Ep. 128: Supporting Bilingual Students in Speech Therapy

In this episode of SLP Full Disclosure, Michelle is joined by AMN Healthcare teletherapist and bilingual SLP, Natalie Jaramillo. Natalie shares her expertise on supporting Spanish-speaking students in a school setting, from the importance of a thorough family interview to understand a child's language exposure and cultural background to how dynamic assessments can reveal a child's learning potential beyond standardized testing. They also discuss common articulation differences between Spanish and English, strategies for improving intelligibility without diminishing a child's cultural identity, and the nuances of assessing language skills in both languages.

Timestamps

00:44 – Introduction to Natalie the episode's topic: working with bilingual children.

03:03 – The first thing to consider when you receive a referral for a bilingual student.

05:34 – Using dynamic assessments (test, teach, reteach) to gauge learning potential.

09:18 – Differences in Spanish and English Pronunciation

11:38 – Accent Versus Speech Sound Error

15:14 – Word Order Differences Between English and Spanish.

18:44 – Differentiating Language Delay and Lack of Exposure to English

22:05 – Bilingual vs. Interpreter Evaluations

24:01 – Therapy Strategies for Engaging Bilingual Students

28:36 – Advice for New SLPs

About Natalie

Natalie Jaramillo, M.S. CCC-SLP, is bilingual speech-language pathologist with AMN Healthcare. Her experience includes home health, therapeutic preschools, private clinics, and teletherapy, with a focus on providing high-quality care to diverse pediatric populations. Natalie earned her undergraduate degree from the University of Georgia and completed her graduate studies at Eastern New Mexico University.

About Michelle

Michelle Gage, MA CCC-SLP, embarked on her journey in speech-language pathology during her undergraduate studies at the University of Mississippi, where she also worked at North Mississippi Regional Center, gaining invaluable experience in various therapy approaches. Following her Master's Degree in Speech-Language Pathology from the University of Central Florida, she has dedicated 25 years to empowering children and families in improving language skills and overall development. Currently residing in Mississippi, Michelle extends her expertise through telehealth services. Additionally, she proudly serves as the host of the SLP Full Disclosure podcast.

Outside of her professional commitments, Michelle is the proud mother of Mia, an accomplished middle school math teacher and all-around amazing human. In her leisure time, she indulges in her love for travel and cherishes moments spent with family and friends.

Transcript

00:00:00:02 - 00:00:21:13

Hey, y'all, it's Michelle with SLP Full disclosure, welcome to the podcast today. We are joined today by another fellow am in tell IT therapist, Natalie Jaramillo. Natalie, thank you so much for joining us. I'm so excited to have another tell a therapist on someone with Am in. Isn't it an amazing job? Don't you just love your job? It really is.

00:00:21:14 - 00:00:44:06

It's pretty niche and I feel like as a year go on, it gets better. I know, I absolutely love it. I can't say enough wonderful things about I am in and tell it. Therapy has been an absolute life changer for me, so I'm so excited to have you on the podcast today. So Natalie is a speech language pathologist and she is working in the great southern state of Georgia.

So she's down in the South, working in the South where I like like where I live. And today we're going to be talking with her about something that I know a lot of us as speech pathologist have been facing, and it's working with bilingual children. Natalie speaks Spanish. And so we're going to be talking about how to prepare for those evaluations.

00:01:05:03 - 00:01:27:18

What are some things that we can do in therapy to help our children who are speaking Spanish? I know you may be working with other students who speak other languages. Predominantly in California. I had a lot of Spanish speakers, Natalie, but I also had a lot of Hmong speakers. So I know you're not among speakers, and today we're going to be focusing primarily on Spanish.

I have just, you know, I've been practicing for 25 years, so I'm so excited to have your expertise and get some tips and tricks to help me in my evaluation and treatment, because I always feel so ill prepared, and I feel like all of my information and all of my training and everything just leaves my mind when I get a student who speaks Spanish because it's the same, but it's also very, very different.

And there are some other things that we have to consider and things that we need to know going into into that correct? Yeah, absolutely. Okay. So before we get started, I want to tell you guys a little bit about Natalie. Natalie began her journey in speech language pathology after earning her undergraduate degree from the University of Georgia.

00:02:09:05 - 00:02:32:17

She moved to Texas and began working as an SLP a in home health, serving children from birth to age 21. After completing graduate school at Eastern New Mexico University during the post-Covid era. She transitioned into tele therapy. Her experience includes working at a therapeutic preschool with children ages 2 to 6 and offering bilingual speech services in a private clinic setting.

In August of 2023, she joined Am in health care as a Tela therapist, continuing her passion for providing accessible, high quality care to diverse pediatric populations. So, Natalie, I'm so excited to have you here. Let me let's see, what should my first question be? I guess it would be what is the first thing that we have to consider when we get those referrals of children that are bilingual speakers, specifically the in Spanish?

What is the first thing we need to consider as we go? I feel like obviously in the state, Spanish is a big language that we see. And one of the things that I like to think about and consider is how much exposure they've had to other languages that they know, whether it be English or Spanish, how long they've been exposed.

00:03:25:05 - 00:03:45:05

So Spanish and step in their primary language up until they went to kindergarten or really exposed to English as well. Right. And how do you go about is there a specific assessment that you like to do to find out these things? Because I became familiar with something called let me find the name of it. I want to say it correctly.

The Alberta Language and Development Questionnaire. Okay. Are you familiar with that one? I'm not familiar with that one. So the county that I'm currently working with, we do an informal kind of evaluation looking at, oh, our screener I should say. So looking at language and Arctic. And then also we really try to dive deep into the parent in the family interview.

That's what that Alberta does. Yeah. And it asked I, I mean I don't know, I'm sure there are people out there that are going to be a lot more familiar with it than I am, but I felt so intrusive asking those questions. So when you say dive deep into that family history, what do you mean? So history of like education, what it looks like child care.

You know, just kind of how they plan their milestones, developmental where they hit it, just all those sorts of questions and help. And those are the kinds of questions that are on the Alberta. And I found myself being I just felt like it was kind of intrusive. Yeah. Like what is your what is mom's education? What is dad education.

And I think, you know, and then you have to ask, well, if they didn't finish high school or they didn't go to college, what what is your job? Those kinds of things. So why is it important to know those things? I think it's super important to know them just, better understand the student that you'll be working with.

00:05:11:08 - 00:05:34:07

So I had recently a family that just came from, from another country. Right. And education was very minimal because they had to work and they had to work to survive. So just understanding all those different cultural differences is just important. So, you know, if they don't know a certain word for the tests, it might just be that they weren't exposed, not necessarily that they don't understand.

Right. And that's where those dynamic assessments come into play. Yeah. So let's talk a little bit about those dynamic assessments where you test, teach and reteach. Yeah. Just to see how that child learns. And that is something that working with. Yeah. Out in California I had the opportunity to do. And it is so eye opening because you're like, wow, just like you said, maybe they don't know the word, but it's not that they don't know the word.

They've never heard the word. So if I tell them the word, can they remember it and then use it correctly? So tell me a little bit about the dynamic assessments that you do and why that's important. Yeah. So we're fortunate enough in the county to kind of tag team. I have another bilingual P that's in person. So oftentimes she will go in and do a dynamic assessment just to again kind of get a gauge like that body language.

00:06:27:11 - 00:06:49:07

I feel like you can get a lot from an I dynamic assessment when it's in person. But for those that we can't do in person. I really love to do like some visuals. So we'll do like slam cards while we kind of retell a story. We'll also do some, like open ended questions so they can tell me what they know.

You know, we have like a beach or like, oh, tell me, like, what do you do at the beach? They might not know. Right. And it's not that they don't know. It's not. They haven't had those experiences. And it's so hard to figure out with these little bitties what they've been exposed to, because that that's where you have to bring in the cultural dynamics and you have to bring in the family dynamics because just because one family goes to the beach and travels and has been on an airplane, it doesn't mean that another that another child has had those same experiences.

So I think the experience is really play a big role in that. Yeah. Now when you get these referrals, do you have any like go to assessments that you do specifically? You're like, okay, this is a bilingual child. I know they speak English in Spanish. I'm going to do this one just to kind of avoid some of those biases.

Yeah. So Mo so for articulation we do do the due to the gift. That's just pretty accessible kind of straightforward. And then I have access to the self in Spanish which can be a little long. However this one's good. Yeah. But the some other subtests do a really good job of like giving you really good information especially like you know we were reading a story of the recall, the comprehension and even the word finding.

So there are some some tests that we tend to like gravitate more towards. Just to kind of really get a representation of their abilities. Now are you doing English and Spanish evaluations for language and articulation. So you're testing both languages. So that's essentially for assessments that you have to give. So I think just it's they're so time consuming as well.

00:08:32:01 - 00:08:55:05

So time consuming. So especially is so if what happens if I see you know once we gather like some information from the family from teachers, if it's kind of leaning towards they are more dominant in a language or that they prefer that they are. You know, I had a student that we started in Spanish and all their responses were in English.

So even though they're bilingual, I just shifted to English. So it's entirely dependent on the students. And if they're more comfortable, if they know a language but they don't feel comfortable testing, I don't force it on them. Yeah. When you're doing those let's go. Let's start with the articulation, because that is what's so intriguing to me. I love articulation and I used to not like articulation, but I love it now.

It's one of my favorite things to do just knowing and under. What are some of the primary different sources that we need to know as monolingual English speakers in the Spanish and English pronunciation and in sound development? Yeah. Yeah, there are quite a few. I mean, I'm like similar to I feel like RJ has kind of grown on me specifically when I'm working with these bilingual kiddos, kind of determine what is actually what sound they actually can't see or what's just kind of an accent.

Right? So one that comes to mind there TS sometimes are pronounces disease. So if you have like the number two what else do you do. What's another one. Let's see. Phoneme. So for the z sound they'll pronounce it as an s s. So like please will be like please. Yeah. Yeah. A big one that I see especially with the K through like fifth grade is the s-h sound or the C-H.

So if it's like she, they'll say she. Yeah. That's a probably a really big one. Are there any that you see that are pretty. Well those are the primary ones that I see. Yeah I had the, the funniest thing ever was I had a little girl that could not chew the trill. I can't do it.

00:10:50:07 - 00:11:14:20

Yeah okay. So I can't do it. I'm just I mean, I can't trill my r. But when she spoke Spanish, she did not trill her r, but every English word she said car, rabbit, anything that had an R, no matter where it was initial, medial or final, she would fill the r. And it was the most interesting thing I had ever seen.

00:11:14:22 - 00:11:38:04

So I have had parents ask me, you know, when they're in speech because they get we get the referral. Yeah. And I want to talk a little bit about something you said a minute ago. The errors versus the, the accent that makes them hard to understand. Yeah. So I get lots of referrals, especially for the little bitties. My kindergarten, first grade, sometimes my preschoolers.

And there are definite speech sound errors, but it's predominantly the strong accent that is causing them to be unintelligible. So how is speech pathologist do we handle that when we bring them in. Yeah we've done the evaluation. We've done the assessment. Let's talk specifically articulation right now. Yeah. And we see that there aren't really any sound errors, but they are unintelligible when they're speaking in English because they do have that strong accent.

How do we handle that. How do we handle that as therapists? And how do we explain that to parents and teachers? Yeah. So I'd love to. At the beginning of the year, there's like a she and you could kind of find a lot of like there's just the sheet that I have that kind of shows the differences of like some of the errors that you will see in articulation when it comes to working with a child or the student.

00:12:35:07 - 00:12:58:22

I love to just kind of have a conversation with them and see I'm like, can I understand this? Or I'll bring another student and they'll kind of I like to see them have a conversation. And if one student can not, you know, understand what the other students saying, I'll kind of gauge like, well what do you think he's saying.

And kind of gauge like those errors. It's a little time consuming, but usually in a group you could kind of narrow it down. Yeah. Like okay, let's work on what can support you to be a little more intelligible right across. Because. Right. Because we're looking at the, you know, education code criteria. Yes. Yeah. That's standard deviation. Yeah. But and and I know that conversational speech is a big component of that evaluation process.

Yeah. How do we work on that as speech pathologist when we get students who they have great language skills? Yeah. All of the articulation sounds are there. Yeah. They're developed. Yeah. But that intelligibility piece is still really low just because of the accent. Do you have any strategies for us to work with? Sometimes we'll do. I'll also consult with the teacher and we'll sometimes practice some drills just to see how that kind of works over time.

Like just a repetitive, like pronouncing it a little more. College will. They still have their little accent sometimes. But just again just clarifying like you're doing a great job of clear of right pronouncing it. But we just need to practice a little more. Right. And it's so hard because you don't want to take that part of who they are, their individuality.

00:14:15:01 - 00:14:36:13

You don't want to take that away because that's who they are. Exactly. You know. Yeah. And I've got some of my kiddos that have the sweetest little accents and some of the things that they say, and it's adorable, and you don't want to change that. Yeah. But we also, at the same time, our job, I mean, if they can't communicate with their peers and they can't communicate with their teachers and no one understands them, yeah, then we have to step in and we have to do something.

Yeah. I would love to get that list of your articulation errors. I would love if we could get that linked in the podcast, because I think that would be really helpful and that would be really, really helpful for me. I mean, I know them off the top of my head, but yeah, any resources that you have like that, I would love to get those.

So that would be great. All right. Let's talk about the language. I think one of the the first things that I noticed out in California, and I don't know if I'm going to say this correctly, but if we said the dog is brown in English. We would not say it in the same word order in Spanish.

Yeah. We're going to put that descriptive word before. The noun. Right. Correct. Yeah. So then when we're giving this self and we're looking at all those language pieces and we're looking at syntax and we're looking at grammar and we're looking at word meaning. We're looking at all of those things. And they make those errors. How does this does the self English and Spanish.

00:15:35:16 - 00:16:01:22

Does it distinguish between those errors. And does it pull those errors out or does it cover them up. So it does it it doesn't necessarily. So for the Spanish it does switch up the the order in English it doesn't necessarily cover it up because a lot of this. So it can be challenging. That's another part with the validating because they're technically a lot of the students that I see, they're not really part of the norm.

Like the testing norm that those like standard scores. So it's like proceed with caution. Kind of always have discretion. Interpret scores with caution, right? Yeah. So yeah. So it really just kind of depends on they don't in English it's. Yes. The descriptor before the noun in Spanish. I'm sorry. And it it's always I just love it when they do it.

Especially the little bitties and when they're in, you know, and it's so interesting to see their little brains working. Right. Yeah. Especially those kids that when you speak to them like my para facilitator is bilingual. And so she would speak to them in Spanish as they're coming to the speech room, and then they would get in there with me, and I've got the southern accent.

Yeah, speaking English. And I could ask them questions and talk to them, and they would respond to me in Spanish. That has got I mean, that is so interesting to me that they can make that switch. And just like you said, with some of the kids you evaluate, you're doing the evaluation in Spanish, but they're responding to you in English.

00:17:08:15 - 00:17:43:01

Yeah, that is fascinating to me. That's a pretty high level skill. Very high level. Yeah. And I think that's one of the things that kind of gets like kind of like not really brushed under the rug. Christian world. Yeah. And it's like a lot it's very impressive that you can do that right. And I think it's so important, like you said, to that's because so many of them, you know, they get shy or they don't want, you know, they feel like shy using their language or they know that it's not doesn't come that easy, but really just, you know, that positive reinforcement I think goes a long way.

Like things like that I was like that's amazing that you're understanding me and two languages and you can respond. I know and being able to make that switch I think that would be, that would be the most difficult thing in the world to do. Yeah. That's why I want to have my interpreters and my translators. I'm like, that's just wild to me.

And that is, I will say, and I've said it before, my biggest regret in life is not learning to speak Spanish. Yeah. Yeah. It's my biggest regret when we're talking about that. The evaluation and the language piece. Yeah. And we're looking at these kids that come in and they have a dominant language nine times out of ten. Yeah.

And let's say you're coming from a Spanish speaking only home. Where they only speak Spanish at home with their caregivers. That's all they've spoken their entire life. And then they're put into a general education classroom in the state of Georgia. Yeah. Possibly in California or anywhere in the United States where the teacher and all of their peers are speaking English in a language that they don't understand.

And then we get these referrals for a language delay. Because they're not doing well academically. They're not progressing. There. Social and emotional skills are not interacting with peers. How do we proceed with those kiddos. Because I think I get those most often than anything. Yeah. They're not getting exposed to English anywhere except at school. Yeah. And so is it a language delay or is it just lack of exposure?

00:19:15:01 - 00:19:40:08

Yeah. So how do we proceed with those kids? Yeah. So we see that a lot. Yeah, I feel like yeah, we definitely especially we get a handful where they won't qualify in their language. But many of them what we've found do qualify in other areas. So whether that's in writing or in math support. So they are getting some version of support.

When it comes to language it could be quite challenging because we're not English teachers right. They would really benefit from English courses. Right. Yeah. And and that's when we have to you have to really start peeling back the layers. Yes. And being like we've done you know, what do you do when you've got you do the self in English.

Yeah. You do this self in Spanish. And because a language delay is going to show up in and. Yeah. And both. Yeah. But if you were to give me the self in English I think I would do fairly well. But if you gave me that same test in Spanish, my scores are going to be really, really low and it's going to look like I don't know a whole lot.

When in reality you're just speaking to me in a language that I don't understand. Yeah. So what do we do with those kids. Yeah. Yeah. And I feel like that's more of the challenge that we're seeing nowadays. And so for the kiddos at that it's their situation. We they do get speech services. So I've found so some students they're like kind of right on the cusp.

So even like a as a support or even like through RTI services that has been really helpful just to kind of kind of keep track of like if they are progressing, how they're progressing. Yeah. Because they're kind of like an onion because sometimes you don't see these things or you're like, oh, wow, you actually do need a little more support than we originally thought.

00:21:15:06 - 00:21:39:04

Yeah. So I kind of like to just keep them on my radar in some capacity. So for those. Yeah. And a lot of them we have, we have a large population that are migrants. So a lot of them haven't really gotten the same construction that let's say a fifth grader gets. And, and whatever country that they're coming from.

The education systems are vastly different. Very. So taking that into consideration, like, well they've made a lot of progress with what they have. Right. So it's just so hard. So let me ask you this. I know there are speech pathologist out there who work with multilingual children, maybe Spanish. Probably predominantly Spanish, but maybe Russian, maybe Hmong, whatever it may be.

What is your thought on you or I? Bilingual speech pathologist. You're very lucky. And I'm so envious of you. Yeah. I am a monolingual speaker. What what are your thoughts on Évalué eating those children? As a bilingual speech pathologist and you can do both languages. Yeah. Versus someone like me who when I do my evaluations I'm going to have to use an interpreter.

Right. Yeah. So do you see any difference in the in that evaluation process when you do it as a bilingual speaker versus when someone as a monolingual speaker like myself would use an interpreter? What about impact? Yeah. No, that that's a great, point to bring up. What I have seen again, that little that cultural aspect, I feel like doesn't quite get translated as well or like, passed on.

00:22:57:14 - 00:23:16:09

And what do you mean by that in that sense of like, what I'm seeing is like, you know, I'm not you know, that expectation is low. Like, I'm just like, whatever. I have a mindset of like, you know what? Show me what you can do. I don't want to find what you can't do. Right. I want to find what you can do.

And I feel like sometimes it's very like, kind of by the book where it's like, this is the standardized test with, like, really taking into consideration those dynamic assessments, the. Yeah, just the informal assessment. I think also plays a big role even if you are using an interpreter. You can find a lot of information outside of just a standardized test.

I love that Natalie. Focusing in trying to find out what they can do. Yeah. When you start that process. Yeah. And in doing that you are going to find out what their weaknesses are. Right. Yeah. When you find out what they can do, what they can't do, that kind of comes to the surface. Yes. Yeah. I love that.

00:24:01:02 - 00:24:29:06

Yeah. I love it. Yeah. Do you have any specific strategies that you use in your therapy with kids who are bilingual to kind of help them pick up those skills? Yeah, I just love to find what they're, like, interested in, especially with child therapy. A lot of it is like conversational. To begin, because I feel I have found that like once, once you kind of get to know, like what they like and their interests, they really start to open up.

Right. Yeah. So that is a really key piece, especially with the population of like whatever other language they know. They could just they're coming from different cultures. And I think sometimes it could be a little closed off. It's like well we're here to help but they're not used to that help. Right. So really taking the time to find their interests.

Right. I always let my kids teach me. And this brings me to a point. I wanted to say a little story. I love telling stories. Yeah. So I always let my kids who speak Spanish or Hmong teach me words in their language. So whether it's mostly foods, I remember Pepino and said, I don't know why I nice strawberry.

And cucumber. But those are two that I always remember. I usually forget the others, but colors and things like the animals. Yeah. And they have a really good time teaching me. I'm like, okay, what are you going to teach me today? So that's how I start, especially with Tila therapy. Teach me a new Spanish word today. Yeah. And I let them teach me.

00:25:29:00 - 00:25:51:16

And then, then we get into our lesson. Yeah. But what I have, you know, the Hispanic culture. And I've learned a lot about the Hispanic culture from my friend Genesis out in California, who is one of my dearest friends. And I talk to her every day. She was a facilitator with me for several years. Yeah. And I learned a lot about the culture and cooking and family time is really important in the culture.

So typically when they come in, I'm like, what did you do over the weekend? And they would say, oh, well, I went to my aunt's house and they don't. What's the word, aunt in Spanish there? You. Yeah. I went to my dad's house and my mom, my dad, every. My grandma, my grandpa, everybody was there. And I'm like, well, what did you eat?

And they tell me this really long, like, elaborate Spanish dish that they've made. Yeah. Now, when they're teaching me words like, you know, cow and dog, Pedro, maca. Those things, I can say them. Yeah. And what I found myself doing was when they would come in and they would say, oh, well, we cooked, blah, blah, blah, blah, blah, blah.

00:26:30:00 - 00:26:52:12

And it's this really long term Spanish dish. I said, well, I'm not even going to try to say that because that would be really hard. Yeah. And a light bulb went off in my head and I was like, you know what? If I'm intimidated, yeah, let's say to speak their language. What makes me think that they aren't intimidated to speak language?

And it was such a light bulb moment for me. And I was like, you know what? I'm going to be a little bit gentler in how we go about this, because it was a really profound moment in my career. And it happened like the first year that I was working with a lot of bilingual children, and it has really shifted my thought process.And when I have these kids, because cooking is easy for me to say and milk and use and I need a break and those kinds of things. But that doesn't mean that it's easy for them. And it can be if it's intimidating for me, it's going to be intimidating for them, right? Yeah. No, I agree. And I feel like a lot of times our job it's to, you know, show a lot of compassion and support like we're here to you know, I think sometimes they're they don't feel like we're here to help them.

00:27:41:08 - 00:27:57:15

Yeah. I feel like this is just like, I don't want to do this. Right, but just kind of building up their little their confidence and whatever language they're, they're working on, I think is really important. Yeah. And I tell them all the time how cool it is that they speak two languages. Yeah. Yeah. I'm like, you speak two languages?

I only speak one. Yeah. So you have to help me so I can write. You know more than I know. Yeah. So let's help one another. That's kind of how the approach that I take. Yeah. And it really helps them open up a lot. Natalie, it's been great having you on the podcast today. I definitely want to get your, handouts linked, if we possibly could.But I always ask my guests at the end what advice? You know, a lot of new grads, a lot of kids listen to this podcast, and there are people like me who've been around the block, that are really seasoned. What advice do you have for SLPs listening to become comfortable working with a child who is bilingual?

00:28:36:12 - 00:29:00:18

Yeah. I think it's important to know that you're not alone. There's always a team behind you in whatever setting you may be in. So kind of reaching out for help is always my first kind of. Don't be afraid to ask for help. Use the interpreter as needed. And sometimes even learning a few phrases here and there really go a long way, even if you don't know a ton.It's okay. But I think sometimes students and clients and just patients from all over, if they see a small effort, I feel like that really makes them feel comfortable. And I think you could get a lot more out of them. Yeah, I love that. That is so awesome. Natalie, it has been awesome meeting you. Yeah. I definitely love meeting other Tila therapists with Aman because I know that I love my job, and it has been just, an amazing blessing in my life.So I really appreciate you joining us today and sharing all of the tips and tricks in the knowledge on working with these kiddos, because we're seeing it more and more often everywhere. And I'm not going to hold it against you that you're a Georgia Bulldogs. Although I went to Ole Miss chair. Oh my goodness. Oh I had to bring that up.So yeah. Yeah. So thank you so much for joining. I hope you guys enjoyed the podcast today. I'm going to do my best to get those, handouts from Natalie and get them tagged in the podcast. You guys have a great day and we'll talk to y'all soon. Thank you for tuning in to SLP. Full disclosure.

00:30:03:23 - 00:30:25:15

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