145 International Pediatrics / Vol. 17/ No. 3/ 2002 Culture as Context for Intervention Review Article Culture as Context for Intervention: Developing a Culturally Congruent Early Intervention Program Brenda Louw, Carina Avenant Abstract Black South African children with hearing loss are affected by the issues facing the deaf population as well as those facing the Black population educationally, socially and vocationally. The cultural context in which the child exists will not only influence the acquisi- tion of communication skills but also the context in which interven- tion occurs. It is imperative that early interventionists have insight into, and understanding of the ethnographic - and family character- istics that may influence responses to early intervention. A theoreti- cal framework for the design and implementation of culturally con- gruent early intervention programs for young Black South African children with hearing loss is developed. The aim of this paper is to describe culture as a context for early intervention and to provide a cultural perspective of early intervention for young Black children with hearing loss. Based on these theoretical underpinnings, mod- els are suggested and guidelines are formulated for early communi- cation intervention for young Black South African children with hearing loss. Int Pediatr. 2002;17(3):145-150. Key words: deaf, intervention, South Africa, culture, hearing and screening Introduction Deafness transcends decibels and embraces deaf people, their communities, and their culture. 1 Deafness has taken precedence over ethnicity in the deaf community and it has been erroneously assumed that deafness precludes ethnic and racial group membership. Immersed in both deaf and Black cultures, Black South African children with hearing loss are affected by the issues facing the deaf population and those facing the Black population educationally, socially and vocationally. This population has traditionally been under-served and service delivery to Black children who have hearing loss in South Africa remains problematic. 2 The diversity in language and culture in South Africa, and the growing awareness and recognition of this diversity, presents a challenge to speech-language therapists in early intervention service delivery to young From the Department of Communication Pathology, University of Pretoria, Pretoria, South Africa. Address reprint requests to Carina Avenant, Department of Communication Pathology, University of Pretoria, Pretoria, South Africa 0002. children with hearing loss. When children acquire language within the context of the family, 3 a dynamic interaction exists between the language development of children on the one hand and the cultural beliefs, family values and child rearing practices on the other. 2,4 According to Crago, acquiring language and becoming a cultural member are intertwined processes that are deeply embedded in each other. 3 The increasing awareness that differences, across and within cultural–linguistic groups, need to be accounted for, has led to the rethinking of previous practices that defined good interventions as those in which clients incorporated the values, beliefs, and behaviors congruent with White middle-class culture. 5 The inherent problem with the application of traditional practices is that they may not be appropriate for families from other cultures and may create conflict and stress within families. 5,6 Such a situation is, at best, insensitive, and at worst, destructive, of the cultural and communicative fabric of the child’s or family’s life. 7 Cross-cultural differences are not only present regarding communication interaction patterns, but societies also differ with respect to what they consider to be normal or pathologic. Currently the majority speech- language therapists and audiologists providing services to Black children with hearing loss and their families in South Africa are White, middle-class, and they cannot assume that the families whom they serve share their basic ideas and beliefs regarding disabling conditions and interventions. These differences necessitate professionals to develop cultural competence and become committed to honoring cultural diversity through the services provided to families of young Black children with hearing loss. 5 However, each family is unique and should be regarded as an individual unit with its own values, beliefs, practices and needs. 4, 5 The recognized relationship between culture and language reinforces the fact that cultural issues should be considered by speech-language therapists and audiologists when delivering help to young Black children with hearing loss. Cultural factors in the South African context that are relevant to the provision of early intervention services are illustrated in Figure 1. A theoretical framework is proposed for the design and implementation of culturally congruent early intervention programs for young Black South African children with hearing loss.