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Preparing Health Professionals for Models of Interdisciplinary Practice
in an Aging Society
JoAnn Damron-Rodriguez, PhD, LCSW
School of Public Affairs
Department of Social Welfare
University of California, Los Angeles
Taipei, Taiwan
May 17, 2010
Worldwide AgingPercent of Population over age 65Both Taiwan and USA in the 8.0 to 12.9 Category
Average Life Expectancy in Asian Countries and the U.S.A.
1986 1991 2005
Indonesia 55 61 70
Philippines
Taiwan
62
73
64
74
70
78
China 64 69 72
Japan 77 79 81
U.S. 75 75 78
OUR AGING WORLD: CHANGING THE SHAPE OF THE AMERICAN
POPULATION
THE FUTURE OLDER POPULATION WIIL:
BE MORE EDUCATED AND DIVERSE
BE CHALLENGED TO MANAGE CHRONIC
ILLNESS
DEMAND SERVICE CHOICES
HAVE FEWER FAMILY CAREGIVERS
OUTLINE
I. Preparing Competent Health Professionals in the Field of Aging
II. Interdisciplinary and Cross-Cultural Competence
III. Evidence-based Models of Interdisciplinary Healthcare
SOCIAL WORK RESPONSIBILITIES INToday’s Delivery System for the
Growing Population of Older Persons and Their Families
I. Patient Centered Care
II. Family Care giving Support
III. Community Care
IV. Cultural Competence
I.
COMPETENCE IS THE STANDARD Council on Higher Education Accreditation (CHEA)CBE Now Required 76 Different Professions
Define Competence
Competence:The state or quality of being adequately or well qualified… a specific range of skill, knowledge or ability
Professional Competence:The achievement and demonstration of core knowledge, values and skills in social work practice
Geriatric Competence:
Establishing geriatric competencies shape curricular, field training, and continuing education programs that effectively prepare practitioners to address the need of older adults and their families
Elements ofCompetency-Based
Education and Evaluation (CBE)for the Field of Aging
Adoption of defined set of competencies as a framework for education
Establishment of student learning goals based on the competencies
Assessment of student skill level using the identified competencies
Integration of classroom and field curricula
Hartford Foundation Geriatric Nursing and Social Work
Competencies :Cross-Cultural
Recognize one’s own and others’ attitudes, values, and expectations about aging and their impact on care of older adults and their families.
Respect diversity among older adult clients, families, and Professionals (e.g., class, race, ethnicity, gender, and sexual orientation).
Nursing Competency Social Work Competency
Diversity: Attitudes and Values Clarification
Appreciate the influence of attitudes, roles, language, culture, race, religion, gender, and lifestyle on how families and assistive personnel provide long-term care to older adults.
Address the cultural, spiritual, and ethnic values and beliefs of older adults and families.
Damron-Rodriguez,J.A. (2008). State of the science:
Developing nurse and social worker competence for professional practice with family caregivers.
American Journal of Nursing & Journal of Social Work Education
Geriatric Nursing and Social Work Competencies :
Family Caregiver Support
Family Education
Nursing Social Work
Involve, educate, and, when appropriate, supervise family, friends, and assistive personnel in implementing best practices for older adults.
Use educational strategies to provide older persons and their families with information for wellness and disease management.
Interdisciplinary Teamwork
Recognize the benefits of interdisciplinary team participation in care of older adults.
Understand the perspective and values of social work in working effectively with other disciplines in geriatric interdisciplinary practice.
Competencies to Learner Outcomes
Professional Competency
Educational Program
Learning Objectives
Learning Activities to Support Objectives
Assessing Competency-based Learner Outcomes
Multidisciplinary Interdisciplinary Transdiciplinary
Common goals
Individual efforts
Discipline expertise
Responsibility for groupeffort
Requires skills in effectivegroup integration
Each membersupports/enhancesprograms and activities
TYPES OF CROSS-DISCIPLINARY TEAMS
II.
Cross-Cultural Practice
Distribution by Race and Ethnicity
Asian Americansrefers to individuals who trace their heritage to the
following countries:
BangladeshBhutanCambodiaChinaHong KongIndiaIndonesiaJapan
MacauLaosMalaysiaMaldivesMongoliaMyanmarNepalNorth Korea
PakistanPhilippinesSingaporeSouth KoreaSri LankaTaiwanThailandVietnam
Minority Elders Barriers to LTCNeed Utilization
PROGRAM
APPROPRIATENESS
Geriatric Assessment, Level of Care Continuum, Continuity, Coordination,
ACCESSIBILITY
Information and referral, Healthcare coverage,
Location, Accommodate Disability, Intake, Hours, Translation
ACCEPTABILITY
Outreach, Cultural Diversity, Family Friendly
POPULATION
Acute, Chronic,Disease Prevalence,Symptom Presentation,
SES, Health Insurance,Immigration Status,Neighborhood,Language, Functional Level
Ethnicity, Support Systems, Acculturation,
STRUCTURAL
CULTURAL
IOM: Redesign models of care broaden provider & patient roles to achieve greater system responsiveness Needs must be addressed comprehensively
Services must be provided efficiently
Older persons must be active participants in their own care
Increased dissemination of more effective and efficient models is needed
Expanded roles of health care providers
III.
OLDER ADULTS AT RISK IN TRANSITION
Why at risk?
Co-morbidity
Disability
Frailty
At risk for?
Incompatibility in treatments
Polypharmacy/adverse drug events
Social Isolation/similarly frail caregivers
Rapid decompensation
Re-hospitalizations, institutionalization, mortality
Adults are Most Vulnerable at the Transitions in Care
1997 The Advisory Board Company
Needs/Circumstances of Clients
&
Family/Social Network
In-Community Services
Congregate Housing Services
In-Home Services
Institutional Services
IOM Recommendation: Care Coordination
•PACE
•Social HMO
•Medicare Coordinated Care Demonstration
•Arizona LTC System
Community Services
Adult day health care Congregate meals Exercise program Information and referral Legal Money management Outpatient mental health Protective services Public Guardian Recreation Respite care Senior Center Support groups Transportation
Home Services
Emergency response system Home-delivered meals Home health care Home Health Aide
Homemaker/Companion Telephone Reassurance Friendly Visitor Hospice Home repair Residential Services
Assisted living Continuing care retirement community Nursing Home Residential care (Board & Care) Senior Citizen Apartments Shared Housing
Site of Program in Community-Based Care
IOM Recommendation: Interdisciplinary Teams
For Geriatric Assessment and Intervention
Functional Status
Social Support
Spirituality
Affective
Medical
Cognitive
Environment
Economic
•IMPACT •GRACE
.
IMPACT Intervention Team FlowDepression Care Specialist (PCP)=Nurse or Social Worker , Primary Care Doctor, Psychiatrist
PCP Team Referral
Initial visit with DCS Consult with PCPand team psychiatrist
Step 1 treatment
Reevaluation
Relapse prevention
Consult with team psychiatrist -> adjust
Treatment plan
IOM Recommendation: Involvement of Family and Caregiver
•AIM
•IDEAtel
•Family Health Options
Primary Care in the Veterans Primary Care in the Veterans Health AdministrationHealth Administration
Largest integrated health care system in the US
Comprehensive electronic medical record
>850 sites of Primary Care
152 Medical Centers
>700 Community Based Outpatient Clinics (CBOC)
4.8 million primary care patients-each assigned to an individual primary care provider
53% in 12 million encounters/year in CBOCs
Patient Centered Primary CarePatient Centered Primary Care
Replaces episodic care based on illness and patient complaints with coordinated care and a long term healing relationship
The Primary Care Team Takes collective responsibility for patient care
Responsible for providing all the patient’s health care needs
Arranges for appropriate care with other specialties as needed
Enhanced Access
Enhanced communication between
Patients
Providers
Staff
Team-based CarePatient-centered Care
Continuous Improvement
Pillars of the Medical HomePillars of the Medical Home
Patient-Centered Patient-Centered PerspectivePerspective
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