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When it comes to diversity, equity, and inclusion, the physical therapy profession has an "intercultural developmental disability," according to Lisa VanHoose, PT, PhD, MPH, who delivered the third annual Lynda D. Woodruff Lecture. During her presentation, VanHoose made it clear that she believes it's high time to take ownership of that disability and work to overcome it by recasting the very concepts of DEI from aspiration into action.

Titled "DEI Fatigue? RST Is the Intervention (Representation, Sankofa, and Trustworthiness)," VanHoose's lecture centered on how the physical therapy profession is in danger of stalling out in its efforts to create more just and inclusive environments. Through a combination of research-grounded insights, candid assessments, and recommendations on a path forward, VanHoose made the case for urgent action to address what she described as "structural and functional impairments" that are limiting the profession's ability to act.

The lecture was the third in an annual series named in honor and memory of Woodruff, a physical therapy leader and advocate, and longtime APTA member. Sponsored by APTA, the American Council of Academic Physical Therapy, American Academy of Physical TherapyAPTA Academy of Education, National Association of Black Physical Therapists, and Physical Therapy Learning Institute, the event also recognizes Juneteenth.

At the heart of VanHoose's presentation was the concept of "DEI fatigue," a term used to describe any stress associated with DEI efforts in organizations, but that manifests itself in what VanHoose described as a "subtle resistance [to DEI efforts] that may erode workplace performance." This resistance can surface as a lack of participation in or enthusiasm for DEI initiatives, a sense of general disillusionment about progress, or even discouragement of DEI efforts, she said.

VanHoose said that if she were asked to assess the current level of DEI fatigue in the profession on a 0-10 scale with 10 being the worst possible fatigue, she'd give physical therapy an 8. "I do feel like there's probably more resistance than we are willing to acknowledge as a profession," she said.

The reasons behind the profession's DEI fatigue are rooted in what VanHoose believes is a fundamental imbalance in approach: For all the thinking, discussion, and initiatives that have taken place, the profession has not nurtured a value of enablement — what she describes as the "heart" of DEI.

"DEI is not our heart work as a profession," VanHoose said. "It may be our hands. It may be our head work. But I don't feel like it's our heart work."

VanHoose believes the resultant fatigue has ramifications that touch on physical, social, psychological, and spiritual elements — everything from being short on time and resources, to difficulties in holding to long-term commitments, to a general lack of interest or motivation.

The lack of attention to "heart work" has created a condition within the physical therapy profession that VanHoose calls an "intercultural developmental disability." The pressing issue, she told viewers, is to find out whether this disability is transient or permanent—and the only way to do that is through an intervention that stresses enablement.

"I feel like DEI has only taken us so far," VanHoose said. She urged viewers to move on from "diversity" to "representation," from "equity to Sankofa," and from "inclusion" to "trustworthiness."

VanHoose explored each shift, sometimes offering examples of how the concepts might be embodied by real-world actions.

Representation could be reflected through more transparency in identifiers for physical therapy faculty, staff, student, and leadership that could be compared with similar identifiers for educational programs, clinics, journals, and professional organizations, VanHoose said. In addition, APTA could publish what she described as a "communication guide for the evaluation of deficit-based language" in a range of education, member, and marketing materials; and the Commission on Accreditation in Physical Therapy Education could press programs "to assess and address representation among faculty, staff, and students."

Sankofa — the concept of bringing knowledge gained in the past into the present as a tool for making progress — could be embraced by paying particular attention to the insights of the second annual Woodruff lecture by Charlene Portee, PT, PhD, VanHoose said. She also recommended increasing access to past organizational datasets that could inform future directions, launching an APTA-sponsored institutional review board to guide research, and expanding the types of support that could be provided through the PT Fund beyond scholarships, among other initiatives. "Equity cannot be achieved without Sankofa," VanHoose said.

Trustworthiness, linked to the development of a "trust climate," is the pathway to true engagement, according to VanHoose. But that key element can only be achieved through inclusion, which she described as "the moderator of trust." Trustworthiness can be further broken down into three fundamental areas of belief held by the trustor: that their object of trust is capable of doing what is promised, that the object of trust truly cares about the trustor, and that the object of trust adheres to an acceptable moral code.

While trustworthiness is key to overcoming DEI fatigue, VanHoose reminded viewers that it's not a given.

"I do believe that for those of us who represent minoritized, marginalized communities, we have had to live in a world where we try to have more hope and more trust," VanHoose said. "But I do feel a tide is turning where people are done. They're done handing out trust to those who are not trustworthy. So use that trust and recognize it as a gift. It is not a requirement — it's a gift."

VanHoose's presentation was followed by a panel discussion moderated by Julian Magee, PT, DPT, ATC, and including Emmanuel B. John, PT, DPT, PhD, MBA, MPH; Tim Vidale, PT, DPT, MBA; and Adrienne N. Pinkney, PT, DPT, PhD.

A recording of the lecture and discussion is available for free viewing. The first and second annual Woodruff lectures, "Who Do We Want To Be? Responsible Stewardship of Our Profession" by Gregory Hicks, PT, PhD, FAPTA; and "The Road to Success: Are We Ready to Change Direction?" by Charlene Portee, PT, PhD, are also available.

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