Your world with Dr. Beatrice Hyppolite
Hello,
I am Dr. Marie Beatrice Hyppolite. I hold a doctorate in Health Science with emphasis on Global Health and master’s degree in social work. I have over 14 years of experience in the field of health and human services.
This podcast is primarily focused on mental health and the quality-of-life elements that affect it such as divorce, death, domestic violence, trauma, toxic relationships, and single parenthood to name a few. It is no secret that mental health challenges continue to profoundly impact modern society although not enough discussion is given due to stigma. Research has shown an increase of 25 % in mental health crises after COVID-19. It is important to have honest, uncomfortable conversations about mental health while being supportive. Although we are interdependent, change begins with the individual, hence “your world.”
I welcome you to join me on my journey and look forward to your responses.
Your world with Dr. Beatrice Hyppolite
Embracing Cultural Context in Healthcare
Cultural humility isn't just a buzzword—it's a transformative force that reshapes how healthcare professionals approach treatment. As Dr. Gus Schlegel shares in this deeply moving episode, a simple moment watching a family eat their traditional meal completely changed her understanding of occupational therapy.
When milestone charts indicated a two-year-old child from an African immigrant family should be learning to use utensils, Dr. Schlege initially saw the mother's questioning response as resistance. Then came the breakthrough: witnessing the family's cultural practice of eating with hands—forming rice patties with meat inside—revealed how irrelevant the standardized recommendation was to this child's daily reality. This profound realization became the foundation for a more contextual, culturally-responsive approach to therapy.
The conversation broadens as both speakers share humbling experiences from home visits that revealed clients' true circumstances. One particularly moving story involves discovering a mother who carried her 17-year-old son with cerebral palsy up two mountains—a 2.5-hour journey—to reach appointments, which prompted the implementation of home-based care. These moments underscore how entering clients' environments unveils realities impossible to understand from clinical settings alone.
The episode explores occupational therapy's unique contributions to mental health treatment, from helping clients develop essential daily living skills to implementing structured group therapy using protocols like Cole's Seven Steps. The "relative mastery" concept emerges as particularly powerful—therapy success defined by clients' own standards rather than textbook examples. A compelling illustration is the photo-based customized patient education materials being developed, which use images of clients performing exercises at their current ability level, respecting their dignity and autonomy.
Whether you're a healthcare professional seeking to deepen your cultural responsiveness or simply interested in more humanistic approaches to care, this conversation offers transformative insights into how understanding context creates more meaningful human connections. Share your own "aha moments" that have changed your perspective, and subscribe for more thought-provoking discussions about bridging gaps in healthcare and human services.
Hello everyone. I'm Dr Beatrice Ippolit and this is your World.
Speaker 2:So way back when I was working in an early intervention, it's a birth to three program. So before children go into school, where the municipality really takes over the funding and the programming for children, they're eligible for birth to three and it's really a federal program. So from zero to three, it varies depending on the state, but it's generally from zero to 36 months and there might be that bridge. If a child turns 36 months in May and school doesn't start until September, the birth to feed program will cover the expense of sending the clinician out if needed until they start school. So I was working with a wonderful family. I've worked with a lot of immigrant families, but this family came from a country in Africa and I always loved those experiences because I learned so much. I love people and so just that just enriches my understanding of people. But I was a young clinician and had just really started. I was maybe three years into my career. And I was a young clinician and had just really started. I was maybe three years into my career and I was looking at milestone charts and so there was a two-year-old, this two-year-old boy, and so I suggested to the mother one day we really need to start working on utensil use Fork, spoon and the mom looked at me why? And I said well, that's what the milestone chart says, it's right here, look. And I showed it to her and she goes oh okay, wasn't convinced, and I left there thinking what can I do to convince her? Because there wasn't buy-in, and so that was my line of thinking, right.
Speaker 2:A couple of sessions later I came back and I happened to catch the family. They were still enjoying their meal, their family meal, and they were sitting on the floor surrounded. There were two pots in the middle, one was a big pot of rice and the other one was a big pot of meat. And they were, and they invited me to come and sit down and participate. And then you reached in with your hand and you made yourself a rice patty like a big patty, and then you took some meat and you put it inside, rolled it up like a ball and you ate it. And there were no utensils involved, and so in that child's everyday use, at least until the child went to preschool or to school, that child wouldn't even have been exposed to a fork or a spoon. It just didn't make any sense Because that was not part of her culture.
Speaker 2:It wasn't part of their culture, and so that's where really understanding the context became so important to me, and that was one of those. You know how you have those aha moments. For me, that was a big aha moment and that just really changed the entire way that I looked at my work. That humbled me tremendously. So that's what I mean by.
Speaker 1:You know what Many of us can relate to some level, so I may not have the same experience you had. That humble you, but I had my experience that humble me. I remember I was working with an agency which I'm not gonna mention the name, and I had a client and went to see that client. In the chart it says client was 26. But upon visiting the client, client was laying in a crib and I went there play with the baby for a while and after maybe one or two minute I looked toward the caretaker at that time and I said, oh, where is my client? And that was my client in the crib.
Speaker 1:Yeah man. I look at the chart, look at the caretaker, look at the child. I'm like 26 years old, weighted less than 40 pounds. All the health condition in the world, you name it, that child has it. So could not see, could not hear, could not walk, and that moment really was like a wake-up call moment for me.
Speaker 1:And that moment had really humbled me. Personally, I'm not a complainer, but that moment I said you know what? I should be grateful for everything that I have Instead of complaining for things that I should have and I didn't have. So it's like that was a ha-ha moment for me. That moment really had humbled me. So I completely understand when you said you know, you got your ha ha moment I had it very, very important.
Speaker 1:And that's the beauty of being in the community, being in people lives, being in people you know like home, to see their living condition, their comforts. I've visited clients who literally didn't have anything you see what I mean but the joy that they always have on their face. You're like wait a minute. So you will have thought that. You're like wait a minute, so you will have thought that client will have a different attitude. But you're like, okay, somebody who basically don't have anything can carry that smile on her or his face. What about other people who are blessed with a little of something? So that's very important.
Speaker 2:I'll tell you another aha moment that I had. That just occurred to me too. So, working in Haiti and there's a real you've heard of Paul Farmer, who he helped start Partners in Health, and so Zamni La Sant, which is the sister organization in Haiti he led that up until his passing. One of the things that he said was that if clients don't come, then go and find out what's up with them. If they were supposed to show up, then go and find them. And so it was really important in Haiti too, with our partners, those that we were working with, to have this clinic, this fixed facility. That was a sign of status, and you have to come to our clinic, regardless of how far you have to travel. That makes sense to me, because that's where you have your equipment and there's a question of safety and so on. But one of the things that we said well, when our patient because we would go down and we would treat patients didn't show up, we said to the people that we're working with, can we go visit them? And so they looked you really want to leave here and go out and walk? And I said, yeah, and so that's when we started going on home visits, and our first home visit was, and it really just we became aware of what this looks like.
Speaker 2:So it was this young, was 18 or 19 years old, and he had cerebral palsy. So that's when there's some oxygen deprivation that occurs during the birth. So the child is typically okay, the fetus, but then during birth, some complications, so that part of the brain doesn't get oxygen for a period of time, and so that leads to some physical conditions and also there could be some cognitive impacts. So this child well, I call him a child, but he was a late teenager wasn't able to walk, he wasn't able to speak, and so his mother had to carry him. We wondered well, where are they? Let's go? And so we said let's go visit them.
Speaker 2:They lived up two mountains over, and so in order to get there, we had to climb up one, two and then up the next third mountain to get to them. So, valley up, valley down, and it took us two and a half hours to get there and we were just walking with our light backpacks, hours to get there and we were just walking with our light backpacks. But then you consider that there, whenever the mom had to take the child, her child, to an appointment had to carry the child on her back, this 17-year-old. That was just amazing to us. So then that's when we said you know what we're really going to start coming to people's homes and doing visits. That's where the home care visits started, just because, also just understanding the context, how people live, that's what's really appealing to me, and I also, aside from being an educator, I still work and see clients in their home, so I go and visit them.
Speaker 1:Yeah, it's amazing, and I do love home visits because you know, sometimes you have people who may be in need for certain things but will not be comfortable to ask the OT person, the social worker or whomever may come. You know so over the phone. But as an occupational therapist, a social worker or whatever the title may be, when you get to visit that patient you get to see what the client needs, what the client doesn't have, what the client should have. So based on your own assessment, you can put recommendation. So I had a client I will never thought that she didn't have enough to eat until I visited that time and I'm like now this is a client that need to be on million wheels you know.
Speaker 1:So it's like because we have the services out there, so if there are people in need, they may benefit from it. But some people they may not know how to look for the resources, or some people, for whatever reason, they don't feel comfortable to go and ask. And I'm like, no, if you have the needs for the services and it's there, so you may as well apply for it. Yeah, so that was the joy that I used to have when I used to come back home visit with uh, my previous employment. Yep, it's very important, so I'm gonna with like few one or two benefits of uh ot. On mental health According to research, ot helps individuals develop skills for daily living, such as self-care, productivity and leisure activities and when copying mechanisms. Ot also teaches individuals coping strategies and techniques to manage stress, anxiety and other mental health challenges. Will you agree?
Speaker 2:Yes, and that's a lot. There's a lot there, and OT really does touch on all of those. So let me start with self-care. And so that's really just a fundamental component of what we call activities of daily living ADLs for short. And so, as occupational therapists, we focus on helping clients either develop those skills or return to engaging in them successfully. And so, with clients who have mental health conditions, we know that there are mental health conditions like depression or schizophrenia, where those activities, they become disrupted and so the client doesn't engage in them effectively. And so we work with our skill set of being able to break down activities and coaching to be able to bring that person back to being able to engage in them successfully. Tell me some of the others.
Speaker 1:OT helps individuals with techniques to manage stress, anxiety and other mental health challenges.
Speaker 2:Yeah.
Speaker 1:To meaningful activities and accomplishments. Social participation OTSI also encourages or assists with that and really helps clients into promoting social connection and relationships.
Speaker 2:Yes, and so one of the things that we as occupational therapists do really well is have a beautiful protocol for running groups. It's called Cole's Seven Steps and it was developed by Madeline Cole. She was a professor at Quinnipiac University in Connecticut, and so Cole's Seven Steps it's pretty, I would would say, pretty much used by by most most schools or in some form, and there's there's a real found foundation. There. We learn about the, the roles that different people take on within a group environment. We learn how to leverage groups to to be able to elicit outcome, and, and so those outcomes can be group goals, they can be individual goals. We leverage social learning, so looking and learning from each other too. So peer learning, that's really important.
Speaker 1:What size, normally between 6 to 12, or what's the size of the group?
Speaker 2:So it can really depend. It depends on how many facilitators you have. If I were running a bigger group, then I would want to have another facilitator, too, to support me. So the way that they would typically run is there would be some warm-up, right? So just something to just you know, start, and it might be what's your favorite movie, or something like that, and then we, as clinicians, will talk about what the lesson is or what the focus of the group session is, and it might be some activity to further enhance some understanding. It might.
Speaker 2:It could be, honestly, it could be something that's not mental health related. It could be being able to use we use sock aids to put on socks, and so educating and providing that block of instruction about how to use the sock aid, what its purpose is, and then we take and we give them some background. This is important so that you can be independent. Then we practice it and we'll go through steps. Okay, now take this and you might take turns with the person next to you or within a group. Well, the important part, then, too, is the processing part, because during processing, we go through and there's a group dialogue where we talk about why this is important to me as a group participant and why this particular activity that we engaged in is relevant, what we learned today and how we're going to then use it or generalize the skill.
Speaker 1:Okay, so when running those groups, so the group leader will be chosen from the group participant or it will be the OT person.
Speaker 2:You know it would be the OT, we could have a co-leader. So and that's a really good point too, if I've had, so in inpatient settings very often there's one or two patients that just in inpatient settings very often there's one or two patients that just they're not discharged, there's no safe discharge plan, and so they tend to stick around, and so because we have patients come in and out, it might be that we run a similar group maybe maybe two or three or four weeks later, and so that person that's been there for a while, they might have had exposure to that. We've worked with them individually to develop that skill, and so we, we give them that opportunity to really showcase hey, this is what I know, and and that's and they engage in in educating their peers, other patients.
Speaker 1:And they can relate to each other as well. Absolutely, Because it's like that's one of the beauty of group, so it's like to know that, hey, I'm not on the world alone. Whatever that I'm dealing with, there are other people who are facing the same situation and as a group, so it's like we can be helped to work things out. So group is very important.
Speaker 2:And, as you know too, when I teach something, sometimes it becomes clear for me too, and so I know that giving those that have been around, those patients that have been on the unit for a while, the opportunity to teach their peers, that helps them really solidify that skill too and it might get them closer to discharge.
Speaker 2:Most certainly they're developing self-esteem because they did something that was very useful that day.
Speaker 2:And so I know in some units there's different levels, status levels, right, they call them different things level one, two and three. I know in the military it had to do with you had to stay on the unit if you were level one all the way up to level three, where you could wear your uniform and weren't in a hospital gown, you could actually wear your shoes and go out and go around the hospital, go to the mess hall, the cafeteria and eat. So that really helps prepare the person that's been on the unit for a while for discharge and that could be part of their care plan too, being able to educate others. That really translates to into when they're out in a community setting, at a community mental health facility, they can be really, they can feel comfortable being in a leadership role at times to help educate others. This is I know a lot about this and that all would go with them and they can let the staff know and that, hey, you know I've gone through this, I've done this.
Speaker 1:That's good. Those who work in the KSAC field. They have a similar approach.
Speaker 2:Okay.
Speaker 1:And I think you know so they let other peers who have experience, who have struggled with drugs and addiction, who over time had overcome the addiction and now they use them as peer specialists to go and help other people through their life's challenges. So it's very important when you can use other group members to educate one another, it's wonderful.
Speaker 2:And a real parallel to that too is the AA, the 12 Steps with the sponsors, those sponsors that have been sober for a period of time. They, they have their struggles, but in in them, being a sponsor for someone else really helps reinforce their determination and and their willpower to to continue on. So it can be very validating, rewarding and in a practical sense too, it's yes, yes, indeed yes indeed my next question how do you measure the effectiveness of your occupational therapy services?
Speaker 2:ah. So if you were to ask me that it would be. And so, after the the evaluation process, I really include my patients in helping understand what it is that they want to accomplish. And so there's this, there's this idea, there's this concept called relative mastery, which means that tying your shoe or frying an egg there might be this textbook example of this is how you fry your egg or you make a breakfast or iron a shirt, but I can't impose what the textbook says or what everyone else says about this is how.
Speaker 2:This is what a shirt should look like. It has to come from the client. It's really important for them to know how to use an iron and how to iron, but really the outcome is really it has to be important to the client. And so that relative mastery is they complete the ironing task or they fry the egg to their specifications, and so when I flip my egg, I would dread breaking the yolk. To them it might not be important, so I can't impose on them don't break the yolk or you were not successful with frying this egg.
Speaker 1:So the service is kind of like client-centered.
Speaker 2:It's very client-centered, yes, and that even comes to play when we talk about exercises.
Speaker 2:And so there's this program that I've been developing, that Sheila's been helping with too.
Speaker 2:It's photo-based, customized patient education material, and so very often when you receive therapy you're undoubtedly given some instruction sheet.
Speaker 2:So a home exercise program program HEP we call them and there's very often a picture of a 20-something year old right doing some exercise and they're they're able to raise up all the way up and full extension or go out, and they might be able to, or go out, and they might be able to whatever our patients might not be able to do that. So if they can't reach all the way up, all the way up to the, to the, to the ceiling, extend their, their shoulders 180 degrees, then by look, based on the picture, they weren't successful in that activity, right, because that's what the 20 something was doing so with. With our photo based customized approach, we really take that, that concept of relative mastery. Let me see how high you can get that up, and then I use their customized picture and I embed it in the instruction sheet so that they know, based on the picture, that that shows their success in the exercise or the activity. So it's very, very client driven because it cannot be your treatment.
Speaker 2:You're not the one dealing with the issue exactly and and the people love see them seeing their themselves on the instruction sheets too I've've gotten we both have, we've gotten really good feedback.
Speaker 1:You know, that approach, you know really shows a sense of respect and dignity for your patients.
Speaker 2:Yes, absolutely too.
Speaker 1:Because people want to feel that, hey, you know what I'm capable of making the change that I need in my life. So as a professional, you may see the need, but you don't come and just impose your own walls. So you make sure that whatever the treatment plan gonna be is gonna be based on the client decisions.
Speaker 2:That's exactly right.
Speaker 1:That's powerful. My next question what role do you think occupational therapy plays in promoting overall health?
Speaker 2:So because we're very client-centered, we very often are kind of the person and we're also team players. We're the discipline that kind of pulls the team together and gets everyone talking and makes those connections, and so we might not have the skill set in a particular especially when it comes to medication, for example, we engage with the nurse who knows about medication. Do you think that the medication is impacting the patient? Maybe a side effect or something is impacting the patient's performance? What other alternatives are there? And so we are collaborators, which is really, really important. Also because we can spend the time with our clients. We also get to know them. We get to know the family.
Speaker 2:I love going to my clients' homes on the weekends and the evenings because I run into their caregivers, they're visiting family and so and I'll do that deliberately sometimes, oh no, you can't come, then my son's coming. I don't want the son to interrupt the session and I say you know what it would be. Does your son come? Does your son help you sometimes? Yes, I would love to meet your son, if that's okay with you, and maybe we can show your son what you do, what we do during the sessions Okay, and those, and maybe we can show your son what you do, what we do during the session. Okay, and those sessions they turn out to be sometimes the best sessions, because I'm engaging them and if we're doing some task, I have the family member there working with us together, especially if it's a cooking task. Maybe the client will make some toast, some butter toast for all of us, right? And then we sit down and we enjoy it together with a cup of tea. Those are the special sessions that I really appreciate, so that's really valuable.
Speaker 1:I assume that oftentimes you will see the joy on your client face. Oh yeah, you know because, knowing that, oh, you know what, I toasted those two slices of bread by my own, so I was able to do it my way and so having people enjoying eating those slices of bread with them, with tea, so that can bring a lot of joy.
Speaker 2:Absolutely, you know so. Absolutely. It really touches on the social piece too right. Mm bread with them, with tea, so that can bring a lot of joy. Absolutely, you know so. Absolutely. It really touches on a social piece too right yeah, exactly, yeah, exactly, yeah.
Speaker 1:So it's like the way that I've seen ot people may think helping somebody. You know, fry some eggs or toast to slices of bread, some eggs or toast to slices of bread, people who have the capability of doing it.
Speaker 2:They say it's not a job. What's the benefit, what's the importance of it? Believe it or not, it's very people who are in need of autism services. Yes, I agree, I agree.