Creating a Healthy Caregiver-Therapist Relationship Through Culture
At Nurtured Pediatrics we value inclusivity and quality services for all of our families. That is why we always consider culture during our family evaluations and sessions. We were ecstatic to welcome a student, now Doctor of Occupational therapy, Summer Akbar, OTD last year and observe her Capstone Project that considered culture in therapy. Here is her work! Comment below if this resonates with you.
Caregivers make choices every day for the well-being of their children.
What is not often realized is that a caregiver’s choices in day-to-day tasks, such as choosing what show their child is going to watch or what their child is going to eat for breakfast, are heavily based upon caregivers’ cultural backgrounds (AOTA, 2020; Golos et al., 2020).
Usually the phrase ‘cultural background’ is used synonymously with ‘race,’ but culture also includes:
• Environment
• Socioeconomic status
• Gender
• Religion
• Customs
• Language
• Beliefs (Beagan, 2015)
Each of these cultural factors affects the choices that make up lifestyle, personality, and day-to-day activities. An example of how culture makes up a lifestyle is if a caregiver speaks a different language and wants their child to learn that language, they may support their child watching a television show in that language for educational purposes. When it comes to caregivers caring for their child, a caregiver’s cultural beliefs, based on their past and their present experiences, will affect all the choices that make up their child’s way of living.
A choice that many caregivers make is whether they support and prioritize the decision of their child to attend rehabilitative therapy services. While it is important for a child to be present in therapy services, therapy is only effective if the caregiver believes that the reasoning behind the service will benefit their child. A caregiver must understand the effects of their child’s diagnosis on their life, the reasoning for the need for therapy services, and the reasoning behind each intervention to maintain motivation to consistently take part in therapy. If caregivers do not have a clear understanding of the benefits of therapy, they are at risk of not prioritizing their child's participation, which in turn, puts the child at risk for making little to no developmental improvement. Studies have shown that consistent caregiver engagement in therapy services can highly improve children’s overall well-being, including their cognitive, gross motor, fine motor, verbal, social, and self-care skills, more so than children without caregiver involvement in their treatment (Lin et al., 2018). Not only does caregiver participation help the child developmentally in the long run, but it increases the psychological well-being of both parent and child, as well as parent satisfaction in the confidence of their own childcare (Bazyk 1989; Lin et al., 2018). At the end of the day, caregiver participation is essential to therapy services because a caregiver is the only person who knows their child best, the only person who can implement therapy activities in their child’s daily routine, and is the only person who can communicate their child’s needs and progress to a third party.
Here are a few examples of what caregiver participation may look like throughout therapy services:
• Caregivers asking questions or sharing opinions to the therapist
• Participation in therapy interventions
• Monitoring changes in your child’s behavior
• Leading therapist’s recommended activities with your child at home
• Attendance to therapy sessions and shared decision-making with goals and interventions • Forming trust between caregiver and therapist
It is the therapist’s duty to set the caregiver and the child up for success. Caregivers must make sure that their child’s therapist respects every single one of the caregiver’s and the child’s cultural needs. Cultural needs may include religious holidays, respect for the caregiver’s home and food eaten, understanding of any financial needs that may arise, and even making sure that the therapist is teaching about the child’s therapy in the caregiver’s own learning style. When cultural needs are unmet or caregivers do not feel welcome by therapists, this leads to cultural inequalities in services, caregiver’s having further needs and concerns, lower quality of life for the caregiver and their child, and a probable decrease in engagement in therapy services down the line (Rothlin et al., 2021; AOTA, 2020). On this flip side, it has been found that when therapists are aware of how caregiver’s culture impacts lifestyle and try to help in any way that they can, this helps in caregivers feeling empowered to maintain consistent engagement in their child’s therapy care (AOTA, 2020; D’Arrigo et al., 2020).
Here are a few examples of therapist’s duties:
• Therapists collaborating with families to meet the
child’s needs
• Open communication between families and therapists
• Establishment of trust, honesty, and respect
• Individualizing services to meet the family’s needs,
concerns, and questions
• Providing information in a way that the parent
understands
• Practicing consideration and acceptance of family’s cultural differences
• Consciously trying to build a caregiver-therapist relationship
• Building parent empowerment
• Tending to parent or child psychological needs
The method to try to solve any confrontation or express any cultural needs with therapists is through communication and making sure that therapy sessions are tailored specifically to the caregiver and their child. Bringing cultural differences to therapist’s attention allows therapists to recognize the causes of any caregiver concerns that may be affecting caregiver engagement in therapy and the child’s health outcomes (Beagan, 2015). Some therapists are not aware of what style of learning works for caregivers and may lack familiarity with a family’s cultural identity. If caregivers feel they are treated unfairly because of any cultural needs, it may be due to the therapist’s lack of familiarity with a caregiver’s culture rather than purposeful disregard for caregivers and their family (Stille et al., 2013).
It is important to note that not every therapist is one-size-fits-all. This means if one therapist does not meet a caregiver’s needs after caregivers have communicated them, it may be more beneficial to find another therapist who will be more receptive to listening and are able to accommodate caregiver needs to their liking.
RESOURCES
American Occupational Therapy Association. (2020). The Association-Educator’s guide for addressing cultural awareness, humility, and dexterity in occupational therapy curricula. American Journal of Occupational Therapy, 74, 1-19. https://doi.org/10.5014/ajot.2020.74S3005
Bazyk, S. (1989). Changes in attitudes and beliefs regarding parent participation and home programs: An Update. American Journal of Occupational Therapy, 43(11), 723–728.
Beagan, B. (2015). Approaches to culture and diversity: a critical synthesis of occupational therapy literature. Canadian Journal of Occupational Therapy, 82(5), 272-282. doi: 10.1177/0008417414567530
D’Arrigo, R., Copley, J., Poulsen, A., & Ziviani, J. (2020a). Parent engagement and disengagement in pediatric settings: An occupational therapy perspective. Disability and Rehabilitation, doi: 10.1080/09638288.2019.1574913
Golos, A., Mor, R., Fisher, O. & Finkelstein, A. (2021). Clinicians’ views on the need for cultural adaptation of intervention for children with ADHD from Ultraorthodox community. Occupational Therapy International.
https://doi.org/10/1155/2021/5564364
Lin, C. L., Lin, C. K., & Yu, J. J. (2018). The effectiveness of parent participation in occupational therapy for children with developmental delay. Neuropsychiatric disease and treatment, 14, 623–630. https://doi.org/10.2147/NDT.S158688
Rothlin, E., Uno, F., Saminen, H., Wandell, P., Ekblad, S. (2021). Virtual patients reflecting the clinical reality of primary care- a useful tool to improve cultural competence. BMC Medical Educatio, 21(1). http://dx.doi.org/10.1186/s12909-021-02701-z
Stille, C. J., Fischer, S. H., La Pelle, N., et al. (2013). Parent partnerships in communication and decision making about subspecialty referrals for children with special needs. Acad Pediatr, 13, 122-132.