Bridging disciplines through service-learning.

Abstract

One of the goals of service-learning is to serve the needs of the community. Before this can be accomplished, roles of the various individuals involved in the partnership must be established. The purpose of this study was to investigate the differences in perceptions of oral and general health issues between dental hygiene and social work students in order bridge disciplines through multidisciplinary collaboration through service-learning. Curriculum development is necessary to ensure professional groups have an awareness of the skills and contributions each can provide.

Introduction

Multi-disciplinary collaboration is an increasingly important dimension of the helping process for professionals working within health and human service arenas. A critical component of this preparation process is to encourage the development of multi-disciplinary partnerships through service-learning approaches. One of the goals of service-learning is to serve the needs of the community. Before this can be accomplished, roles of the various individuals involved in the partnership must be established and understood through contact and collaborative activities. To date, a limited amount of research has been conducted to understand how service-learning activities bridge disciplines to collaborate, builds an understanding of other's professional perspectives, and prepares students for multidisciplinary collaboration.

Service-learning has been adopted by many campuses associated with higher education within the United States and Canada. The definition of service-learning carries different connotations depending upon the setting. For example, an early definition of service-learning has been defined by Boyer (1994) as "an approach to teaching, learning, and service that not only celebrates the scholarship of discovering knowledge, but also celebrates the scholarship of integrating knowledge, and applying knowledge through professional service" (p. A48). One of the earliest approaches to service learning was conceptualized by John Dewey (Boydston,1977), who conceptually moved away form the paradigm of service related to volunteerism and charity to the role of service as a responsibility of the individual toward democratic citizenship. Dewey sought to link the concepts of education/human learning with community service and democratic participation (Taylor, 2002). Eyler & Giles (1999) suggests that service-learning is a method by which students improve their academic learning and develop personal skills through structured service projects. In turn, these projects meet community needs, and build upon students' service activities by providing these students with opportunities to learn through reflecting upon their service experiences.

Service-learning is distinguished from volunteerism by the nature of its reciprocal relationship. Students not only provide service to the community, but also receive a benefit from their involvement, while volunteerism relies solely on the recipient as the primary beneficiary (Furco, 1996a). Service-learning is also distinguished from internships because internships are intended to provide the student with hands on experience that will enhance the students' skills and knowledge, and the student is clearly the beneficiary (Furco, 1996b).

The distinctions among Dewey's early teachings, volunteerism, internships and service-learning are important to discern because of the historical roots found within the helping professions. For example, many human service professionals such as nurses, teachers and social workers evolved from charitable works and voluntary efforts.

Volunteerism was initially the basis of activity for many human service professionals, while internships have been traditionally used in order to ensure that the skills and competencies of professional training were developed. Internships have also been used historically as a vehicle to contribute to the workforce.

Service-learning, however moves beyond these parameters and promotes both good citizenship, and breeds a partnership between two beneficiaries, the service recipient and the candidate providing service. The concept of service-learning becomes critical in the process of building multi-disciplinary partnerships because one cannot serve in a vacuum without being touched by the other disciplines. (If a component of service-learning is to meet the need of the community, one must consider that needs are interrelated.)

Increasingly academic institutions, accreditation bodies and professional organizations are recognizing the value of service-learning activities for both the students and communities. Given this increased emphasis, the authors speculate that over the next decade, an increased emphasis will be seen in the value of service-learning activities within course curricula for professional socialization and to foster multi-disciplinary collaboration.

While there is no single definition of service-learning, for the purpose of this study, service-learning has been defined as having three general characteristics: 1) It is based on the experience of meeting needs in the community; 2) It incorporates reflection and academic learning; and 3) It contributes to students' interest in and understanding of community life (Bringle & Hatcher, 2000).

Service-learning and academic curricula

At face value, one may question what the relationship between dental hygiene and social work education may be. However, in reality, many of the Healthy People 2010 (USDHHS, 2000) goals identified, particularly within disenfranchised and oppressed groups cannot be met without the development of partnerships and multidisciplinary collaboration. Social workers are also the gatekeepers within school settings for children to access oral health services such as sealants and dental screenings. Social workers are also the venue for reaching older adults, because they have captive audiences of seniors within case management/home care programs, senior meal sites and long term care facilities. This is further emphasized in the recent National Call to Action to Promote Oral Health (USDHHS, 2003) which prescribes the need for increased collaboration, through collaborations and partnerships that are community-based, cross-disciplinary and culturally sensitive. Consequently, the importance of multi-disciplinary collaboration cannot be underestimated.

In summary service-learning is an approach which promotes the integration of citizenship and reflective learning. It is an innovative avenue to help professionals learn about disciplines other than their own. The purpose of this study was to investigate the differences in perceptions of oral and general health issues between dental hygiene and social work students in order to develop multidisciplinary collaboration through service-learning activities. Both groups of students had been introduced to, and engaged in service learning activities as a component of their educational activities. This study sought to determine if these activities made a difference in how students perceived their ability to collaborate with other professionals within the helping arena.

Methods

Sampling frame, sample

The sampling frame for this study consisted of a convenience sample of students registered in either the social work or the dental hygiene program at a state supported Research Extensive University, located in the Midwest, within a non-metropolitan community of about 50,000 people. The campus hosts approximately 24,000 students. Students were solicited for feedback during the first two weeks of classes in January, 2004. Dental Hygiene (n=78) and Social Work (n=120) students were included in the sample, and were recruited to participate voluntarily in this study in accordance with the University's Human Subjects Review protocol.

Survey instrument

Although students were administered a survey instrument which consisted of true/false, yes/no and open-ended questions related to assessment, referrals and health relationships, only qualitative open-ended items were used for the purpose of this study, along with a descriptive analysis of the demographics in the sample.

Analysis strategies

Data for the quantitative portion of the survey instrument was analyzed using SPSS. Descriptive statistics were used for the demographic portion of the survey. The qualitative portions of the survey (definitions) were reviewed for main themes by three different coders. The items which were most consistent between the three reviewers were then used as themes within the qualitative portion of this study. This approach ensured inter-rater reliability.

Findings

Demographics

The sample was predominantly represented by females (92.1%, n=186), while males represented 7.9% (n=14) of the sample. One hundred percent of the males were represented by social work students, while no males were represented in the dental hygiene student sample. Social work students were represented by 55.3% (n=121) of the sample, while dental hygiene students represented 35.9% (n=79). The mean age of the sample was 24.5 years of age while the age of respondents ranged from 19-56 years of age. Social work students were on average older (mean = 36.4, range = 19=56) when compared to the dental hygiene students (mean =21.4; range =19-25 years of age).

The majority of the respondents of the sample were Caucasian (78.6%, n=158), followed by African American (14.9%, n=29), while other groups (6.4%, n=13) were represented. This breakdown was not consistent across the two disciplines however. Social work was represented with a broader range of minority students, while the sample of students from the dental hygiene program was homogeneously represented by Caucasian students.

The student status breakdown in the sample was represented by students at the undergraduate sophomore (15.7%, n=32) to Master in Social Work (M SW) levels (8.8%, n=18, Foundation year MSW; 5.6% graduating MSW). Nearly half of the sample (48.1%, n=96) were graduating seniors. Student grade point averages were primarily represented as "B" or better in the sample. Table 1 provides an overview of the demographics and a broader spectrum of the GPA breakdown. See issue website http://www.rapidintellect.com/AEQweb/spr2007.htm

Open ended questions for assessment

In the segment of open-ended questions related to patient assessment, several differences were noted. Although this analysis was qualitative, specific differences were noted in several areas. These include the following:

* Social workers are more inclined to look at needs, background information, and resources as compared to the dental hygiene or "other" disciplines.

* Dental hygienists are more specific to health and mental health when considering questions in the patient assessment process, while social workers tended to ask questions from a more holistic perspective. Social work students on the other hand, were more likely to be interested in feelings, health history and eating.

* Similarities in questions between the two groups existed between last doctor's appointment, previous hospitalization and medications.

* Dental hygienists will ask questions related to pain and self-care while social workers are more inclined to ask about last dental appointment and self-care.

Definition of specific professional titles

A segment of the questionnaire asked respondents to provide definitions of helping professionals such as social worker, case manager, dental hygienist, primary care provider, physician and dentist. A qualitative analysis of the responses for each category revealed differences between disciplines.

Social Worker

Content analysis revealed that dental hygiene students consistently did not have a strong command of the breadth of activities that social workers actually engage in. The dental hygiene students perceived the social worker's role as "solving client problems", while social work students perceive a social worker's role as "counselors, case managers, advocates, providing information and assistance for assessment".

Case Managers

A qualitative content analysis of the responses defining case manager revealed that dental hygiene students had a limited idea of what case managers' responsibilities and activities included, however, health care management was identified in the majority of cases where a definition was provided. Social work students on the other hand viewed the role of the case manager as involved in assessment, health care management, and service co-ordination.

Dental Hygienist

With respect to the definition of the dental hygienist, the qualitative analysis of responses revealed that the social work students viewed the dental hygienists as someone who "cleaned teeth" and helped in the dental office as a dental assistant. On the contrary, dental hygiene students viewed their role as "educators", health care providers or involved in the prevention of disease in addition to "cleaning teeth". Ironically, they did not include the range of activities identified by the American Dental Hygienists' Association (ADHA, 2005) which include administrator/manager, clinician, educator, advocate, and researcher roles interwoven within a public health framework.

Physician

Interestingly, social workers reported repeatedly that physicians were defined as a "medical doctors", while hygienists defined physicians as providing general health care.

Primary Care Provider

In terms of similarities in definitions, the primary care provider was one of the few areas where there were similarities in the definition between both the social work students and the dental hygienists. The qualitative analysis revealed that these professionals are seen equally as health insurance or health care providers by both groups.

Dentists

A qualitative analysis of the responses indicated that the dental hygienists perceived dentists to be "oral health care providers", while social workers were more inclined to perceive dentists as providing treatment and as a "doctor". Oral hygiene was cited almost equally by social workers and dental hygienists, as were diagnosis and treatment when describing the roles that a dentist actually performed.

Conclusion

Findings from this study suggest that there are some similarities and differences in the perceptions of how specific professionals practice their professions, and in the way each profession perceives their comfort level to be when service delivery issues are concerned. Differences in how cases are assessed were apparent between social workers and dental hygienists. There are also differences in how helping professionals are defined by each respective discipline. On one hand, there is a limited understanding of the breadth of functions that a social worker or dental hygienist can perform. In addition, there is a limited view of the range of activities health professionals and providers also undertake.

Discussion

Findings from this study reveal that there is a need for both disciplines (social work and dental hygiene) to understand each other's roles and relevance. Furthermore, it is also important for each profession to understand the vital role they play in the contribution to a patient/client's overall health. The results from this study also point to the critical need to address the roles of various health professionals within the undergraduate curriculum in social work education. The findings from this study also suggest some important implications for collaboration within social work education not only for students, but also for faculty members. The range of definitions provided by students points to the need for exposure of faculty and students to the range of roles that other disciplines actually assume, and how these roles interface with the case management process in social work.

In addition, the findings uncover some additional curricular issues which will see a growing need for development in the next decade, that is within the areas of aging, older adults and disability. The prospective growth in this area in the future will heighten the need to expose students to interventions and comfort levels when dealing with wheelchair bound and aging clients. Finally, the importance of interdisciplinary collaboration cannot be articulated strongly enough, for if other health professionals are unaware of the multiple roles undertaken by social workers or dental hygienists, they will not include social work as a discipline in the multidisciplinary process. Thus, the relative dearth in understanding of each other's professions makes the case for the importance of service learning activities implemented at various stages in the curriculum.

Implications for curriculum development

As dental hygienists and case managers work together, curriculum development is necessary to ensure that both professional groups have an awareness of the capabilities and contributions each can make to service-learning activities. The findings from this study suggest that there is not only need for social workers and dental hygienists to work together in service learning activities, but both professions could benefit from working collaboratively with other helping and health professionals such as physicians, primary care and case managers.

In order to foster service-learning activities, there must be a willingness on the part of educators and professional programs to integrate service learning activities into course content and assessment strategies. Since service-learning moves beyond experiential learning and serves as the bridge between theory and practice through the use of reflective thinking. Assessment procedures will also need to be revised from traditional forms of testing such as multiple choice and short answer exams. Assessment techniques within curriculum can be strengthened to support service-learning activities through the use of written work by the students (i.e., journals, essays, diaries, etc.) group discussions, individual conferences with students, evaluation by supervisors and self-assessment by students (Conrad & Hedin, 1987).

Thus, service-learning suggests implications for curriculum development and will challenge faculty and administration to devise approaches to student-learning and assessment. These approaches will facilitate personal and professional development, ethical and critical reasoning and build upon values and attitudes, in addition to the traditional mastery of clinical skills.

Trends and opportunities for the future

Opportunities for the future should incorporate strategies for multidisciplinary collaboration which integrates service-learning strategies. However, the findings from this study suggest there is a growing need to re-evaluate the settings within which service learning activities actually occur. In such efforts, social workers can expand their range of opportunities by exercising their multiple roles and interfacing with other professions in creative ways. These can include undertaking service-learning activities that include some of the skills social workers use that are not so obvious to other professions. These will include the roles of brokering, educator, negotiator, case manager, mediator, advocate and/or counselor.

Dental hygiene students can educate others and consequently become linked in new ways with other helping professionals by expanding their roles and exercising the breadth of roles identified by the American Dental Hygienists' Association (ADHA, 2005). These roles can include the role of clinician, educator, administrator/manager, researcher, change agent and patient advocate. Additionally, both groups can work in collaboration through service-learning activities with case managers within a range of settings to expand the opportunities to enhance multi-disciplinary collaboration. Some examples of these settings can include the following:

* Working in collaboration with case managers and older adults.

* Working in primary care settings.

* Work in school based settings.

* Working in public health settings.

* Working in school based health clinics.

* Working in adolescent health centers.

* Working in free clinics.

Multidisciplinary collaboration is the wave of the future. Service-learning can be an integral key to bridging the interface between professional disciplines and fostering multidisciplinary collaboration.

References

American Dental Hygienists' Association. (2005). Focus on advancing the profession. Chicago: Author.

Boyer, E. (1994).Creating the American college. The Chronicle of Higher Education. March 9. A48.

Boydston, J.A. (1977). John Dewey: The middle works, 1899-1924. Volume 4:1907 1909. Carbondale, IL: Southern Illinois University Press.

Bringle, R.G., & Hatcher, J.A. (2000). Institutionalization of service learning in higher education. Journal of Higher Education. 71:273-290.

Conrad, D., & Hedin, D. (1987). Youth service: A guidebook for developing and operating effective programs. Independent Sector.

Eyler, J. & Giles, D.E. (1999). Where's the learning in service-learning? San Francisco: JosseyBass Publishing Company.

Furco, A. (1996a). Service learning: A balanced approach to experiential education: Expanding boundaries, serving and learning. Washington, DC: Corporation for National Services, 2-6.

Furco, A. (1996b). Service learning and school to work: making the connections. Journal of Co-operative Education. XXXII(1), 7-14.

Taylor, J. (2002). Metaphors we serve by: Investigating the conceptual metaphors framing national, community and service learning. Michigan Journal of Service Learning, 7(1), 45-57.

United States Department of Health and Human Services. (2003) National Call to Action to Promote Oral Health. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Dental and Craniofacial Research. NIH Publication No. 03-5303, Spring 2003.

United States Department of Health and Human Services (2000). Healthy People 2010: Health Objectives for the Nation. MD: Government Office.

Charla J.Lautar, Southern Illinois University Carbondale, IL

Elaine T. Jurkowski, Southern Illinois University Carbondale, IL

Lautar, RDH, Ph.D. is an Associate Professor and Director, School of Allied Health and Jurkowski, MSW, Ph.D. is an Associate Professor and Graduate Program Director in the School of Social Work.