The Leader Update - A SMART Collaborative Learning Experience

The adage "it takes a village to raise a child" has been taken to a whole new level through a pioneering course at The University of Texas School of Nursing at Houston.

Project SMART participants included an
interdisciplinary group of UT Health Science Center
at Houston students, shown with Marianne Marcus,
Ed.D., back row, third from left, and Pastor Thomas
Walker of St. Mary’s United Methodist Church, back
row, far right. The students, back row: Kingsley
Ilochonwu, far left; Carol Steans, second from left;
Lilian Duogo, fourth from right; Tong Liu, third from
right; Francis Benson, second from right; front from
left, Deidra Carroll and Katie Scala.

In this case, "the village" is a southeast Houston neighborhood and an inter-professional working community of UT Health Science Center students from the School of Nursing, the School of Public Health and Medical School at Houston.

The course is an extension of Project SMART (St. Mary's Academic Research Team), an ongoing service learning collaboration between the nursing school and the community of St. Mary's United Methodist Church, working with nearby Houston Independent School District (HISD) schools Foster Elementary and Cullen Middle School.

Begun over a year ago by Marianne T. Marcus, Ed.D., of the School of Nursing, and the Rev. Thomas Walker, pastor of St. Mary's, the goal of Project SMART is to improve the general health of the residents of this underserved community between the Sunnyside and Old Spanish Trail/South Union neighborhoods.

Marcus, the John P. McGovern Professor in Addiction Nursing, first met Walker when they collaborated on an addiction prevention program at Windsor Village United Methodist Church, where he served as a youth minister. Marcus is also director of the nursing school’s Center for Substance Abuse Prevention, Education and Research.

"This project focused on prevention," Marcus explained, "prevention of childhood obesity through fostering good nutrition and physical activity. It’s an important perspective for health science students whose clinical training is usually geared toward acute care and treatment.”

Project SMART is a part of the university's service learning initiative and is supported by a grant from the Association for Prevention Teaching and Research. The course was developed and taught by Marcus with colleagues Wendell Taylor, Ph.D., associate professor of Health Promotion and Behavioral Sciences in the SPH, and Mark Hormann, M.D., associate professor and director of Medical Student Education, Department of Pediatrics, Medical School

Nine students completed the course, which meets the objectives for both an undergraduate Community Health Clinical and a master's level Independent Study at the nursing school.Public Health students who took the course received credit for an independent study, and the one medical student participated as a volunteer.

For nursing student Carol Steans, a former community health educator in Miami, the course brought her to familiar territory working in socio-economically disadvantaged communities. But it also gave her the opportunity to combine her clinical nursing expertise with her public health training to implement successful public health models. "It allows us to share information and expertise and benefit from each other's approach, be it clinical or epidemiological, to health care," she said.

"Working with this team," agreed Katherine Skala, an SPH student in the class, "allowed me, as a public health practitioner, to see issues from a nursing and medical perspective and gain new insights on health issues in the community."

The students began by studying a myriad of statistical and demographic profiles, especially those relating to child health. According to Marcus, those findings, combined with the concerns and issues they heard from Walker, neighborhood residents and school personnel, convinced them to focus their efforts on the major health concerns of the children:

Another important benefit was the real world perspective the students gained by working in the community. "It is very easy to spend the entire four years of medical school in the classrooms, labs and hospitals, without actually going into the communities in which our patients live," said Hormann.

"Most of our time is spent in the hospital," said nursing student Lilian Duogo, "and that is where we have contact with our patients. This course opened my eyes and taught me there's much to learn from seeing these people in their community. After this experience, I am seriously considering doing some community nursing."

They also consulted and worked closely with Walker and the church's senior ministry, as well as the principal and school nurse at Foster Elementary, even participating in the weekly support groups Walker held for the fourth and fifth grade students.

"The UT Houston students really interacted with the children and spent time getting to know them," said Walker. "They also were able to make the members of our congregation—mostly senior adults and grandparents—appreciate how they could make a difference."

"These children have a lot of potential and big dreams," said Duogo, "but it was clear that without role models and someone to talk to, some would never overcome their situations."

Neighborhood Environmental Assessment

During a "microscale neighborhood environmental audit," each student in the class walked a particular set of blocks within a 4-6 mile radius of St. Mary's and Foster Elementary. "They used a standard audit survey to assess those characteristics of the environment that would either promote physical activity or those which interfered or were barriers to active living," he said.

Among the nine categories inventoried by the students were the presence and quality of sidewalks, the number of stop signs or "traffic calming" devices, amount of shade trees, the presence of pleasant amenities, such as parks, grocery stores, post office, etc. and, conversely, the amount of physical disorder, such as trash, stray animals.

"The students' audit uncovered a number of opportunities that could be taken advantage of for physical activity in the neighborhood," Taylor said, "including a jogging track and the facilities at the two schools. There were other situations, such as unsavory street activity and drug use, which the community could not tackle on its own."

A major part of the course was an "environmental assessment" of the neighborhood, led by Taylor. (Please see sidebar story)

Under Marcus’ direction, the students also conducted a nutritional survey, assessing the quality and quantity of neighborhood supermarkets, grocery stores and restaurants, along with federal and local nutritional guidelines for school breakfasts and lunches.

The capstone for the course was a community-wide meeting held at St. Mary's, during which each of the UT Houston students presented his or her findings, along with suggested interventions, improvements and actions to build upon what had already been accomplished.

The students also shared their responses to working with the community, highlighting the community’s strengths, especially the stakeholders' strong sense of commitment to improving the neighborhood for their children. "This community meeting was the culmination of all the work done by the students," said Marcus, "and it was a wonderful event."

Walker describes the students' presentation as an empowering experience for the residents. "This debriefing had a galvanizing impact on our parishioners and residents," he said. "Our community had shared their concerns and problems with these students and health experts and they'd been heard and validated. It's started a dialogue and turned a light on in the community, allowing neighbors to share their concerns and inspiring residents to take action."

In fact, a recommendation by Steans has generated a lot of enthusiasm in the neighborhood: to hold a neighborhood-wide athletic festival—the "Olympic Stars Olympics"—involving the elementary school children, their parents and even the senior citizens in training and competing together in various physical fitness events.

"What was interesting and encouraging was to find out the sense of mutual concern embedded in this community," said Skala. "The people are tightly knit and although they may be underserved, they are extremely vocal and determined to make sure that their community is well taken care of."

As Marcus and her students prepared for an invited poster presentation about their course at the national meeting of the Association for Prevention Teaching and Research in Austin this month, she also is actively pursuing funding to design and fund interventions, like the community Olympics.

"Such cross-disciplinary experiences benefit students by giving them a broader perspective and new insights into disease and prevention," said Taylor. Also, from a public health perspective, collaboration among disciplines is key to solving national healthcare problems."

"Medicine," Hormann added, "continues to become more about a care team and less about a single caregiver. Students need to learn how to work with members of other disciplines and understand what other medical disciplines can add to their research and clinical work."

Marcus plans to offer the course again next fall, believing the benefits and rewards for the student health professionals go far beyond credit earned toward a degree. Those benefits, said Skala, were most rewarding. By sharing their multi-disciplinary health knowledge, the students “were able to empower this community and encourage them to step up to initiate a health change for themselves and their children."

A ‘SMART’ Collaborative Learning Experience