Contributing Authors

Cristina 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)

Presentation Outline

• History, Background, & Socio-Political Context

• Best Practice Guidelines for OT Practice • Resources for OT Practice • Developing an Action Plan

Case Study #1

Eduardo

History, Background, & Socio-Political Context

Current U.S. Demographics

•As of 2011: 16.7% of the U.S. population is

of 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)

Current U.S. Demographics

•52 million people of Hispanic origin in the U.S. as of 2011 (largest ethnic/racial group)

•12.8% of all U.S. residents aged 5

and above speak Spanish

•75% of Hispanics aged 5 and older

spoke Spanish in the home as of

2010

(U.S. Census Bureau, 2012)

Future U.S. Demographics

The U.S. Census Bureau expects the Hispanic

population to rise from 52 million people

(2011 estimate) to 133 million by 2050.

This would raise the U.S. population make-up of

Hispanics to 30%.

(U.S. Census Bureau, 2013)

U.S. Hispanic Population: Growth Trends

Current U.S. Demographics

According to 2010 American Community Survey 1-

Year Estimates:

In your area, can Spanish-speaking clients

access needed

OT services and resources?

Common Practice Areas for Encountering 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

Policy, Legal, and Ethical Considerations

• American Civil Liberties Union

o Immigrant Rights • Healthcare Reform

o Public health initiatives

o Focus on prevention

o Emergency services • Immigration Law Reform

o Federal and State

• Protection for charitable and religious groups

Policy, Legal, and Ethical Considerations

• U.S. Dept of Housing & Urban Development

o Housing discrimination • U.S.D.H.H.S. Office of Minority Health

o CLAS Standards

o Insurance coverage • U.S.D.H.H.S. Office of Civil Rights

o HIPPA

o PSQIA • U.S. Dept of Labor

o Worker's Compensation Laws

Where are we going as a profession and with healthcare in general?

AOTA Centennial Vision

We envision that occupational therapy is a

powerful, widely-recognized, and evidence-

based profession with a globally-

connected and diverse

workforce meeting society's

occupational needs.

(AOTA, 2008)

OT Practice Framework (2008) Definition of Cultural Context

“Customs, beliefs, activity patterns,

behavior standards, and expectations accepted by the society

of which the individual is a member."

Includes: • political aspects (i.e laws related to

access and personal rights) • opportunities for education,

employment, and economic support

ACOTE Standards

B.1.8. Articulate the influence of

social conditions and the ethical context in which humans choose and engage in occupations.

B.1.9. Demonstrate knowledge of global social issues and prevailing health and welfare needs.

(AOTA, 2006)

ACOTE Standards

B.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 context

o family/society influence occupational performance B6.6. Integrate national and international resources

(AOTA, 2006)

What would you like to see?

Breakout Session: Share your

experiences

Best Practice Guidelines for OT Practice

OT Statements and Guidance Documents

Centennial Vision

OT Code of Ethics

Health Literacy Societal

Statement

OT Practice

Framework

Health Literacy & the Health Belief Model

Health literacy: "the degree to which individuals have the

capacity to obtain,process, and understand basic health information and services needed to make appropriate health decisions" (IOM, 2004, p. 32).

Perceived

Susceptibility

Perceived

Severity

Perceived

Barriers

Perceived

Benefits

Demographics : age, gender, ethnicity,

religion, socio-economic status

Personal: personality, coping style, self

efficacy, perceived control, perceived threat

Environment: Support mechanisms,

sources of reinforcement for health

behaviors

(Institute of Medicine, 2004)

Attitudes Answer 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 be

bilingual) because...

Cultural Considerations

Hispanic vs. Spanish vs. Latino • Influence of country of

origin • Attitudes towards

pluralism and assimilation

Everyday expressions • Use of words and tenses to

convey respect Family

• Inclusion of extended family, padrinos (godparents)

• May have multiple surnames

Surnames

• Multiple Surnames • Importance for

Billing/Documentation

o May have both, or just Dad • Example:

Hernán Gonzalo Álvarez Barriga

First Middle Dad's Mom's

Cultural Considerations

• Language

o Many dialects • Religion • Doctor/patient relationship • Therapist/patient

relationship • Role & depreciation of ADL's • Hesitation/reluctance • Trust/knowledge of the

medical system

Cultural Considerations • Variation in concepts of

o "healthy eating"

o "illness/sickness” & “disability”

o "germs" and hygiene

o Appropriate exercise and wellness practices

• Use of healers/"curanderos" • Use of antibiotics • Home remedies (remedios caseros)

o Tea, herbal remedies

o "Mal de ojo" or "evil eye"

Cultural Considerations • Family in country of origin

o Aging parents

o Children

o Limited support system • Mental health stigma

o May say one suffers from "nervios"

• "Machismo":

o Men may be expected to deny symptoms

o Women may downplay symptoms

Cultural Considerations

• Appropriate body space

• Handling difficult conversations

• Environmental barriers

• Boundaries:

Translators, Caregivers, &

Therapists

• OT looks different in different

countries

How does the

environment of care

assist or limit clients to

understand and apply

OT interventions to their daily lives?

"As contributors to society, it is not enough to acknowledge that we each have a different way of interacting in the world-to be truly effective we must understand and grow from the richness that others offer the social fabric."

Diversity in Occupational Therapy

(Johnson et al. 2012)

Diversity in Occupational Therapy

• Recruitment:

o college expo/ high school presentations in diverse communities

o media representation diverse publication of the profession

• Retention:

o "safe places" for students to discuss cultural differences

o inclusive academic culture

o cultural resources for students

(Johnson et al.2012; Black.2002)

AOTA Diversity Resources

"Defínase A Sí Mismo" ("Define Yourself")

o AOTA Article for Prospective Students in Spanish o http://www.aota.org/Students/Prospective/Spanish.aspx

The Many Faces of OT: Cultural Reflections

o Interview videos of OT's in their native languages

o Created by OT students at Univ of Illinois at Chicago o www.aota.org/Students/Prospective/Diversity.aspx

"Why I Choose Occupational Therapy as a Career"

o Perspectives of Hispanic Occupational Therapists

o Articles written in English and in Spanish o http://www.aota.org/Students/Prospective/Diversity/Hispanic.aspx

Value of Interdependence

Patient's preferences

o Independence

o Autonomy

o Safety

Family members' preferences

o Patient independence

o Patient cared for

Client centered

o Patient vs. family goals

-Importance of family -60 year old woman reported

pain with

-Solution: Partner with

family members

Clinical Implications: Importance

of rapport with client and family

Family Members & Interdependence

Language Considerations

1) Spanish from different countries

have different language use

that may not translate accurately

2) OT translators must remain

objective and culturally sensitive

respect patient/family dynamic

3) Ask an expert from the culture

about words that might be

considered "inappropriate"

Language Considerations 3) Family members as translators can

give their own impression-not the

patient’s occupational history

-OTs must keep eye contact

4) Interpreters should be positioned to

facilitate communication between the

provider and patient

-Beside or behind the provider

5) Consider interpreting proficiency,

signage, written/verbal communication

Documentation Assessments

o Use a licensed translator when possible Family members may re-word questions which can

affect validity of evaluation

o Use assessments available in first language Keep in mind that Spanish has many dialects and

European Spanish is quite different

Patient Education o Provide demonstrations and encourage

patient/caregiver to imitate

o Add images whenever possible

Documentation Home Programs

o Should be provided in clients first language when possible

o Many pictures to describe exercises or recommendations

o Have family demonstrate all recommendations on the therapist before leaving ("Teach back")

Documentation

Treatment Notes • Document the translator used to

report (i,e., family, staff, hospital translator, etc.)

• Document patient understanding education provided

How does documentation relate to health literacy in OT practice?

AOTA Societal Statement on Health Literacy

Health literacy:

Ability of individuals to gather, interpret, and

use information to make suitable health-

related decisions

(Institute of Medicine, 2004)

Occupational therapy:

• Promote health thru health education

approaches

• Materials understandable and accessible

• Materials usable by the full spectrum of

consumers

(AOTA, 2011)

AOTA Societal Statement on Health Literacy

Inadequate 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-related

activities (Greenfield, Sugarman, Nargiso, & Weiss, 2005

as cited in AOTA, 2011)

• Disproportionately affects the poor (living at or below the

poverty level)

(AOTA, 2011)

AOTA Societal Statement on Health Literacy

• Health-related information and education matches

individual

o literacy abilities

o cultural sensitivities

o verbal, cognitive, and social skills.

• Enable all people to self-manage for optimum health

o gain access to, understand, and use OT and other

health-related services and information

o education participation (AOTA, 2011)

Health Literacy Strategies & Tools

Harvard School

of Public Health: Tools for Assessing and

Improving the

Environment of Care

http://www.hsph.harvard.edu/healthliteracy/practice/

Resources for OT Practice

Self-Assessments for Cultural Competence

NCCC Self Awareness series

Cultural Competence Health Practitioner Assessment

See session handout for: Comprehensive list of pediatric

assessment and intervention tools available in Spanish

Handouts for parents/caregivers Communication tools Additional online resources

Pediatric Assessment and Intervention Tools in Spanish

See session handout for: Comprehensive list of pediatric assessment and

intervention tools available in Spanish Mental health resources Handouts for caregivers/patient education Useful apps and online resources Communication/phrase translation Additional online resources

Adult Assessments Available in Spanish

• Artículos de Interés para Consumidores

o Colegio de Profesionales de Terapia Ocupacional de Puerto Rico

http://www.cptopr.org/consumidores.html • Catálogo De Las Carreras Y Asociaciones De Terapia

Ocupacional Latinoamericanas

o Composed by Rosibeth Palm of Lima, Peru http://www.reneto.org.br/pdf/catalogo.pdf

• La Asociación Profesional Española de Terapeutas Ocupacionales (APETO--Spain) http://www.reneto.org.br/pdf/catalogo.pdf

Global Resources

Global Resources

WFOT Bulletin "Working with Families"

o May 2013 will be published in English and Spanish http://www.wfot.org/bulletin.aspx

¿Qué es Terapia Ocupacional? Video

o Escuela de Terapia Ocupacional Universidad Austral de Chile

http://www.youtube.com/watch?v=rayFX-H9UMo

o Washington University in St. Louis http://www.youtube.com/watch?v=-1kpP-carnU

Global Resources

La Confederación Latinoamericana de Terapeutas Ocupacionales "CLATO"

• Congreso 2013: 10/26-11/1 en Venezuela

• http://www.congresoclato2013.com/

OT4OT 24 Hour Virtual Exchange

Host: Online Technology 4 Occupational Therapy (OT4OT)

Celebration of World OT Day on Oct 30, 2012

Features 24 leaders in occupational therapy from

around the world

Each provide one hour online presentation

Archived lectures available on the website:

www.ot4ot.com

Tech Day Presentation

Tech Tools for OT Practice With Spanish-Speaking Clients

4/27/2013 9:30-11:00 AM, TD301

See session handout for additional resources

Areas for Growth Towards the Centennial Vision

• Recruitment and retention of diverse workforce

• Increased availability of culturally-sensitive

evaluation and intervention tools

• Increased availability of OT practice tools in Spanish

• Increased availability of AOTA resources in Spanish

• Increased knowledge of global resources available

Developing an Action Plan

Breakout Session: Action Steps

• American Occupational Therapy Association. (2002). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 56, 609–639.

• Black, R. M. (2002). Occupational therapy’s dance with diversity. American Journal of Occupational Therapy, 56, 140–148

• Chase, R.O. & Medina de Chase, C.B. (2010). An Introduction to Spanish for Health Care Workers: Communication and Culture. 3rd ed. New Haven: Yale University Press.

References

• Johnson et al.2012. Multiple views to address diversity issues: an initial dialog to advance the chiropractic profession. Journal of Chiropractic Humanities; 19.1-11

• Passel, J. & Cohn, D. (2008). U.S. Population Projections: 2005-2050. Retrieved from http://www.pewhispanic.org/2008/02/11/us-population-projections-2005-2050/

• U.S. Bureau, 2010 American Community Survey. Retrieved from http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=ACS_10_1YR_B16006&prodType=table

References (cont.)

• U.S. Census Bureau. (2012). Profile America Facts for Features. Retrieved from http://www.census.gov/newsroom/releases/archives/facts_for_features_special_editions/cb12-ff19.html

• U.S. Census Bureau (2013). An Older and More Diverse Nation by Midcentury. Retrieved from http://www.census.gov/newsroom/releases/archives/population/cb08-123.html

• U.S. Census Bureau. (2013). State and Country QuickFacts. Retrieved from http://quickfacts.census.gov/qfd/index.html

References (cont.)