Abstract
This article provides a lens through which occupational therapy practitioners (OTPs) can support immigrants seeking asylum in the United States. We argue that navigating legal services is a critical entry point where OTPs can collaborate with asylum seekers and legal aid organizations. While existing literature addresses occupational therapy assessments and interventions for this population, few studies emphasize how OTPs can assist asylum seekers in navigating the legal system to secure rights that enable safe participation in essential occupations such as work, education, social engagement, and leisure. To address this gap, we propose three strategies: (1) building partnerships with legal aid organizations, (2) conducting ongoing needs assessments with legal organizations and asylum seekers, and (3) collaborating to provide occupation-based resources and care. Partnerships among OTPs, asylum seekers, and legal professionals foster knowledge exchange and holistic, client-centered, evidence-based support. Legal experts offer insight into structural barriers; asylum seekers contribute lived experience and personal strengths; OTPs bring expertise in promoting participation and wellbeing through meaningful activity. Recognizing that asylum seekers often face systemic obstacles to daily engagement, we position legal navigation as a critical focus for OTPs. By outlining actionable strategies, this article equips OTPs to deliver responsive, justice-oriented care tailored to asylum seekers’ lived realities.
Synopsis & Plain Language Summary
People seeking asylum in the United States often live for months or years without legal protection, stable housing, or permission to work. This uncertainty makes it hard to take part in everyday activities that support health and wellbeing, such as working, going to school, caring for family, or building community connections. Occupational therapy practitioners (OTPs) are trained to support people's participation in daily life, yet their role in helping asylum seekers navigate the legal system has received little attention.
This article highlights legal navigation as an important and often overlooked area where OTPs can support asylum seekers. Access to legal services is often the gateway to safety, stability, and participation in meaningful daily activities. When people cannot navigate the legal system, they face ongoing barriers that affect their routines, roles, identity, and health.
The article proposes three practical ways OTPs can help: building partnerships with legal aid organizations, regularly identifying needs alongside asylum seekers and legal teams, and using storytelling to support healing and increase understanding among healthcare providers, communities, and policymakers. These approaches recognize asylum seekers as experts in their own lives and emphasize collaboration rather than one-size-fits-all solutions.
By working alongside legal professionals and asylum seekers, OTPs can help reduce barriers to daily life while promoting dignity, participation, and wellbeing. This article offers a justice-focused framework to guide occupational therapy practice that is responsive to the real-life challenges asylum seekers face as they pursue safety and belonging.
Occupational Justice is Not a Luxury. It is a Human Right
Background
OTPs are fundamentally committed to occupational justice, the belief that every person—regardless of background, ability, or circumstance—deserves the opportunity to engage in meaningful activities that support health, identity, and belonging (AOTA, 2020). This commitment goes beyond clinical care; it is a social and ethical stance that challenges systems of exclusion and advocates for equitable access to work, education, leisure, and community participation. OTPs recognize that when individuals are denied these opportunities—whether due to poverty, discrimination, disability, or displacement—their wellbeing suffers. The profession's holistic, client-centered approach positions therapists as powerful agents of change, especially for those whose lives have been disrupted by injustice (Suarez-Balcazar et al., 2023).
Occupational injustice refers to situations where individuals or groups are prevented from engaging in meaningful activities—known as “occupations”—that promote health, wellbeing, and a sense of purpose (Whiteford et al., 2018). Occupational injustices often stem from social, economic, political, or cultural factors beyond the individual's control and have negative impacts on health and identity (Townsend & Wilcock, 2004). At best, being unable to engage in meaningful occupations can lead to mental distress and reduced life satisfaction. At worst, it can result in occupational deprivation, which refers to circumstances that deny people the opportunity to participate in activities that are essential to their survival and/or identity (Whiteford et al., 2018) (Table 1).
Types of Occupational Injustice.
Note. Adapted from Townsend and Wilcock (2004).
Asylum Seekers in the United States Face Grave Occupational Injustices
Migrants, refugees, and asylum seekers all cross-international borders in pursuit of safety, opportunity, or improved living conditions, yet they differ markedly in their reasons for migration, legal status, and access to rights and protections. Migrants are individuals who move either voluntarily or involuntarily—most often for economic, educational, family, or lifestyle reasons—and their legal status and access to benefits vary widely by country and visa type (Erdal & Oeppen, 2020). Refugees, by contrast, are forcibly displaced due to war, persecution, or other serious threats, have demonstrated a well-founded fear of harm, and are formally recognized and protected under international law, including the 1951 Refugee Convention (Ahmad et al., 2023). Asylum seekers occupy a uniquely precarious and liminal position: they are individuals who have fled danger and applied for protection but are still awaiting a legal determination of their status (Domínguez et al., 2022). Unlike recognized refugees, asylum seekers must navigate complex legal systems to prove their eligibility for protection, often while facing restricted access to employment, housing, healthcare, and social services, and the ongoing risk of deportation if their claim is denied (Doctors without Borders, 2022). This prolonged uncertainty heightens vulnerability to occupational injustices, making targeted supports—such as legal assistance, mental health care, stable housing, and opportunities for community integration—especially critical. Supplemental Table 1 provides a comparative overview of migrants, asylum seekers, and refugees across key dimensions, including reasons for migration, voluntariness, legal recognition, rights, and protections.
Argument
Occupational Therapy for Asylum Seekers
Asylum seekers in the United States are often in legal limbo for months or years, navigating trauma, uncertainty, and systemic barriers that hinder their opportunities to participate in everyday life (Domínguez et al., 2022). This precarity has been further exacerbated by recent U.S. policy shifts, including the termination or proposed termination of Temporary Protected Status (TPS) for multiple national groups, which has placed hundreds of thousands of individuals at renewed risk of job loss, housing instability, and deportation. Although TPS is distinct from asylum, many asylum seekers and mixed-status families have relied on TPS as a critical form of humanitarian protection and work authorization; its removal intensifies insecurity across immigrant communities and deepens barriers to occupational participation (Vermont Asylum Assistance Project, 2026).
Legal uncertainty is also heightened by ongoing changes to employment authorization for asylum seekers. While asylum seekers may apply for work authorization during the pendency of their claims, access to Employment Authorization Documents has become increasingly unstable due to shifting eligibility rules, extended waiting periods, increased filing fees, and the elimination or reduction of automatic extensions for some applicants. As a result, many asylum seekers experience prolonged periods without the legal right to work, or face sudden gaps in authorization despite ongoing cases—conditions that directly undermine financial stability, mental health, and community integration (Doctors without Borders, 2022; Vermont Asylum Assistance Project, 2026). These policy dynamics reinforce the structural conditions that produce occupational injustice by restricting asylum seekers’ ability to engage in meaningful, productive, and socially valued roles.
Although current literature on occupational therapy practice for asylum seekers in the United States remains limited, existing studies highlight a growing recognition of the profession's role in addressing the complex needs of immigrants, including migrants, refugees, and asylum seekers (Im & Swan, 2022). For example, a scoping review by Cipriani et al. (2020) identified emerging evidence-based interventions tailored to these populations, including trauma-informed care, community integration strategies, and culturally responsive assessments such as the Refugees and Asylum Seekers Occupational Satisfaction (RASOS; Psychouli et al., 2023) assessment, which aims to measure occupational engagement and satisfaction. Evidence also emphasizes cultural responsiveness, recognizing the need to develop care plans not just for but with immigrants, and supports OTP interventions focused on rebuilding meaningful routines and adapting to new environments (Trimboli et al., 2024).
OTPs have provided effective services for promoting mental health, social participation, and independence through life skills training, vocational support, and community integration for immigrant populations (Bonham Corcoran et al., 2025). Arts-based interventions—such as visual arts, music, dance, and storytelling—have also emerged as powerful tools offered by OTPs, providing nonverbal avenues for emotional expression, cultural identity affirmation, and healing from trauma (Hintz & Lee, 2025; Oepen & Gruber, 2024). These creative modalities foster connection, reduce isolation and anxiety, and empower individuals to reclaim agency through self-expression. Supplemental Table 2 illustrates examples of how OTPs have partnered with community organizations to support immigrants, refugees, and asylum seekers, offering models that can inform future program development specifically tailored to asylum seekers experiencing prolonged legal and occupational precarity.
Despite promising outcomes, the literature identifies persistent barriers, including limited awareness of OTPs’ roles in supporting asylum seekers and the need for broader implementation across immigration, health, and social service systems (Canadian Association of Occupational Therapists, 2018). There remains a critical need for more U.S.-based research, interdisciplinary collaboration, and sustained advocacy to address the occupational consequences of restrictive immigration policies and to support asylum seekers in reclaiming meaningful roles and routines that promote health and dignity (Trimboli & Halliwell, 2018). This need is particularly urgent in the context of current U.S. immigration enforcement practices—including increased Immigration and Customs Enforcement raids, detentions, deportations, and the erosion of humanitarian protections such as TPS—which continue to threaten the safety, stability, and wellbeing of asylum seekers and their communities (Reader, 2025).
Action
Navigating the path to asylum is fraught with occupational injustices and complex occupational needs (Trimboli & Halliwell, 2018), but access to legal services stands out as a critical priority for OTP intervention. To establish collaborative partnerships with asylum seekers, OTPs must be equipped to embrace a truly holistic approach that is responsive to priorities communicated by asylum seekers. These may include mental, physical, emotional, spiritual, and psychological needs, but also to practical necessities such as transportation, food, shelter, childcare, social support, and tools to help sustain motivation, cognitive aptitude, and resilience throughout the asylum-seeking journey (Hintz & Lee, 2025; Winlaw, 2018). OTPs have comprehensive training across these domains and have demonstrated a longstanding commitment to occupational justice—illustrating a promising partnership for providing support to asylum seekers in navigating the legal system, which can lead to milestones such as obtaining a visa, or legal protections and rights that can unlock access to education, employment, housing, and other fundamental resources. 1 While not a replacement for changing the oppressive systems themselves, such support may help mitigate some of the impacts of systemic barriers to justice for asylum seekers.
Importantly, OTPs can also engage beyond the individual level to challenge and transform the oppressive systems that produce these barriers. This may include advocacy alongside asylum seekers, collaboration with legal and community organizations to address structural gaps in services, documentation of occupational injustices to inform policy reform, and participation in interdisciplinary efforts aimed at dismantling exclusionary practices embedded within immigration, healthcare, and social service systems. While individual-level support is not a replacement for systemic change, such actions can help mitigate and disrupt the impacts of structural inequities while contributing to broader efforts to advance occupational justice (Crooke, 2024).
However, even after obtaining protected legal status, policies, societal values, and beliefs that reinforce marginalization often persist, creating a prolonged trauma experience by sustaining environments in which occupational injustices continue to shape an asylee's daily life (Domínguez et al., 2022; Reader, 2025). Thus, adopting strategies—such as the narrative approaches described below—that explicitly attend to systemic, environmental, and contextual barriers is a critical and ongoing need to facilitate wellbeing and support sustained occupational participation for this population (Oepen & Gruber, 2024; Hou, 2023; Philip et al., 2025).
Occupational Therapy for Navigating Legal Services
We propose a three-tiered lens (Figure 1), informed by OTP literature and conversations with legal aid organizations and asylum seekers (Wasmuth et al., 2026) to guide OTP service provision for asylum seekers as they navigate the legal system: (1) establishing community-engaged partnerships with organizations providing legal aid; (2) conducting ongoing multisite needs assessments to cultivate and adapt occupational therapy care plans that are responsive to identified needs; and (3) narrative storytelling to promote healing among asylum seekers and, through intentionally crafted dissemination of these stories, increase insight and empathy among educators, students, policymakers, healthcare providers, and community members.
Tiers to guide occupational therapy for asylum-seekers navigating legal services.
Community-Engaged Partnerships
Establishing community-engaged partnerships with organizations that provide legal aid is a vital strategy for OTPs committed to working with asylum seekers and can help OTPs ensure their interventions are informed by the complex legal realities their clients face. These collaborations can illuminate systemic barriers that prevent asylum seekers from accessing meaningful occupations—such as work, education, and social participation—due to legal precarity and marginalization. Community engagement with legal organizations such as the Vermont Asylum Assistance Project (VAAP, n.d.) fosters a rich exchange of knowledge and the translation of evidence-based practices across disciplines. Legal professionals bring critical insights into the structural and procedural barriers that shape clients’ lived experiences, while OTPs contribute expertise in assessing the factors limiting and contributing to occupational participation and engagement (Ahmad et al., 2020). Both professions are deeply client-centered and committed to learning from and partnering with the clients they serve (Ahmad et al., 2023; AOTA, 2020). This collaborative work enables OTPs to tailor interventions that are not only clinically sound but also contextually relevant, aligning therapeutic goals with legal and personal realities. It creates opportunities to co-develop culturally responsive, trauma-informed approaches grounded in legal advocacy, occupational science, lived experiences, and OT practice. Through shared dialogue, case collaboration, and joint training, both fields can refine their practices, ensuring that evidence-based strategies are applied in ways that uphold human rights and advance occupational justice for this population (Winlaw, 2018). Additionally, both fields and the clients they work with may experience the benefits of interprofessional practice, such as shared goals, mutual respect, positive communication, and better outcomes (Bolton et al., 2021).
Multisite Needs Assessments
Multisite needs assessments conducted in collaboration with legal aid organizations offer a powerful lens for tailoring OT practice to the diverse realities of asylum seekers. By gathering data across multiple geographic and organizational contexts, therapists can identify patterns of occupational disruption, legal barriers, psychosocial stressors, and healthcare access impacts that vary by region, policy environment, and population demographics (United Nations High Commissioner for Refugees, 2021). These assessments can illuminate both shared and site-specific needs—such as access to housing, employment, education, or healthcare services—allowing OTPs to offer interventions that are locally responsive and culturally attuned. Legal aid partners contribute critical insights into procedural timelines, documentation challenges, and advocacy strategies, which help OTPs align their support with the legal journey of each client. For example, an OTP may assist an attorney by providing detailed descriptions of the lived experiences of asylum seekers and the impacts of trauma, injuries, and other personal or contextual factors that may impact both their daily life and their testimony. These rich descriptions may inform how attorneys present cases and may increase their knowledge and understanding of how an asylum-seeker may or may not testify during court proceedings. Ultimately, this collaborative, multisite approach fosters a dynamic feedback loop where evidence-based OTP services evolve in real time, grounded in the lived experiences and legal contexts of asylum-seeking communities.
Narrative Storytelling
Narrative storytelling is a powerful tool for bridging divides and humanizing complex issues like immigration (Philip et al., 2025). Never should asylum seekers bear the burden of educating U.S. populations on their experiences. However, numerous studies have illustrated how telling one's story has a generative power that goes beyond self-expression—it is a transformative act that can shape identity, build resilience, and spark collective change (D'Cruz et al., 2020; Wasmuth et al., 2023).
Occupational therapy is uniquely positioned to engage in narrative work because of its longstanding commitment to understanding people as occupational beings whose identities, health, and wellbeing are shaped through lived experience, context, and participation. OTPs are trained to attend to the meaning people assign to their daily activities, roles, and routines—making narrative not an adjunct to practice, but a foundational way of knowing. Unlike professions that primarily privilege symptom reduction, diagnosis, or cognition, OT centers the person-in-context and recognizes story as essential data for understanding how individuals live, adapt, and imagine their futures.
Narrative Storytelling and Story Making to Promote Healing
Narrative helps people make sense of their lives by transforming experiences into coherent stories. This process reveals patterns, assigns meaning, and restores agency—particularly following trauma. Narrative psychology suggests that telling one's story allows a person to shift from a passive character to the author of their life. Through this process, individuals can reclaim voice, reconstruct identity, and orient themselves toward possibility rather than rupture (Clarke & Mullings, 2022; Philip et al., 2025).
OTPs bring a distinctive lens to this work by situating narrative healing within everyday occupations. Rather than focusing solely on verbal recounting, OTPs attend to how stories are embodied, enacted, and reshaped through doing—through caregiving, work, play, advocacy, and community participation. This occupational focus allows narrative work to move beyond reflection toward action, supporting asylum seekers in integrating their stories into meaningful roles and future-oriented life projects. In this way, narrative becomes both a therapeutic process and a pathway to occupational justice.
Narrative to Increase Insight and Empathy
Many asylum seekers’ experiences—such as navigating prolonged legal uncertainty, facing cultural erasure, or living with chronic displacement—are unfamiliar or misunderstood by U.S. citizens who lack these lived realities. Narratives that foreground diverse voices disrupt monolithic assumptions (e.g., that all immigrants are refugees, or that all refugees are fleeing war) and illuminate the complexity and heterogeneity of asylum seekers’ experiences.
Narrative storytelling also fosters emotional resonance. When individuals share fears, hopes, and moments of joy, listeners engage at a human level, creating opportunities for empathy, humility, and self-reflection. Existing work in occupational therapy has used narrative storytelling through theater to invite audiences to examine their own assumptions, privileges, and positionality (Wasmuth et al., 2023). OTPs are particularly skilled in facilitating these exchanges because OT practice emphasizes relational engagement, reflexivity, and attention to power within therapeutic and community contexts (D'Cruz et al., 2020).
Narratives for OTPs and Healthcare Providers
For OTPs, attending to narrative is not merely a communication strategy—it is central to ethical, person-centered practice. Narrative engagement supports the development of strong therapeutic alliances grounded in cultural humility, shared decision making, and recovery-oriented care, all core values of occupational therapy. By listening to and co-constructing narratives, OTPs can better understand how asylum seekers’ occupational lives have been disrupted and how systems either enable or constrain participation (Wasmuth et al., 2023).
While other healthcare professionals may also value patient stories, OTPs uniquely translate narrative insight into occupational possibilities—adapting environments, redesigning routines, and supporting participation in meaningful activities. Narrative thus becomes a bridge between understanding and intervention, ensuring that care is responsive to lived realities rather than abstract categories.
Narratives for Policymakers
For policymakers and the community at large, listening to personal stories is a strategic and necessary step toward shaping effective, humane policy, and building resilient communities (Crow & Jones, 2018). Personal stories expose the disconnect between policy intentions and real-world outcomes. They highlight where systems fail and help policymakers avoid one-size-fits-all solutions by understanding the diversity of asylum seekers’ experiences. Stories challenge harmful assumptions and reduce stigma. They show asylum seekers not as statistics or political talking points, but as individuals with hopes, skills, and struggles.
OTPs can serve as vital intermediaries in this process. Grounded in both individual stories and systemic analysis, OTPs are well positioned to synthesize narrative evidence in ways that are accessible to policymakers while remaining accountable to community voices. This translational role distinguishes OT from professions that are less explicitly oriented toward systems, participation, and environmental change.
Narratives for Communities
When community members hear firsthand accounts, they are more likely to support inclusive policies and advocate for change. Stories offer ongoing insight into how policies are working (or not), creating a dynamic way to improve systems over time. Sharing stories builds empathy and connection across cultural lines. It helps communities see asylum seekers as neighbors, not outsiders. Personal testimony can galvanize grassroots movements, influence legislation, and inspire civic engagement (Hou, 2023).
OTPs contribute uniquely to community-level narrative work by focusing on collective occupations—how communities live together, share resources, and co-create inclusive spaces. Through this lens, narrative storytelling becomes not only a tool for understanding but also a catalyst for community participation, civic engagement, and occupational justice.
Direct Care
While existing assessments and interventions for asylum seekers hold promise, it is critical to maintain that OTP's role in helping asylum seekers navigate the legal system is inherently individualized and deeply contextual, rejecting any notion of a one-size-fits-all approach. Each person's journey is shaped by unique cultural backgrounds, trauma histories, legal circumstances, and occupational disruptions, which demand nuanced and responsive care. Through ongoing community engagement with legal aid organizations, OTPs build trust and cultural humility with clients and colleagues and gain insight into the collective needs and strengths of this population specific to occupations and meaningful participation in daily life (Rodríguez-Martínez et al., 2025; Wilcock, 1998). Ongoing needs assessments—conducted in collaboration with community partners and informed by lived experience—help identify barriers to participation and tailor interventions that promote resilience, agency, and belonging (Trimboli & Halliwell, 2018). Narrative storytelling and story making can play a central role, as asylum seekers’ stories illuminate the meaning behind their occupations and the injustices they face (D'Cruz et al., 2020; Clarke & Mullings, 2022). By listening deeply and sharing narratives to promote societal change, OTPs co-create pathways to healing and empowerment that reflect both individual aspirations and broader social realities (Wasmuth et al., 2023).
Potential Challenges and Limitations
A range of potential challenges may limit OTPs’ work with asylum seekers. Time constraints, productivity demands, and reimbursement structures within healthcare settings can restrict OTPs’ ability to engage in nontraditional, systems-level roles such as legal navigation. Additionally, navigating complex, constantly shifting systems—common in both healthcare and immigration—can be emotionally taxing and contribute to provider strain, particularly when working with highly vulnerable populations (Shommu et al., 2016). Structural barriers—including fragmented service systems, limited access to legal aid, and challenges inherent to interprofessional collaboration such as unclear roles and insufficient training—may also impede OTPs’ work in this area (Bolton et al., 2021). Addressing these challenges will require strong interprofessional partnerships as well as intentional training and support to ensure that OTP involvement in legal navigation remains ethical, effective, and sustainable.
Summary
This introductory article presents a lens for OTPs collaborating with immigrants navigating the U.S. asylum process. It argues that occupational justice is a human right and highlights the severe occupational injustices asylum seekers face due to legal uncertainty, trauma, and systemic exclusion. We suggest a lens that centers on navigation of legal services as a strategic entry point for OTPs while emphasizing a holistic approach that includes mental health, daily living support, and community integration. We outline three tiers: building partnerships with legal aid organizations, conducting ongoing needs assessments, and applying narrative storytelling to support cultivating person-centered, collaborative care plans. Ultimately, our argument positions the navigation of legal services as a critical focal point for OTPs working with asylum seekers.
Supplemental Material
sj-docx-1-aot-10.1177_19437676261464058 - Supplemental material for Navigating Legal Services: A Proposed Lens for Occupational Therapy Practitioners Supporting Asylum Seekers
Supplemental material, sj-docx-1-aot-10.1177_19437676261464058 for Navigating Legal Services: A Proposed Lens for Occupational Therapy Practitioners Supporting Asylum Seekers by Sally Wasmuth, Annie DeRolf, Hannah Romero De Gante and Leah Brenner in American Journal of Occupational Therapy
Supplemental Material
sj-docx-2-aot-10.1177_19437676261464058 - Supplemental material for Navigating Legal Services: A Proposed Lens for Occupational Therapy Practitioners Supporting Asylum Seekers
Supplemental material, sj-docx-2-aot-10.1177_19437676261464058 for Navigating Legal Services: A Proposed Lens for Occupational Therapy Practitioners Supporting Asylum Seekers by Sally Wasmuth, Annie DeRolf, Hannah Romero De Gante and Leah Brenner in American Journal of Occupational Therapy
Footnotes
Funding
The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Supplemental Material
Supplemental material for this paper is available online.
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References
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