Academic partnerships are commonly developed as a means to engage students in service-learning (SL) experiences with an emphasis on student and client outcomes. SL is both a teaching strategy and a philosophy, used to advance students into individuals who contribute to their communities and promote social justice. It is considered a powerful educational tool that encourages student participation and collaboration in the classroom and community (Currie-Mueller & Littlefield, 2018). Utilizing SL as a strategy for academic partnerships allows for the incorporation of course objectives and assignments that transform theoretical thinking into actual practice. Health care professional students are in a unique position to transfer their experiences into a variety of health care settings upon graduation and serve as future catalysts in community care.
Challenges for newly developed partnerships involve trust, communication, diversity, and shared power (Wright et al., 2011), but with communication and compatible and comprehensive goals, barriers to success can be combated. Both the academic and community institutions are encouraged to investigate ways to welcome new relationships without emphasis on their own power or knowledge base (Thompson & Hood, 2016), with the acknowledgment that the contributions of all partners are essential through the steps of program development and for sustainability.
IN THE BEGINNING
When developing any academic/community program, it is wise to utilize a practice model as a guiding force through development, implementation, and evaluation. The Camden Model (Camden Coalition of Healthcare Providers, 2018) was used to establish the overall development of the Interprofessional Community-Academic Navigation Program (iCAN) as well as its underlying interprofessional curriculum. Sacred Heart University (SHU) health care students participate in iCAN as part of a separate semester-long course to fulfill clinical or field experience hours, which range from 6 to 24 per week, depending on requirements for the student's program of study. Reflective journaling and project development play a key role in capturing the student's journey throughout this SL experience.
The Institute for Healthcare Improvement's (2019) Triple Aim Framework provides insight into the overall quality of health care management for the target population, individuals who are homeless or at risk for homelessness. Students interact and work with clients in greatest need of navigation services, that is, clients who utilize the emergency department (ED) for their primary care and chronic illnesses. The National Alliance to End Homelessness (2017, para. 2) cites US Department of Housing and Urban Development statistics, indicating that "people living in shelters are more than twice as likely to have a disability compared to the general population" 20 percent of the homeless have a serious mental illness, 16 percent have conditions related to chronic substance abuse, and more than 10,000 have HIV/AIDS. Chronic illnesses within the population served by iCAN are representative of these data.
PROGRAM DEVELOPMENT
Program development began in fall 2016, with multiple meetings attended by all team members including the Director of the RN to BSN and RN to MSN program, Dean of the College of Nursing at SHU and Western Connecticut Healthcare Network (WCHN) representatives. WCHN selected SHU as an academic partner to incorporate students within the navigation services it already offered. According to its mission statement (SHU, n.d.), the university "embraces a vision for social justice and educates students in mind, body and spirit to prepare them personally and professionally to make a difference in the global community." Students from the RN-to-BSN and RN-to-BSN-to-MSN programs and other programs, including occupational therapy and social work, are involved in iCAN. Initial discussions focused on community needs and the health care curricula, with the understanding that SL was crucial to the collaboration. "Service-learning[horizontal ellipsis]focus(es) on both the service provided and the learning that occurs. The primary beneficiaries of service learning are the students who learn and the communities they serve" (Anderson & Hill, 2001, p. 2).
As in any relationship, stakeholders had different agendas, and they used the initial meetings to align goals for the community and the curricular needs of the academic setting. Communication and face-to-face contact were a priority for establishing the partnership and allowing all members to understand the dynamics of the team. Open dialogue, where each partner offers insight into their own specialties, is key to bringing the entities together.
WCHN's existing Community Care Team (CCT) at Norwalk Hospital was the setting for the first SL experience with three nursing and two occupational therapy students. The CCT is facilitated by a high-risk navigator who meets weekly with members of the community, including health care professionals, law enforcement, and representatives from services such homeless shelters, soup kitchens, care management teams, and rehabilitation centers. They discuss and track homeless and at-risk individuals to provide appropriate community services. Prospective clients are referred by community representatives and affiliated hospitals. A significant factor for determining the need for services is how often individuals return to the ED within a specified time period. The long-range vision is to improve the mental health of the larger community, increase the use of interprofessional teams, and decrease ED utilization due to poor navigation through community resources (American Hospital Association, 2017).
INTERPROFESSIONAL EDUCATION AND COLLABORATION
Interprofessional education and collaboration are key to the iCAN Program and the community/academic partnership. Offering students from a variety of health care programs the opportunity to participate in iCAN aligns with Interprofessional Education Collaborative Core Competencies for Interprofessional Collaborative Practice, "use the knowledge of one's own role and those of other professions to appropriately assess and address the health care needs of clients and to promote and advance the health of populations" (Interprofessional Education Collaborative, 2016, p. 10). Not only do students interact with other professions, they are also directly involved in health promotion for a specific population in need.
Innovative teaching and learning, combined with compassionate care, are the ultimate vision and mission of both SHU and WCHN. The partnership serves multiple purposes and multiple stakeholders and provides a way to enhance collaboration among professionals to advance the care provided along the care continuum. Through the program, student navigators work alongside the CCT high-risk navigators and SHU preceptor and serve as resource contacts to establish a plan of care for vulnerable clients. Due to the transient nature of the focused population, the students, along with members of the CCT, work tirelessly to determine the ongoing needs of clients and their willingness to accept and follow through on service suggestions.
FUTURE OF THE iCAN PROGRAM
As the iCAN Program enters its fourth year, the team has grown in number and sites. Ten health care professional students completed a semester-long experience at Danbury and Norwalk Hospitals in 2018. Reflections from past students are highly positive, noting that the program has had a direct effect upon their careers and educational trajectory. Many students had never worked before in the community with an at-risk population. This learning experience has impacted their views on homelessness and quality of life.
Research into students' perceptions and attitudes, as well as their self-awareness of social biases, is ongoing. Data collection will focus on obtaining measurable outcomes of the experience. Future plans are to focus on the community being served to identify key factors offered to individuals. The homeless population continues to require services and depend on those who support their pursuit of quality of life.
The development of an interprofessional community-academic partnership such as iCAN is buried deep in the overall concept of population health. According to the Centers for Disease Control and Prevention (2018), population health provides "an opportunity for health care systems, agencies and organizations to work together in order to improve the health outcomes of the communities they serve." With the ongoing development of the iCAN program, reflective comments from students showcase that health outcomes of clients are becoming more apparent. ED readmissions are being tracked through WCHN and provide promising data highlighting the benefits of the program. Students consistently report on what they have learned about working effectively within an interprofessional team. The iCAN Program overall continues to adapt to new challenges related to changes in health care, higher education, and population diversity.
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