank you for taking the course!
Thank you for completing the Racial Stress and Trauma (RST) Learning Modules. Your engagement supports the growth of justice-informed occupational therapy practice for youth of color. We appreciate your time, reflection, and commitment to creating spaces of belonging, healing, and equity within our profession. Your participation helps shape the future of inclusive OT education and practice! To receive your certificate of completion, please fill out this Google Form.
Feedback is always welcome! Please reach out to jadehernandez.ot@gmail.com for any questions, comments, or concerns.
References
Scan or click the QR code for references
Rocks (Iwa)
Rocks in the river represent life challenges, difficulties, or barriers that impede flow. These can include illness, trauma, financial stress, discrimination, or other interpersonal conflicts. Rocks can vary in size and number, affecting the impact they may have on the flow. Some rocks may cause stagnation of the river while others create manageable ripples.
Driftwood (Ryuboku)
The driftwood represents an individual's personal attributes and resources such as values, personality traits, knowledge, experience, skills, and material assets. Driftwood can either help or hinder the river's flow. For example, traits of creativity and resilience may push rocks aside to improve flow, while negative self-beliefs may add to the blockage.
Water (Mizu)
Water represents one's life flow from beginning to end. It considers the person's occupations, energy and overall well being. The strength and smoothness of the water symbolizes the person's current life flow. A strong, unobstructed flow reflects well-being and balance, while disruptions from other elements may suggest barriers in occupational enagagement.
Williams et al. (2018)
Riverbank (Kawa Zoko)
The riverbank represents an individual's physical and social environment (i.e., family, culture, community, and physical surroundings). These boundaries can shape and contain the flow of the river, just as environmental and social factors can shape a person's life. Supportive environments can be reflected in stable flow, while a restrictive riverbank can constrain a person's flow.
Interpersonal Racism
Involves discriminatory interactions between individuals, including microagressions, exclusion and mistreatment based on race, and overt discrimination or acts of violence. Interpersonal racism can occur vicariously when a member from a marginalized community witnesses or learns of the targeting of another racialized person (Beagan et al., 2023).
HPA Axis Break-Down- Repeated experiences of racialized stress (e.g., discrimination, microaggressions) act as ongoing triggers.
- The hypothalamus detects the stress and releases CRH (corticotropin-releasing hormone)
- The pituitary gland responds by releasing ACTH (adrenocorticotropic hormone) into the bloodstream.
- The adrenal glands release cortisol, the body’s main stress hormone
- With repeated racial stress, the HPA axis stays overactive and becomes chronic stress, wearing down the body and brain.
Internalized Racism
Refers to the process by which individuals from marginalized racial groups internalize negative beliefs and attitudes about their own group’s perceived inferiority and the assumed superiority of dominant racial or ethnic groups (James et al, 2025).
Institutional Racism
Also referred to as systemic racism, this form involves the perpetuation of racial inequities through the policies, practices, and procedures of institutions such as schools, healthcare systems, governments, and the justice system. Although these organizational structures (i.e., standards, rules, and operating processes) are often presented as race-neutral, they consistently advantage white individuals while marginalizing or disadvantaging people of color. This form of racism frequently occurs through interpersonal interactions, as institutions function through the actions of individuals (Beagan et al., 2023).
Structural Racism
Refers to the social structures and systems that create unequal access to and benefits from a society’s economic, political, material, and social resources. Structural racism refers to the ways in which interconnected social systems and institutions (such as the media, education, health care, policing, law, and politics) work together to create and maintain racial hierarchies within a society (Beagan et al., 2023).