preparing health professionals for models of interdisciplinary practice in an aging society joann...

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

34

THANK YOU FOR INVITING ME

感謝聆聽

JoAnn Damron-Rodriguez’s e-mail: jdamron@ucla.edu