|ORIGINAL RESEARCH PAPER
|Year : 2007 | Volume
| Issue : 3 | Page : 92
Partnering to Enhance Interprofessional Service-Learning Innovations and Addictions Recovery
TV Mihalynuk1, P Soule Odegard2, R Kang2, M Kedzierski2, N Johnson Crowley2
1 Alberta Cancer Board, Calgary, AB, Canada
2 University of Washington, Seattle, WA, USA
|Date of Submission||28-Jul-2007|
|Date of Web Publication||27-Nov-2007|
T V Mihalynuk
Box ACB-2210- 2 St SW, Calgary, AB Canada T2S-0H6
Source of Support: None, Conflict of Interest: None
Context: Service-learning programs are reported to benefit students, faculty, higher education institutions, community agencies and the relationships among these groups. An interprofessional service-learning paradigm may strengthen these benefits. Community settings can expose students to social and cultural determinants of health, in addition to those biomedical determinants more commonly addressed in health sciences curricula. These experiences can also enhance student understanding of the complexities underlying treatment and prevention of modern health problems, particularly chronic diseases.
Objective: The purpose of this initiative was to create and deliver interprofessional service-learning innovations that would enhance student learning and addictions recovery. To address this initiative, the University of Washington's Health Science Partnerships in Interdisciplinary Clinical Education (HSPICE) and the Salvation Army Adult Rehabilitation Center (ARC) began a community-campus partnership in 1997. Innovations took into account student educational objectives established by HSPICE which included: participation in interdisciplinary teams, in conjunction with community partners to identify and reduce population based health issues, realization and articulation of biases regarding issues faced by the participating community, acquiring an understanding of the broader determinants of health and developing an understanding of why the complexity of population health requires interdisciplinary strategies for cost effectiveness.
Discussion: Findings are reported from evaluations, needs assessments and ongoing feedback of men recovering from addictions, as applied to health education materials and presentations developed for the ARC. Future directions are highlighted, including the need for further research and evaluation efforts aimed at rigorously assessing cost savings and student knowledge, skills and cultural sensitivity, among others.
Keywords: Interprofessional, service-learning, community-campus partnerships, alcohol and drug addictions recovery, education innovations
|How to cite this article:|
Mihalynuk T V, Soule Odegard P, Kang R, Kedzierski M, Johnson Crowley N. Partnering to Enhance Interprofessional Service-Learning Innovations and Addictions Recovery. Educ Health 2007;20:92
|How to cite this URL:|
Mihalynuk T V, Soule Odegard P, Kang R, Kedzierski M, Johnson Crowley N. Partnering to Enhance Interprofessional Service-Learning Innovations and Addictions Recovery. Educ Health [serial online] 2007 [cited 2020 Aug 10];20:92. Available from: http://www.educationforhealth.net/text.asp?2007/20/3/92/101602
Service-learning has been defined as “a teaching and learning strategy that integrates meaningful community service with instruction and reflection to enrich the learning experience, teach civic responsibility and strengthen communities” (National Service-Learning Clearinghouse Online, 2001). Service-learning programs have been reported to benefit students, faculty, higher education institutions and the relationships among these groups (Seifer, 1998). An interprofessional service-learning paradigm may strengthen these benefits. Mareck et al. (2004) observed that “students demonstrated interprofessional group synergy and significant creativity in addressing multiple community health care issues and needs”.
Health educational experiences of campus and community partners can extend beyond conventional curricular experiences. Students are exposed to social and cultural determinants of health in addition to biomedical determinants more commonly addressed in health sciences curricula. Moreover, students are able to incorporate the development of skills and attitudes needed to work in interprofessional environments (Parsell & Bligh, 1998). Reported qualities of successful interprofessional working teams include communication, the opportunity to develop creative working methods and personal qualities and commitment of staff (Molyneux, 2001).
The University of Washington’s (UW) Health Sciences Partnerships for Interdisciplinary Clinical Education (HSPICE) model supports “students and faculty working together to solve complex problems that come from real world experiences or are faced by community partners” (Mitchell & Crittenden, 2000). A partnership was created between UW’s HSPICE and the Salvation Army Adult Rehabilitation Center (ARC) as one of many HSPICE collaborations (Mitchell et al., 2006). The Seattle ARC is one of many nation-wide Christian-based residential addiction recovery programs. Referred to as ‘beneficiaries’, up to 101 men can participate in this 6 to 12 month residential program at no cost. Yet, occupancy fluctuates with the seasons and recidivism rates. Through work therapy in the thrift industry, and individual and group counseling and social services, the physical, emotional and spiritual needs of individuals are addressed to facilitate recovery. This article describes the creation and delivery of UW-ARC interprofessional service-learning innovations to enhance student learning and addictions recovery. For the purpose of this article, ‘interprofessional’ and ‘interdisciplinary’ are used synonymously, and we define these as “two or more disciplines working together to achieve common goals”.
Development of Interprofessional Educational Objectives
HSPICE student educational objectives were developed early in the UW-ARC partnership and include: 1) Participating in interdisciplinary teams including community partners in identifying population-based health issues, 2) Creating skills for working with those who are not health science professional team members or other individuals interested in the community, 3) Participating with community partners in creating and maintaining viable solutions to health issues influencing the target population or community of interest, 4) Realization and articulation of the individual and others’ perspectives and biases on clinical and socio-economic problems in the population of interest, 5) Acquiring an understanding of the broader determinants of health, including housing, social and socio-economic issues, and 6) Developing an understanding of why the complexity of population health requires interdisciplinary strategies for cost saving and cost effectiveness (UW Health Sciences, 1999). A discussion follows on how these student objectives were considered through the creation and delivery of interprofessional service-learning innovations.
Objective 1: Participating in interdisciplinary teams including community partners in identifying population-based health issues.
Interdisciplinary student and faculty-led teams were created that represented the six UW health sciences schools (Dentistry, Medicine, Nursing, Pharmacy, Public Health and Community Medicine and Social Work) as well as the Information Sciences school. Each participating school was responsible for establishing clinical contracts between UW and the ARC.
Based on a service-learning model, students would receive course credits from their respective schools. A three hour on-site experience was planned every Tuesday evening, with most students participating for the entire academic year. Community and campus partners reported this quantity as sufficient. Weekly on-site experiences provided opportunities for reflection by students and beneficiaries, and the momentum of the partnership was maintained. Also dedicated to the program was a half-time health sciences teaching assistant whose role was general program coordination, support and collaborative involvement in the teaching and learning process with other students and faculty.
Students in the ARC-UW partnership have represented Nursing, Medicine, Public Health, Pharmacy and Information Sciences. Dentistry and Social Work students have participated on a limited basis due to reported curricular or supervisory constraints. Undergraduate students have also participated to gain volunteer experiences. We provide representative quotes regarding the student benefits of interdisciplinary, community-based experiences. An Epidemiology student commented: “Often careers involve interdisciplinary collaboration—it was a really good experience working with different backgrounds”. A Pharm D student noted: “Other practicums were more scientific and methods-based—I wanted more community and public health experience”.
Objective 2: Creating skills for working with those who are not health science professionals or other people interested in the community.
A vehicle for students and community partners to work together in a real-world context was needed. Accordingly, UW students, faculty, four or five beneficiaries and the ARC Administrator (when available) created and participated in weekly Health Advisory Board (HAB) discussions. The HAB vision is “to help beneficiaries to live healthy, clean and sober lives.” The HAB goals include: 1) Assist individuals in learning how to access and use health information and available health services to promote health for themselves and others; 2) Be of service to the community by providing knowledge and skills that will provide healthier lifestyles; and 3) Provide opportunities for interdisciplinary education of health and information science students.
An evaluation questionnaire was created for beneficiaries on the HAB and comments made were overwhelmingly positive. Regarding serving on the committee, one beneficiary noted: “Yes. I enjoy serving on the committee. It has offered me a chance of making a commitment to be involved in my community and following through with my involvement”. Concerning change in perspectives over time, a beneficiary commented: “I was honored to be invited and welcomed in such a warm way and my feelings stand strongly the same today”. Regarding effective use of time on the HAB, a beneficiary noted: “Hands down, yes. I am working for my recovery whenever I’m involved”.
To facilitate the connection between the ARC and other community services, speakers from private practice, the local health department, medical centers and community colleges made presentations on various health education topics, including HIV/AIDS, physiological effects of alcohol, foot care, re-entry programs and relapse prevention, among others. Additionally, UW students were provided opportunities to work with ARC staff outside of the health education framework. Following requests made by beneficiaries, multivitamins became available during morning medication dispensing. Kitchen staff members were provided suggestions regarding cooking nutrient-dense, calorie-reduced foods. Soap dispensers were added in restrooms and sandals were made available for use in showers. Responding to beneficiaries’ requests and needs in a timely manner was an important part of building mutual trust, respect, genuineness and commitment, identified as one of the nine principles of partnerships outlined by Community Campus Partnerships for Health (1998).
Objective 3: Participating with community partners in creating and maintaining viable solutions to health issues influencing the target population or community of interest.
The UW-ARC partnership was designed to include the voice of both campus and community members. For example, development of student education innovations was preceded by a survey of priority education needs of beneficiaries (Table 1).
Table 1. Priority community health education topics by beneficiaries* (fall, 2000)
The majority of respondents provided more than one priority health issue. Subsequently, evaluation forms were given to beneficiaries at the end of health education presentations to assure beneficiary needs were met. Questions included:
- What did you learn?
- Was there anything not covered that you would like to know more about?
- What other health education topics would you like to learn more about?
The majority of beneficiaries would fill in the evaluation forms, and comments made were generally positive and constructive (Table 2), and considered when revising materials and developing future materials of interest.
Table 2. Examples of beneficiary comments to the health education lecture evaluation question ‘What did you learn?’ *
A sustainable education innovation included the creation of health education modules and accompanying one-page handouts based on priority topics identified by beneficiaries. Modules were designed to be self-instructional or readily converted to small or large group presentation format. Modules were co-created by students and HAB beneficiaries with the ongoing direction of faculty members. The format of the modules followed a template developed by Mihalynuk and Kolasa (1996) and included: purpose, objectives and directions, ‘self-prescriptions’, and ‘check-point questions’. Sequential revisions were carried out after testing and re-testing these materials in small group settings with beneficiary and faculty representation.
The one-page handouts highlighted the main topics covered in the module (Table 3).
Table 3. Sample ‘Nutrition and Recovery’ one-page handout that accompanies module
A readability test was carried out to finalize the content of the modules, including reducing jargon and polysyllabic words (Estey, 1992). In creating the health education modules, questions asked of beneficiaries in small group sessions included:
- Is the information relevant?
- Does the information make sense to the beneficiaries, or is it too ‘jargony’?
- Is the content interesting and informative?
A health education resource binder was also developed. Information on priority health education topics as identified by beneficiaries was collated, which included Journal of the American Medical Association (JAMA) patient education pages online (2007). Regarding the benefits of participating in the development and delivery of health education information, a pre-medical student commented: “I improved my oral presentation skills, and learned more about health education and ‘real-world’ alcohol issues”.
Objective 4: Realization and articulation of the individual and others’ perspectives and biases on clinical and socio-economic problems facing people in the population of interest.
In real-life community contexts, students have the opportunity to observe the complex interactions of social, cultural and biomedical determinants of health, including recognizing the strong societal stigmas associated with addictions. Many beneficiaries are faced with co-morbid conditions such as mental illness, which can exacerbate these stigmas. Collaborating with beneficiaries was observed as a powerful means of reducing individual and collective biases. During HAB meetings, beneficiaries shared their personal stories about addictions and recovery. Students and faculty were able to observe first-hand that addictions affect people from all socio-economic strata and walks of life, as well as the complexities and challenges of addictions recovery. At times, faculty and students would also share stories of anonymous friends and family members battling addictions, further diminishing biases associated with these conditions.
Objective 5: Acquiring an understanding of the broader determinants of health, including housing, social and socio-economic issues.
Addictions are multi-faceted, affecting the body’s physiology from the cellular to the organ system level, and socio-cultural dynamics from the individual to the community level. When the beneficiaries are nearing the completion of the ARC program, they are often faced with housing, social and socio-economic issues. These issues can be stress inducing, which may lead to recidivism and aggravate existing health problems. In the health education evaluation forms, several beneficiaries raised concerns about access to low cost medical services due to socio-economic constraints. Subsequently, concerted efforts were made by ARC and UW representatives to reduce these stressors, and encourage a smoother and more successful transition upon completion of the ARC program. Community speakers also discussed available community resources for beneficiaries. To guide HAB and beneficiary work and transitions during the summer months, a resource manual was compiled with information on community health resources, housing, job training and educational opportunities. In a related study of male substance abusers, Castellani et al. (1997) found that effective coping skills and resources moderated the negative effects that emotional and psychological distress, social structure and substance relapse had on one another.
Objective 6: Developing an understanding of why the complexity of population health requires interdisciplinary strategies for cost saving and cost effectiveness.
To insure that students are exposed to a wide variety of patients with a range of disease conditions, while gaining a deeper appreciation of cost effectiveness and cost savings, service-learning is being increasingly considered (Cauley et al., 2001). As drug and alcohol addiction is a pervasive and complex health issue, it provides an ideal medium for developing sustainable education approaches to prevention and treatment and related cost savings. In the first year, the HAB members helped to build and maintain a computer-based Health Resource section in the existing ARC library. A large bulletin board was salvaged from the ARC stock and mounted in the library. Health information and beneficiary comment cards from weekly presentations were placed on the bulletin board. A HAB beneficiary was recruited to update this board every two to three weeks with pertinent information related to recent weekly health education topics and evaluations. The creation of sustainable education mechanisms that could exist with or without UW backing was intended to address cost effectiveness issues of this partnership.
UW and ARC participants have reported many benefits from this community-campus partnership. New relationships were established between the UW, ARC and other community groups. Students learned to work together and across disciplines while gaining an appreciation for disciplinary-based and overlapping knowledge of addictions recovery. They learned about the variety of health and social resources available in the Seattle area and existing gaps in resources for addictions recovery. They developed leadership and public speaking skills and competencies necessary for the creation and delivery of health education materials, including cultural sensitivity about issues related to addictions.
Beneficiaries learned about health education, the recovery process, re-entry issues, and community resources. ARC administrators found the weekly program helpful for expanding the health promotion aspects of the ARC. They appreciated the connections established between the ARC, UW, local health departments and medical centers. For HAB beneficiaries, this was often their first time to work on a community project, define issues, follow through on agreements, represent others and interact on a regular basis with UW faculty and students. HAB beneficiaries were a critical link for reaching other beneficiaries in the facility.
Although we share our process with the hopes that insights may be gleaned by others who are embarking on a similar partnership, there are many limitations. To date, a conventional research framework has not been implemented at the ARC due to the sensitive nature of addictions recovery combined with the high beneficiary recidivism rate. Yet, it is possible that beneficiaries would have been less likely to openly share their experiences in a research-oriented setting. Second, there are ongoing challenges with recruitment and retention of UW students and faculty, changing beneficiary needs, and turnover of administrators and beneficiaries at the ARC. Third, although we were able to achieve a majority response rate (60%) by beneficiaries for education innovations, we would have benefited from a more rigorous process and outcome evaluation of student, faculty, beneficiary, administrator and other community stakeholder experiences from the onset of the partnership. For example, we would be very interested in measuring whether learning objectives were achieved, such as cultural sensitivity gained by students in this partnership.
There is plenty to learn about the effectiveness of community-campus partnerships in addressing the unique health education and health care needs of communities while remaining aware of the factors affecting the sustainability of these collaborations. More rigorous research and evaluation measures, including cost-benefit analyses of programs of this nature would better speak to governments, policy and overall program sustainability.
We gratefully acknowledge Dr. Pamela Mitchell for her ongoing direction and support, the beneficiaries, administrators and directors of the ARC, and Bertine Easterling for her continuing assistance and insights. Resources to implement interdisciplinary experiences at the ARC were supported through grant funds from HSPICE.
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