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Objective To obtain expert consensus on indicators of quality rehabilitation services for individuals with limited English proficiency (LEP). Design Three-round Delphi study. Setting Delphi survey conducted online with 30 experts. Most experts worked in adult physical rehabilitation settings and were from Illinois (n=16), with remaining participants from eight other US states or Canadian provinces. Participants Experts had a minimum of two publications on healthcare services for patients with LEP and/or a minimum of five years clinical experience in physical rehabilitation. Of 43 experts (11 researchers, 32 clinicians) emailed the Round One survey, 30 returned complete responses (70% response rate). Of those, 25 completed Round Two, and 24 completed Round Three. Of Round One participants, most (n =21) identified their primary professional activity as clinical, whereas the others worked in research (n =5) or education (n =4). Twenty-four were female. Median age was 43 (range 27-67). Disciplines included occupational therapy (n =14), physical therapy (n =13), psychology (n=1), nursing (n=1), and medicine (n=1). Interventions Not applicable. Main outcome measures Indicators rated on a seven-point Likert scale for importance and feasibility. Interquartile range (IQR) and 95% confidence intervals calculated for importance and feasibility ratings. Indicators with an IQR Results Round One responses were categorized into 15 structural, 13 process and 18 outcome indicators. All 15 structural indicators reached consensus for importance; eight were rated as feasible. All 13 process indicators reached consensus, of which eight were deemed feasible. Sixteen outcome indicators reached consensus, of which seven were deemed feasible. Conclusions This Delphi study identified structural, process, and outcome indicators that can inform delivery and assessment of quality rehabilitation services for individuals with limited English proficiency. Future research should operationalize and measure these quality indicators in clinical practice.

Global migration has contributed to greater language diversity in many parts of the world. Many migrants experience language barriers in their adopted countries. Language barriers hinder access to healthcare, including mental health. There exists little research on the extent of communication difficulties during language discordant mental health services. A cross-sectional observational study design was used to examine prevalence of communication challenges, use of communication best practices, and training needs among mental health providers and interpreters working with immigrants with Limited English Proficiency (LEP) in the United States. Using snowball sampling methods, 38 providers and 34 interpreters were recruited to complete online surveys. Challenges reported by interpreters pertained to technicalities of communication, while those reported by providers pertained to content of communication. Communication best practices such as pre-session briefings and post-session debriefings were used infrequently by providers in the sample. Providers with higher education levels were more likely to endorse some best practices. Fifty-four percent of the providers and 84% of the interpreters were interested in additional training in working with patients with LEP. Findings suggest the need for customized trainings for providers and interpreters to improve the quality of mental healthcare for patients with LEP.

Importance: Occupational therapy can play a role in primary care management of chronic diseases among older adults. Objective: To assess the feasibility of delivering a primary care occupation-focused intervention (Integrated PRimary care and Occupational therapy for Aging and Chronic disease Treatment to preserve Independence and Functioning, or i-PROACTIF) for older adults with chronic disease. Design: Feasibility study comparing i-PROACTIF with complex care management using a two-group randomized controlled trial design with data gathered at baseline and during and after the 8-wk intervention. Setting: Family medicine clinic serving an urban, low-income, working-class community. Outcomes and Measures: Feasibility indicators were recruitment, retention, utility of clinical assessments, and acceptability of interventions assessed through feedback surveys completed by patients and primary care providers (PCPs). Patient outcomes, including perspectives on chronic illness care, occupational performance, and overall well-being, were collected using standardized, validated measures and analyzed descriptively. Participants: Eighteen adult volunteers, ages ≥50 yr, with heart disease, arthritis, and uncontrolled diabetes completed the study. Ten PCPs completed feedback surveys. Intervention: i-PROACTIF focuses on preserving functional independence, is based on the Person–Environment–Occupation framework, and consists of two assessment sessions and six weekly treatment sessions. Results: Recruitment goals were achieved, with an 86% retention rate. Clinical measures unearthed deficits in areas that were unreported or underreported by patients. Participants reported being extremely satisfied with the intervention. Physicians and nurses also supported the intervention. Both groups showed improved scores on most outcomes. Conclusion and Relevance: Delivering and evaluating i-PROACTIF was feasible and acceptable. Future efficacy trials are needed before it can be used in clinical settings. What This Article Adds: The results of this study can inform future occupational therapy interventions and clinical trials in primary care for older adults with chronic conditions.

Purpose: Individuals who lack proficiency in the dominant language of their region experience difficulty accessing healthcare and exhibit poorer health outcomes. Utilization of professional interpreters can improve health services and outcomes for this population. Most existing studies focus on medical settings, with very little research about language barriers in rehabilitation services such as occupational and physical therapy. The purpose of this study was to explore experiences of English-speaking rehabilitation clinicians working with limited English proficient (LEP) patients, as well as LEP patients receiving rehabilitation services. Methods: A qualitative study was conducted involving four focus groups with seven Spanish-speaking patients and 13 primarily English-speaking occupational and physical therapy clinicians. Transcripts and field notes were analyzed using directed content analysis. Results: Time and resource constraints, session demands, environmental factors, previous experiences, and patient characteristics influenced clinicians' decisions about whether to use professional interpretation, rely on untrained interpreters, or go without interpretation. Clinicians discussed both challenges and joys of working across language barriers. Patients reported minimal experiences with, and expectations of professional interpretation in rehabilitation, instead describing clinicians' attempts to "get by" with limited non-English language skills. Conclusions: Findings highlight unique considerations for language access in rehabilitation compared with other settings. These findings inform structural, process, and outcomes recommendations and changes in practice guidelines to improve language access in rehabilitation services.Implications for RehabilitationRehabilitation encounters present unique challenges for language interpretation services that require creative technological, procedural, and structural solutions.Technological solutions include flexible and mobile telecommunication devices, such as headsets, which allow real-time interpreting without interfering with treatment processes.Procedural solutions include establishing a systematic mechanism for recording patients' language needs, creating a standard and seamless protocol for clinicians to obtain language supports, and hiring trained interpreters who are familiar with rehabilitation jargon.Structural solutions include budgeting for interpreter services, sponsoring trainings for staff and clinicians, and adjusting clinicians' workload and expectations to allow greater time and flexibility to meet patients' language needs.

Background A large number of U.S. children are identified as having special health care needs (CSHCN). Despite parents' central role in managing their child's needs, many parents report difficulties in navigating service systems, finding information about their child's condition, and accessing health care and community resources. Therefore, there is a need for interventions that "activate" parents of children with special health care needs to increase their knowledge, skills, and confidence in managing, coordinating, and advocating for their child's needs. This study sought to review the existing literature and examine the effects of parent support interventions that focus on parental activation either in part or whole, on child, parent, or family outcomes. Specific aims included (a) summarizing the nature and content of interventions; (b) describing changes in relevant outcomes; (c) identifying limitations and making recommendations for future research. Methods Following electronic databases were searched: MEDLINE, EMBASE, PsycINFO via ProQuest, PubMed, Cumulative Index to Nursing and Allied Health via EBSCO, Education Resources Information Center (ERIC) via ProQuest, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), and Google Scholar. Twenty-two studies were selected, data were extracted, and quality was assessed using standardized procedures. Results Five intervention categories were identified: parent-to-parent supports, psycho-educational groups, content-specific groups, community health worker model, and self-management-based interventions. Although most studies showed positive effects of the intervention, evidence was inconsistent for parental outcomes such as self-efficacy, confidence, strain, depression, and perceived social support. Evidence was more consistent in showing improvement in parent coping and in use of community-based services and resources. Conclusions There is a need to boost active ingredients of interventions that specifically target enhancing parent skill sets relevant to areas of self-efficacy, confidence, and empowerment. Future studies must also adapt intervention and study design to recruit socioeconomically vulnerable families.

Objective: This article describes the demographic distribution of, and association between, neighborhood disorganization and mental health diagnosis by race in a large cohort of urban children with chronic medical conditions. Methods: Data for this study were from Coordinated Healthcare for Complex Kids (CHECK), a health care demonstration project funded by the Center for Medicare and Medicaid Innovation. We conducted regression analyses to examine the relationship between neighborhood disorganization and mental health diagnosis among 6,458 children enrolled in CHECK. Results: The most common mental health diagnoses were mood disorders (8.6%), Attention-Deficit/Hyperactivity Disorder (7.4%), conduct disorders (6.1%), and anxiety disorders (4.8%). Black children had the highest neighborhood disorganization scores compared with other racial/ethnic categories. However, Black children had the lowest proportion of mental health diagnoses. Lower neighborhood disorganization was associated with having a mental health diagnosis; however, when adding race/ethnicity to the model, neighborhood disorganization no longer was significant. Conclusions: Level of neighborhood disorganization was highly correlated with racial/ethnic composition of the neighborhoods, and Black children disproportionately resided in highly disorganized neighborhoods compared with other groups. Neighborhood disorganization may not have sufficient variability within the racial/ethnic categories, which may explain the absence of an interaction between race/ethnicity and mental health diagnosis.

Background Social determinants of health play a vital role in population health. Awareness of household social factors and their impact on health can help health professionals to provide effective strategies in health promotion, especially for children and adolescents showing signs of psychosocial dysfunction. The objective of this study was to explore the association between parents' perceptions of the psychosocial behaviour of their children and the functionality of their household. Methods This cohort study analysed data from the Coordinated Health Care for Complex Kids programme. The sample included 293 parents of children aged 4-17 years with chronic conditions, and from urban, low-income families. Psychosocial behaviour of the child was measured using the Pediatric Symptom Checklist (PSC-17), which included subscales for internal, external, and attention symptoms. Household functionality was measured using the Confusion, Hubbub, and Order Scale. Responses to both assessments were scored in a standard manner. Results There was a significant association between parents' perceptions of the psychosocial behaviour of their children and the functionality of the home environment. The mean Confusion, Hubbub, and Order Scale scores in the home environment improved from baseline to the first reassessment (the period between the two assessments ranged from 4 to 8 months). Additionally, positive PSC-17 screening results of the children decreased by 11% in the first reassessment. The odds of having a positive PSC-17 screening result also decreased in the first reassessment after receiving interventions. Conclusion The association between psychosocial dysfunction and household functionality indicates the importance of family-centred care and taking the home environment into consideration when administering health services to low-income children with chronic conditions. This study brings attention to the more hidden factors that influence child mental health, which must be addressed to improve care delivery and child health outcomes.

Little attention has been given to the processes and dynamics involved in community-engaged research with hard-to-reach and marginalized communities. This concept paper focuses on experiences with and lessons learned from the developmental phase of a community-engaged research project aimed at promoting the economic self-sufficiency of refugees with disabilities in Illinois. Steps taken to foster collaboration between academic researchers and community stakeholders are described, followed by the authors’ commentary on challenges encountered and how these were addressed. Several methods were used to facilitate engagement of community stakeholders. In the pre-funding stage, lead researchers identified potential community partners by networking with coalition groups and task forces focused on disability- and refugee-related issues. In the post-funding stage, relationships with partners were formalized, partners’ roles were defined, and contractual agreements were developed. An advisory board consisting of representatives from partner agencies and self-advocates with disabilities was also assembled to help guide the project goals and deliverables. Structured group and one-on-one meetings were held to sustain community partner engagement. These community engagement strategies were deemed successful. However, challenges did emerge due to conflict between community stakeholders’ preferences, and research logistics and regulatory requirements of the academic institution. Findings suggest that with careful planning, barriers to community-academic collaborations can be addressed in ways that benefit all parties. This paper offers practical strategies and a roadmap for other community-engaged research projects focusing on vulnerable and marginalized groups.

Trends in policy, practice, and research point to the need for a community-engaged Scholarship of Practice (SOP) model that can be used to inform the development of occupational therapy practitioners, educators, and researchers. This article describes a community-engaged SOP model, the evidence justifying the need for such a model, and strategies to effectively create community-engaged practitioners, educators and career scientists within occupational therapy. We highlight several examples of community-based participatory research to further inform this model, and in turn, translate this knowledge back to communities for action and systems change that can affect the lives of people with disabilities and the communities in which they seek to live and participate long term.

Chronic conditions and related functional disabilities are highly prevalent among resettled refugees in the United States. There is a need to explore this population's access to appropriate healthcare services in order to identify service disparities and improve interventions. Using a community-based participatory research approach, semi-structured interviews were conducted with key informants to identify healthcare access barriers affecting disabled and chronically ill refugees. Eighteen participants were interviewed, revealing three main barriers: (1) inadequate health insurance, (2) language and communication barriers, and (3) a complex maze of service systems. These barriers were found to operate at systems, provider, and individual levels. Broad-based policy and practice interventions are required to address barriers including: an expanded pool of medical interpreters, peer navigators, innovative health information technologies, and greater collaboration and information-sharing between service systems. Further research is needed to monitor the impact the Affordable Care Act on service access of refugees with disabilities and chronic conditions.

Objectives . (1) To profile children’s health insurance coverage rates for specific rehabilitation therapies; (2) to determine whether coverage for rehabilitation therapies is associated with social participation outcomes after adjusting for child and household characteristics; (3) to assess whether rehabilitation insurance differentially affects social participation of children with and without disabilities. Methods . We conducted a cross-sectional analysis of secondary survey data on 756 children (ages 3–17) from 370 households living in low-income neighborhoods in a Midwestern U.S. city. Multivariate mixed effects logistic regression models were estimated. Results . Significantly higher proportions of children with disabilities had coverage for physical therapy, occupational therapy, and speech and language pathology, yet gaps in coverage were noted. Multivariate analysis indicated that rehabilitation insurance coverage was significantly associated with social participation (OR = 1.67, 95% CI: 1.013-2.75). This trend was sustained in subgroup analysis. Conclusions . Findings support the need for comprehensive coverage of all essential services under children’s health insurance programs.

Today, more than ever, occupational therapists are engaged in close partnerships with community organizations and community settings such as service agencies, refugee and immigrant enclaves, and faith-based organizations, to name a few, for the purpose of engaging in scholarship of practice. However, we know little about the views of community partners regarding the development and sustainability of university-community partnerships. The purpose of this article is twofold: First, we will describe a pilot study in which we gathered qualitative data from community partners engaged in scholarship of practice with faculty and students, regarding their views about benefits of partnerships, challenges, and characteristics of sustainable partnerships. Second, based on this pilot study and extensive experience of the authors, we propose a revised version of a partnerships model available in the literature. We illustrate the model through examples of the authors' collective experiences developing and sustaining successful university-community partnerships.

To pilot-test and evaluate an innovative program providing information technology (IT) access to people with disabilities transitioning out of nursing homes into the community using a participatory approach.Pre- and post-training data was collected on the 61 program participants to reflect three broad areas related to the IT training experience: performance; self-efficacy; importance, satisfaction and control. Additionally, semi-structured interviews were conducted with seven participants and five members of the program staff to explore environmental barriers to IT access for this group and the efficacy of the program in addressing these barriers. Data analyses followed a mixed methods approach incorporating both qualitative and quantitative techniques.Participants showed substantive changes in different spheres of IT use after completion of training. Post-training changes were significant particularly in areas related to self-efficacy, importance and satisfaction pertaining to use of IT. Qualitative findings substantiated the quantitative results and also revealed the numerous barriers to IT access that persons with disabilities continue to face within their communities.Results indicate the feasibility, effectiveness and value of IT access to people with disabilities particularly those transitioning from institutional life to community living. Further action research aimed at increasing IT access for this group within local communities and neighborhoods is needed to address this issue at a broader societal level.

Purpose – Disability-related politics and discourse in developed countries seldom includes the voices of disabled people from immigrant ethnic communities. Attending to the experiences of people with disabilities among immigrant communities is particularly salient when considering questions about community participation and citizenship in the context of immigrant-receiving societies such as the USA. This chapter aims to shed light on this topic by examining the narratives of refugees with disabilities resettled in the USA. Methodology – A global ethnography framework was used to collect narrative data from eight Cambodian and seven Somali refugees with disabilities through observations, in-depth interviews, focus groups, and social network surveys. Additionally semistructured interviews were conducted with 10 service providers/key experts. Data were analyzed using grounded theory techniques. Findings – Data from the study revealed that the Cambodian and Somali participants were distinct in terms of their access to sources of support and community and in their experiences of community participation barriers. Depending on their respective circumstances, they engaged in various tactics and strategies to negotiate these barriers and to create new networks of support and advocacy. Limitations – The study sample was purposively selected and therefore findings represent only the views and experiences of the participants precluding any claims about generalizability. Furthermore, owing to the cross-cultural nature of this research there is a possibility that certain linguistic and cultural nuances were missed during data collection and analysis. Implications – Findings suggest a need to recognize and support heterogeneous disability experiences and diverse expressions of “disability activism” enacted in individually, contextually, and culturally preferred ways in order to draw disabled people from diverse groups into the broader disability community in the USA.

There is an emerging interest in issues of occupational justice and occupational deprivation within contemporary occupational therapy practice and theory. To inform this emerging agenda, research with populations at risk of occupational injustice is crucial. This study used a global ethnography framework to explore disabled refugees' access to occupational participation in the context of the U.S. refugee resettlement program. Narrative data from eight Cambodian and seven Somali refugees were combined with documentary analysis and information obtained from service providers. Data were analyzed using grounded theory techniques. Findings revealed a strong policy emphasis on employment and self-sufficiency within the U.S. refugee resettlement program. Consequently, resettlement service providers focused on the dichotomous options of work or welfare, overlooking the broader occupational needs of disabled refugees. Lacking supportive services for developing vocational skills or exploring occupational alternatives, the refugees struggled to find occupational avenues that would earn them social validity and integration into American society, leading to feelings of isolation and inadequacy. Research and practice initiatives with this population need to consider the role of institutional factors in shaping their occupational participation and evolving occupational needs.

A growing emphasis has been placed on providing equal opportunities for all people, particularly people with disabilities, to support participation. Barriers to participation are represented in part by physical space restrictions. This article explores the decision-making process during the construction of a new office building housing a disability-rights organization. The building project featured in this study was developed on the principles of universal design, maximal accessibility, and sustainability to support access and participation.A qualitative case study approach was used involving collection of data through in-depth interviews with key decision-makers; non-participant observations at design meetings; and on-site tours. Qualitative thematic analysis along with the development of a classification system was used to understand specific building elements and the relevant decision processes from which they resulted.Recording and analyzing the design process revealed several key issues including grassroots involvement of stakeholders; interaction between universal design and sustainable design; addressing diversity through flexibility and universality; and segregationist accessibility versus universal design.This case study revealed complex interactions between accessibility, universal design, and sustainability. Two visual models were proposed to understand and analyze these complexities.