The profession leaps forward into the future

By Vicky Boyd

Cindy Esquivas, MS Ed, MS, CCC-SLP, compares efforts to address diversity, inclusion, culture and bullying within the profession and California Speech Language Hearing Association to early childhood intervention to improve literacy. The results of literacy programs implemented several years ago are just beginning to improve outcomes, especially among underserved populations. But the changes didn’t happen overnight and are following a path for continuous improvement.

And Esquivias, a former high school teacher and current licensed bilingual pediatric SLP, sees the results of CSHA’s restructuring that began a few years ago finally coming to fruition. As a graduate student and student member of CSHA several years ago, Esquivias says she didn’t feel supported and didn’t see other members reflective of herself, so she let her membership lapse. But viewing CSHA’s ongoing efforts to change a pervasive culture prompted her to return as a member.

“This year with the changes that have happened, I felt I could have a voice, which is why I’ve started to become more active and more of an advocate for other SLPs to become members,” says Esquivas, also a CSHA Advocacy Committee member. “For an organization to make me feel like that is a positive indication, so I’m hopeful because they are allowing me a voice. Not everybody agrees with me, and that’s OK. Just the fact they gave me an opportunity to speak, for that to happen, I’m very hopeful since they are allowing multiple perspectives, which in the past hadn’t been listened to.”

Linda Pippert, MA, CCC-SLP, MBA and CSHA immediate past board chair, says the association as it was previously organized needed to evolve with the times.

Pippert says she’s encouraged by organizational restructuring that, for example, established term limits throughout the governance structure to allow an influx of new blood and new ideas, implemented board best practices and sought more collaboration.

“It’s getting people to try something new,” she says. “Again, it’s that openness to adapt and to listen to new ideas. CSHA doesn’t have to run like when I was a grad student. CSHA doesn’t have to run like when I was just starting on the board as a treasurer, because we’re in a different world and I don’t expect it to run like it did back then. I’m going to expect that it needs to change.”

Enlarging the CSHA tent

CSHA began a renewed level of organizational and professional introspection in the fall of 2018. Many questions drove that work, including the need to better understand why CSHA membership has over the years hovered around 3,000, while the potential membership in the state is approximately 27,000 professionals. Gaining insights as to why that number hasn’t risen over the decades was and is seen as critical to the association’s future of service to the profession.

The bottom line was that the tent needed to be expanded to include everyone in the community.

A broad swath of the CSHA community was involved in that process, starting with a two-day workshop that included veteran members, those new to leadership in the association, students, nonmembers and consumers. A group of 30 individuals comprised the Brand Strategy Task Force Workshop and offered frank insights into the association’s strengths and challenges. Issues across the organization were discussed, including tough topics like diversity, inclusion and culture.

The bottom line was that the tent needed to be expanded to include everyone in the community. That meant creating the space for all voices to be heard, growing member value, increasing communication and awareness of the many ways CSHA serves its members and the broader community, and more.

That work was built upon throughout 2019 as new board policies were adopted and the board launched a new strategic planning process. At its September 2019 meeting, the board engaged in a two-day working session with diversity and inclusion experts, and that work has inspired subsequent efforts. This includes the launch of virtual CSHA Convos in June 2020 and the board’s adoption at its June 2020 meeting of two strategic priorities: fiscal sustainability, and diversity, inclusion and culture.

Frank Convos

The CSHA Convos organically evolved from that work as a way to create, according to the association’s website, “…a safe place where some of the most-needed conversations can happen … a place for insights, knowledge and awareness. CSHA hopes to elevate the unique and upcoming voices in the field, creating the opportunity for learning from the lived experiences of professionals who are navigating through these challenging times.”

Five Convos took place between June 2020 and February 2021, with more on the horizon.

“There has been some backlash to the CSHA Convos,” says CSHA Board Chair Raquel Narain, MA, CCC-SLP, BCBA, “from members who see our efforts to include more people in the CSHA tent instead as a way to exclude those who were already inside. That’s absolutely not the case.”

Narain says the association genuinely listened and heard from people who felt excluded over a period of years. “The only way to make people feel included is to actually include them,” she says. “Making the tent bigger and becoming stronger as a result is the goal.”

The CSHA Convos have not been recorded so participants feel more comfortable to speak openly about their experiences. “There have been many emotionally powerful and moving experiences and insights shared in the Convos,” Narain says. She adds that some individuals opted out of participating, however, because of the risk of going public with their perspectives. In fact, several individuals declined to be interviewed for this story for the same reasons.

Superiority complex?

During the third Convo, a diverse panel with varied seniority and authority shared personal experiences and discussed possibilities for cultural change in the field.

They discussed what is considered by some to be a culture of superiority and bullying that many in the field experience in their graduate training, the workplace and administrative settings.

While acknowledging that the field is imbued with many dedicated individuals who care genuinely about others and are caring and compassionate to those they work with, some comments reflected otherwise and pointed to a need to look more deeply at the culture within the profession.

“Many supervisors actually yell at their CF or master’s student in clinic, and in front of others,” one participant commented. “Many blatantly shame the CF right in front of clients and/or colleagues in a meeting.”

Another participant commented: “I have seen them treated very badly by those they are there to help. Instead of treating the relationship as a collaboration; I have seen SLPs act more like their boss than their colleague and as someone who is there to help them.”

Bullying was a common theme in the first round of CSHA Convos and was identified as a continuing challenge in the SLP and audiology professions. A handful of Convos participants – from graduate students and clinical fellows to SLPs and SLPAs – spoke of how they were “targeted.”

University students and those in their clinical year also may feel bullied by professors who hold their grades and possibly their livelihood in their hands. As a result, they may be hesitant to report the bad behavior for fear of repercussions.

One of the themes was a sense that while CSHA members may be brilliant in their work and very intelligent people, perhaps not all of them are well versed or equipped with the skill set to address issues of intimidation and bullying.

Pippert says bullying is a form of harassment or abuse that won’t be tolerated. That message is contained in a code of conduct CSHA updated as part of its restructuring in 2019, she says. In addition, universities and workplaces should provide training to enhance soft skills, such as interpersonal communication and supervision.

Pippert says students, SLPs and SLPAs need to learn who within their department they can feel safe talking to about this possible abuse of power.

Those being bullied may be hesitant to report the activity, since they feel intimidated or threatened. They may even think their grade or job is on the line. To help break the cycle, she says colleges and workplaces need to empower people with the knowledge they need to recognize bullying and how to report it.

During the past 18 years as an SLPA, Shelley Mizubayashi, who currently works in schools in Long Beach and Lakewood, says she’s been bullied a few times. Each time she talked to her supervising SLP to let them know what was going on and also spoke directly to the person in a diplomatic way. That seemed to address the issue.

“One thing I personally think is SLPs in general as a field don’t like to make waves,” says Gabriela Simon-Cereijido, PhD, CCC-SLP, who . “Sometimes some supervisors may be older and they may not have kept track with the latest developments or the differences with non-English speakers. Maybe the supervisors are not aware of these, so there may be some miscommunication.”

Esquivas adds, “I think there are certain professors who are really, really great educators. There are some professors who are great researchers, and there are some who are really great at both. What we need are more educators within our field.”

Faces of diversity

Some other Convos have addressed diversity and inclusion within CSHA and the profession. For Gilda Dominguez, MS, CCC-SLP, the Convos Zoom format helped illustrate how CSHA was promoting inclusivity and diversity, and also providing a safe platform for communication.

“I see faces of diversity, and this is a message in itself and a very positive message,” says Dominguez, a Convos panelist and former CSHA District 7 director. “What’s really important is to be able to communicate without judgment. I feel that CSHA is fostering that environment of collaboration and community.”

Simon-Cereijido has spent more than 11 years as a professor teaching communications disorders at California State University, Los Angeles. She’s noticed changes in the student body that better reflect Southern California demographics, with an increase in Latinx and Asian representation.

As equity coordinator in the Communications Disorders Department, Simon-Cereijido is actively involved in committees at the department and university level addressing diversity, inclusion and equity. During the summer of 2020, she says she was heartened to see SLP and audiology students on their own formed a diversity, inclusion and equity committee.

But encouraging students of color to apply for programs may be a challenge because they may not be familiar with SLP and audiology fields, they may not have the background or they may be the first in their families to attend college.

“They have no idea it’s so competitive, so the system is set up in such a way that it’s really hard for them to get admitted,” says Simon-Cereijido, who was also a Convos panelist.

At Cal State Los Angeles, for example, she says 400 students recently applied for 24 openings, putting untold stress on applicants. At times, the competitive atmosphere may create some hostilities between those accepted and those who were declined. But she says she repeatedly emphasizes to students that they be more collaborative when dealing with peers.

Esquivias says she was also glad to see some universities moving away from basing acceptance solely on certain standardized tests. In their place, they have added personal interviews to get to know prospective students – a move designed to bring more equity to the process.

“So much of what we do as professionals has to do with the personal interactions,” she says. “We need to be effective and great communicators and bring different approaches to the table.”

Simon-Cereijido says she’s proud of the progress her department has made in encouraging students from underrepresented groups who have the persistence, integrity and passion to apply. And she hoped a bill currently in Congress will create a federal grant program for students in certain health-related fields, including SLP and audiology, and offer more opportunities to enhance diversity.

CSHA, through the work of its Advocacy Committee and legislative advocate, continues to push for public policies that support undergraduate and graduate speech-pathology and audiology programs and increasing the number of graduate program slots, Pippert says.

Despite the gains, many college SLP and audiology programs still lack a diverse student enrollment, prompting CSHA to advocate for diversity training as a graduate requirement. While not a replacement, the classroom study is designed to help students recognize the differences among the patients and colleagues with whom they may interact.

Having more diversity among college educators within the field is another challenge facing the profession.

Many graduate students report not having any interactions with an instructor or professor of color. That’s one reason why Esquivas encourages those with a passion for teaching, especially from underrepresented groups, to consider academia.

Simon-Cereijido agreed, saying it starts with having diversity among students.

“If we don’t have many graduate students of color, we cannot get the Ph.D. students,” she says.

During another Convo, several speakers who identified as Black, Indigenous and People of Color pointed out that they didn’t see fellow students or SLPs like themselves, which can be off-putting.

Some participants also talked about how the makeup of the profession didn’t reflect their patients, who bring diverse ethnic, racial and gender identity backgrounds.

Shelley Mizubayashi, a SLPA who works in schools in Long Beach and Lakewood, says she’s seen a slow evolution within the profession, but it isn’t there yet.

“I have seen some improvement over the years, but would love to see more of a diverse population of SLPs and SLPAs,” she says. “Also, I would love to see more men in the field.”

Although Pippert says that while the change may be slower than some would like, she’s encouraged when she visits Southern California college campuses. The diversity among students enrolled in SLP and audiology programs is shifting to be more representative of the communities in the region.

“What I’ve been seeing in terms of graduate program responses has been very positive,” she says. “It seems to be moving in the right direction, so I know just looking at the state of California, there are several universities that have started to make changes within the university to the programs themselves that are reflective of the types of changes that CSHA is trying to instill within the organization and within the profession in California.”

Breaking down silos

Bullying, diversity and inclusivity – or a lack of diversity and inclusion – may be related in some workplaces.

In a previous experience early in her career, “My voice was silenced,” Dominguez says. “Silencing voices is not conducive to inclusivity. It’s not conducive to diversity because we need to provide platforms and environments where they can safely come to someone and say, ‘I am not comfortable with the environment. I am not comfortable with the situation. I am not comfortable with what’s happening to me right now.’

“Walk through the situation and give a different perspective.”

In her current position in a medical setting in the San Gabriel Valley, Dominguez says she works in an environment where dismantling silos is a focus and collaboration is the norm.

“So, if supervisors are striving to be compassionate, they’re going to work on providing you a compassionate work environment,” she says. “Working in an organization that focuses on the same vision and values you have is important.”

Having an environment where people are able to have a voice and others listen also leads to more inclusivity and more acceptance of diversity, says Dominguez. That, in turn, leads to more workforce engagement and employee satisfaction.

“I think it starts from leadership, but your peers need to take care of each other, too,” she says. “If you see someone being excluded from an activity, invite them. Reach out.”

Making the effort to include more people in the tent, “whether at work or in your association, only helps us all be stronger,” Narain says.

Vicky Boyd is an award-winning journalist who has spent more than three decades writing for newspapers, magazines and digital publications.