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Out With the Old Medical Models, In With a New Ecological Response

Paradigm Shifts in EAL
By Dr. Virginia Rojas
Out With the Old Medical Models, In With a New Ecological Response

The TESOL (formerly Teachers of English to Speakers of Other Languages) 2019 Standards for pre-K-12 Teacher Preparation programs differ from previous versions in three significant ways. First, the standards ask for candidates to be prepared to teach language using a functional linguistics approach which views language as a resource learners use to make meaning from spoken and written texts within the context of specific disciplinary content. The second shift calls for English as an Additional Language (EAL) teachers to develop knowledge and skills for collaborating with content teachers in order to accelerate learners’ access to the academic language of grade-level curricula. A final shift asks for shared responsibility and advocacy for multilingual learners, and it is this change which hints at transformational perspectives and practices for multilingual learners as well as for the ensuing shift in EAL specialists’ roles and responsibilities from past expectations of “fixers” of learners to leaders for developing a schoolwide advocacy ecosystem. However, in order to make these shifts become a reality for international schools with multilingual learners, there is a need to reflect on the factors potentially hindering the implementation of a responsive ecological model.

EAL medical models problematize learners who come to school using a language other than English as having a language handicap, an impairment preventing them from accessing the school curriculum. The resonating message is that potential or actual learning problems stem from not fitting the native-speaking, monolingual English ideal, a message which may stigmatize the way multilingual learners see themselves and unsettle parents who may be asked to pay extra tuition for support services to meet learners’ needs as they transition to English mastery and to mainstream education. Given these circumstances, it is not surprising that medical model policies, programs, and practices are generally housed within the structure of Student Support Services.

Student Support Service Delivery Models

The original medical model of language support, pull-out classes concentrated on English-language proficiency first, then access to content. Later, pull-out classes shifted from language-led to content-based curriculum in an effort to connect with mainstream classes. With the advent of push-in support, EAL teachers enter mainstream classrooms to support identified English learners, often as a part of their caseloads. Generally, EAL teachers frontload vocabulary, provide sentence starters, graphic organizers, and use translanguaging tools to facilitate multilingual learners’ access until English proficiency is achieved. Additionally, EAL teachers support these students’ access to content by modifying tasks or simplifying texts, depending on English-language proficiency levels. When walking into “inclusion” classrooms with either an EAL or a Learning Support teacher, it is sometimes difficult to distinguish how what each does differs. In fact, some international schools use these specialists interchangeably, despite distinct training and licensure backgrounds.

Several international schools have adopted the Multi-Tiered System of Support (MTSS) problem-solving process, designed to assist in the identification of all students who need additional support in the classroom, school environment, and in online instruction. These students may include multilingual learners or English-proficient students who encounter academic difficulties. Successful implementation of the MTSS process is perceived as key to ensuring that multilingual learners receive appropriate intervention to maximize their academic achievement and language acquisition, while not being over- or under-identified for special education services. One of the key components of MTSS is a tiered structure that offers a range of interventions based on the needs of individual students. Once a skill deficit or need is identified, students are given the targeted interventions or the appropriate additional supports. A student’s responsiveness to the tiered support is monitored until it is decided whether they need even more support or if that supplemental support can be removed.

A few factors can hamper the well-intended MTSS process. Teachers may not know or be skilled at using best practices for multilingual learners, thereby recommending them for interventions they may not need. Similarly, teachers may confuse a learning issue with a language proficiency issue and wait to refer an emergent bilingual who may also have a special need. Further complicating accurate referral is a continued deficit lens when associating non-English proficiency with a learning issue or when overlooking the linguistic and cultural assets multilingual learners possess. As pointed out by Short et al (2018), multilingual learners are not given sufficient time to do ‘double the work’ of learning academic English while studying the content areas before they must participate in English-language, high-stakes assessments used to refer them for multitiered systems of support.

Content and Language Integrated Learning (CLIL): An Ecological Response

The question of how to best educate multilingual learners might be better posed in reverse; that is, not to ask how double-burdened multilingual learners’ academic and language needs should be supported but rather to ask what approach would best be adopted by schools with majority multilingual populations capable of simultaneously acquiring a language while achieving academically in rigorous learning environments. Such a dual-focused curriculum approach, one with the primary objective of promoting both content mastery and language proficiency, is CLIL. Born in the mid-1990’s in the context of sweeping language policy innovations in Europe, CLIL has become widely accepted and available throughout the world, especially in contexts where classrooms provide the most significant amount of time for language learners’ interaction in the target language (Christison, Crandall, & Christian, 2022; Dalton Puffer, 2011; Tedick & Cammarata, 2012). Given that the greatest number of international schools are in countries where English is not the lingua franca, a CLIL approach meets this criterion.

CLIL represents a paradigm shift from medical EAL support models in significant ways. First, CLIL transcends any notion of content and academic language development as separate entities and instead thinks of them as one and the same (Cenoz, Genesee & Gorter, 2013). Corollary CLIL principles include higher-order cognitive engagement and an affectively-inclusive environment as engines for learning and for language progression. Recognizing the linguistic and cultural funds multilingual learners bring to classrooms, CLIL principles propose a language-as-resource orientation across the school and emphasize biliteracy and biculturalism as integral components of one’s identity. CLIL advocates for EAL and world language teachers to collaborate using functional linguistics and genre-based approaches to inform and organize instruction so all language learners comprehend how languages work and how languages are interrelated (Troyan et al, 2019). A final CLIL principle emphasizes pluricultural citizenship for success in an ever-evolving world, another shared goal with world language programs and with international schools’ missions (Coyle & Meyer, 2021).

Methodically, CLIL classrooms are characterized by scaffolded learning experiences differentiated for learners with varying degrees of understanding and language proficiencies. The traditional teaching of simple-to-complex grammatical categorizations of noun, verb, or adjective gives way to an instructional framework focused on how languages work in spoken and written texts. CLIL teachers use genre-based pedagogies to deconstruct the language features of a narrative, an explanation, an argument, or a report and then create opportunities for teacher-learner and learner-learner interaction to negotiate meaning as new texts are jointly constructed as guided practice for learners’ independent text constructions. Most important to CLIL instruction is a corresponding assessment process where evidence and data are collected using a pluriliteracies, glass full approach in contrast to the glass empty, English-only perspective of medical support models (Coyle & Meyer, 2021). CLIL fosters a reality of learners using multiple languages as one communication system, providing students with translingual and transcultural ecological learning spaces.


Current discussions on diversity, equity, inclusion, and justice (DEIJ) offer a timely frame as a means of addressing imbalances within deeply institutionalized EAL medical model policies, programs, and practices. This framing inspires a powerful shift in the way that multilingual learners are perceived as it leaves behind the notion that multilingual learners are a double burden in need of an array of targeted systems of support which, in the end, may perpetuate inequalities and entrench institutional monolingual bias and orientations of language-as-a-problem (Cleave, 2020). Instead, we see a broader focus on learners’ access to a learning environment whereby schools foreground content and language-integrated learning as the responsibility of all teachers, not only as a mantra but as a way of establishing a more sustainable provision for the continuing demographic reality of majority school populations of multilingual learners. To build an ecosystem in which all teachers are in reality teachers of language and content, this conversation calls for international schools to start with the revised TESOL standards in conjunction with the research-based CLIL principles as guidelines for enabling EAL teacher-leaders to implement ecological models for multilingual learners.



Cenoz, J., Genesee, F. & Gorter, D. (2013). Critical analysis of CLIL: Taking stock and looking forward, Applied Linguistics, pp. 1-21. doi:10.1093/applin/amt011

Christison, M.A., Crandall, J., & Christian, D. (2022). (EDS.). Research on integrating content and language in diverse contexts, Routledge Publishing.

Cleave, E (2020). Language, education, and social justice: International strategies for systems change in multilingual schools, The Bell Foundation.

Coyle, D. & Meyer, O. (2021). Beyond CLIL: Pluri-literacies teaching for deeper learning, Cambridge University Press.

Dalton-Puffer, C. (2011). Content-and-language integrated learning: From practice to principles, Annual Review of Applied Linguistics, 31, pp. 182-204. doi: 10.1017/S0267190511000092

Short, D. J., Becker, H., Cloud, N., Hellman, A. B., & Levine, L. N. (2018). The 6 Principles for exemplary teaching of English Learners. Alexandria, VA: TESOL press.

Standards for initial TESOL pre-K-12 teacher preparation programs, TESOL International Association, 2019 (TESOL-CAEP Standards for P-12 Teacher Education Programs).

Tedick, D.J. & Cammarata, L. (2012). Content and language integration in K-12 contexts: Student outcomes, teacher practices, and stakeholder perspectives, Foreign Language Annals, 51(1), pp. 28-53.

Troyan, F.J., Sembiante, S.F. & King, N. (2019). A case for a functional linguistic knowledge base in world language teacher education, Foreign Language Annals, pp. 1-26.


Dr. Virginia Rojas currently teaches the EAL certification program in partnership with the Principals’ Training Center. Before semi-retiring, she was a faculty member for the Association of Supervision and Curriculum Development (ASCD) and a language education consultant for over 350 international schools. She was inducted into the Association for the Advancement of International Education (AAIE) Hall of Fame in 2016.

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