Grossmont Adult Education, A Campus-wide IET Model for Healthcare Training

The Program of Practice

The Health Occupations Center (HOC), part of Grossmont Adult Education (GAE), offers 12 CTE training programs for health occupations including certified nursing assistant (CNA), clinical & administrative medical assistant, dental assistant (RDA), emergency medical technician (EMT-B), healthcare interpreting, home health aide (HHA), licensed vocational nursing (LVN), medical office professional, patient care aide (PCA), pharmacy technician (PTCB), phlebotomy technician & medical lab assistant (CPT-I), and veterinary assistant (AVA). HOC holds 10 separate accreditations with all but one program conferring a state or national certificate or license. The programs are well-established and well-respected in the San Diego County healthcare community averaging 600 graduates available for employment annually. Previous to the 2019-2020 school year, prospective students were required to take a non-standardized English/math assessment and individuals who earned higher scores received priority enrollment. Through data analysis of enrollment and completion rates for students with self-identified barriers, we identified limited participation and completion by English Language (EL) students in HOC programs. Grossmont Adult Education offered a Vocational ESL for Healthcare Careers class from 2015 - 2019 that consistently had high enrollment. Still, only a few completers could score high enough on the assessment to receive a spot in a healthcare training program. A thorough data analysis in 2019 identified that historically equitable access to healthcare training programs and successful program completion for EL students at the Health Occupations Center was limited. For perspective, in the 2017-2018 school year three EL students enrolled in a healthcare career training program, and only one completed.

The Response

In the 2019-2020 school year, the Health Occupations Center established a goal to improve equitable access to career training in health occupations. The entry process and assessment changed from a non-standardized exam to CASAS Reading GOALS. Rather than enrolling students with the highest test scores first, a minimum score of 228, or High Intermediate Basic Education and above, was implemented. In addition, two Integrated Education and Training (IET) courses were offered, Patient Care Aide (PCA) and Certified Nurse Assistant (CNA), that combined an EL and CTE instructor within the class setting. Both courses saw limited enrollment. When surveyed, EL students did not enroll because they wanted to pursue a wider variety of healthcare occupations. Due to the entry process changes EL student enrollment in all CTE programs increased. However, students and teachers expressed frustration with a limited support structure in the classroom, specifically for English Learners. With the onset of COVID-19 in March 2020, HOC could not bring students on campus to CASAS test before enrolling. For the 2020-2021 school year, enrollment was open to all students without an assessment score. While this change greatly accelerated efforts to provide equitable access, it presented many challenges. Healthcare training programs are strictly regulated by accreditation boards, contain high-level medical vocabulary & reading comprehension, move quickly through content, and require certification or licensure exams that must be passed to receive industry certification or licensure. The focus for planning and professional development shifted to increasing IET support and arming CTE instructors with a toolbox of resources for all students.

In the 2020-2021 and 2021-2022 school years, Grossmont Adult Education dedicated collaboration time and funding towards the development and implementation of a campus-wide IET model at HOC, with literacy instruction provided in and out of the CTE classroom setting. The Canvas Learning Management System was integrated into all programs, allowing the EL instructor to provide immediate feedback and work with students outside the CTE classroom. Professional Learning Community (PLC) work evaluated qualitative and quantitative data to determine best practices and strategies for EL students. Workshops for instructors to explore and integrate strategies for Universal Design for Learning (UDL) into the curriculum were well attended in the summer of 2021 and 2022.
In the 2021-2022 school year, IET instruction was embedded into most classes on campus with two EL instructors scheduled in multiple Health Science & Medical Technology classes. An open literacy lab outside of the CTE classroom was made available. EL instructors worked with CTE instructors to integrate COAPPS and literacy strategies around the CTE Anchor Standards. By focusing on the CTE Anchor Standards, EL instructors developed lesson plans that were not limited to a single class and could meet the needs of more students on campus.

During the 2022-2023 school year, the onboarding process was further adapted to include a mandatory orientation before registering for a healthcare training program. The orientations include an overview of programs, but most importantly it provides a review of opportunities for EL students to improve English literacy and fluency before enrolling in a program by participating in EL classes. Orientations also introduce students to the IET support available when they enroll in a CTE class. Literacy and Workforce Preparation were further integrated into all CTE classes through Canvas modules that could be assigned and differentiated by the EL instructor.

In the Fall of 2023, GAE brought back a VESL class, Foundations for Health Careers, for EL students who do not feel ready to enroll in a CTE program allowing them to improve their English literacy and fluency through the context of healthcare. Additionally, we expanded our approach to support EL students in our non-medical career training classes through a general VESL class, Foundations for Careers, and IET-supported programs in our Business and Education Pathways offered in the 23-24 school year. We have made many data-driven adjustments since 2019, which have proven effective. We continue to adapt based on the needs of students and input from healthcare industry experts.

The Unique Features of the Program

The Integrated Education and Training (IET) program at the Health Occupations Center is unique in that it does not focus on a single program, but allows the EL instructors to provide support over multiple Health Science & Medical Technology CTE programs by focusing on the overarching CTE Anchor Standards that apply to them all. Time is scheduled in class for the EL instructor to support program-specific content and COAPP training/assessment. Focusing on the CTE Anchor Standards maximizes the EL instructor's time and effort. Some examples of CTE Anchor Standards include patient communication, resume writing, and interview skills. Using the Canvas LMS, EL instructors can push out modules to support literacy and language development on a needs basis. Instructors can differentiate instruction for each student based on student response and understanding checks using Canvas LMS tools.

The Outcome

In the 2017-2018 school year, English Language (EL) student participation was limited to three students enrolled and one completer, for a completion rate of 33.3%.

In 2018-2019 EL enrollment increased slightly with 19 enrolled. Most of those students were participants from VESL for Healthcare Careers. Completion rates continued to be low with 11 completing for a 57.8% completion rate.

In 2019-2020, with the change in the entry process, we saw an increase in enrollment with 48 EL students. Low completion rates persisted with a 60.4% completion.

2020-2021 was the first year of open enrollment and the beginning of our efforts to build a support system through IET and professional development. EL enrollment rose to 105 students and 71.% of students completed.

In 2021-2022, adjustments were made based on data analysis, as well as instructor and student input. We added a full-time EL instructor who provided open support lab time. 132 EL students enrolled and 81.1% completed.

In 2022-2023, further adjustments were made by adding a program specialist to focus on IET efforts. An additional EL instructor was added expanding access to more students. Canvas modules focused on ESL COAPPS that overlapped with CTE Anchor Standards were incorporated. In the 2022-2023 school year, 151 EL students enrolled, and 86.1% completed. The average 2022-2023 completion rate for all students in HOC programs was 85.6%.

The data demonstrates that the efforts to integrate EL support through implementing the IET model across multiple programs in a career sector, combined with instructor professional development increased success and completion rates for EL students.