Speech language therapists (SLTs) deliver evidence based services worldwide for communication disorders to culturally and linguistically diverse (CLD) populations. They have to modify their approaches and tailor them to the needs of their students / patients. This article studies the responses of nine school SLTs in a diverse region of the USA to a semi-structured interview about how they modify their approaches, if at all, when interacting with culturally and linguistically diverse students and their families. The data analysis suggested four main factors faced by the SLTs: 1) language for communication with students and their families could be a barrier but also a bridge; 2) communicating through an interpreter was fraught with its own set of problems; 3) cultural differences had to be respected; 4) interacting with CLD students and their families was challenging but also associated with positive experiences. This article highlights the need for further research for culturally competent practices in the areas of assessment and intervention.