Implementing the HPPAE model in VA Social Work Graduate Education-GRECC Pilot Project Lorn Gingrich, LCSW-R National Social Work Program Manager Care Management and Social Work Services Department of Veterans Affairs: VA Central Office November 2, 2013

Social Work in VA Largest employer of social workers with nearly 11,000 master’s prepared social workers Largest graduate social work training program Train over 1100 MSW interns each year Offered 879 stipends last year; 49 GRECC SW stipends Affiliated with over 180 graduate schools of social work Licensed independent practitioners Leaders in psychosocial care of Veterans, families and Caregivers -Update from Pat’s slide-nearly 11,000 now. -The GRECC stipends must be used in the GRECC setting; general stipends may be used in the GRECC setting as well -All VA Swers must be licensed in a state

VA Social Work: Mission and Vision Mission: The mission of VA Social Work is to maximize health and well- being, through the use of psychosocial interventions for Veterans, Families and Caregivers Vision: VA Social work will be the preeminent leader, setting standards for innovative psychosocial care and treatment This will be accomplished by developing and maintaining integrated quality programs in patient centered care, informed and evidence based practices, community partnerships, research, education, health promotion and disease prevention

VA Social Work: Values Values: VA Social Workers are advocates for the optimal health and well-being of Veterans, Families and Caregivers. Our Core Values are to: Respect the dignity and worth of the individual Appreciate the Veteran within his or her family and socio-cultural environment Empower the Veteran as the primary member of their health care team Respect the distinctive role and expertise of each member of the health care team with the Veteran at the center Advocate for systems changes that are responsive to Veteran’s evolving needs with a focus on at-risk populations Promote a learning environment that fosters knowledge, enhances clinical social work practice, and advances leadership and administrative excellence Exemplify and model the highest professional and ethical standards Promote conscientious stewardship of organizational and community resources

National Social Work Program Social Work is woven into the fabric of VA health care in the Department of Veterans Affairs Primary focus of social workers in VA is to assist Veterans and their families/Caregivers in resolving psychosocial, emotional and economic barriers to health and well-being Social Work brings a unique program of clinical practice supported by professional values and skills, education and training, program development, professional standards, accountability, and research Social Work provides a major link for Veterans and families with VA facilities and with the community

Today’s Veterans This demographic is key; we are providing services to a geriatric population in every clinical area of the medical center. This opens up myriad opportunities for rotations for social work students into many clinical areas and programs during their graduate education with VA. AGE (Under Secretary for Health, Veterans Health Administration)

Social Work and Care Coordination for Older Adults Social Workers play an integral role in care coordination and service delivery for older adults Advanced illness Multiple chronic conditions Caregiver stress and strain Facilitate access to health and psychosocial services Improve health outcomes Decrease health care costs Support aging in place Identify resources to maximize functioning and independence Arrange home and community based services Social work expertise is critical to navigate complex health and social service systems of care for older adults

Caring for Older Veterans VA offers an array of non-institutional and institutional home and community focused programs to support older Veterans, their families and Family Caregivers Institutional Care Contract Nursing Home Residential Care Medical Foster Home Non-institutional Care Home Based Primary Care Adult Day Health Care Homemaker/Home Health Aid Respite Care Skilled Nursing Home Care Caregiver Support

Home and Community Care Services Home Based Primary Care (HBPC) Provides comprehensive, interdisciplinary, primary care in the homes of Veterans with complex medical, social, and behavioral conditions for whom routine clinic-based care is not effective Homemaker Home Health Aide (H/HHA) Permits VA to pay for homemaker and home health aide assistance for Veterans Veterans Directed Home and Community Based Programs Veteran and their family Caregiver will: manage a flexible budget; decide for themselves what mix of services will best meet their personal care needs; hire their own personal care aides, including family or neighbors; and purchase items or services to live independently in the community Purchased Skilled Home Care Professional home care service that is purchased from private-sector providers at every VA medical center

Home and Community Care Services Respite Provides Veterans with short-term services to give the Caregiver a period of relief from the demands of daily care for the chronically ill or disabled Veteran Caregiver Support Program Provides Veterans and their family Caregivers with a menu of VA Services such as in-home care, respite care, services to address mobility issues, education and training, financial support, information and referral and caregiver support Adult Day Health Care A therapeutically oriented outpatient day program that provides health maintenance and rehabilitative services to frail elderly and functionally impaired Veterans in a congregate setting

Community Care Services Community Nursing Home Contract Program (CNH) Provides long term care services through contracts with community nursing homes to match the Veterans' geographic preferences and institutional long term care needs Community Living Center Provides compassionate care to eligible Veterans with sufficient functional impairment to require the level of service and skill available in VA Community Living Centers (VACLC)  Palliative Care Program This program is designed to focus on the quality of life and comfort for a Veteran with an advanced disease that is life-limiting. Hospice and Palliative Care supports a balance of comfort measures, interventions and provides bereavement care to the Veteran's family

Community Care Services Community Residential Care This program provides health care supervision to eligible Veterans not in need of hospital or nursing home care but who, because of medical and/or psychosocial health conditions as determined through a statement of needed care, are not able to live independently and have no suitable family or others to provide the needed supervision and supportive care Medical Foster Home (MFH) A type of Community Residential Care (CRC) home chosen by the Veteran who is unable to live independently, as a preferred means to receive family-style living with room, board, and personal care; Veteran is receiving HBPC services in the MFH

Social Work Care Coordination with Older Veterans Social workers coordinate many Long-Term Care Programs: Community Nursing Home Homemaker/Home Health Aide Contract Adult Day Health Care Respite Care Medical Foster Home Caregiver Support

VA SW/GRECC/HPPAE Important collaboration with the John A. Hartford Foundation’s Geriatric School of Social Work Initiative, VA Social Work and Geriatric Research Education Clinical Center (GRECC) and the Social Work Leadership Institute utilizing the Hartford Practicum Partnership in Aging Education (HPPAE) model Competency-based geriatric social work graduate internships Strengthen capacity of social work to address the health and psychosocial needs of older adults Key to the HPPAE model is

Important Aspects of Care Coordination Early identification of psychosocial issues Early education and intervention Encourages exploration of alternatives to care Reduces risk for hospitalization or institutionalization Reduction in utilization of health care resources Helps monitor the status of the Veteran between provider contacts Enhances connection to Veteran’s local community

Impact of VA Social Work Social Workers are not just “value added” Social workers are essential members of interdisciplinary treatment teams Social workers are critical in increasing health care supports and service delivery and reducing cost Social work participates in the development of programs and services to meet the changing needs of our Veterans resulting in significant contributions of our profession

The VHA GRECC Program In the 1970s the Veterans Health Administration began planning to meet the challenges the aging World War II Veteran population would present. At the time the field of geriatric medicine was rather small, so to help grow the field and develop the infrastructure necessary to handle the complexities such a large influx of elderly patients would present the Geriatric Research Education and Clinical Centers (GRECCs) were developed. GRECCs were meant to attract scientists and health science students to the field of geriatrics in order to help increase the basic knowledge of aging, transmit this knowledge to health care providers, and improve the quality of care delivered to elders.

The VHA GRECC continued Each GRECC contains a research component, a education component, and a clinical component. Currently there are 20 GRECCs which compete for research grants to conduct basic laboratory research on the origins of aging and the diseases commonly associated with it as well as research how care is delivered to elders and the effects of rehabilitation. GRECCs help disseminate existing knowledge of geriatrics and new discoveries gained through research by offering regular educational events and products such as national conferences, regional conferences, telephone and video conferences, special fellowship programs to train physicians in geriatric medicine, conducting grand rounds and journal clubs, and producing peer reviewed papers and other materials such as newsletters, CD-ROMs, and web based presentations. The GRECCs also work with clinical staff in VA medical centers to provide care to elderly Veterans and demonstrate new and improved ways for that care to be delivered.

GRECC continued GRECCs are not meant to be large enterprises but centers of excellence with a core staff equaling 12 full time employees. Each year these small research units publish hundreds of peer reviewed articles, provide thousands of person hours in geriatric education, and are awarded millions of dollars in research grants. More significantly they provide care to the aging Veteran population while at the same time training many of the healthcare professional which will provide that care for years to come http://www.va.gov/grecc/

GRECC/HPPAE Pilot Given the synergy between the HPPAE model of geriatric graduate social work education and the GRECC model of education, research, and practice, tremendous opportunity to integrate Proposed to GRECC leadership, Dr. Kenneth Shay, and Office of Academic Affiliations, Dr. Robert Zeiss accepted Partnership established in 2010: VA John A. Hartford Foundation Social Work Leadership Institute (New York Academy of Medicine) To facilitate development of advanced competencies in geriatric social work practice in VA and encourage young social workers to enter the field of geriatrics. VA a natural support for rotational model of training, interdisciplinary collaboration, and an emphasis on education- distance learning, on-line trainings, in-house trainings and presentations, and case conferences. VA has students and trainees from a wide variety of fields at all times, and one of the pillars of the VA mission is education.

Partnership Goal Enhance education of MSW social work students to develop specific competencies in working with geriatric populations Framework for collaboration to advance preparation of the profession of social work in geriatric issues Bring together our mutual interests and complementary resources to further this goal OAA- Provide student stipends Social Work -Provide preceptors and supervision for social work interns GRECCs -Provide geriatric education and interdisciplinary training Hartford Foundation – develop local partnerships with schools of social work SWLI – provide orientation, consultation and mentorship through implementation of the HPPAE social work education model

Pilot Project Toss back to Pat for slide 17 onward

Questions or need to contact: Lorn Gingrich, LCSW-R National Social Work Program Manager Lorn.Gingrich@va.gov (518)424-2347