Transcript Document

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 Aging
Percent of Population over age 65
Both Taiwan and USA in the 8.0 to 12.9 Category
Average Life Expectancy in Asian
Countries and the U.S.A.
1986
55
62
1991
61
64
2005
70
70
Taiwan
73
74
78
China
Japan
U.S.
64
77
75
69
79
75
72
81
78
Indonesia
Philippines
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
I.
SOCIAL WORK RESPONSIBILITIES IN
Today’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
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 of
Competency-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
Nursing Competency
Social Work Competency
Diversity: Attitudes and Values Clarification
Recognize one’s own and others’
attitudes, values, and expectations
about aging and their impact on
care of older adults and their
families.
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.
Respect diversity among older
adult clients, families, and
Professionals (e.g., class,
race, ethnicity, gender,
and sexual orientation).
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.
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.
Interdisciplinary Teamwork
Competencies
to Learner Outcomes
Professional Competency

Educational Program

Learning Objectives

Learning Activities to Support Objectives

Assessing Competency-based Learner Outcomes
II.
TYPES OF CROSS-DISCIPLINARY
TEAMS
Multidisciplinary
Interdisciplinary
Transdiciplinary
Common goals
Individual efforts
Discipline expertise
Responsibility for group
effort
Requires skills in effective
group integration
Each member
supports/enhances
programs and activities
Cross-Cultural Practice
Distribution by Race and Ethnicity
Asian Americans
refers to individuals who trace their heritage to the
following countries:
Bangladesh
Bhutan
Cambodia
China
Hong Kong
India
Indonesia
Japan
Macau
Laos
Malaysia
Maldives
Mongolia
Myanmar
Nepal
North Korea
Pakistan
Philippines
Singapore
South Korea
Sri Lanka
Taiwan
Thailand
Vietnam
Minority Elders Barriers to LTC
Need
POPULATION
Acute, Chronic,
Disease Prevalence,
Symptom Presentation,
SES, Health Insurance,
Immigration Status,
Neighborhood,
Language, Functional
Level
Ethnicity, Support
Systems, Acculturation,
Utilization
PROGRAM
S
T
R
U
C
T
U
R
A
L
APPROPRIATENESS
C
U
L
T
U
R
A
L
Location, Accommodate
Disability, Intake, Hours,
Translation
Geriatric Assessment,
Level of Care Continuum,
Continuity, Coordination,
ACCESSIBILITY
Information and referral,
Healthcare coverage,
ACCEPTABILITY
Outreach, Cultural
Diversity, Family Friendly
IOM: Redesign models of care broaden
III.
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
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
In-Home
Services
In-Community
Services
Needs/Circumstances
of Clients
&
Family/Social Network
Congregate
Housing Services
Institutional
Services
IOM Recommendation:
Care Coordination
•PACE
•Social HMO
•Medicare
Coordinated
Care
Demonstration
•Arizona LTC
System
Site of Program in Community-Based Care
Community Services
Home Services
Emergency response
system
 Home-delivered meals
 Home health care
 Home Health Aide
 Homemaker/Companio
n
 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














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
IOM Recommendation:
Interdisciplinary Teams
For Geriatric Assessment and Intervention
•IMPACT
•GRACE
Medical
Cognitive
Affective
Social Support
Environment
Economic
Functional
Status
Spirituality
.
IMPACT Intervention Team Flow
Depression Care Specialist (PCP)=Nurse or
Social Worker , Primary Care Doctor, Psychiatrist
PCP Team Referral
Initial visit with DCS
Consult with PCP
and 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
Health 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 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 Care
Patient-centered
Care
Continuous
Improvement
Pillars of the Medical Home
Patient-Driven
• The primary care team is focused on the whole person
• Patient-preferences guide the care provided to the patient
Team-Based
• Primary care is delivered by an interdisciplinary team led by a
primary care provider using facilitative leadership skills
Efficient
• Veterans receive the care they need at the time they need it
from an interdisciplinary team functioning at the highest level
of their competency
Comprehensive
• Primary care serves as point of first contact for a broad range of
medical, behavioral and psychosocial needs, fully integrated
with other VA health services and community resources
Continuous
• Every patient has an established and continuous relationship
with a personal primary care provider
Communication
• The communication between the Veteran patient and other
team members is honest, respectful, reliable, and culturally
sensitive
Coordinated
• The PCMH team coordinates care for the patient across and
between the health care system including the private sector
Patient-Centered
Perspective Personal Health Care
Building Relationships
Provider skills
• Cultural competency
• Motivational
interviewing
• Preferred means of
communication
• Involving families and
caregivers
• Continuity
• Clinical Management
• Provider/Team
• Information
Shared Decision
Making
Preference centered health
care choice made by the
patient together with the
provider
• Education
• Decision Support Tools
• Resources
Patient
Self Management
Patients, not health care
providers, are the primary
managers of their health
conditions
• Education
• Support Tools
• Resources
• Home Telehealth, My
HealtheVet, Other tools
Patient
Participation
• New patient orientation
• Personalized brochures
• Staff information
• Patient advisory board
• Focus groups
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THANK YOU FOR INVITING ME
感謝聆聽
JoAnn Damron-Rodriguez’s e-mail: [email protected]