Working with people whose native language is something other than English is a difficult, but increasingly necessary, niche to fill in speech-language therapy services. According to U.S. Census data, the population of the country that speaks a language other than English at home grew by nearly 160 percent between 1980 and 2010.
The demand is also increasing in schools, the largest single sector in which SLPs are employed. According to the National Center for Education Statistics (NCES), between 2004 and 2014 the number of ELL students in American schools increased by 300,000. In some states, like California, ELL enrollment can approach one-quarter of all students; the average for urban school districts nationwide is 16.8 percent.
Both of those trends result in an increasing number of patients with every type of issue requiring attention from a speech-language pathologist. From autism to aphasia to hearing-impairment, larger patient populations whose primary language is not English are affected.
ASHA’s (American Speech-Language-Hearing Association) Code of Ethics, binding all board certified SLPs and audiologists, requires therapists to provide culturally and linguistically appropriate services to all patients, regardless of their caseload demographics. This commitment has opened up a large practice area for bilingual or multilingual speech-language pathologists.
Working With English Language Learners as a Speech-Language Pathologist
SLPs, whether bilingual or not, face a particular difficulty when working with ELL patients: which artifacts or deficiencies in their English language use are the result of a disability or disorder, and which are simply due to their lack of English proficiency?
Further, the language acquisition patterns of children living in multilingual environments does not necessarily follow patterns that are established and well-understood among monolingual groups. Very young children, those below the age of three, tend to not differentiate between multiple languages when they are learning them simultaneously; they may be unaware that listeners do not, like themselves, have command of all the same words and speech patterns. They will use words and language structures interchangeably, which can throw off conventional assessments.
Nonetheless, there are characteristic signs that SLPs look for to determine genuine impediments even among non-native speakers. These include:
- Inability to produce bilabial sounds
- Slow word acquisition in both languages
- Acquisition of second language leads to syntactic errors in the first language
Bilingual SLPs provide their services to ELL patients just as they would with native English speakers, using the same array of assistive devices, technology, and techniques that all SLPs use. Although the exact delivery of services may vary slightly with cultural and language-specific issues, the desired outcomes are identical.
Working Through a Translator
For SLPs who are not bilingual, working through a translator is the only way to make therapy accessible to ELL patients. Translators fill a number of roles in speech-language therapy:
- Interpreting the words and meaning of sentences back and forth between the patient and SLP.
- Acting as a linguistic assessor of the patient’s use of their native language.
- Serving as a cultural broker in aiding the SLP to grasp elements of behavior or speech by the patient which are the result of cultural differences rather than language difficulties.
An interpreter may also be essential in taking a case history from parents or caregivers when the patient is a child. Many ELL students have parents who are not fluent in English and cannot be directly consulted by the SLP to uncover patterns of language use at home or over time. An interpreter may be the only interface the SLP has with the parents.
Interpreters may also have to participate in therapy itself. Whether delivering instructions or assessing results, they become the funnel through which services are delivered.
This requires both an exceptionally talented interpreter and good judgment and planning on the part of the SLP. Fortunately, specialized medical interpreters are available who have experience in such matters. The National Council on Interpreting in Health Care offers certification for such interpreters, and many local hospitals and health care agencies have lists of locals who are experienced in working in health care settings.
Speaking a Foreign Language is Key to Being Able to Serve ELLs
Having a native or near-native proficiency in another language is the first and most obvious step to becoming a bilingual or multilingual SLP, but there is a lot more to it than that. ASHA identifies five key points of competency that an SLP must achieve before advertising themselves as being a bilingual provider:
- Native or near-native proficiency in another language.
- Knowledge of typical language development patterns for both monolingual and bilingual speakers of that language.
- The ability to administer and interpret diagnostics in that language.
- The ability to provide treatment in that language.
- The ability to recognize cultural factors among speakers in that language group that may impact services.
ASHA does not, itself, provide any sort of certification or testing on these guidelines, however. Some states, such as Illinois and New York, do offer and even require specific credentials for bilingual SLPs, although often only in the specific practice area of education.
There are a number of graduate programs that specifically offer bilingual speech-language education, and graduate certificate programs that can provide similar training if you already have a master’s degree. These programs commonly involve taking a language proficiency test and enrolling in certain specific courses either involving the target language or other speech and language topics. They may require 100 hours or more of supervised bilingual practicum.
Most of these focus on Spanish, the second most widely spoken language in the United States, but others have options for Japanese, Chinese, Korean, and other language groups.
Acquiring the second language you plan to practice in, if you are not already a speaker, is the obvious first step, but it may also be the most difficult. Language learning to the point of near-native proficiency is a topic that involves deep study and practice in and of itself, quite apart from learning the additional professional linguistic and assessment skills required for offering speech-language therapy.