4- Assessment in Culturally and Linguistically Diverse Populations-.pptx

CDS 236 Communication Disorders & Cultural Diversity DR. DAL AL AL ALI Assessment in Culturally and Linguistically Diverse Populations  Assessment in Culturally and Linguistically Diverse (CLD) populations Assessment in CL...

CDS 236 Communication Disorders & Cultural Diversity DR. DAL AL AL ALI Assessment in Culturally and Linguistically Diverse Populations  Assessment in Culturally and Linguistically Diverse (CLD) populations Assessment in CLD refers to the process of evaluating students who come from different cultural and linguistic backgrounds, as well as those who are bilingual. This form of Ax considers the unique needs and characteristics of CLD students.  CLD Population in Kuwait One of the most prominent groups is the expatriate community. Kuwait attracts a significant number of foreign workers and their families. They mostly work in sectors like construction, healthcare, and education. They are mainly Indians, Pakistanis, Egyptians, Bangladeshis, Filipinos & others. They bring their unique languages, traditions, and beliefs, contributing to the cultural diversity of Kuwait.  Cultural Competence in the Clinic Clinical approaches that are appropriate for one may not be appropriate for another. The individual's cultural & linguistic background may change over time & circumstance. It is therefore necessary to adjust clinical approaches.  Cultural Competence in Service Delivery Cultural competence in service delivery is increasingly important to respond to demographic changes in a country. It improves the quality of services and health outcomes of people of diverse racial, ethnic, and cultural backgrounds.  Cultural & Linguistic Pre-assessment & Assessment Strategies Pre-assessment knowledge Planning & completing the assessment Making a diagnosis Working with interpreters  The Assessment Process When conducting assessments, SLPs must consider the client's/patient's level of acculturation and assimilation within the mainstream culture.  The Assessment Process SLPs must determine how familiar & comfortable the individual is with testing procedures. Familiarity with testing procedures may influence performance during the assessment process.  The Assessment Process An appropriate evaluation may have to be completed over multiple sessions. If there is a need to assess a patient in more than one language, collaborate with an interpreter. If there is need, utilize alternate assessment formats, and/or adapt an assessment for a given client population.  Remember Before evaluating a client, SLPs should : 1. Know the culture of the client 2. Know the history of the client 3. Know the normal communicative patterns of the client’s dominant language This is pre-assessment research Without this knowledge, assessment may be inappropriate & diagnosis may be incorrect.  Know the Culture of the Client Every culture has a set of pragmatic social rules These social rules guide the individual’s behaviors Knowing this allows the clinician to exchange information with clients and their families in a culturally sensitive manner  Know the Culture of the Client Disregarding these rules: ◦ May be offensive ◦ Can result in misunderstanding ◦ Can lead to inaccurate diagnosis Remember that within each culture there is individual variation.  Know the Culture of the Client Cultural groups hold differing views of disability and intervention Some cultures view people with a disability as bewitched (some Asian cultures). Some cultures believe disability is someone’s fate and intervention is useless. In some cultures, parents feel responsible for a child’s disability. In other cultures, parents feel disability is a punishment. In some cultures, a spiritualist or herbalist may be chosen to provide health care. As a results in these cultures: ◦ Clients may refuse treatment that would change the disability. ◦ Clients may rely on non-Western treatment methods/remedies.  Know the Culture of the Client Cultural groups hold differing views of a woman’s role in society Gender may influence choice of profession, decision-making and authority in the family. In some cultures, clients/caregivers may not respect female professionals. Socially unacceptable for a female professional to make physical contact with a male client. Gender roles in the Latino/Asian/Arab families Male control and female obedience The male is considered the head of the household and the final decision- maker. Today in many Asian and Arab countries: higher education and economic independence of women have begun to change traditional female roles  Know the Culture of the Client Cultural groups hold differing views of class & status (power factor) High power-distance culture: Asians no questioning about the orders/suggestions of the SLPs Authoritativeness: teacher-student, teacher-parents, SLP- caregivers-patient Low power-distance culture: Western cultures Equality is important; clients may not necessarily accept the SLP’s orders/instruction  Know the Culture of the Client Cultural groups hold differing views of names & titles In some cultures, its more common to address certain family members by their relationship than their name. o E.g., Uncle or aunty rather than Mr. or Mrs. o Always ask how to address someone  Know the Culture of the Client Cultural groups hold differing views of case history intake & interview. Certain questions may be considered rude or personal. Establish rapport first with the client and family before asking personal questions. Multiple visits needed.  Know the Culture of the Client Cultural groups hold differing views of the assessment process Asking “pseudo questions” – these are questions to test a person rather than gather new information e.g. “where is your nose?” The SLP must be creative in assessing a CLD child’s speech & language. In some cultures, children learn mostly by observing and maybe unwilling to attempt an unfamiliar task.  Know the Culture of the Client Cultural groups hold differing views about a child’s behavior in the company of adults In some cultures, children are expected to be seen and not heard. Children do not initiate conversations Other cultures expect high level of participation from their children  Know the Culture of the Client Cultural groups hold differing views of nonverbal communication. A culturally competent SLP would be aware of nonverbal aspects of communication In some cultures, it is disrespectful for children to make prolonged eye contact with adults. Asian populations, adults avoid eye contact  Know the Culture of the Client Cultural groups hold differing views of nonverbal communication. Asians Silence is valued Lack of eye contact is valued Avoidance of conflict Westerns Direct, expressive, confrontational, engaging through eye contact  Know the Culture of the Client Cultural groups hold differing views of concepts of time & personal space Time-oriented Western Emphasize punctuality Event-oriented Latinos, South Asians, Arabs, Africans Less rigid with time and appointments than are European Americans. Completion of the event is more important; Not overly concerned with time. Being late is not really considered rude or disrespectful. They expect to be accommodated if they miss or cancel a session.  Know the Culture of the Client Social customs & beliefs that may affect communication with CLD clients & their families: Cultural groups hold differing views of concepts of time & personal space Space - Refers to personal space and how much distance between conversational partners is required for individuals to feel comfortable. Some cultures need less space (closer) to feel comfortable, others require 2-4 ft of personal space (Americans, Europeans).  Know the Culture of the Client Cultural groups place different value on individualism vs collectivism Individualism (Western cultures) Clinical decisions made by the client independently Promoting self-expression, individual thinking Frequent use of “I” OWN personal achievement matters Everyone is expected to look after him/herself and his/her immediate family.  Know the Culture of the Client Cultural groups place different value on individualism vs collectivism Collectivism (Most Asian, Arab cultures) Clinical decisions made by the members of the group Frequent use of “we” Feel safe in a group Strong, cohesive in-groups. Often extended families (with uncles, aunts, grandparents”  Know the Culture of the Client Ethnography – is a method of becoming more culturally knowledgeable ◦ It is the scientific study of a culture by observing and interviewing members of a culture ◦ This gives us an understanding from an insider's perspective without personal judgments or biases  Know the Culture of the Client You can collect the previous information by: ◦ Interviewing members of the cultural community ◦ Observing members of a community in naturalistic situations ◦ Ask the client to share information about his/her culture ◦ Consult with other professionals ◦ Read literature  Know the Culture of the Client Why is gaining knowledge of cultural features important? It enhances clinical service delivery. It assist SLPs in determining specific, culturally sensitive ways to conduct sessions. It ensures clients & families are engaged, as sessions are adapted to their culture needs. It ensures that communication is aligned with the values and beliefs of the individuals It reduces cultural stereotyping. Cultural stereotyping occurs when one assumes that all people within a culture act, think, and behave the same way.  Know the Culture of the Client How can we gain knowledge about the client’s culture? Use a trained professional interpreter, or cultural guide. The interpreter should: Be familiar with the purposes and objectives of the session. Be familiar with the need for confidentiality know the importance of a non-judgmental attitude regarding the information exchange. Data gathering must include getting the client’s view rather than the interpreter’s view. Use ethnographic interview techniques (Next slide)  The Right Ways: General Question-Asking Principles The following are general principles to consider when asking questions: Ask for specific examples. Use open-ended questions rather than questions that trigger a yes/no response. Restate what the client says by repeating the exact words; do not interpret. Avoid multiple questions. Avoid leading questions that tend to orient the person to a particular response. Avoid using why questions because such questions tend to sound judgmental.  The Right Ways: General Question-Asking Principles The use of ethnographic interviewing can: Have a powerful impact on planning intervention goals and strategies. Increase the clinician’s understanding of the clients’ viewpoints regarding their needs and preferences. Enable SLPs not only to develop an awareness of other factors in clients’ lives that may directly or indirectly influence the communication disorder.  The Right Ways: General Question-Asking Principles Be sensitive about how to obtain the information It may be best to gather the information orally Limited English and/or Arabic proficiency may result in difficulty reading, understanding and answering the questions. May need to meet the client several times, build rapport before asking the questions. Interpreter may be needed to translate. Know the Normal Communicative Patterns of the Client’s Dominant Language Be familiar with your client’s normal communication patterns associated with their cultural group This helps determine if there is a communication difference or disorder Know the Normal Communicative Patterns of the Client’s Dominant Language Remember there may be many dialects within a language. This means variations in grammatical and phonologic rules Dialect is NOT a disorder; Know the characteristics of a client’s dialect