2011 - 2012 ISCOPES Annual Overview by Rachel Glassford

Collaborating for Health 2011 2012 Iscopes Annual Overview

“coming together is a BEGINNING. staying together is PROGRESS. working together is SUCCESS.” ---Henry Ford

2011 - 2012 Annual Overview

“Everything you guys did was very interesting, helpful, and I feel really blessed to be a part of it.” - Sibley Plaza Resident, A Wider Circle Team 04

2011 - 2012 Annual Overview

Contents Mission, Values, & Goals

Annual Overview Introduction

Teamwork: We Depend On It

Team Projects 10 Our New Blog 18

2011 - 2012 Annual Overview

The mission of ISCOPES is to provide students* with a service-learning experience while addressing community-identified needs in the Washington, DC metropolitan area. Interprofessional teamwork and community partnerships make ISCOPES a unique approach to promoting health in DC and reducing barriers to accessing health information and care.

Mission, Values, & Goals We Value:

GOAL 1: GW students effectively engage in intensive, health promotion experiences.

1. Universal health care access 2. Authentic collaboration between GOAL 2: GW faculty/staff effectively serve university and community as community health promotion coaches. 3. Service Learning as a core strategy GOAL 3: Community leaders facilitate 4. Evidence-based, researchinformed, and/or science-based capacity building through universitycommunity health promotion resources enhanced with partnerships. culturally appropriate adaptation options GOAL 4: High priority target populations 5. Interprofessional Teamwork 6. Culturally Competent Health in the DC Metro area participate in health Services promotion experiences. 7. Sustainable, outcomes-driven GOAL 5: University-community project development, implementation, and evaluation partnerships are strengthened. *2011-2012 included students from the Physician Assistant (PA), Physical Therapy (DPT), Medicine (MD), and Public Health (MPH) Programs.

2011 - 2012 Annual Overview

Anyone who has ever been involved in community health and/or service knows from experience that our work is not easy. Limited resources, little (wo)man power, insufficient time in everybody’s schedules, and managing expectations of 200+ participants are just some of the challenges that the ISCOPES program faces each year. Despite some of these barriers, we have seen success year after year. With every “thank you” we hear strangers say to a student at a team event, with every e-mail we read praising a team’s efforts and progress, and with each End of Year Celebration that highlights true team collaboration and achievement, we feel better about the efforts that we all put into to making ISCOPES possible. This work is not easy, but it’s well worth it thanks to the committed people we have the pleasure of learning from and serving with as we seek to improve health for all in the DC Metro area. This year in particular, ISCOPES has evolved with the addition of a few new outcomesfocused activities – rotating team leadership roles, a student-driven blog, and the diligent use of evidence-based materials from our Resource Library. None of that compares, however, to how students, coaches, partners, and consumers have built each other up, circumvented challenges together, and seen 17 different projects through even if it meant sacrificing extra time, resources, and energy. We have seen teams – big and small – persevere against all odds. The “We Are All in This Together” spirit is very much alive and present as we celebrate the close of 2012! This year reconfirmed our belief that we accomplish more when we learn about, with, and from each other. We serve more effectively when we collaborate. Success for one is success for all and challenges are lessened when they are shared. As we move forward, we know change is inevitable. Our social, physical, and political environments are constantly moving and shifting. Our program will be growing and we hope this team spirit will remain strong for many years to come. We look forward to having you with us on our collective journey as we continue to come together, progress together, and succeed together. Thank you! Warmest Regards,

Angie Hinzey & Donna Javellana ISCOPES Leadership Team

2011 - 2012 Annual Overview

[Our community coach] is a great role model and provided some great information about the community and the city as a whole.

[Our faculty coach] genuinely cares not only about our target population, but about humanity as a whole.

[Our faculty coach] has a treme passion for serving this popula 08

2011 - 2012 Annual Overview

Teamwork: We Depend On It

mendous lation.

“Teamwork is the ability to work together toward a common vision...the ability to direct individual accomplishments toward organizational objectives. It is the fuel that allows common people to attain uncommon results.” One of the four main competency domains in ISCOPES relates to teams and teamwork. Being a team player is not just a theory described on paper or talked about as a part of intellectual discourse, however; in ISCOPES, being a team player is lived out by our coaches, our students, and our community partners. In fact, ISCOPES is its people. Without each of them and their commitment to one another, there would be no program.

“No member of our team, as an individual, could have completed our goal, but because we were able to combine our experience, knowledge, and creativity, the finished project was truly greater than the sum of its parts.” -- Community of Hope Marie Reed Team

2011 - 2012 Annual Overview

Team Projects A Wider Circle

Bread for the City - Food For Health

“Interprofessional teamwork is hard work but pays dividends.” Academies at Anacostia This year at the Academies at Anacostia – a DCPS high school in Ward 8 – this team had the opportunity to get to know students with interests in health-related careers. While spending time with these students, the team realized that there was a lack of extracurricular organizations geared toward a future in health and healthcare. When consulted, the young people at Anacostia voiced an interest in forming a Red Cross Club, a school-based student organization that would house both community service opportunities and events that would help them learn about working in health and public service. After much planning and adapting the plan, the team met with the founding group of Anacostia students several times, assisted with elections for officer positions, hosted the local Red Cross representative, and planned an upcoming field trip to a local Fire/EMS Station. The team learned the importance of sustainability, regular communication, and adaptation to the needs of the population served; as such, they relied on Facebook, Twitter, and Skype, and some team members have committed to assisting the Club beyond the end of the ISCOPES year. A Wider Circle (New Partner!) This team collaborated with A Wider Circle to serve and learn from the community at Sibley Plaza, a DC Housing Authority site in Ward 6 dedicated to older adults and individuals living with disabilities. Assessment interviews revealed a need for activities that would reduce stress, decrease social isolation, and increase knowledge about various health issues. As a result, the team planned, implemented, and evaluated six themed events in the Sibley community room for the residents including an Intro Party with Bingo, Laughter Yoga, Healthy Heart Day, Stroke Awareness, Falls Prevention, and an Easter Party. Exercise – like chair aerobics and dance – was routinely incorporated into the activities. A core group of 15-20 residents regularly participated. The team learned that quick, 30-minute educational presentations, and positive, friendly interaction goes a long way! 10

2011 - 2012 Annual Overview

“Visiting poorer areas of the city and interacting with the community there has been an eye-opening experience. It makes you appreciate the life and opportunities you have.” -- PA student Bread For the City –Food For Health At Bread for the City (BFC) – a nonprofit in Ward 2 – the Food for Health team worked with the Community Engagement and Advocacy Department to develop a survey to assess client’s awareness and utilization of as well as satisfaction with the organization’s food-related activities. These activities include nutrition education classes, free farmers markets, orchard gleaning, rooftop gardening, and computer health literacy classes. Survey development led to collaboration with each activity’s program director. In addition to assessing the visibility and utility of these resources, the team learned about BFC’s commitment to soliciting client feedback about how to improve each of the extant activities. In that vein, survey drafts were submitted for rewrite and approval to the Client Feedback Committee at BFC. The team learned that while the collaboration model of care is challenging to execute, the final product will more closely reflect the organization’s values and capacity. Most importantly, this evaluation tool will better capture the met and unmet needs of BFC’s clients, ultimately leading to programs that are more effective and sustainable.

Bread For the City –Health Resource Room The Bread for the City (BFC) Health Resource Room (HRR) team set out to provide free, age and literacy-appropriate health resources to BFC’s clients through the dedicated health education space in the NW medical clinic located in Ward 6. Prevention, treatment, and/or management of diabetes, cancer, heart disease, and stroke through increased physical activity, correct prescription drug use, cessation of smoking, and healthier eating were the primary focus points. One-on-one sessions were conducted with clients at BFC using Prezi presentations developed by the team. Each of these sessions was followed by a summative formal assessment. BFC clients suggested the presentations were appropriate in length and worth their time; they described the content as informative and fun, and reported learning novel information. The team learned that tailored discussions with clients using standardized tools were an effective strategy to client empowerment in personal health maintenance. They also learned that limited personnel and limited awareness about available evidence-based materials in health education spaces tend to render resources underutilized and client potential underdeveloped.

“We discovered that ‘health’ is about more than just treating the disease or condition you see immediately in front of you. Health is about the whole person, as influenced by their community, lifestyle, activities, ideals, and beliefs.” -- DC Parks and Recreation Team

Bread for the City - Health Resource Room

2011 - 2012 Annual Overview

Community of Hope - Girard Street

DC Parks & Recreation

Emery House

2011 - 2012 Annual Overview

“[My teammate] is going to be a great professional wherever he ends up.” “[My teammate’s] dedication was inspiring.” Community of Hope - Marie Reed This team collaborated with a DC Public School in Ward 1 – Marie Reed Elementary – through a health education partnership with Community of Hope, a local nonprofit with a District-wide reach. The team first learned about how the growing epidemic of childhood obesity has affected the young people of Marie Reed. They also learned that the school has a particularly important asset: monolingual classes taught in English as well as dual language classrooms offering content in English and Spanish, critical in providing culturally competent education to this largely Hispanic community. Given the aforementioned, the team decided to create a program that would integrate fun physical activity into the kids’ everyday routine while simultaneously reflecting the values of the school and neighborhood. With a grant the team received from the Public Service Grant Commission at GW, the team introduced Excitadores de los Niños to five classrooms at the school. Program materials included energizer kits for teachers based on a national evidence-based physical education program, Spark. With a scalability plan intact, this team’s efforts are on track to mold the school into a physically fit environment!

three themed life skills workshops: 1) physical activity and hypertension, 2) parent-child communication regarding love, sex, and relationships, and 3) developmental milestones. Pre-and Posttest evaluation results indicated the workshops were effective in increasing knowledge and self-efficacy on the topics discussed. Through this process, the team learned the importance of user-friendly health materials, relationship building, health marketing, and advance planning. The team also learned how to better meet the needs of transitioning populations as well as the value of community experts.

Community of Hope - Girard Street This team began their year by conducting a needs, resources, and interest assessment in tandem with a potluck at one of Community of Hope’s transitional houses located in Ward 1. This assessment guided the team to build on a past ISCOPES project wherein families would complete tailored health histories called “Health Passports” with one-on-one assistance. Additionally, the team planned

DC Parks and Recreation The DC Parks and Recreation team began their year learning about community gardens and food access issues in various parts of the District. Then, after researching evidence-based programs involving community gardens and childhood nutrition, the team designed and implemented several after-school workshops focused on growing and eating healthy food. The Seeds of Change pro-

“This was very motivating and it taught me that young people do not give up on you and that they believe in you and will fight with you to the end.”

ject involved female youth, ages 4 – 12 living near the Trinidad Recreation Center (TRC) in Ward 5. The primary goal of the project was to improve healthy eating behaviors by increasing awareness of the community garden located at TRC, increasing knowledge about a balance diet, and increasing access to fresh fruits and vegetables. The team learned effective techniques for empowering young people to choose healthier food options, but also learned the importance of including parents in future efforts in order to modify family norms and reinforce workshop health messages. Emery House This team had the opportunity to serve and learn from the staff and residents of Emery House, a transitional workbed facility for men in Ward 5 operating within the DC Coalition for the Homeless network. After conducting an initial needs, resources, and interest assessment, the team developed health logs to use in one-on-one health education sessions with the men. Topics covered in the sessions focused on chronic disease prevention, diagnoses, and treatment especially related to diabetes and hypertension. Healthy behaviors – including eating a nutritious diet and getting adequate exercise – were also highlighted in these sessions. To reinforce individual session messages as well as reach those men who were not able to participate in the sessions, the team created an updated health resource table complete with materials from federal and national agencies.

2011 - 2012 Annual Overview

Cultural Humility is Key “Onsite…attempting to convey health info to residents, I experienced cultural humility in realizing that not all “commonly known” health info is common.” --DPT Student Department of Mental Health The Department of Mental Health team served on a larger team of mental health professionals working throughout the District to implement Primary Project, an evidence-based, early intervention and prevention program designed to reduce social, emotional, and school adjustment difficulties in children kindergarten through third grade. Learning from direct service providers in the field, this team first focused their efforts on learning about child-centered play. After honing their skills and traversing the difficulties of finding the young people most in need, this team had the opportunity to provide services through the child development center at Martha’s Table in Ward 1. Additionally, the team planned a book drive to benefit the many locations served by Primary Project. The team learned the importance of early intervention and tailored care, as well as the usefulness of established, evidence-based, funded programming. The team also witnessed firsthand the importance of collaborative partnerships between government and nonprofit entities in delivering effective health-related services. Health Information Partners The Health Information Partners (HIPS) team quickly integrated themselves into the established initiatives of this local nonprofit via a variety of health education activities at various sites throughout Wards 7 and 8. They conducted street outreach to increase awareness about HIV/AIDS, diabetes, and cancer prevention, care, and treatment; they implemented computer-based workshops at Whitman Walker’s Max Robinson Health Center to improve computer health literacy; they taught workshops at Stoddert Terrace – a DC Housing Authority site – where they focused on HIV stigma reduction and diabetes prevention; and they conducted health education sessions at Ballou High School about healthy versus unhealthy relationships and alcohol, tobacco and other drug (ATOD) abuse . They used a mix of evaluation techniques for all of their formal workshops. The team also used their SMART objectives to direct their collaborations with each of these partner organizations. Throughout these experiences, the team reported that community collaboration and input were critical to their overall success.

Health Information Partners

A Wider Circle

Mary’s Center

2011 - 2012 Annual Overview

La Clinica Community Health Action This team was housed within the Community Health Action (CHA) department at La Clínica del Pueblo, a federally qualified health center (FQHC) serving immigrants in Ward 1 as well as throughout the entire metro region. Given the CHA’s priorities of conducting health outreach and connecting clients to health-related resources in the community, the team was charged with creating a database of accessible physical activity resources. Accessibility in this case was defined as resources that meet the language, affordability, and transportation needs of the client population. Childcare provisions, gender-specific options, and age appropriate resources were also considered. After extensive research that involved visiting each of the sites, the team found 18 accessible locations in Ward 1 alone where people could and might be more likely to engage in physical activity including parks, gyms, and community centers. Fortunately, this resource can be used and adapted over time by La Clínica clinicians and Promotores de Salud of the CHA department to complement their culturally appropriate health education efforts!

“Having meetings onsite… allowed me to see patients utilizing the health services available. The clinic was almost always full and busy. Seeing these patients helped me realize the stereotypical patient with HIV I had in my mind was wrong.” --DPT Student La Clinica Immigrant Patient Rights Building on the efforts of previous ISCOPES teams, the La Clínica Immigrant Patients’ Rights (IPR) team began by learning about limited or non-English proficiency (LEP/NEP) people who utilize language services while seeking healthcare, as well as their direct/indirect service providers within the DC metro area. The team saw a need for an updated cross-sectional snapshot of barriers LEPs and their providers are facing that prevent healthcare facilities from providing optimal access to language services in hopes of finding solutions to those barriers. After reviewing the way La Clínica currently evaluates LEP patient access to language services, the team developed two population-specific surveys. Pilot testing of the surveys is underway. Throughout the year, the team has reflected on the importance of building on the work of others as well as the importance of self-sustaining evaluation methods. They are hopeful La Clínica can use their project to compound the success of the ISpeak campaign as well as maximize the use of their limited medical interpreter resources.

“It can take a lot of time and effort to truly be accepted into a community that is culturally different, but ISCOPES gave us the chance to begin to break down these barriers and begin to impact the community.” --MPH Student Mary’s Center This team had the opportunity to serve through Mary’s Center, a federally qualified health center with locations in Wards 1, 2, and 4. This team’s project was crafted around the need for targeted health messaging in Mary’s Center’s multiple waiting rooms. To maximize reach with limited resources, the team employed edutainment principles and focused on creating engaging, informative, medically accurate, and culturally appropriate videos. The team also chose video content that would be easy to absorb by viewers of varying health literacy levels. The final product is a combination of sourced health education videos from high-quality sources like Unicef and health tips from Mary’s Center providers. Next steps at this site will include evaluating the impact of these videos and adding to the series as needed.

“During ISCOPES, I have experienced cultural humility when implementing [our project]. I think when discussing important and sometimes personal health topics, a lot can come out in conversation to make you realize how different your upbringing/background is.” --MD Student 15

2011 - 2012 Annual Overview

“Understanding the challenges faced by the women of N Street Village and how our ISCOPES team could make a difference was an incredible experience which we could never get in a classroom.” -- N Street Village Team

Southeast Children’s Fund

Understanding those we serve “I learned that just because you might identify with the same race as your service population does not mean that you know everything about that culture or group of people. What it comes down to is that if you are not an actual member of that community, it is hard to fully relate and understand all of the community characteristics.” --MPH Student

N Street Village

N Street Village (NSV) is a nonprofit located in Ward 2 that serves nearly 900 homeless and low-income women from all over the District. The NSV team started off by learning about these women and the case-management, residential, medical, and crisis support services NSV offers to them. Then, the team decided to address some of the unmet needs of the nonresidential women who access crisis care. Specifically, they decided to develop singlestep Smart Start guides for circumventing some of the most commonly reported barriers these women face. The guides focus on housing, employment, transportation, legal services, legal documents (birth certificates, social security cards, identification cards), SNAP, health insurance (DC Healthcare Alliance and Medicaid), and TB testing. The project serves as an important starting place for returning women to a state of physical, emotional, spiritual, and mental well-being.

2011 - 2012 Annual Overview

“I was developing a cover for a client binder and realized that I couldn’t find any clip art of African American people. It made me step back and think about how that would feel to not be acknowledged as a worthy citizen.” -- PA Student

Transitioning Veterans Collaborative

Whitman Walker Clinic Southeast Children’s Fund (New Partner!)

This team collaborated with Southeast Children’s Fund (SCF), a nonprofit serving families in Wards 7 and 8. Specifically, they focused on SCF’s early learning center in the Solomon G Brown Corps Community Center that serves children ages birth to three years old. First, the team conducted an informal needs assessment among the parents and staff of SCF, and discovered that the required District of Columbia Universal Health Form is challenging and overwhelming for both groups. As such, the team created comprehensive binders including best practices materials on child health, development, and healthcare navigation tools. They then walked through these binders with parents at a mandatory PTA meeting. This experience gave the team the chance to share their individual expertise on various health topics and gave them the opportunity to learn about the importance of parent empowerment when it comes to children’s healthcare.

Transitioning Veteran’s Collaborative

The Transitioning Veterans Collaborative involved many levels of partnerships, including GW Student Veterans, the Office of Veterans Services, and ISCOPES students, many of whom are also veterans. After surveying current student veterans, the team ultimately decided to put together a welcome packet of resources particularly geared toward successfully transitioning from military service to student and civilian life. The final welcome packet included information about the following: maps (of Foggy Bottom and Mount Vernon Campus), Office of Veteran Affairs, GW Student Veteran Organization, student academic success, transportation in DC, off-campus housing, Tri-Care providers, dental health, mental health, military family resources, and social activities in DC. The team also helped coordinate two inaugural activities on navigating the VA Medical System and Effective Resume Writing at the new campus Veteran’s Center.

Whitman Walker Clinic

This team served through Whitman-Walker Clinic, a Federally-Qualified Health Center look-alike with locations in Wards 2 and 8. After learning about the importance of medical adherence and viral load among patients living with HIV, the team was asked to explore options for returning patients to care who were lost to follow up as a part of a larger, national campaign. The team created a list of 61 high priority patients based on a database of various clinical factors including low CD4 count, high viral load, co-morbidities, and time out of care greater than 6 months. Using a script the team developed, each team member called patients to encourage them to return to care. Each conversation was documented and return-tocare rates were then calculated. Of the 61 patients contacted by phone, 36% of individual cases were resolved and 21% of patients returned to care. The team reflected that while phone calls are very effective for some people, other communication means are necessary for disconnected numbers. Moreover, finding out more about why patients are lost to follow up will set the stage for future efforts.

2011 - 2012 Annual Overview

Our New Blog “I would say our greatest success was the discussion we had about “them” and “us”. Throughout the meeting these terms were used often, until one of the group members pointed out that ‘we’ are ‘them.’” – TVC, first blog post

Interprofessionalism

Teamwork

Comfort Zone

“We started to create a collective identity as a team.” -– Transitioning Veterans Collaborative (TVC) Team

Sustainability

Empowerment

“It’s great to feel that we may start these kids off to a healthy routine that could help them lead long and healthy lives.” --Community of Hope Marie Reed Team

Institutional Passive Indifference: A Call to Mobilize “We take many things for granted. As young, educated, privileged students of a private university we are sometimes sheltered from the harsh realities of the communities around us. Through work with Health Information Partners (HIPS), I became aware of the various health disparities in and around the Anacostia community of Washington, DC. One of the disparities we fight is the issue of varying levels of health literacy. The small group training session on November 15, 2011 presented by Professor Tamara S. Ritsema discussed the importance of being cognizant of health literacy in the work that we do through ISCOPES. It was astonishing to learn that the nation’s capital has a mean reading level of a 9 year old. There is a fundamental and institutional problem we need to address when 40% of DC residents have no more than a high school degree. In my opinion, it doesn’t necessarily have to do with the physical ability or capacity level of these individuals as much as it has to do with system/institutional issues. Health literacy dictates whether or not a person will access or seek medical care. Medical adherence and patient/physician communication are also dependent on the level of health literacy of the patient. The capacity to obtain, process, critique and apply basic health information and services is compromised when an individual has low literacy. Unfortunately, an array of social and behavioral 18

2011 - 2012 Annual Overview

“Our time with WWC this month has been focused on developing a way to identify patients who have fallen out of care, who is at most risk for poor health outcomes when out of care and a way to return those patients to care. Additionally our group has been looking into the future at developing a way to identify risk factors for poor retention and find a way to prevent fall out all together. Our large group will be dividing this undertaking into 2 subsets of our project. One will be using clinic data to analyze the patient’s lost to follow up and the characteristics surrounding that, as well as finding which patients are most in need of return to care. The second group will be developing a script to use in order to talk to these patient’s about returning to care and getting feedback from actual WWC clients regarding the efficacy and cultural competency of our methods. Our group is hoping to empower this community and use all the assets WWC has to offer to create something that is meaningful and sustainable.” – Whitman Walker Clinic Team (WWC), 2nd blog post

determinants impacts the ability to maximize a person’s health utility or capacity. Through street outreach and personalized weekly training courses, we are trying to fight this disparity on the grassroots level. Collectively, we try to educate community members on the health disparities associated with their cohort and help them advocate for better health care for not only themselves but for their communities. Furthermore, we want to ideally help individuals make lifestyle changes to improve their personal health so that the high prevalence of chronic, communicable, and mental illnesses can be addressed. As a coalition of young professionals bound together by a common interest, we need to galvanize and excrete morality back into the health arena. There is a need to create and organize a system where there is a fair distribution of access to health. Look around you; DC is a great place to grow academically but it is riddled with racial and socio-economic stigmas that have consequently marginalized many of the people that we work with. Through social justice initiatives and advocacy work, we can potentially alter discourse and promote education and responsibility to help combat some of the societal and political problems that pervade our local, state, and federal government currently. In order to make a systematic and vital contribution to health reform at least in the DC area, somehow we need to ground reform back to a moral issue. Perhaps we will move one step closer in the new year…” --Asha Cesar, Health Information Partners (HIPS) Team . 19

2011 - 2012 Annual Overview ISCOPES 2300 I Street, NW #316A Washington, DC. 20037 Website: www.gwumc.edu/iscopes Email: iscopes@gwu.edu