Accelerating Initiative Case Briefs
Arizona State University College of Nursing and Health Innovation
Interprofessional by Design™: Meeting at the Crossroads to Accelerate Leadership Competency and Readiness for Transition to Interprofessional Practice
Since its inception, the Student Health Outreach for Wellness (SHOW) has aimed to provide meaningful interprofessional experiences to the current and future health care work force, and also address pressing needs in the local community. As one of sixteen awardees of the Accelerating Interprofessional Community-Based Education and Practice Grant, SHOW was given the opportunity to extend its efforts even further into the community. With funding provided in October 2016, and with support from the National Center for Interprofessional Practice and Education, SHOW expanded the services of the SHOW Clinic to Crossroads, Inc., a large residential substance use recovery center in Phoenix, Arizona. The grant also funded the development of a novel interprofessional leadership training available to all students involved with the initiative.
So far, the initiative has had some tremendous results. Since the clinical collaboration officially launched in February 2017, SHOW has served over 200 residents through the care management team and over 200 residents and family members through health promotion teams. Prior to the collaboration, residents at Crossroads were generally forced to leave the facility to take care of minor and moderate health concerns. This is particularly risky because when residents leave the campus during treatment, it heightens their exposure to relapse. Sometimes, residents do not return. In the six months the interprofessional teams have been active, Crossroads has seen a trend in increased program completion rates. They are also seeing fewer incident reports and higher patient satisfaction rates. Having interprofessional care management and health promotion teams at their facilities has helped Crossroads leadership keep residents focused on what is most important: progress towards their recovery.
The impact this collaboration has had on students is no less impressive. This project has engaged a variety of graduate students studying family nursing practice, psychiatric nursing practice, physical therapy, social work, occupational therapy, and the science of health care delivery. Graduate students are currently working on improving discharge planning, sponsorship programs, and quality improvement activities. Health promotion teams across all Crossroads sites have conducted comprehensive assessments and provided residents with education on job skills, pursuing employment, leisure management, and coping strategies. Students have described the experience as a unique and necessary addition to their health professions education. One student stated “It works. This model of care really works,” when considering the implications of community-based interprofessional practice. Another student who has taken on care coordination and management responsibilities has expressed increased comfort leading interprofessional teams.
We will attempt to define the impact this initiative has had on students by evaluating their improvement on key interprofessional competencies. The grant is also funding the development of an interprofessional leadership program. Our goal is to capitalize on this unique experience by creating a leadership program that will integrate contemplative learning and practice with a focus interprofessional education/collaboration competencies, and key leadership competencies. The innovative leadership program will incorporate both the art and science of team development and we hope it will effectively prepare students to be leaders not only in interprofessional care, but across all aspects of health care.
The project has already proven that this integrated and interprofessional service model is an effective way to provide gap services for those recovering from substance abuse. More broadly, this initiative also addresses critical issues in health care, population health and the Triple Aim. As similar models become a standard of practice across the health system, SHOW and Crossroads’ partnership in a new and innovative practice model is ahead of the curve. The efforts from this grant address social determinants of health, close service gaps, and most importantly represent a dramatic paradigm shift in health care. By allowing us to extend SHOW’s efforts into a community setting, the grant has allowed Crossroads to remain the most affordable substance use recovery center in the Southwest.
This initiative is both timely and necessary. Just a few months ago in July 2017, Arizona’s governor declared a state of emergency over the opioid crisis. With support from this grant, SHOW and Crossroads are able to join other key stakeholders in reducing the negative effects stemming from this crisis. One of the most powerful things this experience has illuminated is the need for interprofessional practice to address the needs of this population.
Substance use disorders are all encompassing, and their treatment requires expertise from multiple health professions. Understanding exactly how disciplines not traditionally involved in the substance abuse recovery process, such as physical therapy and speech and language pathology, can massively improve how the entire health care system addresses the opioid epidemic.
As a result, there is immense interest in service expansion and diversification. SHOW and Crossroads have identified many opportunities for growth, including a faculty-practice funding model, expansion into all of Crossroads’ facilities, and engagement of additional health professions. As SHOW’s Program Director, Liz Harrell, says, “It takes a village to transform an idea into a functioning practice, but with excellent village partners, it is worth it.”
University of California, San Francisco School of Nursing
New Roles and Healthcare Teams Tackle the Mental Health Care Crisis at University of California, San Francisco
Untreated mental illness can be devastating to individuals, families and communities. These conditions often further complicate other health problems and are extremely expensive for our healthcare system. At the same time, as the US population ages and grows, we are facing an alarming shortfall in the number of providers to care for individuals with mental illness.
UCSF is in a unique position to explore a unique, promising solution by developing partnerships between two groups of qualified professionals on the front lines of mental health care—psychiatric nurse practitioners and clinical pharmacists. In California, both professions are able to order and manage medications, making the state an ideal environment for them to step into expanded roles.
Psychiatric Mental Health Nurse Practitioners (PMHNP) provide primary mental health care to patients seeking mental health services in a wide range of settings; these nurse practitioners have advanced training and can now perform much of the patient care and management previously reserved for psychiatrists. Pharmacists are increasingly being trained and utilized as vital members of a mental health care team, managing the complex psychotropic drugs used. Because mental illness often occurs alongside other health conditions (including diabetes, heart disease, chronic pain, and many others), it is a gift to the health care team to have a qualified pharmacist monitoring and in some cases, managing, the complex drug interactions for multiple disorders.
In California, over 2 million people are estimated to suffer from serious psychological distress each year, making it one of the top five serious health concerns affecting the population. Alameda County, across the bay from the University of California San Francisco (UCSF), is an area of stark contrasts, where extreme wealth sits alongside staggering poverty. The homeless population is increasing rapidly, with 5,629 people living on the streets in 2017. Access to mental and behavioral health, particularly for this vulnerable population, is a challenge that community services throughout the county face daily.
The National Center for Interprofessional Practice and Education (NCIPE) selected UCSF’s School of Nursing for an Accelerating Interprofessional Community-Based Education and Practice program grant to support their practice and research into this model. UCSF’s project starts upstream, training School of Nursing and Pharmacy students together. Once ready to add value to community mental health settings, the students are sent out in teams of two for hands-on clinical experience. Chelsea Landolin, assistant clinical professor in the UC San Francisco School of Nursing’s Department of Community Health Systems (CHS), is the project lead for the grant-funded program. This project is funded as part of the Accelerating Interprofessional Community-Based Education and Practice Grant, supported by the National Center for Interprofessional Practice and Education, in collaboration with the Robert Wood Johnson Foundation, the John A. Hartford Foundation, the Josiah Macy Jr. Foundation and the Gordon and Betty Moore Foundation. Landolin is joined by co-investigator Rosalind De Lisser in the School of Nursing and Patrick Finley, Professor of Clinical Pharmacy and a Board Certified in Psychiatric Pharmacy (BCPP). The project would not be possible without expertise and strong commitment from the community mental health providers who care for psychiatric patients while helping train the next generation of psychiatric professionals. Clinical pharmacists Seth Gomez and Charles Raynor, both from Alameda County Behavioral Health Care Services, are co-investigators and a vital community connection.
The project is currently preparing five or more 1st-2nd-year students from the School of Nursing’s Psychiatric/Mental Health Nurse Practitioner (PMHNP) program with the same number of 2nd-3rd-year students from the UCSF School of Pharmacy in a variety of learning activities and environments designed to increase collaboration and communication before they head into the field. Community-based organizations, including Alameda County’s Bonita House and Alameda County Behavioral Health Care Services (ACBHCS), have agreed to accept the nursing-pharmacy student pairs into their agencies to learn on-the-job and provide care. The students will be overseen by pairs of preceptors from the schools of nursing and pharmacy. In total, the project aims to intensively train 10 or more students in this model during the grant period and send five student dyads into community clinics inside and outside of Alameda County each year. In addition, many more students (25 or more) are benefiting from one component of the program, a interdisciplinary journal club that is student-led but facilitated by a clinical pharmacist, which occurs twice monthly all school year and is open to all interested students from both schools.
The project is gaining traction and momentum, and more community partnership possibilities are beginning to emerge. Landolin reports that as they tell the story of how this model can impact the psychiatry provider shortage, excitement builds. For example, the Director of Healthcare for the Homeless in Alameda County has expressed interest in creating opportunities to work together. Many other local community sites are considering hosting student teams as well.
The ultimate aim is to combat shortages in the mental health and psychiatric workforce with the combined strengths of PMHNPs and clinical pharmacists. With support and coaching from the National Center and peer sites across the country, UCSF is poised to demonstrate the power of teams in addressing vital community needs.
University of Colorado College of Nursing
Pharmacy, nursing students provide home visits to elderly
The IPE Student Home Visit Project offers assistance, assessment, education
A new project at the CU Anschutz Medical Campus pairs pharmacy and nursing students to offer home visits to the elderly, providing a health team that acts as a liaison between the clinic and the patient.
The Interprofessional Practice in Education (IPE) Student Home Visit Project sends a School of Pharmacy student and College of Nursing student to conduct screenings, provide myriad assessments and educate patients on health topics ranging from proper nutrition to drug management, all in the comfort of their home.
The collaboration – launched in January with seven nursing and seven pharmacy students – is the brainchild of Eric Gilliam, assistant professor in the Department of Clinical Pharmacy in the Skaggs School of Pharmacy and Pharmaceutical Sciences and director of clinical integrations at the CU Center for Interprofessional Practice and Education, and Amy Barton, professor, Daniel and Janet Mordecai Endowed Chair in Rural Health Nursing and associate dean for clinical and community affairs in the College of Nursing.
“We’re giving students new interprofessional training through extracurricular opportunities, community engagement and volunteerism, as well as when they complete their clinical training,” Gilliam said. “They are working with other professions and health profession students intentionally and collaboratively.”
The young project is already making a difference, Gilliam and Barton said. They cited a case where a patient had gone to the emergency room and had been taken off his hypertensive medications, they explained.
“When the students visited him his blood pressure was elevated,” Barton said. “It was not a good situation and we were able to get him into the clinic the next day and get him back on his meds.”
The project works through the Sheridan Health Services Clinic, a nurse-led federally qualified health center and a faculty practice institution for the College of Nursing. The clinic holds time open each day for cases that need more immediate attention.
“What we’re able to do is screen our older adult patients for those who could benefit from a home visit and dispatch a student dyad to go and interview them in the home,” Barton said, noting one of the fundamental purposes is to focus on health literacy, an issue for many populations across the country.
“A variety of people (older adults, low income, those with limited English proficiency) just don’t necessarily understand their plan of care. Our thought was that if they had an
unhurried visit within their home environment that we could help them with self-management of whatever their condition might be,” she said.
A lot can be learned from a home visit and the students are enthused.
“The students say, ‘It makes so much more sense now.’ They start learning a lot more about the patients, so patients really enjoy this and our students feel like they’re doing good work,” Gilliam said. In addition, subtle observations the students make in the home can make a big difference in overall patient care.
“The patients’ environmental issues are apparent and mental health issues are more likely to emerge,” Barton said. “Their social factors, like who’s in the home, who’s smoking in the home when it’s not in the patient record. Do they really understand their plan of care and their meds?”
The process entails students calling the patient in advance and asking if it’s OK to visit. The nursing students take vital signs – heart rate, blood pressure, temperature – and ask general questions about their quality of life. Depending on the answers, the students ask more specific questions until they have a strong indication of where the patient stands and what he or she might need.
“They talk about pain or any issues with pain management,” Barton said. “They’ll talk about mood, how they’re feeling if they haven’t been feeling their best lately, once again that triggers another round of assessments.”
The pharmacy students ask the patients to bring out all of their medications, supplements, and over-the-counter remedies.
“They’ve asked about going to see their medicine cabinet, but have not had a lot of takers on that,” Barton chuckled. “So that in and of itself was an interesting finding.”
“They will go through their medicine, ‘What is this? Why do you take it?’ and attempt to assess the patient’s understanding,” Gilliam said. “We want to focus on medication safety within the household, not just the right prescription for the moment.”
As with many projects and programs at the CU Anschutz Medical Campus, the students are not only participating in the program, they’re helping to build it.
“They have really been open to a quality improvement approach,” Barton said. “In our first set of visits, we gave them a whole series of assessments and said ‘Here, try this and let us know what works, and they were good with that. They really embraced the opportunity to help mold it, and that will continue as we move forward.”
The students took ownership of the project even before they went for their first home visit.
“Even before the pharmacy students went out initially, they were asking, ‘Do we have pill boxes we can give out?’ And we’re like ‘Well there’s something!’” Barton said. “It is more collaborative than what they would have guessed,” Gilliam said. “More-so than if they were in a traditional clinic -- just going into the room together. Having the extra time together, having the conversation with the patient for a longer period of time, it’s an important element.”
Even the trips to and from the home are important to the project, he said.
“They do go in tandem and that has been beneficial not only for safety purposes, but also they prepare for the visit on the drive over, and they debrief on the way back before they get back to the clinic,” Gilliam said. “That has allowed them to establish rapport, be able to think through the visit, and prioritize things before they get there and then compare notes on their way back.”
“The key is making sure we close the loop, so we have a coordinator at the clinic that the students report back to, and then the students also document a note in the patient chart about what they found,” Barton said.
The project was funded through the National Center for Interprofessional Practice and Education, located at the University of Minnesota, which itself is funded by several foundations. Their grant was $50,000, with the College of Nursing providing matching funds.
“We strategically started this program with our own students in our own clinic and I think what we’re doing is creating a model Eric is going to be able to take to other clinical agencies to say, ‘This is how this can work,’” Barton said. “That’s the key, being able to collect data early on it so we can facilitate the spread of this model of care for our students to other clinics throughout the metro area.”
Denver metro area has a lot of federally qualified health centers with lots of patients in need. “I think the way we streamlined the model will facilitate expanding these opportunities for our students,” she said.
“Leveraging the interprofessionality of the project and giving students the opportunity to really practice what they’re learning here on campus about the values of interprofessional education is important to us. Students see first-hand that working together can help improve care for patients,” Gilliam stressed. “The motivation is not just do of IPE for the sake of IPE, but really get involved in meaningful patient care as a team.”
Creighton University College of Nursing
Creighton University: True interprofessional care delivered
OMAHA, Neb. (Sept. 12, 2017) –
A new ambulatory care center has been created through a partnership of CHI Health and Creighton University. The center opened in January 2017 with the vision of creating a learning laboratory for Interprofessional Education (IPE) and Interprofessional Collaborative Care (ICC) while serving the community.
Creighton, in partnership with CHI Health, is one of 16 recipients and the only Jesuit institution to receive the Accelerating Interprofessional Community-Based Education and Practice Grant supported by the National Center for Interprofessional Practice and Education, in collaboration with the Robert Wood Johnson Foundation, the John A. Hartford Foundation, the Josiah Macy Jr. Foundation and the Gordon and Betty Moore Foundation. The intent of the funding was to support projects that would accelerate models of sustainable interprofessional care through the collaboration of health professional education and community partnerships. Creighton is using funds from this grant to support the development of a clinical and educational model of interprofessional collaborative care at the new CHI Health-University Campus.
Uniquely, Creighton is one of the only grant recipients implementing a collaborative care model in a relative value unit (RVU) clinic. The collaboration between CHI Health providers and Creighton educators seeks to show that collaborative care in an RVU model can have positive outcomes for the patient, the system, the providers, and the students.
Receiving this grant accelerated the need to hire and add a nurse practitioner to the collaborative care team which previously had been a missing role. “Nurse practitioners are increasingly taking lead roles in a number of clinical and educational health care situations,” said Catherine Todero, PhD, dean of the College of Nursing. “This grant and the project created by a dedicated group of Creighton health professions educators and clinicians reflects the pull toward a collaborative, team-based approach to caring for patients. I am excited about the grant and look forward to learning of the improved patient outcomes that will be accomplished.”
The work to create the team huddles, collaborative care planning processes, and pre-visit planning has truly been the work of the providers from all aspects and levels of care. The team shares the leads between all disciplines including behavioral health, diabetes educators, interpreters, medicine, medical assistants, nursing, pharmacy, physical therapy, occupational therapy, social work, and administration. An imperative part of the design was to have no one profession identified as the leader, rather there are champions from all professions that help to initiate huddles and start the collaborative care planning sessions.
Grounded in the values of a Jesuit, Catholic education and Catholic social teaching, both Creighton and CHI Health recruit students and professionals with a strong moral and professional commitment to social justice. The model of healthcare proposed as part of this grant aligns with the Triple Aim and the Nexus initiative by targeting improved patient satisfaction by providing access to multiple disciplines, thereby reducing the total annual cost of care for patients over time.
University of Hawaii at Manoa School of Nursing
University of Hawai`i at Mānoa – HIPEC Alliance working to help keep Hawai`i’s children (keiki) healthy through school-based interprofessional practice
A unique collaboration between The University of Hawai`i (UH) at Mānoa Hawai`i Interprofessional Education and Collaboration (HIPEC) Alliance and the Stanford Dole Middle School aims to reduce health-related middle school student absenteeism while providing health professions students community-based, primary care practice experience. UH is one of sixteen schools of nursing across the country to receive a RWJF grant as part of the Accelerating Interprofessional Community-based Education and Practice Initiative.
With support from the National Center for Interprofessional Practice and Education, the HIPEC Alliance builds on the well-established partnership between the Hawai`i Department of Health’s and the UH Mānoa School of Nursing and Dental Hygiene’s (SONDH) “Hawai`i Keiki – Healthy and Ready to Learn” SBHC program. This program has nurse practitioners housed in the 15 school districts in Hawaii to provide services to students. A primary goal of the “Hawai`i Keiki” Program is to keep students healthy so they can remain in school and actively engage in learning. Integrating an interprofessional collaborative practice (IPC) model in SBHC provides important opportunities for the SBHC nurse practitioners and school staff, and UH graduate health professions students and faculty to address unique and challenging issues of vulnerable groups of children, especially those with complex health care and socio-economic needs.
Stanford Dole Middle School is located in the Kalihi Valley on O`ahu. The school has a little over 800 students, many of whom are Native Hawaiian (NH), part NH, and/or Pacific Islander (e.g., from Micronesia) with some being recent immigrants to the State. There is a high rate of absenteeism at this school, which is one of the reasons that the HIPEC Alliance pilot is located there – to help reduce missed school days due to having to leave school to have a medical evaluation.
The HIPEC Alliance is a unique and dynamic IPC practice project for several reasons. The population of Hawai`i is the most diverse in the United States, thereby providing health care professions students and faculty opportunities to provide services to children from many different cultural and socio-economic backgrounds. This results in the students and faculty having to critically evaluate and develop plans that address challenging social and economic issues, in addition to complex health problems, while remaining sensitive to the cultural backgrounds of the children. Health care assessments and action plans are not solely taking place at the SBHC. When needed, and agreed to by parents, Dole Middle School children may have assessments by the team in their homes in order to develop recommendations for their care. The HIPEC Alliance project has direct involvement from the State’s Dental Director to guide the inclusion of preventive dental services for the SBHC and consider expansion of the project.
Other partnerships for the HIPEC Alliance are possible based on recent requests for the SBHC IPC practice model to be considered for the Home Project – a project that provides
care to Hawai`i’s homeless where they reside (i.e., in parks, shelters, churches) by UH Mānoa John A. Burns School of Medicine faculty and medical students. This request will expand the Home Project team to include faculty and advanced level nurse practitioner and clinical pharmacy students and dental care providers using an IPC practice model. This is an opportunity to have the IPC practice model grow to address critical health care needs of vulnerable groups in additional community settings. Finally, the potential involvement of other disciplines (e.g., nutrition, advance public health and social work students) is being considered as this initiative moves forward and grows within the community. The contribution of the faculty and students from these disciplines has the potential to increase access to care and other needed social services for some of Hawaii’s most vulnerable groups in several community settings.
The HIPEC Alliance project team has made encouraging progress in a short time. Mobilizing faculty, students and SBHC staff requires agreat deal of collaboration and cooperation on the part of everyone – not to mention patience and creativity when unanticipated challenges occur. Providing updates about the progress of the project to the UH CWHHS Interprofessional Committee, the Hawai`i Action Coalition, the faculty and students, our SBHC colleagues and the community is essential for the ongoing success of the project, as well for future expansion. Moreover, the funding from the National Center and the Hawai`i Action Coalition has significantly contributed to the acceleration of IPE and IPC practice for UH advanced health professions students and the further development of role of advanced practice primary care nurses in IPC practices serving vulnerable patient populations.
The University of Hawai‘i at Mānoa School of Nursing & Dental Hygiene (SONDH) is the premier nursing and dental hygiene school in the State of Hawai‘i. Located on the Mānoa campus, the only doctoral/research university-intensive institution in Hawai‘i, we are dedicated to improving health through education, research, and service. The School provides instructional, clinical and research activities to enhance the health and care of diverse populations in the State of Hawai‘i and the Asia-Pacific region.
University of Maryland School of Nursing
University of Maryland, Baltimore Expands Community-Based
Interprofessional Education Initiatives in Montgomery County
New $50,000 Grant from the National Center for Interprofessional Practice and Education “Accelerating Interprofessional Community-Based Education and Practice” Funds Schools of Nursing, Pharmacy & Social Work Programs in Montgomery County
The University of Maryland Baltimore Schools of Nursing, Pharmacy and Social Work and the University of Maryland Baltimore County School of Social Work are working closely together on a new project, bringing their faculty and students to two additional ambulatory clinics in Montgomery County to learn and provide care. The four schools already run an interprofessional education (IPE) clinic at one location in Montgomery County, and the grant has allowed them to expand their efforts to two more clinic facilities.
The project’s expansion also adds a new educational program to the list of those that provide team-based care in the interprofessional clinics. Now, faculty and students of the Doctor of Nursing Practice/Family Nurse Practitioner program are also seeing patients and learning interprofessional skills at these Montgomery County clinics.
“When healthcare disciplines work collaboratively, communication and teamwork are enhanced, leading to improved quality of care for patients,” explains Heather Congdon, PharmD, BCPS, CDE, assistant dean for the Universities at Shady Grove, co-principal investigator on the grant, and co-director of the Center for Interprofessional Education at the University of Maryland, Baltimore.
The Montgomery County clinics provide a unique opportunity for interprofessional learning experiences with real patients in the outpatient setting, according to Rowe. “Multiple barriers prevent IPE education in outpatient clinics versus the inpatient setting, including the fact that different healthcare disciplines aren’t all in the same place at the same time, fewer patients are available all at once, and there is often limited space and fewer resources,” Rowe says. “The most exciting part of this new initiative is that it allows our students to learn about interprofessional practice in the context of caring for real patients in the community-based primary care setting.”
Services provided by nurse pracitioner, nursing, social work and pharmacy students and faculty are complementary. Supervised by their respective faculty members, family nurse practitioner and undergraduate nursing students work with pharmacy students and social work students to provide health assessment, patient education, and care coordination services. Students work together to develop a plan of care to assist patients with self-management of disease processes. Patients referred to the IPE team often have uncontrolled diabetes and/or other chronic health conditions as well as psychosocial concerns exacerbated by poverty, lack of resources, lack of education and language barriers. The patients also benefit from the initiative’s expansion to two additional clinics, according to Congdon, who also is an associate professor at the University of Maryland School of Pharmacy.
“The patients cared for in these clinics are low income, underserved patients, a significant portion of whom have limited education and health literacy” Congdon explains. “The team-based approach is tremendously beneficial to them. It facilitates enhanced services for patients who “need a little more”, such as increased patient education on medications and chronic conditions, as well as assistance with increased access to much-needed resources such as clothing or food.”
The National Center for Interprofessional Practice and Education awarded grants to 16 academic institutions nationwide – including $50,000 to the University of Maryland – in order to boost community-based interprofessional education and practice. The University of Maryland Baltimore’s Interprofessional Education Center provided $50,000 in matching funds to facilitate the project.
“We are striving to produce generations of health professionals who are trained to work harmoniously together, ensuring the best outcomes for patients,” says Jane Kirschling, PhD, RN, FAAN, dean and professor at the School of Nursing and director of the interprofessional education at the University of Maryland, Baltimore. “This expansion of our community-based IPE initiative is a significant step toward that goal.”
What has been exciting in the first phase of our project initiative has been the support from our clinic partners. Our team is not regularly housed within the clinics where IPE Clinic occurs; however, the clinics have warmly welcomed our team and provided numerous compliments on how comprehensive and thorough the care has been to the patients who seen through the IPE Clinic. Furthermore, the patient population has welcomed the expansion of the IPE Clinic to the new site with open arms. Patients are truly grateful for the extra time they are able to spend with the care team to work through their complex medical problems.
We hope to demonstrate the effects of our IPE interventions not only on intermediate outcomes such as number of patient services provided but also on patient outcomes, such as control of blood sugar levels in patients with diabetes. Furthermore, our collaborative team gained a tremendous amount of insight from our interactions with other successful ambulatory clinic IPE teams from across the country through participation in the kick-off IPE summit for awardees in October, 2016. The best practices shared by successful teams have helped our team to shape the way in which we have proceeded with our initiative as well as helped to define our plans for future IPE endeavors, after completion of activities associated with the current grant. Our team also benefits from the “Affinity Group” teleconferences. It is reassuring to hear how other teams are progressing and to learn from their best practices and pitfalls.
The expansion of IPE clinics to multiple out-patient sites in Montgomery County, made possible by the grant award from the National Center for Interprofessional Practice and Education, has built momentum for and raised interest in interprofessional education at other clinics within Montgomery County’s Primary Care Coalition, a coaltion of twelve clinics that provide primary and preventive care to low-income and/or uninsured county residents. We have begun to discuss further expansion modalities for when the current initiative ends, in order to expand interprofessional learning and care opportunities to other clinics within the Primary Care Coalition. To date, our IPE clinics have been largely precepted by university faculty. As resources are limited, our team has begun looking at alternative models of expansion. Two of our team members participated in the “Preceptors in the Nexus: Interprofessional Learning IN Practice Workshop” in June of this year. Information gained at this conference on alternative preceptor-lead IPE Clinic models has energized our team to consider additional funding opportunities to develop such models in our County so that we can continue to engage and serve the community through expansion of IPE Clinic locations in a sustainable manner.
University of Michigan School of Nursing
Schools of Nursing and Medicine Partner to Expand Care at Free Clinic
The University of Michigan School of Nursing (UMSN) students and faculty have joined U-M Medical School faculty and medical students currently operating the Student-Run Free Clinic (SRFC) in Pinckney, MI in an effort to expand care for area residents and accelerate interprofessional learning for students. The medical students, nurse practitioner students, nurse practitioners and physicians will work together to provide care, learning in the process how to become collaborative, efficient teams.
Established in 2012, the clinic offers free care every Saturday afternoon to uninsured and underserved residents of rural Livingston County and surrounding areas. The addition of UMSN students and faculty will help expand capacity and improve patient care while enhancing the learning experience for health professions students at the clinic.
The nursing students joining the clinic efforts will be from UMSN’s Primary Care Advanced Practice Registered Nurse (APRN) graduate programs. In addition, UMSN APRN faculty member, Megan Eagle, MSN, MPH, FNP-BC, will be embedded into the site to provide leadership for the initiation of the plan, including expanding access for community members by adding Wednesdays as clinical days. All of the clinical days will have varied opportunities for IPE experiences.
UMSN was one of 16 nursing schools selected by The National Center for Interprofessional Practice and Education to lead programs in which graduate nursing students and students from other health professions will work together in community-based clinical settings. Students and faculty from the School of Nursing and Medical School will implement interprofessional education (IPE) and team-based care into action in clinical settings.
This project is funded as part of the Accelerating Interprofessional Community-Based Education and Practice Grant, supported by the National Center for Interprofessional Practice and Education, in collaboration with the Robert Wood Johnson Foundation, the John A. Hartford Foundation, the Josiah Macy Jr. Foundation and the Gordon and Betty Moore Foundation.
University of Missouri-Kansas City School of Nursing and Health Studies
Cultivating an Empathic Understanding of Aging: An Interprofessional Approach to Enhanced Provider-Patient Relationships as the Cornerstone of Patient Centered Care
As individuals age, their reliance on providers in healthcare and other fields, such as law, increases. Unfortunately, many of these providers work in silos despite evidence that interprofessional collaboration is key to improving quality of care and reducing costs. The University of Missouri-Kansas City (UMKC), five professional schools – Nursing & Health Studies, Medicine, Dentistry, Pharmacy, and Law are working to change the silo mentality. Together they are developing an innovative and synergistic approach to interprofessional education (IPE) focused on the geriatric population by changing the nature of the conversation between providers and patients/clients.
Enhancing provider-patient relationships and increasing empathic care through active listening and deep engagement with patients/clients can prepare interprofessional student teams to partner and actively collaborate as advocates for the aged. This project employs narrative and reflective practice for developing culturally humble patient-centered relationships with the aged. Faculty serve as facilitators for guiding students in creating meaningful relationships with one another, an important step to successful collaboration and teambuilding. By cultivating empathic understanding of older adults, the immersion training incorporates mindfulness, interpersonal communication, cultural humility, patient advocacy, and health literacy to enhance students’ abilities to engage with patients/clients in community settings and to solve problems as interprofessional teams.
With a specific focus on active listening and empathic understanding, students’ first build meaningful relationships with one another by developing a community of practice that allows each participant to contribute his/her own skills across domains, then with aged clients/patients through personal interviews to capture an individual’s narrative about the lived experience of aging.
This IPE/IPC initiative builds on outcomes and lessons learned through other IPE grants and internal projects at UMKC by accelerating IPE and community partnerships through engagement with non-traditional healthcare facilities serving a geriatric and often overlooked patient/client population. Additionally, it serves to investigate the health and legal needs of aged persons and the impact these have on an individual’s health and well-being.
This project is funded as part of the Accelerating Interprofessional Community-Based Education and Practice Grant, supported by the National Center for Interprofessional Practice and Education, in collaboration with the Robert Wood Johnson Foundation, the John A. Hartford Foundation, the Josiah Macy Jr. Foundation and the Gordon and Betty Moore Foundation.
Working with two community partners, the Don Bosco Senior Center and Reconciliation Services who provide programs for diverse older adult populations in Kansas City, Missouri, student participants have access to aged individuals who are socially, medically and economically disadvantaged. Using personal interviews, the student IPC teams capture the older adult’s lived experience of aging, such as the loss of social capital, freedom and independence, age-related stigma, and socio-economic issues affecting access to care. These stories provide a much-needed “voice” within the community about the specific needs of older underserved adults. The personal interaction between the students and the aged individuals also provide the IPC student teams with unique opportunities to gain empathy for working with older adults and to develop team-crafted, personalized patient education plans of the individuals’ lived experience.
University of Nebraska Medical Center College of Nursing
The surgeon general has reported that about 33 percent of those admitted to skilled nursing facilities from acute care settings were experiencing serious preventable medication events or injuries. The UNMC Colleges of Nursing and Pharmacy are working together to change these statistics. Funded by the National Center for Interprofessional Practice and Education, the NEXUS Initiative, Comprehensive Geriatric Assessment Practice and Interprofessional Education (CGAP IPE) is a new model of geriatric interprofessional team training for future teams working in skilled nursing facilities led by gerontological nurse practitioners and trained pharmacists.
Team training is not a new concept in geriatrics, but comprehensive geriatric assessment practice models are unique to physician-led ambulatory clinics. To get into such a comprehensive geriatric assessment clinic may take up to three months and often skilled nursing facility patients are not eligible for such a service. Because there is a shortage of geriatricians, geropsychiatric physicians, and other related specialized physicians, and the numbers of older adults are increasing exponentially, new models that support and provide needed geriatric specialized services in the community are a critical need. The need for a new team model of gerontologically specialized nurse practitioners and pharmacists leading skilled nursing facility trained teams is urgent. The public safety demands this.
From the beginning, the community skilled nursing facilities have been champions for the initiative. The two community partners; small, skilled nursing facilities are inner-city dually certified agencies. They serve the poor. They work hard with fewer resources than other settings and serve more complex hard-to-place residents.
The commitment the two skilled nursing facilities have to their patients is evident through their outcomes: a business model to envy, one that has a 5-star rating and the other a 4-star rating and the best physician champion for improved transitional care in the city. Many other well-funded agencies have difficulty getting such high ratings amidst ongoing dangerous admissions.
The National Center for Interprofessional Practice and Education has been a huge asset to move this initiative forward. The principal investigators meet in affinity groups, request additional resources and education, and the National Center is quick to respond. The most recent event, the NEXUS SUMMIT 2017, provided positive energy to further achieve our NEXUS initiative goals. The additional help with measures for interprofessional education and interprofessional collaboration. And with the National Center site fast approaching, the other Colleges at UNMC are starting to take notice, and are eager to participate.
New York University Rory Meyers College of Nursing
An Interprofessional Oral Health Community Experience
The Senior Oral Health Program is an exciting new initiative of the Hartford Institute for Geriatric Nursing (HIGN) and the Oral Health Nursing Education and Practice Program (OHNEP) at NYU Rory Meyers College of Nursing. Funded through a grant from the National Center for Interprofessional Education and Practice Accelerating Interprofessional Community- Based Education and Practice Initiative, the program is designed to improve the oral health of older adults, enhance students’ experience of community-based healthcare, and potentially reduce the use of expensive acute care resources by promoting systemic health through oral hygiene.
The program features a partnership of NYU Rory Meyers College of Nursing (NYU Meyers), NYU College of Dentistry, and RAIN (Regional Aid for Interim Needs), a large not-for-profit community agency in the Bronx serving the health and social needs of older adults, to provide an interprofessional community-based oral health program for older adult consumers, community volunteers, and home health aides working in home care settings.
This program takes place in 11 RAIN senior centers the Bronx, which is a New York City county ranked lowest in health outcomes of all the counties in the state. RAIN addresses the social determinants of health and improves the quality of life and health for the Bronx older population.
Oral health is a major issue for our aging population. Many older adults have limited access to oral health care, as no preventive or therapeutic dental care benefit is provided under Medicare. Seventy percent of older adults have no dental benefit; the importance of oral health to the overall health in older adults (eg. nutrition, weight, strength, pain, dry mouth) is often overlooked and undervalued, especially in communities characterized by significant poverty as well as racial and ethnic diversity. Educating nurse practitioners and dentists about the importance of oral health promotion practices, including oral hygiene and its impact on overall well-being, is essential in preventing co-morbidities associated with their chronic health conditions and overall health status.
As of August 31, 2017, our initiative has provided 11 senior centers with 16 teams of nursing and dental students who have presented an oral health educational program to groups of older adults in the senior centers. We have had more than 75 seniors attend these sessions and they have reported an overwhelmingly positive response. In fact, many seniors were eager to attend a second presentation on oral health and were disappointed to find that the same information was going to be presented in our fall 2017 sessions. The seniors have requested new information and, in response, we have prepared new presentations for the next semester dealing with diabetes, nutrition, and oral health.
A second professional development workshop for NYU faculty and RAIN leadership and staff included an expert consultant on oral health and dementia. Both faculty and our RAIN community partner found this to be an extremely valuable lesson which can be shared with students, community workers, volunteers, and caretakers. Our NYU team now is prepared to train ~100 home health aides, employed by the RAIN Home Health Program during the fall 2017 and spring 2018 semesters, about strategies for improving the oral hygiene of older adults with dementia that will be integrated as a standard of care component for their patient population. Together, we also developed an oral health graduate program simulation experience which addresses the oral health issues involved in caring for an older adult with dementia.
We are able to provide this program through the generous support of the National Center for Interprofessional Practice and Education with matching funds from the NYU Rory Meyers College of Nursing. Colgate Palmolive has donated toothbrushes and toothpaste to be given to each senior who attends an educational session. NYU College of Dentistry has donated floss and clinic vouchers to the seniors attending the sessions.
Oregon Health and Science University School of Nursing
Oregon Health and Sciences University has a deep and ongoing commitment to Interprofessional Practice and Education (IPE), or teaching students from various health professions their clinical skills and how to learn together in teams while providing valuable service in communities. This project is funded as part of the Accelerating Interprofessional Community-Based Education and Practice Grant, supported by the National Center for Interprofessional Practice and Education, in collaboration with the Robert Wood Johnson Foundation, the John A. Hartford Foundation, the Josiah Macy Jr. Foundation and the Gordon and Betty Moore Foundation. The OHSU School of Nursing will support nurse faculty leaders to create the Reaching Rural Residents, or R3 IPE, program. R3 IPE student teams go to rural Klamath Falls with the goal of improving the health of vulnerable older adults.
Building upon past efforts, R3 IPE is helping OHSU advance their vision to serve Oregon’s statewide rural vulnerable populations through its Campus for Rural Health. By connecting students, communities, clinicians, with patients and their families, everybody wins. In the case of Klamath Falls, R3 IPE teams will address some of the state’s lowest health scores. With the Accelerating grant, this community becomes the second OHSU-affiliated site to test the new community teaching model at the Cascade East Family Medicine primary clinic, a Federally Qualified Health Center.
Globally, recognition is growing that social conditions determine 80% of whether people and populations are healthy or not. Therefore, only 20% is determined by the health care they receive in clinics and hospitals. Clinics like Cascade East work with citizens to expand access to social and other services beyond their walls into the community. R3 IPE student teams follow patients whom they see in the clinic into their homes during visits where they learn active listening skills and observe support systems and conditions that may contribute to their health conditions.
A local interprofessional preceptor and project coordinator assures R3 IPE teams meet their community rotation requirements. The daily activities include team huddles to learn more about the patients, develop a plan, participate in a home visit, and then afterwards debrief, document and develop a plan of care. For example, during a recent home visit, the R3 IPE team learned that a patient was illiterate and could not read his care instructions, contributing to his diabetes being out of control. With this new information from the students, his care managers and clinicians changed the way they communicated with him and approached his care differently. In another instance, a patient who lives remotely does not have transportation to the grocery store or the clinic in town, contributing to her poor nutrition. Students immediately understood the situation and arranged for the Klamath Falls Meals on Wheels and rides to clinic visits. Besides the individual patient home visits, R3 IPE students also participate in population health community services such as smoking cessation or health foods campaigns. In other words, student teams become clinic to community extenders while learning valuable lessons.
With the National Center, R3 IPE is a national, state and local partnership program, joining a cohort of 15 other universities implementing similar IPE programs throughout the United States. This project is funded as part of the Accelerating Interprofessional Community-Based Education and Practice Grant, supported by the National Center for Interprofessional Practice and Education, in collaboration with the Robert Wood Johnson Foundation, the John A. Hartford Foundation, the Josiah Macy Jr. Foundation and the Gordon and Betty Moore Foundation. The Oregon State Action Coalition for nursing is working with the R3 IPE team to identify ways they can expand this model statewide. The OHSU Office of the Provost provided the financial match for the grant while Cascades East Family Medicine supports the student teams during the home visits. The OHSU advanced practice nursing, medicine, physician assistant and the Oregon State University pharmacy programs work together to place the teams in Kalmath Falls. The faculty have developed a standardized program for student orientation, the home visit experience, and data management systems.
Through the Accelerating Initiative, OHSU faculty contribute to the national discussion about how to change health professions education so that interprofessional practice and education is THE modality for student teams to make significant contributions to the health and health care in the United States.
Oregon Health and Science University is Oregon’s only public academic health center and respected nationally as a prominent hub for life-changing research. It educates health professionals and scientists, and provides leading-edge patient care, community service and biomedical research. OHSU has more than 200 community health care programs, reaching out to vulnerable groups in urban areas as well as underserved rural communities throughout the state.
University of Pittsburgh School of Nursing
University of Pittsburgh iPEEP Team Working to Promote Independent Living and Quality of Life for Older Adults
The InterProfessional Education Exchange Program (iPEEP), led by the University of Pittsburgh (Pitt) School of Nursing, is engaging faculty and graduate students from the University’s Schools of Nursing, Pharmacy, Health & Rehabilitation Sciences, and Social Work, together with community-based partners, to accelerate students’ application of vital skills for IPC with emphases on social determinants of health, disability prevention and quality of life among community-dwelling older adults.
This project is funded as part of the Accelerating Interprofessional Community-Based Education and Practice Grant, supported by the National Center for Interprofessional Practice and Education, in collaboration with the Robert Wood Johnson Foundation, the John A. Hartford Foundation, the Josiah Macy Jr. Foundation and the Gordon and Betty Moore Foundation. iPEEP builds upon the momentum of established, successful workshop style IP education offerings at the University and will lay the groundwork for sustaining an ever growing IP consultation and collaboration network as students graduate and enter into professional practice “IPC-ready”.
iPEEP facilitates “hands-on” learning through community partnerships that include a rural primary care practice and two urban geriatric home care programs. Staying-at-Home, a program of the University of Pittsburgh Medical Center (UPMC) Senior Services, is a care coordination service designed to help older adults with chronic health conditions receive the support needed to remain in their homes. A sister program, Living-at-Home, is a geriatric care coordination program for ongoing in-home care for older adults. Both programs serve residents in the greater Pittsburgh metropolitan area. Associates in Family Health Care, a nurse practitioner-led primary care practice located in rural SW Pennsylvania, serves residents who live, work, and age in an environment with limited access to numerous social and economic opportunities and resources which impact health, functioning, and quality of life.
Excitement and interest in the project has grown over the last year. Initially developed around engaging graduate family and adult-gerontology nurse practitioner, pharmacy, occupational therapy, and social work students, other program faculty subsequently approached the team and expressed an interest in having their students participate in the program. To this end, iPEEP has since extended its welcome to graduate psychiatric mental health nurse practitioner and audiology students in addition to those enrolled in the School of Social Work’s Integrated Healthcare Certificate Program.
Recognizing the profound impact social determinants have on health care and health outcomes, iPEEP has several events planned for the coming year to help students, faculty, and community stakeholders alike to deepen their understanding of and increase capacity to address social determinants as all work collectively to build a culture of health.
University of Rochester School of Nursing
Rochester ‘Home Visiting for Healthy Aging’ program fosters interprofessional collaboration, links older adults to critical services
Older adults in the Rochester and surrounding Finger Lakes area report more “poor mental health” days than their peers across New York State, a fact compounded by a shortage of behavioral health providers in the region. But an innovative interprofessional home visit program has the potential to better address seniors’ complex health needs.
The University of Rochester School of Nursing and its partners, the University of Rochester School of Medicine and Dentistry; SUNY Brockport’s Department of Social Work; and Lifespan, a community aging services agency, are collaborating to better understand the situation of these older adults and link them to support services to reduce their risk for needing institutional care.
Building on longstanding academic-community partnerships, the goal of “Home Visiting for Healthy Aging” is to accelerate the development of community-based teamwork across organizations and professions. This initiative is supported by the National Center for Interprofessional Practice and Education, and four foundations dedicated to advancing health care as an interprofessional endeavor: the John A. Hartford Foundation, the Robert Wood Johnson Foundation, the Josiah Macy Jr. Foundation, and the Gordon and Betty Moore Foundation.
The project, which pairs a nurse practitioner student in primary care and a medical student in psychiatry with a social worker to provide an in-home screening visit with an older adult, is a leading-edge approach to supporting the growing number of primarily homebound older adults who struggle with unmet emotional health and wellness issues. It is a critical tool to the development of an integrated physical, behavioral, and social support care plan, and also helps to build a workforce of health professionals better able to identify and collaboratively manage the population’s health needs using new models of care delivery.
“This is a very special opportunity to partner with older adults and their family members and collaborate across professions and organizations to break down silos and improve the integration of community-based care,” said Tobie H. Olsan, PhD, RN, CNL, FNAP, professor of clinical nursing at the University of Rochester School of Nursing and principal investigator on the grant. “Interprofessional teams are the key to safe, high-quality, patient-centered care. Our focus has been in the hospital. This initiative is about learning and working together to accelerate the use of best team practices in the home, which is increasingly where we are caring for older adults.”
“We are profoundly aware that the future of health professions education will necessarily be interprofessional, community-based, and community-driven,” said Kathy H. Rideout, EdD, PPCNP-BC, FNAP, dean of the UR School of Nursing and vice president of the University of Rochester Medical Center. “This initiative moves forward our work in these domains, and excitingly, moves us to a new model for the involvement and co-education of our nursing and medical students, along with social work professionals, toward improved patient and family care and outcomes.”
As many as 40 interprofessional teams will have the opportunity to participate over the course of the two-year project with faculty rotating responsibility for mentoring team cohorts and serving on committees to evaluate the project and make plans to integrate the home visit experience into professional school curricula. Since the launch of the project in May 2017, seven different three-person home visit teams have conducted screenings for seven older adults throughout Monroe County in urban, suburban, and rural settings. Among the social and emotional health issues that could become a barrier to independent living identified in those screenings are: grieving from the loss of a spouse, loss of social networks, untreated depression, and having family caregivers living a significant distance away.
Unmet behavioral health needs of older adults impose significant health, social and financial costs to communities. By 2030, an estimated 14.4 million older adults will need care for mental health or substance abuse disorders. A 2016 report by the Finger Lakes Health Systems Agency noted that mental health and substance abuse disorders are associated with 45 percent of the region’s hospital admissions, and suicide ranks as the leading cause of years of potential life lost. Adults age 65 and older account for 15 percent of the region’s population with projections indicating that the number could reach 22 percent by 2025. Older adults already face severely constricted access to behavioral health services due to difficulty in leaving their home and shortages in the number of providers, exacerbated by poorly integrated systems of physical and behavioral health care.
Lifespan social workers serve older adults who are among the most vulnerable and underserved in the region – 45 percent have income less than $15,000. The agency conducts an increasing number of behavioral health screens each year, totaling 426 in 2015.
“Across our programs, we see an escalating need for improved behavioral health identification and intervention. Daily, we hear from our clients and their families that they are struggling with complex behavioral issues,” said Ann Marie Cook, president and CEO of Lifespan, which assists 31,000 clients annually. “As profound as is the apparent need is the corresponding necessity for enhanced resources and professionals educated to meet it.”
“It is gratifying to see the return of home-based health care,” said Eric Caine, MD, professor of psychiatry at the UR School of Medicine and Dentistry. “Too often we wait for people to come to our hospital or clinic door. Now students will learn the skills of going to the doors of older people who face multiple health challenges — individuals who often do not have the ability or support to readily seek care. For persons with mental health concerns, this is especially important.”
The power of collaboration has been apparent from the first home visit and continues to be demonstrated with each additional team. Team members resoundingly agree that they learned more working together than they would have on their own. An NP student, for example, reflecting on his approach to assessing an older adult’s medication dosing and side effects, appreciated the broader view of the social worker during the interview, exploring more basic questions related to if the older adult has been able to obtain the medications, how medications are paid for, and trade-offs made between purchasing medications and daily living expenses.
The home visit is also proving invaluable to helping team members examine their biases and put the older adult’s health issues in the broader context of their life. Initially, a medical student concluded that an older adult’s home was overly cluttered, but observing during the home visit how the client managed with limited mobility, realized there was a creative strategic organization to everything placed around the room to ensure easy and safe accessibility to needed items.
From the start of the project, the planning group has wrestled with the question, “What can be learned from just one home visit?” Answers are quickly emerging.
“The ‘Home Visit for Health Aging’ assignment was eye-opening and will be very helpful to look back on as I move forward in my career,” said one UR medical school student. “I learned a lot about the kinds of questions I should have in mind when I am caring for older patients, as well as the barriers that they may face on a daily basis. I really enjoyed working on an interprofessional team and gained much insight into the different strengths that all team members bring to the table, and how I can better collaborate with all team members in the future.”
“I LOVED the home health care experience,” added a UR nurse practitioner student. “It convinced me that where I want to practice is with older adults in the community.”
Christine Peck, LMSW, director of care coordination at Lifespan, said, “The screening home visits are not provided by students outside of our agency, it is a service we provide as part of us,” revealing the integrated nature of relationships that can be developed between health care organizations and community agencies.
Following the advice of the National Center to “Think Big - Start Small,” we are thinking big about where we go from here, discussing with health care organizations and community stakeholders about transforming what has been a very effective thus far initiative into a sustainable home-based model of primary care.
University of Utah College of Nursing
The Health and Homes Collaborative
Accelerating Interprofessional Student Hotspotting at the University of Utah
The Utah Health and Homes Collaborative (UHHC) uses interprofessional education (IPE) hotspotting immersions to foster student development of core competencies for interprofessional collaborative practice while addressing community-identified needs. Hotspotting is the term used to describe local team-based interventions designed to improve health and health care utilization for both individuals and communities with highly complex needs. In this project, IPE student hotspotting teams investigate and address individual and population-level drivers of health for chronically homeless individuals living in a supportive Housing First model.
Fostering New Models for Interprofessional Education
The National Center’s Accelerating Interprofessional Community-Based Education and Practice award has charted a new course for IPE community engagement at the University of Utah. The call for proposals challenged the faculty to imagine new ways of aligning IPE with the needs of our community and spurred us forward. In addition to the acceleration of community-based IPE at the University of Utah, this award catalyzed and synergized the IPE program in ways that were both planned and unexpected.
New partnerships and rapid growth in program and student participation have served to broaden the impact of this initiative. The number of IPE hotspotting teams has increased from one pilot team in 2016-17 to eight teams in 2017-18. UHHC supports four student teams with faculty from the College of Nursing and the College of Social Work. Four additional teams have been added through support received as a newly designated training hub for Camden Coalition’s Interprofessional Student Hotspotting Learning Collaborative.
Successful community-facing activities require strong and healthy partnerships with community agencies. The UHHC leadership team has developed a mutually beneficial relationship with the Housing Authority of the County of Salt Lake (HACSL). Housing First populations face challenging social and structural drivers of poor health. Building upon the College of Nursing’s relationship with HACSL, hotspotting teams working on-site with individual residents and case managers have the opportunity to broadly and positively impact the entire resident community.
The mission of the University of Utah Health includes identifying and implementing value-based interventions which benefit Utah residents. Based on the student value-added education model, this initiative is designed to provide data for evaluating the educational and clinical value of IPE hotspotting teams. By integrating educational goals with interprofessional activities in the community, UHHC and Hub leadership are building a foundation that will boost the long-term sustainability of hotspotting across the University of Utah.
Synergizing Community-based Interprofessional Education Efforts
This project allows two grants to work in conjunction with one another to advance parallel goals, maximize impact, and contribute to the long-term sustainability of deploying interprofessional student hotspotting teams in Utah. The UHHC team is able to focus on a Housing First population, while the Hub-sponsored teams focus on additional groups including geriatric, refugee, community clinic, and Spanish-speaking populations. The dovetailing of the two grants allows the University of Utah the ability to assess and evaluate hotspotting across multiple patient populations.
The IPE Program serves as an ideal entity to house hotspotting as it serves as a nexus point for programming and curriculum development that addresses IPE competencies and breaks down institutional silos. The hotspotting program now includes seven colleges on the University of Utah campus, with students from 12+ disciplines. This diversity of disciplines offers a rich environment for promoting interprofessionalism and advancing the skills necessary for our students to thrive in a team-based care environment. In addition, the inclusion of undergraduate pre-professional students moves the hotspotting concept upstream in the educational pipeline and provides undergraduates with mentorship from the professional students on their hotspotting teams.
It is anticipated that the IPE hotspotting program will become an increasingly popular curricular offering for University of Utah students. There is increasing momentum within the Health Sciences to implement targeted social and educational interventions that seek to improve the coordination of care and management of disease. This synergy has led to discussions about current and future collaborations with many departments and programs ranging from undergraduate to graduate and Health Sciences programs, including Main Campus, the HRSA-supported Area Health Education Centers, University of Utah Health Plans, Connect2Health, the Center for Latin American Studies and University Neighborhood Partners.
Washburn University of Topeka School of Nursing
Unique, innovative and collaborative are terms that characterize successful, meaningful team-based community care, and such is the case at Washburn University in Topeka, Kansas. Washburn is one of sixteen schools of nursing from across the country that received a RWJF grant as part of the Accelerating Interprofessional Community-based Education and Practice Initiative. Washburn’s project develops nursing leadership to establish health teams that serve the Topeka community.
With funding provided in October 2016, and with support from the National Center for Interprofessional Practice and Education, Washburn’s Doctor of Nursing Practice (DNP) program is now aligned with the Topeka Housing Authority and Pine Ridge Manor, the largest, oldest public housing community in Topeka, to develop a primary care clinic that will provide care within the housing community. The importance and necessity of this service is confirmed by the fact that 44 percent of the 500 Pine Ridge community residents are elderly and/or disabled, and 90 percent live at or below the federal poverty level. Community innovation is benefiting this primarily underserved group of people, as Topeka’s county, Shawnee, is one of the least healthy of Kansas’ 105 counties.
What is particularly exciting about Washburn’s new program -Classroom to Community (C2C) –is that multiple stakeholders are enthusiastically getting involved and are benefitting from creating the clinic as well as expanding wellness services at Pine Ridge Manor. After working on this project for less than a year, team leaders and others will open the new clinic in November[SD1] . Nurse practitioners will serve as the key primary care providers and as leaders of the team to provide safe, high quality and affordable primary care for people in their own setting.
Others have noticed this project’s successes, as nursing’s leaders have successfully engaged their colleagues in the Washburn School of Business and the Department of the Communicatio[SD2] n [SD3] Studies and the Office of Sponsored Projects. All are benefitting by educating students in teams to work cross-profession in an on-the-ground, real-life project with big impacts. Leadership from each program is also learning with, about and from community members while implementing this interprofessional endeavor. They are breaking new ground.
Collaboration started on a national scale early on as part of the vision for the Accelerating Initiative. The Robert Wood Johnson Foundation engaged three other foundations to support nursing leaders to provide interprofessional, team-based care as envisioned in the 2010 Institute of Medicine Future of Nursing report. Colleagues from the Josiah Macy Jr. Foundation, the Gordon and Betty Moore Foundation and The John A. Hartford Foundation joined RWJF to fund the National Center to provide grants and to work with sixteen nursing schools selected in a peer-review process. Each of the selected schools received a relatively small investment, with a requirement to work with state Action Coalitions. Each school also receives substantial coaching support from the National Center to nurture school and community partnerships for large-scale, long-term, positive impact. The Washburn University - Topeka C2C project is accelerating from concept to reality, and is a perfect example of how starting small with national recognition and help can lead to a significant impact on a local community.
Washburn’s interprofessional accomplishments and its pace of momentum are impressive as this project moves forward. Teams in Topeka are comprised of community leaders, faculty and students from the three Washburn University programs, the director of the university’s Office of Sponsored Projects, and local experts in health care. The C2C initiative has extensively engaged and will continue to engage Pine Ridge residents to seek input that will assure the long-term viability of the expanded wellness center and new clinic. THA, Inc., the non-profit arm of the Topeka Housing Authority, has invested in remodeling[SD4] [SL5] a 4-bedroom family unit in the housing community to serve as the primary care clinic, and has committed to fully support the facility’s operating expenses. The new PRM Primary Care Clinic opened in November 2017. The Washburn team members celebrated, knowing that the benefits, obligations and opportunities of the clinic and related team-based care endeavors at Pine Ridge will exist for many years.
This project’s snowballing effect continues, as three Washburn – community advisory groups are now energized and contributing. Future plans include adding optometry, behavioral health, dental health and an interprofessional home visit program to the project. Washburn also plans to add expertise and students from the School of Law, and Social Work and Psychology departments.
The C2C project is an excellent example showing how a community and organizations can work together to craft a shared vision of sustainable innovation, and transform that innovative vision into reality. By supporting this project, leaders of the National Center for Interprofessional Practices and Education are leaving their mark on this community. C2C truly does blend interprofessional educational achievement and action with community betterment.
Washburn University, with an enrollment of 7,500 students, is a public institution located in Topeka, Kansas. Topeka, the Kansas state capital, has a population of about 127,000, with the city’s overall metropolitan area population numbering 233,000 people.