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Early Childhood Intervention September 9, 2015

Ellen Kester, Ph.D

Disclosure: Financial Relationships — Ellen Kester is the owner of Bilinguistics and receives a salary. Bilinguistics receives payments for services and produces provided to ECI agencies. Nonfinancial Relationships — None

Disclosure Statement:

Additionally, this presentation should not be viewed while operating heavy machinery.

Learner objectives

•  Participants will: ▫  Describe ways to address ethical dilemmas in the

workplace ▫  List the limitations of testing tools with

multicultural populations ▫  Describe the appropriate use of test norms ▫  Identify how language differences affect

assessment and intervention

Survey 1

• Have you have been put in a situation in your current or previous professional setting in which you were concerned about your ethical values being compromised?

•  Share your story so we can discuss it during Case Studies.

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Why study ethics? “With great power comes great responsibility.” Responsible practice means adherence to a standard of ethics.

It makes us better people? Because we have to? Professional Requirement Why have the requirements changed? What happened?

Survey 2: Rate the following professions Scale 1-3: 1 = not very ethical 3 = very ethical •  Lobbyists •  Teachers •  Doctors •  Policemen •  Journalists •  Telemarketers

•  Congressmen •  Stockbrokers •  Early Intervention Specialists •  Occupational Therapists •  Speech-Language Pathologists •  Car Salesmen

Probing the Field of Law

•  “Two-thirds of respondents in a survey of California lawyers said they “compromise their professionalism as a result of economic pressure.”

•  Lawyers in Virginia were asked whether the increasing problems in

professionalism were attributable to “a few bad apples” or a widespread trend. They overwhelmingly said, “a widespread trend.”   •  Lawyers in Florida reported that a “substantial minority [were]

money grabbing, too clever, tricky, sneaky, and not trustworthy.”

Trying to correct the downward trend.

•  “At present, several state bars and professional organizations are scrambling to shore up their professional ethics. Some are increasing courses in college and graduate schools, and others are requiring brush-up ethics classes.”

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Can we change behavior? A study by MIT So what can we do? How do we change a profession’s ethical behavior?

Ethical Studies by MIT

Study  1  50  math  questions  

Study  2  15  math  

questions  +  Book  Lists  

Study  3  20  math  questions  

+  Ethics  Code  

Group  1  Control    

32.1/50  

Group  2  Test  

Group  3  Test  

36.2/50

36.2/50

3.1/15

4.1/15

3.0/15

3.0/20

5.5/20

3.o/20

Principles of Codes of Ethics Personal Responsibility Professional Competence Responsibility to the Public Responsibility to the Profession

The origins of ethics Influence of Greek Philosophers Codes of Ethics

•  Personal Happiness (Aristotle) •  Promoting Peace of Mind

(Epectetus) •  Social Interaction (Socrates) •  Professional Influence (Epicurus)

•  Personal Responsibility •  Professional Competence •  Responsibility to the Public •  Responsibility to the

Profession

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The Relativity of Ethics • Ethical standards evolve over time. • Consider the practices of Lionel Logue in the

King’s speech

Our discussion today

•  The original intent of Ethics, it was meant as a way of creating dialogue.

•  This dialogue is created by:

1)  naming or bringing to attention a goal or value

2)  putting it to the test with rigorous discussion about real life circumstances.

Texas ECI Demographics FY 2012

Percent

Hispanic/Latino

White

Black/African American

Asian/Pacific Islander

American Indian/Alaskan

How do culture and language impact influence ethical practice

• Consider the limitations of standardized tests

• How do language differences affect test results?

• How do cultural differences influence test results?

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Considerations when using translated tests •  Linguistic equivalence •  Functional equivalence • Cultural equivalence • Metric equivalence (Peña, 2007)

Lack of equivalence in any of these areas can threaten content validity (Rogler, 1999).

Basal and Ceiling Rules across two test versions

•  Items have to be ordered from easiest to hardest.

• When a test is translated, item difficulty levels are not the same.

•  Solution: test below the basal and above the ceiling.

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Spanish Translation

•  Provides an adaptation/translation of all spoken text

•  Provides Spanish Record Forms (Full, Screening, Electronic)

•  Requires English test kit materials and manual •  Allows an estimate of abilities combining English

and Spanish (only if using software option)

The Spanish version of the BDI-2 is not normed.

• Keen clinical judgment is necessary • While many motor skills and daily living skills

are not influenced by language, communication skills are obviously strongly affected.

• Norms do not transfer from one language to the other.

Understanding Linguistic and Cultural Differences

Informed Clinical Opinion

•  Per DARS ECI, “Teams must use Informed Clinical Opinion when a child qualifies under developmental delay.”

•  This can apply to: ▫  an individual test item ▫  interpretation of test scores ▫  determining the adequacy of testing tool (i.e., the BDI-2) ▫  reviews of results

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A look at the items…

Linguistic Differences– Communication Domain • RC 14 ▫  English: Responds to the prepositions “out” and

“on.” ▫  Spanish: Responde a las palabras “fuera” y

“sobre.”

Linguistic Differences– Communication Domain

• RC 17 ▫  English: Understands the possessive form ’s. �  Baby’s mommy. Daddy’s boy. ▫  Spanish: Entiende las formas del posesivo. �  El bebé de la mamá. El hijo del papá.

Linguistic Differences– Communication Domain • RC 28 ▫  English: Understands irregular plural forms. ▫  Spanish: Usa el plural.

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Linguistic Differences– Communication Domain • EC 17 ▫  English: Uses three-word phrases meaningfully. ▫  Spanish: Usa frases coerentes de 3 palabras.

• Children can express something that is at the same level of complexity with fewer words in Spanish than in English. ▫  “I want cookie.” = “Quiero galleta.” ▫  “Pick me up.” = “Recójame” ▫  “Give to me.” = “Dame”

Linguistic Differences– Communication Domain • EC 19 ▫  English: Uses the pronouns I, you, and me. ▫  Spanish: Usa los pronombres, yo, me, mi, tú, te, ti

Linguistic Differences– Communication Domain • EC 25 ▫  English: Uses the articles the and a. ▫  Spanish: Usa los artículos el, la, un, and una.

Linguistic Differences– Communication Domain • EC 27 ▫  English: Uses plural forms ending in /s/ and /z/. ▫  Spanish: Usa las terminaciones plurales.

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Considering Culture

• Culture can influence performance on test items • Understand how culture can affect responses •  Incorporate cultural variation into your

Informed Clinical Opinion

Cultural Considerations

Receptive Communication 32 ▫  Recalls events from a story presented orally. �  En la mesa había huevos, pan tostado y jugo de

naranja. (On the table there were eggs, toast, and orange juice.)

Expressive Communication 13 ▫  Communicates in back-and-forth, turn-taking

style Reasoning and Academic Skills 9 ▫  Child names the colors red, green and blue

Determine Percent Delay ▫ Adaptive ▫ Personal-Social ▫ Communication ▫ Gross motor ▫ Fine Motor ▫ Cognitive

If the child is from a bilingual environment consider the items carefully and use your informed clinical opinion on each item.

Language samples in all languages Inside HELP PLS-4-Spanish or PLS-5-Spanish (and English) Use intelligibility guidelines Other resources about bilingualism

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Analyzing Language Samples

•  Transcribe online or record •  Identify errors • Classify the errors

Difference vs. Disorder

TYPICAL DEVELOPMENTAL

ERRORS

SECOND-LANGUAGE INFLUENCE

ATYPICAL ERRORS

•  For parents: (Lynch, Brookshire & Fox, 1980) ▫  18 months - ~25% intelligible ▫  2 year olds - 50-75% intelligible ▫  3 year olds - 75%-100% intelligible

•  For unfamiliar: (Flipsen, 2006) ▫  18 months - ~25% intelligible ▫  2 year olds - ~50% intelligible ▫  3 year olds - ~75% intelligible ▫  4 year olds - 100% intelligible

Additional Resources

•  http://speechpathologyceus.net/cld-resource-library/

Link to Live Site

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Ethics through Case Study Which Principles are violated? Which Ethic Rule is in Violation? How you will respond to the situation?

Case Study

• A monolingual SLP is pushed to evaluate and provide therapy for children who don’t speak English. When he told his employer that this was an ethically uncomfortable situation, the response was, “Any service is better than no service. What is unethical is not serving the clients.”

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Selecting Personnel to Conduct the Evaluation

•  Level 1: trained (in CLD issues) bilingual speech-language pathologist fluent in the native language

•  Level 2: trained (in CLD issues) monolingual speech-language pathologist assisted by trained bilingual ancillary examiner.

•  Level 3: trained (in CLD issues) monolingual speech-language pathologist assisted by trained interpreter

Source: ASHA

•  At a child’s intake meeting his mother brings a copy of a report from a private practice that was done a few months earlier. The family speaks only Spanish. You see that the student was evaluated with a test normed on monolingual English speakers and was diagnosed with a severe expressive and receptive language delay. What do you do?

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Case Study

• Bilingual speech therapist goes to a daycare to serve student. Next to her is an English-speaking SLP serving a Spanish-speaking child and intervening on the unvoiced “th” sound that does not exist in Spanish.

• What should she do?

Case Study

•  You are a graduate student intern and your supervisor tells you to implement an intervention strategy that a recent study demonstrated was ineffective. What do you do?

•  You are one of the few bilingual SLPs in the XYZ ECI Program and your caseload reaches an all time high and is twice the size of your monolingual peers. You do not feel you are able to provide effective services to that many children.

•  What do you do?

•  Your supervisor asks you to complete 45-minute sessions with your students in a 40-minute period, stating that they are students receiving Medicaid and the Medicaid regulations state that if you complete at least 7 minutes of your last 15-minute unit, you can report it as a complete 15-minute unit.

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•  Near the end of the fiscal year you run out of BDI-2 protocols but still have many more evaluations to complete. You tell your supervisor you need more protocols and she informs you that there is no budget for that and you will have to make photocopies of the protocols for the rest of the school year. What do you do?

Case Study

To receive your certificate of completion

Send an email to admin@bilinguistics.com with: Subject Line: 9/9 webinar • Name • Address • Occupation (SLP, EIS, etc.) • EIS License # or ASHA #

Thank you!

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More Resources on Bilingualism •  Cultural and linguistic diversity resource guide for

speech-language pathologists. (Goldstein, 2000) •  Bilingual Language Development and Disorders in

Spanish-English Speakers, Second Edition. (Goldstein, 2011)

•  The International Guide to Speech Acquisition (McLeod, 2007)

•  Assessing culturally and linguistically diverse students. A practical guide. (Rhodes, Ochoa, & Ortiz, 2005)

•  SMILE for Young Children (Prath et. al, 2012).

References

•  Battelle Developmental Inventory, Second Edition (BDI-2). (2005). Riverside Publishing: Illinois. •  Determining Eligibility. (n.d.). Retrieved August 9, 2012 from http://www.dars.state.tx.us/ecis/

eligibility.shtml#eligibility.  •  Ennis, S. R., Rios-Vargas, M., & Albert, N. G. (2011). 2010 Census Briefs: The Hispanic Population : 2010.

Retrieved April 7, 2013 from http://www.census.gov/prod/cen2010/briefs/c2010br-04.pdf.  •  Figueroa, R. (1989).  Psychological testing of linguistic-minority students:  Knowledge gaps and regulations. 

Exceptional Children, 56, 145-148. •  Goldstein, B. (2011, ed.), Bilingual language development and disorders in Spanish-English speakers (2nd ed.).

Baltimore, MD: Brookes Publishing. •  Hofstede, Geert (2001). Culture consequences (2nd ed.). London: Sage. •  Iglesias, A. (2002). Latino Culture. In D. Battle (Ed.), Communication disorders in multicultural populations (p.

179-202). Boston: Butterworth-Heinemann. •  Langdon, H.W.. (2008) Assessment and intervention for communication disorders in culturally and linguistically

diverse populations . Book. Clifton, NY: Cengage, (2008). •  Kester, E. S. & Peña, E. D. (2002). Language ability assessment of Spanish-English bilinguals: Future directions.

Practical Assessment, Research, and Evaluation, 8, 4. •  Newborg, J. (2005). Battelle Developmental Inventory, 2nd Edition, Spanish, User’s Guide. Itasca, IL: Riverside

Publishing.

References (continued) •  Peña, E. D. (2007). Lost in translation: Methodological considerations in cross-cultural research. Child

Development, 78, 4, 1255-1264. •  Restrepo, M. A., & Silverman, S. W. (2001).  Validity of the Spanish Preschool Language Scale-3 for use with

bilingual children.  American Journal of Speech-Language Pathology, 10, 382-393. •  Rogler, L. H. (1999). Methodological sources of cultural insensitivity in mental health research. American

Psychologist, 54, 424-433. •  Tamayo, J. (1987).  Frequency of use as a measure of word difficulty in bilingual vocabulary test construction and

translation.  Educational and Psychological Measurement, 47, 893-902. •  Tamayo, J. (1990). A validated translation into Spanish of the WISC-R vocabulary subtest words. Education &

Psychological Measurement, 50, 915-921.  •  Zimmerman, I. L., Steiner, V. G., & Pond, R. E. (1993).  Preschool Language Scale-3: Spanish Edition.  San

Antonio, TX:  Psychological.