Fostering and assessing students’ intercultural competence Claire Penn and Jackie GuendouziCAPCSD 2012
Outline • Diversity and what it means • Introductions • Two case studies • Some orienting theories and terminology • Some research findings • Suggestions for clinical practice and training
Our main claim • Current methods for training SLP/A students about cultural diversity are inadequate • Our professions have a critical role in facilitating intercultural communication
Number of languages considered indigenous to each country that are still spoken there
Global public health spending www.worldmapper.org
First things first • “Who’s your mob?” • “What’s your landscape?”
CP :Who am I • Born on the equator • Schooled in East Africa, England and South Africa • University in South Africa and England • Worked in South Africa ,US, Europe Australia and Saudi Arabia • I now have US family
My “cultural lens” Merging of paths: clinician/researcher/educator/social activist Fields of interest: aphasia, TBI, health communication, bilingualism, ethics Combining lines of evidence, developing contextually relevant frameworks A cultural approach to SLP demands new methods of research, assessment and intervention and training
Potential barriers and their origin (Chick,1995) Historical factors Ideology of separatism Segregation Discrimination Social barriers and power differential Stereotypes Ignorance of culture- specific communication conventions of other groups Misinterpretation of motive and misevaluation of abilities Communication failure
Some challenges of my workplace Bilingualism/multilingualism is the norm Different cultural views: etiologies, illness management, help-seeking behaviors Factors determining language use are extremely complex and linked to issues of context, socio political history and social and gender identity Unique burden of disease and expected outcomes (AIDS) Huge disparities remain in health systems, access and attitudes
Case Study 1 A stroke patient has been admitted to the hospital as a result of poisoning His family have been administering rat poison as they have been told that this is the cure for his problems He has been stabilized and requires assessment and rehabilitation
Case study 2 A five-year-old child is brought to the clinic by his mother for an assessment and hearing test. The mother speaks Xhosa and only a little English. She has a Grade 7 education, is currently unemployed and is looking after 3 other children. They live in an impoverished township.
Some questions for the SLP Why don’t stroke patients come to hospital/come back to hospital? What are the perceived causes of stroke in the community? How can I understand and be understood ? How can we be effective in rehabilitation given parallel paths of explanation and treatment which exist? What’s it like to be a person living with a communication disability in another community?
Main challenge How can I as a clinician working in a culturally diverse context make the environment for my clients culturally safe? How can I teach my students the skills and values that are needed to do that ?
JG:Who am I 7 years - England 10 years - Australia 3 years – England 18 months– Australia 4 years – England 9 years – Algeria 13 years – Wales 12 years - USA Who am I ?? Whose my mob?? Where’s my landscape??
How do I define myself? Do I define myself by ethnicity /race, physical appearance Ethnic background forms??
Asha’s knowledge standards: bilingualism, cultural and linguistic diversity…. So can we teach these things in the classroom Let’s have a course Differences & Disorders
One approach to teaching cultural diversity • Designed a course – what do you include with only one semester? • Selected a text book • Lots of volunteers to teach - cultural tourists So did it work?? What has been the results??
Evidence from exam questions: I must be aware that if my clients are Asian that the wife will be timid Women from the Middle-eastern countries will not make eye contact People from the middle-east are likely to think a speech disorder is because they are being punished When doing a prescreen or assessment on infants or children from different cultures I would find the list of developmental milestones for that culture
We clearly need: • Some new vocabulary • Some new methods • Some new skills
Learning outcomes Explore culturally relevant methods of assessment and therapy Understand new terminology and problem solving approaches Reconcile cultural models with traditional SLP models Potential central role of our professions in broader issues of global health
Some terminology issues Transcultural Inter-cultural Cultural safety Culture shock Culture Cultural desire Cross cultural Cultural competence Cultural awareness Cultural incompetence
Culture • An integrated pattern of learned beliefs and behaviors that can be shared and include thoughts ,styles of communicating , ways of interacting , roles and relationships, values, practices and customs (Betancourt)
Cultural safety (Ramsden) “When a client feels that their cultural, social and human values are respected and that an organization providing services to that client reorients its institutional practice values resource and governance arrangements accordingly” (Phillips) “An environment which is safe for people; where there is no assault, challenges or denial of their identity of who they are and what they need. It is about shared respect, shared meaning, shared knowledge and experience of learning together and truly listening” (Eckermann et al)
‘cultural tourism’: “…the nurse stood outside, secure in the culture of nursing, and surveyed the patient from the viewpoint of their interesting exoticism” (Ramsden, 2002) comparison with ‘normal’ ‘unsafe taxonomies’ (Iwama, 2007)
Unsafe taxonomies “Canadian Aboriginals have been routinely identified with or described as having high levels of alcoholism, drug dependency, glue and petrol sniffing, criminals, diabetes, malnutrition, etc; and not much effort or attention provided for a profound examination of context of experience and how the devastating disruption of a way of life and way of knowing passed down from the ancients may have contributed to these horrific health outcomes.” (Iwama, 2007)
‘culturally unsafe practice’ Pt HCP CULTURAL LENS Hear my story in my own words Let us change your story Let us compare you to our ‘normal’ We are the experts “Any actions that diminish, demean or disempower the cultural identity and well being of an individual” (Nursing Council of New Zealand ) (Iwama, 2009)
MACRO CONTEXT DISEASE CONTEXT ORGANISATIONAL CONTEXT INTERPERSONAL CONTEXT PREDISPOSING INFLUENCES COGNITIVE – AFFECTIVE MEDIATORS Health Professional Patient MEDIA CONTEXT HISTORICAL CONTEXT Caregiver Interpreter VERBAL & NON-VERBAL BEHAVIOURS CULTURAL ATTUNEMENT CONCORDANCE CULTURAL - SOCIOECONOMIC CONTEXT POLITICAL-LEGAL CONTEXT Watermeyer (2008) - Ecological model of potential influences on pharmacist-patient communication(after Street, 2003; Street et al., 2007; and Chick, 1995)
Cultural incompetence A healthy goal? (Swartz 2008)
Students have misconceptions which arise from their prior backgrounds, lack of exposure not only to cultures but to knowledge areas at stake ……….Composite Stereotypes
Some knowledge areas at stake Geography – national boundaries, how we identify what group a person belongs to? History – colonization and the influence of other cultures Languages – and what has influenced a language e.g. Maghreb – Berber, Arabic, French & marginally Turkish, Religions & beliefs systems e.g. influence of Shaman in health matters etc Social differences – gender, age etc within a particular culture
Example 2. Features of Asian Languages Japanese – syllabic Chinese – tone Korean – an isolate (probably derived from Mongol roots ??)
Macro versus Micro cultures In your own social network • Teenagers • Older people • Football fans • NPR / TV types • Anime fans • Jocks • Nerds • Preppy etc etc • Teachers • Parent • Public state school versus private school Professional cultures • Culture of the deaf • Culture of dementia • Parents of child with ASD • Child language SLPs • Adult acquired SLPs • Audiologists vs SLPS • Neurologists • Doctors (MDs) • Nursing • OT • PT • Special ed teachers
What do our students think? Student Project (Southeastern Louisiana University) Anna Pate Courtney Montreuil Hannah Smith Students perceptions of culture and their learning experiences in college