We have recently been thinking about the auxiliary services that Speech & Language Pathologists (SLPs) may be providing when committed to providing culturally responsive care.
Many SLPs will serve clients who differ from them in terms of both culture and language background. The American Speech-Language-Hearing Association’s 2010 demographic statistics indicate that the racial and ethnic makeup of ASHA members (about 89% white, 4% Hispanic/Latino, and 7% members of a racial minority) differs from the racial and ethnic makeup of the U.S. population (about 56% white, 16% Hispanic/Latino, and 28% members of a racial minority), making cross-cultural match-ups between SLPs and clients inevitable. (See also: Kohnert, et al., 2003)
Our thoughts about working with a culturally and linguistically diverse (CLD) caseload of clients have been informed by a course that we took as part of our MA degree program at the University of Minnesota, Twin Cities. During this excellent course, we developed a greater understanding of both typical and atypical bilingual language acquisition, as well as theoretical knowledge of how language can exist as a system composed of one or more languages. We explored the empirical evidence that points to a conclusion that supporting all languages used by a client is the most appropriate way to facilitate his or her language learning. We also investigated the concept of culturally responsive care, which must be effective and considerate despite the challenges faced by cross-cultural differences in worldview.
Over the past few years, we have refined our understanding of what culturally responsive care encompasses in actual, clinical practice. Indeed, one of the most critical variables of culturally responsive care, is time. When doing both long-term and short-term planning, we now take into account the auxiliary services typical of culturally responsive care, in terms of time spent with family members, time spent in dual-language treatment activities, and time spent advocating for our client.
During time spent with family members:
- We use conversation and observation to create a working picture of this specific client, understanding that the picture, similar to the client, will be evolving over time.
- We consider how therapeutic suggestions may be understood in a different cultural framework (which may require reading about that culture and/or lived experience interacting within that cultural group and/or members of the group).
- We partner with family members who will likely be providing support of the language spoken at home. This requires explaining techniques in a detailed but non-technical way.
- We employ flexibility in what we understand to be ‘best,’ reminding ourselves that the individual’s family may have different priorities. Sometimes this means accepting the family’s way of teaching the client when it differs from our vision of ‘best practices.’ (See also: The Spirit Catches You and You Fall Down)
- We support the family as they attempt to navigate other therapy services, the health care system, social services, and the educational system, understanding that they may not have the benefit of cultural ‘insider knowledge’ about these systems.
- We exert the extra communicative effort required when speaking through an interpreter to maintain an authentic connection with the client and family members.
During time spent in treatment:
- We engage in English-language activities if the client is currently part of an English-speaking community
- We engage in activities that develop the other language(s) spoken by the client. This is done directly when we have sufficient skills in that language, and indirectly when our skills are not sufficient. Indirect treatment activities will be family-centered, perhaps with an interpreter. (See also: Kohnert, et al., 2005)
During time spent advocating:
- We ensure the translation of SLP-specific documents (e.g. plans of care, assessment reports)
- We help interpret related documents (e.g. from other therapists)
- We take a leading role in advocating to insurance companies or school administrators for the client’s need for speech & language services. This may include explaining the additional components when planning and delivering an appropriate intervention for a bilingual client.
- We partner with interpreters (who may also be cultural brokers) and provide detailed, non-technical background information that may allow them to convey information in a more meaningful way
Irrespective of the number of clients whose cultural and linguistic background differ from yours, the time required may seem daunting. We don’t intend for this information to be overwhelming, but rather to be useful in helping you substantiate a case for the time you need to provide culturally responsive care.
