ACQ Vol 13 no 3 2011

Suggestions In summary, when working with patients who either do not speak any English or who are limited in their English proficiency, speech pathologists may consider the following: • book extra time with the interpreter, especially on the first few sessions; • consider the need for formal assessment and plan and modify assessments in advance; • investigate the availability of resources in other languages; • request cultural awareness training with the interpreter, especially for cultures the speech pathologist is unfamiliar with; • use professional interpreters and also engage any English-speaking family as early as possible; • request the same interpreter for consistent translation services; • consider age- and gender-matching of the interpreter and speech pathologist to the patient; • be mindful of confidentiality in small ethnic communities; • liaise with the interpreter to check appropriateness of treatment; • consider the location of management (clinic, ward, or home) and the effect of this location on your ability to conduct management as well as the impact this may have on the patient; • set goals with the patient, family, and interpreter and clarify patient priorities; • consider the patient’s previous exposure to formal education and literacy levels which may result in a lack of familiarity with western teaching techniques and reduced self-confidence with therapy; • encourage home practice and provide linguistically appropriate materials; • attempt to use culturally appropriate and functional therapy activities; • consider access to appropriate community services; • include non-English-speaking or LEP patients into Quality, consistent professional interpreting services are essential to build rapport and deliver efficient and effective speech pathology management when working with patients who have LEP. Understanding a patient’s background can increase the speech pathologist’s cultural competence which may, in turn, improve rapport and patient outcomes. LEP patients such as Gloria are at risk of decreased access to health care but can benefit from home-based speech pathology with cultural, linguistic, and time modifications. Acknowledgements The author greatly acknowledges Gloria and her family, The National Stroke Foundation for funding the Clinical Research Development Award, and Professor Graeme Hankey and the staff at Rehabilitation in the Home, Royal Perth Hospital for their ongoing support and advice. research to investigate the suitability of speech pathology interventions for this population. Summary

References Clark, E. (1998, May). Interpreters and speech pathologists: Some ethnographic data . Paper presented at the Critical Link 2 Conference, Vancouver, Canada. Dunn-Marcos, R., Kollehlon, K.T., Ngovo, B. & Russ, E. (2005). Liberians: An introduction to their history and culture. Culture Profile No. 19 (April). Washington: Center for Applied Linguistics. Retrieved from http://www.cal.org/ co/liberians/liberian_050406_1.pdf Enderby, P., Pickstone, C., John, A., Fryer, K., Cantrell, A,. & Papaioannou, D. (2009). RCSLT Resource manual for commissioning and planning services for SLCN Dysarthria. Royal College of Speech and Language Therapists. Retrieved from http://www.rcslt.org/speech_and_language_ therapy/commissioning/dysarthria Frayne, S.M., Burns, R.B., Hardt, E.J., Rosen, A.K., & Moskowitz, M.A. (1996). The exclusion of non-English- speaking persons from research. Journal of General Internal Medicine , 11 (1), 39–43. Hadziabdic, E., Heikkilä, K., Albin, B., & Hjelm, K. (2009). Migrants’ perceptions of using interpreters in health care. International Nursing Review , 56 , 461–469. Hu, D.J., & Covell, R.M. (1986). Health care usage by Hispanic outpatients as a function of primary language. Western Journal of Medicine , 144 , 490–493. Isaac, K. M. (2005). Managing linguistic diversity in the clinic: Interpreters in speech-language pathology. In M. J. Ball (Ed.), Clinical sociolinguistics (pp. 265–280). Malden, MA: Blackwell. Riquelme, L.F. (2007). The role of cultural competence in providing services to persons with dysphagia. Topics in Geriatric Rehabilitation , 23 (3), 228–239. Robertson, S. (2001). The efficacy of oro-facial and articulation exercises in dysarthria following stroke. International Journal of Language and Communication Disorders , 36 , 292–297. Schmidt, S. (2009). Liberian refugees: Cultural considerations for service providers. Bridging Refugee Youth and Children’s Services Bulletin . Retrieved from http://www.brycs.org/documents/upload/Liberian_Cultural_ Considerations.pdf Sherman, F. (2001). Liberia: The land, its people, history and culture . Tanzania: New Africa Press. Tribe, R., & Thompson, K. (2008). Working with interpreters in health settings: Guidelines for psychologists . Leister, UK: The British Psychological Society.

Katy Stewart is a senior speech pathologist at Rehabilitation in the Home, Royal Perth Hospital. Her research interests include stroke rehabilitation and the use of therapy assistants.

Correspondence to: Katy Stewart Senior Speech Pathologist

Rehabilitation in the Home, Royal Perth Hospital GPO Box X2213, Perth, Western Australia, 6001 phone: 618 6477 5152 email: khackling@hotmail.com

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ACQ Volume 13, Number 3 2011

www.speechpathologyaustralia.org.au