Bridge to Health Care: Alabama???s Health Professions Partnership Initiative

Filling the academic pipeline has long been the theme of the University of Alabama at Birmingham (UAB) Academic Health Center. Our Health Professions Partnership Initiative (HPPI) project, entitled Bridge to Health Care, has as its primary objective to increase the flow of minority students into the health professions by building upon the success of ongoing projects of local partners that are already promoting academic achievement and personal development in the Birmingham City Schools. The well documented underrepresentation of minorities in the nation’s health professions is magnified in Alabama, where minorities are approximately 26% of the state’s population. Despite the fact that minorities comprise 55% of Birmingham, they make up less than 15% of Birmingham’s physicians, nurses, dentists, physical therapists, optometrists, and public health workers. Over the years, efforts to increase minority enrollment in and graduation from UAB’s health professions schools have made considerable progress; the number of minorities in health professions schools is at an all-time high. Unfortunately, the number of applicants per professional school considered by the admissions committees to be noncompetitive and unlikely to graduate has grown even faster—hence, the obvious need for the HPPI. We concluded that further growth in minority graduates from UAB health professions schools is highly unlikely unless the resources of several organizations are brought to bear on the flow of students through earlier segments of the academic pipeline. We also learned and concluded that it is equally important to change the culture such that the faculty, staff, and administrators recognize that investing their time, effort, and funds in minority students is not only a humanitarian but also an educationally and economically sound investment. Building a Pipeline Partnership Planning for the HPPI-type partnership began over 15 years ago, under the leadership of Marlon L. Priest, MD, then associate dean for minority affairs in the University of Alabama School of Medicine (UASOM) and professor of emergency medicine. As associate dean in the UASOM and later as associate vice president for health affairs, Dr. Priest oversaw the academic health center’s minority enhancement programs. He developed and advocated for enrichment-type programs with an underlying premise that retention to graduation is the best recruitment tool. This early premise provided fertile ground for K–12 outreach programs. Dr. Priest hired Shirley S. Ginwright, a corporate sales executive, as UASOM coordinator of minority enhancement, 1989–1992, and later as director of Medical Center student development, 1992–1998. Mrs. Ginwright organized representatives of each UAB health professional school to present programs that would help provide students at an early age with the understanding of what it takes to become a health care professional. Prior to concentrating on K–12 education, the group developed and implemented programs focused on students of Historically Black Colleges and Universities. During its 1997 annual review of activities and opportunities, this close-knit group felt that further exploration of K–12 programs was now warranted. The timing of this decision coincided with extramural funding opportunities, such as the “Request for Proposal” of HPPI. Having applied for and being awarded the HPPI grant, the group formed the HPPI Task Force; developed an Executive Council, consisting of leaders of each partnership institution; and developed a Partnership Coordinating Committee, consisting of current UAB health professions representatives and other community partners to determine how the HPPI focus and objectives might integrate into the current efforts to increase the number of minority health care professionals. Collaboratively, analyzing existing educational and enrichment programs in the Birmingham City Schools, the Birmingham Urban League and UAB designed programs to better prepare students to enter into science-intensive careers. The HPPI Task Force determined that the commonalities between the established group, the proposed HPPI, and proposed partners’ interests uniquely positioned UAB to enter into a partnership with Birmingham City Schools, the Birmingham Urban League, and HPPI. Together, four entities, two foundations, and a professional association form Alabama’s HPPI partnership: the UASOM as the lead, the Birmingham City Schools, the Birmingham Urban League, and the UAB Undergraduate Student Services who partner with The Robert Wood Johnson Foundation, the W.K. Kellogg Foundation, and the Association of American Medical Colleges. Additional partners from UAB that help ensure this project’s success are the UAB Center for Community OutReach Development and UAB Academic Health Center schools of Dentistry, Health Related Professions, Nursing, Optometry, and Public Health. The Alabama HPPI is currently housed in the UAB Center for Community OutReach Development (CORD), an outreach center established by UAB’s president in 1998 to enhance relations between UAB and the community by focusing on public education. Methodically, the Alabama HPPI achieved its goals by taking action steps along four simultaneous tracts to foster student performance. Partners determined organizational interests and strengths and each agreed to assume primary responsibility (as indicated below) for one of the following action tracts: Tract 1—Academic. Birmingham City Schools elected to assume primary responsibility for Tract 1 – Academic. This component provided continued assistance to the Birmingham City Schools with revisions in the science and mathematics curricula. Tract 2—Exposure. The UAB and the Academic Health Center selected Tract 2—Exposure, which is designed to provide stimulating and recurrent exposure to a full spectrum of health career opportunities for fifth, seventh, and ninth grade mathematics and science club members, their parents, counselors, and teachers. Tract 3—Personal Development. The Birmingham Urban League selected Tract 3—Personal Development, to provide organized training in leadership, education enrichment, information technology, and job-placement and interpersonal skills. Tract 4—Counseling. UAB Student Affairs selected Tract 4—Counseling, to provide college preparation and prehealth majors with academic counseling. Partnership Activities Building upon the success of ongoing projects from each partner helped the HPPI to collaboratively achieve its program goals. The cornerstone of the Birmingham City Schools’ contribution from 2000–2005 was the Comprehensive Partnership for Mathematics and Science Achievement (CPMSA), a $10 million dollar grant from the National Science Foundation awarded to Birmingham City Schools in earlier years. Its primary goals were to double the number of minority graduates who are prepared to enter college as science, mathematics, engineering, and technology majors. A key element of CPMSA was each school’s organized mathematics and science club; approximately 20 students per club would meet twice monthly for one hour. The Alabama HPPI was designed and built around this cohort of Birmingham City Schools science club students. Collaborative Projects Annually, the group collaboratively presented programs with partners (see Table 1). The list below is a small indication of the types of programs presented. It is noteworthy that these programs continue to date.Table 1: Programs and Activities of the University of Alabama at Birmingham’s Health Professions Partnership Initiative, Bridge to Health CareBirmingham City Schools and UAB Academic Health Center/UAB student affairs. In conjunction with Carver High School for the Health Professions, Engineering & Technology, the Task Force developed a science course taught “for credit” at Carver. Offered in the winter term, the overall purpose of the course is to increase students’ knowledge of the health professions through the introduction of content relative to a selected health career choice. Led by K. Alberta McCaleb, DSN, the course was designed in line with the Alabama Science Course of Study. Therefore, each week UAB professors and/or health professionals cover a topic, such as biology, microbiology, anatomy, physiology, genetics, etc. The health professionals from UAB spend the entire week teaching the science class at Carver. Practitioners introduce the career topic and give examples of the work that professionals do in the field, assign literature to review and homework, discuss the knowledge and skills necessary for the selected health profession, provide a guest lecturer from the health-related field with experiments and examples of work from the profession, and administer a test at the end of the week. Exposure health course. In the fall term, representatives from each health professions school at UAB visit Carver to introduce their health profession. They discuss “what it takes” to become a health professional, the criteria for acceptance into the program, how to pay for health professions school, examples of opportunities in the field, and the pay options associated with the profession. CORD laboratories at the McWane Science Center. In addition to courses taught at schools during the academic year, weekend academies, and summer programs, CORD has two laboratories housed at the McWane Science Center in Birmingham where middle and high school students from Birmingham City Schools learn hands-on science with their instructors, depending on what topic is discussed in the school curriculum at the designated time. Summer science institute. In conjunction with CORD, and the academic health center, high school sophomores, juniors, and seniors are placed in laboratories throughout the campus for nine weeks actively studying actual research under a mentor. This program has three phases, BioTeach, ChemTeach, and the Summer Internships. From 2000 to 2005, 66% of students who participated in the Summer Science Institute have continued on to college, with 50% of these students choosing a science-related major and 57% attending UAB. Birmingham Urban League. The Birmingham Urban League brings to this project a cadre of 14–17-year-olds on its Youth Board of Developers. The League provides leadership training, caring mentors, access to educational enrichment, and training information technology to our ninth-grade participants and parents. HPPI students annually joined the Youth Board of Developers as scheduled sessions were presented. College career and job class. The Birmingham Urban Leagues’ Youth Board of Developers; UAB Undergraduate Admissions (College Prep); and the UAB schools of Dentistry, Health Related Professions, Medicine, Nursing, Optometry, and Public Health held several Saturday sessions on job readiness, presentation skills, and the health professions on the UAB campus and the Birmingham Urban League’s office. UAB professionals and practitioners along with community professionals engaged students on “what it takes” to become a health professional and college and career preparation. UAB student affairs. Throughout the term of this project, Ms. Cynthia F. Scott, director of retention programs, has worked with students as an advisor. She schedules numerous one-on-one sessions and groups in the summer and academic year depending on when programs are offered. She has counseled students on “College Preparation,” “How to Choose a Major,” “How to Choose a College,” and “Financial Aid,” among other topics. Lessons Learned As a world-renowned university, and as with most higher education institutions, we began with the premise that we had “most of” if not “all of” the answers to the problems and concerns of K–12 education. Our hands-on partnership with the Birmingham City Schools quickly brought us to realize that neither our institution nor higher education has all of the answers to the concerns and needs of K–12 education. We learned we should respect the knowledge of, learn from, and work together to utilize resources from both higher education and K–12 education to accomplish our goals. It must be mentioned that our initial approach was and will continue to be that we would “establish new and build on existing relationships” in order to accomplish our goals. This approach, coupled with the mutual respect of all entities, worked extremely well for our “Bridge to Health Care” project. We had an “initial edge.” From our perspective, building on “existing partnerships” eliminated working through the initial struggle of selling a major project to a public school system. In the first five years, we did quickly learn nine valuable lessons as we became engrossed in working with the public school system. 1. Bringing partners of diverse backgrounds together around a common theme is difficult. While many of the initial challenges of working with diverse organizations toward a common goal on such a long journey were anticipated, when we began the partnership we were somewhat surprised by the difficulty of overcoming each organization’s cultural bias toward the other partners. This required many conversations, followed by small steps together, and the blending or meshing the best of each organization together in a trusting environment. Many meetings and programs later, partners worked in great harmony to reach our objectives and to enhance each other’s programs. 2. Leadership will shift. Over the five-year period, personnel changed in UASOM and in the public school system; the associate dean for fiscal affairs, our fiscal officer responsible for accounts, our dean of the School of Medicine, and the original superintendent of schools along with the Board of Education changed and/or accepted other positions. As expected this naturally interfered with the program’s financial focus, leadership, and support, and affected the infrastructure supporting students near the beginning of the academic pipeline. It took time to educate new leadership. 3. Create a mechanism to keep focused and plan programs—not to concentrate solely on what we do best. Develop a balance between program activities and activities that change the culture. While successful universities and academic health centers are good at dissecting problems into digestible sizes that are fundable and achievable, we needed to identify bites that were tasty enough that the next bite would naturally be taken by our partners. For example, Weekend Academy was initially designed to engage both students and parents in preparation for the state-mandated test of academic performance beginning in the third grade. After seeing how successful participation was both for parents and students, the “next bites” for the school system were the expansion of the program to other schools followed by movement into earlier pipeline flow at the K–12 grades. 4. Simplify program(s). Each of our many proposed programs would have added to the success of HPPI. On the other hand, pursuing every program would have been all-consuming and detracted from creating a culture of improvement and empowerment for local schools and parents as we prepared students for careers in health care. Collectively, we had to select specific programs that would bind us to our communities while increasing credibility through measurable success. 5. Multiple academic calendars pose a planning, maintenance, and momentum challenge. One of the largest challenges during our first year was the incongruence of the academic calendars of the Birmingham City Schools, the UAB and the academic health center. This was further complicated by the calendar of the Birmingham Urban League. It was midyear before we had strategies in place to address these differences. By year’s end, we were using the alternating build up and slow down periods to our advantage. 6. Student participation changes. We found out that at some schools participants in the science and mathematics clubs changed per semester, while at other schools, students participated throughout the entire academic year. This required programmatic adjustments and provided a welcomed increase in the number of students we had an impact on. 7. Budget around important issues. The majority of the HPPI budget was proposed to be spent on programs. Increasingly, the university is tying time and effort to percentages of support. Our most valuable tool, while small, is salary support. We have determined that as budgets shrink we need to reallocate resources to provide some visible salary support to faculty, the key Birmingham School teachers, and the Urban League Coordinator. This will give the program visibility in each organization’s budget and annual report. 8. Simplify the decision-making process. Each organization has its own decision-making process and time frame. We have learned that these do not coincide without help. We had to simplify the process through the use of e-mail. The group adopted an operating policy that required time-sensitive responses only if there was disagreement or recommended changes. This policy helped build trust and allowed the members of the team responsible for the action to move forward without delay. 9. Partner challenges. Our partners experienced personnel and financial challenges throughout our project period. For instance, in Year Three, the Youth Board Director at the Birmingham Urban League took a counseling position at one of the local school systems. His position was filled within the last two years of the program. In the midst of leadership change at the Birmingham City Schools (also during Year Three) it was determined that the district had significant financial mismanagement concerns; faced possible state takeover; and experienced numerous forced retirements and dismissals of nontenured principals and teachers, school closings, and overall reorganization. Announcements of the closings and dismissals created a tremendous morale issue. It must be noted that in spite of the difficult challenges, we believed that our continuity with Bridge to Health Care and our infrastructure, working with the students, teachers, and principals would continue to build and excel. Thus, we continued to journey ahead in spite of the challenges. Institutionalizing the Project Fortunately, as with all programs implemented within the university, our approach has been to incorporate programs into the fabric of the university and to that of our partners. We have been fortunate also in that the leadership of the university has always been sensitive and supportive of the need for nurturing programs directed at underrepresented and disadvantaged students and families. And again, early in our process of building a pipeline of minority students into health careers we learned that “it is equally important to change the culture such that the faculty, staff and administrators recognize that investing their time, effort, and funds in minority students is not only a humanitarian but also an educationally and economically sound investment.”

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