Full Obpp Paper

Running Head: INCREASING INDEPENDENCE IN GUATEMALA 1
Humanitize Expeditions - Serving Individuals in Guatemala:
An Occupation-Based Needs Assessment
Katrina Smith
University of Utah
INCREASING INDEPENDENCE IN GUATEMALA 2
Humanitize Expeditions - Serving Individuals in Guatemala:
An Occupation-Based Needs Assessment
The purpose of this assignment is to develop and propose an occupation-based program
in a rural community based off of findings from a local needs assessment. Within 80 hours,
information was collected by conducting formal and informal interviews with the executive
director of a humanitarian organization, volunteers, native occupational, physical and speech
therapists, and staff members at a local orphanage who work with children receiving therapy
services. Information was also gathered by observation at various sites. With data and
information collected, along with a review of the literature, the results lead to a proposal for an
occupation-based program to be established to benefit the greatest need for the given population.
Description of the Setting
Humanitize Expeditions is a humanitarian organization that travels to Guatemala various
times during the year with education and medical teams. Their mission statement states, By
providing volunteer service to the poor and needy, participants will gain integrity, earn self-
esteem, and broaden their respect and acceptance of other cultures. The world will never look the
same. (About Us, n.d., para. 1). Service is given to members in a small community who do
not have access to the education and health care which they are in need.
The teams are made up of volunteers ranging from early teens to retired professionals,
interpreters, a co-lead and the executive director. Each trip is self-funded by the volunteers.
During the expeditions, the teams stay at an orphanage which has a medical clinic on site. The
community hears about the arrival of the organization and the specific services being provided
during their expedition via word of mouth. Most of the population in the area are Mayan and are
very poor. They have to work hard to put food on the table for their family and their education
level is very low.
In Guatemala, one of the main current policy issues we found is that occupational
therapists are actually trained as both physical and occupational therapists. This is unfortunate
because much of what can be learned about occupational therapy is lost due to the pressure of
squeezing in all that is needed to know during their time in school. Physical therapy tends to be
the priority with occupational therapy added in when seen fit. Political factors include the fact
that tourists traveling to Guatemala are endangered, specifically in Guatemala City. Many
volunteers fly into this city and stay the night before traveling to the town of Los Robles. It is
important to stay in at night due to the high level of crime. Stereotypes also exist in Guatemala.
Some do not like the idea of white people coming into their country to provide services to help.
Some of the natives view these volunteers as arrogant or superior. This can lead to a negative
response and could possibly put the volunteers in danger. An interesting economic factor to keep
in mind when traveling to Guatemala is the fact that serving the poor may take away from their
economic system. If they are receiving free services, others may not receive as much revenue as
they need. In this case, however, the people that Humanitize Expeditions serves are located far
away from where therapy services are offered, that this organization is less likely to impede the
economic growth within the community. It is important, however, to keep in mind and to be
sensitive to this factor and if at any point the organization is observed to be inhibiting rather than
helping the economy, review and changes will need to be made to ensure service is of benefit to
the community as a whole. A geographic factor to consider in this particular community is
location in relation to resources. These remote towns require great distances to travel to citys
where therapy, medical, and dental services are found. As low-income families, it can be
difficult to find the means to pay for their travel fare, let alone for the actual services received.
By going into these communities and providing free services, families are able to receive the care
they need without the added stress of the amount of time and cost it takes to travel.
One of the sites Humanitize Expeditions works with is an orphanage called Hogares
Seguros Para Ninos (Safe Homes for Children). It is funded by an organization called Casa de
Sion whose motto is, To enhance the lives of Guatemalas least fortunate children by nourishing
their bodies as well as their minds with nutritional, educational and medical initiative. (Our
Mission, n.d., para 1). Funding comes from donations within the country. Fifteen to twenty
children are housed at the orphanage however, expansions are being made so 50 will be able to
stay at one time. The staff at the orphanage is composed of an administrator, four nannies, and 3
cooks. The children who are old enough, attend school which is right next door. Those who are
too young to attend school, receive education fit for their age at the orphanage. They are taught
by the nannies. Each of the children sees a psychiatrist, on a regular basis to help with any
trauma or torture they have experienced prior to their arrival.
Four of the children at the orphanage travel 30 to 40 minutes to the nearest city,
Panajachel, to receive therapy services each week. The clinic they attend is one of 22 in
Guatemala and is called Fundabiem. The name comes from a lengthier title, Fundacion Pro-
Bienestar Del Minusvalido, which translates to: In Favor of the Well-Being of the Disabled
Foundation. Originally it was titled, Foundation for the Disabled however, the desire was to
change the focus from their disability, to their well-being. The following statement can be found
on their website: We believe that physically rehabilitating the individual has the power to
transform forever the lives of entire families, communities and countries. We are a national
professional rehabilitation system open to the attention of any person with physical disabilities
who needs it, regardless of their social, economic or cultural origin.
Fundabiem in Panajachel serves children and adults of all ages; 60% pediatric, 40%
adults. The most common diagnoses they see are patients with cerebral palsy, strokes, and spinal
cord injuries. Services include combined physical and occupational therapy, and speech therapy.
Clinics are open from 7:30 a.m. to 1:30 p.m. serving about 25 patients per day. Therapists will
often treat more than one client at a time. This shows how great of a need there is for more
therapists. The organization is funded primarily by private donations via a yearly telethon and is
partly funded by the government. Therapists are paid a salary and sessions are free for clients.
Some live in Panajachel while others travel greater distances for their appointments which are 1-
2 visits per week.
This was the first expedition made with this particular organization, Humanitize
Expeditions, that focused strictly on physical and occupational therapy. A total of 86 patients
were seen, 76 in the clinic and 10 home visits. The primary impairments that were seen included
low back pain, carpal tunnel, downs syndrome, and cerebral palsy. Each of the individuals
interviewed expressed their gratitude and desire for this type of expedition to become a regular
team in the future that comes out at least once a year.
Programming Strengths and Areas for Growth
Staff Perspective:
Formal and informal interviews were conducted with local therapists and other
leaders/staff members to collect data and to better understand the strengths as well as the areas of
growth in this particular region of Guatemala and where occupational therapy services would be
of greatest need. In speaking with licensed occupational therapists, I learned that in general,
people are very receptive to receiving therapy when needed, however, due to there being so
much poverty in the country, most individuals or families who would like to attend, are unable to
afford to leave their work and pay for travel to get to the nearest clinic. Each of the therapists
expressed the need for home health, particularly in the remote, rural areas, such as the town we
were staying in. If services were closer to their homes, then more people, particularly children,
would be able to improve their level of function, which in turn would improve their quality of
life as well as the families quality of life.
I also learned from the local therapists that education for parents is greatly needed when
it comes to children who are born with special needs. They reported that many parents in this
country are ashamed of their children who are born with a disability and as such, treat them as
though they are unable to progress or contribute to the family. The therapists are extremely
concerned about this and expressed the importance of going into the homes to help educate
parents one by one that their child has potential for growth and increased independence. They
feel the parents would benefit from understanding the importance of treating their child with a
disability as they would their other children. The therapist also indicated that education is needed
to help parents understand that occupational therapy can help their children become more
independent, which can take some stress off of the parents as the children learn how to work and
participate in the daily tasks or duties found at home. The therapists reported a need for children
to learn to help clean the house, work in the field, and go to school to become more educated.
One therapist suggested showing families examples of how children in the United States receive
therapy, gain an education, and are able to help out in the home. Giving visual examples may
help the families to change their perspectives.

The therapists expressed interest in exchanging referrals with team members of
Humanitize Expeditions. For example, they suggested that if volunteer therapists work with a
client at the clinic in Los Robles, and find they could benefit from receiving additional services,
information and recommendation could be given to the client about Fundabiem. Likewise,
Fundabiem can be in touch with Humanitize Expeditions each time a volunteer team arrives so
home visits can be made to any of their clients living in the rural areas.
The therapists also pointed out that in Guatemala, the professional education of a
therapist is set up to receive dual licensing as both physical and occupational therapists. They
mentioned that their focus is primarily physical therapy, and occupational therapy is used as
needed in order to help the clients focus on become more independent. When the therapists
learned how physical and occupational therapy services are provided in the United States, they
could see the benefit and even expressed desires to be able to have therapy services delivered in
the same way. They could see how beneficial it would be for the clients to have separate
physical and occupational therapy sessions.
At the orphanage, information was collected via informal interviews with the
administrator and nannies. When the children arrive to the orphanage, they are not formally
evaluated by therapists. Those with obvious needs are taken to Panajachel twice a week to
receive speech, and physical/occupational therapies. The staff from the orphanage who pick up
and drop off the children are unable to implement any therapy techniques throughout the week
back at the orphanage. This is because they do not observe the children during their sessions to
learn what activities and skills the therapists work on with them.
Informal interviews were continually taking place with the director of Humanitize
Expeditions. As a retired registered nurse, she understands the importance and benefit of
occupational therapy and would like to continue to have therapy expeditions take place through
Humanitize Expeditions on a regular basis. She was the one who suggested we visit the orphans
in Panajachel to observe their therapy, the clinic, and the therapists. This would allow us to build
rapport and provide us with information and connections to learn more about how we can be of
greatest help in the future.
Client Perspective
Information was obtained from clients during their visits to the medical clinic at the
orphanage, Fundabiem, and also home visits that were performed during this particular
expedition. All were informally interviewed and observed. They were asked questions such as
their name, age, and diagnosis. Information was gathered relating to their family situation, their
support system, and home environment. They were asked about occupations that were impacted,
goals, and current level of function. If they had children, they were asked about their view and
beliefs of the potential of their childs ability to contribute to society. Each client interviewed
expressed interest in receiving continued therapy services from volunteer therapists in the future.
They explained how beneficial and convenient it was to receive help in their own town, rather
than finding the means and time to travel to a larger city, such as Panajachel.
Student Perspective
During my time in Guatemala, I was surprised to find that occupational therapy is much
more well-known than I thought it would be and is viewed in a positive light. I found that many
have desires to participate in therapy, but do not have the means to do so. There is a huge need
for occupational therapy, particularly in the rural areas. I met with a number of parents who have
children with disabilities and found that they as a caregiver are extremely worn out. Some have
taken their child into Panajachel for services and have learned a few techniques to help their
child, but are unable to return often due to the expense of getting into town. Others have never
had the opportunity to receive therapy and were grateful for any advice and suggestions given.
It was also observed that many parents do not understand that their children have the
potential to progress in such a way that they can be of help in the home, rather than being viewed
as a burden. Caregivers are in need of education to understand how their children can improve
and help around the home and in the community. Education is also needed in knowing how to
care not only for their children but for themselves. Many parents experience a lot of physical
pain from carrying their older children on their back or in their arms. Many expressed that they
have a lot of back pain. This is where education on ergonomics and proper body mechanics
would be of help to them.
On one occasion while I was at the orphanage during the childrens down-time, I took
one of the kids aside who has poor gross motor skills with his right hand and had an informal
session with him. The administrator came over and it was noted how beneficial it was to have
him there. He has extremely good rapport with the children, and was able to encourage this
particular child to participate in my therapeutic activities. The administrator began to take the
role of the therapist and applied what I was teaching on his own. This observation made it clear
how important it is to have the staff observe, learn, and implement what goes on in therapy so
that they can help the children throughout the week to increase the rate of their progress.
During our discussion with the therapists in Panajachel, we as students and volunteers
took the opportunity to learn more from the therapists about what they view the role of therapy to
be in their country. We inquired as to how we as volunteers could be of most help in the future.
By the end of the week, we discovered the greatest benefit and service we could provide as
occupational therapists, would be to perform home visits to children and their families in the
rural areas where we were staying. During the home visits, it would be anticipated that
evaluations be done, demonstrations would be given of what parents can do to best help their
child become more independent, and education would be provided to the parents to better
understand that their children can learn and develop skills needed to become useful at home and
in society.
Evidence-Based Practice
Based upon the findings from the needs analysis, it is evident that one of the highest
priorities to focus on for this population is the need to educate caregivers of children with special
needs. Specific education would address 1.) improving caregiver health 2.) understanding the
potential of children with special needs and 3.) treatment ideas to help children achieve their
greatest potential. The literature reflects the need to address these specific areas and also
provides ideas for potential interventions that can be used with this particular population.
Aspects to Consider
Caregiver Education
Caring for a child with special needs can be extremely stressful and even jeopardize ones
health. Burnette (2000) reviewed the impact of health among Latino caregivers who were caring
for children with developmental, behavioral, or emotional problems. He observed that health
was poor or very poor across the board for caregivers of children with special needs. He stated,
Caring for a child with special needs requires considerable physical strength and stamina (p.
12). Another study showed the negative impacts of caregiving; in this case, it was referring to
parents who were rearing children with ASD. Estes et al. (2011) found that parents of children
with ASD reported greater caregiving challenges and parents reported increased stress levels,
depression, anxiety, and physical health challenges.

For reasons mentioned above, it is important to provide help and support as needed to
those caring for children with special needs. Burnette (2000) expressed the great need to support
family members, particularly caregivers who have a child with special needs. He went on to
provide suggestions as to how and where this support could be found, including peer counseling
and community and church services. He said other supports include services such as education,
support groups, and respite child care. These services can go far towards improving mental
health, and in turn, ensure the current and long-term well-being of the children in their care.
How Cultural Implications Affect Caregivers and Children
It is important to familiarize oneself with the clients culture in order to provide the best
care or treatment. Mandell and Novak (2005) stated, The role of culture is critical in working
with families with children, including children with disabilities (p. 2). According to Flores,
Bauchner, Feinstein, and Nguyen (1999), Latino cultures believe that there is very little that can
be done to alter their fate. For this reason, parents in Guatemala do very little to help their
children progress developmentally. They believe their child is incapable of improving, and
participating in household activities or performing activities of daily living. Unfortunately, this
puts an added stress on the parents, especially the mother. Blanche, Diaz, and Barretto (2015)
pointed out, In many Latino cultures, gender roles are firmly established, and the mothers
primary role is to care for the children (p. 5). This implies that mothers are likely burdened by
their responsibility to care for their disabled child.
Parents are often ashamed or embarrassed by their child with special needs, causing them
to restrict their social life to avoid negative encounters that could arise from their childs
behavior (Blanche, Diaz, & Barretto, 2015, p. 8). This is unhealthy for the caregiver as limiting
their social interactions could lead to negative effects such as depression. Yang (2015) also
pointed out that parents of children with disabilities or developmental delays have been
described as being more directive, less responsive, and less attentive to their children than
parents of children without disabilities (p. 28). This impacts the child in such a way that they
are not receiving the attention or care that is needed to develop appropriately. As a result, these
children will likely grow up with increased developmental delays and a decrease in their level of
function. According to Bowlby (2014) there is a direct link between the bond children have with
their parents and their emotional security which in turn affects their success in life.
Food preparation is another important aspect in the Latino culture to consider. According
to Plastow, Atwal, and Gilhooly (2015), identity is maintained through engagement in food
activities. They found that engaging in food activities was an important part of productive aging.
They went on to discuss how men and women feel socially connected when they cook and eat
with their families; this was the case across different cultures. It is important to note the impact
children with special needs have on the parents fully participating in food preparation. This can
impact the parents ability to be involved in fulfilling and satisfying traditions. If the parents
came to understand the importance of their children learning to participate in household duties,
such as cooking, it could help to maintain the parents quality of life and improve their
relationship with their children. The children would also receive attention needed from their
parents to learn how to participate in food preparation, allowing them to feel involved and
capable of participating in important cultural occupations.
Interventions
Yoga
Children in orphanages come from many different backgrounds but most have
experienced some sort of stress and tragedy in their lives. Culver, Whetten, Boyd, and
ODonnell (2015) explained that post-traumatic stress disorder (PTSD) is one of the most
common disorders among youth who have been exposed to extreme traumatic events. The
distress they experience can affect their lives in many ways including interference with their
relationships, schoolwork and their ability to complete routine tasks. Their ability to function in
society is also strained which may lead to substance-use disorders, depression, self-harm, and
trauma in their adult life. For this reason, it is important for appropriate interventions to take
place to help children develop in a way that they are able to function and succeed in society.
Yoga has been found to be an intervention that can be of help to reduce symptoms of PTSD,
depression, schizophrenia, chronic pain and attention-deficit-hyperactivity disorders. It also
promotes educational achievement, behavior regulation, and cognitive development among
school-aged children and adolescents (Culver, Whetten, Boyd, & ODonnell, 2015, p. 540).
Culver, Whetten, Boyd, & ODonnell (2015) examined the effects of an 8-week yoga
intervention among 76 children in two orphanages living in Haiti. Their ages ranged from 7 to
17 years-old. The children focused on doing different poses, concentration and breathing. It was
found that the negative symptoms the children experienced prior to participating in the
intervention, such as anxiety, hyperarousal, and avoidance, decreased. The participants expressed
a positive effect on their mood after completion of the intervention. They said that they felt
calmer, less angry, and less stressed. Implementing a program such as this could allow children,
along with caregivers, to improve their level of function, relationships with others, and quality of
life.
OT Home Programs
Home programs can be of great benefit for children with disabilities. Milton and Roe
(2017) researched the effects of home programs for children with cerebral palsy (CP) and
explained how important the home context is for the child to practice meaningful occupations.
The critical review focused on obtaining greater knowledge of how bimanual therapy and
modified constraint induced movement therapy methods are used in occupational therapy home
programs from the occupational therapy perspective. The results revealed the importance of
combining motor and non-motor approaches, core occupational therapy skills, working within
individual contexts, and valuing family preferences to create a successful home program for
children with CP. It was also found that the children would have greater participation in
occupations when child-specific goal-setting instruments were used.
Another study was done to compare the effect of a 20-week occupational home program
for children with intellectual disabilities who participated in a home program to those with
intellectual disabilities who did not receive the home program. (Wuang, Ho, & Su, 2013). The
Canadian Occupational Performance Measure, Bruininks-Oseretsky Test of Motor Proficiency-
Second Edition, and the Childrens Assessment of Participation and Enjoyment were given at 10
and 20 weeks as the outcome measures. Those children who received the home program were
found to improve significantly in areas such as fine motor function, activity participation, and
parent satisfaction in comparison to those who did not receive the home program. This evidence
shows how beneficial it is to provide therapy in the home environment. Implementation of a
home program for children with disabilities will allow children to improve their occupational
performance. In turn this will increase their participation in preferred occupations.
Sensory Integration Therapy
Sensory Integration Therapy (SIT) is a common intervention used primarily among
children. It was developed originally by Jean Ayres with the desire to help children achieve their
optimal level of functioning (Shamsoddini Holisaz, 2009, p. 44). This approach is done with
hopes to improve ones ability to be able to process and integrate sensory information which
includes but is not limited to visual, perceptual, proprioceptive, and auditory. This is done by
receiving, registering, modulating, organizing, and interpreting information that comes to their
brains from their senses (Shamsoddini, 2009). Trained occupational therapists are typically the
ones who administer this type of therapy which involves equipment including big balls,
trampolines, and swinging hammocks, all of which provide proprioceptive, vestibular and tactile
input (Shamsoddini, 2009).
Shamsoddini and Holisaz (2009) examined the effect of Sensory Integration Therapy on
children with cerebral palsy, specifically on their gross motor function. They found that the
children who participated in SIT one hour a day, five days a week for 12 weeks had significant
improvement in the areas of sitting, crawling, and standing, compared to the control group. The
treatment was given by an occupational therapist and each session included exercises, visual
perception activities, body awareness, tactile perception, and visual-motor co-ordination training.
These activities were performed while on their forearms and hands in prone, sitting, crawling,
semi-kneeling, and/or standing position with support as needed. A CP ball and tilt board were
also used to help with balance and corrective reactions.
Several studies have also been done that show the positive effects in children with ASD
who receive SIT. A study was done by Pfeiffer et al. (2011) to observe the outcome of sensory
integration therapy on children with autism. It was found that those who received SI treatment
showed more positive results in the Goal Attainment Scale (GAS) than those of the control
group. Improvement was seen in areas such as social responsiveness, sensory processing,
functional motor skills, and social emotional. Autistic mannerisms were significantly less in
children participating in the SI group after participating in the intervention. Iwanga et al. (2013)
showed similar results in their study that focused on the comparison between SIT and group
therapy (GT) for children with high-functioning autism spectrum disorder (HFASD). All who
participated in SIT had greater improvement in aspects such as coordination and non-verbal
skills compared to those who participated in the GT.
These studies show the positive impact SIT has on children with varying types of
disabilities. As a sensory environment is created, the childrens ability to process and integrate
sensory input increases. This in turn provides increased opportunities for them to participate in
desired occupations.
Summary
In summary, as found in the needs analysis, research also shows that there is a common
trend among parents who have children with special needs. In Guatemala, parents often feel
embarrassed if they have a child with a disability. Because of their culture, they feel that fate
keeps them from seeking services which in turn inhibits the ability for their childs progression.
It also impacts the mothers who feel their role is to care for their children but feel embarrassed
by them. This directly impacts the mothers health, well-being, and quality of life. Universally,
the caregivers health is in greater jeopardy. They are in need of education and assistance to
know how to improve not only their childrens lives, but also their own. The literature shows
that interventions such as yoga, home programs, and sensory integration therapy benefits
disabled children and their families.
Program Proposal
Program Overview
Based off of the needs analysis and the literature review, it can be concluded that the
rural communities in Guatemala would benefit most from an occupational therapy home program
for families with children with disabilities. This program will focus on providing parent
education, and occupational therapy based interventions for the children. Parents will obtain an
understanding of how their children can participate in various occupations, particularly in the
home. At the initial visit, an evaluation will be done to obtain needed information for effective
interventions to take place. This will include interviewing the caregiver to understand what they
view to be most difficult at this time, administering assessments on children when appropriate,
and making observations. During therapy sessions, occupational therapists will administer
interventions to the children, demonstrating to the parents what can be done to increase their
level of function. Parents will be able to implement what the therapist does when they are not
present. A social support group will also be offered for parents. This will allow for an
opportunity to collaborate with others who are in a similar family situation.
The literature demonstrates positive outcomes on both caregiver education and
occupational therapy home programs. Due to the socio-economic status of the population, this
program will be implemented by volunteers and will be free of charge for the participants.
Occupational therapists will travel to Guatemala for two weeks to provide these services. This
will allow families to obtain help that is greatly needed, that they would otherwise not be able to
receive. At this point in time, those in rural areas who travel to the clinic in the city receive dual
physical/occupational therapy. In addition to being free of charge, this program will allow for
families to receive focused occupational therapy sessions.
Rationale for Occupational Therapist
Occupational therapists are specialized in administering therapy in order to help
individuals obtain the highest level of independence and quality of life possible. Each session is
client-centered, and occupation based. According to the American Occupational Therapy

Association (AOTA, 2017), Occupational therapy is the only profession that helps people
across the lifespan to do the things they want and need to do through the therapeutic use of daily
activities (occupations). Occupational therapy practitioners enable people of all ages to live life
to its fullest by helping them promote health, and preventor live better withinjury, illness, or
disability (para. 2). Caregivers in Guatemala have a misconstrued perspective that their children
with disabilities are unable to participate in meaningful occupations. As occupational therapists
take a holistic approach and with the training they have received, they will provide help in a way
that is unique to all other professions. This approach includes keeping in mind the culture, which
the literature discussed as being very important. Occupational therapists are trained in a way that
they will be able to help the families in Guatemala achieve optimal quality of life. This will be
done by focusing on the individual, the environment, and the occupations they desire to
participate in.
Theoretical Foundation
Multiple theoretical models have been created to help guide interventions of the
occupational therapists. This allows them to provide the best treatment for their clients. The
models are set up to focus on client needs, settings, and desired outcomes. Some are specific to
pediatrics, some are geared more towards adults, while others are pertinent to both. There are
models that are considered to be broad while others are developed to be more specific. This
particular program will use three models to guide intervention of occupational therapy.
Person-Environment-Occupation (PEO) Model
PEO is a broad model that can be used universally. The purpose of this model is to
observe the person, their environment, and the occupation at hand. The occupational
performance is a result of the way the three interact with each other (Law et al., 1996). This
means the goal of the occupational therapist is to help the client align the three elements as much
as possible. The closer each is aligned, the greater the occupational performance. This model is
appropriate for the client population of this program in that both the caregivers and their children
with disabilities are experiencing a decrease in their occupational performance in many areas of
life. Satisfaction and quality of life will increase for both as the occupational therapist gets to
know the family and the clients needs, observe their home environment and make adaptations as
needed, and address any concerns or barriers to occupations at hand.
Of the three elements, and because the therapists only have limited visits each year with
the clients, assessing the home environment by observation will be extremely important. This is
why a home program will be extremely beneficial. Going into the homes will allow the therapist
to observe how occupations are performed in their own environment. It will be most effective to
try to eliminate or decrease any barriers that prevent the client from full participation in desired
occupations. For example, a mother of a child with severe cerebral palsy expressed immense
back pain during the past trip. Her child was completely dependent upon her. By going into her
home and observing how she interacted with the environment during occupations, we found
various ways to adapt her surroundings to decrease back pain. Rather than carrying her son from
the bed to the wheelchair on the other side of the room, we suggested moving the wheelchair
next to the bed. This made the transfer much easier. It was also suggested to raise the bed so
that she was not constantly leaning over while helping him with dressing and other ADLs
performed in bed. These simple adjustments allowed less stress on the mothers body,
decreasing her back pain, and increasing occupational performance.

Kawa Model
The Kawa Model (Iwama, et al., 2009) is a model that focuses on the contexts that form
and have an impact on the realities and challenges of individuals everyday lives. In Japanese,
Kawa means river. Using this model, clients take the time to symbolically draw their own
personal riverbed which represents what makes up the contexts of their lives. Rocks represent
their life circumstances, walls and bottom of the river signify their environment, while driftwood
is symbolic of their assets and liabilities. The goal of this model is to help the client reach an
optimal state of flow, or state of well-being in their life. This model works well with those who
are illiterate or who may have difficulty understanding the purpose of occupational therapists.
For these reasons, using this model is very fitting for this program. Clients in Guatemala who
are illiterate will be able to express the strengths and barriers in their lives in such a way that is
quick and easy to understand. After participating in this activity, they will better understand the
purpose of occupational therapists working with them in their home; primarily to help remove or
decrease the barriers they are faced with in their lives. This will also help the occupational
therapist learn about their lives in such a way that is non-interrogating. It will also help in
getting to know the client and their family circumstances fairly quickly as time spent with them
is rather short.
Sensory Processing Model
Another fitting model for this population is the Sensory Processing Model. This model
explains certain behavioral responses found in both children and adults by depicting processing
preferences. A Sensory Profile collects information on the history of responses to sensory
experiences. Sensory categories include auditory, visual, taste/smell, movement, body position,
and touch (Brown, Tollefson, Dunn, Cromwell, & Filion, 2001). This program will primarily
focus on obtaining a sensory profile for the children in the household with special needs.
According to Dunn (1997), Sensory processing is an important factor in young childrens
performance. During our visit to Guatemala, there were a number of children who displayed a
need for help in knowing how to regulate sensory input or lack thereof. Using this model will
act as a guide to help occupational therapists know what suggestions to provide for the parents in
order to help their children obtain and maintain regulation. This will allow children to increase
their occupational performance.
Goals and Objectives
Goal 1: Through individualized education to each family, caregivers with children with special
needs will improve their quality of life.
Objective 1: 80% of caregivers seen during home visits will participate in at least one
social gathering with other caregivers of children with special needs within two weeks, to
increase their education and obtain a social support group.
Objective 2: 90% of caregivers will obtain an understanding that their children with
special needs are capable of increasing in function by receiving occupational therapy
services.
Goal 2: Children will obtain optimal quality of life by receiving interventions by occupational
therapists with parents present.
Objective 1: Within 2 weeks, 90% of children seen will demonstrate ability to
implement at least 2 new skills that will help increase their level of independence in
completing ADLs.
Objective 2: Within 1 week, 90% of children seen will develop at least 1 new skill to be
able to participate in completing household chores.

Increasing Independence in Guatemala:
A Home Health Program for Children with Disabilities
Detailed Description
Introduction
This program will be comprised of a team of occupational therapists who volunteer their
time to serve low-income families with special needs in Guatemala for two weeks. This will be
an annual trip through Humanitize Expeditions. Referrals will be made primarily via word of
mouth from prior expeditions made by Humanitize Expeditions. Participants will also hear about
the program as it is announced via intercom, a common method for advertising in their country.
In this case, a truck drives around Los Robles and surrounding communities with a loud speaker
announcing upcoming events.
Each participant will receive an average of three visits per week in their home.
Therapists will work in pairs with an interpreter present when needed. The initial visit will
consist of an evaluation where the therapist will gather information on the child, the caregiver,
and the home environment. Assessments will primarily be observations and using the Kawa
model to have participants draw their personal riverbed. When appropriate, administration of the
Sensory Profile, and the Pediatric Evaluation of Disability Inventory (PEDI) will be given.
Goals will be established, and explanation of future sessions will be given. Following sessions
will be based off of the information obtained through the assessments and evaluations, keeping
interventions occupation based and client-centered. Parent education will be critical as continual
services will not be available throughout the year. Therapists will focus on providing caregivers
with education and skills that will be most beneficial in helping their children progress. Children
will also receive interventions to learn how to participate in occupations specifically in the home.
A social support group will be held once a week for parents to attend. Therapists will
plan and facilitate group sessions. Participants will have the opportunity to get to know other
caregivers who are caring for a child with a disability. Participants will be able to have open
discussions. This will allow for friendships to be made and ideas to be shared to help one
another. Therapists will talk about the potential each child has to participate in various
occupations. They will also teach caregivers about the importance of taking care of their own
health as well.
Volunteers will create a schedule at the beginning of the week based off of referrals
obtained. Each night, the team will have a meeting to discuss the schedule for the following day.
This will also be a time for each therapist to report back on how their day went. At this point,
numbers will be reported, and documentation of any needed information will be done. This will
be a time for volunteers to collaborate and share ideas with each other.
Participant Criteria
All families who have at least one child living in the home that has a disability will be
eligible to participate in this program. They must live in a rural community within 25 minutes of
Los Robles, Guatemala. Parents will be encouraged to attend at least one of the two social
support group sessions held at the clinic in Los Robles. If the travel expense will keep them
from attending, other arrangements or accommodations will be discussed.
Staff Involvement and Role of Occupational Therapist
The staff will be made up of a team of volunteers, including the team lead who is the
founder of Humanitize Expeditions, a co-lead, occupational therapists, and three interpreters.
The team lead will be in charge of the meetings held each night with additional meetings as
needed to plan, collaborate, and discuss topics to make the expedition as successful as possible.
The team lead will also keep track of the data collected, such as how many visits were made each
day. The co-lead will be in charge of scheduling transportation, overseeing the interpreters, and
funding/expenses. Occupational therapists will provide services in the home and will organize
and carry out the social support groups. They will perform evaluations and assessments, provide
parent education and treatment sessions, and will document each visit. Interpreters will be used
throughout the two weeks and will be available to attend visits, schedule appointments and make
any other arrangements as needed.
Community Resources
Humanitize Expeditions travels to Guatemala various times throughout the year with
different teams. During the medical, education, and physical therapy expeditions, the clinic is
open to those in the community and offers free resources for those who could benefit from
services being provided at that time. This particular program that will be made up of
occupational therapists will be able to refer clients to services being provided by the other teams.
Dates, times, and details on provided services will be given to the clients. Clients will also be
referred to Fundabiem, the clinic in Panajachel, as needed and as seems appropriate. The social
support group for caregivers is also considered a community resource. This will allow
participants to meet other caregivers of children with disabilities to collaborate, share ideas and
support one another.
Space Requirements
Therapy sessions will take place in the homes of referred clients. Transportation will be
provided by the vans utilized by the organization. Social support groups will be held at the clinic
which shares the same grounds as the orphanage. There is a large room with four large tables and
eight benches. A large field is also available for use. The same large room is used as a cafeteria
and meeting room for the volunteers. In addition, the same site has living quarters for the
volunteers to stay in as well. Materials and other supplies including donated items, evaluations,
and equipment used during the sessions, will be stored in the clinic. Additional storage space is
also available as needed as there is a separate storage unit on site.
Time Requirements
Volunteers will work from 8:00-12:00, break from 12:00-1:00 for lunch, and continue
working from 1:00-5:00 Monday through Friday. Saturday and Sunday will be used for personal
time which will include a group outing to visit and tour nearby sites. This will allow the
volunteers an opportunity to come to better understand the history and culture of the country.
The schedule is very flexible, however. If there is a client that is interested or in need of services
outside of these hours, and if volunteers are willing, the group can decide to help those
individuals at a time that works best for them. Each home visit will last 50 minutes.
Appointments will be set up according to location and availability to decrease the commute time
of the therapists. The social support group will be held on Friday afternoons from 1:00-2:00.
Budget
In budgeting for this program, the start-up costs, direct costs, and indirect costs were
taken into consideration (See Appendix B). The hours were calculated based off of a regular
full-time work week. Though therapists will not be paid, calculations for what their salary would
be if it was a paid position was calculated. Perhaps in the future, this program will lead to the
hiring of an occupational therapist. The budget also includes the expenses of each volunteer
including room and board, ground transportation, and their roundtrip flight.
Expected Outcomes
The outcomes for this program focus on both children with disabilities and their
caregivers. By providing services in the home, children will increase their level of function to be
able to participate in desired occupations. This will be accomplished by modifying the
environment and providing adaptive equipment as needed. Children will learn skills that will
contribute to their future success such as gaining an education and finding employment. This in
turn will allow them to use their talents and abilities to contribute to society and be involved in
their community in ways that they would otherwise not be able. Caregivers will receive
education to gain an understanding as to how their children are capable of progressing and
increasing their independence. They will learn how they can provide support for their children
and teach them how to participate in daily occupations. They will attend a social support group
which will provide education and emotional support. This in turn will decrease the amount of
stress that the caregiver experiences and increase their quality of life.
Funding
Funding Options
Option 1: The Wheeler Foundation awards grants to those who are seeking to establish
humanitarian, educational, and cultural needs. There are no program limitations; however
special consideration is given to organizations who are serving those of Maryland, Oregon and
Utah. The average grant size is anywhere between $10,000-$30,000. They may require progress
reports on the program, which increases the importance of detailed documentation in order to
provide feedback to this foundation.

Audit trail
Google Search: Humanitarian Grants Utah Wheeler Foundation, Foundation Grants,
Wells Fargo Overview Grant Guidelines
Option 2: Another grant option is the Maya Relief Foundation which is based out of
California and was established in 2002. They primarily give grants to those in California and
Guatemala with a focus on child welfare and human services. Grants have been awarded from
$500-$32,600. Their mission is to help poverty-stricken people become self-sufficient, and to
empower people to make their way out of poverty, to improve health, and to insure a better
future for their children and their communities. (Our Mission, n.d., para. 1).
Audit trail
Eccles Library Research Databases F Foundation Directory Online Search
Grantmakers Geographic Focus (Guatemala) / Keyword Search (Humanitarian)
Search Maya Relief Foundation
Program Evaluation
This program will use qualitative and quantitative data to determine its effectiveness.
This information will be used to know what adjustments could be made to improve future trips.
Keeping in mind the low education level of participants, a simple 3-point Likert scale will be
given verbally before and after intervention to the caregivers. (See Appendix C). The questions
will address the caregivers quality of life. Exit interview questions will be given verbally at the
end of the two weeks as well. The questions will be open ended and will be administered by the
occupational therapists. (See Appendix D). Participants will also be asked during their last visit
to pull out the picture they drew of their river with regards to the Kawa Model. They will be
asked, If you were to draw it again, would it look the same? If not, what would you change?
A log will be kept for attendance for the social group. A log will also be kept for
documentation of home visits. Each therapist will be asked to document each visit in a notebook
that will be kept in the clinic. This log will be used for therapists to look back on in the future.
It will also be kept on hand for other teams, such as the medical team, as a reference if they end
up working with the same client and have questions about the therapists prior visit.
References
About Us. (n.d.). Retrieved November 10, 2017, from
http://www.humanitizeexpeditions.com/about-us.html
Blanche, E. I., Diaz, J., Barretto, T., & Cermak, S. A. (2015). Caregiving experiences of latino
families with children with autism spectrum disorder. American Journal of
Occupational Therapy, 69(5). doi:10.5014/ajot.2015.017848
Bowlby, J. (2014). Parent-child attachment and healthy human development. Great Britain:
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profile: measuring patterns of sensory processing. American Journal of Occupational
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Appendix A: Interview Questions
1. In what way is occupational therapy most needed in this region?
2. Is occupational therapy very prevalent here?
3. What is the education level/requirements to become an occupational therapy?
4. How can occupational therapy be of greatest help in the future?
5. Are children at the orphanage evaluated formally for special needs when they arrive?
6. Do children at the orphanage receive help from other professionals?
7. What does occupational therapy enjoy about their program? Job?
8. Tell us more about your organization.

Appendix B: Budget
Source of Specific costs or sources of Cost

income
Start-up Costs
In kind -benches/tables $100
-advertisement $75
-equipment/supplies $500
(for home visits/support group)
Total= $675
Direct Costs
-OTR salary to cover 2 weeks $2,400
$30 x 80 hours/year
-Sensory Profile Starter Kit $270
(available in Spanish)
-PEDI Manual $126
-PEDI Scoring Forms (pkg of 25) $46
-Eval (Likert Scale) $20
Total= $2,862
Indirect Costs
-Room/board for OT $300
-Flight (OT from states to Guatemala) $900
-Ground transportation (from airport to $150
Casa de Sion/getting around town-
commuting from home to home/commuting
into town to obtain any needed supplies)
$1350
Total=
Income
N/A
Total= $0
Budget Summary
Total costs $4,887
Total in-kind $100

contributions
Total income N/A
contributions
(income)
Net cost of $4,787
program (covered by grants, donation, and self-pay)
Appendix C: Caregivers Quality of Life
Poor (1) Neutral (2) Good (3)

1. How do you rate your overall quality of life over the last 3
months?
2. How have you been able to sleep in the past 3 months?
3. How would you rate your involvement in preferred activities
in the past 3 months?
4. How well have you been able to perform your household
chores in the past 3 months?
5. How would you rate your relationship with your child with
special needs?
Appendix D: Exit Interview Questions
1. Tell me about your experience having occupational therapists work with you and your child in
your home.
2. What did you find most helpful?
3. In the past two weeks have you seen improvement in your childs ability to participate in
preferred occupations? If so, in what ways?
4. Would you like therapists to come to your home again in the future? If so, what would you
like them to work on with you and your child? Is there anything that was done this time, that you
would like them to do again?
5. What feedback do you have for the therapists?
6. Do you prefer home visits, or would you prefer receiving services in a clinic?

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Running Head: INCREASING INDEPENDENCE IN GUATEMALA 1

Humanitize Expeditions - Serving Individuals in Guatemala:

An Occupation-Based Needs Assessment

Humanitize Expeditions - Serving Individuals in Guatemala:

An Occupation-Based Needs Assessment

The purpose of this assignment is to develop and propose an occupation-based program

director of a humanitarian organization, volunteers, native occupational, physical and speech

Description of the Setting

Humanitize Expeditions is a humanitarian organization that travels to Guatemala various

level is very low.

the community as a whole. A geographic factor to consider in this particular community is

trauma or torture they have experienced prior to their arrival.

who needs it, regardless of their social, economic or cultural origin.

2 visits per week.

team in the future that comes out at least once a year.

Programming Strengths and Areas for Growth

life as well as the families quality of life.

help the families to change their perspectives.

The therapists expressed interest in exchanging referrals with team members of

physical and occupational therapy sessions.

greatest help in the future.

would be of help to them.

depression, anxiety, and physical health challenges.

How Cultural Implications Affect Caregivers and Children

participating in household activities or performing activities of daily living. Unfortunately, this

their responsibility to care for their disabled child.

capable of participating in important cultural occupations.

depression, schizophrenia, chronic pain and attention-deficit-hyperactivity disorders. It also

promotes educational achievement, behavior regulation, and cognitive development among

occupations when child-specific goal-setting instruments were used.

Canadian Occupational Performance Measure, Bruininks-Oseretsky Test of Motor Proficiency-

shows how beneficial it is to provide therapy in the home environment. Implementation of a

performance. In turn this will increase their participation in preferred occupations.

Sensory Integration Therapy

Sensory Integration Therapy (SIT) is a common intervention used primarily among

input (Shamsoddini, 2009).

also used to help with balance and corrective reactions.

skills compared to those who participated in the GT.

disabled children and their families.

opportunity to collaborate with others who are in a similar family situation.

The literature demonstrates positive outcomes on both caregiver education and

families to receive focused occupational therapy sessions.

Rationale for Occupational Therapist

Occupational therapists are specialized in administering therapy in order to help

client-centered, and occupation based. According to the American Occupational Therapy

with disabilities are unable to participate in meaningful occupations. As occupational therapists

Person-Environment-Occupation (PEO) Model

needed, and address any concerns or barriers to occupations at hand.

decreasing her back pain, and increasing occupational performance.

Sensory Processing Model

preferences. A Sensory Profile collects information on the history of responses to sensory

According to Dunn (1997), Sensory processing is an important factor in young childrens

their occupational performance.

Goals and Objectives

needs will improve their quality of life.

increase their education and obtain a social support group.

special needs are capable of increasing in function by receiving occupational therapy

therapists with parents present.

Objective 1: Within 2 weeks, 90% of children seen will demonstrate ability to

able to participate in completing household chores.

Increasing Independence in Guatemala:

A Home Health Program for Children with Disabilities

announcing upcoming events.