plans and actions, and could even be run under the auspices of the established associations in this field: ASHA, WHO, and CPLOL (https://cplol.eu). An added intrinsic value is ongoing training, that is, the enhancement of cultural and linguistic competency and, most importantly, the confidence that emanates from knowing that one has a starting point when dealing with the stumbling blocks associated with cultural and linguistic diversity within one’s own clinic and as part of one’s standard clinical practicum.
2.7 Issues in Cultural Competence
Cultural (or intercultural) competence (CQ) is a term used to denote behavioral patterns, attitudes, and policies that encourage effective interaction in cross‐cultural contexts (e.g., Cross, Bazron, Dennis, & Isaacs, 1989). Cultural competence is yet another requisite aptitude for clinical service providers, when collaborative and culturally competent practices are aimed for (e.g., Verdon, Wong, & McLeod, 2016; Westby, 2007). Because a person’s cultural experiences change over time, the ability to be effective in cross‐ or multicultural interactions depends upon those life experiences, which themselves ultimately guide one’s conscious and unconscious deeds. The first step is awareness. According to Cross et al. (1989), there are six gradually overlapping stages in acquiring cultural competence, starting with complete lack of it and hostility: destructiveness → incapacity → blindness → pre‐competence → proficiency → cultural responsiveness, and → competence. The term responsiveness (e.g., Hyter & Salas‐Provance, 2019) is preferred over competence (a higher endpoint) to denote a more realistically attainable level of ability, since one’s cultural learning experience has the potential to keep developing throughout one’s lifetime.
To be culturally responsive/competent, a service provider needs to have a degree of acculturation/assimilation of one’s own self (“identity”; Sarbin, 1997) to that of the client and the client’s supporting party (family/peers), that is, to exhibit a combination of knowledge of facts, an ability to empathize (emotional quotient, EQ), as well as, a capacity to fine‐tune one’s behavior with respect to that of others. In other words, cultural competence involves combining a “mindset”, a “heartset” and a “skillset” (e.g., Kim, 2019)—aptitudes that are built on knowledge, awareness, humility, sensitivity, reciprocity, critical and dialectical thinking, linguistic responsiveness, metacognitive skills, and so forth. Beginning with self‐reflection, an actual process of evolution needs to be initiated, often depicted by a spiral: the inner part of the spiral starts with the self (one’s own undercurrent cultural beliefs/values/perspectives that affect one’s resulting behaviors) that expands upwards and outwards, gradually diverging toward an understanding of the self of others, either of one’s own or of different culture(s). Such spiral‐like progression also involves substages in the development of intercultural sensitivity, what Bennett (2004) has identified to be as follows: denial → defense → minimization → acceptance → adaptation → integration; personal attributes affecting this process also include “open‐mindedness,” “self‐concept” (Shavelson & Bolus, 1982), a lack of prejudice, and the capacity to control one’s emotions in social interaction.
Metacognitive skills that positively contribute in enhancing cultural competence involve cognitive flexibility, comparative thinking, and a realization that biases (conscious or unconscious) are acquired, and that, as such, they can also be identified, suppressed, and overcome (e.g., Cheng, 2007). The quest for intercultural competence is open‐ended and varies from individual to individual; it may come as a revelation that so much relevant information goes unnoticed during a therapist’s clinical practicum, due to lack of awareness, or when one does not intentionally scrutinize personal, social, or domestic factors that may affect one’s viewpoint and stances in the interaction with the client, starting at the stage of interviewing to discharge. The ultimate aim of this quest is to primarily maximize communication by first focusing on differences, making sense of them, and then utilizing these differences to the best of one’s ability to address clinical conditions, where such differences may or may not influence the manifestation and/or nature of disorder.
Lastly, cultural competence is vital in gaining control of the ability to treat a client equitably, that is, in a way that best promotes the client’s interests, taking into consideration her/his particular circumstances, which may be different from those of another with a similar diagnosis. Equitable treatment leads to true equality and curtails disparities in clinical service provision, meeting people where they are, not where one thinks they are or should be.
2.8 Concluding Statements
This chapter endeavors to showcase, as comprehensively as space limitations permit, significant pieces that make up the diversity training puzzle in the theory and practice of speech and language pathology. A concluding statement would identify sociology, ethnography, psychology, applied linguistics, and communication studies as the backbone structure feeding multilingual/multicultural issues relevant to the training of speech language therapists. A more in‐depth coverage and specific suggestions on how these perspectives can be utilized along each specific phase of the clinical practicum is beyond the scope here. It is felt that an overarching approach that succinctly summarizes relevant issues is the first place for a naïve clinician to start their ascent to well‐targeted cultural and linguistic efficacy as part of their clinical repertoire. Last but not least, curiosity, and a thirst for new knowledge, or in other words a knack for research, are also imperative to meet the code of ethics requirement for lifelong learning.
Whether that is something a clinician will do in the end, or not, is best answered by Ingram (2012, p. 3):
The linguist David Crystal once raised the question of whether or not a monolingual English‐speaking … (SLP) would ever need to know something about Swahili. The answer, of course, is a definite yes, no or maybe. Reasons why she should, include the fact that it is interesting to linguists and SLPs, she might move to a Swahili‐speaking country one day, she might develop an interest in Swahili folk music and culture or she might have a Swahili‐speaking client on her caseload. Reasons why she should not, include she might not like linguistics, never move to a Swahili‐speaking country, care for international music or ever see a Swahili speaking client. That leaves us with maybe.
REFERENCES
1 American Speech and Hearing Association. (2010). Designing ASHA’s future: Trends for the association and the professions. Retrieved from https://www.asha.org/uploadedFiles/Designing‐ASHAs‐Future.pdf
2 American Speech and Hearing Association. (2018). Demographic profile of ASHA members providing bilingual services. Retrieved from https://www.asha.org/uploadedFiles/Demographic‐Profile‐Bilingual‐Spanish‐Service‐Members.pdf.
3 American Speech and Hearing Association. (2019a). Diversity and inclusion. Retrieved from https://www.asha.org/About/Diversity‐and‐Inclusion‐at‐ASHA
4 American Speech and Hearing Association. (2019b). Multicultural/multilingual issues courses: A resource for instructors. Retrieved from https://www.asha.org/practice/multicultural/faculty/metaanalysis
5 Anderson, S. R. (2019). How many languages are there in the world. Retrieved from https://www.linguisticsociety.org/content/how‐many‐languages‐are‐there‐world
6 Arias, J., & Lleó, C. (2013). Rethinking assessment measures of phonological development and their application in bilingual acquisition. Clinical Linguistics & Phonetics, 28, 153–175.
7 Armon‐Lotem,