Competency Based Education and Interdisciplinary Care Coordination Implications for Health Care Professional Education Patricia J. Volland Director, Social Work Leadership Institute May 24, 2011

Frame Work for Healthcare Professional Education The context: creating a workforce with expertise and competency in working with the older adult population. Care Coordination is still coming into its own as a model of care Experts in the field continue to evaluate the effectiveness of different models Establishing the evidence-base for care coordination will help to determine expertise necessary in providing care coordination As common elements are identified/refined professional training will be more clearly achievable

Competency-Based Training 2008 Institute of Medicine Report “Retooling for an Aging America” highlights need for competency based education:

Interdisciplinary Care American Geriatrics Society (AGS) and IOM support interdisciplinary care “Interdisciplinary care meets the complex needs of older adults with multiple, interacting comorbidities; improves health care processes and outcomes for geriatric syndromes; and benefits the healthcare system, as well as caregivers of older adults; and interdisciplinary training and education effectively prepares healthcare providers to care for older adults.” (AGS, 2006) “The second principle underlying the vision of care in the future is that services need to be provided efficiently. Providers will need to be trained to work in interdisciplinary teams, and financing and delivery systems need to support this interdisciplinary approach.” (IOM, 2008)

The Road to Integrated Care Geriatric Competencies in All Educational Settings Interdisciplinary Collaboration among Providers, Patients and Caregivers Integration of Medical and Long-Term Care Services

Establishing Competencies for Care Coordinators Results of NYAM/SWLI research completed for New York State Department of Health (2008) Research and analysis of 50 state programs Research and analysis of nationally recognized guidelines New York State stake-holders perspective via multiple focus groups Older adults Care givers Providers of care management

Essential Functions Identified for Care Coordination: Domain 1: Develop and maintain relationships Domain 2: Train and educate patients Domain 3: Goal setting Domain 4: Care planning Domain 5: Coordination of services Domain 6: Insure cost effectiveness while maintaining quality Domain 7: On going quality improvements

A Competency-Based Approach Competency based-education provides an effective framework for integrating geriatric knowledge into the curriculum Competencies are clear and measurable practice behaviors with evidence based indicators to gauge performance Competencies are often organized into relevant domains that can be tailored to specialist or generalist educational aims

Enhancing Competence in Geriatric Education Development of discipline specific competencies Doctors, nurses, social workers, pharmacists, and dentists Nurse aides, home health aides, personal and home care aides Direct-care workers Development of core competencies across professions Competencies in support of informal caregivers Develop competencies related to interdisciplinary practice and care coordination

Initiatives for Competency Development Across professions, multiple initiatives have been undertaken to develop geriatric competencies and promote interdisciplinary care Foundations have partnered with professional organizations and educators to integrate competencies into educational programs Established competencies provide foundation for expansion within professions and to other disciplines The following slides describe the Social Work initiative representative of this trend

Case Study: Social Work Competencies Geriatric Social Work Initiative to create aging competencies for social work (collaborative effort among multiple organizations) Integration of competencies in curriculum with specific educational outcomes for required coursework Tailored to both undergraduate and graduate level through collaborative approach The Social Work Leadership Institute (SWLI) has focused on establishing competencies at the MSW level for specialists in aging in the Hartford Partnership Program in Aging (HPPAE)* * Funding provided by The John A. Hartford Foundation

HPPAE Competency Development Phase I: The identification of competencies Geriatric social work competency development was initiated in 1998 with the first Hartford-funded curriculum development project, CSWE SAGE-SW Phase 2: Essential Skills for Measurement: The Geriatric Social Work Competency Scale A concise, measurable, and consensus-based list of skills for geriatric social work was tested and completed by California HPPAE sites and implemented by New York Academy of Medicine’s PPP (now the HPPAE) Phase 3: Implementation Geriatric Competencies in the HPPAE School adoption of HPPAE geriatric social work competencies Identification of individual student learning goals Integration of class and field work learning Assessment of student skill level and progress (pre and post) Phase 4: Endorsed by the Gero-Ed Center/Council on Social Work Education Phase

HPPAE Focus on Competencies HPPAE Social Work with Aging Skill Competency Scale II contains 40 items with both micro and macro content organized into 4 domains: Values, Ethics, and Theoretical Perspectives Assessment Intervention Aging Services, Programs, and Practices HPPAE convened workgroup to develop leadership competencies Added fifth domain to GSW Competency Scale II: Leadership Practice in the Field of Aging

HPPAE Outcomes Regular evaluations demonstrate significant increase in aging knowledge from pre- to post-test, with students reporting an increase in skill level in the areas of values, assessment, intervention, and aging services Ninety-one percent of students agreed that their goals in learning to work with older adults were achieved through their field experiences Eighty percent of graduates of HPPAE’s report working in aging related agencies 18 months post graduation

Support for Interdisciplinary Competencies Health Resources and Services Administration (HRSA) recommends competencies that include shared knowledge and decision making 2008 IOM report notes that interdisciplinary training requires competencies founded in evidence based practice American Geriatric Society 2006 position statement on the importance of interdisciplinary care If not directly stated, many competencies have implicit focus on interdisciplinary approach and care coordination, e.g. comprehensive assessment, development of care plan, etc.

AGS Geriatrics Competencies Work Group Group of over 20 healthcare professional organizations Competency development representing Dentistry, Medicine, Nursing, Nutrition, Occupational Therapy, Psychology, Pharmacy, Physical Therapy, Physician Assistants, and Social Work Four of the participating disciplines have existing competencies (medicine, nursing, pharmacy, and social work). Identify a shared set of competencies across professions and develop these for healthcare professionals at the entry level of training

The Partnership for Healthy Aging (PHA) AGS work has been formalized in the PHA, which released a 2010 report “Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-level Health Professional Degree” Iterative process to identify 6 competency domains relevant to 10 different professions Endorsed by 28 national organizations Focus on core competencies across professions

PHA: Care Coordination and Interdisciplinary Team Care Domain #3: Care Planning and Coordination Across the Care Spectrum (Including End-of-Life Care) Develop treatment plans based on best evidence and on person-centered and -directed care goals. Evaluate clinical situations where standard treatment recommendations, based on best evidence, should be modified with regard to older adults’ preferences and treatment/care goals, life expectancy, co-morbid conditions, and/or functional status. Develop advanced care plans based on older adults’ preferences and treatment/care goals, and their physical, psychological, social, and spiritual needs. Recognize the need for continuity of treatment and communication across the spectrum of services and during transitions between care settings, utilizing information technology where appropriate and available. Domain #4:  Interdisciplinary and Team Care Distinguish among, refer to, and/or consult with any of the multiple healthcare professionals who work with older adults, to achieve positive outcomes.  Communicate and collaborate with older adults, their caregivers, healthcare professionals, and direct-care workers to incorporate discipline-specific information into overall team care planning and implementation.  

In conclusion: A working definition of care coordination “Care coordination” is a person-centered, assessment-based, interdisciplinary approach to integrating health care and social support services in a cost-effective manner in which an individual’s needs and preferences are assessed, a comprehensive care plan is developed, and services are managed and monitored by an evidence-based process which typically involves a designated lead care coordinator. Developed and refined by the National Care Coordination Coalition.

In conclusion: Interdisciplinary Care Coordination Care coordination works to overcome fragmentation and inefficiency Ensures collaboration among providers Helps consumers and caregivers gain access to needed services Provides services to older adults in a home and community based setting Effective care coordination models increasingly take an interdisciplinary approach Integrate medical and social services Are consumer directed Include all caregivers

Incorporating Lessons Learned As models of care continue to be developed and implemented, interdisciplinary training will be essential to care coordination Programs pioneered by Veterans Administration, e.g. Geriatric Research, Education, and Clinical Centers (GRECCs) support continued development of interdisciplinary care Interdisciplinary training programs such as those supported by JAHF, the Geriatric Interdisciplinary Team Training Program (GITT),provide important lessons for strengthening interdisciplinary professional education

Future Opportunities Passage of Patient Protection and Affordable Care Act offers opportunities to improve geriatric care through educational programs, interdisciplinary teams. and deployment of evidence based models of care Sampling of provisions focused on care coordination, long-term care and the workforce: The Center for Medicare and Medicaid Innovation (CMMI) The Federal Coordinated Health Care Office (Duals Office) Workforce Provisions for Geriatric Education and Training (Title V, Subtitle D, Sec. 5305); Training Opportunities for Direct Care Workers ((Title V, Subtitle D, Sec. 5302); and a National Health Care Workforce Commision Title V, Subtitle B, Sec 5101) Current educational programs and workforce initiatives provide foundation on which to build, though much work remains ahead!