Infusion of Culturally and Linguistically Diverse Issues into a University Curriculum ASHA Conventio

1
Infusion of Culturally and Linguistically Diverse
Issues into a University CurriculumASHA
ConventionNovember, 2008

• Marlene Salas-Provance, Ph.D., CCC-SLP,
  University of Montevallo
• Debra Vigil, Ph.D., CCC-SLP, University of Nevada
  Reno
• Karen P. Harris, Ph.D., CCC-SLP, University of
  West Georgia
• Cheryl Messick, Ph.D., CCC-SLP, University of
  Pittsburgh
• Deborah Rhein, Ph.D., CCC-SLP, New Mexico State
  University

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• ASHA Knowledge and Skills document for working
  with CLD Populations http//www.asha.org/docs/html
  /KS2004-00215.html

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Voice and Resonance

• Resonance/Voice/Fluency
• 9.0 Role Identification/Assessment and
  Treatment/Management of individuals at risk for
  resonance, voice, and/or fluency disorders. This
  includes knowledge and skills related to
• Current research on preferred practice patterns
  in the identification/assessment and
  treatment/management of resonance, voice and/or
  fluency disorders.

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Voice and Resonance

• Resonance/Voice/Fluency
• Community standards of typical resonance, voice,
  and/or fluency patterns.
• Application of the standards of the
  client's/patient's speech/communication community
  for dismissal/discharge criteria.

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Voice and Resonance

• Areas of consideration for CLD Populations
• In order to fully understand the impact of a
  communication disorder on a persons life,
  assessment and treatment of communication
  disorders must be done in the context of the
  patients language and culture
• Mattes, L.J., Omark, D.R. (1991). Speech and
  language assessment for the bilingual handicapped
  (2nd ed.). Oceanside, CA Academic Communication
  Associates.

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Voice and Resonance

• Incidence (rate of new occurrences) Prevalence
  (total cases at one time)
• Little reliable data on incidence and prevalence
  for CLD populations
• Salas-Provance, M.B., (1996). Orofacial,
  Physiologic, Acoustical Characteristics
  Implications for the Speech of African American
  Children. In Kamhi, A.G.,. Pollock, K.E., Harris,
  J.L(Eds). Communication Development and Disorders
  in African American Children Research,
  Assessment, and Intervention, pgs 155-188.

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Voice and Resonance

• Toliver-Weddington, G (1990). Cultural
  considerations in the treatment of craniofacial
  malformations for African Americans, Cleft Palate
  Journal, Vol 27, No. 3
• Race of mother appears to have more influence on
  production of cleft
• Cheng, L.L. (1990). Asian American cultural
  perspectives on birth defects Focus on cleft
  palate. Cleft Palate Journal, Vol 27, No. 3
• Cao Gio, Bat Gio, Giac, Xong

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Voice/Resonance Multicultural Curricula

• Cultural beliefs about cleft lip and palate
• Un rayo
• Safety Pin
• Caida de mollera
• Handicapping condition a result of a wrongdoing
  of individuals ancestors
• Handicap a gift from God (Chamorro culture)
• Handicap a curse (Philippines and China)

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Voice/Resonance Multicultural Curricula

• Cultural beliefs about voice disorders
• Impact of voice disorder on quality of life
• Collectivism (We) vs. Individualism (I) cultures
• Wun, Mo-yan (2003) A cross-cultural comparison on
  the impact of voice disorder on quality of life.
  Dissertation, University of Hong Kong
  http//hub.hku.hk/bitstream/123456789/48829/1/ft.p
  df

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Voice/Resonance Multicultural Curricula

• Culturally sensitive and relevant prevention
  strategies
• Knowledge of cultural diversity (individual,
  family and culture)
• Interactional styles
• Do not have preconceived notions of clients
  assumptions about handicaps and intervention
• Altenberg, E.P., Ferrand, C.T. (2006).
  Perception of individuals with voice disorders by
  monolingual English, bilingual CantoneseEnglish,
  and bilingual RussianEnglish women. Journal of
  Speech, Language and Hearing Research, Vol 49, p
  879-887.

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Voice/Resonance Multicultural Curricula

• ASSESSMENT
• Family-centered approach
• Ethnic or cultural beliefs regarding examination
  of vocal tract
• Use of normative data based on predominantly
  white subjects
• ½ of the world is bilingual most data from
  monolingual speakers
• Mayo, R. Grant, W.C. (1995). Fundamental
  frequency, perturbation, and vocal tract
  resonance characteristics of African-American and
  White American males. Echo, 17, 32-38
• Mayo, R., Floyd, L.A., Warrren, D.W., Daltson,
  R.M., Mayo, C.M., (1996). Nasalance and nasal
  cross-sectional area Cross-racial study. Cleft
  Palate-Craniofacial Journal, 33, 143-149.

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Voice/Resonance Multicultural Curricula

• TREATMENT
• Cultural mistrust
• Personal credibility
• Patients perception of norm
• Participants born outside of North America, in
  particular participants from Southeast Asia,
  China, and Hong Kong, believed that English
  speakers with disorders could do better if they
  tried.
• Bebout, L., Arthur, B. (1992). Cross-cultural
  attitudes toward speech disorders. Journal of
  Speech and Hearing Research, 35, 4555.

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Voice/Resonance Multicultural Curricula

• TREATMENT
• Facilitating techniques and their cultural
  appropriateness
• Facilitating techniques for voice
• Family involvement
• Meyerson, M.D. (1990). Cultural considerations
  in the treatment of Latinos with craniofacial
  malformations. The Cleft Palate Journal, 27 (3),
  279-288

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Voice/ResonanceReferences

• http//www.asha.org/about/leadership-projects/mult
  icultural/readings/cleft.htm
• Salas-Provance, M.B., Erickson, J.G., Reed, J
  (2002). Disabilities as viewed by four
  generations of one Hispanic family. American
  Journal of Speech-Language Pathology, 11,
  151162.
• Kuehn, D.P. Henne, L.J. (2003). Speech
  evaluation and treatment for patients with cleft
  palate.
• American Journal of Speech-Language Pathology,
  12, 103-109.
• Kuehn, D.P. Henne, L.J. (2003). Evaluación del
  habla y tratamiento para pacientes con fisura
• palatina, American Journal of Speech-Language
  Pathology, 12, 1-8.
• Vieira, A.R., Karras, J.C., Orioli, I.M.,
  Castilla, E.E., Murray, J.C. (2002) Genetic
  origins in a South American clefting population.
  Clinical Genetics, 62, 458463.
• Anderson, R. (1996). Nasometric values for normal
  Spanish-speaking females A preliminary report.
  The Cleft Palate-Craniofacial Journal, 33,
  333-336.
• Dalston, R., Neiman, G., González Landa, G.
  (1993). Nasometric sensitivity and specificity
  Across-dialect and cross-culture study. Cleft
  Palate and Craniofacial Journal, 30, 285-291.
• American Cleft Palate/Craniofacial Association
  (ACPA) and Cleft Palate Foundation (CPF)
• informational booklets in Spanish
  http//www.cleftline.org/espanol/publicaciones
• Chan, R.K.K., McPherson, B., Whitehill,
  T.L.(2006). Chinese Attitudes Toward Cleft Lip
  and Palate Effects of Personal Contact. The
  Cleft Palate-Craniofacial Journal, 43(6),
  731739.
• Dagher, D. Ross, E. (2004). Approaches of South
  African traditional healers regarding the
• treatment of cleft lip and palate. The Cleft
  Palate-Craniofacial Journal, 41 (5), 461469.

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Voice/ResonanceReferences

• http//www.asha.org/about/leadership-projects/mult
  icultural/readings/
• http//www.asha.org/about/leadership-projects/mult
  icultural/readings/voice.htm
• Agin, R.L. (2000). Clinical management of voice
  disorders in culturally diverse children Therapy
  and intervention.  In T. Coleman (Ed.), Clinical
  Management of Communication Disorders in
  Culturally Diverse Children (pp. 227- 250). 
  Needham Heights, MA Allyn and Bacon.
• Duff, M.C., Proctor, A., Yairi, E. (2004).
  Prevalence of voice disorders in African American
  and European American preschoolers.  Journal of
  Voice, 18 (3), 348-353.
• Miller, B.A., Kolonel, L.N., Bernstein, L., et.
  al. (1996). Racial/ethnic patterns of cancer in
  the United States, 1988-1992. Washington, DC
  National Cancer Institute (NIH Pub. No. 96-4104).
  
• Dobres, R., Lee, L., Stemple, J.C., et. al.
  (1990). Description of laryngeal pathologies in
  children evaluated by otolaryngologists. Journal
  of Speech and Hearing Disorders, 55(3) 526-532.

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Language Disorders/Language Theory

• Areas of consideration for CLD population
• How do we infuse?
• Multicultural/multilingual instructional goals
• Language theory
• Tomasello
• Culture as ontogenetic niche
• Social/cultural transmission
• Rogoff
• Psycho-Cultural Model
• Bronfenbrenners Ecological Model
• Sociocultural activity Cultural Tools

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Language Disorders/Language Theory

• Laosa
• Intercultural transition
• Intercultural change
• Assimilation vs Acculturation
• Biculturalism
• Cultural change development
• Funds of knowledge
• Deficit vs Difference
• Greenfield
• Independence vs interdependence
• Belief system Cultural Scripts

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Language Disorders/Language Theory

• Infusion
• Facts

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Language Disorders/Language Theory References

• Battle, D.E. (2001). Communication Disorders in
  Multicultural Populations. Stoneham, MA
  Butterworth-Heinemann.
• Damico, J.S. Armstrong, M.B. (1990-1991).
  Empowerment in the clinical context The
  speech-language pathologist as advocate.
  National Student Speech Language Hearing
  Association Journal. 18, 34-43.
• Goldstein, B.A. (2004). Bilingual Language
  Development Disorders. Baltimore, MD Brookes
  Publishing.
• Genesee, F., Paradis, J., Crago, M.B. (2008).
  Dual Language Development Disorders. Baltimore,
  MD Brookes Publishing.
• Greenfield, P.M. (1994). Independence and
  interdependence as developmental scripts
  Implications for theory, research, and practice.
  In P.M. Greenfield R.R. Cocking (Eds.),
  Cross-Cultural Roots of Minority Child
  Development, (pp. 1-37). Hillsdale, New Jersey
  Lawrence Erlbaum.
• Kim, U. Choi, S.H. (1994). Individualism,
  collectivism, and child development A Korean
  perspective. In P.M. Greenfield R.R. Cocking
  (Eds.), Cross-Cultural Roots of Minority Child
  Development, (pp. 227-257). Hillsdale, New
  Jersey Lawrence Erlbaum.
• Langdon, H.W. (2007). Assessment Intervention
  for Communication Disorders in Culturally
  Linguistically Diverse Populations. Clifton Park,
  NY Thomson Del Mar Learning.
• Laosa, L. (1999). Intercultural transitions in
  human development and education. Journal of
  Applied Developmental Psychology, 20, 355-406.
• Langdon, H.W. Cheng, L.L. (1992). Hispanic
  Children and Adults with Communication Disorders.
  Gaithersburg, MD Aspen Publication.

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Language Disorders/Language Theory References

• Lynch, E.W. Hanson, M.J. (1999). Developing
  Cross Cultural Competence. Baltimore, MD Brookes
  Publishing.
• Nelson, K. (2007). Young Minds in Social Worlds.
  Cambridge, MA Harvard University Press. Rogoff,
  B. (2003). The Cultural Nature of Human
  Development. New York Oxford University Press.
• Roseberry-McKibbin, C. (2007). Language Disorders
  in Children. Boston Pearson.
• Schieffelin, B.B. Ochs, E. (1986). Language
  Socialization Across Cultures. New York
  Cambridge University Press.
• Tomasello, M. ((1999). The Cultural Origins of
  Human Cognition. Cambridge, MA Harvard
  University Press.
• Van Kleeck, A. (1994). Potential cultural bias in
  training parents as conversational partners with
  their children who have language delays in
  language development. American Journal of Speech
  Language Pathology, 3, 67-78.

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Phonology

• Incidence/Prevalence Data for CLD populations
• Estimated 5.2 million bilingual children enrolled
  in U.S. schools
• A 61 increase since 1994
• ASHA Focused Initiative 2001 (CLD Populations)

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Phonology

• ASHA KS for working with CLD Populations
• Identification/Assessment
• Current research and best practices
• Phonemic and allophonic variations
• Terminology
• Standards of clients speech community
• Treatment/Intervention
• Current research and best practices
• Community standards of typical articulation and
  phonology patterns
• Standards of clients speech community

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Phonology

• Areas of consideration for CLD Populations
• L1 plays large role in L2 phonological
  development
• L1 often influences L2 when students are learning
  L2 (transfer)
• Errors reflect influence of L1
• Can occur in all areas syntax, morphology,
  phonology, semantics, and pragmatics
• Determining communication disorder versus
  communication difference
• Challenges to providing assessment and
  intervention due to lack of understanding

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Phonology

• Required Texts
• Traditional articulation and phonological text
• Adger, C. T., Wolfram, W., Christian, D.
  (2007). Dialects in Schools and Communities (2nd
  Ed.). Mahwah, NJ Lawrence Erlbaum Associates.
• Text focused on dialects and linguistic
  variations
• Pena-Brooks, A., Hedge, M. N. (2000).
  Assessment and treatment of articulation and
  phonological disorders in children. Austin, TX
  Pro-Ed.

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Phonology

• In-Class Activities and Resources
• Case studies
• Videos
• American Tongues
• Discussion questions
• The nature of dialect differences
• Manifestations of dialect variation
• Reasons for dialect differences
• Attitudes about dialects
• Dialect identity
• The uses of standard and vernacular dialects

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Phonology

• Do You Speak American?
• PBS
• Discussion questions
• Reflective journals
• Assessment critiques
• Handouts

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Phonology Infusion at Work

• Normal development of articulation and
  phonological skills
• Theoretical issues in articulation and
  phonological development
• Assessment of articulation and phonological
  disorders
• General assessment procedures for articulation
  and phonological disorders
• Specific treatment approaches

• Typical acquisition in bilinguals
• Theoretical perspectives on speech sound
  disorders in bilingual children
• Ethnocultural variables of articulation and
  phonological development
• Minority language differences
• Evidence-based phonological assessment of
  bilingual children
• Evidence-based practice and treatment of speech
  sound disorders in bilingual children

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Phonology

• Course Assignments
• Proficiency exams
• Case interpretations
• Journal critiques
• Online discussion threads

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Phonology References

• American Speech-Language-Hearing Association
  (2001). Guide to speech-language pathology
  assessment tools for multicultural and
  bilingual populations. Rockville MD Author.
• American Speech-Language-Hearing Association
  (2001). Focused initiative Culturally/Linguisti
  cally diverse populations. Asha Supplement, 21,
  9.
• Anderson, R. (1999). Impact of first language
  loss on grammar in a bilingual child.
  Communication Disorders Quarterly. 21(1), 4-16.
• Barlow, J. A. Enriquez, M. (2007). Theoretical
  perspectives on speech sound disorders in
  bilingual children. Perspectives on
  Communication Disorders and Sciences in
  Culturally and Linguistically Diverse
  Populations.
• Coleman, T. J. (2000). Clinical management of
  communication disorders in culturally diverse
  children. Needham Heights, MA Allyn Bacon.

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Phonology References

• Fabiano, L. C. (2007). Evidence-based
  phonological assessment of bilingual children.
  Perspectives on Communications Sciences and
  Disorders in Culturally and Linguistically
  Diverse Populations.
• Goldstein, B., Iglesias, A. (2001). The effect
  of dialect on phonological analysis Evidence
  from Spanish-speaking children. American Journal
  of Speech-Language Pathology, 10, 394406.
• Goldstein, B. A., Fabiano, L. (2007, Feb. 13).
  Assessment and intervention for bilingual
  children with phonological disorders. The ASHA
  Leader, 12(2), 6-7, 26-27, 31.
• Goldstein, B. Gildersleeve-Neumann, C. (2007).
  Typical phonological acquisition in bilinguals.
  Perspectives on Communications Sciences and
  Disorders in Culturally and Linguistically
  Diverse Populations.
• Hwa-Froelich, D., Hodson, B. W., Edward, H. T.
  (2002), Characteristics of Vietnamese phonology.
  American Journal of Speech-Language Pathology,
  11(3), 264- 273.
• Kohnert, K. (2007). Evidence-based practice and
  treatment of speech sound disorders in bilingual
  children. Perspectives on Communications Sciences
  and Disorders in Culturally and Linguistically
  Diverse Populations.

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Phonology References

• National Center for English Language Acquisition
  and Language Instruction Education Programs
  (2005). The growing number of limited English
  proficient students. Retrieved November 29,
  2006, from http//www.ncela.gwu.edu/policy/stat e
  s/reports/statedata/2004LEP/GrowingLEP_ 0405_Nov06
  .pdf  PDF - 598KB
• Ray, J. (2002). Treating phonological disorders
  in a multilingual child A case study. American
  Journal of Speech-Language Pathology, 11,
  305 315.

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Clinical Education

• Developing awareness understanding of cultural
  differences
• Examples of clinical education learning
  activities
• Connecting Clinic Academics
• Documentation of cultural competency skills

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Developing Awareness of Diversity Clinical
Orientation

• Broad notion of diversity
• Book Club
• The Spirit Catches You and You Fall Down (Ann
  Fadiman)
• What is the What The Autobiography of Valentino
  Achak Deng (Dave Eggers)
• Mama May be Better off Dead The Failure of
  Healthcare in Urban America (L.K. Abraham)
• There are no children here the story of two boys
  growing up in the other America (Alex Kotlowitz)

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Ethnographic Interviewing

• Panel Interview
• How long have you been in the US why did you
  come?
• What are some differences you initially noticed
  between American society and that of your home?
• What do you wish Americans knew about your
  culture?
• How is healthcare in the US different from your
  home?
• Interviewing one another
• Where are you from
• Describe one important holiday in your family and
  how it is celebrated
• What role does religion play in your family
• Education extended family politics, etc

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Learning Activities

• Interview role play incorporating 2nd language
  users
• Analysis of diagnostic tools validity with
  culturally/linguistically diverse populations
• Clinical Reference Sheets
• Dialectical speech/language variations
• 2nd language use speech/language variations
• Cultural guidelines for interacting with families

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Broad View of Diversity Poverty, Disability, Gay
Rights (etc)

• Photo Voice Websites books
•  www.photovoice.org,
• www.photovoice.com
• Examples of Projects
• Ewald, W. (ed.), Appalachia A Self-Portrait,
  Gnomon Press for Appalshop, Inc., Frankfort,
  Kentucky, 1979.
• Ewald, W. The Best Part of Me. Megan Tingley
  Books, Little, Brown and Company, New York, 2002.
• Ewald, W. Magic Eyes, Scenes from an Andean
  Girlhood.  Bay Press, Seattle, 1992.

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Connecting ClinicAcademics Spirit Catches you
and You fall down

• Artic/Phonology Viet Namese speech patterns
• Child Language home based parent traininng
  program for families from Viet Nam (0-3 yr old
  child)
• Counseling development of cultural guidelines
  for interviewing/counseling
• Dysphagia food/feeding recommendations for
  patient from Viet Nam

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Documentation of Clinical Skills

• Student demonstrates. . . .
• Awareness of own beliefs/biases in clinical
  interactions
• Respect for clients background (ethnic,
  lifestyle, physical/mental ability, religious
  beliefs/practices, and heritage)
• Ability to modify clinical procedures by
  considering clients traditions, customs, values,
  and beliefs
• Awareness of own limitations in providing
  services to clients/patients from diverse
  backgrounds (cultural/linguistic)
• Skill in incorporating strategies that form a
  bridge between client/patients culture and
  community or communication environment
• Ability to incorporate values in counseling which
  are consistent with client/patient values

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Documentation (cont)

• Logging of practicum experiences
• Development of portfolio items
• Artifact cover sheet what did you do
  differently to meet the diversity needs of the
  client/patient?

40
Clinical Education References

• ASHA Multicultural Website http//www.asha.org/a
  bout/leadership-projects/multicultural/readings/re
  ading_5.htm
• American Speech-Language-Hearing Association.
  (2004). Knowledge and Skills Needed by
  Speech-Language Pathologists and Audiologists to
  Provide Culturally and Linguistically Appropriate
  Services.
• Campbell, L., Brennan, D., Steckol, K. (1992).
  Preservice training to meet the needs of people
  from diverse cultural backgrounds. Asha, 34(2) ,
  29-32.
• Campbell, L. R. (1994). Learning about culturally
  diverse populations. Asha, 36(6) , 40-41.
• National Standards for Culturally and
  Linguistically Appropriate Services in Health
  Care. (2001, March). Washington, DC U.S.
  Department of Health and Human Services, OPHS
  Office of Minority Health.
• Patterson, J. (1994). A tutorial on
  sociolinguistics for speech-language
  pathologists An appreciation of variation.
  National Student Speech-Language-Hearing
  Association Journal, 21 , 14-30.
• Van Kleeck, A. (1994). Potential cultural bias in
  training parents as conversational partners with
  their children who have delays in language
  development. American Journal of Speech-Language
  Pathology, 3(1) , 67-78.
• Westby, C. E. (1990). Ethnographic interviewing
  Asking the right questions to the right people in
  the right way. Journal of Childhood Communication
  Disorders, 13(1) , 101-111.

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Fluency

• Four main issues
• Cultural beliefs regarding causes of stuttering
• Cultural attitudes toward stuttering
• Bilingualism and stuttering
• Intervention models for stuttering with CLD
  populations

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Fluency--Beliefs about causes

• Erickson, J.G., Devieger, P.J., Sung, J.M.
  (1999). Korean-American perspectives on
  disability. American Journal of Speech-Language
  Pathology, 8, 99-108
• Salas-Provance, M. B., Erickson, J.G., Reed, J.
  (2002) Disabilities as viewed by four generations
  of one Hispanic family. American Journal of
  Speech-Language Pathology, 11,151-162.

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Fluency-- Cultural attitudes toward stuttering

• Bebout,. L Arthur., B, (1992). Cross-cultural
  attitudes toward speech disorders. Journal of
  Speech and Hearing Research, 35, 45-52.
• Tellis, G.M. (2002). Multicultural aspects of
  stuttering. Perspectives 14.
• Daniels, d., E., Hagstrom, F., Gabel, R.M.,
  (2006). A qualitative study of how
  African-American men who stutter attribute
  meaning to identity and life choices. Journal of
  Fluency Disorders, 31, 200-215.

44
Fluency-- Bilingualism and stuttering

• Van Borsel, J. , Maes, E., Foulon, S. (2001).
  Stuttering and bilingualism A review. Journal of
  Fluency disorders, 26, 179-205.
• Howell, P., Davis, S.R. Williams, R. (2008,
  September). The effects of bilingualism on
  stuttering during late childhood. ADC Online,
• Retrieved November 4, 2008,from
  http//adc.bmj.com.
• Jankelowitz, D.L. Bortz, M.A. (1996). The
  interaction of bilingualism and stuttering in an
  adult. Journal of Communication Disorders, 29,
  223-234.

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Fluency Clinical implications

• Shenker, R.C. (2004). Bilingualism in early
  stuttering empirical issues and clinical
  implications. In Bothe (Ed.). Evidence-based
  treatment of stuttering pp. 81-96. Mahwah, NJ
  Lawrence Erlbaum Associates.
• Robinson, T.L. Crowe, T.A.(1998). Culture-based
  considerations in programming for stuttering
  intervention with African American clients and
  their families. Language, Speech and Hearing
  Services in the Schools, 29, 172-179.