Category: Newsletter

Scores of speech therapists across the country erupted last month when their leading professional association said it was considering dropping language calling for diversity, equity and inclusion and “cultural competence” in their certification standards. Those values could be replaced in some standards with a much more amorphous emphasis on “person-centered care.” 

“The decision to propose these modifications was not made lightly,” wrote officials of the American Speech-Language-Hearing Association (ASHA) in a June letter to members. They noted that due to recent executive orders related to DEI, even terminology that “is lawfully applied and considered essential for clinical practice … could put ASHA’s certification programs at risk.” 

Yet in the eyes of experts and some speech pathologists, the change would further imperil getting quality help to a group that’s long been grossly underserved: young children with speech delays who live in households where English is not the primary language spoken. 

“This is going to have long-term impacts on communities who already struggle to get services for their needs,” said Joshuaa Allison-Burbank, a speech language pathologist and Navajo member who works on the Navajo Nation in New Mexico where the tribal language is dominant in many homes.

In a written statement after this story published, a spokesperson for the association stressed that the proposed changes have not been finalized, and said that member feedback is currently under review.

“ASHA remains steadfast in our belief that all health care services should be non-discriminatory and address the needs of every individual,” the spokesperson added. She characterized the proposed changes as “an evolution, not a retreat,” and noted that person-centered care aims to ensure “clinicians are equipped to deliver services tailored to each person’s context, including their lived experience, language background, cultural identity, and home environment.”

Across the country, speech therapists have been in short supply for many years. Then, after the pandemic lockdown, the number of young children diagnosed annually with a speech delay more than doubled. Amid that broad crisis in capacity, multilingual learners are among those most at risk of falling through the cracks. Less than 10 percent of speech therapists are bilingual.

A shift away from DEI and cultural competence — which involves understanding and trying to respond to differences in children’s language, culture and home environment — could have a devastating effect at a time when more of both are needed to reach and help multilingual learners, several experts and speech pathologists said. 

They told me about a few promising strategies for strengthening speech services for multilingual infants, toddlers and preschool-age children with speech delays — each of which involves a heavy reliance on DEI and cultural competence.

Embrace creative staffing. The Navajo Nation faces severe shortages of trained personnel to evaluate and work with young children with developmental delays, including speech. So in 2022, Allison-Burbank and his research team began providing training in speech evaluation and therapy to Native family coaches who are already working with families through a tribal home visiting program. The family coaches provide speech support until a more permanent solution can be found, said Allison-Burbank.

Home visiting programs are “an untapped resource for people like me who are trying to have a wider reach to identify these kids and get interim services going,” he said. (The existence of both the home visiting program and speech therapy are under serious threat because of federal cuts, including to Medicaid.) 

Use language tests that have been designed for multilingual populations. Decades ago, few if any of the exams used to diagnose speech delays had been “normed” — or pretested to establish expectations and benchmarks — on non-English-speaking populations.

For example, early childhood intervention programs in Texas were required several years ago to use a single tool that relied on English norms to diagnose Spanish-speaking children, said Ellen Kester, the founder and president of Bilinguistics Speech and Language Services in Austin, which provides both direct services to families and training to school districts. “We saw a rise in diagnosis of very young (Spanish-speaking) kids,” she said. That isn’t because all of the kids had speech delays, but due to fundamental differences between the two languages that were not reflected in the test’s design and scoring. (In Spanish, for instance, the ‘z’ sound is pronounced like an English ‘s.’)

There are now more options than ever before of screeners and tools normed on multilingual, diverse populations; states, agencies and school districts should be selective, and informed, in seeking them out, and pushing for continued refinement.

Expand training — formal and self-initiated — for speech therapists in the best ways to work with diverse populations. In the long-term, the best way to help more bilingual children is to hire more bilingual speech therapists through robust DEI efforts. But in the short term, speech therapists can’t rely solely on interpreters — if one is even available — to connect with multilingual children.

That means using resources that break down the major differences in structure, pronunciation and usage between English and the language spoken by the family, said Kester. “As therapists, we need to know the patterns of the languages and what’s to be expected and what’s not to be expected,” Kester said.

It’s also crucial that therapists understand how cultural norms may vary, especially as they coach parents and caregivers in how best to support their kids, said Katharine Zuckerman, professor and associate division head of general pediatrics at Oregon Health & Science University. 

“This idea that parents sit on the floor and play with the kid and teach them how to talk is a very American cultural idea,” she said. “In many communities, it doesn’t work quite that way.”

In other words, to help the child, therapists have to embrace an idea that’s suddenly under siege: cultural competence,

Quick take: Relevant research

In recent years, several studies have homed in on how state early intervention systems, which serve children with developmental delays ages birth through 3, shortchange multilingual children with speech challenges. One study based out of Oregon, and co-authored by Zuckerman, found that speech diagnoses for Spanish-speaking children were often less specific than for English speakers. Instead of pinpointing a particular challenge, the Spanish speakers tended to get the general “language delay” designation. That made it harder to connect families to the most tailored and beneficial therapies. 

A second study found that speech pathologists routinely miss critical steps when evaluating multilingual children for early intervention. That can lead to overdiagnosis, underdiagnosis and inappropriate help. “These findings point to the critical need for increased preparation at preprofessional levels and strong advocacy … to ensure evidence-based EI assessments and family-centered, culturally responsive intervention for children from all backgrounds,” the authors concluded. 

Carr is a fellow at New America, focused on reporting on early childhood issues. 

Contact the editor of this story, Christina Samuels, at 212-678-3635, via Signal at cas.37 or [email protected].

This story about the speech therapists association was produced by The Hechinger Report, a nonprofit, independent news organization focused on inequality and innovation in education. Sign up for the Hechinger newsletter.

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