ASHA 1) identifies knowledge needed by SLPs to provide culturally and linguistically appropriate services. The official statement pertaining to providing services to individuals that speak a language in which the clinician is not proficient is as follows.

Clinician without native or near-native proficiency in the language(s)/dialect(s) spoken or signed by the client/patient. Knowledge and skills related to:

• Obtaining information on the features and developmental characteristics of the language(s)/dialect(s) spoken or signed by the client/patient (see Language section).
• Obtaining information on the sociolinguistic features of the client's/patient's significant cultural and linguistic influences.
• Developing appropriate collaborative relationships with translators/interpreters (professional or from the community):
  • Maintain appropriate relationships among the clinician, the client/patient, and interpreter/translator.
  • Ensure that the interpreter/translator has knowledge and skills in the following areas:
    • Native proficiency in client's/patient's language(s)/dialect(s) and the ability to provide accurate interpretation/translations.
    • Familiarity with and positive regard for the client's/patient's particular culture, and speech community or communicative environment.
    • Interview techniques, including ethnographic interviewing.
    • Professional ethics and client/patient confidentiality.
    • Professional terminology.
    • Basic principles of assessment and/or intervention principles to provide context to understand objectives.

van Kleeck (1994)2) published a tutorial that summarizes key studies and discusses cultural variations in parent-child interactions patterns and what this may mean in regards to parent training as an intervention procedure. Some highlights from her work are summarized below; please refer to her work for more in-depth descriptions.

A common practice when focusing on intervention with children is to target the parent-child interaction. Within these intervention programs parents are taught strategies for interacting with their child and are often encouraged to follow the child’s lead, respond quickly to the child’s attempts to communicate, provide clear and simple language models and promote turn-taking. The goal is usually to get children to communicate a often as possible. These suggestions on ways to interact are based on linguistic research derived from the dominant American middle class culture. So while they are research proven methods of ways to positively influence language in children, the researched population is somewhat limited in scope. The values and beliefs reflected in some parent-training programs are not shared by all cultures.

• Some assumptions parent training programs make about typical parent-child interactions:
  • Parents are the child’s primary caregiver
  • The family values children talking a lot
  • Children should initiate conversation
  • Children should direct conversations rather than adults
  • Adults should accommodate to children

• In many cultures siblings perform the role of primary caregiver; typical caregiving arrangements differ across cultures.
• Many cultures value quietness in children as opposed to American culture valuing highly verbal children. How cultures view the amount of talk expected from children may vary from culture to culture.
• Other cultures may not encourage or allow children to direct conversational topics; rather it’s the adults responsibility to direct and the child’s role to obey.
• In American mainstream culture (and in school settings) it’s common for adults to ask children questions which the adults already know the answer to; in other cultural groups such requests for verbal display of knowledge is not made.
• Cultures vary on what is considered intentional language and when children begin using intentional language.
• The degree of “child directed talk” or “motherese” can vary considerably across cultures. It is not universal to use this type of intonation when speaking with small children.

It must be considered that a parent-training program may not match the parent-child interaction patterns of all cultural groups. It may be beneficial for the SLP to modify parent-training programs to better fit the family’s interaction patterns and allow strategies to evolve into how they best benefit the family.

Strategies for learning about a family’s communication patterns:

• Interview with the aim to understand the family’s social organization: Who interacts with the child? How? In what contexts?
• Ask open-ended questions that require descriptions of the child’s language or how the child interacts within the family.
• Use observation: note the value of talk, status within the family, beliefs about intentionality and successful interactive strategies already in place
• Be aware of your own cultural bias.
• Listen carefully to each family.

Frequently cited studies of non-American and American non-dominant cultures and social groups, borrowed with permission from van Kleeck: 3)

AFRICA:

• Lou in Kenya: Ben Blount, 1972
• Basotho in Lesotho: Katherine Demuth, 1986

CANADA:

• Athabaskans of Alaska and Canada: Ron & Suzanne Scollon, 1981
• Inuit of Arctic Quebec: Martha Crago, 1990

JAPAN:

• Tokyo suburbs: Patricia Clancy, 1986

MELANESIA (SOLOMON ISLANDS):

• Kawara'ae: Karen A Watson-Gregeo, David Gregeo, 1986

POLYNESIA:

• Kaluli of Papua New Guinea: Bambi Schieffelin, 1979, 1984, 1986
• Western Samoans: Elinor Ochs, 1982, 1984, 1988

UNITED STATES:

• African American: Low SES, rural group in Louisiana: Martha Ward, 1971
• African American: Low SES community in Carolina Piedmonts: Shirley Brice Heath, 1982, 1983, 1989
• Hawaiian: Contemporary culture: Stephen Boggs, 1985
• Mexican/American: Immigrant families in California: Ann Eisenberg, 1982
• Native American:
  • Athabaskans of Alaska: Scollon & Scollon, 1981
  • Navajo of Arizona & New Mexico: Muriel Saville-Troike, 1982
  • Warm Springs Indians of Central Oregon: Sue Phillips, 1983
• White: Low SES neighborhood in Baltimore: Peggy Miller, 1986

Some useful information about different cultural groups is available through the language and Cultural Topic pages. Suggestions about ways to communicate with culturally diverse parents can be found here.

A successful approach to speech-language intervention should take into account the cultural and linguistic diversity of the family, within the treatment process. It is important to be aware of cultural biases that may stem from a monolingual mindset. For many individuals in the mainstream culture, bilingualism may seem abstract and complicated. However, to individuals who are part of bilingual/multilingual communities, the process of learning more than one language is familiar and very natural. Recognizing that there are many perspectives on language acquisition will allow professionals to be increasingly competent in dealing with a wide variety of situations.

Children begin with a single linguistic system that separates into two separate systems over time.

Children obtain and maintain separate language systems from the beginning of language acquisition.

The Interactional Dual Systems Model recognizes two separate linguistic systems that influence and interact with one another while maintaining specific language components. Bilinguals utilize the resources from both of their languages in order to efficiently organize and produce language. 4)

Treats errors that occur in both languages. Stems from the framework that intervention toward changing patterns in one language may affect linguistic/phonological patterns in the second language. Choose goals for treatment that are found in both languages. In this way, it is not one language you are treating, but the characteristics of both languages. This is a good place to begin the intervention process.

Treats each language separately but equally in the intervention process. Recognizes and addresses differences in the linguistic structures/patterns of the two languages. May be most helpful in combination with the bilingual approach. After treating sounds or components found in both languages, it may be necessary to treat specific areas found in one of the languages but not the other.

Overall, the goal of intervention with multilingual individuals is to support the development of all languages that he/she speaks. Studies have shown that increasing abilities in the first language can also benefit the acquisition of the second language. In addition, removing one language will not cure or improve the underlying language difficulties. Specific language instruction in the native language (L1) facilitates second language acquisition (L2) (Kiernan & Swisher, 1990). A study conducted on PAVE Preliteracy program obtained results indicating that bilingual intervention of preliteracy skills (Spanish-English) significantly increased both the Spanish and English alphabet knowledge and vocabulary as well as improved areas of expressive language measured by MLU.

Biliteracy instruction of literacy skills and metalinguistic concepts may help to make the transfer of literacy skills to English easier by supporting the first language and by preventing language loss. (Lindsey et l, 2003) Traditional fundamental strategies that are used for monolingual children can be applied to bilingual children as well. Treatment should be relevant to the child's natural setting. Materials should be meaningful and activities will be most beneficial when they are motivating for the child. However, it is important to also consider cultural differences when selecting content and materials to incorporate into treatment.

In order to ensure that the treatment is meaningful and relevant to the child's life it is necessary to support the child's environmental needs. Treatment should support all areas of language including but not limited to the home, school, and community environment. Restricting support to a single language will limit the child's opportunities to participate in all areas of his/her environment. The child's social, emotional, and cognitive development is facilitated through the communication of the home culture and linguistic context. Language is the main tool to communicate the values of the family system. Failure to support the home language can result in a loss of cultural identity and may limit the child's participation level in many areas. Support of the home language may also help to facilitate academic achivement and cognitive development, which can in turn influence self-esteem and social-emotional development. Facilitating, rather than simply encouraging the first language is necessary toward promoting further language development for the child (Kohnert et al, 2005).5)

Families should be included in the treatment process and may be trained by the clinician to provide therapy services to their child throughout the language intervention process. This can be a helpful strategy especially in situations in which the clinician is not fluent in the home language of the child. Parent and family training programs are supported by the federal mandates that support partnership and cooperation betweeen professionals and families (Public Law 99-457). According to Kohnert et al. (2005), successful parent training strategies should include techniques to facilitate expressive language (expansion, modeling and parallel talk) as well as instructional techniques from the clinician to provide feedback to the family in a systematic way (eg., demonstration, videotaping). This dynamic method of intervention allows the family and clinician to work together and to be flexible in the treatment process of implementing an individualized plan that is tailored to the individual needs of the client and his/her family.

Multilingual individuals come from a variety of different backgrounds and contexts. Getting to know the client and the client's family is important in order to provide and implement the most relevant and specific intervention plan. Many of these factors will be determined during the assessment process. Cultural factors include a wide variety of components that can impact the linguistic diversity of the client. These factors should be considered when creating an individualized treatment plan. These factors may include: socioeconomic level, religious beliefs, and sexual orientation (Aoyama et al., 2005) 6) However, information will constantly be obtained throughout the treatment process as well. Children have many different strengths, weaknesses and abilities that will change and evolve over time. The treatment process should be dynamic and flexible to accomodate changes in the child and the environemnt in which the child is a part of. Professionals working with the individual must take into account these factors: 7)

What is the culture of the family system and what are the roles of family members? Who is included in the family dynamic and how does each member interact with others within the family? What are the families goals for treatment?

How long has the child been bilingual? At what age did he/she become bilingual?

Professionals must know the extent to which the child uses each language and in what settings and contexts they are often used most successfully.

What language does the child speak in various contexts and environments? Who does the child communicate with on a regular basis?

• Phonological skills/representation
  • Phonemes that are similar/different between the two languages
  • Errors/error patterns
    • Found in each of the two languages
    • Frequency of occurrence
• Syntax/Morphology
  • Meaningful vocabulary
  • Grammatical rules
    • Similarities/differences

There is limited information available regarding the acquisition of phonology in languages other than English as well as assessment and treatment techniques for children who speak one than one language. Typically, intervention techniques designed for English speaking monolingual children with phonological disorders are used for bilingual children with phonological disorders. However, there is little data to support that these intervention techniques are effective for bilingual speakers.

Yavas and Goldstein (1998) 8) compiled available research and provided an outline for valid and reliable ways to treat phonological disorders in bilingual speakers. Their recommendations are as follows. Language examples are cited directly from their work.

Choose an intervention approach

This is determined according to each child’s unique phonological profile and will depend on a number of factors including: age, language status, length of exposure to L1 and L2, and dialect. The intervention approach may need to be modified according to these factors as well.

Choose specific targets

The following suggested procedures should be followed in order.

1. Initially target phonological patterns that have similar error rates in L1 and L2. These are likely the patterns used to diagnose the phonological disorder. Further, these patterns probably significantly affect intelligibility in both languages. Treatment targeting these patterns should occur in both languages. In selecting targets, please consider:
   1. Syllable structure and word structure patters in the languages. For example, Hmong word patterns contain 56 initial consonants and one final consonant therefore treating word initial consonants would be a better initial choice than word final.
   2. Targets not to treat. For example, Vietnamese contains few word final consonants therefore choosing final consonant deletion would not likely be a pattern that affects intelligibility in both languages.
2. Target phonological patters that present with unequal frequency in L1 and L2. These patterns may affect indelibility in one language considerably more than the other. However, if they occur in both languages then intervention should occur in both languages.
3. Finally target phonological patterns that present in only one language. It’s likely that patterns occur and exist in only one language. Treatment in this case should occur in one language.

The American Speech and Hearing Association (ASHA) provides phonemic inventory information for some languages here http:www.asha.org/about/leadership-projects/multicultural/Phono.htm. Additional languages can be found through the language page.

Perozzi and Sanchez (1992) 9) found that Spanish-English bilingual children with language delays learned new English (L2) vocabulary more rapidly when it was initially presented in Spanish (L2). This supports the idea that new vocabulary is more easily learned when it is first presented in a familiar context in the stronger language system.

Thordardottir (2006) 10) suggests that when targeting vocabulary and language skills ask the child to translate words from L1 to L2. Encourage parents to read with their children and participate in language facilitating activities (playing games, dramatic play) in home language. Be aware of cultural appropriateness when suggesting activities.

In intervention, promote and accept (don't try to limit) the natural ways in which bilingual speakers use language, this includes characteristics such as code switching.11)

• For vocabulary
  • When supporting L1 choose stimuli relevant to L1 culture (for example, meaningful pictures)
  • Real objects used in natural context
  • For English sessions:12)
    • Collaborate with the classroom teacher to determine vocabulary that will be used in future lessons and focus on those items
    • Send the vocabulary items home for translation. Suggest that the child use any resources available for this task: parents, siblings, dictionaries, internet, etc.
    • Create journals of targeted vocabulary written in English and with translations
    • Create an audio-vocabulary journal: have the child audio-record target words and their definitions in English, then have the child get parents or other bilingual speaker to record the translation and definition of the target words

• For Syntax
  • Language use should be facilitated within activities that are relevant to the client's natural context
  • Work with the child to identify grammar and morphology components that are shared between the L1 and L2
  • Address deficits that are common across the languages using the Bilingual Intervention Model
  • Using the Cross-Linguistic approach, separately but equally address components of the syntax not shared between the two languages of treatment

Gutierrez-Clellen (1999) 13)suggested intervention strategies to develop reading and spelling skills of Spanish speaking children with language difficulties. However, the general strategies suggested could be used in intervention with children who speak other languages as well. Some of her suggestions are below.

As with monolingual children, bilingual children may have different experiences with literacy instruction prior to entering school system. Intervention needs to focus on addressing normal differences in language experiences that may effect children’s acquisition of literacy, and incorporate intervention strategies to focus on needs of L2 learners with language disabilities. The same general intervention strategies for literacy used with monolinguals can be used with bilingual children: such as cooperative learning, and reciprocal teaching. Additionally, these approaches group children with differing language levels so bilingual children can model English for less proficient peers.

Culturally diverse students may be unfamiliar with the expected writing formats used in American schools (poems, reports, narratives, news stories, etc.), in this case appropriate models and instruction about the purpose of writing should be given.

Reading and spelling are interrelated processes. It’s suggested that the two skills be targeted together in therapy. Further, even if a child seems to have adequate skills in retrieving phonology when speaking in English they may not have adequate ability to retrieve phonology when reading or spelling.

• Spelling strategies:
  • Find a way to integrate teaching spelling with meaningful reading and literacy interventions
  • Create lists of words similar to ones children misspell in writing activities, then teach spelling regularities and rules

As with monolingual students, problems with decoding words will lead to problems with reading comprehension. Poor reading comprehension and limited access to English literature further compound low levels of English proficiency and vocabulary knowledge. For these reasons it crucial to not treat word decoding in isolation, but to use meaningful language rich activities.

• Word decoding strategies:
  • Explicitly teach the similarities between the phonological and orthographic systems of the two languages
  • Teach strategies that are thought to be useful for successful L2 learners: use contextual cues, use prior knowledge, identify cognates (associated or related word), and translate parts of text into native language to clarify meaning.
  • For older children explicitly teach similarities between the morphology of the two languages

Resources for selecting multicultural literature:

http://edweb.sdsu.edu/people/jmora/MulticulturalLit/ Provides extensive information on how to use multicultural literature to teach reading

http://content.scholastic.com/browse/article.jsp?id=3757 An article suggesting many books appropriate for children K-8 about Native Americans, Latinos, African-Americans, Jews, and Asian-American.

http://old.sandi.net/depts/instructional_materials/10ways.pdf For the process of selecting books, this page provides suggestions on how to examine children's books for racism and sexism.

Cross language or linguistic transfer refers to the generalization of newly acquired skills across languages and settings 14).

Interventions in one language cannot be expected to result in transfer or gains in the other language(s) for all features in all areas. Transfer can be affected by several factors including:

• the components of language targeted (phonology or grammar)
• the mode being targeted (expressive or receptive)
• the degree of similarity between targets across languages (are phonological processes similar, do similar morphological rules apply)
• the severity of the individual's disorder
• the intervention used 15)

Transfer will also likely be affected by the similarity between the languages. Transfer may more easily happen between languages that are more typologically (letter symbols) and phonemically similar. For example, for individuals who speak Spanish as L1, phonemes present in both L1 and English L2 may be good targets for promoting transfer.16)

Monolingual clinician provides therapy services with the help of a bilingual assistant in providing services.17)

Monolingual and bilingual clinicians work together to provide services.
* Training Parents, Paraprofessionals, Cultural Community Partners (Kohnert et al., 2005).18)

• Family Training Programs
  
  • Parents can be used to support the home language by incorporating techniques into the families natural interactions
    • A program must be modified or created to fit the specific needs of the family in order to be successful, especially for linguistically/culturally diverse families
    • Siblings/Peers may be used to engage young children ,and may be used as models for interaction

• Paraprofessionals may be used to facilitate communication between the clinician and family/caregivers
  • Community partners/cultural brokers
  • Interpreters
  • Teachers/counselors

Bilingual cinician provides all intervention services

The American Speech and Hearing Association (ASHA) provides phonemic inventory information for some languages here http:www.asha.org/about/leadership-projects/multicultural/Phono.htm. Additional languages can be found through the language page.

http://coe.sdsu.edu/people/jmora/MulticulturalLit/ Provides extensive information on how to use multicultural literature to teach reading

http://content.scholastic.com/browse/article.jsp?id=3757 An article suggesting many books appropriate for children K-8 about Native Americans, Latinos, African-Americans, Jews, and Asian-American.

http://www.birchlane.davis.ca.us/library/10quick.htm For the process of selecting books, this page provides suggestions on how to examine children's books for racism and sexism.