Cultural Competence in Professional Service Delivery

It is the position of the American Speech-Language-Hearing Association (ASHA) that professional competence in providing speech-language-hearing and related services requires cultural competence. Cultural competence is a dynamic and complex process requiring ongoing self-assessment and continuous expansion of cultural knowledge. Cultural competence involves understanding the unique combination of cultural variables that the professional and patient/client bring to interactions. These variables include, for example, age, ability, ethnicity, experience, gender, gender identity, linguistic background, national origin, race, religion, sexual orientation, and socioeconomic status.

Cultural competence includes the following:

• valuing diversity: awareness and acceptance of differences

• conducting cultural self-assessment

• being conscious of the dynamics inherent when cultures interact

• having institutional cultural knowledge: integration of cultural knowledge within individuals and systems

• adapting to diversity and the cultural contexts of the communities served (Cross, Bazron, Dennis, & Isaacs, 1989).

Cultural competence evolves over time. It begins with understanding one's own culture and continues through interactions with individuals from various cultures and expansion of knowledge (ASHA, 2004a). It is imperative that ASHA members continually and critically assess their own level of cultural competence. This process, known as “cultural humility,” includes critical self-assessment, recognition of limits, and ongoing acquisition of knowledge. Cultural humility may require an attitude shift in which speech-language pathologists and audiologists recognize what they do not know and seek to gain knowledge and experience with the relevant languages and cultures of the individuals (Tervalon & Murray-Garcia, 1998), families, and communities they serve. A cultural mismatch within the clinical context may have an impact on perceptions and interactions, with critical implications in diagnostic and therapeutic decisions.

This position statement is an official policy of the American Speech-Language-Hearing Association (ASHA). The ASHA Scopes of Practice state that the practice of audiology (ASHA, 2004c) and the practice of speech-language pathology (ASHA, 2007) include clinical services, prevention, advocacy, education, administration, and research in the areas of speech, language, hearing, swallowing, and balance across the life span from infancy through geriatrics. The patient/client population reflects a wide array of differences as well as similarities across cultural variables. Given the diversity of the client population and accountability across professions and settings, ASHA policy requires that these practices be conducted in a manner that considers the impact of culture and linguistic exposure/acquisition and uses the best available evidence for practice to ensure optimal outcomes for persons receiving professional services. Audiologists and speech-language pathologists are prohibited from discriminating in the provision of professional services based on these factors (ASHA, 2010). In some cases, such factors may be considered in assessment and treatment plans and, when appropriate evidence is available, grounded in scientific and professional knowledge (ASHA, 2004c).

Professionals must be knowledgeable of federal and state laws that have an impact on service delivery. Evidence-based practice requires that professionals be mindful of each patient's/client's cultural and linguistic characteristics so that the most effective assessment and intervention services may be provided to meet the needs of the individuals they serve (ASHA, 2004b; ASHA, 2006). Services should be provided in a manner congruent with the patient's/client's, family's, and community's cultural beliefs, practices, and linguistic background. Speech-language pathologists and audiologists must recognize each patient's/client's unique cultural background and avoid making assumptions about an individual's culture and communication characteristics. Therefore, techniques appropriate for one individual may not be appropriate for another. It is also important to recognize that the unique influence of the individual's cultural and linguistic background may change over time and according to circumstance.

In summary, culturally competent professionals must have knowledge, understanding of, and appreciation for cultural and linguistic factors that may influence service delivery from the perspective of the patient/client and his or her family as well as their own.

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References

American Speech-Language-Hearing Association. (2004a). Knowledge and skills needed by speech-language pathologists and audiologists to provide culturally and linguistically appropriate services. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004b). Preferred practice patterns for the profession of speech-language pathology. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2004c). Scope of practice in audiology. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2006). Preferred practice patterns for the profession of audiology. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2007). Scope of practice in speech-language pathology. Available from www.asha.org/policy.

American Speech-Language-Hearing Association. (2010). Code of ethics. Available from www.asha.org/policy.

Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989). Toward a culturally competent system of care (Vol. 1). Washington, DC: CAASP Technical Assistance Center, Georgetown University Child Development Center.

Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117–125.

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