First Steps Toward a Participatory Research Program: Early Intervention Perspectives on SLP Services for Children of Diverse Backgrounds

Abstract

This research was designed to deepen the understanding of contributing factors to disparities in speech-language pathology (SLP) service delivery to children of diverse backgrounds with language and communication delays, as well as to initiate community connections. We sought to understand the perspectives and experiences of those who provide or oversee SLP services to children with communication disorders in early intervention settings in Washington State. Individual semistructured interviews were completed with six SLPs and three administrators across five organizations. The interviews were designed to understand both individual- and systems-level contributing factors to service delivery challenges. Interviews were analyzed using an iterative coding process with multiple rounds of coding and multiple coders. In addition to synthesizing participants' understandings of, and preparation for, culturally responsive practice, three overarching themes are presented: (1) assets of early intervention as a service delivery model, (2) the distance between families and the practitioners and systems that serve them, and (3) compromised access and quality of services due to a predominantly monolingual-English system. Findings inform the next steps for building community partnerships with early intervention organizations. The long-term goal of this work is to collaboratively develop a participatory research program on equitable service delivery that addresses children's, families', and SLPs' needs.

Keywords

culturally responsive practice - cultural humility - cultural and linguistic diversity - graduate training - IDEA

Publication History

Article published online:
15 November 2024

• References

• Abdelaziz, M. M., Matthews, J. J., Campos, I., Fannin, D. K., Rivera Perez, J. F., Wilhite, M., & Williams, R. M. (2021). Student stories: microaggressions in communication sciences and disorders. American Journal of Speech-Language Pathology, 30(5), 1990–2002
• Albin, M., Micsinszki, S., & Phoenix, M. (2022). Cultural adaptation of parent-implemented early communication interventions: a scoping review. American Journal of Speech-Language Pathology, 31(5), 2229–2247
• Alonzo, C. N., Komesidou, R., Wolter, J. A., Curran, M., Ricketts, J., & Hogan, T. P. (2022). Building sustainable models of research-practice partnerships within educational systems. American Journal of Speech-Language Pathology, 31(3), 1–13
• Alper, R. M., Beiting, M., Luo, R., Jaen, J., Peel, M., Levi, O., & Hirsh-Pasek, K. (2021). Change the things you can: Modifiable parent characteristics predict high-quality early language interaction within socioeconomic status. Journal of Speech, Language, and Hearing Research, 64(6), 1992–2004
• Banerjee, R., & Luckner, J. (2014). Training needs of early childhood professionals who work with children and families who are culturally and linguistically diverse. Infants and Young Children, 27(1), 43
• Barnard-Brak, L., Morales-Alemán, M. M., Tomeny, K., & McWilliam, R. A. (2021). Rural and racial/ethnic differences in children receiving early intervention services. Family & Community Health, 44(1), 52–58
• Batz, R., & Yadav, A. (2024). Parents' experiences navigating early intervention and early childhood special education services: a qualitative metasynthesis. Journal of Early Intervention, 46(1), 19–38
• Baum, F., MacDougall, C., & Smith, D. (2006). Participatory action research. Journal of Epidemiology and Community Health, 60(10), 854–857
• Beauchamp, M. L. H., Amorim, K., Wunderlich, S. N., Lai, J., Scorah, J., & Elsabbagh, M. (2022). Barriers to access and utilization of healthcare services for minority-language speakers with neurodevelopmental disorders: a scoping review. Frontiers in Psychiatry, 13, 915999
• Behrens, T. R., & Foster-Fishman, P. G. (2007). Developing operating principles for systems change. American Journal of Community Psychology, 39(3-4), 411–414
• Black, L. I., Vahratian, A., & Hoffman, H. J. (2015). Communication Disorders and Use of Intervention Services among Children Aged 3–17 Years: United States, 2012. NCHS Data Brief. Number 205 Centers for Disease Control and Prevention
• Blum, S. D. (2018). Unseen WEIRD Assumptions: The So-Called Language Gap Discourse and Ideologies of Language, Childhood, and Learning. In: Critical Perspectives of the Language Gap. Routledge
• Boone Blanchard, S., Ryan Newton, J., Didericksen, K. W., Daniels, M., & Glosson, K. (2021). Confronting racism and bias within early intervention: the responsibility of systems and individuals to influence change and advance equity. Topics in Early Childhood Special Education, 41(1), 6–17
• Brassart, E., Prévost, C., Bétrisey, C., Lemieux, M., & Desmarais, C. (2017). Strategies developed by service providers to enhance treatment engagement by immigrant parents raising a child with a disability. Journal of Child and Family Studies, 26(4), 1230–1244
• Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101
• Bravo, A., Ibañez, L. V., Scott, S., Dick, C., Carpentier, P., & Stone, W. L. (2023). Telehealth delivery in part C early intervention: provider and caregiver perspectives. Journal of Autism and Developmental Disorders, 53(12), 4545–4559
• Brown, J. A. (2016). Coaching in parent-implemented early communication interventions: understanding and overcoming individual-level implementation barriers. Perspectives of the ASHA Special Interest Groups, 1(1), 144–153
• Butkus, R., Rapp, K., Cooney, T. G., Engel, L. S., & The Health and Public Policy Committee of the American College of Physicians. (2020). Envisioning a better U.S. health care system for all: reducing barriers to care and addressing social determinants of health. Annals of Internal Medicine, 172(Suppl), S50–S59
• Caesar, L. G., & Kohler, P. D. (2007). The state of school-based bilingual assessment: Actual practice versus recommended guidelines. Language, Speech, and Hearing Services in Schools, 38(3), 190–200
• CCPH Board of Directors. (2013). Position Statement on Authentic Partnerships. Community-Campus Partnerships for Health Accessed September 24, 2024 at: https://ccphealth.org/partnering/principles-of-partnering/
• Chan, H., Tidd, C., & Phoenix, M. (2024). Addressing bias in SLP problem-based tutorials through critical reflexivity, curriculum development, and instructor training. Teaching and Learning in Communication Sciences & Disorders, 8(1) doi: 10.61403/2689-6443.1295
• Connery, A., & Salsberg, J. (2024). Exploring participatory health research and its application to speech and language therapy research practices. International Journal of Language & Communication Disorders, 59, 1257–1268
• Cook, K. J., Messick, C., Baylor, C., & McAuliffe, M. J. (2024). A qualitative study of reflective practice in the workplace. Speech-language pathologists have their say. International Journal of Speech-Language Pathology, 26, 637–651. 10.1080/17549507.2023.2267193
• Creswell, J. (2007). Qualitative Inquiry and Research Design: Choosing Among 5 Approaches. SAGE
• Culver, J. N., Martin Herz, S. P., Guzman, A., Aguayo, J., Marbin, J., Martinez, K., & James, J. (2024). Caregiver experiences of racialization while accessing early intervention (EI) services for their children. Topics in Early Childhood Special Education; doi: 10.1177/02711214241249110
• Cycyk, L. M., Coles, K., O'Dea, K., Moore, H., Sanford-Keller, H., Dolata, J., De Anda, S., Gomez, M., Huerta, L., Libak, A., & Zuckerman, K. E. (2022). Serving young children with communication disabilities from Latinx backgrounds and their families with equity: provider perspectives. Journal of Communication Disorders, 99, 106254
• Cycyk, L. M., De Anda, S., Moore, H., & Huerta, L. (2021). Cultural and linguistic adaptations of early language interventions: recommendations for advancing research and practice. American Journal of Speech-Language Pathology, 30(3), 1224–1246
• Davidson, M. M., Alonzo, C. N., & Stransky, M. L. (2022). Access to speech and language services and service providers for children with speech and language disorders. American Journal of Speech-Language Pathology, 31(4), 1702–1718
• Davis, R., Zaki, F. B. M., & Sargent, L. (2024). Autism and bilingualism: a thematic analysis of practitioner perspectives in the United Kingdom. International Journal of Language & Communication Disorders, 59(1), 205–222
• Di Sante, M., & Potvin, L. (2022). We need to talk about social inequalities in language development. American Journal of Speech-Language Pathology, 31(4), 1894–1897
• Douglas, N., Hinckley, J., Grandbois, K., Schliep, M., Wonkka, A., Oshita, J., & Feuerstein, J. (2023). How a power differential between clinicians and researchers contributes to the research-to-practice gap. American Journal of Speech-Language Pathology, 32(2), 803–810
• Drahota, A., Meza, R. D., Brikho, B., Naaf, M., Estabillo, J. A., Gomez, E. D., Vejnoska, S. F., Dufek, S., Stahmer, A. C., & Aarons, G. A. (2016). Community-academic partnerships: a systematic review of the state of the literature and recommendations for future research. The Milbank Quarterly, 94(1), 163–214
• Dunst, C. J. (2002). Family-centered practices: birth through high school. The Journal of Special Education, 36(3), 141–149
• Dunst, C. J., & Trivette, C. M. (1996). Empowerment, effective help giving practices and family-centered care. Pediatric Nursing, 22(4), 334–337, 343
• Ebert, K. D., & Williams, L. (2023). Perceptions of racism among graduate students of color in audiology and speech-language pathology. American Journal of Speech-Language Pathology, 32(6), 2982–2998
• Escoffery, C., Lebow-Skelley, E., Udelson, H., Böing, E. A., Wood, R., Fernandez, M. E., & Mullen, P. D. (2019). A scoping study of frameworks for adapting public health evidence-based interventions. Translational Behavioral Medicine, 9(1), 1–10
• Feinberg, E., Silverstein, M., Donahue, S., & Bliss, R. (2011). The impact of race on participation in part C early intervention services. Journal of Developmental and Behavioral Pediatrics, 32(4), 284–291
• Feuerstein, J. L., Olswang, L. B., Greenslade, K. J., Dowden, P., Pinder, G. L., & Madden, J. (2018). Implementation research: embracing practitioners' views. Journal of Speech, Language, and Hearing Research: JSLHR, 61(3), 645–657
• Forum on Child and Family Statistics. (2023). America's Children: Key National Indicators of Well-Being, 2023. Childstats.gov
• Friesen, A., & Mihai, A. (2024). Promoting EI/ECSE practitioners' professional growth through a reflective practice framework. Young Exceptional Children, 27(1), 16–28
• Girolamo, T., Ghali, S., & Eigsti, I. M. (2023). A community-based approach to longitudinal language research with racially and ethnically minoritized autistic young adults: Lessons learned and new directions. American Journal of Speech-Language Pathology, 32(3), 977–988.
• Guiberson, M., & Atkins, J. (2012). Speech-language pathologists' preparation, practices, and perspectives on serving culturally and linguistically diverse children. Communication Disorders Quarterly, 33(3), 169–180
• Guiberson, M., & Ferris, K. (2023). Speech-language pathologists' preparation, practices, and perspectives on serving indigenous families and children. American Journal of Speech-Language Pathology, 32(6), 2858–2870
• Guiberson, M., & Ferris, K. P. (2019). Early language interventions for young dual language learners: a scoping review. American Journal of Speech-Language Pathology, 28(3), 945–963
• Hammond, C., Mitchell, P., & Johnson, M. (2009). Academic and clinical preparation for cultural and linguistic diversity in speech-language pathology: program director perspectives. Contemporary Issues in Communication Science and Disorders, 36(Spring), 63–76
• Hancock, C., Morgan, C., & Holly, J. (2021). Counteracting dysconscious racism and ableism through fieldwork: applying DisCrit classroom ecology in early childhood personnel preparation. Topics in Early Childhood Special Education, 41(1), 45–56
• Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O'Neal, L., McLeod, L., Delacqua, G., Delacqua, F., Kirby, J., Duda, S. N., & the REDCap Consortium. (2019). The REDCap consortium: building an international community of software platform partners. Journal of Biomedical Informatics, 95, 103208
• Higby, E., Castillo, M. M., Aranda, A., Nicholas, K., & Datta, H. (2024). Pedagogical approaches to cultural and linguistic diversity in communication sciences and disorders programs: a nationwide survey. American Journal of Speech-Language Pathology, 33, 1831–1853
• Hudnall, M. (2022). Self-reported perspectives on cultural competence education in speech-language pathology. American Journal of Speech-Language Pathology, 31(2), 631–638
• Hyter, Y. D., & Salas-Provance, M. B. (2021). Culturally Responsive Practices in Speech, Language, and Hearing Sciences, Second Edition. Plural Publishing
• Individuals with Disabilities Education Improvement Act (2004). Pub. L. No. 108–446, 118 Stat. 2647
• Kimble, C. (2013). Speech-language pathologists' comfort levels in English language learner service delivery. Communication Disorders Quarterly, 35(1), 21–27
• van Kleeck, A. (1994). Potential cultural bias in training parents as conversational partners with their children who have delays in language development. American Journal of Speech-Language Pathology, 3(1), 67–78
• Kohnert, K., Kennedy, M. R. T., Glaze, L., Kan, P. F., & Carney, E. (2003). Breadth and depth of diversity in Minnesota: challenges to clinical competency. American Journal of Speech-Language Pathology, 12(3), 259–272
• Kover, S. T., & Abbeduto, L. (2023). Toward equity in research on intellectual and developmental disabilities. American Journal on Intellectual and Developmental Disabilities, 128(5), 350–370
• Larson, A. L., Cycyk, L. M., Carta, J. J., Hammer, C. S., Baralt, M., Uchikoshi, Y., An, Z. G., & Wood, C. (2020). A systematic review of language-focused interventions for young children from culturally and linguistically diverse backgrounds. Early Childhood Research Quarterly, 50(Part 1), 157–178
• Lee, H., Ostrosky, M. M., Bennett, T., & Fowler, S. A. (2003). Perspectives of early intervention professionals about culturally-appropriate practices. Journal of Early Intervention, 25(4), 281–295
• Leko, M., Hitchcock, J., Love, H., Houchins, D., & Conroy. (2023). Quality indicators for mixed-methods research in special education. Exceptional Children; doi: 10.1177/00144029221141031
• Love, H. R., & Beneke, M. R. (2021). Pursuing justice-driven inclusive education research: Disability Critical Race Theory (DisCrit) in early childhood. Topics in Early Childhood Special Education, 41(1), 31–44
• Mahendra, N., & Kashinath, S. (2022). Mentoring underrepresented students in speech-language pathology: effects of didactic training, leadership development, and research engagement. American Journal of Speech-Language Pathology, 31(2), 527–538
• Mahendra, N., & Visconti, C. (2021). Racism, equity and inclusion in communication sciences and disorders: reflections and the road ahead. Teaching and Learning in Communication Sciences & Disorders, 5(3) doi: 10.30707/TLCSD5.3.1649037688.713933
• Melvin, K., Meyer, C., & Scarinci, N. (2021a). Exploring the complexity of how families are engaged in early speech-language pathology intervention using video-reflexive ethnography. International Journal of Language & Communication Disorders, 56(2), 360–373
• Melvin, K., Meyer, C., & Scarinci, N. (2021b). What does a family who is "engaged" in early intervention look like? Perspectives of Australian speech-language pathologists. International Journal of Speech-Language Pathology, 23(3), 236–246
• Mills, M. T., Balz, M., & Price, D. (2023). Implementing strengths-based dialogue to reframe clinical education and community engagement. Perspectives of the ASHA Special Interest Groups, 8(5), 1055–1064
• Moll, L. C., & Diaz, S. (1987). Change as the goal of educational research. Anthropology & Education Quarterly, 18(4), 300–311
• Morris, M. A. (2022). Striving toward equity in health care for people with communication disabilities. Journal of Speech, Language, and Hearing Research: JSLHR, 65(10), 3623–3632
• Olmsted, M. G., Bailey, D. B., Raspa, M., Nelson, R. E., Robinson, N. D., Simpson, M. E., & Guillen, C. (2010). Outcomes reported by Spanish-speaking families in early intervention. Topics in Early Childhood Special Education, 30(1), 46–55
• Olswang, L. B., & Prelock, P. A. (2015). Bridging the gap between research and practice: implementation science. Journal of Speech, Language, and Hearing Research: JSLHR, 58(6), S1818–S1826
• Parveen, S., & Santhanam, S. (2021). Speech-language pathologists' perceived competence in working with culturally and linguistically diverse clients in the United States. Communication Disorders Quarterly, 42(3), 166–176
• Paul, D., & Roth, F. P. (2011). Guiding principles and clinical applications for speech-language pathology practice in early intervention. Language, Speech, and Hearing Services in Schools, 42(3), 320–330
• Peña, E. D., & Fiestas, C. (2009). Talking across cultures in early intervention: finding common ground to meet children's communication needs. Perspectives on Communication Disorders and Sciences in CLD Populations, 16(3), 79–85
• Raspa, M., Bailey, D. B., Olmsted, M. G., Nelson, R., . . . Houts, R. (2010). Measuring family outcomes in early intervention: findings from a large-scale assessment. Exceptional Children, 76(4), 496–510
• Rosenzweig, E., & Voss, J. (2022). Their words, their world: a paradigm for culturally relevant family-centered intervention. Perspectives of the ASHA Special Interest Groups, 7(2), 553–559
• Saldaña, J. (2014). Thinking qualitatively: methods of mind. Sage (Atlanta, Ga.).
• Saldaña, J. (2021). The Coding Manual for Qualitative Researchers. Sage Publications Ltd; 1–440
• Santhanam, S. P., & Parveen, S. (2018). Serving culturally and linguistically diverse clients: a review of changing trends in speech-language pathologists' self-efficacy and implications for stakeholders. Clinical Archives of Communication Disorders, 3(3), 165–177
• Scharff Rethfeldt, W., McNeilly, L., Laasonen, M., Meir, N., Abutbul-Oz, H., Smolander, S., & Frances Hunt, E. (2024). Assessment of developmental language disorder in multilingual children: results from an international survey. Folia Phoniatrica et Logopaedica, 76(2), 127–150
• Stahmer, A. C., Vejnoska, S., Iadarola, S., Straiton, D., Segovia, F. R., Luelmo, P., Morgan, E. H., Lee, H. S., Javed, A., Bronstein, B., Hochheimer, S., Cho, E., Aranbarri, A., Mandell, D., Hassrick, E. M., Smith, T., & Kasari, C. (2019). Caregiver voices: cross-cultural input on improving access to autism services. Journal of Racial and Ethnic Health Disparities, 6(4), 752–773
• Steed, E., & Stein, R. (2023). Initial evaluation practices: a survey of early childhood personnel. Topics in Early Childhood Special Education, 43(1), 30–45
• Verdon, S., McLeod, S., & Wong, S. (2015). Supporting culturally and linguistically diverse children with speech, language and communication needs: overarching principles, individual approaches. Journal of Communication Disorders, 58, 74–90
• Wolford, L. L., Wolford, G. W., Smith, L., Clement, A., & de Diego-Lázaro, B. (2023). The impact of treating bilingual clients on speech-language pathology students' cultural responsiveness. American Journal of Speech-Language Pathology, 32(6), 2960–2981
• Yu, B., & Epstein, L. (2011). Facilitating critical reflections about disability among students in speech-language pathology. Perspectives on Issues in Higher Education, 14(1), 11–20
• Yu, E. (2020). Community approaches to systems change. Journal of Public Health Management and Practice, 26(2), 195–197