1. Join the conversation! Our Twitter hashtag is MSE12 ¡Una Vida Sana! Assessing and Improving the Health Status of Richmond’s Hispanic Community Through Health Professional Student Service Learning

2. Join the conversation! Our Twitter hashtag is MSE12 Mark Ryan, MD – Department of Family Medicine, VCU School of Medicine Allison Gregory, FNP-BC – Department of Family and Community Health, VCU School of Nursing Rishika Kaundal, MD – Chesterfield Family Medicine Residency Program Sallie Mayer, Pharm.D., MBA, BCPS, CDE – Department of Pharmacotherapy and Outcomes Science, VCU School of Pharmacy

3. Join the conversation! Our Twitter hashtag is MSE12

4. ¡Una Vida Sana! ¡Una Vida Sana! (UVS) is a multi-disciplinary service learning program with a focus on providing cardio-metabolic disease screenings to the Hispanic community in Richmond, VA Currently supported by a grant from VCU’s Council on Community Engagement

5. Join the conversation! Our Twitter hashtag is MSE12 Background City of Richmond’s Hispanic community has increased from 5,704 (2000 estimate) to at least 13,000 (2010 estimate). Large proportion first generation immigrants. Similar changes in surrounding counties.

6. Join the conversation! Our Twitter hashtag is MSE12 Barriers to health care access Richmond City Latino Needs Assessment, 2008: – 65% “very worried” about access – Recommended increased access to and hours of health care services – Explore use of mobile clinics – Extend weekend and evening hours – Expand promotora programs

7. Join the conversation! Our Twitter hashtag is MSE12 Health professional interest SOM: LCME requires increased service learning opportunities, encourages student participation SOP: ACPE encourages community engagement, integrating service learning. SON: AACN requiring increased inter-professional collaboration and cultural competence.

8. Join the conversation! Our Twitter hashtag is MSE12 Health professional interest Interest from students for increased service learning opportunities, and opportunities to work with Spanish-speaking communities. Student interest developed independently of school requirements.

9. Join the conversation! Our Twitter hashtag is MSE12 Program design Develop mobile, community-based project to provide cardio-metabolic disease screenings. Cross-disciplinary team with academic and community partners. Workshops to teach students necessary skills.

10. Join the conversation! Our Twitter hashtag is MSE12 Coalition Building Generation of the idea: – Identify a community and a need. Assessing student interest Identifying potential partners – SON, SOP, Office of Language Services, community clinics and health promoter programs, Hispanic Liaison Office – School of Social Work, School of Dentistry

11. Join the conversation! Our Twitter hashtag is MSE12 Coalition Building Early meetings – Determined each partner's needs, goals and values. – Developed of a working group to address specifics. – Emphasized on student leadership and student ownership. – Consider liability and coverage.

12. Join the conversation! Our Twitter hashtag is MSE12 Coalition Building Organizational meetings – Identified sites. – Identified and coordinated student participation and faculty coverage. – Determined necessary equipment, assessment and risk prediction tools, and housekeeping needs. – Scheduling. And more scheduling.

13. Join the conversation! Our Twitter hashtag is MSE12 Participants VCU SOM, SON, SOP VCUHS Office of Language Services City of Richmond Hispanic Liaison Office CrossOver Ministry: already a known resource within the community. – Promotoras – Clinical care/volunteers

14. Join the conversation! Our Twitter hashtag is MSE12 Venues Churches and faith communities Community events Government events

15. Join the conversation! Our Twitter hashtag is MSE12 Hispanic Liaison Office Local churches with Hispanic ministries CrossOver Ministry Health Center CrossOver Ministry’s Lay Health Promoter Program Partners Health promotion and education Referral for further care to area clinics and/or CrossOver Ministries Interdisciplinary service-learning Cultural competence Results Event organization and flow V i r g i n i a C o m m o n w e a l t h U n i v e r s i t y Screening events Check in Blood test (Cholesterol and blood sugar) Blood pressure Body Mass Index (BMI) Framingham analysis Education Patient survey Consultation Referral

16. Join the conversation! Our Twitter hashtag is MSE12 Project goals Hold events every 2 months. Establish new model of service learning, and determine the validity of the approach. Develop a health profile of the adult Hispanic community, especially regarding cardio- metabolic risks.

17. Join the conversation! Our Twitter hashtag is MSE12 Project goals Patient satisfaction measures – Developed a patient survey to assess how well the project meets the community’s needs. Learner impact/satisfaction – Used a previously-developed survey that includes measures of cross-cultural awareness and cultural competency. Enhanced impact for promotoras.

18. Join the conversation! Our Twitter hashtag is MSE12 Results Approximately 365 total screened – 306 included in analysis – Average age: 36.8 yrs – Approximately 50% male:50% female – 10% self-identified as smokers. – 96% self-identified as Hispanic/Latino

19. Join the conversation! Our Twitter hashtag is MSE12 Results These results suggest that in the patients we have screened there is not yet a high burden of established disease, but that we are working with a community at risk of developing cardio-metabolic disease in the future. Low rate of smoking in the screened population.

20. Join the conversation! Our Twitter hashtag is MSE12 Results Approx 10% patients referred for further care; of them to CrossOver. Higher percentages in smaller events than larger. Range 8-33%. Few referrals were successfully completed at the beginning, partly due to patients lost to follow-up, and partly due to patients who did not qualify for free clinic services.

21. Join the conversation! Our Twitter hashtag is MSE12 Preliminary Patient Survey Results These results indicate that we are accessing a community that is medically underserved and that lacks meaningful primary care access. There are indications that patients are seeking services beyond what our program can provide.

22. Join the conversation! Our Twitter hashtag is MSE12 Student Impact Over 50 students have participated, including 8 student leaders. Average 19 students per event. Events 4-6 hours long. There are over 100 students with a current interest in participating in UVS events.

23. Join the conversation! Our Twitter hashtag is MSE12 Student Impact The impact of participation in UVS upon students was measured using a survey designed by the Center for Healthy Communities of Wright State University. The survey was used with their permission. The survey includes two parts: – 23 questions, administered separately pre- and post-participation, which addresses civic, cultural, and social issues, and post- graduation work placement. – 9 questions addressing broader community issues, administered post-participation, designed as retrospective pre/post questions.

24. Join the conversation! Our Twitter hashtag is MSE12 Student Impact In the separate pre/post surveys (N=9 matched surveys), students expressed agreement that healthcare would “always be improved by the increased practice of multidisciplinary care teams” and were more likely to consider working at a community health clinic after graduation.

25. Join the conversation! Our Twitter hashtag is MSE12 Student Impact In the retrospective pre/post reflective questions (N=17 surveys), students reported increased knowledge about: – Community resources – Health delivery systems – Community health care needs and barriers to care – Responsibilities of other members of the healthcare team – The impact of socioeconomic status on health/illness – How to work with patients of varying levels of healthcare knowledge.

26. Join the conversation! Our Twitter hashtag is MSE12 Student Impact “hands on experience working with underserved populations is an invaluable experience that can't be taught in a classroom” “this cannot be taught in class, you have to experience it”

27. Join the conversation! Our Twitter hashtag is MSE12 Student Impact Multidisciplinary care teams mimic real-world practice and enhance interdisciplinary approach. Participation highlighted lack of medical school training regarding nutrition, community resources and access to primary care. Participation provided early, real-world experience in patient counseling regarding nutritional and lifestyle interventions.

28. Join the conversation! Our Twitter hashtag is MSE12 Student Impact Limits of the survey: – Risk of bias in the pre/post retrospective/reflective questions. – Small number of matched pre/post surveys available for review. – Length of the survey (many incomplete). – Is survey design the best fit for our student participants. – Inability to assess which students (SOM/SON/SOP) were more likely to complete surveys, meaning that we cannot assess if positive changes were more likely in one school than another.

29. Join the conversation! Our Twitter hashtag is MSE12 Challenges Appropriate sites with sufficient patient access and participation. Incomplete referrals: – Patients who do not come to CrossOver for their financial screening and/or appointments. – Patients who do not qualify for services at CrossOver, and lack of information on alternatives. – Have increased resources and support to better address this issue, both from UVS and community partners.

30. Join the conversation! Our Twitter hashtag is MSE12 Challenges Sufficient faculty volunteers to meet student interest and patient needs. Medical interpreter coverage. Patient misunderstanding of the group’s capabilities. Difficulty coordinating the participating groups’ schedules, and assessing resource needs. Are we reaching the communities that most need our services?

31. Join the conversation! Our Twitter hashtag is MSE12 Future plans Strengthen the project’s service learning structure. – Enhance UVS student group’s role. Increase capacity: – For students – For the community Increase community input. Increase the services offered. – Nutrition information, financial screening – Flu vaccinations – Additional health screenings Identify additional event sites.

32. Join the conversation! Our Twitter hashtag is MSE12 Contact information Mark Ryan: – mryan2@mcvh-vcu.edu mryan2@mcvh-vcu.edu Allison Gregory: – aagregory@vcu.edu aagregory@vcu.edu Rishika Kaundal: – Rkaundal@ChesterfieldFP.com Rkaundal@ChesterfieldFP.com