From multiculturalism to critical consciousness: Updated concepts for providing culturally responsive practices at home and abroad

In the 1990s a new generation of faculty members in Communication Sciences and Disorders (CSD) emerged, ready to infuse courses with or to develop and teach courses focused on “multicultural content,” which was the term at the time. There were a limited number of comprehensive texts on how to employ culturally relevant practices as a speech-language pathologist. Many of the SLP faculty who were teaching courses about “multiculturalism,” or “cultural competence” often utilized texts from other fields, such as those from education, nursing, or communication and rhetoric, and relied heavily on published articles in disciplines such as anthropology, political science, nursing, and social work. It was only in the early 2000s that one of the more complete books on multiculturalism in communication sciences and disorders (CSD) was published (e.g., Battle, 2002, 2012). Nevertheless, as the world has become more complex and smaller as a result of global processes, new concepts and more comprehensive practices that consider causal relations are required.

Multiculturalism is a contested concept, but typically refers to including people from diverse cultural backgrounds (Malik, 2015) in program development or service delivery for example.  Multiculturalism as a concept falls short, primarily because it suggests that inclusion (or assimilation) is the principle issue. Although health care providers and educators offer and provide services to all people regardless of their cultural (or racialized class, ethnic, gender, national or linguistic) backgrounds (e.g., inclusion), services can remain inadequate or irrelevant if we also do not consider how services might be reconceptualized or changed to meet the cultural premises of those receiving services. 

Cultural competence, a concept that emerged in the 1980s (e.g., Cross, Bazron, Dennis, & Isaacs, 1989), is more useful than multiculturalism but is weighed down by pre-conceived notions of competence. The perception is that “competence” refers to skills or knowledge that one acquires, and those skills can be completed or mastered (checked off), are static, and independent of context or history (Willbergh, 2015; Hyter & Salas-Provance, 2018). This perception of competence has caused many disciplines in the health professions to move away from it in favor of other terms.

Cultural responsiveness, a term coined by Ladson-Billings (1995), seems to be more accessible than multiculturalism and cultural competence. It refers to engaging in practices that are consistent with or relevant to the cultural values, beliefs and assumptions of a person or group with whom a solution (or clinical outcome) is co-created. In this manner, responsiveness is inherently dynamic, dependent on context and shared historical memories.  Hyter (2014) has conceptualized culturally responsive practices as those that take place beyond the micro level (individual), but also at the meso (community and family) and macro levels (social structures such as economics, politics, culture, cultural institutions, and state sanctioned violence [Hyter & Salas-Provance, 2021]). Culturally responsive practices require knowledge that is not always a part of the CSD curriculum such as critical consciousness – the ability to deconstruct one’s own social, cultural, historical situation and co-construct solutions to problems (Freire, 1974); dialectical thinking – the ability to synthesize conflicting perspectives; cultural humility – believing that cultural practices and perspectives different than one’s own are as valuable as one’s own  (Tervalon & Murray-Garcia, 1998; Ortega & Faller 2011); and cultural reciprocity – understanding and using the client’s cultural beliefs to co-construct (with the client) services provided (Kalyanpur & Harry, 2012). Culturally responsive practices also require an elevation of concepts that are already inherent in CSD clinical practice such as critical thinking, critical self-awareness, and reflection.  To truly work at the level of cultural responsiveness or relevancy in the US or abroad, as a profession, speech-language pathologists and audiologist need to adapt new vocabulary and new theoretical frameworks that will help us question the dominant premises, change the terms of public and professional debate, and address the shared problems of structurally excluded groups with interventions that acknowledge and incorporate their world view.  

References

Cross, T., Bazron, B., Dennis, K., & Isaacs, M. (1989) Towards a culturally competent system of

            care: A monograph on effective services for minority children who are severely

            emotionally disturbed. Washington, DC: Georgetown University Child Development

Center, CASSP Technical Assistance Center. Retrieved from https://files.eric.ed.gov/fulltext/ED330171.pdf

Hyter, Y. D. (2014). A conceptual framework for responsive global engagement in

            communication sciences and disorders. Topics in Language Development, 34(2), 103 –

            120.

Hyter, Y. D. & Salas-Provance, M. (2021). Culturally responsive practices in speech, language

            and hearing sciences, Second Edition. San Diego, CA: Plural Publishing

Kalyanpur, M., & Harry, B. (2012). Cultural reciprocity in special education: Building family-

            professional relationships. Baltimore, MD: Paul H. Brookes.

Ladson-Billings, G. (1995). Toward a theory of culturally relevant pedagogy. American

            Educational Research Journal, 32(3), 465 – 491.

Malik, K. (2015). The failure of multiculturalism. Foreign Affairs, 94, 21 – 32

Ortega, R. M., & Faller, K. C. (2011). Training child welfare workers from an intersectional

            cultural humility perspective: A paradigm shift. Child Welfare, 90(5), 27 – 49.

Tervalon, M., & Murray-Garcia, J. (1998). Cultural humility versus cultural competence: A critical

distinction in defining physician training outcomes in multicultural education. Journal of

Health Care for the Poor and Underserved, 9(2), 117 – 125.

Willbergh, I. (2015). The problems of ‘competence’ and alternatives from the Scandinavian

            perspective of Bildung. Journal of Curriculum Studies, 47(3), 334 – 354.