Service Learning: Meaningful, Community-Centered Professional Skill Development for Occupational Therapy Students Anne Marie Witchger Hansen, MS, OTR/L Jaime Muñoz, PhD, OTR/L, FAOTA Patricia A. Crist, PhD, OTR/L, FAOTA Jyothi Gupta, PhD, OT(C), OTR/L Roger I. Ideishi, JD, OTR/L Loree A. Primeau, PhD, OTR Debra Tupé, MPH, MS, OTR/L ABSTRACT. The profession of Occupational Therapy advocates for new and emerging areas of practice that more fully embrace our moral reAnne Marie Witchger Hansen is Instructor, Duquesne University, Department of Occupational Therapy, Pittsburgh, PA. Jaime Muñoz and Patricia A. Crist are affiliated with Department of Occupational Therapy, Duquesne University, Pittsburgh PA. Jyothi Gupta is affiliated with Department of Physical Therapy, College of Saint Catherine, Minneapolis, MN. Roger I. Ideishi is affiliated with Department of Occupational Therapy, University of the Sciences in Philadelphia, Philadelphia, PA. Loree A. Primeau is affiliated with Department of Occupational Therapy, University of Texas Medical Branch, Galveston, TX. Debra Tupé is affiliated with Programs in Occupational Therapy, Columbia University, New York, NY. Address correspondence to: Anne Marie Witchger Hansen, Duquesne University, Department of Occupational Therapy, 225 Health Science Building, Pittsburgh, PA 15282 (E-mail: hansen@duq.edu). Occupational Therapy in Health Care, Vol. 21(1/2) 2007 Available online at http://othc.haworthpress.com © 2007 by The Haworth Press, Inc. All rights reserved. doi:10.1300/J003v21n01_03 25 26 OCCUPATIONAL THERAPY IN HEALTH CARE sponsibility to address significant social injustices that exist in our communities (Kronenberg, Algado, & Pollard, 2005). The service-learning pedagogy is impacted by the philosophical and theoretical influences of John Dewey, the mission and purpose of American higher education including Boyer’s (1994) call for an engaged citizenry, and the social vision of occupational therapy. The pedagogy of service learning provides a natural context for students to experience community practice while contributing to reducing existing social injustices. This paper provides an overview of service learning (SL) as a philosophical and pedagogical approach in occupational therapy education, key processes in developing successful service learning experiences and community partnerships to support service learning. Characteristics of effective service learning, assessment of community and institutional outcomes of service learning and the scholarship of service learning are also discussed. Most importantly, strategies for developing service learning scholarship, an important but frequently neglected requisite to validate any educational practice, are delineated. The authors conclude that service learning provides educators with an opportunity to provide students with experiences in natural, community contexts while developing life-long commitment to civic engagement and social responsibility. doi:10.1300/J003v21n01_03 [Article copies available for a fee from The Haworth Document Delivery Service: 1-800HAWORTH. E-mail address: <docdelivery@haworthpress.com> Website: <http:/www.HaworthPress.com> 2007 by The Haworth Press, Inc. All rights reserved.] KEYWORDS. Educational pedagogy, service learning, civic engagement INTRODUCTION Many within the profession advocate for occupational therapists to consider areas of practice that embrace more fully our moral responsibility to address social injustices that exist in our communities (Kronenberg, Algado, & Pollard, 2005). A natural synergy exists through service learning between the need for students to experience practice in natural contexts and the call to contribute to reducing existing social injustices. The purpose of this paper is to provide an overview of service learning (SL) as a philosophical and pedagogical approach in occupational therapy education. Key to developing successful service-learning experiences are elucidated based on the combined expertise of five academic programs in occupational therapy that have successfully Service Learning 27 integrated service learning into their respective curricula. The paper describes characteristics of effective service learning, the design of service-learning experiences, the development of community-university partnerships, and the assessment of learning outcomes. Most importantly, strategies for developing service learning scholarship, an important but frequently neglected requisite to validate any educational practice, are delineated. THE CONTEXT FOR SERVICE LEARNING In July 1999, Thomas Ehrlich, senior scholar at the Carnegie Foundation for the Advancement of Teaching and Elizabeth Hollander, executive director of Campus Compact and other distinguished educators, drafted the Presidents’ Declaration on the Civic Responsibility of Higher Education (Ehrlich & Hollander, 1999). This document, signed by over 400 college and university presidents, challenged Higher Education to become engaged with its communities through actions and teaching. In part they declared, Higher Education is uniquely positioned to help Americans understand the histories and contours of our present challenges as a diverse democracy. It is also uniquely positioned to help both students and our communities to explore new ways of fulfilling the promise of justice and the dignity for all, both in our own democracy and as part of the global community. (Ehrlich & Hollander, 1999, p. 1) The Presidents’ Declaration highlighted serious concern in Higher Education about a growing national trend toward civic disengagement as well as its own failings in engaging students as active citizens (Battistoni, 2002). In addition, prominent scholars called for American colleges and universities to return to their earliest mission of educating citizens for democracy (Barber, 1992; Benson & Harkavy, 1997; Bok, 1990; Boyer, 1994, 1996). Today, most universities have created mission statements that reveal a commitment to service and civic engagement, yet the reality on college campuses does not match the rhetoric (Boyer, 1994, Boyte & Hollander, 1999; Checkoway, 2001). Advocates for a renewed commitment to a civic mission in Higher Education identify three strategies for achieving this goal of civic engagement: (1) Rigorous focus on education in democratic values and citizenship, (2) formation 28 OCCUPATIONAL THERAPY IN HEALTH CARE of collaborative community-university partnerships, and (3) promotion of service learning (Hutchinson, 2001, p.1). The Pew Health Professions Commission Report (1995) struck a similar chord of advocacy for civic engagement when it recommended that health care practitioners of the twenty-first century demonstrate the following core competencies: care for the community’s health, understanding of the role of the environment, participation in racially and culturally diverse society, involving clients in decision making, practicing prevention, promoting healthy lifestyles, and continuation of learning (Connors, Cora-Bramble, Hart, Sebastian, & Seifer, 1996; Shugars, O’Neill, & Bader, 1991). The premise of occupational therapy rests on human dignity and equality. Out of this premise stem a number of official documents which explicitly support the core competencies identified by the Pew Commission Professions Report. These include the Occupational Therapy Code of Ethics (2005), Core Values and Attitudes of Occupational Therapy Practice (AOTA, 1993), The Philosophical Base of Occupational Therapy (AOTA, 1995), and the Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002). Our professional beliefs of person-centered practice, enablement, empowerment, and participation fit perfectly with the call to address social issues and to collaborate with communities to address their needs. Law (2002) underscored this fit when she defined participation in the Occupational Therapy Framework as, “a vital part of the human condition and experience–it leads to life satisfaction and a sense of competence and is essential for psychological, emotional, and skill development” (AOTA, 2002, p. 641). The primary objective of service learning is the enhancement of academic learning through engagement in authentic community service (McGowan, 2002). As occupational therapy practitioners, we are well aware of the value and benefits of engagement in activity and occupation. Service learning provides occupational therapy educators with an innovative approach to education and skill development that supports occupational therapy’s core tenets of engagement, social participation, and learning by doing. Dewey (1938) and Kolb (1984) assert that experiential learning is superior to abstract learning and richest when it involves experience, reflection, and comparison. These philosophers also provide a link between community-based learning and academic enhancement suggesting that hands-on experience in service to others not only contributes to the holistic development of students but also cultivates civic mindedness, an essential element of social participation. Service Learning 29 Service learning embedded in occupational therapy education is an educational pedagogy that helps students reap the benefits of participation. We have the knowledge, skills, attitudes and professional responsibility to promote health and well being through participation in a just and inclusive society along with working toward social change. Townsend (1993) has urged a social vision of occupational therapy that includes promotion of social justice in order for individuals, with or without disabilities, to fully participate as members of society. Service learning is an approach that can help the profession’s graduate entrylevel practitioners to understand and enact a social vision of occupational therapy that has been developed through thoughtfully planned educational experiences of community engagement. CHARACTERISTICS OF SERVICE LEARNING Service learning is a type of experiential learning. Community-Campus Partnerships for Health, an organization focused on this educational approach for health professional students, clearly articulates a comprehensive definition for service learning. Service learning is defined as a structured learning experience that combines community service with preparation and reflection. Students engaged in service-learning provide community service in response to community-identified concerns and learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as citizens. (Seifer, 1998, p. 274) In keeping with occupational therapy tradition, for students to be engaged as learners, learning must be made meaningful, purposeful, contextual, and empowering. When students participate with community members in person-centered collaborative endeavors to address issues of common good, they apply abstract classroom knowledge to community issues. Such positive experiences are an impetus for life-long learning, civic engagement for the common good, and “a larger view of the world as articulated through their own voices and insights” (Mintz and Hesser, 1996, p. 36). When planning these experiences, occupational therapy educators consider the best practices for service learning (see Table 1) as well as the various approaches to SL. 30 OCCUPATIONAL THERAPY IN HEALTH CARE TABLE 1. Best Practice in Service Learning 1. Engages students in responsible and challenging actions for the common good. 2. Provides structured opportunities for people to reflect critically on their service experience. 3. Articulates clear service and learning goals for everyone involved. 4. Allows for those with needs to define those needs. 5. Clarifies the responsibilities of each person and organization involved. 6. Matches service providers and service needs through a process that recognizes changing circumstances. 7. Expects genuine, active, and sustained organizational commitment. 8. Includes training, supervision, monitoring, support, recognition, and evaluation to meet service and learning goals. 9. Insures that the time commitment for service and learning is flexible, appropriate, and in the best interests of all involved. 10. Is committed to program participation by and with diverse populations (Porter Honnet & Poulsen, 1989). Service-Learning Approaches Approaches to curriculum-based service learning are integrated, comprehensive, or programmatic (Marstellar & Kowalewski, 2005). Each approach requires that the course instructor clearly defines the parameters of the SL activity, identifies host sites, and designs a learning experience that is meaningful and relevant to the community agency while meeting course objectives. An integrated approach incorporates community service as only one of several required or elective components of the course. In some cases, the SL experience counts as extra credit or is taken for additional course credit. The service activity clearly relates to the course objectives and requires more than one visit to the community site. For example, in a course on sociocultural diversity one course objective reads, “Demonstrate an increased awareness of institutional barriers that may prevent persons from diverse backgrounds from using occupational therapy and other health or rehabilitation services.” In this course a student may spend time at a local health clinic with the expectation that they survey or interview consumers about their perspectives on services. In a comprehensive approach to service learning, the communitybased activity is the central focus of the course and evolves during the semester in concert with the student’s learning. Student assignments and experiences reflect the developmental progression of the course pedagogy. The course may offer one service experience in which the entire class participates or several service opportunities from which the Service Learning 31 faculty assigns or lets the students choose. In all cases, the SL project is based on a community-identified need, and not driven by the need for students to develop practice skills and grow professional as in fieldwork. For example, in a two-semester sequence of clinical reasoning courses, students work with staff and consumers at a local elder daycare center to design and implement meaningful individual and group activities on site based on the community agencies’ identified needs. The frequency and duration of this type of SL approach can challenge or enhance students’ communication and decision-making skills, understanding of the community context, advocacy, professional ethics, teamwork and develop leadership abilities, too. The programmatic approach views service learning as a fundamental component of the program’s mission and incorporates required SL experiences at multiple points throughout the curriculum. In this approach, faculty meet to carefully consider a series of SL experiences that meet curriculum objectives and which are graded to match the students’ levels of personal and professional development. When employing a programmatic approach, a specific community site may be selected to meet course objectives across several courses or curriculum objectives are met through SL experiences at a variety of community settings. Successful programmatic service learning is supported by the faculty’s inventory of community partners and identification of courses within the curriculum that are good candidates for community-based learning. However, the programmatic approach may also be threatened by a shortage of community partnerships or lack of faculty support (Marullo, 2005). When choosing a SL approach, educators carefully consider institutional issues such as management of the relationship with community agencies, liability, funding, student off-site supervision, faculty load and productivity, and programmatic support. If institutional support for service learning is not available, educators often seek advice of colleagues in other institutions with SL experience. Service Learning and Fieldwork Service Learning is often mistaken to be equivalent to volunteerism and/or fieldwork. SL differs from volunteerism in that the service activities are clearly linked with academic course objectives. In fieldwork, service is guided by professional learning outcomes and accreditation requirements. In volunteerism, the benefit of the service to the community is emphasized over benefit to the learner. Similarly, in fieldwork, the benefit to the learner is emphasized over the benefit to the community. 32 OCCUPATIONAL THERAPY IN HEALTH CARE In service learning, the benefit is reciprocal to both students and community. Although students often verbally share their volunteering and fieldwork experiences, they usually are not required to complete extensive assignments that connect learning goals with the service experience or to complete guided reflections which are at the heart of service learning. Perhaps the most striking difference between SL and fieldwork is that SL is created to address community-identified needs. This characteristic is not fundamental to volunteerism or fieldwork. Although fieldwork is complementary to SL, it cannot substitute for authentic SL experiences (O’Brien & D’Amico, 2004). However, SL experiences can be organized as community-based Fieldwork I when the fieldwork coordinator plans an experience which follows the characteristics of service learning as well as professional learning outcomes and fieldwork accreditation requirements. For example, the first author organizes SL experiences for students in Clinical Reasoning I and II that spans across two semesters. Students are given a SL assignment to work in pairs in local community agencies during the first semester to understand the community context, assets, and needs as well as meet with consumers to develop clinical reasoning skills. In addition, during this semester, each student participates in Fieldwork IA for four hours each week at a traditional acute care or rehab setting. During the second semester, students initiate a weekly group intervention at the community agency based on the community-identified needs (from the first semester) to enhance their developing clinical reasoning skills. Because students are addressing community-identified needs based in reciprocity with the community agency staff and consumers, follow specific learning and service objectives, and write weekly guided reflections, this is service learning. Additionally, the course instructor weaves into the group projects, the appropriate professional learning outcomes and fieldwork accreditation requirements thus fulfilling fieldwork IB requirements. With a good understanding of best practices in service learning as well as the expectations for fieldwork, creating a fieldwork/ service-learning project is possible. PROMOTING SOCIAL RESPONSIBILITY AND PROFESSIONAL DEVELOPMENT Educational experiences that facilitate students’ engagement with marginalized populations are reported to improve students’ capacities to practice in a more culturally responsive manner (Whiteford & Wright St. Service Learning 33 Clair, 2002). These experiences may also increase students’ awareness of issues of aging with a disability (Green 1998; Lohman & Aitken, 2002) and expand their understanding of disability as a lived experience. Environmental and societal conditions which impinge on the lives of people with disabilities are also revealed (Gitlow & Flecky, 2005). Through SL experiences, students learn how social responsibility calls them to address these conditions through encounter and action. Service provision is viewed on a continuum of charity to social change. The charity model emphasizes giving as a civic duty and is, at best, an additive to any learning experience. The social change model, on the other hand, is about caring, social reconstruction, and transformation (Kahne & Westheimer, 1996). Students are challenged to move from a perspective of giving to one that explores the root causes of social problems and builds relationships with people in the communities in which they serve. Morton (1995) asserts that students who are open to becoming transformed by these new relationships and understanding of social issues are often moved to work for social change. Mezirow (1990) states that lifelong transformational learning in adults occurs in three phases: “critical reflection on one’s assumptions, discourse to validate the critically reflective insight, and action” (Merriam & Caffarella, 1999, p. 321). Service learning engages all three of these transformative processes. Reflection plays a key role in student growth, transformation, and is instrumental in promoting civic engagement for social change. Consistent guided reflection that is contextualized and which connects community experience with learning is associated with application of curriculum-based concepts to new situations, enhanced problem solving, critical thinking, and student openness to new ideas and perspective transformation (Eyler & Giles, 1999). Effective faculty mentors facilitate student growth by providing the right level of challenge in an authentic and appropriate context, emotional support, and guided reflection exercises that help students process their experience. DESIGNING AND IMPLEMENTING EFFECTIVE SERVICE-LEARNING PROGRAMS Designing SL opportunities with authentic community engagement requires occupational therapy educators to consider all aspects of the SL pedagogy, including developing trusting relationships with community agency. These relationships are key to successfully designing and 34 OCCUPATIONAL THERAPY IN HEALTH CARE implementing community-university partnerships for service learning (see Figure 1). Service-Learning Pedagogy Conceptualization and operationalization are essential pedagogical elements in designing successful community-learning experiences. McGowan (2002) describes conceptualization of service learning as the process in which the connection between community experience and advancement of course objectives is established. This process entails linking specific course objectives with community service. For SL to be successful, the conceptual link between the service activity and the desired learning is clearly articulated and agreed upon by both the community partners and faculty. To operationalize service learning, the course instructor identifies learning activities for both inside and outside the classroom that connect FIGURE 1. Service-Learning Implementation Service Learning Implementation 1. Instructor • Researches mission, purpose, assets, needs of community agency • Develops relationship with community agency • Discusses all aspects of service learning pedagogy with community agency 5. Instructor & Community Agency & Students • Keep in touch with students to ensure project focus in keeping with need • Communicate weekly regarding project • Plan final presentation/celebration • Evaluate the experience • Continue dialogue and find ways to sustain partnership 2. Instructor & Community Agency • Determine if service learning is feasible • Determine focus of project, timeline, responsibilities & liability 3. Instructor & Students • Introduces course objectives to students as well as service objectives to students • Clarifies specifies of agency needs, service learning project focus, goals, assignments & timeline, evaluation methods 4. Community Agency & Students Instructor Community Agency Students • Orientate student to community agency • Introduce agency staff to pedagogy of service learning & to students • Supervise students as they carry out service learning project Service Learning 35 the service experience to course objectives. Written essays, in-class debriefings, and guided reflection questions for journaling are examples of learning activities that ensure the conceptual connection between the community experience and advancement of course objectives. Assessment of these SL experiences is essential to sustaining the operational connection between service and learning. Eyler and Giles (1999) suggest other design components that play a role in effective SL experiences and which contribute to student learning. These include placement quality, opportunities for student reflection, and designing an experience that provides students with the “just right” challenge, that resonates in occupational therapy practice. Community placements in which students take responsibility and work as peers with community members is associated with student interpersonal development and is a positive predictor of diversity tolerance (Eyles & Giles, 1999). A primary challenge is to encourage students to develop more complex ways of viewing the world and of applying academic knowledge without being overwhelmed by the demands and novelty of the SL experience. For example, a service-learning component of a community health course requires that students spend four to six hours a week at a community site for a 10-week period. During this time they collaborate with the program director, staff, and consumers to complete a needs assessment, design and propose an occupational therapy program that addresses a facility-defined need, and draft a possible basic grant proposal to fund the implementation of the program (Munoz, Provident, & Witchger Hansen, 2005). Such a challenge is inappropriate if students have not been equipped with the requisite knowledge and skills to complete such tasks. An additional element to consider in planning and designing SL projects is liability. In managing risk in SL partnerships, faculty should be aware of policies and procedures already in place on campus and ask the community partners to identify the risks and relevant policies and procedures of their agency. To reduce risk, faculty and agency staff provide orientation to the community site, clearly delineate learning objectives, create a learning plan or contract, and meet with university risk manager and community partners to discuss liability issues and develop a risk management policy (see Table 2). Efforts should be made to define the agency’s role in student oversight and determine the instructor’s flexibility to accommodate the agency’s needs. 36 OCCUPATIONAL THERAPY IN HEALTH CARE TABLE 2. Considerations for Reducing Liability Agency Responsibility 1. Provide orientation for students 2. Generate an orientation checklist 3. Notify other staff about service learning Instructor and Agency Responsibility 1. Determine service learning site supervisor 2. Discuss learning and service objectives 3. Document a learning plan/contract for learning 4. Discuss risk management University Risk manager and with partners 5. Conduct site reviews (before, during, and after) 6. Create a site-visit checklist Instructor Responsibility 1. Offer alternative placement if necessary 2. Require student activity log to verify activity 3. Maintain emergency contact information on every student Developing Community Partnerships to Support Service Learning Occupational therapy educators locate agencies whose goals match the goals and outcomes of the course. Although the vast majority of the authors’ collective SL experiences have been with agencies that address needs of underserved populations, Zlotkowski (1999) asserts that authentic service learning can also be created with “organizations whose primary purpose is the common good” (p. 98). Designing effective SL experiences requires attention to developing strong community-university partnerships and integrating host agency priorities with course objectives. Development of a mutually committed working relationship with an agency is key to sustaining successful and meaningful communitylearning experiences and to the enhancement of student learning and advancement of course objectives. Development of the relationship requires partnering and collaboration with the host organization grounded in ongoing dialogue with a clear understanding of respective needs. Effective community-university partnerships “are mutual, collaborative relationships that bring individuals from both academia and the community together to work on a common goal, that result in benefits to both the university and community partners” (Suarez-Balcazar, Muñoz, & Fisher, 2006). Collaboration is a creative process that recognizes and respects the complementary skills and knowledge of each partner. Schrage Service Learning 37 (1991) has eloquently captured the essence of collaboration in the following passage: Collaboration is the process of shared creation: two or more individuals with complementary skills interacting to create a shared understanding that none had previously possessed or could have come to on their own. Collaboration creates a shared meaning about a process, a product, or an event. In this sense, there is nothing routine about it. Something is there that wasn’t there before. (p. 140) Community-university partnerships for service learning require faculty and community partners to communicate effectively, building a sense of trust as they work together. Through the sharing of information about their programs, these partners develop an understanding of their partners’ respective mission, goals, assets, and needs and determine a focus for the service-learning partnership based on these needs. To build a sustainable partnership, the community and university partners develop a common vision, involve staff and students on every level of communication, develop ongoing communication, define shared outcomes, implement evaluation methods, and continuously reflect on the evolution of the projects. Characteristics of an effective communityuniversity partnership include a shared commitment to address complex social problems, mutuality, and a participatory, shared approach to the service, education and research activities of this partnership. Faculty and community partners further accept joint responsibility for effective communication, recognizing, utilizing and assimilating change, sustainability of the project, and working toward student development of cultural competence. After faculty identify an appropriate SL site, they begin to develop an agency profile by assessing the assets and needs of the local agency and population they serve. This profile is created in advance of the course by the faculty member in collaboration with the community partner, or the assessment is conducted by the students in partnership with the community agency as part of the course and service-learning assignment. To develop a community profile, SL faculty or students collect and assess health status data, conduct a walking or windshield tour of the community, develop an assets map, and interview key community leaders. To create an organizational profile, faculty or students research the history, mission and organizational structure, profile of current services, referral base, staffing, and job descriptions. 38 OCCUPATIONAL THERAPY IN HEALTH CARE Challenges There are challenges in creating an SL project. Although the course instructor is crucial for continuity of projects and effective communication between the community partner and students, one of the challenges is facilitating the establishment of student relationships with community members with each new semester, and/or reestablishing relationships with the community members with each new group of students. There is a period of developing and evolving expectations with each new semester and each new student group, too. The students need time to learn about the social norms, facilitators, resources, strengths, and barriers of the setting. In addition, faculty need to spend time guiding students to be pro-active in problem solving and breaking down barriers to creating a successful project, such as identifying clear learning and service objectives, as well as dealing with staff, service-learning participants, university time versus community time, and issues of power sharing, just to name a few. While the challenges of service learning are numerous, so too are the benefits. The community benefits directly from the service students provide to improve the overall health, wellness, and quality of life of its members. The university benefits as its reputation is enhanced by the students’ positive contribution to the common good. And, finally, students benefit from SL as they grow professionally, academically, and personally through their service as engaged, socially responsible citizens who have contributed to the common good. ASSESSMENT OF STUDENT LEARNING Effective assessment of student learning requires that faculty develop methods and strategies reflective of the course objectives and the purpose for the SL experience. Faculty define the key learning objectives for the service experience and determine how to assess student achievement of objectives. The assessment of course objectives tends to be a summative process. For example, summative course objectives might be “understanding the types of preventative health” (knowledge) or “analyzing the type of preventative care offered by different community agencies” (skill). Service-learning objectives tend to be formative or process oriented to help students focus on the continuous and changing nature of their learning process, value and belief inquiries, or professional attitudes and behaviors. For example, a course objective such as “appreciating Service Learning 39 approaches to family and culturally centered care” is achieved through a service-learning experience such as creating a family and culturally centered community health fair in an impoverished neighborhood. The student’s summative learning of this course objective is assessed if the health fair was successfully completed through a health fair participant survey. Assessment includes evaluation of logistics, scheduling, travel, and agency preparation. Choosing the type of reflective activity and assessment strategies requires thoughtful planning. Characteristics to be considered include the needs of the community, type of service setting, the frequency of contact at the setting, the duration of the experience and the nature, depth, and sophistication of the service experience (Delve, Mintz, & Stewart, 1990). For example, an episodic, simpler, and shorter service experience with less frequent exposure may require a more outcomesoriented assessment process. Whereas, a longer, more complex service experience with more frequent exposure may allow for thoughts and reflections to be challenged and evolve over time. In addition, whether the focus of the objective is knowledge, skill, or values also impacts which type of assessment strategy is the best fit (see Table 3). Reflective activities and documentation are used to assess achievement of process-oriented objectives and to document a student’s transitions and insight into a situation. Reflection involves critical thought processes such as elaborating, differentiating, reinforcing, and creating TABLE 3. Assessment Strategies Focus of Objectives Knowledge Skill Value Sample of Assessment Strategies • Pre/post tests based on course objectives • Pre/post surveys based on preconceived concepts related to the course objectives, community/social barriers, and facilitators, service-learning, community-based education • Reflection journal or paper • Self-assessment and goal setting • Reflection journal or paper • Self and peer assessments • Service project or product completion • Student portfolios • Professional behavior rubrics • Pre/post surveys • Focus and discussion groups • Writing an issues paper • Peer assessment • Reflection journal or paper 40 OCCUPATIONAL THERAPY IN HEALTH CARE new meaning and the interpretation of frame of references in order to take informed action (Mezirow, 1990; Bringle & Hatcher, 1996, 1999). Guided reflection, that is reflection that responds to instructor-generated reflection questions, is often preferred rather than open-ended reflection. Guided reflections involve an interactive communication that is connected, continuous, challenging, coached, and contextualized (KeslerGilbert, 2003). Guided reflection often helps students to focus and notice elements of a novel experience, as compared with having students reflect on anything that may or may not be relevant to the course objectives. A variety of reflective activities can be found in Table 4. Not all students will like service learning. For example, some feel that it is too much work outside of the classroom and the outcomes are unpredictable from the onset. However, as teachers we are often faced with facilitating learning even when the student’s learning style does not match the teaching. Inherently, assessing student learning with service-learning experiences has a certain degree of ambiguity and uncertainty. When instructors present service learning with the caveat of “expecting the unexpected” in a community setting, however, students tend to be more flexible and willing to deal with the uncertainties. The contextualized learning approaches, reflection activities, and assessment strategies are designed to provide a record of valuable personal and professional growth and development throughout the experience that students can use to promote lifelong learning. ASSESSMENT OF COMMUNITY AND INSTITUTIONAL OUTCOMES Because SL programs have a dual emphasis on service and learning (Giles, Honnet, & Migliore, 1991), student evaluation needs a dual focus. Evaluation moves beyond assessing the effects of service learning on students and their learning to consider additional effects on community partners and their clients, and on the faculty and the academic institution itself. Accordingly, assessment of community and institutional outcomes consist of process and outcome indicators in the areas of community partners, clients, and professional education. Effects of SL programs on health professional education is examined further in terms of the educational system, the educational curriculum, and faculty development and involvement. Potential indicators of community and institutional outcomes and their data sources are provided in Table 5. Service Learning 41 SCHOLARSHIP OF SERVICE LEARNING Faculty in health professional education programs are increasingly challenged to manage already existing tensions among their teaching, research, and service roles, including the additional responsibility to maintain their professional competence and incorporate professional practice TABLE 4. Reflection Activities Reflection Activity Brief Description Double-entry journal • This method involves both summative and formative assessment of the service experience. On one side of the paper, the student writes down personal reactions to the service experience. On the other side of the paper, the student links key course concepts and information to the reaction and service experience (Bringle & Hatcher, 1999). • This method involves responding to three issues for each journal entry (Bringle & Hatcher, 1999). For example: • Describing what happened • Analyzing how the course content relates to the experience • Applying the learned experience to a personal story • Bringle and Hatcher also suggest a simpler method by asking, “What, so what, and now what?” This stimulates the student to describe: • The experience • What the experience means • How does the experience affect the future of the student and the community • Other adaptations such as a SOAP note to encourage students to address different aspects of the service experience can be used as well. • This method involves responding to a particular event during the service experience (Bringle & Hatcher, 1999). • For example: Describe an incident that created a dilemma for you because you did not know how to act or respond. • Why was it confusing? • How did you feel about the event? • What did you do? • List three actions that you might have taken and analyze each action. • Discuss these journal entries with instructor, with class or on an electronic discussion board with instructor and classmates. • Group journaling or discussion boards on Web-based course platforms can promote group cohesion, support, validation, as well as public challenge (Mills, 2001). Three-part journal Incident journal Web-based journal 42 OCCUPATIONAL THERAPY IN HEALTH CARE TABLE 5. Assessment Indicators of Outcomes Community Partners Indicators • Number of community partners and differing agency purposes • Duration of community partnerships • Agency service provision • Number of clients receiving services • Amount/type of services provided • Agency and staff satisfaction with services • Survey instruments, individual/focus group interviews, faculty/student fieldnotes • Commitment to the project and its sustainability • Hiring of new staff • Inclusion in funding applications Client Indicators • Client knowledge, skills, and/or performance • Tests, assessment batteries, survey instruments • Client satisfaction with services • Survey instruments, individual/focus group interviews • Participation and follow-through such as attendance frequency or monitoring changes • Client health and quality of life • Tests, assessment batteries, survey instruments • Frequency of use of community and health care services • Costs for health care and healthier living Health Professional Education Indicators Educational system • Number of students involved • Student development (leadership, cultural sensitivity, commitment to service, personal and professional development) • Survey instruments, individual/focus group interviews, faculty/student field notes • Hours and types of community service prior to graduation and after • Number of graduates working in community settings Educational curriculum • Number of service learning into curriculum objectives into courses • Curriculum content related to practice in community settings • Incorporation into curriculum philosophy and model including periodic student and alumni learning outcomes assessment • Value placed on service-learning needs observable measure or delete as really the above are the actions demonstrating this value • Number of faculty involved • Participation in and leadership of service-learning-related faculty development activities • Influence on faculty teaching • Development of new teaching skills • Implementation of new teaching methods • Time spent on service-learning components • Time spent in student mentoring • Student satisfaction surveys and course evaluation • Influence on faculty scholarship • Number of research projects • Quantity of applications for funding support • Amount of grants awarded • Frequency and quality of conference presentations, and publications • Influence on faculty practice • Hours spent in community practice Faculty Development Indicators Service Learning 43 into their service activities (Arana & McCurdy, 1995; Hanson, Gibson, & Scoggin, 1997). Service-learning programs have the potential to integrate faculty members’ teaching, research, and professional practice activities, and bring their skills in these areas to bear on the real-world problems that their communities face (Conners, Cora-Bramble, Hart, Sebastian, & Seifer, 1996; Crist, Muñoz, Witchger Hansen, Benson, & Provident, 2005; Muñoz, Reichenbach, & Witchger Hansen, 2005; Kielhofner, 2005; National Association of State Universities and Land Grant Colleges. 1999). The dual focus of SL programs, service to the community, and student learning, raises two very different types of research questions. One question considers effects on participants: students and clients; and the other question considers effects on institutions: educational and community. A wealth of research questions generated by The National Society for Internships and Experiential Education (see Table 6) is found in the Research Agenda for Combining Service and Learning in the 1990s (Giles et al., 1991). Many of these questions are appropriate to occupational therapy education and outcomes including, “What are the effects of service learning on students as learners and as citizens? Does TABLE 6. Research Questions Students • What are the effects of service learning on students as learners? • What are the effects of service learning on students as citizens? • What knowledge and skills do students gain as a result of service learning? • Does participation in student learning affect students’ perception of self and others and their view of the world? Clients • What are the effects of service learning on clients’ health and quality of life? • What knowledge and skills do clients gain as a result of service learning? • Does participation in service-learning affect clients’ perceptions of self and others and their view of the world? Educational institutions • What are the outcomes of service learning that contribute to institutional missions? • How can service learning lead to the effective integration of teaching, research, and service? • How can service learning be used as a vehicle for reform in areas of teaching effectiveness, curriculum design, and faculty scholarship? Community institutions • To what extent does service learning address real community needs? • To what extent does service learning build capacity of community partners to meet clients’ needs? • What are the benefits and costs for community partners as a result of service learning? 44 OCCUPATIONAL THERAPY IN HEALTH CARE participation in student learning affect students’ perception of self and others and their view of the world? What are the effects of service learning on clients’ health and quality of life?” Scholarship of service learning is initiated and transformed easily by careful consideration of student assessment of learning processes described in previous sections of this paper. For instance, systematic analysis of students’ reflective journals, especially ones that are faculty guided can not only measure student learning but also provide outcomes-oriented scholarship. Additionally, documenting and reporting the outcomes from service learning may influence best practices to be emulated in practice. STRATEGIES TO SUPPORT THE SCHOLARSHIP OF SERVICE LEARNING Service-learning programs are natural settings for collaborative action research or community-based, participatory research models that create partnerships between scholars and practitioners. There are several strategies that facilitate the development of effective partnerships to support scholarship within service-learning programs (Giles et al., 1991). First, choose research-oriented questions that are of mutual interest and benefit to scholars and the communities in which the service-learning program is being conducted. Second, ensure that both institutional partners (educational institutions and community organizations) are represented on the research team and that they are involved in all stages of the research from initial planning through project completion. Third, it is important that the members of the research team are committed to managing immediate logistical issues that arise within the program without losing sight of the larger research questions. Fourth, adequate time for a needs assessment and the planning process to meet these needs must be built into the research timeline. Fifth, recognize and acknowledge that the needs of involved partners and their interests and stakes in the program will differ. Sixth, for the scholarship of practice to naturally and smoothly occur, incorporate research questions and design into early program development stages so it becomes an embedded component of program delivery. Scholarship activities and outcomes will result earlier and meet with less resistance. And, finally, present partnership opportunities to scholars and practitioners as a source of intellectual and career renewal and rejuvenation (Giles et al., 1991). Service Learning 45 Institutional support for SL programs and their concomitant scholarship opportunities is essential for their success (Bringle & Hatcher, 1996). Educational institutions demonstrate this support when service learning is included in their institutional mission statements and when SL programs are identifiable features of their educational curricula. Additional indicators of institutionalization of SL programs are hard-line budget commitments and evaluation of these programs through institutional assessment processes. Faculty members’ involvement is maximized when their accomplishments in SL programs are recognized, publicized, and endorsed, particularly by inclusion in personnel decisions, such as hiring, annual review, promotion, and tenure practices. Finally, faculty participation in service learning is enhanced when educational institutions support faculty development through offering workshops and mentoring programs related to service learning (Bringle & Hatcher, 1996). When institutional support is not present, faculty find insight from service-learning colleagues in other institutions of higher education, benchmark comparable universities that have institutionalized service learning, and cite the growing body of research that supports the pedagogy of service learning. CONCLUSION Service learning is a philosophical and pedagogical approach in occupational therapy education that is grounded in the philosophical and theoretical influences of John Dewey. Service learning is consistent with the mission and purpose of American higher education including Boyer’s call for an engaged citizenry, and the social vision of occupational therapy. In this paper, the authors argue that service learning provides a natural context for students to experience community practice while contributing to reduction of existing social injustices. The pedagogy of service learning provides students with a structured learning experience that combines community service with academic learning objectives to address community-identified needs. Reflection throughout this pedagogy gives students an opportunity to consider the connection between their academic coursework and their role as citizens. While providing students with an opportunity for skill development, service learning also supports occupational therapy’s core tenets of engagement: social participation and learning by doing. Developing strong community-university partnerships characterized by trust and mutuality are essential to supporting effective service learning. Together, faculty, students and 46 OCCUPATIONAL THERAPY IN HEALTH CARE community partners accept joint responsibility for effective communication, sustaining the project and working with students to develop crosscultural awareness and at times cultural competence while addressing a community-identified need. Assessment of service learning moves beyond understanding the effects of service learning on the students to assessing the community and institutional outcomes of service learning. These assessment indicators may include the following: • Community-partner indicators such as number and duration of community partnerships, • Client indicators such as client satisfaction with services, health, and quality of life, • Health professional-education indicators such as number of students involved and student leadership, personal and professional development; and • Faculty-development indicators such as influence on faculty teaching and scholarship. Service-learning programs also provide faculty the opportunity to integrate their teaching, research and practice activities by addressing community-identified problems. Developing SL scholarship is a frequently neglected necessity to validate this innovative educational practice. From its inherent benefit of enhancing academic and service goals to address community-identified concerns and problems, service learning provides educators with an opportunity to present students with experiences in natural, community contexts. 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(Eds.), Colleges and universities as citizens (pp. 96-120). Boston, MA: Allyn & Bacon. doi:10.1300/J003v21n01_03 View publication stats