Notes

Outline

Individual with Disabilities: Consideration of Systems and Cultural Diversity

Communication, Culture, Society (Orlando Taylor) All communication, normal and pathological, emerges out of  systems and a cultural context Culture plays a significant role in terms of what is judged as normal or abnormal Cultural practices may contribute to the presence and prevalence of communication disorders in a specific populations, what are considered disorders and how they are viewed

Disablement Insider’s Perspective what does the person think of him/herself what does the person think of the impairment and how it is to live with it Outsider’s Perspective different “outsiders” family, friends, professionals, organizations, society what do these different “outsiders” think of the impairment, person who is living with the impairment, how their own lives are impacted

Views of Disability-Systems and Culture Macrosystem:  National level WHO (impairment, activity limitation, participation restriction) American with Disabilities Act Assessment of perceived disability must include society, community, family (i.e., outsider’s perspective) Public Laws 99-142; 99-457--Education for all nondiscriminatory testing that are racially and culturally nonbiased testing done in native language extensive data from various sources Asha

Views of Disability--Systems and Culture Meso/Exosystem: State level/Local level (Outsider’s perspective) State and county governments Local public health care policies School District and home school policies Funding agencies Professionals

Views of Disability from a Cultural Perspective Microsystem:  Family level (Outsider’s Perspective and Insider’s Perspective) Attitudes/beliefs understanding of disability degree of acceptability perceived cause of disability attitude towards healthcare western view--scientific orientation cross-cultural view--role of fate, responsibility of individual or individual’s family beliefs about change fatalism individualism

Influencing Variables re. Systems and Culture Generational membership Length of residence--acculturation Socioeconomic status Educational level Urban or rural background Age and gender Language spoken

Assessment and Intervention: Cultural Considerations Assessment and intervention are always more successful when context is considered (situational, interpersonal, cultural) Assessment Tools (beware of cultural biases) observation interview standardized tests Intervention direct treatment indirect--family, significant others

Considerations in Assessment Form & Content bilingualism simultaneous sequential English proficiency dialects code switching

Considerations in Assessment Use eye contact nonverbal communication conversational rules turn taking topic initiation resolving communication breakdowns/conflicts amount of talking narratives rules and expectations between speakers and across contexts

Considerations in Treatment Attitude about change can there be change Attitude about treatment who should be involved who is responsible how shall it be delivered (when, where, how, by whom, with whom)

“Assumptions are the things you don’t know you’re making…the shock is that it had never occurred to you that there was any other way of doing it.  In fact, you had never even thought about it at all, and suddenly here it is different.  The ground slips.

Some assumptions you may have Time punctuality is important and is an intrinsic part of a professional relationship based on mutual respect Beginning an interaction in professional situations such as meetings, it is important to get down to business as quickly and efficiently as possible

Some assumptions you may have Formality vs. Informality informality and social equality are the ultimate goals in all interactions between professionals and clients Directness frankness, openness, and honest discussion of situations and feelings is important Gender the gender of the clinician and the client is not important, the clinician's competence is the most important variable

Some assumptions you may have Age the age of the clinician, relative to the client, is unimportant, as long as the clinician is competent Written documentation written documentation is necessary and an intrinsic part of professionals’ interactions with clients and families. Nature of disabilities communication is a critical aspect of a disability to assess and treat

Some assumptions you may have Intervention and independence independence is the goal and thus, intervention may be needed to achieve this goal…caring for the individual is not necessarily/only the responsibility of the family Western intervention is probably most effective Family participation families should be involved as much as possible and in collaboration with the clinician

Some assumptions you may have Control or destiny individuals have control over their own destiny Language in the home families who speak other languages at home need to speak English to their children so that the children will learn English

Cross Cultural Effectiveness: Guidelines Know your own biases and assumptions Know your own cultural limitations Separate cultural preferences from personal preferences or lack of information View intercultural interactions as learning opportunities

Cross Cultural Effectiveness: Guidelines Consider your assumptions--maybe you will need to modify your method of greeting type of dress eye contact who to talk with method/style of communication

Cross Cultural Effectiveness:  Guidelines You may be asked to learn about family practices related to child rearing, health, disablement explain your role interpret mainstream culture design an intervention program to meet the individual needs of the client and the family consider and handle cultural practices that maybe be detrimental or even harmful to the child

Cross Cultural Effectiveness: Guidelines You may need to prepare family for meetings--formality, topic, participants encourage families to bring whomever they wish to sessions encourage input from family in a way that is comfortable encourage goals and objectives that address the family concerns design treatment strategies that are compatible with families beliefs/values use a cultural mediator/interpreter

Cross Cultural Effectiveness:  Gathering Information Observation: Determine if this is appropriate Watch family interact--waiting room

Cross Cultural Effectiveness:  Gathering Information Interview:  Ask open-ended questions (e.g., Would you describe a typical playtime for your child, or a typical day at home for your spouse) to determine family’s: child rearing practices developmental expectations decision making willingness to accept outside help views on illness and disability values, beliefs, traditions

Cross Cultural Effectiveness: Gathering Information Utilize cultural mediators/interpreters when appropriate: Criteria for interpreter: demonstrates good bilingual skills demonstrates professional attitude establishes good rapport maintains confidentiality

Cross Cultural Effectiveness: Gathering Information Using an interpreter: meet with interpreter before to prepare--vocabulary etc. seat interpreter next to client, facing you, look at client introduce everyone and make sure the purpose of the meeting is understood speak in short sentences and allow time for translation encourage direct translation of client/your words

Cross Cultural Effectiveness:  Summary Be willing to recognize and discuss your biases and assumptions Be open to, appreciate and respect family practices as valid and important even if different from your own doesn’t mean you need to become part of other’s culture doesn’t mean you need to know everything about another culture there are many ways to view the world

Cross Cultural Effectiveness:  Summary Avoid stereotyping Remember: respect client as individual recognize that cultural influences change as the situation changes establish a collaborative relationship be flexible and considerate

Application Scenarios for discussion Consider each scenario What would you do? What questions might you ask client/family?  How would you phrase them?