Transcript Health Reform for An Aging America

Competency Based Education and
Interdisciplinary Care Coordination
Implications for Health Care Professional Education
Patricia J. Volland
Director, Social Work Leadership Institute
May 24, 2011
Frame Work for
Healthcare Professional Education
The context: creating a workforce with expertise and
competency in working with the older adult population.
 Care Coordination is still coming into its own as a model of care
 Experts in the field continue to evaluate the effectiveness of
different models
 Establishing the evidence-base for care coordination will help to
determine expertise necessary in providing care coordination
 As common elements are identified/refined professional training
will be more clearly achievable
Competency-Based Training
 2008 Institute of Medicine Report “Retooling for an Aging
America” highlights need for competency based
education:
Interdisciplinary Care
 American Geriatrics Society (AGS) and IOM support
interdisciplinary care

“Interdisciplinary care meets the complex needs of older adults
with multiple, interacting comorbidities; improves health care
processes and outcomes for geriatric syndromes; and benefits
the healthcare system, as well as caregivers of older adults; and
interdisciplinary training and education effectively prepares
healthcare providers to care for older adults.” (AGS, 2006)
 “The second principle underlying the vision of care in the future
is that services need to be provided efficiently. Providers will
need to be trained to work in interdisciplinary teams, and
financing and delivery systems need to support this
interdisciplinary approach.” (IOM, 2008)
The Road to Integrated Care
Geriatric
Competencies in
All Educational
Settings
Interdisciplinary
Collaboration
among Providers,
Patients and
Caregivers
Integration of
Medical and LongTerm Care
Services
Establishing Competencies for
Care Coordinators
Results of NYAM/SWLI research completed for New York
State Department of Health (2008)
 Research and analysis of 50 state programs
 Research and analysis of nationally recognized
guidelines
 New York State stake-holders perspective via multiple
focus groups
 Older adults
 Care givers
 Providers of care management
Essential Functions Identified for
Care Coordination:
Domain 1: Develop and maintain relationships
Domain 2: Train and educate patients
Domain 3: Goal setting
Domain 4: Care planning
Domain 5: Coordination of services
Domain 6: Insure cost effectiveness while maintaining
quality
Domain 7: On going quality improvements
A Competency-Based Approach
 Competency based-education provides an effective
framework for integrating geriatric knowledge into the
curriculum
 Competencies are clear and measurable practice
behaviors with evidence based indicators to gauge
performance
 Competencies are often organized into relevant domains
that can be tailored to specialist or generalist educational
aims
Enhancing Competence in Geriatric
Education
 Development of discipline specific competencies
 Doctors, nurses, social workers, pharmacists, and
dentists
 Nurse aides, home health aides, personal and home
care aides
 Direct-care workers
 Development of core competencies across professions
 Competencies in support of informal caregivers
 Develop competencies related to interdisciplinary
practice and care coordination
Initiatives for Competency
Development
 Across professions, multiple initiatives have been
undertaken to develop geriatric competencies and
promote interdisciplinary care
 Foundations have partnered with professional
organizations and educators to integrate competencies
into educational programs
 Established competencies provide foundation for
expansion within professions and to other disciplines
 The following slides describe the Social Work initiative
representative of this trend
Case Study: Social Work Competencies
 Geriatric Social Work Initiative to create aging
competencies for social work (collaborative effort among
multiple organizations)
 Integration of competencies in curriculum with specific
educational outcomes for required coursework
 Tailored to both undergraduate and graduate level
through collaborative approach
 The Social Work Leadership Institute (SWLI) has
focused on establishing competencies at the MSW level
for specialists in aging in the Hartford Partnership
Program in Aging (HPPAE)*
* Funding provided by The John A. Hartford Foundation
HPPAE Competency Development

Phase I: The identification of competencies
 Geriatric social work competency development was initiated in 1998 with the first

Hartford-funded curriculum development project, CSWE SAGE-SW
Phase 2: Essential Skills for Measurement: The Geriatric Social Work Competency
Scale
 A concise, measurable, and consensus-based list of skills for geriatric social

work was tested and completed by California HPPAE sites and implemented by
New York Academy of Medicine’s PPP (now the HPPAE)
Phase 3: Implementation Geriatric Competencies in the HPPAE
 School adoption of HPPAE geriatric social work competencies
 Identification of individual student learning goals
 Integration of class and field work learning
 Assessment of student skill level and progress (pre and post)

Phase 4: Endorsed by the Gero-Ed Center/Council on Social Work Education Phase
HPPAE Focus on Competencies
 HPPAE Social Work with Aging Skill Competency Scale II
contains 40 items with both micro and macro content
organized into 4 domains:
I. Values, Ethics, and Theoretical Perspectives
II. Assessment
III. Intervention
IV. Aging Services, Programs, and Practices

HPPAE convened workgroup to develop leadership
competencies

Added fifth domain to GSW Competency Scale II:
Leadership Practice in the Field of Aging
HPPAE Outcomes
 Regular evaluations demonstrate significant increase in
aging knowledge from pre- to post-test, with students
reporting an increase in skill level in the areas of values,
assessment, intervention, and aging services
 Ninety-one percent of students agreed that their goals in
learning to work with older adults were achieved through
their field experiences
 Eighty percent of graduates of HPPAE’s report working
in aging related agencies 18 months post graduation
Support for Interdisciplinary
Competencies
 Health Resources and Services Administration (HRSA)
recommends competencies that include shared
knowledge and decision making
 2008 IOM report notes that interdisciplinary training
requires competencies founded in evidence based
practice
 American Geriatric Society 2006 position statement on
the importance of interdisciplinary care
 If not directly stated, many competencies have implicit
focus on interdisciplinary approach and care
coordination, e.g. comprehensive assessment,
development of care plan, etc.
AGS Geriatrics Competencies
Work Group
 Group of over 20 healthcare professional organizations
 Competency development representing Dentistry,
Medicine, Nursing, Nutrition, Occupational Therapy,
Psychology, Pharmacy, Physical Therapy, Physician
Assistants, and Social Work
 Four of the participating disciplines have existing
competencies (medicine, nursing, pharmacy, and social
work).
 Identify a shared set of competencies across professions
and develop these for healthcare professionals at the
entry level of training
The Partnership for Healthy Aging (PHA)

AGS work has been formalized in the PHA, which released a 2010
report “Multidisciplinary Competencies in the Care of Older Adults at
the Completion of the Entry-level Health Professional Degree”

Iterative process to identify 6 competency domains relevant to 10
different professions

Endorsed by 28 national organizations

Focus on core competencies across professions
PHA: Care Coordination and
Interdisciplinary Team Care
Domain #3: Care Planning and Coordination Across the Care Spectrum (Including Endof-Life Care)
 Develop treatment plans based on best evidence and on person-centered and -directed
care goals.
 Evaluate clinical situations where standard treatment recommendations, based on best
evidence, should be modified with regard to older adults’ preferences and treatment/care
goals, life expectancy, co-morbid conditions, and/or functional status.
 Develop advanced care plans based on older adults’ preferences and treatment/care
goals, and their physical, psychological, social, and spiritual needs.
 Recognize the need for continuity of treatment and communication across the spectrum of
services and during transitions between care settings, utilizing information technology
where appropriate and available.
Domain #4: Interdisciplinary and Team Care

Distinguish among, refer to, and/or consult with any of the multiple healthcare
professionals who work with older adults, to achieve positive outcomes.

Communicate and collaborate with older adults, their caregivers, healthcare professionals,
and direct-care workers to incorporate discipline-specific information into overall team care
planning and implementation.
In conclusion:
A working definition of care coordination
“Care coordination” is a person-centered, assessmentbased, interdisciplinary approach to integrating health care
and social support services in a cost-effective manner in
which an individual’s needs and preferences are assessed,
a comprehensive care plan is developed, and services are
managed and monitored by an evidence-based process
which typically involves a designated lead care coordinator.
Developed and refined by the National Care Coordination Coalition.
In conclusion:
Interdisciplinary Care Coordination
 Care coordination works to overcome fragmentation
and inefficiency
 Ensures collaboration among providers
 Helps consumers and caregivers gain access to needed
services
 Provides services to older adults in a home and
community based setting
 Effective care coordination models increasingly take
an interdisciplinary approach
 Integrate medical and social services
 Are consumer directed
 Include all caregivers
Incorporating Lessons Learned
 As models of care continue to be developed and
implemented, interdisciplinary training will be essential to
care coordination
 Programs pioneered by Veterans Administration, e.g.
Geriatric Research, Education, and Clinical Centers
(GRECCs) support continued development of
interdisciplinary care
 Interdisciplinary training programs such as those
supported by JAHF, the Geriatric Interdisciplinary Team
Training Program (GITT),provide important lessons for
strengthening interdisciplinary professional education
Future Opportunities

Passage of Patient Protection and Affordable Care Act offers
opportunities to improve geriatric care through educational
programs, interdisciplinary teams. and deployment of evidence
based models of care
 Sampling of provisions focused on care coordination, long-term care
and the workforce:
 The Center for Medicare and Medicaid Innovation (CMMI)
 The Federal Coordinated Health Care Office (Duals Office)
 Workforce Provisions for Geriatric Education and Training (Title V,
Subtitle D, Sec. 5305); Training Opportunities for Direct Care Workers
((Title V, Subtitle D, Sec. 5302); and a National Health Care Workforce
Commision Title V, Subtitle B, Sec 5101)

Current educational programs and workforce initiatives provide
foundation on which to build, though much work remains ahead!