Complete Chapter 8

IOH Toolkit

Chapter 8. Cooperative Education

Cooperative education (Co-op) is a powerful vehicle for helping students develop the set of oral health competencies needed for integrated primary care delivery. This curricular innovation provides students with meaningful, semester-long immersion experiences in real-world employment settings, an arrangement that differs from service-learning in both depth and breadth. During a Co-op semester, students are paid for their labor and receive academic credit. They do not take courses or pay tuition.

Creating a Co-op to equip students with the skills to integrate oral health competencies into primary care practice requires partnering with a primary care provider that is already committed to oral health integration. Students from the health sciences who participate in the Co-op will have an opportunity to develop core oral health competencies while gaining experience in integrated primary care delivery.

Critical elements of a successful Co-op program include:

Community Partnerships and Co-op Planning

Student Learning Objectives

Student Job Description(s) for the Co-op Position(s)

Educational Programming

Evaluation Methods

Chapter 8 Resources

Note: If you do not have the infrastructure to support a cooperative education initiative at your institution, the information in this unit can be applied in any clinical practice setting wanting to integrate oral health with primary care.

IOH at Northeastern University (NEU)

The IOH Oral Health and Primary Care Co-op provides students with a 6-month immersion experience at a federally qualified health center (FQHC) with a Patient-Centered Medical Home (a primary care practice that has adopted a set of processes aimed at coordinating and improving the delivery of patient care). The selected FQHC provides primary care integrated with behavioral and oral health services. Student learning outcomes for the program were adapted from the Core Competencies for Interprofessional Collaborative Practice and the Interprofessional Oral Health Core Clinical Domains and Competencies. In the Co-op, students deliver patient-centered, integrated, team-based care to vulnerable and underserved populations. This hands-on experience offers multiple learning and growth opportunities. Among them, students are able to cultivate collaborative skills in an interprofessional setting, contribute to the FQHC’s goals in a meaningful way, and witness some of the challenges involved in addressing health disparities.

For more information about Northeastern University’s cooperative education program visit: http://www.northeastern.edu/coop/.

Community Partnerships and Co-op Planning

Initiate your Co-op through faculty-led partnerships that include one or several clinical practice settings. Take the same steps to build these community partnerships as are outlined in the Service-Learning chapter under the heading, Community Partnerships.

Once you have identified Co-op partners, faculty from your institution and key personnel at the employer site(s) should collaborate to develop a plan for the Co-op purpose and function that considers the following:

Student Learning Objectives. The needs of the partner site will drive the development of these objectives and shape the Student Job Description(s) for the Co-op Position(s).

Educational Programming. To prepare both students and site employees for the Co-op experience, faculty and site personnel may want to conduct some training in advance. This might include online training, in-person training, or a combination of both. Teaching strategies and workshops provided in this toolkit can be adapted for this purpose.

Evaluation Methods. These should be determined by Co-op partners during the development of the student Co-op position. Methods may draw on student, faculty, and employer observations or additional data.

Student Learning Objectives

Student learning objectives can be adapted to suit the specific site, student interests, and the needs of the participating employer. Objectives might also vary according to duration of student placement and type of service provided.

The Co-op experience should prepare students to do at least some of the following:

Choose effective communication tools and techniques, including information systems and communication technologies, to facilitate interactions that enhance team function.
Listen actively, and encourage other team members to express ideas and opinions.
Contribute to effective communication, conflict resolution, and positive interprofessional working relationships.
Recognize one’s own uniqueness, including experience level, expertise, culture, power, and hierarchy within the health care team.
Engage appropriate health professionals in shared patient-centered problem solving.
Integrate the knowledge and experience of other appropriate professions to inform care decisions, while also respecting patient and community values, priorities, and preferences for care.
Perform effectively on teams and in different team roles.
Conduct preliminary oral health risk assessments tailored to individual patients.
In collaboration with a licensed health care provider, perform oral health evaluations linking patient history, risk assessment, and clinical findings.
Provide targeted patient education about the importance of oral health and how to maintain good oral health. Consider the patient’s oral health literacy, nutrition, and perceived oral health barriers.
Exchange meaningful information among health care providers to identify and implement appropriate high quality care for patients. Base these care decisions on comprehensive evaluations and the options available within the local health delivery and referral system.
Apply interprofessional practice principles that lead to safe, timely, efficient, effective, and equitable planning and delivery of patient and population-centered oral health care.
Facilitate patient navigation in the oral health care delivery system by collaborating with oral health care providers and providing appropriate referrals.
Identify barriers to care for people experiencing challenges such as homelessness, addiction, or poverty.
Recognize the unique presentation of medical or behavioral health conditions that impact oral health for individuals with challenges such as those stemming from homelessness, addiction, or poverty.
Collaborate with other health care professionals to design interventions for overcoming barriers to care for people with these or other challenges.

Sources

Interprofessional Education Collaborative Expert Panel. (2011). Core Competencies for Interprofessional Collaborative Practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.

U.S. Department of Health and Human Services. (2014). Integration of Oral Health and Primary Care Practice. Rockville, MD: Health Resources and Services Administration.

Student Job Description(s) for the Co-op Position(s)

To create a student job description, faculty should collaborate with key personnel at the participating employer site to consider the following factors:

Number of openings
Duration of placement
Full-time vs. part-time employment
Hours of operation
Pay
Required experience, field of study, and credentials
Other qualifications
Responsibilities
Job-specific training recommended or required

All of these elements should be addressed in detail to ensure faculty, employers, and students understand the expectations of the position.

Sample Co-op Job Description

Position Title. Oral Health Coordinator
Location. Boston, MA
Type of Industry. Hospital/Clinic
Job Type. Full-Time
Employment Type. Undergraduate Co-op, U.S.A
Term Year. Spring Term 2015
Number of Openings. 1
Wage. $15.00/hour

Company Description. Since its founding in 1985, Boston Health Care for the Homeless Program (BHCHP) has been driven by a singular, powerful mission: to provide and assure access to the highest quality health care for Boston’s homeless men, women, and children who face daily threats to their health and well-being through increased exposure to illness, injury, and disease. Amid the chaos of homelessness, health care often becomes a distant priority, allowing preventable illnesses to go undetected and minor symptoms to escalate into avoidable health crises. A nationally recognized model of innovative health care for homeless patients, BHCHP provides medical, dental, behavioral health, and supportive services at over 80 clinic sites across greater Boston through the work of its multidisciplinary health care teams.

Major. Health Sciences, Nursing
GPA. 2.00 minimum
Minimum Experience. Sophomore

Qualifications.

Strong interpersonal and communication skills
Ability to self-direct and manage individual projects
Basic computer skills
Interest in working with vulnerable populations
Bilingual ability a benefit

Hours. Flexible. Dental clinic hours are M–F, 7:00 a.m. to 3:30 p.m. Hours may change according to site and project. May include occasional evening hours.

Position Description. This is a new, innovative cooperative education position specially designed for students from Bouvé College of Health Sciences to develop oral health core clinical competencies in primary care. The student will be based in the BHCHP Dental Department, which will provide an excellent opportunity for interprofessional collaboration to improve oral health for vulnerable populations. The Oral Health Coordinator will focus on strengthening BHCHP’s medical and dental integration in a patient-centered medical home model. This unique cooperative education role will support current efforts in integrating oral health and primary care. The candidate will also develop and implement new projects. The student will be based at our main location and will also have the opportunity to collaborate with dentists, dental assistants, primary care providers, nurses, case managers, and others at several outreach sites.

The Oral Health Coordinator will be an integral team member in a program-wide effort to improve medical and dental integration. The Oral Health Coordinator will work under the direction of the Associate Dental Director and the Associate Medical Director and will assist with both direct patient care and administrative support.

Clinical and administrative duties:

Assisting with oral health evaluations and risk assessments
Performing oral health evaluations and risk assessments
Chairside dental assisting
Developing patient education tools
Educating patients, including parents and children
Applying fluoride varnish
Calling patients to confirm, schedule, or reschedule appointments
Collaborating with medical and dental providers, as well as other health care team members
Following up with patients who need referrals or additional care
Participating in medical and dental integration team meetings
Developing resource and referral networks for use at medical sites
Designing and conducting a survey of patient needs at outreach sites
Recording patient information into the electronic medical record
Organizing oral health fairs at outreach sites
Performing other duties as needed

Educational Programming

To ensure students and site employees are prepared for their Co-op experience, programs may want to conduct some training in advance.

This toolkit outlines four interprofessional learning opportunities to help students and site personnel begin to develop competency in oral health integration. Even with this training, students should be supervised by a dental professional while receiving hands-on training in oral examination, oral health risk assessment, and fluoride varnish at the Co-op site.

To help you make programming decisions, the table below lists workshop topics, corresponding workshop titles with links, and an overview of relevant learning objectives. Remember to schedule pre- and post-assessments so you can track the effectiveness of your programming.

Workshop Topic	Workshop Materials	Learning Objectives
Teamwork and Communication in Health Care	Didactic Session 2, Case-Based Learning	Understand the terminology and concepts of interprofessional education and collaborative practice. Consider how collaborative practice can increase provision of comprehensive oral health services.
The Oral Examination	Workshop 1, Faculty Development	Conduct an oral examination on an adult patient. Conduct an oral cancer screening on an adult patient.
Oral Health Risk Assessment and Dental Referral	Workshop 2, Faculty Development	Conduct an oral health risk assessment on an adult patient. Provide a dental referral.
Fluoride Varnish Training Caution: States have laws and regulations governing the application of fluoride varnish. Consult with your state health agency before implementing this training.	Smiles for Life, third edition, Course 6: Caries Risk Assessment, Fluoride Varnish and Counseling Note: Complete fluoride varnish section only (slides 25–48). These slide numbers match the slides in the third edition of Smiles for Life in their downloadable format and will differ from those numbers on the web interface.	Describe the effects, sources, benefits, and safe use of fluoride. Describe the benefits and indications of fluoride varnish. Demonstrate the application of fluoride varnish.

Evaluation Methods

To evaluate your Co-op program, gather data from multiple sources including:

Student reflections
Assessments
Employer assessments of student performance
Other data from the Co-op employer site

This information will help you:

Evaluate student performance
Evaluate site performance
Justify your program
Make improvements where appropriate

In the following table you’ll find several evaluation methods listed along with their purposes. Links to sample forms and questionnaires are also provided.

Each of these evaluation tools can be adapted for your needs and used as a stand-alone assessment or as a pre- or post-assessment tool.

Evaluation Method	Purpose
TeamSTEPPS® Teamwork Attitudes Questionnaire (T-TAQ)	To measure participants’ attitudes toward various components of teamwork, as related to patient care and safety.
Student Oral Health Survey	To measure participants’ oral health knowledge, skills, and attitudes.
Reflection Paper Template	To encourage participants to reflect on their experience working within a patient-centered medical home and collaborating with other health care providers.
Employer Site Data	Data collection points may include the number of: Patient encounters Scheduled appointments Referrals Fluoride varnish applications Attendees at organized health fairs or outreach efforts