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

2. 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)

3. Presentation Outline
• History, Background, & Socio-Political
Context
• Best Practice Guidelines for OT Practice
• Resources for OT Practice
• Developing an Action Plan

4. Case Study #1
Eduardo

5. History, Background,
& Socio-Political Context

6. 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)

7. 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)

8. Future U.S. Demographics
The U.S. Census Bureau expects the Hispanic
population to rise from 52 million people
(2011 estimate) to 133 millionby 2050.
This would raise the U.S. population make-up of
Hispanics to 30%.
(U.S. Census Bureau, 2013)

9. U.S. Hispanic Population:
Growth Trends

10. Current U.S. Demographics
According to 2010 American Community Survey 1-
Year Estimates:

11. In your area, can Spanish-speaking clients
accessneeded
OT services
and resources?

12. 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

13. 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

14. 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

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

16. 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)

17. 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

18. 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)

19. 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)

20. What would youlike to see?

21. Breakout Session: Share your
experiences

22. Best Practice Guidelines
for OT Practice

23. OT Statements and
Guidance Documents
Centennial
Vision
OT Code of
Ethics
Health Literacy
Societal
Statement
OT Practice
Framework

24. 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)

25. 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...

26. 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

27. 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

28. 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

29. 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"

30. 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

31. Cultural Considerations
• Appropriate body space
• Handling difficult conversations
• Environmental barriers
• Boundaries:
Translators, Caregivers, &
Therapists
• OT looks different in different
countries

32. How does the
environment of care
assistor limitclients to
understandand apply
OT interventions to their daily lives?

33. "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)

34. 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)

35. 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

36. 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

37. -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

38. 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"

39. 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

40. 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

41. 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")

42. Documentation
Treatment Notes
• Document the translator used to
report (i,e., family, staff, hospital
translator, etc.)
• Document patient understanding
education provided

43. How does documentation relate to
health literacy in OT practice?

44. 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)

45. 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)

46. 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)

47. Health Literacy Strategies & Tools
Harvard School
of Public Health:
Tools for Assessing and
Improving the
Environment of Care
http://www.hsph.harvard.ed
u/healthliteracy/practice/

48. Resources for OT Practice

49. Self-Assessments
for Cultural Competence
NCCC Self Awareness series
Cultural Competence
Health Practitioner
Assessment

50. 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

51. 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

52. • 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

53. 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

54. Global Resources
La Confederación Latinoamericana de Terapeutas
Ocupacionales "CLATO"
• Congreso 2013: 10/26-11/1 en Venezuela
• http://www.congresoclato2013.com/

55. 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

56. 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

57. 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

58. Developing an Action Plan

59. Breakout Session: Action Steps

60. • 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

61. • 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/pag
es/productview.xhtml?pid=ACS_10_1YR_B16006&prodTy
pe=table
References (cont.)

62. • U.S. Census Bureau. (2012). Profile America Facts for
Features. Retrieved from
http://www.census.gov/newsroom/releases/archives/fa
cts_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/p
opulation/cb08-123.html
• U.S. Census Bureau. (2013). State and Country QuickFacts.
Retrieved from
http://quickfacts.census.gov/qfd/index.html
References (cont.)