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Sarah Forgue
Masterson-Algar
HONR-330
3 May 2013
OT Preparation for Work with the U.S Latino Populations
In 2010, the Patient Protection and Affordable Care Act was signed into law. This act
was designed to ensure quality healthcare to all Americans regardless of class, race, age, or
current medical condition. One component of the Affordable Care Act is to expand cultural
competence within higher education in the healthcare and related fields. With this information,
this project seeks to explore the current condition of the Latino Populations1 in the United States,
but specifically in the Midwest. Then, it will explore the condition of Latinos within the U.S
health system regarding disparities especially among minorities. Finally, it seeks to look at
institutions of higher education with programs in occupational therapy, also particularly in the
Midwest, to determine if these schools are preparing their students for future work with this fastgrowing minority population and to set forth suggestions of how these institutions can improve.
In order to analyze how programs in occupational therapy are preparing their students to
work with the growing Latino populations in the United States, this project will use a case-study
model of six institutions of higher education. The six schools to be analyzed are: Washington
University in St. Louis, St. Ambrose University in Davenport, Rush University in Chicago,
Governor’s State University in University Park, Baker’s College Center for Graduate Studies
which has several locations in Michigan, and Chicago State University in Chicago. These
schools cover a large spectrum of program options including the highest and lowest ranked
1
For the purpose of this paper, Latino population or Latino culture refers to the people or cultures of “those of
Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race”
(U.S Census Bureau).
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programs in the Midwest according to the American Occupational Therapy Association, or
AOTA (Washington University and Chicago State University respectively), a private school
more local to the Quad Cities and also the only accredited school in Iowa (St. Ambrose
University), a program tied to a major hospital and centered in a large urban setting (Rush
University), a public option in Illinois (Governor’s State University), and a program unlike the
other programs chosen by combing both undergraduate and graduate programs into one (Baker’s
College Center for Graduate Studies). Schools in the Midwest were chosen because the United
States Midwest is one of the regions with the fastest growing Latino population in the country.
Overall, the large increase in the Latino populations in the United States in general, and
in the Midwest in particular, over the last ten years raises concern over the preparedness of
medical professionals, especially occupational therapists, to effectively treat these populations to
the best of their ability. Since Latinos constitute a larger percentage of the population, and the
medical field is tied to social processes such as population growth, its development will be
inseparable from the U.S Latino reality. Given these facts, how are institutions of higher
education with programs in occupational therapy preparing their students to work with these
populations? What steps are being taken to move the field of occupational therapy toward being
able to meet the needs of the United States’ growing number of Latino residents?
To answer these questions, I will analyze the above mentioned institutions with an
analysis of these six schools through their curriculum published online and the use of student and
faculty interviews. This opens a window to better understand how institutions in the Midwest are
preparing their occupational therapy students to work with the Latino populations. Based on the
conclusions of the analysis of these institutions, I argue that for the most part, institutions of
higher education in the Midwest are not yet taking the necessary steps to prepare their students to
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work with the Latino populations in the United States because there is an alarming absence of
courses which specifically teach to Latino cultural understanding and cultural literacy.
Furthermore, a second language competency is not integrated in any comprehensive or uniform
way.
In addition to outlining the general context of occupational therapy, researching the
current situation of Latinos in the United States and in the context of healthcare, and a case-study
analysis of how institutions in the Midwest are preparing future occupational therapists to work
with these populations, this project will also seek to set forth suggestions for an improvement of
programs in occupational therapy in order to prepare students to be more culturally competent
and explore current legislation regarding the matter.
The Field of Occupational Therapy
Occupational therapy is an upcoming and quickly growing field of rehabilitative health.
The goal of an occupational therapist is to help people in need live an independent, normal life,
even with a disability. A therapist may use techniques such as strengthening exercises, use of
adaptive living equipment, or fitting a patient with specialized splints to help the patient live as
independently as possible. Clients can range from small children to the elderly, and the
disabilities they work with may include anything from a learning disability or an injury to normal
challenges that accompany old age. A simplified explanation of typical treatment by an
occupational therapist includes an initial evaluation to determine current abilities and goals,
specialized treatment for each individual, and several assessments during the sessions to ensure
that goals are being met or to see if changes need to be made to the plan. Generally, an
occupational therapist will work in an outpatient setting such as a hospital, school, or prison.
However, there are therapists who work in inpatient settings as well, such as hospitals or in
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nursing homes. An occupational therapist may also provide home health treatments where they
will go to a patient’s home to evaluate their living space and help adapt it to fit the client’s needs.
In addition, therapists will educate family members and other caregivers about treatment and
adaptive living equipment (AOTA). For this reason, it is important for occupational therapists to
be culturally competent. For many Latinos, according to the book, Medical Spanish:
Interviewing the Latino, a Cross-Cultural Perspective, family is very important in the process of
decision making and the treatment process. It states that family takes on the responsibility to care
for and protect the patient, almost to the point where they “think for” the patient. It continues to
explain that the rationality for the family assuming these responsibilities is so the patient can
concentrate all of their strength and energy in recuperating (Gonzalez-Lee et al. 166-67). In
addition, because the therapist is trying to help the patient adapt to their individual needs, it is
important to understand their culture and the specific kinds of needs they may have.
In order to become an occupational therapist, one must complete an undergraduate
degree, most commonly in biology or psychology, bust most other fields of study are acceptable
for admittance into graduate school. After that, a student must enroll in an accredited program of
occupational therapy which is usually a two to three year program for a master’s degree.
According to the American Occupation Therapy Association (AOTA), there are approximately
forty accredited occupational therapy programs in the Midwest, including the second highest
ranked program in the country, Washington University in St. Louis. Programs also require
several weeks of fieldwork to be completed. In addition, students can choose to specialize in
certain areas such as pediatrics or geriatrics, or they may choose to pursue a doctorate degree.
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The Latino Populations in the United States and the Healthcare System
When one professor from St. Ambrose University was asked the question of whether or
not the university offered a class which specifically taught cultural competence and literacy of
the Latino populations in the United States, her response was that they did not. She continued to
give her reason of why they did not, “Our curriculum emphasizes the inherent dignity of all
people and promotes resources and supports to engage in occupations of a person’s choosing.”
While it is extremely true that people of all races and ethnicities deserve to have professionals
who are culturally competent, it is responses like these which show why it is necessary to have
classes which teach of the Latino populations. Because the United States is such a diverse
country, occupational therapists should be trained and prepared to work with all different kinds
of populations, but at this point in time, especially the Latino populations, which are the largest
growing minority in the United States. According to the 2010 census, between 2000 and 2010,
the Latino populations grew in every region of the United States but most significantly in the
South and Midwest. In fact, the Latino Populations increased by more than 15 billion and
accounted for over half of the total population growth in the U.S, and it is continuing to grow.
An article by Kaplan et al. states that, “by the year 2050, 30 percent of all U.S residents will be
part of this [Latino] ethnic group “(86). In the Midwest, the Latino populations grew by 49
percent which is a high percentage when taking into account that the Midwest population as a
whole grew by only four percent. In the Midwest, the Latino populations at least doubled in one
out of every four counties, and Chicago, Illinois is ranked fifth overall with over 750,000 Latinos
(U.S Census Bureau). If institutions of higher education, especially those in the Midwest where
the Latino populations are growing rapidly, do not think that classes which are specifically
designed to teach to Latino culture competency and literacy are necessary simply because their
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curriculum is designed to “uphold the inherent dignity of all people,” the Latino populations in
the United States are going to continue to be underserved for lack of understanding and
education. For this reason, in order to uphold the dignity of more people, it is imperative to at
least offer, if not require, education surrounding the Latino populations in the United States.
Despite their growing numbers, the Latino populations remain a minority in the United
States, and like other minority groups, its constituents are often underserved when it comes to
healthcare. In fact, The Pew Research center revealed that more than one quarter of all Latino
adults in the United States lack a usual healthcare provider and medical insurance.
According to the Pew Research Center, six out of ten Latinos in the U.S who are not legal
permanent residents lack health insurance. However, even a high percentage of those Latinos
living in the U.S who are permanent legal residents do not have health insurance. According to
Kaplan et al., “Data reveals that forty-two percent of Hispanics in the United States are presently
uninsured compared to only twenty percent of non-Hispanic Blacks and twelve percent of nonHispanic white Americans” (89). This is a large amount considering that the overall percentage
of all uninsured adults in the U.S is only seventeen percent. While these percentages may seem
like only numbers, the social implications of being uninsured are complex. For example, “Those
without health insurance tend to receive far less health care services and tend to perceive greater
barriers to service access compared to those with insurance” (Kaplan et al. 85). This makes the
social implications complex because without healthcare, one cannot receive regular physicals,
routine check-ups, and other medical attention at a reasonable cost. Also, treatments such as
rehabilitative heath, including occupational therapy, are often not an option for the uninsured.
Because these limitations are placed on individuals without health insurance, “when researchers
asked Hispanic and Latino respondents to rate their perception of their overall general health,
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those without insurance were more likely to perceive their health status as being either fair or
poor in comparison to those with insurance” (Kaplan et al. 87). Without health insurance one is
less likely to be able to afford regular visits and may only visit the doctor when they are very
sick.
When one lacks health insurance, it is also common that one is without a usual healthcare
provider as well. Often, those who do not have a regular physician have to resort to using the
emergency room as a means of getting treatment for everyday ailments such as colds or flus. In
the United States, only fifty-seven percent of non-legal resident Latinos have a usual healthcare
provider, not including the use of emergency rooms. Although seventy-percent of Latinos who
are legal residents do have a regular physician, a disparity in the numbers can still be seen when
compared to the overall adult population of the U.S in which eighty-three percent have a usual
healthcare provider (Pew Research Center). If people lack a usual healthcare provider and only
seek medical attention when they are sick, they will most likely not be able to seek preventative
care and routine examinations. In addition, they may have waited too long to receive help, and if
they just would have had a regular physician that they could see, they might have been able to
prevent the illness in the first place. Not only does the lack of a usual healthcare provider
interfere with the ability to receive preventative care, it also interferes with the ability to receive
rehabilitative care, which is the core purpose of occupational therapy.
While lacking a usual healthcare provider causes many people not to receive the proper
medical care they may need, for most people this is not a choice. The most common reasons are
the financial limitations such as the lack of health insurance and the increasing medical costs;
however, these are not the full extent of why Latinos do not have a usual healthcare provider. In
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fact, five percent of Latinos who do not have a usual healthcare provider state that it is because
of the difficulty associated with navigating the U.S system (Pew Research Center).
Another aspect that must be taken into account when looking at the Latino context of
healthcare is the quality of healthcare received. According to the Pew Research Center, more
than one third of Latino patients reported that they felt that their race or ethnicity played a part in
receiving poor treatment. This feeling may stem from the fact that not all healthcare providers
are trained or culturally competent to work with the Latino populations, and this may come
across to the patient as poor treatment even if it is not the intention of the provider. This is
because Latinos may have a specific set of expectations in the context of the medical field, thus,
the importance of addressing cultural and linguistic literacy among professionals.
For example, Rush et al. has noted how some people of Latino background, especially
women, are more modest and would rather not discuss certain elements of their lives with
strangers, even in a medical setting. This concept is known as “pudor” and is defined as, “a core
value of modesty that touches on issues of morality, intimacy, and respect” (Rush et al. 56). The
medical professional may ask personal questions in order to gain a better sense of the patient’s
health, but to a Latino patient, these questions may be uncomfortable because, “Pudor can make
patients too shy to talk about certain symptoms or illnesses and too embarrassed to listen to
explanations about them” (Rush et al. 56). The lack of effective communication between
provider and patient can easily lead to less effective treatment, or worse, misdiagnosis. In the
context of occupational therapy, a patient who does not reveal all of their problems may not be
able to be fully rehabilitated if the therapist does not know there is a specific problem. However,
this is just one example that certainly does not apply to all Latino groups in the United States.
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Yet, this work by Rush et. al. alerts to the need of cultural and linguistic literacy and the
implications of its lack thereof.
The implications of a lack of culturally competent medical professionals do not stop at
just a lack of effective communication; it also extends to the actual language barrier itself as well
as financial and navigational problems dealing with the healthcare system in the United States.
For example, race and ethnicity was not the largest reason why Latino patients felt they did not
receive adequate treatment. Forty-six percent believed that the poor treatment they received was
because of their accent or the way they spoke English. In addition to ethnic and language
barriers, many Latinos believed that financial barriers also left them receiving poor treatment. In
fact, forty-three percent of Latinos believed that they received poor treatment because of their
inability to pay. Obviously, there are many disparities among the Latino populations when it
comes to access to and quality of healthcare. These are all issues that should be examined by and
addressed by not only medical institutions but also the institutions of higher education who train
future members of the medical community, especially in a region such as the U.S Midwest where
the Latino population is the largest growing population.
Case-Study
One way to judge just how important and necessary cultural competency and literacy is in
higher education, is to use a case study model of how one specialized area, occupational therapy,
within the health field as a whole is training their future professionals to work with one minority
population, the U.S Latino population. This case-study of six institutions of higher education
with programs in occupational therapy show whether and how each institution is preparing their
students to work with the growing Latino populations in the U.S Midwest.
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After an independent assessment of the curricula for each institution, interviews were
conducted with faculty/and or students at each. A total of nine interviews included
correspondence with three faculty members (Washington University, St. Ambrose University
and Rush University) and seven students (Rush University, St. Ambrose University, Washington
University and Chicago State University). Neither students nor faculty could be reached after
multiple inquiries for an interview at Baker’s College for Graduate Studies and Governor’s State
University, and therefore, as to not make false assumptions based solely on the curricula found
online, these two institutions were eliminated from analysis.
The first step in analyzing the six institutions involved in this study was to research each
of their program requirements for graduation. To do so, I researched their course requirements to
identify classes with content possibly tied to cultural competency. Only one institution, Rush
University in Chicago, required a class focused explicitly around cultural competency and
understanding which was called, “OT Perspectives in Ethics and Multiculturalism.” The
remaining three schools did require courses which taught “principles of OT” or “contexts of
OT,” however it remained unclear whether these courses actually have any focus on cultural
literacy. On the other hand, each of the six programs does require some kind of independent
study or fieldwork, and it is possible that students may gain valuable information about different
cultures from these experiences, although this is a supposition. For instance, students could
choose to do their fieldwork in a suburban, predominantly white neighborhood and therefore, go
through their entire education without being exposed to the Latino populations. In addition, no
classes at any institutions were found to teach specifically neither about the healthcare system in
the United States, nor its relation to any minority groups. Furthermore, none of the institutions
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requires foreign language courses in their curriculum, nor as a requirement to have been taken as
a part of or for admittance into their programs.
Since Rush University, based on their online curriculum, seemed to be the only
institution which required a class specifically designed to speak to cultural competence in
occupational therapy, an interview was conducted with the current professor of this course. This
course, “OT Perspectives in Ethics and Multiculturalism” was the only one in the program that
this faculty member could identify as teaching any sort of cultural literacy/competence.
According to the professor, this class was designed to teach how individuals and groups from
various ethnic and cultural backgrounds experience the healthcare process, as well as discuss the
challenges professionals may face in multicultural settings. One goal of this course would be to
make the students more culturally sensitive. As stated in the course syllabus, “This course will
focus on understanding the many dimensions of multiculturalism so that students may develop a
basis from which to be sensitive to the uniqueness of individuals and increase awareness of
cultural diversity” (Rush Professor). Also stated on the syllabus, and as students who were
interviewed and have taken the class report, this class uses case study examples to achieve its
goals. However, since this course is designed as a survey of cultural differences at large, the
Latino populations is not covered in great depth and many elements of cultural expectations are
overlooked simply for lack of class time. Perhaps the reason why Rush University offers such a
class is because of its location and connection to a major hospital in a large urban setting.
Chicago, Illinois is a very large and diverse city. As previously, Chicago has a growing
population of over 750,000 Latinos. Perhaps the visibility of Latinos and their long history in
Chicago is a factor in why this particular university requires students to take this course.
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Through interviews, students from all four institutions under study reported that there
were no foreign language requirements to be admitted to their programs. While it would be
unrealistic to require every student to have complete competency in Spanish, and while a portion
of the Latino population does not speak Spanish, it would be beneficial to at least offer a course
on basic medical terminology. Surprisingly, one student who is fluent in Spanish and who
identifies herself as a Latina, reported feeling uncomfortable when having to translate for
Spanish-speaking patients despite being fluent in Spanish herself. She stated, “As a student who
is fluent in Spanish, I have had to translate for patients in the clinic and have felt uncomfortable
with this because of my lack of knowledge of medical terminology” (Rush Student 1) Thus, even
those who have spoken Spanish their entire lives would benefit from a course on Spanish
medical and occupational therapy terminology.
Most importantly, both the students and faculty interviewed recognized the importance
of being culturally competent, especially in regards to the Latino populations as a resident of the
Midwest and spoke to the need to improve in this direction. Since Rush University is centered in
the Chicago area where there are a large number of Latino residents, the students seem to
recognize that it is very likely that they will have patients of Latino descent. Students report
having limited experience working with the Latino populations through required clinical work,
however, when asked about their feelings on the importance of being culturally prepared to work
with the Latino populations they used words such as “necessary” and “imperative.” When asked
the same question, one faculty member stated, “If we are not prepared to work with the Latino
populations, we are going to be doing many people a terrible disservice as we won’t understand
what their unique needs are and they won’t benefit as much from our service.” The fact that these
students and faculty from this institution recognize that it is important to have the cultural
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competency and that a class is required which specifically addresses this issue is quite telling. It
shows the recognition of the need and desire for the implementation of curriculum addressing
cultural and linguistic competency.
On the contrary, the interviews with students at St. Ambrose University and Chicago
State University were not as promising. A student who attends Chicago State University
recognized that importance of being linguistically and culturally competent to work with the
Latino populations, especially as a Latina herself, but she stated that her school did not require
any classes which taught to these subjects. She mentioned that there were classes in which
elements of different cultures were addressed, but it was not a big “chunk” of the material. It is
interesting to remember that Chicago State University is the lowest ranked program in the United
States, so the fact that the students here felt like they did not receive very much education in
regards to multiculturalism could speak to this ranking.
The students interviewed at St. Ambrose University also felt that it was important be
culturally competent and they did recognize the population changes among the Latino
populations in the U.S Midwest. However, through the interviews, it seems that these particular
students were not as aware of the growing Latino populations and the specific issues surrounding
this group as the students and staff from Rush University in Chicago. Again, this could be a
result of the location and demographics of the schools, for Rush is centered in Chicago whereas
St. Ambrose is a private school centered in Davenport, IA which is a much smaller city. Both
students that were interviewed at St. Ambrose reported touching on the needs and challenges of
various ethnic groups in the U.S but did not report having a class which specifically taught to this
subject or which focused specifically on Latinos. They did however report that they had the
option to study abroad in Brazil, a trip in which they thought did help the students to experience
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first-hand some aspects of culture in this country that may be similar to some aspects of U.S
Latino culture. While this study abroad experience could be very helpful, it must be noted that
the trip is optional, so not all students attend, and the native language of Brazil is Portuguese, and
plus, the context is outside of the United States. Thus, while students may be able to pick up
some language skills, it may not be very helpful to the majority of the Latino populations in the
U.S of which the native languages are usually Spanish and/or English. In addition, the fact that
students would consider a fieldwork experience in Brazil as an opportunity to study the Latino
populations in the U.S is a little surprising. It is telling that students thought of “Latino” as
associated to “abroad.” Students were clearly unable recognize that the cultures of people living
in Spanish-speaking or Latin American countries and the culture of Latinos living in the U.S,
while they share some similarities, are by no means comparable.
Finally, the last school to be analyzed is Washington University in St. Louis. This school
is ranked among the top two in the country, and number one in the Midwest, so it was of high
interest. While Rush University was the only institution under study to require a class on
multiculturalism, interviews with faculty revealed that Washington University did offer one class
that taught specifically to Latino culture and language as an elective which is titled, “Medical
Spanish and Hispanic Culture: Promoting participation and performance in minority
populations.” In fact, even though this class is only an elective, it was the only one from all
universities studied which taught solely to the Latino context. This class was not required by the
program, but the fact that it is even offered is a large step considering that among the six schools
analyzed in this project, it is the only one which teaches specifically to the Latino context in
occupational therapy.
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In addition to offering the Medical Spanish class, this school does requires students to
participate in projects to help them gain a larger world view and better understand different
backgrounds, in which they partner with a different cultural group from the community and
prepare a meal, have a discussion, and write a reflection paper. While all students participate in
this project, it is not necessarily centered on the Latino culture. For example, they could partner
with people of Indian, African, Chinese or any other culture.
Just like the study abroad program offered at St. Ambrose, Washington University also
offers a study abroad trip to Guatemala which would give the students experience in the Spanish
language and also the Guatemalan culture in which some aspects may transcend across the
cultures of other Latino countries as well. However, just like the misconceptions found in
relating the term “Latino” to an abroad experience when speaking to the students from St.
Ambrose, this trip to Guatemala does not give the students experience working with the Latino
populations in the United States, specifically in the Midwest.
Future Suggestions and Current Legislation
The above case study sheds some light on how the system of multicultural education is
currently working. It allowed for the construction of a model of how institutions of higher
education with programs in occupational therapy in the Midwest are training their students to
work with the U.S Latino populations. Based on the six institutions surveyed, the model would
include a few classes which taught elements of cultural understanding/literacy. However, these
classes are very broad and often the context of multiculturalism was sort of weaved into classes
which taught overall principles of occupational therapy rather than having a class specifically
devoted to teaching cultural literacy and understanding. If this model were to be applied
nationwide, only one out of every six institutions would require a class specifically devoted to
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increasing cultural awareness such as that required at Rush University entitled, “OT Perspectives
in Ethics and Multiculturalism.” However, at best, this course will spend a limited time on the
Latino populations specifically. The same amount of institutions, only about seventeen percent
(1/6), would offer a class which specifically taught language and cultural competency in relation
to the Latino culture. None of the institutions would require this class as part of the graduation
requirements. The example in the group of institutions studied would be Washington University
which offers, but does not require, the course, “Medical Spanish and Hispanic Culture:
Promoting participation and performance in minority populations.” In addition, not a single
institution would require competency in a foreign language for graduation.
While this was just a case study of a small sample size, if one imagined that this type of
model was applied when talking about the education of all health professionals, it would mean
that one out of every six professionals from different institutions would have taken a course that
taught about multiculturalism, and that only one out of every six professionals had been offered
the option to take a course on language and cultural competency addressing the Latino
populations specifically.
With this scenario, it is not surprising that, as previously explained, Latinos in the U.S
reported feeling that their medical care was not of very good quality, simply for lack of language
or cultural misunderstandings (either referring to the way they spoke English or not
understanding the healthcare system in the U.S). If medical professionals across the entire field,
not just in occupational therapy, are lacking the necessary language and cultural understanding
skills to effectively treat Latino patients, who are members of the largest and fastest growing
minority population in the United States, it seems as though it is time to revise our educational
system to address this common lack of knowledge and training.
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The final goal of this project is to set forth recommendations which may help to move the
field of occupational therapy forward towards producing students who are competent and
confident in working with the U.S Latino populations. Based on the background information of
the context of Latinos in the United States, and specifically in the Midwest, the first logical step
would be to educate more people about what the demographics in our region of the United States
actually are. Many people are aware that the Latino populations are growing; however, they are
usually not aware just how fast these populations are growing or how prominent culture, and
especially the Spanish language, will be in the United States in just a few short years. I believe
that if more people understood just how large of a percentage the Latino populations are
compared to our overall population, they would see just how important it is to be educated on
Latino cultural literacy and understanding topics.
Next, in order to move the field of occupational therapy towards preparing their students
to work with the Latino populations which they are very likely to encounter, it is critical to not
only start offering more courses at institutions of higher education, but also to require them. It is
true that some institutions offer classes which teach basic medical Spanish or “Latino culture,”
but not all students choose to take these courses even when offered. Having even a basic grasp of
the Spanish language and U.S Latino cultures could help not only the professionals to
communicate more effectively and treat the patient at a higher quality, but it could also create a
more comfortable atmosphere for the Latino patients who are receiving the treatment.
In addition to offering and requiring more cultural competency and literacy classes,
perhaps one of the most important things that need to be done in order to move the field of
occupational therapy towards being prepared to work with the U.S Latino populations is to make
occupational therapy more well-known and accessible among these populations. As a new field
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in itself, it is not very well known among the general public, but it might be especially not well
known among those who do not have health insurance, lack a usual healthcare provider and those
who do not understand the United States healthcare system very well. Because as stated before, a
percentage of Latinos living in the U.S, with or without documents, find themselves in one or
more of these categories, it is very probable that many have not even heard of occupational
therapy, or if they have, they do not know exactly what it is for or how to access it. This is
extremely alarming since the main purpose of occupational therapy is rehabilitative care.
Without insurance, those who cannot afford the treatment will end up living the rest of their lives
unable to do the things they once did with ease. This loss of independence has implications much
deeper than just medically.
In order to set into motion the suggestions put forth, it is important to ask what action has
been done or is being done to help battle the disparities among the U.S Latino populations and
the lack of Latino cultural competency education in institutions of higher education. On March
23rd, 2010, the Patient Protection and Affordable Care Act was signed into Law by President
Obama (Healthcare.gov). This act is especially important to the underserved Latino populations
because as Kaplan et al. explains “The Patient Protection and Affordable Care Act will provide
uninsured Hispanic and Latino Americans with a number of beneficial options that will
substantially increase their ability to access culturally competent services from the American
health care system” (90). One of the implementations of this act will be the formal establishment
of the ‘Office of Minority Health’ within the Department of Health and Human Services. This
new office will monitor and evaluate programs for minority health which are federally funded
and in turn, ensure that money is being allocated to implement programs which will specifically
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serve minority populations s. As Latinos are the largest and fastest growing minority in the U.S,
the Office of Minority Health will surely work to address the needs of that group.
The Affordable Care Act also helps to lessen the gap for uninsured Americans by giving
them the option to buy health insurance through a government plan. The cost of this option
would offer financial subsidies to low-income families. Since a number of Latinos in the U.S
who are uninsured state that it is simply because of the high cost of health insurance, this
provision will provide them with an opportunity to be covered in an affordable way. Also, the
Affordable Care Act provides the public with 100 percent insurance coverage for preventative
care and prevents insurance companies from denying coverage to people with pre-existing
conditions or from dropping members who become sick.
In addition to addressing the problem of inadequate insurance coverage, the Affordable
Care Act also would help lessen the disparities of not having a usual healthcare provider among
the U.S Latino populations. This Act will provide funding for community health centers that can
“offer their patients comprehensive affordable services that are customized to the health care
needs of the racial and ethnic minority communities they serve (Kaplan et al. 91). By providing
health centers in communities which need them, the residents of those communities will have
easier access to health care, and they will feel more comfortable knowing that the people
working in those centers are trained to specifically work with their own culture and speak their
native language. They will also give people who lack a usual health provider an option of having
one there in their own community at a lower cost than through a private practice since these
centers will be governmentally funded. With the establishment of these centers, and also the fact
that the Affordable Care Act will reduce out of pocket expenses, it makes sense that more people
will chose to use the government health centers as a usual healthcare provider rather than going
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to the emergency room when the illness is not an emergency which will, in turn, reduce the cost
of insurance even more.
There are many more important parts of the Patient Protection and Affordable Care Act,
but one part that is specifically pertinent to this project is the fact that it calls for cultural
competency within the health field. First, it would use federal funding to employ health workers
within state institutions, public health departments, clinics, and hospitals to help “bridge the gap”
between healthcare professionals and the populations they serve. This act would also create
scholarships and other financial aid for students from disadvantaged backgrounds who want to
enter the health field and who would be committed to serving in underserved institutions and in
minority communities. Finally, perhaps one the most relevant provision of the Affordable Care
Act to this project is that it will, “expand the development, evaluation, and dissemination of
cultural competency model curricula within health care professional schools and continuing
education programs for health care providers” (Kaplan et al. 91). This part of the act will be
essential in training future employees of the health professions to be prepared to work with
minority groups within the United States, including the largest which are the Latino population.
All in all, while the results of this research and case study were not shocking, they were
at the least a little surprising. With the current disparities in regards to healthcare the Latino
populations in the United States face, it is unnerving to discover that institutions of higher
education have not yet caught up with these growing populations. While it is true that some
institutions, especially those located in larger cities where the Latino populations may be more
prominent, or those institutions of higher quality may offer some sort of class specifically
centered around multiculturalism or Latino cultural literacy and understanding, it is saddening to
find that this is the exception rather than the rule. However, with the passing of the Patient
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Protection and Affordable Healthcare Act, it is hopeful that when all programs get put into place,
things such as healthcare will become more affordable for more people, patients will have easier
access to healthcare through community based clinics, and perhaps most importantly, more
money will be allocated to institutions to start preparing their students to be culturally competent
and to be able to work with a culture which is different than their own. The future of
occupational therapy, and the entire medical field in general, would be able to much better serve
a greater percentage of the population if more professionals were trained to work the U.S Latino
populations, and it is my hope that with more research, understanding and education, the field
will be able to realize this goal in the near future.
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Bibliography
Bourke-Taylor, Helen, and Dawn Hudson. “Cultural Differences: The Experience of
Establishing an Occupational Therapy Service in a Developing Community.” Australian
Occupational Therapy Journal 52.3, 3, pp. 188-198, Academic Search Premier,
EBSCOhost, viewed 6 December 2012.
Chicago State University Student 1 Email Interview. 21 Feb. 2013.2
Chicago State University Student 2. Personal Interview. 24 Feb. 2013.
"Census Bureau Homepage." Census Bureau Homepage. N.p., n.d. Web. 20 Dec. 2012.
"CSU | Occupational Therapy." CSU | Occupational Therapy. N.p., n.d. Web. 04 Dec. 2012.
"Data and Resources." Pew Hispanic Center RSS. N.p., n.d. Web. 30 Nov. 2012.
Gonzalez-Lee, Teresa, and Harold J. Simon. Medical Spanish: Interviewing the Latino Patient, a
Cross-Cultural Perspective. New Jersey: Prentice Hall, 1990. Print.
Kaplan, Mitchell A., and Marian M. Inguanzo. “The Social Implications of Health Care Reform;
Reducing Access Barriers to Health Care Services For Uninsured Hispanic and Latino
Americans in the United States.” Harvard Journal of Hispanic Policy 23. (2011): 83-92.
Academic Search Premier. 10 Dec. 2012.
"Master of Occupational Therapy (MOT)." Governors State University. N.p., n.d. Web. 04 Dec.
2012.
"Master of Occupational Therapy :: St. Ambrose University, Davenport, Iowa." Master of
Occupational Therapy :: St. Ambrose University, Davenport, Iowa. N.p., n.d. Web. 04
Dec. 2012.
"MSOT Sample Curriculum." WUSTL Occupational Therapy. N.p., n.d. Web. 04 Dec. 2012.
2
To maintain the anonymity of students and professors interviewed, they have been identified simply by the name
of their institution.
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"Programs." Master of Occupational Therapy (MOT). N.p., n.d. Web. 04 Dec. 2012.
Rush University Professor. Email Interview. 15 Feb. 2013.
Rush University Student 1. Email Interview. 15 Feb. 2013.
Rush University Student 2. Email Interview. 3 Mar. 2013.
St. Ambrose University Professor. Email Interview. 28 Feb. 2013.
St. Ambrose University Student 1. Personal Interview. 12 Dec. 2013.
St. Ambrose University Student 2. Email Interview. 2 Jan. 2013.
Rush, Patricia, and Patricia Houston. Spanish for Health Care. 2nd ed. New Jersey: Pearson,
2011. Print.
Rush University Professor. Email Interview. 15 Feb. 2013.
Washington University Professor. Email Interview. 19 Feb. 2013.
Washington University Student 1. Email Interview. 20 Feb. 2013.
"Welcome to Rush University Online Catalog." Welcome to Rush University Online Catalog.
N.p., n.d. Web. 04 Dec. 2012
Washington University Student 2. Email Interview. 20 Feb. 2013.