Interprofessional Education: Co-located Services, Not Just Classwork When five clinical programs moved into one building to provide coordinated training and services—faculty learned as much as students. Features
Free
Features  |   October 01, 2017
Interprofessional Education: Co-located Services, Not Just Classwork
Author Notes
  • Sharon Glennen, PhD, CCC-SLP, is a professor of speech-language pathology, interim chair of the Kinesiology Department, and director of the Institute for Well-Being at Towson University. She is an affiliate of ASHA Special Interest Group 10, Issues in Higher Education. sglennen@towson.edu
    Sharon Glennen, PhD, CCC-SLP, is a professor of speech-language pathology, interim chair of the Kinesiology Department, and director of the Institute for Well-Being at Towson University. She is an affiliate of ASHA Special Interest Group 10, Issues in Higher Education. sglennen@towson.edu×
  • The following faculty members from the Towson University Institute for Well-Being co-authored this article: Karen Pottash, MA, CCC-SLP; Karen Helmuth-Day, MS, CCC-SLP; Iona Hutton-Johnson, MS, CCC-SLP; Lisa Geary, MS, CCC-SLP; and Jacqueline Wilson, MS, OTR/L.
    The following faculty members from the Towson University Institute for Well-Being co-authored this article: Karen Pottash, MA, CCC-SLP; Karen Helmuth-Day, MS, CCC-SLP; Iona Hutton-Johnson, MS, CCC-SLP; Lisa Geary, MS, CCC-SLP; and Jacqueline Wilson, MS, OTR/L.×
Article Information
Professional Issues & Training / Features
Features   |   October 01, 2017
Interprofessional Education: Co-located Services, Not Just Classwork
The ASHA Leader, October 2017, Vol. 22, 50-54. doi:10.1044/leader.FTR2.22102017.50
The ASHA Leader, October 2017, Vol. 22, 50-54. doi:10.1044/leader.FTR2.22102017.50
Students from an array of health professions sit in a room together listening to a lecture. Is this interprofessional education (IPE)?
By now, most of us know the answer to this question is “no.” Most of us know that IPE involves students learning with and from each other through activities and clinical experiences. We also know that IPE is essential: Many health education accrediting bodies, including the Council on Academic Accreditation in Audiology and Speech-Language Pathology, now require university programs to include IPE in the curriculum.
Now comes the hard part: Implementing IPE across departments and majors brings with it many challenges. This is especially true for academic programs like ours at Towson University in Maryland, a large state university where the Speech and Hearing Center and other outreach programs operate separately on campus. Not to be deterred, however, we’ve been on a mission to move IPE from concept to reality.
Our initial charge? Move clinical training in audiology, speech-language pathology, occupational therapy, exercise science and—to some extent, nursing—out of their separate dwellings into one new building. We’ve managed to make it happen, and we’re seeing success with both student training and integrated patient services.
But along the way, we encountered—and continue to grapple with—a number of obstacles we didn’t necessarily anticipate. These involve competing scheduling demands, separate program requirements, differing student and faculty expectations, confusion about who’s in charge, and increased program costs. We hope sharing how we addressed these challenges in the IPE trenches helps smooth the way for other academic programs implementing IPE.
Beginnings: IPE exposure
Towson University began implementing IPE more than 15 years ago by creating one-time events for health profession students. These included case study grand rounds, in which we created lengthy, detailed cases to facilitate participation from every major. We also developed a health professions tour where students went on visits to departments outside their major.
Our college biannually runs a popular emergency preparedness event in which students role-play being “victims” or work beside community first-responders practicing disaster training skills on campus. This event requires plenty of notice to the campus community so they are not alarmed when emergency helicopters buzz overhead! While these one-time events give students exposure to IPE, they did not fully prepare our students for the reality of working as part of a health care team.
Most students will experience interprofessional teams in their off-campus clinical placements, but we felt our students needed to learn team skills before this. For IPE to be successful, students need to move from exposure to immersion to competence. Our IPE activities were at the exposure level and we needed more immersion in the curriculum. Here was the problem: Our College of Health departments were located in separate buildings scattered across campus, and most did not provide on-campus clinical training. The few clinical IPE experiences we started 14 years ago were limited, small in scale and hard to sustain. Key faculty left, curricula changed or course schedules did not line up.
For years our dean and department chair advocated for a new clinical facility, and we developed preliminary plans. When an office building near campus became available, the university green-lighted renovations to create a new College of Health Professions community outreach center. Some departments could not see how this move would benefit their curriculum and declined to participate. Others reluctantly participated in the planning process. We moved forward anyway, opening the Institute for Well-Being (IWB) in fall 2012 with five centers. Three of the centers previously existed on campus: Speech and Language, Hearing and Balance, and the Wellness Center, a health fitness center linked to the Department of Kinesiology. The Hussman Center for Adults with Autism had existed in name but did not have dedicated space, and the Occupational Therapy Center was created when our building opened.

Most students will experience interprofessional teams in their off-campus clinical placements, but we felt our students needed to learn team skills before this.

Developing immersive IPE
Our new building gave us the location and space to develop programs offering clinical services to the community and IPE to our students. We created multiple group programs for children with disabilities. Teeny Tigers for 1- to 2-year-olds runs once weekly, our Children’s Therapeutic Center includes three classrooms of children ages 3–6 who come for morning programs, and our summer programs expand to a day camp for children up to age 9. We also offer sensory-motor groups for children of all ages. All of these children’s programs pair speech-language pathology and occupational therapy students in teams. We offer weekly parent-education sessions and bring in experts from nursing, psychology and community health to discuss nutrition, sleep, behavior and other topics of interest to parents.
We also worked with our Department of Music to develop a coordinated musician’s health program, Sound Whhave (sound wellness in hearing, hands, voice and ergonomics). Audiology provides free hearing screenings and at-cost professional earplugs for musicians, speech-language pathology students screen voice majors, and occupational therapy students work with instrumentalists.
The Hussman Center for Adults with Autism brings students together across all majors in peer-mentoring programs. Students enroll in an undergraduate “Introduction to Autism” course that fulfills a core graduation requirement. Young adults with autism participate in art, fitness, cooking, job skills and other training classes while paired with undergraduate peer mentors. Additional students from occupational therapy and speech-language pathology blend into programs to enhance communication and community-living skills. Nursing students in mental health rotations participate in some of the programs for adults with autism.
We also developed programs for older adults. Our most successful is WISH (Wellness in Stroke and Head Injury), which brings together adults for a twice-weekly morning of activities involving speech-language pathology, occupational therapy and exercise science students. The mornings end with an adapted workout in our Wellness Center. We also run community screening programs involving students across disciplines. Across all programs, we use the Interprofessional Collaborative Competency Attainment Survey (ICCAS) to measure students’ pre- and post-experience IPE skills, and we have found significant gains in IPE teaming skills.
At this point we could end this article and let everyone think that a new building was our IPE solution. Bringing all of the centers together under one roof certainly helped. The center directors have adjacent offices, which facilitates communication and rapid decision-making. However, physical proximity alone did not make IPE happen. We made many mistakes, learned many lessons, and are still making mistakes and learning lessons as we go. The rest of this article will discuss some of the issues we faced, along with some of the solutions we tried.

Physical proximity alone did not make IPE happen. We made many mistakes, learned many lessons, and are still making mistakes and learning lessons as we go.

Challenge: Student schedules
Getting students together for IPE experiences was, and continues to be, a major challenge. Although our center directors are located in one building, their academic departments are located elsewhere. Our departments were used to developing class schedules independently, without consulting others. Although the center directors provided scheduling input to their home departments, the home department often made changes without notifying us. Over time, we worked to block out times so classes aren’t scheduled when IPE clinical programs are running. Even so, we still run into scheduling surprises each semester.
Another difficulty we encountered was how different clinical teaching models affect scheduling. Speech-language pathology, audiology and exercise science had dedicated practicum or internship courses in which students could be assigned to a variety of experiences for an entire semester. In contrast, occupational therapy integrated clinical work into existing didactic courses. Occupational therapy students were restricted to clinical experiences that matched course content and initially were available only for six weeks of the semester. There were also semesters when occupational therapy did not offer certain courses and no students were available for some of our programs. We resolved this problem using different strategies. Occupational therapy flexed some courses to make students available for 12 weeks each semester. We also developed six-week rotational models with one group of students at the beginning of the semester and another at the end. When students are not available, we hire professional occupational therapists to continue services.
Challenge: Student requirements and grading
One issue that caught us by surprise was how to manage different programs’ requirements for their majors. The speech-language pathology and audiology model of separating clinical practica from other didactic courses meant that the clinical supervisor determined the practicum grade and that clinical documentation was written by students to meet the client’s needs.
In contrast, occupational therapy clinical work was integrated into didactic classes, which meant the clinical supervisor was not always the course instructor. Some occupational therapy clinical documents were also course assignments. Both the supervisor and instructor reviewed documents, which increased the time needed to finalize them. In addition, the practicum grade was a percentage of the overall course grade. Because it was a small portion of the final grade, some students did not prioritize their clinical work.
The occupational therapy center director worked with her department to change practices and improve this situation. Instructors graded documentation assignments for the class, and the supervisor separately edited and approved documentation that went into client charts. Instructors also revised course syllabi to include clinical competencies in the course grading criteria.

One issue that caught us by surprise was how to manage different programs’ requirements for their majors.

Challenge: Student ability levels and expectations
We encountered difficulty when students at different levels of experience were paired together. For example, in our WISH program we might have a junior occupational therapy student and senior exercise science student in their first clinical experiences working with a speech-language pathology graduate student in the third semester of clinical work. Depending on the program, we had students taking different levels of ownership of the client. For example, speech-language pathology students in programs primarily focused on communication skills were reluctant to let occupational therapy students take the lead, and the same students were less confident at asserting themselves in unfamiliar territory. Finally, our clinical supervisors also had to work out lines of authority. Could an occupational therapy supervisor directly intervene with a speech-language pathology student, or did they need to first discuss it with the speech-language pathology supervisor?
One solution we developed was to co-orient students. Clinical supervisors from all disciplines orient students as a group before the experience begins. Students see their supervisors working as a team and start learning basic foundations, cross-disciplinary information and clinical expectations as a team. The group then meets weekly to assess their progress, solve problems and plan next steps. When scheduling conflicts occur, we video the meetings and post them online. Program supervisors also meet without the students to discuss student and client issues.
Challenge: Who’s in charge?
When the IWB opened, we developed an administrative model that would keep centers linked to their respective departments while trying to centralize and standardize operations. Our dean wisely created an IWB director position to oversee all centers. The IWB director reports directly to the dean, is considered equal to the department chairs, and attends all leadership meetings in the college. Center directors report dually to their respective department chairs and the IWB director.
We started with five different centers, each with its own way of running programs. For example, occupational therapy paid a higher hourly supervisor rate but contracted only for direct client hours. Speech-language pathology and audiology had a lower hourly rate but paid for time spent meeting with students and reviewing documents. Over several years, the IWB director worked with center directors and department chairs to develop consistency in supervision expectations and faculty workloads, create equitable pay rates, centralize hiring procedures, manage budgets (including shared expenses), and develop operating policies and procedures.
Ceding control to the centralized IWB was difficult for programs that existed before the IWB opened. Administrative assistants who had worked for one center now had to work for multiple centers and take on new duties. This change led to cost savings, but it was a difficult adjustment that took a year or two before it felt “normal.” We also had to determine who was in charge at the program level. When we started, supervisors tried to run programs as a team, leading to duplication of effort and tasks that fell between the cracks. We resolved this by creating a primary program coordinator for each of our IPE programs. This person coordinates all the supervisors, reviews client admissions, and oversees program purchases and documentation, student meetings, scheduling and future program planning.
Challenge: Increased program costs
One issue that still challenges us is how to manage the high cost of delivering quality IPE programs. Programs that involve two or more majors require multiple clinical supervisors, which increases program costs. When developing new programs, we start by calculating IPE program expenses and potential revenue. We then determine the break-even client enrollment point. New programs often need time to grow to that enrollment level, and also require additional supplies to initiate services.
We successfully applied for internal university and community grant funds to cover these initial start-up costs. Some IPE programs require additional time to reach the break-even point. For example, the WISH program took three years to grow a stable group of clients large enough to sustain the program. Although we had a few semesters in which it cost us more to run the program than the revenues received, we felt that the learning opportunities for our students were important, and remained committed to its success.
One strategy is to continue offering a mix of single-profession individual client services in hopes that those revenues will offset the losses in our developing IPE programs. Another strategy is to run our IPE programs as flat-rate classes rather than billing health insurance. Insurance companies will not allow simultaneous billing of multiple therapy services, and the flat rate is less than what the separate services would cost if they were individually billed.
For example, the WISH program runs for three hours each morning. Participants pay $60 for the week (two mornings), which includes an hour of cognitive/communication skill-building, an hour of functional-living activities and an hour of adapted exercise in our Wellness Center. If we billed insurance for the same services, clients would have a $30 (or more) co-pay per session, therapy charges would be higher for self-pay clients, and our insurance reimbursement rates would likely be much lower.
In reviewing our overall development since the IWB opened five years ago, we have more than exceeded our initial growth expectations. Last year almost 4,000 people from the Greater Baltimore community received services at the IWB and visited us more than 22,000 times. More than 1,000 students engaged in 27,000 hours of clinical training in our programs.
Still, our IPE efforts are a work in progress. Each semester we encounter student scheduling obstacles, student expectation differences, supervisor authority issues and other problems that need to be resolved. Each semester we work to address any new and recurring issues and remain committed to providing our students with quality IPE experiences. We hope our learned lessons will provide other programs with ideas to develop and sustain their own IPE programs.
Sources
Archibald, D., Trumpower, D., & MacDonald, C. (2014). Validation of the interprofessional collaborative competency attainment survey (ICCAS). Journal of Interprofessional Care, 28(6), 553–558. [Article] [PubMed]
Archibald, D., Trumpower, D., & MacDonald, C. (2014). Validation of the interprofessional collaborative competency attainment survey (ICCAS). Journal of Interprofessional Care, 28(6), 553–558. [Article] [PubMed]×
Barr, H. (2003). Interprofessional education. In Dent, J. & Harden, R. (Eds.), A practical guide for medical teachers, 161–170. Elsevier: Sydney.
Barr, H. (2003). Interprofessional education. In Dent, J. & Harden, R. (Eds.), A practical guide for medical teachers, 161–170. Elsevier: Sydney.×
Kandiko, C., & Blackmore, P. (2008). Institutionalising interdisciplinary work in Australia and the UK. Journal of Institutional Research, 14(1), 87–95.
Kandiko, C., & Blackmore, P. (2008). Institutionalising interdisciplinary work in Australia and the UK. Journal of Institutional Research, 14(1), 87–95.×
0 Comments
Submit a Comment
Submit A Comment
Name
Comment Title
Comment


This feature is available to Subscribers Only
Sign In or Create an Account ×
FROM THIS ISSUE
October 2017
Volume 22, Issue 10