Our Health Resources and Services Administration (HRSA) funded project (2015-2019), Teaching Today’s Students for Tomorrow’s America (TTSTA), implemented and evaluated an interprofessional collaborative practice (IPCP) model through an across-system partnership, including a nurse-managed health center, a major local health system, and a community-based resettlement organization. Aims of the project were to improve access to and quality of primary care for refugees while preparing healthcare providers and students to care for this population. The first goal of the project was to develop and test an IPCP Community-Centered Health Home (CCHH) model of care for refugees across systems and settings. The clinical providers on the interprofessional team included Community Health Workers, Nurse Practitioners, an MSW Health Manager, Nurse Case Managers, a Physician and multiple students from related disciplines.
The U.S. healthcare system is described as complex, fragmented, costly, and inefficient. Multifactorial failings stem in part from the provision of non-integrated services and inoperability across health systems. The Community-Centered Health Home (CCHH) (Cantor et al, 2011) model was proposed to expand the concept of primary care medical homes beyond the walls of a traditional primary care clinic. This model asserts that a person is only as healthy as the community in which they live. The following table compares the CCHH model with the traditional US primary care delivery model and a collaborative model, which is used in our project’s NMHC.
Strategies to decrease health disparities and lower health costs for vulnerable populations include increasing access to culturally responsive care through interprofessional collaborative practice (IPCP). The second goal of TTSTA was to implement a model of interprofessional education (IPE) that prepares future health care professionals to meet the health needs of diverse populations. In addition to improving access to and quality of primary care for local immigrant and refugee populations, this initiative provided an IPCP environment that fostered interprofessional clinical learning for health professionals and students across disciplines. Initial staff development took place through email communications with project staff and students, which are included in this toolkit. In addition, two clinical online learning modules, Refugee Culture and Health and IPCP Competencies, were developed for ongoing staff development and academic education to continue to break the current silos of health care delivery.
Strategies to decrease health disparities and lower health costs for vulnerable populations include increasing access to culturally responsive care through IPCP. “Collaborative practice in health-care occurs when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings” (WHO, 2010). The Interprofessional Education Collaborative defined four IPCP competencies:
Interprofessional Collaborative Practice Competencies
|4 Core Competency Domains||General Competency Statement|
|Values/Ethics for Interprofessional Practice||Work with individuals of other professions to maintain a climate of mutual respect and shared values|
Use the knowledge of one’s own role and those of other professions to appropriately assess and address the healthcare needs of the patients and populations served
|Interprofessional Communication||Communicate with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and the treatment of disease|
|Teams and Teamwork||Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patients-/population-centered care that is safe, timely, efficient, effective, and equitable|
We want to make note that while we focused our refugee CCHH on caring for refugees and use that term throughout this toolkit and other publications, we also provided services to asylees and immigrants. While their migration journeys may be motivated by the same impetus, their process for entering the United States differ.
Anyone who is not a U.S. citizen at birth. Includes those who have become U.S. citizens through naturalization, asylees, refugees, foreign students, immigrants and unauthorized immigrants. (US Census, 2016)
A person outside his or her country of nationality who is unable or unwilling to return to his or her country of nationality because of persecution or a well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion. (https://www.dhs.gov/immigration-statistics/refugees-asylees)
A person who meets the definition of refugee and is already present in the United States or is seeking admission at a port of entry. (https://www.dhs.gov/immigration-statistics/refugees-asylees)
A foreign citizen who wants to live permanently in the United States (https://travel.state.gov/content/travel/en/us-visas/immigrate/the-immigrant-visa-process.html)
Anyone born in the United States, Puerto Rico or other U.S. territories, or born abroad of a U.S. citizen parent or parents. (US Census, 2016)
We offer these web-based resources free of charge in the spirit of improving primary care delivery and interprofessional collaborative practice education. Thank you for your interest in our work.
The authors acknowledge the unwavering dedication and visionary contributions of the across-site, across-system refugee CCHH team members throughout the three years of the project.
This project was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) Nurse Education, Practice, Quality and Retention (NEPQR) Interprofessional Collaborative Practice (IPCP) and Interprofessional Education (IPE) Cooperative Agreement under grant number, UD7HP28542, for $1,337,115. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.
Comparison of Community Centered Health Home (CCHH) Model with the Traditional Primary Care Delivery Model and a Collaborative Care Nurse-Managed Health Center (NMHC) Model
|Collaborative NMHC Model|
|CCHH Model (Cantor et al, 2011; Mikkelsen et al, 2014)|
|Location||Community-based||In existing CBO||Across institutions|
|Structure||Stand-alone primary care center||Interdependent partnership||Collaborative healthcare institution partnerships|
|Community of Service||Registered clinic clients||All members of an identified community||Patients, families, and indirectly, all members of an identified community|
|Determination of Services||Defines and develops services on staff mix, marketing data||Defines & continually modifies on a continual engaged assessment of community needs & strengths||Strategically engages partner efforts to improve community environments|
|Point of Entry||At clinic registration.||Community residents determine.||Clinic, community services or community health promotion|
|Service Unit||The individual (and sometimes the family)||The family, aggregate and whole community.||Participates to improve health & safety for all residents|
|Access||Restricted by criteria of insurance coverage or membership||Open and unrestricted by criteria of insurance or membership||Multiple partner institutions coordinated between providers|
|Setting||Clinic only||Inside and/or outside the clinic setting||All partners with active involvement in community advocacy & systems of change|
|Clients||Individuals and families who become registered||All members of the community if they are seen in the clinic or not||All members of an identified community|
|Service Coordination||Competitive with other primary care providers||Complementary to other primary care providers||Complementary to existing community partners|
|Timing||Services are episodic||Services are continuous||Ongoing active involvement|
|Level of care||Mostly secondary or tertiary prevention nature focused on cure||Mostly a primary prevention nature (even in the clinic setting)||Mostly primary prevention nature with focus: care management & coordination|