Transcript Slide 1

GERIATRIC SOCIAL WORK
INITIATIVES
Round Table on Value &
Science-Driven Health Care
Institute of Medicine
July 27, 2011
Presented By
Patricia J. Volland
Robyn L. Golden
 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
Training Future Generations of
Social Workers
 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
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 Perspectives
II. Assessment
III. Intervention
IV. Aging Services, Programs, and Practices
V. 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 Team
Pharmacist
Hospital
Home
Health
Care
Community
Primary
Care
Provider
Dialysis
Center
Hospitalist
EDPP
SW +
Pt/Cgvr
Discharge
Planner
Dept of
Rehab
Services
Patient
Relations
HCBS
Providers
RN
Appt
Schedulers
Dept of
Aging
BRIGHTEN Process
Entry into BRIGHTEN
Assessment with Program Coordinator
Results sent electronically to the BRIGHTEN team
Recommendations presented to patient; Treatment plan developed
collaboratively
Evidence-Based Treatment Provided
Virtual Staffings
Outcome Assessment
Continued evidence-based treatment and virtual staffing as necessary
EDPP Process
Referral
PreAssessment
Assessment
© Rush University Medical Center, 2009
Intervention
BRIGHTEN Outcomes
Depression Results: N=44
16
PHQ-9 Total Score
14
12
Clinical
Range
10
8
6
4
2
0
Baseline
Month 1
Month 2
Time
BAI Total Score
Anxiety Results: N=44
Moderate
Anxiety
20
18
16
14
12
10
8
6
4
2
0
Baseline
Month 1
Time
Month 2
EDPP Outcomes
Patients scheduling and attending follow-up appointments
Intervention
Usual Care
Yes
239 (74.9%)
206 (57.4%)
No
80 (25.1%)
153 (42.6%)
 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)
© Rush University Medical Center, 2009
EDPP Outcomes
Readmissions to Rush University Medical Center
Since Discharge
Intervention
Usual Care
13.6%
16.1%
30 days
20.8%
27.5%
60 days
26.4%
34.2%
90 days
120 days
180 days
30.8%
36.1%
36.5%
42.5%
p-value
.201
.031*
.018*
.078
.068
*significant at the p<.05 level
Mortality at 30 days, p=0.03
Alive
Overall (n=740)
712 (96.2)
Intervention (n=360)
352 (97.8)
Usual Care (n=380)
360 (94.7)
Dead
28 (3.8)
8 (2.2)
20 (5.3)
© Rush University Medical Center, 2009
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)