Interprofessional Practice in Community Outreach — Health Crisis Creates New Challenges
By Sue Coyle, MSW
Social Work Today
Vol. 20 No. 3 P. 12  

Effective community work requires interprofessional collaboration, and it has never been more evident than in this time of an unprecedented health crisis and uncertainty.

Interprofessional practice is most often discussed in terms of health care—doctors, nurses, social workers, and other mental health professionals coming together within a health system to prevent and address concerns. However, it is not only a person’s being that needs to be served across sectors.

People in our community don’t live their lives in silos,” says Emma Hertz, director of external affairs at the HealthSpark Foundation in Montgomery County, PA. “Often, people will need multiple social services at one time—mental health services and shelter, or job training and groceries from a food pantry. It’s essential that our organizations and professionals in the safety net system begin working together in order to better meet the needs of the whole person.”

The New Normal
This understanding—that collaboration is a key to community outreach and engagement—is increasing throughout the country, particularly now, as the country and the world struggle with the realities of a pandemic. “Disasters or other types of cataclysmic events tend to recalibrate our focus to the community needs and needs of others,” says John Tropman, MA, PhD, Henry J. Meyer Collegiate Professor of Social Work Emeritus at the University of Michigan and a fellow at the American Academy of Social Work and Social Welfare. “Such occasions overcome our usual tendency to think about ourselves first and others second. The enormity of the pandemic threat and its omnibus impact solidifies concern for others.”

As a result, professionals across a variety of fields are looking to work together to provide the best possible information and services to their communities and community members.

Interprofessional Practice
The World Health Organization (2010) has defined interprofessional practice or collaborative practice as occurring when “workers from different professional backgrounds provide comprehensive services by working with patients, their families, careers, and communities to deliver the highest quality of care across settings.” Though this definition is specific to health care, it can be applied to community outreach as well.

In health care, the goal of interprofessional practice is the physical and mental well-being of the individual. The goal in community outreach and engagement is similar yet broader. Those involved are aiming to create a place in which services promote the well-being of individuals, as well as the community as a whole.

“The community setting is really unique,” says Tina Atherall, DSW, LMSW, CEO of PsychArmor. “When you’re in a hospital setting, you’ve got your day prescribed.” However, when working in a nonprofit setting, for instance, the nature of the work requires outreach to communities, almost automatically leading to collaboration.

The collaboration looks different depending on the makeup of the community, as well as the professionals involved. Tropman relates it to a musical ensemble. “There are orchestras, trios, quartets, mixed, and single instruments,” he says. “It depends on the music and what is available. But all of us have team membership potential and experience.”

He adds that in community outreach and engagement the hierarchy that exists within health care is often absent, allowing for greater collaboration.

Including the Community
One of the key components of interprofessional practice in community outreach is involving the community. Without appropriate representation from a variety of individuals, the work will be less effective. This inclusion happens on multiple levels.

First, the professionals involved in discussing and disseminating services should not just be the social workers, mental health professionals, and physical health professionals one would automatically think of.

At the HealthSpark Foundation, there is a focus on ensuring that their safety net includes a wider reach of professionals. “We believe everyone in our community benefits when we have a strong safety net system,” Hertz says, “and therefore it is imperative that we expand the circle of participants to include those who traditionally haven’t thought of themselves as ‘safety net partners’: the local business owner whose employees rely on subsidized child care, for example, or the lawyer whose aging mother is receiving in-home care, or the pastor whose congregation includes people who are struggling financially.

“We are conducting outreach to these groups—often through affinity organizations like Chambers of Commerce or faith groups—and inviting them to participate in our free, community-based event called the Community of Practice,” she says.

Atherall agrees, noting that her organization works directly with employers, helping to educate them on the benefits of hiring veterans and their spouses. By engaging the employers, PsychArmor increases the likelihood that veterans will be able to transition into civilian life and that the communities they live within will benefit as a result.

Both Hertz and Atherall add that the individuals served (or hoped to be served) need to be involved as well. “You have to go to the community itself,” Atherall says. “Be inclusive of the population you’re serving. It takes a very active and intentional practice.”

Atherall adds that she has seen clinicians say and advertise that they would like to serve veterans but not actually seek out the population. By being passive, they ultimately do not serve any or as many veterans as they could. “It is one of the mistakes I see,” Atherall says, again emphasizing the need for action. “You have to go where they are.”

And in fact, to be truly effective, professionals need to go one step further. They need to invest in fully understanding the populations they aim to serve. Many active community workers don’t live and work in the same community. Even when they do, it is impossible to have a full understanding of the individuals within it without additional legwork.

The same is true when a community is not a physical location but rather a population of individuals, such as veterans. Atherall notes that the veteran population is unique in that the majority of those providing services have never served in the military. According to the Substance Abuse and Mental Health Services Administration, only 8% of health care providers, who are not within the military connected system or Tricare network, self-reported military cultural competency. Increasing cultural awareness within health care providers in communities is critical for enhanced care of this population.

The HealthSpark Foundation has employed multiple strategies in working to ensure community involvement. “People who are currently or who have received services in the past should have a stronger voice in designing and improving service delivery. They are the experts at what works and what doesn’t, after all,” Hertz says. “Our outreach to these groups has been through two main strategies. First, we’re providing grant funding to our safety net partners to build up better community engagement practices and to involve the people they’re serving in their decision-making processes, and second through building a consumer feedback system, which is still under development.”

Rising to the Challenges
There are of course challenges to interprofessional community outreach and engagement. For one, the investment described above, including and understanding the community, takes a great deal of time—time that all parties need to devote. That can be complicated to manage but always necessary, especially in times of crisis.

UT Health San Antonio launched a community outreach program called STEM Scholars. The program involved bringing together a variety of students from UT Health San Antonio’s School of Dentistry, School of Medicine, School of Nursing, School of Health Professions, and Graduate School of Biomedical Sciences. They worked to create presentations on Alzheimer’s disease, diabetes, and cancer. The presentations were delivered to elementary school children and their families.

Both Irene C. Chapa, PhD, director of recruitment and science outreach, and Ramaswamy Sharma, PhD, an associate professor in the department of cell systems & anatomy at UT Health San Antonio, say that time was the biggest obstacle throughout the program.

“Challenges to working interprofessionally in this program mostly had to do with the logistics of finding appropriate times to meet, since the students’ schedules were set by different programs and varied greatly,” Chapa says.

Sharma adds that “all of the participants were volunteers and could work on the slides only during the evenings or weekends. [Additionally], with this program being implemented for the first time, it was hard to gauge the amount of time that would be required to develop a single presentation.”

Even with time and the necessary logistics in place, there needs to be an understanding of what each person can contribute and of the community served. “We’ve seen challenges with professionals not understanding or simply not knowing who else is working on similar issues—the housing sector may be unaware of who is working on workforce development issues, the mental health sector may not have a good grasp of the aging services community,” Hertz says by way of example. “Because most organizations have never had a strong reason to collaborate before, they are just building their bench strength in doing so.”

Sharma agrees, noting that, among the students, “there was a surprising lack of understanding about each other’s professions, though there was a wonderful sense of respect regarding each other’s professions.”

Regarding the new challenges of community outreach and interprofessional practice during the recent health crisis, Sharma says, “While community outreach and volunteering has been temporarily curtailed by most organizations to implement social distancing during the COVID-19 outbreak … with a plethora of online conferencing tools available, ‘virtual outreach’ is now not only possible but also critical to prevent social distancing turning into social isolation.”

The COVID-19 crisis has changed the nature of interprofessional practice in community outreach and education, albeit temporarily, but Chapa says, “While person-to-person outreach is not possible right now, the COVID-19 issue and precautions have afforded us an opportunity to think outside the box. Using Zoom or Canvas to have meaningful discussions and keep students focused on the achievement of their dreams is important. During time of ‘separation’ from peers or mentors, students run the risk of mentally losing focus, becoming depressed, or losing motivation. Staying connected and mentally stimulated through reading or educational activities is imperative—perhaps even more so now than ever before.”

Benefits
“All those challenges aside,” Hertz says, “we have seen an overwhelming interest in interprofessional networking and relationship-building from our safety net partners. People want to collaborate; they just often lack the time, resources, or knowledge about how to do so effectively.”

That is because, despite the challenges, there are significant benefits to interprofessional practice in community outreach. For one, if done correctly, it will create the opportunity for community members to not only better access services but also access services that are right for them.

When that happens, the community members and the community itself are more likely to grow. Take for example, veterans. “There is a benefit to having veterans and their families in the community,” Atherall says. “They are more engaged in community service and civic leadership. Communities benefit when veterans [successfully] transition.” She points to the Blue Star Families Annual Lifestyle Survey, which highlights the challenges and benefits of military families. The connection between the civilian and military community help communities thrive socially and economically.

But it’s not just the community that benefits; it is also the professionals involved. At UT Health San Antonio, the students preparing and giving the presentations found that they were able to learn from the program. For example, while they did not have a good understanding of each other’s professions at the start, they were able to build that knowledge through their work.

“Once we understand one another’s role on the education/health care team, we can then better create a unique education plan designed to serve and educate the community on various health care topics,” says Aldo Hernandez, a second-year Master of Respiratory Care student at the School of Health Professions at UT Health San Antonio.

“Working together generates more ideas and innovations,” says Manpreet K. Semwal, a fifth-year PhD student. “Programs and presentations like these, where different schools reach out together as a team to the community, emphasize that the role of every professional school is important in the scientific community.”

What’s more, says Samantha Yee, a PhD candidate in the Integrated Biomedical Sciences Program and Physiology & Pharmacology discipline at the Graduate School of Biomedical Sciences, working together shows the community that it is possible and that there truly is a team looking out for their best interests. “I think showing the community that we can indeed work with one another and actually do it behind the scenes is very important,” she says.

Additionally, as evidenced by the COVID-19 pandemic, ongoing collaboration allows organizations and communities to better respond to crises. “[In] what feels like a ‘moment’s notice,’ COVID-19 and the public health pandemic took over global operations and daily lives. In an instant, those who have been collaborative and incorporated collective impact practices in their communities were ready to activate networks to respond to this pandemic,” Atherall says.

As more and more businesses were closed and individuals ordered to remain home, collaborative teams still found ways to work together. “The rise of virtual technology has made ongoing professional engagement more accessible via video conferencing, conference calling, and team-based apps,” Hertz says. “People are getting creative, too, with ‘virtual happy hour’ and ‘breakfast meetings’ with colleagues.”

Social Work/Leadership
Given the benefits, the questions left for social workers then are where they fit into this interprofessional team and how they can help to lead the efforts.

Social workers are a critical component of community outreach and engagement and have been working in this field for a long time. However, Atherall says, social workers need to ensure that they are actively seeking a broader team. Looking at PsychArmor, Atherall notes that the organization was created by mental health professionals and remains largely run by them. In order to continue growing and best serve the veteran community, PsychArmor needs to “build out,” as she puts it.

This applies to all community outreach settings. When leading the way, social workers must diversify their team in order to be most effective.

And they need to see leadership in all roles, not just those defined by it. “It is so important for people at all levels in organizations to view themselves as systems leaders, which is distinct from organizational leadership. A systems leader is someone who routinely thinks about their work in the broader context of the community and who can see how their contributions fit into a larger leadership role,” Hertz says.

That being said, Hertz does acknowledge that leaders need to develop certain skills to be most effective. “First and foremost,” she says, “it starts with educating oneself about the issues at hand and the people and organizations that have power in their community.

“Second, it means finding out what information is needed to drive the conversation forward. How can you share your perspective on the key issues? How does what you see every day relate to the broader trends in the community?” Hertz continues.

Finally, she says, leaders must be willing to come up with solutions and to compromise. Doing so will keep them at the table and keep their voices heard. This is critical, because being at the table is the key. No one—no profession or individual community member¬—can have a leadership role or even an impact if they are not there. And the global pandemic of COVID-19 may be a catalyst for a new model of community outreach and interprofessional practice.

— Sue Coyle, MSW, is a freelance writer and social worker in the Philadelphia suburbs.

Reference
World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/70185/WHO_HRH_HPN_10.3_eng.pdf;
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