Centering Cultural Values as Precision Medicine in Clinical Service Delivery

Evidence-based practice (EBP) in the field of speech-language pathology (SLP) frames clinical service delivery as a triad: (1) the best external and internal scientific evidence; (2) clinical expertise and experience; and (3) client values (American, Speech, Language, and Hearing Association [ASHA], 2025). While scientific evidence and clinical expertise are easily defined and often demonstrated via concrete processes and behaviors, the third of the triad called client values is more opaque in its meaning. How are client values identified via the EBP process? How are client values communicated to the speech-language pathologist (SLP)? How do the SLP and the client negotiate assessment and treatment plans that integrate client values throughout? How often does this process take place? Client values are purportedly equal in their capacity to influence the quality of clinical service delivery, but are they truly addressed during the EBP process or is this third of speech-language services just giving lip service? The idea of culturally responsive service delivery as precision medicine was first introduced to the child development literature by Allison-Burbank and Collins (2020), adapted from Collins and Varmus (2015) Precision Medicine Initiative. Precision public health is an approach adapted from this framework that studies people and their communities across the lifespan to develop interventions that reduce risk for negative health outcomes in minoritized populations. Allison-Burbank and Collins (2020) coalesced the findings from a number of studies that examined home health visits and their impact on parent training, early childhood developmental milestones, and parent-child interactive activities, such as book reading, in North American Indigenous communities. What made these home health visits unique was that clinicians were trained to support traditional practices to increase bonding between fathers and children, strengthening positive outcomes. Since this publication appeared, Dr Allison-Burbank has led the integration of precision medicine into the field of SLP with numerous publications illustrating how client values can be brought to the forefront of EBP, increasing the likelihood of positive treatment outcomes, client buy-in, and client satisfaction with clinical services (e.g., Allison-Burbank et al., 2023; Billey et al., 2024; Allison-Burbank et al., 2025). In this special issue, Allison-Burbank (2026) again illustrates how client values can be centered to weave precision medicine into the EBP process, enhancing clinical service delivery. Allison-Burbank et al. (2026) identified a clinical challenge in tribal communities: Early intervention (EI) SLPs do not always connect culturally with indigenous communities, and the rural setting of tribal communities often creates a geographical barrier to receiving speech and language EI services for infants and toddlers. Young children with Developmental Delay demonstrate more positive outcomes in gross motor, fine motor, and communication abilities when they have access to EI services. The solution to this challenge was the development of the Tribal Home Visiting Program, a parent training program individualized to each family’s needs and culturally specific child-rearing practices. Community members, instead of SLPs from outside the community, were taught the parent training components. These community members, who were aware of the historical trauma of the tribe or nation, the linguistic history of the family, and their cultural beliefs were well equipped to implement the parent training program in a way that centered the family’s values. By prioritizing client values over clinician expertise and experience, the children in the study had better outcomes. This work challenges us to engage in cultural humility in order to provide the best possible service delivery to our clients. We are accustomed to being the expert and relying on scientific knowledge to provide the best possible services to our clients, but we may be missing opportunities to engage in best practices with minoritized communities by prioritizing client values above the other two-thirds of the EBP triad. Marrodan et al. (2026) built on this early work by surveying parents on their value of a narrative intervention treatment plan. The authors designed an evidence-based treatment program for hard-of-hearing children with language delay, administered by monolingual English speaking and bilingual Spanish-English-speaking SLPs, and also asked parents whether they felt the treatment was effective. Parents reported they observed positive outcomes in both vocabulary and morphosyntax and noted they were especially pleased their that children were able to receive treatment in Spanish, as there is a significant shortage of bilingual SLPs in the US. Applying the precision medicine framework in the form of surveying client values in order to individualize treatment to the specific wants and needs of the clients (and their families) resulted in positive outcomes for the children, measured by objective data as well as subjective parent report. Moya-Galé et al. (2026) also took a precision medicine approach by using focus groups to design peer support groups for Hispanic/Latine adults with Parkinson’s Disease (PD). With the goal of increasing mental health, communication, and social connection, the authors aimed to directly integrate client values into the group treatment design. A Reflexive Thematic Analysis Reporting Guidelines methodology was applied to the focus group data and themes surfaced detailing the client values associated with the treatment support groups. The PD experience was once thought to be universal cross-culturally, but this study revealed the Hispanic community has unique concerns including the absence of speech therapists in their home countries and/or the absence of speech therapists in the US who speak Spanish, difficulty in communicating with their doctors due to the compounded effect of being a monolingual Spanish speaker and having PD, difficulty working with interpreters, and coming from societies that are not prepared for disabled people (i.e., stigmatization and lack of accessibility). Tailoring support group treatment to the ethnic group it is designed for is precision medicine and, according to this study, predicts better outcomes for clients and their family members. Client values are often the overlooked third of the EBP triad, but this special issue highlights its importance in the effectiveness of clinical service delivery. SLPs are encouraged to not simply give lip service to culturally informed practice but start out by asking clients for feedback on their wants and needs, their cultural approaches, and what they want to see happen in their sessions. Cultural humility means we might have to hand the reigns over to another professional if that person can better connect with the community we aim to support. We must find creative ways to reach the clients that do not fit the mainstream mold we were trained on in graduate school and acknowledge that client lead treatment might be the most effective treatment available. Flexibility, listening, unlearning, and growing are all part of meeting each client where they are, and during that process, we may just find out more about ourselves.