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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.

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Presentation on theme: "Preparing Health Professionals for Models of Interdisciplinary Practice in an Aging Society JoAnn Damron-Rodriguez, PhD, LCSW School of Public Affairs."— Presentation transcript:

1 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

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

3 Average Life Expectancy in Asian Countries and the U.S.A Indonesia Philippines Taiwan China Japan U.S.75 78

4 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

5 OUTLINE I. Preparing Competent Health Professionals in the Field of Aging II. Interdisciplinary and Cross-Cultural Competence III. Evidence-based Models of Interdisciplinary Healthcare

6 SOCIAL WORK RESPONSIBILITIES IN Todays 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.

7 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

8 Elements of Competency-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

9 Hartford Foundation Geriatric Nursing and Social Work Competencies :Cross-Cultural 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). Nursing CompetencySocial 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

10 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.

11 Competencies to Learner Outcomes Professional Competency Educational Program Learning Objectives Learning Activities to Support Objectives Assessing Competency-based Learner Outcomes

12 TYPES OF CROSS-DISCIPLINARY TEAMS II.

13 Cross-Cultural Practice

14 Distribution by Race and Ethnicity

15 Asian Americans refers 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

16 Minority Elders Barriers to LTC Need 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, STRUCTURALSTRUCTURAL CULTURALCULTURAL

17 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.

18 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

19 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

20 IOM Recommendation: Care Coordination PACE Social HMO Medicare Coordinated Care Demonstration Arizona LTC System

21 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/Companio n 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

22 IOM Recommendation: Interdisciplinary Teams For Geriatric Assessment and Intervention Functional Status Social Support Spirituality Affective Medical Cognitive Environment Economic IMPACT GRACE

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26 IMPACT Intervention Team Flow Depression 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 Reevaluation Relapse prevention Consult with team psychiatrist -> adjust Treatment plan

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28 IOM Recommendation: Involvement of Family and Caregiver AIM IDEAtel Family Health Options

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30 Primary Care in the Veterans Health 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

31 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 specialties as needed Enhanced Access Enhanced communication between Patients Providers Staff Team-based Care Patient-centered Care Continuous Improvement Team-based Care Patient-centered Care Continuous Improvement

32 Pillars of the Medical Home The primary care team is focused on the whole person Patient-preferences guide the care provided to the patient Patient-Driven Primary care is delivered by an interdisciplinary team led by a primary care provider using facilitative leadership skills Team-Based Veterans receive the care they need at the time they need it from an interdisciplinary team functioning at the highest level of their competency Efficient Primary care serves as point of first contact for a broad range of medical, behavioral and psychosocial needs, fully integrated with other VA health services and community resources Comprehensive Every patient has an established and continuous relationship with a personal primary care provider Continuous The communication between the Veteran patient and other team members is honest, respectful, reliable, and culturally sensitive Communication The PCMH team coordinates care for the patient across and between the health care system including the private sector Coordinated

33 Patie nt Personal Health Care Building Relationships Preferred means of communication Involving families and caregivers Continuity Clinical Management Provider/Team Information Shared Decision Making Preference centered health care choice made by the patient together with the provider Education Decision Support Tools Resources Patient Participation New patient orientation Personalized brochures Staff information Patient advisory board Focus groups Self Management Patients, not health care providers, are the primary managers of their health conditions Education Support Tools Resources Home Telehealth, My HealtheVet, Other tools Provider skills Cultural competency Motivational interviewing Patient-Centered Perspective

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35 THANK YOU FOR INVITING ME JoAnn Damron-Rodriguezs


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