Significance of the Native American Program at WSU
There is a critical need to increase both the quantity and quality of personnel providing speech, language, and hearing services to Native American infants, toddlers, children, and youth with communication disorders. This need is especially acute given the high incidence of communication disorders in a rapidly growing Native American population. This project will concurrently address inadequate services and the shortage of professionally trained Native Americans in the field to support Native American communities and individuals facing educational problems associated with communication disorders.
Increased Prevalence of Communication Disorders: Many sources report that communication disorders occur more frequently in the Native American population than in the general U.S. population (Johnson, 1991; O’Connell, 1987; U.S. Department of Education, 1994). However, the exact level of prevalence is difficult to determine due to the paucity of accurate data. While it is estimated that 10% of the U.S. general population is affected by communication disorders (Battle, 1993), Harris (1986) has estimated that communication disorders occur with 5 to 15 times greater frequency in the Native American population. Thus, based on 1990 census counts, between 320,000 and 960,000 Native American children under age 20 are in need of speech, language, and hearing services. In contrast, recent data (Ayers, 1994), indicates that only 11,686 Native American students received special education services for speech-language impairments on a national level in 1991-92. Estimates provide clear evidence of a national need for additional speech and language services for Native American children.
Substantial Population Increase: Not only is there a higher rate of occurrence of speech, language, and hearing disorders for Native Americans, but population and birth rate statistics suggest that the number of Native Americans with communication disorders will substantially increase in the near future. From 1980 to 1990 the U.S. Native American population increased from 1.4 to nearly 2.0 million, a gain of 37.9%, compared to a 5.6% increase in the White population for the same 10-year period (Cook, 1991; U.S. Census, 1990). A birth rate 67% greater than for all other races in the U.S. (U.S. Department of Health and Human Services, 1995), along with 39% of the Native American population identified as under the age of 20 (U.S. Department of Commerce, 1993), suggests that an increase in occurrence of communication disorders in Native American infants, toddlers, children, and youth will be even more pronounced than is reflected in the percentage of overall Native American population increase.
Critical Shortage of Speech-Language Pathologists: The number of speech-language pathologists in the U.S. is inadequate to meet the speech and language needs of children in all school settings. Ayers (1994) indicated that an additional 29,511 special education teachers, which includes speech-language pathologists, were needed to serve 3- to 21-year-old students with disabilities. Within 45 teaching areas, speech-language pathology was considered one of the four areas with the most severe shortage and greatest need (Haselkorn & Calkins, 1993). Limited access to special education personnel is a particular problem in rural/remote communities where most Native American families reside (U.S. Department of Education, 1994).
Increased Personnel Needs in the Northwest: Extreme shortages of speech-language pathologists and audiologists have been identified in the Northwest. For 1992-93, U.S. Department of Education data showed vacancy rates for speech-language pathologists (special education teachers for speech-language impairments) to be as high as 22% in Idaho and 16% in Oregon (ASHA, 1996). A 100% vacancy rate was identified for both teachers of children with hearing impairments and for audiologists in the state of Washington. In Montana, Idaho, and Alaska, 33%, 17%, and 20%, respectively, of audiologist positions were unfilled. Although other northwest state-specific vacancy rates for speech-language pathologists and audiologists ranged from 0 to 11%, it is unlikely that lower rates are characteristic of Native American communities. For example, Montana was the only northwest state to report a 0% vacancy rate for speech-language pathologists. However, two full-time, speech-language pathology positions were recently vacated on the Blackfeet Reservation in Montana. Positions on Indian reservations have historically been difficult to fill and, when professionals are hired, the attrition rate is high.
The critical shortage of speech-language pathologists in the Northwest is further substantiated by U.S. General Accounting Office data (1990) regarding service delivery to 3 to 4-year old Native American children with disabilities. For reservations in Washington state, it was estimated that 55% of 3 to 4-year olds with disabilities were not receiving special education services. Reservations with particularly high rates of nonservice included the Quileute (100%), Colville (81%), Muckleshoot (71%), and Yakama (56%). In Montana it was estimated that 52% of Native American preschoolers who needed special education services were not receiving them, with Rocky Boy Reservation exhibiting the highest rate of nonservice (77%). Since the overwhelming majority of the children receiving special education services had been categorized as speech-impaired, it is likely that the majority of the children not receiving services would also be speech-impaired and in need of services from speech-language pathologists. (It should be noted that this project will focus recruitment efforts on these specific high-need areas.)
The main reason cited for lack of service delivery to Native American preschoolers with disabilities was personnel shortages (USGAO, 1990). The Bureau of Indian Affairs (BIA) has a long-standing history of difficulty in attracting and retaining special educators to provide services on reservations (USGAO, 1990). Over half of BIA and tribal schools reported vacancies in special education for the 1990-91 school year and, of these, 60% reported difficulty in filling these positions (Pavel, Curtin, Thorne, Christenson, & Rudes, 1995). The rural, remote nature of many reservations and cultural and linguistic differences between professionals and community members contribute to difficulty in recruiting personnel.
Lack of Adequate Service Delivery: Native Americans have historically not received adequate speech, language, and hearing services (Robinson-Zanartu, 1996; Toubbeh, 1982; 1991). This has been officially recognized by the U.S. Public Health Service and the World Health Organization with their identification of the Native American population as "underserved" (ASHA, 1991). To compound this designation Native Americans also fall within 3 of the 5 other groups classified as "underserved" - linguistic minorities, economically disadvantaged, and remote/rural populations. These designations highlight aspects of service delivery which must be addressed by training programs if the "underserved" status of Native America is to change.
Difficulty encountered in recruiting and retaining speech/language pathologists in remote/rural Native American communities is a significant factor associated with inadequate speech, language, and hearing service delivery (Harris, 1993; Johnson, 1991). Training of Native Americans as speech/language pathologists and audiologists will likely decrease attrition rates, as Native Americans are more familiar and comfortable with cultural characteristics of Native American communities served.
Lack of Native American Professional Representation: Native American speech/language pathologists and audiologists are severely underrepresented given the need for more adequate service delivery to Native Americans. Of approximately 84,000 speech/language pathologists and audiologists certified by the American Speech-Language-Hearing Association (ASHA), only 219 are Native American and of these only 12 serve the states of Alaska, Idaho, Montana, Oregon and Washington (Scott, 1996).
With the small number of Native Americans enrolled in speech-language pathology and audiology training programs the prospects of increasing Native American representation in the profession are limited. In 1995 only 56 Native Americans were enrolled in master’s level training programs nationally and only six were enrolled in Region X master’s programs - Alaska, Idaho, Washington, and Oregon (Council of Graduate Programs in Communication Sciences and Disorders, 1995). Considering that 3 of the 6 Native American students counted were enrolled in the WSU Department of Speech and Hearing Sciences, the need for this special program to recruit and train Native Americans in the Northwest, as speech/language pathologists and audiologists, becomes especially apparent.
Furthermore, the impact of Native American trainees in speech-language pathology and audiology needs to be extended by preparing them to assume leadership roles as they move into professional positions. The unique cultural knowledge and sensitivity of these professionals makes their input essential in the development of speech, language, and hearing service delivery models for the Native American population. Training programs can play an important role in assisting Native American students to draw upon and to share their rich sources of information through leadership development activities. This is particularly important at the national level where the number of Native Americans representatives continues to be extremely small.
Need for Improvement in the Quality of Training
Training of Native American personnel will partially meet the critical need for appropriate speech, language, and hearing service delivery to Native American infants, toddlers, children, and youth. However, there is a need for specialized training to reach all speech/language pathologists and audiologists, regardless of race or ethnic heritage. Because the majority (87%) of Native American children attend public schools (Reyhner, 1994), it is likely that non-Native American speech-language pathologists and audiologists in the school setting will serve Native American children.
Evidence exists that professional training programs do not adequately address issues associated with serving multicultural populations. According to the 1993 ASHA Omnibus Survey, only 18.8% of ASHA members reported having specific graduate course work pertaining to communication disorders among multicultural populations. Unfortunately, this figure indicates little progress since 1988 when 17% of ASHA members reported obtaining their education in this area through graduate course work (ASHA, 1994). This inadequacy in training results in decreased effectiveness in service delivery to culturally diverse populations, including Native Americans.
Training programs in speech-language pathology and audiology are at a particular disadvantage in preparing students to meet the needs of Native American individuals with communication disorders. There is a paucity of accurate written information regarding Native American cultural characteristics (Mankiller, 1991; Wallace, Inglebret, & Friedlander, in press). The Native American tradition of passing down information orally through the generations has gone largely unrecognized, while non-Natives have primarily relied on other non-Natives to provide them with written information about Native American values, beliefs, and traditions. As a result, discrepancies exist between Native perspectives portrayed in books and those held by the Native Americans themselves. Training programs must develop new means which allow Native Americans themselves to portray their own views of their cultures. The multimedia units being developed at Washington State University provide one mechanism for accomplishing this.
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Copyright © Ella Inglebret 1997
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