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)