Using Standardized Role Play to Enhance Skills in Gerontological Social Work Practice Charles A. Emlet, Ph.D., MSW University of Washington Tacoma CSWE Gero-Ed CDI program October 14, 2010

Overview  Our Challenge  My Experiment with Assessing Clinical Skills in a Gerontological Context  Benefits and Challenges  Discussion

Background  EPAS will require the assessment of core competencies tied to practice behavior  How do we integrate into gerontological practice in the classroom or field?  This approach was:  Developed before EPAS  Experimental  Deviates from Objective Structured Clinical Examination (OSCE) processes  Was developed for a graduate elective in GSW

The Assignment  Part of a “case-based” final product (1 of 4) required activities for the final exam  Each student is given the same material consisting of: a) the agency; b) the case; c) suggested reading and; d) task  Uses a scenario-based role play that is an amalgam if clients from a 20 year practice history

The Client (Mr. G)  Mr. Gagnon is an 82 year old, widowed, Caucasian male. He lives in a small home where he has lived for the past 40 years. His wife of nearly 50 years died of cancer approximately 10 years ago. Mr. Gagnon has only one child – an adult daughter that lives in the neighboring town with her husband and two children. She is a loving and supportive daughter, but her two children and job take up much of her time. They have her father over for dinner nearly every Sunday and she is as supportive as she can be. She has “recently” noticed numerous problems with her father. He has received several “shut-off” notices from utilities for unpaid bills. Last week she called him to remind him of their dinner plans (he was scheduled for Sunday dinner) and Mr. Gagnon could not comprehend whom he was speaking to on the phone (and hung up). Mr. Gagnon’s daughter (Mrs. Erickson) is committed to assisting her father, although having him move in with her and her family is not an option due to the house size and children. Over the past several months, Mr. Gagnon seems increasingly distant in casual conversation and sometimes provides a nonsensical response.

The Assignment  Students are asked to:  Set an appointment with Mr. G (Mr. Gagnon) by phone  Conduct a sensitive and appropriate initial interview and complete a MMSE  Score the MMSE based on depicted cognitive abilities  Submit a written report including:  MMSE score  Written assessment of his strengths, weaknesses and cognitive function  Discuss cognitive function and impairment in context of his social support and develop an initial plan

Standards, Clinical Components and Evaluation Criteria StandardClinical AppCriteriaScoring Interview was conducted in a sensitive, respectful and appropriate manner Acquisition of clinical data (interview skills) Student identifies themselves at the door and states purpose of visit; Speech and tone takes into account potential hearing loss of Mr. G Interview is respectful without talking down to the client; Questions are appropriate and rephrased if not understood by Mrs. G 0-5 points MMSE was administered competently and accurately scored Interpretation of clinical data The MMSE is administered in a way consistent as modeled in class. MMSE score is  1 point from standardized presentation. (For scores with greater difference than  1 point, 1 point is deducted for each point away from presentation 0-5 points

Standards, Clinical Components and Evaluation Criteria StandardClinical AppCriteriaScoring Plan was developed and considered client’s needs and social support Interpretation of clinical data Plan addresses initial reasons and problems causing the referral; Plan acknowledges client self determination and wishes of Mr. G; Plan incorporates client’s social support system while recognizing the limitations of that system. 0-5

Benefits and Limitations  Competency based assignment  Ability to assess students’ skills and abilities on the spot while role playing (duel cognitive process)  Ability to identify the competencies and skill sets you wish to teach and observe  Provides feedback to you regarding patterns of issues i.e. sensitivity to sensory loss or scoring the MMSE Where do I need to change my instruction?

Benefits and Limitations  Limitations/Challenges Time: Takes me minutes per student  Enrollment – Works with enrollment of approximately 15, would need to change with higher enrollments Willingness to Act: I need to be willing to “be” Mr. G and play that role Consistent presentation of symptoms: Can threaten validity of student performance Potential Student Anxiety: Literature suggest role play with faculty may create greater anxiety  I’ve not experienced this problem