Interprofessional Teams Enhance Community Outreach and Clinical Education. Carol Cokely, PhD University of Texas at Dallas

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1 Interprofessional Teams Enhance Community Outreach and Clinical Education Carol Cokely, PhD University of Texas at Dallas

2 Financial Disclosures Paid consultant 2017 CAPCSD Registration waived CAPCSD Employed by the University of Texas at Dallas

3 Themes Inter-professional Education Community Clinics & underserved Non-standard clinical education opportunity

4 Interprofessional Care & Education Interprofessional, collaborative-care relies on members of different professions working together toward the goal of improving patient outcomes.

5 Interprofessional Care & Education Shift in focus to collaborative health care to improve efficiency and effectiveness and benefit to stakeholders..

6 Interprofessional Care & Education Joint-care focus. need for collaboration incorporated into health care education Complement existing profession-specific expertise Students more responsive to patient needs

7 Community Health Centers/Clinics Goal: Healthcare to medically underserved communities Health = Individual Health + Community Health accessible, target population, community buy-in Federally Qualified Community Health Centers Demonstrated poverty; poor health status indicators; #s of providers Non-profit/public organizations BOD including service users Primary, preventive, dental, mental health Sliding fee; insured & un-insured Health Center Program look-alikes no funding; can bill Medicare/Medicaid Independent, non-profit, Community Clinics

8 Health = Individual Health + Community Health Tacos con juevos y queso Tacos con juevos y queso

9 Brother Bills Helping Hand is not Households making less than $25,000/year: West Dallas=45% / Dallas=28.7% / Texas=23.8% Adults not completing high school: West Dallas=51.5% / Dallas=25.8% / Texas=18.8% Unemployment: West Dallas=10.5% / Dallas=6.3% / Texas=5.2% Infant mortality rate: West Dallas=23% / Dallas=4.8% Pre-K vocabulary: West Dallas = words affluent Dallas = words 9

10 Brother Bills Helping Hands Mission: enriching the lives of men, women, and children in the community of West Dallas by empowering through learning, encouraging through relationships, and ensuring the essentials of life. Programs: Grocery Store, English Class, Health Clinics (& Specialties), Kids Crafts; Exercise; Computer; Birthday Party in a Bag; Health & Well- Being Classes.. 10

11 BBHH serves the neighborhood since 1933 Community Clinic Unduplicated number of individuals served: 4,375 Total number of households: 1,205 Total units of service: 96,319 Income: 100% low-income Household status: 48.9% married, 51.1% households with children Spanish speaking-only household: 42%

12 Brother Bills Helping Hands Empowering through Learning Programs: 20,504 Visits (Bible Study, Devotional Time, English Class, Faith & Finances, Kids Craft Time, PathWays, National Day of Prayer) Essentials of Life Programs: 63,375 Visits (Birthday Party in a Bag, Neighbor Day, Back to School Carnival, Grocery Store, SNAP Registration, Children's Christmas Celebration) Community Clinic: 7,943 Visits (Adult, Women, Dental, and Eye Clinics, EKG, Flu Shots, Labs, Glasses, Mammograms, Prescription Aid Program, Prostate Screening, UT Southwestern Depression Study) Health Living Programs: 4,497 Visits (Diabetes, Exercise Classes, Healthy Eating, Blood Pressure, High Cholesterol seminars, Family Talk/Diaper Day, Medicaid Registration, Mr. Donovan's Sport Camp, Soccer Camp, Super Saturday)

13 Brother Bills Helping Hands: Demographics Ethnicity of individuals served Age of individuals served by % Hispanic African American Other Children Adults Adults 60 +

14 Agape Clinic 35 years.community Clinic facility 2012 "The mission of the Agape Clinic is to improve the health of medically underserved people by providing quality community health services. Over 17,000 visits thousands of volunteer hours - medical/healthcare teams. $175,000 dollars in pay what you can and donations Translates to $6,000,000 worth of care 14

15 Agape Services Family Medical Care Dental Services Social Services Women s Health Specialty Services: Dermatology, Neurology, Allergy, Pediatrics Counseling, ENT/Audiology

16 Agape Clinic Professional Education: School of Nursing University of Texas Southwestern Medical School Baylor College of Dentistry

17 Agape Partnership University of Texas Southwestern Medical Center Medical School Student Manager Team that populates: Multidisciplinary Clinics: ENT/AUDIO/PT Pediatric Clinic Family Medicine (Endocrinology)

18 Agape Saturday Clinics Operates 7 days per week Daily clinics: Nurse practitioners, volunteers Partnership with UTSW MC student-run clinics Student Managers: Staff clinics with attending physicians, volunteers Agape staff gatekeepers Patients referred by Family Medicine +

19 Ear, Hearing & Balance Clinic BBHH/Agape Clinics Initial visit in General Medical Referred to Saturday clinic Students follow patient through cycle 1 Audiology ENT 2 3 Physical Therapy 8-10 patients

20 Audiology Equipment Environment Evaluation: basic comprehensive Counseling/Referrals

21 Resources Texas Resources Texas Workforce Commission Early Childhood Intervention 0-6 program extension of ECI Other specialty clinics within community clinic framework UTD Callier: Hearing Aid Recovery Program (HARP) $700 SAMs Club; OTC

22 Physical Therapy BALANCE ASSESSMENT: Motion provoked dizziness Visual dominance for balance Visual motion sensitivity Subjective Visual Vertical Decreased reliance on proprioceptive cues Decreased proprioceptive cues Persistent Postural-Perceptual Dizziness (Chronic Subjective Dizziness) BPPV: R L Posterior, R L Horizontal, R L Anterior

23 Physical Therapy Back, neck, extremity TMJ Motor development Exercise programs

24 Center of Hope Women and Children s Shelter We meet people experiencing homelessness at their personal points of need by providing food, shelter, clothing, and basic clinic services. With these immediate needs met, homeless people can begin to learn how they can change their lives building on a solid foundation of faith.

25 Center of Hope Union Gospel Mission Center of Hope Capacity: 234 women and their children Exclusively for single women with children Shelter (3 months) Discipleship Program (18 months- 2 years) Daily meals library, learning center, clothing center, life-skill classes, chapel and medical clinic on-site Discipleship program Transitional living facility Involved with a local church Have a savings account Hold a job and be living independently. 25

26 Audiology- SLP-ENT. PT Once per semester Thursday parent education class Monday afternoon clinic Hearing: OAEs, Immittance, Behavioral Speech-Language: Fluharty-2; REEL [Motor Development]

27 Evolving Programs Motor developmental screenings Early Childhood Intervention on site at COH during screenings Parent-education programs Parent-clinics

28 Brother Bills Ear, Hearing, Balance Clinic Volunteers

29 Student Participation 2 years approximately 1 clinic per month- Class of 2017: 6/8 Class of 2018: 6/8 Class of 2019: 11/12 Class of 2020: 13/14 Class of 2021: 9/14 Total: 45/56 over 80 %

30 Patients Seen Adult Clinics: Pediatric: 8 10 patients per clinic ( per year) 20 per clinic (60 per year)

31 Perceived student learner benefits Recognize/prioritize patient needs enhance referral network teach other professionals/students learn about/from the other disciplines recognize respect from other professionals other students aren t always confident platform for exchange of knowledge develop peers outside of discipline working alongside not for address the big problems

32 Collaborative Benefits Breaking Bread Projects: Risk for Falling Walk and Talk Teaching exchange Student coordinators Community Engagement: Diaper program, Food-delivery, Camps

33 Goal: Improved Patient Outcomes Frequency counts Brother Bills: remissons Stress/anxiety Blood pressure Referrals: Pediatric: 40 % speech/language 30 % ENT Adults: 40 % referral

34 Challenges Is it enough? Stability of volunteer program Student Manager Volunteer physicians Training staff re: referrals Resources Data collection/monitoring