Our Profession Should Be Community-Minded—and Community-Invested
By Bill Healey, PT, EdD, Board-Certified Geriatric Clinical Specialist
A few years ago, my husband's father, who was a sociologist at the University of Wisconsin and an advocate for his ill father, shared something he found surprising about physical therapists (PTs). He watched as his father received care from a PT, and then watched as his father's episode of care ended—and that was it. He asked me, "Why don't PTs follow their patients once they stop caring for them?"
I didn't have an answer.
Newer health care models and payment systems may constrain the autonomous and inter-professional practitioner, but perhaps we as a profession are still trapped in the lens of short-term rehab after injury: wait until the patient comes to us. Treat. Discharge. We don't think in terms of population health, prevention, and long-term care. While PTs are excellent at interviewing patients and identifying their work and home environments, lifestyles, and activity limitations and participation restrictions, there are other questions that need to be addressed as well:
What do we do with information we gather from patients? How do we include that information in shared decision making about physical therapy care and life after physical therapy is finished? Do we consider community centers and the patient's neighborhood during discharge planning to sustain physical activity and independence? Does the patient have a support network and family members who will help them maintain that physical activity? Who will cover the costs involved in improving the patient's "health span"—years of staying healthy—and institute regular follow-up strategies to provide lifetime care over the long term?
This kind of commitment to all our patients and lifetime care will spread the word about physical therapy, who we are, and what we do. Despite the profession being around for almost 100 years, I don't think the public knows who we are and what we do until they need us and meet us in the hospital or clinic. PTs are not the preferred providers when it comes to movement dysfunction.
When conducting focus groups in medically under-served communities in Chicago about residents' knowledge and use of physical therapy, my colleague and I heard several things. Two statements in particular stuck with me: "Physical therapy is for the rich and famous," and, "Why don't you put a physical therapy clinic in our community?" Our research showed the community was unaware of physical therapy and its role in prevention, beyond catastrophic care.
These patients also had to travel great distances to see a provider. When we explored the presence of outpatient physical therapy providers in selected Chicago communities, we identified "PT deserts"—areas with few outpatient physical therapy providers in medically under-served communities.1 For example, there was only 1 outpatient PT in Chicago's largest neighborhood, Austin, a predominantly black and medically under-served community.
Austin builds on its own community resources to address health inequities. Thanks to the Westside Health Authority (WHA), a community-based organization (CBO) that has served Austin and Chicago's west side since 1988, residents are engaged in the pursuit of active lifestyles and invested in wellness and prevention. The Department of Physical Therapy and Human Movement Sciences at Northwestern University, where I teach, has partnered with the WHA for 10 years, and each year I bring groups of DPT students into Austin and collaborate with WHA leadership on projects that achieve its mission—and help students learn what's involved in taking our profession beyond the clinic and beyond the short-term. If you are considering establishing or expanding your practice to a medically under served community, here are some lessons we've learned along the way:
Build relationships by asking what residents need. It takes time to build community relationships. My colleagues and I have been going into various Chicagoland neighborhoods for over a decade. I've made contacts all over the city, and while those community contacts may change, I'm in for the long haul. Don't go in expecting a hallelujah chorus thanking you for coming in. When we went in with plans for a 3-times weekly exercise program for 12 weeks to improve fitness and function, community residents said, "We don't want that. We go to the park district and do exercises there. Instead, why don't you train champions in our community to be go-to leaders and resources for their neighbors?" These communities already have assets and want to know how you will improve their health. Now I go into communities thinking, "I'm a movement expert, what can I do for you to improve your movement performance and prevent or manage disability?"
Partner with existing community programs. Many communities already have institutions conducting community outreach programs, and physical therapy just needs a seat at the table. Identify 2 people in rehab—a PT and an occupational therapist—to represent rehab and offer to go into communities with physicians, nurses, and other health care providers. Once you've found a partner, you will have a better chance of getting started. Physical therapy doesn't need to be a standalone service—and shouldn't be. Find out what nursing, audiology, medical, and diabetes educators are doing and go with them. Offer to perform blood pressure, balance, and fitness screenings. Go to community health fairs. Support these efforts by giving interested colleagues time and resources. We should know more about the communities we serve, and that means leaving the hospital or clinic and actually spending time in the communities in which we work.
Transitions in community-based organizations, much like transitions in your own institutions, will include barriers to overcome. It will help to write down what you hope to do and establish a memorandum of understanding between you and the CBO that delineates tasks and outcomes. Spend time in the community. We were lucky in that each year we could take a group of students out into the community to do research and participate in community-driven health fairs. The community got to know us, and we got to know them. We've presented together with these organizations at community and national meetings.
Look for like-minded physical therapists and physical therapist assistants. Valuing the social determinants of health---the environment in which our patients are born, grow, live, and work---is the way of future health care and we don't want to be left behind. Go to local and national meetings and look for presentations on community health, including at APTA's NEXT Conference. Keep up-to-date on the research. It's sparse, but our colleagues in nursing have been doing this for decades.
Bill Healey is an assistant professor of physical therapy at Northwestern University and a partner with the Westside Health Authority