Putting the Spotlight on Racial Disparity in Speech Therapy
Speech-Language Pathologists (SLPs) are all driven by one common goal: to help others communicate effectively. However, for as long as the profession has been around, there have been disparities between how children who are minorities – mainly Black or Hispanic – receive support compared to white children. Other minorities are likely also being negatively impacted, however, most studies to-date have focused on these two minority groups in the USA. It’s important for families, as well as SLPs, to recognize the barriers preventing minorities from getting the help they deserve so that we can find ways to make therapy accessible to everyone.
Minority Students’ Needs Not Being Identified
Despite the commonly held belief that minorities are over-represented in special education, Black and Hispanic children often go without the intervention they need; Morgan et al. (2017) conducted a study comparing groups of kindergarten students. They found that children who were ethnic or language minorities were less likely than white and/or English-speaking children to receive speech services.
For both Black and Hispanic children in this study, the odds of receiving services were “46% lower than for otherwise similar White children” (Morgan et al.). This is concerning since kindergarten is an ideal age to get help for many speech/language delays, and having untreated disorders can set these children up for lower academic achievement and a lack of confidence.
There are a variety of potential reasons as to why a child may not receive speech therapy, including long wait times in schools or a lack of knowledge about the services. However, what can cause non-white children in particular to miss out on speech therapy is that practitioners (and teachers) are less likely to ask parents who are minorities about developmental concerns, as opposed to parents of white children (Zuckerman, Sinche, et al., 2014).
A Primarily White Profession
The SLP profession is also no stranger to racial disparity; according to the American Speech-Language-Hearing Association (ASHA) in 2016, only 5.7% identified as a non-white, 3% of whom were Black, and 81% were white. This is why it’s so important for SLPs to be continuously checking their biases and learning more about the diverse cultures they serve in order to provide the best possible therapy.
For example, in the 1960s, minorities with cultural differences in the way they spoke were diagnosed with speech disorders. While speech therapy has come a long way, many SLPs still lack the understanding that African American English (AAE) is its own dialect, rather than grammatical errors. According to a 2016 survey of 390 SLPs, only 24% had received training on how to support AAE speakers (Latimer-Hearn, 2016).
It would be ideal for Black and other minority children to see themselves represented in the people who provide them with therapy, however it’s also important for white SLPs to educate themselves on the populations they interact with to better understand their needs.
Listening to Unheard Voices
A study in 2009 held focus groups with 52 men and women who were parents of children with speech and language disorders or who were adults with communication differences (Malendra et al.). The majority of the participants were bilingual and first generation immigrants to the U.S.. When asked about the barriers to receiving therapy as a minority, some popular answers were:
Lack of timely and/or appropriate advice from primary care physicians and pediatricians
Inadequate advertising of SLP services
Limited or no knowledge about typical speech and language development and expected milestones
Difficulty verbally asserting concerns to health care service providers
When asked what advice they would give SLPs to provide better therapy for minorities like them, the participants expressed the desire for SLPs who:
Provide them with knowledge about their rights
Are able to express terminology clearly and in plain language
Support bilingualism and biculturalism
Are not afraid to say “I don’t know enough about that”
Ask parents if performance during an evaluation was representative of child’s typical performance
This post is by no means exhaustive – more research needs to be done on the disparities between minority children and white children, especially in Canada where discrimination is still present but often ignored. As a clinic, we are comamitted to reflecting inwards on our own biases and looking into how we can do our part to break down barriers in the field. Keep an eye out for a future blog post about ways to combat racial disparity in speech therapy.
Latimer-Hearn, Dionna. “Don’t Get It Twisted—Hear My Voice.” The ASHA Leader, vol. 25, no. 1, 2020, pp. 54–59., doi:10.1044/leader.ftr2.25012020.54.
Feinberg E, Silverstein M, Donahue S, Bliss R. The impact of race on participation in part C early intervention services. J Dev Behav Pediatr. 2011;32(4):284‐291. doi:10.1097/DBP.0b013e3182142fbd
Highlights and Trends: Member and Affiliate Counts, Year-End 2016. American Speech-Language-Hearing Association, www.asha.org/uploadedFiles/2016-Member-Counts.pdf.
Morgan, Paul & Hillemeier, Marianne & Li, Hui & Pun, Wik Hung & Cook, Michael. (2017). Cross-Cohort Evidence of Disparities in Service Receipt for Speech or Language Impairments. Exceptional Children. 84. 001440291771834. 10.1177/0014402917718341.
Nidhi Mahendra, Katie Schoneman, and Nisha Engineer. "Barriers influencing minority clients’ access to speech language pathology services. Poster" ASHA Annual Convention (2009).
Andalusia Speech Therapy has two Toronto speech therapy clinics and offers speech teletherapy to anywhere in the world. Contact us more for information.