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Round Table on Value & Science-Driven Health Care
Institute of MedicineJuly 27, 2011
Presented ByPatricia J. VollandRobyn L. Golden
GERIATRIC SOCIAL WORK INITIATIVES
Interdisciplinary skill set Participate in
comprehensive assessment and monitoring
Help coordinate among multiple providers
Integrate social, psychological and environmental with medical
Advocate for client and link to resources across settings
The Hartford Partnership Program for Aging Education (HPPAE)
- Goals of the HPPAE: Educate over 2,500 Social Workers to work with
older adults Establish the HPPAE as the norm for MSW
programs- Innovative field education model provides multiple
rotations integrated with academic learning- Competency-based educational model- Leadership focus for Deans, Directors and Students
Training Future Generations of Social Workers
HPPAE Status Today
2,615 HPPAE Graduates as of 2011
89 MSW Programs that have implemented HPPAE
+ 22 MSW Programs planning to implement HPPAE
111 Total MSW Programs engaged in HPPAE Mode out of 203 CSWE accredited programs
HPPAE Competency Goals
Identification and implementation of geriatric social work competencies in both classroom and field
Emphasize measuring changes in competence over the course of the student’s educational experience through pre and post testing
HPPAE Competency Scale organized into 5 domains:I. Values, Ethics, and Theoretical PerspectivesII. AssessmentIII. InterventionIV. Aging Services, Programs, and PracticesV. Leadership Practice in the Field of Aging
Evaluation of Student Outcomes
Administration of pre and post testing: Knowledge of Aging for Geriatric Social Work Test Knowledge of Services for Older Adults Test HPPAE Geriatric Social Work Competency Scale Self-Reported
Assessment
HPPAE Career Tracking Survey
Preliminary analysis of the career tracking data shows that approximately 8 in 10 MSW graduates who participated in the HPPAE work with older adults
The HPPAE appears to facilitate careers focusing on services to older adults. 61% reported that they would like aging to be the primary focus in
their career
Another 37% reported wanting their career both older adults and other adults
27% of graduates report being hired to work at one of their rotation sites following discharge
HPPAE Interdisciplinary Focus
Year end reports highlight schools are focusing on interdisciplinary training opportunities in field placements, courses/seminars and development of competencies Interdisciplinary initiatives within HPPAE programs: Several
schools have targeted increased collaboration with other disciplines to address geriatric education
Increased agency based interdisciplinary experiences for students during rotations
Development of “Centers on Aging” at HPPAE sites provide venues to facilitate interdisciplinary collaboration and learning
Social Workers and Interdisciplinary Teams in Practice
Social workers are both a valuable contributor to a team and an effective leader
This can be seen in two successful models utilizing social workers as team coordinators BRIGHTEN
- Virtual interdisciplinary program integrating mental health into primary care
Enhanced Discharge Planning Program (EDPP)- Transitional care model provided by Master’s-prepared
social workers from a biopsychosocial perspective
BRIGHTEN Team
Along with the social workers, the team is comprised of: Patient Geropsychologist Geropsychiatrist Physical Therapist Occupational Therapist Nutritionist Chaplain Pharmacist Primary Care Physician
EDPP SW + Pt/Cgvr
Pharmacist
Home Health Care
Hospitalist
Discharge Planner
Patient Relations
RN
ApptSchedulers
Dept of Aging
HCBS Providers
Dept of Rehab Services
Dialysis Center
Primary Care Provider
Hospital Community
EDPP Team
BRIGHTEN Process
Entry into BRIGHTEN
Assessment with Program Coordinator
Results sent electronically to the BRIGHTEN team
Recommendations presented to patient; Treatment plan developed collaboratively
Virtual Staffings
Outcome Assessment
Continued evidence-based treatment and virtual staffing as necessary
Evidence-Based Treatment Provided
© Rush University Medical Center, 2009
Referral Pre-Assessment Assessment Intervention
EDPP Process
0
2
4
6
8
10
12
14
16
Baseline Month 1 Month 2
Time
PHQ-
9 To
tal S
core
Depression Results: N=44
BRIGHTEN Outcomes
Clinical Range
Anxiety Results: N=44
02468
101214161820
Baseline Month 1 Month 2
Time
BAI T
otal
Scor
e
Moderate Anxiety
Patients receiving the EDPP intervention were significantly more likely to: Communicate with their PCP within 30 days of discharge Schedule and attend their post-discharge appointments
(χ²=9.88, p=.001)
Patients scheduling and attending follow-up appointmentsIntervention Usual Care
Yes 239 (74.9%) 206 (57.4%)No 80 (25.1%) 153 (42.6%)
© Rush University Medical Center, 2009
EDPP Outcomes
Readmissions to Rush University Medical CenterSince Discharge Intervention Usual Care p-value30 days 13.6% 16.1% .20160 days 20.8% 27.5% .031*90 days 26.4% 34.2% .018*120 days 30.8% 36.5% .078180 days 36.1% 42.5% .068
© Rush University Medical Center, 2009
*significant at the p<.05 level
Mortality at 30 days, p=0.03Overall (n=740) Intervention (n=360) Usual Care (n=380)
Alive 712 (96.2) 352 (97.8) 360 (94.7)
Dead 28 (3.8) 8 (2.2) 20 (5.3)
EDPP Outcomes
Gaps to Incorporating Social Workers in Team/Interprofessional Efforts
Few evidence-based team models incorporate social work participation with a specified role
Social Work role and contribution not clearly understood
No financial incentives for Social work values and skills on teams
Policy Implications
Components of the Affordable Care Act could benefit from team involvement Community Based Care Transitions Patient Centered Medical Homes Bundled Payments Accountable Care Organizations
Other legislation with team implications Positive Aging Act of 2011 (S. 525) Retooling the Health Care Workforce for an Aging America
Act (H.R. 468)
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