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Andrea Moxley, Nidhi Mahendra, and Carmen Vega-Barachowitz, American Speech-Language-Hearing Association (page 1 of 3) Page 1 of 3
The rapidly altering United States demographics have dramatically affected health care service provision. According to the U.S. 2000 Census, approximately 18% of the population over age 5 speaks a language other than English in the home. This number is projected to increase.
Consequently, speech-language pathologists and audiologists working in the health care setting must be prepared to provide services that are respectful of and responsive to cultural and linguistic needs of a diverse patient population.
For instance, health care disparities in racial and ethnic minorities in the United States can no longer be discounted or ignored. The Institute of Medicine (IOM) Report, Unequal Treatment, summarized a growing body of literature documenting racial or ethnic differences in health care outcomes for many different diagnoses including coronary artery disease, diabetes, cancer, and HIV. Health care providers have to overcome cultural and communication barriers that may negatively influence appropriate diagnosis and treatment, provide culturally competent health care, and create health care systems that provide equitable access to all clients/patients.
Expanding Government Resources
CLAS Standards
What is culture? According to the U.S. Department of Health and Human Services' Office of Minority Health (OMH) Culturally and Linguistically Appropriate Services (CLAS) standards, culture is defined as "the thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious or social groups." The OMH established a set of 14 national CLAS standards in health care that constitute mandates, guidelines, and recommendations intended to inform, guide, and facilitate required and recommended practices related to culturally and linguistically appropriate services.
The standards are divided into three sections-Culturally Competent Care, Language Access Services, and Organizational Supports for Cultural Competence. These standards define how health care information is received, how rights and protections are exercised, what is considered to be a health problem, how symptoms and concerns about the problem are expressed, who should provide treatment for the problem, and what type of treatment should be delivered.
Executive Order 13166
President Clinton's signing of Executive Order 13166 in August 2000 was a landmark event in attempting to "improve access to federally conducted and federally assisted programs and activities for persons, who, as a result of national origin, are limited in their English proficiency (LEP)." This order reminded agencies of Title VI of the Civil Rights Act of 1964, which guarantees that "no person in the United States shall, on the ground of race, color or national origin, be excluded from participation in, be denied benefits of, or be subjected to discrimination under any program or activity receiving federal financial assistance."
Expanding ASHA Resources
It is incumbent upon ASHA members, as lifelong learners, to become culturally competent-that is, to develop their skills when working with all clients/patients regardless of cultural and linguistic (CL) background.
An important example of an ASHA resource available to members is the document, "Knowledge and Skills Required by a Speech-Language Pathologist or Audiologist to Provide Culturally Competent Services." This document was developed by the Multicultural Issues Board and reminds us that every client, just as every clinician, has a culture. The development of competence begins with each of us, as individuals, and it proceeds along a continuum. Progress results from valuing differences, self-assessment, building cultural knowledge, and adapting practice to reflect the patient's CL background. An understanding of our own culture and values is essential in order to fully understand how those values may affect our interactions with clients and how we deliver services.
Generalizations of cultural characteristics, behaviors, and values may be accurate, however, only to a certain extent. They will never be wholly true of an individual. Within any culture, there is always a broad range of behaviors. Clinicians must be aware of patient-related factors that affect behavior. These factors include age, socioeconomic status, educational level, patterns of acculturation and assimilation, and the client's knowledge of health systems, conditions, and treatments.
Our goal should be to tailor our verbal and nonverbal interactions to the individual patient and family. This goal can be achieved only by being sensitive to the client's cultural and linguistic context. The clinician's desire to help and educate culturally and linguistically diverse clients with warmth and openness is not enough to ensure that they understand or accept our recommendations. The practice of speech-language pathology and audiology must include educating and counseling individuals and families regarding acceptance of, adaptation to, and decision making about assessment and treatment recommendations pertaining to communication, swallowing, or other upper aerodigestive concerns (see SLP Scope of Practice, 2001, and Audiology Scope of Practice, 2004).
Counseling, Assessment and Management of Individuals with Neurogenic Communication Disorders
Given the cultural and clinical heterogeneity of the United States, a one-size-fits-all approach is not effective. CL variables significantly influence clinical interactions, in turn affecting understanding and acceptance of treatment approaches and therapeutic outcomes.
Working with patients and families requires creating an environment of trust and mutual respect. Therefore, acquiring knowledge about non-verbal aspects of communication is essential and includes learning about parameters specific to individual cultures. For example, consider the personal distance one should sit or stand from somebody or the significance of body motions and gestures.
Gaining knowledge of salient cultural features also includes learning about social organization and communication styles. Does the culture have an individual or collectivist orientation? Is the focus on the nuclear or extended family? Is the communication style implicit or explicit?
From the American Speech-Language-Hearing Association. Used with permission. www.asha.org.
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