I still wonder what it means to have cultural sensitivity. This is one competency area that ASHA has put into the Definition of a Bilingual Speech-Language Pathologist and Audiologist. I've read that there are tests to assess a person's ability to adapt to another culture, thus your ability to travel in other countries and adapt to the new culture. There are people who are more adept to learning about another group of people and are more likely to succeed in integrating with the new group. Brislin from the University of Hawaii talks about specific characteristics that a person must have, such as a sense of humor and the ability to laugh at oneself when you make a mistake in the language.
For some people, the term cultural sensitivity may mean using culturally diverse foods and presenting holidays in therapy to add "culture" to the mainstream curriculum. For some it may mean speaking Spanish to children during therapy, not necessarily for therapy, just speak a few words to help the child feel comfortable. What ever has been done in the name of "cultural sensitivity" I'm sure ranges from a greeting to the unique possibilities in a curriculum.
As I've worked with bilingual graduate students, native and non native, I can see and hear the differences in "Culture" by the way a student greets a parent, speaks to a child, or interprets the results from a testing or conference session. Students from different cultures will perceive the same situation differently. We all have these cultural lenses that affect how we see an event and how that event is interpreted. This may be the reason that we try so hard to recruit native speakers of Spanish to the field of speech language pathology and audiology.
It is assumed that clinicians from the same ethnic and cultural background as the client may have the cultural sensitivity to recognize clinical practices that might affect the performance of the client. What exactly these characteristics may be are still unclear. I tried to describe these verbal and nonverbal communicative behaviors with two clinicians during a speech and language screening event with monolingual English-and monolingual Spanish-speaking Hispanic preschoolers. Both clinicians were first year graduate students. They didn't have extensive diagnostic clinical experiences as well as orientation to how program supervisors may want a student to administer a screening test. I was hoping to see what these two students would do on their own without the typical indoctrination that is given in most graduate programs in speech language pathology. One clinician was a native monolingual Anglo English speaker and the other was a bilingual Mexican American whose first language was Spanish when she entered the public schools. They each screened 10 Spanish monolingual or 10 English monolingual children. All children were Hispanic.
What I observed was interesting and a pattern consistent for all of the children they tested. The two clinicians were different in four nonverbal areas of interaction:
- touching for behavior control,
- head nodding or shaking,
- facial expression, and
- eye gaze.
Touching was not observed for the English-speaking clinician (EC), but was a behavior consistently used by the Spanish-speaking clinician (SC). Touching was used to control the child's behavior or to get his or her attention on the immediate task. SC touched the child's hands, fingers, and back. Therefore, SC was no more than 1 foot away from the child and EC had more distance between herself and the child. SC also used head nods and shakes to affirm, agree, and disagree with the child. These nonverbal acts were frequently the only communicative acts used by SC. Although EC frequently smiled and was friendly, SC's facial affect had much more variation. She would show facial grimaces that expressed confusion if the child's utterances were unclear, dissatisfaction if the child did not behaviorally comply, and interest in the child's background and knowledge. Of particular interest was the increased use of eye gaze by the Hispanic clinician to control the child's behavior. A stern look at the child was frequently all that was necessary to regain attention for a task. This "look" is so often seen in Hispanic mothers' control of children.
The sequence of interactions used by these two clinicians as they administered a test stimulus was also different. After EC administered a test stimulus, she looked down at the protocol and then looked up at the child. The Hispanic child would respond either verbally or non verbally. If the child responded non verbally, EC would miss the nonverbal responses such as eye gaze for referencing or the slight movement of the child's body to indicate the answer (e.g., child lifts shoulder to show his or her "shoulder"). The Hispanic clinician continued to observe the child after giving the stimulus. If the child responded non verbally, SC accepted or rejected the response and then proceeded to mark her protocol. SC didn't have to have a pointing or verbal response to give the child credit for the test stimuli.
Verbally, SC would begin each session with an introduction, "my name is and what is your name"? SC would give the child compliments on a dress, shoes, shirt, or something the child was wearing and then ask, "who gave you that .?" The child always responded appropriately. Again, this is so often part of the family's socialization of the child and the socially acceptable way of responding to compliments. There were three specific differences observed in the clinicians' linguistic behaviors. These included the use of (1) directives, (2) clarifications, and (3) explanations. The Hispanic clinician was direct in her requests of the child's behavior and performance on the screening test. Her directives were performatives such as di (say) or haz (do). In contrast, EC was indirect in her requests of the child's behavior and performance on the test. Her indirect requests were in the form of hints (e.g., "Did you have milk or orange juice?" after asking "Can you tell me what a class is used for?"), questions (e.g., "Can you point to your nose?"), permission statements (e.g., "Can we finish this?"), and statements of need (e.g., "I want you to do some things for me"). The overall communicative style of the Hispanic clinician was direct, whereas the Anglo clinician's style was polite and indirect.
The second linguistic difference between the two clinicians was in the use of clarifications during communicative breakdown. SC used repetition as the means for clarifying with the children. Repetitions ranged from one to four times for the same test stimulus, without a change in the form. EC used rephrasing as the means for clarifying information for the children. If the child did not respond to the clinician's statement, the clinician immediately rephrased the test stimulus. I asked the clinicians why they used repetition or rephrasing when the child did not respond. SC repeated because she was sure the child was not paying attention and she just needed to repeat. EC stated that she rephrased because she felt that the child did not understand and so tried to rephrase to make the request simpler.
The third linguistic difference between the two clinicians was in the use of explanations by EC to introduce each subtest. The clinician would give an explanation and then ask if the child understood and was ready to begin the testing. The Hispanic clinician did not provide explanations but instead was directive and told the child what to do next. The Hispanic clinician's interaction lacked explanations and used no transition into the next subtest. Needless to say, the Hispanic clinician's testing time was 3-5 minutes faster than EC's testing time.
What was the result of the testing? All of the children were typical language learners and 9 of 10 passed SC's testing. Only 2 of EC's children passed the testing. I've seen this same pattern with non native bilingual clinicians. They can speak Spanish, but miss the cultural aspects of interactions. I've learned enough about Hispanic clinicians and their interactions with Spanish speaking children to see the same patterns as that one graduate student with other children. It's a matter of pointing this out to non native speakers so that they recognize that speaking a language with a native speaker is like a dance. Each one makes a move and the other follows in synchrony. The reverse is also true. When Hispanic clinicians interact with Anglo families, they're interactions have to change so that they're perceived to be in synchrony with these families expectations. Both Hispanic and Anglo bilingual clinicians have to be sensitive to the cultural differences of the families they will work with, whether it's mainstream, Puerto Rican, Dominican, Mexican, or Cuban. We are slightly different from each other.
I've tried to address the issue of cultural sensitivity in our work with bilingual clients. I've used foods, holidays, dress, music, dance, and role play as a vehicle to convey culture and help children progress in therapy. The interactive component of culture is just as important and probably an area that is not as well defined for us. But it is an area that we need to think about. I hope that this perspective of culture and its importance in diagnostics and treatment is one that we all will attempt to address in our work with children and adults.
