July 20, 2004 Feature

Multicultural Issues in Academic and Clinical Education

A Cultural Mosaic

In 1985, ASHA first encouraged educational programs to include multicultural issues in the professional education of speech-language pathologists and audiologists. At that time, compliance was voluntary and program accreditation was not jeopardized. By 1994, voluntary compliance was no longer an option. Accredited programs were required to include multicultural content in their curricula.

ASHA's 1999 reauthorization of accreditation standards reaffirmed and strengthened this requirement. Yet academic programs continue to face challenges in compliance. Faculty have been expected to teach about multicultural issues even though most completed their professional education before this curricular content was addressed. They had few, if any, guidelines about what or how multicultural content should be taught. In addition, the knowledge base on multicultural issues was not clearly defined for our professions early on, although it has evolved rapidly over the past decade.

Thus, it is not surprising that our national survey of CAA-accredited programs revealed variability in how multicultural instruction was carried out (Stockman, I., Boult, J., & Robinson, G. [2003]. Multicultural content in speech-language pathology and audiology curricula: A survey of ASHA-accredited programs. A poster session presented at the ASHA Convention, Chicago, IL). Yet most respondents agreed on the importance of including multicultural issues in academic and clinical instruction.

Despite good intentions, many faculty are challenged by the practical implementation of multicultural instruction. The survey respondents suggested that faculty need better guidelines for including multicultural content in academic and clinical education and access to instructional resources that support teaching efforts.

Curricular Infusion of Multicultural Content: Terminology Issues

The infusion of multicultural content into existing courses is now the preferred instructional model. However, academic instruction has not been guided by consensus about what is meant by either multicultural or infusion.

Defining Multicultural

The concept of "culture" is embedded in the word multicultural. Culture can be viewed broadly as the socially constructed and learned ways of believing and behaving that identify groups of people. Verbal and nonverbal communication behaviors readily identify cultural groups. By attaching the prefix multi- to the word culture, we can refer to more than one socially constructed and learned way of believing and behaving. This definition recognizes the United States as a multicultural nation because of the different cultural groups, inclusive of mainstream varieties, that co-exist within its borders. However, this interpretation of multicultural is not the sense in which the word is commonly used in our professions.

Multicultural is used often to refer to one or more particular minority racial/ethnic groups in the United States. For example, African Americans are viewed as a "multicultural population" as are Native, Hispanic, Asian, and Arab Americans. The reference is not to the various cultures existing within these broadly defined groups. The reference is to an entire minority group whose cultural identities are rooted largely in a non-European ancestry. Multicultural instruction is required because these cultural identities and differences historically have been marginalized in the larger society and have remained unfamiliar to the professionals who most often deliver clinical services.

Nevertheless, the meaning of multicultural is narrow when applied only to certain minority racial/ethnic groups. It excludes the full range of people that define the U.S. cultural landscape, and worse, suggests there is a homogeneous "culture-free" mainstream society. This is so, although all human social communication is inherently a cultural experience.

Ultimately, we hope our professions can move to a more inclusive perspective that recognizes that individuals in all cultures have multiple and complex identities. These identities are created by their membership not only in a racial or ethnic group, but also in groups defined by gender, social class, religious preference, geographical region, sexual orientation, linguistic community, and so on. In this sense, every person belongs to a multicultural group. We advocate using the term multicultural to refer to the full range of co-existing cultural groups within a society.

Defining Infusion

According to our survey, most ASHA-accredited programs lack a course dedicated to multicultural issues. They most often require that multicultural content be infused into the existing curriculum. However, professionals do not interpret infusion in the same way. Some view infusion as inclusion. This interpretation does not commit instruction to any specific expectation about how multicultural issues are taught; a program merely needs to show that multicultural content is addressed somewhere in the curriculum or in a given course.

For others, infusion means adding to a course a separate lecture or unit of instruction devoted to multicultural issues. Such isolated, in-depth treatment of multicultural issues can enrich course content, just as a review of other areas (e.g., language development) might. But including multicultural information only in the context of isolated units of instruction represents an annexation perspective. It sends the message that the added information is peripheral and possibly less important to the core of knowledge covered in the rest of the course.

Alternatively, we advocate integral infusion. This viewpoint requires multicultural issues to be embedded throughout the content of a given course and academic curriculum. This relies on the premise that all communication interactions are inherently cultural experiences, and that culture can influence human experience (physical-biological, mental, social, linguistic, emotional, and so on). Therefore, multicultural content should neither add to nor replace existing course content. Instead, integral infusion means that instruction aims to blend existing knowledge about audiology and speech-language pathology with the knowledge about culture in ways that create a different and richer academic content than is obtained by treating these two aspects in isolation.

Strategies for Structuring the Infusion of Multicultural Content

Educational programs may commit to an integral infusion model. Yet, implementing it across a curriculum comprising different types of course content remains an issue. We offer an example here of how a generic framework could guide instructional infusion efforts. The example focuses on clinical instruction. We identified seven generic professional activities routinely carried out when delivering clinical services regardless of clinical disorder type:

  • Referring-providing client access to clinical services
  • Scheduling-selecting the time for client to receive clinical service
  • Gathering information-obtaining client's initial background information
  • Assessing-determining the nature of client complaint
  • Treating-modifying client's hearing and/or communication status
  • Recommending-advising and counseling client about potential action plan
  • Discharging-terminating client/clinician relationship

We considered how these professional tasks can be influenced by one or more of the following shared aspects of culture that can identify social groups:

  • Common history-shared experiences as member of a group with particular racial, ethnic, and national origins
  • Beliefs and values-commonly held truths and values that shape one's view of the world and actions
  • Customs-traditional, ritualistic modes of behavior
  • Material culture-artifacts and tools, including technology
  • Learning style-preferred mode of acquiring new information
  • Language-formal systems of social communication
  • Social interaction style-rules of social engagement and negotiation
  • Social organization-family and local community structure

A mosaic of cultural variation is created by the patterning of similarities and differences among groups. Two groups may differ on some cultural variables but not others. Groups A and B may significantly differ in language but not learning style. Groups A and B may differ from Group C in customs, but Group C may be like Group A in religious beliefs and like Group B in social interaction style, and so on (see schematic). A client need not differ from the professional who delivers clinical services in every respect, even if both are from different cultures.

The pairing of each shared cultural element with each type of professional service delivery activity or task identified above can yield many opportunities for naturally infusing multicultural content across courses and clinical practica. For example, a client's native language and social interaction style can affect nearly every aspect of service delivery. We already know that service delivery strategies must be modified depending on whether a client speaks a prestigious regional or social English dialect, or one or more languages other than English. Aside from that, social interaction style in all areas of service delivery can be influenced by the cultural value placed on behaviors such as maintaining eye contact and talking a lot (verbosity).

However, all eight of these cultural elements need not be relevant to every clinical activity. Even different aspects of the same cultural element (e.g., beliefs and values) can influence different clinical activities. For example, beliefs about disabilities can determine whether a referral for clinical services is even taken seriously. Some clients may view a communication disorder as a sacred gift, while others may view it as a necessary burden that should not be eliminated. Alternatively, some groups may believe that a client's disorder should be treated but only by the local expert designated by a cultural group (e.g., a community elder or chief).

Even when clients follow up on a referral for conventional hearing, speech, and language services, scheduling of clinical services can be influenced by a client's beliefs about time. Some groups follow event-time as opposed to chronological clock time. Particular customs (e.g., holiday and religious observances) must be considered when scheduling services. The same clients' attitudes about time need not affect the type of assessment and intervention activities. Other factors could be relevant such as learning style or the artifacts of the material culture.

Each of the remaining shared elements of culture can be applied in a similar manner. The specific cultural content that becomes relevant may vary with the type of course content taught (e.g., clinical services for hearing versus speech-language disorders).

When all is said and done, multicultural infusion should not mean that faculty must know and teach about every possible culture or cultural difference, however committed and sensitive their professional outlook may be. Nevertheless, instruction should expose students to enough examples to prime their expectations that cultural differences do matter in their professional work.

Using Available Instructional Resources

Our national survey of ASHA-accredited programs revealed that most professionals would welcome access to multicultural information that can be included in their course content. Most respondents preferred obtaining such information from professional development workshops and online sources. Taking a course on multicultural issues was the least preferred option.

Fortunately, ASHA's Office of Multicultural Affairs is responding to this need for more information. Its Web site is being expanded to include information about a variety of print, media, and digital instructional resources focused on multicultural issues. These resources will include exemplary course syllabi, descriptions of special instructional projects, reference lists of journal articles and books categorized by type of communication disorder, as well as multimedia (video, film) and digital resources (compact disks and Web sites).

The Present and Future

Over the past decade, ASHA's accredited educational programs have made strides in meeting the accreditation mandate to infuse multicultural content into the professional education of SLPs and audiologists. Many professionals now take for granted that it is necessary to distinguish a normal communication difference from a clinical disorder.

Nonetheless, the continuing trend to treat multicultural issues as just a minority racial/ethnic group issue suggests that we have not come far enough. We have not recognized culture as a basic determinant of social communication. It is not surprising, therefore, that the social-cultural basis of communication is not among the core knowledge areas required for the professional education of audiologists and SLPs along with the anatomical, biological, cognitive, psychophysical, psychometric, and developmental areas.

Other challenges remain. In this article, we have offered one strategy for guiding attempts to create culturally embedded academic content in ways that may better prepare students to work in a culturally heterogeneous world. The professionals who instruct the various courses must determine whether this recommended approach to multicultural curricular infusion or some other approach can be actually implemented for a given area of expertise or specialization in hearing, speech, and language disorders.

 A Schematic of How Cultures Share and Differ  [PDF] 

Ida J. Stockman, is a professor of communication disorders at Michigan State University. Her research and teaching focus on multicultural issues in the professions spans more than two decades. Contact her at stockma1@msu.edu.

Johanna Boult, is a doctoral student at Michigan State University. Her primary research interest is in the area of multicultural issues, specifically multicultural pragmatics and African American language development and assessment. She has worked as a certified SLP in such diverse environments as Honolulu, HI, and rural Louisiana. Contact her at boultjoh@msu.edu.

Gregory Robinson, is a doctoral student at Michigan State University focusing on multicultural/multilingual issues in speech-language pathology and minoring in sociolinguistics. He has worked as a SLP and clinical instructor for the past five years in health care, schools, and academic settings. Contact him at robin465@msu.edu.

cite as: Stockman, I. J. , Boult, J.  & Robinson, G. (2004, July 20). Multicultural Issues in Academic and Clinical Education : A Cultural Mosaic. The ASHA Leader.

ASHA Web Resources

Minority Student Recruitment and Retention: Preface

Exemplary Practices in Recruitment, Retention and Career Transition of Racial/Ethnic Minorities to Communication Science Disorders

Minority Student Recruitment, Retention and Career Transition Practices: A Review of the Literature

Compendium of Exemplary Practices by Colleges and Universities in the Recruitment, Retention and Career Transition of Communication Sciences and Disorders Professionals

Policies and Procedures

There are several documents in ASHA's Desk Reference that are important to service and delivery to culturally and linguistically diverse populations. Members can access these and other Desk Reference documents in the "For ASHA Members Only" section of the ASHA Web site.

  • Definitions of Communication Disorders and Variations (Vol. 4)
  • The Knowledge and Skills Needed by Speech-Language Pathologists and Audiologists to Provide Culturally and Linguistically Appropriate Services (Vol. 4)
  • Provision of English-as-a-Second-Language Instruction by Speech-Language Pathologists in School Settings (Vol. 3)
  • Clinical Management of Communicatively Handicapped Minority Language Populations (Vol. 4)
  • Social Dialects (Vol. 3)
  • Implications of the Position on Social Dialects (Vol. 3)
  • The American English Dialects (Vol. 3)
  • Students and Professionals Who Speak English With Accents and Nonstandard Dialects: Issues and Recommendations (Vol. 3)
  • The Code of Fair Testing Practices in Education (Vol. 1).

Select Readings on Multiculturalism

American Speech-Language-Hearing Association. (1987). Multicultural professional education in communication disorders: Curriculum approaches. Rockville, MD: Author.

Battle, D. (1993). Curriculum approaches for teaching cultural diversity in professional programs in allied health. In L. Clark (Ed.), Faculty and student challenges in facing cultural and linguistic diversity (pp. 221–241). Springfield, IL: Charles C. Thomas.

Battle, D.E. (2000). Becoming a culturally competent clinician. Newsletter of ASHA Special Interest Division 14: Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 6(3), 19–22.

Bensimon, E.M. (Ed.) (1994). Multicultural teaching and learning: Strategies for change in higher education. University Park, PA: National Center on Postsecondary Teaching, Learning, and Assessment: The Pennsylvania State University.

Clark, L.W. (Ed.). (1993). Faculty and student challenges in facing cultural and linguistic diversity. Springfield, IL: Charles C. Thomas.

McGee, P. (1992). Teaching transcultural care: A guide for teachers of nursing and health care. London: Chapman and Hall.

Peters-Johnson, C. (1992). Professional practices: Perspective on multicultural issues. Asha, 34, 14.

Rosa-Lugo, L., & Fradd, S. (2000). Preparing professionals to serve English-language learners with communication disorders. Communication Disorders Quarterly, 22, 29−42.

Saenz, T. (1994). Teaching and mentoring culturally diverse students. Creative Teaching, 6, 1−4.

Terrell, S.L., Mueller, P.B., & Conley, L. (1991). Sister programs: Historically Black and majority-White universities. ASHA, 33, 45−48.


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