Round Table on Value & Science-Driven Health Care Institute of Medicine July 27, 2011 Presented By Patricia J. Volland Robyn 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 Perspectives II. Assessment III. Intervention IV. Aging Services, Programs, and Practices V. 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 Appt Schedulers Dept of Aging HCBS Providers Dept of Rehab Services Dialysis Center Primary Care Provider HospitalCommunity 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 AssessmentIntervention EDPP Process

Depression Results: N=44 BRIGHTEN Outcomes Clinical Range Anxiety Results: N=44 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 appointments InterventionUsual Care Yes239 (74.9%)206 (57.4%) No80 (25.1%)153 (42.6%) © Rush University Medical Center, 2009 EDPP Outcomes

Readmissions to Rush University Medical Center Since DischargeInterventionUsual Carep-value 30 days 13.6%16.1% days 20.8%27.5%.031* 90 days 26.4%34.2%.018* 120 days30.8%36.5% days36.1%42.5%.068 © Rush University Medical Center, 2009 *significant at the p<.05 level Mortality at 30 days, p=0.03 Overall (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)