E6 - Ethics in International Practice
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[00:01:04] Narrator: Okay, welcome Dr. McFarland and Yvette. 
[00:01:12] Dr. McFarland: Welcome to Ethics is Essential. Today, we're going to be discussing ethics in international practice. More and more speech language pathologists have opportunities to engage in international practice.
[00:01:28] For some, it may come as an invitation to develop or assist with a new speech language pathology or dysphagia program in a distant country. For others, what starts as a volunteer activity for a few weeks each year may become a longer term commitment. More and more colleges and universities have overseas programs that offer students academic credit for summer volunteer work with children or adults with communication disorders.
[00:01:59] As a member of Special Interest Group 17, I'm seeing more graduate students asking questions about clinical fellowship year replacements abroad and how to get certified speech language pathologists to supervise them during their nine months of practice. Telepractice also allows speech language pathologists to provide services for clients in distant countries.
[00:02:24] Other international opportunities may come via invitations to teach in university programs overseas or consult in the development of programs for educating students for the field of speech language pathology in other countries. What are the requirements for successful international practice? We know culture may influence how programs are developed and how and to whom services are provided.
[00:02:52] Though culture, cultures may vary from one country to another. Speech language pathology services provided by certified clinicians must be conducted in keeping with ASHA's code of ethics, regardless of where they're provided. What are the challenges for ethical practice away from America? How do we honor our clinical obligations?
[00:03:18] Our guest today is going to answer that question and several more. Dr. Yvette Hyter is Professor of Speech Language and Hearing Services at Western Michigan University. She's also an ASHA fellow. She focuses on culturally, linguistically responsive services and macro level structures affecting participation in daily life.
[00:03:42] She developed a social pragmatic communication assessment battery for children that is being implemented in the United States, Greece and Brazil. Dr. Hyter has served in positions regarding culturally responsive practices and competent global engagement at her university, at the American Speech Language and Hearing Association, and the International Association of Logopedics and Phoniatrics.
[00:04:09] As co director of the non profit organization entitled Cultural Connections Transnational Research and Education Laboratory, Dr. Hyter and her partners develop curriculum units and teach courses in West Africa and the United States about causes and consequences of globalization on systems, policies, and practices.
[00:04:34] She and her colleagues have a website that provides information about pragmatics and social communication of African people and the African diaspora. It is www.africansocialpragmatics.net. Dr. Hyter, welcome to All Things Ethics. Thanks for being here with me today to discuss ethics in international practice.
[00:05:01] It's an interesting topic for very interesting times. You have a practice in West Africa and you've had quite a bit of international experience as a speech language pathologist, teacher, and consultant. So I'm very anxious for you to share information from your experiences and expertise about the ethical aspects of international practice.
[00:05:24] So, let's begin with the question I'm sure some of our listeners have. I know our listeners are familiar with the term ethics and the importance of adhering to ASHA's code of ethics in their practices here in the United States. What do our listeners need to know about ethics in the practice of our profession in an international setting?
[00:05:45] Is ethical practice the same all over the world? 
[00:05:51] Dr. Hyter: Thank you for that introduction, Elise. Thank you very much. I'm happy to be here. I do want to make one small correction, is that the name of my department is Speech Language and Hearing Sciences at Western. I want to start by saying that how ethics is defined and therefore practice differs Based on different ways of knowing or different, what we call epistemological frame.
[00:06:18] So these different ways of knowing these ways of knowing are based on historical experiences and socialization. For example, in communication sciences and disorders, at least in the United States, ways of knowing that are more consistent with Eurocentric perspectives have been highlighted and ways of knowing consistent with.
[00:06:42] Let's say feminists or LGBTQIA or people from ethnic groups other than European American have often been marginalized. Gloria Ladson Billings, who is a educator and her work has focused on culturally relevant pedagogy. She. Dr. Billings has said that the differences between Eurocentric and other ethnic epistemologies or ways of knowing depend on whether the individual is the source of knowledge, or whether knowledge is based on relationships with others.
[00:07:19] So in this regard, ethics is not the same all over the world. Just as an example, the individual is inherent in the saying that's pretty popular in the United States. This saying is, pull oneself up by one's bootstraps. So no one in the world has accomplished that feat. Meaning, no one in the world has accomplished important things in life by oneself without outside help.
[00:07:48] That's a myth, but that is often used in political discourse in the United States. And it's supposed to point to self sufficiency, individuality, self reliance. On the other hand, an example of knowledge being contingent on relationship with others is expressed in the concepts and practices of collaboration, interprofessional education, and research.
[00:08:17] And my own perspective is that these relationship based knowledge productions occur. In a transdisciplinary team of course, you can team in all different types of ways. But for me, the transdisciplinary team is the more evolved process of this relationship building work. In my own practice, teaching and research, I've always pulled into my knowledge base literature from the social sciences.
[00:08:49] Such as economics, politics, sociology, and anthropology. I've already always read in those disciplines and I've adapted the definition of ethics that comes from critical social theories. So I've also always engaged in transdisciplinarity and most of my work is transdisciplinary. So I work with people from disciplines outside of speech language pathology and outside of communication sciences and disorders.
[00:09:19] From this perspective, from these more critical social theories perspectives, Or excuse me, some of these social theories, for example, are like Marxism or Western Marxism or critical social theory. Ethics is usually contrasted with morality, so in that ethics is the emancip considered to be these emancipatory actions of groups of people who are usually economically exploited or politically oppressed or socially excluded.
[00:09:52] Morality, on the other hand, is defined as a way to justify the rightness of the exist or righteousness of the existing practices that often include unequal power relations. So from the, this more social sciences. Base, I think of ethics more as liberate, liberatory activities that are done by groups of people.
[00:10:19] It's not one individual discipline or person engaging in these behaviors. A good example of morality and ethics, as I just defined them, can be made by talking a little bit about the work that we do in Senegal. As an example. Morality would be the group that I work with forging ahead to work on what we think the people in Senegal need.
[00:10:46] So what we would be doing is just replicating some of these exploitative or exclusionary practices by forging ahead and working on what we think is important for the people in Senegal. An example of ethics of collective action, on the other hand, would be practice and research grounded in partnership with people who are living and working and in Senegal, people who know and say what they need in their own communities and people who invite.
[00:11:26] others to engage in activities that are beneficial to the whole society, not just to the individual, not just to the SLP or the researcher, for example. If we take the example of ways of thinking that I mentioned earlier, for many years in our profession, and this issue still exists in large numbers today, the GRE scores were highly valued and more valued actually than other kinds of knowledge on admissions committees.
[00:11:55] In communication disorders and sciences programs, because the GRE score is quantitative, and I'm using air quotes there. I'll mention that a lot. I use air quotes a lot. That's a parenthesis. So since the GRE score is quantitative, many scholars are more highly value that score than qualitative indicators of knowledge and ability, such as resilience.
[00:12:24] or intellectual curiosity, or efforts to seek out experiences that provide to seek out experiences that provide exposure to cultures and languages other than one's own. This over focus on quantitative measures is a very Eurocentric way of thinking that comes from a social theory called positivism.
[00:12:48] And in this Pop this social theory of positivism came about in the mid 1800s, and it focuses on the search for the quote objective and quote, and these objective variables that exist outside of oneself, and it suggests that quantitative research or data. Is not subjective, but objective, and that meant that measurable and observable behaviors are the basis of knowledge and skills.
[00:13:22] So morality, so differentiating morality from ethics, or the moral argument would be that applicants who have a low score are somehow less able to be successful academically and clinically. This is probably this moral argument from the more exploitative. Oppressive and exclusive thinking. The ethical argument is that low GRE scores do not determine the real outcome of educational attainment, particularly because they're based biased against people of color.
[00:13:59] They're biased against people who speak more than one language, older women, and people who grew up impoverished. What really determines one's success is grit. Resilience, the ability to work with others. And these things are what we, what can help someone be successful in graduate school in this field.
[00:14:20] So in this way, ethical practice, getting back to your original question, ethical practice is not the same all over the world because what is ethical and moral are not considered to be universal. There's this concept called absolutism, the belief in a single truth. Where the belief is that there is one universal or standard of ethical behavior, but in reality, the context or the context in which we find ourselves should really dictate that ethical practice.
[00:14:55] So, Here's an example. Here's another example of this, how the context could determine ethical behavior and practice. And I, this example comes from Donaldson in the Harvard Business Review. But before I give that example, I do want to say that I'll be using some content concepts that I want to make sure the listeners understand.
[00:15:19] First is minority world. and the minority world countries is where the minority of people in the world live. which includes North America, Australia, Israel, Europe, and is contrasted in the literature with majority world countries. And that's where the majority of the people in the world live, which includes countries in Africa some parts of Asia, South and Central America and the Caribbean.
[00:15:53] So getting back to this example of how the context can determine ethical behavior. This example from Donaldson in the Harvard Business Review, he wrote that a rich country, let's just say the U. S., pays very low wages to a company in a majority world country, where the majority of people live.
[00:16:16] Let's say that's, that would be an example of unethical behavior. But a country in the majority world who accepts low wages from a company in the minority world in order to improve living standards of the people in their country might be considered a more ethical position. And here's an example that's more specific to SLP.
[00:16:41] So an SLP goes to Mali to help and to set up an SLP practice without first having the historical, political, economic, social history of the people there. That would be an unethical practice. Another SLP goes to Mali after learning and understanding the historical, political, economic, social history of the people in that country, and after making connections with others like educators or community rehab workers or NGOs that are run by Malians, and after having been invited to learn about Malians and the, and the context in which they are, Living and and what they see is their own needs.
[00:17:26] That's a more ethical position. And I will just in answer in responding to that 1st question by suggesting that in communication sciences and disorders, we really need to incorporate global ethics into our curricula. And practices. And currently global ethics focuses on ethical issues. This is it's a field of study and it focuses on ethical issues such as war on terror, child labor, human trafficking, migration, climate change, and my gloss or my understanding of this field is that it's it focuses on common social problems.
[00:18:14] Thank you That affects humanity worldwide. And I would say that communication disorders fits well into that list. of common social problems affecting humanity worldwide. 
[00:18:29] Dr. McFarland: I think you've given us a really interesting perspective Dr. Hyter, in terms of variability of ethics in relation to to international practice.
[00:18:40] And I think that your your examples, your examples from our own profession of speech language pathology really do bring a lot of light to the rather, what I consider complicated explanations that you gave in terms of in terms of ethics and morality but the examples that you gave really kind of brings all of that together.
[00:19:03] And I think it really gives us something to think about as speech language pathologists who are increasingly. are being asked or have opportunities to provide services in in an international context. But the fact that there's a lot of work that has to be done and a lot of, a lot of knowledge acquired prior to making those commitments or developing programs or providing services, I think I think is very, very important.
[00:19:33] Obviously having that background information and having connections with people who can provide that kind of information. It's very, very important. So thank you. Let me ask you another question. Are there ethical principles beyond ASHA scope of practice and the ASHA code of ethics that speech language pathologists in America should incorporate into their international practice?
[00:20:01] Dr. Hyter: Yes I first like to talk a little bit just to summarize what our current documents do say. And then I'll talk about how there are some ethical positions that we or ethics, additional things that should be incorporated into those documents. So with regard to the ASHA code of ethics that The focus is on what there are rules or the, in the principle, the ethics one, for example, rule B suggests, or says that individuals should use every resource.
[00:20:36] And I'm quoting here, including referral and or interprofessional collaboration when appropriate, which suggests that if a professional feels like they are not prepared on an individual basis to provide culturally and linguistic. services that are responsive, then that person needs to make an appropriate referral.
[00:21:01] Rule C also says that the individual, the SLP, should not discriminate in the delivery of professional services. And so, We shouldn't discriminate, but if we're feeling unprepared to provide services to someone who's from a cultural or linguistic background, different than our own different from our own, then we should not we should make a referral to an appropriate person or group principal ethics too.
[00:21:28] And rule a highlights that only those aspects of the. Professions that are within our scope of professional practice and competence should be practiced. That's the only thing we should engage in. And that we rule D underscores that we should approach our work as lifelong learners. In terms of, that was the Code of Ethics, in terms of ASHA's scope of practice, we are committed as SLPs to providing culturally and linguistically appropriate services, and I'll just put a parenthesis here, that I would, in my own language I would usually replace appropriate with responsive.
[00:22:11] Appropriate as we know is culturally defined and or conceptualized and responsive is a more dynamic and less static concept in my mind. So, continuing with the highlighting of the astroscope of practice that We are called to increase national international interchange of professional knowledge, information, and education.
[00:22:37] And again, I put a parenthesis here that in my mind, I would gloss interchange as being an exchange, which suggests a bidirectional, which very clearly suggests a bidirectional relationship between equal partners. So, these are people who are on the same page. You're perceiving them as being just as knowledgeable as you who are joining, you're joining together to work together on a common or shared problem. Something else that's in the scope of practice is that our scope of practice is consistent with the World Health Organization International Classification of Functioning Disability and Health. And Which provides a standard language or standard framework to use in describing functioning and health.
[00:23:29] And then it looks at health conditions as well as contextual factors, such as environmental factors or personal factors that might influence the intervention outcome. And practice. So just as I mentioned a few minutes moments ago earlier, when I was responding to question one, we really do need and I'm going to keep coming back to this point.
[00:23:53] We really do need to incorporate global ethics into our curriculum practices. It would help us as a field acquire the knowledge, skills, and behaviors that my colleagues and I wrote about in our paper called Global Competencies. And specifically, I'm quoting from page 11 of that article, we would gain comprehensive knowledge about global issues and the ability to critically analyze and apply that knowledge in culturally responsive ways.
[00:24:26] We'd be able to be critically reflective. professionals and use a diverse range of frameworks to examine shared problems. And we'd approach those shared problems from diverse perspectives. And we'd engage in interprofessional practice and education in transdisciplinary and then transnational ways. So there's across blurring the boundaries across nations.
[00:24:53] It would help us just be more effective because we could recognize the cultural context, acquire the strategies and the skills to adapt to the cultural linguistic differences, and then be responsive, responsive to the cultural context and the material context. different from our own. And then we could do some reflective thinking about, you know, how we would change our own cultural values or change how we're working to be a better match for the people with whom we are engaged in collective and collaborative work. So global ethics also focuses on the importance of bridging theory and practice and practice being broadly defined as the sum of our clinical activities, but it also includes teaching and research. We have a speech language pathologist and individual and as a profession, communication sciences and disorders, we have ready access to language learning theories.
[00:25:54] You start learning those in undergraduate school throughout graduate school, you use them in clinical practice. But we do not typically examine or employ frameworks or theories that support our global engagement. And that's something that I write about quite often. And so do others like PelŽ and Cathard.
[00:26:15] They, we, we write about the importance of changing our, our frameworks in order to help us practice and engage globally. in a more effective and responsive way. So as a profession, we need to acquire and understand and utilize these theories and frameworks to help us understand totality. That is the links between social structures and society like history, economic, politics, race, State control and culture, for example.
[00:26:49] So it helps us make sense of the how all of these social structures are connected and how we can identify causes of common problems shared among peoples around the world. And I'm putting in there, this communication communication disorders and sciences, the importance of communication and how challenges to being, being able to communicate might be.
[00:27:14] Maintained or might be also thwarted by some of the social structures and how they behave in different contexts and different situations. So, to implement any of these such suggestions that I'm making here, I understand, or I think I know that we would need to really look at our curriculum content.
[00:27:37] Because global ethics and diverse conceptual frameworks for guiding practice and research abroad don't usually show up in our local curricula here in the US or practica until the SLP or the audiologist decides to go out of the country or is invited to go out of the country to engage with others.
[00:27:59] Dr. McFarland: You know, I'm, I was really glad to, that you and incorporated principles and mentioned principles and rules from ASHA's Code of Ethics. And principle one, rule B you said relates to making appropriate referrals. And I think that's very interesting because, you know, there are situations internationally in which an ASHA certified.
[00:28:23] Speech language pathologist may be the only speech language pathologist in the area, and in some instances, even in the country. And so, given that given that possibility and in some instances, reality, what what is that speech language pathologist? speech language pathologists to do if in fact they're confronted with a situation with a person who has a communication disorder that they're not they're not equipped to handle either culturally or in terms of their training and education and knowledge.
[00:28:59] Dr. Hyter: Thanks for that question. I think it's a very good question that requires some thought. Often in Other countries, I know, particularly in minority, I mean, I'm sorry, not minority, but majority world countries that S. L. P. S. or individuals who work on communication, supporting communication. They don't have they're not necessarily certified asha.
[00:29:27] S. O. P. S. and sometimes their community based rehabilitation workers. Sometimes their community members that are working together. When in an international context, I think it's always important for the S. O. P. who's working in an international context to still partner with people who are on the ground doing the work in that particular area.
[00:29:52] Now, if that S. O. P. is a resident and living. In another country is very familiar with the culture, the requirements, the nature of the country has relationships with community members, then that person would be qualified to provide those services. If, you know, if they felt qualified to provide those particular language or speech services, that of the types of disorders that they were coming across.
[00:30:24] Dr. McFarland: Okay. Well, I think that certainly gives our, our listeners some, some good information and some options. So let's move on. Let me ask you another question. Speech language pathology practice overseas is often referred to with the term global engagement. What is that? In your previous response, you mentioned the World Health Organization's International Classification of Functioning, Disability, and Health.
[00:30:51] For our colleagues who want to develop programs and services overseas, are there international reports, documents, and policies they should be aware of or familiar with as they begin planning for overseas practice? 
[00:31:05] Dr. Hyter: Yes, there are. I would say in addition to the ICF, the International Classification of Functioning, Disability, and Health, in addition to that document, I think it would be important to know of five others.
[00:31:18] And I'll just say one thing about the ICF is that the, it's, It's a framework for measuring clinical outcomes, and I recently read an article by my dear friend, Carol Westby and another colleague, Carla Washington, which was published in 2017. And that article in that article, they stated that many schools in the US.
[00:31:42] Are not necessarily using to frame assessment and intervention, but they are using idea like individuals with disabilities education act of 2004 to qualify students for special education services. So, I think incorporating into the. School systems in the United States is also something that we should be looking to do and that article by Westby in Washington provide a primer or tutorial on how to apply ICF to children, school age children with language impairments.
[00:32:15] So these, there are five other documents that I think our listeners need to be aware of. And anyone else considering working outside of their own home country home country. And so I'm going to list those documents and then talk a little bit about each of them. So, 1 is the convention on the rights of persons with disabilities.
[00:32:39] The 2nd is the world report on disability. The 3rd. Is the U. N. sustainability goals. And the 4th is the International Communication Project, which is promoting communication as a human right. And the 5th is education for all. Now, all of these documents and policies originated in the United Nations or UNESCO or SLP organizations within the minority world countries.
[00:33:12] But so the Convention on the Rights of Persons with Disabilities is an international treaty to address disability rights and according to its web page, that it's one of the first or it is the first comprehensive human rights treaty of the 21st century, which I think is pretty important. The goal of these Convention of Rights with Persons with Disabilities, and this is a United Nations document, the, the goal is to remove barriers and increase accessibility of environments and to provide equal opportunities to people with disabilities.
[00:33:52] It's similar to the American with Disabilities Act, I think. But it goes a little further and it's also similar to the American with Disabilities Amendments Act of 2008. But ratification of the Convention on the Rights of Persons with Disabilities would help. Help us in the United States to fully realize the promise of the 80 and the 80, for example, still relies on a medical model.
[00:34:21] So it continues to locate the disability in the person rather than also in the elimination of barriers. The. This Convention on the Rights of Persons with Disabilities was ratified by almost all of the countries that are part of the UN, but not the United States, among others. The second document is the World Report on Disability, which was published in 2011 by the World Health Organization and the World Bank.
[00:34:54] And it The goal of this document was to provide a comprehensive description of the, of the the type of disabilities or the state of disabilities around the world. And at the time of the report that the report was published the report said that 15 percent of the world's had some form of disability. And but that, Did not necessarily include individuals that had communication disabilities and there have been speech language pathologists have who have written about that gap and the need as a matter of fact, there's an international, there's a special issue of the hope I have the name, right?
[00:35:38] The International Journal of speech language pathology I think that came out in 2013 that talks about the impact of the world health. Organization's world report on disability and how as a field, as a discipline, we should be moving forward, forward, given that information. The third document is the U. N. Sustainability Development Goals. Now this these goals were developed by the United Nations, and they are picking up where the U. N. Millennium Development Goals left off, which the U. N. Millennium Development 2000 to 2015. Only 189 countries signed on to those goals, but this new iteration of the goals, these worldwide goals, the U.
[00:36:31] N. sustainability development goals, all countries that belong to the United Nations signed on to this agenda and It has 17 different goals. Some of them include no poverty, good health and well being quality education, reduced inequality. There's 717 different goals that we can talk about if you're interested.
[00:36:57] But I'll continue the 4th. Document is the international communication projects communication promotion of communication as a human right. And so the goals of this project is to advocate for people with communication disabilities and also to raise awareness worldwide about communication disabilities. Which I think is very important. And I mentioned earlier in one of the earlier questions that I thought that communication disabilities was one of those worldwide major concerns that we all that everyone should be focused on. So some of the premises of this particular document. Focused on that communication is vital to life and this is from its web page.
[00:37:44] The communication is vital to life, but it's often not considered to be a disability widely that speech language pathologists and audiologists make a critical difference in the lives Of people that have communication disabilities in their families. Early intervention is key and that communication is a human right.
[00:38:06] So being able to communicate is a human right. And then the last document that I had mentioned is UNESCO's Education for All. And this. The objective of this education for all document is to ensure that the quality, universal, basic education is in place and that education is a basic right and a basic need for all African children, including those children that have disabilities.
[00:38:39] And this is I also happen to know that this is part of the car. Part of the Senegal framework for action and so some of the emphasis is to make sure that every child has basic education or has received basic education I'll say, just to close this question out, is that, just to underscore that it's important to know about what services and service organizations already exist in a place where people are wanting to practice or or go into support and to make some connections with those services or, or organizations that already exist and that are being effective in the community.
[00:39:24] country where people are interested in, in working. Because if we're duplicating services, we're also displacing we run the risk of displacing people and displacing existing services too. 
[00:39:36] Dr. McFarland: I think that's a great point and something that, you know, in terms of international practice, we really need to be very very aware of.
[00:39:46] You, at the beginning of your your answer to my question, you mentioned a An article by Drs. Washington and Westby in relation to the International Classification of Functioning for some of our, or any of our educators who may be listening. There's also another very good article by Dr. Lemietta McNeely. That was published in Perspectives for the ASHA Special Interest Groups in 2018 that I think is entitled Requisite Knowledge for Teaching Graduate Students to Use the ICF Disability and Health Framework. And that's a, another article that I think is really good in terms of helping us build that capacity with our students.
[00:40:32] Okay. Thank you. Let's I have another question for you. Professionals who establish international practices do so because they want to provide programs and services that benefit the people who need them. The opportunity to do good can be a strong, a very strong motivation, and there can be some very beneficial outcomes.
[00:40:54] But can there also be unintended consequences in the development and implementation of international practice? And if so, what are they and what are the ethical implications of these, what I'll refer to as, unintended consequences? 
[00:41:12] Dr. Hyter: Mm hmm. Excellent question. And at first, I will say a very short yes. There are certainly unintended consequences.
[00:41:21] And I'll talk a little bit about that and, and ways that we can try to minimize those unintended quest consequences. My friend and colleague, Beast Daly at Darwin University in Australia has recently organized an online book club discussion. And right now, We're reading a book called No More Heroes, Grassroots Challenges to the Savior Mentality, and that's written by a person named Jordan Flaherty.
[00:41:50] F L A H E R T Y, I'm not sure I pronounced that correctly, but that's the spelling. So he starts the book by reviewing the history of the savior mentality. And this is because of the colonial history of people who were born and raised in the minority world countries. So North America, Europe, Australia, Israel.
[00:42:13] So this kind of savior mentality that we often have in that this part of the world, and so most people affected by these quote saviors, and I'm quoting something from his book most people affected by these saviors are. Those who are most affected by any inequity in the world. And there, these are the people who are least have the least economic and often social privileges and on the world scale.
[00:42:46] So we really need to be aware of unintended consequences of our behaviors. And some of the unintended consequences or working abroad abroad without. sufficient knowledge. This is especially when you don't have sufficient knowledge about the area in which you are working. But working abroad without that sufficient knowledge and experience and humility is to, you know, we often end up reproducing some paternalistic and colonial relationships between people who are traveling abroad and the And those people who are trying to, and I'm putting in my air quotes, trying to help.
[00:43:29] So, and I'm, I'm going to just put in a parenthesis here about that word help another issue that we need to be aware of is what we call things. We. And I'm very conscious of how we refer to our practice or our collaboration or the, the way that we engage abroad and here in the U.
[00:43:52] S. There's a a colleague, Megan Brett Hamilton, she's a an assistant professor at Auburn University in Alabama. She wrote a recent paper, I think it's in one of the the Journals but she wrote a recent paper in 2018 about speech language pathologists needing to use language. That's not deficit based, she was speaking specifically about African American English and in much of my writing I've made similar claims about language that we use to refer to culturally responsive and globally engaged behaviors and help is 1 of those problematic words.
[00:44:29] And I think when we say that we want to go help. You know, someone in another country that that should be a red flag that goes off in our heads about us needing to deconstruct what we mean by help by what we mean by that and, you know, another word that We should be questioning probably is service as the, you know, service.
[00:44:52] I have a friend just almost a lump. So Amani at Baldwin Wallace University who leads several scholars who led up several scholars on a panel and Asha and in Basler about our need to change our epistemological frameworks or ways of knowing and, she raised my awareness of the paternalistic connotation of the word service which I used to use all the time.
[00:45:18] But it suggests a passive stance on the part of a person being served, right? So it suggests like, I'm going to do something for you or I'm going to do something to you. So I've struggled with, you know, different language about how do we describe what it is that we do. And what I'm using now is practice or join a partner in one's care or collaborate a collaborator or something of that sort.
[00:45:45] Well, That's the end of my parenthetical part of my response, but so it's important to build partnerships and to prepare people who are traveling abroad about the cultural history, the ethnographic methods for observing and way ethnographic methods for gathering information, and also a very I Self reflective process in terms of understanding how as a person coming from outside of that country, how we will be perceived.
[00:46:17] And how our knowledge will be perceived, or how our, our practice will be perceived and, so, it's important to have that to do that work before traveling abroad. And so that's really engaging in. what I call a transdisciplinary praxis. The praxis being this ongoing process of Working in groups with others that are, you know, like interprofessional group where we can be reflective and deconstruct our own cultural practices and worldviews and understanding how our worldview shape the way we see others in the world.
[00:47:04] So that requires a great deal of self-reflection and self-awareness. So. You know, some of the ethical implication, or I think probably the primary ethical implication is that we could be doing harm if we're not evolving. If if our practice and our thinking is not evolving with the context in which we find ourselves, our ultimate goal should always be to behave justly and equitably, particularly because.
[00:47:35] We're in a world that is often unjust and inequitable. Something that I read years and years ago that I stay with me and I, that stays with me and I keep this. I also often mentioned this to my students and my culturally responsive practices course that, and this comes from Elsa Barkley Brown, who is a historian.
[00:47:56] And she wrote. This is a quote from her. Well, I'm going to paraphrase. I don't have the document right at me to give a direct quote, but she says that, you know, you don't have to be displaced. No one has to be displaced in order to question our own beliefs. You know, our own beliefs and anyone else's beliefs to center other people's experiences.
[00:48:21] So we don't have to displace anything. We don't not trying to get rid of anything that makes up the core of who we are. All we have to do, according to Elsa Barkley Brown, is just pivot. We just need to pivot off of our center and try to see the world from other people's perspectives and points of view.
[00:48:41] And I think the more that we're able to do that, the more that we are we will be behaving in, in ways that are just and equitable. 
[00:48:51] Dr. McFarland: Great response. I want to bring into the a concept that that I've heard Many, many times in the last few years, and that's volun tourism. And that refers to, you know, people who have very good intentions, who say that they're going to volunteer their services, and they may do that, but Really, what they're most interested in, perhaps, or, or equally is interested in, is you know, being a tourist in the, the area of the space or the country that they're going to.
[00:49:22] And so I think that's something that, that we need to be very very careful about. If in fact you're going to learn about the area that you're going to, learn about the people, the history, and the culture of that particular. area and those particular people. And if in fact, you're very willing to work with and join in I think that that kind of indicates the true nature of, of your intention and the benefit that you can bring that you can bring to people.
[00:49:58] All right, let's go on. One more question for you. ASHA's Code of Ethics requires certified speech language pathologists to be culturally competent as a prerequisite for ethical evidence based practice. You co authored a book entitled Culturally Responsive Practices in Speech Language and Hearing Services, in which you write about what you refer to as culturally responsive assessment and intervention.
[00:50:27] What guidance do you have for our listeners on engaging in sustainable, culturally and linguistically responsive global practice as a speech language pathologist? And what is the relationship between culturally responsive practice and ethics in international settings? 
[00:50:45] Dr. Hyter: Thank you for that question.
[00:50:47] The title of the book is Speech, Language and Hearing Sciences. I often sometimes miswrite that myself, but culturally responsive practices and speech, language, and hearing sciences. The, in terms one of the things is that I think, well, in terms of guidance I think we need to find frameworks that will help us approach our work in a sustainable, culturally and linguistically responsive manner.
[00:51:17] And we write about that in our textbook. Marlene solace province, and I write about that in our textbook about is 1 of the main parts is really thinking about frameworks that will help us approach our work differently. And we need to become what's familiar with international documents as as we mentioned and talked about earlier and we need to read and talk about others. Talk about talk to others. I mean, about how they've engaged and how they've engaged in sustainable work in global work. For example, there is a a model that is, I think was developed by Green and Cruder, but Westby writes about it, too. It's called the pre seed, pro seed model, for example. There's a pre assessment, that's the pre seed part where you are engaged with the community.
[00:52:12] Learning from the community, what community members really feel is important for them and what they would like to work on to for to better their communities. And then the proceed is part of that model is to, engage in intervention in ways that are fitting the context and the needs the way that the community said that that would fit into their community in which it directly addresses their needs.
[00:52:41] There's also global ethics I mentioned earlier, I think that really should be incorporated. Into the educational aspects of communication sciences and disorders, and then we all should be exercising, not just as individuals, but as a discipline, cultural and global humility, self awareness and reciprocity and.
[00:53:04] You know, we talk about that in our, our textbook too, and I can say more about those concepts as necessary. But then the 2nd, part of your question was really the relationship between culturally responsive practice and ethics and international settings. And what I will say about this is that culturally responsive practice and ethics are reciprocal and they're interdependent.
[00:53:29] I don't think they're separable from each other. So if you're, if you're, truly engaged in culturally responsive and sustainable practices, then you're behaving ethically. And if you're not engaged in those practices, then you're not engaged. Engaging ethically, and I think that they're so interdependent.
[00:53:52] They can't be teased apart. At least that's how it is framed in my own mind. And we need to make we need to insist that this. You know, continue to insist in this relationship in our practice, in our curricula in policy documents that we have in the discipline culturally responsive practices inform ethical decision making and ethics can be influenced by culturally responsive practices.
[00:54:22] If this connection is clear, and if the connection is also consistent with the organization policy documents as well as certification standards. So we, it's so, and I also think, though, that there's a need that we have a need to revise the underpinnings of communication sciences and disorders.
[00:54:41] And I know that's a big ask for us to kind of rethink. Rethink the foundations of what we're standing on. But I, I think, you know, we need to adapt these more fluid and more responsive frameworks in order to be able to do. Just an equitable practice and sustainable practice that in, in these other frameworks from other disciplines often, or even reworking our own foundations will help us in ways that we haven't yet as a field contemplated.
[00:55:20] Dr. McFarland: And I think, you know, I think your point about more fluid perspectives or foundations is particularly important in terms of the international setting where many things are different, everything from the culture to the facilities to people's knowledge about communication disorders to their acceptance of of intervention and rehabilitation.
[00:55:44] And so. I think, especially when you find yourself in an international setting where all of these things have to be considered you do have to be nimble and you do have to be able to adapt to what you find as well as incorporating what you know. But, as, as important as incorporating what you know in terms of rehabilitation and speech language pathology and intervention is, you know, being able to put all of that together with not only what the needs are, but what, what people's expectations are, both personally and culturally.
[00:56:23] So that nimbleness does become really, really important, very important. 
[00:56:28] Dr. Hyter: And I, and I do want to just underscore another, I mean, a point I'm sure I've probably made during the time that we were talking and that we've talked about, but just to underscore it is to that we, you know, we We are a discipline that focuses on evidence based practice, and we look to our language.
[00:56:51] For example, if you're a language practitioner or language, child language person, for example, we look to our language learning theories to help guide our practice, our assessment, how, like, how we would assess and how we would, intervene. And there are even textbooks, all of our textbooks include those language learning theories.
[00:57:15] And there are textbooks that also are focused on theories about intervention, what intervention processes work and which ones don't. And I just think we need to do the same due diligence about how we work How we do globally responsive and I'm sorry, culturally responsive and globally sustainable work.
[00:57:36] How do we need the same kind of guidance that we have in terms of how we address our professional practice in terms of, like, what assessments we would use with a particular client and what interventions we would use in a particular setting or with a particular client or a particular need. We need the same type of.
[00:57:59] Of guidance, so we need to look at different frameworks and ways of knowing that will help us, you know, that will help provide a road map for us as a field as a discipline of how do we engage and how, you know, how does we can say we want to engage. To engage in culturally responsive work and globally sustainable work, but what are the steps?
[00:58:26] What's the pathway? What's the roadmap for actually getting there? It's something I think that, you know, we need to continue to develop those kind of frameworks are very far and few between in our discipline. 
[00:58:43] Dr. McFarland: That, that is very true. And for, you know, our colleagues that we know who have practiced in different places around the world, one of the things that they will tell you is that the paradigm is different wherever you go.
[00:58:57] And and so that that is in terms of ethics and ethical practice that that becomes very, very interesting and in some instances, very challenging. But I think that you have certainly given our listeners much to think about and a lot of good information and guidance. So I want to thank you so much.
[00:59:20] You've really been a a very wonderful guest. Sharing your first hand experiences and the information that you've gained from your international practice and relationships has really been very very informative. I really appreciate you sharing this timely and important information about ethics and ethical practice in the United States.
[00:59:39] international practice because ethics is essential. 
[00:59:44] Dr. Hyter: Thank you, Elise. Thank you. 
[00:59:46] Dr. McFarland: Thank you very much. 
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