This article presents an integrative perspective on the role that doctor-patient communication and cultural competency training play in health care disparities. Communication between minority patients and physicians is characterized by doctors' biased expectations, patients' perceptions of discrimination, linguistic asymmetry, and self-fulfilling prophecy spirals. Cultural competency training, which has been put forth as a remedy, is itself a complex construct, and methodological variations in cultural competency research make it difficult to reach simple conclusions about its effects. The authors review and synthesize the cross-disciplinary literature in these areas. They propose several directions for research, emphasizing that new studies can lay the groundwork for more trusting verbal communication between doctors and minority patients.

Culture influences occupation as well as perceptions of health, illness, and disability. Therapists are aware of the need to address culture in interventions. However, definitions of culture can be unclear, providing little guidance to therapists about how to recognize its effects in therapeutic encounters. A pragmatic definition of culture as emergent in everyday interactions of individuals encourages reconsideration of the main elements of culture, that it is learned, shared, patterned, evaluative, and persistent but changeable. Understanding of culture as emergent in interaction, including therapeutic intervention, suggests three important characteristics that therapists can cultivate to enhance clinical encounters: careful attention, active curiosity, and self-reflection and evaluation.

For occupational therapy to provide a holistic view of meaningful activity, we must understand the relationship between physical, psychological, and social variables, especially as they affect our psychosocial evaluations and treatment. Existing definitions of psychosocial variables are unclear and, for occupational therapy practice, must be linked to activity and occupational performance. Occupational therapists need to become more educated about the uses and limitations of psychosocial instruments and to develop new instruments that address the central tenets of occupational therapy by focusing on whether or not a person is able to do what is necessary and fulfilling. Further, understanding what is meant by meaningful activity and what people need to accomplish it will advance our effectiveness in occupational therapy assessment and practice.

For at least a decade, concern has been expressed about the status of occupational therapy in mental health. Increases in the number of new jobs and clinicians have not kept pace with growth in other practice areas. Although growing criticism of the practice of deinstitutionalization and an increased focus on cost-effectiveness have recently become major public policy trends in mental health practice, the psychological and nursing professions have responded creatively in order to expand their influence and practice. This paper relates changes in the delivery of mental health services to the systematic study of policy development and careful planning needed to help occupational therapy accomplish the same goals.

Enhancement of hand function in cerebral palsied children is a priority of occupational therapists working with this population. While splinting is used as an adjunct to active treatment with many other patient groups, it is not as consistently used with these children. This pilot study was designed to investigate the effects of hand splinting on bilateral hand use, grasp skill, and arm-hand posture in hemiplegic cerebral palsied children, using three different splints: the orthokinetic cuff, the short opponens thumb splint, and the MacKinnon splint. Each was selected based on its reported utility in reducing spasticity and thereby enhancing function. A counterbalanced experimental design was used with the 12 subjects wearing all three splints in a randomly assigned order. Splints were worn 8 hours per day for 6 weeks, with a 2-week interval between splints. Measures were developed for documentation of the three dependent variables. Analysis of the data revealed no significant relationship between splint type and change in the dependent variables. However, when scores for clusters of subjects were analyzed significant differences in response to the splints were identified Improvement in bilateral hand use was associated with the orthokinetic cuff and the MacKinnon splint; grasp skill improved most significantly with the MacKinnon splint. Arm-hand posture did not seem to be affected by splint wear. The study was limited by a lack of standardized measures of bilateral hand use and grasp skill for children, suggesting a need for development of such measures In addition, further investigation of the effectiveness of the MacKinnon splint on improving functional skills with cerebral palsied children is indicated.