Table 2.

Case Example: “Cesar.”

Patient and family sociodemographic background

Seven-year-old bilingual Latino male, diagnosed with high-risk ALL at age two years.

Treated as per CCG 1961 protocol with intrathecal chemotherapy agents.

Almost two years off treatment at the time of his first survivorship clinic visit.

Parents were Mexican immigrants (5 years in the United States) with reported middle school education and monolingual Spanish speakers living 100 miles from cancer center.

Father worked in agriculture, and mother did not work outside of the home.

Patient was attending general education in the first grade after retention in kindergarten.

He was recommended for retention again in the first grade and had never been evaluated.

Academic problems attributed by parents and school to behavioral difficulties.

Presenting symptoms

Concerns manifested at home and school included difficulties with attention, effort, comprehension, completing homework, following directions, aggression toward younger brother, and frequent school absences due to somatic complaints.

Patient presented as anxious, ashamed due to not being able to read, and aware of his difficulties.

Cultural considerations for services

Family endorsed common Latino values including personalismo, respeto, simpatía, and familismo.

Services provided in Spanish, assistance given for completing measures (literacy concerns), consideration given for parental lack of experience with the U.S. educational system, and language barriers.

Awareness that standardized testing is affected by poor language development in both languages.

Parental intervention completed verbally with teaching back to ensure understanding.

Provision of psychoeducation about cognitive profile affecting academics, behavioral, and emotional functioning.

Coached parents in U.S. school services, educational rights, and process of requesting services.

Taught strategies to support homework and learning, manage acting out behaviors, and promote self-efficacy.

Outcomes

Results and recommendations were incorporated into patient’s survivorship care plan.

Results indicated a profile of strengths and weaknesses, including average verbal reasoning, strong sustained attention, and good effort and cooperation.

English and Spanish academic language skills were significantly and equally insufficient for demands of grade.

Recommended promotion to second grade and Individualized Educational Program (IEP).

Parents followed-up with recommendations, IEP was put in place with resource specialist services and patient was promoted to second grade.

Behaviors were reported to be improved and absenteeism reduced.

At 1-year follow up, academics were reported to be improving, school services remained in place, and improved behaviors at home continued.

Abbreviations: ALL, acute lymphoblastic leukemia; CCG, Children’s Cancer Group.