1. Team Form & Functions: From Multi-Disciplinary to Interprofessional Collaborative Geriatric Teams- Assessment & Educational Models
Marla Berg-Weger
Professor, School of Social Work
Executive Director, Geriatric Education Center
Saint Louis University
Debra Fromm Faria
V. Associate Professor, Social Work
Co-Director Center for Excellence in Gerontological Social Work
College at Brockport, State University of New York
Webinar
October 23, 2012
The Presenters also wish to acknowledge a collaborative input for some of the health care slides by Assistant Professor Thomas Caprio, MD,MPH, FACP, University of Rochester Medical Center , School of Medicine, Division of Geriatrics

2. Objectives Define types of teams Multidisciplinary Interdisciplinary
Interprofessional
Transprofessional
Understand the roles of interprofessional team members
Describe the value of interprofessional geriatric assessment
Introduce model of using interprofessional education in clinical settings and courses to prepare the next generation of interprofessional team members
Provide resources for future use

3. What are the differences and similarities with types of teams?
The terms multidisciplinary, interdisciplinary, interprofessional and transdisciplinary often are used interchangeably.
It is useful to understand definitions, and assess how our teams are functioning

4. 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.

5. 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.

6. 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.

7. Example of Transdisciplinary Team in Behavioral Health
Assertive Community Team (ACT)
Evidence–Based Practice Model designed to provide treatment, rehabilitation and support services to individuals
diagnosed with a severe mental illness
whose needs have not been met with traditional mental health services
ACT team:
psychiatry, nursing, psychology, social work, substance abuse & vocational rehabilitation.
Based on respective areas of expertise, team members collaborate to deliver integrated services of the recipients' choice,
assist in making progress towards goals,
adjust services over time to meet recipients' changing needs and goals.
NYS Office of Mental Health, Assertive Community Treatment

8. 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 Available from:

9. 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 .

10. Benefits of an Interprofessional Team Approach
Interprofessional approaches to health and social care are linked to improved clinical services and enhanced problem-solving
(Mitchell, Parker& White, 2010)

11. Characteristics of Effective Collaborative Interprofessional Teams
Belief that the team is important to the outcome
Open communication
Equality of resources
Respect
Shared decision making
All members feel valued

12. Meet Mrs. C.

13. Mrs. C. Social History Data
92-year-old woman lives alone
Widowed 14 years ago; daughter lives locally and son lives in Arizona
Worked for 15 years as an executive secretary at a local company
Active in her faith community all her life
Volunteers in a children’s reading program at the local library

14. Case Presentation - Mrs. C. Health History
Multiple chronic health problems (Cardiac, Pulmonary, Diabetes, Arthritis)
Hospitalized for shortness of breath and chest pain twice in the last 3 months

15. Acute Incident Falls at home Taken by ambulance to the hospital
paramedics arrive and find her with right leg pain and unable to walk
Taken by ambulance to the hospital

16. Diagnosed with Hip Fracture

17. Admitted for surgery and day #2 develops worse shortness of breath, complaints of pain, nausea, and constipation

18. Mrs. C. - Discharge Planning
Fearful of falling, hard time using walker
Discharged to a skilled nursing facility for rehabilitation

19. Mrs. C. - Rehab Update
4 weeks of rehabilitation: family is concerned about her returning home alone
They report Mrs C. has a history of several falls at home without injury
Family is concerned she is
“taking her medications wrong”
sometimes they notice “she is wearing clothes that have stains and appear dirty”

20. Mrs. C. - Rehab Discharge Outcome
Discharged back home after 6 weeks
Plan includes:
Home Care Aids 4 hours per day
Weekly nursing visits
Referral to outpatient PT
Daughter plans on shopping weekly and setting up mediset

21. Mrs. C. - Five days later…..
Family brings Mrs C back to hospital Emergency Department
Increased confusion, not eating/drinking
Found on the floor where it appeared she had been for many hours after aide left in morning and daughter visited at night
Admitted to the hospital with pneumonia, dehydration, and “failure to thrive”

22. With which health care teams did Mrs. C. interface?
Hospital: Multi-Disciplinary?
discipline-oriented with each team member responsible only for the activities related to his or her own discipline. Communicate with one another through chart documentation and unit reports.
Rehabilitation Nursing Home Stay?
Likely interdiscplinary / perhaps interprofessional
Discharge Home?
Multi-Disciplinary
PCP for medical Care
Home Care agency
Outpatient PT clinic
Family

23. Mrs. C.’s Story: Important to Assess how team function can improve across service sectors
Next steps in management?
How could this have been prevented?
How can the team think about?
Prior level of function at home
Hospital management
Rehabilitation course in nursing home
Home Care Plan and safeguards
What about:
Cognitive & psychosocial strengths and challenges
Family caregiving & interface with the formal care system
Functional & Environmental Factors

24. Why the need for interprofessional collaboration and effectiveness?
Population is Aging:
Largest increase in Age > 85
Older adults are seen as patients/clients in all health care settings
Source: Administration on Aging, January 2004

25. Where are older adults interfacing with service providers?
Home (independent in the community)
Home (with Home Care Services)
Independent or Senior Housing
Assisted Living Facilities
Adult Day Care Programs
Long-Term Care Facilities (Nursing Homes)
Rehabilitation Centers
Hospitals
Community Retail Providers (Pharmacy )

26. What challenges do older adults experience as they age?
Disability (loss of function)
Comorbidity (chronic medical conditions)
Frailty (vulnerability)
Multiple Losses (compounding effect)

27. Why is assessment important?
Goal: decrease disability and dependence
Identify “pre-clinical” disability
Majority older adults live independently
50% Lifetime Risk of nursing home placement

28. Geriatric Syndromes Vision impairment Hearing loss Incontinence
Broad categories of signs and symptoms common in the geriatric population
Vision impairment
Hearing loss
Incontinence
Falls/Mobility
Depression
Memory disorders
HELP!

29. What is geriatric assessment?
Method to identify problems/challenges early
Goal to maintain or improve FUNCTION
Screen for common problems of aging (geriatric syndromes)
Identifies the strengths/resilience of the individual and family system
Performed by interdisciplinary/interprofessional team
Focus on chronic disease management and effective resource utilization to enhance quality of life
Debra *
ACUU Conference 2010

30. Geriatric Assessment: Interprofessional Team Interface
Comprehensive assessment is performed by an interdisciplinary/interprofessional team
Each team member’s professional domain knowledge is recognized. Collaborative team practices are central to the model. Allowing for contextual understanding of complex issues.
Geriatricians
Social Workers
Patient/Family
Neuropsychologists
Nurses
Pharmacists

31. Addressing Complexities Through an Interprofessional Approach
Medicine
Association of American Medical Colleges / John A. Hartford Foundation, Inc. July 2007 Consensus Conference on Competencies in Geriatrics Education
Academic Medicine. 84(5):604-10, May 2009.
Nursing
John A. Hartford Foundation
Institute for Geriatric Nursing,2002
Social Work
Geriatric Social Work Competency Scale II with Life-long Learning in Relationship to Leadership Skills
Assess & describe baseline and current functional abilities in an older patient (ADLs/IADLS) by collecting historical data and performing a confirmatory physical exam
Demonstrate within care plan appropriate intervention to promote function in response to change in ADLS and IADLS
Conduct a comprehensive biopsychosocial-spiritual assessment identifying older adults strengths and problems, social supports, social functioning, ADL and IADLs
Interface of
Geriatric
Competencies
Functional
Assessment

32. Interface of Competencies
Interface of Competencies
Medication
Management
Medicine
Association of American Medical Colleges / John A. Hartford Foundation, Inc. July 2007 Consensus Conference on Competencies in Geriatrics Education Academic Medicine. 84(5):604-10, May 2009.
Pharmacist
Medication Management Therapy in Pharmacy Practice, (2008).
Nursing
Geriatric Social Work Competency Scale II with Life-long Learning in Relationship to Leadership Skills
Explain impact of age-related changes on drug selection and dose based on knowledge of age related changes in renal & hepatic function, body composition & CNS sensitivity
Perform basic elements of geriatric pharmacotherapy assessments, interpret physical, laboratory and diagnostic test results, monitor drug therapy, provide medication counseling
Assess barriers, drug interactions, … that impact patients’ understanding of information, following directions and making needs known.

33. Components of Geriatric Assessment
Cognitive
Social
Economic
Family Dynamics
Medical
Functional
Psychological

34. Dimensions of Geriatric Assessment: Medical Assessment
Geriatric Syndromes:
Vision & Hearing
Incontinence
Falls/Mobility
Memory/Mood
Nutrition
Pain
Past Medical and Surgical Histories
Family History
Physical Exam
Review Medications:
Polypharmacy
“Bad Drugs”
Tom *
ACUU Conference 2010

35. Medication Review: Medicine, Nurse Practitioners and Pharmacy
Drug distribution and metabolism altered with aging
Adverse Drug Reactions & Drug-Drug Interactions
Number of medications
OTC and herbal/dietary
“Inappropriate” Meds: falls, urinary problems, delirium, hospitalizations
While Social Workers are not the primary profession dealing with medication review, observations from home assessments, knowledge of environmental issues such as finances can inform the interprofessional team

36. Functional Assessment: Activities of Daily Living (ADL)
Geriatric Assessment
Functional Assessment: Activities of Daily Living (ADL)
Dressing
Eating
Bathing/Hygiene (personal care)
Toileting (+/- continence)
Mobility
Ambulating
Transferring
ACUU Conference 2010

37. Instrumental Activities of Daily Living (IADLs)
Shopping
Housekeeping (cleaning, laundry)
Finances
Cooking
Using telephone
Medications
Transportation (driving, buses, etc.)

38. Psycho-Social * Social History
Geriatric Assessment
Psycho-Social
Social History
Contextual understanding of who the patient is
Presenting Challenges & Goals
Patient perspective
Family perspective
Mental Health Assessment
Coping skills, stressors, risk factors, depression screen
Social Functioning Assessment
Social skills, social activity level, social supports
Caregiver Needs/Levels of Stress
Debra *
ACUU Conference 2010

39. Assessment Cognitive Function
Dementia
Mild Cognitive Impairment
Normal Aging
Alzheimer’s Disease

40. DEMENTIA
Cognition
Behavior
Function

41. Geriatric Assessment Assessments depend on context and location:
Hospital – discharge planning
Clinic/office – comprehensive assessment
Nursing Home – improve or maintenance
Home – mobility and safety
Rehabilitation – improve function

42. Core Areas Functional assessment (observations)
Areas of concern (mobility impairment, weakness, ROM, falls, etc.)
Medical Conditions (dementia, CHF, etc.)
Rehabilitation tolerance and potential
Psycho/Social Assessment

43. Establishing Goals with Older Adults
Geriatric Assessment
Establishing Goals with Older Adults
Individualized and person-centered
Maintain independence longer
Reduce stress or burden on caregivers
Gradual or stepwise loss of function common in patients
Some older adults’ function may “plateau” after an illness or injury
Small improvements in physical function go a long way (high “investment payoff”)
Tom *
ACUU Conference 2010

44. Function Time Family & Caregiver Stress Nursing Home
Functional Decline:
Illness
Good Health
Functional Impairment
Hospitalizations
Family & Caregiver Stress
Function
Rehab
Threshold
Nursing Home
Disability
Time

45. Summary
Interprofessional team collaboration improves communication and patient/client outcomes
Geriatric assessment emphasizes functional status and the goal of maximizing independence and quality of life
Loss of function is common but small improvements go a long way
Person-Centered Approach

46. Next Steps: Workforce Preparation through Interprofessional Educational Models
Engaging students across professional disciplines
Source: Core Competencies for Interprofessional Collaborative Practice . Report of an Expert Panel, May 2011, Sponsored by the Interprofessional Education Consortium, cover page picture.

47. What is Interprofessional Education?
When “students” from two or more professional 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

48. Educational Models to Prepare Competent Interprofessional Practitioners
“The transformation envisioned would enable opportunities for health professions students to engage in interactive learning with those outside their profession as a routine part of their education”
Source: Core Competencies for Interprofessional Collaborative Practice . Report of an Expert Panel, May 2011, Sponsored by the Interprofessional Education Consortium, p3.

49. Educational Strategies in Fostering Interprofessional Collaborative Practice
Patient/family centered
Community/population oriented
Relationship focused
Process oriented
Linked to learning activities, educational strategies, and behavioral assessments that are developmentally appropriate for the learner
Able to be integrated across the learning continuum
Sensitive to the systems context/applicable across practice settings
Applicable across professions
Stated in language common and meaningful across the professions
Outcome driven
Source: Core Competencies for Interprofessional collaborative Practice
Report of an Expert Panel, May 2011, Sponsored by the Interprofessional Education Consortium

50. Partnership for Health in Aging (PHA)
Competencies in the Care of Older Adults at the Completion of the Entry-level Health Profession
Representing 10 Health Care Professions
Dentistry
Medicine
Nursing
Nutrition
Occupational Therapy
Pharmacy
Physical Therapy
Physician Assistants
Psychology
Social Work
Partnership for Health in Aging (PHA)
Developed broad competencies in six domains to provide a baseline for geriatrics and gerontology training
To Access competencies: ments/health_care_pros/PHA_Multidisc_Co mpetencies.pdf

51. Health Promotion and Safety Evaluation and Assessment
Competencies in the Care of Older Adults at the Completion of the Entry-level Health Profession
Domains:
Health Promotion and Safety
Evaluation and Assessment
Care Planning and Coordination Across the Care Spectrum
Interdisciplinary and Team Care
Caregiver Support
Healthcare Systems and Benefits
Source: Partnership for Health in Aging Workgroup on Multidisciplinary Competencies in Geriatrics

52. Endorsements Competencies in the Care of Older Adults at the Completion of the Entry-level Health Profession
Alliance for Aging Research
American Academy of Nursing – Expert Panel on Aging*
American Academy of Physician Assistants
American Assisted Living Nurses Association*
American Association of Colleges of Pharmacy
American Association for Geriatric Psychiatry
American Association for Long Term Care Nursing*
American Association of Nurse Assessment Coordinators*
American College of Clinical Pharmacy
American Dental Association
American Dietetic Association
American Geriatrics Society
American Occupational Therapy Association
American Pharmacists Association
American Physical Therapy Association
American Society on Aging
American Society of Consultant Pharmacists
Association of Directors of Geriatric Academic Programs
Association for Gerontology in Higher Education
Council on Social Work Education
Gerontological Advanced Practice Nurses Association*
Gerontological Society of America
The Hartford Institute for Geriatric Nursing*
National Association for Geriatric Education
National Association of Geriatric Education Centers
National Association of Directors of Nursing Administration in Long Term Care*
National Association of Professional Geriatric Care Managers
National Gerontological Nursing Association*
New York Academy of Medicine/Social Work Leadership Institute
PHI – Quality Care through Quality Jobs

53. Lessons Learned….
Social workers are experts on interprofessional collaboration so should be at the forefront
Review the Core Competencies for Interprofessional Collaborative Practice
Utilize the Partnership for Health and Aging (PHA) Core Competencies to establish dialogue with other professions in exploring interprofessional educational opportunities
Remember: Interprofessional Education as a model is a long term “process”
Seek funding

54. Getting Started…. Determine your goals for interprofessional education
Gain support from university leadership at all levels
Conduct syllabus audit to identify strengths and areas for change related to interprofessional content
Document and promote the interprofessional collaboration strengths of the social work profession

55. Getting started… Curricular interventions:
Integration into existing courses (including practicum seminar)
Cross-listing courses
Co-teaching courses
Certificate/minor/specialization
If your university has no health professions, consider reaching out to the community

56. Resources: Interprofessional Teams, Assessment & Instruction Tools
King, G., Shaw, L., Orchard, C., & Miller, S. (2010). The interprofessional socialization and valuing scale: A tool for evaluating the shift toward collaborative care approaches in health care settings. (35 ed., pp ). IOS Press.
Team Fitness Test (GITT) Geriatric Interprofessional Team Tools) available
Models of Care and Inter-Professional Care Related to Complex Care of Older Adults by Sharon Stahl Wexler pdf download available at : hartfordign.org/uploads/File/.../gnec_interdisciplinary_care.pdf
GITT video on You Tube available: available at
Interprofessional Care and Training ( Pharmacy & Medicine) University of Pittsburgh available at

57. Resources: Interprofessional Teams, Assessment & Instruction Tools
Online training module on Interprofessional Geriatric Assessment available from the Finger Lakes Geriatric Center (Includes Social Work)
The Center for Interprofessional Education and Research, Saint Louis University ipe.slu.edu
The National Coordinating Center for Interprofessional Education and Collaborative Practice, University of Minnesota
For information on this new project, contact: Barbara F. Brandt; 612/

58. Resources: Interprofessional Teams, Assessment & Instruction Tools
American Association of Colleges of Pharmacy (AACP)*
*See Core Competencies for Interprofessional Education
Framework for Action on Interprofessional Education & Collaborative Practice