Cooperative Education: A Transprofessional
Education Model for Oral Health and Primary
Care Practice Integration
2015 Collaborating Across Borders V
Roanoke, VA
September 30, 2015
Authors
Northeastern University:
Maria Dolce, PhD, RN, CNE
Jessica Holloman, MS, BSDH
Dierdre Jordan, MS
Veronica Ramirez, Health Sciences Student c/o ‘16
Boston Health Care for the Homeless Program:
Pooja Bhalla, RN
Colleen Anderson, DDS
Learning Outcomes
• Discuss the importance of integrating oral health
and primary care practice.
• Describe a Co-op model for integrating oral health
and primary care competencies.
• Apply Co-op strategies at your institution.
Panel Overview
• Bouvé College of Health Sciences at Northeastern
University
• Innovations in Oral Health Program
• Oral health & primary care integration
• Co-operative education
• Co-op model:
– Development, setting, implementation, evaluation
• The student perspective
Founded 1898
1,157 full-time faculty
30,000 students
Bouvé College of Health Sciences
2,800 students
205 full-time faculty
3 Schools
Three Schools:
• Nursing
• Pharmacy
• Health Professions
– Counseling & Applied
Educational Psychology
– Health Informatics
– Health Science
– Physical Therapy
– Speech-language
Pathology/Audiology
– Physician Assistant Studies
– Public Health
2013 - 2018 Strategic Plan
Goal 1. To be a national model for interprofessional health
education.
In preparing students for interprofessional practice through
campus-based learning and experiential education, the College
will:
•Incorporate interprofessional education and practice throughout
student learning experiences.
•Assess and expand the College’s capacity to engage in
interprofessional education and practice.
•Promote interprofessional education and practice through
scholarship.
Innovations in Oral Health:
Technology, Instruction, Practice, Service
The DentaQuest Foundation is committed to optimal oral
health for all Americans through its support of prevention
and access to affordable care, and through its partnerships
with funders, policymakers and community leaders. For
more information, please visit dentaquestfoundation.org
Improve Workforce Training and
Capacity Building
• Primary care
• Rural and medically
underserved areas
• Preventive medicine
• Public health
• Behavioral health
• Oral health
• Team management of
chronic disease
Experiential Curriculum
Guiding Principles
• Core
competencies
collaborative
practice
• Person- and
family centered
• Integrated care
• Primary care
and
communitybased settings
SimulationLearning
• Students from
two or more
disciplines
• Team-based
• Standardized
patient cases
• Scenarios
address health
care needs of
vulnerable and
underserved
populations
Cooperative
Education
• “Co-op”
• Integrate
academic study
and full-time
employment
• Work-based
learning
• Integrate
classroom
learning and
real-world
experiences
Community
Service-LearningLearning
• Faculty-led
partnerships
with
communitybased entities
• Address needs
or interests
identified by
the community
• Hands-on roles
and projects
100+ Years of Co-op History
1909
2015
Co-op Connects
Academic and Experiential
Traditional Approach
• Students attend classes
• Students complete internship
or work assignment
• Classes and work are two
distinct experiences
Innovative Approach
• Classes and Co-op are
integrated
– Co-op preparation course
– Guided reflection during and
after Co-op
– Related online coursework
during Co-op
Class
Class
Co-op
+
Co-op
Co-op Cycle
POWERFUL LEARNING
MODEL
Intellectual
Inquiry
Experiential
Education
Global
Opportunities
Required Core Courses
• American Healthcare
Systems
• Community and Public
Health
• Communication Skills for
the Healthcare Professional
• Biostatistics
• Healthcare Management
• Race, Ethnicity and Health
• Health Education &
Program Planning
• Health Policy
Required Courses
•
•
•
•
•
•
•
•
•
Chemistry 1 & 2
Biology 1 & 2
Anatomy and Physiology 1 & 2
Calculus
Nutrition
Foundations of Psychology
Healthcare Research
College and Advanced Writing
Professional Development Coop
• Capstone
BEHRAKIS HEALTH
SCIENCES CENTER: AN
INNOVATIVE LEARNING
ENVIRONMENT
• State-of-the-art classrooms and labs
• Arnold S. Goldstein Simulation Laboratories with nine highfidelity patient simulators, video capture technology, four
simulation bays, and two debriefing rooms
• Interdisciplinary healthcare team approach
• Clinical faculty who are practicing professionals
HEALTH SCIENCE @ NU:
INTELLECTUAL INQUIRY
• What is Health Science?
• Challenging coursework
• Flexibility
• Outstanding faculty
Essentials for Co-operative Education
1. Mindfulness in learning
2. Reflections promote deep
learning
3. Student-Employer goal
planning
4. Student self-evaluations &
Employer evaluation
Competency Frameworks
Job Description
• Assist with risk
assessments & oral
health evaluations
• Develop patient
education tools
• Provide oral health
education to patients
• Collaborate with medical
and dental providers
• Participate in
medical/dental
integration meetings
• Develop resource and
referral networks for use
at medical sites
• Design and conduct a
survey for patient needs
at outreach sites
22
Student Learning Outcomes
IPEC:
•Engage other health professionals – appropriate to the specific care
situation – in shared patient-centered problem solving.
•Perform effectively on teams and in different team roles in a variety
of settings.
HRSA:
•Conduct preliminary patient-specific, oral health risk assessments on
all patients.
•In collaboration with a dental provider, perform oral health
evaluations linking patient history, risk assessment, and clinical
findings
23
Workshops
• Teamwork &
Communication in
Health Care
• Risk Assessment
• The Oral Exam
• Fluoride Varnish
24
Evaluation Methods
• TeamSTEPPS® T-TAQ
• Oral Health Knowledge, Skills, and Attitudes
Survey
• Workshop Evaluation Forms
• BHCHP Data
• Student reflections
25
Patient-Centered Medical Home
BHCHP Mission
To provide & assure access
to the highest quality
health care
for Boston’s homeless
men, women & children
Photos courtesy of J O’Connell
Homeless Health
• Acute & chronic health
problems
• Morbidity & mortality
• Premature aging
• Delayed treatment &
reliance on ED
• Access to health care
• Follow-up
• Trust & hope
BHCHP Care Model
• Patient-centered
• Comprehensive
• Collaborative, team-based
• Culturally competent
• High quality
Jean Yawkey Place
Boston Medical Center
Family Team
Street Team
Suffolk Downs Racetrack
Barbara McInnis House
Evolution to PCMH
•
•
•
•
•
Care teams
CCM & Risk Stratification
Population Management
Open Access
EMR Changes
– Med Rec
– Goal Setting
– Visit Summaries
Case Conferencing
What is PCMH, again?
• Improved access and continuity for
patients
• Collecting and using data in EMR to
better care for patients
• Care coordination across settings
• Providing patients with selfmanagement support
• Data gathering and quality
improvement
Oral Health in the Homeless Population
• Oral disease is very prevalent in the homeless population
– Higher incidence of caries, gum disease, tooth loss, and oral pain
• Disease conditions are more often severe when diagnosed
• Access to treatment is often difficult to obtain
• Often a low priority for patients
• At BHCHP, Dental sees less than 25% of our overall patients
How do we provide oral health
care to the rest of our patients?
38
Medical and Dental Integration at BHCHP
Formed a multidisciplinary Integration Team
• 1st Goal: increase the oral health care patients receive in medical
settings
• Oral exams to identify/screen for disease
• Provide oral health education
• Identify acute issues for immediate referral
• Connect patients with dental clinics
• Target:
• Primary care patients at our main medical clinic
• Family Team patients at a variety of family shelter settings
Initial Integration Steps
Changes to EMR medical notes
40
•
•
•
•
Challenges
Resources are limited
Staff may not feel they have the right skills
There are many competing priorities
How do you make the connections?
41
The Co-op Position
• A new role for BHCHP
“oral health coordinator/oral health community support worker”
• An oral health ambassador to other parts of the program
-both patients and staff!
• A researcher and resource finder
• An organizer – events, publicity, patient education
• A care coordinator for individual patients
Training and Position Development
•
•
•
•
•
•
Site visits
Medical and dental conditions common to the homeless population
Assisting and observing in the dental clinic
Work shops on oral health topics for all BHCHP co-ops
Time for the student to help develop and define the role
Scheduled to rotate in the main medical clinic, three family team sites, and the
dental clinic.
Integration Efforts
• Staff knowledge and attitude survey
• Adult and pediatric oral health risk assessment tools
• Staff trainings
• Oral health fairs at family team sites
• Resources for staff and patients
• Events to raise staff awareness and encourage oral exams
• Risk assessments, patient education, and care coordination within our
medical clinic and family team clinics
Student Perspective
Veronica Ramirez, Health Sciences
Student c/o ‘16
Background
• Grew up in an urban setting as a culture and community
oriented individual
• Interested in the field of dental medicine for over 8 years
• Involved in a student driven interprofessional
organization
• Currently a senior majoring in Health Sciences at
Northeastern University
46
The Co-op Search
• Looking to
–Gain clinical experience in a dental setting with
patient interaction
–Expand my knowledge and skills in
interprofessional education
–Work with an underserved population
–Practice my bilingual medical terminology
47
Professional Development
• Practiced leadership skills by
– Coordinating dental care for patients and providing education on
the oral-systemic connection
– Designing a risk assessment tool for non-dental staff
– Participating in the development of a simulation-based training
on oral health for medical staff and case managers
– Organizing oral health fairs and an oral exam challenge for the
medical staff
48
Improving Oral Exam Count
49
Results
• Scheduled a total of
110 appointments
• Applied fluoride
varnish to 29 children
• Increased percentage
of patients receiving
oral health exams in
the medical setting by
21%
50
Professional Development
• Patient interaction
– Building rapport
– Translating book knowledge to simple conversational language
– Problem solving and critical thinking
• Academic knowledge
– Variety of working environments that highlighted the
interprofessional environment
– In depth opportunities to learn about dental treatment plans,
protocols and procedures
51
Personal Development
• Clarification of professional goals
• Became a more compassionate, patient and dedicated
individual
• Helping to achieve patient centered care
• Stronger understanding of interprofessional education
and competencies in medical and dental setting
52
The DentaQuest Foundation is committed to optimal oral
health for all Americans through its support of prevention and
access to affordable care, and through its partnerships with
funders, policymakers and community leaders. For more
information, please visit dentaquestfoundation.org
Thank you
QUESTIONS ?
m.dolce@neu.edu
j.holloman@neu.edu