• Race refers to a person’s physical characteristics, such as bone structure and skin, hair, or eye color.
• Ethnicity, however, refers to cultural factors, including nationality, regional culture, ancestry, and language.
• In a 2019 ASHA member survey, 95% of speech-language pathologists (SLPs) and audiologists indicated that they speak only one language. This indicates a 15% gap between members and the U.S. population.
• Most (92%) speech-language pathologists working in the field identify as white, not Latino or Hispanic. Only 4% of SLPs identify as Black. This is far below the diversity of the U.S. population.
• However, ASHA reports that compared with data from 10+ years ago, new SLPs entering the field in the last 5-10 years are more likely to belong to a racial or ethnic minority.

This means that as clinicians, we must improve our ability to meet the needs of the diverse populations that we serve in our clinics, schools, and practices.

One thing the pandemic has shown us is that we must be flexible in how we provide our services. Even with many schools and clinics providing online/telehealth options, there are still various barriers for people to even access these services. A common misconception is that everyone has access to the internet, but that is not true.

According to R.M. Zimmerman’s 2020 article focused on who is often left behind in the provision of tele-health; internet services are not as widely available to everyone as might be believed. The following statistics should be considered:

Availability of Internet

• 3% of individuals in urban areas have internet.
• 73% of individuals in rural areas have internet.

Quality/Speed of Internet

• 30% of counties in the U.S. had download speeds less than the federal minimum.

Cost of Internet

• Internet is more expensive in rural areas due to lack of competition. Cost of devices and data caps are additional barriers.

Literacy

• Limited educational opportunities can lead to lower income, lower literacy, and limited experience with technology in school.

As a clinician, what can be done to help mitigate these systemic issues? Here are a few possible aides from R.M. Zimmerman’s article:

• Consider how treatment “looks” on smartphones, as that may be the only internet available for some patients, and plan your lesson accordingly
• Use the phone to provide support through phone calls
• Provide loaner devices
• Train caregivers to supplement treatment
• Mail materials to families

Professional competence requires clinicians to practice in a manner that considers each client’s/patient’s/family’s cultural and linguistic characteristics and unique values so that the most effective assessment and intervention services can be provided (ASHA, 2004, 2006). In the past, this has been referred to as cultural competence with the idea being that we can take a course to learn about cultural awareness and then be competent. However, that will not get us to where we need to be to meet the needs of all of the children who need services for CAS. We can get to that point by practicing cultural humility, which includes cultural competence.

Cultural humility entails a life-long learning process that begins with self-assessment and understanding your own culture, and continues with learning from and interacting with others from various cultures. We have to recognize and learn about our own cultural identity so that we can explore the areas we have biases and how that impacts us on a daily basis. These biases can lead to microaggressions, which can be either intentional or unintentional, and are verbal, behavioral, or environmental acts that are slights or insults to a targeted person or group. Even if they are unintentional, they can still do damage to the person and the relationship with that person.

Be encouraged and even challenged to begin taking the first steps towards cultural humility by doing some self-reflection:

• Take this Cultural Competence Check-in from ASHA and self-reflect on your responses.
• A fun way to test your cultural competence (C²) is to take this quiz about culture as it relates to the profession from the “That’s Unheard Of” website.
• Take these speed-based tests to learn your level of bias to different aspects of culture – race, age, weight, disability, and more. The data from these tests have provided much research information on implicit biases.
• Use these four short videos to learn about microaggressions that occur and are frequently overlooked as not being harmful even though they often have detrimental effects.
• Read this eye-opening article to learn the message behind common statements which are considered to be racial microaggressions.

As part of cultural humility and cultural competence, you learn about yourself and about different cultures. The next step is what you do with that information – cultural responsive practice; that is being able to take the information you have learned and use it in meaningful ways in order to provide service delivery that takes into account each person and their experiences. Below are a few actionable items you can do.

• Evaluate how you approach interviews with families/clients, the assessment tools you use, and the therapy techniques you use for their appropriateness for each of the individuals on your caseload. Seek out additional tools and resources that are appropriate as needed. This checklist from ASHA provides a way to think how culture influences a variety of aspects of your practice.

• You can also evaluate your awareness of your agencies’ policies and procedures and the impact of cultural and linguistic factors. This checklist from ASHA is a nice starting point.

• Educate yourself on different cultures by talking with people and learning about the contrastive features that distinguish between normal and disordered speech and language. Those two pieces of information will help you be responsive to the needs of the client as an individual based on their values in order to recognize similarities while respecting differences. You are not going to know everything about every culture, so ask questions and be prepared to really listen to the answers. This link from Baylor University SLP Grad program has great ideas and links for resources including 9 questions to learn more about a patient’s culture and values.

• One of the most important decisions we make as clinicians is whether the characteristics we see in our client are a disorder or a difference. Finding information on the contrastive features, along with clinical judgement and caregiver input, can help make the appropriate diagnosis.

• ASHA provides a list of phonemic inventories and linguistic information across a variety of languages.

• This website by Dr. Gildersleeve-Neuman and her students at Portland University has great information and resources for working with children and adults from diverse cultures and languages including information for many different languages. Look for their podcast and handout on Childhood Apraxia of Speech presented in Spanish and English and an article on Multicultural Considerations for AAC.