A Black Caribbean Family’s Therapeutic Intervention Process:

Navigating, Implementing, and Understanding Cultural Differences

 

 

 

 

 

 

 

 

 

 

 

 

by

Keysla Monique Byrd

 

 

 

 

 

 

 

 

 

 

 

An Applied Dissertation Submitted to the

Abraham S. Fischler School of Education

in Partial Fulfillment of the Requirements

for the Degree of Doctor of Education

 

 

 

 

 

 

 

 

 

 

 

Nova Southeastern University

2014

 

 

 

 

ii

Approval Page

 

This applied dissertation was submitted by Keysla Monique Byrd under the direction of

the persons listed below. It was submitted to the Abraham S. Fischler School of

Education and approved in partial fulfillment of the requirements for the degree of

Doctor of Education at Nova Southeastern University.

 

 

 

 

Charlene Desir, EdD Date

Committee Chair

 

 

 

Shelley Victor, EdD, CCC-SLP Date

Committee Member

 

 

 

Ronald J. Chenail, PhD Date

Interim Dean

 

 

 

 

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Statement of Original Work

 

I declare the following:

 

I have read the Code of Student Conduct and Academic Responsibility as described in the

Student Handbook of Nova Southeastern University. This applied dissertation represents

my original work, except where I have acknowledged the ideas, words, or material of

other authors.

 

Where another author’s ideas have been presented in this applied dissertation, I have

acknowledged the author’s ideas by citing them in the required style.

 

Where another author’s words have been presented in this applied dissertation, I have

acknowledged the author’s words by using appropriate quotation devices and citations in

the required style.

 

I have obtained permission from the author or publisher—in accordance with the required

guidelines—to include any copyrighted material (e.g., tables, figures, survey instruments,

large portions of text) in this applied dissertation manuscript.

 

 

 

 

Signature

 

 

Keysla Monique Byrd

Name

 

 

Date

 

 

 

 

 

 

 

 

 

 

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Abstract

A Black Caribbean Family’s Therapeutic Intervention Process: Navigating,

Implementing, and Understanding Cultural Differences. Keysla M. Byrd, 2014: Applied

Dissertation, Nova Southeastern University, Abraham S. Fischler School of Education.

ERIC descriptors: Speech Language Pathology, Early Intervention, Dialects, Language

and Speech, Cultural Differences

 

This applied dissertation was designed to provide a better understanding of Black

Caribbean culture for the parents, speech-language pathologists (SLPs), rehabilitation

therapists, and other professionals that provide health care services to the pediatric

population aged 3–5 years. The current literature for SLPs that is geared toward cultural

and linguistic diversity has limited research specific to the English-speaking Caribbean

population. Particularly, research is lacking on the role and perceptions of the Black

Caribbean family nucleus in the carryover process for therapeutic intervention. The

majority of literature focused on the perspective of the minority population is based on

data derived from the Latin or Black American culture. The Caribbean and Jamaican

culture is unique in how it perceives the U.S. health care system as well as the dyad that

should occur between the parent or caregiver and the health care provider. Although

continuing education is provided on cultural and linguistic diversity through academic

institutions and workshops, many SLPs lack cultural sensitivities and education to other

cultures outside of the African American and Latino culture. Further, once individuals

from the English-speaking Caribbean migrate to the United States, the acculturation

process may involve lifestyle, food, and behavior but not the U.S. health care culture.

 

The knowledge gained from this study contributes to existing literature specific to

cultural and linguistic differences in the field of communicative sciences and disorders,

and qualitative studies. The information obtained from this case study allowed the

researcher a platform to increase the awareness and sensitivities of cultural differences,

so that best practiced care and carry over can be provided for individuals from other

countries and or different cultural backgrounds such as the Black Caribbean. It also

brings awareness of the need for speech and language services and resources across the

Black Caribbean islands.

 

 

 

 

 

 

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Table of Contents

Page Chapter 1: Introduction …………………………………………………………………………………………………….. 1

Statement of the Problem ………………………………………………………………………………………. 1 Definition of Terms ……………………………………………………………………………………………… 9 Purpose of the Study …………………………………………………………………………………………… 10

 

Chapter 2: Literature Review …………………………………………………………………………………………… 11 Theoretical Framework ……………………………………………………………………………………….. 12 Early Intervention ………………………………………………………………………………………………. 13 Language and Dialects ………………………………………………………………………………………… 16 Speech-Language Pathology ………………………………………………………………………………… 18 Children who Are Immigrants ……………………………………………………………………………… 19 Acculturation …………………………………………………………………………………………………….. 21 Jamaican Family Nucleus ……………………………………………………………………………………. 24 Female Headship in Jamaica ………………………………………………………………………………… 25 Parenting in Jamaica …………………………………………………………………………………………… 27 Education in Jamaica for the Preschool-Aged Child ……………………………………………….. 29 Special Education Services in Jamaica ………………………………………………………………….. 32 How Jamaican Immigrants Perceive Health Care in the United States ………………………. 38 Research Questions …………………………………………………………………………………………….. 41

 

Chapter 3: Methodology …………………………………………………………………………………………………. 42 Aim of the Study ………………………………………………………………………………………………… 42 Qualitative Research Approach ……………………………………………………………………………. 42 Participants………………………………………………………………………………………………………… 43 Data Collection Tools …………………………………………………………………………………………. 45 Procedures …………………………………………………………………………………………………………. 49 Data Analysis …………………………………………………………………………………………………….. 52 Ethical Considerations ………………………………………………………………………………………… 54 Potential Research Bias ………………………………………………………………………………………. 55 Limitations ………………………………………………………………………………………………………… 56

 

Chapter 4: Results ………………………………………………………………………………………………………….. 57 Introduction ……………………………………………………………………………………………………….. 57 Family Service …………………………………………………………………………………………………… 58 Cultural Differences ……………………………………………………………………………………………. 60 Seeking Intervention …………………………………………………………………………………………… 64

Speech and Langauge Intervention ……………………………………………………………………….. 66

Voice of the Family ……………………………………………………………………………………………. 70 Chapter 5: Discussion …………………………………………………………………………………………………….. 74

Implications and Findings ……………………………………………………………………………………. 79 Limitations ………………………………………………………………………………………………………… 81

Future Research ………………………………………………………………………………………. 81

References …………………………………………………………………………………………………………………… 84

Appendices

A Caregiver’s Role in the Speech Therapeutic Process Questionnaire …………………… 96 B Interview Questionnaire ……………………………………………………………………………….. 99

 

 

 

 

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Chapter 1: Introduction

Statement of the Problem

The use of the American English dialect is common in the United States, as well

as the varying types of dialect such as African American English (AAE), Appalachian

English, Jamaican Creole, and Standard American English, to name a few (American

Speech-Language-Hearing Association [ASHA], 2003). Dialect is a term used to define a

neutral label shared by a group of speakers, including but not limited to social as well as

regional dialects, cross-linguistic parameters, and pragmatics (Wolfram, 1991). For

example, the AAE dialect spoken primarily by African Americans, often referred to as

Black English, Ebonics, or African American Vernacular, is different from the Standard

English often required in schools (Campbell, 1993). Likewise, on the Caribbean island of

Jamaica, Jamaican Patois, pronounced /pat-wah/, or Jamaican Creole is a common dialect

spoken, other than the standard or literary dialect of Standard English spoken by the

native people (“Jamaican Patois,” 2014).

Historically, studies of the Black dialect have focused on the AAE dialect and its

characteristics, such as identifying and describing the features of the AAE dialect (Coles-

White, 2004). Unfortunately, because of the similarities in skin tone shared between

Black Americans and Blacks from the Caribbean, most educators and authority figures

have mistakenly believed that educational levels and language usage are also the same,

labeling the two as one ethnic category (Deaux et al., 2007). Similarly, the same is true

for some speech and language therapeutic intervention, as little research has explored the

implementation of therapeutic intervention from the family’s perspective concerning the

support and understanding of the intervention process for the Black Caribbean child

(Yearwood, 2007). For example, most of the previous and current literature focused on

 

 

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dialects and language diversity has leaned more toward African American children and

their use of AAE (Bland-Stewart, 2005; Lippi-Green, 1997; Seymour & Pearson, 2004;

Stockman, 2010).

Despite the increase of minority health care professionals since 2000, the ethnic

and racial composition of allied health professionals has not changed commensurate to

the U.S. demographic shift (Hayward & Charrette, 2012). In particular, there is an

inadequate supply of culture-specific programs for diverse populations, specifically

within the Black-Caribbean group (Archibald, 2011). Studies have addressed the AAE

dialect of Black Americans (Lippi-Green 1997; Seymour, 2004; Stockman, 2010), but

there has been limited research on dialects and accents spoken by the Black Caribbean

population and the cultural differences in comparison to Americans. As the U.S.

population becomes more diverse, speech-language pathologists (SLPs) both prospective

and practicing must implement evidence-based practices to meet the needs of persons

from diverse populations and be more aware of cultures that may be different from their

own (Scheffner-Hammer, 2011).

Currently, SLPs implement the majority of speech and language intervention

across the varying treatment settings grounded in the cultural beliefs and practices of the

White American, middle-class population (Scheffner-Hammer, 2011). The need to

address the identification of other dialects and features that may coexist with Black

American children, such as the Caribbean dialect of Jamaican Patois, is one to consider

for largely diverse cities such as Miami, Florida. For instance, Florida is the third fastest

growing immigrant receiving state, after New York and California (Camarota, 2007).

Most Caribbean immigrants come to South Florida because of its proximity to the

Caribbean, the climatic conditions, and the Caribbean connectivity (Archibald, 2011). Of

 

 

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the 1.2 million African Americans living in the city of Miami, 31.6% are reported to

speak a language other than English in their home, according to U.S. Census Bureau data

(“Miami African American Population,” 2011). Of that, only 7.2% of the pediatric

population attends nursery or preschool (“Miami African American Population,” 2011).

Because of this, maintenance of the integrity of the child’s home linguistic variations is

essential to culture and sociolinguistics within the natural environment, particularly with

preschool children (Campbell, 1993).

The need for SLPs to integrate cultural competence emerged from the current and

projected growth in the cultural and linguistic diversity of the U.S. population and the

increased demand for SLP accountability (ASHA, 2011a, 2011b). Cultural competence

for SLPs is the ability to demonstrate sensitivity to cultural and linguistic differences that

can affect the management of communicative disorders and differences (ASHA, 2004;

Hammond, Mitchell, & Johnson, 2009). No individual SLP can possibly know every

other culture, but it is nonetheless essential for SLPs to know enough to understand the

essential features of different cultures. Clients can receive the most appropriate treatment

only when SLPs understand the client’s cultural background, and the likely effects of this

background on their speech or language pathology (Hammond et al., 2009).

Therefore, clients may not receive the most appropriate and culturally sensitive

treatment, which may result in a sense of isolation for both the clients and their families

(ASHA, 2011a). When a client’s family feels isolated, family members may not be able

to be engaged and helpful in supporting a specific therapeutic intervention. This poses a

problem, as many Caribbean people have difficulty establishing a rapport of trust with

health care providers outside of their home country; as a result, therapeutic carryover and

generalization into the natural environment may be difficult (Dumont-Mathieu,

 

 

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Bernstein, Dworkin, & Pachter, 2006).

SLPs may face the challenge of facilitating cultural adaptation to English-

speaking Caribbean families for treatment efficacy; as a result, cultural competence is

imperative. Treatment efficacy can be especially challenging when SLPs are providing

pediatric care, as the parents are the most integral part of the therapeutic plan (Parra-

Cardona et al., 2012), and SLPs may be unaware of undisclosed cultural values and

beliefs regarding health care (Dumont-Mathieu et al., 2006).

Therefore, when servicing a client base that is culturally and linguistically

diverse, the ASHA (2011a) position statement on cultural competence in professional

delivery suggests the following: (a) value diversity, (b) conduct self-assessments, (c) be

conscious of the dynamics inherent when cultures interact, (d) have institutional and

cultural knowledge, and (e) adapt to the diversity the cultural contexts of the communities

served. SLPs must be aware that the family is the primary socialization agent for the child

and the key enforcer of the values and beliefs of the cultural group (Harrison, Wilson,

Pine, Chan, & Buriel, 1990; Yearwood, 2001). This awareness is critical to the provision

of high-quality and competent clinical services to clients who are culturally and

linguistically diverse (Hammond et al., 2009; Kohnert, Kennedy, Glaze, Kan, & Carney,

2003).

Furthermore, research by Parra-Cardona et al. (2012) addressed only the concern

of cultural adaptation with the Spanish-speaking Caribbean; limited research has been

conducted on the English-speaking Caribbean. The cultural knowledge and awareness at

present regarding clients of Caribbean heritage tend to focus on the experience of

Spanish-speaking Caribbean culture, which is distinct from English-speaking Caribbean

culture (Parra-Cardona et al., 2012). As mentioned earlier, English-speaking Black

 

 

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individuals of Caribbean heritage are often wrongly classified together with speakers of

AAE. SLPs who do not have a diverse background in culture and dialects therefore may

continue to underestimate the speech and language abilities of both clients who speak

AAE and clients of English-speaking Caribbean heritage. This can lead to misdiagnosis,

isolation of the client, and a lack of appropriate support.

Phenomenon of interest. This study explored the perception of one Jamaican

American family’s culture, beliefs, and values that might or might not shape the

progression of pediatric therapeutic speech and language intervention. Specifically, the

researcher’s study investigated the caregivers’ understanding of their role in the delivery

of therapeutic speech intervention for a Black Caribbean child from the island of Jamaica.

The context of this case study was investigated by an SLP who does not have a shared

national, ethnic, or cultural background with the family and has limited familiarity with

the family’s culture and or belief systems. This study used a qualitative methodology

approach, including qualitative interviews with family members, care providers,

evaluation scores, and audio recordings within the child’s home environment. This study

gathered information from first-, second-, and third-generation Jamaican American

family members who act as active caretakers and respected members from within the

child’s English-speaking Caribbean family dynamic.

Background and justification. The diversity of the U.S. population is increasing,

with 13% of the contributing population being African American (Scheffner-Hammer,

2011). In 2000, foreign-born Blacks made up 12% of all first-generation immigrants in

the United States and 6% of the total U.S. Black population (Deaux et al., 2007; Logan &

Deane, 2003). Currently, more than 100,000 documented immigrants of all ages come to

the United States annually; of those, one quarter are children younger than 15 years of

 

 

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age (Yearwood, 2007). Migrants commonly seek their own cultural enclave in a new

environment—a place where the inhabitants share a common language, practice, and

needs. The presence of a “Chinatown” in every major U.S. city is one example of cultural

groups self-segregating in their own communities, maintaining many of the age-old

traditions beyond third, fourth, and later generations (Davidhizar, 1999). The desire to

maintain one’s cultural heritage while mainstreaming into American society is a critical

component to successful adaptation (Spector, 1996).

This case study consisted of an exploration of a family’s perception of the speech

and language therapeutic care given to a pediatric child from a Black Caribbean family

currently residing in Florida. The researcher chose a Jamaican American family because

of the high incidence of international clients, specifically Black Caribbean, who receive

speech and language services at the researcher’s work site in Florida. In a like manner,

the choice of a Caribbean family for this study provided a greater insight into the

Jamaican culture as well as the Black Caribbean caregivers’ perception of their role in the

therapeutic intervention process.