Word games.

I think that’s what it comes down to. Just word games.

But words matter, and optics matter, and these word games should not have happened.

Bear with me for a long story.

I had posted on April 25, 2025, and again on July 7, 2025, about the CAA’s attempts to remove requirements related to diversity, equity, and inclusion from our profession’s accreditation standards.

(The Council on Academic Accreditation, the CAA, is associated with the American Speech-Language-Hearing Association. It is the official accrediting body for clinical preparation programs, primarily master’s-degree programs, in audiology and speech-language pathology in the U.S.)

On August 19, 2025, the CAA announced in a widely distributed email update that, at their July 2025 business meeting, they had in fact voted to accept some edits to the standards for program accreditation that literally struck the phrase “diversity, equity, and inclusion” from Standard 3.4A (for audiology) and Standard 3.4B (for speech-language pathology).

It was a blatantly and openly political decision. The explanation for the review that led to this change started by stating that, beginning in January 2025, the CAA had “monitored the (a) Executive Orders from the current federal administration, (b) communications [PDF] from the Department of Education, and (c) state legislation regarding eliminating diversity, equity, and inclusion (DEI) from higher education and the impact that it has on accredited programs as it relates to Standard 3.4 A/B.” Part of their reasoning for the change was that “Concerned programs have stated that in order to comply with state laws and regulations, some institutions are now requiring the removal of any reference to diversity, equity, and inclusion from course titles and content.”

So, in a premptive attempt to appease our current federal government, or in a preemptive attempt to resolve some isolated state or institutional accreditation concerns, the notions of “cultural humility, cultural responsiveness, and cultural competence in service delivery” were struck from our profession’s accreditation requirements. These words were literally lined out in the side-by-side comparison of old and new accreditation requirements.

The requirement that “students [should be] given opportunities to identify and acknowledge…the impact of how their own set of cultural and linguistic variables affects” the care they provide to “patients/clients/students” was similarly struck.

Speech-language pathology master’s degree programs are no longer required to teach students about “the impact of [clients’] cultural and linguistic variables” on the “delivery of effective care.” Programs are no longer required to teach future speech-language pathologists about the “interaction of cultural and linguistic variables between the caregivers and the individual served” or about the “impact of multiple languages” on service delivery. Programs are no longer required to ensure that future speech-language pathologists have the “ability to explore approaches to addressing bilingual/ multilingual individuals requiring services.”

Programs are no longer even required to “provide evidence that students are given opportunities to recognize that cultural and linguistic diversity exists.”

All of these requirements had been in our accreditation standards, and all of them have now been removed.

Our profession just literally struck culture, language, bi-/multilingualism, cultural competence, cultural responsiveness, and even basic cultural awareness from our accreditation standards. Our profession just declared that high-quality clinical preparation programs do not need to teach students any of this material, much less require students to wrestle with the complexities of this material, apparently on the logic that becoming a good speech-language pathologist does not require understanding or applying this material.

What do we have instead? What has Standard 3.4B become?

Here you go, the new Standard 3.4B: “An effective speech-language pathology program is organized and delivered in such a manner that the tenets of person- and family-centered care are reflected in the program.”

Oh.

Okay.

Um….that doesn’t sound too terrible?

It does not say “seek homogeneity” or “ignore a client’s language” or “ignore clients’ identities.”

Maybe this is not actually so bad?

Hmm.

But what is “person- and family-centered care,” and why has it replaced such notions as equity, inclusion, and cultural responsiveness in our accreditation standards?

Good questions.

Let’s see what we can do.

Patient-centered, client-centered, and person-centered care have been defined in many ways for many reasons, ranging from old Rogerian therapy to current healthcare systems (see Institute of Medicine, 2001, or see DiLollo, 2010, for one view from within speech-language pathology).

Most recently, and in the sense that the CAA seems to be invoking, person-centered care tends to have been discussed in the context of medical systems that are described as having forgotten that the person in the middle of all this is a real and complete person, not a symptom or a disease. The overall goal is for organizations and professionals to slow down, ask questions, develop relationships, and work with the whole people who have sought their professional assistance as whole people — rather than popping into the room, proclaiming something in Latin, and popping back out.

Santana et al.’s (2017) comprehensive review, similarly, described person-centered care as “a model in which health-care providers are encouraged to [1] partner with patients to co-design and deliver personalized care that provides people with the high-quality care they need and [2] improve health-care system efficiency and effectiveness.” Their review and analysis resulted in a conceptual framework for person-centered care that incorporates three domains: Structure, at the level of healthcare systems and organizations; Process, at the level of patients with providers; and Outcomes, some of which are at the patient level and others of which are for the provider or for the healthcare system itself.

The CAA’s definition captures a small part of the Process level, in our new Standard 3.4B, by asserting that “services provided by audiology/speech language pathology (AuD/SLP) professionals should be tailored and responsive to the individual’s unique circumstances, culture, experiences, beliefs, and wishes.” Similarly, programs must assist future speech-language pathologists to “consider and respond with respect to these differences in planning, implementing, and evaluating individualized health education programs, assessments, and interventions.” The new Standard also addresses a small part of the Structure level, in its requirement that, within high-quality accredited preparation programs, “students are given opportunities to reflect on their own unique circumstances, culture, experiences, beliefs, and wishes, and how those may differ from their clients/ patients.”

Oh.

But — so — hang on a second — is this all still about culture, circumstances, beliefs, and wishes? Recognize, respect, and respond?

I thought we had struck all that, in favor of system-level effectiveness and co-designed care plans?

Well, yes and no.

First, yes. Definitely. The words diversity, equity, and inclusion were struck from our Standard 3.4B. All the other requirements I quoted earlier in this over-long post were also struck. And the words person-centered care were added to our Standard 3.4B.

But also, no, apparently not.

This part is where the word games come in.

Consider some additional implementation language and definitions provided with the new standard:

“Speech-language pathologists provide services to a wide population of individuals that could include those with cultural and linguistic expectations, differences, and histories with which the service provider may not be familiar. Effective clinical relationships require service providers to understand and respect values, attitudes, beliefs, circumstances, experiences, modes of communication, and mores that differ from their own. It also requires service providers to consider and respond with respect to these differences in planning, implementing, and evaluating individualized health education programs, assessments, and interventions. Person- and family-centered care as it is referenced in these standards refers to, ‘integrated … services delivered in a setting and manner that is responsive to individuals and their goals, values, and preferences’” (emphases added).

So.

Okay.

Let’s see.

The word “diversity” was struck, but the revised Standard 3.4B addresses “a wide population of individuals” who have “cultural and linguistic expectations…with which the service provider may not be familiar.”

The word “inclusion” was struck, but the revised standards “require providers to understand and respect” the “wide population of individuals” and to “consider and respect” all clients’ and families’ many differences.

The word “equity” was struck, but the revised standards specify that “services provided by audiology/speechlanguage pathology (AuD/SLP) professionals should be tailored and responsive to the individual’s unique circumstances, culture, experiences, beliefs, and wishes.”

Honestly, then, where are we? What do any of the words in our new Standard 3.4B mean?

I don’t know.

I have lost track.

On the one hand, we might be discussing little more than a performative removal of three politically charged words or trendy terms, with no real change to the underlying requirements.

But on the other hand, I also see a large and problematic failure.

It does matter that we literally just struck the word “diversity,” the word “inclusion,” and the word “equity” from our profession’s accreditation requirements.

And it absolutely matters that the CAA has added person-centered care to our accreditation standards using its own definition of person-centered care and without referring to most of what most definitions of person-centered care actually include.

Words matter. Definitions matter. And we are word professionals. We are communication professionals.

We should not be playing word games.

The contribution of the old Standard 3.4B was that it named diversity, equity, inclusion, and other related key words.

The old Standard 3.4B was important because we, as professionals, should be able to state, clearly, that our profession values all people, values all languages, values all dialects of all languages, values the group-level diversity that occurs when all people are included, and seeks to provide kind, respectful, high-quality, and equitably effective services to all individuals, regardless of their cultural, regional, familial, racial, linguistic, religious, ethnic, or any other (any other!) background or identity.

The old Standard 3.4B was important because we, as professionals, should be able to state, clearly, that CAA-accredited preparation programs help future speech-language pathologists to understand what our profession values and therefore to act in the professional manner we value.

Stating that we value or require person-centered or family-centered care is fine. I am not against person-centered or family-centered care.

But the entire large construct and the entire large three-domain entity of person-centered care is not the same thing as culturally appropriate, linguistically appropriate, culturally responsive, or identity affirming clinical service delivery. Person-centered care includes all of those, which is why the new Standard 3.4B might be read as having achieved little more than a politically expedient sleight of hand: They removed the trendy or hot-button words that our federal government seems to be currently penalizing while also, in many ways, not changing much about the actual underlying requirements. But person-centered care also includes much more, at many levels, and the CAA has just introduced some enormous complexities into our accreditation requirements by using a large term and then redefining it in an idiosyncratic small way.

So now what?

Ironically, after all this, I will calm down and simply do what the new Standard 3.4B asks us to do, which in many ways has not changed: try to “understand and respect values, attitudes, beliefs, circumstances, experiences, modes of communication, and mores that differ” from our own. I will continue to try to “consider and respond with respect to these differences in planning, implementing, and evaluating individualized health education programs, assessments, and interventions.”

But I will also continue to say the words culture, identity, diversity, inclusion, and equity, among other words that were struck from the previous Standard 3.4B, because words matter. And I will continue to try to help current and future professionals think about everything these topics can mean, to reflect on what kind of professionals they want to become, and to reflect on how we can each be trying to improve our entire profession for everyone.

Anne Marcotte | August 23, 2025