Part I: Meeting the Health and Social Welfare Mission of UAA:

1. What are the top 15 health and social welfare needs of the state of Alaska.

I truly don’t know how to answer this question because it could be approached in so many ways. You could approach the problem from the perspective of the need for solutions to diseases that either disproportionately impact Alaskans (i.e., higher incidence) or that have a disproportionate impact on Alaskans (i.e., greater morbidity/mortality in Alaska than elsewhere).

From that standpoint, solutions to the factors that contribute to the high incidence of Hepatitis A – which involve improving sanitation and water supplies across the state and training local people to operate those facilities – would seem to be a major health need.

Another approach would be to look at identifying solutions to health disparities – e.g., the mortality rates for uterine and breast cancer are substantially higher in Alaska Natives than among non-Natives. Similarly mortality from gunshot injuries is substantially higher in rural than in urban Alaska – and that difference is largely related to differences in the availability of emergency care services. (Interestingly, the intentions involve in gunshot injuries vary for rural and urban Alaska also with rural residents more likely to experience such injuries as part of a suicide attempt in contrast to urban residents, where intent to harm another is more common).

Another approach would be to look at population trends – that approach would suggest that, given our relatively high proportion of youth and our rapidly expanding population of elders, we should focus of strategies to improve health care to youth and elders.

Prevention of problems would also seem to be a logical viewpoint – which would give credence to development of programs in substance abuse and smoking prevention.

Of we could focus on the need for workers to staff a diverse array of health and social welfare programs – particularly critical because of the state’s reliance on workers prepared outside.

It is clearly apparent that social issues are at least as important as issues related to physical health. Indeed, the rates of domestic abuse and violence in Alaska are among the highest in the country.

It seems to me that, rather than try to identify specific health needs and social welfare needs in the state, we should focus our attention on developing approaches to preparing an adequate number and array of individuals to staff whatever programs are developed to address needs on which there is wide consensus.

I would propose that this dialog regarding the top 15 needs in the state be expanded to either include additional (non-university) knowledgeable players or that we take advantage of the work of the DHSS on healthy People 2010 (which is still in the process of being finalized with regard to indicator identification). It does not make sense to me to re-invent a wheel – especially since there may not be consensus on what we identify as the top needs.

At the same time, it is critical that we respond to the workforce needs in critical shortage areas. Finally, we should probably get a bit ahead of the curve and think about what is going to be needed to meet the needs of a population that will become increasingly aged.

If I were going to identify the top needs of the state I would suggest that they revolve around the need for a diverse and well-prepared health care worker workforce, the need for preventive efforts, the need to develop programs and services in anticipation of predictable future needs, and the need to correct health disparities within the State.

Currently, what is well agreed on are that 1) we do not have enough nurses to meet current – and certainly not future needs; and 2) behavioral health issues emerge in nearly every arena in the state and there are not a sufficient number and quality of behavioral health program workers.

2. What are the health and social welfare services offered by UAA?

1. training (can I suggest that you use the term education or at least refer to education and training?)

I do not really understand this question – unless you are asking about services in the form of educational programs. There are a host of education and training services that we offer:

Nursing education – at vocational (practical nurse), technical (AAS program), professional (BS program), and graduate levels.

Training for assistive health care personnel – e.g., nursing assistants.

Dental health care workers – hygienists, assistants

Behavioral health care workers – social workers at baccalaureate and graduate levels, human services workers at associate and baccalaureate levels, training for workers in disability services and in substance abuse treatment programs, counseling psychology program

Preparation of individuals to provide primary care services – e.g., first year of Medical School, collaboration in Family Practice residency program, graduate level Family Nurse Practitioner Program, and the baccalaureate level Physician’s Assistant program (just starting).

A host of allied health programs – Radiology, Medical Technology, Medical Assistant, Massage Therapist, etc., etc.

Occupational health and safety training, certification, and ?degree? program (in CTC).

                        Health care management/administration education – e.g., the Health Care Administration specialty in the nursing MS; the health administration focus within the MPA.

2. direct service

Formal provision of service – probably only the Student Health Center, the dental clinics, and the Counseling Center (managed by psychology department).

Direct service to the community as part of educational programs – there are a host of such services – you’d have to ask each department. As an example, nursing students provide in excess of 75,000 hours of free augmented health and nursing care services under the supervision of expert faculty in a diverse array of settings within the context of their clinical learning experiences - annually. In the process of completing community health projects focused on aggregate populations, they often leave behind learning materials or health support services that persist long after they graduate (e.g., literature on health resources for women with breast cancer; on-going hepatitis C support group).

3. research – development of knowledge

Again, you would need to do a survey. I could summarize the contributions of nursing faculty as individuals and of the workforce descriptive work done as part of Colleagues in Caring – but that would only scratch the surface.

4. networking – don’t we do this in everything we do?

3. Who are the other major players in the state’s health and social welfare system?

Department of Health and Social Services

Alaska State Hospital and Nursing Home Association

Private health care facilities – particularly Providence and Lutheran (Fairbanks Memorial Hospital) Health systems because they cross community boundaries

Native health organizations, including Alaska Native Tribal Health Consortium and Southcentral Foundation

State Medical Society and State Nurses Association – as well as other health professions organizations (e.g., physical therapists)

State Health Professions Licensing Boards

Consumers???

Also a player in a different way are the various accrediting bodies – accreditation standards for Nursing and Social Work – and I’ll bet Dental and other program – vary considerably.

4. How does UAA interact with them?

This will vary substantially among the various programs that work with them – may I suggest a survey?

As an example, the School of Nursing convened a group of direct service providers from across the state in initiating planning for a major revision of the baccalaureate curriculum revision. A similar group was convened last year to provide input into the design of the new practical nurse education program. And, of course, we rely on all of those groups to identify and access clinical learning opportunities for our students.

5. Who are the health and social welfare consumers?

This seems pretty self-evident to me – the state’s citizens. However, the state’s health employers are the consumers of most of our graduates (although not all graduates become employees of someone else – two UAA FNP graduates own and operate free-standing clinics that serve a primarily underserved clientele).

6. How does UAA interact with them?

Again, an unanswerable question – if you want a comprehensive answer. Each program interacts with consumers in different ways. The School of Nursing has a Community Consultant Board that meets twice a year and includes no health professions members. In addition to sharing their very substantial expertise (financial, marketing, involvement opportunities, political, etc.) with the School, they also share their own experiences with the health care system, identifying the things that are important to their health and comfort – and we use that input to inform our curriculum and our courses.

But there are numerous examples outside of the School of Nursing.

At the risk of being redundant – may I suggest a more formal survey?

7. For which needs is UAA the sole provider?

Well, we offer the only nursing education in the state

8. What needs are not being met by anyone?

I think it is more a matter of what needs are not being adequately met by everyone – and I’d have to answer that I think that behavioral health issues are the least effectively addressed by all of the players combined. And, at present, nursing education is not sufficient in quantity.

Part II: UAA – Health and Social Welfare Programs

1.            List all the UAA programs that have a “health” or “social welfare” component.

Please see answer to # 2a in Part I – and I know I missed some

2.            List all of the interdisciplinary (multiple programs, departments, colleges) working together on health and social welfare projects you know of.

I don’t know of an extensive list – certainly most of the interdisciplinary interaction is occurring in the CHESW at present. You would have to check with individuals regarding specific interdisciplinary efforts.

3.            List the interdisciplinary relationships/programs there should be.

It seems pretty obvious to me that there should be a much closer interaction between allied health programs and programs in CHESW.

I think that dual degree programs (e.g., MBA/MS-Nursing or MBA/MSW) also need to be made available.

4.            Suspend reality for a minute. What would the ideal UAA health and social welfare presence look like in terms of a) what its outputs would be and b) what its organization would look like.

Oh, Steve, I don’t know that I have the energy to visual this.

I think that the ideal program would look like it provides a wide variety of options for preparing health care workers and professionals in fields that fit the current and anticipated future needs within the State. Those providers would be prepared to deliver culturally sensitive preventive, protective, restorative, and rehabilitation services in communities across the State. They would also be prepared to work collaborative together. And the delivery of those programs would transcend the geographic boundaries that currently divide UAA, UAF, and UAS.

Additionally, those programs that have separate accreditation options should be accredited.

Logically that suggests that there should be some organization in which all of the health and social welfare programs interact together.

5.            What are the obstacles?

Space, Money, Personnel, Time, and History and Distrust!

Part III. Are there other questions that should be addressed? Probably – but it is almost midnight on a Friday night!! Good night.