Preparing Health Professionals for

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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
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Worldwide AgingPercent of Population over age
65Both Taiwan and USA in the 8.0 to 12.9 Category
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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
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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

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OUTLINE

1. Preparing Competent Health Professionals in the
   Field of Aging
2. Interdisciplinary and Cross-Cultural Competence
3. Evidence-based Models of Interdisciplinary
   Healthcare

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SOCIAL WORK RESPONSIBILITIES IN Todays Delivery
System for the Growing Population of Older
Persons and Their Families
I.

1. Patient Centered Care
2. Family Care giving Support
3. Community Care
4. Cultural Competence

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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

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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

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Hartford Foundation Geriatric Nursing and
Social Work Competencies Cross-Cultural
Nursing Competency
Social Work Competency
Diversity Attitudes and Values Clarification
Recognize ones 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).
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
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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
Understand the perspective and values of social
work in working effectively with other
disciplines in geriatric interdisciplinary
practice.
Recognize the benefits of interdisciplinary team
participation in care of older adults.
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Competencies to Learner Outcomes

• Professional Competency
• ?
• Educational Program
• ?
• Learning Objectives
• ?
• Learning Activities to Support Objectives
• ?
• Assessing Competency-based Learner Outcomes

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TYPES OF CROSS-DISCIPLINARY TEAMS
II.
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Cross-Cultural Practice
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Distribution by Race and Ethnicity
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Asian Americansrefers to individuals who trace
their heritage to the following countries

• Bangladesh
• Bhutan
• Cambodia
• China
• Hong Kong
• India
• Indonesia
• Japan

• Macau
• Laos
• Malaysia
• Maldives
• Mongolia
• Myanmar
• Nepal
• North Korea

• Pakistan
• Philippines
• Singapore
• South Korea
• Sri Lanka
• Taiwan
• Thailand
• Vietnam

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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, Langu
age, Functional Level Ethnicity, Support
Systems, Acculturation,
STRUCTURAL
CULTURAL
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IOM Redesign models of care broaden provider
patient roles to achieve greater system
responsiveness
III.

• 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

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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

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Adults are Most Vulnerable at the Transitions
in Care 1997 The Advisory Board Company
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IOM Recommendation Care Coordination

• PACE
• Social HMO
• Medicare Coordinated Care Demonstration
• Arizona LTC System

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Site of Program in Community-Based Care
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IOM Recommendation Interdisciplinary TeamsFor
Geriatric Assessment and Intervention

• IMPACT
• GRACE

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IMPACT Intervention Team FlowDepression Care
Specialist (PCP)Nurse or Social Worker , Primary
Care Doctor, Psychiatrist
PCP Team Referral
Initial visit with DCS
Consult with PCP and team psychiatrist
Step 1 treatment
Consult with team psychiatrist -gt
adjust Treatment plan
Reevaluation
Relapse prevention
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IOM Recommendation Involvement of Family and
Caregiver

• AIM
• IDEAtel
• Family Health Options

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Primary Care in the Veterans Health Administration

• Largest integrated health care system in the US
• Comprehensive electronic medical record
• gt850 sites of Primary Care
• 152 Medical Centers
• gt700 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

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Patient 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 patients
  health care needs
• Arranges for appropriate care with other specialti
  es as needed 
• Enhanced Access
• Enhanced communication between
• Patients
• Providers
• Staff

Team-based Care Patient-centered Care Continuous
Improvement
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Pillars of the Medical Home
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Patient-Centered Perspective
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THANK YOU FOR INVITING ME

• ????
• JoAnn Damron-Rodriguezs e-mail jdamron_at_ucla.edu