Brain Injury, Cultural Competency, and Relevance in Rehabilitation

We just talked about a whole lot of different levels of causality of an auto accident or a brain injury. At the same level, there are a whole lot of different levels of causality or of difficulties with regard to cultural competence and cultural accessibility of rehabilitation. There's the individual level that we were talking about once the person who is an ethnic minority arrives at a rehabilitation center. And there some of the obstacles have to do with the way rehabilitation is structured, the way that goals are set. And we are getting better at that. I see a lot of movement not only here but in the literature in general at being more open to that flexibility and that other point of view. Some of that has come from the results of rehabilitation. Some of that has come from observing that things that are done in the clinic or in the hospital don't generalize to home very easily. Some of it's coming from how expensive inpatient rehab is, and so we're saying, "We need to look out there and do rehabilitation "more in the community." Actually we have some models that come from the developing world where they're already doing that much better than we are, and we can learn from rehabilitation practices in developing countries that we can apply more appropriately in the developed world of how to do rehabilitation in the community, how to involve family members. Before we do that, we also need changes in our other structures as well; that our funding is so individually oriented and it can be very difficult to convince funding sources that we really need to work with the family, we really need to go out and make a visit to their church or to work with their friends or things of that sort, and actually to interface with other parts of our society that will be doing this kind of work and to have more of a community-based rehabilitation. If you look at things like the school system, or if you look at things like Disabled Student Services in Higher Education or disabled worker services in the larger corporations and government units and so on, that's community-based rehabilitation. There you have somebody who is in a particular, although somewhat artificial or constructed community--a school community or a work community. Their job there is to help that person find the ways to fit in. So they can really be doing the kind of-- We talk about two models: place and train or train and place. The hospital rehabilitation model is train and place. You've got somebody in the hospital, you work with them on this, this, or this until it's fixed enough to be able to go out and put them out there. With the place and train, put them in there and train them in the location where they are to do what it is they're going to do. We're finding that we need to be doing a lot more place and train-- not exclusively, but we need to be expanding that model. And when we do that, we need to be using natural helpers-- schoolmates, co-workers, supervisors and so on-- that we can give a little bit of training to to facilitate what they're going to do to be there day by day to give that little indicator, that zone of recovery, cueing that's needed to allow the person to be successful. So the obstacles are somewhat those institutional obstacles that don't let us go there yet, though we're getting better, and those are some things that we can restructure. The kind of universalist assumption that the way we do things is the right way, we're getting better at that, we're doing more training along those lines. I think that, in a sense, one of the stages of that--the stage is both progress and a barrier-- in our development in various rehabilitation professions is the idea that, "Oh, yes. Diversity is important "and taking culture into consideration is important," so we'll have a course about it over here. And we've hired our Hispanic or we've hired our African American to teach that course, so it's taken care of. That's good too because one needs to focus on what those principles are, one needs to learn them in a systematic way at some point, but it needs to be infused throughout the curriculum of training, it needs to be infused throughout the institution. If you've got a clinic, are the signs just in English or are they in other languages? Do they have graphics as well that help? What kind of materials do you have in your waiting room? If somebody calls up on the phone, what are they going to get? What kinds of decorations do you have? What makes people feel welcome? We look at it at all levels. So I think that we are en route that way, we are making some progress towards that kind of cultural sensitivity, and the obstacles are at many levels.

Neuropsychologist Tedd Judd talks about the way professionals can help their patients with TBI — and their families — who are from different countries or cultures.

Posted on BrainLine April 29, 2009.

Produced by Victoria Tilney McDonough and Brian King, BrainLine.