CSHA Diversity Issues Committee. Cultural and Linguistic Competence A Guide for the 21 st Century Clinician. CSHA Diversity Issues Committee. Co-Chairs Pamela Norton CCC-SLP, Ph.D., & Sandra Gaskell CCC-SLP, D-ABD Members
Pamela Norton CCC-SLP, Ph.D., & Sandra Gaskell CCC-SLP, D-ABD
Christine Maul CCC-SLP, Ph.D., Elisabeth Ward CCC-SLP, M.A., & Sofia Carias CCC-SLP, M.S.
Moderator: Betty Yu CCC-SLP, Ph.D.
Friday, March 28, 2014
San Francisco, CA
Introduction: The changing face of California (Sofia Carias) 10mins
What is the Diversity Committee: Purpose, Roles, & Participation (Sandra Gaskell) 10mins
ASHA documents on Multicultural Practices(Christine Maul) 25mins
Non-Biased Assessment Procedures: What’s new(Pam Norton & Sofia Carias) 30mins
Culturally Competent Clinical Skills: What Works (Elisabeth Ward) 25mins
Case Studies: Small Group Activity40mins
Gaining Support for Culturally Competent Practices (All) 15mins
Questions & Wrap up (Until the end)
Why are we here?
Dramatic population growth decade after decade
1970 – 20 million people
80% identified as white on census data
2010 – 40 million people. We doubled in 40 years!
Today, no race or ethnic group has a majority
Fastest growing groups are Asians & Latinos
In next decade, Latinos will be single largest population
Large international immigrant influx & higher birth rates
Projected for next 10-20 years: 400,000 people per year (size of Long Beach!)
2030 – 1 in 5 over age 65
Changes in Public Policy
Transportation, water, education, & healthcare
SLPs will need to keep up with growing demand for services to multicultural groups
Diversity of skills, interests, beliefs will challenge our own therapy practices
Purpose, Roles, and Participation
The mission of the Diversity Issues Committee is to assist CSHA members in increasing knowledge and awareness of issues related to cultural and linguistic diversity in speech-language pathology and audiology
On the Web
First Issue was in 2005
Available at every CSHA since then
Projects updated in articles
Special Interest information/ Resources
Cultural Competence Presentations: CSHA 2005, 2008, & 2014
Brislin, R. W. (1970). Back-translation for cross-culture research. Journal of Cross-Cultural Psychology, 1, 185–216.
Brislin, R. W. (1980). Translation and content analysis of oral and written materials. In H. C. Triandis & J. W. Berry (Eds.),
Handbook of cross-cultural psychology: Methodology. (pp. 89–102). Boston: Allyn and Bacon.
Observation & Interview
“In contrast to an impairment or a delay, a language difference is associated with systematic variation in vocabulary, grammar, or sound structures. Such variations is ‘used by a group of individuals [and] reflects and is determined by shared regional, social, or cultural and ethnic factors’ and is not considered a disorder”(Prelock et. al, 2008:136)
Prelock, P., Hutchins, T., Glascoe, F. (2008). Speech-Language Impairment:
How to Identify the Most Common and Least diagnosed disability of childhood.
Medscape Journal of Medicine.10(6): 136.
Cultural Competence in Professional Service Delivery
Providing competent services requires cultural competence
To be culturally competent, individuals should:
“In summary, culturally competent professionals must have knowledge, understanding of, and appreciation for cultural and linguistic factors that may influence service delivery from the perspective of the patient/client and his or her family as well as their own.”
Why should we be culturally competent?
With all due to respect to ASHA, I would add. . .
. . . BECAUSE IT’S THE
RIGHT THING TO DO!!!
ASHA has adapted a framework suggested by research conducted by Hofstede & Hofstede (2005) to describe cultural dimensions
While somewhat useful in organizing our thinking, this framework has had its critics, to say the least!
The framework may be of little use in attempting to understand individual human beings
Not mentioned in the ASHA (2011) documents
Proposed by Kalyanpur & Harry (1999) writing in the field of special education
We recognize the limitations of a framework such as that discovered by Hofstede & Hofstede (2009) in attempting to understand cultural differences at the level of the individual human being
We examine more thoroughly alternative models to “cultural competency”
We embrace a more holistic approach in educating SLP students regarding lifelong self-examination and development of appreciation of cultural variations
Defining English Language Learners
Do you have a Bias? We all do!
How do we reduce examiner
Sherman-Wade & Bader, 2013
• WHAT IS THE PURPOSE OF THE TEST?
• Who is requesting the evaluation?
• WHO ARE THE RESULTS FOR?
• What will the results be used for?
• WHO IS PAYING FOR THE EVALUATION?
• Legal guidelines?
Racial and cultural biases in assessment materials = disproportionate representation of minority children in Special Ed. – HOW?
Activities of daily living, vocabulary exposure, idioms, socialization practices, etc.
Examples from commonly used tests
What does IDEA 2004 say?
IDEA 2004 says…
VALIDITY - Does the test actually test what it is meant to test?
RELIABILITY - Quality of test scores. Degree of inaccuracy of measurement due to errors. Stability of scores. Consistency with which a test measures a given behavior.
CONFIDENCE INTERVAL - This analysis assumes the test is valid, reliable, and has no significant cultural or linguistic biases
Sherman-Wade & Bader, 2013
What are they?
What does it include?
Crowley 2009, 2011
Normal Second Language Acquisition – Simultaneous? Sequential?
Factors influencing bilingual development – Interlanguage, Silent period, Language loss, Exposure to dialects, Exposure to code-switching
Know the client’s cultural views on Health, Disability, Religion, etc.
Again – know your test!
Sherman-Wade & Bader, 2013
• Give instructions in the first language and in English
• Rephrase confusing instructions
• Give additional examples and demonstrations
• Provide extra time for the student to answer
• Repeat items when necessary
• Check the Administrator’s Guide…
This is the basis for all we do! Eligibility, Tx goals, frequency, dismissal!
Be descriptive – do not rely solely on the numbers
WHY DOES ANY OF THIS MATTER??!!
Dialectal Variations & Bias
“no diialectal variety of English is a disorder or pathological form of speech or language.”
“The professional must recognize that differences do not imply deficiencies or disorders..”
Type 1 and Type II errors (Peters-Johnson, 1986)
80-90% of African American students speak African American English to some degree varying by environment
CASL, CELF-5, EVT, OWLS, PPVT, ROWPVT, TAPS-3, TELD: construct validity by correlating with IQ tests (Kaufman, WISC) or with other tests that correlate with IQ
CELF - Expert bias panel and alternative rubrics but inconsistent in application
ARTICULATION TESTS are strongly MAE-based
*All demonstrate linguistic bias
- averaged normative population samples are not valid
- valid tests should demonstrate population subgroup
means and standard deviations
-- all ethnic subgroups should perform “similarly”
TWF-2, TAWF, TWFD, but not CTOPP or TOPS-3
Diagnostic Evaluation of Language Variation – Screening Test (DELV-ST)
Diagnostic Evaluation of Language Variation - Norm-Referenced (DELV-NR)
“When standardized tests are…invalid, expected language performance level shall be determined by alternative means”. (CDE, 1989)
- not discriminatory
- no IQ tests or tests CORRELATED with IQ tests
- result in inclusive written reports
How will tests vary from standard conditions
environments – agreement?
Sampling and analysis – deep vs. surface structure
- understood by familiar family listener?
- understood by unfamiliar, community listener?
Language – naturalistic – 50 utterances
Communicative competence, complexity, pragmatics
Are you aware and mindful of your own cultural beliefs, values, and behaviors?
How do your own beliefs affect your interactions with your patients and clients?
Do you refer a client to a colleague if you cannot manage your biases?
Do you accept and welcome cultural differences?
Are you tolerant of those who look, speak, act differently from you?
Do we understand the dynamics of differences when making decisions?
If we believe in one treatment but the client does not, do we fit the client into what we think is best or respect their decisions?
Do we interact with culturally diverse people and then integrate the lessons that we learn?
Are we aware of our limitations in this area?
Do we know when to seek additional knowledge, understanding, and sensitivity?
How do we know what we do not know?
Do we assign motivations to people based on our own culture?
Do we stereotype one culture of people to be “all the same.” (they do this or that)
Can we adapt to the needs and preferences of our clients and patients that have a difference in values, beliefs, and attitudes?
Exploring the meaning of Illness
What do you think has caused your or your child’s problem? What do you call it?
Why do you think it started when it did?
How does it affect your or your family’s life?
How severe is it? What worries you the most?
What kind of treatment do you think would work?
The Patient’s Agenda
How can I be most helpful to you?
What is most important for you?
Have you seen anyone else about this problem?
Have you used non-medical remedies or treatment for your problem?
Who advises you about your health?
NIH, Ped Review, 2009, February 30 (2)57-64
What qualities/ knowledge do you need to be qualified to work with clients from culturally and linguistically diverse backgrounds?