By Yvette D. Hyter, PhD, CCC-SLP
Co-Author of Culturally Responsive Practices in Speech, Language, and Hearing Sciences
In the 1990s a new generation of faculty members in Communication Sciences and Disorders (CSD) emerged, ready to infuse courses or to develop and teach courses focused on “multicultural content,” which was the term at the time. There were a limited number of comprehensive texts on how to employ culturally relevant practices as a speech-language pathologist. Many of the SLP faculty who were teaching courses about “multiculturalism,” or “cultural competence,” often utilized texts from other fields, such as education, nursing, or communication and rhetoric, and relied heavily on published articles in disciplines including anthropology, political science, nursing, and social work. It was not until mid-1990s that one of the more complete books on multiculturalism in communication sciences and disorders (CSD) was published (e.g., Battle, 1993, 2012). Nevertheless, as the world has become more complex and smaller as a result of global processes, new concepts and comprehensive practices that consider causal relations are required.
Multiculturalism is a contested concept, but typically refers to including people from diverse cultural backgrounds (Malik, 2015) in program development or service delivery for example. Multiculturalism as a concept falls short, primarily because it suggests that inclusion (or assimilation) is the principle issue. Although health care providers and educators offer and provide services to all people regardless of their cultural (or racialized class, ethnic, gender, national, or linguistic) backgrounds (e.g., inclusion), services can remain inadequate or irrelevant if we also do not consider how services might be reconceptualized or changed to meet the cultural premises of those receiving services.
Cultural competence, a concept that emerged in the 1980s (e.g., Cross, Bazron, Dennis, & Isaacs, 1989), is more useful than multiculturalism but is weighed down by preconceived notions of competence. The perception is that “competence” refers to skills or knowledge that one acquires, and that those skills can be completed or mastered (checked off), are static, and independent of context or history (Hyter & Salas-Provance, 2019; Willbergh, 2015). This perception of competence has caused many disciplines in the health professions to move away from it in favor of other terms.
Cultural responsiveness, a term coined by Ladson-Billings (1995), seems to be more accessible than multiculturalism and cultural competence. It refers to engaging in practices that are consistent with or relevant to the cultural values, beliefs, and assumptions of a person or group with whom a solution (or clinical outcome) is co-created. In this manner, responsiveness is inherently dynamic, dependent on context and shared historical memories. Hyter (2014) has conceptualized culturally responsive practices as those that take place beyond the micro level (individual), but also at the meso (community and family) and macro levels (social structures such as economics, politics, culture, cultural institutions, and state sanctioned violence [Hyter & Salas-Provance, 2019, p. 171]). Culturally responsive practices require knowledge that is not always a part of the CSD curriculum such as critical consciousness—the ability to deconstruct one’s own social, cultural, historical, economic, and political situation and co-construct solutions to problems (Freire, 1974); dialectical thinking—the ability to synthesize conflicting perspectives; cultural humility – believing that cultural practices and perspectives different from one’s own are as valuable as one’s own (Ortega & Faller 2011; Tervalon & Murray-Garcia, 1998); and cultural reciprocity—understanding and using the client’s cultural beliefs to co-construct (with the client) services provided (Kalyanpur & Harry, 2012). Culturally responsive practices also require an elevation of concepts that are already inherent in CSD clinical practice such as critical thinking, critical self-awareness, and reflection. To truly work at the level of cultural responsiveness or relevancy in the United States or abroad, as a profession, speech-language pathologists and audiologist need to adapt new vocabulary and new theoretical frameworks that will help us question the dominant premises, change the terms of public and professional debate, and address the shared problems of structurally excluded groups with interventions that acknowledge and incorporate their world view.
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