Cultural barriers to rehabilitation

As a lawyer specialising in brain injury compensation claims on behalf of children, I have seen first-hand how important it is for injured children to have early access to rehabilitation. A thorough assessment of the injured child’s injuries, symptoms and needs, as well as early intervention in order to meet those needs is in the interests of the injured child and the insurer who will ultimately pay the child’s compensation claim.

The Rehabilitation Code encourages insurers to agree to fund rehabilitation and support for the injured person at the earliest possible stage even before the issue of fault has been decided which generally improves the outcomes for our injured claimants.

However, an injured child isn’t affected by their brain injury in isolation. Particularly for those who are or become dependent, following their injury, their families’ views, culture and norms must also be appreciated in order to contextualise the barriers that may exist in relation to accessing or accepting rehabilitation. I hope that greater awareness will encourage those touched by brain injury to overcome these barriers in order to access and engage in early rehabilitation and ensure that they have the best legal team to help support this.

Language barriers

Primary barriers such as language can hinder families reaching out for support because they fear that rehabilitation providers/clinicians will not understand the challenges they or their loved ones are facing. They may already be feeling frustrated that the medical team are not understanding the challenges they face, and the additional layer of struggling to communicate their feelings in English can compound the frustration.

Whilst GPs and hospitals will make clinical referrals where appropriate, sometimes patients and families are signposted to charities without a full understanding what these charities do and how they can provide support to them and their loved one. It is therefore helpful to see leaflets being translated into different languages with clear references to bilingual staff members.

At Bolt Burdon Kemp, we can arrange for a qualified case manager who is familiar with our client’s culture or language to support them with their rehabilitation. This is important as a trusting relationship between a child, their family and their case manager can help support the child in reaching their rehabilitative goals. We frequently instruct translators to communicate transparently with our clients’ families should they need this assistance.

Reluctance to accept external support

There can be a variety of reasons why families may be reluctant to accept external help. Societal worry or judgement about a child being labelled as disabled or different to others can play a part.

Some families struggle to accept that support is needed for their child, from anyone outside the family, including traditional health care providers. This can be common in ethnic groups such as those from South East Asian countries and East African countries. Communities such as these tend to be quite close-knit and rely on family and friends for help, rather than seeking out help from those outside their community because they often fear that they will be seen as unable to cope.

At Bolt Burdon Kemp, we have acted for many families with particular distrust of community care organisations and have worked with them to positively overcome their fears and distrust. With these clients, we have met them in the comfort and security of their own homes and explained to them the role of case managers and therapists, and the benefits that can be gained by engaging in rehabilitation. These discussions have helped build up trust and understanding about why they were reluctant to accept support and to find a way to both educate, empower and empathise with their needs.

Cultural awareness amongst practitioners and in the services themselves

I have had clients in the past who struggled to find carers and therapists that could relate to them on a personal level because they may not share the same cultural or religious views or have any understanding of what’s deemed appropriate or acceptable for a family according to their beliefs. This stalled any progress from a rehabilitation perspective, as my clients didn’t want to engage with someone who could not understand their priorities or outlook on life.

Some examples include:

• observances such as the month of Ramadan and the requirement to not eat and drink from sunrise to sunset which can impact fatigue and the ability to engage in therapies
• the importance of congregational Friday prayers for men in Mosques and holy days such as Eid, which may mean tailoring therapy and medical appointments around these observances
• females who observe the headscarf would need to be bathed by female carers
• carers and therapist having an understanding of religious dietary preferences of clients and respecting these
• providing families with a care and support team who are either from the same cultural background and/or speak the same language.

At Bolt Burdon Kemp, we have been fortunate enough to work with many case managers and therapists that are aware of the nuances at play when working with people from certain cultural or religious communities and pro-actively take steps to accommodate for their needs.

How do we as lawyers help overcome these cultural barriers?

In order to overcome the barriers I have identified, it is helpful to have lawyers and a rehabilitation team with specialist knowledge of brain injuries as well as cultural issues.

Although there might be some comfort in instructing a solicitor from one’s own community to try to bridge the gap in understanding of beliefs or norms, for those parent or carers who have a child with an acquired brain injury, expert legal knowledge, as well as understanding of the nuances of brain injury acquired in childhood, pays far greater dividends in terms of quality of advice, care and support for the injured child and their family.

At Bolt Burdon Kemp, we go the extra mile to understand and accommodate our client’s needs. We can arrange meet and greets with qualified case managers to help find the perfect fit for our child clients and their families. The case manager who is then instructed by the family can set up a team of experienced medical and rehabilitation service providers who understand the needs of the child and their family including cultural, religious and language needs.

I strongly believe that open conversations, increased awareness, and a willingness to listen and learn on the part of legal and clinical teams can really help to reassure families about the importance of rehabilitation and help overcome the barriers to accessing care, therapy and support. This is important, as specialist rehabilitation at the earliest possible opportunity following a brain injury acquired in childhood is vital, as this is when it has the greatest chance to improve the long-term outcomes for the child.