Faculty Development Program in Alcohol and Other Drug Abuse
Current Projects
Vanderbilt University has made a strong commitment to developing health professions faculty capable of providing education and training in the knowledge and skills needed to provide prevention, screening, assessment, early intervention, treatment, and relapse prevention services for alcohol, tobacco, and other drug use. Recent programmatic efforts have been directed at dissemination of critical knowledge and its clinical applications from the university to the community we serve. The Vanderbilt Integrated Curriculm in Alcohol and Drugs was the initial foundation for the establishment of what is now an interdisciplinary program encompassing medicine, nursing, and psychology. Through faculty development initiatives, Vanderbilt University provides a broad base of interdisciplinary training, clinical, and community enhancement programs. Dr. Mark Werner is Director of Faculty Development Programming for VARC.
Vanderbilt Vine Hill Community Faculty Development Program for Preventing Alcohol and other Drug Abuse
Faculty in schools that train health professionals frequently lack sufficient expertise to integrate material on alcohol, tobacco, and other drug (ATOD) use into their teaching. Many health professions schools have developed and implemented successful ATOD curricula; one such program is the Vanderbilt Integrated Curriculum on Alcohol and Drugs (VICAD). Vanderbilt University has a well established track record of successful curriculum and faculty development programs in ATOD use. Our most recent effort is the Vanderbilt Vine Hill Faculty Development Program for Preventing Alcohol and Other Drug Abuse. This program aims to address the difficulties involved in training an interdisciplinary cadre of faculty who are within the academic mainstream of their specialties to actively participate in the evolution of an ATOD curriculum.
Vanderbilt University Medical Center, in collaboration with Meharry Medical College and the Nashville community, is developing, implementing, and evaluating an interdisciplinary faculty development program in alcohol, tobacco, and other drug abuse prevention. Faculty from Vanderbilt's Departments of Pediatrics, Psychiatry, Internal Medicine, Psychology, Community Nursing, Mental Health Nursing, and Family Practice Nursing and the Department of Family and Preventive Medicine at Meharry Medical College participate. A major component of this program is based in the Vine Hill community enterprise/empowerment zone. The program strengthens a well established Vanderbilt faculty development program by disseminating ATOD training to a broader base of professionals within Vanderbilt, Meharry, and the community. Faculty and community health professionals' training is being extended and improved by fostering new collaborations among faculty and the community for clinical services, training, and research efforts. As a result of participation in this program, faculty fellows in medicine, nursing, and psychology develop expertise in 1) state-of-the-art prevention strategies, 2) current ATOD use research methodologies, findings, and clinical applications, 3) application of state-of-the-art clinical instruction materials and methodologies, and 4) application of ATOD prevention services to cost effectively augment the quality of patient care within a managed care environment.
A Faculty Working Group and Community Advisory Board composed of senior mentors and community leaders direct the efforts of the faculty fellows. Faculty fellows develop a program of patient care, teaching, and research pertinent to needs within their specialties. This program also serves as a resource for teaching ATOD prevention to other health professionals. The structured training program for fellows includes 1) weekly seminars, 2) design and implementation of community-based ATOD prevention projects that apply the principles of continuous quality improvement to health outcomes research, 3) facilitation of learner-centered individual and group learning plans, and 4) presentation of annual ATOD prevention symposia.
The Community Advisory Board represents state and local agencies and assists with strategies to develop joint university-community projects and to facilitate knowledge transfer between the university and community. Dissemination strategies include connecting the program to Prevline and other telecommunication networks. Because Vanderbilt and Meharry participate in numerous managed care organizations, this development program is well positioned to impact and evaluate changes in managed care guidelines for ATOD use. An evaluator provides formative and summative assessments of the training, curriculum development, community linkage and dissemination aspects of the program in addition to directing the application of continuous quality improvement methods to ATOD prevention. By locating components of the program in the Vine Hill Clinic a practical focus to the training program is ensured.
Specific Goals:
The specific aims of the Vanderbilt Vine Hill Community Faculty Development Program are:
- 1) to provide leadership within Vanderbilt's Schools of Medicine and Nursing and Meharry Medical College in order to advance training in the clinical knowledge, skills, and attitudes needed to effectively prevent ATOD use;
2) to expand the faculty development process by establishing an interdisciplinary team of academically based health professionals who will provide leadership in alcohol, tobacco, and other drug use training and research within their clinical specialties;
3) to create further linkages and working relationships among health professionals, their schools, and the communities they serve through collaborative clinical services and health education programs;
4) to develop strategies for systematically disseminating state-of-the-art information and clinical skills related to alcohol, tobacco, and other drug use to communities and to health care providers responsible for the prevention, identification, treatment, and referral of patients with ATOD use problems;
5) to conduct a health care systems analysis which focuses on improving the ability of health care providers to prevent, identify, and treat ATOD use problems, thereby improving patients' health and reducing health care expenditures in a managed care environment.
Using Continuous Quality Improvement Methodology to Prevent Substance Abuse in a Community-based Primary Care Setting
The emphasis on quality improvement in health care evolved from the revolutionary changes produced in business and industry when quality improvement methodology was introduced. Batalden defined a system as a group of interdependent people, items, processes, and products and services that have a common purpose or aim. Continual Improvement focuses on analyzing the system of service delivery, breaking it down into the component parts (processes) and then identifying the points at which interventions can make a substantial difference. Emphasis is placed on improving the processes and setting new levels for standard performance and then monitoring the processes for achievement of the outcomes, thus creating a mechanism for continual improvement. This process affords a natural opportunity for the Faculty Working Group to be a driving force behind better application of prevention knowledge in community settings.
The continuous improvement approach augments the health care provider's ability by combining knowledge for improvement (knowledge of a system, knowledge of variation, knowledge of the psychology of change, and a theory of knowledge) with discipline specific professional knowledge (knowledge of subject, discipline, and values). In order to understand the systems and processes associated with health care delivery, information must be derived from all of the people involved in patient care thereby necessitating an interdisciplinary team composed of both the direct care providers and those influenced by the clinical decisions. Measurement of outcomes in health care using continual improvement methodology focuses on the immediate clinical outcome and also on the patient's overall health status, associated costs, and satisfaction of those affected by the health care delivery system. In the proposed program, the outcome will be development of the faculty fellowship team's ability to improve the efficacy of a system of primary care delivery in recognizing and treating substance abuse.
An interdisciplinary group of faculty are conducting a systems analysis of the primary care delivery system of the Vine Hill Community Clinic using Batalden's "Organizing the Production of Health Care as a System Guide". The system analysis includes clearly defining the current process of primary care delivery for the Vine Hill clients, defining the customers of the primary care services, determining the community/social need for the services, analyzing the vision of the clinic, determining the gaps in the current system, and developing a plan to improve the system. The analysis focuses on improving the ability of health care providers for the Vine Hill community to recognize substance abuse behaviors in their clients and to improve the treatment and prevention of substance abuse for the clients. The systems analysis will allow the faculty to understand the process of delivering primary care to an at risk community and to determine how to improve the care by linking with other community agencies to prevent substance abuse in a specific population.
Currently there are numerous social service agencies serving family and youth from Vine Hill and surrounding communities. They currently have inadequate collaboration and integration of their services. In particular, the health care services provided through the Vine Hill Community Clinic and its affiliated Fall Hamilton School Health Center are inadequately integrated with these social services. As part of the CQI process, the faculty are developing a business plan which addresses cost effective methods for improving collaboration and integration of substance abuse prevention and treatment services across all health care and social service providers in the Vine Hill community. Much of the business plan will focus on improved cost effective prevention services as they can originate or be case managed from the Vine Hill Community Clinic and the Fall Hamilton School Health Center. Initial steps will include 1) an analysis of the strengths, weaknesses, opportunities, and threats related to substance abuse prevention services throughout Vine Hill, 2) financial analysis of current prevention services, 3) clarifying the value added by additional prevention services, 4) analysis of market forces including strengths of "buyers and suppliers" of prevention services, 5) an environmental analysis of factors that can affect programs, 6) reviewing potential scenarios for prevention services and the consequences of each scenario, and 7) making recommendations to the providers and agencies within Vine Hill as a result of these analyses.
For more information contact Dr. Mark Werner, Program Director.
Informatics Center, Vanderbilt University Medical Center
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