Passion for health. Compassion for people.

SHOW Student Health Outreach for Wellness

Learning Objectives

At the end of this conference, participants will be able to:

Explain how SHOW assigns treatment teams to patients based on patient need and provider scope of practice

Recognize overlap areas among the professions and describe practical ways to use interprofessional team members to best meet patient needs

Delineate the role innovative collaborative partners can have in maximizing the access to and quality of care for primary care patients

Background: What is SHOW?

• Student Health Outreach for Wellness (SHOW) Community Health Initiative and Free Clinic

• Arizona’s first tri-university collaborative project

• Run by students and guided by faculty

• Diverse backgrounds: traditional health care disciplines, business, journalism, law, global health, and computer science

• Unites students, faculty, community providers, community & government organizations, and underserved populations

• Mission: to provide holistic, client-centered health care services

• Interprofessional team-based care model

https://www.youtube.com/watch?v=tgntjQnJOhk

Passion for health. Compassion for people.

SHOW Clinical ModelStudent Health Outreach for Wellness

Clinic Management

Student Management

Shift Manager

Dispensing Manager

Lab Manager

Navigator Lead

Faculty Management

Program Director

Medical Director

Administrative Director

Outreach Director

ResearchLead

Management teams operate side by side (flattened hierarchy)

Patient

Management Team

Navigator Team

Teaching Team

Provider Team

Clinic Structure: Patient-Centered Care

Navigator Team

• Comprised of undergraduate students

• Advocate for patients

• Direct patient flow

• Connect patient to ongoing program activities

• Collect data for clinic improvement

Teaching Team- Integrated, Interprofessional

Nursing

General Medicine

Physician Assistant

Behavioral Health

Physical Therapy

Audiology

Speech Pathology

Social Work Occu-

pationalTherapy

Physical Therapy

Pharmacy

Health professional students

• Responsible for patient assessment, diagnoses, treatment, planning,

and evaluation

Preceptors: Licensed Faculty & Community Providers

• Responsible for facilitating and mentoring the Teaching Team in

developing diagnoses and treatment plan for patients

Clinic Structure- Integrated, Interprofessional

Waiting Room

• Patient fills out forms

• Entered into EMR

• Social Work forms filled out

Initial Exam

• Health Professional Students conduct triage/initial exam

Final Exam• Provider conducts

final visit with assistance of health professional students

Patient Surveys

• Navigator follow-up

• Patient satisfaction surveys

Patient Leaves Clinic

Teaching Team Huddle #1

Teaching Team Huddle #2

Clinic Structure- Integrated, Interprofessional

Interprofessionalism is encouraged by:

1) interdisciplinary assessment 2) team huddles and 3) post-shift huddles

The “Team Huddle” is crucial to interprofessional (IP) care in SHOW • Team leader (preceptor) facilitates

discussion regarding patient case• Occurs intentionally three times

throughout visit

1. After vitals, patient history, and chief complaint are collected

2. After initial examination 3. After patient’s visit has ended (to

review the case)

Interprofessional Team Members

Medical Doctor

Nurse Practitioner

Physician Assistant

Nurse

Occupational Therapist

Physical Therapist

Social Worker

Speech Language Pathologist

Pharmacist

Audiologist

As we use an all volunteer model, team composition can vary. Typical team members include these fields (preceptors and students):

Treatment teams dictated by

Patient needs

Professionals available

Red team• Primarily medical issues (e.g. tendinitis, wounds, medication

management, etc.)

Yellow team (has a BH provider: SW, OT, psych NP)• Primarily diagnoses with behavioral health issues (HTN w/ anxiety, c/o

headaches w/ depression, medical conditions w/ hx of mental health issues)

• Teams communicate and share clinicians as indicated by patient needs determined after evaluation

Medical Doctor

MD/DO

• Primary Care

Assesses, diagnoses, treats

• Examples:

• Physical health (acute care and chronic disease management)

• Trauma/injuries (sprains, sutures, wound care)

• Mental health (depression, anxiety, bipolar, etc)

• Procedures (biopsies, joint aspirations, injections)

Interprets labs and imaging (ekg, spirometry, etc)

Provides education, counseling and resources

• Handouts, motivational interviewing, brief interventions for tobacco/substance use

Nurse Practitioner

Nurse Practitioners (NP) are register nurses who have higher education and training in a specialty area. Doctors of NP’s have the additional expertise of research translation- research into practice, evaluation of outcomes

A nurse practitioner role focuses on preventative and holistic care, with specialized and personalized treatment areas for each individual patient (environmental manipulation). • Assesses, diagnoses, treats conditions and illnesses• Counseling and educating patients

Psychiatric and Mental Health NP role overlaps with MD, SW, Counselors and OTs

Occupational Therapist

Treat medical and behavioral health issues that affect function and quality of life

Work with patients within the context of their lives within their families and communities, working with their own habits and routines to improve health

OTs scope of practice includes medical, rehabilitation, and behavioral health (overlaps with NP, SLP, PT, and SW)

OT can address: medication adherence, lifestyle issues affecting health/chronic illness, behavioral health issues, rehabilitation needs.

Examples:

• HTN w/anxiety: OT will give medication adherence and lifestyle modification strategies, relaxation strategies (will get NP for medication management needs, and SW for community resources) all 3 of the BH providers can offer some level of counseling, but each provider has some skills specific to their discipline.

• Ankle sprain: PT will address the ankle support, rehab exercises, MD or NP order pain meds, OT will work with the patient on pain management strategies and adapted techniques and equipment to maximize functional independence.

Physical Therapist

Musculoskeletal experts that reduce pain and restore mobility through patient centered care, education and optimization of soft tissue healing. The physical therapist is able to aide in the treatment and prophylactic management of a wide range of conditions that can limit functional mobility, including:

Examples of inter-professional management: Mental Health: PT will treat musculoskeletal dysfunction and manage psychomotor factors (e.g. fear

avoidance behavior and/or poor internal motivation). Team based medicine will be implemented for additional psychosocial management via psychotherapy and/or psychopharmaceutic treatment.

Internal Medicine: PT will refer patients with non-musculoskeletal and/or systemic involvement for additional medical management in the form of imaging, pharmaceuticals, surgery and/or specialist care.

Health Promotion: PT will work with OT, SLP, SW and PCPs to manage risks to health (e.g. weight, smoking cessation, drug side-effects, substance abuse, sedentary life-styles, behavioral maladjustments etc.)

Chronic Pain Progressive neurological disorders

Headaches Post-surgical sequelae

Vertigo Pelvic floor dysfunction

Acute and chronic musculoskeletal injuries Deconditioning

Social Worker

BSW, MSW, LMSW, LCSW – opportunities at all levels of practice

Social work addresses medical and behavioral health issues across the lifespan holistically and in the context of the environment where they occur specifically targeting the most vulnerable populations to improve wellbeing and quality of life.

Roles include: Advocate, Educator, Counselor, Case Manager, Broker, Researcher, Clinician, Mediator, Facilitator, Coordinator, Navigator and Activist

As part of integrated care team conducts various assessments such as Biopsychosocial-spiritual, SBIRT, PHQ-9, Mini-mental status, etc.

Care team examples: Social workers assist with gathering patient medical and behavioral health histories, provide resources, conduct assessments, refer for additional treatment and services, provide health promotion through patient education, assist with aftercare planning, advocate to support treatment goals, address social determinants of health, assist with outreach and assist with crisis management

Speech Language Pathologist

Scope of Practice

Students gain knowledge and skills about interdisciplinary teams and other collaborative models to diagnose, treat, and counsel and advocate for those individuals are normatively characterized as vulnerable populations and present with communication disorders.

• Examples include

• Receptive and Expressive language skills

• Dysphagia (Swallowing)

• Traumatic Brain Injury (TBI), aphasia ( e.g., cognitive, attention, and memory skills)

• Hearing impairments

• Voice and fluency

• Social language skills

• Functional literacy

Future Directions

• Continue to encourage undergraduate and graduate SLP students to volunteer at SHOW because of the unique opportunity it gives them to serve others and to grow both professionally and personally.

• Continue to integrate students on teams at Crossroads, Inc.

• Develop useful referral sources for patients working with social work and other team members.

Pharmacist

Scope of Practice• Participate in the patient care process through ensuring safe and

appropriate medication therapy and outcomes

• Advise & educate on the safe administration, dispensing, storage, and disposal of medications

• Advise & educate on medication therapy selection & dosing, drug interactions, and side effects

• Perform point of care testing & physical assessment (based on specialty training)

• Participate in clinic compliance and quality assurance activities

Future Directions

• Integrate 1st year pharmacy students into the waiting room procedure to obtain medication histories

• Integrate 2nd, 3rd, & 4th year pharmacy students into the teams

• Expand scope as pharmacist preceptors with specialty training recruited

SHOW Rapid Cycle Quality ImprovementIncorporates PDSA

Plan (Post-Shift Huddles)

What are we doing now and how can we improve it?

Create process for improvement

Do

Implement solution

Study

Did plan lead to improvement?

Any unexpected effects?

Adjust

Make changes to further improve plan

Internal “Customers”- Students, preceptorsExternal “Customers”- Community Partners, patients

Team Based Care – Better Outcomes

Cost effective use of team clinicians as we recognize overlap in scope of practice which allows us to meet patient needs more quickly and effectively, and reduces redundancy

Reduced number of people sent to urgent cares or emergency departments by 30%

Increased access to a wider range of services, including occupational therapy, physical therapy, pharmacy, speech language pathology, and audiology

Increased opportunity for inter-agency education

Increased collaboration on population health (i.e., diabetes screening AHEC grant)

Increased awareness regarding community-based services

Improved coordination of population services to leverage existing resources

Increased access to shared patient information through involvement in the Health Information Exchange

Increased educational opportunities for our future healthcare providers on social determinants of health effects related to the well-being of individuals, communities and populations

Future Directions

Optimal care delivery with our available disciplines –

• to meet needs of patient

• provide necessary care in a cost effective manner

Future Directions

Expansion into Crossroads Inc.

Street Medicine-Phoenix

REACT Refugee Clinic

Student Leadership Measures

Increase Formalized Quality Measures