Serving a diverse population: The role of speech-language pathology professional preparation programs

Journal of Allied Health, Winter 2002 by Stewart, Sharon R, Gonzalez, Lori S

A national survey of 228 program directors was conducted to determine how master's level professional preparation programs are meeting the challenge of preparing speech-language pathologists to provide quality services to an increasingly diverse population. A total of 91 respondents provided information regarding their programs' efforts to address diversity by increasing the diversity of speech-language pathology professionals, preparing students in research for diverse populations, and providing students with the didactic knowledge and clinical experience required to serve diverse populations. Results indicated that professional preparation programs continue to lag in their enrollment of minority students, but there are efforts actively to recruit and retain students from diverse groups. Much variation in preparation in research was found across programs. Graduate students are being presented with information concerning diversity issues, but clinical experiences vary greatly according to the geographic location of the preparation program and individual practicum placements. Implications of these findings for speech-language pathology preparation programs and other allied health programs are discussed. J Allied Health. 2002; 31:204-216.

HEALTH CARE PROFESSIONS in the United States are faced with the challenge of providing high-quality services to an increasingly diverse population. U.S. demographics are changing rapidly as a result of significant increases in racial, ethnic, and linguistically diverse populations already residing in the United States and adjustments in immigration patterns. The federally designated minority population of the United States increased by 7.1% between 1990 and 1997 and is projected to expand to about 30% of the population by 2005 and to 47% by 2050. Although the present U.S. population is about 13% African American, 11% Hispanic, 4% Asian/Pacific Islander, and 1% Native American/ Eskimo/Aleutian, the population is expected to shift to about 24% Hispanic, 15% African American, 9% Asian/ Pacific Islander, and 1% Native American/Eskimo/Aleutian by 2050.1

Presently, almost 10% of U.S. residents were born outside of the country,2 and a language other than English is spoken in at least 14% of U.S. homes.3 Immigration patterns have become increasingly diverse, with individuals arriving from Russia, the Middle East, India, the Philippines, Laos, Bosnia, and many other countries.4 The geographic distribution of the population is shifting so that the diversity once concentrated in metropolitan areas is becoming dispersed in smaller communities.5

As the population changes, the number of individuals from diverse backgrounds with health care problems can be expected to increase. Individuals representing racial and ethnic groups in the United Statesare more likely to be economically disadvantaged, which presents increased risks for health problems because of poor living conditions, inadequate diet, poor or no health insurance coverage, and lack of health care access.6- Of the 13.8% of the U.S. population living below the poverty level in 1995, 29.3% were African American, 20.3% were Hispanic, and 14.6% were Asian.' The percentage of minority populations needing health-related services, including speech-language pathology (SLP) and audiology services, is likely to continue to increase until economic conditions improve.

The health care professions, including SLP, recognize the crucial need to prepare professionals better to work with an increasingly diverse population. Professionals, administrators, professional associations, accreditors, and educators across the spectrum of health-related professions have responded with various initiatives to improve professionals' competence in working with patients from diverse backgrounds.9,10 Establishing competence in working with individuals from diverse backgrounds is best considered a process that progresses through various states. Cross et al.11 described a continuum of competence with six possible stages as follows: 1) cultural destructiveness (intentionally destructive to diverse cultures), 2) cultural incapacity (unintentionally destructive because of lack of capacity to respond to diversity); 3) cultural blindness (profess to being unbiased and view all people and cultures as the same); 4) cultural pre-competence (realize weaknesses in serving diverse groups and desire to provide quality services); 5) cultural competence (demonstrate an acceptance and respect for differences); and 6) cultural proficiency (engage in practices that demonstrate high esteem for diverse cultures).

Moving professionals along the continuum to greater competence requires comprehensive, coordinated, longterm planning and implementation. To that end, the SLP profession has launched many ambitious initiatives. Some of these initiatives have important implications for SLP professional preparation programs, especially initiatives whose goals include 1) increasing the diversity of speechlanguage pathologists; 2) increasing the quantity and quality of research regarding prevention, normal development, assessment, and treatment of communication disorders across diverse populations; and 3) improving academic and clinical preparation in the areas of assessment and treatment of communication disorders and differences in diverse populations.