The INTERACT Program:
What is It and Why Does It Matter?
Joseph Ouslander, MD
Ruth Tappen, EdD, RN, FAAN
Jill Shutes, GNP
Nancy Henry, PhD, GNP
Michelle Duhaney, DO
Laurie Herndon, MSN, GNP-BC
Gerri Lamb, PhD, RN, FAAN
Jo Taylor, RN, MPH
Florida Atlantic University
Florida Atlantic University
Florida Atlantic University
Florida Atlantic University
Florida Atlantic University
Mass Senior Care Foundation
Arizona State University
The Carolinas Center for Medical Excellence
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
The INTERACT Interdisciplinary Team
Joseph Ouslander, MD
Ruth Tappen, EdD, RN, FAAN
Jill Shutes, GNP
Nancy Henry, PhD, GNP
Michelle Duhaney, DO
Maria Rojido, MD
Sanya Diaz, MD
Laurie Herndon, MSN, GNP-BC
Jo Taylor, RN, MPH
Gerri Lamb, PhD, RN, FAAN
Annie Rahman, PhD, MSW
Dan Osterweil, MD
Amy E. Boutwell, MD, MPP
Mary Perloe, GNP
John Schnelle, PhD
Sandra Simmons, PhD
Alice Bonner, PhD, GNP
Florida Atlantic University
Florida Atlantic University
Florida Atlantic University
Florida Atlantic University
Florida Atlantic University
Florida Atlantic University
Florida Atlantic University
Mass Senior Care Foundation
The Carolinas Center for Medical Excellence
Arizona State University
USC Davis School of Gerontology
California Association of Long Term Care Medicine
Collaborative Healthcare Strategies
Georgia Medical Care Foundation
Vanderbilt University
Vanderbilt University
Center for Medicare and Medicaid Services
In collaboration with participating nursing homes
© Florida Atlantic University 2011
The INTERACT Program:
Background and Why it Matters
College of Medicine
College of Nursing
New Dorms
New
FOOTBALL
STADIUM
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Objectives of this Presentation
1. Discuss key health policy issues related to the
future of nursing home care
2. Provide a broad overview of the INTERACT
quality improvement program and how it fits with
health care reform initiatives
3. Highlight future directions for INTERACT
4. Discuss key concepts for eINTERACT
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Health Care Reform
 The Affordable Care Act is
focused on a “triple aim”:
1.
2.
3.
Improving care
Improving health
Making care affordable
 This presents major
opportunities to improve
geriatric care in the U.S.
© Florida Atlantic University 2011
The INTERACT Program:
Background and Why it Matters
Medicare Fee-for-Service
 Financial incentives in the
Medicare fee-for-service
program incentivize overuse
of diagnostic tests and
procedures that do not benefit
many elderly people, and can
result in morbidity and costs
 By far, the most costly
example in the geriatric
population is potentially
preventable hospitalizations
Willie Sutton
FBI Ten Most Wanted Fugitives
Born/Died
1901 -1980
Charges
Bank robbery
Caught
February 1952
During his forty year criminal career he stole an
estimated $2 million, and eventually spent
more than half his adult life in prison.
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
The U.S. Department of Health and Human Services
“Partnership for Patients”
1. Accelerate Reduction in Harm to Patients in Hospitals


Achieve a 40% reduction in preventable harm by 2013
~ 1.8 million fewer injuries to patients; ~ 60 000 lives saved;
~ $20 billion in health care costs avoided
2. Decrease Preventable Hospital Readmissions Within
30 Days of Discharge


Reduce readmissions by 20% by 2013
~1.6 million hospital readmissions prevented and ~ $15 billion
in health care costs avoided
http://www.healthcare.gov/center/programs/partnership
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Changes in Medicare Financing
 Pay-for-Performance (“P4P”)
 No payment for certain complications;
disincentives for avoidable
hospitalizations
 Bundling of payments for episodes of care
 Accountable Care Organizations that
include hospitals, physicians, home health
agencies, and SNFs that are responsible for
the care of a defined group of patients
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Why Does This Matter?
1. Hospital transfers are common and often
result in complications in older NH residents
2. Some hospital transfers are preventable
3. Care can be improved, resulting in fewer
complications and reduced cost
4. Cost savings to Medicare can be shared
with NHs to further improve care
5. Financial and regulatory incentives are
changing
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
1 in 4 patients admitted to a SNF are re-admitted to the
hospital within 30 days at a cost of $4.3 billion
Mor et al. Health Affairs 29: 57-64, 2010
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Why Does This Matter?
Hospitalization
 At the beauty salon
 At risk for complications






Delirium
Polypharmacy
Falls
Incontinence and catheter use
Hospital acquired infections
Immobility, de-conditioning,
pressure ulcers © Florida Atlantic University 2011
The INTERACT Program:
Background and Why it Matters
Some Hospitalizations of NH Residents are Avoidable
• As many as 45% of admissions of
nursing home residents to acute
hospitals may be inappropriate
U.S. Healthcare System
Saliba et al, J Amer Geriatr Soc
48:154-163, 2000
• In 2004 in NY, Medicare spent close
to $200 million on hospitalization
of long-stay NH residents for
“ambulatory care sensitive
diagnoses”
Acute Care
Facility
Home
Care
Outpatient/
Ambulatory
Facility
Tranquil Gardens
Nursing Home
Long Term Care
Facility
Grabowski et al, Health Affairs
26: 1753-1761, 2007
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
CMS Special Study in Georgia – Expert Ratings of
Potentially Avoidable Hospitalizations
Based review of 200 hospitalizations from 20 NHs
Was the Hospitalization Avoidable?
Definitely/Probably
Definitely/Probably
YES
NO
Medicare A
69%
31%
Other
65%
35%
HIGH
75%
25%
59%
41%
68%
32%
Hospitalization Rate Homes
LOW
Hospitalization Rate Homes
TOTAL
Ouslander et al: J Amer Ger Soc 58: 627-635, 2010
© Florida Atlantic University 2011
The INTERACT Program:
Background and Why it Matters
CMS Study of Dually Eligible
Medicare/Medicaid Beneficiaries
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Opportunities for You and Your Facility
HIGH
Reduced Avoidable
Hospitalizations
Quality
Improved Quality,
Reduced Costs
$ Incentives for
Providers
Costs Avoided
LOW
$
LOW
$ Costs
HIGH
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Maslow, K and , Ouslander, JG: Measurement of Potentially Preventable Hospitalizations.
White Paper prepared for the Long Term Quality Alliance, 2012.
(Available at: http://www.ltqa.org/wpcontent/themes/ltqaMain/custom/images//PreventableHospitalizations_021512_2.pdf
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
 Defining “Preventable”,
“Avoidable”, “Unnecessary”
hospitalizations is challenging
because numerous factors
and incentives influence the
decision to hospitalize
 Risk adjustment is very
complicated
Maslow, K and , Ouslander, JG: Measurement of Potentially Preventable Hospitalizations.
White Paper prepared for the Long Term Quality Alliance, 2012.
(Available at: http://www.ltqa.org/wpcontent/themes/ltqaMain/custom/images//PreventableHospitalizations_021512_2.pdf
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Opportunities for You and Your Facility



The Affordable Care Act mandates that each
facility have a Quality Assurance and
Performance Improvement program
(“QAPI”)
The regulation and related surveyor
guidance are being written
Improving management of acute change in
condition and reducing unnecessary
hospital transfers is one potential focus of
your QAPI
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
What Do You and Your Facility Need to Take
Advantage of These Opportunities?
QI Programs
Infrastructure
Tools
Incentives
Safe Reduction in Unnecessary
Acute Care Transfers
Quality
Costs
Morbidity
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
(“Interventions to Reduce Acute Care Transfers”)
Is a quality improvement program designed
to improve the care of nursing home residents
with acute changes in condition
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
 Includes evidence and expert-recommended
clinical practice tools, strategies to implement
them, and related educational resources
 The basic program is located on the internet:
http://interact2.net
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Acknowledgement
The INTERACT Program and Tools were initially developed by Joseph G. Ouslander, MD and Mary
Perloe, MS, GNP at the Georgia Medical Care Foundation with the support of a contract from the Center
for Medicare and Medicaid Services.
The current version of the INTERACT Program, including the INTERACT II Tools, educational materials,
and implementation strategies were developed by Drs. Ouslander, Gerri Lamb, Alice Bonner, and Ruth
Tappen, and Ms. Laurie Herndon with input from many direct care providers and national experts in a
project based at Florida Atlantic University supported by The Commonwealth Fund. The Commonwealth
Fund is a private foundation supporting independent research on health policy reform and a high
performance health system.
Some materials herein are © Florida Atlantic University 2011. Such materials and the trademark
INTERACTTM may be used with the permission of Florida Atlantic University.
Permission can be granted by Dr. Ouslander (jousland@fau.edu)
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
INTERACT is One of Several Evidence-Based
Care Transitions Interventions
“BOOST”
(Better Outcomes for Older Adults
Through Safe Transitions)
“Bridge Model”
http://www.hospitalmedicine.org
http://www.transitionalcare.org/the-bridge-model
• Social Worker coordinating Aging Resource
Center Services at hospital discharge
“Project RED”
(Re-Engineered Discharge)
https://www.bu.edu/fammed/projectred
• Enhanced hospital discharge planning
“Care Transition Program”
http://www.caretransitions.org
• Transition coach
• Trained volunteers
• Empowered patients and caregivers
“POLST” (or “MOLST”)
(Physician (or Medical) Orders
For life Sustaining Treatment)
http://www.ohsu.edu/polst
• Advance care planning
High Quality Care
Transitions for
Older Adults &
Caregivers
“Transitional Care Model”
http://www.transitionalcare.info/index.html
• APN coordinates care during and after
discharge
• Home, SNF, and clinic visits
“INTERACT”
(Interventions to Reduce
Acute Care Transfers)
http://interact2.net
• Communication Tools, Care Paths,
Advance Care Planning Tools, and QI
tools for nursing homes and SNFs
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
 The goal of INTERACT is to improve care,
not to prevent all hospital transfers
 In fact, INTERACT can help with more
rapid transfer of residents who need
hospital care
HALT
Unnecessary
Hospital Stays
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
 Can help your facility safely reduce hospital transfers by:
1. Preventing conditions from becoming severe enough to
require hospitalization through early identification and assessment
of changes in resident condition
2. Managing some conditions in the NH without transfer when
this is feasible and safe
3. Improving advance care planning and the use of palliative
care plans when appropriate as an alternative to hospitalization for
some residents
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
A Tale of Three Siblings
 Sadie
 Sara
 Sam
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Sadie
A 96 year old long-stay NH resident
 Hospitalized for UTI and dehydration
 Discharged back to the NH after 4 days
 Re-hospitalized 7 days later for
dehydration and recurrent UTI
Avoidable?
INTERACT strategy:
 Prevent conditions from becoming severe enough to require
hospitalization through early detection and evaluation
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Sara (Sadie’s younger sister)
A 92 year old long-stay NH resident
 Hospitalized for a lower respiratory
infection, but had normal vital signs
and oxygen saturation
 Developed delirium in the hospital,
fell, fractured her pubis, and
developed a pressure ulcer
Avoidable?
INTERACT strategy:
 Manage some conditions in the NH without transfer
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Sam (Sara and Sadie’s older brother)
A 101 year old long-stay NH resident
 Hospitalized for the 4th time in
2 months for aspiration
pneumonia related to endstage Alzheimer’s disease
 Transferred to hospice on the
day of admission
Avoidable?
INTERACT strategy:
 Improve advance care planning and the use of palliative care
plans when appropriate as an alternative to hospitalization
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
CMS Pilot Study Results
1. Tools and implementation strategies were pilot
tested in 3 Georgia NHs with relatively high
hospitalization rates
2. Tools were acceptable to staff
3. Significant reduction in hospitalizations
4. Significant reduction in transfers rated as
avoidable by an expert panel
Ouslander et al: J Amer Med Dir Assoc 9: 644-652, 2009
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
 The program and tools were revised based
on CMS pilot study, and input from front-line
NH staff and national experts
 The revised program and INTERACT II Tools
are available at: http://interact2.net
Supported by a grant from the Commonwealth Fund
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Implementation Model in the
Commonwealth Fund Grant Collaborative
 On site training (part of one day)
 Facility-based champion
 Collaborative phone calls with up to 10
facility champions twice monthly facilitated
by an experienced nurse practitioner
 Availability for telephone and email consults
 Completion and faxing of QI Review Tools
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Commonwealth Fund Project Results
Mean Hospitalization Rate
per 1000 resident days
Facilities
Mean Change
Pre
intervention
During
Intervention
All INTERACT facilities
(N = 25)
3.99
3.32
- 0.69
Engaged facilities
(N = 17)
4.01
3.13
- 0.90
Not engaged facilities
(N = 8)
3.96
3.71
- 0.26
p value
0.02
Relative
Reduction in AllCause
Hospitalizations
17%
0.01
24%
0.69
6%
Ouslander et al, J Am Geriatr Soc 59:745–753, 2011
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
Commonwealth Fund Project Results - Implications
1. For a 100-bed NH, a reduction of 0.69 hospitalizations/1000
resident days would result in:
 25 fewer hospitalizations in a year (~2 per month)
 $125,000 in savings to Medicare Part A (using a conservative
DRG payment of $5,000)
2. The intervention as implemented in this project cost of
~ $7,700 per facility
3. Net savings ~ $117,000 per facility per year
 Medicare could share these savings to support NHs to further
improve care
Ouslander et al, J Am Geriatr Soc 59:745–753, 2011
© Florida Atlantic University 2011
Putting the Tools to Work in
Everyday Practice
Communication Tools
Decision Support Tools
Advance Care Planning Tools
Quality Improvement Tools
© Florida Atlantic University 2011
Putting the Tools to Work in
Everyday Practice
Note
 The program and tools are currently being updated
 “INTERACT III tools” and an updated INTERACT
website should be available by the end of 2012
©©Florida
FloridaAtlantic
AtlanticUniversity
University2011
2011
Putting the Tools to Work in
Everyday Practice
The INTERACT tools
are meant to be used
together in your daily
work in the nursing home
http://interact2.net
© Florida Atlantic University 2011
Getting Started: Tracking Hospital Transfers and
The Quality Improvement Review Tool
Getting Started: Keys to a QI Program
 Tracking, trending, and benchmarking well-defined
measures
 Root cause analysis to learn and guide care
improvement and educational activities
©©Florida
FloridaAtlantic
AtlanticUniversity
University2011
2011
The INTERACT Program:
What is It and Why Does It Matter?
Maslow, K and , Ouslander, JG:
Measurement of Potentially Preventable
Hospitalizations. White Paper prepared for
the Long Term Quality Alliance, 2012.
(Available at: http://www.ltqa.org/wpcontent/themes/ltqaMain/custom/images//Pr
eventableHospitalizations_021512_2.pdf)
© Florida Atlantic University 2011
Getting Started: Tracking Hospital Transfers and
The Quality Improvement Review Tool
© Florida Atlantic University 2011
Getting Started: Tracking Hospital Transfers and
The Quality Improvement Review Tool
Highlighting identifies residents at risk for
30-day readmission and those who
returned to hospital within 30 days
Flyover boxes provide
instructions for data entry
Advancing Excellence tool will be located at: http://www.nhqualitycampaign.org
©©Florida
FloridaAtlantic
AtlanticUniversity
University2011
2011
Getting Started: Tracking Hospital Transfers and
The Quality Improvement Review Tool
Dropdown lists for easy
data entry
Transfers that occur within 30
days of admission from the
hospital are highlighted
Advancing Excellence tool will be located at: http://www.nhqualitycampaign.org
©©Florida
FloridaAtlantic
AtlanticUniversity
University2011
2011
Getting Started: Tracking Hospital Transfers and
The Quality Improvement Review Tool
Rates trended by month – in this
graph 30-day readmissions from
PAC, LTC, and total
Advancing Excellence tool will be located at: http://www.nhqualitycampaign.org
©©Florida
FloridaAtlantic
AtlanticUniversity
University2011
2011
Getting Started: Tracking Hospital Transfers and
The Quality Improvement Review Tool
© Florida Atlantic University 2011
Getting Started: Tracking Hospital Transfers and
The Quality Improvement Review Tool
© Florida Atlantic University 2011
Getting Started: Tracking Hospital Transfers and
The Quality Improvement Review Tool
© Florida Atlantic University 2011
Getting Started: Tracking Hospital Transfers and
The Quality Improvement Review Tool
© Florida Atlantic University 2011
Getting Started: Tracking Hospital Transfers and
The Quality Improvement Review Tool
© Florida Atlantic University 2011
Getting Started: Tracking Hospital Transfers and
The Quality Improvement Review Tool
© Florida Atlantic University 2011
Getting Started: Tracking Hospital Transfers and
The Quality Improvement Review Tool
Unplanned Transfer Assessment Data Collection Tool
Facility Name:
Date Completed:
Time Period Being Reviewed:
Name
Date
Summary
Using information from the Unplanned Transfer Assessments reviewed during the timeframe you have identified in Row #5, enter item totals in the following
sections.
10
Day of Hospital Transfer:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Total
#
4
2
4
5
6
7
8
36
%
11%
6%
11%
14%
17%
19%
22%
100%
8
6
4
2
0
Sun
How many transfers occurred on the following shifts:
%
#
1st Shift: 7AM-3PM
2
17%
2nd Shift: 3PM-11PM
4
33%
3rd Shift: 11PM-7AM
6
50%
Total
12
100%
Mon
Wed
Thu
Fri
Sat
7
6
5
4
3
2
1
0
1st Shift
Notes:
Tue
2nd Shift
3rd Shift
© Florida Atlantic University 2011
Putting the Tools to Work in
Everyday Practice
© Florida Atlantic University 2011
Putting the Tools to Work in
Everyday Practice
© Florida Atlantic University 2011
Putting the Tools to Work in
Everyday Practice
© Florida Atlantic University 2011
Putting the Tools to Work in
Everyday Practice
© Florida Atlantic University 2011
Putting the Tools to Work in
Everyday Practice
 The INTERACT Change
in Condition File Cards:
 The case of Mrs. S: a
classic case that
illustrates their purpose
© Florida Atlantic University 2011
Putting the Tools to Work in
Everyday Practice
© Florida Atlantic University 2011
Putting the Tools to Work in
Everyday Practice
© Florida Atlantic University 2011
Putting the Tools to Work in
Everyday Practice
© Florida Atlantic University 2011
Putting the Tools to Work in
Everyday Practice
INTERACT Care Paths
 9 conditions
 All structured the same way
 Provide guidance on when to
notify the MD/NP/PA
consistent with File Cards
 Suggest evaluation strategies
 Provide recommendations for
management and monitoring
in the facility
© Florida Atlantic University 2011
Interacting with Your Hospitals
The new INTERACT III NH
to Hospital Data List will
contain recommended data
elements consistent with national
standards for CCDs
The sample Resident Transfer
Form has two pages:
 The first page has information
that ED physicians and nurses
identified as essential to make
decisions about the resident.
© Florida Atlantic University 2011
Interacting with Your Hospitals
This Transfer
Checklist can be
printed or taped onto
an envelope, and is
meant to compliment
the Transfer Form by
indicating which
documents are
included with the Form
© Florida Atlantic University 2011
Interacting with Your Hospitals
Information Transfer From the Hospital
The new INTERACT III Hospital
to PAC Data List will contain
recommended data elements
consistent with national standards for
CCDs, and data that is critical for
safe care in the first 24-72 hours
The sample Hospital to PAC
sample Transfer Form will provide
an example of how to put the data in
easy to read format for the receiving
clinician.
© Florida Atlantic University 2011
ADVANCE CARE PLANNING TOOLS
Advance Care Planning
When?
 ACP should occur at
some time shortly
after admission
 Decisions should be
reviewed regularly
and at times of acute
changes in condition
© Florida Atlantic University 2011
ADVANCE CARE PLANNING TOOLS
Adapted from Tulsky, JA. Beyond Advance Directives – Importance of
Communication Skills at the End of Life. JAMA 2005; 294:359-365
.
© Florida Atlantic University 2011
ADVANCE CARE PLANNING TOOLS
 Comfort or palliative care,
whether or not the resident is
enrolled in a hospice
program, should include
standard orders that address:
 Nutrition and hydration
 Activity
 Monitoring in the least
disruptive way
 Hygiene
 Comfort and safety
This material was adapted from the Birmingham
VA Safe Harbor Project in 2007
© Florida Atlantic University 2011
Future Directions for INTERACT
1.
Test INTERACT in clinical trials to improve the
evidence-base
a. NIH grant (funded)
b. VA grant (scheduled for funding later in 2012)
2.
Refine the program and the implementation
training curriculum (Medline Industries grant)
3.
Further spread the INTERACT program in
conjunction with the QAPI roll-out
(Commonwealth Fund grant)
4.
Develop ethnically and culturally sensitive
person-centered decision tools about hospital
transfer (Patient-Centered Outcomes Research
Institute grant)
© Florida Atlantic University 2011
Future Directions for INTERACT
4. Further spread the INTERACT program in other
settings
a. ALFs, home care (CMS Innovations Grant)
b. Other countries (e.g. England, Canada, Singapore)
5. Combine INTERACT with other interventions
a. Care transition interventions (CMS Innovations Grant)
b. Telemedicine and others
6. Work with regulators and payers to incentivize
INTERACT implementation (underway with CMS)
7. Embed INTERACT into HIT (PointClickCare)
a. EMRs (LTC software)
b. Inter-facility transfer platforms
© Florida Atlantic University 2011
Examples of HIT Applications
Using INTERACT Tools
HIT
© Florida Atlantic University 2011
Examples of HIT Applications
Using INTERACT Tools
HIT
 Facility QI Reports
 Information for
hospital transfer
 Quality Measures
© Florida Atlantic University 2011
Examples of HIT Applications
Using INTERACT Tools
HIT
 Nursing assistant
notes
 Automated alerts
to licensed nurses
© Florida Atlantic University 2011
Examples of HIT Applications
Using INTERACT Tools
HIT
© Florida Atlantic University 2011
Examples of HIT Applications
Using INTERACT Tools
HIT
© Florida Atlantic University 2011
Examples of HIT Applications
Using INTERACT Tools
HIT
 Secure information
transfer to
emergency room
or acute care unit
 CCD that meets
national standards
© Florida Atlantic University 2011
The INTERACT Program:
What is It and Why Does It Matter?
 Questions?
 Comments?
 Suggestions?
jousland@fau.edu
© Florida Atlantic University 2011