Program Modification: Using Focus Groups to Alter Primary Care Practicum Experiences for HRSA Fellows

Background and Purpose: Tasked with implementing a training grant to MSW students aimed at improving skills/knowledge regarding transitional age youth (TAY), this research team opted to include an interprofessional element in the form of primary care experiences. Over the three years of the grant, focus groups were conducted with the purpose of improving the implementation and design of important grant elements. 

Methods: Researchers conducted three semi-structured, hour long focus groups – one for each cohort.  Interview questions asked participants to share overall experiences within interprofessional primary care settings, perceived benefits and barriers, and areas for improvement. 

Participants (n = 24, 8 from cohort 1, 7 from cohort 2, 9 from cohort 3) consisted of advanced placement MSW students within the Mental Health and Addiction concentration accepted into the fellowship program.

Researchers coded data using the coding methods of grounded theory (Charmaz, 2014).  After data were initially coded with line-by-line coding, focus coding aided in organizing the codes into larger themes.  Axial coding facilitated in creating subcategories that defined the characteristics of the emerging themes.  Finally, theoretical coding aided in determining potential relationships among the categories that were constructed in the focused coding phase  

Findings: Though students from the first two cohorts appreciated the opportunity to engage in a primary care setting, a major theme was “wanting more” form the primary care experience indicating strong challenges and barriers.  One such challenge was “lack of work” including both tasks and client contact. 

Another major theme that highlights the challenges in the primary care settings, one related to lack of work, was the theme of “placement issues” which included issues with the social worker, the site itself, and the time of the student’s placement as some days and times were simply not busy.  Burnout and the heavy student load the social workers were required to have at each site resulted in students feeling guilty about asking questions and their shadowing in general. 

The final barrier in this primary care experience was “unclear expectations” regarding the program.  This is something that the students reported feeling themselves while also reporting that they felt their sites were unclear as well.  In some cases, this provided flexibility for students to create their own experiences like shadowing other professions but in the majority of the cases it hindered the overall experience. 

Conclusions and Implications:  In examining the themes from the focus groups of first two cohorts, the grant team altered the scheduling and rollout of the primary care practicums for the final cohort, delaying the start and reducing the overall length to eight weeks.  This allowed the team to improve efforts to secure quality placements based on student recommendations.  It also improve its communication to both students and sites by adding a new team member dedicated to securing and monitoring placements.  Despite these improved efforts, elements of not having enough time to plan for placements and students not fully understanding requirements/responsibility are still present in the cohort 3 data indicating that there is still room for improvement.