Published on May 12th, 20162
The Benefits and Challenges of Multilingual Communication Services
By Elaine Kwok, Winner of the 2016 Isabel Richard Student Paper Award (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.
In preparation for our clinical placements, the clinical supervisor of our speech-language pathology program asked our first-year class, “Who is confident in providing bilingual services in English and French?” No one raised her hand. Interestingly, many hands shot up in response to the prior question, “Who is fluent in a second language?” From French to Spanish to Punjabi to Cantonese, our linguistically diverse class of thirty-six students should be well-positioned to serve the communication needs of the twelve million bilingual Canadians (Statistics Canada, 2011). And yet, why are we hesitant to provide bilingual services? What challenges await communication professionals hoping to provide multilingual services to clients experiencing communication difficulties and what benefits will these services generate? I believe that better understanding the population we serve and recognizing our strengths and weaknesses will allow us to identify and overcome the hurdles precluding the implementation of multilingual service.
With two official languages and a growing population whose native language is neither English nor French, Canada is a linguistically diverse country. The 2011 National Household Survey reported that 36.6% of Canadians speak more than one language, the majority of whom speak a language other than English or French (Statistics Canada, 2011). As such, many industries have already begun providing services in multiple languages. Banks for example now offer telephone banking and counter-services in a variety of languages. Communication health professionals too have recognized the diverse communication needs of the population. For instance, the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA) currently has postings for multiple bilingual speech-language pathologist positions in Ontario. This is with good reason as there are many benefits of providing communication health services in more than one language.
Perhaps the most apparent benefit of offering multilingual communication health services is the facilitation of a positive client-clinician relationship. With multilingual service providers, individuals with communication difficulties can seek therapy in the language they feel most comfortable expressing themselves. Being able to articulate one’s communication needs and therapy goals in his or her native language fosters a more intimate atmosphere that is conducive to a positive client-clinician relationship. Some studies have examined the impact of bilingual health services on bilingual communities. For example, a systematic literature review found that access to bilingual health service providers and professional interpreters yielded optimal patient communication, satisfaction and outcomes (Flores, 2005). These findings suggest that bilingual services may not only improve access to care, but quality of care as well. Indeed, there is mounting evidence supporting the provision of bilingual services for individuals with communication impairments. For example, several studies on bilingual children with language delay compared the effectiveness of monolingual therapy to bilingual therapy. Across studies, it has been consistently demonstrated that bilingual therapy results in better language outcomes, including vocabulary performance (J. A. Perozzi, 1985; Thordardottir, 1997) and use of prepositions and pronouns (J. Perozzi & Sanchez, 1992).
Conversely, providing bilingual clients with therapy in only one language has been demonstrated to bring suboptimal outcomes. In one study, a majority of children with language impairment who received English-only therapy were more likely to lose their ability to speak their native language. This resulted in serious developmental consequences in some cases, including loss of parental authority and respect (L Wong Fillmore, 1991; Lily Wong Fillmore, 1991). Since family likely plays a major role in the client’s life and communication needs, particularly for pediatric clients, fostering one’s native language ability in addition to a second language is of utmost importance. Communication professionals could promote healthy interactions with one’s family by encouraging bilingual language development. As a second-language learner of English, I can attest to the importance of maintaining one’s native language and cultural identity, as social and family support has been crucial in many pursuits throughout my life, including my language learning journey.
Providing multilingual communication services is beneficial not only to the publc or clients seeking services but to communication health professionals as well. For instance, being capable of providing services in multiple languages would increase the number of job opportunities a professional could seek. Alternatively, if one operates a private practice, competency in multiple languages could increase the number of potential clients one could serve. A multilingual clinician would also be able to seek employment across a larger geographical area. For example, an English-French bilingual speech-language pathologist would be better qualified than an English monolingual peer for positions in Quebec and Ottawa. Additionally, as previously mentioned, clinicians who already serve bilingual clients will be able to interact with them in their native language, improving their relationship with their client. Therefore, the provision of multilingual communication health services is beneficial to the community and profession alike.
With all of the potential benefits of providing multilingual communication services, what roadblocks lie ahead? There are several challenges that need to be addressed before effective multilingual communication services can become widespread.
Currently, all speech-language pathology and audiology programs in Canada are offered in either English or French; therefore clinicians who wish to provide services in other languages will need additional training. For communication health professions in particular, simply being fluent in a language is often not sufficient to provide adequate services in that language. Personally, despite being a native Chinese speaker, I still feel the need of receiving more formal training in order to delivery therapy in Chinese. In Cantonese Chinese, for example, even native speakers like myself are not cognizant of the phonology, prosody and syntax of the language. These knowledge are required to are integral to deliver successful therapy such as language or articulation. While it is understandably not feasible to develop two-year clinical programs for the gamut of languages spoken in Canada, it is perhaps possible that organizations such as Speech-Language & Audiology Canada (SAC) and/or OSLA offer training in a variety of languages for professionals interested in providing multilingual services.
There are a couple of challenges in addition to clinician-training that are inherent in providing multilingual communication services. As health professionals, we pride ourselves in providing evidence-base practice, hence, part of the challenge of providing bilingual services is our current lack of knowledge and research concerning bilingual language impairments. Identifying language and communication impairments in multilingual individuals, for example, has been shown to be unreliable (Bedore & Peña, 2008). This is in part due to the heterogeneous nature of language acquisition in multilingual individuals. Some learn multiple languages concomitantly, while others learn sequentially. The duration and context of language exposure also varies. Therefore different bilingual clients are often at different stages of language development. This heterogeneity makes language assessment challenging, and has often lead to the over-identification or under-identification of language impairments in multilingual children (Bedore & Peña, 2008). To improve the sensitivity of assessments, new measures will have to be developed to assess the communication abilities of bilingual children. Audiologists, as well, are recognizing the challenges bilingualism brings to clinical assessments and considerations in hearing aid fitting. In one study, late bilingual speakers were found to perform more poorly than early bilingual speakers and monolingual individuals in tasks requiring speech recognition in a noisy environment (Weiss & Dempsey, 2008). The authors note that individual differences in language exposure should be taken into account while interpreting bilingual client’s hearing test results.
In addition to insufficient empirical evidence on assessment sensitivity, therapy available to clients seeking bilingual services are also in their infant stages of research and development. Although bilingual therapy has been demonstrated to be effective across several domains of language (J. A. Perozzi, 1985; J. Perozzi & Sanchez, 1992; Thordardottir, 1997), there is still debate on the most effective method of administering bilingual treatment to bilingual clients. Longitudinal studies have recently been published examining post-treatment outcomes of bilingual language therapy. One study examined the effectiveness of several treatment modalities for bilingual children with language impairment and found positive changes in English language skills three months after bilingual treatment (Pham, Ebert, & Kohnert, 2015).
Cultural factors also need to be considered when providing multilingual services to communities of diverse origins. One study found that different cultures have different attitudes toward speech disorders like disfluency, hearing impairments and misarticulations (Bebout & Arthur, 1992). For instance, individuals born in certain Asian regions, including: Mainland China, Hong Kong and Southeast Asia were more likely than North American-born study participants to view individuals with disordered speech as “emotionally disturbed”, and that these individuals could improve their speech by exerting more effort. Bebout & Arthur speculate that this may result in some individuals with speech disorders being regarded as abnormal by their community, which may hinder therapy progress or even willingness to access therapy. However, it is important to note that attitudes vary within cultures and culture stereotyping must be avoided. This data does highlight the fact that different attitudes regarding communication difficulties exist however. Conceptual differences of the origins of communication disorders and the effectiveness of treatments should thus be addressed with care when working with clients from different cultures. Additionally, it may be necessary to promote the nature of communication therapy and treatment to ensure the community has an accurate picture of what can be accomplished through therapy. Finally, the influence of cultural exposure was highlighted in a survey of speech-language pathologists who provide bilingual services. Interestingly, bilingual speech-language pathologists who learned a second language in a cultural rather than academic context reported more personal efficacy in delivering bilingual services (Kritikos, 2003).Therefore while clinicians may be proficient in a second language, it may also important to immerse ourselves in the culture surrounding the language in order to provide better bilingual services.
There are many benefits of providing multilingual communication services for both the community and professionals. However, there are still underlying challenges that need to be addressed. Professional development and understanding the communities we wish to serve will empower communication health professionals to work with multilingual communities. I am confident that moving forward, the next wave of communication health students will confidently raise their hands when asked by their supervisor if they feel ready to provide bilingual services.
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Table 3 Number of languages spoken by immigrant status and period of immigration, Canada, 2011. (2011). Retrieved November 12, 2015, from http://www12.statcan.gc.ca/nhs-enm/2011/as-sa/99-010-x/2011001/tbl/tbl3-eng.cfm.
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Weiss, D., & Dempsey, J. J. (2008). Performance of Bilingual Speakers on the English and Spanish Versions of the Hearing in Noise Test (HINT). Journal of the American Academy of Audiology, 19(1), 5–17. http://doi.org/10.3766/jaaa.19.1.2
Elaine Kwok, M.Cl.Sc./PhD
Winner of the 2016 Isabel Richard Student Paper Award (Doctoral Category)