Post on 10-Jul-2018
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
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)
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
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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
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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
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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.
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