JCPSLP November 2016

Creating sustainable services: Minority world SLPs in majority world contexts

Applying theories of cultural competence to speech- language pathology practice in East Africa Helen Barrett

As global mobility increases and populations diversify, challenges to delivering appropriate, responsive, ethical and effective SLP services have emerged and services users, practitioners and national bodies are increasingly calling for delivery of culturally sensitive services. It is therefore crucial to look beyond our own cultural reference points and adopt an attitude of open-minded and continuous learning about others in order to provide the best services to all clients. Models of cultural competence have been developed across the allied health professions and have been described as: practitioners’ awareness, knowledge, skills, and sensitivity in relation to their clinical practice with people from cultural and linguistic backgrounds other than their own. This paper draws on the author’s experience of working across east Africa, with reference to two frameworks for cultural competence which are applicable to speech-language pathology practice. The paper highlights the multifaceted and interactional nature of different dimensions of cultural competence and queries whether this is accurately represented in the current theoretical frameworks. E ast Africa is a region defined by diversity, and the challenges to developing cultural competence for external speech-language pathologists are enormous. Not only is the ethnic and linguistic diversity in the region extensive, but explanatory models of disability are often heavily influenced by the medical profession, stigma surrounding disability, and religious and /or cultural beliefs (Barrett, 2013). Professional training courses and services to meet the needs of people with communication difficulties are emerging 1 but are in their infancy, are frequently facilitated by external speech-language pathologists and often require ongoing support once established (e.g., Robinson, Afako, Wickenden, & Hartley,

2003). It is therefore crucial that the external practitioners involved are culturally competent to deliver appropriate, responsive, ethical and effective support. The need for a culturally competent profession Many national speech-language pathology associations stress the need for professionals to offer appropriate and sensitive services to diverse client groups (e.g., ASHA 2011; RCSLT 2003; SPA, 2016), but more guidance is needed on how to fulfil these obligations, specifically regarding issues beyond bilingualism and multilingualism (Leadbeater & Litosseliti, 2014). Much of the available literature exploring speech- language pathology with clients from a range of backgrounds describes practice in multicultural societies in the minority world 2 (e.g., Leadbeater & Litoselliti, 2014). However, literature is also emerging on how external speech-language pathologists working in the majority world can do so ethically and effectively (e.g., Crowley & Baigorri, 2011; Hickey, McKenna, Woods, & Archibald, 2014). Current literature addressing the needs of people with communication disabilities in the majority world primarily focuses on issues and methods of professional or service development (e.g., Wickenden, 2013; Wylie, McAllister, Davidson, & Marshall, 2013) and, though this literature identifies the need for speech-language pathology education programs and services to be developed using culturally appropriate methods (e.g., Wickenden, Hartley, Kariyakaranawa, & Kodikara, 2003), the question remains as to how external speech-language pathologists can develop competence to facilitate these processes effectively. For speech-language pathologists to become sufficiently competent to practise internationally, it is essential to reflect upon motivations, skills and learning needs (Brown & Lehto, 2005; Hickey et al., 2014) and upon what cultural competence means in relation to their home, and overseas, practice. In addition, it is critical to consider the concept of cultural humility in relation to cultural competence; cultural humility being the acceptance that it is not possible to be fully knowledgeable about a culture other than that which one is born into (Levi, 2009; Walters, 2015). Practitioners must therefore understand that cultural competence and cultural humility are critical prerequisites to the delivery of appropriate, relevant and effective services and apply both concepts to their practice.

KEYWORDS CULTURAL

COMPETENCE EAST AFRICA SPEECH- LANGUAGE PATHOLOGY

THIS ARTICLE HAS BEEN PEER- REVIEWED

Helen Barrett

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JCPSLP Volume 18, Number 3 2016

www.speechpathologyaustralia.org.au