Public Health Placements for Student · Web viewAssessment of user experience of a Healthy...

Public Health Placements for Student DietitiansBackground:Dietetic students complete a number of placements during their training one of which is a three week public health placement. The purpose is to ensure that students have an understanding of the application of dietetics in the public health context. The remit of the project is broad and flexible, and may take place in a wide range of settings. For example, some students will work within a local authority public health team, whereas others may complete projects with voluntary organizations, health campaign/advocacy agencies, or charities. The key requirement is that the student is able to appreciate how the dietetic care process they learn in a clinical setting (assessment and analysis, planning and implementing the intervention, monitoring and evaluation – see Appendix 1 for further information) can be applied at a population level. A population in this context could be anything from all the people living in a specific London borough, to the inhabitants of a care home or the sixth formers in a particular school. In the time available it is not possible for a student to actively participate in each of these stages so it is likely they will be directly involved at only one (e.g. needs assessment, evaluation of an intervention), but their experience should enable them to understand where this work fits into the process overall. The work undertaken on placement should contribute to meeting one of

the two outcomes set out in the Public Health Outcomes Framework:Outcome 1: Increased healthy life expectancy: taking account of the health quality as well as the length of life. Outcome 2: Reduced differences in life expectancy and healthy life expectancy between communities: through greater improvements in more disadvantaged communities. In addition, the project should be relevant to one of the following four

domains described in the Public Health Outcomes Framework:Domain 1: Improving the wider determinants of healthObjective: Improvements against wider factors that affect health and well being, and health inequalities Domain 2: Health improvementObjective: People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Gillie Bonner v7 02:11:17

Domain 3: Health protectionObjective: The population’s health is protected from major incidents and other threats, while reducing health inequalitiesDomain 4: Healthcare public health and preventing premature mortalityObjective: Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities Finally, projects should be related to one or more of the indicators listed for

the above 4 domains (please refer to Appendix 2 for the full list).(Improving Outcomes and Supporting Transparency Part 2: Summary technical specifications of public health indicators, updated 2016)

What kinds of things do students actually do on placement?

Previous students have completed a wide range of tasks in a diverse range of settings. Some examples are given below, but this list is by no means definitive.

Evaluation of a pilot childhood obesity intervention Creating teaching materials on healthy nutrition for use by those working

with people living with HIV Survey of (healthy/less healthy) food and beverage provision in local-

authority run premises (e.g. leisure centres, libraries etc) Developing a survey tool to assess nutritional status and level of food

insecurity in homeless young people Assessment of user experience of a Healthy Start Maternal Vitamin

scheme, and development of recommendations to increase uptake of the scheme

Scoping local food retailers prior to implementation of a proposed healthy catering scheme

Quality assurance of lay health educators’ practice Mapping community gardens and food growing projects in a London

borough Audit of food provision for NHS staff against government standards for

NHS staff healthSimilarly, placement ‘products’ are also diverse; the ‘product’ should simply be whatever is appropriate to the needs of the project in the format most usable by you and your organisation. Some placement providers have asked students to produce a brief PowerPoint presentation to illustrate their findings as this is what they will find most useful to share with funders/commissioners. In other cases (e.g. where students have worked on developing a resource) the draft resource materials are the natural project products, and where a student has completed a survey or carried out an audit an executive summary of their work with a more detailed results paper might be appropriate. Overall, it is important to consider what is realistic within the short time-frame and what is most useful for your project/organisation.


Please note: dietetic students are usually diligent and very keen to please, and unless you give them clear and realistic guidelines about what is expected they sometimes spend many additional hours producing great tomes – so please support them in acquiring the skill of time management and setting realistic goals!In terms of day-to-day activities during the three weeks this will depend entirely on the nature of the project. However, there are some elements that should be common to all settings:

Induction – all students will need an initial meeting with their project supervisor and to be introduced to other key people. Early on somebody will need to orientate them to the work of the organisation, how work is commissioned and delivered, the organisation’s goals and strategy etc. You will also need to help your student understand where your organisation (and their specific project) sits in relation to the national and local public health agenda. You will need to brief them about the project you are asking them to complete and agree a work plan and arrangements for supervision. Students will also need a potted version of all the information you would give to a new employee – ‘loos and lockers’, health & safety/fire, local polices & procedures etc (please see Appendix 3 for a suggested list).

Orientation/background reading – you will need to direct the student to some key resources to help them make sense of the project. This might include more information about your organisation, the community or population you work with, relevant needs assessments and public health reports and further details about the larger programme of work within which their project is set, plus any other information you consider relevant. Students will be familiar with searching for evidence in a clinical context but may be much less confident about searching for ‘grey’ literature so are likely to need clear signposting for these types of resources.

Supervision – undergraduate students do their public health placements at the beginning of their fourth year of study, and postgraduate students at the beginning of the second year of their course (having previously completed a degree in nutrition or a related subject). In both cases this means that they are only a few months from being qualified as dietitians, so should be able to show initiative and be able to work fairly independently once they are clear what is expected of them. Nevertheless, all students require supervision meetings to establish goals for the project and to develop a work programme, as well as deal with any difficulties that arise. Frequency of supervision will vary depending on the nature of the project but as a guide we would suggest weekly meetings (in addition to the initial orientation meeting and a final review meeting). Please also make sure the student knows how to contact whoever is supervising them by phone or email in between meetings. Please note that supervisors do not necessarily need to be registered dietitians or nutritionists.


Where possible, it is beneficial for students to take the opportunity to see the wider context of public health work so if you are able to facilitate any additional activities this would be greatly valued by the students. Again, this will depend on your setting, but examples might include:

Observation of training sessions such as facilitator training for lay health educators

Attending a cook and eat club or healthy weight session Observing at a meeting discussing commissioning/funding a public health

intervention or service Doing a self-guided ‘tour’ of the local area – with some basic directions

and some questions to answer/tasks to do around food prices, food access, transport, green space, food outlet types etc. This type of activity can be very successfully used to orient a students to the health needs of a local population

Project plans:

Prior to the placement, a project plan should be agreed with the university. Placement tutors are happy to support placement providers in developing project plans, and can also supply examples of previous project plans as a reference. The project plan does not need to be lengthy; it just needs to clarify the overall aim, the project objectives and the main tasks the students will be required to do to achieve these, plus the anticipated products. – Please note: a placement can’t go ahead without a plan, so if you are struggling to put one together please let us know so we can support you with it. A template is provided in Appendix 4, and a sample plan is shown in Appendix 5.

Practical arrangements:

Placement dates: Placements are needed for both London Metropolitan University and King’s College students for 3 weeks in September (14:09:15- 2:10:15), and smaller number of placements are also needed for King’s College students in January each year.

Pre-placement process: once we have agreed with a placement provider that they are willing to host a placement we will ask you to develop a project plan. Approximately 4 weeks prior to the start of the placement we will send you some background information about the student(s) who will be working with you, along with their contact details. You will then be expected to contact the student directly to agree a start time and location for their first day. We also recommend that you send them some suggested reading to help orient them to your organization and the nature of the project they will be working on.

Office space/IT access/working hours: students are expected to work full-time for the three week period, but this need not necessarily be all on-site with you, and need not necessarily be standard office hours (although this should be agreed in advance with the student if they have responsibilities such as child-care). If you can offer desk-space on–site


this may help the student to feel more involved and will also mean it is easier for them to access relevant people and resources, but we are aware office-space is often limited so in some cases students may be able to spend part of their time working at home or in college where this is not detrimental to the progress of the project. However, you should ensure they have access to all the resources they will need, so it is very helpful to plan ahead for ID badges or IT access for example. The students should be capable of working independently and showing initiative so you do not need to feel they must be timetabled or supervised all-day everyday as long as they are clear about their overall work programme and tasks.

Visits/contact with college: we do not routinely contact/visit students on public health placements but if there are any concerns please let us know immediately, we can support by phone, email or visits as necessary where concerns have been raised.

London Metropolitan –

Placements team: [email protected] phone: 020 7133 4193King’s –

Gillie Bonner (placement tutor) [email protected] phone: 020 7848 4512

Renata Adamcova (professional programmes officer for dietetic placements) [email protected] phone: 020 7848 4271

Sickness: if a student has a brief absence due to sickness and you and the student are in agreement that the project is still viable in the available time no action needs to be taken. However, if the student has a longer period of absence then please notify the university as soon as possible so alternative plans can be discussed.

Multiple students: where more than one student is placed with the same host organisation it is often most practical for them to work together on a larger piece of work. However, it is important that the work should be divided up such that each student has individual objectives to work towards. This makes it simpler to assess whether a student has completed the project satisfactorily and also reduces the chances of an imbalance of workload (should a more industrious student happen to be placed with one who is less well motivated).

DBS checks/occupational health: All students undergo DBS checks at the start of their course, and also have to have clearance from the University occupational health service in order to be able to go on placement. If their DBS and occupational health clearances are more than a year old at the start of placement they are also required to make a declaration stating there has been no change to their status.

Insurance/indemnity: you will need to confirm that your insurer is aware that you will be taking student(s) to make sure that your public and employer’s liability insurance is valid for them.


mailto:[email protected]



Payment: Non-NHS placement providers are entitled to claim an allowance of £69.78 per student per week (please contact us if you are an NHS placement provider but think your organization may not be claiming payment through the system used for clinical placements). The relevant University will inform you of how and when to claim payments. Please note that the Universities are paid by the NHS in arrears for all the placements taking place in an academic year, so there may be a considerable delay before we are able to pay your invoice. We apologise for this but we are constrained by the wider system!

Assessment:Students are required to complete two types of assessment for their portfolio (the portfolio is used to assess both the public health and clinical placements) – however, you are only responsible for one of these. You are required to sign-off to confirm that the student has demonstrated professionalism, good communication, and reflective practice. This will include confirmation that they have completed the task(s)/project assigned to them (taking into account any constraints or setbacks encountered). The form is primarily completed by the student but should be informed by discussion between the placement supervisor and student. There is space for your comments too, with notes to indicate areas to consider when giving your comments, (see Appendix 6). If at any stage during the placement you feel a student’s behavior is not consistent with them being signed off as having been professional and demonstrated reflective practice please broach this with them at the earliest opportunity so that they have the chance to remedy the situation, and if the student is not able to respond positively to this feedback then contact the university as soon as possible. Ultimately, if you feel you will be unable to sign a student off as having completed their task(s) and shown evidence of professionalism, good communication and reflective practice you will need to inform the university – we will then take up the matter and arrange a remedial plan. As in the vast majority of cases the students move directly from their public health placement to their clinical placement weeks there is no option for ‘add-on’ time to be given to enable a student to meet their learning outcomes. However, we will of course seek your recommendations on any remedial plan that is to be put in place.The second part of the assessment takes place once the student has moved from their public health placement into their clinical placement and is the responsibility of the clinical placement team. Students will be required to demonstrate to their clinical supervisory team that they understand how the Process for Nutrition and Dietetic Practice (Appendix 1) can be applied to populations and that are able to reflect on the skills they have developed and implications of what they have learned for their future practice.Please note that London Metropolitan students are also required to complete a piece of academic coursework which links their placement to the public health Gillie Bonner v7 02:11:17

module they have studied at university. This is a separate piece of work and you are not required to input to it directly or to assess it. However, students may well have it in mind as they are doing their placements and if they are sensible they may take the opportunity to ask questions or access relevant information – but they should not allownot allow this to impact their work on your project.

Appendix 1 – Nutrition and dietetic care process


1.Assessment

Assessment is the first step in the nutrition and dietetic process. Its purpose is to obtain adequate and relevant information in order to identify nutrition-related problems and to inform the development and monitoring of the intervention. It is initiated by identification of need, such as public health data, epidemiological data or similar.

Information sources for assessment at the population level:

Nutrition surveys Local health surveys Epidemiological studies Field activities including Community-based surveys and focus groups Joint Strategic Needs Assessment

Factors that may need to be considered as part of assessment:

• Population/group knowledge, willingness to change and potential for changing behaviour.

• Opportunities to effect change. • Population / group perceptions of health issues. • Identifying and assessing health conditions and wider determinant

factors and associated risk to long term health. • Nutritional and food intake. • Physiological measurements, anthropometrics, disease incidence and

prevalence.

2.Identification of nutrition and dietetic diagnosis

Within a public health needs assessment framework the nutrition diagnosis involves determining a nutritional health priority for action; choosing nutritional health conditions and determinant factors with the most significant size, impact and severity. It includes the identification and categorisation of an actual occurrence, risk of, or potential for developing a nutritional problem that a dietitian is responsible for contributing to the strategy to manage/prevent.

Data sources/tools:

• Service user or population perspective and priorities • Assessment information (from step 1)• Joint Strategic Needs Assessment • Practice based Evidence in Nutrition (PEN) • Evidence based guidelines or professional consensus such as

professional guidelines or BDA professional guidance documents • NICE/SIGN or other national guidance or strategy • Current research literature, meta analysis such as Cochrane reviews

and Campbell Collaboration • National and local health and social policy


• Results of audits • Behaviour change and educational theories applied at individual and

population level. • Interpersonal skills • Campaign and health improvement theories • Reflection and professional experience

3.Plan nutrition and dietetic intervention

The intervention is a set of actions and activities designed with the intent of changing nutrition related behaviours, risk factors, environmental factors or aspect(s) of physical or psychological health or nutritional status of the group or population. All interventions are planned in conjunction with the group or population that will be the recipient of the intervention.

A) Define outcomes – which may include:

• Anthropometric change (weight, MUAC, waist:hip ratio) • Biochemical indicators (laboratory values, indicators of nutritional

status) • Clinical / Symptoms (clinical status, complications, symptom scales) • Environmental/behavioural/Social (Client-focussed outcomes: quality

of life, client identified outcomes, satisfaction, self-efficacy, self-management, functional ability)

• Behavioural (food related behaviour, physical activity) • Psychological (self – efficacy, self management, mental health state) • Health care utilisation and cost outcomes (medication changes,

special procedures, planned/unplanned clinic visits, preventable hospitalisations, length of hospitalisation, prevent or delay nursing home admission)

• Diet and nutrition goals (food or nutrient intake changes) • Environment/behavioural/social (self management, physical activity,

functional)

B) Determine the intervention plan required to meet the outcomes:

• Select interventions based on the best available evidence. • Define length, frequency and duration of the intervention. • Identify who will carry out which part(s) of the intervention. • Identify any resources needed. • Optimise intervention within resource allocation. • Apply risk management strategies as necessary.

4.Implement nutrition and dietetic intervention

Factors to consider:

Project management/timeline


Developing opportunities for involvement. Community capacity building Collaboration with other professionals, community, voluntary and

statutory agencies Apply and tailor evidence based approaches to population health Mentoring, education and supervision of other team members Provision of evidence based nutrition resources

5. Monitoring and review

This process should determine if the intervention is being implemented as planned, as well as monitoring outcomes. The data to be collected should be directly related to the proposed outcomes and the form of the intervention and should provide evidence to show that the intervention is or is not changing group or population knowledge, behaviour, nutrition or health status. Where possible use standardized methods to increase the validity and reliability of measurements of change and facilitate consistent recording, coding, and outcomes measurement.

6. Evaluation

Evaluate process • Evaluate intervention against the original aims and objectives of the

project; identifying what went well and not so well, plus barriers and facilitators

• Identify further action to be taken.

Evaluate outcomes • Compare current findings with previous status, intervention goals, and/or

reference standards. • Evaluate overall effectiveness of intervention

Decide on further action • Identify health needs for further action • Identify and communicate research gaps • Identify and communicate learning for practice


Appendix 2 - Public Health Outcomes Framework Indicators


https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/520457/At_a_glance.pdf

Appendix 3 - Sample induction checklist

Induction item Covered Not relevant

Additional notes

Introduction to team

Lead supervisor (provide contact details)

Layout of office/site tour (including fire exits, loos, kitchen/coffee room etc)Hours of work

Procedures for unexpected absence (e.g. sickness)Dress code

Health and safety information relevant to the placementFire instruction and proceduresID badges

Security (personal; personal effects and building)Access to IT systems

Placement program/timetable

Project plan – background, aims, objectives, tasks

Supervision plans




Appendix 4 - Public Health Project Plan Template

Host organization:

Name and contact details of placement supervisor:

Dates of placement:

The project meets the following outcome from the public health outcomes framework (please delete as appropriate):

Outcome 1: Increased healthy life expectancy: taking account of the health quality as well as the length of life. Outcome 2: Reduced differences in life expectancy and healthy life expectancy between communities: through greater improvements in more disadvantaged communities.

The project is relevant to the following domain(s) (please delete as appropriate):

Domain 1: Improving the wider determinants of healthObjective: Improvements against wider factors that affect health and well being, and health inequalities Domain 2: Health improvementObjective: People are helped to live healthy lifestyles, make healthy choices and reduce health inequalitiesDomain 3: Health protectionObjective: The population’s health is protected from major incidents and other threats, while reducing health inequalitiesDomain 4: Healthcare public health and preventing premature mortalityObjective: Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

The project relates to the following health indicator(s) (please select from list in Appendix 2):


Background:

(Insert brief note about the host organization, wider project or programme that the placement project sits within.)

Project Aim:

(Insert overall aim of project)

Project Objectives:

(Insert project objectives)

Target Population/Group:

(Insert target group)

Project tasks

(Outline proposed method by which the objectives will be achieved i.e. what tasks and actvities the student(s) will need to carry out)

Project products

(Describe the expected outputs of the project e.g. draft resource, or summary of evaluation results and recommendations, or results of a needs assessment)


Appendix 5 - Sample Project Plan

Host organization: Localsville Council public health team

Name and contact details of placement supervisor:

PJ Nobody ([email protected])

Dates of placement: 14:09:15 - 02:10:15

The project meets the following outcome from the public health outcomes framework (please delete as appropriate):

Outcome 1: Increased healthy life expectancy: taking account of the health quality as well as the length of life. Outcome 2: Reduced differences in life expectancy and healthy life expectancy between communities: through greater improvements in more disadvantaged communities.

The project is relevant to the following domain(s) (please delete as appropriate):

Domain 1: Improving the wider determinants of healthObjective: Improvements against wider factors that affect health and well being, and health inequalities Domain 2: Health improvementObjective: People are helped to live healthy lifestyles, make healthy choices and reduce health inequalitiesDomain 3: Health protectionObjective: The population’s health is protected from major incidents and other threats, while reducing health inequalitiesDomain 4: Healthcare public health and preventing premature mortalityObjective: Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities


The project relates to the following health indicator (please select from list in Appendix 2):

Diet Excess weight in adults

Background:

Our vision for public health services in Localsville over the next four years is to:Create a local public health service that is valued by local people, and works with the community and our partners to make a real impact on the health and wellbeing of residents.The Public Health Commissioning Strategy 2014-19 explains how we will do this.For further information about health needs in Localsville, please see Localsville's Joint Strategic Needs Assessment and the Public Health Outcomes Framework.One of our key focus areas is diet and healthy weight. We have a broad programme of activities relating to this target area. W are considering developing a traffic light labelling scheme for public sector food provision outlets and this project seeks to do some of the preliminary work to establish feasibility of such a scheme.

Project Aim:

The aim is to design and plan a field trial intervention to influence food purchasing choices towards healthier options within a workplace canteen using traffic light labelling.

This will involve broadly replicating methodology used in existing trials (See Boston example) to see if this is an effective intervention which can be used within Localsville.

Depending on the results of this trial, this approach could be rolled out to include schools, workplaces and hospitals in the future.

Project Objectives:

Establish criteria and practical approach for categorising food items into red, amber and green options.

Work with canteen provider to analyse food items, categorise them and establish a practical way to implement labelling.

Plan a trial to test whether the intervention impacts on purchasing. (Note: Implementation of the trial may start during the placement, but may not be possible to complete within the placement time).


http://www.sciencedirect.com/science/article/pii/S0749379713005527

http://www.phoutcomes.info/

http://www.phoutcomes.info/

http://www.hounslow.gov.uk/index/health_and_social_care/health_policies.htm

http://www.hounslow.gov.uk/public_health_strategy_2014.pdf

Target Population/Group:

Staff who use the on-site canteen at the London Borough of Localsville.

Project tasks

Literature review of relevant theory and evidence behind traffic light labelling interventions.

Synthesis of research, existing approaches and guidelines into a practical approach.

Design and plan field trial. Data analysis of purchase data (time permitting).

Project products

Categorisation framework document Examples of labelling and communication to be used Field trial protocol Results/findings (time permitting)


Appendix 6 - Public Health Project Sign-off Sheet

Professionalism, reflective practice and communication during the public health placement (LOs 6 & 7)Brief summary of project (you can copy and paste this from the original project plan unless it changed since this was submitted):

Project product(s) e.g. needs assessment/teaching resource/evaluation report. (Just name what you produced; you can add a copy of any products as evidence in your portfolio if you wish)

1. Professionalism and communication:

Placement supervisor comments:

Please consider areas such as reliability, punctuality, time management, project management, initiative, ability to relate to and communicate with peers/supervisors/service users/external agencies etc), ability to achieve goals set (given any resource and time constraints), quality of project ‘product’ (given resource time/constraints)


Student reflection:

(Comment on any differences on how professionalism is displayed and on communication styles and methods in a public health setting vs. a clinical dietetic setting. Consider practical differences such as dress and documentation, as well as less tangible differences.)

2. Reflective practice

Placement supervisor comments:

(Please consider aspects such as the ability to use feedback effectively, ability to engage in discussion about public health practice in general and the student’s specific role in it, ability to relate theory to practice, ability to generate ideas.)


Student reflection:

(Briefly describe how your public health placement might influence your dietetic practice in the future.)

I confirm that: (name of student)

has displayed professional behaviour and the ability to practice reflectively during their placement.

Signature:

Name:

Date:

Job title:

Organisation:


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