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To explore parent perspectives on barriers, facilitators, and priorities related to coordinating care for children and youth with special health care needs (CYSHCN).Thirty-nine parents of Medicaid-eligible CYSHCN participated in focus groups and completed a brief survey about their child's health insurance coverage, access to specialized services, and need for support with service coordination. Survey data were analyzed using descriptive statistics. Focus group data were analyzed by multiple independent coders using an approach that combines inductive reasoning with predetermined coding strategies.Sixty-seven percent of parents reported that they needed care coordination support. Qualitative data were organized into three main themes: the work of caregiving; the impact of caregiving on multiple aspects of parents' lives; and caregivers' needs related to emotional acceptance, service referrals and navigation, and developmental transitions.Findings support importance of services such as medical homes, care coordinators, peer navigators, respite care, and transition planning.

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.

Evidence to inform rehabilitation service delivery for individuals with deafblindness, especially in the Indian context, is inadequate. Rehabilitation professionals often find it challenging to design rehabilitation interventions that promote participation for those with deafblindness. Therefore, our purpose was to understand the contextual factors that influence the participation of individuals with deafblindness in India from the perspectives of those who are involved in providing rehabilitation services to them. Using the International Classification of Functioning, Disability, and Health (ICF) as a framework, we conducted two focus group discussions with 16 rehabilitation service providers in India. We used a content analysis approach to examine the data. Rehabilitation service providers perceived participation barriers to be linked primarily to the social environment. Specifically, participants identified four major factors acting as barriers, including (a) lack of awareness about deafblindness; (b) negative attitudes and stigma associated with disability; (c) lack of access to resources such as assistive technology and interpreter support; and (d) communication challenges associated with severe impairments. Facilitators include accessibility of the built environment for multisensory impairments, affordable technology, provision of an interpreter and personal support worker, and training on deafblindness for professionals. The participation of individuals with deafblindness could be enhanced by identifying and removing environmental barriers and improving knowledge about deafblindness among rehabilitation professionals for proper identification, assessment, and access to rehabilitation services.

Objective To identify and describe the contextual factors that influence the participation of people with deafblindness in India. Design Qualitative study, using directed content analysis approach and the International Classification of Functioning, Disability and Health (ICF) as a framework to analyze the data. Setting Community and social participation settings. Participants Community-dwelling individuals with deafblindness (N=16). Age ranges from 18-45 years. Interventions Not applicable. Main Outcome Measures Personal and environmental factors that influence the participation of individuals with deafblindness using the ICF framework. Results Results indicate that the age of onset and nature of impairment (deafblindness) and willingness to explain the condition (functional consequences of deafblindness) emerged as important personal factors. Access to resources such as assistive technology, social support, and deafblind-specific services were found to be enablers of participation. Lack of services, systems, and policies specific to deafblindness along with negative societal attitude toward disability were highly perceived environmental barriers that influence participation of people with deafblindness in India. Conclusions Professionals must acknowledge aspects of the environment in conducting assessments and delivering interventions and understand the dynamic interactions between environment of the individual and his/her concurrent vision and hearing impairments. Approaches to enable participation require rehabilitation professionals to work with those with deafblindness to advocate for removal of environmental barriers and ensure provision of appropriate resources from the government to facilitate their participation. Social policy and government must ensure emphasis on awareness about deafblindness, access to deafblind-specific services, positive societal attitude, and opportunities for full participation for people with deafblindness in society.

The COVID-19 pandemic has impacted the entire world in unprecedented ways. However, populations that have had a history of marginalization have experienced a more profound impact. One such group is Latinx families of children with intellectual and developmental disabilities (IDD) in the Unites States. In this study, we used a mixed methods approach to explore the impact of the pandemic on the mental health and well-being of Latinx caregivers of children with IDD. Specifically, we (1) identified which social determinants of health are correlated with maternal caregivers perceived general health, mental health, and well-being, (2) explored the impact of the pandemic on families’ overall eating and physical activity routines, and (3) identified emergent themes from caregivers’ experiences during the pandemic. Thirty-seven Latinx caregivers participated in three interviews in which several validated instruments were administered. The results indicated that perceived social support, annual family income, food security, and receipt of financial benefits were correlated with fewer depressive symptoms. Annual family income was also significantly correlated with perceived general health. Most caregivers reported that the pandemic had placed a strain on their economic situation, increased their isolation, and disrupted their child’s therapeutic supports, online education, eating routines, and engagement in physical activity. Meanwhile, some caregivers reported positive changes as a result of the pandemic. Implications for future research and practice are discussed.

Medicaid beneficiaries in most states must go through a redetermination process every 6–12 months to demonstrate continued eligibility. This study sought to examine Medicaid redetermination experiences among beneficiaries with Limited English Proficiency (LEP). A sequential mixed methods study was conducted involving quantitative phone surveys and semi-structured, in-person interviews with Arabic, Chinese, Korean, and Vietnamese speaking beneficiaries in Illinois. Survey respondents experienced notable barriers during the redetermination process. Quantitative data showed LEP respondents to have 5.3 times the odds of losing their Medicaid benefits as compared to English proficient respondents. Qualitative interviews illustrated the impact of Medicaid loss on individuals and families, as well as strategies for successfully navigating redetermination. Findings suggest that language barriers hinder Medicaid redetermination and play a role in cancellation of benefits. Recommendations for better language supports during the Medicaid redetermination process are discussed.

Date Presented 04/01/2022 This study used a mixed-methods approach to explore how the coronavirus disease 2019 (COVID-19) pandemic affected the well-being of 37 Latinx caregivers of children with developmental disabilities. Perceived social support, family income, and receipt of financial benefits were associated with caregiver depressive symptoms. Most caregivers reported that the pandemic had placed a strain on their economic situation, increased their isolation, and disrupted their child’s therapeutic supports, online education, and routines. Primary Author and Speaker: Jasmine Brown-Hollie Contributing Authors: Mansha Mirza, Yolanda Suarez-Balcazar, Vanessa Errisuriz, Weiwen Zang, Nazanin Hyderian, Deborah Parra-Medina, Paula Morales, Hilda Torres, Sandy Magana, Sarah Camillone, Estefania Garcia Gomez

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.

Research Objectives To identify ways to enhance the social participation of individuals with deafblindness or dual sensory impairment. Design The exploratory study involved a scoping study followed by two qualitative research studies. Data were collected through qualitative interviews with 16 adults with deafblindness, as well as through two focus group discussions with their 16 rehabilitation service providers in India. Various accessible modes of communication were used to conduct qualitative interviews with individuals with deafblindness. Directed content analysis approach and the International Classification of Functioning, Disability and Health (ICF) as a framework were used to analyze the qualitative data. Setting Community and social participation settings. Participants Sixteen community-dwelling adults (18-45 years of age) with deafblindness as well as their sixteen rehabilitation service providers in India. Interventions Not applicable. It was an exploratory study. Main Outcome Measures Social participation of individuals with deafblindness Results Participants with deafblindness or dual sensory impairment identified access to information, communication, mobility, relationships, education and productivity, and recreation and leisure as important domains of life for their participation. The rehabilitation service providers suggested developing deafblind-specific rehabilitation services and assistive technology (e.g., hearing aids, cochlear implants, refreshable braille displays, magnifiers) to improve access to information, communication and social interactions, and thus to enable the social participation of individuals with deafblindness or dual sensory impairment. Conclusions Our findings suggest that the interventions should focus on enabling access to information for these individuals as it is available for their non-disabled counterparts. It is imperative for clinicians to design rehabilitation services to remove participation barriers located in the environment and focus on life domains that they value to enable the societal participation of those with deafblindness or dual sensory impairment. Author(s) Disclosures No conflict of interest to declare.

Premigration trauma and postmigration stressors put refugees at high risk for mental health concerns, including substance use. However, there is limited systematic research on substance use in refugee communities exists. We conducted exploratory qualitative research to examine Bhutanese and Iraqi refugee perspectives related to the use of recreational substances after resettlement in the United States. Data were collected through separate focus groups with 28 Bhutanese and 22 Iraqi adult men. Focus groups were facilitated by an experienced clinician with an in-person interpreter, audiorecorded, and transcribed. Transcripts were checked for accurate translation and then analyzed using a conventional content analysis approach. Findings revealed similarities and differences between the two refugee groups with regard to recognizing excessive use, triggers for use, and preferred modes of outreach and intervention. Findings also revealed postmigration changes in substance use behaviors stemming from issues related to access, cost, and perceived legal ramifications.

This themed issue focuses on understanding and addressing several public health issues affecting communities today nationally and internationally. Health disparities, and global health in general, cover a large breadth of health concerns impossible to address in one issue. Here we provide a scope of some health disparities while focusing on health promotion and well-being of diverse populations, specifically within urban undeserved populations, rural communities in Peru, Roma minorities in Spain, and refugee communities. We focus on understanding contextual issue that affect health disparities as well as on examining the effectiveness of community-based interventions and community coalitions designed to address disparities.

Supplemental material, COREQ_Checklist for Factors that influence the participation of individuals with deafblindness: A qualitative study with rehabilitation service providers in India by Atul Jaiswal, Heather Aldersey, Walter Wittich, Mansha Mirza and Marcia Finlayson in The British Journal of Visual Impairment

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.

Effective communication is essential in mental healthcare, where language often represents the primary means of treatment. In intercultural counseling sessions, communicating with Limited English Proficient (LEP) clients calls for skillful collaboration with language interpreters. However, best practices in medical interpretation may not be equally effective in mental health settings. This study examined the factors promoting and hindering successful communication during interpreter-mediated counseling sessions with LEP Bhutanese and Iraqi refugee men. Researchers observed eight substance use counseling sessions in real-time to make note of communication patterns and key communication breakdowns. Then, researchers conducted video-elicitation interviews with the client, clinician and interpreter immediately after each session to dissect communication events from each party’s perspective. Session videos and interview transcripts underwent qualitative analysis to identify factors that predict or prevent communication breakdowns. Findings indicate important differences between mental health interpretation and interpretation in other healthcare settings. Common practices such as simultaneous interpreting and first person interpreting were found to function differently in a mental health setting. Some therapeutic maneuvers, such as irreverence and humor, were difficult to employ cross-culturally. The adaptation and negotiation of interpersonal relationships between clinician, client and interpreter were central to the success of communication. Trust and flexibility were key to the functioning of the triadic relationship. Clinicians, clients and interpreters were found to adopt different roles and responsibilities throughout the session in an ongoing manner. Implications for the training of interpreters and clinicians are discussed.

Objective To investigate the content and effectiveness of interventions that address poststroke community participation. Data Sources EMBASE, PsycINFO, PubMed, and Cumulative Index to Nursing and Allied Health (CINAHL) were searched using 3 indexing terms and respective thesaurus: stroke, social participation, and clinical trials. Filters for English, publication dates (January 2001-May 2017), and publication types were used. The search also included checking references from relevant systematic reviews. Study Selection Studies conducted with adults with stroke, evaluating interventions addressing community participation, having a comparison group, and reporting at least 1 of 3 outcomes (participation, depression, and health-related quality of life) were selected. Retrieved articles were screened by 2 reviewers. After substantial agreement was achieved using interrater reliability, reviewers screened articles independently. Eighteen of 1130 articles were included. Data Extraction Characteristics of participants, key elements of intervention, comparator, and results were independently extracted by 2 reviewers. Intervention content was categorized based on 9 categories from the International Classification of Functioning, Disability, and Health Activities and Participation domains. Risk of selection, performance, attrition, and reporting bias were evaluated. Data Synthesis Two intervention categories were identified: leisure participation and community integration. Three leisure and 4 community integration interventions showed significant group differences favoring the intervention group in the target outcomes. The majority of interventions addressed the leisure, interpersonal relations, and community life categories of International Classification of Functioning, Disability, and Health with few focusing on political life, education, assisting others, and religion. Conclusions A limited number of studies showed an effect on participation, depression, and health-related quality of life outcomes. There were gaps in intervention content indicating that current community participation interventions fall short in addressing full inclusion and citizenship of people with stroke. Future interventions should focus on civic- and societal-level participation and community activities beyond leisure.

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.

Background Deafblindness, also known as dual sensory loss, is a varying combination of visual and hearing impairment in the same individual. Interest in this topic has increased recently due to evidence suggesting an increase in prevalence of this condition among older adults. Persons with deafblindness frequently experience participation barriers and social isolation. Developing an understanding of their experiences can inform the design of programs and policies to enhance participation of people with deafblindness in society. Objective To identify and summarize available research literature on participation experiences of people with deafblindness or dual sensory loss. Methods A comprehensive literature search of eight databases (CINAHL/EBSCO, Embase, ERIC, Global Health, MEDLINE, ProQuest, PsycINFO, PubMed) was performed in accordance with the Preferred Reporting Items for Systematic Reviews (PRISMA) during January 2017 and last updated in June 2017. In addition, non-peer reviewed (grey) literature was also retrieved in the form of online published reports of research projects by 16 deafblind-specific organizations across the globe. To be included, sources had to be published after 1990, had persons with deafblindness as the focal population, and focused on their participation experiences. Results A total 1172 sources were identified of which 54 studies were included. The findings reveal that persons with deafblindness, regardless of origin of their impairment, experience difficulty in communication, mobility, daily living functioning, and social interactions. While these experiences may vary between individuals with congenital versus acquired conditions, they generally feel socially isolated, insecure and uncertain about their future. Conclusion Participation experiences of persons with deafblindness are shaped by dynamic interactions between personal factors (such as onset and type of impairments) and environmental influences (such as attitude, technology, and supports). A better understanding of participation experiences may help professionals in placing emphasis on affected participation domains to design services to enhance participation of people with deafblindness.

Research on Latino parents of children with intellectual and developmental disabilities (IDD) suggests that these parents often use spirituality to conceptualize and to cope with their child’s diagnosis. However, there are no studies that examine religion among Latino parents of children with autism spectrum disorders (ASD). The current study explores how Latino parents of children with ASD incorporate spirituality into their conceptualizations of their child’s disability. In the current study, 34 Latina mothers of children with ASD were interviewed about autism-related services, family characteristics, and cultural beliefs including spiritual beliefs. Thematic analysis of the transcribed interview data relating to spiritual beliefs was conducted for the present study. Most mothers endorsed beliefs that their child with a disability was a message from God. Within this theme, mothers reported beliefs that their child was a blessing from God, a test from God, a sign from God or that the parent was s...

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.

The population of immigrant children in the United States has increased dramatically. Little is known about how immigrant children, especially those with disabilities, fare on outcomes relevant to occupational therapy such as participation in home, school, and community activities. Using secondary data from the Making Connections survey, we compared social participation outcomes and predictors for children with/without disabilities from underserved immigrant and nonimmigrant households in a sample of 2,295 children aged 3 to 17 years. We found that social participation rates differed significantly for children based on their disability and immigrant status and were lowest for immigrant children with disabilities. Several contextual factors were found to be associated with social participation of immigrant children, such as health insurance coverage, household education, household connectedness with the neighborhood, and access to computers and the Internet. Implications of these findings for occupational therapy practice and research are discussed.

Nearly one in ten US residents have difficulty speaking and understanding English and are deemed to have limited English proficiency (LEP). Despite federal mandates for provision of interpreters and other language access services, individuals with LEP experience notable health disparities. Occupational therapists must be prepared to equitably serve this population, however there is a dearth of research evidence and practical recommendations about our profession's readiness to serve this growing population. This paper maps the current healthcare policy environment and existing language access research relevant to occupational therapy. Implications for the future of occupational therapy research, education and practice are discussed.

Effective communication between occupational therapists (OTs) and their clients is key to quality, client-centered services. Most OTs can expect to work with clients with Limited English Proficiency (LEP). Language barriers may negatively impact client safety and client satisfaction. Working with language interpreters is a key means for OTs to best serve clients with LEP; however, few OT curricula provide adequate training in working with interpreters. This paper presents a new, innovative online training for preparing OT students to work with clients with LEP and interpreters. The brief online training used informational slides, video role plays and written case studies to prepare OT students to provide and advocate for quality services for clients with LEP. The training was evaluated by 26 second year MSOT students at a large, urban university. Student learning was assessed with a pre-test/post-test questionnaire. Pre-test results indicated that while most students (86%) reported working with LEP clients on fieldwork, few (less than 27%) felt well prepared to do so. A majority (60%) of students were unaware or unsure of how to access interpreter services at their fieldwork site. Post-test results indicate that the training significantly improved student knowledge, skills and attitudes for working with LEP clients and interpreters. The implications for OT education, including the importance and feasibility of training entry-level OT students to work with interpreters, are discussed. Opportunities for increased emphasis on cultural competence and language access education within future entry-level OTD curricula are highlighted.

Date Presented 04/04/19 This presentation will share findings from a descriptive, mixed-methods study involving clinical and health services experts, physical rehabilitation practitioners, and patients with limited English proficiency (LEP). The study identified clinical indicators and challenges related to optimal delivery of physical rehabilitation services for patients with LEP. Professional, practice, and policy implications of these findings will be discussed. Primary Author and Speaker: Mansha Mirza Additional Authors and Speakers: Elizabeth Harrison

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.

Background A consumer-directed service-delivery approach to assistive technology and environmental modification intervention was examined with people who were ageing with intellectual disabilities. Material and Methods The intervention was based on a collaborative approach involving consumers, their social supports and service deliverers. Thirty individuals were randomly selected to receive the intervention from a sample of 75 community-dwelling adults. Outcomes related to consumers’ and significant others’ perceptions of performance and satisfaction with goal attainment were assessed and the consumer-directed goal planning process examined. Results Participants in the intervention group reported significantly higher levels of performance and satisfaction related to goals identified at baseline than participants in the control group. Two broad categories of goals were addressed during the intervention – basic self-care goals and participation/environmental/systems level goals. A 98% direct agreement rate between consumer-identified goals and goals addressed by service deliverers was found during the intervention. Of the environmental strategies employed during the intervention, assistive devices and systems level advocacy and action were the two most frequently used across goals. Conclusion Results provide evidence in favour of a consumer-directed approach to assistive technology and environmental modification service delivery for consumers who are ageing with intellectual disabilities.

People with psychiatric disabilities represent a growing group within the population of nursing home residents in the USA. Despite a preference for living in community‐based settings, the availability of supportive services for community living is hindered by barriers at both the service provision and public policy levels. Therefore, understanding and responding to the community living and participation needs of people with psychiatric disabilities is a highly relevant area for action research. This paper discusses a participatory action research endeavor carried out in collaboration with key personnel at Centers for Independent Living who work to provide community reintegration services for individuals with psychiatric disabilities. The events of this 15 month partnership are extensively described, analyzed and discussed. Findings reflect the critical need for communication, dialogue and action to support people with psychiatric disabilities in the community.