Multilingual Service Providers

This page focuses on the knowledge and skills needed for a multilingual audiologist, speech-language pathologist (SLP), audiology assistant, and speech-language pathology assistant.

For more information about clinical practice with clients who use a language different from that of the provider or one who uses multiple languages, see ASHA’s Practice Portal page on Multilingual Service Delivery in Audiology and Speech-Language Pathology.

In this page, “care partner” will refer to families, parents, and caregivers.

A multilingual service provider is an audiologist, an SLP, an audiology assistant, or a speech-language pathology assistant who uses more than one language during professional and/or clinical service delivery (ASHA, 2023a). As of recent literature, 12.9% of audiology assistants and 11.5% of speech-language pathology assistants identified as multilingual service providers (ASHA, 2021). As of 2022, 8.3% of ASHA-certified audiologists and SLPs identified as multilingual service providers (ASHA, 2023b). They reported providing services in 86 spoken languages plus American Sign Language, other sign languages, and Manually Coded English.

All providers maintain competencies for multilingual service delivery. See the Ad Hoc Committee on Bilingual Service Delivery’s Final Report: Competencies, Expectations, and Recommendations for Multilingual Service Delivery [PDF].

There are two ways that multilingual service providers engage in service delivery:

language-matched: for example, when an audiologist who speaks Vietnamese and English provides services in Vietnamese with their Vietnamese-speaking patient
cross-linguistic: for example, when an audiologist who speaks Vietnamese and English collaborates with an interpreter to work with a Spanish-speaking patient

Any clinician—monolingual or multilingual—can deliver cross-linguistic services with necessary language assistance. Language assistance can include an interpreter or a translator. Visit ASHA’s Practice Portal pages on Multilingual Service Delivery in Audiology and Speech-Language Pathology and Collaborating With Interpreters, Transliterators, and Translators.

Using More Than One Language

The Ad Hoc Committee on Language Proficiency defined spoken language proficiency as “effective receptive and expressive language skills in both written and spoken modalities” (ASHA, 2019). A person can still be considered proficient in a spoken or signed language if that language does not have a written modality. The Ad Hoc Committee on Language Proficiency focused on spoken language proficiency. Many institutions use the American Sign Language Proficiency Interview to assess an American Sign Language user’s language proficiency.

Multilingual service providers require a deep understanding of their primary language(s) and at least one additional language in the following domains during clinical management:

lexicon (vocabulary)
semantics (meaning)
phonology (pronunciation)
morphology/syntax (grammar)
pragmatics (social use)

In addition to language proficiency, the provider must have the specific knowledge and skills necessary for the services to be delivered. See the Ad Hoc Committee on Bilingual Service Delivery’s Final Report: Competencies, Expectations, and Recommendations for Multilingual Service Delivery [PDF].

Language proficiency and intelligibility of accented speech are not the same. Professionals and students in the communication sciences and disorders discipline who speak with “perceived” accents or dialects can provide speech, language, and audiological services.

See ASHA’s position statement, Students and Professionals Who Speak English With Accents and Nonstandard Dialects: Issues and Recommendations, and professional issues statement, The Clinical Education of Students With Accents.

Identifying as a Multilingual Service Provider

Traditional definitions of language proficiency focused on being like a “near-native” or “native” speaker, but these terms are vague, and definitions vary greatly. These terms make assumptions that can systematically exclude historically marginalized and minoritized populations (Cheng et al., 2021).

Many audiologists and SLPs feel discouraged to identify as a multilingual service provider because of one or more of the following reasons (Yu et al., 2021):

They lack “near-native” language proficiency (the term that was previously used to describe a multilingual provider).
The field lacks assessment and treatment tools and research in target languages.
Language proficiency varies in different contexts of service delivery.
There is a lack of non-English education on professional and technical language that is equivalent to the meaning of the term in English (e.g., there is no term for “aphasia” in another language, or if there is, it has not been communicated via professional education outlets).

Knowledge and Skills of Multilingual Audiologists

Multilingual audiologists independently provide comprehensive diagnostic services for auditory, vestibular, and related impairments using the patient’s language and preferred mode of communication. They must also have the language proficiency necessary to

select, administer, and interpret culturally and linguistically appropriate assessment materials, tools, and methods (e.g., self-report measures, objective measures) and
instruct, assess, and counsel the patient.

Knowledge and Skills of Multilingual SLPs

Multilingual SLPs independently provide comprehensive diagnostic and treatment services for speech, language, cognitive, voice, or swallowing disorders using the client’s language and preferred mode of communication. They must also have the language proficiency needed to fulfill the following roles:

describe the concepts of typical speech and language acquisition for monolingual and multilingual people as well as common communication features of disorders in the language(s) used by clients, patients, or students
select, administer, and interpret formal and informal assessment procedures to distinguish between communication influenced by heritage languages and communication disorders
apply intervention strategies for treatment of communication disorders in the language or mode of communication most appropriate for the needs of the individual

Checklist of Tasks and Behaviors for Audiologists or SLPs Who Identify as a Multilingual Service Provider

With limited formal certification programs, language verification mechanisms, or validated occupational language assessment tools in the communication sciences and disorders discipline, multilingual service providers may benefit from identifying clinical tasks and behaviors in which they can engage. Such tasks and behaviors may include the following:

Introduce yourself to, and engage in casual or informal conversation with, clients/patients/students and care partners using their language.

Ask clients/patients/students for basic information, such as name, age, contact details, and language(s) used.

Discuss preferences, scheduling, expectations, and/or procedures for service delivery with clients/patients/students and care partners.

Collect and discuss case history information, including social determinants of health, and referral concerns with clients/patients/students and care partners.

Make clinical judgments about intent/meaning, quality, and/or quantity of client responses provided in the language used.

Recognize dialectal or regional variations, distinct features of the client’s linguistic community, and/or speech-language errors presented across clinical interactions.

Instruct, assess, and counsel clients/patients/students.

Use diverse vocabulary and sentence structures (with increasing complexity, as needed) for modeling and/or stimulus presentation in service delivery.

Explain the intent of activities and goals.

Answer client/patient/student and care partner questions about clinical procedures, and provide additional requested information, such as referral options.

Multilingual service providers can also use the list above to identify areas where they need more training or practice. Providers can also describe the types of clinical interactions they can implement comfortably in the languages they use (Yu et al., 2021). For example, an SLP who speaks English and Mandarin may feel comfortable using Mandarin to counsel their patient’s care partner but feels more comfortable using English to provide swallowing treatment.

Visit the Foreign Language Assessment Directory to find more information about assessments that test your skills in the languages that you use. See also the Ethical Considerations section of the Multilingual Service Delivery Practice Portal page to ensure that you are providing ethical multilingual services.

Knowledge and Skills of Multilingual Audiology Assistants and Speech-Language Pathology Assistants

Interpreters have unique skill sets and expertise. Clinicians collaborate with them whenever possible, as appropriate, in clinical service provision. Multilingual audiology and speech-language pathology assistants are not interpreters. Audiology and speech-language pathology assistants may be able to interpret to meet an unanticipated need.

Consult the Scope of Practice for Audiology Assistants and the Scope of Practice for the Speech-Language Pathology Assistant (SLPA). See also ASHA’s Practice Portal pages on Speech-Language Pathology Assistants; Audiology Assistants; and Collaborating With Interpreters, Transliterators, and Translators.

Receiving Salary Supplements as a Multilingual Service Provider

Some multilingual audiologists and SLPs receive a salary supplement, a stipend, or another type of “salary upgrade” for their multilingual skills or experience (ASHA, 2022b, 2022c). Currently, no data are available about differential pay for multilingual evaluations.

See ASHA’s 2022 Schools Survey Summary Report for Educational Audiologists [PDF] and 2022 Schools Survey Summary Report for SLPs [PDF]. See also ASHA’s advocacy resource, Salary Supplement for Educational Audiologists and School-Based Speech-Language Pathologists.

Becoming a Multilingual Service Provider

Training Programs

ASHA does not accredit or approve specialty training programs for multilingual service providers, nor does ASHA review, evaluate, or rank such programs in any way. Some schools offer bilingual specialty training programs at the undergraduate, graduate, or postgraduate levels, but the depth and breadth of training in this area varies from program to program. You can find academic programs with a bilingual emphasis on ASHA EdFind.

State Certification/Licensing

Laws and regulations for multilingual service providers in audiology and/or speech-language pathology vary by state. State requirements may differ, including

proficiency in oral and/or written language, education, and continuing education;
titles used to identify multilingual service providers; and
regulations or laws—or lack thereof.

Audiologists and SLPs should check with their state licensure board and/or departments of education for the requirements stipulated by specific practice settings.

ASHA Resources

Other Resources

This list does not include every website on this topic. ASHA does not endorse the information on these sites.

References

American Speech-Language-Hearing Association. (2019). Ad Hoc Committee on Language Proficiency [Final report]. https://www.asha.org/siteassets/reports/ahc-language-proficiency.pdf [PDF]

American Speech-Language-Hearing Association. (2021). 2021 ASHA Audiology and Speech-Language Pathology Assistants Survey Results. https://www.asha.org/siteassets/surveys/2021-aud-slp-assistants-survey-results.pdf [PDF]

American Speech-Language-Hearing Association. (2022b). 2022 schools survey. Survey summary report: Numbers and types of responses, educational audiologists. https://www.asha.org/siteassets/surveys/2022-schools-survey-audiologist-summary-report.pdf [PDF]

American Speech-Language-Hearing Association. (2022c). 2022 schools survey. Survey summary report: Numbers and types of responses, SLPs. https://www.asha.org/siteassets/surveys/2022-schools-slp-summary.pdf [PDF]

American Speech-Language-Hearing Association. (2023a). Ad Hoc Committee on Bilingual Service Delivery: Competencies, expectations, and recommendations for multilingual service delivery [Final report]. https://www.asha.org/siteassets/reports/ahc-bilingual-service-delivery-final-report.pdf [PDF]

American Speech-Language-Hearing Association. (2023b). Profile of ASHA multilingual service providers, year-end 2022. https://www.asha.org/siteassets/surveys/2022-profile-of-multilingual-service-providers.pdf [PDF]

Cheng, L. S. P., Burgess, D., Vernooij, N., Solís-Barroso, C., McDermott, A., & Namboodiripad, S. (2021). The problematic concept of native speaker in psycholinguistics: Replacing vague and harmful terminology with inclusive and accurate measures. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.715843

Yu, B., Rajappa, A., Sun, L., Chiou, H. S., & Sundarrajan, A. (2021, November). Problematizing the native-speaker construct of proficiency: A survey of bi/multilingual Asian American/Pacific-Islander clinicians [Paper presentation]. American Speech-Language-Hearing Association Convention, Washington, DC, United States.