Teaching and Learning in Communication Sciences Teaching and Learning in Communication Sciences & Disorders & Disorders Infusing Multicultural Instruction: An Experiential Learning Project Infusing Multicultural Instruction: An Experiential Learning Project

Abstract The study investigated the effectiveness of a multicultural project implemented for the purpose of infusing multicultural instruction into a graduate level infant language disorders class in a speech-language pathology graduate program. The participants were 24 graduate students who ranged in age from 23-32, 20 were white, 4 were Black. A pretest and posttest survey were implemented along with journal entry thematic analysis to evaluate qualitative changes in learning. The results of the survey indicate that this experiential learning project can promote increased understanding, awareness and confidence in students related to multicultural issues. The journal analysis revealed that students were provided an opportunity to understand the impact of structural inequities related to intersectionality.


Introduction and Literature Review
Teaching graduate students in speech-language pathology (SLP) is a privilege that comes with the responsibility to ensure a well-rounded, evidence-based education. A key aspect of this education is preparation to develop strong clinical relationships with a diverse population. Mainstream, white students make up the majority of speech-language pathology graduate program cohorts in the United States, resulting in a field of practicing speech-language pathologists (SLPs) who are largely from the majority culture. In fact, only 14% of SLPs in the United States (US) identify as a racial or ethnic minority (ASHA, 2019). Though there are efforts in motion to attempt to diversify our field (ASHA, n.d.-a.), the fact remains that most of the students moving through SLP programs are white. These data indicate that faculty of SLP graduate programs have a responsibility to ensure multicultural and multilingual instruction (MMI) is infused throughout courses. White students, in particular, may experience "racial obliviousness" because the issues that are related to racial awareness are often not considered. This may be due to lack of exposure and lack of interaction with people who are racially different. White students, especially, may come to the classroom with low awareness of their own privilege, and may not even think about race as an aspect of their own culture (Preis, 2013). Students should be exposed to the idea of white privilege described as white individuals being awarded benefits and advantages in social, economic, political, and educational arenas (Kohnert, 2013). By supplying direct instruction to include topics such as biases, power, and white privilege as classroom topics, the authors looked to expand students' cultural awareness.
The concept of multicultural and multilingual instruction (MMI) is defined by its individual terms: multicultural and multilingual (Stockman et al., 2004(Stockman et al., , 2008. These terms encompass the wide array of human cultural differences, which include, but are not limited to the social categories mentioned in the ASHA Code of ethics (i.e., race, ethnicity, sex, gender identity/gender expression, sexual orientation, age, religion, national origin, disability, culture, language, or dialect (ASHA, 2016). Since linguistic differences are one of the major sociological expressions of cultural difference, multilingualism can be seen as one aspect of multiculturalism. It should be noted that multilingual aspects, in particular, were not an overt focus of this project.
MMI instruction is needed because of the historical marginalization of minorities (i.e., marginalized) groups from the institutions of the mainstream culture. However, since any type of cultural difference may influence clinical service delivery, the meaning of MMI should encompass culture in a broad sense. For example, restricting the definition of MMI to race/ethnicity only, or focusing only on traditionally recognized minority groups, will not expose students to the full range of clients' cultural differences that they will encounter. Acknowledging MMI in this broad sense allows each individual's microcultures (Banks, 1995) to be acknowledged. For example, two people who share the same ethnicity may differ in some respect. They may differ racially or in terms of gender, for instance. A definition of MMI that acknowledges microcultures allows for negotiation across each person's multiple cultural identities.
Dedicated MMI courses, often provided at the undergraduate level, provide a specific focus on MMI and set the stage for later discussion in graduate-level courses about more advanced subjects. Non-dedicated MMI courses, especially at the graduate level, provide students with information about specific disorder areas (e.g., language disorders, motor speech disorders, etc.). Stockman, et al. (2008) found that SLP instructors in university programs who had both a dedicated MMI class and used integral infusion of MMI into non-dedicated graduate courses, felt more confident in their ability to impart the necessary curricular content than those without a dedicated course (2008). As such, SLP curricula would benefit from a dedicated MMI course in addition to integral infusion of MMI instruction into non-dedicated courses across the curriculum. The current paper addresses one way in which MMI can be infused into an existing, non-dedicated SLP course that addresses required elements of instruction in speech-language pathology.
Students can benefit from experiences that challenge bias and ensure well-rounded, flexible clinical skill (Bucher, 2004;Hancock, 2011). Further, clients served by professionals who have engaged in personal reflection and explicit education in MMI are more likely to receive leastbiased services, the standard for service provision issued by a mandate of the American Speech-Language-Hearing Association (ASHA, 1983). Diversity, inclusion, and multiculturalism have been expected elements of instruction in accredited graduate curricula since 1985 (ASHA, n.d.-b;Farrugia-Bernard, 2018;Stockman, et al., 2008). Further, in a study in 2008, it was found the SLP instructors of non-dedicated MMI courses reported they were not well-prepared to infuse MMI content into their courses (Stockman, et al., 2008). Given these results, instructors can benefit from having clearly defined and well-developed course projects to teach MMI concepts in nondedicated courses.
Any strong education includes an element of experiential learning. We know that students learn best through doing (Bandura, 1993;Vygotsky, 1978). A well-rounded education should include overt instruction and experiential learning in MMI (Ladson-Billings, 2000). Learners must not only be exposed to didactic teaching, but ideally should have access to an element of experience to fully integrate concepts (Georgiou, et al., 2008). Furthermore, students may benefit from the mentorship provided by an experienced professional who can provide the student with a clinical perspective and guiding theories to motivate clinical decision-making. Two guiding frameworks used for this project are Culturally Sustaining Pedagogy (CSP) (Paris & Alim, 2014) and Disability Critical Race Theory (DisCrit) (Annamma et al., 2018;Crenshaw et al., 1995).
Culturally Sustaining Pedagogy. CSP views classrooms as places where authentic "being" for people of color is not eradicated but sustained (Paris and Alim, 2014). CSP strives to ensure access and opportunity. It also supports students to critique and question dominant power structures in societies (Paris and Alim, 2014). The current project implemented CSP by encouraging graduate students to interact with a person (i.e., a partner) from a non-dominant cultural group to provide an experience that (a) promoted understanding of the partner's non-dominant culture and (b) encouraged students to think about critique of power structures that affected the partner.
Disability Critical Race Theory. The social co-constructions of race and disability traditionally have been used as grounds to impose biases toward others through unjust labeling, surveillance, and punishment. DisCrit is a tool to examine and reconceptualize education's contribution to problematic classroom spaces. It requires activism, supports all forms of resistance, and pushes the boundaries of intersectionality (Annamma et al., 2018). DisCrit has roots in Critical Race Theory (CRT) (Crenshaw et al., 1995). CRT has two major themes: (a) unequal societal power structures are perpetuated by white supremacy and (b) the pursuit of justice is carried out through the transformation of policy and institutional organization, thereby reducing oppression (Crenshaw et al., 1995). DisCrit is an extension of CRT to include individuals with disabilities (Annamma et al., 2018). The current project attempts to integrate discussion of intersectionality, causing students to reconsider potential bias related to disability and apply ideas learned to future practice.
Before an SLP can support parents of children from diverse backgrounds, it is essential that they learn how to navigate cultural divides with humility, self-examination, and critical reflection (Farrugia-Bernard, 2018;Stockman et al, 2008;Boult, et al., 2021). A deepened understanding of differences in access and opportunity can be obtained through life experience (Paris & Alim, 2014). The current project created an ideal context to emphasize the elements of both CSP (Paris & Alim, 2014) and DisCrit (Annamma et al., 2018). While theory-based MMI course content for SLP courses is needed, there are few resources to guide SLP educators on how to best teach these concepts to students (Farrugia-Bernard, 2018). This class project has the potential to be one such resource.
It is important to make clear that the authors of this paper are white, which requires not only disclosure, but admission that their life experience influences both the implementation of the project described herein and the analysis of project outcomes. In addition to racial identity, the regional and sociocultural context of our communities and workplace institutions are also relevant to our stance as researchers. Each of us lives in a small Southern city, the demographics of which are almost exclusively white and Black. Each city has a Black majority population. In contrast, students in each of our programs tend to be predominantly white women. Although not exclusively, Black students are those represented within our institutions' next largest racial/ethnic demographic category. Even so, Black students are consistently represented in our programs in the minority. (At the recommendation of the Associated Press, in this paper, Black is capitalized and not white as an intentional symbol of an antiracist viewpoint [Bauder, 2020]).
Although the details provided above are not an exhaustive ethnographic description, they give some background in terms of the context in which the project used in the current study was developed and implemented. Our goals in completing this project were first to address and confront bias within our own pedagogy, critically reflect on the policies that sustain our pedagogy, and finally, to assess the quality of student learning for the purpose of optimizing future learning outcomes.
Research Questions. The purpose of this investigation was to ask the questions: did this class project a) result in significant shifts in understanding related to the project objectives and b) what was the qualitative nature of those shifts in understanding?

Method
In order to answer these questions, we conducted a survey before and after the project began to measure changes in the subjective reports of comprehension of the topics. We studied qualitative aspects of the nature of these shifts in understanding by conducting a thematic analysis of journal entries.
Multicultural Issues Infusion Project: The "CCC-ND". The current project was created and implemented in a graduate course and was modeled after the Cross Cultural Communication (CCC) project described by Boult, et al. (2021). Two different universities have implemented the original CCC project in a dedicated MMI course at either the graduate or undergraduate levels for several years. The original CCC project consisted of a semester-long partnership for each student with a person (i.e., the CCC partner) from a different cultural background than the student. The students were required to have three conversations with their CCC partner over the course of the semester, with journal entries submitted after each conversation, and a presentation about the CCC partner given at the end of the course (Boult, et al., 2021). Readers who are interested in learning more details about this original project are encouraged to refer to the citation noted above.
The original CCC project, as described above, is an intensive, immersive experience that requires several dedicated class periods to complete. The students are required to hold a minimum of twohour long conversations, journal extensively about the content of these conversations, and then present to the class, providing an account of their intercultural experience to their classmates. The presentations for this project are relatively time consuming --taking between 20 -60 minutes each depending on university program requirements --and take weeks of class time to complete. Due to the extensive time spent on project presentations, it is difficult to replicate the original project in a non-dedicated class. Therefore, an adaptation was created to suit the needs and available resources of a non-dedicated course. Infant Language Disorders, a graduate-level course, was chosen for this project, in an effort to promote integral infusion of concepts previously learned in the dedicated undergraduate MMI course. For these reasons, the project described here was termed the Cross-Cultural-Communication Project -Non-Dedicated (CCC-ND).
The purpose of the CCC-ND was to prepare graduate students who were learning about early intervention as an SLP to practice the principles of active listening, increase self-and otherawareness, increase cultural awareness, to listen to the firsthand, lived experiences of parents of children with disabilities, and to witness the impact of potential structural inequities that surround individuals who experience intersectionality related to disability.
Prior to initiating the project, the instructor covered the following topics with students to set the tone for the project: a review of the definition of culture with emphasis on the responsibilities of students to enter into relationship with their partners, to consider how they might advocate for them, and to self-reflect on their own biases. The students were required to fill out a survey that examined their own culture and the nature of their own potential bias. Additionally, the concept of ableism, which is a system of excluding that oppresses individuals who are abled in ways that differ from mainstream perspectives with respect to emotional, cognitive or physical abilities, was addressed both in this class and within the clinical education component of this program (Castañeda & Peters, 2000).
A recent cultural competency survey of speech-language pathology graduate programs reported that ethnographic interviewing is the least frequently taught skill (Guiberson & Vigil, 2021). However, it has been suggested that ethnographic interviewing can help the clinician and client establish a stronger, more authentic relationship, develop a deeper understanding of strengths and needs, and that biases may be reduced (Riquelme & Rosas, 2020). Ethnographic interviewing stipulates open-ended questions, avoidance of leading questions, and summarizing responses to avoid misinterpretation (Westby, 1990;Westby et al., 2003). Therefore, the instructor provided a lecture on the principles of ethnographic interviewing to help the students acquire a description of the most authentic lived experiences from their project communication partners. Ethnographic interviewing was encouraged in the context of the conversations, though an authentic conversation was considered essential. No specific instructions beyond these described above were provided in an effort to allow naturally occurring realizations by the students as they interviewed their project communication partners and wrote their journals.
Project Requirements. This class project involved three activities: 1) conversation(s) with a person from a different culture (i.e., a CCC-ND partner) who also had a family member with a disability, 2) a journal entry completed after the conversation(s), and 3) an in-class small group discussion guided by the instructor at the end of the semester. The graduate students were asked to find a person from a cultural background that differed from their own specific background who also had a family member with a disability (age of family member with disability was not a limiting factor) who was willing to serve as their partner. The partners in this project could have been a client (served in the university clinic) or client's parent. The partner could also have been someone they found through social connections. The students were encouraged to meet in-person in a public place. However, this project occurred during the COVID-19 pandemic. A statewide stay-at-home mandate occurred midway through the semester. Therefore, video conferencing and phone conversations were allowed as meeting modalities as needed. All students were able to find a partner for the project.
Procedures to protect the rights of the students were approved by IRB. Although written consent was not required of conversational partners, the students were required to read a prepared script to introduce the project. This script also asked for verbal consent from the partner, before the conversation began. This script asked for agreement to take part in the project and made it clear that, though this information would be shared in class discussion and a journal entry, no identifying information would be used in these contexts. The script also asked for consent to record with the understanding that the recording would be deleted after journal entries had been written.

Conversations.
Students were encouraged to have more than one conversation with their partner, if possible. However, since the project required participation from families with children with disabilities who often have limited time, the students weren't required to have more than one conversation. Students were encouraged to enjoy an unstructured conversation, but the project stipulated general guidance on the following topics to cover, if possible: a) discussion of home and work life, b) the process of their child's education, c) establishment of relationships, d) the nature of interactions with professionals, e) the nature of interactions with the public, and finally f) written reflection on any listening techniques the students used to ensure the conversation was focused respectfully on their partner.

Journals.
The students had to report the content of their conversations with their partner; though, no specific terms were given about what they should report. This lack of overt direction was intended to preserve authenticity in their conversations. No other requirements were implemented for the journal entries. Though no length requirement was stipulated, each entry was 6-10 pages long.
Small group discussion. At the end of the semester, the instructor assigned small groups and had a 30-minute video conference with each group of students for the purpose of sharing collective experience and peer learning. During discussion, the instructor reiterated goals of CSP and DisCrit. The instructor, to facilitate honest discussion, made it clear that no beliefs or views different from the instructor's would cause a deduction in their participation grade. Evaluation measures. This project was worth 100 points. The journal entry was awarded 75 points. The instructor assigned journal points according to the number of topics they addressed in the reflection paper as well as the depth and completeness of discussion. If students presented with strong participation in the group discussions, they were awarded 25 points.
Participants. The participants were 24 graduate students enrolled in Infant Language Disorders, a graduate-level SLP course. The students ranged in age from 23-32: 20 were white, 4 were Black. The participant communication partners were from a wide range of differing cultural backgrounds and communities that included those from Black, Indigenous, and/or People of Color (i.e., BIPOC) backgrounds, diverse religious backgrounds, and white, American parents of internationally adopted children.
Data Collection. Data collection began after IRB approval, on January 30 th , 2020. Students were required to submit a survey before the project began as well as at the end of the semester after the project was completed. Filling out the survey was a mandatory requirement to reduce the potential for self-selection bias. All students filled out the pre-test and post-test survey and were given 20 minutes to complete it. Additionally, the project required that students submit a journal entry at the end of the semester detailing and interpreting their experience. Journal entry data allowed the authors to analyze the specific nature of any self-reported changes in understanding that occurred as a result of participating in the project. Instrument used. The use of a survey allowed the authors to evaluate general shifts in thought related to diversity, stereotyping, and self-awareness in the students. The survey statements were developed to align with the purposes of the project and included the following statements: (a) I understand myself and others in ways other than stereotyped groups and categories; (b) I am aware of the causes and effects on a family unit of social exclusions based on prejudice; (c) I feel confident in my ability to work with families from different cultural backgrounds than myself; (d) I am aware of my own biases and am prepared to confront them; (e) I understand how to conduct an interview to respectfully glean information from families of diverse backgrounds; (f) I understand how my life experiences should be viewed as compared to the experiences of the families and children that I serve. Students were asked to respond to these six statements on the pre-test and post-test survey using Likert-scale responses ranging from 1-5 (strongly disagree to strongly agree).

Data Analysis.
To objectively evaluate whether a shift in understanding was noted, pre-test and post-test course surveys were analyzed using a paired t-test. A paired t-test was applied to investigate significance at the p = .05 level. A paired t-test was utilized instead of the nonparametric counterpart, because the sample was negligibly smaller than the recommended 20 participants, and the two participant groups (pre/post) had identical characteristics (de Winter, 2013).
To evaluate qualitative aspects of the nature of the shifts in understanding, the authors analyzed the journals using thematic analysis (Creswell, 2013). The authors coded the journal entries for themes and then linked those codes across journal entries to consolidate units into broad themes (Denzin & Lincoln, 2003). Five entries were coded to establish initial themes, then the authors organized and defined those themes. The remaining journal entries were coded based on this organization using thematic analysis. Journal entries were coded according to guidelines set forth in Creswell (2013). The broad themes and subcategories that emerged are described in the sections below. Overall, three broad themes, new cultural knowledge, student shift in perspective, and intersectionality were established. Disability, race, and religion were subthemes that emerged intermittently throughout new cultural knowledge and student shift in perspective.
Descriptive aspects of the small-group discussion were captured through participant observation conducted by the instructor. The instructor met with the students in small groups via video conference at the end of the semester. These sessions were not recorded. The instructor approached these sessions as a participant observer and took notes throughout each one in order to report significant statements and events. Students were asked to describe their experience and report main learning points. Because topics of activism and participation in policy change were not mentioned by students in their journals, the instructor was able to amplify the need for activism and participation in policy change in this context.

Survey.
The results of this survey are given in Table 1 below. Each question reached statistical significance at the p = .05 level, indicating an overall increase in understanding of concepts related to MMI education.
Specifically, statements three, four, and five reflected growths. It appeared that the project increased confidence to work with families from different backgrounds (statement 3), awareness of bias and preparation to confront them (statement 4) and understanding of how to conduct an interview with a person from a different background (statement 5). Statements one, two, and six were also significant which indicated that their understanding of stereotypes, prejudice, and relative privilege increased as well.
Journal Entries. Each of the 24 students submitted one journal entry each. Thematic analysis of the journals resulted in the establishment of three broad themes: new cultural knowledge, student shift in perspective, and intersectionality. Disability, race, and religion were subthemes that emerged from the thematic analysis. In the 24 journal entries, 21 students explicitly mentioned race, 24 students mentioned disability, eight students mentioned religion, and 11 students discussed the concept of intersectionality.
Theme 1: New Cultural Knowledge. Each student reported a significant number of facts regarding disability, race, and, to a lesser degree, religion. These facts were considered new cultural information, to which the student was exposed, and of which they would likely not have been aware, if not for the class project. This is a key aspect of this projectto provide experience with and intimate knowledge of a person from a different culture with life-experience with disability. The parent(s) or family member(s) of individuals with a disability provided a wealth of knowledge that informed the students' eventual shifts in perspective. Disability. The students reported a wide variety of information about their participants' experiences navigating life with a family member with a disability. Sentences in journal entries were coded as new cultural knowledge related to disability if the project partner mentioned their family members' diagnosis or issues related to the diagnosis. In the journal entries, experiences with the diagnosis, education, the medical field, and family were frequently described in detail. These re-counted experiences were both positive and negative in nature. Some project partners reported supportive teachers and schools. Others did not. Some of the project partners had experienced misdiagnoses whereas others reported admirable medical professionals within their experiences. Overall, this new information seemed to increase the disability-related awareness of the students. They often went into the interview expecting to hear a particular version of a story and reported that they realized, ultimately, that they needed to adopt a different view of disability. An example of the realization of a need for perspective shift is illustrated in the journal entry excerpt below: When [the child] was only three years old, he walked out of his home alone looking for his mother. At that time, he did not have the expressive language skills to ask where she was. He was missing for over an hour as he wandered, and his family was distraught. His parents contacted the police department and reported their son to be missing, and thus when the child happened along a law enforcement officer, he was quickly identified and returned to his home.

Although the child has two loving, caring, and attentive parents, they felt a sense of guilt and shame when a police officer approached their doorstep with their son. [The parents] felt as if they failed their son and as if the officer assumed they were neglectful. This incident serves as a pivotal marker in the parents' lives; within a moment, their minds were opened to a new list of worries as they considered the outcome of their son's future.
This journal entry quotation reveals that the student was able to hear a real-world account of their partner's lived experience. This particular experience as well as other similar reported experiences enhanced the students' knowledge, awareness, and empathy with families who experience disability.

Race and ethnicity.
Twenty-one journal entries overtly discussed race or ethnicity, or issues related to race or ethnicity. Sentences were coded as new cultural knowledge related to race if the family member discussed race or ethnicity as it related to their life experience. The unique experiences that the participants recounted highlighted for many of them that no race is a monolith. Additionally, many of the students reported that they were amazed at the similarities they discovered between themselves and their partner. Still others reported surprise over the circumstances their partner faced related to race. An example:

Many people in her culture view autism, bipolar disorder, and ADHD, etc. as behavior problems. People have told her that she does not discipline [her child] enough. In [racial identity] culture, to believe that it could be something else or to believe that it could be some chemistry flaw in the body that makes you behave a certain way is taboo. It is hard for most of the [racial identity] community to believe that there is a functioning or chemical flaw in my son's brain where the information going from his senses to his brain does not work the same as another person's. If I were to explain this to them, they would look at me sideways. She mentioned instances of her telling [her child] to do something and he wouldn't. Those around her would look at her expectantly because they thought she should discipline him. They want to believe that I can [discipline] the autism out of my child.
This quotation highlights the fact that there are racial and ethnic norms for the interpretation of the meaning of disability. The perspective discussed in the quotation provided this student with a window into the complexities of life with a disability, and potentially, into her future clients' lives, especially those who do not identify with the majority culture. While intersectionality is discussed later as a separate broad theme, this quotation highlights the impact of both race and disability.

Religion.
While religion was mentioned less frequently, sentences in a journal were coded as new cultural knowledge related to religion if the CCC-ND partner reported it, and it was discussed as being a part of the family's life experience. Students reported on the influence of religious beliefs on families. The following journal quotation is an example of new cultural knowledge related to religion:

She grew up in a spiritual household with her mother, father and four other siblings. They attended church and practiced [religious tradition]. They believed in the basic teaching of [religious tradition]. […] the belief is that karma will always come back around. She explained it as: "if you do good, you get good, and if you do bad you get bad in return."
This student went on to explain how this religious belief influenced the perception of disability and the family's interaction with disability. The project partner had believed her child's disability was due to bad karma initially but had come to different conclusions as her child's life progressed. Another project partner reported that her church was dismissive of her child's disability, which led them to attend another church. These experiences highlighted for the students that disability and religion sometimes interact in a person's life. This interaction can have a significant impact on a person with disabilities and their family.
Theme 2: Graduate-Student Perspective Shift. The students in this study were required to write about the content of their conversations but were not required to report an internal shift in understanding. This was intentional to allow for naturally occurring realizations. Even though it wasn't a requirement, many of the students reported an internal change in the way they thought about diversity particularly in terms of the interaction between disability and race/ethnicity.

Disability.
It was common for the students to report that they held stereotypical views of disability previous to their conversation with their partner. Specifically, before the project, they viewed disability as either an extremely positive or negative experience for families. The students frequently conveyed that the process of slowing down to listen to the experiences of their partner allowed them to learn something nuanced about their partner's life. They realized that creating authentic relationships through listening was an important aspect of being a strong clinician. An example:

This second interview opened my eyes to how different families may have different views on people with disabilities. I found it interesting how some [race identity] families view people with disabilities to be an embarrassment, and some [race identity] families view their family member with disabilities to be equal to them and love them no matter what. [My partner] shared with me that, "No matter what a family's culture is, I believe that every family is different and unique when establishing their opinions and beliefs." When [my partner] told this to me, I thought of how speech-language pathologists should always consider that when working with these unique families on their caseload.
This quotation highlights the realization experienced by many of the students that not all families feel the same way about disability. It is an example of how important it is to view disability through an individualized lens rather than a lens of stereotype. These data add further support to the notion that, in alignment with DisCrit, students who participated in the CCC-ND project tended to reconsider potential biases as they relate to disability, with the potential to apply concepts learned to future practice (Annamma et al., 2018).

Race and ethnicity.
The authors coded sentences in the journals as student shift in perspective if the student noted an internal change as it related to race or ethnicity.

After having the first interview with [my partner], it opened my eyes to his culture. It made me realize how important it is to respect people's culture, values, and beliefs when providing healthcare services to them. It's not only crucial for speechlanguage pathologists to respect individuals' lifestyles, but other healthcare professionals such as nurses, doctors, and occupational therapists should respect their patients' perceptions as well. […] I believe that it could be beneficial for speech-language pathologists who have multicultural clients on their caseloads to have an initial meeting with the client's parents or caregivers to get to know not only the client but the family as well.
The students in this study reported many realizations related to cultural difference based on race. The entry above indicates the student realized how important it is to understand the family and the complexities of family life. However, more importantly, this excerpt indicates the student realized how essential it is for clients from minority backgrounds to receive inclusive, culturally competent services no matter what type of professional they seeand that this is likely not always the case for SLP clients. This is an important realization especially as it relates to identifying and handling systemic racism within a broader infrastructure.
Theme 3: Intersectionality. The concept of intersectionality emerged in the analysis of the data from the journals. Intersectionality is defined as the convergence of multiple forms of oppression (Hankivsky & Christoffersen, 2008). Intersectionality does not refer to the simple fact that multiple forms of oppression can impact an individual (Hankivsky & Christoffersen, 2008). Rather, intersectionality refers to the idea that our identities and daily life experiences are made up of multiple forms, and these forms can enhance power or create oppression (Butler, 2015;Nash, 2008). The following quotation is an example:

As a young a child, [the child] is seemingly accepted by the public, but his parents worry that a person of color with a disability will be terribly misunderstood and mistreated as an adult. [The father] recalls witnessing horrifying experiences for young [racial identity] men with disabilities within his high school. He fears that if someday [the child]
were to wander the streets as an adult and be approached by law enforcement, he may close himself off and withdraw out of fear and thereby seem uncooperative. He explains that while law enforcement keeps us all safe and he feels a great connection to them as a volunteer firefighter, he knows they receive no training in interacting with disabled persons on the job. This quotation exemplifies the many reports in the journals that refer to multiple aspects of life that are impacted by having a life that intersects with multiple identities -identities that are impacted by systemic injustice, oppression, or stereotyping. The students were able to see the amount of stress and daily life impact this circumstance can have on a parent. This project highlighted the fact that disability, race, and religion are aspects of life that intermingle to create unique experiences for individuals. While it wasn't a surprise that the students in this study realized the impact of multiple barriers to healthcare, education, etc., it was not an overt topic of discussion when the project was introduced to the class. Despite it not being taught overtly, the journal entry analysis indicated students realized that intersectional aspects of life experiences can create unique circumstances for a family experiencing disability. Ultimately, the existence of intersectionality was an important realization for several of the students within their journals and was also a point of discussion in the small group discussions.
The themes that emerged from this project (namely: new cultural knowledge, graduate student perspective shift, and intersectionality related to race, religion, and disability) align with the purposes of CSP and DisCrit. This project served as a vehicle to imbue these theories by giving the students perspective and promoting the needed insight to become an agent of change for clients (Annamma et al., 2018;Paris et al., 2014). Findings from the journal data are also in alignment with survey results that indicated an upward trend in understanding of stereotypes, social exclusion based on prejudice, confidence in working with families from a different background than their own, awareness of bias, and potential differences in privilege.
Small-Group Discussion. Concepts of CSP (Paris & Alim, 2014) and DisCrit (Annamma et al., 2018) were highlighted during the small-group discussion; There were two main points made throughout each discussion. First, nearly all students reported they needed to keep an open mindto both accept individual differences and recognize common humanity. They ultimately agreed that no two people were the same and that even when someone seemed to be drastically different from themselves, often there were more shared characteristics than they realized. At this point in the discussion, the instructor had the opportunity to address the reality of power hierarchies, privilege, and oppression, to discourage a post-racially influenced mindset of cultural pluralism, such as colorblindness. Second, one student made the statement that highlighted the systemic nature of racism and the impact of intersectionality. The student said, "everyone needs a village, but sometimes, the village isn't always there." The groups were able to discuss the fact that every family who experienced disability needed a community of support, but that systemic injustice had resulted in unequal access to resources in educational and healthcare institutions.

Discussion
The investigation posed the following questions: did the CCC-ND project (a) result in significant shifts in understanding related to the project objectives, and (b) what was the qualitative nature of those shifts in understanding?
The first question was investigated through use of a survey. The survey demonstrated that the project had a positive, expected impact on student learning. Previous research has indicated that professionals need more than academic knowledge of cultural differences and complexities during their education; they need experiences (Bucher, 2004;Laing & Kamhi, 2003). Survey results from the current study support this assertion. The CCC-ND project increased students' MMI awareness using an experiential project in a way that may not have been expected given the didactics of a non-dedicated Language Disorders class alone.
Even though most students increased ratings to a level of "strongly agree" on post-test, one caveat to these gains needs acknowledgement. Specifically, most of the students rated themselves as agree or strongly agree even at pre-test. They then increased or kept those high ratings at post-test. One explanation that could account for the dynamic of strong initial pre-test ratings is that many of these students had taken a dedicated MMI course during their undergraduate studies at the same university, where this study was conducted. The course provided foundational knowledge of cultural and linguistic difference and contained the CCC project --an experiential learning project which included partner meetings. This previous coursework could have contributed to the high pre-test self-ratings particularly as reflected in answers to statement 3, "I feel confident in my ability to work with families from different cultural backgrounds than myself." Although a measurable change in awareness was documented, if this project had been the only MMI-related academic experience the students had, pre-test scores may not have been as high comparing to the post-test scores. In this case, one, limited, non-clinical experience, may not have made a notable increase in their abilities. It is important to note that these results do not suggest that a short series of conversations with families from a background different from graduate students is all that is required to increase knowledge and skill in all matters related to culturally responsive practice. Although this project appears to have helped provide some dimension of increased awareness, it is likely not solely responsible for these students' confidence in their abilities to work with families from backgrounds different from their own. It seems plausible that this group of students had been primed for positive results with the CCC-ND after having had a more in-depth experience with MMI instruction within their undergraduate curriculum.
An alternative explanation for high pre-and post-test ratings is that on the journey to develop cultural awareness, reported competence is often outstripped by reported confidence (Stockman et al., 2008). Just because high subjective reports of awareness were given, doesn't mean that students are prepared with the knowledge and skills to carry out culturally competent service provision. If this confidence/competence mismatch is the explanation for the current findings, further support of knowledge and skill development is needed, and could be provided through integral infusion of MMI via clinical practica and an MMI dedicated graduate-level course or courses addressing first, foundational concepts related to cultural and linguistic variation and second, advanced concepts related to power, privilege, intersectionality, structural inequity and advocacy.
The second research question was investigated through journal analysis. This journal analysis showed, as stipulated in the research, specific training and experience with diverse populations is beneficial (Caesar & Kohler, 2007;Roseberry-McKibbin, et al., 2005). When the students learned about personal experiences and ideas surrounding disability, race, and religion, it broadened their understanding of the families with whom they will interact professionally after they graduate from an SLP programwhich supports the goals of culturally-sustaining pedagogy. Additionally, the project gave students a personal experience through which to understand the impact of unequal societal power structureswhich supports the objectives of DisCrit.
The journal analyses also revealed that this project appeared to encourage personal and internal perspective shifts in students. Research indicates that students can benefit from interacting with people from differing cultures, because it challenges belief systems and encourages a shift in perspective (Cheng & Soudack, 1994;Walters & Geller, 2002). Several students interpreted their experiences with the class project in ways that realigned their values.
The results also amplified the fact that students will encounter the realities of intersectionality when they work with a diverse population. The students described hearing stories about the life experiences of individuals who have a disability and come from a historically marginalized background. The class project provided valuable exposure for graduate students prior to graduation as they heard accounts of life experience, processed it, and engaged in conversation about what they heard related to intersectionality. This finding is supported by research that indicates clinical fields must evolve to embrace the complexity and degrees of subtlety that surround individuals whose identity is connected to multiple racial, ethnic, and social groups (Buchanan & Wiklund, 2020). The small group conversation was found to help the students in this study interpret what they heard and shape how they should engage with multiple points of intersectionality within an individual or community. This appeared to encourage the students to not only recognize that intersectionality exists, but that there are structural inequities related to intersectionality. This is an important realization in the preparation to be a professional in a clinical field (Buchanan & Wiklund, 2020). The authors believe this finding indicates that intersectionality definition and theory should be taught overtly in SLP graduate courses as part of MMI prior to engaging in a project like this one (Crenshaw et al., 1995;Farrugia-Bernard, 2018). This finding supports the integral infusion of multicultural and multilingual course content into the SLP master's-level curriculum; one in which advanced topics such as these are addressed in a graduate-level MMI dedicated course.

Conclusion
The results of this investigation indicate that this experiential learning project can promote increased understanding, awareness, and confidence in students related to MMI. The survey indicated that students' understanding did increase significantly. The thematic analysis of the journal entries indicated that this experience allowed the students to see issues related to intersectionality and reflect deeply on those issues. The students also appeared to recognize structural inequities that surround the individuals they interacted with -which was a significant goal of this project.
It is important to note that this class project is not optimally implemented as a "tack-on method" where students complete a project outside of class with little discussion and guidance from the instructor. Rather, this project provides an option for implementing integral infusion of MMI wherein the entire experience is guided by the instructor. Direct instruction supporting the project should be provided via lecture before the project is initiated, and the students' experience should be mediated throughout discussion and journaling by the instructor.
Limitations and Critical Reflexivity. The study did not evaluate the differences between white and Black student journal entries. There is significant potential for further exploration of this difference and its ramifications. Although white students are centered in this project due to their majority status and the authors acknowledge that it is incumbent upon the majority culture to address issues of systemic bias, BIPOC students should not be inadvertently decentered within this process. On the contrary, the perspectives of BIPOC students should be an influencing force in the implementation of this project. BIPOC students should never be responsible for teaching white students about MMI. Rather, their perspectives, when they emerge organically, should be honored, affirmed, and integrated into future iterations of this project. In this way, the voices of BIPOC students contribute to the co-construction of the knowledge base of the class. No matter the cultural background of the student, the CCC-ND project provides opportunities for deepened understanding of intersectionality related to historically disenfranchised communities. The role of BIPOC SLP students in working with a multicultural society should continue to be explored in future research.
Additionally, the journal entries did not reflect full understanding and integration of agency and motivation to promote policy change. Also, while the journal entries and small-group discussions reflected some awareness of disparities, the students did not overtly discuss realizations around the full impact of intersectionality until they met in small groups with the instructor. The authors believe this indicates the need for more preparation prior to initiating the project in the form of a dedicated MMI course at the graduate level.
Another limitation of this study is the fact that only one lecture on ethnographic interviewing was provided. More extensive instruction and in-class active learning on ethnographic interviewing is suggested.
Upon reflection, the authors believe that data collection should include more points of triangulation in the future. For example, an evaluation of the student interaction completed by the CCC-ND partners would provide further insight into the effectiveness of the project. Additionally, evaluation by instructors regarding application of principles of social justice in a clinical setting would further inform conclusions. The current project investigated the student perspective -a perspective that exists in a particular context and has not been triangulated with other sources.
Additionally, if students rate themselves high on the survey to begin with and they are still novices from a clinical perspective, this indicates a gap in their competency. An adjustment should be considered in which the students are not only supported to be aware and confident and also have structural support to ensure their competency in the curriculum and in the clinic setting.
Specifically, the authors believe that such a course could offer, in addition to grounding in CSP and DisCrit, instruction in anti-racism as outlined by Kendi (2019), and Ethics of Care (Gilligan,1982(Gilligan, , 2013a to promote increased agency and motivation to promote policy change. Ethics of Care is an approach to others that facilitates attentiveness, responsibility, competence, and responsiveness. Ethics of Care combined with a decidedly anti-racist focus could have provided more opportunity for the students to fully integrate agency for change and care in their interpretation of their partner's experience.
In the interest of critical reflexivity, the CCC-ND project is acknowledged as an ongoing, everchanging endeavor that, in the future, must bend to constant realization and increased awareness related to MMI, realities of oppression, and bias. In fact, CSP indicates an ongoing, multidimensional process. This project fulfills one small objective that is part of a larger goal --a goal focused on developing multi-layered, CSP within SLP curricula and imparting a CSP perspective of clinical practice to students. The authors expect the project to evolve as ongoing feedback from others and continued self-reflection are welcomed and integrated. Future application of this project could investigate its utility with non-white students and instructors, and further investigate its potential for bias reduction related to intersectionality in students.

Jennifer Whited
Financial: The first author receives compensation as a tenure-track assistant professor in the Speech-Language Pathology program at the University of Louisiana Monroe.