PH+HP: the future of health care

The merger of health professions and public health programs into one college has broadened future health workers’ perspectives on research, health problems and care.

By Laura Mize

Occupational therapy student Lindsey Dhans works with 3-year-old patient, Phillip./Photo by Jesse S. Jones

For the first time in months, the man was able to take a shower.

“You got to see him just glowing,” says Lindsey Dhans, a UF occupational therapy student, of a patient she spent weeks working with at Shands Select Hospital. “He was refreshed in every sense of the word, because he was able to do this basic thing that, as an adult, he should be able to do for himself. For a patient who’s been bed-bound for weeks in the hospital and has not been able to independently brush their hair, brush their teeth, take a bath, those become things that are really valuable and important to them.”

It’s something most of us take for granted. But for patients who have suffered strokes or other debilitating conditions, the ability to regain even just the smallest bit of normalcy is priceless. This is what occupational therapists spend their days doing — helping people regain the skills of life. Unfortunately, as Dhans has discovered, many patients don’t understand what exactly an occupational therapist does, a fact that can prevent people from getting the life-changing care they need.

“Most people, when they hear occupational therapists, assume that our role is to help people with their occupation,” says Dhans, a student in UF’s College of Public Health and Health Professions. “For occupational therapists, occupations are the activities of living, the job of living. That comes down to feeding, dressing, all of those basic sorts of things, as well as driving and getting a job.”

As an occupational therapy student, Dhans is learning how to work with individual patients. But educating the public as a whole to change people’s perceptions about occupational therapy isn’t her specialty. So Dhans teamed up with professionals and students from the department of epidemiology, a joint department within the College of Public Health and Health Professions and the College of Medicine. With funding from “Bridging Public Health and Health Professions,” a grant award program based in the college, Dhans and Corrine Ruktanonchai, M.P.H., a recent graduate of UF’s Master of Public Health program, are leading an effort to increase local awareness of and accessibility to occupational therapy services, and to assess the community’s need for such services.

“That’s something public health can come in and do, because their goal is to reach the public,” she said. “Being involved with them has really helped me to learn how to do that, and I think that having the public health students involved in the clinical world helps them see the issues that we see in the clinic.”

Because of the complexity of health care and the disease process, there are precious few problems in health that can be solved with one solution or one point of view. For example, in the 1990s, public health experts launched campaigns to encourage women to take folic acid supplements in early pregnancy, as the vitamin was shown to drastically reduce the incidence of neural tube defects in babies. But because nearly one-third of neural tube defects cannot be prevented with folic acid, the work of disability experts who interact with individual patients continues. It’s just one of many examples of how the fields of public health and the health professions often intersect. So why not bring them together under one roof?

In the early 2000s, UF’s College of Public Health and Health Professions became one of the first colleges in the nation to merge individual patient-focused disciplines with population-focused public health, a move that has sparked innovative collaborations and led to an expansion of the college’s programs during the past decade. Today, the college is one of just two accredited by the Council on Education for Public Health that has robust programs devoted to public health and the health professions.

“By combining the public health focus on populations and prevention with the individual treatment perspective of the health professions, we have created important synergies in education, research and service,” said Michael Perri, Ph.D., the college’s dean. “Our ultimate goal is to improve people’s lives by promoting healthy lifestyles and addressing critical issues, such as the health needs of a growing population of older adults and the prevention and control of outbreaks of infectious diseases.”

Expanding focus

Since its inception in 1958 as the College of Health Related Services, UF’s College of Public Health and Health Professions has continually paved the way for other health professions schools across the country. Offering academic programs in occupational therapy, physical therapy and medical technology, it was one of the first colleges in the nation to house programs on several different health disciplines under one roof as part of an academic health center. It grew quickly and has continued adding academic departments.

The decision to expand into public health came after faculty discussions highlighted the nation’s need for more prevention- and population-based health care. Initially, this led to an expansion of the college’s programs, and in 2003, the college began emphasizing collaboration between public health and the health professions in classrooms and through research projects. The next year it started seeking accreditation as a school of public health. That came in 2009.

Today, colleges that house multiple health disciplines are common, but the marriage of public health and the health professions into one college is still rare.  Many universities have separate programs or colleges dedicated to both fields of study, but only two of 49 accredited schools of public health in the U.S., Puerto Rico and Mexico, have a wide spectrum of programs in public health and the health professions. PHHP is one and the other is housed at the University at Buffalo, The State University of New York.

Thomas Elwood, Dr.P.H., executive director of the Association of Schools of Allied Health Professions, says many universities maintain a “silos” approach to the health sciences, keeping students and faculty from various areas of health care separated into individual colleges or schools. He notes that people from public health and health professions programs at other institutions may work together, even if they aren’t joined into one college. But UF students and faculty say uniting provides benefits.

One result has been cultivating a unique mix of collaborative research projects, such as Dhans’ and Ruktanonchai’s.

Their team includes two other occupational therapy students and two faculty sponsors. The group’s main avenue for involvement with the public is UF’s HealthStreet program. The program aims to assess the local community’s health needs and to connect people to social and medical services and UF research studies. HealthStreet’s flagship effort is a community health assessment administered by staff and volunteers.

Dhans’ team will review survey data to see how many participants have conditions that make them good candidates for occupational therapy services. They’ll hold four educational sessions for the public at HealthStreet’s new facility on Archer Road, plus an accessibility fair at the Porters Community Center. The fair will focus on helping people access rehabilitative health services, including occupational therapy. Dhans’ group also plans to start an equipment closet at HealthStreet so that members of the public can obtain much-needed adaptive equipment, such as shower chairs, canes and walkers.

Collaborative research

Ever since public health came on board, “collaboration” has been a buzzword around the college. PHHP leaders have worked hard to emphasize the importance of cooperation between the folks in public health programs and those in the health professions. They even formed a committee to support it.

Michael Moorhouse, Ph.D., a research assistant scientist in the department of behavioral science and community health, chairs the Collaboration Committee. The committee co-sponsors events, such as speaking engagements relevant to both groups, and also founded and administers the Bridging Public Health and Health Professions grant program, which funds Dhans’ project with HealthStreet.

“Our biggest mechanism is promoting collaboration through graduate students,” Moorhouse says.

The committee has also supported faculty projects that span multiple disciplines. Such partnerships are prolific in the college. Researchers in the public health department of biostatistics, which also is part of the College of Medicine, are particularly prone to collaborate.

“We exist partially to assist researchers in other areas of the health sciences with the design and analysis of their studies,” explains Babette Brumback, Ph.D., an associate professor in the department. “We also investigate statistical methods that are used by researchers in the health sciences.”

One of Brumback’s primary collaborations has been with Sherrilene Classen, Ph.D., M.P.H., an associate professor of occupational therapy. Classen evaluates the driving skills of and develops interventions for those who need special attention on the road — adolescents, “at-risk” senior drivers and people with neurological conditions.

Brumback helped Classen craft an evaluation for older drivers. They developed questions to assess driving ability, then used focus groups to test whether the questions did so reliably and validly.

Brumback says she learned much working with Classen.

“I learned a bit about developing a new assessment or measure and about evaluating the reliability and validity of a study,” she says, noting she also rethought aspects of a measurement model familiar to her. “There are a couple different ways of doing it.”

In the classroom

It takes years of training to oversee a detailed research or community outreach project such as the ones managed by Brumback, Classen, Dhans and Ruktanonchai. But even the college’s newest students can be a part of the collaboration between public health and the health professions.

Marisa Dunkel, a first-year student in the college’s master’s in speech-language pathology program, graduated from the college this past spring with a bachelor’s degree in communication disorders. She says a required class in public health concepts helped her get started in a health-focused college after switching from the UF College of Journalism and Communications.

“It gave a really good overview of what public health is — defining it, talking about the spread of diseases, talking about ethics in medicine, standards in practice,” she says. The class put “everybody on the same playing field in that college, because we all need to know the same standards and ethics.”

Some public health classes regularly feature guest lecturers representing a variety of health professions. A psychologist, a nutritionist, medical doctors and environmental health professionals speak in the college’s maternal and child health class.

“I rely on people who have expertise in areas that affect the health of mothers and children to bring their knowledge and skills to the classroom,” says Mary Peoples-Sheps, M.S., Dr.P.H., the college’s senior associate dean for public health who co-teaches the class. “It’s pretty typical (to collaborate) in schools of public health, but I think for us it’s even more effective because we have so many resources to draw on.”

 Changing the world

With all this effort going into collaboration, the question arises: does it make a difference for society? Dhans believes one of America’s toughest health problems shows that it can.

“The obesity epidemic leads to a lot of conditions that we end up seeing people for in the clinics: stroke, heart disease, heart attack, orthopedic issues that come along with being heavy, such as arthritis,” she says. “In partnership with public health, I think occupational therapists, physical therapists and speech-language pathologists are really in a great position to reach out to the community and not only take a rehabilitative role, but a preventive role.”

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