6 Ways to Become the Best Multilingual Speech Therapy Provider in Your Area

America is a nation of immigrants. Around 20 percent of the population in the United States primarily speaks a language other than English at home sitting around the kitchen table.

But just as many of those people have speech, swallowing, and language acquisition difficulties as the rest of the population. In fact, since many are in a disadvantaged position, they are probably less likely to be receiving adequate care.

According to ASHA (the American Speech-Language-Hearing Association) data from 2022, around 5 percent of adult SLP patients have a primary language other than English.

That’s even more common in one of the primary areas of employment for speech therapists, the world of education. From the 2020-2021 school year, almost 12 percent of students who had an IEP (Individualized Education Program) were also classified as English Language Learners (ELL)… meaning English was not their first language.

Speech therapy isn’t easy in the first place, but it is even more challenging when you are working across language boundaries. Yet both high demand and professional ethical standards mean that SLPs today need to meet that challenge.

Providing Therapy Services to America’s Multilingual Population Takes Dedication

Members of ASHA are committed to providing “…culturally and linguistically appropriate services to their clients and patients, regardless of the clinician’s personal culture, practice setting, or caseload demographics,” according to the organization’s Code of Ethics.

There are also a broad range of federal and state regulations around offering speech therapy services that require culturally-competent, appropriate, and non-discriminatory treatment. IDEA, for example, the Individual With Disabilities Education Act that many school-based speech therapists deal with regularly, requires assessment and evaluation materials that aren’t racially or culturally discriminatory, and may need to be offered in the child’s native language. Further, IEPs have to take into account the language needs of the child, including communication requirements at home as well as in the classroom.

According to ASHA member surveys, only around 8 percent of SLPs identify as expressly multilingual service providers… the majority of them working in Spanish. Most work in educational settings, and tend to be found on the coasts. This hits particularly hard in parts of the country where poverty is rampant and speech therapy services are hard to find, such as rural areas and Indian reservations.

Perhaps surprisingly, more American SLPs offer services in Icelandic than in native languages like Hopi.

For many SLPs, then, that means finding ways, despite language differences, to provide competent and effective care for any client.

That’s easy to say but tough to do.

These six steps can help you find a way to effective multilingual speech therapy services, no matter where you are or what clients you serve.

1. Get a Handle on How Language Differences Are Tied to Cultural Differences

Surprisingly, sometimes the biggest obstacle in cross-lingual speech therapy isn’t speaking in a different language; it’s dealing with different cultural expectations.

Sometimes, cultural differences can throw you a curve even if you happen to be fluent in the client’s language.

These differences can lead to blown diagnoses, ineffective therapy techniques, and poor relationships with family members and caregivers. Everything from eye contact to feeding practices can vary. Therapists have to be culturally sensitive to such possibilities without verging into stereotypes.

This is a skill that can play just as much a role in day-to-day SLP practice depending on the local patient population and your own cultural background, so it’s a great place to start with multi-lingual practice, too. ASHA publishes an entire practice portal page on the issue of Cultural Responsiveness, and it’s a great skill to cultivate no matter who you are treating.

That’s because the greatest skill involved in culturally responsive practice is simply listening and reflecting on your own assumption and expectations. Putting yourself in the patient’s shoes is a great habit to have for any practitioner in any language.

Of course, any master’s degree in speech-language pathology today will cover this material at least in basic form, as a part of both ethics and practical clinical instruction. So you can walk into any kind of cross-language scenario and be confident of having at least some preparation for the challenge.

2. Develop Your Knowledge of Secondary Language Acquisition and Phonological Impacts

Some of the toughest parts of practicing with clients from another language background can be differentiating what are genuine speech-language deficits and what are simply artifacts of a speech pattern engrained by different phonological patterns. Some patients may not even be able to distinguish between two sounds that English speakers naturally differentiate. That can make therapy tough if you don’t realize the root of the issue.

ASHA, again, can help come to the rescue with a large catalog of phonemic inventories for different languages. These offer a quick reference for common English phonemes that aren’t found in those languages, as well as the closest correlates you may be able to work with.

This information can help you assess clients from different language backgrounds more accurately, and keep you from wandering into blind allies therapeutically as you treat them.

3. Tap Into Local Multilingual Support Systems When Possible

It’s quite common for communities of non-native speakers to cluster together when they settle in the United States, for practical purposes as well as social ones—when it’s tough to communicate with the natives, it’s a good idea to have folks around who can understand what you are talking about.

ASHA has an entire practice portal dedicated to helping speech-language pathologists collaborate with translators.

These communities can often be more familiar with some of the most common cross-linguistic communication issues between their native speech and English than you are. They also will have developed a variety of social and language support systems, formal and informal, that you can take advantage of in your own treatment plans.

Cultural informants are individuals who have relevant knowledge of different cultures who are also capable for relating that information back to therapists.

So reaching out to local groups or support networks around your client may unearth unexpected resources. You may find family members capable of helping translate, or even other SLPs who have worked with the group in the past and can share hard-won knowledge from their own practice.

4. Make Common Cause With Other Practitioners Handling Multilingual Clients

That point ties in with another important step: collaborating with other professionals who are serving your client or the same population.

Everyone from healthcare professionals to social workers to teachers are likely experiencing some of the same challenges in working across language barriers. They will also have their own approaches and resources to help them work effectively—which can also work to your advantage.

Building these relationships can clue you in to ideas and resources that you didn’t even know existed.

Even more important may be making contacts with ELL (English Language Learning) teachers serving the same population. Through daily contact and with their own path to learning and understanding linguistic challenges, you may find some unexpected insights. Language teachers quickly grasp the norms of pronunciation and language acquisition among different groups, and they can help you understand both what is normal and tricks to assess and teach key pronunciation skills.

5. Get Certified as a Bilingual SLP in the Most Common Local Language

While you will find patients among every single one of the 42 different language groups and estimated 350 different languages spoken in the United States, the reality is that the bulk of them come from one group: Spanish speakers. Almost 43 million, or around 13 percent of the population, speak Spanish natively, making up fully half of non-English speakers in the country.

Even if this isn’t true in your local area, chances are that the bulk of potential patients come from a single language group, like remote areas in Alaska, where Native dialects remain in heavy use, or areas of California where Asian languages predominate.

So some SLPs choose to go the extra mile and get official certified as a bilingual speech-language pathologist.

The hardest part of this, unless of course you are a native speaker of that other language already, is learning it yourself. But with competency in that area, it’s not all that tough to find graduate programs in speech pathology that offer bilingual certification options.

6. Look to New AI Tools To Bridge Language Gaps

Even in a person-to-person field like speech therapy, it’s impossible to escape the reach of artificial intelligence. There are many ways in which AI is expected to revolutionize the practice of SLP.

One of those that may be least appreciate today is the potential to work across linguistic barriers between therapist and patients, however.

Machine translation has already made progress in leaps and bounds, going from text-only quickly to near real-time spoken word translation. The average smartphone can already perform like something out of Star Trek to connect two people trying to communicate in different languages.

There are even a number of new AI models cracking the tough problem of providing translation to and from American Sign Language.

Integrating this kind of translation ability with other leaps in AI-therapy will not only build your ability to deliver multilingual therapy services, but it can make that therapy more efficient and effective. Although there aren’t solutions in this space just yet, keep your eyes open: the field is changing fast.