The Importance of Support Groups for Spanish-Speaking Adults with TBI

May 17, 2019
9 min read
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Language barriers and lower quality treatment can make recovery difficult for the Spanish-speaking population. Support groups offer a community space for those with TBI.

The Importance of Support Groups for Spanish-Speaking Adults with TBI.png

Spanish Speakers and Speech-Language Pathology

As a future speech-language pathologist, I am well aware (and incredibly excited to know) that Spanish-speaking clients will always be a part of my caseload. Speech-language therapy with Spanish speakers is more commonly discussed in the school setting, but as our country’s Spanish speaking population continues to grow (the US is projected to be over 28% Spanish-speaking by 2060), the need for bilingual SLPs in both pediatric and adult-based settings grows along with it.

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Many Latinos in the U.S. face socioeconomic disadvantages, communication barriers, and acculturation demands that can impact their utilization of mental health services. Due to the variety of sociocultural factors affecting Latinos in the utilization of healthcare services, as SLPs it is our responsibility to ensure that we are providing services that reflect Latino culture and values.

This is where community-based, group therapy service delivery models come into play. By accommodating the cultural and linguistic needs of our clients and their families, we can make sure that they make optimal gains in therapy!

Latinos and Traumatic Brain Injury

Traumatic brain injury (TBI) occurs when an external force causes a blow to the head, which can lead to cognitive, physical, or psychosocial impairment, as well as diminished or complete loss of consciousness.

Statistically, Latinos are more at risk for TBI because they are also more regularly in a lower socioeconomic status (SES) group than the norm. Lower SES can be associated with higher risk jobs and living in areas with higher rates of crime. Higher risk jobs or areas with higher crime rates are two environments that TBIs are more likely to occur in.

Latinos are also less likely than their white counterparts to be discharged to a level of rehabilitation consistent with their injury, and the dual impact of being at higher risk for TBI and receiving a lower quality of treatment are exactly why SLPs need to become informed about this population. By understanding the disadvantages this population may face, and how to address them, we can improve the quality of their services and their quality of life.

Types of Group Therapy

For Spanish-speaking adults with TBI and their families, research seems to point to two major support group models: Solution-Focused Brief Therapy and Trabajadora de Salud. The latter works off of the former’s fundamental concepts as the cornerstone of TBI support group approaches to therapy, but both differ in many ways.

Solution-Focused Brief Therapy

Solution-Focused Brief Therapy is a treatment protocol outlined in the 1999 study, A Multimodal Support Group with Hispanic TBI Survivors, which aimed to pilot an approach that addresses social, vocational, and emotional barriers to adjustment in Hispanic and Latino TBI survivors. This was the first intervention study solely for Latinos/as with TBI—it was only 20 years ago! The support group met for ten weeks and involved six participants with mild TBI, aged 20-42, and focused on TBI education, relaxation strategies, coping mechanisms, goal setting, and family participation.

As a result of this treatment program, participants demonstrated a significant difference in scores on all three measurement tools evaluating quality of life (based on the Beck Hopelessness Scale, Purpose in Life Test, and the Perceived Self-Regulatory Ability Inventory).

Qualitatively, a greater sense of confidence was reported by group members, which could be attributed to the opportunity to share wisdom developed over their time struggling with their disability. It also provided a space for them to exchange practical information including job leads and community resources. Overall, this group treatment was very effective!

Trabajadora de Salud

A 2017 pilot study examined the use of lay health workers to facilitate support groups for people with traumatic brain injuries and their caregivers. Lay health workers are community members who have received some training to carry out healthcare services but are not healthcare professionals themselves. In this model, trabajadoras, who are bilingual and bicultural, are trained on the targeted health condition and provide culturally-grounded education and support for the patients. This is very promising for SLPs, as there is always a shortage of Spanish-speaking care providers and training lay health workers can help to fill in that gap!

“In this model, trabajadoras, who are bilingual and bicultural, are trained on the targeted health condition and provide culturally-grounded education and support for the patients.”

This study addressed several limitations of the 1999 study and revamped the treatment methods. Unlike the work in 1999, this study involved a control group and addressed an important variable: participants with transportation difficulties. The aim of the 12-week program was to assess the effectiveness of Trabajadora de Salud in improving hospital readmission rates, functional abilities, rehabilitation, depression, employment, somatic symptoms, and caregiver burden in both Latinos/as with TBI and their caregivers.

The authors of the article concluded that the Trabajadora de Salud model is a promising approach in working with those with TBI and their caregivers and that future research should further explore this model. Groups like these would be an excellent resource in any community, so long as the group is conducted in the language(s) most appropriate for the community. A great example of a support group for those with TBI and their caregivers is Puertas de Esperanza, a Spanish-only group in Portland, OR.

Puertas de Esperanza

I have been a volunteer assistant facilitator for a Spanish TBI support group in Portland, OR for the past year, and the experience has opened up my eyes to the holistic model of treatment for this population. Addressing the cognitive and communicative needs of clients post-TBI involves treatment of the person as a whole. Addressing their needs in a group-based therapy approach where they can receive education, coping strategies, and community support can help treatment efforts to improve beyond the therapy room.

If you're working with a group as a student you're ahead of a lot of your peers. Using volunteer opportunities is a great way to prepare for your fist clinical placement as an SLP graduate student!

The group I volunteer with is called Puertas de Esperanza (or “Doors of Hope” in English). We meet once a month, we bring food and drinks, and we start the group by just catching up. We don’t rush into discussing the “tough stuff,” rather, the group participants grab something to eat or drink, make small talk, and get settled. Sometimes, new members will come with family members, friends, or even previous caretakers. At times, we have meditated. In other meetings, participants have shared concerns, stories, advice, and connections; participants have cried, laughed, and grown through this group.

As much as I value this group for my own clinical and academic growth, I know that the members themselves also see the group as their second family and look forward to coming every month. As a student, I cannot provide treatment, but I can provide information and resources about what I’ve learned and provide a listening ear.

One day I hope to develop a support group of my own, with consideration to the studies discussed here and the experiences I’ve had with Puertas de Esperanza. The field of speech-language therapy goes so far beyond the treatment room; it extends into the community, the lives, and the experiences of those affected by communication disorders.

For more information about Puertas de Esperanza, please see here.

What can SLPs do to help?

For SLPs, it is encouraging to see that research has been done about such a specific part of our field. As our country’s Spanish-speaking population continues to grow, the need for this research and for clinical expertise about these kinds of treatment approaches are what can help you make even more of a difference in your community as a clinician.

If this is an area of the field that interests you, and you may have thought before this article that you couldn’t start a TBI support group yourself— you can! It’s absolutely possible, and with help from research, clinical expertise, and community connections, you can start a group in your area.

To get a TBI support group going in your area, here are some steps to get you started:

Check for any existing support groups!

You can refer to the Brain Injury Association for your state to determine if there is one near you.

Determine the need

If there are two or more people in your community that have sustained a TBI and you can confirm with them that they would be interested in a group, then you have the need for a TBI support group!

Plan the logistics.

You’ll need to consider things like time, location, funding, and facilitation support. Check out Charlotte Institute of Rehabilitation’s guide here.

Incorporate the use of lay health workers or Trabajadores de Salud.

To learn more about finding lay health workers or how to train them, check out these resources:

References

  1. Dawodu, S. T. (2017, August 18). Traumatic Brain Injury (TBI) - Definition, Epidemiology, Pathophysiology. Retrieved from https://emedicine.medscape.com/article/326510-overview
  2. Armengol, Carmen G., Ph.D; A Multi-modal Support Group with Hispanic Traumatic Brain Injury Survivors; Journal of Head Trauma Rehabilitation; June 1999:14(3); 233-246; copyright Aspen Publishing, Inc.
  3. Linton, Kristen F., M.S.W., Ph.D. and Kim, Bum Jung, M.S.W., Ph.D; A pilot study of Trabajadora de salud, a lay health worker intervention for Latinas/os with traumatic brain injuries and their caregivers; Disability and Health Journal 11(2018) 161-164; https://www.disabilityandhealthjnl.com/article/S1936-6574(17)30080-8/pdf
  4. http://www.who.int/bulletin/volumes/89/12/11-087825/en/
About Sarah Shellard

I am second year grad student at Portland State University and was a participant in the Bilingual Concentration and traveled to Ecuador this past summer as part of the program. I've been volunteering for almost a year now with a Spanish support group for adults with TBI and their families. I also presented in Ecuador about the value of support groups for this population (adult Spanish speakers with TBI).

I have been blogging for packardcommunications.com, an accent modification website and blog, since this fall. I really enjoy post-writing, optimization with Yoast SEO, and collaboration with another professional (SLP colleague)