1. The RICE Project
(Rural Interprofessional
Clinical Expansion)
School of Social Work
University of New
England
February 28, 2014

2. Day’s Objectives
Interprofessional
Collaborative
Practice with
Medically
Underserved &
Vulnerable
Populations
• 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

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

4. 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).

5. 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.”

6. 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.

7. 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

8. BIG Picture

9. WHAT STUDENTS TELL US

10. COMMUNITY Landscape
Medically Complex Conditions
Maine’s Rural Population
Maine ranks 3rd in the nation and 1st
in New England for food insecurity
• 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

11. Child Poverty
American 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.

12. 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)

13. 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

14. Applying Core Competencies
What people and situations come to mind in
your practice setting as we explore the
competencies?

15. 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.

16. 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.

17. 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

18. 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.

19. 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.

20. 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.

21. 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

22. 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

23. Person/Patient-Centeredness
Clinical
Providers
Invite & empower
people to engage
with choices &
adhere to prescribed
treatment protocols,
life style changes and
medication regimens.
Public Health
Provide tools to
inform & engage
consumers in health
decision-making, selfmanagement, and
health advocacy
Persons/
Patients
Capacity to
think critically &
make informed and
shared decisions in
collaboration with
health care teams

24. Qualities of Person-Centered Practice
Attitudes
o Respect for complementary expertise
o Value for patients as a vital members of the team
o Trust in each other & in the team
o Connection & Compassion
Actions
o Explicitly invite patients to be part of the health care team
o Introduce patients to empowering practice & facilitate skills
o 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.

25. Change

26. Culture Change
• A process of
institutional-systems
socialization
(Ideas, language, value
s, & 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 goals
Step 2:
Form an Inclusive Coalition and invite
meaningful change
Step 3:
Create a Common Vision for achievable change
Step 4:
Walk the Talk – reach out to colleagues
Step 5:
Appreciate small successes and build on them
Step 6:
Remove obstacles & sidestep barriers
Step 7:
Sustain momentum – establish a domino effect
Step 8:
Anchor change in the workplace

27. Pat Video

28. Patricia Chalmers, 31
Pat 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.

29. Patricia Chalmers
1. 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?

30. The Nexus
The next step forward is to increase the link between
future healthcare employers and campus-based
interprofessional educational initiatives.

31. Shared Learning Environments
Crossprofessional
preceptorships
6 Week Shared
Placements
Common
Client/Patient
Panel
Shared
Assignments
& Didactics
Clinical-Public
HealthSystems Health

32. “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. “
“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.”
“We have the same goal:
to provide excellent
patient care, but we
approach this goal from
very different
perspectives.”

34. 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 Ayer
Betsey Gray
Amy Coha
Danielle Wozniak
Shelley Cohen Konrad