Disclaimer: Law, rules and regulations, not Guidelines, specify the requirements for practice and violating them constitutes professional misconduct. Not adhering to this Guideline may be interpreted as professional misconduct only if the conduct also violates pertinent law, rules and regulations.
Culture and Diversity in Training and Practice
Every person deserves to receive professional services in a manner that is sensitive to their values and personal identity. Speech-Language Pathologists and Audiologists must be particularly attuned to linguistic and communication differences. These guidelines offer a broad overview of approaches to support cultural competency in an effort to provide the highest quality services possible.
Speech-Language Pathologists and Audiologists must determine if they have sufficient competency in an individual’s language or dialect and sufficient knowledge of the general linguistic and sociolinguistic issues of the individual. If an interpreter is needed, the clinician must know how to use an interpreter’s services appropriately.
Clinicians need to be able to distinguish typical from disordered communication skills. This begins with ensuring effective communication between the clinician and the patient/family member/caregiver. They should therefore consider and review:
- Current research and best practices in the identification/assessment of communication disorders.
- Cultural effects on self-reporting.
- Cultural perceptions of physical abnormalities/pathologies.
- Sociolinguistic and cultural influences including:
- Impact of social and political power and prestige on language choice and use;
- Impact of patient’s use of a non-native language on articulation, word choice; and
- Impact of topic, participant, setting, and function on language use/production.
- Language socialization patterns that affect language use, including narrative structures; labeling; metaphors; attitudes toward appropriateness of child-adult and child-child communications; discourse norms; and ways of gathering information.
Clinicians should consider:
- Current research and best practices in the treatment/management of communication disorders/delays, including various delivery models and options for intervention.
- Attitudes, values, and beliefs toward non-oral approaches to communication, such as augmentative/alternative communication, manually coded systems of communication, and assistive listening devices when those approaches are incorporated into treatment.
- A patient’s desire and need for fluency in their native language and/or English when determining the language of intervention.
- Recognition of the standards of an individual's speech community or communication environment in determining discharge/dismissal criteria for patients.
When working with patients and their caregivers, clinicians should communicate knowledge and abilities related to the cultural differences that affect the identification, assessment, treatment, and management of communication disorders, including but not limited to:
- Respect for an individual's race, ethnic background, lifestyle, physical/mental ability, religious beliefs/practices, and heritage.
- Understanding of how an individual's traditions, customs, values, and beliefs may impact the effectiveness of services.
- Recognition of the clinician's own limitations in education/training when providing services to an individual from another cultural and/or linguistic community.
- Appropriate communications with individuals, parents or caregivers, and significant others, so that values imparted in the counseling are consistent with that of the individual.
When providing experiential supervision to a clinical fellow, both parties should engage in self-awareness and self-reflection. Supervisors should understand the power dynamic inherent in this dyad and model transparency in interactions with clinical fellows. The goal is to promote open communication and facilitate an atmosphere of belonging. Be ready to learn and grow from the clinical fellows as they are learning and growing from you. In the end, it is the welfare of the patient that is critical for both parties to understand.
Academic programs are encouraged to include instruction in:
- Language development in simultaneous and sequential bilinguals;
- Differences between an accent, a dialect, and a language;
- Techniques to identify typical development based on norms for the individual’s language or communication environment;
- Introduction to appropriate use of available assessment tools;
- Appropriate use of alternative approaches to assessment;
- Awareness of cultural and linguistic biases in testing materials; and
- Recognition that differential diagnosis between true communication disorders and cultural/linguistic differences may appear synonymous to an untrained clinician.