After becoming a bilingual clinical supervisor at the Communication Disorders Department at North Carolina Central University (NCCU, Durham) in 2004, I began considering how to implement a Spanish-language practicum. Students we recruited were interested in bilingualism and the department attracted more and more students who spoke, read, and wrote Spanish.
North Carolina has fewer than 40 bilingual speech-language pathologists to serve its burgeoning Hispanic population, which has grown more than 500% in the last decade. The need for quality bilingual evaluations and interventions for monolingual and bilingual preschool and school-age children is critical, but no bilingual sites in our state offered supervision for graduate students doing their practica.
A fortuitous sequence of events led to an NCCU summer Spanish practicum in 2007. NCCU had been expanding its global contacts. NCCU's head of international affairs, Emmanuel Ortisejafor, and provost went to the Universidad del Valle de Orizaba (UniVO), in Veracruz, Mexico, in early 2006 to set up a memorandum of understanding that allows students to receive credit for courses taken in the reciprocal university. Veracruz was selected because a large percentage of immigrants in the Research Triangle area (Durham-Raleigh-Chapel Hill, N.C.) are from that Mexican state.
A few months later, unaware of the agreement, I asked for Ortisejafor's help in taking our speech-language pathology students to Mexico for a summer experience in clinical work and intense Spanish study. An NCCU delegation visited UniVO in fall 2006 to verify that practicum sites would be adequate—an important question because only seven SLPs in Mexico are ASHA-certified. Mexico has no equivalent to ASHA certification. Physicians list audiology-phoniatrics as a specialty and there are speech "therapists," although the latter often have the equivalent of an associate's degree.
In June 2007, I traveled with six NCCU graduate students to Orizaba for a five-week program. To participate, students were required to complete three semesters of college-level Spanish, a semester-long practicum using only Spanish with clients, and a semester of Spanish for SLPs.
Before departing, students completed sections of the Woodcock-Johnson Test of Language Proficiency-Revised. They also produced a two-minute audio language sample by responding to questions provided by a professional Spanish speaker. Two native Spanish speakers and a Spanish teacher independently judged the students' Spanish proficiency. The three judges had a .95 inter-rater agreement for the pretest and a .92 inter-rater agreement for the post-test level of proficiency of the oral language samples. They used modified criteria from the Interagency Language Roundtable Scale and rated the students on the post-test oral sample at level 2 (working level) and level 3 (professional level).
An Overwhelming Pace
Students lived with local families and studied Spanish at UniVO for six and a half hours per week. Linguistic knowledge alone is insufficient for cultural competence, so the students were immersed in Mexican culture (see sidebar).
For the first two weeks, students worked at Centro de Atención Multiples (CAM), a multidisciplinary center for children with disabilities, and a regular-education primary school, Abelardo. Students spent the second two weeks in planning and treatment. During the last week, students wrote progress reports. During the weekends, UniVO scheduled three trips to visit Córdoba, Veracruz, and Puebla. Two weekends were set aside to spend with the host families.
Six undergraduate English majors from UniVO assisted, accompanying the graduate students and interpreting for physicians, occupational therapists, physical therapists, and teachers. The UniVO students reported positive interactions with the NCCU group. Because of the experience, four of the UniVO students are considering careers in speech-language pathology and two are considering careers in special education.
The graduate students and I trained the UniVO students to interpret, as their faculty had no prior experience teaching interpreters. We used Henriette W. Langdon's manual (2003), a glossary of terms, and templates of letters and forms from our schools and clinics.
In addition to their time at CAM and Abelardo, the students gained experience in an interdisciplinary medical clinic—Centro de Rehabilitación Integral en Orizaba (CRIO)—and a preschool. At each setting, the students diagnosed and/or treated a number of people with various communication disorders.
The students worked with one trilingual (Spanish/English/Portuguese) client who had aphasia as a complication from chemotherapy for leukemia. They also worked with an elderly stroke survivor who was bilingual (Spanish/English) premorbidly, and another elderly client with hemiplegia subsequent to stroke who had dysphagia. Other adults with language disorders included a 57-year-old woman with cognitive disabilities. She had never been encouraged to speak, and spoke her own name for the first time during one of the graduate student sessions.
Children with language disorders included a 4-year-old with Down syndrome who had a vocabulary of only three words, and many other children with delayed or specific language impairments. We also saw several children with cleft palate.
The students also gained practicum hours working in the area of aural rehabilitation with a child who had a severe bilateral hearing loss and ill-fitting hearing aids; a patient with bilateral atresia and hearing loss associated with cleft palate; and others with hearing loss, some of whom who used Mexican Sign Language.
Noise levels were high in all the schools we visited—many sixth-graders in Abelardo failed a hearing screening. The children probably experienced learning difficulties because of the ambient and competing noise. We sent recommendations to these schools to help them monitor and improve the signal-to-noise ratio.
Two of the NCCU students worked on their research thesis topics, which involved bilingual or Spanish language-only children. One student standardized the Test de Vocabulario en Imagenes Peabody (TVIP) on the Orizaban children, thus helping to make the use of the TVIP in North Carolina more reliable and valid. The other graduate student sought to standardize a Spanish preliteracy screening tool developed in North Carolina.
All graduate students were interns on a training grant funded by Sheila Bridges-Bond, an associate professor in the Department of Communication Disorders. She specializes in multiculturalism, augmentative and alternative communication, and early childhood development. The grant stipulates multicultural and augmentative communication components as part of the training and students participated in several projects reflecting this requirement: the development of a Spanish preliteracy kit for toddlers; Mexican Sign Language communication boards with Spanish subtitles for medical staff; laser-light head-pointing device plus interactive Internet Spanish keyboard and word prediction for an individual with quadriplegia; and a presentation to a group of Orizaban teachers and psychologists on classroom management with augmentative and assistive technology devices.
Ronald C. Jones, an audiologist and professor at Norfolk State University in Virginia, addressed the interns about professional publishing in a presentation broadcast live from NCCU to the Universidad del Valle de Orizaba. Jones was then editor of ECHO, the electronic journal of the National Black Speech-Language-Hearing Association. The students in Mexico were able to see and talk with him over free teleconferencing software.
At the end of the summer NCCU students rated their experiences in the areas of practicum, language training, cultural exposure, and expected application in North Carolina. Students rated the Spanish class in Mexico as most valuable, but rated the Spanish language training prior to traveling to Mexico much lower. They all rated the experience as being helpful for working in North Carolina and Mexico, as well as working professionally and personally in the future. All students improved their oral and written Spanish skills. Two speech-language pathology students graduating at the end of the term want to return after earning their Certificates of Clinical Competence to supervise the next group of students.
It was a great adventure that we repeated. A group of speech-language pathology graduate students, special education students, and I traveled back to Veracruz in summer 2008, with communication disorders students placed primarily at CRIO.