3 Promising Strategies to Help Kids as Speech Therapy Group Shifts Away From DEI

A shift away from DEI and cultural competence — which involves understanding and trying to respond to differences in children’s language, culture and home environment — could have a devastating effect at a time when more of both are needed to reach and help multilingual learners, several experts and speech pathologists said.

They told me about a few promising strategies for strengthening speech services for multilingual infants, toddlers and preschool-age children with speech delays — each of which involves a heavy reliance on DEI and cultural competence.

Embrace creative staffing

The Navajo Nation faces severe shortages of trained personnel to evaluate and work with young children with developmental delays, including speech. So in 2022, Allison-Burbank and his research team began providing training in speech evaluation and therapy to Native family coaches who are already working with families through a tribal home visiting program. The family coaches provide speech support until a more permanent solution can be found, said Allison-Burbank.

Home visiting programs are “an untapped resource for people like me who are trying to have a wider reach to identify these kids and get interim services going,” he said. (The existence of both the home visiting program and speech therapy are under serious threat because of federal cuts, including to Medicaid.)

Use language tests that have been designed for multilingual populations

Decades ago, few if any of the exams used to diagnose speech delays had been “normed” — or pretested to establish expectations and benchmarks — on non-English-speaking populations.

For example, early childhood intervention programs in Texas were required several years ago to use a single tool that relied on English norms to diagnose Spanish-speaking children, said Ellen Kester, the founder and president of Bilinguistics Speech and Language Services in Austin, which provides both direct services to families and training to school districts. “We saw a rise in diagnosis of very young (Spanish-speaking) kids,” she said. That isn’t because all of the kids had speech delays, but due to fundamental differences between the two languages that were not reflected in the test’s design and scoring. (In Spanish, for instance, the ‘z’ sound is pronounced like an English ‘s.’)

There are now more options than ever before of screeners and tools normed on multilingual, diverse populations; states, agencies and school districts should be selective, and informed, in seeking them out, and pushing for continued refinement.

Expand training — formal and self-initiated — for speech therapists in the best ways to work with diverse populations

In the long-term, the best way to help more bilingual children is to hire more bilingual speech therapists through robust DEI efforts. But in the short term, speech therapists can’t rely solely on interpreters — if one is even available — to connect with multilingual children.

That means using resources that break down the major differences in structure, pronunciation and usage between English and the language spoken by the family, said Kester. “As therapists, we need to know the patterns of the languages and what’s to be expected and what’s not to be expected,” Kester said.

It’s also crucial that therapists understand how cultural norms may vary, especially as they coach parents and caregivers in how best to support their kids, said Katharine Zuckerman, professor and associate division head of general pediatrics at Oregon Health & Science University.

“This idea that parents sit on the floor and play with the kid and teach them how to talk is a very American cultural idea,” she said. “In many communities, it doesn’t work quite that way.”

In other words, to help the child, therapists have to embrace an idea that’s suddenly under siege: cultural competence,

Quick take: Relevant research

In recent years, several studies have homed in on how state early intervention systems, which serve children with developmental delays ages birth through 3, shortchange multilingual children with speech challenges. One study based out of Oregon, and co-authored by Zuckerman, found that speech diagnoses for Spanish-speaking children were often less specific than for English speakers. Instead of pinpointing a particular challenge, the Spanish speakers tended to get the general “language delay” designation. That made it harder to connect families to the most tailored and beneficial therapies.

A second study found that speech pathologists routinely miss critical steps when evaluating multilingual children for early intervention. That can lead to overdiagnosis, underdiagnosis and inappropriate help. “These findings point to the critical need for increased preparation at preprofessional levels and strong advocacy … to ensure evidence-based EI assessments and family-centered, culturally responsive intervention for children from all backgrounds,” the authors concluded.

Carr is a fellow at New America, focused on reporting on early childhood issues. 

Contact the editor of this story, Christina Samuels, at 212-678-3635, via Signal at cas.37 or samuels@hechingerreport.org.