“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.”

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“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.

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.