Speech-Language Pathology & Audiology

Practice Guidelines

Speech-Language Pathologists and Audiologists in a Pluralistic Society

We live and work in a culturally and linguistically diverse state. Cultural diversity can result from many different factors and influences including ethnicity, religious beliefs, sexual orientation, socioeconomic levels, regionalisms, age-based peer groups, educational background and mental/physical disability. This cultural diversity brings linguistic diversity, including an increase in the number of people who are English Language Learners, in addition to those who speak non-mainstream dialects of English.

Every clinician has a culture, as does every individual we assess and treat. Given the myriad factors that shape one's culture and linguistic background, it is not possible to match clinician to individuals based upon their cultural and linguistic influences. Yet, professionals must be knowledgeable about how these cultural and linguistic differences contribute to the effectiveness of our services. This alert provides a broad overview of issues that will support higher quality of services to the public.

Language Proficiency. Speech-Language Pathologists and Audiologists must determine whether they have sufficient competency in an individual's language(s)/dialect(s) to assess or treat that individual.

• Here competency includes sufficient proficiency in the language(s)/dialect(s) spoken by the individual, and sufficient knowledge base in the general linguistic and sociolinguistic issues to perform the evaluation.
• If an interpreter is used, the clinician must know how to use an interpreter's services appropriately.

Cultural Competence and Sensitivity. This includes knowledge and abilities related to cultural differences that affect the identification, assessment, treatment, and management of communication disorders, including:

• 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 in providing services to an individual from a particular 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.

Assessment. This includes knowledge and ability sufficient to distinguish typical from disordered communication skills and includes but is not limited to:

• Current research and best practices in the identification/assessment of communication disorders.
• Sociolinguistic and cultural influences including: 1) Impact of social and political power and prestige on language choice and use; and 2) Impact of topic, participant, setting, and function on language use/production; and 3) Language socialization patterns that affect language use, including narrative structures; importance of labeling; use of metaphors, attitudes toward appropriateness of child-adult and child-child communications, discourse norms, and ways of gathering information.
• Language and linguistics including: 1)language development in simultaneous and sequential bilinguals; 2) difference between an accent and a dialect, and a language and a dialect; and 3) typical development in an individual's language(s)/dialect(s), including how to determine and identify typical development based upon the norms of the individual's speech community or communication environment.
• Assessment materials/tests/tools including: 1) appropriate use of available assessment tools so that those that fail to meet standards be used as informal probes, with no accompanying scores; 2) appropriate use of alternative approaches to assessment; and 3) awareness of cultural and linguistic biases in testing materials.
• Making the differential diagnosis between a true communication disorder a cultural or linguistic difference that might appear as a disorder to the untrained clinician.

Treatment/Management Issues. This includes but is not limited to knowledge and ability related to:

• 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.
• When considering language of intervention, consideration of individual and his/her parent/caregiver's desire and need for fluency in the native language and/or English.
• Standards of an individual's speech community or communication environment in determining discharge/dismissal criteria for clients.