BACKGROUND: Achieving effective communication
between medical providers and families with limited
English proficiency (LEP) in the hospital is difficult.
OBJECTIVE: Our objective was to identify barriers to and
drivers of effective interpreter service use when caring
for hospitalized LEP children from the perspectives of
pediatric medical providers and interpreters.
DESIGN/ PARTICIPANTS/ SETTING: We used Group Level
Assessment (GLA), a structured qualitative participatory
method that allows participants to directly produce and
analyze data in an interactive group session. Participants
from a single academic children’s hospital generated
individual responses to prompts and identified themes and
relevant action items. Themes were further consolidated by
our research team and verified by stakeholder groups.
RESULTS: Four GLA sessions were conducted including
64 participants: hospital medicine physicians and pediatric
residents (56%), inpatient nursing staff (16%), and interpreter
services staff (28%). Barriers identified included: (1)
difficulties accessing interpreter services; (2) uncertainty in
communication with LEP families; (3) unclear and inconsistent
expectations and roles of team members; and (4) unmet family
engagement expectations. Drivers of effective communication
were: (1) utilizing a team-based approach between medical
providers and interpreters; (2) understanding the role of
cultural context in providing culturally effective care; (3)
practicing empathy for patients and families; and (4) using
effective family-centered communication strategies.
CONCLUSIONS: Participants identified unique barriers
and drivers that impact communication with LEP patients
and their families during hospitalization. Future directions
include exploring the perspective of LEP families and
utilizing team-based and family-centered communication
strategies to standardize and improve communication
practices.
Although the prevalence of mental illness is similar across ethnic groups, a large disparity exists in the utilization of services. Mental health attributions, causal beliefs regarding the etiology of mental illness, may contribute to this disparity. To understand mental health attributions across diverse ethnic backgrounds, we conducted focus groups with African American (n = 8; 24 %), Asian American (n = 6; 18 %), Latino/Hispanic (n = 9; 26 %), and White (n = 11; 32 %) participants. We solicited attributions about 19 mental health disorders, each representing major sub-categories of the DSM-IV. Using a grounded theory approach, participant responses were categorized into 12 themes: Biological, Normalization, Personal Characteristic, Personal Choice, Just World, Spiritual, Family, Social Other, Environment, Trauma, Stress, and Diagnosis. Results indicate that ethnic minorities are more likely than Whites to mention spirituality and normalization causes. Understanding ethnic minority mental health attributions is critical to promote treatment-seeking behaviors and inform culturally responsive community-based mental health services.
In our cohort, AA fathers have a strong desire to be involved in their children's healthy development, but feel marginalized in their parenting role. AA fathers want improved communication with physicians and their children's mothers and to be actively included in health care decision-making. Enhanced efforts to engage fathers in the pediatric medical home may lead to improved health outcomes and reduced disparities for minority children.
CONTEXT: Early childhood is a critical period for socioemotional development. Primary care is a promising setting for behavioral health programs. OBJECTIVES: To identify gaps in the literature on effectiveness and readiness for scale-up of behavioral health programs in primary care.
There is a growing recognition that integrated primary care (IPC) services can address longstanding sociodemographic disparities in access to and utilization of behavioral health services. At the same time, there has been increasing attention to the complex ethical and legal considerations that can emerge for psychologists working in these interdisciplinary settings. There are challenging ethical dilemmas that arise when providing services to youth and their caregivers involved in IPC services. Unfortunately, although some ethical guidelines and case illustrations relevant to IPC are available, very few focus on the pediatric IPC context. The purpose of this article is to examine salient ethical and legal dilemmas that may emerge in pediatric IPC practice. These issues are examined through the use of 4 case illustrations that collectively address issues related to consent for services among pediatric populations, confidentiality, scope of practice for the pediatric IPC psychologist, and multiple relationships. We apply an adapted ethical decision-making framework (Kanzler, Goodie, Hunter, Glotfelter, & Bodart, 2013) to highlight practice points drawn from each of these cases. Throughout this article, we reference the American Psychological Associ-This article was published Online First January 23, 2017.
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