By Meghan Golden, DSW, LCSW, Director of Community Health, Director of Survivor Recovery Center; Janice Frueh, PharmD, Clinical Associate Professor Southern Illinois University School of Pharmacy Edwardsville, Medical Coordinator for Survivor Recovery Center; Janet Albers, MD, Chair of Department of Family & Community Medicine; Hope Cherry, MA, BS, Program Director, Department of Family & Community Medicine; Sicely Kluge, MSW, LCSW, Therapist, Survivor Recovery Center

The need for change: Moving away from traditional healthcare models

Southern Illinois University School of Medicine (SIU SOM) trains medical students who are committed to rural health, outreach, and addressing health disparities in the communities we serve. The school has created innovative strategies and programs to improve access to care among our underserved, marginalized, and underrepresented populations by expanding access to high quality healthcare services, connecting individuals to community-based support services, and managing chronic conditions. However, in about 2010, it became apparent that there were high-risk vulnerable populations that were not being reached through traditional models of care. These patients with complex medical and social needs were using significant resources within the healthcare system, but not achieving improved health outcomes. These patients did not trust or engage with traditional healthcare.

Transitioning from a free clinic to Student Hotspotting

An early example of SIU School of Medicine’s innovation in engaging these high-risk patients was the development of a student-run free medical clinic located near one of the most impoverished neighborhoods in Springfield, Illinois. This clinic without walls was organized four times each year. Medical students worked alongside volunteer health professionals and community agencies to provide health screenings and assessment, enroll patients in health insurance programs, and connect patients to community support services to address their social needs.

Many patients experienced multiple chronic and complex conditions that required care beyond the scope of the episodic student-run clinic. In 2011, SIU’s Department of Family and Community Medicine became a federally qualified health center (FQHC). In collaboration with the student-run clinic, the new SIU Center for Family Medicine-FQHC was able to provide expanded, longitudinal services for all patients regardless of ability to pay. However, there was still a group of patients with complex needs who were not engaging with primary care and instead received episodic care in the emergency room or hospital when in crisis.

In 2014, an SIU medical student involved in the student-run clinic worked with several key interprofessional SIU faculty members to apply to be one of the inaugural 10 colleges and universities across the country to take part in the Interprofessional Student Hotspotting Learning Collaborative (Student Hotspotting) program — to prepare the next generation of providers to deliver integrated, person-centered care for patients with complex needs. Student Hotspotting started on a small scale at SIU through collaboration with the Camden Coalition and found a home in the Department of Family Medicine. Interdisciplinary students and faculty coaches from throughout the community formed Student Hotspotting teams, and SIU eventually became a Student Hotspotting hub in 2017. Since 2015, over 200 students have participated in SIU School of Medicine’s Student Hotspotting program. Student Hotspotting has helped patients receive better access to care and helped students learn how to interact with patients in places they feel safe: in their homes and in the community.

Student Hotspotting partnering with community health workers

Also in 2015, the first community health worker (CHW) program was launched in Springfield, IL, housed within SIU Center for Family Medicine – FQHC, based on the results of a community health needs assessment. Like the Student Hotspotting program, the CHW program quickly saw positive outcomes in addressing access to care and social determinants of health. This led to a unique and synergistic partnership between SIU School of Medicine’s Student Hotspotting program and the CHW program.

CHWs are typically individuals from the community who are employed and trained to provide outreach services to residents in the neighborhood. SIU’s CHWs have provided on the ground support and teaching as students worked to engage individuals referred to the Student Hotspotting program. Additionally, as each Student Hotspotting cohort nears the end of the program year, CHWs help students and their patients create individuated discharge plans.

Student Hotspotting as a catalyst for creative community outreach programs

The Student Hotspotting program at SIU School of Medicine has provided mentoring for students, has improved access to healthcare and social services in the community, has and engaged faculty and learner interprofessional teams in a new and innovative learning model focused on a renewed vision for person-centered care and patient engagement. In 2015, SIU Family Medicine was awarded a Health Resources & Services Administration grant for Population Health and Systems Thinking that further expanded Student Hotspotting to SIU’s southern campus. Building on the critical foundation set by Student Hotspotting, the grant also provided for system-wide trauma-informed care training, integration of community health workers as permanent team members within the FQHC sites, and expansion of interprofessional educational curriculum to address complex care needs and social determinants of health.

Student Hotspotting laid the foundation for the growth and development of other programs to build outreach to additional vulnerable populations including patients with mental illness, patients with multiple chronic and complex conditions, patients with diminished capacity to manage their own healthcare, patients in the criminal justice system, and K-12 students with high absenteeism rates. The CHW program has grown as well to support the needs of our courts, schools, mental health partners, hospitals, and most recently those quarantined at home during the COVID-19 pandemic who needed ongoing healthcare and monitoring through phone and telehealth services. The expansion of these services led to a newly formed Office of Community Care at SIU to develop and support community outreach services.

In early 2021, SIU SOM opened a Survivor Recovery Center (SRC) which uses the nationally renowned trauma recovery center care delivery model developed at University of California-San Francisco. The SRC interprofessional model provides free individual and group psychotherapy, psychiatric evaluation and treatment, pharmacological services, case management, and trauma informed yoga for victims of violent, life-threatening trauma. The SRC has built innovative learning pathways for a variety of interprofessional students as well, and will work closely with students in the Student Hotspotting program.

The need for leaders: Mentoring the next generation of change makers

As Student Hotspotting at SIU has grown, it has become clear that individual students have deepened their knowledge of social determinants of health, trauma informed care, and harm reduction. Several students have reported that being part of the Student Hotspotting and community outreach programs developed at SIU SOM has been key to their education and overall development. Many noted that Student Hotspotting experiences have helped them to excel during residency, postgraduate, and/or job interviews. Multiple coaches have identified Student Hotspotting as something that helps themselves as well as students stay engaged and avoid burnout.

While students remain the focus of SIU SOM’s Student Hotspotting program, it has also enhanced opportunities for young professionals to build their own leadership skills, learn to engage students from various backgrounds with different learning styles, and learn to work alongside individuals from different fields, including community-based service providers. Young faculty coaches have been able to build skills in writing, presenting, and coaching. This has helped SIU School of Medicine to recruit a wide pool of talented, compassionate, and creative faculty coaches and staff interested in serving their communities.

A Student Hotspotting alum voice

Sicely Kluge, a former social work student at the University of Illinois-Springfield, participated in the 2016-2017 Student Hotspotting cohort. She is currently employed as a trauma-focused psychotherapist at SIU School of Medicine’s new Survivor Recovery Center, and has agreed to share her experience in the Student Hotspotting program.

Following my internship with SIU’s Student Hotspotting program, I chose to further my career by obtaining my Masters of Social Work. Upon completion, my husband accepted a new assignment at Elmendorf Airforce Base in Anchorage, Alaska. While there I worked for a non-profit organization called Alaska Behavioral Health. I worked as a clinician providing psychotherapy and case management services within the Alaska Child Trauma Center. I focused on providing mental health services to children who had experienced complex traumas.

The exposure I gained from SIU’s Student Hotspotting program to patients living with complex health and social needs has undeniably impacted my career path. Through these patient experiences, I realized the impact of trauma on a patient’s life including long-term health outcomes, inequitable access to resources, and the difficulty of healing from traumatic experiences. I also learned the impact that various systems can have on patients and developed essential skills for working in an interprofessional team. SIU’s Student Hotspotting program challenged me to think innovatively and strategically about ways to provide services and support vulnerable patient populations. The SIU SH program also motivated me to choose a career path where I am able to provide high quality patient care but also support patients in navigating the difficult systems they come in contact with.

Looking back at my internship experience through SIU’s Student Hotspotting program, I now realize it was the catalyst for my professional career. Today, I work for SIU’s Survivor Recovery Center as a licensed clinical social worker and trauma therapist, and will be taking on the role of Student Hotspotting coach for future Student Hotspotting learners.