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Given the complexities involved in bilingualism and the significant variability that exists among the linguistic skills of multilingual individuals, clinicians must be prepared to address the unique situation of each client. Complex cases may lead to misdiagnosis, which in turn feeds into larger problems, such as disproportionality concerns in schools and health care disparities in hospitals and long-term care facilities.
The answer to the question of who provides audiology and/or speech-language pathology services to bilingual clients varies depending on each client's linguistic abilities in their first and second language.
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Bilingual clinicians who have the necessary clinical expertise to treat the client may not always be available. There are circumstances in which a clinician who does not have native or near-native proficiency in the target language is able to use the skills they do have to provide services to a client. In determining the appropriateness of this solution, the clinician considers both their own language proficiency in the target language and the language demands of the client and family.
As indicated in the Code of Ethics, audiologists and SLPs are obligated to provide culturally and linguistically appropriate services to their clients and patients, regardless of the clinician's personal culture, practice setting, or caseload demographics. In providing services to bilingual individuals, SLPs consider how communication disorders or differences might be manifested, identified, or described in the client's/patient's cultural and linguistic community and integrate this knowledge into all areas of practice, including assessment, diagnosis, treatment, and treatment discharge.
Bilingual audiologists must be able to independently provide comprehensive diagnostic and treatment/rehabilitative services for auditory, vestibular, and related impairments using the client's/patient's language and preferred mode of communication. They must also have the linguistic proficiency to
Bilingual SLPs must be able to independently provide comprehensive diagnostic and treatment services for speech, language, cognitive, voice, and swallowing disorders using the client's/patient's language and preferred mode of communication. They must also have the linguistic proficiency to
ASHA Principles of Ethics I, Rule C from ASHA's Code of Ethics states that providers shall not discriminate when providing professional services. ASHA members and Audiologists and SLPs who hold the certificate of clinical competence and are not competent to provide services to bilingual clients still have a professional responsibility to ensure that a client receives appropriate services.
Understanding the normal processes and phenomena of second-language acquisition is important to ensure accurate assessment of bilingual clients. While the experience of learning a second language is unique to each individual, common phenomenon during the second-language acquisition process are listed below. See additional resources and information on Learning More than One Language.
Identifying a communication disorder in a bilingual individual requires careful consideration of the multitude of factors that influence communication skills. True communication disorders will be evident in all languages used by an individual; however, a skilled clinician will appropriately account for the process of language development, language loss, the impact of language dominance fluctuation, and the influence of dual language acquisition and use when differentiating between a disorder and a difference. Language dominance may fluctuate across a patient's/client's lifespan based on use and input and language history (Kohnert, 2012).
Bilingual clients/patients may benefit from visual modeling of commands to facilitate comprehension of tasks during oral-peripheral examination. Cultural and individual differences may influence how clients perceive tasks, such as a sticking out their tongues; therefore, it may be necessary to explain the reason for requested activities.
Criterion-referenced assessment tools can be used to identify and evaluate a client's strengths and weaknesses, as opposed to norm-referenced testing, which assesses an individual relative to a group. Standardized test scores are not valid for an individual who is not reflected in the normative sample for a given assessment; however, these assessments may still provide valuable descriptive information about a client's abilities and limitations in the language of the test (i.e., a test given in English will speak to a child's ability in English; a test given in Spanish will speak to a child's ability in Spanish). When possible, use culturally and linguistically adapted test equivalents in both languages to compare potential deficits.
An accommodation, for the purpose of this page, refers to an adjustment or change to the environment or mode of client/patient response in order to facilitate access and interaction and to remove barriers to participation.
Accommodations and modifications during the assessment process may be necessary to gain useful information about the client's abilities and limitations. However, some changes may invalidate the standardized score.
Speech and language samples offer a window of opportunity to observe and analyze communicative skills as they are functionally used and may provide more insight than the typical standardized or criterion-referenced test. Single-word and connected-speech (conversation or narrative) samples should be obtained in all languages used by the client, through collaboration with an interpreter if necessary, to allow for an in-depth assessment of the individual's morphological, syntactic, phonological, and lexical systems. While a comparison of each of these areas across languages used can be informative, clinicians must keep in mind that skills across languages may not be easily comparable. Phonological acquisition will not be parallel across a bilingual child's two languages, especially when the two languages have vastly different phonemic systems (Goldstein & Fabiano, 2007). Morphological markers will look different across languages as will the syntactic complexity.
Speech perception testing measures how well an individual is able to understand speech and predicts how well they will perform in everyday listening environments. Speech reception thresholds and word recognition ability should be evaluated using culturally and linguistically appropriate recorded test materials that reflect the background of the client. Best practices utilize pre-recorded materials to ensure consistency across trials (Mendel & Owen, 2011). Monitored live voice testing may be used, given a client's unique needs, such as age or ability. Careful consideration of accent, dialect, and linguistic background is given for the speaker used in live voice testing.
A number of state and federal regulations have implications for the provision of audiology and speech-language pathology services to bilingual clients/patients. Differences in state regulations may be reflected in a number of requirements, including education. See ASHA's state-by-state page for a summary of state requirements.
Resources listed below are intended to contribute to foundational awareness of potential cultural and linguistic influences. There are variations within cultures, and regional and dialectal variances exist in all languages. Therefore, a single chart/page on cultural and/or linguistic features is not meant to provide a comprehensive overview. Clinical judgment, client/patient/student and caregiver input, and additional research are needed to ensure culturally responsive services.
ASHA's policy documents state that SLPs and audiologists must consider the sound systems of all the languages used by a client in order to provide appropriate assessment and treatment services.
Costa, B., & Dewaele, J. M. (2012). Psychotherapy across languages: beliefs, attitudes and practices of monolingual and multilingual therapists with their multilingual patients. Language and Psychoanalysis, (1), 18-40.
If you are reading this article, you likely need to offer multilingual customer support. You may have thought about providing multilingual support or have done the math and realized that there is a substantial financial upside to accommodating the six billion people worldwide who are non-native English speakers. So, what can Multilingual Customer Support offer your customers?
With six billion non-native English speakers worldwide, expanding your multilingual support can only increase your market accessibility. Translating your website can improve the visibility of your offerings on search engines across the different languages you are targeting. Also, the translation of your support materials, such as videos and your social media content, and customer accessibility increases substantially. As a result, businesses accommodating this large population segment have a higher chance of winning more customers than those without.
One of the easiest ways to add multilingual support is with live chat. Live chat has enabled businesses to instantly talk to online visitors and generate more leads while enhancing the online customer experience. If done correctly, chat can benefit both the customer and the agent. Chat can be a huge convenience to customers when offered around the clock. Offering live chat in multiple languages can increase sales and customer retention by building stronger relationships and creating a more authentic customer experience for everyone, regardless of language and culture.
There are many benefits to adding Over-the-Phone Interpretation (OPI) to your contact center. The main advantage of OPI is that it instantly gives your agents access to on-demand interpreters. A leading language provider can offer 24/7/365 access to professional interpreters in multiple languages. It is a cost-effective way to improve multilingual support for many contact centers without requiring in-house resources. This service can also be complementary in contact centers with in-house interpreters but may need to fill occasional needs for additional languages or resources.
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