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No Hablo Ingles--Client-Centered Occupational Therapy Practice with Spanish-Speaking Clients
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No Hablo Ingles--Client-Centered Occupational Therapy Practice with Spanish-Speaking Clients


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These are the slides from a presentation at the 2013 American Occupational Therapy Association Conference in San Diego, CA.

These are the slides from a presentation at the 2013 American Occupational Therapy Association Conference in San Diego, CA.

Published in: Health & Medicine

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  • 1. Contributing AuthorsCristina Reyes Smith, OTD, OTR/L (Medical University of South Carolina)Catherine Hoyt, OTD, OTR/L (Washington University)Susan Toth-Cohen, PhD, OTR/L (Thomas Jefferson University)D’Andre Holland, MA, OTD Candidate, OTR/L (Univ. of Southern California)Pamela Vesely, BA, MSOT Candidate (Medical University of South Carolina)Kristin Will, BA, MSOT Candidate (Washington University)Kristin Miller, BA, MSOT Candidate (Washington University)Special Thanks:Juan Pablo Saa, MS, OTD Candidate, OTR/L (Washington University)
  • 2. Presentation Outline• History, Background, & Socio-PoliticalContext• Best Practice Guidelines for OT Practice• Resources for OT Practice• Developing an Action Plan
  • 3. Case Study #1Eduardo
  • 4. History, Background,& Socio-Political Context
  • 5. Current U.S. Demographics•As of 2011: 16.7% of the U.S. population isof Hispanic or Latino origin•Across the board:oMontana: 3.1%oMissouri: 3.7%oMinnesota: 4.9%oSouth Carolina: 5.3%oNew York: 18.0%oCalifornia: 38.1%oNew Mexico: 46.7%(U.S. Census Bureau, 2013)
  • 6. Current U.S. Demographics•52 million people of Hispanic originin the U.S. as of 2011 (largestethnic/racial group)•12.8% of all U.S. residents aged 5and above speak Spanish•75% of Hispanics aged 5 and olderspoke Spanish in the home as of2010(U.S. Census Bureau, 2012)
  • 7. Future U.S. DemographicsThe U.S. Census Bureau expects the Hispanicpopulation to rise from 52 million people(2011 estimate) to 133 millionby 2050.This would raise the U.S. population make-up ofHispanics to 30%.(U.S. Census Bureau, 2013)
  • 8. U.S. Hispanic Population:Growth Trends
  • 9. Current U.S. DemographicsAccording to 2010 American Community Survey 1-Year Estimates:
  • 10. In your area, can Spanish-speaking clientsaccessneededOT servicesand resources?
  • 11. Common Practice Areas forEncountering Spanish-Speaking Clients• NICU• Acute inpatient/rehab hospitals• Out-patient rehab clinics• Skilled Nursing Facilities• Early intervention• Out-patient pediatrics• Schools• Charitable/free medical clinics
  • 12. Policy, Legal, and EthicalConsiderations• American Civil Liberties Uniono Immigrant Rights• Healthcare Reformo Public health initiativeso Focus on preventiono Emergency services• Immigration Law Reformo Federal and State• Protection for charitable andreligious groups
  • 13. Policy, Legal, and EthicalConsiderations• U.S. Dept of Housing & Urban Developmento Housing discrimination• U.S.D.H.H.S. Office of Minority Healtho CLAS Standardso Insurance coverage• U.S.D.H.H.S. Office of Civil Rightso HIPPAo PSQIA• U.S. Dept of Laboro Workers Compensation Laws
  • 14. Where are we going as a profession andwith healthcare in general?
  • 15. AOTA Centennial VisionWe envision that occupational therapy is apowerful, widely-recognized, and evidence-based profession with a globally-connected and diverseworkforce meeting societysoccupational needs.(AOTA, 2008)
  • 16. OT Practice Framework (2008)Definition of Cultural Context“Customs, beliefs, activity patterns,behavior standards, andexpectations accepted by the societyof which the individual is amember."Includes:• political aspects (i.e laws related toaccess and personal rights)• opportunities for education,employment, and economic support
  • 17. ACOTE StandardsB.1.8. Articulate the influence ofsocial conditions and the ethicalcontext in which humans chooseand engage in occupations.B.1.9. Demonstrate knowledge ofglobal social issues andprevailing health and welfareneeds.(AOTA, 2006)
  • 18. ACOTE StandardsB.2.6. Analyze the effects of• physical and mental health• heritable diseases and predisposing genetic conditions• disability• disease processes• injury to the individual within the cultural contexto family/society influence occupational performanceB6.6. Integrate national and international resources(AOTA, 2006)
  • 19. What would youlike to see?
  • 20. Breakout Session: Share yourexperiences
  • 21. Best Practice Guidelinesfor OT Practice
  • 22. OT Statements andGuidance DocumentsCentennialVisionOT Code ofEthicsHealth LiteracySocietalStatementOT PracticeFramework
  • 23. Health Literacy &the Health Belief ModelHealth literacy: "the degree to which individuals have thecapacity to obtain,process, and understand basic healthinformation and services needed to make appropriatehealth decisions" (IOM, 2004, p. 32).PerceivedSusceptibilityPerceivedSeverityPerceivedBarriersPerceivedBenefitsDemographics : age, gender, ethnicity,religion, socio-economic statusPersonal: personality, coping style, selfefficacy, perceived control, perceived threatEnvironment: Support mechanisms,sources of reinforcement for healthbehaviors(Institute of Medicine, 2004)
  • 24. AttitudesAnswer the following questions:o I like people who speak Spanish who...o I feel afraid of Spanish-speakers who...o My parents think that Spanish-speakers are...o Latino men are...o Latina women are...o Immigrants...o Undocumented aliens...o Government forms ought to be English (or ought to bebilingual) because...
  • 25. Cultural ConsiderationsHispanic vs. Spanish vs. Latino• Influence of country oforigin• Attitudes towardspluralism and assimilationEveryday expressions• Use of words and tenses toconvey respectFamily• Inclusion of extended family, padrinos (godparents)• May have multiple surnames
  • 26. Surnames• Multiple Surnames• Importance forBilling/Documentationo May have both, or just Dad• Example:Hernán Gonzalo Álvarez BarrigaFirst Middle Dads Moms
  • 27. Cultural Considerations• Languageo Many dialects• Religion• Doctor/patient relationship• Therapist/patientrelationship• Role & depreciation of ADLs• Hesitation/reluctance• Trust/knowledge of themedical system
  • 28. Cultural Considerations• Variation in concepts ofo "healthy eating"o "illness/sickness” & “disability”o "germs" and hygieneo Appropriate exercise andwellness practices• Use of healers/"curanderos"• Use of antibiotics• Home remedies (remedios caseros)o Tea, herbal remedieso "Mal de ojo" or "evil eye"
  • 29. Cultural Considerations• Family in country of origino Aging parentso Childreno Limited support system• Mental health stigmao May say one suffers from"nervios"• "Machismo":o Men may be expected to denysymptomso Women may downplay symptoms
  • 30. Cultural Considerations• Appropriate body space• Handling difficult conversations• Environmental barriers• Boundaries:Translators, Caregivers, &Therapists• OT looks different in differentcountries
  • 31. How does theenvironment of careassistor limitclients tounderstandand applyOT interventions to their daily lives?
  • 32. "As contributors to society,it is not enough toacknowledge that we eachhave a different way ofinteracting in the world-to be truly effective wemust understand andgrow from the richnessthat others offer the socialfabric."Diversity in Occupational Therapy(Johnson et al. 2012)
  • 33. Diversity in Occupational Therapy• Recruitment:o college expo/ high school presentations in diversecommunitieso media representation diverse publication of theprofession• Retention:o "safe places" for students to discusscultural differenceso inclusive academic cultureo cultural resources for students (Johnson et al.2012; Black.2002)
  • 34. AOTA Diversity Resources "Defínase A Sí Mismo" ("Define Yourself")o AOTA Article for Prospective Students in Spanisho The Many Faces of OT: Cultural Reflectionso Interview videos of OTs in their native languageso Created by OT students at Univ of Illinois at Chicagoo "Why I Choose Occupational Therapy as a Career"o Perspectives of Hispanic Occupational Therapistso Articles written in English and in Spanisho
  • 35. Value of Interdependence Patients preferenceso Independenceo Autonomyo Safety Family members preferenceso Patient independenceo Patient cared for Client centeredo Patient vs. family goals
  • 36. -Importance of family-60 year old woman reportedpain with-Solution: Partner withfamily membersClinical Implications: Importanceof rapport with client and familyFamily Members & Interdependence
  • 37. Language Considerations1) Spanish from different countrieshave different language usethat may not translate accurately2) OT translators must remainobjective and culturally sensitiverespect patient/family dynamic3) Ask an expert from the cultureabout words that might beconsidered "inappropriate"
  • 38. Language Considerations3) Family members as translators cangive their own impression-not thepatient’s occupational history-OTs must keep eye contact4) Interpreters should be positioned tofacilitate communication between theprovider and patient-Beside or behind the provider5) Consider interpreting proficiency,signage, written/verbal communication
  • 39. DocumentationAssessmentso Use a licensed translator when possible Family members may re-word questions which canaffect validity of evaluationo Use assessments available in first language Keep in mind that Spanish has many dialects andEuropean Spanish is quite differentPatient Educationo Provide demonstrations and encouragepatient/caregiver to imitateo Add images whenever possible
  • 40. DocumentationHome Programso Should be provided in clientsfirst language when possibleo Many pictures to describeexercises orrecommendationso Have family demonstrate allrecommendations on thetherapist before leaving("Teach back")
  • 41. DocumentationTreatment Notes• Document the translator used toreport (i,e., family, staff, hospitaltranslator, etc.)• Document patient understandingeducation provided
  • 42. How does documentation relate tohealth literacy in OT practice?
  • 43. AOTA Societal Statementon Health LiteracyHealth literacy:Ability of individuals to gather, interpret, anduse information to make suitable health-related decisions(Institute of Medicine, 2004)Occupational therapy:• Promote health thru health educationapproaches• Materials understandable and accessible• Materials usable by the full spectrum ofconsumers (AOTA, 2011)
  • 44. AOTA Societal Statementon Health LiteracyInadequate health literacy:• More likely adverse health outcomes (DeWalt, Berkman,Sheridan, Lohr, & Pignone, 2004 as cited in AOTA, 2011)• Limits ability to sufficiently participate in health-relatedactivities (Greenfield, Sugarman, Nargiso, & Weiss, 2005as cited in AOTA, 2011)• Disproportionately affects the poor (living at or below thepoverty level)(AOTA, 2011)
  • 45. AOTA Societal Statementon Health Literacy• Health-related information and education matchesindividualo literacy abilitieso cultural sensitivitieso verbal, cognitive, and social skills.• Enable all people to self-manage for optimum healtho gain access to, understand, and use OT and otherhealth-related services and informationo education participation(AOTA, 2011)
  • 46. Health Literacy Strategies & ToolsHarvard Schoolof Public Health:Tools for Assessing andImproving theEnvironment of Care
  • 47. Resources for OT Practice
  • 48. Self-Assessmentsfor Cultural CompetenceNCCC Self Awareness seriesCultural CompetenceHealth PractitionerAssessment
  • 49. See session handout for: Comprehensive list of pediatricassessment and intervention toolsavailable in Spanish Handouts for parents/caregivers Communication tools Additional online resourcesPediatric Assessment andIntervention Tools in Spanish
  • 50. See session handout for: Comprehensive list of pediatric assessment andintervention tools available in Spanish Mental health resources Handouts for caregivers/patient education Useful apps and online resources Communication/phrase translation Additional online resourcesAdult AssessmentsAvailable in Spanish
  • 51. • Artículos de Interés para Consumidoreso Colegio de Profesionales de Terapia Ocupacional dePuerto Rico• Catálogo De Las Carreras Y Asociaciones De TerapiaOcupacional Latinoamericanaso Composed by Rosibeth Palm of Lima, Peru• La Asociación Profesional Española de TerapeutasOcupacionales (APETO--Spain) Resources
  • 52. Global Resources WFOT Bulletin "Working with Families"o May 2013 will be published in English and Spanish ¿Qué es Terapia Ocupacional? Videoo Escuela de Terapia Ocupacional Universidad Australde Chile Washington University in St. Louis
  • 53. Global ResourcesLa Confederación Latinoamericana de TerapeutasOcupacionales "CLATO"• Congreso 2013: 10/26-11/1 en Venezuela•
  • 54. OT4OT 24 Hour Virtual ExchangeHost: Online Technology 4 Occupational Therapy (OT4OT) Celebration of World OT Day on Oct 30, 2012 Features 24 leaders in occupational therapy fromaround the world Each provide one hour online presentation Archived lectures available on the
  • 55. Tech Day PresentationTech Tools for OT Practice With Spanish-Speaking Clients4/27/2013 9:30-11:00 AM, TD301See session handout for additional resources
  • 56. Areas for Growth Towards theCentennial Vision• Recruitment and retention of diverse workforce• Increased availability of culturally-sensitiveevaluation and intervention tools• Increased availability of OT practice tools in Spanish• Increased availability of AOTA resources in Spanish• Increased knowledge of global resources available
  • 57. Developing an Action Plan
  • 58. Breakout Session: Action Steps
  • 59. • American Occupational Therapy Association. (2002).Occupational therapy practice framework: Domain andprocess. American Journal of Occupational Therapy, 56,609–639.• Black, R. M. (2002). Occupational therapy’s dance withdiversity. American Journal of Occupational Therapy, 56,140–148• Chase, R.O. & Medina de Chase, C.B. (2010). AnIntroduction to Spanish for Health Care Workers:Communication and Culture. 3rd ed. New Haven: YaleUniversity Press.References
  • 60. • Johnson et al.2012. Multiple views to address diversityissues: an initial dialog to advance the chiropracticprofession. Journal of Chiropractic Humanities; 19.1-11• Passel, J. & Cohn, D. (2008). U.S. Population Projections:2005-2050. Retrieved from• U.S. Bureau, 2010 American Community Survey. Retrievedfrom (cont.)
  • 61. • U.S. Census Bureau. (2012). Profile America Facts forFeatures. Retrieved from• U.S. Census Bureau (2013). An Older and More DiverseNation by Midcentury. Retrieved from• U.S. Census Bureau. (2013). State and Country QuickFacts.Retrieved from (cont.)