Telepractice with Culturally Diverse Students

Diversity Defined

Among its many benefits, telepractice has enabled speech-language pathologists (SLPs) to connect to clients across geographical boundaries. This has opened the door for many culturally and linguistically diverse clients previously underserved to benefit from top-quality speech therapy.


However, this giant step forward is accompanied by a new challenge. SLPs delivering therapy via telepractice to diverse populations must become sensitive to the cultural considerations of their culturally diverse clients. Roughly one-third of the U.S. population belongs to an ethnic or racial minority group. Nearly 14 percent of Americans, the highest percentage in history, are now foreign-born.


The Mandate for Cultural Sensitivity

There is nearly unanimous agreement in the field of healthcare that an individual's cultural sensitivities must be treated as a critical factor. The Surgeon General's report, Mental Health: Culture, Race, and Ethnicity, states, "Substantive data from consumer and family self-reports, ethnic match, and ethnic-specific services outcome studies suggest that tailoring services to the specific needs of these [ethnic] groups will improve utilization and outcomes" (U.S. Department of Health and Human Services 2001, p. 36).


The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994), obligated clinicians to understand how cultural differences impact the therapist-client relationship. These understandings and sensitivities must be applied in other therapies and forms of care as well.


Telepractice that is Culturally Sensitive

Telepractice that is culturally sensitive takes into account the SLP's knowledge and understanding of the client's background, ethnicity, and system of beliefs. Once the SLP is aware of the cultural differences, she is in a position to respect and accommodate differences in attitudes, values, and opinions of various types of people and different cultures.


Cultural sensitivity has another benefit - the acquisition of cultural competence. Cultural competence is the capacity to understand one's own cultural bias and its influence on the client-therapist relationship. Grounded in this understanding, the therapist is poised to respond to another's culture more accurately, making the treatment more effective.


There are two components involved in meeting the needs of diverse clients: (1) knowing how to interact and work with people from different cultures and (2) understanding the particular culture of the client (Jezewski and Sotnik 2001). In other words, being a culturally competent clinician is very similar to being a caring, responsible clinician who ignores first impressions and stereotypes and instead treats clients with respect.


Like the rest of us, therapists often believe that their social values are the norm, and therefore typical of all cultures. American culture differs from most other cultures in several ways. The first step in understanding another’s culture is to have a full grasp of the tenets of the Anglo-American culture of the United States.

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When seen in contrast to much of the rest of the world, Anglo-American culture in general is competitive, materialistic, has a heavy emphasis on accomplishment, and has its orientation on the future. Most people in the United States experience a fast-paced life split between family and work. It is often compartmentalized and deemphasizes community and spirituality.


Getting a bit More Nuanced

The cardinal rule in avoiding the temptation to stereotype is to remember that each client is an individual. Every culture has its complexities and is therefore not easy to reduce to a formula or exact description. It may be something as seemingly innocuous as an observation that is highly accurate regarding a large group of people, but misleading and hurtful when applied to an individual.


It must be remembered that culture is only the point of orientation when attempting to understand an individual's values, wishes, and perceptions. How neatly aligned any given individual is with the current values of his/her culture is dependent on many factors such as how integrated that person has become into U.S. society, socioeconomic status, and education.


Culturally Diverse Worldviews:

  • Holistic worldview. Many cultures, among them Native-American and Asian cultures, have a holistic view of the world. They comprehend all of nature, the animal kingdom, the heavens, and the spiritual world as an integrated whole.

  • Communication styles. Communication problems between client and therapist and cultural misunderstandings may prevent people of different cultures from accessing therapy altogether, or lead to a compromised experience.

  • Multidimensional learning styles. American culture emphasizes learning through reading and teaching, focusing on reasoned facts. Other cultures place heavy emphasis on their oral tradition. Learning often comes through parables and stories that interweave emotion and narrative.


Issues Impacting the Therapist-Client Relationship:

  • Authority and Boundaries. Clients who come from other cultures usually perceive the therapist as the authority. This may create more of a natural distance between the client and the therapist.
  • Respect and dignity. American culture is more informal regarding how people are addressed. Treating others in a friendly way is considered to be respectful. This is in stark contrast to other cultures, especially where people have been oppressed, where formality and honor are considered paramount in importance. In these cultures, informality is tantamount to disrespect and rudeness.

  • Attitudes regarding therapists. There are considerable differences across cultures regarding how comfortable people feel about accepting professional help. For some individuals, the family or the extended family is where problems are handled.


Want to Know More?

You have an excellent opportunity for a more in-depth exploration of this increasingly relevant topic given by Lesley Edwards Gaither, MA, CCC-SLP at the upcoming 2019 ASHA Convention at the Orange County Convention Center in Orlando, Florida, November 21-23. The session entitled, "A Pilot Study of Speech-Language Pathologists' Use of Telepractice with Culturally Diverse Students" will be held on Thursday, Nov 21, 11:30 AM-12:00 PM in CC/231A.


Lesley Edwards-Gaither has over seven years of experience performing telepractice and is currently pursuing a Ph.D. at Howard University in Washington, D. C. Her research interests include the delivery of telepractice services to culturally diverse populations and the application of educational technology to the field of speech-language pathology.


The session will review a pilot study designed to explore the clinical knowledge, concerns, activities, and materials used by SLPs providing treatment to culturally diverse students via telepractice. While you are there, please visit us at the Global Teletherapy Booth #1452.

speech therapy and mental health therapy sinking ship

A Very Difficult and Complex Problem

The latest results of the tests known as the Nation's Report Card released last month offer a mostly grim view of academic progress in U.S. schools.

"Over the past decade, there has been no progress in reading performance, and the lowest-performing students are doing worse," said Peggy Carr, associate commissioner of the National Center for Education Statistics, which administers the National Assessment of Educational Progress (NAEP).

"In fact, over the long term in reading, the lowest-performing students—those readers who struggle the most—have made no progress from the first NAEP administration almost 30 years ago." Since 2017, reading performance has dropped significantly across grades 4 and 8, with math performance mixed, based on the results of the 2019 NAEP.

U.S. Education Secretary Betsy DeVos considers the results a "wakeup call." "Every American family needs to open the Nation's Report Card this year and think about what it means for their child and our country's future," said DeVos. "The results are, frankly, devastating. This country is in a student achievement crisis, and over the past decade, it has continued to worsen, especially for our most vulnerable students."

Root Causes That are Being Overlooked

1. Speech-Language Disorders

Speech-language disorders will likely impair a child's ability to learn. Children diagnosed with a speech-language disorder, especially receptive language disorder, may struggle with understanding, processing, and retrieving verbal information.

This handicap in remembering or even understanding verbal information or instructions will take its toll on the child's ability to complete assignments and tasks.

Also, children who have speech-language deficits are more likely to struggle with learning how to spell and read. Research has consistently shown that verbal skills are an accurate predictor of reading skills development. Segmenting letters and words, a necessary skill for reading, can be very challenging for these children.

2. Mental Health Disorders

Mental Health Disorders disrupt academic performance in different ways. The following is just a partial list:

  1. Screening out external stimuli – an inability to block out sights, sounds, or smells that interfere with the ability to focus on assignments or tasks

  2. Maintaining concentration – reduced attention span, easy distractibility, being restless, difficulty focusing on or remembering verbal directions

  3. Sustaining stamina – struggling with having the energy to put in a full day in school due to sleeping issues or drowsiness caused by medications

  4. Inability to juggle multiple tasks and deadlines – preoccupation with anxiety, fears, and thoughts interfere with completing tasks and assignments

  5. Social difficulties – problems interacting with peers, grasping social cues, and fitting into a group

  6. A healthy response to negative feedback – comprehending and interpreting low grades or criticism, being paralyzed by low self-esteem

  7. Adjusting to change – due to internal unsettledness, finding it challenging to cope with or integrate changes in assignments, substitutes, and deadlines

Teletherapy: A Game Changer

Speech-Language Therapy

Here are three areas where speech-language teletherapy can help children succeed in school:

Executive Function Skills

Executive function and self-regulation skills are crucial to a child's ability to execute daily functions and tasks. Children who have difficulty planning for upcoming tests, scheduling their time, or remaining focused on the teacher's instructions benefit significantly from an SLP (Speech-Language Pathologist) who teaches them how to focus and organize their thoughts. Improving in these areas is at the core of academic success.

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Auditory Processing Disorder

Sometimes children, especially in noisy environments, can hear words being said, but their brains have a hard time processing what they are hearing. SLPs can help students distinguish, recognize, and understand auditory information, which is invaluable to academic achievement.

Language Skills

Language skills are building blocks of conveying thoughts and ideas. Being proficient with these skills is essential to both social and academic success. Language skills encompass both expressive language (communicating thoughts) and receptive language (understanding others' thoughts). These are some ways that an SLP can be helpful:

  1. Following directions (simple, one-step, multi-step, and complex directions)

  2. Grammar (proper verb tense, grammatically-correct sentences, subject-verb agreement, etc.)

  3. Vocabulary (comprehending and using age-appropriate vocabulary)

  4. Understanding what, where, when, why, and how questions

  5. Conveying thoughts both orally and through the written word

Mental Health Therapy

School psychologists (also social workers and counselors) work with children, teachers, and families to facilitate academic success, appropriate behavior, and the mental health of all students, in particular children whose learning is handicapped by mental health issues.

These psychologists have been trained extensively in assessing children, monitoring their progress, child development, and child psychology, consultation, counseling children, responding to a crisis, evaluating programs, and working with data.

Providing those mental health services that lower learning barriers is at the very core of the mission of these teletherapists. The success of their efforts can be measured by the healthy psychological development, academic achievement, and responsible citizenship of the students with whom they work.

These are some of the ways that school psychologists can help via teletherapy:

  1. Together with teachers, school psychologists work to motivate children to more fully engage in learning. The psychologists' interventions are designed to improve the academic success of the students and their enjoyment of learning.

  2. School psychologists work together with teachers to craft and implement both behavioral and academic interventions. Research has shown that these interventions reduce behavior problems and improve academic performance.

  3. These teletherapists often work with school administrators to design and implement mental health programming for the entire school. These programs enhance academic success by improving attendance, reducing discipline problems, and improving test scores.

  4. In collaboration with SLPs, school psychologists help children develop social and communication skills. Improved ability to problem-solve, control anger, self-regulate, and be more optimistic all have a direct bearing on increased academic success.

Bottom Line

At the end of the day, we are dealing with a very difficult and complex problem. The continuous decline of our schoolchildren's ability to read threatens the efficacy of our entire educational system. It doesn't matter in what form the written material is delivered, the old-fashioned way, or via the latest technology. Our children must be able to read and understand what they have learned.

Other solutions aside, speech and mental health teletherapy will undoubtedly be suggested. Providing great value, these become invaluable as part of the solution. Let's not forget something so basic as empowering our children with the speech and mental health therapy they so richly deserve!

Teen Suicide Is Going Over The Cliff! How Can We Stop It?

Our Teens’ Growing Suicide Problem

The National Institute of Mental Health reports that, in 2017, there were over 47,000 suicides in the United States. Over 10% of those suicides were teenagers. In fact, suicide is the second leading cause of death among teens. Accidental death is the leading cause.

What Drives Teens to Suicide?

Remember that suicidal thoughts and behaviors are not an automatic reaction to severe life stressors. Some teens experiencing stress who feel intense anger, anxiety, sadness, loss, and even hopelessness may occasionally feel that they would be better off dead. But this is not the normal reaction of most teens.

Depression and Other Mental Illnesses

Research shows that nearly all teens who committed suicide had a mental illness, most commonly depression. Depression’s great emotional pain and loss of hope blind teens and young adults from seeing another way out of the pain aside from suicide. Other mental illnesses such as schizophrenia, bipolar disorder, borderline personality disorder, and eating disorders, including anorexia and bulimia, have also been shown as causes.

Traumatic Stress

Those teens who suffered a traumatic experience, including childhood sexual abuse, rape and physical abuse, are at a higher risk for suicide, even if many years have passed since the trauma. A diagnosis of PTSD, or multiple incidents of trauma, has been shown to raise the risk even further.

Substance Abuse and Impulsivity

Abusing alcohol and drugs also has a significant impact on teens who are suicidal. Substance abuse causes these teens to act more impulsively upon urges than they would have while sober. Substance abuse can have an indirect effect as well, such as causing the loss of a job or relationship, or exacerbating a psychological disorder.

Loss or Fear of Loss

When a teen is facing a painful loss or even afraid that such a loss might occur, committing suicide may seem like the only option. Such a loss may be the ending of a close friendship or romantic relationship, losing a job, being bullied, socially targeted in a negative way, or failing academically.


When teens feel they no longer have hope and are unable to do anything about it, suicide seems like a viable option. While it may be apparent to an outsider that things will get better, to a hopeless teen this reassurance sounds like wishful thinking that has no basis in reality, and thus is discounted as irrelevant.

Social Isolation

Social isolation can happen for a variety of reasons. It could be the loss of friends, physical or mental illness, moving to a new location, or even social anxiety. Sometimes low self-esteem can lead to loneliness, which could ultimately result in suicide.

A Cry for Help

At times a teen will attempt suicide not because of a desire to die, but because the pain is overwhelming, and he/she doesn’t know where to go to for help. Such an attempted suicide isn’t the teen crying for attention, but crying for help. But these cries can be fatal if the teen doesn’t appreciate the lethality of her chosen suicide method.

Warning Signs that Suicide may be near:

  • Obsessively talking about suicide or death

  • Feelings of intense sadness, helplessness, and hopelessness

  • Becoming disinterested in physical appearance or daily activities

  • Desire to be alone/withdrawal from friends and family

  • Giving away meaningful possessions

  • Risky behavior such as substance abuse or reckless driving

  • Persistent lack of energy

  • Difficulty thinking clearly and concentration problems/academic failure

  • Suffered a recent traumatic event/exposure to other teen suicides

  • Unable to extricate from a hostile social or school environment

  • A significant change in sleeping or eating habits

  • Running away/violent or rebellious behavior

  • Saying goodbye to people in a way that suggests they won’t be seen again

  • Trying to access weapons, other objects or pills that could be the means

  • Expressing feelings of self-loathing, guilt, or shame

How Can You Prevent Suicide?

(While these tips are directed towards the parent of the teen at risk of suicide, the therapist or a bystander can implement these tips as well.)


Tip 1: Speak Up If You’re Worried

If your teen presents any of the above warning signs, you may question whether or not you should say anything. What if you drew the wrong conclusion, and this got your teen angry at you? Feeling uncomfortable in such a situation is only natural, but remember that your teen’s life might be at stake, so it is undoubtedly better to err on the side of caution.

Be natural. The words are often unimportant. What is critical is to let your teen know that you care. Your body language and voice will convey that loud and clear.

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Listen. Allow your teen to vent his/her anger and unload those feelings of despair. Having the conversation is essential irrespective of how negative it becomes. 

Be sympathetic, accepting, calm, patient, and, most of all, nonjudgmental. This is isn’t about what is right and what is wrong. It is about saving your teen’s life.

Offer hope. Continuously reassure your teen that suicidal feelings are temporary, and help is always available. Let your teen know how important he/she is to you.


But don’t:

Argue with your suicidal teen. Don’t say things like: “You have such a wonderful life ahead of you,” or “C’mon, nothing could be that bad.”

 Act shocked, or give a lecture on how precious life is, or that suicide is like murder.

 Promise confidentiality. Don’t be sworn to secrecy. You may need to speak to a mental health professional to ensure safety, and you don’t want to lose your child’s trust.

 Give advice, offer solutions to problems, or ask your teen to justify feelings of wanting to die. It’s not about the problem; it’s about the pain emanating from the problem.


Tip 2: Respond Quickly and Effectively in a Crisis

If your teen tells you that suicide is being considered, you must promptly evaluate the immediate danger. Those teens at highest risk have a specific suicide PLAN, the MEANS to implement the plan, a TIME SET for carrying it out, and the INTENTION to do it.

Ask your teen the following questions to assess the immediate suicide risk:

  • Do you have a plan to commit suicide? (PLAN)

  • Do you have what’s necessary to carry out your plan (pills, weapon)? (MEANS)

  • Did you decide when you are planning to do it? (TIME SET)

  • Do you intend to commit suicide? (INTENTION)

  • If suicide is imminent, call a crisis center, dial 911, or go to an emergency room.

  • Under no circumstances should you ever leave a suicidal person alone.


Tip 3: Offer Help and Support

If you have determined that your teen is suicidal, the optimal way to help is by offering your empathetic listening ear. Let your child know that he or she is not alone and that you care.

    1. Remove any suicide means, such as weapons, knives, razors, or pills. Lock up medications and dispense them only as your teen needs them.
    2. Get professional help. Do whatever you can to get your teen the professional help he/she needs. Call your local suicide hotline for advice and referrals.
    3. Be proactive. Often, teens considering suicide have given up any hope of being helped. You may need to take the initiative in getting the needed assistance
online speech therapy myths

Debunking the 5 Most Destructive Online Speech Therapy Myths

When Mythology Can Be Harmful

As a conscientious parent concerned about your child’s apparent speech or language problem, you most likely have done some research into speech or language disorders, and how online speech therapy could help. And your research has probably led you to either incomplete or incorrect information.

Take, for example, the quite common belief that there is no reason to be worried about a speech delay since your child will outgrow it. Or that you should avoid using "baby talk" with a tiny infant. Maybe you have read that, if your home is bilingual, you are practically guaranteed that your kid will come out with some kind of speech problem.

If any or all of the above is making you anxious, know that you aren't alone. You could save yourself a lot of unnecessary anxiety by speaking with an expert speech therapist. Voice your concerns and get complete, and accurate information from someone who is credible. In the meantime, let's debunk some of the common myths.

Myth 1: Online Speech Therapy Only Helps Stutters and Lisps

Stutters and lisps are probably the most famous speech disorders. But that doesn't mean that they are the only ones. The truth is that online speech therapy is helpful for a broad range of speech and language disorders such as aphasia, executive dysfunction, and apraxia, to name but a few.

Perhaps the problem is rooted in the name of the discipline itself, speech-language therapy. Speech-language therapy encompasses a diverse set of challenges. The common denominator is they all involve some facet of communication.

A more accurate list of those challenges would look something like this:

  • Fluency — cluttering and stuttering

  • Speech — articulation and phonological disorders

  • Language — comprehension, and production of spoken and written language

  • Cognition — capacity to solve problems, attention, and memory

  • Voice — vocal tone and its various characteristics

  • Auditory Rehabilitation and Auditory Habilitation — recovery techniques connected with speech, language & hearing disorders; cochlear implants

  • Swallowing disorders — either congenital or caused by stroke/disease/aging

  • Miscellaneous — accent or dialect modification, vocal hygiene, voice development, professional voice coaching, literacy (reading/writing)

Myth 2: Don't Worry, Your Kid Will Outgrow It

It seems that everyone has a distant cousin or has heard of someone who wasn't talking before his fifth birthday- and now everything is just fine! While it is undoubtedly true that there are late talkers who catch up by the time they begin school, this isn't necessarily the case with every child. And if you are concerned, don't push things aside.

How could you possibly know if your child will outgrow the delay or if there is a legitimate cause for concern? The best advice is to play it safe. Have the child evaluated and, if necessary, begin online speech therapy as soon as possible.

A study titled "Profiles of Toddlers With Slow Expressive Language Development" indicates that about 40-50% of children who are late to begin talking (and aren't lagging behind in other areas) do not catch up on their own. Those children who are late talkers and use few or no gestures to express themselves are at greater risk for long-term language problems.

What’s more, many of those late talkers are at higher risk of reading difficulties even after they catch up to the other children verbally. All this points to one thing. A parent who is concerned about a language delay should not be too laid back by adopting a "wait and see" approach; but instead, she should act upon her instinct.

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While it's been noted that girls generally begin talking at a younger age than boys, this doesn't mean that a late talking boy is necessarily free of a language disorder. If the young boy is behind the developmental timeline of other boys his age, an evaluation should be considered.

Myth 3: Speech Therapy Isn't Much More Than Playtime With The Therapist

Every dedicated online speech therapist has one goal: make the online speech therapy work! So it certainly makes sense for the therapist to integrate playing and having fun into the therapy. What better way to solicit the child's full involvement and engagement in the session?

When you understand this basic truth, you realize that what appears to be nothing more than playtime is actually highly effective therapy. And the playing and having fun need not be left at the online speech therapy session. Parents can emulate the therapist by integrating play and enjoyment into homework and other speech development opportunities available in the home.

Myth 4: "Baby Talk" Retards Your Child's Language Development

Contrary to what many believe, you shouldn't worry about talking to your baby like a baby! "Baby Talk" has many benefits for an infant: a higher-pitched voice, shorter words, and repeated sounds, to name just a few. In fact, "baby talk" syncs very well with the infant's developing brain, which facilitates learning language quite naturally.

What's more, many babies better respond to exaggerated facial expressions and voices. And "Baby Talk" can help calm a fussy baby with its very soothing rhythm.

Lauren Lowry of The Hanen Centre characterizes "Baby Talk" as "the very recognizable speech patterns people use when speaking to babies. "Baby Talk" has a higher-than-normal and more varied pitch, a slower rate of speaking, more straightforward vocabulary, lots of repetition, an emphasis on essential words, and exaggerated positive facial expression."

Lowry notes that, in her research, "it has been well-established that babies prefer 'baby talk' as it helps them pay closer attention to speech…" It "makes it easier for babies to figure out how language works and which words are most important to the meaning of what's being said. This helps them learn what words mean and, in time, helps them learn to say words." Caregivers are advised to gradually fade the baby talk as the baby becomes a toddler and starts speaking.

Myth 5: Children in Bilingual Homes are at Greater Risk of Having Speech Disorders

It has been observed that children raised in bilingual homes may go through a period when they speak less. However, this doesn't necessarily indicate that there is a speech disorder. Most of the time, this decline is because the child is struggling with the confusion of learning the vocabulary and grammar of two different languages at the same time.

The American Speech-Language-Hearing Association (ASHA) has found in their research that there is no correlation between bilingualism and speech-language disorders. They found that children learning two languages at the same time follow the same developmental patterns in both of their languages within the milestones of children learning each language.