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Evolved Living Podcast

Evolved Living Podcast

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

josiejarvisot.substack.comDr. Josie Jarvis OT Sozialwissenschaften Wissenschaft
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  • 🌿 Beyond the Hierarchy: Rethinking Evidence in Occupational Therapy

    🌿 Beyond the Hierarchy: Rethinking Evidence in Occupational Therapy
    Oct 27 2025
    When I first learned about evidence-based practice, I remember staring at that glossy triangle — the research hierarchy pyramid — with meta-analyses gleaming at the top like sacred scripture.It was comforting at first. Finally, a clear map of what counts as truth.But once I entered practice, that tidy hierarchy started to crumble under the weight of real people’s lives.Human beings aren’t controlled variables, and occupation doesn’t fit neatly into double-blind trials.The Trouble with the Old PyramidThe traditional Evidence-Based Practice (EBP) pyramid was built for biomedical and pharmaceutical research, where the goal is to test isolated variables across large populations (Duke University Medical Center Library, n.d.).That works beautifully when you’re measuring how a medication lowers blood pressure.But occupation is not a pill — it’s a process.It’s meaning, context, motivation, and environment woven together.In OT, our “data set” is often one person at a time — a life lived in context.Trying to flatten that into a universal protocol often means losing what makes our work effective and human.The Tomlin & Borgetto Research Pyramid: A Model That Fits Our FieldIn 2011, George S. Tomlin and Brandon Borgetto published Research Pyramid: A New Evidence-Based Practice Model for Occupational Therapy in The American Journal of Occupational Therapy (Tomlin & Borgetto, 2011).They didn’t just redraw the pyramid — they reimagined what evidence could look like.Their four-sided model includes:* Descriptive research — defining and observing occupational phenomena (the foundation).* Experimental research — asking causal questions under controlled conditions.* Outcome research — measuring effectiveness and impact in practice settings.* Qualitative research — exploring lived experience, culture, and meaning.Each side contributes uniquely to a full picture of occupational reality.Rather than stacking these methods into a hierarchy, Tomlin and Borgetto framed them as mutually reinforcing, like the faces of a pyramid that meet at the top — where evidence becomes practice.“Rather than ranking designs by hierarchy, the research pyramid encourages practitioners to evaluate rigor based on the type of question being asked.”— Tomlin & Borgetto (2011, p. 190)Why This Matters in PracticeIn home health, I’ve seen firsthand how rigid hierarchies undervalue the evidence that actually drives change.An RCT can tell me which exercise statistically improves shoulder flexion — but not whether my client can now garden with her grandchildren, or return to painting without pain.Occupational therapy lives where biology meets biography.To serve people well, we need research frameworks that make room for both.The Critiques That Strengthen UsScholars such as Gallew (2016) argue that the old hierarchy often silences the very forms of knowledge that make OT powerful — narrative, context, creativity.When we measure success only by quantitative control, we risk missing the human story.Occupational science reminds us that people are meaning-making beings.Our science must be capable of holding that complexity.How I Apply the Tomlin & Borgetto Pyramid* For mechanical reliability, I turn to experimental studies.* For real-world effectiveness, I consult outcome research.* For understanding experience, I value qualitative inquiry.* And at the root of it all, I rely on descriptive studies to ground my reasoning.Each approach has a place.Evidence becomes less about hierarchy and more about harmony — a dynamic ecosystem of knowing.Reclaiming Evidence as a Living PracticeEmbracing this model isn’t about lowering standards; it’s about broadening the lens.It validates community programs, arts-based methods, trauma-informed care, and culturally grounded interventions that might never fit into traditional RCTs.When we expand what counts as evidence, we expand what’s possible — for our clients, our profession, and the world we’re helping to rebuild.🌿 Learn More: Foundations of Occupational Science for U.S.-Based OTPsIf this conversation sparks something in you — the urge to better understand why occupational therapy feels different from other disciplines and how to ground that difference in research and policy — I invite you to join me inside Foundations of Occupational Science for U.S.-Based OTPs.This self-paced capstone learning experience bridges theory and practice, guiding practitioners and students to:* Decode the real meaning and application of the Tomlin & Borgetto Research Pyramid.* Integrate occupational science concepts into documentation, advocacy, and program design.* Reclaim OT’s creative and psychosocial roots while navigating contemporary U.S. systems.* Build confidence in articulating the full scope of practice — in language policymakers, payers, and interdisciplinary teams understand.You can explore the course and all current offerings here:👉 ...
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    13 Min.
  • 🌿 “Reclaiming the Roots of Care: Witches, Midwives, and Nurses—Reviving the Feminine Lineage of Healing through Occupation.”

    🌿 “Reclaiming the Roots of Care: Witches, Midwives, and Nurses—Reviving the Feminine Lineage of Healing through Occupation.”
    Oct 26 2025
    This month, I’m inviting occupational therapists, assistants, students, and allies to join a special conversation and art-making circle:🌿 “Reclaiming the Roots of Care: Witches, Midwives, and Nurses—Reviving the Feminine Lineage of Healing through Occupation.”Together we’ll trace the story of how our field—and the U.S. medical system itself—was built on both the wisdom and the erasure of women, craftspeople, and community healers.🔥 A Forgotten Lineage of OccupationBefore “occupational therapy” was a profession, it was a practice of communal survival.Herbalists, weavers, potters, midwives, and caregivers used occupation—the everyday work of hands, heart, and imagination—to restore rhythm and balance in their communities. These were the first practitioners of holistic health. Their medicine was relational, cyclical, and often communal.But as Barbara Ehrenreich and Deirdre English so sharply remind us in Witches, Midwives, and Nurses, the rise of industrialized medicine and patriarchal institutions criminalized and professionalized care—pushing women, poor people, and folk practitioners out of authority.That legacy persists today in how our systems undervalue both the crafts of care and those who carry them.🩺 The Occupational Therapy ConnectionOccupational therapy was born from the same soil as these folk practices:the moral treatment movement, the arts and crafts movement, and the belief that doing—making, creating, and belonging—heals.Yet, in today’s medical hierarchies, OT remains one of the most undervalued disciplines—our relational, craft-based, and psychosocial roots often sidelined in favor of “productivity metrics” and “efficiency scores.”We see it in the divestment from community programs, the burnout of first responders, and the shrinking access to care.Just as women healers were once pushed out of medicine, today OTs, PTs, and nurses face systemic devaluation.It’s the same story—different century.🌾 Why This Matters NowWe’re living through an era of healthcare collapse and collective burnout.Medicare cuts, staffing shortages, and inaccessible insurance structures are leaving entire communities without care.When institutional medicine retracts, folk medicine revives.We’re already seeing this—through herbalism, creative arts, community mutual aid, and occupation-based micro-healing collectives.Occupational therapists have the power to become the bridge between regulated healthcare and ancestral care:to hold dignity, skill, and accessibility where the system no longer reaches.🌙 What We’ll Explore in This GatheringIn this 90-minute virtual reflection and collective art-making session, we’ll:🕯️ Read and reflect on excerpts from Witches, Midwives, and Nurses (Ehrenreich & English, 1973).🎨 Create simple symbolic art—our “Window Between Worlds”—to honor the silenced healers in our lineages.🪶 Explore how OT’s founders carried forward folk-craft medicine under the language of “occupation.”💬 Share reflections on how today’s clinicians can reclaim and protect those roots amid healthcare divestment.🌱 Discuss how reviving folk practices—community weaving, kitchen herbalism, neighborhood arts—can complement and extend our scope of meaningful care.💌 An Invitation to RememberIf you’ve ever felt the ache of doing too much in systems that care too little,or if you’re yearning to reconnect your professional role with your deeper lineage as a healer, maker, and witness—this space is for you.Join us as we remember that the future of care may not lie in the systems we built, but in the occupations that built us.On Sunday, November 2 (2:30–4:00 PM PT), I’m hosting a free virtual book circle exploring these roots through the lens of Witches, Midwives & Nurses — a short, powerful feminist classic that uncovers the haunting origins of U.S. healthcare and what they reveal about our present.You can join live via Skool:👉 Event link: https://www.skool.com/live/dJLMncrh6hX🕯️ When: Sunday, Nov 2 | 2:30–4:00 PM PT🇦🇺 Monday, Nov 3 | 9:30–11:00 AM AEDT💻 Virtual on Skool📖 Access the book (quick + free):• Free PDF* Text Without Pictures:• Independent Publisher → https://www.feministpress.org/books-n-z/witches-midwives-nurses-second-edition• Kindle/Audiobook → https://a.co/d/1oZu9zOCome as you are — even if you haven’t read it all. Presence matters more than perfection.References & Further Reading* Ehrenreich, B., & English, D. (1973). Witches, Midwives, and Nurses: A History of Women Healers. Feminist Press.✨ Closing ReflectionWhen systems collapse, it’s not the sterile rooms that survive—it’s the kitchens, the gardens, the song circles, and the hands that remember how to make.Occupational therapy has always been a revival movement disguised as a profession.Now is our time to remember. This is a public episode. If you would like to discuss this with other subscribers ...
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    5 Min.
  • Building Our Own Tables: A Response to “The Seat at the Table Fallacy”

    Building Our Own Tables: A Response to “The Seat at the Table Fallacy”
    Oct 26 2025
    Last week I reacted live to a powerful post shared by Bill Wong in our community. The article in question — “Occupational Therapy and the ‘Seat at the Table’ Fallacy” by ABC Therapeutics — suggests that the push for higher credentials in OT (e.g., mandatory OTD) has been mis-directed:“A degree doesn’t grant influence. Credentials open doors, but they don’t dictate what happens once you step through them … A ‘seat at the table’ means very little if the table itself was built by someone else.” ABC TherapeuticsIt’s a critique worth hearing. But it’s also an invitation—not to retreat—but to re-vision how we approach our profession.The core tensionThe article argues:* Many OTD programs replicate existing content under new credentials, without generating genuine contribution. ABC Therapeutics* Visibility campaigns (hashtags, social media posts) risk being “toothless” when they lack scalable frameworks or evidence. ABC Therapeutics* We have long sought a seat at others’ tables rather than designing our own tables.You’ll hear echoes of that critique in my video: I reflected on how OT education, biomechanics-dominated models, and reimbursement systems have siloed us—and how that matters for people with disabilities, for social justice, and for innovation.My take: Let’s build AND sit1. Building our own tablesYes—the article is right: credentials alone don’t guarantee influence. But I take that as a call to action. We need to:* Design models where OT is not just invited, but indispensable (policy, systems, community, creative arts)* Co-create the future with interdisciplinary, cross-cultural, and justice-oriented partners* Use our degrees (OTD or otherwise) to contribute—not just credential-inflate2. Recognizing the invisible tables people actually builtOT’s lineage includes folks who built their own tables: moral treatment movement, arts & crafts interventions, community-based rehabilitation, disability justice activism. In my video I referenced how we’re responding to human rights crises, climate, trans / disability access barriers—these aren’t “outside” OT—they’re core.3. Expanding practice beyond the “biomechanical king of the castle”The article critiques that OTD programs default to clever “hobbie” capstones (“OT in football”, hashtag activism) without rigor or depth. My sympathy to the students who poured their hearts and best work in to their first major OT project. Perhaps some encouragement and support for the potential of their future work is also in order. I can’t tell how much more difficult contributing to the advancement of one’s field without the support or encouragement or belief in possibilities from one’s elders also want to offer what depth and rigor can also look like:* Confronting systems of oppression (transphobia in toileting access, disability justice, policy literacy)* Measuring participation, identity, belonging—not just ROM, strength, task time* Using community arts, folk craft, cross-generation dialogue as legitimate knowledge translation pathwaysWhy this matters—especially now* People with disabilities face occupational deprivation, systemic barriers, and need OT thinking that goes beyond physical rehab.* The U.S. health-human services system is stressed; OT’s value-add includes bridging discipline silos, addressing context, and enabling participation.* New generations (Gen Z, Gen Alpha) bring fresh epistemologies. If we insist on “sit at the table”, we risk boxing their potential. My mantra: “Make room for the next table-builders.”An invitation to youIf you resonate with any of these questions:* How might OT design a new table rather than merely trying to sit at one?* What kind of praxis (not just theory) can we commit to that spans social justice, policy literacy, community arts, and cross-cultural collaboration?* Can we mentor and co-create with newer cohorts, rather than gate-keep?Then join me. Let’s build Evolved Living OT/OS Collaborative as a space for these conversations and creations.ReferenceABC Therapeutics. (2025, October 17). Occupational Therapy and the ‘Seat at the Table’ Fallacy. Retrieved from https://abctherapeutics.blogspot.com/2025/10/occupational-therapy-and-seat-and-table.html This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit josiejarvisot.substack.com
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    16 Min.
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