ethical considerations for culturally and linguistically diverse populations in eci
TRANSCRIPT
Ethical Considerations for Culturally and Linguistically Diverse Populations
Ellen Kester, Ph.D., CCC-SLP
First3Years Meeting
– Describe the root of ethical dilemmas in the
workplace
– List the limitations of testing tools with
multicultural populations
– Describe the appropriate use of test norms
– Identify how language differences affect
assessment and intervention
– Describe methods for supplemental or alternative
assessments
LEARNER OBJECTIVES
The Routines-Based
Early Intervention
Guidebook
Successfully increases the
communication and interactions
of young children by building on
the home routines with activities
that are based on effective
research.
Spanish and English Activities and
Materials!
Click Here to View
Disproportionality
ELLsELLs
Texas 0-4 Population 2015
Percent
Hispanic/Latino
White
Black/African American
Asian
American Indian/Alaskan
Pacific Islander
Two or More Race Groups
The Annie E Casey Foundation
Kids Count Data Center
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to listen to this course live?
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the online courses.
SLP Confidence Serving ELLs
per ASHA Schools Survey
Why Study Ethics?
Can we change behavior?
Dan Ariely on Ethics and Cheating
Study 1
50 math
questions
Study 2
15 math
questions +
Book Lists
Study 3
20 math
questions
+ Ethics Code
Group 1
Control 32.1/50
Group 2
Test
Group 3
Test
36.2/50
36.2/50
3.1/15
4.1/15
3.0/15
3.0/20
5.5/20
3.o/20
Case StudyTo whom it may concern,
I am looking for guidance toward best practice on an inpatient rehabilitation unit. The details about the case are as follows:
The SLP only speaks English and does not understand Spanish. There is a Spanish speaking patient who suffered a stroke while at work. This individual spoke several languages prior to the accident and as of this time, only his primary language of Spanish has returned. The company will provide a translator during OT, PT, and ST treatments. The SLP does not feel competent to treat this individual due to the language barrier. She stated it is “unethical” for her to provide ST services because she cannot verify the validity of the translation. I am looking for guidance on how to provide the best skilled ST services for this individual. The other resources available at our hospital include certified translators as well as a “blue phone” translator service. (I have searched the ASHA website and have contacted the only bilingual SLP in our area and she is not available for hospital coverage.)
• TSHA received a call from a SLP who was
concerned about the ethical behavior of an
ECI agency. The SLP referred a Mandarin-
speaking child to the ECI agency. The ECI
agency had a staff SLP who speaks only English
perform an evaluation in with the support of
the child’s parent, who is bilingual.
Selecting Personnel to Conduct the
Evaluation
Level 1: trained (in CLD issues) bilingual speech-language pathologist fluent in the native languageLevel 1: trained (in CLD issues) bilingual speech-language pathologist fluent in the native language
Level 2: trained (in CLD issues) monolingual speech-language pathologist assisted by trained bilingual ancillary examiner.
Level 2: trained (in CLD issues) monolingual speech-language pathologist assisted by trained bilingual ancillary examiner.
Level 3: trained (in CLD issues) monolingual speech-language pathologist assisted by trained interpreter
Level 3: trained (in CLD issues) monolingual speech-language pathologist assisted by trained interpreter
Source: ASHA
Testing
Linguistic equivalence
Functional equivalence
Cultural equivalence
Metric equivalence(Peña, 2007)
Lack of equivalence in any of these areas can threaten content validity (Rogler, 1999).
Considerations for translated tests
Basal and Ceiling Rules
• Basal and ceiling rules only
work when items are ordered
from easiest to hardest.
• Item difficulty levels do not
translate.
• When using a translated
version of a test, test below the
basal and above the ceiling.
• Based on developmental milestones
• Uses basal and ceiling rules
• Used by all ECI programs in Texas since Sept
2011
The Spanish version of the BDI-2
IS NOT NORMED!
• Keen clinical judgment is necessary
• While many motor skills and daily living skills
are not influenced by language,
communication skills are strongly affected.
• Norms do not transfer from one language to
the other.
Informed Clinical Opinion
• This can apply to:
– an individual test item
– interpretation of test scores
– determining the adequacy of testing tool (i.e., the BDI-2)
– reviewing results
– making a qualitative determination of developmental delay
Understanding Linguistic and Cultural Differences is essential
Linguistic Differences– Communication
Domain• RC 14
– English: Responds to the prepositions “out” and “on.”
– Spanish: Responde a las palabras “fuera” y “sobre.”
• These prepositions are similar in meaning,
though they do not have a one-to-one
correspondence across languages and therefore
likely differ in their level of difficulty.
Linguistic Differences– Communication
Domain
• RC 17
– English: Understands the possessive form ’s.
• Baby’s mommy. Daddy’s boy.
– Spanish: Entiende las formas del posesivo.
• El bebé de la mamá. El hijo del papá.
• In English this deals with morphology and in Spanish it deals with syntax. It cannot be assumed that these will follow the same developmental sequence.
Linguistic Differences– Communication
Domain
• RC 28
– English: Understands irregular plural forms.
– Spanish: Usa el plural.
• There are no irregular plurals in Spanish. This
is a much more challenging item in English
than it is in Spanish but the use of basal and
ceiling rules that are based on English
assumes the same level of difficulty.
Linguistic Differences– Communication
Domain• EC 17
– English: Uses three-word phrases meaningfully.
– Spanish: Usa frases coerentes de 3 palabras.
• Children can express something that is at the same level of complexity with fewer words in Spanish than in English.
– “I want cookie.” = “Quiero galleta.”
– “Pick me up.” = “Recójame”
– “Give to me.” = “Dame”
Linguistic Differences– Communication
Domain• EC 19
– English: Uses the pronouns I, you, and me.
– Spanish: Usa los pronombres, yo, me, mi, tú, te, ti
• The requirement is that each of them is used on a daily basis. The Spanish pronouns “me” and “te”are more complex pronouns that those tested in English. Additionally, pronouns are used with less frequency in Spanish than in English. Thus, this item would be more difficult for Spanish speakers.
Linguistic Differences– Communication
Domain
• EC 25
– English: Uses the articles the and a.
– Spanish: Usa los artículos el, la, un, and una.
• In Spanish the article system is more complex because it includes gender, which does not exist with the same complexity in English. Instead of two articles, Spanish has six (un, el, los, una, la, las). The Spanish translation focuses on the four singular articles.
Linguistic Differences– Communication
Domain• EC 27
– English: Uses plural forms ending in /s/ and /z/.
– Spanish: Usa las terminaciones plurales.
• In English this tests two plural forms ending with /s/ and two endings with /z/. In Spanish this difference would be /s/ and /es/. The Spanish item tests three /s/ and one /es/. In English the number of syllables in the word remains the same, while in Spanish the number of syllables increases when /es/ is required.
Linguistic Differences– Communication
Domain• EC 29
– English: Repeats familiar words with clear articulation.
– Spanish: Repite palabras conocidas articulandoclaramente.
• The sound inventories of the languages are not equally represented. There are no final consonants evaluated in Spanish but there are 6 in English. There are fewer final consonants in Spanish than in English but they do exist.
Considering Culture
• Culture can influence performance on test
items
• Understand how culture can affect responses
• Incorporate cultural variation into your
Informed Clinical Opinion
Cultural Considerations
Receptive Communication 32
– Recalls events from a story presented orally.
• En la mesa había huevos, pan tostado y jugo de naranja. (On
the table there were eggs, toast, and orange juice.)
Expressive Communication 13
– Communicates in back-and-forth, turn-taking style
Reasoning and Academic Skills 9
– Child names the colors red, green and blue
Determine Percent Delay
If the child is from a bilingual environment consider the items carefully and use your informed clinical opinion on each item. If you calculate a percent delay based on test results, know that they might provide a guideline but could misrepresent the child’s abilities.
Case Study
• Bilingual SLP goes to daycare to serve student.
Next to her is an English-speaking SLP serving
a Spanish-speaking child and intervening on
the unvoiced “th” sound that does not exist in
Spanish.
Case Study
• A monolingual SLP is pushed to evaluate and
provide therapy for children who don’t speak
English. When he told his employer that this
was an ethically uncomfortable situation, the
response was, “Any service is better than no
service. What is unethical is not serving the
clients.”
• You do a Child Find evaluation. The mother brings a copy of a
report from a private practice that was done a few months
earlier. The SLP used the PLS-3-English with an interpreter
and reported the norms from the English version. The results
indicated a severe expressive and receptive language delay.
Difference vs. Disorder
TYPICAL
DEVELOPMENTAL
ERRORS
SECOND-
LANGUAGE
INFLUENCE
ATYPICAL
ERRORS
Spanish & English Phonemes
/ɲ/
/ɾ/
/R/
/x/
/ð/ /dʒ/
/h/ /ŋ/
/θ/
/ɹ/ /ʃ/
/v/
/z/ /ʒ/
SPANISH ENGLISH
/b/ /d/ /ɡ/
/p/ /t/ /k/
/m/ /n/ /s/ /tʃ/
/j/ /l/ /f/
/w/*
/w/ is produced as a bilabial in English and as a labiovelar in Spanish
Alice 5;6
• Home Language: Mandarin Chinese
• School Language: English
• Parent Concerns: “She has difficulty
expressing her ideas.”
• Teacher Concerns: “She is hard to
understand.”
stom for stov
bihaif for bihaiv
zibə for zibrə
Dynamic assessment
“…a strategy for differentiating students
who do not perform well because of
unfamiliarity with the tasks from those
who do not perform
well because they have intrinsic
cognitive or language
learning disorders”
(Westby, 2001).
Test Teach Retest
Learning Potential
Case Study
• Bilingual SLP goes to daycare to serve student.
Next to her is an English-speaking SLP serving
a Spanish-speaking child and intervening on
the unvoiced “th” sound that does not exist in
Spanish.
Case Study
• A monolingual SLP is pushed to evaluate and
provide therapy for children who don’t speak
English. When he told his employer that this
was an ethically uncomfortable situation, the
response was, “Any service is better than no
service. What is unethical is not serving the
clients.”
• You do a Child Find evaluation. The mother brings a copy of a
report from a private practice that was done a few months
earlier. The SLP used the PLS-3-English with an interpreter
and reported the norms from the English version. The results
indicated a severe expressive and receptive language delay.