The initiative – led by Laura Coca, director of clinical education – is designed to give students hands-on experience while providing much-needed speech-language pathology (SLP) services to the local community.

“This project is a win-win,” Coca said. “Our students get to apply what they’re learning in a real-world setting, and Interfaith gains access to services that support families and caregivers in meaningful ways.”

Through the partnership, students will collaborate with community members and allied health professionals, offering screenings, support and educational resources. The goal is to strengthen student learning while promoting community well-being.

Alison Scheer-Cohen, chair of the SLP department, said the initiative reflects the department’s commitment to community-engaged scholarship.

“We’re proud to be part of a university that values service and connection,” Scheer-Cohen said. “This partnership bridges academic knowledge with practical service, and it’s a great example of how our students are making a difference even before they graduate.”

The collaboration with Interfaith is expected to enhance access to care for underserved populations while giving students a deeper understanding of the social and cultural factors that shape health outcomes.

“This is about more than clinical skills,” Coca said. “It’s about empathy, communication and building trust with the people we serve.”

The department plans to share outcomes from the project with the campus community, highlighting how engaged scholarship can create lasting impact.

Media Contact

Brian Hiro, Communications Specialist
bhiro@csusm.edu | Office: 760-750-7306

Keehr, who graduated in 2016, now works as a speech-language pathologist in the San Marcos Unified School District (SMUSD). She has remained closely connected to CSUSM, regularly supervising SLP graduate students working as interns in the district. 

In somewhat of a full circle moment for Keehr, she now sends her daughter to the CSUSM SLP clinic where she once trained as a graduate student. 

Keehr’s daughter Lyra was born with Nicolaides-Baraitser syndrome, a rare genetic condition that affects how a child grows and develops. It can cause learning difficulties, seizures, delayed speech, and unique physical features like coarse facial features or small hands and feet. 

Though Lyra will turn 3 years old in September, she weighs just 15 pounds and is still learning to walk independently. When Lyra's physical therapist recommended a walking device to improve her mobility, the SLP clinic was there to help. Lyra’s tiny frame meant a standard walking device wouldn’t work, and a custom-made one came with an exorbitant price tag. 

One of Keehr’s SMUSD coworkers suggested she talk to CSUSM about the possibility of developing something. 

Laura Coca, CSUSM’s director of clinical education for the SLP department and one of Keehr’s mentors while she was a student, reached out to engineering professor Reza Kamali, who is the faculty adviser for the university’s chapter of Tikkun Olam Makers (TOM), an assistive technology organization that matches students with people living with neglected disabilities.  

“It was such a wonderful opportunity for students to collaborate,” Coca said. “I cannot thank Reza and TOM enough. They were just so fast and so comprehensive.” 

Kamali and the TOM team had several meetings with Keehr and Lyra’s physical therapist. Less than four months later, they had created a lightweight walking device tailored for Lyra. 

“These experiences offered a unique opportunity for students to engage in community-based projects where they could see firsthand how their knowledge and skills could be applied to create meaningful change,” Kamali said. “Watching their product go from an idea to a tangible device used by a child in need was an emotional and inspiring moment for everyone involved.” 

Keehr said the additional support has helped Lyra in many ways, including socially, with play skills that she’s learning from the SLP clinic and in her general mobility. 

“I didn’t know what to expect, and that’s why I was pleasantly surprised,” Keehr said.“Since getting the trainer, she has been able to stand by herself for a few seconds. It’s definitely been helping with her development. 

"I'm just very grateful for both of those programs and what they're doing for the community. Trying to navigate the insurance world and all the paperwork and everything that comes with it, it's programs like the SLP clinic and TOM that make it just a little bit easier for families like ours. They’re people who have good hearts and just want to help their community. So I'm very grateful for making those connections and also being able to promote them to other families that I work with so that they can benefit from these services.”

Media Contact

Eric Breier, Interim Assistant Director of Editorial and External Affairs

ebreier@csusm.edu | Office: 760-750-7314

Belanger is a 2020 master’s graduate of CSUSM’s speech-language pathology (SLP) program, and she recently returned to campus as part of the university’s SLP summer clinic. A regional implementation lead for the state-funded Open Access project, she made a significant impact by mentoring students and introducing pediatric clients to augmentative and alternative communication (AAC) devices.

“CSUSM’s SLP program provided me with a solid foundation for a successful career,” Belanger said. “Returning to supervise this summer was my chance to give back to a program that helped shape me as a clinician. I was thrilled to enrich my supervisees’ experience and inspire their passion for the field.”

At the summer clinic, which operated for four hours each weekday morning through Aug. 9, Belanger and other supervisors helped 120 pediatric clients and 24 adults receive vital speech and language services at no cost. The program not only provided crucial support to the community, but it also served as a hands-on training opportunity for graduate students in the SLP program.

Adrienne Shah, a lecturer and supervisor at the clinic, highlighted the dual benefits of the program.

“Our students provided over 3,000 hours of free speech therapy this summer,” Shah said. “It was an incredible opportunity for them to build clinical skills while serving our community.”

Shah, who had a positive experience as a CSUSM student, was driven by a desire to support current students.

“I wanted them to recognize the value of their hard work and the difference they were making in people’s lives,” she said.

Sarah Alapizco, another clinical supervisor, emphasized the importance of building confidence among students.

“I aimed to build their confidence and show them that they had the skill set to implement successful therapy,” she said. “The summer clinic also fostered collaboration, helping students support each other and enhance their learning experience.”

The clinic’s impact extended beyond the academic and professional spheres. A mother of a young adult client shared her appreciation for the services.

“I was so happy that we found this clinic,” she said. “We had never been a part of a program like this, and my son had needed these services for a very long time. This was a special place, and I was excited to continue coming.”

Karen Delfau, visiting from France, brought her 10-year-old daughter, Augustine, to the clinic.

“I sought a range of speech and communication resources unavailable in my region,” Delfau said. “While visiting family this summer, I was pleased that Augustine could benefit from the program, and I hope to return next year.”

For more information about career opportunities in speech-language pathology or to learn about clinic services, visit CSUSM’s SLP department website.

Media Contact

Brian Hiro, Communications Specialist

bhiro@csusm.edu | Office: 760-750-7306

James felt moved by the story but powerless to make an impact.

“This really bothered me because essentially this was their voice being left behind,” James said. “To some degree it was as if their voice didn’t belong to them and the idea of it being stripped away from them did not sit well with me. This caused me to ask questions, do research and explore this situation further.”

Last summer, Laura Coca, the director of clinical education in the department of speech-language pathology (SLP), presented a challenge to graduate students to advocate for something they were passionate about.

Now in her second year of CSUSM’s SLP graduate program, James decided to take that challenge head on. She chose to write advocacy letters to various agencies in support of K-12 students with communicative disorders.

James’ letter explained how without these devices, students are unable to communicate their basic wants and needs, ideas, and it prevents them from participating in social interactions. She wrote about how going long periods of time without their device prevents them from making personal and academic progress. 

Her proposal called for districts to allow these students to take their AAC devices home during all school breaks.

The response she received from San Diego Unified School District was a positive one. After meeting with James in person, the district was clearly impressed. A new policy is being drafted currently and the expectation is that it will be in place soon.

“Now that I felt better equipped, had the support from faculty and realized that no change has been made since 2019, I thought that I had to be the one to get this ball rolling,” James said. “I am currently working with four elementary school students who use AAC devices as their primary form of communication and I couldn’t imagine them not having access to a device for a long period of time. This should be a concern for everyone.”

This new policy will allow district students to take home their loaned devices with them over school breaks regardless of whether or not it is specifically stated in their Individualized Educational Plan (IEP).

As long as the student is enrolled through the district, the AAC device will stay with them across grade levels. Parents and students will no longer have to worry about not having access to a device at home if they don’t already have one.  

James knew at a young age she wanted to work in education. She became interested in SLP after shadowing a professional in the field and “observing all the wonderful work she was doing for her students.”

After graduating from CSUSM with a bachelor’s degree in SLP, it was an easy decision to continue her passion on campus. She points to the supportive faculty and staff as the main reason for remaining at CSUSM.

“Sue Moineau, our program director and my academic adviser, has always been such a role model to me,” James said. “She has always been so supportive and provided me with words of encouragement when I needed it the most. (Coca) is someone I was fortunate enough to learn from. The care and compassion she has for our clients and students is inspirational. I am extremely grateful that she provided this opportunity for us students to have our voices heard and encourage us to advocate for those who can’t for themselves. This was a wonderful experience and opportunity. I am incredibly grateful and humbled by this experience.”

As for the future, James will graduate in May and plans to work as a school-based SLP at a middle school or high school.

Like many CSUSM students, she is looking to have a positive impact on the community she serves.

One thing is for certain – she will continue to advocate for students who don’t have a voice at the level it matters most.

“Hopefully have this policy be one that is made in all school districts,” said James of her goal. “I have already reached out to other school districts and will hopefully hear from them soon. I hope to continue volunteering and providing my services to underserved communities in other countries. Perhaps in the future I will continue my education and obtain a Ph.D.”

Media Contact

Eric Breier, Public Affairs Specialist

ebreier@csusm.edu | Office: 760-750-7314

“I knew it would be a challenge,” said Dominguez, who moved from her hometown of Escondido. “After graduation, my mom and my boyfriend helped move me out. And then it was just me and my cat in rural Arizona. The town was very small. I had elk and wild pigs in my backyard.”

Even so, the experience was invaluable. In less than a year, Dominguez was able to complete her clinical fellowship hours and then move to an SLP position in Escondido, followed by her current position at Temecula Valley Hospital.

Settled into her duties today as a full-time speech-language pathologist, her career path seems predestined. But if you had talked to undergrad Dominguez back in 2011, she was on a very different course.

As a liberal studies major and linguistics minor at CSUSM, Dominguez had planned to become a K-8 teacher, but she eventually realized she did not have the passion required for the field. As she considered new careers, a co-worker pointed her toward speech therapy, which immediately piqued her interest, especially with her undergraduate studies in linguistics.

A new course 
The Speech-Language Pathology Prep program at CSUSM prepared Dominguez with the prerequisites needed to apply to graduate SLP programs, and she ultimately was admitted to the Master of Science in Speech-Language Pathology at Cal State San Marcos. It was exactly what she had hoped for.

“I really valued that our professors were clinicians first, and it was a diverse group,” Dominguez said. “We had professors who worked with adults, with early intervention, with children with cleft lip and cleft palate, with voice disorders, and in schools. That made it a well-rounded program.

“Also, we were put into a clinical setting on day two. The curriculum was set up so we could take what we learned and use it in our clinical setting the next day. That was important to immediately apply what we learned.”

The clinicals help students determine their SLP pathway. With her past interest in teaching, Dominguez was sure she would be on track to become an SLP in a school setting. But in practice, she found that was not a good fit for her. Fortunately, there was time for her to
complete a clinical with adults in a medical setting, both inpatient and outpatient, and she loved it.

“That immediately solidified what I want to do,” she said. “That was huge.”

In practice 
The rigorous MS SLP curriculum at CSUSM prepared Dominguez for her responsibilities today as a speech-language pathologist, a critical function at Temecula Valley Hospital.

“We have to have a speech therapist at the hospital seven days a week; that’s part of what makes us a Comprehensive Stroke Center,” she explained. “Because of the importance of our swallow evaluations, we have to evaluate our acute stroke patients within 24 hours of the order being received.”

Arriving by 6:30 a.m. four days a week, Dominguez works 10-hour shifts. She starts each day prioritizing what needs to get done—from evaluations to treatments—and assigns patients to SLPs. The caseload determines how many SLPs are staffed for the day, and they review charts as well as triage any incoming patients to see who needs immediate attention. Communication with nurses, doctors, dieticians and family members is essential, as is charting notes for each patient before the end of each shift.

From pathway to passion 
In the midst of patient care, Dominguez has also found a way to incorporate her longtime interest in teaching by accepting a graduate student as part of an externship, which has opened new possibilities for her.

“I’m realizing how much I really enjoy teaching something I’m passionate about,” she said.

In particular, Dominguez has a growing interest in dysphagia (swallowing difficulties), which she first started exploring during graduate studies. She continued building knowledge about dysphagia during her final clinical in grad school and her clinical fellowship in Arizona.

She is also researching becoming a board-certified specialist in swallowing and swallowing disorders, a designation that takes years to accomplish by demonstrating advanced competency through clinical hours, continuing education, leadership roles, scholarship activities
and/or education outreach. But she said she is motivated to move forward.

“My passion has grown for dysphagia,” she said. “I realized that this is my calling. My ultimate goal is to teach dysphagia at the college level.”

For more information on the SLP Prep program, visit csusm.edu/el/slpprep, and on the MS SLP, visit csusm.edu/el/msslp.

Media Contact

Eric Breier, Public Affairs Specialist

ebreier@csusm.edu | Office: 760-750-7314

Gallardo attended Long Beach City College before transferring to Cal State Fullerton to study communications. But it was almost a decade from the time she started until she received her bachelor’s. College was put on hold for many of those years so Gallardo could care for her father after he suffered a debilitating stroke.

It was from that tragedy that Gallardo found a new calling.

“That is actually how I was introduced to the world of speech pathology,” Gallardo said. “I didn't even know it existed. I learned, first and foremost, from the caregiver side. And then I was like, ‘Wow, this is a really interesting domain. I think I could really get into this.’ And even though my father did pass, I think he would be very proud of that.”

Gallardo completed her studies in communications at Fullerton after her father’s death, but learning through his health struggles about speech, swallowing and communication issues faced by stroke victims left a lasting impression.

As Gallardo began researching speech-language pathology programs, she was drawn to Cal State San Marcos’ master’s program because of its commitment to diversity, equity and inclusion.

The speech-language pathology field is composed of 92% white females, and few of the people of color are Asian Pacific Islander Desi American. Gallardo wants to be part of changing that number, and her achievements in advancing CSUSM’s goals in the areas of diversity, inclusive excellence, educational equity and social justice were recently recognized by President Ellen Neufeldt, who presented Gallardo with the President’s Student Champion Award for Inclusive Excellence and Diversity at the university’s All Peoples Luncheon on Oct. 12.

“I'm honored,” Gallardo said. “And even though I'm a communications grad and an SLP major, I was speechless when I found out.”

Gallardo has been an integral member of the student organization Students of Speech and Language for Inclusion, Diversity, and Equity (SSLIDE), a group that grew out of discussions that speech-language pathology faculty and staff organized to help students struggling in the wake of the George Floyd murder. SSLIDE aims to increase diversity in the SLP field, address health disparities in diverse populations, and increase education around systemic racism.

Gallardo volunteered to chair SSLIDE’s marketing subgroup and wrote a vision statement that received unanimous approval from the members:

We will change the face of speech-language pathology through inclusion, diversity, and equity. We will set the precedent of diversity in the SLP world by elevating awareness and taking righteous action.

“A unique feature of the SLP department is that we have a student-led group that is tied into the department’s DEI strategic plan,” said speech-language pathology professor Sue Moineau, who nominated Gallardo for the President’s Student Champion Award. “Ashley put in noteworthy effort researching DEI initiatives, presenting at our monthly meetings and following up across various entities to ensure that all student, faculty and staff voices were heard and represented in the vision and in the marketing plan that was evolving in 2020."

Gallardo’s work with SSLIDE led to other notable opportunities. She participated in a leadership panel for student inclusion and diversity at Cal State Northridge and at the California Speech Language Hearing Association Conference earlier this year. Gallardo also is part of a CSUSM team that developed a presentation called “Taking Righteous Action – Changing SLP Diversity Statistics Through the Creation of Student Organizations,” which the group will present next month at the American Speech-Language-Hearing Association Convention.

Gallardo completed CSUSM’s post-baccalaureate SLP preparatory program last year and will graduate with her master’s in May 2023. In addition to the faculty and staff of CSUSM’s speech-language pathology department, she said the support of her family has been vital, including her husband, Steven, their three young children and her sister, Nicole Williams, who helped care for their father. And Gallardo is looking forward to a career dedicated to helping young children in a Title 1 elementary school, which include children from a high percentage of low-income families.

“Ashley is a dedicated and conscientious student who has maintained exceptional grades while engaging in extracurricular activities aimed at increasing diversity in the field of speech-language pathology,” Moineau said. “Not only does she represent diversity within the field, but she is also a strong advocate for inclusionary practices and equitable treatment for all.

“Her contributions thus far reflect a student committed to CSUSM’s goals of creating access, fostering success, and practicing inclusive excellence by setting and maintaining a welcoming climate for all.”

Media Contact

Eric Breier, Public Affairs Specialist

ebreier@csusm.edu | Office: 760-750-7314

Through the one-year, $250,293 grant from Small Business Innovation Research arm of the NSF, CSUSM will collaborate with Verboso, a Chicago-based company that uses state-of-the-art technology to create therapy video games with automated feedback.

The principal investigator for the grant from CSUSM is Alison Scheer-Cohen, an associate professor in the Department of Speech-Language Pathology who will conduct the research along with two student assistants. In partnership with San Diego Unified School District and Capistrano Unified School District, school-age students will be able to use automated technology to practice their speech at home. Scheer-Cohen and her team will collect participant recordings to produce a larger pediatric data set and refine the automated technology.

“I’m excited to be a part of a project that is building automatic technology for speech sound production practice,” Scheer-Cohen said. “Ultimately, this will provide resources for children and families to practice their speech production at home and potentially have an impact on treatment outcome.”

The target of the project is children with speech sound disorders (SSD), which means that they have trouble saying certain sounds and words past the expected age. Approximately 5% of children have an SSD, which places them at risk for reading difficulties and processing challenges into adulthood.

Less than 70% of affected children receive needed speech therapy, however, due to difficulty accessing care and cost. The NSF project will develop artificial intelligence that can recreate the feedback decisions that a speech-language pathologist makes in a live therapy setting. Because of the automation, the cost of receiving services can be drastically reduced and many more children can receive treatment.

The objectives of the study are to:

• build a database of impaired and accurate productions of the eight English consonants most commonly in error;
• use this database to develop and train algorithms for identifying specific errors of segmented target phonemes (units of sound that can distinguish one word from another);
• complete reliability tests of the trained algorithm with decisions from trained speech-language pathologists to ensure adequate agreement of presence of error and error type.

“This grant is a great recognition of the potential of our technology to significantly improve access to, and impact the delivery of, speech therapy,” said Amy Linde, chief clinical officer for Verboso. “We are thrilled to have Dr. Scheer-Cohen and her research team at CSUSM bring their expertise in pediatric speech sound disorders and motor learning approaches to speech therapy to this project. Verboso is excited about this collaboration and working with all of our research partners on this important work.”

For the previous few years, Bishop had been a steady and familiar presence at the physical clinic, relying on close, one-on-one interactions with CSUSM speech-language pathology students to help reverse the effects of the debilitating stroke he suffered in 2015. Even before the stroke changed his life forever, he had never owned a cellphone, had very little interest in technology. 

So imagine the disorientation Bishop felt as he and his wife, Alice, logged on for their initial remote session in early July when the clinic opened back up for summer after nearly a four-month hiatus because of the coronavirus pandemic. 

“He couldn’t make sense of the relationship between somebody in a screen and him responding to that person in the screen,” said Alice Bishop, Norm’s constant companion for his therapy. “He couldn’t even wrap his head around the fact that somebody was talking to him over a square box.” 

But the two students on the other end of the Zoom meeting were patient and prepared, and they quickly picked up on Norm’s bodily cues. When he would lean closer to the tablet’s screen, it was because he didn’t understand. When he would turn his head, it was because he couldn’t hear well enough.  

And because Norm wasn’t used to speaking into a machine, his voice was barely audible. One of his first projects was to repeat, again and again, the line, “I need to speak louder now so people can hear me.” 

Over the next couple of weeks, he gradually grew accustomed to the foreign medium. 

“Well, you can’t beat the in-person interaction. You can laugh and point and see the mouth movements better,” Alice said. “But this is working out a lot better than I ever anticipated.” 

The summer session of the Speech-Language Clinic (SLC) marked the first use of telehealth at CSUSM since the dawn of the pandemic – the trial run for a practice that will continue this semester and may become a staple throughout the health care industry depending on how long COVID-19 lingers in the United States.  

Telehealth, defined as the use of digital information and communications technologies to access health care services remotely, is not a new concept. But its utilization has skyrocketed during the pandemic as a means of keeping both patients and health care providers safe and reducing the potential strain on the nation’s health care system.  

“We’re being told by our national governing board that telehealth is going to stay for some time, past COVID,” said Laura Coca, the supervisor of the SLC and a lecturer in the speech-language pathology department. “Not that we’re going to be solely doing telehealth, but we’re going to be seeing a lot more folks that way.” 

The SLC began as just a summer clinic before its services expanded to be offered year-round in 2014, because it had become challenging to find placements for students in adult facilities. The clinic serves as one of the four placements that students pursuing a master’s degree in speech-language pathology must cycle through, with the commitment totaling 400 clinical hours. During a typical academic year, the SLC features about 15 graduate students and three supervisors working with around 25 community clients, most of whom are middle ages or older and are impaired by neurological conditions.

As of last spring, of course, it ceased to be a typical academic year. The clinic, which used to be housed in a leased building off Furniture Row in San Marcos, moved into its spiffy new home in the Extended Learning building for the 2019-20 school year, featuring eight clinic rooms, a control room for the supervisors and multiple simulation rooms. But the operation shut down in mid-March, about the same time as the university switched to virtual instruction.

While the speech-language students went to an online program called Simucase to keep their clinical skills fresh, the community clients were left to do without one of their favorite social and psychological outlets for a period of months.

“It was really hard for the clients,” Coca said. “They really love interacting with the students and with each other, so not having the clinic was certainly a bummer for them.”

Alice Bishop said she and Norm stayed in touch with many of their friends from the clinic during the down time and even went on a picnic with one man. “But otherwise,” she added with a smile, “it was just the two of us staring at each other. I don’t know who wanted to slap who first.”

The return of the SLC this summer was just the antidote they needed for their quarantine malaise. Coca had worked diligently with IITS in the preceding weeks to ensure that the technology would work smoothly; then, during the first five weeks of the summer session, while the students trained on the new virtual platform, Coca met with each of the clients remotely to acclimate them to their new normal.

For its telepractice, the clinic is using Zoom for Healthcare, which is like the Zoom that most of the nation has grown familiar with, but adds an extra layer of security that makes it compliant with HIPAA, the 1996 law governing the privacy of certain health information.

“We all have encrypted computers, and if we were to record something, it would go automatically to an encrypted drive at the university,” Coca said.

At the advice of its national certification board, the SLC returned this summer by serving only clients who aren’t profoundly impaired. But because the clinic will be virtual only for the rest of the calendar year, and likely beyond, it developed a workaround that will allow clients who rely on assistive communication devices to take advantage of the same Zoom service as everyone else.

Coca said it’s uncertain whether, or to what extent, the SLC will continue to employ telehealth once the pandemic is over.

“I think it’s more convenient for certain patients,” she said. “We’d be able to serve a wider scope of patients – those who are homebound, people who are in rural communities. If we could make it something that is viable for the students and the community members, it could become a long-term asset.”

The Bishops will remain clinic fixtures regardless of the format. Five years ago, the Colorado couple were visiting their two adult sons in San Diego County when Norm had a stroke. After spending a month in the intensive care unit at Tri-City Medical Center, he was transferred to a nursing home in Vista, where he had a second stroke. Following another stint in both the ICU and the nursing home, he was finally discharged.

The Bishops, though, never moved back to Colorado. Oceanside became their home; it’s where they still live today. Norm began to undergo speech therapy at Tri-City, but his therapist recommended that he try the clinic at CSUSM because he could receive greater personal attention without any fear of his insurance ceasing coverage. The service at the SLC is free, of course.

“It’s probably the best thing we’ve ever done,” Alice said of the move. “We would gladly pay for what Norm is getting out of this.”

Alice says Norm feels invigorated by being in the presence of college students and that the clinic has designed a program that is tailor made for his needs and limitations.

So even though Norm prefers in-person contact to the “square box,” the Bishops’ devotion to the Speech-Language Clinic will outlive their days of Zoom sessions.

“Norm loves speech any way you can give it to him,” Alice said. “He’s willing to improve, and whatever they can do to help him, he’s going to be on board. We’re in it for the long run.”

Media Contact

Brian Hiro, Communications Specialist

bhiro@csusm.edu | Office: 760-750-7306

“Part of me was like, ‘Oh my gosh, I totally want to go,’ ” said Nahrstedt, who is a lecturer and has been the director of clinical education in the speech-language pathology department at CSUSM since 2013. “But then there was a part that was like, ‘What? In three weeks I’ve got to leave? What are you talking about?’ ”

After a quick check-in with her personal responsibilities, Nahrstedt heeded the call. And it ended up being one of the best decisions of her professional career.

“To be able to go over there and see the differences here in the states and see the amount of services we have for our population compared to other countries, especially a Third World country, it’s quite an eye-opening experience,” Nahrstedt said. “I think for a lot of these students, it kind of shapes their practice once they start to go out and become speech-language pathologists.”

This is the first time CSUSM SLP students have done clinical work in a foreign country.

The person who laid the foundation for the trip – and who’s indirectly responsible for Nahrstedt’s attendance on the trip – is Darin Woolpert, an assistant professor at CSUSM whose expertise is working with bilingual kids in the field of SLP.

Woolpert took a trip during winter break a year ago to Peru, Guatemala and Costa Rica to plan where he wanted to take students to work with local organizations. When he went on medical leave late in the fall semester, however, it left a huge spot to fill. The students already had been selected and were ready to depart.

Department chair Lori Heisler then contacted Nahrstedt to see if she’d be willing to step in for Woolpert.

“Originally I was going to attend the trip out of pocket for the majority of it with Darren but was unsure and kind of forgot about it,” said Nahrstedt, who was on the committee to select which students would be attending. “The reason (Heisler) asked me is because when I did practice in the school district, that was also my area, mostly working with Spanish-English speaking kiddos.”

The group spent time at two different sites. The first, Virgen del Socorro, is a residential facility that houses about 240 kids and adults. Seventy percent of the residents there have been abandoned by their families while the rest have families who will visit them and take them out of the facility for periods of time.

“The residents from Virgen del Socorro and the students from FUNDAL had the biggest hearts of all,” said Eric Rubic, who will earn a bachelor’s degree in SLP this spring. “These two weeks have given me a perspective on life that I will take with me into my career as an aspiring speech-language pathologist.”

Rubic, who plans to attend graduate school, was moved by his clinical interaction with one patient in particular.

“One that shines the brightest among them is the last patient I saw at Virgen del Socorro,” Rubic said. “He was the first patient I had the opportunity to feed with the assistance of the nursing staff. Those few sessions with him rekindled my passion for my speech-language pathology. This patient had dysphagia, which means he had difficulty swallowing. My first session with him was rough because he kept coughing, turning red, and paused between spoon servings. But my last session with him led to no coughing, turning red and long pauses.”

The final stop was at FUNDAL (Fundación Guatemalteca para Niños con Sordoceguera Alex), which is a nonprofit day program for kids who are deaf and blind or have other developmental disabilities.

The staff at FUNDAL wanted CSUSM visitors to experience the daily challenges that kids there encounter, so they put blindfolds and earplugs on them for 15 minutes at a time while a staff member guided them around the facility.

“The staff members at FUNDAL were particularly inspiring due to their creative ways of solving problems,” said Kristen Mazza, who will graduate from CSUSM with a master’s degree this spring. “They demonstrated how to make the most out of a limited supply of resources, such as by building custom adaptive equipment from cardboard. Seeing the unique methods they used to enable their students with disabilities to communicate with others and participate in everyday activities was incredibly encouraging.”

There are not many speech therapists in Guatemala. The programs that exist in the United States to help adults who have strokes, an acquired language disorder, aphasia, dementia, a traumatic brain injury and the ensuing problems don’t exist there.

So the sense of overwhelming joy on the faces of the residents brought equal happiness to the CSUSM contingent.

“The highlight of the trip was being welcomed with smiles by residents at the facility where we volunteered,” said Mazza, who hopes to work in a health care setting. “The simplest of acts, such as talking with them and taking them on trips to the facility’s garden, brought joy to their faces. The staff at the facility reported that many of the residents did not receive much one-on-one interaction, so we aimed to improve their quality of life in the time we had with them. The bonds we formed despite our short time together were impactful and left me wanting to return.”

Nahrstedt went on a similar trip to Costa Rica as a 19-year-old with a similar program. On that trip, she came across kids with cleft palates, who have difficulty with eating, swallowing and speech.

She left that trip inspired to begin what would become a speech-language pathology career helping people in school settings, clinical settings and now in academia.

She knows all about making positive contributions, even in abbreviated settings.

“I think the kids were amazed at the difference they could make in a matter of just two weeks,” Nahrstedt said. “We didn’t fix any huge problems there. When we first got there, we were wondering what we could do, how we could provide services, how we could make a difference. Just building those relationships and showing some of those people in a facility where maybe they felt like nobody cared about them.”

Media Contact

Eric Breier, Public Affairs Specialist

ebreier@csusm.edu | Office: 760-750-7314

“It really builds your confidence,” said Erica, who will graduate from the SLP master’s program in May. “The simulations really help show us that we do have the necessary skills. We have what it takes to go out there and apply what we’ve learned in our classes. They want to show us through these simulations that we have no reason to doubt ourselves.”

The simulations are an example of the student-centered approach used by SLP, which has enlisted CSUSM’s School of Nursing for help in developing the simulations.

Deb Bennett, CSUSM’s nursing simulation director, has brought her expertise to SLP to aid in the development and execution of the simulations.

Bennett said simulation methodology is a case or scenario developed in a real-world situation that allows students to work with either a human actor or a high-fidelity mannequin to experience certain situations they might face in the real world.

“It’s a safe environment for them to learn,” Bennett said. “Students love it. They always want more, so we’re always looking at different ways that we can implement more simulations and more scenarios.”

Lori Heisler, the SLP department chair, said they want to integrate simulations across the entire curriculum. The simulations give students an opportunity to learn in a low-stakes environment while receiving immediate feedback that helps them learn from their mistakes.

“We’re there to help coach them through and help them through this learning environment before they have to go out in the real world,” Heisler said.

Count BreeAnn Montes Ayala among those who credit the simulation program for helping them thrive in the working world.

BreeAnn, who graduated from CSUSM last spring, is a speech-language pathologist for Escondido Union School District. She said she was pleasantly surprised by the authenticity and effectiveness of the simulations, also noting that it provided the opportunity to collaborate with other disciplines.

“Helping a student realize their fullest potential is a daily task and requires a team effort,” BreeAnn said. “I consider myself fortunate to have participated in this simulation as it was one of the most authentic experiences I have taken away from my graduate/academic career.”

Bennett said the simulation program is continuing to grow. She is training SLP faculty the process of writing cases for students to go through the simulations.

“The key is realism,” Bennett said. “We go in and say, ‘This is your client, this is your patient. Go in and take care of them.’ ”

The realistic representation of patients by the actors impressed Erica, particularly for a simulation in which actors portrayed patients with Parkinson’s disease. The actor with whom Erica and her partner worked never broke character, even exhibiting the trembling one might see from a Parkinson’s patient.

In a different simulation, students from the School of Nursing portrayed patients, which provided another excellent perspective for the SLP students. Erica noted that the language used to communicate varies widely depending on whether they’re speaking with a patient, parent, doctor or nurse.

Nursing students provided feedback after the simulation about the type of information nurses would want in a hospital setting, which proved invaluable to the SLP students.

“That really helped to prepare me for when I went into my hospital placements,” Erica said. “When I started talking to the nurses in the hospital, I wasn’t as nervous. When you’re in the medical setting, you have this sense of pressure on you. All the simulation experiences for the medical side was really helpful in relieving a lot of that pressure.”

Bennett and Heisler both noted that the simulation experience offers an important opportunity not only for SLP students, but for students in other areas such as nursing and social work to gain a greater understanding of everybody’s role in treating patients.

“You don’t work in a silo when you’re out in the real world,” Heisler said. “This is good for the students. We’re trying to really model the real-world experience of collaboration and inter-professional education because that’s what really happens in the school setting or the hospital setting.”

Norman was in an intensive care unit for almost a month. He was eventually moved to a rehab center and suffered another stroke six weeks later.

The strokes left Norman with aphasia, a communication disorder that can cause speech and language difficulties, among other issues.

But the Bishops have found a measure of relief through Cal State San Marcos’ Speech-Language Clinic.

“It’s been a blessing,” Alice said. “Norman’s evaluation scores have really improved a lot.”

The Bishops found CSUSM’s Speech-Language Clinic through a recommendation from Norman’s speech therapist at an outpatient center in Oceanside.

CSUSM graduate students work with clients under the supervision of state-licensed and nationally certified speech-language pathologists. The free clinic provides services to people with neurological impairments to help improve speech, language and cognitive skills.

“The students are extremely well prepared,” Alice said. “They’re really positive and friendly and make you feel welcome. They do a great job.”

Laura Coca, one of the clinical supervisors along with Decemna Tang, said the majority of the clinic’s clients are people who have had a stroke or traumatic brain injury, have gone through acute rehab and their insurance has run out.

“They usually have 10-15 speech therapy visits, and for someone who has had a major stroke 10-15 visits isn’t going to get you too far,” Coca said. “So they come to us and our students do a full assessment on them. Then the students do traditional speech therapy with them. It’s a great community service.”

Clients visit the clinic for two-hour sessions on Tuesdays and Thursdays during the fall and spring semesters and attend daily during the summer program.

Twelve students work in the clinic each semester during the academic year and six in the summer, each working 80 contact hours.

“So many clients really feel like they are giving back to the students,” Coca said. “They can participate in this community situation where they’re also giving back and helping the students learn.”

Chelsey Johnson is one of those students. She worked with Tony Munoz at the clinic during the summer session that recently ended.

Munoz suffered a brain injury in April 2009 when he was thrown from a horse and then kicked in the head. Marisol Munoz, Tony’s wife, said he has undergone 12 brain surgeries and been in multiple comas, including one that lasted five months.

“The students really are involved,” Marisol said. “Chelsey knew right away what he needed to do and the things he likes.”

The clients receive individual speech therapy at each visit followed by group sessions that include a variety of activities.

One of the summer session group activities included a series of art-healing workshops led by Marilyn Huerta, a public affairs communication specialist in CSUSM’s College of Education, Health and Human Services.

The art workshops were interactive projects that helped clients and students communicate with one another. Clients completed tasks and then reflected by addressing questions such as why they selected certain colors and what the artwork means to them.

The projects included a small personal painting, painting a mask that described how they felt and a group project in which they painted a canvas together.

“Art uses another area of the brain, so it’s another way for the clients to express themselves,” Coca said.

Alice Bishop said the sessions have had a positive impact on her husband. She said he also has benefited from the connections made through the clinic.

“Just through their knowledge with what’s happening in the community, it’s opened up a lot of things for us,” she said. “The socializing with other people who have been through the same type of things, they’re so understanding. It’s like a camaraderie within the group.”

The clinics are equally beneficial for the students.

“When you get to apply your knowledge and interact with the clients, that’s what makes it rewarding and makes all of the classwork worth it,” Chelsey said. “The whole environment of the program is really positive and supportive and helpful.”

Professors who work closely with the Institute say integrating curriculum from different disciplines—also known as interprofessional education—is common sense. Suzanne Moineau, a speech-language pathologist and chair of the Department of Speech-Language Pathology at CSUSM, is among them.

“Quality of life is a central element of what we’re teaching in speech-language pathology, and palliative care is all about improving quality of life in individuals with chronic illness and their families,” said Moineau. “Most health care professionals at one point or another work with people with chronic conditions, so palliative care is critical.”

Moineau has been supportive of the California State University Institute for Palliative Care since it was established at Cal State San Marcos three years ago, and she served on a planning and implementation committee that took the early lead in planning for activities specific to the CSUSM campus. The Institute is a statewide initiative to educate current and future health care professionals, as well as community members, to ensure that patients who are living with serious or chronic illness and their families have access to palliative care. The California State University Institute for Palliative Care now includes centers at seven CSU campuses.

Palliative care has been shown to extend the life of a patient, improve his or her quality of life and reduce stress on caregivers and families, and Moineau was among the faculty members from four different departments of the College of Education, Health and Human Services at CSUSM who collaborated last year with consultants from the California State University Institute for Palliative Care to pilot, the Palliative Care Interprofessional Experience for Students, an interprofessional education program with a palliative care focus. Using the framework developed by the Institute, over several months, faculty from the School of Nursing and the Departments of Kinesiology, Social Work and Speech Language Pathology developed two palliative case studies based on actual patients with chronic obstructive pulmonary disease and traumatic brain injury.

“At the Institute we rely on faculty to work with us to integrate palliative care interdisciplinary practice into student learning” said Helen McNeal, executive director of the CSU Institute for Palliative Care. “We are grateful to the faculty and students at CSUSM for being the pioneers on this project and for being such dedicated supporters of our work, right from day one.”

Sixteen students then participated in interprofessional team activities, including a problem-based learning component and simulated patient/family interviews. CSUSM faculty and Institute consultants will discuss the project in detail during the Second Annual CSU Palliative Care Symposium scheduled for Oct. 6 and 7 in San Marcos.

Molly Abbott, who graduated from CSUSM last spring, took part in the interprofessional education project. Now she’s a speech pathologist at Scripps Memorial Hospital in La Jolla.

“My understanding of palliative care prior to the IPE project was limited,” Abbott said. “I thought palliative care was confined to hospice or end-of-life care. Taking part in the project showed me that palliative care goes far beyond that and is really about improving the quality of life for any patient with any chronic condition. It’s all about comfort care.”

An example of how palliative care works can be found at the CSUSM Speech-Language Clinic where graduate students—under the guidance and supervision of state-licensed and nationally certified speech-language pathologists—are incorporating palliative care in serving people with neurological impairments to improve speech, language and cognitive skills.

Wrote one client in the clinic’s newsletter, The Wave:

“Now, in my third semester of being a client at CSUSM, I am living much more independently than before. I can now cook a meal for myself (healthier and less expensive than always eating out!), and through being aware of how I handle my divided attention, I can accomplish more things. Therefore, I can keep up with the speed of life.”

Forward Together: The Critical Need for Palliative Care

The need for palliative care is reaching critical proportions. By 2030, 1 in 5 Americans will be over the age of 65, and 90 percent of Americans will have at least one serious or chronic condition. Now, Cal State San Marcos is raising funds through its historic campaign to support the Institute in addressing the critical shortage of nursing, social work, spiritual and other professionals with palliative care skills and training—and to refine the model being developed locally for replication at other interested universities across California.

Sharon Hammill, a CSUSM professor of psychology who serves as faculty director for the CSUS Institute for Palliative Care at Cal State San Marcos emphasizes the case for support.

“We need to focus on educating both the current and future health care workforce so that everyone who needs palliative care will be able to get it,” she said. “By integrating palliative care into the curriculum for health care professionals, in addition to broad-based integration across the curriculum in other disciplines, we are training future doctors, nurses and social workers in palliative care practices, as well as educating consumers of health care services.”

To learn more about Forward Together: The Campaign for California State University San Marcos and how you can help solve critical issues through the CSU Institute for Palliative Care or other initiatives, visit: www.csusm.edu/forwardtogether.

“Earning initial accreditation reflects the department and University’s commitment to the implementation and maintenance of rigorous performance standards and in providing exceptional education to students in our service region,” said Suzanne Moineau, chair of the Department of Speech-Language Pathology.

The CAA holds graduate education programs to 30 standards that cover a broad range of requirements over the administrative structure and governance, faculty, curriculum, students, assessment and program resources. Initial accreditation is a five-year process that includes a step-wise progression towards full implementation and maintenance of the 30 programmatic standards. Programs are required to submit annual reports reflecting progress towards full compliance and in the fourth year undergo a site visit prior to receiving accreditation.

“Strengths of the program include the relationship that it has with the community and the array of clinical experiences that we offer our students,” said Moineau. “This summer the department ran 11 free clinics, which provided about 2,300 hours of free speech, language and swallowing services to 137 community members. We are just underway on a $1.25 million grant to train SLP graduate students for practice in high-need school districts with a special emphasis on the assessment and treatment of communication and swallowing disorders in children with craniofacial anomalies.”

The SLP program in the College of Education, Health and Human Services boasts a 100 percent pass rate on the Praxis national examination as well as a 100 percent employment rate for those graduates seeking employment.

“Thanks to the wonderful CSD program at CSUSM,” said Debra Stoermer, SLP Masters graduate, “I began my career in speech-language pathology with a strong foundation, confident in my skill-set. Dr. Moineau and her colleagues have created a comprehensive program that will fully prepare students for careers in both medical and educational settings.”

Under the supervision of CSUSM faculty members, students pursuing a Master of Arts in education with an option in communicative sciences and disorders offer one-on-one and group therapy services. This fieldwork is an important part of training for students in the assessment and treatment of individuals with varying communication difficulties.

"The new clinic allows students to get the clinical training they need while providing a vital community service to adults with acquired communication and swallowing disorders," explained Mike Schroder, dean of Extended Learning at CSUSM. "Restoring speech and language skills is a major hurdle for people who have survived neurological injury or disease and this clinic provides both a high-quality educational experience for our students and a valuable service to members of our community."

The 1,700-square-foot facility is located at 135 Vallecitos De Oro, #D, on San Marcos' Furniture Row. To learn more about the clinic, visitwww.csusm.edu/el or call 760-750-4020.