Developing Social Work Leadership in IPE

CSWE Annual Program Meeting

Dallas, Texas

October 31, 2013

Barbara L. Jones, PhD, MSW, University of Texas at Austin

Shelley Cohen Konrad, PhD, LCSW, University of New England

Jayashree Nimmagadda, Ph.D., MSW., LICSW, Rhode Island College

Maureen Rubin, Ph.D., MSW, MA, University of Nevada, Reno

Anna M. Scheyett, PhD, MSW, LCSW, University of South Carolina

Our goals for today

Review the current state of Interprofessional Education (IPE)

Identify the connections between IPE and SW

Discuss obstacles and successes in IPE development

Describe the leadership roles and strategic opportunities for social work

Introductions

Why are you here?

Why do we care about IPE?

Historical Context of SW in Interdisciplinary PracticeShelley Cohen Konrad

Social Work Leadership & Interprofessional Education

Is health a human right?

Social Work as a Health ProfessionPublic Health Act, 1992

• Titles VII and VIII of the Public Health Services Act (PHA) expanded the geographic, racial and ethnic distribution of the health care workforce.

• Increased number of providers working in the public health sector and improving diversity of the public health work force.

• Increased the number of underrepresented minorities in the health care field.

• Minority providers are more likely to treat minority patients and provide health care to poor, uninsured and publicly insured patients, improving access to care.

• 2001 review of PHA found that training workforce in “interdisciplinary” and “community-based” concepts was effective and ensured national best practice sustainability in underserved geographic regions or in service to vulnerable populations.

U.S. Department of Education 1995 “… a new way of preparing all professionals needs to be built. This will require changes throughout the campus culture and new relationships between professional preparation programs, communities, and clients.”

Allen-Meares, P. (1998). The interdisciplinary movement. J SW in Education, 34(1), 2-5.

The Interdisciplinary Movement“Education on all levels needs to forge institutional ties with health care providers and incorporate into

curriculum interactions with students from fields such as medicine, nursing, education, law,

economics, and political science.”

Allen-Meares, P. (1998). The interdisciplinary movement. J SW in Education, 34(1), 2-5.

44,000 – 99,000 DEATHS every year in the U.S. from preventable adverse events – medical errors

Institute of Medicine (IOM) 1999

Crossing the Quality Chasm (2001)“One approach is to redesign the way health

professionals are trained and to emphasize the six aims for improvement, which will mean placing

more stress on teaching evidence-based practice and providing more opportunities for

interdisciplinary training.”

IPE and the Strengths Perspective

“Highlighting the strengths of multiple disciplines along with the merits of interdisciplinary collaboration not only exposes

students to collaboration early in their careers, but also enables instructors to model the strengths perspective”

Berg-Weger, M. & Schneider, F. D. (1998). Interdisciplinary collaboration in social work education. J of SW Education, 34(1), 97-107.

Roles & Responsibilities“Social work students who are exposed to the benefits of collaboration and taught effective collaboration skills early in their training can become effective collaborators throughout their careers.”

“Highlighting the strengths of multiple disciplines along with the merits of interdisciplinary collaboration not only exposes students to collaboration early in their careers, but also enables instructors to model the strengths perspective.”

Berg-Weger, M. & Schneider, F. D. (1998). Interdisciplinary collaboration in social work education. J of SW Education, 34(1), 97-107.

Collaboration: A Social Work Method

Collaboration proposes joint sharing and decision-making in the interest of change, as well as changes in relationships to facilitate these ends.

Collaboration assumes the inevitability of conflicting ideas; differentials in power; and necessity of compromise and continued advocacy.

Graham, J. R., Barter, K. (1999). Collaboration: A social work practice method. FIS, 80(1), 6-13.

Collaboration: Social Work Definition

“… interdisciplinary collaboration is the achievement of goals that cannot be reached when individual professions act on their own.”

Bronstein, L. R. (2003). A Model for Interdisciplinary Collaboration, Social Work, 48(3), 297-306.

Intentional Culture ChangeCollaboration is an intervention that begins with communication, requires preparation, and ends

with collaboration.

Change requires careful preparation.

PT Playing a Nurse

Pharmacy Student

playing a NAScript

Writer Videogra-pher

CollaborationSocial Work Model

“Trends in social problems and professional practice make it virtually impossible to serve clients

effectively without collaborating with professionals from various disciplines.”

Bronstein, L. R. (2003). A Model for Interdisciplinary Collaboration, Social Work, 48(3), 297-306.

Natural Collaborations

Social Work & Public Health

School-based

Practice

Practice with

Children &

Families/Child

Welfare

Social Work & HealthCare

Social work

& Criminal Justice

Social Work & Social

Service

Collaboration takes place when “autonomous, interdependent stakeholders with their respective

competency domains” organize around common goals for the greater good.

Building Trust

Strategies for

cooperation

Managing Diversity

Resolving Conflict

Naming Power

Inequities ClientFamily

Community

Claiborne, N. & Lawson, H. A. (2005). An intervention framework for collaboration. FIS, 86(1), 93-103.

Interprofessional Collabor

ation

• When expertise of different professions come together to facilitate culturally responsive services, structures and practices

• Systems and Ecological; Functional School, Group Dynamics

Community

Collaboration

• When expertise of all stakeholders comes together to improve the well-being of community residents

• Community Organization, Participatory Advocacy Models, and Community Economic Development

Inter-organizational

/Interage

ncy

• When independent organizations with different missions come together to work together towards a common purpose

• Network Theory; Exchange Theory; Organizational Culture Theory

World Health Organization (2010)“Once students understand how to work

interprofessionally, they are ready to enter the workplace as a member of the collaborative

practice team.”

International Federation of Social Work

- 2013Strategies for intervention, desired end states and policy

frameworks are based on holistic, biopsychosocial, spiritual assessments and interventions that transcend the micro-macro divide, incorporating multiple systems levels and inter-sectorial

and interprofessional collaboration.

National Association of Social Workers- Winter 2013

Making Interdisciplinary Collaboration WorkInterdisciplinary Collaboration can be one of the most rewarding, yet challenging, aspects of social work practice. It’s also increasingly essential, regardless of practice setting or client population. [NASW Tools & Techniques]

Articulate your role in the team

Understand the roles and

responsibilities of other team

members

Identify and seek common ground with

your interdisciplinary

colleagues

Acknowledge the differences among social

work and other disciplines

Address conflict and don’t let resentment accumulate

Be proactive in establishing

and maintaining collegial

relationships

http://www.socialworkers.org/assets/secured/documents/practice/interdisciplinarycollaboration.pdf

IPE-Current Definitions and CompetenciesMaureen Rubin

IPE Definition “Interprofessional Education occurs when two or

more professions learn with, from and about each other to improve collaboration and the quality of care.”(CAIPE, 2002).

Interprofessional education/training (IPE): Members (or students) of two or more professions associated with health or social care, engaged in learning with, from and about each other. It is an initiative to secure interprofessional learning and promote gains through interprofessional collaboration in professional practice. (Freeth, Hammick, Reeves, Koppel and Barr, 2005)

World Health Organization (2010). Framework for Action on Interprofessional Education and Collaborative Practice. Page 9. Switzerland, Geneva.

Interprofessionality “the process by which professionals reflect on and develop

ways of practicing that provides an integrated and cohesive answer to the needs of the client/family/population…{I}t involves continuous interaction and knowledge sharing between professionals, organized to solve or explore a variety of education and care issues all while seeking to optimize the patient’s participation….Interprofessionality requires a paradigm shift, since interprofessional practice has unique characteristics in terms of values, codes of conduct and ways of working. These characteristics must be elucidated” (p.9)

D’Amour and Oandasan (2005). Inerprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept.

Core Competencies for Interprofessional Collaborative Practice (May 2011)

Sponsored by the Interprofessional Education Collaborative (IPEC) American Association of Colleges of Nursing American Association of Colleges of Osteopathic Medicine American Association of Colleges of Pharmacy American Dental Education Association Association of American Medical Colleges Association of Schools of Public Health

Why core competencies are needed?1. Create a coordinated effort across the health

professions to embed essential content in all health professions education curricula

2. Guide professional and institutional curricular development of learning approaches and assessment strategies to achieve productive outcomes

3. Provide the foundation for a learning continuum in interprofessional competency development across the progressions and the lifelong learning trajectory

4. Acknowledge that evaluation and research work will strengthen the scholarship in this area

Why core competencies are needed? Contd. 5. Prompt dialogue to evaluate the “fit” between

educationally identified core competencies for interprofessional collaborative practice and practice needs/demands

6. Find opportunities to integrate essential interprofessional education content consistent with current accreditation expectations for each health professions education program

7. Offer information to accreditors of educational programs across the health professions that they can use to set common accreditation standards for interprofessional education, and to know here to look in institutional settings for examples of implementation of those standards

Why core competencies are needed? Contd.

8. Inform professional licensing and credentialing bodies in defining potential testing content for interprofessional collaborative practice

Core competencies Competency Domain 1: Values/Ethics for Interprofessional

Practice Competency Domain 2: Roles/Responsibilities Competency Domain 3: Interprofessional Communication Competency Domain 4: Teams and Teamwork

Small Group DiscussionBarbara Jones

Film/Case DiscussionShelley Cohen Konrad

Meet Pat Chalmers

Patricia Chalmers, 31Patricia (Pat) Chalmers is a 31-year-old woman who prides herself on self-sufficiency and resourcefulness. She works part-time as a bookkeeper and gets paid to take care of her aging grandmother with whom she lives.

Pat describes herself as having been a caretaker since adolescence. It is therefore difficult for her to acknowledge her own needs or to seek others for help.

Pat is tired of people commenting on her weight, diet, and need to exercise. She avoids health care as much as possible because she knows she’ll be told to lose weight or be blamed for “being fat” (her words). “I know what risks I face” she says. “But I’ve tried everything and nothing works. I’ve accepted my size and would like others to respect that.”Pat found herself in the ED with a broken ankle several months ago. The break was significant enough to require surgery. Labs revealed elevated glucose levels and surgery was put off until further tests could be done to determine whether Pat might have diabetes. When asked about this possibility, Pat reacted strongly. “I don’t have the time or money for diabetes,” she explained.

Questions

1. What do we know about Pat?

2. How can Pat’s case be used to educate social work and other health professions students in IPE competencies? Social determinants of health?

3. What health professions might contribute to Pat’s rehabilitation and recovery?

4. How can Pat’s case be used for health professions faculty development?

Exemplars

Obstacles & Barriers to IPE DevelopmentShelley and Jay

Activity As you think about your experience in creating/implementing IPE

in your school what challenges you have faced?

Single Discipline

Multiple Discipline

s

Administrative & Curricular BarriersB

UD

GE

T

• Funding• Faculty

Workload• Faculty

Training• Onsite

Faculty

AC

AD

EM

IC-P

RA

CT

ICE

• Curricular differences

• Accreditation• Too much

Content• Different

Assessment Tools

• Misalignment of Academic IPE and IPC Site Readiness

SC

HE

DU

LES • Different

Academic Calendars

• Different Credit Systems

• Different Practice Schedules

ATTITUDINAL BARRIERS

SILOED TRAINING NO EXPOSURE

HISTORIC RIVALRIES STEREOTYPES

IPE SKEPTISM MEDICAL MODEL

STUDENT DISINTEREST NO MODELS

Professional Barriers Profession-centrism – preferred view of the world:

“Interdisciplinary context requires the ability to suspend the tendency to evaluate difference as right or wrong.”

Dewees, M. (2004). Postmodern social work in interdisciplinary contexts: Making space on both sides of the table. Social Work in Health, 39(3/4), 343-360.

Example – Profession-centrism Article response from prominent Social Work Journal:

This is a notable beginning for the interdisciplinary work of social work and nursing and I applaud the effort. However, the current manuscript is quite slanted toward the value of nursing and less so towards social work. One example is the following excerpt: Nursing student: when do I call for a social worker? Social work student: “How do I talk to a nurse when they are so busy and doing important medical things?” Don't social workers do important things as well? You may think that I have missed the point of your work, but I have a great deal of respect for your attempt to write this paper. It requires additional thinking about how it would be read by social work educators who are the primary readers of this journal.

Finally, the references only include 2 articles from social work journals. I know that many exist in health care and even in hospital care. Please consult the journals Social Work in Health Care and also, Health and Social Work for current social work involvement in the health care field.

Barriers within our profession Collaboration is ethically challenging Professional training guides social workers to advocate for social

justice and client empowerment. How then does one advocate while also being a member of the team?

Social Work Identity

Critical Constructionism“Social work designed from the standpoint of critical construction

… helps clarify and make transparent professional expertise through raising differences and assumptions, honoring the

multiplicity of ideas and possibilities, and reflexively working through them. It can make space at the table for differing

professional views as well as differences between the team and the family” (Dewees, 2004).

Working with professional differencesCollaboration assumes the inevitability of conflicting ideas;

differentials in power; and necessity of compromise and continued advocacy

(Graham & Barter,1999).

“Collaboration proposes joint sharing and decision-making in the interest of change, as well as changes in relationships to facilitate

these ends”

(Graham & Barter,1999).

“Only after disciplines become aware of how others can contribute to achieving shared goals can the stages of realistic

appraisal, accommodation, and integration take place” (Germain, 1984).

LeadershipBarbara Jones and Maureen Rubin

Social Workers as Leaders of IPE

CSWE White House Briefing - Oct 2013

Addressing the Social Determinants of Health in a New Era: The Role of Social Work Education.

Preparing the next generation of social work practitioners for the new paradigm in health professional education and collaborative practice to meet the needs of all Americans.

The briefing featured panels of White House and federal agency officials speaking on the following topics:

Shifting US Demographics: Ensuring Care for All New Expectations for Health Care: Including Interprofessional

Health Care National Dialogue on Mental Health Building Capacity to Meet the Need

CSWE Leadership for IPE…According to Dean Barbara Shank, Chair, Board of Directors, and CSWE President, Darla Spence Coffey: CSWE is very supportive of social work programs and

educators' engagement with interprofessional practice. Many programs are engaged, and the 2014 Annual

Survey of Accredited Programs is going to include questions that will allow CSWE to more clearly articulate social work's investment and activity in the interprofessional "space."

CSWE strongly encourages people to advocate for social work being at the table in IPE discussions.

CSWE, APM – Track:Interprofessional and Transdisciplinary Practice

Strengthen the areas of interprofessional practice, education, and research

collaborative initiatives between social workers and other professionals to address micro and macro work related to social issues, ethical dilemmas across professions

researchers, practitioners, and educators explore and examine social problems, target populations, and practice interventions through an interdisciplinary lens, as well as how such teams recommend measures for social policy, education, and practice.

Affordable Care Act (ACA) and IPE ACA became law in 2010 It is expected to bring

Insurance reform Health System Reform

With increased need for workforce, need to establish Interprofessional team is included

Subtitle F—Health Care Quality ImprovementsSubpart II—Health Care Quality Improvement ProgramsSEC. 3502 o42 U.S.C. 256a–1 - ESTABLISHING COMMUNITY HEALTH TEAMS TO SUPPORT THE PATIENT-CENTERED MEDICAL HOME. (p.435)

(a) IN GENERAL. — The Secretary of Health and Human Services (referred to in this section as the ‘‘Secretary’’) shall establish a program to provide grants to or enter into contracts with eligible entities to establish community-based interdisciplinary, interprofessional teams (referred to in this section as ‘‘health teams’’) to support primary care practices, including obstetrics and gynecology practices, within the hospital service areas served by the eligible entities. Grants or contracts shall be used to—

(1) establish health teams to provide support services to primary care providers; and(2) provide capitated payments to primary care providers as determined by the Secretary.

(b) ELIGIBLE ENTITIES.—To be eligible to receive a grant or contract under subsection (a), an entity shall—

(1)(A) be a State or State-designated entity; or (B) be an Indian tribe or tribal organization, as defined in section 4 of the Indian Health Care Improvement Act;

(2) ensure that the health team established by the entity includes an interdisciplinary, interprofessional team of health care providers, as determined by the Secretary; such team may include medical specialists, nurses, pharmacists, nutritionists, dieticians, social workers, behavioral and mental health providers (including substance use disorder prevention and treatment providers), doctors of chiropractic, licensed complementary and alternative medicine practitioners, and physicians’ assistants

IPE in Cancer CareIOM, 2013

The IOM committee will examine opportunities for and challenges to the delivery of high-quality cancer care and formulate recommendations for improvement.

www.iom.edu/qualitycancercare

Recommendations

Recommendation 3

Academic institutions and professional societies should develop interprofessional education programs.

The Need for Interprofessional Collaboration – International perspective (WHO, 2010)

Family and Community Health women worldwide die from complications in pregnancy

or childbirth HIV/AIDS, tuberculosis and malaria

expertise and resources critical to the success of disease management

Health action in crisis Interprofessional education provides health workers

with the kind of skills needed to coordinate the delivery of care when emergency situations arise.

The Need for Interprofessional Collaboration contd.. Health Security

Epidemics and pandemics place sudden and intense demands on the health system - collaboration among health workers is the only way to manage the crisis.

Non-Communicable Diseases Interprofessional teams - more comprehensive

approach to preventing and managing chronic conditions such as dementia, malnutrition and asthma

Health Systems and Services Interprofessional education and collaborative practice

– enables health workers to function at the highest capacity.

Social work education: International perspective Infuse in curriculum Field placement Study-abroad Exchange programs Fulbright scholarship University-community collaboration to prepare students

to work in their own communities – refugees, immigrants, etc.

The IPE Strategic Advantage: A Social Work Dean’s PerspectiveAnna Scheyett

University of South Carolina

In addition to all the benefits already articulated, there are a number of strategic advantages to IPE for deans…but they may not be fully aware of them.

Your job is to make them aware. Here are a few suggestions for talking points.

“Involvement with IPE makes Social Work more competitive within the university”

Increases: Other departments’ and colleges’ understanding of Social

Work as a discipline (internal public education) Other departments’ and colleges’ understanding of the

value-added Social Work brings to a collaboration Other departments’ and colleges’ awareness of Social Work

faculty skills and capacities

“Involvement with IPE makes Social Work more competitive within the university”

Increases: Opportunity to “be at the table” for large interdisciplinary grants

Ability to recruit excellent students and have students from other disciplines take our courses

Opportunity for joint appointments and creative hires

Scholarly productivity and funding, and thus successful faculty

“IPE furthers the agenda of upper administration”A good IPE program can make a Provost and a President happy by:Enhancing the reputation of the university and

creating a nicheAttracting and retaining excellent facultyAttracting and retaining excellent students, both

graduate and undergraduate

“IPE furthers the agenda of upper administration”A good IPE program can make a Provost and a President happy by: Increasing collaboration and decreasing silos

across the university Increasing opportunities for service learningEnhancing the potential for large interdisciplinary

grants and centers

“IPE makes us stand out with external constituents”Funders (private and governmental) and providers will

think highly of us because:We are training students in a model that is Evidence-based Cost-effective Congruent with current health policies (e.g. ACA) i.e. we are graduating students who can “hit the ground

running” in contemporary health settings

We are raising the profile of the social work profession in the health community

Communicating Your MessageIf you are engaged in IPE:

Include IPE in recruitment materialsWork to get internal and external pressFind champions outside of IPEPublish Include IPE in your annual performance reportGive your dean regular outcome-driven reportsGive your dean “good news” s/he can share with the

ProvostMeet with your dean to talk about the ROI of IPE for

social work

Communicating Your MessageIf you are not yet engaged in IPE, but are working to develop:Make sure to create a clear mission statement

and goalsGet your dean involved early Invite experienced IPE educators to campus for

seminar, workshop, colloquiumGather literature, examples from other

universities, funding opportunities, evidence of ROI

Keep talking!!!

Group Activity in TeamsJayashree Nimmagadda

ConclusionNext StepsBarbara Jones