Language Services

Although speech-language pathologists in the schools are being encouraged to provide services more inclusively, they often express concern that they are becoming like classroom teachers and are "watering down" the therapy they should be providing to students on their caseloads. This article explores these concerns and offers solutions to the role confusion and dissatisfaction of many speech-language pathologists who provide in-classroom speech-language services. Two key principles are offered to preserve the speech-language pathologist's role identity and the integrity of services provided: maintaining a therapeutic focus and sharing the responsibility for student success.

OBJECTIVES. Patients with limited English proficiency confront multiple barriers to health care access in the United States. Appropriate language services for families with limited English proficiency are essential; however, little is known about pediatricians' use of language services. The objective of this study was to examine pediatricians' provision of language services to patients with limited English proficiency and the pediatrician, practice, and state characteristics associated with use of these services. METHODS. Data were obtained from the Periodic Survey of Fellows No. 60, a nationally representative survey of members of the American Academy of Pediatrics. A total of 1829 surveys were mailed, and responses were obtained from 58%. Use of 6 language services was assessed. Factors associated with language services use were examined after adjusting for physician, practice, and state characteristics. RESULTS. Bilingual family members (70%) and bilingual staff (58%) were the most frequently reported language services; 40% of respondents report the use of professional interpreters, 28% use telephone interpreters, and 35% of practices report provision of translated written materials. Pediatricians in smaller and rural practices and in states with higher proportions of limited English proficiency persons report less use of professional interpreters. Pediatricians in states with third-party reimbursement for language services are more likely to report use of professional interpreters. CONCLUSIONS. Most pediatricians report using untrained interpreters to communicate with limited English proficiency patients and their families. Pediatricians in regions with high proportions of limited English proficiency persons may be less likely to provide appropriate language services. Third-party reimbursement for professional language services may increase the use of trained interpreters and quality of care.

BACKGROUND AND OBJECTIVES: Access to appropriate language services is critical for ensuring patient safety and reducing the impact of language barriers. This study compared language services use by US pediatricians in 2004 and 2010 and examined variation in use in 2010 by pediatrician, practice, and state characteristics. METHODS: We used data from 2 national surveys of pediatricians (2004: n = 698; 2010: n = 683). Analysis was limited to postresidency pediatricians with patients with limited English proficiency (LEP). Pediatricians reported use of ≥1 communication methods with LEP patients: bilingual family member, staff, physician, formal interpreter (professional, telephone), and primary-language written materials. Bivariate analyses examined 2004 to 2010 changes in methods used, and 2010 use by characteristics of pediatricians (age, sex, ethnicity), practices (type, location, patient demographics), and states (LEP population, Latino population growth, Medicaid/Children’s Health Insurance Program language services reimbursement). Multivariate logistic regression was performed to determine adjusted odds of use of each method. RESULTS: Most pediatricians reported using family members to communicate with LEP patients and families, but there was a decrease from 2004 to 2010 (69.6%, 57.1%, P < .01). A higher percentage of pediatricians reported formal interpreter use (professional and/or telephone) in 2010 (55.8%) than in 2004 (49.7%, P < .05); the increase was primarily attributable to increased telephone interpreter use (28.2%, 37.8%, P < .01). Pediatricians in states with reimbursement had twice the odds of formal interpreter use versus those in nonreimbursing states (odds ratio 2.34; 95% confidence interval 1.24–4.40). CONCLUSIONS: US pediatricians’ use of appropriate language services has only modestly improved since 2004. Expanding language services reimbursement may increase formal interpreter use.

PURPOSE The current study was conducted to investigate the provision of written language services by school-based speech-language pathologists (SLPs). Specifically, the study examined SLPs' knowledge, attitudes, and collaborative practices in the area of written language services as well as the variables that impact provision of these services. METHOD Public school-based SLPs from across the country were solicited for participation in an online, Web-based survey. Data from 645 full-time SLPs from 49 states were evaluated using descriptive statistics and logistic regression. RESULTS Many school-based SLPs reported not providing any services in the area of written language to students with written language weaknesses. Knowledge, attitudes, and collaborative practices were mixed. A logistic regression revealed three variables likely to predict high levels of service provision in the area of written language. CONCLUSION Data from the current study revealed that many struggling readers and writers on school-based SLPs' caseloads are not receiving services from their SLPs. Implications for SLPs' preservice preparation, continuing education, and doctoral preparation are discussed.

Since their inception nearly 100 years ago, speech-language services in the schools have undergone profound fundamental changes in scope and focus. This article reviews the legislative/ regulatory, societal, professional, and demographic influences that shaped and defined school-based speech-language pathology over the past half century and then describes school-based speech-language practice as it is today. Particular attention is paid to the fundamental elements of contextually based assessments, educationally relevant intervention plans, and increased collaboration/consultation. Finally, strategies are presented that can help to facilitate the changes needed to move from past practice patterns to those that reflect current legislation, research, and practice guidelines.

Background Significant health disparities exist between limited English proficient and English-proficient patients. Little is known about the impact of language services on chronic disease outcomes such as for diabetes. Methods/Principal Findings To determine whether the amount and type of language services received during primary care visits had an impact on diabetes-related outcomes (hospitalization, emergency room utilization, glycemic control) in limited English proficient patients, a retrospective cohort design was utilized. Hospital and medical record data was examined for 1425 limited English proficient patients in the Cambridge Health Alliance diabetes registry. We categorized patients receiving usual care into 7 groups based on the amount and combination of language services (language concordant providers, formal interpretation and nothing) received at primary care visits during a 9 month period. Bivariate analyses and multiple logistic regression were used to determine relationships between language service categories and outcomes in the subsequent 6 months. Thirty-one percent of patients (445) had no documentation of interpreter use or seeing a language concordant provider in any visits. Patients who received 100% of their primary care visits with language concordant providers were least likely to have diabetes-related emergency department visits compared to other groups (p<0001) in the following 6 months. Patients with higher numbers of co-morbidities were more likely to receive formal interpretation. Conclusions/Significance Language concordant providers may help reduce health care utilization for limited English proficient patients with diabetes. However, given the lack of such providers in sufficient numbers to meet patients' communication needs, strategies are needed to both increase their numbers and ensure that the highest risk patients receive the most appropriate language services. In addition, systems serving diverse populations must clarify why some limited English proficient patients do not receive language services at some or all of their visits and whether this has an impact on quality of care.

PURPOSE: This study describes the alignment between the need for AAC among a group of young children with cerebral palsy (CP) who had clinical communication disorders and the speech-language goals/objectives being targeted in the IEPs of these children. METHOD: 22 children with CP who had clinical communication disorders were classified into groups according to their need for AAC based on prospective assessment data. Individualized Education Plans (IEPs) in place at the time of the assessment were analyzed to characterize the type of speech-language goals/objectives being addressed for each child. RESULTS: 95% of children with CP in this sample could benefit from some form of AAC. Among these, 62% had at least some functional speaking ability. Among all children who could benefit from AAC, 57% had AAC-focused speech-language goals/objectives in the IEP. Children who had any functional speaking ability were less likely to have AAC-focused speech language goals/objectives than children who were unable to speak. CONCLUSIONS: Results suggest that a majority of young children with CP and communication disorders would benefit from some form of AAC, however these children seemed to be under-served with regard to AAC interventions, particularly those who had any functional speaking ability. Additional pre-service and in-service training for speech language pathologists and other professional is necessary to ensure that children with CP receive the AAC-focused speech-language services they need.

Twenty-four million people in the United States have limited English proficiency. They experience barriers to health care because of their inability to communicate effectively with providers. Hospitals are required to provide language services that reflect the needs of people in their communities, but these services are not available systematically.

More than 23 million Americans have limited English proficiency, which complicates their ability to obtain quality health care. Language barriers in the health care setting can lead to miscommunications and cause medical errors, delay or denial of services, issues with medication management, and underutilization of preventive services. This brief assesses emerging national efforts to address language barriers and profiles work in three states—California, Minnesota, and New York—to highlight challenges, successes, and implications for future policy and activities related to providing language services.

EXECUTIVE SUMMARY Despite efforts to advance effective patient‐provider communication, many patients' language needs continue to be unmet or inappropriately addressed by healthcare providers (Wielawski 2010; Patek et al. 2009; Wilson‐Stronks and Galvez 2007). This study presents a picture of the language resources currently provided by hospitals and those resources practitioners actually use. Questionnaire data were collected from 14 hospitals in Florida's Palm Beach, St. Lucie, and Martin counties on availability, staff awareness, and staff use of linguistic resources and services. Inconsistencies were identified between the language tools, services, and resources hospitals provide and those staff use. In addition, a large majority of staff respondents still rely upon someone accompanying the patient for communication with patients who have limited English proficiency, despite evidence that this practice contributes to miscommunication and serious medical errors (Flores et al. 2003; Flores 2005; HHS OMH 2001; Patek et al. 2009). Hospitals that use bilingual staff as interpreters often do not test the competency of these staff, nor do they assess the utilization or effectiveness of the tools and resources they provide. Hospitals can improve the cultural and linguistic care they provide if they (1) address the practice of using ad hoc interpreters, (2) effectively disseminate information to hospital staff regarding how and when to access available resources, and (3) collect patient population data and use it to plan for and evaluate the language services they provide to their patients.