University of Southern California
Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy
Redesigning Lives Globally
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Boundary Crossing

In 1997, Professors Mary Lawlor and Cheryl Mattingly began conducting a longitudinal study of health care trajectories in 30 African-American children with illnesses and/or disabilities, their families, and practitioners who serve them. In the study, cross-cultural health care encounters with families were examined and situated in broader temporal and developmental trajectories as well as sociocultural contexts including family, home, community, and institutional sociocultural worlds. The research aims were to identify, describe, and situate how families contribute to the production of culturally responsive care, and to reveal the strategies families and practitioners employ to establish commonality, bridge differences,
and effectively “partner up.”

Although an overwhelming body of literature documents health care disparities for ethnic minorities, there is a striking paucity of strategies to address this significant public health issue. Much research on cultural competence radically underestimates how much work families do to achieve culturally competent care. Longitudinal and learning aspects are under-described, as are the strengths and resources that families bring to healthcare encounters. Using an approach that is both event-centered and longitudinal, this study led to information about how discrete moments of healthcare encounters produce effects across both context and time. Findings of this study facilitate a reconsideration of dominant models of cultural competency and health literacy at multiple policy levels.

In total, the Boundary Crossing research program has been supported with over five million dollars in federal funding.