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Consideration of Systems and Cultural Diversity |
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All communication, normal and pathological,
emerges out of systems and a
cultural context |
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Culture plays a significant role in terms of
what is judged as normal or abnormal |
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Cultural practices may contribute to the
presence and prevalence of communication disorders in a specific
populations, what are considered disorders and how they are viewed |
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Insider’s Perspective |
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what does the person think of him/herself |
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what does the person think of the impairment and
how it is to live with it |
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Outsider’s Perspective |
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different “outsiders” |
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family, friends, professionals, organizations,
society |
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what do these different “outsiders” think of the
impairment, person who is living with the impairment, how their own lives
are impacted |
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Macrosystem:
National level |
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WHO (impairment, activity limitation,
participation restriction) |
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American with Disabilities Act |
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Assessment of perceived disability must include
society, community, family (i.e., outsider’s perspective) |
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Public Laws 99-142; 99-457--Education for all |
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nondiscriminatory testing that are racially and
culturally nonbiased |
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testing done in native language |
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extensive data from various sources |
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Asha |
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Meso/Exosystem: State level/Local level
(Outsider’s perspective) |
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State and county governments |
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Local public health care policies |
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School District and home school policies |
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Funding agencies |
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Professionals |
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Microsystem:
Family level (Outsider’s Perspective and Insider’s Perspective) |
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Attitudes/beliefs |
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understanding of disability |
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degree of acceptability |
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perceived cause of disability |
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attitude towards healthcare |
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western view--scientific orientation |
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cross-cultural view--role of fate,
responsibility of individual or individual’s family |
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beliefs about change |
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fatalism |
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individualism |
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Generational membership |
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Length of residence--acculturation |
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Socioeconomic status |
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Educational level |
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Urban or rural background |
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Age and gender |
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Language spoken |
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Assessment and intervention are always more
successful when context is considered (situational, interpersonal,
cultural) |
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Assessment Tools (beware of cultural biases) |
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observation |
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interview |
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standardized tests |
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Intervention |
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direct treatment |
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indirect--family, significant others |
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Form & Content |
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bilingualism |
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simultaneous |
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sequential |
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English proficiency |
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dialects |
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code switching |
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Use |
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eye contact |
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nonverbal communication |
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conversational rules |
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turn taking |
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topic initiation |
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resolving communication breakdowns/conflicts |
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amount of talking |
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narratives |
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rules and expectations between speakers and
across contexts |
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Attitude about change |
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can there be change |
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Attitude about treatment |
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who should be involved |
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who is responsible |
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how shall it be delivered (when, where, how, by
whom, with whom) |
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Time |
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punctuality is important and is an intrinsic
part of a professional relationship based on mutual respect |
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Beginning an interaction |
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in professional situations such as meetings, it
is important to get down to business as quickly and efficiently as possible |
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Formality vs. Informality |
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informality and social equality are the ultimate
goals in all interactions between professionals and clients |
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Directness |
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frankness, openness, and honest discussion of
situations and feelings is important |
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Gender |
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the gender of the clinician and the client is
not important, the clinician's competence is the most important variable |
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Age |
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the age of the clinician, relative to the
client, is unimportant, as long as the clinician is competent |
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Written documentation |
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written documentation is necessary and an
intrinsic part of professionals’ interactions with clients and families. |
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Nature of disabilities |
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communication is a critical aspect of a
disability to assess and treat |
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Intervention and independence |
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independence is the goal and thus, intervention
may be needed to achieve this goal…caring for the individual is not
necessarily/only the responsibility of the family |
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Western intervention is probably most effective |
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Family participation |
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families should be involved as much as possible
and in collaboration with the clinician |
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Control or destiny |
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individuals have control over their own destiny |
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Language in the home |
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families who speak other languages at home need
to speak English to their children so that the children will learn English |
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Know your own biases and assumptions |
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Know your own cultural limitations |
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Separate cultural preferences from personal
preferences or lack of information |
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View intercultural interactions as learning
opportunities |
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Consider your assumptions--maybe you will need
to modify your |
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method of greeting |
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type of dress |
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eye contact |
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who to talk with |
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method/style of communication |
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You may be asked to |
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learn about family practices related to child
rearing, health, disablement |
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explain your role |
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interpret mainstream culture |
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design an intervention program to meet the
individual needs of the client and the family |
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consider and handle cultural practices that
maybe be detrimental or even harmful to the child |
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You may need to |
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prepare family for meetings--formality, topic,
participants |
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encourage families to bring whomever they wish
to sessions |
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encourage input from family in a way that is
comfortable |
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encourage goals and objectives that address the
family concerns |
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design treatment strategies that are compatible
with families beliefs/values |
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use a cultural mediator/interpreter |
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Observation: |
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Determine if this is appropriate |
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Watch family interact--waiting room |
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Interview:
Ask open-ended questions (e.g., Would you describe a typical
playtime for your child, or a typical day at home for your spouse) to
determine family’s: |
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child rearing practices |
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developmental expectations |
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decision making |
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willingness to accept outside help |
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views on illness and disability |
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values, beliefs, traditions |
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Utilize cultural mediators/interpreters when
appropriate: |
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Criteria for interpreter: |
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demonstrates good bilingual skills |
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demonstrates professional attitude |
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establishes good rapport |
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maintains confidentiality |
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Using an interpreter: |
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meet with interpreter before to
prepare--vocabulary etc. |
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seat interpreter next to client, facing you,
look at client |
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introduce everyone and make sure the purpose of
the meeting is understood |
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speak in short sentences and allow time for
translation |
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encourage direct translation of client/your
words |
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Be willing to recognize and discuss your biases
and assumptions |
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Be open to, appreciate and respect family
practices as valid and important even if different from your own |
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doesn’t mean you need to become part of other’s
culture |
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doesn’t mean you need to know everything about
another culture |
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there are many ways to view the world |
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Avoid stereotyping |
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Remember: |
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respect client as individual |
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recognize that cultural influences change as the
situation changes |
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establish a collaborative relationship |
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be flexible and considerate |
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Scenarios for discussion |
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Consider each scenario |
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What would you do? |
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What questions might you ask client/family? How would you phrase them? |
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