Khalilah Johnson - Academia.edu (original) (raw)
Papers by Khalilah Johnson
OTJR: Occupation, Participation and Health
Theater has long-standing roots in social justice and holds promise for reducing racist attitudes... more Theater has long-standing roots in social justice and holds promise for reducing racist attitudes and behaviors. Objectives of this study were to (a) collect and theatrically portray narratives from Black occupational therapy students and practitioners to a national audience and (b) examine the impact of the theatrical performance on anti-Black racism among attendees. The Identity Development Evolution and Sharing (IDEAS) model guided translation of narratives into a filmed performance. Paired t-test of pre/post administration of the Acceptance and Action Questionnaire–Stigma (AAQ-S) measured changes in stigma beliefs. Qualitative thematic analysis of an open-ended post-survey question elucidated experiences of the performance. The performance engendered significant decreases in stigma; qualitative data elucidated potential mechanisms of change. This study provides insight into experiences of anti-Black racism within occupational therapy and offers a promising means for occupational...
The American Journal of Occupational Therapy
In the wake of sociopolitical movements to address health inequities and race-based violence in t... more In the wake of sociopolitical movements to address health inequities and race-based violence in the United States, there have been calls to take up antiracist practices in the occupational therapy profession. This call aligns with Vision 2025 and requires intentional dialogue and instruction on racism and antiracism, beginning in occupational therapy academic programs. Although it is important to engage in discussions on racism and antiracism, it is equally imperative that members of the profession take action to ameliorate the consequences of racism. In this column, we argue for the need for occupational therapy educators to take immediate action. We provide specific recommendations and strategies to broach these topics, examples of classroom activities, and practical approaches for translating these skills to fieldwork settings. Continued work is needed to establish robust policies and practices to ensure that all occupational therapy program graduates enter the workforce prepared...
If you are a doctoral student, you know a postdoc is likely your next step following graduation, ... more If you are a doctoral student, you know a postdoc is likely your next step following graduation, but do you know how to choose a postdoc that will help you accomplish your career goals? Do you know what you want from a postdoc, or how to find one? Through a panel discussion, learn from Dr. John Ryan, Associate Vice President for Research Development and head of the office of Postdoctoral Scholars at VCU, as well as a number of successful postdocs, about what you need to do to pick the best postdoc for you. This session is co-sponsored by VCU Career Services
The overall aim of this dissertation was to determine how the daily operations and institutional ... more The overall aim of this dissertation was to determine how the daily operations and institutional structures of an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) coordinate what residents and staff do. The specific aims were to (1) identify and describe the daily operations and institutional practices of the facility; (2) identify and describe the activities of the residents and staff; and (3) identify and describe how the opportunities for residents to choose and participate in meaningful activities were affected by institutional operations and culture. Institutional ethnography was applied as a social theory and methodology. Data were collected over 14 weeks with seven residents with profound ID and eight staff members. Data collection methods included participant observation, ethnographic interviewing, and text work. Conceptual mapping and narrative analysis were employed as iterative and reflexive processes to systematically extract narrative ...
Inclusion, 2021
A nuanced understanding of disparities impacting racialized people with intellectual and developm... more A nuanced understanding of disparities impacting racialized people with intellectual and developmental disabilities (IDD) requires scholars employ research methods that make visible the structural factors that influence outcomes. Following the work of Tukufu Zuberi and Eduardo Bonilla-Silva, we explore race-based methodological considerations for disparities research with Black people with IDD. Specifically, we discuss (a) structural racism in research methods, employing disability critical race theory as a framework, (b) the absence of Black voices and Black scholarship, (c) the abstraction and misuse of race as a variable, and (d) mapping race as a point of discussion in the IDD discourse. Implications for research are discussed and recommendations for contextualizing race, ensuring equity in representation and dissemination, and amplifying the voices of Black scholars are provided.
Occupational Therapy in Acute Care, 2nd Edition, 2017
Autism in Adulthood, 2020
The American Journal of Occupational Therapy, 2021
Importance: Occupational therapy practitioners use a range of habilitative and compensatory appro... more Importance: Occupational therapy practitioners use a range of habilitative and compensatory approaches to teach new skills or modify tasks and environments to address occupational performance among adults with intellectual disability (ID); therefore, they must identify and use available evidence to guide intervention planning. Objective: To summarize the scope of evidence that can inform occupational therapy intervention with adults with primary or comorbid ID. Data Sources: Articles published in peer-reviewed journals between January 2002 and January 2018 and indexed in PubMed, CINAHL, PsycINFO, and Scopus. Study Selection and Data Collection: A total of 159 articles met inclusion criteria and contained information on occupational therapy intervention with adults ages 18 yr or older with primary or coexisting ID. Findings: Fifty-seven of the 159 articles focused on intervention to address occupational performance outcomes (i.e., employment, self-care, leisure and social interaction...
The American Journal of Occupational Therapy, 2021
Importance: Occupational therapy practitioners use structured assessment tools to gather informat... more Importance: Occupational therapy practitioners use structured assessment tools to gather information from adults with intellectual disability (ID) in order to develop the occupational profile, guide occupational therapy intervention, and assess change over time. Objective: To identify occupational therapy–related tools in the peer-reviewed literature for use in practice with adults with ID. Data Sources: Peer-reviewed literature published between January 2002 and January 2018 included in CINAHL, PsycINFO, PubMed, and Scopus. Study Selection and Data Collection: The review included articles that had information on occupational therapy–related assessment with adults 18 yr or older who had primary or co-occurring ID. Findings: Fifty-eight articles identified 73 occupational therapy–related assessment tools. Conclusions and Relevance: This scoping review identified a broad range of assessment tools in the occupational therapy domain that are appropriate for adults with ID, some of which...
The American Journal of Occupational Therapy, 2021
Importance: Adults aging with intellectual and developmental disabilities (IDD) continue to face ... more Importance: Adults aging with intellectual and developmental disabilities (IDD) continue to face barriers to participation in meaningful occupation; moreover, the increased life expectancy of adults with IDD intensifies the need for age- and environment-specific support. Objective: To map and categorize transdisciplinary literature on environmental modifications and supports for adults aging with IDD. Data Sources: Studies published between January 1, 2000, and January 1, 2019, identified through PubMed and Scopus. Study Selection and Data Collection: Eleven articles met the inclusion criteria and contained information specific to occupational participation based on environmental modification (e.g., physical space, technology, universal design, type of living setting), social supports (e.g., family members, caretakers, peer groups, health care professionals, policies, organizational infrastructure), or both and adults age ≥35 yr with IDD. Findings: Eleven studies met the criteria fo...
Journal of Occupational Science, 2020
Journal of Occupational Science, 2020
In the summer of 2020, the death of George Floydyet another unarmed Black man killed at the hands... more In the summer of 2020, the death of George Floydyet another unarmed Black man killed at the hands of policethrust race and racism to the forefront of public attention in the United States. Across the country, demonstrators and protestors mobilized to end police brutality, one mechanism of systemic racism in this country's history and present. As this paper explores, occupation too has played a role in the systemic racism against Black people in the United States. In recent years, occupational scientists have critiqued tacit assumptions regarding the qualities and effects of occupation. The following examination contributes to this growing body of critical literature and considers that occupation can be a vehicle for injustice as much as justice. By investigating the construction of race and the dissemination of racism, including its propagation through everyday living, the role of occupation in community formation and development is more fully understood. In pursuing this goal, we hope to reveal the real and often unacknowledged history of racism in the United States that must be recognized and confronted to move toward reconciliation, healing, and social transformation. This exploration uncovers powerful moments when occupation and everyday doing were conduits through which racism was constructed and calls upon occupational scholars to be reflective and critical in their research and practice in order to optimally support the people they serve.
Intellectual and Developmental Disabilities, 2019
Case management (CM) is one of the most commonly used services by individuals with intellectual a... more Case management (CM) is one of the most commonly used services by individuals with intellectual and developmental disabilities (IDD), but little is known about the workers who provide CM. This study used a mixed methods approach to gain understanding of the CM workforce in one U.S. state. An online survey was completed by 35 IDD service directors (87.5% of directors in the state); and 113 CMs and CM supervisors participated in semistructured interviews and focus groups. Results indicated an annual crude separation rate of 28.2%, and participants often complained that turnover resulted in caseload sizes that prevented optimal outcomes for people with IDD. A limited applicant pool, duties focused on regulatory compliance, and inadequate wages were cited as major challenges for CMs.
Work, Employment and Society, 2019
This article explores how circuits of accountability impact front-line service work in an interme... more This article explores how circuits of accountability impact front-line service work in an intermediate care facility for individuals with intellectual disability (ICF/IID). Institutional ethnography as a theory and methodology guided the data collection and analysis processes. Participant observation and interviews were completed, and text work was employed to make visible the ways staff enacted what they believed to be their roles and responsibilities. Results indicated the service criteria established by regulatory agencies were interpreted and executed in ways that negatively influenced staff’s moral care to residents and restricted their ability to self-govern and utilize their experiential knowledge. Additionally, the institution’s circuits of accountability reflected ideals of front-line work that were inconsistent with staff’s perception of their responsibilities. These findings have implications for management and implementation of direct care in ICFs/IID and underscore the ...
Journal of Intellectual Disabilities, 2018
Institutionalized adults with profound intellectual disabilities (ID) face significant challenges... more Institutionalized adults with profound intellectual disabilities (ID) face significant challenges to having their choice-making cultivated and supported. Based on observational and interview data from an institutional ethnographic study, this article explores how choice-making during mealtimes is acknowledged and problematized by staff. First, we suggest that Foucauldian problematization offers a lens through which to better understand how mealtime intervention plans passed down over time become embodied restrictive practices. Second, we provide examples and analyses of mealtime negotiations between staff and residents. Analyses revealed staff infantilize and misrepresent residents’ choice-making during meals as manipulation; additionally, analyses suggest that past experiences of staff with residents and historical meal plans color how they acknowledge and interpret residents’ choices. Our argument is an attempt to move forward discussions concerning the implementation of quality h...
Career Development and Transition for Exceptional Individuals, 2018
Related services were examined for 1,400 racial/ethnic transitioning minorities enrolled in the N... more Related services were examined for 1,400 racial/ethnic transitioning minorities enrolled in the National Longitudinal Transition Study–2 database after adjusting for demographic and socioeconomic variables. Propensity methods balanced minorities (32%) and nonminorities (68%) on demographic and socioeconomic factors. Logistic regressions determined predictors of each outcome while incorporating propensity scores and survey weights. Education and income influenced more service receipt; whereas, percentage of persons with free or reduced lunch and minorities in high school had lower service receipt. After incorporating propensity scores, differences between minorities and nonminorities attenuated for occupational therapy and career counseling and increased for assistive technology with no services reaching significance after adjustment. Complex analyses incorporating socioeconomic factors best determine differences between racial/ethnic transitioning minorities with intellectual and de...
The Open Journal of Occupational Therapy, 2019
American Journal of Occupational Therapy, 2017
Date Presented 3/31/2017 This presentation discusses how participation in occupation for institut... more Date Presented 3/31/2017 This presentation discusses how participation in occupation for institutionalized adults with intellectual disabilities (ID) is textually mediated, emphasizing why the occupational concerns of adults with ID is an important area of practice and research for occupational therapists. Primary Author and Speaker: Khalilah Johnson Contributing Authors: Nancy Bagatell, Marjorie DeVault
Journal of Occupational Science, 2017
Occupational scientists posit that choosing and participating in occupation contributes to overal... more Occupational scientists posit that choosing and participating in occupation contributes to overall health and well-being. Yet institutionalized adults with intellectual disabilities (ID), a disability community with a long history of enduring grave injustices, continue to face barriers to selfdetermined participation. This paper draws on data from an institutional ethnographic study aimed to make visible the inter-relational ways national, state, and local policies mediate the possibilities to choose and participate in occupations for adults with ID. To explore the impact of state-mandated policies, data were collected in an intermediate care facility. Participants included seven adults diagnosed with profound ID and eight staff members. Participant observation, ethnographic interviews, and organizational texts (e.g., national and state mandates, and policies and procedures) were the main sources of data. Conceptual mapping was employed as an analytic process to connect participants' narratives back to the policies that coordinated their work in the facility. Analyses revealed that the policies guiding the provision of habilitative programming created a systematic regulation of participation in occupations of residents' and staff's choosing. More specifically, analyses demonstrated how policies placed greater value on routinization and efficiency over self-determined participation. These findings highlight the lack of opportunities for residents and staff to incorporate occupations of their choosing into the fabric of daily living in an institutional setting. Additionally, they call attention to the ways institutional routinization is a perpetuation of the historical notions of what adults with ID should do.
OTJR: Occupation, Participation and Health
Theater has long-standing roots in social justice and holds promise for reducing racist attitudes... more Theater has long-standing roots in social justice and holds promise for reducing racist attitudes and behaviors. Objectives of this study were to (a) collect and theatrically portray narratives from Black occupational therapy students and practitioners to a national audience and (b) examine the impact of the theatrical performance on anti-Black racism among attendees. The Identity Development Evolution and Sharing (IDEAS) model guided translation of narratives into a filmed performance. Paired t-test of pre/post administration of the Acceptance and Action Questionnaire–Stigma (AAQ-S) measured changes in stigma beliefs. Qualitative thematic analysis of an open-ended post-survey question elucidated experiences of the performance. The performance engendered significant decreases in stigma; qualitative data elucidated potential mechanisms of change. This study provides insight into experiences of anti-Black racism within occupational therapy and offers a promising means for occupational...
The American Journal of Occupational Therapy
In the wake of sociopolitical movements to address health inequities and race-based violence in t... more In the wake of sociopolitical movements to address health inequities and race-based violence in the United States, there have been calls to take up antiracist practices in the occupational therapy profession. This call aligns with Vision 2025 and requires intentional dialogue and instruction on racism and antiracism, beginning in occupational therapy academic programs. Although it is important to engage in discussions on racism and antiracism, it is equally imperative that members of the profession take action to ameliorate the consequences of racism. In this column, we argue for the need for occupational therapy educators to take immediate action. We provide specific recommendations and strategies to broach these topics, examples of classroom activities, and practical approaches for translating these skills to fieldwork settings. Continued work is needed to establish robust policies and practices to ensure that all occupational therapy program graduates enter the workforce prepared...
If you are a doctoral student, you know a postdoc is likely your next step following graduation, ... more If you are a doctoral student, you know a postdoc is likely your next step following graduation, but do you know how to choose a postdoc that will help you accomplish your career goals? Do you know what you want from a postdoc, or how to find one? Through a panel discussion, learn from Dr. John Ryan, Associate Vice President for Research Development and head of the office of Postdoctoral Scholars at VCU, as well as a number of successful postdocs, about what you need to do to pick the best postdoc for you. This session is co-sponsored by VCU Career Services
The overall aim of this dissertation was to determine how the daily operations and institutional ... more The overall aim of this dissertation was to determine how the daily operations and institutional structures of an Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) coordinate what residents and staff do. The specific aims were to (1) identify and describe the daily operations and institutional practices of the facility; (2) identify and describe the activities of the residents and staff; and (3) identify and describe how the opportunities for residents to choose and participate in meaningful activities were affected by institutional operations and culture. Institutional ethnography was applied as a social theory and methodology. Data were collected over 14 weeks with seven residents with profound ID and eight staff members. Data collection methods included participant observation, ethnographic interviewing, and text work. Conceptual mapping and narrative analysis were employed as iterative and reflexive processes to systematically extract narrative ...
Inclusion, 2021
A nuanced understanding of disparities impacting racialized people with intellectual and developm... more A nuanced understanding of disparities impacting racialized people with intellectual and developmental disabilities (IDD) requires scholars employ research methods that make visible the structural factors that influence outcomes. Following the work of Tukufu Zuberi and Eduardo Bonilla-Silva, we explore race-based methodological considerations for disparities research with Black people with IDD. Specifically, we discuss (a) structural racism in research methods, employing disability critical race theory as a framework, (b) the absence of Black voices and Black scholarship, (c) the abstraction and misuse of race as a variable, and (d) mapping race as a point of discussion in the IDD discourse. Implications for research are discussed and recommendations for contextualizing race, ensuring equity in representation and dissemination, and amplifying the voices of Black scholars are provided.
Occupational Therapy in Acute Care, 2nd Edition, 2017
Autism in Adulthood, 2020
The American Journal of Occupational Therapy, 2021
Importance: Occupational therapy practitioners use a range of habilitative and compensatory appro... more Importance: Occupational therapy practitioners use a range of habilitative and compensatory approaches to teach new skills or modify tasks and environments to address occupational performance among adults with intellectual disability (ID); therefore, they must identify and use available evidence to guide intervention planning. Objective: To summarize the scope of evidence that can inform occupational therapy intervention with adults with primary or comorbid ID. Data Sources: Articles published in peer-reviewed journals between January 2002 and January 2018 and indexed in PubMed, CINAHL, PsycINFO, and Scopus. Study Selection and Data Collection: A total of 159 articles met inclusion criteria and contained information on occupational therapy intervention with adults ages 18 yr or older with primary or coexisting ID. Findings: Fifty-seven of the 159 articles focused on intervention to address occupational performance outcomes (i.e., employment, self-care, leisure and social interaction...
The American Journal of Occupational Therapy, 2021
Importance: Occupational therapy practitioners use structured assessment tools to gather informat... more Importance: Occupational therapy practitioners use structured assessment tools to gather information from adults with intellectual disability (ID) in order to develop the occupational profile, guide occupational therapy intervention, and assess change over time. Objective: To identify occupational therapy–related tools in the peer-reviewed literature for use in practice with adults with ID. Data Sources: Peer-reviewed literature published between January 2002 and January 2018 included in CINAHL, PsycINFO, PubMed, and Scopus. Study Selection and Data Collection: The review included articles that had information on occupational therapy–related assessment with adults 18 yr or older who had primary or co-occurring ID. Findings: Fifty-eight articles identified 73 occupational therapy–related assessment tools. Conclusions and Relevance: This scoping review identified a broad range of assessment tools in the occupational therapy domain that are appropriate for adults with ID, some of which...
The American Journal of Occupational Therapy, 2021
Importance: Adults aging with intellectual and developmental disabilities (IDD) continue to face ... more Importance: Adults aging with intellectual and developmental disabilities (IDD) continue to face barriers to participation in meaningful occupation; moreover, the increased life expectancy of adults with IDD intensifies the need for age- and environment-specific support. Objective: To map and categorize transdisciplinary literature on environmental modifications and supports for adults aging with IDD. Data Sources: Studies published between January 1, 2000, and January 1, 2019, identified through PubMed and Scopus. Study Selection and Data Collection: Eleven articles met the inclusion criteria and contained information specific to occupational participation based on environmental modification (e.g., physical space, technology, universal design, type of living setting), social supports (e.g., family members, caretakers, peer groups, health care professionals, policies, organizational infrastructure), or both and adults age ≥35 yr with IDD. Findings: Eleven studies met the criteria fo...
Journal of Occupational Science, 2020
Journal of Occupational Science, 2020
In the summer of 2020, the death of George Floydyet another unarmed Black man killed at the hands... more In the summer of 2020, the death of George Floydyet another unarmed Black man killed at the hands of policethrust race and racism to the forefront of public attention in the United States. Across the country, demonstrators and protestors mobilized to end police brutality, one mechanism of systemic racism in this country's history and present. As this paper explores, occupation too has played a role in the systemic racism against Black people in the United States. In recent years, occupational scientists have critiqued tacit assumptions regarding the qualities and effects of occupation. The following examination contributes to this growing body of critical literature and considers that occupation can be a vehicle for injustice as much as justice. By investigating the construction of race and the dissemination of racism, including its propagation through everyday living, the role of occupation in community formation and development is more fully understood. In pursuing this goal, we hope to reveal the real and often unacknowledged history of racism in the United States that must be recognized and confronted to move toward reconciliation, healing, and social transformation. This exploration uncovers powerful moments when occupation and everyday doing were conduits through which racism was constructed and calls upon occupational scholars to be reflective and critical in their research and practice in order to optimally support the people they serve.
Intellectual and Developmental Disabilities, 2019
Case management (CM) is one of the most commonly used services by individuals with intellectual a... more Case management (CM) is one of the most commonly used services by individuals with intellectual and developmental disabilities (IDD), but little is known about the workers who provide CM. This study used a mixed methods approach to gain understanding of the CM workforce in one U.S. state. An online survey was completed by 35 IDD service directors (87.5% of directors in the state); and 113 CMs and CM supervisors participated in semistructured interviews and focus groups. Results indicated an annual crude separation rate of 28.2%, and participants often complained that turnover resulted in caseload sizes that prevented optimal outcomes for people with IDD. A limited applicant pool, duties focused on regulatory compliance, and inadequate wages were cited as major challenges for CMs.
Work, Employment and Society, 2019
This article explores how circuits of accountability impact front-line service work in an interme... more This article explores how circuits of accountability impact front-line service work in an intermediate care facility for individuals with intellectual disability (ICF/IID). Institutional ethnography as a theory and methodology guided the data collection and analysis processes. Participant observation and interviews were completed, and text work was employed to make visible the ways staff enacted what they believed to be their roles and responsibilities. Results indicated the service criteria established by regulatory agencies were interpreted and executed in ways that negatively influenced staff’s moral care to residents and restricted their ability to self-govern and utilize their experiential knowledge. Additionally, the institution’s circuits of accountability reflected ideals of front-line work that were inconsistent with staff’s perception of their responsibilities. These findings have implications for management and implementation of direct care in ICFs/IID and underscore the ...
Journal of Intellectual Disabilities, 2018
Institutionalized adults with profound intellectual disabilities (ID) face significant challenges... more Institutionalized adults with profound intellectual disabilities (ID) face significant challenges to having their choice-making cultivated and supported. Based on observational and interview data from an institutional ethnographic study, this article explores how choice-making during mealtimes is acknowledged and problematized by staff. First, we suggest that Foucauldian problematization offers a lens through which to better understand how mealtime intervention plans passed down over time become embodied restrictive practices. Second, we provide examples and analyses of mealtime negotiations between staff and residents. Analyses revealed staff infantilize and misrepresent residents’ choice-making during meals as manipulation; additionally, analyses suggest that past experiences of staff with residents and historical meal plans color how they acknowledge and interpret residents’ choices. Our argument is an attempt to move forward discussions concerning the implementation of quality h...
Career Development and Transition for Exceptional Individuals, 2018
Related services were examined for 1,400 racial/ethnic transitioning minorities enrolled in the N... more Related services were examined for 1,400 racial/ethnic transitioning minorities enrolled in the National Longitudinal Transition Study–2 database after adjusting for demographic and socioeconomic variables. Propensity methods balanced minorities (32%) and nonminorities (68%) on demographic and socioeconomic factors. Logistic regressions determined predictors of each outcome while incorporating propensity scores and survey weights. Education and income influenced more service receipt; whereas, percentage of persons with free or reduced lunch and minorities in high school had lower service receipt. After incorporating propensity scores, differences between minorities and nonminorities attenuated for occupational therapy and career counseling and increased for assistive technology with no services reaching significance after adjustment. Complex analyses incorporating socioeconomic factors best determine differences between racial/ethnic transitioning minorities with intellectual and de...
The Open Journal of Occupational Therapy, 2019
American Journal of Occupational Therapy, 2017
Date Presented 3/31/2017 This presentation discusses how participation in occupation for institut... more Date Presented 3/31/2017 This presentation discusses how participation in occupation for institutionalized adults with intellectual disabilities (ID) is textually mediated, emphasizing why the occupational concerns of adults with ID is an important area of practice and research for occupational therapists. Primary Author and Speaker: Khalilah Johnson Contributing Authors: Nancy Bagatell, Marjorie DeVault
Journal of Occupational Science, 2017
Occupational scientists posit that choosing and participating in occupation contributes to overal... more Occupational scientists posit that choosing and participating in occupation contributes to overall health and well-being. Yet institutionalized adults with intellectual disabilities (ID), a disability community with a long history of enduring grave injustices, continue to face barriers to selfdetermined participation. This paper draws on data from an institutional ethnographic study aimed to make visible the inter-relational ways national, state, and local policies mediate the possibilities to choose and participate in occupations for adults with ID. To explore the impact of state-mandated policies, data were collected in an intermediate care facility. Participants included seven adults diagnosed with profound ID and eight staff members. Participant observation, ethnographic interviews, and organizational texts (e.g., national and state mandates, and policies and procedures) were the main sources of data. Conceptual mapping was employed as an analytic process to connect participants' narratives back to the policies that coordinated their work in the facility. Analyses revealed that the policies guiding the provision of habilitative programming created a systematic regulation of participation in occupations of residents' and staff's choosing. More specifically, analyses demonstrated how policies placed greater value on routinization and efficiency over self-determined participation. These findings highlight the lack of opportunities for residents and staff to incorporate occupations of their choosing into the fabric of daily living in an institutional setting. Additionally, they call attention to the ways institutional routinization is a perpetuation of the historical notions of what adults with ID should do.