The Changing Demographic Landscape: Implications for CSD Education and Practice
Noma Anderson, PhD
Diversity within our country is steadily increasing. Growing numbers of racial and ethnic minorities, as well as individuals emigrating from all parts of the globe, are transforming our country into a more multicultural and multilingual land. According
to Grimes (2000), there are 176 indigenous languages in the United States, and there are approximately 337 spoken or signed languages. One striking observation is that practically every language, race, ethnicity, and religion is reflected in the populace of our
CSD program faculty are keenly aware that speech-language pathologists (SLPs) and audiologists must have an armamentarium of diagnostic and intervention knowledge and skills in order to deliver competent clinical services to all, including culturally
and linguistically diverse populations. The requirement of university programs to educate students in cultural competence is an essential standard. Specifically, Council on Academic Accreditation in Audiology (CAA) Standard 3.2 (ASHA, 2014b) reads, "The diversity of society is reflected throughout the curriculum."
Developing cultural competence evolves over time, and audiologists' and SLPs' career-long journeys begin in communication sciences and disorders (CSD) university programs.
A message to be communicated to students is that cultural competence is vital to clinical effectiveness. Every state and the District of Columbia are culturally and linguistically diverse. So, wherever graduates from CSD programs work, they are expected to
provide services that are appropriate, effective, and meaningful for their clinical populations. According to the U.S. Census, as of 2015, 21% of people in the United States who are older than 5 years of age speak a language other than English (U.S. Census Bureau,
2015). The U.S. English Foundation (2015) cites that the five most linguistically diverse states are California (207 languages), New York (169 languages), Washington (163 languages), Texas (145 languages), and Oregon (138 languages). Even in this list of top
five states, the one with the lowest diversity (Oregon) still has 138 languages represented. Diversity is our nation's norm.
Accordingly, there is a tremendous need for audiologists and SLPs to provide bilingual services. In 2013, there were 6,491 SLP and 580 audiology bilingual service providers in the United States (ASHA, 2014a). These numbers represent 5% of the ASHA membership-and, of the vast majority of these bilingual service
providers, 81% are white. This is not enough!
Another persisting concern is that the numbers of certified ASHA members and certificate holders who are non-white and Hispanic are not representative of the diversity of the U.S. population. Historically, culturally and linguistically diverse students have
been underrepresented in CSD programs. See Table 1 for the numbers. This is not enough!
Table 1: Percentage of non-white and
Hispanic certified ASHA members
Racial minority (%)
(who identified their race and ethnicity)
(who identified their race and ethnicity)
SLP master's degrees awarded3
AuD degrees awarded3
1Per 2014 U.S. Census data. 2Per 2015 ASHA year-end member counts. 3Per 2015 Council of Academic Programs in CSD and ASHA CSD Education Survey data.
Strategies to Promote Diversity
- It is important for CSD university programs to increase students' exposure to clinical services that are responsive to the wide variety of cultural and linguistic backgrounds and to the values of individuals with communication and swallowing disorders
and with English language learning needs.
- CSD faculty, ASHA, and National Student Speech Language Hearing Association (NSSLHA) members can take advantage of the many ASHA resources to disseminate best practices in cultural and linguistic diversity. In addition to journals and convention offerings, there are e-communities for the purpose of sharing ideas
about culturally competent clinical practice. SIG 14's Perspectives, SIG 14's Cultural and Linguistic
Diversity Digests, and the ASHA Practice Portal are three examples. ASHA also supports diversity in the professions through two programs that are specifically aimed at students who have been historically underrepresented in the CSD professions: the
Student to Empowered Professional (S.T.E.P.) program and the
Minority Student Leadership Program (MSLP) Award. S.T.E.P. is an online mentoring program in which experienced mentors and mentees are matched according to professional interests and work toward specific goals as they form meaningful one-to one supportive relationships. MSLP is a leadership development program
that provides focused educational programming to build and enhance leadership skills for undergraduate and graduate students enrolled in CSD programs. Other ASHA resources include the
Self-Assessment for Cultural Competence (2010) and
Working with Culturally and Linguistically Diverse Students in Schools (2010). In addition, ASHA's
Office of Multicultural Affairs offers policy documents, guides, and tips for addressing the needs of culturally and linguistically diverse students in schools.
- It is so important that CSD university programs recruit, admit, and graduate larger numbers of students from culturally and linguistically diverse groups. I would ask that CSD programs engage in a targeted recruitment process that changes the demographic makeup of CSD student cohorts and future professionals.
Nationwide, large numbers of students of color are in graduate programs-but are not in CSD programs. According to the Council of Graduate Schools (Allum, 2014), students of color make up more than one quarter of all graduate students in the United States. Minority
student enrollment grows at approximately 5% annually, whereas white student enrollment remains unchanged. African American students constitute the largest minority group, followed by Hispanic, Asian American, and American Indian students. Education is the most popular program of graduate study for African American,
Hispanic, and American Indian students. Asian American students are found in higher numbers in engineering and the physical sciences (see
GradSchools.com). I believe that, with improved messaging about the CSD discipline, students who are not familiar with audiology and speech-language pathology yet who are interested in education, engineering, and the physical sciences will become interested in exploring the CSD
- CSD programs can adopt a more holistic student review and admissions process. Holistic review is an admissions process that assesses applicants' unique experiences alongside traditional measures of academic achievement, such as GRE and GPA. The outcome of a holistic process is a more diverse
student enrollment-a student body that is diverse in ethnicity, race, experiences, and socioeconomic status (SES). The Association of American Medical Colleges-together with the Coalition of Urban Serving Universities and the Association of Public and Land-Grant
Universities-is advancing the concept of holistic admissions review process through a program called
Urban Universities for HEALTH (n.d.), a nationwide network of urban universities dedicated to preparing the next generation of health professionals; this and similar programs could be explored by CSD university programs.
The changing demographic landscape in the United States is presenting tremendous demand for culturally competent clinical services in audiology, speech-language pathology, and swallowing disorders. However, the current supply of culturally competent
service providers and the level of diversity in the academic student pipeline are two indicators that supply is seriously lagging behind demand. In 2007, while I served the professions as ASHA president, ASHA's vision statement was rewritten to read: "ASHA: Making effective communication, a human right,
accessible and achievable for all." Diversity is our nation's norm, and our CSD academic programs can make the vision evolve into reality.
About the Author
Noma Anderson, PhD, is dean of the College of Health Professions at The University of Tennessee Health Science Center in Memphis, Tennessee.
References and Resources
Allum, J. (2014). Graduate enrollment and degrees: 2003 to
2013. Washington, DC: Council of Graduate Schools. Retrieved from
http://cgsnet.org/ckfinder/userfiles/files/GED_report_2013.pdf [PDF, 5.9MB].
American Speech-Language-Hearing Association. (2010).
Self-assessment for cultural competence and working with culturally and linguistically diverse students in schools.
American Speech-Language-Hearing Association. (2014a). Demographic profile of ASHA members providing bilingual services. Rockville, MD: Author. Retrieved from
American Speech-Language-Hearing Association. (2014b). Standards for accreditation of graduate education programs in audiology and speech-language pathology. Rockville, MD: Author. Retrieved from
Council of Academic Programs in Communication Sciences and Disorders & American Speech-Language-Hearing Association. (2015). CSD Education Survey National Aggregate Data Report:
2013, 2014 academic years. Retrieved from
http://www.asha.org and from
Grimes, B. F. (2000). Ethnologue: Languages of the
world. Dallas, TX: SIL International.
Urban Universities for HEALTH. (2014). Holistic admissions
in the health professions: Findings from a national survey.Retrieved from http://urbanuniversitiesforhealth.org/media/documents/Holistic_Admissions_in_the_Health_Professions.pdf [PDF].
U.S. Census Bureau. (2015, December). U.S. Census Bureau: State & County QuickFacts [Data derived from Population Estimates, American Community Survey, Census of Population and Housing, State and County Housing Unit Estimates, County Business Patterns,
Nonemployer Statistics, Economic Census, Survey of Business Owners, Building Permits]. Washington, DC: Author. Retrieved from
U.S. English Foundation. (2015). Many languages, one America: Most linguistically diverse states. Washington, DC: Author. Retrieved from