We are pleased to welcome Deborah Jill Chitester, MS, CCC-SLP,
as our guest host for the SLP chat tonight, Monday, May 17, 2004. 
She will be addressing the topic of Assessment and Intervention
for Culturally/Linguistically Diverse Populations.

Deborah Jill Chitester is a bilingual SLP with many special
certifications and extensive expertise necessary for mastering
spoken language to use as a tool to enhance reading, writing and
spelling skills, where true literacy will be the result. Deborah's
own success as a fluent/competent second language learner
(English/Spanish) and knowledge of language development combine to
effectively allow her to develop communication competence for her
diverse client mix. Mrs. Chitester has also has participated in the
Bilingual Extension to Teacher of Speech Hearing Handicapped, a
program which prepares the bilingual SLP to clinically interact with
the Hispanic population in terms of treatment as well as testing
procedures taking into account culturally relevant factors that impact
a bilingual/monolingual child's performance.  Deborah has over ten years
of experience working with clients of all age levels and has given many
presentations on the topic of bilingual speech pathology and working
with culturally linguistic diverse populations.
<Robin>  Welcome to all of you!  We are chatting tonight with Deborah Jill Chitester, MS,
          CCC-SLP, about Assessment and Intervention for Culturally/Linguistically Diverse
<Deb_Chitester>   I have been a bilingual SLP for about 10 years and have much info in many
<Robin>  Deb, please tell us about how you became bilingual.
<Deb_Chitester>  Long story--but entertaining-I always loved languages, especially Spanish-
          I did very well in high school and then after college and my masters I did a placement
          and it became obvious to me that there was a need for bilingual SLPs-so I took a course
          in Berlitz and then started working with the Hispanic population almost exclusively-
          I took coursework in this area a few years later-worked 18 hours days with Spanish
          speakers, studied, traveled, and that is it.  Mow I am completely bilingual and and
<AdrienneFSU>  Deb, what populations do you work with?  Kids?
<Deb_Chitester>  Kids and adults-
<Stephanie>  Deb, I came to the US when I was in high school, therefore, we are in a similar
          situation. But I am a very new SLP.
<Deb_Chitester>  Where were you born?
<Stephanie> I am from Taiwan.
<Deb_Chitester>  What other languages do you speak?
<Stephanie>  I speak Mandarin (Chinese) and Taiwanese.
<Deb_Chitester> A lot of the information I have pertains to working appropriately with
          children of many different language backgrounds.
<Deb_Chitester> I want to stress that becoming able and most suited to work with the CLD
          (Culturally/Linguistically Diverse) population is much more than speaking Spanish.
<Stephanie>  I would love to learn about your experience with the bilingual population.
<Robin>  Deb, lets start with the skills you feel are necessary to work with this diverse
          population....obviously proficiency in the language.
<Deb_Chitester>  The skill needed first is proficiency and an understanding of the culture you
          are dealing with, the socialization -also the development and the inner most information
          about the language -the rules, metalinguistics, if you will.
<Deb_Chitester>  Also, knowledge of the cultural community and the speech community-you almost
          need to be an ethnographer or if you are not bilingual, rely on an ethnographer who can
          give you information regarding culture so you can learn how this impacts language.
<AdrienneFSU>  And you recommending learning these skills by submerging yourself in that
<Deb_Chitester>  In my case, yes-having become bicultural after and at the same time as I was
          becoming bilingual helped me to understand difference from disorder.
<Robin>  How do you determine difference from disorder?          
<Deb_Chitester>  Knowing the culture, knowing how the culture lives and how it impacts
          language and literacy is generally it-now, to be more specific-nonbiased assessment is
          critical-doing informal assessment, dynamic assessment, parent interview and comparing
          the child with what he has been exposed to as opposed to tests that are meant for
          English speaking kids that are merely translated.
<Robin>  What do you mean by dynamic assessment?
<Deb_Chitester>  Dynamic assessment involves providing the child with an MLE or mediated
          learning experience-modeling a concept and seeing if he can integrate it after
          repeated exposures-this is considered nonbiased in nature and yields more meaningful
          results.  It also can provide additional diagnostic evidence as to whether what you
          are observing is a disorder or a difference.
<AdrienneFSU>  Sort of like stimulability?
<Deb_Chitester> It is discerning whether a child, after repeated exposures, masters the ability
          to integrate the information.
<Deb_Chitester>  It helps in gathering information so you can determine disorder vs difference-
<Stephanie>  Have you been in situations where there is no standardized test available when
          doing an evaluation?
<Deb_Chitester>  Yes-standardized testing is not valid in and of itself-and should not be
          relied upon without a disclaimer--
<Robin>  Are there any Spanish assessment tools on the market now that you like or do you
          think that they are all invalid?
<Deb_Chitester> In general, I do not rely strictly on standardized assessment even for the
          mainstream culture, but, for sure with CLD kids, it is very limited. Some tests are
          only translated and they lack norming for this population. If used in conjunction with
          nonbiased forms as described above, and if the results are used as estimates of
          communication and a disclaimer is used , this is much more appropriate and valid. The
          CELF 3Spanish is an okay test but it tends to inflate function.
<Deb_Chitester>  Standardized testing is part of the reason there is an overrepresentation in
          special ed of CLD kids-it is not valid-I just wrote an article for ASHA about this.
<Robin>  What a great topic!
<Deb_Chitester>  Testing in SLP is not normed for CLD kids-although testing is getting better,
          it is not valid and as a result, it needs to be interpreted with extreme caution.
<Deb_Chitester>  I can not tell you how many kids are misdiagnosed or missed due to
          standardized testing.
<Robin>  What in particular are the weaknesses of standardized testing?  Where do these
          standardized tests go wrong...specifically.
<Deb_Chitester>  There is research available on this subject.  I am working on my own now-
          pitfalls of testing for CLD kids, etc.  Pitfalls include that the tests currently on
          the market are not normed and they are not standardized for use with these diverse
          populations. Language sampling is a viable alternative. Also, testing formally does
          not allow you to comtrol for what the child may or may not have been exposed to
          experience wise and concept wise. This is partly why there is an overrepresentation of
          CLD kids in special education.          
<Deb_Chitester>  Without a profile in mind, this is hard-I can give you reasons
          instead and possible scenarios.
<Deb_Chitester>  When kids are being seen from a Dominican subculture, and you use a PLS
          (Preschool Language Scale), if he is unfamiliar with the concepts being tapped due to
          his culture, and has not been exposed and the PLS says he is disordered, well is he?
          Not necessarily.
<Deb_Chitester>  His mom may tell you he is integrating other concepts he is being modeled-
          thus, you may recommend more experiential base but can you say it is a disorder? No!
<Stephanie>  I am seeing a child 20 months old. I suspect that his language is where he should
          be. however, it is difficult to know where the cut off line is in terms of qualifying
          for early intervention.
<Stephanie>  I am trying to provide a profile here...if that works.
<Stephanie>  One example is that in Chinese, there is no difference of the gender (he or she).
          They are the same word in spoken language.
<Stephanie>  Therefore, the child will likely not score correctly on the PLS pronoun section.
          Deb, is this what you are talking about?
<Deb_Chitester>  Correct Stephanie
<Deb_Chitester>  Now, if you do a nonbiased evaluation according to protocol, interview , etc.,
          you get the real picture of language function in these kids that have good implications
          for assessment as well.
<AdrienneFSU>  But if a child does not know he/she difference.... that's a problem! 
          Whether it's a disorder or not, the child can't just keep using he/she interchangably...
<AdrienneFSU>  Is that more the teacher's problem?
<Deb_Chitester>  Language differences ARE NOT disorders just like black dialect is not a
          disorder and modifications can be made in a classroom which is the way you treat it in
          a school system.  In private practice, like I will be doing, you can work with it but
          not treat it as a disorder...like I deal with accent modification.
<AdrienneFSU>  One more thing about that disorder vs difference thing.... if you don't
          classify it as a disorder will insurance, etc., still pay for it?  Would it be
          considered elective?
<Deb_Chitester>  Ethically, if it is a difference insurance should not be involved-the key
          is knowing which is which and making the appropriate recommendation for differences.
<AdrienneFSU>  ok, thanks
<Robin>  Deb, what specific things do you include in your own assessment battery?
<Robin>  You mentioned parent interview, informal observation...
<Deb_Chitester>  Language background,  which is included in an ethnographic interview,
          language sample which is critical, and a measure of MLR-mean length of response since
          Spanish is morphologically rich.
<taylormonicap>  My problem is that parents want their child in the main stream and
          desparately want the SLP to work with them even though they themselves have the same
          speech and language patterns.
<Judith> Taylor, I have experienced that situation too, on many occasions.
<Robin>  Deb, I see how more informal assessment may be done privately...but what does a
          school system expect in terms of evaluations?  What did you use when you worked in NY?
<Deb_Chitester>  Schools in NY DO NOT expect any standardized testing-I use it as an estimate-
          I think in the future all bureaucracies will see the light.
<Deb_Chitester>  They will have to, with the changing demographics and the in this area.
<Stephanie>  I did an assessment on a Chinese-English bilingual child. (I served as both
          interpreter and SLP).  It's difficult as there is so little information about norms
          for bilingual children's language ability and where they should be.
<Deb_Chitester>  There is research here Stephanie.
<Deb_Chitester>  I can give you some info on this-a lot.
<Deb_Chitester>  It is published for Spanish but one of the references relates to your
          language as well.
<Stephanie>  I think there are a lot more for Spanish-English compared to Chinese-English.
<Deb_Chitester>  You are right-so you can contribute-I am starting to publish-there is a lot
          of room for this in our profession.
<Stephanie>  I wonder if there is any standardized test in Chinese with norms. Deb, are you
          aware of tests in Chinese?
<Deb_Chitester>  No, I do not know of any, but I can find out.
<Robin>  Deb, tell us about treatment.
<Stephanie>  Do you treat in L1 or L2?
<Deb_Chitester> Treatment depends upon the overall child and profile and degree of aculturation
          etc. A young child with a delay in L1 in a home that is not acculturated to the
          mainstream should receive treatment in L1. If the child is older and still does not
          have a strong enough base in L1, he may still need help in L1 before introducing L2.
          But, providing scaffolding in L2 may work as well AT THE SAME TIME. See Jim Cummins
          work for more information-he has written books on this topic.
<Stephanie>  Are children entitled to have an interpreter or someone who speaks their L1 to
          evaluate their language when they are referred?
<Deb_Chitester>  Yes children are entitled to the use of interpreter-but number one choice is
          a bilingual SLP-what is important is that the translator be trained appropriate to the
          speech community and the language.
<Deb_Chitester>  The translator needs to be aware not to help the patient or child and not to
          provide cueing-also it is ideal that the translator be trained according to ASHA
          protocols-for information about this (protocols that have been approved) see Henrietta
          Langdon's resources.
<Stephanie>  I also have friends whose children's language appeared to be delayed. However,
          the parents do not seem to be concerned. They are not even interested in an evaluation.
          It seems to me that they may feel ashamed if their child is delayed in speech/language.
<Robin>  That is a problem that is prevalent in many cultures
<Stephanie>  To me it is cultural. This 20 month old child is not speaking...only a few words.
          Does it seem delayed to you guys?
<Debora> He should have at least ten words...don't you think?
<Stephanie>  Mom said that he used to say "mama" but now he has stopped. I am concernred, but
          when I suggested an evaluation, Dad said that he does not think that his child has a
          problem in speech/language. I feel that I may have offended them.
<Stephanie>  The parents say that they know another child who is older and speaks less. He can
          say  "two" if you say "one" in Chinese. Counting is all he can do.
<Deb_Chitester>  This is common in the Hispanic culture as well-what it is is that some
          cultures including Hispanic and possibly Chinese and Asian view their 23-24 month old
          kids as babies and as such do not worry until much later than you may have been brought
          up to think-and remember you are educated in this area-culture has a powerful impact
<Deb_Chitester>  Being Jewish and working a lot with Hispanics almost 100 percent, this was
          a big adjustment for me as well - how language and development are viewed by different
<Judith>  So how should an SLP handle this cultural difference?
<Deb_Chitester>  You can let them know with deference that by age 2 kids usually start with
          sentences and phrases and by age 3 stories and narratives-
<Deb_Chitester>  Give them an ASHA brochure-explain that some kids need a jump start and that
       it has nothing to do with a mental problem.
<Robin>  great suggestions
<Deb_Chitester>  Sometimes dads, for example, think there is a big problem if a boy especially
          his, has a speech problem.
<Deb_Chitester>  They do not know the difference between let's say, MR and LLD, and speech only.
<Stephanie>  My husband told me to be quiet because my friends seemed a little offended.
<Deb_Chitester>  Just be there-they may come to you.
<Stephanie>  I agree that the ASHA brochure is a good idea.
<Deb_Chitester>  I can give an exmaple.
<Deb_Chitester>  Does the couple have another child?
<Deb_Chitester>  I have used a sibling in personal situations where I suspected a delay with
          Hispanic kids-and it helped because the mom and dad saw their other 5 year old was
          doing things the 7 year old for example was not and they asked is this speech, what is
<Deb_Chitester>  So just referencing the parent to the other sibling-lots of this is stemmed
          in cultural beliefs-
<Stephanie>  I know another girl who is a similar age, and speaks a lot more. Do girls speak
          better than boys in general?
<Deb_Chitester>  In general, speech and developmental delays are more common in males then
<AdrienneFSU>  These issues of "nothing's wrong with my child" come up even in "mainstream"
          American culture.
<Robin>  Very true
<taylormonicap>  Deb, what speech sounds should be considered dialectical as far as the
          Hispanic culture and Chinese as well?
<Deb_Chitester>  Chinese I know nothing about-Spanish, dialects are differences-a knowledge of
          Spanish phonological development is critical---but I have seen kids misdiagnosed here
<Stephanie>  In Chinese, there is even a story about there there is a very smart person who
          did not talk until 3 years old, so some people tend to not get worried when their
          child talks late.
<Deb_Chitester>  There are ways of tapping cognition as well which correlates much with oral
<Stephanie>  How do we prevent misdiagnoses?
<Deb_Chitester>  Doing evaluations appropriately -if not bilingual and bicultural, using a
          trained interpreter. Interview the parent about home language and use.  Use
          standardized testing as estimates of communicative behavior.
<Stephanie>  I am in a tricky situation because this child I am interpreting for has 3
          languages going on. Mom speaks another dialect with her child at home. They read some
          books in Chinese, and all the therapists speak in English.
<Stephanie>  The SLP says that the child needs services, because he will be going to English
          speaking school (which I disagree).
<Stephanie>  Mom serves as an interpreter, and I have to constantly remind her not to give too
          many cues when we attempt to do the PPVT.
<Deb_Chitester>  It is a common one-research says without a strong L1, L2 will become
          disordered or ARRESTED later.
<Deb_Chitester>  But I know people who are not bilingual push English only-it is political
          and I consider it to be uninformed.
<Stephanie>  I encourage mom to speak in Chinese to her child, which will be easier for her to
          find an interpreter, but it is difficult as they all speak their dialect at home.
<Stephanie>  Is this not a good recommendation to give?
<Deb_Chitester>  Research says and supports never interrupt or tell a parent not to use home
<Stephanie>  Thank you, Deb.
<Deb_Chitester>  That really gets me and is done a lot in the South which is one of my many
          many elements of culture shock here being from NY-
<Robin> Do you have any references/research you can share with us?
<Deb_Chitester>          Some researchers you can reference include: Brian Goldstein who has done work
          in the area of Spanish phonology, Jim Cummins in second language learning and
          Elizabeth Pena who has written on dynamic assessment.
<Robin>  It is getting late....Deb, thanks so much for sharing your expertise. 
<Deb_Chitester>  You are welcome.
<Robin>  Thank you all for coming and asking such great questions!
<AdrienneFSU>  Thanks so much for all your examples.
<Debora>  Yes, thank you!
<Judith> Interesting topic tonight
<Deb_Chitester>  I love this topic and plan to start doing workshops in the future.
<Robin>  You really should Deb.
<Stephanie>  That was very intersting topic. I learned.
<Robin>  You have a lot of knowledge to share.
<taylormonicap>  Thanks for the information, since I am in the South.
<Robin>  Good night all and thanks for joining us.