Highlighting Geriatric Inter-professional Social Work Programs Paul Gould, LCSW, PhD Frances Wilby, LCSW, PhD Visiting Assistant Professor, Executive Director W.D. Department of Social Work Goodwill Initiatives on AgingAssistant Director, Southern Tier Belle S. Spafford Endowed Center on Aging Chair in Social WorkBinghamton University College of Social Work, University

of Utah

Multidisciplinary Team Approach

– Professional Silos are common• “A multidisciplinary approach to service delivery means that

persons from several disciplines are involved in the delivery of services.

– The approach, however, is discipline-oriented with each team member responsible only for the activities related to his or her own discipline (Melvin, 1989; Rothberg, 1981).

– One team member is affected very little by the efforts of the other team members..”

Melvin, J. L. (1989, April). Status report on interdisciplinary medical education. Archives of Physical Medicine and Rehabilitation, 70, 273–276.Rothberg, J. (1981, August). The rehabilitation team: Future direction. Archives of Physical Medicine and Rehabilitation, 62, 407–410.as cited in Catlett, C. & Halper, A. (1992, Summer). Team Approaches: Working Together to Improve Quality ASHA Quality Improvement Digest. http://www.asha.org/uploadedFiles/aud/TeamApproaches.pdf

Interdisciplinary Team

• An interdisciplinary approach to service delivery requires– Interaction among the disciplines. – Not only are individuals from several disciplines working

toward a common goal, but the team members have the additional responsibility of the group effort (Rothberg, 1981).

– Effective communication is required among those involved (Melvin, 1989).

– The team includes the patient/client and his/her family

Melvin, J. L. (1989, April). Status report on interdisciplinary medical education. Archives of Physical Medicine and Rehabilitation, 70, 273–276.Rothberg, J. (1981, August). The rehabilitation team: Future direction. Archives of Physical Medicine and Rehabilitation, 62, 407–410.

as cited in Catlett, C. & Halper, A. (1992, Summer). Team Approaches: Working Together to Improve Quality ASHA Quality Improvement Digest. http://www.asha.org/uploadedFiles/aud/TeamApproaches.pdf

Transdisciplinary Team Model

“A transdisciplinary model includes the following components:

• one person can perform professionals’ roles by providing services to the patient/client under the supervision of the individuals from the other disciplines involved.

• Disciplines work together in the initial evaluation and care plan, but only one or two members actually provide the services.

• Professionals are still accountable for areas related to their specific discipline and for training the team member delivering the service” (e.g., ACT).

Bailey, D. B., & Wolery, M. (1989). Assessing Infants and Preschooler With Handicaps. Columbus, OH: Merrill Publishing Co.Connor, F. P., Williamson, G. G., & Stepp, J. M. (1978). Program Guide for Infants and Toddlers With Neuromotor and Other Developmental Disabilities. New York: Teachers College Press.

as cited in Catlett, C. & Halper, A. (1992, Summer). Team Approaches: Working Together to Improve Quality ASHA Quality Improvement Digest. http://www.asha.org/uploadedFiles/aud/TeamApproaches.pdf

Definition of Interprofessional Team Collaboration

“ Interprofessional collaboration is a ‘partnership’ between a team of health providers and a client in a participatory collaborative and coordinated approach to shared decision making around health and social issues.”

Canadian Interprofessional Health Collaborative. A national interprofessional competency framework. February 2010. Available from: http://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf

Interprofessional Collaborative Practice Principles

• A process by which professionals:– Reflect on and develop ways of practicing that provides an integrated and

cohesive answer to the needs of the client/family/population.– Involves continuous interaction and knowledge sharing between professionals.– Organized to solve or explore care and social issues while seeking to optimize the

patient’s participation.

Morrison S. Working together: why bother with collaboration? Work Bas Learn Prim Care. 2007;5:65–70.

Sources: Core Competencies for Interprofessional Collaborative Practice . Report of an Expert Panel, May 2011, Sponsored by the Interprofessional Education Consortium, p 8 . http://www.aacn.nche.edu/education-resources/ipecreport.pdf

Community Based Interprofessional Education

• Neighbors Helping Neighbors—HPPAE in the College of Social Work, University of Utah

• Service program providing services to older adults to remain independent in their homes and communities

• MSW students provide care management services to older adults

• Complete mini-rotations providing therapeutic groups in senior centers and bereavement groups.

• Complete one semester rotation in outside agency serving older adults

Community Based Interprofessional Education

When “students” from two or more professions learn about, from, and with each other to enable effective collaboration and to improve health outcomes*

*Framework for Action on Interprofessional Education & Collaborative Practice, World Health Organization, 2010

Disciplines represented:

• Social Work• Nursing• Gerontology Interdisciplinary

Program• Health Educators• Physicians• Nursing• Pharmacists• Licensed Professional Counselors

Community Based Interprofessional Education

• Activities– Care management of NHN

participants– Interdisciplinary Seminar

Series in Aging– Group work in senior

centers– Group work in

bereavement program– Hospice– Veterans Administration– Utah State Division of

Aging and Adult Services

How do professions work and learn together?• Nursing students and social work students

work together with NHN participants to improve quality of life.

• Presenters from different disciplines provide educational opportunities through the Interdisciplinary Seminar Series on Aging.

• Students from various disciplines attend the Interdisciplinary Seminar Series on Aging.

• Students in health concentration complete an interprofessional training module with nursing, medicine, P.T. , O.T., and pharmacy which includes a simulation lab.

• HPPAE students work in interprofessional teams in rotation placements.

• HPPAE-VA GRECC Program

Binghamton University HPPAEGeriatric Consultation Clinic

• Interprofessional Learning Experience

• Part of the rotational model for HPPAE

• MSW students collaborate with Medical Students from Upstate Medical University

• Conduct a 2-part Comprehensive Geriatric Assessment1. Home Visit2. Clinic Visit

• Team Structure:• Clinical Social Worker• Geriatrician• Students from both

disciplines• Family

Student LearningChief Complaint(s) Medical History Social History Family History Functional Assessment Review of Systems Routine Health

Maintenance Advance Directives Review of Medications

Tools used:• Mini-Mental State Exam

(MMSE)• Geriatric Depression

Scale• Clock Test• Get Up & Go Test• Home Safety Checklist• Elder Abuse Screening• 5 Wishes

Identified CompetenciesEPAS 2008

EP 2.1.3 – Apply critical thinking to inform and communicate professional judgments

EP 2.1.4 – Advance diversity and difference in practice

EP 2.1.7 – Apply knowledge of human behavior and the social environment

EP 2.1.10 – Engage, assess, intervene, and evaluate with individuals, families, groups, organizations and communities

GSCW-IIII-2 – Adapt interviewing methods

to potential sensory, language, and cognitive limitations of the older adult

II-3 – Conduct a comprehensive geriatric assessment

III-4 – Mediate situations with angry or hostile older adults and/or family members.

III-10 – Adhere to laws and public policies related to older adults

Binghamton University HPPAEMental & Behavioral Health Outreach

Multidisciplinary Learning Experience

HPPAE Fellows are placed in agencies which do not employ MSWs. Fellowship provides opportunities for community enhancement.

Agency Partners• Broome County Office for

Aging• Tioga Opportunities, Inc. –

Dept. on Aging• Broome County Council of

Churches• Association for Vision

Rehabilitation & Employment

• Rural Health Network of South Central New York

• Delaware County ARC• Retired Senior Volunteer

Program (RSVP)• Alzheimer’s Association

Identified CompetenciesEPAS 2008

EP 2.1.10 – Engage, assess, intervene, and evaluate with individuals, families, groups, organizations and communities

EP 2.1.8 – Engage in policy practice to advance social and economic well being and to deliver effective social work services

EP 2.1.6 – Engage in research-informed practice and practice-informed research

GSCW-IIIII-2 – Adapt interviewing

methods to potential sensory, language, and cognitive limitations of the older adult

III-3 – Utilize group interventions with older adults and their families.

III-5 – Assist caregivers to reduce their stress levels and maintain their own mental and physical health.

III-9 – Advocate on behalf of clients with agencies and other professionals to help elders obtain quality services

University of LouisvilleGeriatric Evaluation & Self-Management

(GEMS) Project Interdisciplinary Learning

Experience

Interdisciplinary home-based geriatric assessment services

SW & PT faculty, students & community providers collaborating with PCP

Self-management care plan including: Individualized exercises Community resources 8 phone calls over 12-week

period

• Experimental longitudinal, pre-post design to test two service delivery models:– Assessment and Brief

Intervention– Assessment and

Telehealth Intervention

GEMS Assessment Mini-Cog (dementia screening tool) General Assessment and Self-Management

Questionnaires Ecomap and Genogram Instrumental Activities of Daily Living (IADL) Physical Therapist Systems Review

(integumentary, cardiovascular, musculoskeletal, neuromuscular)

Functional Reach Test (balance) Timed Get Up and Go test (functional mobility) Timed Chair Stand Test (lower extremity muscle

strength) Geriatric Depression Scale 5/15 Lubben Social Network Scale

West Virginia UniversityGero Certificate Program

A credit-bearing gero certificate program that includes students from SW, public health, pharmacy, speech pathology, and nursing.

Developing an interprofessional CEU certificate scheduled to launch in January 2013

Rural Focus

Teaching Methods Labs Simulation Medical Paraprofessional Rural

Community dwelling and institutional older adults

Next WebinarEvaluation and Measurement of Inter-professional Geriatric Programs

Date: December 18th, 2012, 1:30 ESTFacilitator: Paul Gould, Binghamton University & Kris Hash University of West Virginia

Other Opportunities for Inter-professional Geriatric Education and Practice

Date: January 15th, 2012, 2:00 ESTFacilitator: Robyn Golden, Rush University