Program Implementation
The Mobile Health and Wellness Program was designed to meet the specific needs of the communities it serves.
Many of our participants are over the age of 65 or have a disability and reside in low-income housing in an urban neighborhood with high rates of crime, limited access to transportation, and few options for shopping and food access. Our rural participants live in areas that have limited access to specialty care (i.e., obstetrics, substance use, cardiology, pulmonology, dental)—often requiring them to travel over an hour for treatment and further complicated by restricted transportation options and resources.
Establishing a community wellness clinic requires a thorough initial needs assessment, consultation with community representatives and ongoing evaluation once in operation. The program should be designed with special consideration for its accessibility, sustainability, frequency, staffing and partnerships.
Program Plan
The following plan outlines the foundational elements of MHWP.
On-Site Supplies
- stethoscope
- otoscope
- glucometer and associated supplies (alcohol pads, gauze, lancets)
- blood pressure monitor
- scale
- laptop/tablet
- perinatal ultrasound
Creating Interdisciplinary Teams
In MHWP, interdisciplinary teams were formed from students across multiple schools on VCU’s health sciences campus. Although the number and type of students varies, on most days 10 to 20 students are assigned a clinical experience at MHWP. Teams are composed of four students who interact with one participant at a time. Teams may differ depending on the type of program offered; however, a crucial component of implementing this program is the use of students from different health professions.
At MHWP, teams consist of students from the following disciplines:
- nursing
- pharmacy
- social work
- medicine
- law
- physical therapy
- occupational therapy
- kinesiology and health sciences
- psychology
Social Drivers to Health
In MHWP, we believe the social drivers of health are critical to managing chronic diseases. Our team screens everyone for social determinants of health needs and mobilizes resources to meet those needs. 50% of our participants have food insecurity, 35% have housing insecurity, and 13% have transportation barriers that limit their access to care.
At MHWP, the team provides education, resources and coordination for:
- Food/nutrition
- Health insurance
- Transportation to health care appointments based on insurance type and provider
- Health literacy
- Housing
- Personal technology
- Financial
- Advanced care planning
- Legal
Enrolling Participants
For clinic sites in multi-unit residential buildings, a resident services coordinator, building manager and community leaders promote the program to residents. Resident participation in the program is voluntary. Outreach advertising the program occurs through informational town hall-style sessions in each building, word of mouth and referrals from resident services coordinators.
Individuals who wish to participate sign a consent form as part of the enrollment process. The consent form:
- confirms that participation is voluntary
- states that the participant can drop out at any time
- describes the services provided through program
- informs the participant that these services do not replace those provided by their health care provider
Because the MHWP team does not have access to medical records, the resident-participant is informed that their data and activities are recorded by MHWP as “case notes.” (Visit the case notes section of the Participant Visits page for more information.)
Assessing and Strategizing Student Training
The Mobile Health and Wellness Program supports clinical experiences for undergraduate and graduate students in nursing, pharmacy, and other disciplines. The VCU School of Nursing leads the program by providing a central coordinator who the nursing school employs to manage all student experiences. Coordinating student participation is complex, taking into account the size and capacity of each program site, multiple disciplines, degree plans, and calendars.
VCU health science students have core interprofessional education (IPE) content as part of the curriculum. Two didactic courses are offered for students across disciplines that incorporate IPEC core competencies within the context of case-based learning. The MHWP clinical experience builds on content from the IPE courses. Services are provided by interprofessional student teams and their supervising faculty, making for a rich, practice-based IPE experience.
Students who are assigned clinical experiences at MHWP are required to attend a half-day orientation at the start of the semester to become familiar with the goals of the program, what to expect as a student, protocols and learn what they will be doing while on-site. Students work through a case study simulation that exemplifies a common resident-participant scenario, allowing students to explore how to work in teams, how and when to use evidence-based tools and assessments, and to gain insight into the health disparities and inequity they will encounter. The orientation also includes a session dedicated to motivational interviewing (MI) concepts within an interprofessional framework, with the expectation that students will incorporate MI strategies while interacting with the resident participants.
Students are trained in a number of areas related to their involvement in the program. A sample of those modules includes:
- social connectedness
- ageism and elderhood
- housing instability
- social determinants of health
- opioid risk reduction
- falls risk reduction
- high-risk medication
- functional capacity screening
- behavioral health
- cognition and brain health
COVID-19 fueled growing motivation to address social determinants of health and health equity in order to put population health at the forefront of care. This increased attention on providing equitable health care has had an impact on how health science students are trained, with interdisciplinary collaboration more important than ever.
This cross-professional focus is a central tenet of the MHWP model, and also one of the more complicated aspects to operationalize. There is a high degree of complexity involved in scheduling students from different disciplines while also meeting the objectives and competencies of their respective degree programs. As students have different core competencies, timelines, and required practicum hours, creating schedules for these interdisciplinary teams is challenging and necessitates a clinical coordinator dedicated to managing student team schedules.
Interprofessional learning requirements are a foundational aspect of student participation in MHWP or any similarly-modeled program. Buy-in from supervising faculty who understand each discipline’s needs and schedules and are able to serve as on-site preceptors for their students is necessary for program sustainability and success.
Prior to participating at clinic sites, students should be made aware of certain protocols and recommendations. The following information should be communicated to students prior to their participation:
- parking
- dress code
- storage of personal items
- health and safety protocols