Innovations in Geriatric Education:Considering Cross-Disciplinary Applications of the HPPAE Model

Geriatric Competencies Provide Curricula for and Evaluation of Geriatric Education

JoAnn Damron-Rodriguez, LCSW, PhD

University of California, Los Angeles

Mandate for Competence

Council on Higher Education Accreditation (CHEA), oversees standards for 76 professions adopted a competency model for accreditation (National Center for Higher Education Management Systems, 2000)

Growing necessity for Evidence-based Practice (EBP), Best Practices, Practice Guidelines

Competence Based Education and Evaluation (CBE) is the educational equivalent of EBP

Competency-Based Education and Evaluation (CBE)

Definition of Competence Competence: The state of being adequately or well qualified… a specific

range of knowledge, values and skills

Geriatric Competence: Continuing programs in order to effectively prepare practitioners to address the need of older adults and their families

Essential Elements CBE1) Adoption of a defined set of specific skills (competencies) as a

framework for education in a field of practice

2) Applying the competencies to individual student learning goals

2) Assessment of student skill level, at the beginning oftraining and upon completion, using the identified set of competencies (Bogo et al, 2004)

National Incorporation of Gero Social Work Competencies

I. Council on Social Work Education (CSWE) 2008 Educational Policy and Accreditation Standards (EPAS)

a competency-based outcome approach to curriculum design

a focus on student outcomes based in practice behaviors

competencies are measurable practice behaviors

II. Hartford Geriatric Social Work Initiative Task Force for Advanced Gero Practice (2009)

Relating Gero Social Work Knowledge and Practice Behaviors to EPAS

EXAMPLE CBE APPLICATIONEPAS Competence: Apply critical thinking to inform

and communicate professional judgments

ACTIVITIES, ASSIGNMENTS, READINGSACTIVITIES, ASSIGNMENTS, READINGSADVANCED GERO

PRACTICE BEHAVIORS

CLASS EXERCISES ASSIGNMENTS/MEASUREMENT*

EVIDENCE BASED PRACTICE

Relate concepts and theories of aging to social work practice (e.g., cohorts, normal aging, and life course perspective).

Multigenerational Issues in Caregiving

Perspectives on Older Adults and the Aging Family Safety Checklist/Home visit interview (page 7 of syllabus)

Toseland, R. W.; Blanchard, C. G.; Mccallon, P. (1995). A Problem-Solving Intervention for Caregivers of Cancer-Patients. Social Science & Medicine, 40:4, 517.

Relating Gero Social Work Knowledge and Practice Behaviors to EPAS

Cross Disciplinary Geriatric Competencies

www.socialworkleadership.org

Nursing American Association of Colleges of Nursing and the Institute for Geriatric Nursing

Older Adults: Recommended Baccalaureate Competencies and Curricular GuidelinesGeropsychiatric Nursing CompetenciesAdult/Gero Primary Care Nurse Practitioner CompetenciesAdult/Gero Nurse Practitioner Competencieshttp://www.aacn.nche.edu/Education/adultgerocomp.htm

MedicineAmerican Geriatric Society Geriatric Competencies for Medical StudentsInternal Medicine/Family Practice Residency TrainingSurgical and Related Medical Specialties http://www.americangeriatrics.ogr/health_care_professionals/education/curriculum_guidelines

COMPETENCY EDUCATION FRAMEWORK

Dimension Application

Level Generalist vs. SpecialistFoundation vs. Advanced

DisciplineSpecific Medicine, Nursing, Social WorkCross Disciplinary Multi-disciplines same skill setInterdisciplinary Skills for disciplines in relation to other

disciplinesDomain

Content Geriatrics/GerontologyTopic i.e. Depression, FallsContext SNF, HCBS

Process Specifically identified for a program vs. broadly consensus based

Multidisciplinary Interdisciplinary Transdiciplinary

Common goals

Individual efforts

Discipline expertise

Responsibility for groupeffort

Requires skills in effectivegroup integration

Each membersupports/enhancesprograms and activities

Forms of Cross-Disciplinary Education for Practice and HPPAE Implications

Examples of Cross-Disciplinary Competencies SUPPORTING FAMILY CAREGIVERS

American Journal of Nursing

Gold Award for Special Supplement Assessment

Nursing Social Work

Assess family knowledge of skills necessary to deliver care to older adults

Assess caregivers’ needs and level of stress

Family Education

Damron-Rodriguez, J.A. (2008). Developing competence for nurses and social workers: evidence-based approaches to education. American Journal of Nursing, Vol. 108, No. 9,

40-46.

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.

Rationale and Need for Multidisciplinary Competency-based Professional Education

Focus on skills needed in real-world practice Assess trainees’ skills to:

Enhance learning Inform curriculum development Evaluate training effectiveness

IOM recommendation: “All licensure, certification, and maintenance of certification for healthcare professionals should include demonstration of competence in the care of older adults…”

Partnership for Health in Agingwww.americangeriatrics.org/pha

Consensus BasedGeriatric Competencies

A PHA Workgroup organized by the American Geriatric Society built from the geriatric competencies from social work, medicine and nursing

Over 25 healthcare professional organizations endorsed the competencies

The following 10 disciplines were represented:

Six Multidisciplinary Domains & 23 Foundational Competencies

1. Health Promotion and Safety2. Evaluation and Assessment3. Care Planning and Coordination Across the

Care Spectrum (including End-of-Life Care)4. Interdisciplinary and Team Care5. Caregiver Support6. Healthcare Systems and Benefits

Partnership for Health in Agingwww.americangeriatrics.org/pha

AdoptingNational consensus-based identification of competenciesPrioritization of core skill setInfusion generalist practice and enrichment specialist

practice

Applying to Curricula and Pedagogy- To define learning objectives based on outcomes- To structure student contracts identifying competencies - Develop modules and teaching resources- To train field instructors

Assessing Outcomes- Classroom assignments- Field Practice including instrumentation

Substantive Cross Site Evaluation of HPPAE

Total 67 Graduate Schools of Social Work Participated

Baseline data included year in program, specialization, prior aging courses, prior work experience with older adults, practicum placement and demographic information

Students took on-line survey at PRE, INTERIM, & POST HPPAE to assess: Knowledge (Knowledge of Aging for Social Work Quiz) Knowledge of Community-based Services for Older Adults GSW Competency Scale II Field Instructors also assessed their students’ competency

PRE (Student INTERIM) & POST HPPAE

Geriatric Social Work Competency Scale II

Domains of geriatric social work with 10 skills in each I. Values, ethics and theoretical perspectives II. Assessment III. Intervention IV. Aging services, programs and policies V. Leadership in the Field of Aging

Rating on 5-point Likert scale 0 ----------------- 1 ------------------ 2 ------------------ 3 ---------------- 4

Not skilled at all - Beginning skill - Moderate skill - Advanced skill - Expert skill

“Cannot Assess” for Field Instructors

Social Work Leadership Institutewww.socialworkleadership.org

Field Instructor Rating of Student Competence

0

5

10

15

20

25

30

35

40

45

50

Values p<.001* * *

Assessment p<.001* * *

Intervention p<.05*

Aging services p<.05*

Pre-test

Post-test

0

5

10

15

20

25

30

35

40

45

50

Values p<.001* * *

Assessment p<.001* * *

Intervention p<.001* * *

Aging servicesp<.001* * *

Student Self-Assessment of Geriatric Competencies

An Example of a Systems Level Use of the Hartford Social Work and Nursing Competencies

Improving Education on Aging in California

USDE Fund for the Improvement of Postsecondary Education (FIPSE)

UCLA lead community college, California State University, and University of California collaboration

SAGE partners in nursing, social work and gerontology programs assessed competencies

Rated disciplinary program based on competencies How well it was addressed What classes supported/taught on the competency How students were assessed UCLA

GeroNet www.geronet.ucla.edu

SAGE Gerontology Competency Mapping Strategy

0 = Not skilled at all (no experience with this skill) 1 = Beginning skill (have to consciously work at this skill) 2 = Moderate skill (skill is becoming more integrated into practice) 3 = Advanced skill (skill is done with confidence and is an integral part of practice) 4 = Expert skill (completes skill with sufficient mastery to teach others)

Competency Rating Supported by Courses: Student evaluation methods utilized

C R I T I C A L T H I N K I N G

5. Appreciate the contributions that aging persons make to each other, families and society.

2 SOC 440 (Soc of Aging)PSY 365 (Intro to Gero)FCS 543

(Intergenerational Caregiving)

Papers, exams, service learning activities, presentations, projects

6. Identify and define/describe bio/psycho/social concepts and theories used to study aging.

2 SOC 440 (Soc of Aging)PSY 365 (Intro to Gero)HSCI 418OL (Health and

Aging)

Papers, exams, service learning activities, presentations, discussions

UCLA GeroNet www.geronet.ucla.edu

Competencies to Learner Outcomes

Professional Competency

Educational Program: Integration

of Classroom and Field

CBE Learning Objectives

Learning Activities to Support Objectives

Assessing Competency-based Learner Outcomes

IOM Recommendation: Geriatric Interdisciplinary Practice

Functional Status

Social Support

Spirituality

Affective

Medical

Cognitive

Environment

Economic

GRECC Demographics and Profiles

GERIATRIC RESEARCH EDUCATION CLINICAL CENTERS (GRECC) AND CARE MANAGEMENT & SOCIAL WORK SERVICES PARTNER TO CREATE VA HPPAE MODEL

22

VA IS AN EXAMPLE OF EBP IN HEALTHCARE BUILT ON

INTERDISCIPLINARY TEAMS

Interacting Elements of HPPAE ModelPotential Building Blocks

for Cross Disciplinary Education

1.University-Community Partnerships2. Competency-Driven Field Education3. Integrated Field Education Across Multiple Programs,

Populations and Interventions4. Expanded Field Instructor Role5. Focused Recruitment for Geriatric Social Work6. Leadership Development in Geriatrics

Social Work Leadership Institute www.socialworkleadership.org