Providing Culturally Responsive Treatment in the Schools Kyomi

Providing Culturally Responsive Treatment in the Schools Kyomi Gregory Ph. D. , CCC-SLP Iowa Speech Language Hearing Association Conference 2020 October 16, 2020

Disclosures Financial • Kyomi Gregory is a salaried Assistant Professor in the Communication Sciences and Disorder Department at Pace University. • She is also the topic area expert for nonmainstream dialects, cultural humility, and cultural awareness for the Informed SLP • She also received a stipend for this presentation

Learning Outcomes Participants will be able to: 1. identify and define key terms related to cultural responsiveness 2. define and discuss the relationship between culture and language 3. create and plan an actionable step on how to use curriculum based material that is culturally responsive within the classroom

Why is this topic important? • Culturally responsive instruction promotes the acquisition of increasing complex knowledge and skills in a climate that fosters: • Collaboration • Positive interaction among participants Callins, 2004

Key Terms Related to Cultural Responsiveness

ASHA’s Statement Issues in Ethics: Cultural and Linguistic Competence “This Issues in Ethics statement is developed to provide guidance to ASHA members and certificate holders so that they may provide ethically appropriate services to all populations while recognizing their own cultural/linguistic background or life experience and that of their client/patient/student. ” ASHA (2017) https: //www. asha. org/Practice/ethics/Cultural-and-Linguistic. Competence/

What factors can cultural diversity incorporate? • Intersectionality often exists across: • • • Age Disability Ethnicity Gender identity (encompasses gender expression) National origin (encompasses related aspects e. g. , ancestry, culture, language, dialect, citizenship, and immigration status) Religion Sexual orientation Veteran status Linguistic diversity can accompany cultural diversity Race ASHA, 2017

Culture and Language • The intertwining of these two areas is known as language socialization • Children are socialized into their culture through language Paradis, Genesee, & Crago, 2011

Cultural & Linguistic Competence ● ● It suggests that clinicians can complete a course or class to achieve competence It defines cultural and linguistic competence as a set of behaviors that come together in a system that “enables effective work in cross-cultural stituations” (ASHA, 2017)

“Competence” Can’t Be a Finite Skill ● We simply can’t just tolerate cultures ● Cultures shouldn’t be simply perceived to be monolithic ● All of us belong to multiple cultures ● We need to accept that there are cultures and cultural perspectives that vary from our own ● Instead we must view cultural competence as on ongoing process (Gregory & Ginsberg, 2019; Juarez, Marvel, Brezinski. Glasner, Towbin, & Lawton, 2006)

Cultural Humility ● Incorporates a lifelong commitment to: ○ self-evaluation and self-critique ○ redressing the power imbalances ○ developing mutually beneficial and non-paternalistic clinical and advocacy partnerships within communities (Tervalon & Murray-Garcia, 1998)

The Model of Cultural Humility ● It was first described and adopted by physicians ● It applies equally well to the profession of Communication Sciences and Disorders

Four Key Elements of Cultural Humility ● ● Self-reflection and self-critique Learning from others Partnership building A lifelong process (Chang, Simon, & Dong, 2012)

Self-Reflection & Self-Critique ● Individuals must be aware of the power they have on the individuals they interact with (Cooper-Patrick et al. , 1999). ● Individuals must first acknowledge their assumptions and beliefs before dealing with the belief system of others (Hunt, 2005).

Learn from Others ● Individuals need to listen to the individuals they work with in order to address the power dynamic that exists ○ Be aware of the power differential ● Other individuals should be seen as the source of their own culture ● Each person should learn from the individual’s that they interact with (Chang, Simon, & Dong, 2012)

Partnership-building ● Individuals need to develop and maintain mutually respectful partnerships with others ● This process promotes advocacy if they are working with others (Chang, Simon, & Dong, 2012) ● SLPs must practice ongoing advocacy for our clients

Life-Long Process ● It is an ongoing process when understanding culture ● Each person is constantly examining their relationship with themselves and others (Miller, 2009)

Skills & Characteristics of Cultural Humility ● ● Openness Self-awareness Egolessness Supportive interactions (Foronda, Baptiste, Reinholdt & Ousman, 2015; Trevalon & Murray-Garcia, 1998)

Cultural Competence + Cultural Humility = Cultural Competemility Campinha-Bacote (2018)

Cultural Responsiveness • The basis of doing this is having basic cultural competence in order to move towards cultural humility • You must have the ability to learn and build on the varying cultural and community norms of students and their families NYSED, 2017

Demographics in Iowa q. White: 90. 28% q Black or African American: 3. 51% q Asian: 2. 40% q Two or more races: 2. 10% q Other race: 1. 25% q Native American: 0. 37% q Native Hawaiian or Pacific Islander: 0. 10% v. Culture goes beyond race World Population Review (2020)

Examining how cultural responsiveness applies to treatment

Approaching clinical encounters utilizing cultural humility 1. 2. 3. 4. 5. Understand the role of culture in education Learn about students’ culture and community Use student culture as a context for learning Promote flexible use of local and global culture Establish a trustful relationship with the child, family, and community

Approaching clinical encounters utilizing cultural humility 6. Using this understanding to include culturally relevant material and themes that can be integrated into activities, supports, and teaching strategies 7. Understanding cultural and linguistic factors that may influence identification, assessment, and intervention of language and literacy disorders ASHA, n. d.

What communities do you work in? How can you use the culture of your communities as a context for learning?

How do you establish a relationship with the communities you work in?

How can you use culturally relevant material and themes in treatment?

Embedding • Bridge the gap between the home world of the student and the SLP • Consistent with the values of the home culture • High expectations with genuine respect for the diversity and belief in the students success • Encourage students of diverse backgrounds to use strengths in their home languages as the basis for becoming proficient readers 29

Embedding and/or Direct Instruction • How to teach: • Ideally, need intensive, explicit, comprehensive, individualized instruction (e. g. , Kamil et al. , 2008) • However, SLPs can embed activities to add support to language development 30

Utilizing the Iowa Core Standards and Applying this to Treatment Goals

How many clinicians integrate the Iowa Core Standards into assessment and therapy?

Examining the Iowa Core Literacy Standards • https: //iowacore. gov/standards/iowa-core-standards • Achieve the Core https: //achievethecore. org/ • Aspects that are of interest to SLPs: q 21 st Century Skills q. Essential Elements q. For students participating in alternative assessments q. Literacy q. Mathematics q. Science q. Social Studies

21 st Century Skills • These skills provide access to essential concepts and meaningful learning experience • These are that children: • need to be able to lead • will need to help with economic upward mobility • need for access in the 21 st century q The Framework for 21 st Century Learning stated, “We believe schools must move beyond a focus on basic competency in core subjects to promoting understanding of academic content at much higher levels by weaving 21 st century interdisciplinary themes into core subjects” (Gewertz, 2007).

Picture taken from https: //en. wikipedia. org/wiki/21 st_century_skills

Picture taken from https: //www. aeseducation. com/blog/what-are-21 st-century-skills

Picture taken fromhttps: //3 starlearningexperiences. wordpress. com/2016/11/01/21 st-century-skills-dont-exist-so-why-do-we-need-them/

21 st Century Skills • This is incorporated into the Iowa Social Studies Standard • Civic Literacy • Financial Literacy • Employability Skills • Health Literacy • Technology Literacy

Client Profile: Jennifer is a 10 year old White student who lives in a rural area of Iowa. She is currently in the 5 th grade. She has the disability classification of a learning disability. She also has challenges with social communication skills. She has received special education services since she was preschool. She recently received a 3 year assessment. Testing from the CELF-5 revealed a Receptive Language Index (RLI) with scores that are average and an Expressive Language Index (ELI) that is slightly below average.

Client Profile: Jennifer • CELF-5 Subtest scores with difficulty were: q. Word Structure – slightly below average q. Following directions – slightly below average q. Structured writing – below average

Client Profile: Jennifer Weschler Individual Achievement Test – III (WIAT-III) • Essay Composition – Below Average • Oral Expression – Below Average

Client Profile: Jennifer currently exhibits average development in her expressive language and overall core language skills, as well as a slight delay in her receptive language skills, when compared to children her age. She has several grammatical errors in her written language and is only able to write simple sentences. Jennifer has difficulty following directions, recalling sentences, and word structure. Jennifer’s speech production was judged to be atypical. Her voice was judged to be soft and baby like. However, her articulation and fluency were within normal limits at the time of evaluation.

Client Profile: Jennifer Strengths: q. She is an auditory/ visual learner q. Works best independently or in a small group q. She loves to read q. She has creativity with narrative writing and is able to use dialogue and add sensory details

Client Profile: Jennifer Weaknesses: q. Struggles to explain her thinking q. Has difficulty supporting her answers with relevant evidence from the text q. Struggles to read longer written text and retain information q. Struggles to analyze word problems q. She has a hard time staying focused in the classroom q. She struggles with her social communication skills

What would you work on in therapy with Jennifer?

Speech and Language Services: Jennifer • Annual Goals q. Within one year, with guidance and support, Jennifer will process incoming verbal information, and will identify key information, pertinent supporting details, and inferential thinking, with decreasing verbal and visual cues with 80% accuracy q. Within one year, with guidance and support, Jennifer will expand receptive vocabulary and associative thinking, and will demonstrate improvement of overall processing by following multi-step directive with 80% accuracy q. Within one year, Jennifer will develop and utilize associative thinking skills, with improved semantics, through defining, describing, and comparison/ contrast with 80% accuracy

Speech and Language Services: Jennifer • She benefits from: q. Refocusing prompts q. Proximity to the teacher q. Multiple visual models

How can we connect Jennifer’s therapy sessions to the Iowa Core standards? • Examining the 21 st Century Skills: • Employability Skills (21. 3 -5. ES. 1) q. Communicate and work productively with others emphasizing collaboration and cultural awareness to produce quality work. q. Articulate thoughts and ideas clearly in writing and speaking. q. Cooperate with others in a group setting. q. Recognize the opinions and feelings of others (Theory of Mind) q. Appropriately accept constructive feedback. q. Use information to make decisions. q. Ask appropriate questions. q. Read, understand create information in a variety of forms. q. Follow directions.

How can we connect Jennifer’s therapy sessions to the Iowa Core standards? • Examining the 21 st Century Skills: • Health Literacy (21. 3 – 5. Hl. 1) q. Explain proper prevention/management of health crises q Describe how media, technology, research and medical advances impact health q Recognize how national and international public health and safety issues affect personal and family health status v. Utilize this core standard to discuss COVID-19 and the importance of wearing a mask and washing your hands.

How can we connect Jennifer’s therapy sessions to the Iowa Core standards? • Examining the 21 st Century Skills: • Technology Literacy q. Demonstrate awareness of the dangers of sharing personal information with others q. Demonstrate an understanding of what electronic theft and plagiarism are and why they are harmful q. Identify the positive values of using technology to accomplish tasks q. Use technology to explore and pursue personal interests v. Utilize the internet to help the student seek out resources and answers v. Safety skills around using the internet

How do you use Iowa Core Standards to create quality IEPs? • Well-written Present Level of Academic Achievement and Functional Performance (PLAAFP) • Describe the impact of the IEP on general education • Focus on dosage (frequency, duration, location) • Transition plan

How would you connect treatment to the Iowa Core Standards for Jennifer?

Utilizing Curriculum Based Materials within Treatment

participation, reading, interaction Why should SLPs care about education goals and academic standards? Read, comprehend, respond Following instructions & participate in complex tasks Communication with peers, communicate professionally

Speech Language Services • Link to academic core standards: language arts • Performance goals based on state education standards • IEP goals must reflect grade level performance • Curricular accommodations • Intervention strategies and assistive technology should support standards • Service based on the student’s level of need • Collaboration and consistent intervention

How do you collaborate using Iowa Core Standards? • GOAL: HOTS = Higher Order Thinking Skills • Distinguishing critical thinking skills • Synthesizing • Analyzing • Reasoning • Comprehending • Application • Evaluation • LOTS = Lower Order Thinking Skills • Rote memorization Watson (2020)

Picture taken from https: //sites. google. com/site/4 newfrndzbloomstax/hot-and-lot

Focusing on In-Classroom Collaboration when Providing Culturally Responsive Treatment

What are the benefits of collaboration? • Building relationships with colleagues • Co-treating/ co-teaching • Sharing ideas • Spiraling student skills • Supporting IEP goals

Judy Rudebusch’s 7 steps for Utilizing Common Core State Standards 1. 2. 3. 4. 5. 6. 7. Consider the Content Standards Examine the Data Determine the Student’s Present Level of Performance Develop Measurable Goals Assess Progress Identify Special Instruction Determine the Most Appropriate Assessment Option Rudebusch (2012)

(1) Consider the Content Standards • Discuss with Teachers • Review standards for previous grades • Review the standards from the lens of the SLP: • Syntax • Semantics • Pragmatics • Phonology • Morphology Rudebusch (2012)

(2) Examine the data • Observations • Writing samples • Language samples • Benchmark testing • Universal screening tools (DIBELS) Rudebusch (2012)

(3) Determine the Student’s Present Level of Performance • Determine strengths/ weaknesses • Use multiple forms of current data • How does the disability impact the general curriculum? Rudebusch (2012)

(4) Develop Measurable Goals • Align with grade-level standards • Review the previous years standards • Consult with teachers Rudebusch (2012)

(5) Assess Progress • Utilize dynamic assessment • Collaborate with teachers Rudebusch (2012)

(6) Identify Special Instruction • Create specially designed instruction for each student • What are the accommodations? • Are you making modifications? Rudebusch (2012)

(7) Determine the Most Appropriate Assessment Option • How will progress be measured? Rudebusch (2012)

The role of SLP with Respect to Vocabulary Development, Language, and Literacy • • Vocabulary words- myriad of memory connections SLPS have been trained in functions of brain and neuromechanisms (synapses strengthened w/ myelin sheath) learning through connections via rich contextualized exposure Schemas develop per individual and overtime Socioeconomic, cultural, social, experiential, geographic, physical religious factors • • •

Cont’d. ● Limited experiences= limited schemas ○ Limited education/lack of interaction → 4, 000 words by third grade Well educated/good interaction→ 12, 000 words by third grade The more synapses created in memory cells → easier the student learns vocab → increases literacy → increases academic achievement ○ We create more opportunities for schemas to be built and can do so by working with the general educator ! (Vaishnav, 2005)

Importance of vocabulary Children’s vocabularies (schemas) is a great predictor of… Reading ability. . . Reading ability is a great predictor of… Literacy is a great predictor of… ACADEMIC SUCCESS! [Picture of books (n. d. ) received from http: //clipartlibrary. com/stack-of-books. html

Recommended EBP Service Delivery Formats and Clinical Strategies • Interactive book reading • Facilitate new word learning among pre-school children • 36 exposures to target words in 15 -20 min. /session, rotate books Pre-book reading (what words you’ll hear), book reading (highlight target words), post book reading (encourage discussion) Technology-assisted learning • • • Be sure to scaffold→ present words in varied contexts, provide multiple opportunities to use words in expressive language, select words based on child’s interests/needs, require child to think critically about the word, use visuals as much as possible, use examples and nonexamples, use role-play following video clip

More Clinical Strategies • Sight Words or High-Frequency Words • Quickly decode→ better reading fluency and writing abilities Phrasal Verbs • Two-word combination; just as important (fill out vs. fill in for) General Academic Vocabulary • Not academic content, used frequently in classroom, but not used in everyday lives of students (words about ideas: concept, perceive, literal) Listening, Speaking, Reading, and Writing Vocabulary • • Teaching vocabulary in 4 communication modes • Multiple vocabulary instruction, enrichment, and intervention activities

Cont’d. • Useful Words • Beck, Mc. Keown, and Kucan (2013) provide selection criteria for educators to determine what words to teach • Tier 1: most basic/most common • Tier 2: high-frequency words but not common in daily conversation • Most recommended because they can be used in variety of contexts Tier 3: domain specific (i. e. isotope, enzyme), need to be taught within academic instruction Vocabulary for the Common Core • • • Analyzed CCSS and used the above process focusing on tier 2 and 3, facilitated through 24 different cognitive processes that facilitate critical thinking

Fostering Deeper Processing and Higher Order Thinking Skills • CCSS challenges learners to develop critical thinking skills, problem solving abilities, collaborative characteristics, and confidence to take risks in learning • Intent: learners must be challenged at higher levels of cognitive processing by being engaged in learning activities that go beyond remote memorization of facts • This must be incorporated into specific language impairment intervention

The Importance of Teaching Morphology ● Morphology allows students to manipulate words in a meaningful way ● Engage the student in short, meaningful, multiple lessons of no more than 5 -10 minutes ● Less effective activities for teaching vocabulary include ○ Completing worksheets, using flashcards, choral word drills, matching, other decontextualized practice

The Importance of Teaching Syntax • • • Syntax gives students a language structure in order to use those words in a meaningful way Encourage students to use verbal language Intervention techniques for students who have progressed from learning to read → reading to learn: • Word walls • Graphic organizers • Fill-in-the-blanks • Role playing games • Creating a blog • Free word games

An effective SLP program aligns Language, Literacy, and the Iowa Core Standards ● ● Learning Approach: developmental, logical, sequential SLPs must work collaboratively with IEP team to collect assessment data using a variety of tools and evaluate the data to determine: Student’s strengths, challenges, interests, and learning style IEP team designs an appropriate educational program that must be implemented in the least restrictive environment ○ ●

Q&A

Take Home Message

Select References American Speech-Language-Hearing Association. (2016). 2014 Standards and Implementation Procedures for the Certificate of Clinical Competence in Speech-Language Pathology. Retrieved from https: //www. asha. org/certification/2014 -speech-language-pathology-certification-standards/ American Speech-Language-Hearing Association. (2019). Strategic Pathway to Excellence: Strategic Objective Highlights. Retrieved from https: //www. asha. org/uploaded. Files/Strategic-Objective-Highlights. pdf O’Berry, S. & Gregory, K. (2019). Cultural Humility: Examining Microaggressions to Improve Clinical Encounters. Paper presented at the annual convention of the American Speech-Language Hearing Association, Orlando, FL. Rudebusch, J. (2012). From Common Core State Standards to Standard-Based IEPs: A brief tutorial. The ASHA Leader, 13(1), 17 – 24. Tervalon, M. , & Murray-Garcia, J. , (1998). Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, 9(2), 117 -125. .