by Rachel Nelson, California State University, Fullerton
As speech-language-pathologists (SLPs), it is our responsibility to seek to provide the best care to all of our clients by taking into consideration their “unique combination of cultural variables and the full range of dimensions of diversity” (American Speech-Language-Hearing Association, n.d.a). Each client that comes into contact with an SLP is unique and has their own set of culture and values that must be considered in all interactions. As SLPs, it is not only our job to help others communicate, but for us to communicate well to provide the best possible care for all clients. The following scenario is an example of an SLP having the best intentions, but not appropriately considering the child’s family’s needs when making decisions to communicate.
Marissa is in her first month at her job as an SLP for a public school. She is presented with a school-aged client who has recently moved to the area from a different country. His teacher refers him to Marissa because he is not talking in class, and when he does, his speech is unintelligible. Marissa calls his parents to get permission to assess, and they refuse, saying there is nothing wrong. Marissa is not fluent in the child’s family’s primary language and decides it may be helpful if she can get a translator who speaks in the family’s primary language. Since she is new to the area, she is still learning about the resources available for working with translators, and to save time, requests a school aide to assist her in translating because she already knows this aide speaks the family’s primary language. While the school aide has never translated for an SLP before, Marissa reasoned this was the best and fastest option at the time. Marissa then plans a meeting with the child’s mother and the school aide to discuss the need for further testing.
When the child’s mother shows up to the meeting, she is visibly upset when she sees the school aide. The child’s mother also leaves upset, and Marissa is left feeling confused as to what she did wrong. Marissa later discovers that, in the child’s culture, disabilities are viewed very negatively and may bring feelings of shame, which contributed to the reason this family did not want their child to be assessed. Additionally, the school aide, while fluent in the language, was not trained by Marissa beforehand, and unbeknownst to Marissa, some of her discussion points were altered based on the school aide’s opinion of what would sound better to this child’s mother. This led to errors in translation, such as the mother not clearly knowing their meeting would be confidential. This contributed to this child’s mother’s feelings of embarrassment and fear that news of her son needing assessment would make it to her community and bring shame among her and her family in this new place.
The clinician attempted to use interprofessional collaboration (American-Speech-Language-Hearing Association [ASHA] 2016 Principle of Ethics 1, Article B) to collaboratively bring a higher quality of communication (ASHA 2016 Principle of Ethics IV, Article A). However, she failed to properly train the school aide and to take into account the culture of the child’s family when discussing the child’s need to assess.
According to ASHA’s (2016) Code of Ethics Principle 1, Article E “individuals who hold the Certificate of Clinical Competence may delegate tasks related to the provision of clinical services to…support personal, or any other persons only if those persons are adequately prepared and are appropriately supervised.” Marissa violated the code of ethics in not adequately training the school aide, whom she was responsible for supervising. If she had taken the time to train the school aide beforehand, the miscommunications and fear the family had could have been avoided. One method Marissa could have used to train the school aide is following Dr. Langdon’s BID model (Landon & Saenz, 2016). Dr. Langdon provides a three-step process for training and improving success of interpreting, in which, the B stands for briefing, I stands for interaction, and D for debriefing (Landon & Saenz, 2016). It is the responsibility of the SLP to ensure that, for each of the steps mentioned, the interpreter and/or translator is adequately trained. For example, when briefing, Dr. Langdon discusses that the interpreter or translator may be very helpful in relating to the family’s culture but needs to still remain objective (Landon & Saenz, 2016). In this case, the translator was subjective, and in changing the information based on her own bias created problems by causing the mother fear, which could have and should have been avoided.
Additionally, the child’s mother did not feel that her child’s information was protected and that information was not accurately conveyed. According to ASHA’s Issue in Ethics discussion of confidentiality “clients must be assured that all aspects of their communication with an audiologist or speech-language pathologist regarding themselves or their family members will be held in strictest confidence” (American Speech-Language-Hearing Association n.d.c). By being clear from the beginning of the meeting to both the interpreter/translator and to the child’s family, the clinician could have prevented this family’s concern. Furthermore, this indicates that, while effort was made to educate the family, the translations could have contained misinformation due to the miscommunication between the SLP and the interpreter/translator. ASHA’s Code of Ethics (2016) Principle of Ethics III, Article E states that “individuals’ statements to the public shall provide accurate and complete information about the nature and management of communication disorders.” As discussed previously, the clinician needed to accurately describe the information to the interpreter/translator so that interpreter/translator could accurately convey the information to the child’s family. As SLPs, it is our responsibility to ensure that all information is complete and accurate for us to provide the highest quality of care.
Based on how Marissa handled this situation, she could benefit from gaining more knowledge on working with clients from linguistic and culturally diverse populations. She could accomplish that by incorporating it into her learning experiences required by ASHA Code of Ethics (2016) Principle II, Article D, which states that “individuals shall enhance and refine their professional competence and expertise through engagement in lifelong learning…” Furthermore, according to ASHA’s practice portal on Cultural Competency “clinicians have an obligation to seek the information and expertise required to provide culturally competent services…” (American Speech-Language-Hearing Association n.d.b). Cultural competence refers to having the knowledge and skills necessary to respond appropriately to individuals from linguistically and culturally diverse populations (American Speech-Language-Hearing Association n.d.a). As SLPs, it is our role and responsibility to provide all clinical services competently (ASHA 2016 Principle of Ethics I, Article A), which means that there is a continuing need to seek education to better serve individuals from all cultures and linguistic backgrounds.
In conclusion, it is critically important that SLPs take into consideration that the need to improve communication not only applies to the clients we strive to help, but to our professional conduct and choices. As professionals the words we choose and the actions demonstrated can have lasting impacts on those we serve. The need to respond appropriately to individuals from all cultures and linguistic backgrounds is a choice that should be made every day.
American Speech-Language-Hearing Association (n.d.a). Cultural Competence [Overview] Retrieved from www.asha.org/Practice-Portal/Professional-Issues/Cultural-Competence/.
American Speech-Language-Hearing Association (n.d.b). Cultural Competence [Key Issues] Retrieved from
American Speech-Language-Hearing Association (n.d.c). Issues in Ethics: Confidentiality. Retrieved from /Practice/ethics/Confidentiality/.
American Speech-Language-Hearing Association (2016). Code of Ethics. Retrieved from /Code-of-Ethics/.
Langdon, T., & Saenz, H. (2016). Working with interpreters and translators: A guide for speech-language pathologists and audiologists. San Diego, CA: Plural Publishing.