Cultural competence in occupational therapy A hot topic is geared at providing occupational therapists and occupational therapy students with a list of references (journals, books, assessments, and additional information) in areas identified as emerging and/or topical by members. CAOT invites you to contribute to the ongoing development of these documents. CAOT would like to thank all the members who participated in the development of this hot topic. Thank you especially to Zofia Kumas-Tan, OT(c), for her significant contribution. Culture Culture refers to the values, beliefs, practices, and experiences that are shared by a group or community of people. These cultural groups or communities can be defined by age, gender, sexual orientation, class, ability, religion, ethnicity, race, and so on. This means that we can think of occupational therapists, for example, people with disabilities, or the elderly, as cultural groups. There are two aspects of culture we can consider: The first aspect is what we usually understand as cultural. It concerns people s values, beliefs and customs. The second aspect, which is less commonly acknowledged, concerns power. Cultural differences are very often accompanied by differences in power and social status. Depending on whether someone belongs to a dominant or a minority cultural group, he/she will likely experience privilege or disadvantage, empowerment or marginalization. Cultural competence refers to the awareness, knowledge and skills required to work effectively and equitably with people whose cultural backgrounds differ from one s own. Canadian Association of Occupational Therapists, July, 2009 1
References The following symbols will be used throughout this hot topic: This is a Canadian resource. This resource was designed by/for occupational therapists. Also, please note that the following journal articles represent but a fraction of the existing literature on cultural issues in occupational therapy. These particular readings are listed here either because they provide a broad overview of this topic (i.e. review articles), or because they address the less examined aspects of culture and cultural competence. Canadian Journal of Occupational Therapy Beagan, B. (2007). Experiences of social class: Learning from occupational therapy students. Canadian Journal of Occupational Therapy, 74(2), 125-133. Dyck, I. (1989). The immigrant client: Issues in developing culturally sensitive practice. Canadian Journal of Occupational Therapy, 56(5), 248-255. Mirkopoulos, C., & Evert, M. M. (1994). National perspective - Cultural connections: A challenge unmet. Canadian Journal of Occupational Therapy, 61(2), 67-70. Paul, S. (1995). Culture and its influence on occupational therapy evaluation. Canadian Journal of Occupational Therapy, 62(3), 154-161. Occupational Therapy Now Iwama, M. (1999). Are you listening? Cross-cultural perspectives on client-centred occupational therapy practice: A view from Japan. Occupational Therapy Now,1(6), 4-6. Other journals Awaad, T. (2003). Culture, cultural competency and occupational therapy: A review of the literature. British Journal of Occupational Therapy, 66(8), 356-362. Bailey, D. M. (1996). Closer to home: Creating an effective treatment plan for your gay and lesbian clients depends on acknowledging their relationships. OT Practice, 1(6), 34-38. Bonder, B., Martin, L., & Miracle, A. (2001). Achieving cultural competence: The challenge for clients and healthcare workers in a multicultural society. Generations, 25(1), 35-42. Chiang, M. & Carlson, G. (2003). Occupational therapy in multicultural contexts: issues and strategies. British Journal of Occupational Therapy, 66, 559-567. Dyck, I. (1992). Managing chronic illness: An immigrant woman's acquisition and use of health care knowledge. American Journal of Occupational Therapy, 46(8), 696-705. Evans, J. (1992). Nationally speaking - What occupational therapists can do to eliminate racial barriers to health care access. American Journal of Occupational Therapy, 46(8), 679-683. Fitzgerald, M. H., Mullavey-O'Byrne, C., & Clemson, L. (1997). Feature article - Cultural issues from practice. Australian Occupational Therapy Journal, 44, 1-21. Gill, C. J. (1987). A new social perspective on disability and its implications for rehabilitation. Occupational Therapy in Health Care, 4(1), 49-55. 2 Canadian Association of Occupational Therapists, July, 2009
Hocking, C., & Whiteford, G. E. (1995). Viewpoint - Multiculturalism in occupational therapy: A time for reflection on core values. Australian Occupational Therapy Journal, 42, 172-175. Humphrey, R. (1995). Families who live in poverty: Meeting the challenge of family centred services. American Journal of Occupational Therapy, 49(7), 687-693. Iwama, M. (2003). The issue is - Toward culturally relevant epistemologies in occupational therapy. American Journal of Occupational Therapy, 57(5), 582-588. Kingsley, P., & Molineux, M. (2000). True to our philosophy? Sexual orientation and occupation. British Journal of Occupational Therapy, 63(5), 205-210. Kirsh, B., Trentham, B., & Cole, S. (2006). Diversity in occupational therapy: Experiences of consumers who identify themselves as minority group members. Australian Occupational Therapy Journal, 53, 302-313. Trentham, B., Cockburn, L., Cameron, D. & Iwama, M. (2007). Feature article Diversity and inclusion within an occupational therapy curriculum. Australian Occupational Therapy Journal, 54, S49-S57. Non-occupational therapy journals Delpit, L. D. (1988). The silenced dialogue: Power and pedagogy in educating other people s children. Harvard Educational Review, 58(3), 280-298. Kondrat, M.E. (1999). Who is the self in self-aware? Professional self-awareness from a critical theory perspective. Social Sciences Review, 70, 451-477. Kumas-Tan, Z., Beagan, B.L., Loppie, C. MacLeod, A. & Blye, F. (2007). Measuring cultural competence: Examining hidden assumptions in instruments. Academic Medicine, 82(6), 548-557. McNair, R. (2003). Lesbian health inequalities: A cultural minority issue for health professionals. Medical Journal of Australia, 178, 643-645. Available at http://www.mja.com.au/public/issues/178_12_160603/mcn10852_fm.pdf Rossiter, A. B. (1995). Teaching social work skills from a critical perspective. Canadian Social Work Review, 12(1), 9-27. Books Bonder, B., Martin, L., & Miracle, A. (2002). Culture in Clinical Care. Thorofare, NJ: SLACK. Bette Bonder is an occupational therapist Iwama, M. (2006). The Kawa Model; Culturally Relevant Occupational Therapy. Toronto: Churchill Livingstone-Elsevier Press. Reviewed in Australian Occupational Therapy Journal, 2007, 54, 323-324 Wells, S.A. & Black, R.A. (2000). Cultural Competency for Health Professionals. Bethesda, MD: American Association of Occupational Therapists. Both authors are occupational therapists See CJOT, 2002, 69(1), p.59 for a review of this book Assessment tools National Centre for Cultural Competence: Tools and Processes for Self-Assessment http://www11.georgetown.edu/research/gucchd/nccc/foundations/assessment.html includes tools for individual and organizational self-assessment focuses on early childhood, early intervention, primary health care, mental health, children and youth with special health care needs, and Sudden Infant Death Syndrome (SIDS)/and Other Infant Death (ID) Canadian Association of Occupational Therapists, July, 2009 3
Associations Occupational therapy multicultural networking groups http://aota.org/practitioners/resources/multicultural/resources/37723.aspx includes links to Association of Asian/Pacific Occupational Therapists in America Black Occupational Therapy Caucus Network for Lesbian, Gay, Bisexual and Transgender Concerns in Occupational Therapy Network of Native American Practitioners Network of Occupational Therapy Practitioners with Disabilities and Their Supporters Orthodox Jewish Occupational Therapy Caucus TODOS Network of Hispanic Practitioners Web sites Social inequities Canadian Human Rights Commission http://www.chrc-ccdp.ca/default-en.asp See the Publications page for a list of available products and reports on topics related to discrimination Canadian Race Relations Foundation http://www.crr.ca/index.php See the Resources and Publications page for a list of available materials on topics related to racism These need to be ordered using the on-line order form, but many are free of charge Citizenship and Immigration Canada s Multiculturalism website http://www.cic.gc.ca/multi/index-eng.asp Includes links to: Black history month; Asian history month; The Canadian Multiculturalism Act; Canada s action plan against racism; The Mathieu DaCosta challenge; Racism Stop It! national video competition Health inequities Public Health Agency of Canada http://www.phac-aspc.gc.ca/chn-rcs/index-eng.php - Includes health information specific to children, youth, adults, seniors, aboriginal peoples, and people living with disabilities http://www.phac-aspc.gc.ca/ph-sp/determinants/index-eng.php - Discusses the determinants of health, including income, education, employment, gender, culture, etc. Health Canada s Just for you website http://www.hc-sc.gc.ca/hl-vs/jfy-spv/index-eng.php Provides health information targeting specific groups, including: First Nations and Inuit Health; Immigrants; People with Disabilities; Rural Canadians; Seniors; Men; Women; Youth; etc. These specialized pages offer information on the crucial health issues that affect you while pointing out Health Canada educational kits that can help you improve your health practices. 4 Canadian Association of Occupational Therapists, July, 2009
Health Canada s First Nations, Inuit and Aboriginal Health website http://www.hc-sc.gc.ca/fniah-spnia/index-eng.php Health Canada s Women s Health website: http://www.hc-sc.gc.ca/hl-vs/women-femmes/index-eng.php Factsheets page includes links to info re lesbian health, health of senior women, etc. Gender-based analysis initiative page discusses a gender perspective into the development of policies, programs and legislation, as well as planning and decision-making processes. It helps to identify and clarify the differences between women and men, boys and girls, and demonstrates how these differences affect health status, access to, and interaction with, the health care system. Canadian Council on Social Development. A profile of health in Canada. Online report available at http://www.ccsd.ca/factsheets/health/ Public Health Agency of Canada. (2008). Chief Public Health Officer s Report on the State of Public Health in Canada, 2008. Online report available at http://www.phac-aspc.gc.ca/publicat/2008/ cpho-aspc/index-eng.php World Health Organization. (2003). Social determinants of health: The solid facts (2nd ed.). Online report available at http://www.euro.who.int/document/e81384.pdf Healthcare inequities Health Canada. (2001). "Certain Circumstances": Issues in Equity and Responsiveness in Access to Health Care in Canada. On-line report available at http://www.hc-sc.gc.ca/hcs-sss/pubs/acces/ 2001- certain-equit-acces/index-eng.php Includes: Access to care: Exploring the health and well-being of gay, lebian, bisexual and twospirit people in Canada, http://www.hc-sc.gc.ca/hcs-sss/pubs/acces/2001-certain-equit-acces/ part3-doc1-eng.php Institute of Medicine. (2002). Unequal treatment: What healthcare providers need to know about racial and ethnic disparities in healthcare. Online report available at http://www.iom.edu/file.asp?id=4175 Cultural competence Joint Position Statement on Diversity http://www.caot.ca/default.asp?pageid=2120 Developed in 2007 by the Association of Canadian Occupational Therapy Regulatory Organizations (ACOTRO), the Association of Canadian Occupational Therapy University Programs (ACOTUP), the Canadian Association of Occupational Therapists (CAOT), the Canadian Occupational Therapy Foundation (COTF) and the Professional Alliance of Canada (PAC) Partnerships for healthy communities educational module: Cultural competency in health care http://www.sahs.utmb.edu/programs/ot/partnerships/culturaldiversity/cultsensmaterials.htm Four-week course outline and materials registration not required to view reading materials Developed in 2003 by the Department of Occupational Therapy, University of Texas Canadian Association of Occupational Therapists, July, 2009 5
Provider s guide to quality and culture http://erc.msh.org/mainpage.cfm?file=1.0.htm&module=provider&language=english&ggroup =&mgroup= A tutorial-style website that covers: getting started; patient provider interaction; health disparities; cultural groups; culturally competent organizations; additional resources A joint project of Management Sciences for Health, U.S. Department of Health and Human Services, Health Resources and Services Administration, and Bureau of Primary Health Care US Department of Health and Human Services, The Office of Minority Health http://www.omhrc.gov/ See the Cultural Competency page for: guides and resources; national standards; organizations and programs; policies, initiatives and laws; training tools for physicians and others; and more Hudspith, M. (1999). Caring for lesbian health: A resource for health providers, policy makers and planners. Online report available at http://www.health.gov.bc.ca/library/publications/year/1999/ caring.pdf Last update: July, 2009 Please note that the references provided are not an exhaustive list. If at any point you find a resource which you believe should be on this list, or if a resource appears out of date please contact CAOT at education@caot.ca. Canadian Association of Occupational Therapists CTTC Building, 3400-1125 Colonel By Drive Ottawa, ON K1S 5R1 Canada Tel (800) 434-2268 Fax (613) 523-2552 www.caot.ca www.otworks.ca 6 Canadian Association of Occupational Therapists, July, 2009