Promoting Culturally Effective Care for Hispanic Families (NOT in midterm)

What is culture?

• Culture is the integrated pattern of human behavior that includes thoughts, communications, actions, customs, beliefs, values, and institutions of a racial, ethnic, religious, or social group

• A child’s occupations are ingrained in the cultural values of their family

• The traditional ideologies of occupation have originated from western culture and may not represent pediatric patients whose bases of meaningful activities evolve from different beliefs, values, and worldviews

• Culture may influence many factors impacting a child’s occupations, such as parenting styles, views on independence, expectations of child behavior, and family roles

The Cognitive Behavioral Approach to Pediatric Culturally Effective Care (CB-PCE) is based on Cognitive behavioral therapy

Exploring Bias

• What is Implicit Bias?

  • Implicit bias is a type of automatic thought that an occupational therapist might not be consciously aware of forming, including attitudes or assumptions about a group of people

• Why?

  • Implicit bias occurs unintentionally due to cognitive associations and leads to negative views of a person based on irrelevant factors such as race or ethnicity, which may impact practice

• Ethnocentrism and OT practice

Strategies found to reduce implicit bias

1. Stereotype replacement

   1. Become aware of the automatic thoughts that are stereotypical

   2. Recognize response and identify why it may have occurred

   3. Think about alternative future responses and start consciously using unbiased alternatives

2. Perspective taking

   1. Research found that perspective-taking can combat automatic expressions of racial biases without simultaneously decreasing sensitivity to ongoing racial disparities

3. Increased contact with individuals from different racial/ethnic groups

Who is considered Hispanic, Latino/a, or Latinx?

Hispanic Youth Population Growth in the U.S.

• One in every 4 children in the U.S. were of Hispanic origin in 2020

• One-third of children in the U.S. are projected to be Hispanic by 2060

• The Hispanic population makes up the second largest racial/ethnic group in the country and in NYC

AOTA Code of Ethics: Core Value of Justice

• “Occupational therapy personnel, by virtue of the specific nature of the practice of occupational therapy, have a vested interest in social justice: addressing unjust inequities that limit opportunities for participation in society”

• Occupational injustices are “socially structured, socially formed conditions that give rise to stressful occupational experiences”

Health Disparities

“Health disparities are preventable differences in health and healthcare outcomes due to social, economic, and environmental disadvantages experienced by different populations”

Social determinants of Health

• Social and Environmental factors

  • Socioeconomic Status

  • Education

  • Housing

  • Employment

  • Racism and Discrimination

• Political Factors

  • Access to Care

  • Underrepresentation

  • Laws, services, systems

• Cultural & Psychological factors

  • Beliefs

  • Values

  • Spirituality

Access to Care

• 32% of the Hispanic population is uninsured in the U.S. which is the highest out of any racial or ethnic group

• 50% of first generation Hispanics are uninsured

• Absence of insurance leads to fewer primary care visits and more frequent admissions to emergency rooms

Impact of Immigration Status on Occupational Engagement in the U.S.

• Hispanic immigrants make up largest undocumented population in the U.S.

• Threat of deportation leads many undocumented Hispanics to

  • Withdraw from meaningful occupations

  • Alter engagement in required occupations

  • Be at risk for exploitation by employers

  • Fear driving and occupation participation outside of home

• Occupations that rely heavily on Mexican immigrant labor pay low wages and seldom offer health insurance, which poses health risks for workers and their families

Primary Barriers to culturally effective care in rehab

1. Language: Identified as primary cause of health disparities for Hispanic patients

   1. Leads to:

      1. miscommunication of medical information

      2. an increase in unnecessary intubation of trauma patients

2. Limited Resources

3. Cultural Barriers

   1. decreased patient satisfaction and quality of care

Primary Facilitators to culturally effective care in rehab

1. Cultural Awareness amongst practitioners

2. Cultural Awareness in Services

   1. Use of culturally appropriate assessments and interventions

      1. translated material/resources (always print papers and brochures in Spanish as well!)

   2. Use of visuals for patients without literacy skills

   3. Longer appointments for patients who do not speak English (to account for the time it takes to translate)

3. Explanations of Health Care Systems

   1. What is the purpose of OT?

   2. What is the role of family members in treatment?

Family-Centered Care

Family-centered care focuses on 3 core concepts

• Respect for families and children

• Understanding the family’s impact on the child’s well-being

• Family-professional collaboration

Values ~ Familismo & Respecto

• Dedication, commitment, and loyalty to the family

• Collectivist: Group over individual

• Respect and obedience for authority figures such as elders and parents

• Higher expectations regarding family responsibility & roles compared to non-Latino whites

• Higher level of perceived family support

• Greater levels of familismo associated with fewer depressive symptoms, behavior problems, and academic difficulties in Latino adolescents

Structure of the Family

• Extended Families:

  • Common to see different generations living in the same household

  • Family members may be consulted before making medical decisions

  • Hispanic families often care for elders in the home opposed to nursing homes

  • Children are often expected to “do better” than the previous generation

  • How would caregiving for a child and grandparents at the same time impact a parent?

• Gender Roles “Machismo y Marianismo”

  • Men traditionally take on the role of the provider, decision-maker, protector, and leader in the family

  • Women are expected to care for the home, children, and to be very selfless

Beliefs Regarding Health

• Views on Disability

  • Many Hispanic families view their child’s disability as coming from God

    • Some Hispanics view disability as a punishment from God due to the sins they had committed

    • Others view disability as a gift from God

  • It is common to view disability as belonging to the family and not just the child

  • Shame may be associated with a genetic defect

  • Physical Disability is more acceptable than mental illness

• Mental health stigmas “nervios”

Medicine

• Common to combine natural home remedies with Western medicine

• Home & Folk remedies

  • Curandismo: Folk healer

  • Natural herbs and tea are commonly used

  • Sobador/a: person gives a massage to treat a condition (ex., indigestion)

  • Santero: Santeria traditional healer

Religion

• The majority of Hispanics are Christian with Roman Catholic being the most popular denomination

• Faith is often center of family

• Support System

• Counseling Services

• Community Life & Celebrations (ex., quinceaneras)

Strategies to enhance treatment engagement & rapport

1. Overcoming Language Barriers

2. Developing Shared Understanding of child’s disability

3. Collaborating with caregivers

4. Ensuring caregivers understand the treatment process

Communication with Hispanic families:

• Verbal communication should be respectful avoid calling parents by first name unless they identify a preference

• Physical connection very common; typical greetings include a hug and kiss on the cheek

• Important to know Spanish varies from country to country with different dialects, phrases, and norms

Strategies for OT Evaluations

• Collaborate with child and caregivers to understand child volition by exploring child and family cultural interests, beliefs, and values that impact child occupations

• Identify habits and roles the family and child prioritize and exploring how culture influences expectations associated with the roles

• Assess how environmental factors such as physical, social, cultural, economic, and political factors can either facilitate or hinder a child’s occupational performance

  • Environmental stressors:

    • Discrimination, exclusion, etc.

• Implement language translation services when necessary to effectively communicate with the child and caregivers.

Tips for Using Interpreters

• Introduce yourself to interpreter

• Speak directly to patient during session

• Pause often so all information can be translated in its entirety

• Ask one question at a time

• Ask about potential cultural misunderstandings

• Insist that everything patient says gets interpreted

• Ask patient to repeat back information that you want to make sure they understand

Surnames

• Common to have multiple Surnames

• Important to include proper Surnames in billing and documentation

• Inconsistent documentation of multiple surnames contributes to patient errors and delays in receiving services due to misidentification

Documentation

• Assessments

  • Identify assessments available in patient’s preferred language

  • Use translator when able to

    • Family translators might re-word during translation using a translator helps with validity of results

• Patient Education

  • Use pictures when possible

  • Demonstrate activities and have patient imitate

• Notes

  • Document use of translator

Becoming Agents of Change

• Advocate for patients from culturally diverse backgrounds

• Create inclusive environments in work sites

• Seeking resources to continue to learn and develop culturally effective practice

• Work towards promoting diversity within OT

  • Recruitment

    • High school/college presentations in diverse communities

    • Media representation

  • Retention:

    • Inclusive environment in education

    • Cultural resources for students