Toward Culturally Responsive Disability Services: An International Conference

Presenter Abstracts

Islamic Perspectives of Counseling

October 7, 11-11:30

Author: Shabana Anees, M.A., CRC
Email: shabanees@gmail.com
Institution: PA OVR

Today, we are fortunate to live in a world where geographic boundaries do not severely limit and restrict individuals from experiencing various cultures. With the ever-changing dynamics of the U.S. population, many cultures and beliefs have been integrated to form a more "global" society. However, there still seems to be a great divide between the perspectives of the "Western" world and the Islamic world. This is illustrated in areas regarding culture, society, gender, and religion. Similarly, this rift continues to be quite evident in the issues relevant to counseling and rehabilitation. What are some of these differences? Can any comparisons be found between the two ideologies? Lastly, how can professionals establish parallels for beneficial results and successful outcomes? This presentation will further examine these issues in depth.

Service Delivery to an Arab/East Asian Population

Poster

Author: Shabana Anees, M.A., CRC
Email: shabanees@gmail.com
Institution: PA OVR

Residing in a post 9/11 society, are we truly addressing the rehabilitation needs and concerns of those individuals of Arab or South East Asian descent? What are some of the issues important to these individuals? How can rehabilitation professionals adequately understand and help to support individuals belonging to these cultural groups in outcomes and goals? This presentation will give a brief introduction of these groups from a historical perspective. Issues regarding religion, culture, gender differences, and social ideals in relation to disability will be investigated. The present situation(s) of the Arab-American and South East Asian-American will be addressed. The role of rehabilitation with respect to these groups will also be discussed. Through the use of question/answer and discussion, the audience will be able to gain a better understanding of these particular groups and issues surrounding successful rehabilitation outcomes.

Assessing Students' Developmental Outcomes Related to International Service-Learning

Poster

Author: Jennifer Audette
Email: jaudette@mail.uri.edu
Institution: University of Rhode Island

This poster reviews current and historical literature related to the goals, benefits and assessment of service-learning outcomes in higher education settings. The physical therapy profession is evolving in terms of the diversity experienced in the clinic and the autonomy of the profession. Educational programs have an obligation to provide learning experiences which enhance the students' professional and personal ability to manage and thrive in diverse and autonomous environments. These factors necessitate that physical therapy programs across the country provide meaningful opportunities for developing cultural competence in students. Many programs have added international service-learning to their programs as a way to increase students' cultural competence and other relevant service-learning outcomes. A particular example of how an international service-learning experience in San Juan la Laguna, Guatemala was developed and is carried out as a highly structured course in a graduate level physical therapy program is described.

The developmental goals expected for students are outlined. Classroom and experiential pedagogical methods and values are explored in an attempt to expand the knowledge base in the field. The use of reflective writing is supported as a legitimate assessment tool for international service-learning outcomes.

This poster focuses on the cultural competence, cognitive and higher order thinking development of participants. The paper introduces questions which can be answered with future outcome measure studies in international service learning.

Cultural Competence Evaluation and Training: A Model Program

October 6, 2:30-3

Author: Fabricio E. Balcazar, Ph.D. & Yolanda Suarez-Balcazar
Email: fabricio@uic.edu
Institution: University of Illinois at Chicago

The purpose of this presentation is two fold: First, to summarize the process of validation of an instrument designed to measure cultural competence (CC) as part of a CC training program. The original instrument had 49 items developed on the basis of a conceptual framework that synthesized prevalent models of cultural competence training and reflected 4 main components: cultural awareness, knowledge of diversity, skills and practice/application. The validation study was conducted with a random sample of 477 occupational therapists. Using a Varimax rotation, an exploratory factor analysis and a Confirmatory Factor Analysis yielded a three factor model with the following components: cultural awareness/knowledge, cultural skills, and organizational support. The latest factor acknowledges the role of the organization that may or may not allow employees to engage in culturally appropriate practices. Second, we will describe the utilization of goal setting in the cultural competence training process and will share preliminary data on organizational goal attainment. The implications for training and professional practice in the delivery of culturally competent services to minority individuals with disabilities will be discussed.

Disparities in Vocational Rehabilitation Services for African Americans with Autism

October 6, 1:30-2

Authors: Fong Chan, Ph.D., Alo Dutta, Ph.D., Madan Kundu, Ph.D., Chih Chin Chou, Ph.D., Gloria Lee, Ph.D.
Email: chan@education.wise.edu, alodutta1992@aol.com, kundusubr@aol.com, chihchinchou@yahoo.com, glee4@buffalo.edu
Institute: University of Wisconsin-Madison, Southern University, Baton Rouge, Southern University, Baton Rouge LA, University of Arizona Tucson, Arizona, University at Buffalo

The unemployment rate among people with Autism is high. The problem is even more acute for people with Autism from racial and ethnic minority backgrounds. This study investigated the effect of vocational rehabilitation services provided by states in the United States on work outcomes of people with autism and to examine disparities in vocational services for African Americans with autism comparing to European Americans.

Vocational rehabilitation services were found to be associated employment status. Disparities in vocational services for African Americans with Autism were found. European Americans were provided more services than African Americans including the most significant vocational service predictor, job placement services.

Rehabilitation counselors working with African Americans with autism must be better trained to identify risk and protective personal characteristic factors and vocational services that affect employment outcomes. They also need to make aware of disparities in VR services they provided to their minority consumers.

Developing Culturally Sensitive Measures of Participation to Improve Services

October 6, 2-2:30

Author: Wanda I. Colón
Email: wandacolon@cprs.rcm.upr.edu
Institution: University of Puerto Rico
Additional authors: Carmen Rodriguez

Currently there are no standardized Spanish assessments to measure children's participation in leisure and recreation activities. Leisure and recreation activity participation has been related as fundamental to healthy development and quality of life. Given the need to improve assessment and services to Hispanic populations the Children's Assessment of Participation and Enjoyment & Preferences for Activities of Children (CAPE/PAC) was translated and culturally adapted for Puerto Rican Spanish speaking children. The complex multi-step test translation and cultural adaptation processes will be presented. A nine-step process for test translation and cultural adaptation was used using various groups of stakeholders and experts. The test translation committee included expert translators and content experts. Qualitative and quantitative exercises to culturally adapt the measure were performed with a focus group and various expert panels. These processes will be discussed to support the content validity of the measure. Pilot test data of the Spanish measure will also be presented; which yielded evidence of validity based on test content, internal structure and test construct. Further examination of the measure is needed to expand the use of the measure for other Hispanic groups.

Towards culturally responsive pedagogy on a rural campus- A case of collaborative self-study

October 6, 3:30-4:30

Author: Dennis Conrad
Email: conradda@potsdam.edu
Institution: State University of New York
Additional authors: Deborah Conrad, Anjali Misra, Michele Pinard

Cultural and linguistic diversity is increasingly significant in the U.S., with projections of minorities being close to 50 percent by 2020 (Gollnick & Chinn, 2009). There is consensus that--regardless of definitional and data analysis complications-there is a disproportional representation of these minority groups in special education (Donovan & Cross, 2002). For example, while Black students comprise only 17 percent of the overall population, 33 of them are in special classes for the mentally retarded (Losen & Orfield, 2002). Donovan and Cross assert that this overrepresentation is directly linked to bio-social and poverty issues, referral and assessment procedures, and ineffective instruction exerted essentially via teacher-student interactions. Lorson and Orfield add to this the question of teachers not being adequately prepared to teach diverse learners. To further complicate matters, according to 2006 Census figures, the teacher population is not in sync with the changing student demographics, with 84 percent of teachers being European-American. This cultural dissonance between the lived experiences of these teachers and the students they serve often result in disaffection and resistance to pedagogy (McFalls & Cobb-Roberts, 2001). To minimize this phenomenon, teacher programs need to create opportunities that untangle the interwoven relationships of language, culture, and power in schools (Cochran-Smith, 1995). Preparation programs must facilitate the development of teachers as "insiders" Banks (1998); who are able to go beyond content mastery to culturally responsive teaching (Gallavan, 1998).

Findings reveal how values gained through religion, family, ethnicity, society, and their professional lives as special educators in the Caribbean have shaped the participants' sense of cultural, personal, and identity in the U.S. The identities of the primary co-researchers reveal intersections between personal and professional selves, including their philosophy and mission of teaching towards a student-centered pedagogy; pedagogical responses within their community of learners; and strategies for personal "survival". The findings extend beyond the narratives of the co-researchers to include the lessons learned form the collaborative process, and the use of critical friends.

Language and culture: Key issues in post-accident rehabilitation of migrants

October 6, 10:45-11:15

Author: Dominique Dressler
Email: dominique.dressler@auva.at
Institution: Austrian Workers' Compensation Board
Additional authors: Peter Pils, MD

Globalization has led to a major increase of migration world wide. The European Union has brought about an opening of national borders within the enlarged Europe, a fact that also contributes to a strong migratory flow. The population of the individual European countries is becoming increasingly diverse.

This diversity also constitutes a challenge for the health system and its institutions.

Migrants constitute up to 41 per cent of the patients of the hospitals and health institutions in Vienna, the capital of Austria. Many of those migrant patients do not speak German (the national language of Austria), or have limited knowledge of German.

This was the reason to investigate mainly by expert interviews and fact-finding the problems encountered by the staff of a rehabilitation center in Austria in communication with migrant patients and how these problems are dealt with by the staff.

The investigation has shown that overcoming the language barrier is the key issue in establishing meaningful communication that is the basis for effective and successful rehabilitation. Poor communication leads to stereotyping of cultural differences and is a barrier to perceiving and responding to each patient's individual needs.

Cultural Inclusivity; Egalitarian Participation: How American Indian Drum and Pow Wow (Community Dance Celebrations) Help Today's Elders and Caregivers Living with Alzheimer's and Dementia

October 7, 11:30-12

Author: Randy Eady
Email: aready@netcologne.de
Institution: Founder and Director, Quest Educational Foundation
Additional authors: Richard Loder, Director, Native American Studies, Syracuse University

Vibration, music, rhythm is said to be the first language that arrives in sensate form to the body. The primordial link to a burgeoning social journey that begins in the womb and carries through to late stages of life.

To appreciate and understand this indivisible truth — at an elemental level — this discussion explores the effect of ambient energy (as music) in relation to its effect on communal gatherings in specialized living settings. Elaborates on how music represents a universal language, used for thousands of years as a culturally responsive avenue to healing. Specifically focusing on how drums have been used as an egalitarian "instrument of the people tool for ceremonial and festive communication regardless of musical training or level of ability/disability. For residents, drum circles fulfill many of the dimensions of life-ways represented by American Indian indigenous tribal communities. As a practically experienced way of living, Indian tribes recognize the importance and wisdom of sacred circles. Learning, living and giving repeats an important cycle of community sense of being and responsibility that enable residents to understand health and life fulfillment (whatever their real or perceived limitations may be) by balancing six key dimensions of personal wellness. Those dimensions are: emotional, intellectual, physical, social, spiritual and purposeful.

Service-learning in Mexico: Expanding Cultural Competence

October 7, 11:30-12

Author: Shannon Godsey MA; CCC-SLP
Email: sgodsey@d.umn.edu
Institution: University of Minnesota Duluth

Each January and May, students from the University of Minnesota Duluth departments of Communication Sciences and Disorders, Early Childhood Education, and Early Childhood Special Education are invited to participate in a service-learning trip to Puerto Vallarta, Mexico. This bi-annual trip is offered as an opportunity for students to acquire and strengthen their cultural competence.

The purpose of the program is to increase cultural competence through volunteering and participation in the day-to-day activities in each of the centers, and integration into the culture and language of Puerto Vallarta. Students are often transformed by the experience and many have participated more than once. The program is part of a university-wide commitment to increase the global knowledge of its students and to provide real-world international opportunities for future teachers and speech-language pathologists.

Health Training in Diversity - Reaching Refugees

October 6, 2:30-3

Author: Kim Griswold MD, MPH
Email: griswol@buffalo.edu
Institution: SUNY at Buffalo, Dept. of Family Medicine
Additional authors: Mary Ann Jezewski Ph.D., RN; Judy Shipengrover, Ph.D.; Angela Henke

The Institute of Medicine has recommended several interventions to address health care disparities. These include:

enhancement of cultural competency curricula for health care professionals, and
development of new strategies to provide the necessary set of skills for patient-provider communication

Here in Buffalo, we are implementing curricular change and emphasizing the integration of cross-cultural and cross-discipline health professional training by working with a vulnerable group of resettled refugees from all over the world. Methods: Curricular goals are to increase cultural sensitivity and competency among health care trainees, through both didactic learning and experiential clinical encounters. In regularly scheduled refugee health clinical sessions, student learners from various health disciplines are able to interview and examine individuals from diverse cultures. Students have the opportunity to experience the use of either in-person or telephonic interpretation in many different languages. Experiential learning through patient encounters and community-based interactions with people of different ethnic backgrounds expands students' cultural awareness and skills. Awareness of the importance of communication skills, learning about the cultural norms of others, acknowledging one's own preconceptions, heightened cultural humility, and recognizing that patients are often the best teachers of their culture are all indicators of cultural competency skill development. Key components of clinical encounters are the use of appropriate and high quality interpretation and/or translation services. Avoiding ethnocentrism and stereotyping, and bridging the power gap between provider and patients also are of essence. Findings: Key findings to date include student lessons in humility, cultural awareness, and communication. Students commented on the awareness of their own "privilege" in contrast to the vulnerability of many refugees. Refugees were recognized as "best" teachers of their own culture, and interesting teachers of alternative medicine techniques and ideas. Students recognized differences among refugee groups with respect to issues of gender, religion/spirituality, and family structure. Equally important was the interaction among health care professional trainees - including medical, nursing, occupational and physical therapy, public health, and anthropology, among others; all of whom appreciated the exposure to other disciplines. Discussion: Eliminating health disparities requires a vigorous interdisciplinary training and implementation agenda that cannot be developed in a vacuum. Rather, it must be a collaborative effort among educators, learners, patients and other participants in the health care system as well as our communities. The paradigm of meaningful encounters with refugee patients may be useful to impart a 'pattern-recognition' for health professional students that crosses all cultures. If they can learn to communicate and respect patients from different cultures and backgrounds, then they will use such skills in all their encounters with patients, no matter the background. Cross-cultural healthcare training can also enhance communication with and quality of care between health care professionals. Development of new curricula should be informed by recognition that different models exist and the need for training extends beyond students to educators themselves. In primary care, the need for cross-cultural training and clinical awareness is of paramount importance, as primary care professionals are the front line contact in our communities.

Unveiling Muslim Voices on Issues of Disability and Mental Health

October 7, 10:30-11

Author: Rooshey Hasnain, Ed.D.
Email: roosheyh@uic.edu
Institution: University of Illinois at Chicago, Department of Disability and Human Development

The growing number and diversity of Muslims in the United States challenges providers and researchers to understand this population's perspectives, belief systems, experiences and ways of practicing Islam, particularly relative to disability, mental health and rehabilitation. This presentation is designed to give participants an opportunity to examine critical and complex issues and initiatives in disability and mental health that face Muslims with disabilities, and their families. The purpose of this presentation is to fill a void in the research on disability for rehabilitation and health care professionals by addressing a population that has been seriously overlooked and misrepresented over the years. The presenter will highlight both the risk factors and the protective factors that Muslims with disabilities and their families experience as they seek access to a meaningful life.

This session will help participants to understand the gaps in service provision that face unserved and underserved Muslim communities and the different services and constituency groups (community leaders, service providers, advocates, educators, spiritual healers) that work with this group. The primary aim of the presentation will be to raise awareness in Muslim communities and to reduce the cultural stigma associated with disability and mental health issues through various culturally-supported interventions. To date, the issues of disability and mental health in Muslim communities have received only sporadic attention from service providers and scholars. Even though increasing numbers of Muslim individuals and families of all backgrounds are dealing with disability and mental health issues, few have committed to a movement to change the situation. This session will introduce stigma-reduction strategies that bring disability and mental health issues to the forefront in this community, both locally and globally.

The Possible Impact of White Privilege on Vocational Rehabilitation Outcome Discrepancies

October 6, 4-4:30

Author: Sandra LeBlanc, MRC, CRC
Email: sandy@awebpresentation.com
Institution: Utah State University
Additional authors: Karen Juchau

Vocational rehabilitation outcome discrepancy studies point to a lingering disparity in outcomes between Northern European Americans (white) and racial minority groups in the United States. Despite the history of the study of white privilege and its impact in many fields and disciplines, the possible connection between vocational rehabilitation outcome discrepancies and the values and attitudes engendered by white privilege are rarely discussed in rehabilitation literature. This paper attempts to explore the possible contribution of white privilege to the disparities experienced by racial minority groups during the vocational rehabilitation process.

Disability Disparities: A Beginning Framework to Understand the Phenomenon

October 7, 12-12:30

Author: Allen Lewis, Ph.D., CRC
Email: anlewis@vcu.edu
Institution: School of Allied Health Professions Virginia Commonwealth University

In the new millennium, there is still concern about the ability of disability systems to serve all populations effectively, especially traditionally underserved and ethnic minority populations. In the general health care arena, health disparities, i.e., differential outcomes across groups defined by ethnicity when factors such as access to care and social economic status are controlled, is an important concept in identifying service system ineffectiveness for individuals from diverse cultural backgrounds. Some of the seminal work on health disparities has been produced by the Institute of Medicine in its 2003 book, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Amid a context where we are beginning to know more about general health care disparities, it makes sense to begin to discern a concept of disability disparities to see if such an idea might have utility in terms of explanatory power within the disability field. Toward this end, this session will unveil and describe a beginning disability disparities framework. It is a two-level model in that at the macro-level it informs how one thinks about the notion of disability disparities along a continuum, but at a more micro-level it provides the disability practitioner clues on how to explore where a person is on the continuum of being challenged by disability disparities. Session participants will be exposed to a description of the model and then engage in a dialogue with the presenter about its beginning utility.

International Clinical Practicum and Continuing Education Opportunities in Speech-Language Pathology

October 7, 11-11:30

Author: Katandria Love Johnson
Email: amortcu@yahoo.com
Institution: University of North Texas Health Science Center at Fort Worth

An increasing number of culturally and linguistically diverse (CLD) populations live in the U.S. (U.S. Census Bureau, 2004). However, the field of speech-language pathology faces a shortage of professionals with the competencies requisite to service such populations. According to the U.S. Department of Labor's Bureau of Labor Statistics (2001b), speech pathology is one of the 30 fastest growing occupations for 2000-2010. Yet, increasing shortages of qualified speech pathologists are available to serve the 69.9% of non-English speaking U.S. children in elementary and secondary schools (2001b). In this presentation, several national and international clinical practicum and continuing education opportunities will be discussed to address how continuing education opportunities can be pursued through collaboration with international professionals. Data were obtained from the American Speech-Language Hearing Association webpage and interviews with allied healthcare professionals visited in 12 countries in Europe, Canada, Central and South America. Findings revealed that understanding critical cultural differences will give healthcare professionals insight on how the needs of CLD populations can be met. It is hopeful that international opportunities in clinical practicum and continuing education can provide another avenue by which such challenges can be addressed.

Culturally Responsive Disability & Rehabilitation Research: Findings from the NCDDR Web Casts

October 6, 10:45-11:15

Author: Frank H. Martin
Email: fmartin@sedl.org
Institution: NCDDR

This presentation will provide an overview of the National Center for the Dissemination of Disability Research (NCDDR) and describe findings from the NCDDR Web cast series on culturally responsive disability research and outreach. Research outreach pertains to the dissemination of research results or findings using multiple methods such as education or service-oriented programs to encourage the utilization of research findings. Research outreach also pertains to the gathering of information from a population to help inform a discovery or the research process and activities designed to support recruitment and retention of research participants. NCDDR has aired four 1.5-hour web casts on cultural issues and research outreach topics including:

cultural competence in rehabilitation counseling
Promotoras strategies for improving mental health services
Native American outreach on disability services, and
culturally responsiveness traumatic brain injury (TBI) research

A fifth web cast on diversity, disparities, and spinal cord injury (SCI) is scheduled for May 6, 2008. Each NCDDR web cast has featured a NIDRR funded grantee and provided concrete examples of the barriers and facilitators to culturally responsive research and service delivery. To date, 232 people have viewed the live web casts, and over 4,000 have accessed archived Web cast information. Common themes that emerged from the Web casts include, but are not limited to, participatory action research (PAR), involvement of paraprofessionals, staff training, bilingual staff, sustainability concerns, family strengths, cultural orientation, the role of advocacy, trust-building, and research relevance. Many NIDRR grantees have expressed that they face significant challenges in understanding and addressing research outreach to cultural and linguistically diverse (CLD) communities. The NCDDR Web casts are an effort to exchange knowledge among the community of NIDRR grantees and the broader rehabilitation provider community about salient issues regarding culturally responsive research and outreach.

A Right to Health: Medicine as Western Cultural Imperialism?

October 6, 11:45-12:15

Author: Donna Matheson
Email: donna@coldsnap.ca
Institution: Bridgepoint Health

Relying on personal observations from working as a physiotherapist in Angola for 8 months as well as secondary research, this presentation will explore the ways in which medicine is intrinsically tied with Western culture and as such is foreign to many African cultures. Medicine is deeply rooted in modernity in the way that it highly values scientific research and evidence-based practice. The divide between medicine and religion in Western countries reflects a dichotomy in culture not shared by most African cultures. As well, present models of both public and private healthcare are based on Western understanding of financial matters. In conclusion, medicine does carry with it components of Western culture; however, a preoccupation with removing these differences can be seen as a post-modern, and therefore Western, preoccupation.

Evaluation of Cultural Competence Training among Students Enrolled in Health-Related Professional Programs

October 6, 1:30-2

Author: Mary A Matteliano
Email: mmatte@buffalo.edu
Institution: University at Buffalo

The purpose of this project is to evaluate the effectiveness of the training and education of students in cultural competence at the University at Buffalo's rehabilitation programs. Four rehabilitation programs have been actively infusing cultural competence into their curricula over the past two years. The programs involved are speech language pathology, occupational therapy, physical therapy and rehabilitation counseling.

The evaluation of program effectiveness is the main goal of this project however, at a later date this data may be used to contribute to a broader work on cultural competence among health professionals. Faculty and student's perception of cultural competence training in several key domains have been assessed using the Tool for Assessing Cultural Competence Training (TACCT). The data was collected close to the last semester of the student's enrollment. The analysis of data will answer the research question (1) Do the faculty and students agree on the domains of cultural competence training that have been taught in the curricula? Researchers have concluded that TACCT is a useful tool in helping to identify gaps in curricula that address cultural competence training (Lie, Boker, and Cleveland 2006).

Another tool, the Transcultural Self-Efficacy Tool (TSET) was distributed to students early on in the same rehabilitation programs. The survey included an attached demographic questionnaire. Analysis of the data will answer research question (2) Do certain demographic variables predict a student's confidence when working with racial/ethnic diverse clients? and research question (3) Do students in health professional programs have confidence in their ability to understand the needs of persons from diverse cultural backgrounds? The (TSET) was developed to measure nursing student's confidence in performing nursing duties for culturally diverse patients and has been adapted with permission from the author for rehabilitation professionals (Jeffreys, 2006).

The principles of rehabilitation service delivery in culturally sensitive manner

October 6, 3:30-4

Author: Tahmineh Mousavi
Email: 5stm2@queensu.ca
Institution: Ph.D. student in Rehabilitation Science at Queen's University, Canada

The discussions of the principles of rehabilitation service delivery can be varied due to the time and places, and the cultural tradition of a society, thereby lead to different rehabilitation service delivery principles. This paper is tries is devoted to answering the questions of what principles of rehabilitation service delivery are important to build in, and how can this be done in culturally sensitive manner?

In my point of view, the ethical principles which have almost been existed and governed the ethical behavior of human societies, as applicable to any culture and society, could be the most important rehabilitation principles which formulated as 'respect to autonomy', 'non-maleficence', 'beneficence' and 'justice'.

Beginning With the End in Mind: Outcomes of Cultural Competence in a DPT Program

October 6, 2-2:30

Author: Karen J. Panzarella, Ph.D.
Email: kjp1@buffalo.edu
Institution: University at Buffalo

The education of physical therapists is moving toward the Doctor of Physical Therapy (DPT) degree. This resulted in new curriculum to educate students to be autonomous practitioners with direct access to patient care. All DPT programs need to meet accreditation standards for their novel curriculums to determine that students are deemed competent for practice. The practice expectation of Cultural Competence states that physical therapy students shall identify, respect, and act with consideration for patients/clients' differences, values, preferences, and expressed needs in all professional activities.

This presentation describes two performance tools to measure cultural competence. These tools are the integrated standardized patient examination (ISPE) and a refugee screening program. The importance of incorporating these tools to drive learning and student outcomes determines how expectations are viewed for curricular importance.

This presentation will present a refugee screening program that allows students to practice culturally appropriate care while providing a mechanism to measure outcomes of the curriculum. Students meet with refugees, communicate through a translator to obtain a health history and complete a physical examination. The students discuss the results of their screening and make recommendations to the refugee. Feedback is obtained through follow-up surveys completed by students and refugees. Some the challenges identified have been cultural mannerisms and phrases used by the students that are misinterpreted as offensive or disrespectful by the refugees. Components of the physical examination, such as lifting a teenage girl's shirt to check for scoliosis, have been irreconcilable with a family's cultural beliefs and adjustments to the screening plan needed to be made. Feedback from faculty observers, students and refugees is triangulated for analysis.

Research on Disability and Development

October 6, 11:15-12:15

Author: Penny Parnes
Email: penny.parnes@utoronto.ca
Institution: International Centre for Disability and Rehabilitation, University of Toronto

In 2007/08 the Canadian International Development Agency commissioned a research study to better understand:

the key issues related to disability and development
donor experiences and best practices
what are the positions of Canadian disability organizations on this issue

This presentation will report on the results of that study. Specifically focused on key issues related to:

Disability and Development Issues which emerge from the literature as well as the perspectives of key multilateral, bilateral and civil society organizations
Available initiatives Guidelines and tools
The views of the Canadian disability community; and
Recommendations for further research

The study was undertaken by a team from the International Centre for Disability and Rehabilitation at the University of Toronto. A number of data collection and analysis techniques were employed including recruitment of representatives of Canadian disability groups who acted as key informants.

Bi-Cultural and Bi-Lingual Perspectives in Child Interviewing Practices

Poster

Author: Marie Sanford
Email: sanford@ithaca.edu
Institution: Ithaca College

Culture and language play a substantial role in how a child will respond in an investigative interview. Without full awareness of the diversity of the child's culture and/or language, accuracy and reliability of exchanged verbal and non-verbal communication may be seriously impaired.

The poster presents with an arrangement of cultural and linguistic variables to be considered when examining a child's verbal account. It is well known that developmental stages shape the manner in which a child perceives, recalls, and discloses information. This session recognizes and offers application of the cultural and linguistic variations that modify these mainstream stages.

This poster offers suggested guidelines for the prevention and reduction of errors associated with cultural and linguistic differences, conflicts, and misinterpretations during the child interview process.

Improving culturally competent practice with underserved populations: Lesbian survivors of intimate partner violence

October 6, 11:15-11:45

Author: Emily K. Simpson
Email: esimps@midwestern.edu
Institution: Midwestern University

Intimate Partner Violence (IPV) is a social and cultural epidemic, profoundly affecting diverse groups of women, men and children across the world. The impact of violence on families and communities has been studied for decades in an effort to develop and evaluate effective response systems and emergency services, with an overall emphasis on crisis management and criminal-justice intervention. Neither is able to adequately address the functional consequences of violence or the impact that violence has on its survivors' ability to manage daily life tasks and maintain valued roles. Occupational Therapists are among the first to investigate the relationship between , disability and functional performance. Results of research have demonstrated that survivors of IPV have significant life skill needs, including the need to manage basic finances, take care of health and safety needs, and manage home and childcare tasks. Additionally, a particularly important finding has been that healthcare professionals frequently fail to identify survivors of IPV and as a result, miss valuable opportunities to intervene. Without this support and validation, many survivors fail to access services and remain in dangerous relationships. It is thus the responsibility of all healthcare providers to be competent in screening for violence, be sensitive in addressing their concerns with clients, and have knowledge of appropriate resources and referrals. In an effort to address the differences among survivors' experiences and needs so as to ultimately develop more culturally appropriate services, a preliminary research study was conducted with a subgroup of survivors: African-American lesbians living in poverty in an urban city. Both survivors and service providers participated in qualitative interviews to identify barriers to service and unmet needs. This presentation will summarize the needs identified as well as recommendations for improved service. The focus w ill be on providing healthcare professionals with the tools to examine their own biases and to recognize their role and responsibility in addressing these biases so as to provide the most culturally competent services to an at-risk group of healthcare consumers.

Reflections and Challenges of Volunteer Work in Haiti: An Issue of Cultural Competence

October 7, 10:30-11

Author: Nicole A. Thomson, Ph.D. Student
Email: nicole.thomson@utoronto.ca
Institution: Graduate Department of Rehabilitation Science, University of Toronto
Additional authors: Rona M. Macdonald, Michael Iwama

What happens when occupational therapy practice, as it is understood and taught in North America is taken to Haiti? The reflective experiences of a Canadian occupational therapist providing volunteer rehabilitation services will be discussed from the perspective of developing cultural competency in an international context, specifically Haiti. Haiti is the poorest country in the Western Hemisphere (Jacobson, 2003), and has provided the context for the development of cultural competency.

For therapists to be culturally competent, they must acknowledge the importance of culture, and assess cultural difference and cross-cultural relations. Therapists need to develop knowledge and understanding about specific cultural contexts, and finally adapt rehabilitation services to meet the unique cultural needs of their clients (Cross, Bazron, Dennis & Isaacs, 1989).

Two aspects of the experience of occupational therapy service delivery in Haiti that highlight the process of developing cultural competency will be presented in this paper. First, the realization of difference in cultural belief systems around the causes and management of disability will be discussed using examples. Second, clinical and ethical dilemmas associated with applying concepts from North American occupational therapy practice models to disability services in Haiti will be identified, and the need to adapt rehabilitation service to fit Haitian culture will be addressed.

Through international volunteer rehabilitation experience, this therapist developed the skills necessary for culturally competent practice in Haiti. These skills are not only relevant internationally, but are equally applicable within a multi-cultural North American context. Culturally competent practice is therefore essential for best practice in culturally responsive disability and health services.

The Meaning of Disability within the Culture of Western Occupational Therapy

October 7, 12-12:30

The purpose of this paper is to investigate the meaning of disability in Western occupational therapy, and its implications for practice and research. The findings from a historical review on how disability has been conceptualized in occupational therapy literature to date will be outlined. In order to explore the meanings of disability within the Western context, it is important to consider the ideologies that underlie occupational therapy theory and frameworks.

In Western society these ideologies include, but are not limited to normality/normalcy (disabled people should be rehabilitated to function as close to cultural norms as possible), independence (disabled people should be rehabilitated to function as independently as possible; often the goal of occupational therapy), expertise (health care professionals are the experts and thus power imbalances exist), and disability as undesirable (impairment is seen as a personal tragedy in which people often suffer) (Kielhofner, 2005; Abberley, 1995; Rioux, 1997). These dominant ideologies in Western society shape the ways in which disability is constructed, and thus the ways in which rehabilitation professionals, specifically occupational therapists, practice.