Variation in Family Involvement on Rounds Between English-Speaking and Spanish-Speaking Families

BACKGROUND: Family-centered rounds (FCR) is the standard of care in inpatient pediatrics. Results of studies have revealed that Spanish-speaking families can experience communication challenges and decreased empowerment on rounds. In our study, we aim to identify variation in FCR practices for Spanish-speaking compared to English-speaking families and factors contributing to these disparities. METHODS: This is a cross-sectional observational study performed by secondary analysis of a quality improvement initiative conducted at a quaternary children’s hospital. Data were collected from June 2019 to March 2020 by using observational audits. Encounters were analyzed to compare key elements of FCR (including rounds location, elicitation of family questions, involvement in discharge planning) for English-speaking and Spanish-speaking families. Multivariable logistic regression was used to compare family involvement in FCR. A sensitivity analysis was conducted to evaluate unmeasured confounding. RESULTS: Rounding encounters included 394 families (261 English-speaking and 133 Spanish-speaking). Fewer Spanish-speaking families were included in the medical team’s discussion on rounds (64.7% vs 76.3%, P = .017), were asked about questions at the start of rounds (44.4% vs 56.3%, P = .025), or were involved in discussion of discharge criteria (72.2% vs 82.8%, P = .018) when compared to English-speaking families. These differences were magnified for resident teams rounding with subspecialists. The finding of decreased family involvement in the discussion on rounds persisted after adjusting for patient age and team type. CONCLUSIONS: Spanish-speaking families were less likely to be involved in FCR compared to English-speaking families. Further investigation is needed to explore the root causes of this practice variation and to develop interventions to address disparities.

Overcoming the language barrier: a novel curriculum for training medical students as volunteer medical interpreters

Background Over 41 million people in the United States speak Spanish as their primary language, of which 16 million have limited English proficiency (LEP). It is well-established that language barriers contribute to health disparities and that the use of ad-hoc interpretation by untrained family members results in substandard care. We developed a novel interpreter training program for medical students to serve as in-person interpreters at a charitable, resident continuity clinic so as to overcome the language barrier in the delivery of healthcare to LEP patients. Methods The Medical Student Interpreter Training Program (MSITP) consists of three steps. First, fluent Spanish-speaking students shadowed a licensed interpreter. Second, students took a standardized phone exam to demonstrate language proficiency. Finally, students completed a three-hour training on the methodology and ethics of interpreting conducted by the Department of Interpreter Services. Results Pre- and post-tests were administered to assess students’ familiarity with the Interpreter Code of Ethics and interpreter skills. Familiarity with the Interpreter Code of Ethics increased significantly with all students reporting feeling comfortable (47%) or very comfortable (53%) after training. The pre- and post-tests included free response questions, which were administered to assess competence in the methodology and ethics of interpreting. The cohort’s aggregate score increased by 35% after the training (Wilcoxon signed rank z-score = 2.53; p = .01). Conclusions Implementing the MSITP resulted in an increased number of trained, Spanish-speaking interpreters available to provide their services to LEP patients at an affiliated charitable clinic and throughout the university hospital. Unlike other program models which are time and resource-intensive, this program is replicable and easily managed by volunteers. The MSITP is an effective model for training students as medical interpreters to ensure the delivery of quality healthcare for LEP patients.

The MacArthur-Bates CDI-III for Spanish-speaking Children

Parent report measures have been shown to be effective, valid and cost-effective means for obtaining information about early child language development. There are several measures available in multiple languages for children below the age of 3. There has been a need for such measures for older children. This study presents the development of a Spanish version of the MacArthur-Bates Communicative Development Inventory-III for children 2 ½ to 4 years of age. A total of 571 families of monolingual Spanish-speaking children from a diverse socio-economic group were asked to fill out the parent report measure in order to obtain a norming sample. Data are presented by age and socio-economic groups that show developmental growth curves for vocabulary production and sentence complexity. Norming tables that show variability by ages are presented. Additional information is given for a General Concepts section. This study presents a new parent report instrument that can be used both clinically and for research purposes.

Learning about immigrant and migrant readers, transforming libraries: Spanish-speaking readers in North America

Drawing on data from the qualitative survey study of avid immigrant and migrant Spanish-speaking readers residing in Canada and the U.S., this paper looks at their use of libraries, specifically, in the context of leisure reading. Acknowledging a gap in current research on Spanish-speaking immigrants/migrants, the study focuses on avid lifelong readers rather than information seekers; achieves an understanding of their reading practices and interactions with libraries in the context of their pre-migration experiences; and highlights readers’ suggestions for the improvement of collections, spaces, services, and community engagement. Practical suggestions are made for public, academic, and special libraries.

“Viejas pisadas”: Activating Postvernacular Ladino in the Works of Myriam Moscona

In both her hybrid-language novel Tela de Sevoya (2012) and in her Ladino poetry collec­tion Ansina (2015), Mexican author Myriam Moscona (1955) embraces Ladino as a post­vernacular language without any illusions of recuperating it for daily speech. Although her grandparents spoke Ladino, she herself is not a native speaker. While she recognizes that Ladino is a dying tongue, Moscona makes explicit the power of literary works to infiltrate and function within the liminal spaces that exist between languages, identities, or layers of history. Moscona’s dynamic and future-oriented creative work-composed in a language whose vernacularity exists only in the past-utilizes the tool of postvernacularity and en­ters into the discourse of feminist mobilization. Her works show how the active use of postvernacularity can open opportunities for her Spanish-speaking audiences to collective­ly engage in Ladino’s afterlife through acts of creative play.

Bridging Family-Teacher Relationships in a Predominately Latinx Title I School With a Spanish-English Dual Immersion Strand Program

Spanish-English dual immersion (DI) programs can help bridge the academic achievement gap between Spanish-speaking English language learners (ELLs) and native English speakers. However, for DI programs to help ELLs, both teachers and parents/guardians need to be aware of their existence and long-term benefits. This case study examined under-enrollment in a Spanish-English DI strand program at a predominately Latinx neighborhood school with a sizable Spanish-speaking ELL population. The case study school faced challenges of transience, limited human and financial resources, and misinformation. Both parents and teachers reported a lack of information to make educational choices and recommendations. School employees built bridges between the school and parents by standardizing the introduction of DI at kindergarten parent-teacher conferences, improving the DI open house, and engaging the efforts of the school's bilingual secretary. Recommendations are provided for increasing parents' and teachers' access to accurate information regarding DI in accessible formats.

Difficulties in Establishing “Truth” Conditions in the Assessment of Addictive Smartphone Use in Young Adults

The smartphone revolution has placed powerful, multipurpose devices in the hands of youth across the globe, prompting worries about the potential negative consequences of these technologies on mental health. Many assessment tools have been created, seeking to classify individuals into problematic and non-problematic smartphone users. These are identified using a cutoff value: a threshold, within the scale range, at which higher scores are expected to be associated with negative outcomes. Lacking a clinical assessment of individuals, the establishment of this threshold is challenging. We illustrate this difficulty by calculating cutoff values for the Short Version of the Smartphone Addiction Scale (SAS-SV) in 13 Spanish-speaking samples in 11 countries, using common procedures (i.e., reliability, validity, ROC methodology). After showing that results can be very heterogeneous (i.e., they lead to diverse cutoff points and rates of addiction) depending on the decisions made by the researchers, we call for caution in the use of these classifications, particularly when researchers lack a clinical definition of true addiction—as is the case with most available scales in the field of behavioral addictions—which can cause an unnecessary public health alert.