Summary: Crucial Conversations: An interprofessional learning opportunity for senior healthcare students

Crucial Conversations: An interprofessional learning opportunity for senior healthcare students

             Clinical errors due to human mistakes are estimated to result in 400,000 preventable deaths per year. Strategies to improve patient safety often rely on healthcare workers’ ability to speak up with concerns. This becomes difficult during critical decision-making as a result of conflicting opinions and power differentials, themes underrepresented in many interprofessional initiatives.
These elements are prominent in the Crucial Conversations training course, which is offered as an interprofessional initiative at the University of Manitoba.

             Delisle, Grymonpre, Whitley, & Wirtzfeld (2016) sought to evaluate this initiative as an interprofessional learning (IPL) opportunity for pre-licensure senior healthcare students, as a way to foster interprofessional collaboration, and as a method of empowering students to vocalise their concerns. The attributes of this IPL opportunity were evaluated using the Points for Interprofessional Education Score (PIPES). The University of the West of England Interprofessional Questionnaire was administered before and after the course to assess changes in attitudes towards IPL, relationships, interactions, and teamwork.

             Crucial Conversations strongly attained the principles of interprofessional education on the PIPES instrument. A total of 38 volunteers completed the 16 hours of training: 15 (39%) medical rehabilitation, 10 (26%) medicine, 7 (18%) pharmacy, 5 (13%) nursing, and 1 (2%) dentistry. Baseline attitude scores were positive for three of the four subscales, all of which improved post-intervention. Interprofessional interactions remained negative possibly due to the lack of IPL opportunities along the learning continuum, the hidden curriculum, as well as the stereotyping and hierarchical structures in today’s healthcare environment preventing students from maximising the techniques learned by use of this interprofessional initiative.

KEYWORDS: Communication, interprofessional education, pre-qualifying/pre-licensure, quantitative method


For more: http://www.tandfonline.com/doi/full/10.1080/13561820.2016.1215971

Summary: Interprofessional education in maternity services: Is there evidence to support policy?

Interprofessional education in maternity services: Is there evidence to support policy?

Nigel Davies, Simon Fletcher & Scott Reeves

Against a backdrop of poor maternity and obstetric care, identified in the Morecambe Bay Inquiry, the UK government has recently called for improvements and heralded investment in training. Given the complex mix of professionals working closely together in maternity services addressing the lack of joined up continuing professional development (CPD) is necessary. This led us to ask whether there is evidence of IPE in maternity services. As part of a wider systematic review of IPE, we searched for studies related to CPD in maternity services between May 2005 and June 2014. A total of 206 articles were identified with 24 articles included after initial screening. Further review revealed only eight articles related to maternity care, none of which met the inclusion criteria for the main systematic review. The main reasons for non-inclusion included weak evaluation, a focus on undergraduate IPE, and articles referring to paediatric/neonatal care only. Fewer articles were found than anticipated given the number of different professions working together in maternity services. This gap suggests further investigation is warranted.

https://www.ncbi.nlm.nih.gov/pubmed/27705011

Summary: Interprofessional Education and Practice Guide No. 8: Team-based interprofessional practice placements

Interprofessional Education and Practice Guide No. 8: Team-based interprofessional practice placements

Margo L. Brewer & Hugh Barr

Whilst interest in interprofessional learning (IPL) in practice contexts has grown in recent years, the complexities involved have led many universities to rely on IPL in the classroom, online, and/or simulated contexts. Curtin University’s Faculty of Health Sciences has successfully implemented a multi-award winning, large-scale Interprofessional Practice Programme. This programme, which began with five small pilots in 2009, provides team-based interprofessional practice placements for over 550 students from nine professions per annum. Drawing on both the literature and Curtin University’s experience, this Interprofessional Education and Practice Guide aims to assist university and practice-based educators to “weigh the case” for introducing team-based interprofessional placements. The key lessons learned at Curtin University are identified to offer guidance to others towards establishing a similar programme for students during their prequalifying courses in health, social care, and related fields.

Keywords: Interprofessional education, interprofessional learning, practice-based learning, team-based placements


Volume 30, 2016 - Issue 6: http://www.tandfonline.com/doi/abs/10.1080/13561820.2016.1220930?needAccess=true&journalCode=ijic20

Book Review: Collaborating Against Human Trafficking - Kirsten Foot

Book Review: Collaborating Against Human Trafficking

Kirsten Foot

Rowman and Littlefield (Lanham, Maryland)

September 3, 2015

231 pages, Hardback - $75.00; Paperback-$38.00; eBook-$37.99

Print ISBN 13:9781442246928; eBook ISBN 13:9781442246942

Kirsten Foot is a researcher, activist, and author of “Collaborating against Human Trafficking”. She presents a first-hand account and thoughtfully constructed conclusions around the many issues that develop when anti-trafficking organizations work together towards defeating human trafficking. The appropriate audience for this book includes: government agencies, victim service providers, community service/non-profit agencies including faith-based organizations and survivor-activists. Academics within other fields including sociology, public policy, policing, and psychology may also benefit from reading it.


Foot aims to identify the main problems that are encountered at the interpersonal, intra- and inter-organizational levels when aiming to reduce human trafficking and to give recommendations for tackling these issues. She succeeds in doing this by providing detailed analysis of interviews and observations with key informants within anti-human trafficking initiatives in three states within the United States. Her analysis is complemented by her personal experiences and feelings around being an anti-trafficking activist.


This book is organized into chapters that identify systemic barriers to collaboration as well as opportunities for organizations to improve collaboration efforts. Issues include the value of power and how it is gained and utilized, race and gender issues and the effects of differing beliefs, as well as values and principles held by various stakeholders.


The book summarizes and provides a clear structure to many issues that have yet to be collectively considered in this field. Foot has written a highly practical text that makes many useful suggestions for improving inter-organizational collaboration by offering group exercises and resources that combat human trafficking. Her protocols are well referenced and include detailed footnotes.

This book is best suited for a socio-political system similar to the United States. Foot mentions early on that these accounts and suggestions have the potential to be applied to other locales, despite that the book is from the perspective of organizations within the United States. Perhaps, the
most powerful implication for interprofessional practice is that researchers or activists from other countries should provide their own accounts in order to add further knowledge to Foot’s work and enhance a collaborated global response to human trafficking.


Overall, Foot succeeds in drawing the reader in with captivating notes from her interviews, field work and experiences and utilizes jargon that is accessible to audiences of different levels. This text is succinct yet detailed, and the author makes a clear point to remain as impartial as possible in order to encourage the reader to view issues presented from multiple perspectives. This book is very relevant to inter-professional care because it can be used as a point of reference when considering potential issues and improvements for collaboration within not only criminal justice and social work, but also other health-related and community-focused fields. Foot states that trust, respect and perseverance are the values required to improve interdisciplinary collaboration – a necessary and central factor – in the fight against human trafficking.


Janelle Panday, Masters Student, McMaster University

Blog Article: Capturing Interprofessional Conference Conversations Using a World Café Approach

Capturing Interprofessional Conference Conversations Using a World Café Approach

Anthony Breitbach PhD, ATC

Saint Louis University, St. Louis, Missouri USA

Introduction

Professional and academic conferences are great opportunities to gather with colleagues who have expertise in your field of interest. Many times these events provide opportunities for rich interaction and conversations that could benefit the body of knowledge in your field. Capturing these conversations can be a challenge but, with proper planning, is possible through a World Café. The World Café creates a consensus event that utilizes the shared expertise of stakeholders (e.g. practitioners, educators, researchers) at these conferences allowing researchers to capture conversations on complex or controversial topics.


Based on research by Juanita Brown, the World Café’ draws on seven integrated design principles, it’s methodology is a simple, effective, and flexible format for hosting large group dialogue. The seven design principles are: “1 - Set the Context; 2 - Create Hospitable Space; 3 - Explore Questions that Matter; 4 - Encourage Everyone’s Contribution; 5 - Connect Diverse Perspectives; 6 - Listen for Patterns and Insights and 7 - Share Collective Discoveries.” (The World Cafe Community Foundation, 2016).


The authors conducted collaborative research through a World Café during a workshop entitled “Utilizing Sport to Study and Improve Global Interprofessional Collaborative Health Care” at the All Together Better Health (ATBH) 8th International Conference on Values - Based Interprofessional Practice and Education on September 8, 2016 at Oxford, United Kingdom. ATBH is the leading global interprofessional practice and education conference under the direction of the World Coordinating Committee. It brings together providers, health system executives, educators, policymakers, and healthcare industry leaders to advance interprofessionalism locally, regionally and worldwide. (All Together Better Health, 2016).

Planning the project

Conducting research in conjunction with a workshop at a large international conference requires significant prior planning. The first step is to work with colleagues to develop a proposal for the conference. The proposal must provide the foundational evidence behind the topic and should also present the methodology for the research project. This is best done by conducting a thorough scoping review of the literature on your research topic. Generally these calls for proposals are available 6-9 months before the conference. It is important to submit the proposal for a session of a minimum of 45-60 minutes to allow sufficient time for the research. The work done on this proposal can also provide the foundation for a grant application that assists with research expenses such as World Café materials, travel expenses and the cost of the transcription of the audio recordings from the workshop. This research project was successfully supported through a Beaumont Faculty Development Grant from Saint Louis University.


Once the proposal has been accepted by the conference it is important to gain the appropriate ethics approvals from the collaborating institutions and organizations. The most logical place to start is with the home institution of the Primary Investigator. This project was approved by the Institutional Review Board at Saint Louis University (SLU-IRB). The SLU-IRB also required letters of collaboration from the co-investigators’ institutions and the conference’s steering committee. Proactive planning and communication is especially important when dealing with collaborators from different countries. Special attention must be given to diverse institutional and organizational policies regarding human subject research training and ethics approvals. After gaining the appropriate approvals, the next step is to create the World Café.

Creating the conversations

Establishing the World Café requires appropriate planning with supplies and materials. There are five components comprise the basic model: (1) Setting; (2) Welcome and Introduction; (3) Small Group Rounds; (4) Questions; and (5) Harvest. (The World Cafe Community Foundation, 2016) Each of these step require special preparation to create the best possible environment for research.


1. Setting. The goal is to create a “special” environment, most often modeled after a café. If possible, request 4-6 small tables with 4-5 chairs each for the room from the conference planners. Each table should be covered with a paper “tablecloth” along with colored pens/pencils that can be used to capture graphical representations from the café. Audio conversations also need to be captured, inexpensive recorders for each table are necessary and these can each be used as a “talking stick” by participants.


2. Welcome and Introduction. This is where the investigators present the appropriate research disclosures; provide the foundational context of the workshop; introduce and share the etiquette of the World Café process; and pass out cards to the subjects that volunteered to participate in the study. These cards, distributed randomly to the participants, allow them to anonymously record demographic information on one side of the card and have their individual table assignments on the other side of the card.


3. Small Group Rounds. The process begins with the first of three 10 minute rounds of conversation for small groups seated around the table listed in “Round 1” on the back of their card. At the end of the 10 minutes, participants move to a different table listed as “Round 2” which is also repeated as “Round 3”. Tables are assigned randomly using a random number generator; however 1 of the subjects at each table should stay at the same table for all 3 rounds. This is helpful when managing the recorders and changing the table cloths between each round. Researchers/facilitators should go from table to table to make verify the participants are using the audio recorders correctly.


4. Questions. The researchers provide a guiding question in each round specially crafted for the specific context and desired purpose of the study. Each question builds upon the previous round’s question to allow for the conversations to move from the least to the most complex topics.


5. Harvest. After the small group rounds have been completed, the group reconvenes for a facilitated discussion. This provides richness to the project by combining thoughts from the small groups into a greater conversation and possibly a shared consensus. Effort should also be made to make and audio recording of this discussion.


After the conclusion of the harvest, special care must be made in handling the participant cards, audio recorders and paper tablecloth’s from the World Café. This is research data and should be treated as such with the utmost care to protect the rights of the subjects in the study.

Analyzing the data

This research project is a qualitative study and the data must be prepared appropriately for analysis. Audio recordings must be transcribed anonymously and analyzed through an appropriate coding system. The graphics depicted on the tablecloths should be captured through digital scanning and organized in a logical manner. Demographic data from the participant cards should be recorded in a database to allow the investigators to assign subject information to the appropriate tables in each round. Analysis of this accumulated data can provide an outstanding opportunity to gain greater insight into the topic by utilizing the shared expertise provided by the study participants.

Concluding comments

Conducting a World Café at a conference provides an excellent opportunity to capture the rich conversations that occur in these settings. Conducting this type of research requires prior planning with regard to the proposal submission, a grant application and getting appropriate ethical approvals. At the event, proper organization is essential to support the participants and to capture the data in the best way possible. This collaborative approach provides researchers the ability to capture, analyze and disseminate these conversations which supports clinical practice and may contribute to improved patient outcomes.

Acknowledgements

I would like to thank co-investigators Professor Scott Reeves and Dr Simon Fletcher, Kingston University & St. George’s, University of London for their participation in this project. I would like to thank the organizers of All Together Better Health VIII for their cooperation.

References 

All Together Better Health. (2016). ATBH VIII. Retrieved from http://www.hls.brookes.ac.uk/atbh8


The World Cafe Community Foundation. (2016). the World Cafe. Retrieved from http://www.theworldcafe.com/

Blog Article: An Inter-agency approach to end deaths of homeless persons

An Inter-agency approach to end deaths of homeless persons

Natalie Kroovand Hipple (1); Sarah J. M. Shaefer (2); Robert F. Hipple, Jr. (3)

1. Indiana University, Department of Criminal Justice

2. National Fetal & Infant Mortality Review Program; American College of Obstetricians & Gynecologists

3. Indianapolis Metropolitan Police Department

Contact: nkroovan@indiana.edu

Abstract

The homeless are invisible in many communities; their deaths receive even less attention. An inter-agency review of homeless deaths, modeled after the Fetal and Infant Mortality Review process (FIMR), is an effective public health approach to understanding system gaps, and providing insight into the factors resulting in homelessness and ultimately death. This report describes the process to develop unique police-led reviews of homeless deaths in Indianapolis, Indiana, USA and recommendations for action to decrease these deaths. Additionally, the police can take the lead as part of a comprehensive problem solving effort.

Introduction

The homeless are invisible in many communities; their deaths receive even less attention.  A inter-agency review of these deaths based on the fetal and infant mortality review (FIMR) process can provide insight into the homeless individual, system gaps that led to the death, and ultimately change systems to prevent future deaths (Fetal and Infant Mortality Review Manual: A Guide for Communities, 2008). In Indianapolis, Indiana, USA, law enforcement leads a team that includes community outreach workers, mental health professionals, local hospitals, emergency medical services, probation, the prosecutor’s office, the coroner’s office, the health department, and a local researcher. This short report describes this innovative initiative.

Background

In January 2015, a national effort to count homeless individuals estimated over 564,000 people nationwide were homeless on any given night. Almost one-third of these individuals were found in locations not intended for human habitation and 23% of the total were chronically homeless (Henry, Shivji, de Sousa, Cohen, & Abt Associates Inc., 2015). However, research  suggests that the actual number of individuals experiencing homelessness at any given time is three to five times than this estimate (Sankari & Littlepage, 2015).

The Indianapolis Metropolitan Police Department (IMPD) took a progressive approach to working with the homeless population in Indianapolis when it created the Homelessness and Panhandling Unit (HPU). The HPU established cross-system partnerships in an effort to keep homeless individuals out of the criminal justice system and connect them with appropriate services (Hipple, 2016).

In March 2015, two fishermen found partially mummified human remains under an Indianapolis bridge. There were indications the remains were those of a homeless individual however no one from the HPU or its partner agencies knew this individual even after he was positively identified. This sentinel event raised the question, if no one from the HPU or its partner agencies had contact with him, were there other deceased homeless individuals unknown to officials? In fact, this event highlighted that there was no official count of homeless deaths for Indianapolis. Therefore, IMPD sought comprehensive data on homeless deaths which included reviewing all homeless deaths. Building on their existing partnerships, the HPU recruited a local researcher who could help facilitate the data collection and review process.

Incident/Death Review Process and FIMR

IMPD was no stranger to incident reviews (Klofas et al., 2006). For law enforcement, incident reviews often focus on specific crimes such as homicides, however, most homeless deaths are not the result of a criminal act though data are limited. Since homelessness is not a crime, the HPU needed to modify their review approach, choosing a public health model, FIMR.

FIMR is an evidence-based, action-oriented community process, continually assessing, monitoring, and working to improve service systems and community resources for women, infants, and families (Fetal and Infant Mortality Review Manual: A Guide for Communities, 2008). This standardized approach determines preventability, engages communities to take action and examines various morbidities and mortalities (Koontz, Buckley, & Ruderman, 2004; McDonnell, Strobino, Baldwin, Grason, & Misra, 2004; Nesheim et al., 2012).

The FIMR framework provides a systematic method to obtain information about homeless deaths beyond police and outreach records. FIMR includes consumer/family interviews to determine factors contributing to the individual’s life and death, which yields information about environmental aspects of the case. An inter-agency case review team (CRT) reviews each death to determine preventability and make recommendations for system change. These recommendations are sent to the community action team that is comprised of community leaders with the power to implement higher level proposals and implement recommendations.  Indianapolis partners concerned with homeless deaths supported using the FIMR process to examine causes and preventability of homeless deaths as it added data not part of the traditional crime incident review (Fetal and Infant Mortality Review Manual: A Guide for Communities, 2008).

Case review data also includes interviews with the deceased’s family and/or friends. Interviews provide a consumer/family perspective on the deceased’s situation and what may have led to homelessness and death. Data from medical records, police reports and other sources are compared to this consumer information. Plans are to contact neighbors and family members within one to three weeks after notification of the death.

Homeless death reviews occur in other jurisdictions in the United States such as Philadelphia and Sacramento although the reviews are not police-led like in Indianapolis. IMPD also sought an independent researcher to assist with comprehensive data collection, analysis, and facilitate the review meetings. The HPU introduced representatives from its existing partners to the FIMR process for reviewing homeless deaths.

Inter-agency Review Meetings

Four goals were outlined for the reviews: prevent future deaths of homeless individuals, create a better flow of information; compile accurate data on homeless individual deaths; and create actionable recommendations. Prior to the review meeting, each agency provides relevant information, such as EMS transports, emergency department visits, medical and mental health history, housing information, veteran status, and any other relevant details about each decedent. A summary document for each case which was circulated. During the review meeting, information not available from official sources, such as social engagement, relationships, official/unofficial income is provided. This additional information facilitates identifying service gaps while not assigning blame. The homeless death CRT has met six times, reviewed 12 cases and has made recommendations. Some recommendations have already been addressed by the CRT and some recommendations need to be elevated to the community action team.

Recommendations for Action

First, a common accidental cause of death of homeless individuals is exposure. Indianapolis winters can be harsh. The CRT team identified protocol modifications. Outreach workers and the HPU will be more assertive in locating homeless individuals during cold weather emergencies. For example, looking into tents for vulnerable individuals; prior protocol did not allow this to the protect the homeless individual’s privacy and the outreach worker’s safety. Moreover, part of homeless culture is ‘you are a sucker if you go in’ during extreme weather. The team discussed ways to respectfully provide outreach including, ‘mercy arrests,’ immediate detentions, or other creative options by IMPD to shelter vulnerable individuals temporarily and save lives.

Second, the CRT team identified the need for better coordination between area hospitals and outreach workers. One of the large metropolitan hospitals notifies outreach workers of homeless ‘frequent fliers.’ Outreach workers then engages with these individuals to try and get them into services. The death reviews revealed that this inter-agency communication between the hospital and outreach needs to be expanded to all area hospitals located both downtown and outside of the city center.

Third, in two cases clients agreed to go into inpatient detox but beds were not available. One client was approved for a detox bed but one not available immediately. That client died in the next 48 hours. Another died three days before scheduled to enter detox. Both deaths resulted from alcohol abuse during the waiting period. The CRT believes the deaths could have been prevented if beds had been immediately available. This issue requires a broader community response from the community action team.

Compiling accurate information on homeless deaths beyond those reviewed is an important next step along with establishing the community action team. Key to sustainability, the community action team is charged with developing creative solutions to improve services and resources for the homeless. Also participation is needed from the Veteran’s Administration, the health department, hospitals and elected officials. These individuals have the resources to address the CRT recommendations and system gaps identified in the review process. The community action team’s sponsor should be an important lead agency in Indianapolis. For example, in Baltimore, Maryland, the FIMR community action team is in the Mayor’s office, providing high level visibility and access to city agencies, assuring maximum impact. 

Concluding comments

2016 started ominously for Indianapolis’s homeless population. On January 1st, two homeless individuals died. One individual was found by a friend at a homeless encampment and the other died at a local shelter. A total of four homeless individuals died by January 6th. Ranked one of the ten most violent cities in the United States in 2014 (Federal Bureau of Investigation, 2015), Indianapolis did not recorded its first criminal homicide until January 4, 2016. Homeless individuals, while omnipresent, are often invisible. Their deaths are no different.

Significant progress has been made and using FIMR as a public health approach is effective. One unanticipated benefit was achieved by the CRT. Partners were validated that in some cases, they did everything possible for the homeless. For front line workers who often see the worst, this is affirming and important to acknowledge.

Homelessness is a complex problem for many communities with insufficient data. While housing is a long-term issue, preventing deaths is not. Homeless person death reviews demonstrate there are steps that can prevent needless deaths. The FIMR process provides an inter-agency approach to understanding system gaps with insights into the factors that resulted in homelessness and ultimately death. It is an innovative approach to have the police lead the way and provides a structure for community solutions to address this public health problem. 

References

Federal Bureau of Investigation. (2015). Crime in the United States, 2014.   Retrieved from https://www.fbi.gov/about-us/cjis/ucr/crime-in-the-u.s/2012/crime-in-the-u.s.-2012/violent-crime/aggravated-assault

Fetal and Infant Mortality Review Manual: A Guide for Communities. (2008).  (2nd ed.). Washington, DC: American College of Obstetricians and Gynecologists.

Henry, M., Shivji, A., de Sousa, T., Cohen, R., & Abt Associates Inc. (2015). The 2015 Annual Homeless Assessment Report (AHAR) to Congress: Point-in-Time estimates of homelessness. Retrieved from Washington, DC:

Hipple, N. K. (2016). Policing and homelessness: Using partnerships to address a cross system issue. Policing: A Journal of Policy and Practice. doi:doi:10.1093/police/paw010

Klofas, J. M., Hipple, N. K., McDevitt, J., Bynum, T. S., McGarrell, E. F., & Decker, S. H. (2006). Project Safe Neighborhoods: Strategic interventions crime incident reviews: Case Study 3 Project Safe Neighborhoods: Strategic Interventions. Washington, DC: U.S. Department of Justice, Office of Justice Programs.

Koontz, A. M., Buckley, K. A., & Ruderman, M. (2004). The evolution of fetal and infant mortality review as a public health strategy. Maternal and child health journal, 8(4), 195-203. doi:10.1023/B:MACI.0000047418.14086.fc

McDonnell, K. A., Strobino, D. M., Baldwin, K. M., Grason, H., & Misra, D. P. (2004). Comparison of FIMR programs with other perinatal systems initiatives. Maternal & Child Health Journal, 8(4), 231-238.

Nesheim, S., Taylor, A., Lampe, M. A., Kilmarx, P. H., Fitz Harris, L., Whitmore, S., . . . Mermin, J. (2012). A Framework for elimination of perinatal transmission of HIV in the United States. Pediatrics, 130(4), 738-744. doi:10.1542/peds.2012-0194

Sankari, A., & Littlepage, L. (2015). Many Families in Indiana Not Able to Find Shelter. Indianapolis, IN: Indiana University Public Policy Institute.