The RICE Project(Rural Interprofessional

Clinical Expansion)

School of Social WorkUniversity of New

EnglandFebruary 28, 2014

Interprofessional Collaborative Practice with

Medically Underserved &

Vulnerable Populations

Day’s Objectives• Develop a common

understanding of what is meant by Teamwork, Collaboration & Interprofessional Education

• Provide an overview of national IPE/CP trends and goals

• Discuss populations being served by RICE Project Sites

• Apply IPE/CP principles to collaborative learning & practice opportunities at community sites

• Share methods for improving partnering, networking & team-building skills with clients, systems and each other

Small Group Activity 1

How do you define teamwork?

1. Where did you learn about how to be a team member?

2. What skills are needed to build collaborative team-based practice?

3. What are the barriers to working as a team?

What does collaborative practice look like in your agency?

“… interdisciplinary collaboration is the achievement of goals that cannot be reached when individual professions act on their own” (Bronstein, 2003).

Why is collaborative practice important?

“Trends in social problems and professional practice make it virtually impossible to serve clients effectively without collaborating with professionals from various disciplines.”

Definitions

Interprofessional Education occurs when two or more professions learn about, from and with each other to improve collaboration and the quality of care.

Collaborative Practice promotes the active participation of relevant cross-disciplinary professions in patient-centered care.

Interprofessionality is not

• Simply sharing electronic health records• Sole profession teams (neurologist, pulmonologist, radiologist)• Learners hearing a talk about another profession• Reporting out at interdisciplinary team meetings• Co-location without intentional collaboration• Decision-making without client/patient input

BIG Picture

WHAT STUDENTS TELL US

Maine’s Rural Population

Medically Complex Conditions

Maine ranks 3rd in the nation and 1st in New England for food insecurity

COMMUNITY Landscape

• Fragmentation of health care is associated with worsening MCCs

• Behavioral health disorders (BHD) are associated with worsening MCCs & early death

• Transition to continuous care is associated with improved overall health

Child PovertyAmerican Community Survey Data Findings:

Maine

• More than 1 in 5 children (20.9% under 18 years of age) live in poverty

• More than 1 in 4 young children (26.9% of children under the age of five) live in poverty.

• Child poverty is getting worse, not better: poverty rates are greater than they were just four years ago in the immediate aftermath of the Great Recession.

• Maine median household income in 2012 was $46,709, significantly lower than pre-recession levels and significantly lower than in 2008, 2009, and 2010-the immediate aftermath of the recent financial crisis and recession.

Maine’s Veterans

Maine ranks in the top five states in concentration of Veterans. York, Androscoggin and Kennebec counties are in

the top five counties both in terms of actual numbers of Veterans as well as concentration of Veterans in the overall

population (Government Accountability Report, 2011)

Core Competencies for Interprofessional Collaborative Practice

Values/Ethics for Interprofessional Practice Roles/Responsibilities for

Collaborative Practice Interprofessional Communication Interprofessional Teamwork and

Team-based Care Collaborative Leadership Patient-Centeredness

Applying Core CompetenciesWhat people and situations come to mind in

your practice setting as we explore the competencies?

Roles & Responsibilities

• Communicate roles & responsibilities

• Engage with others to meet the needs of the people & populations served.

• Use complementary skills of all team members to optimize care.

Values & Ethics• Place the interests of patients and populations at the center of health care. • Respect unique cultural values and perspectives of

individuals, populations, and health professionals.

The D-P family is, like many Maine families, struggling to make do despite full-time employment. Mr. D-P suffers with severe knee pain. Mrs. D-P is anxious to return to work but hasn’t been able to as both of her children have special needs. Her son has numerous health concerns as well as development delays and behavioral issues that have made it difficult for him to attend traditional day care.

Communication• Use respectful and

appropriate communication in all situations

• Listen actively and encourage ideas and opinions of all team members

• Become knowledgeable about the cultures in your system & in the community

With Clients/Patients/Families"When I come to Lewiston, not speaking English, not employed, not educated, the gap is already there," she said.

When young he spoke French in the home but increasingly spoke English to "fit in." He had heard

those who did not speak fluent English referred to as "dumb Frenchmen" and he didn't want to be judged by his language skills.

Teams & Teamwork

• Work with others to deliver patient-centered, community-responsive care.

• Integrate knowledge and experience of other professions to inform effective clinical, ethical, and systems-based decisions.

While most recognize the value of collaboration and teamwork they also note many barriers beginning with different definitions of team; lack of systems integration; few policies supporting team practices; and physical separation.

Collaborative Leadership

• Strong leaders value contributions of all health team members’ and also those of the patient, family, and community.

• Leaders facilitate contributions from all team members and build support for working together.

Purposeful Leadership

Consists of purposive efforts to address social determinants of health which negatively impact people and change specific existing conditions, policies and practices on behalf or with a client group, community, or population.

Oandasan, 2014

Person-Centeredness

• Respect for complementary expertise

• Value for clients/patients as a vital members of the team

• Trust in each other & in the team

• Value for clients’ perspectives and needs

• Connection & Compassion• Commitment to shared

decision-making process

Person/Patient-Centeredness

Clinical Providers

Invite & empower people to engage

with choices & adhere to prescribed treatment protocols, life style changes and medication regimens.

Public HealthProvide tools to inform & engage

consumers in health decision-making, self-

management, and health advocacy

Persons/Patients Capacity to

think critically & make informed and shared decisions in

collaboration with health care teams

Qualities of Person-Centered Practice

Attitudeso Respect for complementary expertise o Value for patients as a vital members of the teamo Trust in each other & in the teamo Connection & Compassion

Actionso Explicitly invite patients to be part of the health care teamo Introduce patients to empowering practice & facilitate skillso Communicate openly, listen actively & respond effectively o Engage patients in care planning & collaborate decision-making o Consider utilization of an ongoing evaluation process

Modified from: Orchard, C, Shaw, L, & Culliton, S. Client-Centred Collaborative Care: From the patients’ perspective. Journal of Interprofessional Care 2011.

Change

Culture Change

• A process of institutional-systems socialization (Ideas, language, values, & attitudes )

• Common vision and mission statements

• Preferred workplace/clinical practices

• Common definitions of health & principles of health care delivery

Step 1: Promote ideas that are meaningful to the workplace & set common goalsStep 2: Form an Inclusive Coalition and invite meaningful changeStep 3: Create a Common Vision for achievable changeStep 4: Walk the Talk – reach out to colleaguesStep 5: Appreciate small successes and build on themStep 6: Remove obstacles & sidestep barriersStep 7: Sustain momentum – establish a domino effectStep 8: Anchor change in the workplace

Pat Video

Patricia Chalmers, 31Pat Chalmers is a 31-year-old woman who prides herself on self-sufficiency and resourcefulness. She works part-time as a bookkeeper and gets paid to take care of her aging grandmother with whom she lives in a one bedroom apartment. Pat describes herself as having been a caretaker since adolescence. It is difficult for her to acknowledge her own needs or to seek help from others. Pat is tired of people commenting on her weight, diet, and need to exercise. She avoids health systems as much as possible because she knows she’ll be told to lose weight or be blamed for “being fat” (her words). “I know what risks I face” she says. “I’ve accepted my size and would like others to respect that.” She also avoids contact with human services or any resources she sees as linked to “the state.” Pat’s records reveal that she gave birth to a child at 16 who was adopted. Although she rarely talks about this experience she will say that she felt she was given no choices and had to move on.Pat’s grandmother comes to her appointment today. She is 56 but seems much older. Pat brought her along so she wouldn’t “chicken out” talking to a shrink. Pat has experienced depression since middle school and symptoms have worsened since she severely broke an ankle 6 months ago. The break was significant enough to require surgery. At the same time, Pat learned she had Type II diabetes. When asked about this Pat reacted strongly. “I don’t have the time or money for diabetes,” she explained.

Patricia Chalmers1. What do we know about Pat?2. Reflect upon thoughts and feelings that surface after hearing

Pat’s story? Are there assumptions, biases or experiences that might get in the way of working with Pat?

3. Why is it important for you to understand the roles of others that are working with Pat?

4. How can working with others improve the quality and safety of Pat’s care?

The Nexus

The next step forward is to increase the link between future healthcare employers and campus-based

interprofessional educational initiatives.

Shared Learning Environments

Shared Assignments & Didactics

6 Week Shared Placements

Cross-professional

preceptorships

Common Client/Patient

Panel

Clinical-Public Health-

Systems Health

“One of the best parts of this interaction for me was the ability to learn and share with one another. I was able to share my strengths as a student and learn to appreciate the strengths of student pharmacists. “

“We have the same goal: to provide excellent patient care, but we approach this goal from very different perspectives.”

“Because we know each other better, our interactions come easier and smoother when it comes to patient care… we feel comfortable to chime in and the visits became integrated in an organic way.”

Karen Pardue PhD, RN, CNE, ANEF Associate Dean for Undergraduate Education, Associate Professor of Nursing

Lisa Pagnucco BS Pharm, PharmD, BCACP Assistant Professor

RICE Project Team:Nancy AyerBetsey GrayAmy CohaDanielle WozniakShelley Cohen Konrad