Published on May 4th, 20180
2018 Isabel Richard Student Paper Award Winner (Below Doctoral)
Considering Cultural and Linguistic Diversity for Client Centered Care
By Eleanor Campbell recipient of the 2018 Isabel Richard Student Paper Award (Below Doctoral Category)
Please note that this paper appears in its original form, in the language in which it was submitted; we have not edited it for style or grammar.
We live in a society that is becoming increasingly diverse (Verdon, Blake, Hopf, Phạm, & McLeod, 2016). As health professionals, specifically speech-language pathologists (SLPs), we provide a model of care that is based on the client—also known as patient or client centred care (Caty, Kinsella, & Doyle, 2016). In order to provide client centered care, it is critical to consider all aspects of a client’s life including their cultural and linguistic background. To understand culture, a model has been created that resembles an iceberg (Communicaid, n.d.). The interpretation of this model is that there are visible parts of a culture, such as how a person dresses, and what language they use (the tip of the iceberg), but there are also different parts of a culture that you cannot see, such as beliefs, customs and values (the submerged portion) (Communicaid, n.d.). These are all parts of a client’s culture, whether or not we can see them, and they influence the service we provide because we need to accommodate the cultural and linguistic needs of the clients. Specifically, the way we provide services will be influenced by our client’s linguistic and cultural backgrounds, through the type and nature of the resources we use/access for assessment and treatment, and through how we interact with the clients in general.
The first way that a client’s cultural and linguistic background will influence the services an SLP provides, is through the resources that the clinician will use when treating each client. Each client brings their own values, beliefs and customs as well as linguistic profile to the therapy room. It is important to have the resources to be able to assess and treat these clients in a way that recognizes their languages and their culture. For example, although many standardized speech and language tests are in developed in English, there are translated versions of tests, and tests that exist in languages that the client might use (Bader & Simon, n.d.). The SLP will need to do research into the resources available beforehand. SLPs might also need to focus more on dynamic assessments in the native language, for linguistically diverse clients (Bader & Simon, n.d.) When working with clients from differing linguistic and cultural backgrounds, if the client does come from a different linguistic background, it also might mean providing an interpreter service, so that the client and their family are able to properly express their concerns and ask any questions (American Speech-Language-Hearing Association, 2016). The interpreter might also be involved in explaining what assessments will be done, and working with the SLP on doing dynamic assessments in the native language as discussed above, (Bader & Simon, n.d.) and training the family on treatments (American Speech-Language-Hearing Association, 2016). These are all influencing components of the service that the SLP provides. The linguistic and cultural background of the client would also influence the nature of treatments that the SLP provides. You want to teach the clients skills that are going to allow them to be competent out in their cultural community. It will be important to discuss with the client/family what goals they think are necessary to work on, and what would be relevant for their cultural background. This might mean teaching topics such as social skills in a different way from what the SLP is used to, because a certain culture might have different social interaction styles. The client’s linguistic and cultural background can also affect how you provide rewards and feedback to the clients, for example in some cultures, high fives and thumbs ups can have less polite/offensive meanings (Shulman & Capone Singleton, 2010). Therefore, it is important for the SLP to establish what is culturally acceptable to do in terms of reinforcements, with the client at the beginning of therapy.
The therapy materials that an SLP uses are also influenced by a client’s culture and linguistic background, as you want to cater your therapy stimuli to what the client uses in their daily life, which might be different based on their culture. For example, there was a case of children in Ghana who were learning to use augmentative and alternative communication (AAC) pictures boards, to carry out daily tasks such as go to the market, which is a common task for Ghanaian children (Crowley & Baigorri, 2011). SLPs working with the children first made pictures that did not reflect common cultural and social items that Ghanaian children used, and so the AAC boards were not used. Upon a second trip to Ghana, the SLPs worked with the children and the community to ensure that the communication boards would reflect local items that children might need from the market. Children were able to use the AAC picture boards to communicate at the market, as the pictures considered their culture and practices (Crowley & Baigorri, 2011). This is an example of how SLP materials will be influenced by a client’s cultural and linguistic background. SLPs need modify and create new materials based on the clients they see, in order to provide the best service possible. Not every client will have exposure to what we would consider common stimuli such as a bike or a skateboard, depending on their cultural background. We also have to consider linguistic background when providing stimuli, we might need to work with a translator or interpreter to translate some of the words that are commonly used stimuli in the client’s life, in order to understand what stimuli to use with them.
Cultural and linguistic diversity also influence how clinicians interact with clients in general. It is important to do research into a client’s culture and linguistic background in order to make sure you are providing a service they are comfortable with. As health professionals, SLPs must provide the most client centered care possible, and so we need to be culturally sensitive when interacting with clients. Although it is easy to overlook, even small interactions with clients will be influenced by their backgrounds, as social interactions are different in different cultures. For example, cultural and linguistic backgrounds influence how you greet and talk to the family, as in some cultures, you greet and interact with people in a certain way (Shulman & Capone Singleton, 2010). This could be as simple as knowing that some people do not shake hands when greeting, or knowing that some cultures value dressing a certain way, and so it might be helpful to dress in a way that the client is comfortable with. In this sense, your services as an SLP are influenced by the clients you see, because of their linguistic and cultural background, you might interact with them differently in order to establish and keep rapport, and make the client feel as comfortable as possible. How we interact with clients especially when their linguistic background is different from the SLPs, is influenced by the client’s background, because even when using interpreter services to help the client (as discussed above), it is important to consider that you are still interacting with the client, you are teaching and counselling the client and their family, rather than just talking to the interpreter.
When providing services to clients from different cultural and linguistic backgrounds, it is also important to consider that different cultures have differing perspectives of healthcare, and so the way we interact with the clients needs to take this into account. For example, in Ugandan culture, there is often suspicion of therapies that don’t involve physical medicine (McAllister & Pickering, 2000), and in Belize, some disabilities are seen to be the result of family member’s sins (Jaramillo, 2016). Therefore, we need to ensure that we are providing clear explanations to families about therapies and evidence for their use. The cultural perspective of disabilities being a result of sin, could also mean that the SLP would need to talk to the clients and families in a way that respects their beliefs, but shows that they are not to blame for disabilities. Another example of how interactions will be influenced by culture and linguistic background is that in South Africa, stuttering is seen as the result of exposing a baby to rain in their first 2 months (Weddington, 2002). An SLP would need to interact with families to show respect for their beliefs but also provide evidence for other causes of stuttering and communication disorders in general, in a respectful way.
Alluding back to the cultural iceberg model, it is important that SLPs consider the whole cultural iceberg when providing services for clients and their families. Our use and access to/of resources and the types of assessment and treatments we provide as well as the way we interact with clients in general are all examples of ways in which services are influenced by cultural and linguistic backgrounds. In any case with a client, we do our best to know everything about the client in order to treat them in the best way possible, and culture and language are a part of clients’ lives. It is important for SLPs to research and constantly obtain knowledge about different languages and cultures, in order to provide proper services.
American Speech-Language-Hearing Association. (2016). Collaborating with interpreters. Retrieved from http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589935334§ion=Key_Issues
Bader, S., & Simon, S. (n.d.). Bilingual Assessment for Monolingual SLPs and the BID Process.
Caty, M.-È., Kinsella, E. A., & Doyle, P. C. (2016). Reflective practice in speech-language pathology: Relevance for practice and education. Canadian Journal of Speech-Language Pathology and Audiology, 40(1), 81–91.
Communicaid. (n.d.). The Iceberg Model of Culture. Retrieved from https://www.communicaid.com/cross-cultural-training/blog/the-iceberg-model-of-culture/
Crowley, C., & Baigorri, M. (2011). Effective approaches to international work: Substance and sustainability for speech-language pathology student groups. Perspectives on Global Issues in Communication …, 27–35. Retrieved from http://div17perspectives.asha.org/content/1/1/27.short
Jaramillo, M. E. (2016). Global Speech-Language Health : Belize Country Profile : Belize, 5(October 2015), 45–55.
McAllister, L., & Pickering, M. (2000). A Conceptual Framework for Linking and Guiding Domestic Cross-Cultural and International Practice in Speech-Language Pathology. Advances in Speech-Language Pathology, 2(2), 93–106. http://doi.org/doi:10.3109/14417040008996794
Shulman, B. B., & Capone Singleton, N. (2010). Language Development: Foundations, Processes, and Clinical Applications. Jones & Bartlett Publishers.
Verdon, S., Blake, H. L., Hopf, S. C., Phạm, B., & McLeod, S. (2016). Cultural and linguistic diversity in speech-language pathology. International Journal of Speech-Language Pathology, 18(2), 109–110. http://doi.org/10.3109/17549507.2015.1122838
Weddington, G. (2002). Speech-language pathology / audiology : Service delivery in rural and isolated regions of South A. Folia Phoniatrica et Logopaedica, 54, 100–102.
Eleanor Campbell grew up in Markham, ON and is a third year master’s degree student in the speech-language pathology program at Dalhousie University. Eleanor completed her undergraduate degree in linguistics and psychology at the University of Ottawa in 2015. She has volunteered as an undergraduate research assistant in the Centre for Child Language Research Lab at the University of Ottawa, helping with research on child language development.
Eleanor has spent time volunteering with adults with aphasia, as well as working with children as a camp counselor and as a gymnastics coach. These experiences have helped Eleanor develop and continue her passion for working with children, adolescents and adults with and without disabilities.
Eleanor has also been involved with Dalhousie Toastmasters — a public speaking and leadership club — as the club’s treasurer. This experience provided the chance to improve her public speaking skills, specifically spreading awareness about communication disorders and speech-language pathology. After graduating, Eleanor is interested in working with children with Down syndrome and apraxia of speech, as well as working with children and adults with brain injuries.