3 Tips to Support English Language Learners in Speech Therapy

Speech-language pathologists are considered communication experts, but no single person can communicate in every language. Regardless of the setting, we often find ourselves in situations where we must evaluate and treat individuals whose primary language (L1) or languages (L2, L3, etc.) differ from our own.

The 2015 US Census revealed that at least 350 languages are spoken or signed in the United States.¹ This data contrasts with that from the 2021 Demographic Profile of ASHA Members Providing Multilingual Services, which reported that only 8.2 percent of ASHA-certified speech-language pathologists identified as “bilingual.”²

Given the discrepancy between the number of languages in the US and the number of multilingual speech-language pathologists, we cannot expect multilingual SLPs to support our diverse populations alone. Research indicates that multilingual speech and language treatment for English Language Learners (ELLs) is best practice, but such guidance is complicated by national shortages of multilingual SLPs, lack of resources, and difficulty finding trained interpreters (especially in rural settings).³

Following an evaluation that assesses all languages spoken or signed by an individual, how do SLPs and SLPAs best support individuals with their communication in speech and language therapy when we do not share a primary language?

Here are three tips to help guide your ability to provide culturally and linguistically appropriate speech and language treatment to ELLs who speak or sign a primary language you do not communicate in:

Tip #1: Look at the Research

The most common question I hear regarding working with ELLs is “What language should I target in speech and language treatment?”

Research shows that intervention provided in a primary language (L1) addresses needs in that language. However, scaffolding skills in other languages (L2, L3, etc.) can also help to support cultural/linguistic identity and carries over with family members and friends in their community.⁴ Treatment provided in L1 can work to the benefit of the habilitation and rehabilitation of all languages signed or spoken by an individual, but this can feel impossible when we do not communicate fluently in this language.

We also know that providing intervention in a secondary language (L2) only, such as English, can have detrimental impacts, including language loss in an individual’s L1.⁵ Treatment solely in English supports English only, often at the cost of a primary language.

Resist the urge to offer multilingual clients treatment in English exclusively. We must get creative in how we support L1 without speaking or signing it ourselves. We cannot ignore other languages utilized by the individuals we serve as they also carry significance and importance. Centering English ignores this and causes harm.

Providing multilingual speech and language treatment is the gold standard as it allows clients to address their communication needs in a cross-linguistic and cross-cultural way. Bilingualism is not a choice for our clients; it is a necessity. As previously stated, SLPs and SLPAs need not be multilingual to provide evidence-based multilingual speech-language pathology treatment. The key to supporting our clients, students, and patients is simple: collaboration!

Tip #2: Collaboration Is Key

SLPs and SLPAs may provide intervention in L2 if they cannot speak or sign an individual’s L1 by collaborating with others who do communicate in L1, including the following:

• Trained interpreters
• Bilingual SLPs and bilingual SLPAs
• Dual language/bilingual teachers, bilingual psychologists, bilingual nurses, and other bilingual allied health professionals
• Bilingual support staff such as teaching assistants, CNAs, and rehab technicians

Patients are entitled to medical care in a language they speak. Aid from a trained interpreter by profession is the gold standard. There are other options for collaboration, such as the below, however with these options you will want to take special care as there are potential complexities involved:

• Volunteers in the school, hospital, rehabilitation center, and/or workplace. Be aware that this approach can present confidentiality issues.
• Family members and friends who can carryover skills targeted in treatment at home and the community. But take caution that enlisting the help of members of the clients community should only be used to reinforce what has occurred in therapy. They should not be used as a primary source of aiding in communication during the therapy process as this could be considered unpaid labor due to their cultural relationship to the client, in which case you’re treading into discriminatory territory

While we must be mindful of the caseloads, workloads, and other responsibilities of our collaborators, they can be crucial in ensuring that our treatment is provided and supported in L1. These professionals and community members may also have insights into an individual’s culture that are important for us to understand.

Tip 3: Get Creative with Treatment Sessions and Carryover

Once we identify collaborators to support L1, we can get creative with treatment. Some ways to support L1 in our speech and language treatment sessions and beyond can include:

• Working directly with family members who are multilingual during the session, which supports the individual in many ways and leads to improved carryover at home.
• Having multilingual colleagues assist with providing practice in L1 via voice or video recordings (you can make these on your phone), websites, handouts, books, YouTube videos, or other media that the individual can also access at home for carryover.
• Providing accessible multilingual resources to families, such as Epic!, an app and website that offers books, videos, and audiobooks in Spanish, French, and Chinese. An Epic! subscription is free for any professional who has a school or organizational email address.
• Creating your own resources using materials you already have, along with others, including using blank images for labeling and retelling, teaching family members or friends to partake in no-tech language activities such as “I Spy,” and coaching families to use free printed materials they already receive in the mail such as menus, magazines, and supermarket advertisements to practice labeling, answering questions, and discussing opinions. Model how to use these resources during sessions to ensure the skills carryover.

Providing multilingual speech and language treatment is the best practice for the ELLs we serve. Culturally and linguistically affirming services can be provided and supported by anyone regardless of the languages in which we communicate. What matters more than anything is authentic engagement in L1 by any means necessary. Every SLP and SLPA can provide this cultural and linguistic engagement by collaborating with others who are multilingual in creative and accessible ways that ensure the development of all languages is both reinforced and supported.

For additional information about how you can better serve ELLs in a school-based setting, MedBridge instructor Celeste Roseberry-McKibbin offers this 5-part course series that covers assessment, legalities, interventions, and more.