Addressing DEIAB in Speech-Language Pathology: Overcoming Barriers and Innovating for Change

Published in the August 2024 issue of the ISHA Voice. 

By Angela M. Riccelli and Nicole Bing, Co-Chairs of the DEI Committee

As professors of communication disorders, we have witnessed the evolving landscape of the speech-language pathology (SLP) profession. Despite advancements, significant issues related to Diversity, Equity, Inclusion, Accessibility, and Belonging (DEIAB) persist. These issues impact not only the demographics of our professional community but also the quality of care provided to diverse populations. This article explores the barriers within the American Speech-Language-Hearing Association (ASHA), discusses strategies to enhance access, and presents innovative concepts to foster inclusivity and change in the field of SLP.

ASHA, the governing body for SLPs, has made strides in promoting diversity, yet barriers remain. One significant challenge is the underrepresentation of individuals from diverse racial and ethnic groups within the profession. According to ASHA's 2022 demographic report, only 8% of SLPs identify as racial minorities, despite the increasing diversity of the U.S. population. This disparity can be attributed to several factors.

The pathway to becoming an SLP often starts with undergraduate education, where diverse students are underrepresented. Financial constraints, lack of exposure to the field, and limited mentorship opportunities hinder the entry of diverse students into SLP programs. The high cost of tuition, compounded by the need for unpaid internships and the requirement to purchase specialized materials, poses significant financial burdens. Additionally, diverse students may lack role models and mentors who can guide them through the academic and professional journey, exacerbating feelings of isolation and marginalization (Hirsh & Blitz, 2016).

The certification process, which includes the Praxis exam and Clinical Fellowship Year (CFY), presents additional hurdles. The cost of these requirements and the lack of culturally responsive preparation materials can disproportionately affect candidates from underrepresented backgrounds. Research has shown that standardized tests, such as the Praxis, often contain cultural biases that disadvantage minority test-takers (Pruitt & Isaac, 2020). Furthermore, the CFY can be challenging for those who lack financial resources, as it often involves working in low-paying or volunteer positions to gain the necessary clinical experience.

Once in the profession, SLPs from diverse backgrounds may face implicit bias and a lack of inclusive practices within their workplaces. This can lead to feelings of isolation and hinder professional growth. Studies have documented that minority professionals in healthcare settings frequently encounter subtle forms of discrimination that can affect their job satisfaction and career advancement (Sue et al., 2007). The lack of representation in leadership positions further exacerbates these issues, as there are fewer advocates for inclusive policies and practices within organizations.

To address these barriers, a multifaceted approach is necessary. An idea worth discussing is that of increasing the representation of diverse students in SLP programs is crucial. Outreach initiatives targeting high schools and community colleges in underserved areas can raise awareness about the profession. Offering scholarships and financial aid specifically for minority students can alleviate economic barriers. Universities can also implement pipeline programs that introduce high school students to SLP through summer camps, workshops, and mentorship opportunities (McLeod, 2011). By creating partnerships with community organizations and minority-serving institutions, SLP programs can build a more diverse applicant pool.

Establishing mentorship programs that pair diverse students and early-career SLPs with experienced professionals can provide guidance and support. These programs should focus on career development, navigating the certification process, and building professional networks. Effective mentorship can enhance the retention and success of diverse SLPs by providing them with role models, professional advice, and emotional support (Grant-Vallone & Ensher, 2000). Institutions can formalize these mentorship programs and provide training for mentors to ensure they are equipped to support diverse mentees.

SLP programs must integrate culturally responsive teaching into their curricula. This includes training on cultural competence, anti-racism, and the impact of social determinants of health on communication disorders. Faculty development programs can ensure educators are equipped to teach these critical topics. Incorporating diverse perspectives into coursework and clinical training can help future SLPs understand and address the unique needs of different populations (Betancourt et al., 2003). Additionally, continuous professional development in cultural competence should be mandated for all practicing SLPs to ensure ongoing learning and improvement.

We strongly believe innovation is key to creating a more inclusive and equitable SLP profession. One idea that might drive change is using VR (virtual reality) technology. VR technology can simulate diverse clinical scenarios, allowing students and professionals to practice culturally competent care in a safe, controlled environment. This immersive experience can enhance understanding and empathy for clients from different backgrounds. VR training can expose SLPs to a variety of dialects, languages, and cultural contexts, improving their ability to provide appropriate and effective assessment and interventions (Lamb et al., 2018).

Collaborating with community organizations that serve diverse populations can provide SLP students with real-world experience. These partnerships can also facilitate community-based research that addresses the specific needs of underserved groups. Community engagement ensures that SLP services are relevant, accessible, and helps build trust between SLPs and the communities they serve (Israel et al., 1998). By working directly with community members, SLPs can gain insights into cultural practices and preferences that inform their clinical practice. We are currently doing this in our own Governors State University community via our on-campus preschool program and an off-campus partnership with a residential school serving diverse elementary and middle school students.

The COVID-19 pandemic has accelerated the adoption of telepractice, which can increase access to SLP services for individuals in remote or underserved areas. Developing telepractice models that are culturally and linguistically appropriate can further expand access to care. Telepractice offers flexibility and convenience, making it easier for clients who face transportation or scheduling challenges to receive services (Raatikainen, 2020). Ensuring that telepractice platforms are user-friendly and accessible in multiple languages can enhance their effectiveness for diverse populations.

SLPs must advocate for policies that promote DEIAB within ASHA, the profession at-large and the broader healthcare system. This includes pushing for funding for diversity initiatives, supporting legislative efforts to reduce healthcare disparities, and participating in public awareness campaigns. Professional organizations like ASHA can play a pivotal role in advocating for systemic changes that address the root causes of inequities (ASHA, 2021). By leveraging their collective voice, SLPs can influence policies that improve access to education, certification, and clinical services for all individuals.

Research in communication disorders must prioritize diverse populations. Funding agencies should incentivize studies that focus on the communication needs of racial and ethnic minority groups. Additionally, involving community members as research partners can ensure that studies are relevant and respectful. Inclusive research practices, such as community-based participatory research (CBPR), involve communities in the design, implementation, and dissemination of research, ensuring that their perspectives are integral to the process (Minkler & Wallerstein, 2008). This approach can lead to more accurate and applicable findings that directly benefit underserved populations.

In closing, the SLP profession has a critical role in serving individuals with communication disorders across all demographics. To fulfill this role effectively, we must address the persistent barriers related to DEIAB within our field. By enhancing access to the profession, fostering an inclusive environment, and embracing innovative approaches, we can ensure that all individuals, regardless of their background, receive the high-quality care they deserve. As professors of communication disorders and co-chairs to the DEI Committee for ISHA, we are committed to driving these changes and encourage our colleagues to join us in this vital endeavor. Together, we can innovate change and create a sense of belonging across our profession.

References

ASHA. (2021). Addressing systemic barriers to the full participation of Black and African American members. American Speech-Language-Hearing Association.

Betancourt, J. R., Green, A. R., Carrillo, J. E., & Ananeh-Firempong, O. (2003). Defining cultural competence: A practical framework for addressing racial/ethnic disparities in health and health care. Public Health Reports, 118(4), 293-302.

Grant-Vallone, E. J., & Ensher, E. A. (2000). Effects of peer mentoring on types of mentor support, program satisfaction and graduate student stress: A dyadic perspective. Journal of College Student Development, 41(6), 637-642.

Hirsh, D. G., & Blitz, L. V. (2016). The educational pipeline: Decreasing attrition through multidisciplinary collaboration. Urban Education, 51(2), 135-157.

Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19(1), 173-202.

Lamb, D. J., Wilson, N. A., & Dunn, K. M. (2018). Virtual reality in health care. Journal of Advanced Nursing, 74(6), 1298-1308.

McLeod, S. (2011). Educating speech-language pathologists in culturally and linguistically diverse practices. International Journal of Speech-Language Pathology, 13(5), 370-383.

Minkler, M., & Wallerstein, N. (2008). Community-based participatory research for health: From process to outcomes. John Wiley & Sons.

Pruitt, S. L., & Isaac, C. A. (2020). Standardized testing and its effect on racial/ethnic minority students. Journal of Educational Research and Practice, 10(2), 93-109.

Raatikainen, V. (2020). Telepractice in speech-language pathology: The pandemic's impact and future possibilities.

Nicole M. Bing, Ph.D., CCC-SLP is an Associate Professor in the Department of Communication Disorders at Governors State University. She teaches courses in child language, literacy, and speech disorders, and supervises student clinicians in community-based clinical settings. Dr. Bing’s research is focused on narrative and expository language, connections between spoken language and reading comprehension in school-age children, and evidence-based language interventions for school-age children. Her research also explores multicultural issues and the recruitment and retention of underrepresented students in CSD programs. Dr. Bing currently serves as Co-Chair of ISHA's Diversity, Equity, and Inclusion (DE&I) Committee, is a long-standing member of ISHA's Student Involvement Committee, and formerly served on ISHA's Executive Board as Vice President of Association Affairs.

Angela M. Riccelli, Ed.D., MHS-CCC/SLP is an Associate Professor in the Department of Communication Disorders at Governors State University. She is the advisor for the GovState chapter of the National Student Speech-Language Hearing Association (NSSLHA), and currently a member of both ISHA and ASHA. She is a licensed and certified speech-language pathologist in Illinois. Dr. Riccelli currently serves as Track Chair for Voice & Motor Disorders (2nd term), co-chair of the DEI Committee and is a member of the IPECP Task Force for ISHA. She also coordinates the Knowledge Quest team of students from GovState to participate at ISHA conventions.