Nicaragua Service Learning Project: A Reproducible Model for Interprofessional Student

Engagement

Pacific University Oregon College of Health Professions Saje Davis-Risen, PA-C, MS Tiffany Boggis, MBA, OTR/L

Objectives/Session Overview

• Illustrate an interprofessional educational initiative in Nicaragua

• Discuss a reproducible model to develop an international interprofessional education initiative

• Share student perspectives of the initiative over time.

• Provide insight into challenges and tips for success of program development

Interprofessional International Initiative in Nicaragua • Imbed video here

Model of Community Based Rehabilitation (CBR)

Definition

• A strategy to improve access to rehabilitation services for people with disabilities in low-and middle-income countries, by making optimum use of local resources to ensure inclusion of people with disabilities in society and enhance their quality of life.

Components

• Health

• Education

• Livelihood

• Social

• Empowerment

World Health Organization, (2004,

2010)

Medical Model

Social Model

Principles of Community Based Rehabilitation (CBR)

• Facilitate awareness and positive attitudes of disability

• Focus on prevention & health promotion

• Promote education and sustainable services

• Build social capital to enable communities to help themselves

the World Health Organization

Efficacy of CBR

• Comprehensive literature review shows CBR lacks a coherent core of research or evidence base using rigorous experimental design.

Finkenflugel et al. 2005; Mannan et al, 2012

• Why? No single systematic method for the implementation or study of CBR exists.

WHO 2003, 2006

• Methods are in the process of being developed. Kuipers et al. 2006; Lukersmith, 2013

• CBR may be “evidence poor” but it is “data rich” given a wealth of descriptive analysis.

Lightfoot, 2004

Clinical Evidence for Health Interventions Exists

• India: CBR approach found to be more effective than traditional OP medical services in reducing disability associated with schizophrenia (Sudpito, 2003)

• China: improved functioning of those with disabilities in rural areas (Zhou, 1999)

Program Development

2007

• Partnership with the Jessie F. Richardson Foundation (JFRF)

• Interprofessional team: OT, PT & Dental

• 9 faculty & student participants

• 1 hogar

2012 - 2013 • Multiple partnerships

• Interprofessional Team: OT, PT, Dental, PA, Pharmacy, OPT, Audiology, Psychology

• 28 faculty & student participants

• 6 hogares

Program Overview

• Individual Profession Application and Interview Process

• Pre-trip preparation

• 3 class meetings and blended online learning • Intro to the community based model

• Intro to documentation

• Team building

• Nica Simulation

• Online discussion board topics in global citizenship and global aging

• Spanish language improvement plan

• Nicaragua Knowledge Inventory

• Preparation for travel

• Fundraising to reduce student cost

• Donation gathering for residents

• Trip 10-14 days in-country

• Post-Trip phase

• Reflection on professional development and growth paper

• Assist with marketing the program to new students and others

Program Overview cont. In-Country Experience • Fly to Managua

• 2 Interprofessional teams to serve 2 hogares (Esteli & Sebaco this year)

• Interprofessional team screenings for each resident

• Identify needs for profession specific interventions

• Profession specific interventions

• In interprofessional teams

• One Excursion day

• Fiesta

• Return to Managua for reunion dinner and flight home

A day at the hogar • 6:30 granola bars on the walk to hogare

• 7:00-9:00 Early day to see the AM routine • OT/PT observe and help with AM routine Bathing/transfering/ADLs etc

• PA/Pharm helping with wound care rounds

• Dental filling in with both

• 9:00-12:00 Profession specific interventions • PA/Pharm full physical exams, bp checks, ear lavage

• OT ADL assessments, leisure and productive activity

• PT Movement therapy interventions, modifying equipment

• 12:00-1:00 Lunch (the elders are eating as well)

• 1:00-2:00 Spanish Language class

• 2:00-4:00 Professional specific interventions

• 4:00-5:00 Debrief, plan for tomorrow

• 5:00 – 8:00 Dinner and relaxation in interprofessional teams • Reflection Journal, decompression, study & review in silo as needed

Program Development Process • Identify fit with university vision/mission

• Find a sponsor and/or In-country liaison

• Establish relationships

• Perform a needs assessment: Focus on host’s needs

• Develop network of professional supervisors

• Recruit, orient and prepare students

• Promote interprofessional collaboration

• Develop community support locally & in host country

• Evaluate and monitor progress

Assessment & Monitoring Tools • Outcome measures tracking for our program:

• Direct Service: screening, full assessment, interventions, daily education of residents/caregivers

• Education and Training • Social Capacity Building • Community Meetings • Fund Raising • Donations • Scholarship: Publications, Presentations • Marketing

• Outcome measurements for our students:

• Health Professions Schools in Service to the Nation Service Learning Student Survey

• Readiness for Interprofessional Learning Scale (RIPLS)

Program Outcomes 2007 – 2008 (1st 2 years) Cumulative through Present

Hogares : 1 served Hogares: 4 served ; relationships with 14

Service: 45 older adults, 450 hrs/service

Service: 650 older adults; 1650 hrs / service

Education: 23 hrs for 20 participants

Education: 243 hrs for 211 participants Generated 20 in-country initiatives

Community meetings: 2 Community meetings: 18

Donations: 900 lbs Donations: over 7600 lbs

National Aging Council established. Increased local medical, nursing, PT and volunteer service provided to older adults

Grants totaling greater than $19,000

Student Demographics N = 70 student participants (2009-2012)

• Pacific University Programs (100%)

PA (15/21%); dental (16/23%); Pharm (12/17%); OT (16/23%); PT (11/16%)

• Gender: 90% female; 10% male

• Age: 20% 20-24yrs; 59% 25-29yrs; 14% 30-34yrs; 7% 35+yrs

• Ethnic Identity: 67% Caucasian/white; 14% Asian American; 13% Hispanic American; 2% African American; 4% other/unanswered

• Prior volunteer experience: 48%

• Work in addition to school: 27%

Students’ Experience of Service-Learning Percent of students who agree or strongly agree:

• 98% Participation in service-learning helped me to better understand the material from lectures and readings.

• 98% Service-learning made me more aware of the roles of health professionals in other disciplines besides my own.

• 87% Service-learning helped me to become more aware of the needs in the community.

• 93% I feel that the work I did through service learning benefited the community.

• 94% Doing work in the community helped me to define my personal strengths and weaknesses.

Shinnamon,et al. (1999). Methods and Strategies for Assessing Service Learning in the Health Professions San Francisco: Community-Campus Partnerships for Health,.© 2001.

Students’ Experience of Service-Learning con’t • 91% During this experience, I became more comfortable with

working with people different from myself.

• 70% Service-learning made me more aware of some of my own biases and prejudices.

• 91% Participating in the community helped me enhance my leadership skills.

• 91% The work I performed in the community enhanced my ability to communicate my ideas in a real world context.

• 100% I will integrate community service into my future career plans.

Plan for Success/Address Challenges

Plan for Sustainability • Gain buy-in and financial support from your University and/or stakeholders • Select a sponsor that has a sustainable approach • Enculturate the program into the university system by adding a formal course

and to hold students accountable • Mentor and support core and adjunct faculty

• outstanding students may become adjunct faculty upon graduation

Manage Processes • Address cultural differences among professions • Provide opportunity for Spanish language study (region specific language) • Choose students who are appropriate for the type of experience you are

providing • Identify documentation systems and outcome monitoring measures early in the

process • Be proactive about yearly revision and process improvement soon after return

from the in-country trip • Market the program

What is the future bringing for us? • We are serving a new hogare this year

• Interprofessional International Experience: Nicaragua I & II CHP560/561 & CHP460/461

• Formalized 4 credit course

• Audiology and Professional Psychology are joining us this year for needs assessment

• We are exploring the idea of piloting mentorship trips for guest faculty

References Conrad S, Reeves S,Tassone M, Parker K, Wagner S, Simmons B. Interprofessional education: An

overview of key developments in the past three decades. Work [serial online]. March 2012;41(3):233-245

Doll J, Packard K, Maio A, et al. Reflections from an interprofessional education experience: Evidence for the core

competencies for interprofessional collaborative practice. Journal Of Interprofessional Care [serial online]. March 2013;27(2):194-196

Finkenflugel, H. (1991) ‘Help for the Disabled – in Hospital and at Home’, World Health Forum 12: 325–30.

Finkenflügel, H., Wolffers, I., & Huijsman, R. (2005). The evidence base for community-based rehabilitation: A literature review. International Journal of Rehabilitation Research, 28(3), 187- 201.

Mannan, H., Boostrom, C., MacLachlan M., McAuliffe, E., Khasnabis, C., Gupta, N. A systematic review of the effectiveness of alternative cadres in community based rehabilitation. Human Resources for Health 10(20) www.human-resources-health.com/content/10/1/20

Kuipers, P., wirtz, S., & Hartley, S. (2006) A process for the systematic review of community-based rehabilitation evaluation reports: formulating evidence for policy and practice. International Journal of Rehabilitation Research, 29 (1), 27-30.

Lavin, M.A., Ruebling, I., Banks, R., Block, L., Counte, M., Furman, G., Miller P., Reese, C., Viehman, V., & Holt, J. (2001). Interdisciplinary health professional education: A historical review. Advances in Health Sciences Education 6(1), 25-47.

Leavitt, R. (1992) Disability and Rehabilitation in Rural Jamaica: An Ethnographic Study. Toronto: Associated University Presses.

Lightfoot, E. (2004) Community-based rehabilitation: A rapidly growing method for supporting people with disabilities. International Social Work 47(4): 455–468.

Lukersmith S., Hartley, S. Kuipers P., Madden R., Llewellyn G., & Dune, T. (2013 Apr10) Community-based rehabilitation (CBR) monitoring and evaluation methods and tools: a literature review. Disability Rehabilitation [Epub ahead of print] www.ncbi.nlm.nih.gov/pubmed/23574396

References con’t Pollard, N., & Sakellariou, D. (2008). Operationalizing community participation in community-

based rehabilitation: Exploring the factors. Disability & Rehabilitation, 30(1), 62-70.

The world health report 2006: working together for health. Geneva: WHO; 2006.

Selle K, Salamon K, Boarman R, Sauer J. Providing interprofessional learning through interdisciplinary collaboration: The role of "modelling". Journal Of Interprofessional Care [serial online]. 2008;22(1):85-92.

Shinnamon, A.F., Gelman, S.B., Holland, B.A. (1999). Methods and Strategies for Assessing Service Learning in the Health Professions. San Francisco: Community-Campus Partnerships for Health,.© 2001.

Smit E, Tremethick M. Development of an international interdisciplinary course: A strategy to promote cultural competence and collaboration. Nurse Education In Practice [serial online]. March 2013;13(2):132-136

Sudipto, C., Patel, V., Chatterjee, A. & Weiss, H.A. (2003). Evaluation of a community-based rehabilitation model for chronic schizophrenia in rural India. British Journal of Psychiatry 182, 57-62.

World Health Organization. (2003). International consultation to review community-based rehabilitation. Geneva: WHO Document Production Services.

World Health Organization. (2004). CBR: A strategy for rehabilitation, equalization of opportunities, poverty reduction and social inclusion of people with disabilities. A joint position paper. Geneva Switzerland: WHO Document Production Services.

World Health Organization (2010) Community Based Rehabilitation: CBR Guidelines. Geneva World Health Organization.

Zhuo, D. and N. Kun (1999). Community-based rehabilitation in the People’s Republic of China’, Disability and Rehabilitation 21(10–11): 490–4.