1. What is MAPP?
2. What is the MAPP vision?
3. What is meant by "homegrown"?
4. What is a MAPP Nominee?
5. What is a MAPP Student?
6. What is a Health Professional Shortage Area?
7. What is a Medically Underserved Areas (MUA)?
8. What is the advantage of MAPP over traditional education?
9. Is MAPP for me?
10. Who are the MAPP Partner Education Institutions and what programs do they offer?
11. What is a MAPP Home Institution?
12. How are academic and clinical courses delivered locally?
13. Do I need to be formally admitted to a MAPP Partner's program in order to take courses?
14. Will MAPP pay the educational costs for students?
15. What is a MAPP Preceptor?
16. What is a MAPP Clinical Practice Site?
17. What is the MAPP learner-centered, lifelong learning model?
18. What is the MAPP administrative/management model?
19. What is the MAPP fiscal model?
20. Has MAPP done any program evaluation?

MAPP is a coalition of eight higher education institutions and eight government agencies and community organizations. These sixteen partners are working together to recruit and educate "homegrown" Nurse Practitioners, Certified Nurse Midwives and Physician Assistants who are committed to providing primary health care for underserved areas in Colorado, Wyoming and the bordering states. MAPP uses a three-part distance learning strategy -- interactive video courses, Internet-based courses, and access to telehealth information resources via the web -- so that students can continue to live and work in their hometowns while pursuing their education.

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2. What is the MAPP vision?

The MAPP vision is to create a collaborative, graduate health education and lifelong learning system which ensures that rural and urban underserved areas, in Colorado and Wyoming, have access to high quality, affordable, qualified, mid-level (NP, PA and CNM) primary health care providers, within a half-hour drive of every resident. Such a system would:

• be based on analyses of local community health needs;
• involve local community members in the recruitment, education, training and support of primary health care professionals;
• use a variety of learning methods - one-to-one, small group, large group; on-campus, off-campus and technological;
• meet diverse adult lifelong learners' needs;
• balance didactic (theory) and clinical practice (experiential) preparation;
• utilize interdisciplinary, inter-institutional curriculum, preceptors, faculty and clinical sites; and,
• be community-based and competency-based.

In this way, MAPP will contribute to ensuring a healthy future for all Colorado and Wyoming residents and communities.

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3. What is meant by "homegrown"?

The "homegrown" concept, literally, means something which is produced locally. When applied to advanced practice health providers, it refers to the recruitment, education, and retention of health care professionals within their local community. Supporters of the "homegrown" concept in the education of advanced practice providers recognize that there are: (a) individuals currently living and/or working in health underserved communities who are qualified to become advanced practice providers, (b) potential resources within the community or work environment for training advanced practice providers, and (c) increased incentives for individuals trained locally to remain in their communities. The idea of "growing your own" advanced practice providers is crucial to the MAPP goal of increasing their numbers and, subsequently, improving health care in target areas of Colorado, Wyoming and the bordering states.

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4. What is a MAPP Nominee?

Usually a MAPP Nominee is an individual who has received a commitment of support from an institution, employer, organization or community, but has not yet been admitted as a degree/non-degree seeking or special student into a MAPP Partner Education Institution. Support may be in the form of financial assistance such as, tuition reimbursement, scholarship, loan repayment and the like. Support may also take the form of the designation of a MAPP TeleLearning Center workspace within a health care facility. Such a space could house a MAPP computer with Internet-connectivity for the student's use, and may or may not include interactive video equipment. Other commitments to a MAPP Nominee may include qualified providing clinical preceptors and clinical training sites.

To become a MAPP Nominee in Colorado, an individual must submit a completed MAPP Nomination Form (see question 8) to the Area Health Education Center (AHEC) office in their region. In Wyoming, MAPP Nominees submit the Nomination Form to the University of Wyoming. Employees of MAPP Partner agencies/ organizations submit their Nomination Form to the MAPP Representative of that agency/organization. All of these addresses are available on the MAPP Nomination Form Instructions. Also, in order to be nominated, the potential student should be able to demonstrate their commitment to an underserved or low-income rural or urban community, as well as meet the minimum eligibility criteria (see next question). Becoming a MAPP Nominee is a privilege and a "four-way street" of commitment between the student, the nominator, the community and the MAPP Partners. Potential MAPP students may also nominate themselves.

Submission of a MAPP Nomination Form serves multiple purposes. Completion and submission of the Nomination Form will inform MAPP of the number of individuals interested the program, along with their geographic locations. This is important for planning the numbers and locations of TeleLearning Centers (computers) that will be loaned to students by MAPP. In addition, completion of the Nomination Form indicates your commitment to the goals of the program and solidifies the support of your employer and/or community. Furthermore, admissions and applications materials regarding the programs you indicate interest in on the Nomination Form will be sent to you.

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5. What is a MAPP student?

To become a MAPP student, an individual must be accepted into a Nurse Practitioner, Certified Nurse Midwife or Physician Assistant program offered by a MAPP Partner Education Institution. In addition:

"A MAPP student is a full-time or part-time student who matriculates in a partner education program, and who meets at least one of the following criteria:

1. lives, at the time of enrollment and/or during the education program, in a state or federally designated MUA and/or HPSA; or,
2. works, at the time of enrollment and/or during the education program, in a health care position for an organization that is located in, or primarily serves clients in, a state or federally designated MUA and/or HPSA; or,
3. lives, at the time of enrollment and/or during the education program, in a county which the federal government has designated as rural or frontier; or,
4. works, at the time of enrollment and/or during the education program, in a health care position for an organization that is located in, or primarily serves clients in, a county which the federal government has designated as rural or frontier; or,
5. is a member of a federally defined minority* or lives or works in an historically disadvantaged area.**

 * The federal categories for minority are: Black; Hispanic; Asian and Pacific Islander; American Indian, Eskimo, and Aleut.

** The definition of 'historically disadvantaged' adopted by the Foundation for this project is: an area documented to have a poverty rate twice that of the federally defined poverty rate." (Robert Wood Johnson Foundation, Partnerships for Training Definitions, Application Instructions, Implementation Phase, Appendix H, pp. 35-37, 1996)

Also, MAPP students/learners, as a group, are expected to be culturally diverse, service-oriented, self-directed, working, adult lifelong learners and primary health care professionals who are able to tolerate some degree of ambiguity as the MAPP program is developed.

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6. What is a Health Professional Shortage Area (HPSA)?

Click here for a HPSA/MUA map of Colorado

HPSA designates areas, population groups, and facilities that lack sufficient primary care health
personnel, as measured by population-to-primary care physician ratios.

Rural: Counties located outside of a Metropolitan Statistical Area.

Frontier: Population density of under six per square mile.

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7. What is a Medically Underserved Areas (MUA)?

MUA's are areas and population groups that have inadequate access to health care, as measured by an
index of four weighted indicators of health need:

1. Infant mortality rate;

2. The percent of population 65 or older;

3. The percent of population living in poverty; and

4. The population-to-primary care physician ratio.

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8. What is the advantage of MAPP over traditional education?

The features which make MAPP unique are: the emphasis on maintaining the student/learner in their own community for the majority of their educational/training program; the use of interactive video and computers for courses and individual study; the support of the student's employer and/or community in the educational process; and the implementation of a unique curriculum which will be interdisciplinary, inter-institutional and competency-based. Traditionally, education has required that the student enter the environment of the institution. MAPP proposes the opposite by bringing education to the environment of the student. This is the distinct advantage of MAPP over traditional education.

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9. Is MAPP for me?

MAPP is a new option for advanced practice health education and training in Colorado and Wyoming and the bordering states. MAPP is taking a learner-centered approach, and plans to design highly individualized programs for advanced practice providers. Each MAPP Partner education institution maintains its distinctive campus-based program. MAPP believes that unique, individual circumstances frequently prevent working adults from taking advantage of current educational offerings. As the total MAPP approach evolves, MAPP will work to ensure that both the learner's and the institution's goals are met. MAPP is not for everyone. It requires a high level of self-directedness and independence. However, we believe that MAPP is ideal for many potential advanced practice providers who cannot leave their families and/or work to return to school. MAPP is also designed for those who prefer to utilize advanced telecommunications for study and those who are especially committed to community-based education. Only you can decide if MAPP is the advanced practice program for you. We appreciate your interest in MAPP and look forward to hearing from you.

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10. Who are the MAPP Partner Education Institutions and what programs do they offer?

The eight MAPP Partner Education Institutions are Beth-el College of Nursing and Health Sciences-- University of Colorado at Colorado Springs, Planned Parenthood of the Rocky Mountains, Red Rocks Community College, Regis University, University of Colorado Denver, University of Northern Colorado and University of Wyoming for NP Certificate Master of Science programs. Only the University of Colorado Denver offers certificate degrees and programs for CNMs. Red Rocks Community College offers a PA program. The University of Phoenix, also a MAPP Partner, does not currently offer its NP program in Colorado or Wyoming. (For more detailed descriptions of the programs, see MAPP Partner Education Institutions Program Information).

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11. What is a MAPP Home Institution?

Each MAPP student selects, applies to, is accepted in, and enrolls in one of the MAPP Partner education institutions - their Home Institution - from which the student intends to receive a degree and/or certificate. TeleLearning courses are available to all MAPP students, either on an open enrollment/Special Student basis, regardless of their home institution, prior to acceptance into a degree and/or certificate program, or on a matriculated basis after acceptance.

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12. How are academic and clinical courses delivered locally?

MAPP uses a three-part distance learning strategy -- interactive video courses, Internet-based courses, and access to telehealth information resources via the web -- so that students can continue to live and work in their hometowns while pursuing their education.

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13. Do I need to be formally admitted to a MAPP Partner's program in order to take courses?

Although institutional requirements vary, most MAPP Partners allow students to take some academic courses while in the application process. This means that even if you have not yet formally applied to a particular school, you may be able to begin to take courses. Each institution determines which courses and credits may be applied to their degree and certification programs.

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14. Will MAPP pay the educational costs for students?

MAPP does not pay for tuition or fees to the student's "home institution." However, the MAPP coalition has been successful in obtaining support from many communities, organizations, and employers who will benefit directly from the preparation of "homegrown" advanced practice health providers. As a result, the amount of tuition and fee support available to each MAPP student will vary depending on the financial support offered through the particular community or employer, the amount of tuition reimbursement available through a particular employer, student utilization of financial aid programs, scholarships and loan opportunities, and the current costs of the selected program. MAPP students may apply for financial aid through their home institution. Click here for AHEC's Educational Opportunities and Financial Assistance Guide.

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15. What is a Preceptor?

A Preceptor is a qualified professional (MD, DO, PA, NP or CNM) who assists a student to achieve their academic and professional goals, is appointed as a clinical faculty member by a MAPP Education Institution Partner, and is a co-learner with the MAPP student(s) and the MAPP/RWJF project. Preceptors may be selected by MAPP students or by faculty of the Home Institution. (See Partnerships for Training -- Robert Wood Johnson Foundation definition for further information - 7/96).

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16. What is a MAPP Clinical Practice Site?

A MAPP Clinical Practice Site is a community-based health care facility (clinic, hospital, nursing home, private practice, etc.) where systematic primary care services, clinical preempted experiences and mid-level (NP, PA and CNM) clinical practice opportunities are available to MAPP students. (See Partnerships for Training -- Robert Wood Johnson Foundation definition for further information - 7/96).

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17. What is the MAPP learner-centered, lifelong learning model?

The MAPP learner-centered, lifelong learning model is based on an attitude, a value system and a philosophy which is organized into a coherent educational system. As MAPP evolves, the learner remains "at the center". This means that MAPP Partners and participants share a common set of core values - the most basic of which is that educational institutions are in service to learners, not vice versa.

After specific skills, professional competencies, degrees and licenses are acquired, MAPP learners will continue to have access to MAPP Partner institutions and their resources throughout their lifetimes. MAPP lifelong learning systems and electronic documentation are being developed to support this fundamental value.

The MAPP Partners believe that the evolving "Information Age" and its wide array of constantly expanding technologies require that all health care professionals become self-directed, technologically competent, lifelong learners. The quality of health care in our communities increasingly depends on each professional person keeping up with new information and research findings, preventative strategies, and treatment options. Healthy communities depend on healthy people. High quality health care depends on continuous, lifelong learning by all health care professionals, as well as by the client population. TeleLearning technologies now make individualized learning, co-learning and electronic documentation possible and desirable. The MAPP lifelong learning system, along with appropriate training components, is being developed to account for this paradigm shift.

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18. What is the MAPP administrative/management model?

The initial MAPP administrative/management model was detailed in the MAPP Planning Grant proposal to RWJF (1995-96). The MAPP office is located at the University of Colorado Denver, within the structure of the AHEC office, which is the lead agency and fiscal agent for MAPP. The MAPP Project Director is the AHEC Executive Director (Dr. Marie Miller); other AHEC-related staff serve the MAPP project in specific administrative roles. The MAPP Regional Coordinator (Dr. Elinor Greenberg) has primary responsibility for guiding the project and for its management, as spelled out in the six year (1997-2002) Implementation Grant proposal to RWJF Throughout Colorado, MAPP is supported by four rural field-based AHEC Directors and their staffs, who cover the state outside the Denver metropolitan area. A MAPP urban strategy is being developed. In Wyoming, MAPP is supported by staff and faculty from the University of Wyoming's School of Nursing and by various statewide, health-related agencies.

The participating MAPP Education Institution Partners and the rural Colorado AHECs have subcontracts from MAPP, which specify their responsibilities. These contracts are updated annually to reflect the changing requirements of the six-year Implementation Phase of MAPP (1997-2002).

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19. What is the MAPP fiscal model?

The MAPP fiscal model is continually being developed. Grant funds and matching cash and in-kind services from the Robert Wood Johnson Foundation (RWJF), the Colorado Health Professionals Panel and the MAPP Partners supported the Planning Phase (10/95 - 12/96). Funding for the six-year (1997-2002) Implementation Phase has been awarded by the Robert Wood Johnson Foundation ($1.3 million), the State of Colorado's Education Technology Incentive and Continuation Grant Programs ($594,732) and the Colorado Technology Grant and Revolving Loan Program ($341,000), the Colorado Health Professions Panel ($40,000), the MAPP Partners, and others.

An innovative MAPP fiscal model is being developed for: student tuition and fees, video and Internet-based course delivery, collaborative course development and delivery, on-site teaching, precepting, TeleLearning, training and the MAPP lifelong learning system. The goal is to establish a MAPP fiscal model that is appropriate to and can support an inter-institutional, interdisciplinary, public-private, lifelong learning, technologically-enhanced, collaborative effort as external grant support decreases. Such a fiscal model is envisioned as creating a pool of MAPP resources which are non-FTE-based and which increase over time. This MAPP resource pool would be used in support of MAPP collaborative course development and implementation. The pool would be managed by a designated fiscal agent and the MAPP Partners. This will ensure MAPP's fiscal strength and self-sufficiency, over the long term.

Also, new opportunities for cooperative MAPP purchasing, leasing and/or negotiating for various technology-related items are being explored.

A variety of alternative fiscal models and cooperative arrangements currently exist among the MAPP Education Institution Partners and others. These are being explored to identify which, if any, can be adapted for use by MAPP. Key policy-makers and financial personnel are being consulted prior to the adoption of any new fiscal arrangements.

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20. Has MAPP done any program evaluation?

Between November 1997 and June 1998, the Mountain and Plains Partnership (MAPP) conducted in-depth telephone interviews with 28 MAPP Faculty and Students.  The goal of these interviews was to assess and evaluate the effectiveness and impact of the MAPP TeleLearning Center computers, which had been loaned to each of the twenty-eight interviewees. Open-ended interview questions were designed to elicit responses regarding four of the five project objectives: 1) learning via online courses; 2) impact of MAPP TeleLearning Center computers on academic, professional and personal lives; 3) what differences, if any, the MAPP TeleLearning Center has had on community health care; and, 4) adequacy of training and support. The fifth objective was to assess the effectiveness of the project's design.

The interviews were tape-recorded and transcribed. Interviewees were kept anonymous. Qualitative content analysis was completed on the responses, major themes were summarized and a rating scale was developed. At the conclusion of the assessment project, the fifth objective - assessing the effectiveness of this evaluation process - was completed.

In 1999, MAPP assessed the impact that access to computer-based technology and online education has had on the lives and professional careers of MAPP students and instructional faculty. This evaluation was achieved by conducting telephone interviews with 37 MAPP students and 9 MAPP ONLINE lead faculty members.  This study, entitled MAPP ONLINE VOICES: Listening to MAPP Online Voices, can be found in the web site in several forms: complete manuscript, summary, outline and power point presentations. ONLINE VOICES LINK

For more information about the results of these studies, contact Ellie Greenberg, MAPP Regional Coordinator, at 303-724-0339.