Cultural Differences in Speech Therapy #4

Concepts of Class and Status is part of a 10-essay series.  New? Start here:  Cultural Differences in Speech Therapy and Assessment

What determines an individual’s societal position and place of respect varies across cultures (Tomoeda & Bayles, 2002). Wealth often plays a large part in the determination of class culture. Socioeconomic class may result in even greater group dissimilarities than country of origin. For example, a person from Mexico of low socioeconomic status could share more in common with a poor Peruvian farmer than a member from the Mexican middle class. Formal education and higher education degrees are also sources of respect in most communities (Robayo, 2003).

Indicators of social status may also vary across gender in some communities.  For example, employment can merit respect for married Latino men, but women working outside of the home can indicate family structural weakness and vulnerability (Vega, 1995).

Concepts of Class and Status and Therapy

Many cultures are very class conscious, with members of different social classes not socializing together. Because of this concern with class and status, individuals may be particularly attentive to good hygiene and physical appearance. For others, this might not be a priority.  We can’t allow our cultural bias to influence whether we believe a parent cares or doesn’t care, based on a child’s appearance.  By doing this, we are also assuming that a family has access the clean clothes, time, and water needed to maintain a clean appearance.

A Thought Experiment

Though still an incredible challenge, individuals from the working and middle classes, eager to achieve higher class status, find this feat easier to accomplish in the United States than in their native countries (Robayo, 2003). We must also acknowledge refugees, individuals who flee their native country because of violence, persecution or war. Seeking refuge is surely a life-threatening attempt to seek a better life.  Imagine one day coming home, taking one bag, your family members, and leaving your house, car, culture, country, and life behind.  This is with no guarantees of your future.  This is with a real possibility that you will never see your homeland again.

In 1978 following the Vietnam war, Chuong Khoi Lien, a South Vietnam naval captain, left his home with his wife, Tran Le Ngo.  With 54 other refugees, they stepped upon a wooden boat to cross the South China Sea.  Why would you do this?  To create a better or safer life for you and your children.   Upon their arrival in Hong Kong 11 days later, their daughter, a speech-language pathologist in our clinic, was born.  Can you think of a greater sacrifice?  These decisions are unfathomable for most of us because of the prosperity of our country.  This is our privilege, and taking the time to hear the valuable stories of our families could provide meaningful insight.

Now, let’s think about this on the other end.  Let’s say that you did make this decision, and did make it to somewhere truly better.  Would you be proud?  Would you love your new environment?  I think you would.   I have had the privilege of traveling to or working in many of the countries that our children come from.  I have stayed in towns where no buildings had cement floors or windows.  I stayed in one place where I stepped over a sewage ditch to exit my house each morning.  Now, when I do early intervention visits or home visits in trailer parks or impoverished neighborhoods, I know that my opinion of the circumstance is a matter of perspective.  This “situation” could be the best that the family ever experienced.

Through intervention, we can investigate immigration as part of themes of books we use in therapy.  We can incorporate the parents’ story or home country into our intervention so that they feel we understand a bit about where they are coming from.

Concepts of Class and Status and Assessment

It is important for clinicians to consider the sensitivity that many people have towards social class and status and their concern with maintaining and/or improving their status. On the assessment front, concepts of class status can affect the evaluation process in the following ways:

• Having a title or being a medical professional can be held in high regard.  Some cultures see the professional as the one who interacts with the child and the parent doesn’t “overstep their bounds.”  This can be frustrating for clinicians who are trying to increase parent or caretaker involvement.  For some families, if they are not explicitly taught that they can and should practice with their child, they will see this as your role and won’t follow through on your suggestions.
• Some cultures see challenging a professional as proof that they care about their child.  I recall an IEP annual meeting in a school where a parent went line-by-line through every goal and concluded each question with: “Are you sure this is the best goal for my child?”  This was exhausting to be honest but I gained the biggest advocate for my work in the school for that day forward because the parent was convinced we were both working for their child.
• Class status can also have the opposite effect where a family will not accept a diagnosis because of a stigma they feel is associated with having a child with an impairment.

These personal priorities, coupled with the fact that many cultures are typically more formal than that of mainstream American culture, may make clients more concerned with titles and mannerisms that denote different class levels. For example, it may be particularly important to clients that “Dr.”, “Mr.”, or “Mrs.” be used in addressing others (Robayo, 2003).

Questions for Big Thinking

Did your family discuss class status growing up or was it a non-topic?  Did your family talk about money?  When you began making money, were you expected to contribute a portion of it to the family?  What jobs or professions were idolized by your parents?  What value was put on higher education?   Just think about it or share your comments below.

In our next essay we will talk about Cultural Values .

Want to read about all the cultural parameters in one place, get CEUs and a helpful chart?

Cultural Competence: Overview – ASHA

References:

Iglesias, A. (2002). Latino Culture. In D. Battle (Ed.), Communication disorders in multicultural populations (p. 179-202). Boston: Butterworth-Heinemann.

Lynch, E.W., & Hanson, M.J. (2004). Developing cross-cultural competence: A guide for working with children and their families (3^rd ed.).  Baltimore: Brookes.

Robayo, M. I. (2003). Latinos/Hispanics.  Retrieved April 8, 2006.

Suárez-Orozco, M.M., & Páez, M.M. (2002). Latinos: remaking America. Berkeley: University of California Press.

Tomoeda, Cheryl K. & Bayles, Kathryn A., (2002, April). Asha Leader, 7, p 4-5.

Vega, W.A. (1995). The study of Latino families. In R.E. Zambrana (Ed.), Understanding Latino families: Scholarship, policy, and practice (3-17). Thousand Oaks, CA: Sage Publications, Inc.