Scattergood Foundation

Advancing Innovative Strategies for Change in Behavioral Health

Bridging the Gaps

Name of Innovative Program: 
Bridging the Gaps
Sponsoring Organization
Bridging the Gaps
Name of Innovative Program Lead: 
Bridging the Gaps
E-mail Address of Innovative Program Lead: 
tuton@mail.med.upenn.edu
Project Description: 
In “Treating the Cause, Not the Illness” (NY Times, July 28, 2011) David Bornstein wrote “…the health care system remains senselessly disconnected from the ‘social determinants of health’…if we really want to improve the health of millions of people, we have to address the conditions that make them sick.”  For 22 years, Bridging the Gaps (BTG) has combined health-related service in economically disadvantaged communities with the training of future health and social service professionals.  Through the Community Health Internship Program (BTG CHIP), selected health and social service professional students enhance existing services of partnering organizations that serve the most vulnerable among us.  The program’s combination of community-based service, training and inter-professional collaboration brings students face-to-face with destabilizing forces such as poverty, homelessness, addiction and violence and the ways in which these can impact and undermine health.  Our aim is to foster student reflection, advocacy and action.
Creativity and Innovation: 
Since BTG’s inception, medical treatments have grown increasingly sophisticated, but the underlying issues affecting the health of our communities have either remained stagnant or grown worse, such as poverty, violence, and homelessness.  BTG’s goal is to produce health professionals who understand how social, environmental and economic conditions foster, deepen and perpetuate physical disease (e.g. cardiovascular disease, mental illness, etc.).  These professionals must also have the capacity to work with others to address these conditions.  We try to teach each cohort of students that medical frontiers are but one path to better health, that their interactions with the community are opportunities for collaborative innovation and creativity, and that they themselves can be catalysts for positive change.  BTG strives to give future health professionals new perspectives on how they might advance well-being in cooperation with other professionals and the community.
Leadership: 
BTG focuses on developing health and social service leaders who can engage with and learn from those outside the academic environment, partnering with people on the front lines to provide needed services that are not included in a clinical model.  Over 22 years, BTG CHIP has contributed over 4,000 health and social service professionals who understand that prevention must fundamentally shift toward psychosocial, environmental and economic interventions with a team-based approach.  As summarized by a 2012 student: “The lessons learned at my community site...illustrated to me that caring for a person’s health extends beyond the confines of a hospital or health practitioner’s office.  The patient’s health is intricately tied to their environment, safety, and emotional wellbeing.  I also enjoyed working with students from different disciplines—through conversations and teamwork we were able to learn about the unique perspective each individual person brings to health care.” 
Sustainability: 
Key to the sustainability of the program is the wide array of investment in the program.  The material investment in BTG (both financial and in-kind) comes from private, public and institutional sources.  Community partners provide critically important mentorship for students.  Students give of their time and energy, often well beyond the value of the stipend they receive.  Representatives from multiple academic health centers and educational institutions collaborate with each other and with community organizations to assure that communities receive meaningful service while students gain insight and skills related to community health.  With all this support, BTG achieves its mission by successfully incorporating collaboration, partnership and mutual benefit into every aspect of the program.  BTG’s 22-year vibrancy has been sustained because it is designed to ensure that contributors – community members, students, community partners, academic institutions – are also beneficiaries of the program’s efforts. 
Replicability: 
The BTG model has been replicated in multiple locations.  BTG CHIP was established at one Philadelphia academic health center in 1991.  Within five years it was adopted by all Philadelphia academic health centers, which now make up the BTG Consortium (Drexel University, Philadelphia College of Osteopathic Medicine, Temple University, Thomas Jefferson University, and the University of Pennsylvania).  Other area schools (Bryn Mawr College, La Salle University, and University of the Sciences) formed affiliate programs.  Across Pennsylvania, Lake Erie College of Osteopathic Medicine and University of Pittsburgh also adopted the model, bringing about the Bridging the Gaps Network.  A program was then established in New Jersey (University of Medicine and Dentistry of New Jersey), followed by the establishment of a program in the Lehigh Valley (collaboration between the Lehigh Valley Health Network and DeSales University).  Each academic health institution partners with local community organizations to meet the program’s service and education mission.
Results/Outcomes: 
BTG annually collects quantitative and qualitative data to ensure that it is effective in fulfilling both its service and educational goals.  In 2012, community preceptors reported that students helped their organizations meet an existing demand for services (58.9%), expand existing programs (53.3 %) and/or implement a new program that might be continued (45.8%).  Student evaluation responses in 2012 indicated strong agreement that BTG provided an overall worthwhile experience that helped students to better understand vulnerable populations and also increased their interest in working with those who are disadvantaged.  As noted by a 2012 BTG CHIP student: “...Health is not only biologically but socially determined and while working in the shelter I truly understood that. ... There is no single cause to a public health problem so it will take ... medicine, law, public health, and social services to address it.” 
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