In Their Shoes
Person in red Converse shoes balancing on a railing
Tucked away, in America’s fourth largest city, is a neurologic physical therapy residency program that offers in-patient and out-patient rehab opportunities for Houston-residents, specifically those within Harris County. Houston is one of the fastest growing cities in the United States, and if you ever find yourself in the city, it is also one marked by diversity. The city is home to 2.2 million people from various ethnic backgrounds. Twenty-two percent of Houston’s rapidly growing population live below the poverty level.
For a neurologic physical therapy residency program located in the county hospital, it is about more than just developing care plans for patients. For proposed care plans to be successful, the residents and other physical therapists must understand the patient population they serve. As a part of the one-year residency program curriculum, residents must complete a holistic care course that teaches the importance of understanding the biopsychosocial model of the health framework. To connect with their patients, residents need to consider the biological, psychological, and social factors that play an important role in the patient recovery process.
Residents complete three experiential learning reflections during their time in the program. They choose and complete three from the following list of experiences: ride the bus everywhere for one week (only means of transportation), eat for one week on a $20 budget (including some vegetables and fruit), walk to the grocery store four times in a row, stay at the emergency room with a patient from beginning to the end of treatment (one resident waited 13 hours with a patient), attend a religious service other than their own, or ride a bike everywhere for one week (only means of transportation). At first, we all may think, this is no big deal. Until we try to do it. For many individuals who live in Harris County, this is everyday life.
It is important for residents to understand the mindset of their patients and the daily challenges they face. They must develop low or no-cost alternatives for their patients who have limited financial resources while encouraging positive lifestyle changes to improve their quality of life. While it may sound simple, this is not an easy task. To be effective, the residents must put themselves in their patients’ shoes. As residents working with patients in a county hospital, funding for new equipment can also be limited. Residents are forced to be creative. At times, residents develop rehab equipment from cardboard boxes and duct tape. It is about providing the best possible care with the resources available.
In higher education, we are all quick to jump in with solutions. We praise the idea of free college. We get excited over innovative programs that incorporate the latest technology. We interview the edtech start-ups that vow to disrupt education. However, in the end, we look back and wonder why none of it had an impact at the level and scale we hoped. The answer is that we are not fully understanding the student population who needs help the most.
A Good Call article provided 2015 data “that 51 percent of students from high-poverty public schools entered college in the fall following graduation, compared with a rate of 76 percent for low-poverty schools.” The completion data paints a bleaker picture. The six-year college completion rate was 34 percent higher for students in low-poverty schools than those from high-poverty schools. In response to criticism, higher education is quick to discuss remediation efforts, point fingers at increasing regulations, and blame decreased government funding as factors that affect the level of support available to assist students. While these can all be contributing factors that make finding solutions more difficult, they are not the true source of the issue.
Poor completion rates are not a result of any one specific factor, but a collection of life circumstances. Some institutions are taking time to try and understand their shifting student population. Many institutions are working to combat hunger among college students. Advocates say that hundreds of campus pantries are distributing free food around the country, a total that has risen significantly in five years. Sometimes we tend to think that students are just not applying themselves, when the reality is a more serious problem. One that can be solved with a little generosity and acknowledgement that sometimes we all need a little help along the way.
Higher education is forgetting that to be able to offer effective solutions, we must walk in their shoes. We need to understand the obstacles that face the student population we seek to serve. It could be that the proposed solutions are not effective because they do not remove the challenges affecting students or do not do enough to meet students where they are. By gaining an understanding of students and the community in which they live, we have an opportunity to search for creative answers designed to support student success. Not every solution needs to be expensive and sophisticated, sometimes duct tape and compassion is all you need to change a life.
