Embracing Diversity in the Delivery of Rehabilitation
and Related Services
Emilio Perez, Ph.D.
Associate Professor of Communicative Disorders
Arkansas State University
Phyllis Gordon, Ph.D.
Assistant Professor of Special Education and Rehabilitative Services
San Jose State University
Abstract
This paper presents the discussion of findings resulting from a research project that investigated the following questions: 1) "What are the barriers to multicultural rehabilitation? and 2) "What can be done to overcome these barriers?" The objectives of the project were: a) to identify barriers that are experienced by persons with disabilities from minority groups or with multicultural backgrounds, and b) to develop recommendations for the reduction on elimination of these barriers.
Introduction
In pursuing this project, an audience of rehabilitation personnel were divided into four groups. Each group focused on one of the following four stages of the rehabilitation process: 1) the receptionist meeting the client, 2) the intake process with the client, 3) assessment of the client, and 4) intervention strategies. To accomplish the task, each group was assigned a client who was in the role of a generic non-English speaking minority consumer with a disability. Each group was then asked to characterize the client in accordance with the focus stage of the group and obtain answers to the following questions:
A) What are the barriers to multicultural rehabilitation services?
B) What can be done to overcome these barriers?
There was a recorder for each group to document the group's responses which were later discussed.
Process: Group 1
Group I focused on the role of the receptionist has with regard to meeting the client. The following are some of the barriers and recommendations discussed by this group:
1. Language
The group pointed out that the language barrier often causes the receptionist to use louder, slower, more deliberate speech, with the specific purpose of facilitating communication. When the receptionist fails to communicate, the prospective client, out of frustration of not being able to communicate with the receptionist, may walk out of the interview. The receptionist, on the other hand, perhaps out of the same frustration of failing to communicate, may refer the prospective client to another person or agency. The suggested recommendation was that an interpreter who is knowledgeable about both rehabilitation terminology and rehabilitation services should be provided at this stage.
2. The Assertiveness of the Prospective Client in Obtaining Rehabilitation Services
The prospective client may not be assertive enough with regard to obtaining rehabilitation services. It was felt that educating the prospective client ahead of time about rehabilitation services would be helpful. It was proposed that this can be done by a member of the staff who speaks the same language or someone from a community-based agency.
3. The Sensitivity of the Receptionist to the Prospective Minority Consumer
The receptionist's insensitivity to the prospective minority consumer may result in the use of stereotypical comments and slurs regarding the racial/ethnic group. The group recommended that cultural sensitivity training be provided for all staff members.
4. The Completion of Forms by the Prospective
Asking the prospective client to fill out forms after failure to communicate with the receptionist may result in the prospective client walking out. It was suggested that help with filling out the forms be provided, that the request of the prospective client to fill out forms be postponed to a subsequent visit.
5. Physical
The plate glass which is placed between the receptionist and prospective client is a physical barrier. Although it was placed for the protection of the rehabilitation staff, it was recommended that an attempt be made to remove the physical barrier between the receptionist and the prospective client.
In the discussions, the presenters categorized the afore-mentioned barriers as institutional barriers. These barriers actually begin before the person with a disability from a minority group or multicultural background even thinks about rehabilitation services. For example, the individual with a disability may not be aware of the availability of rehabilitation services and depends upon referrals by other professionals. Upon referral for services, the person with a disability may not be apprized of the types of services provided nor of their rights to such services. It was suggested that announcing rehabilitation services in the native languages of different communities would increase awareness and visibility of rehabilitation services. Furthermore, providing written information in different languages can assist in making the client's first encounter with the rehabilitation agency a more successful one.
The issue of transportation (though not experienced in Group One's actual role- play) surfaced as another institutional barrier and was discussed by the presenters. Very often, consumers in need of rehabilitation services do not possess transportation or easy access to transportation in order to obtain services. Consequently, they rely on family members, neighbors, or public transportation (if it exists), to access rehabilitation services.
Process: Group II
The second group focused on the role of the counselor at the initial interview or intake. Some of the barriers they discussed and suggestions for ameliorating them were:
1. Inability to communicate because of the language barrier
An additional problem may be the client's unfamiliarity of rehabilitation terminology. This makes communication more difficult. Recommendations included the following:
a) Utilizing a family member or providing someone from a community-based agency to interpret. The problems of having a family member interpret were discussed. For example, the member may or may not have the cognitive or linguistic skills necessary to interpret technical information. Further, out of respect for the adult consumer, the member may omit important "negative" information, such as, certain aspects of the disability or limitations to perform certain tasks. Likewise, adult family members may not interpret negative or distressful information which is necessary for the client to know.
b) The use of interpreters, per se. Unless the interpreter knows the rehabilitative service process or possesses the skill to interpret literally when assessing clients, the consumer's needs may be inaccurately assessed.
2. The cultural differences between the counselor and the client
The counselor may not acknowledge the fact that there are cultural barriers. It was considered appropriate and necessary for the counselor to admit barriers to multicultural rehabilitation services such as, and lack of knowledge of the language or culture. Likewise, it was deemed important that the counselor familiarize himself/herself with different cultures.
3. Attempts to establish the client's status on the initial visit
Trying to establish the client's status on the first visit was seen as a barrier. For example, asking too many and/or inappropriate questions without knowing the client has proven to be problematic. The idea promoted was that the counselor should not pursue trying to know the person and his/her needs during the first visit. It was suggested that going to the client's home is deemed desirable in the attempt to establish rapport, gain insight about the client and his/her situation, and to help establish a home support system.
4. Intimidation of a consumer with a disability regarding the referral process
Another barrier discussed was that the client with a disability may be intimidated by the fact that they have been referred due to the disability. Cultural considerations concerning acceptance and understanding of disability may create obstacles. It was felt, again, that educating the prospective client regarding rehabilitative services ahead of time would help. This could be done by a member of the staff speaking the same language or by someone from a community-based agency.
Process: Group III
The third group focused on the role of the clinician in assessing the client. The group characterized the client as a monolingual Hispanic male with a back injury. The following were some of the barriers and recommendations:
1. The language barrier
It was recommended that a course of English as a Second Language (ESL) be provided to the client.
2. The client's frustration level
Suggestions were made to eliminate the language barrier and to educate the client regarding rehabilitative services to help alleviate their frustrations.
3. Lack of sources of consumer support and the need to retrain the consumer
The group encouraged counselors to find community and family resources to help in the retraining and rehabilitation process.
4. Assessment tools which are highly verbal and written in English
The group endorsed the use of a more pragmatic, culturally sensitive approach to assessment rather than using highly verbal, culturally-biased standardized tests.
Process: Group IV
The fourth group focused on the role of the counselor in the intervention stage of the rehabilitation process. The following are the barriers and recommendations:
1. The language barrier
The group advised the audience to provide training in English as a Second Language (ESL) to the client and/or use a counselor who speaks the client's primary language.
2. Lack of many resources for retraining or on-the-job training
Most of the discussion centered on suggestions for intervention, such as, providing on-the-job training or retraining, engaging in networking to find community-based agencies or individuals who may help with the rehabilitation process, and providing tutorial help for clients.
3. The amount of paperwork required It was agreed that the paperwork process takes away time that consumers need with their counselors. Trying to reduce the paperwork was seen as a primary objective. The use of the computer was identified as helpful but was evaluated as inappropriate to use when interviewing the client.
4. Unavailability of time to work in the community and to visit the consumer's home
The group encouraged counselors to, somehow, make the time to visit the consumer's home in order to access family support, and to establish a network of community-based agencies to help in the rehabilitation process.
Summary
The presenters addressed the barriers to multicultural rehabilitation services for persons with disabilities from minority groups or multicultural backgrounds by discussing barriers to the rehabilitation process that are associated with the consumer, counselor, or are institutional. Common to all four stages of the rehabilitation process is the language barrier. Failure to communicate, which is the basis of any type of counseling, was seen as the most serious barrier. Institutional barriers included the lack of visibility of rehabilitation services, the lack of accessibility to services, and the lack of cultural awareness and sensitivity by staff. Barriers associated with the consumer included the lack of knowledge of rehabilitation services, rights to services, and culturally-bound and class-bound values that interfered with rehabilitation. Barriers associated with the counselor included differences between the counselor's and consumer's cultural orientation, preconceptions about the minority group or disability, lack of cultural sensitivity, lack of awareness of the counselor's assumptions, and the use of inappropriate counseling approaches and strategies. In addition, issues pertaining to gender differences within the rehabilitation process were addressed. It was noted that discussing personal information, as required during the rehabilitation service process, may create barriers for all consumers when interacting with a counselor of the opposite sex and, in particular, when the client/counselor are from different cultural backgrounds. Sensitivity to gender issues and specific disability issues was also seen as critical.
Hypertext formatting performed by Megan Dodson
Page last updated on March 20, 1997 by Mary Kaye Rubin