Community Care

Author: Malcolm McDowell Woods

Published Date: 5/30/2019

Categories: F1RST Magazine F1RST Summer 2019 Health Sciences Nursing Occupational Therapy Physical Therapy Physician Assistant Studies Spanish


Community Centered and Collaborative

 
If you’ve visited a healthcare clinic or hospital recently, you’ve probably been met with a bewildering array of healthcare professionals. Someone may record your vitals, another might ask questions about your health, someone else might do a physical exam and yet another person may help provide treatment and therapy.

Healthcare delivery today is a collaborative effort. Nurses, physician assistants and therapists work together alongside other medical professionals to diagnose, assess, prescribe treatment and provide care for patients. This holistic approach looks beyond the immediate medical symptoms a patient may present and instead attempts to address the whole individual seeking care and better understand that person’s world. 

Such an approach makes sense. Patients often interact with a variety of healthcare professionals as they deal with a health issue, from initial diagnosis to recovery. And the medical professionals need to cooperate and communicate with one another if the care they provide is to be helpful. 

But it can be a huge challenge. Each of those professionals has his or her own objectives and areas of expertise. Specialization can create silos and busy workloads can hamper communication. Toss in a medically underserved population and potential language differences, and the challenge grows.

 

a sketchy illustration of two people
a sketchy illustration of a woman
a patient at the United Community Center

“We will all work together in the workforce. So, let’s learn about each (profession) and how we each complement the team and build on those strengths as we work together.”


— Dr. Teri Kaul, chair of the nursing department —


Ramping Up Results

The community analyses that nursing students perform are extensive. Students examine the presence or absence of healthcare facilities, public transit and grocery stores, as well as poverty levels and language barriers. The reports then go to the PCTE students to help prepare them for their first meeting with clients of the senior center. But last year, some nursing students took it a step further, and opted to address pedestrian safety around the United Community Center.

The UCC is located just off I-94 on the near south side. Freeway exit and entrance ramps run alongside the north end of the complex and empty onto residential streets bordering the center, with its schools and senior center. “This year, one of our groups recognized the need for better traffic control for vehicles coming off the freeway,” said Dr. Teri Kaul, chair of the nursing department at Carroll. “They actually developed a public policy issue around that and submitted it to the state.”

In response, the Wisconsin Department of Transportation has drawn up a plan to increase signs and other safety measures to better control traffic exiting the freeway. “That’s a huge outcome that probably wouldn’t have happened unless you were performing such an analysis,” said Kaul.

Learn more about the United Community Center

 


Integrating Care

Which is why teams of Carroll allied health students travel weekly during the school year to Milwaukee’s near south side. There, approximately 130 students from Carroll’s physician assistant (PA), occupational therapy (OT), nursing and physical therapy (PT) programs work together to deliver care to clients of the United Community Center (UCC).

The UCC is a sprawling and vibrant center. It provides programming to local residents of all ages in the areas of education, healthcare, community development and human services. Of the more than 18,000 people who benefited from UCC programs in a recent year, more than 90% were racial or ethnic minorities and more than 40% lived at or below the poverty level. The center’s programs and facilities include two public charter schools, a child care facility, adult day care and a senior center.

Each Monday, teams of Carroll students travel to the senior center. There, they learn how to place a patient at the very center of the universe and how to collaborate with one another to deliver the most effective care possible. 

Carroll officially calls it the Primary Care Training and Enhancement (PCTE) program, funded by a grant from the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA). It provides interdisciplinary training to Carroll health science students as they interact with and provide health literacy services to UCC Senior Center participants. The five-year program is in its third year and involves approximately 130 Carroll students. 

Amy Vega, the project coordinator for Carroll, said this project is unique in several ways. “Our students are getting interprofessional practice experiences out in the community. This is becoming the focus of a lot of educational institutions, but we’re already there,” she noted. “And they’re also practicing in a medically underserved area and working with a senior population.”

Dr. James Brandes, the director of Carroll’s physician assistant studies program, agreed. “It really is pretty unique. While other programs certainly are going to try to introduce their students to underserved populations, we do this on a consistent basis at Carroll.” He also points to the length of the program. “The students have a year-long commitment. It means they are around to see the results of their work.”
 

Case Studies

In early fall, students from Carroll’s nursing and public health programs visited the UCC and its neighborhood to conduct a thorough analysis of the area. They examined what sort of healthcare services were available, the economic condition of the community, access to groceries and more. The intent was to provide the students with a clear and complete picture of their clients’ worlds.

“The nursing students are really looking at the social determinants of good health,” said Dr. Teri Kaul, chair of Carroll’s nursing department. “What sorts of things are available in that community? Do residents have access to clean water, good food, healthcare, parking and transportation, parks, places where people can exercise and the like.” The analysis is critical to the success of the project, Kaul said. “If you have all these great goals for people but they don’t have the resources to accomplish them, it won’t work.”

Then, eight- or nine-person teams composed of students from the physician assistant, physical therapy and occupational therapy programs also toured the area and visited the UCC. Jessica Eckels, an occupational therapy student, said the earlier analyses, combined with intercultural studies the teams did, created a better understanding of the community and built awareness of any potential barriers their clients faced.

“Part of this grant is to expose the students—not just PA, but OT and PT and nursing students as well—to an underserved population of the community,” noted Brandes. “Taking care of the underserved is different than going into a community practice where you’re dealing with completely insured patients. There are different needs and that really does need to be taught.

“The more of these experiences we can provide the better,” he continued. “They have to understand the culture. The lesson is that just knowing the science isn’t enough. You have to know something about the culture of the people you are serving.”

18,000 people benefited from services provided at the UCC in a recent year
a sketchy illustration of a person
a sketchy illustration of a woman
United Community Center Senior Center

“Our students are getting interprofessional practice experiences out in the community. This is becoming the focus of a lot of educational institutions, but we're already there.”


— Amy Vega, PCTE project coordinator —


The Nurse is In

Carroll’s nursing students have an ongoing presence at the United Community Center. “Throughout our curriculum, we thread different opportunities for our students there,” said Dr. Teri Kaul, chair of the nursing department. Nursing students spend time visiting classrooms in the Bruce Guadalupe Elementary School and delivering lessons in health literacy to the students. Nursing students also rotate through the student health center to gain experience in pediatrics. And students in their final year may spend a full semester at the school health clinic, alongside the school nurse, gaining direct experience in dealing with children and their families.

Learn more about Carroll's nursing program

 


 

Building Trust

Then, in fall, armed with that knowledge, the teams were introduced to their clients. Through the semester, the teams met regularly with them, developing a case history of that person. Their task, according to Vega, was to examine three determinants of their client’s physical health—physical, social and emotional—and propose some interventions they could undertake to improve it.

That process, of getting to know a person, of drawing out their story and developing a rapport, can be daunting, even more so when the person speaks another language. Enter Carroll’s Spanish program, which provides students to serve as interpreters. The program has launched a course in medical terminology designed to prepare students to act as interpreters and conduct medical interviews. A student is assigned to each team that requires interpretation.

“We couldn’t function without him,” said Makenzie Kirk, a PA student, of their team’s interpreter, Sam Rodriguez, a Spanish and pre-PT major. Their client, an elderly male, was initially apprehensive about the program. “Until we played dominoes,” recalled Rodriguez with a laugh. Games were just one of the tactics students used to get to know their clients and develop trust.


Faith in Each Other

Of course, the barriers students have to surmount weren’t just between students and clients, but between students from different disciplines as well. “We must teach that collaboration,” said Brandes. “When they go out into practice, it will be expected that they do that. Through this experience they learn what the other practitioners can offer.”

That’s one of the goals of the fall semester for each team. “We each know what we know, but it’s important to realize what all the others know as well,” said Andrew Johnson, a PT student. “Having the members of my team share their wealth of knowledge—their expertise—has just been so beneficial.” 

And practical. After all, said Kaul, “We will all work together in the workforce. So, let’s learn about each other and how we each complement the team and build on those strengths as we work together. We want the best for the patient, however that looks. And every patient will be different. At the bottom line, we are all there for the same reason...better patient outcomes.”

Such awareness is key to the model of integrative care Carroll faculty hope to inspire. It has an added bonus. As they learn what other disciplines can offer and how each practitioner views the patient, the students begin to develop a picture of the patient as a whole, complicated, multifaceted human being.

“It’s enlightening to learn and understand that each student is a part of the team,” said Erin May, an OT student. Samantha Osterberger, a PA student and teammate of May’s, noted how they began to trust one another during this process. “It made me realize I need to rely on the others to manage our client’s whole being. And that we’re treating the whole person.”

The whole person. If you’ve ever gone to seek healthcare and felt reduced to a set of symptoms, you’ll understand how obvious, yet profound, that can be. For the students, who until now have been learning anatomy, science and symptoms, it’s a paradigm shift of sorts.  

 

Client-centered Care

“At first, the students are just so overwhelmed by all the details of it,” said Dr. Wendie Leveille, a clinical assistant professor of occupational therapy. “Our job is just to help them with the next step and then the next step. First, get to know your client and who they are on the personal level. You have to put that person in the middle.”

Johnson said the students had to overcome that challenge first. “How do we find a way into their life so that we can make an impact? How do we motivate them to make changes?”

Hector Hernandez is UCC’s director of programs for the elderly. He has observed the Carroll teams working with their clients for two years. “To build that rapport and that trust with their clients is very important,” he added. He noted that there was some initial hesitation among the seniors, but that now, partly through word of mouth, they have seniors lined up to participate. “This is a win-win collaboration for us,” he said. 

It’s wins all around, really. The students get an immersive education in cutting-edge healthcare practices and experiences dealing with another community. And the clients of the senior center get help.

As part of the grant, teams have money they can spend on health-related items to assist with their proposed interventions. Those might include fitness trackers, water bottles, braces, fitness club memberships or Spanish-language cookbooks, for example. Once the students have spent the fall semester getting to know their clients and conducting their assessments, they’ll work with those clients to come up with some goals for the spring semester.

a sketchy illustration of a man
8-9 students are partnered in care teams through the PCTE program
a sketchy illustration of a woman
students working collaboratively with a patient at the United Community Center

“We must teach that collaboration. When they [the students] go out into practice it will be expected that they do that”


— James Brandes, director of the physician assistant studies program —


Foundation Support

A new $10,000 grant from the Greater Milwaukee Foundation will support Carroll’s work with the United Community Center to develop environmental education opportunities for middle school students. The Greater Milwaukee Foundation is a valued philanthropic partner of Carroll’s, providing annual scholarships, gifts and grants from its donor advised and charitable funds. 

Learn more about the Greater Milwaukee Foundation


 

The Outcomes

In mid-April of this year, the teams gathered with their clients a last time. It was a bittersweet occasion. 

A team that worked with an elderly man who suffered from back and neck pain that impacted his life and interfered with his sleep spent their last meeting going over several health assessments with him. These were identical to ones they had completed at the beginning of the semester. Since then, they had used grant funds to purchase a special sleep pillow, heat pads and ice packs to help alleviate the pain.

Had the interventions helped? “This has been very beneficial to me,” the man reported. He no longer feels the pain. The pillow had been a godsend. 

The man had been a nurse earlier in life, so he was eager to participate in the program and provide what help he could to these students. “I’m very happy that I could help with their learning,” he said. “Knowing that this is helping them learn, I have tried to be very open with them.” And the results have been all he could have hoped for. “I’m very satisfied.”

His progress leaves the students beaming. “After all the work this year, to come here today on our last day and hear how much he has improved,” said May, “well, it’s just the most amazing news.”

Another group, whose client dealt with weight and nutrition issues, began their final meeting with a brief walk together, after which they took their client’s blood pressure and other vitals. As part of their interventions with him, they had purchased a water bottle to encourage him to drink more water during the day, as well as a Spanish-language cookbook.

 

Planting Seeds

It’s a process, wellness. He has admitted to the team not always using his water bottle, not always getting in enough steps each day, and occasionally falling into old food habits. But the members of the team aren’t discouraged. By building a rapport with him, playing dominoes, telling jokes and showing a real concern for his well-being, they have had an impact. His initial apprehensions have dissolved.

“I think he trusts the healthcare profession a bit more now,” said Eckels. Fellow student May agreed. “We planted a seed.”

The teams write about their experiences and share their findings with fellow students and UCC members near the end of the semester. Some may present their research at conferences. And the information gained will help Carroll faculty fine tune the program for future years and add to the overall knowledge base in physical therapy, occupational therapy and physician assistant studies. 

Many seeds have been planted. They will grow in many places–potentially even in medically underserved areas. 

For students like Rodriguez, the program has pointed him in a direction, shown him a possible path. He participated in the program this year as part of his Spanish studies, he said, but “this doesn’t feel like it’s just a requirement,” he concluded. “This feels like what I want my future to be.”

 


Note: This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number T0BHP29989 for $1,242,235 This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government. 

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