Interprofessional (IP) Competencies in Geriatrics Marilyn Luptak, PhD, MSW Associate Professor and Director, Social Work in Aging Emphasis Spafford Endowed Chair in Social Work Hartford Geriatric Social Work Faculty Scholar University of Utah College of Social Work Webinar November 13, 2012

Acknowledgements Adapted from Interprofessional (IP) Competencies in Geriatrics, Prepared & Presented by: Tim Farrell, MD & Marilyn Luptak, PhD, MSW Western Regional Reynolds Meeting July 13, 2012

Objectives  Introduce a paradigm for IP competencies.  Define the “state of the art” in IP competencies, including geriatrics.  Discuss multiple perspectives on IP competencies.  Share lessons learned from IP curricular implementation

TeamSTEPPS website:  Traditionally, each member of the medical team…has trained in educational silos, perfecting his or her own skill set but with a limited understanding of each others’ roles…each individual having a vast amount of experience but the team itself being a complete novice. /

“A team of experts does not make an expert team” Swezey, Salas, eds. Teams: Their training and performance. 1992:3-29.

Why pursue Interprofessional Education (IPE)?  “…how care is delivered is as important as what care is delivered”*  Evidence supports effectiveness of IP care †  Gap between training and practice realities  Need “collaborative practice-ready” graduates * * Interprofessional Education Collaborative Expert Panel (2011) † Partnership for Health in Aging (PHA) Position Statement (2010)

Crew Resource Management

Crew Resource Management (CRM) CRM Characteristic1980s2000s Team compositionPilots onlyPilots, flight attendants, ground crew Educational focusTeam members’ personalities Team members’ interactions Training activitiesUnrelated to aviationRelated to aviation Duration of trainingOne-time experienceLongitudinal experience Organizational features -No “safety culture” -CRM imported from other airlines or countries - “Safety culture” exists -CRM adapted to each airline’s needs Attitude of pilotsOften ridiculedWidespread acceptance

3 Types of Professional Competencies Common Competencies IP Collaborative Competencies Complementary Competencies Adapted from Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative (p. 19)

Spectrum of IP Care  IP collaborative practice  IP teamwork  IP team-based care Increasingly intentional team-based care

Key Aims of IPE Learning is interactive Improve interprofessional communication Enhance collaborative competencies Resolve interprofessional rivalries Improve quality of care, relationships Slide from J Rivera, Interprofessional Education and Assessment Presentation at Reynolds July 2012 Meeting

Back to the Future…

Historical Perspective: Geriatric Interdisciplinary Team Training (GITT) In the mid-1990s the JA Hartford Foundation sought to improve care of older adults via GITT by:  Creating national training models of partnerships between "real world" providers of geriatric care and educational institutions  Improving academic responsiveness to the health care delivery system  Developing well-tested curricula for GITT  Creating a cadre of well-trained professionals competent in gerontology and interdisciplinary team skills  Testing models of staff development training for practicing health professionals JA Hartford Foundation. (2001)

Geriatric Interdisciplinary Team Training (GITT) – State of the Art Rush University GITT Program  16+ years of providing interdisciplinary education, training and applied practice programs in team based geriatric care in a variety of formats.  Has trained > 4000 advance practice students/professionals in > a dozen disciplines.  Piloting an online GITT course that includes learning competencies and knowledge from Core Competencies for Interprofessional Collaborative Practice document. Rush University Medical Center GITT (website accessed June )

IPEC (Interprofessional Education Collaborative Expert Panel)  Multiple stakeholders convened in 2011  Adopted 2003 IOM competencies for health professions education:  Provide patient-centered care  Apply quality improvement  Employ evidence-based practice  Utilize informatics  Work in interdisciplinary teams  Not specific to geriatrics

IPEC Competency Domains  Domain 1: Values/Ethics for IP Practice  Domain 2: Roles/Responsibilities  Domain 3: IP Communication  Domain 4: Teams and Teamwork

Partnership for Health in Aging (PHA)  Similarities to IPEC IP competencies  Multiple stakeholders convened in 2008  Focus on competencies that should be mastered upon completion of a health professions program  Differences from IPEC IP competencies  Geriatrics-specific  Based on 2008 (not 2003) IOM report

PHA “Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry- Level Health Professional Degree”  Domain 1: Health Promotion and Safety  Domain 2: Evaluation and Assessment  Domain 3: Care Planning and Coordination Across the Care Spectrum (Including End-of-Life Care)  Domain 4: Interdisciplinary and Team Care  Domain 5: Caregiver Support

PHA/IPEC Overlap IPEC DomainPHA DomainPHA Subdomain Values/EthicsMultiple2.1, 3.1, 4.1, 4.2 Roles/ResponsibilitiesEvaluation and Assessment 2.1 CommunicationCare Planning and Coordination Across the Care Spectrum 3.4 Teams and TeamworkInterdisciplinary and Team Care 4.1, 4.2

How to implement IPE competencies?  Exposure vs. context  Simply exposing trainees to other disciplines is probably insufficient  Must ground IPE in a relevant clinical setting to promote behavior change  Optimal approach is unclear  Timing  Duration  Required vs. elective experiences  Separate course vs. “thread”

Challenges in IPE  Developing its theoretical underpinning  Engaging trainees from multiple disciplines  Promoting contextual learning  Overcoming barriers to instilling IP “culture”  Scheduling  Assessing trainees’ performance in IP competencies*

IPE implementation status  Nursing  Integrated into baccalaureate, master’s and doctoral levels  Medicine  ACGME: “Next Accreditation System” (Milestones)  Osteopathic: Preliminary work under way  Dentistry: Pending within 2013 accreditation standards  Pharmacy: Part of current accreditation standards  Public health: 10 master’s level IPE competencies  Social work: In process….

IPE Competencies: Social Work  Since 1998, Hartford Social Work (SW) curriculum development projects have used a competency- based approach to infuse gerontological SW content in classroom and field curricula that:  Focuses on student outcomes based in practice behaviors  Stipulates 10 competencies common to generalist and advanced SW practice  The gero competencies are linked to current CSWE Educational Policy and Accreditation Standards practice behaviors. Council on Social Work Education and the Social Work Leadership Institute. (2009)

Geriatric Social Work Competency Scale II With Life-Long Leadership Skills  Domains of geriatric social work with 10 skills in each  I. Values, ethics and theoretical perspectives  II. Assessment  III. Intervention  IV. Aging services, programs and policies  V. Leadership in the practice environment of aging  Rating on 5-point Likert scale Not skilled at all - Beginning skill - Moderate skill - Advanced skill - Expert skill Council on Social Work Education and the Social Work Leadership Institute. (2009)

Geriatric Social Work Competency Scale II… (cont) Social Work Skills Related to Interprofessional Practice  Understand the perspective and values of SW in relation to working effectively w other disciplines in geriatric interdisciplinary practice.  Advocate on behalf of clients w agencies and other professionals to help elders obtain quality services.  Assess “self-in-relation” in order to motivate yourself and others including trainees, students, and staff toward mutual, meaningful achievement of a focused goal or committed standard of practice.  Create a shared organizational mission, vision, values and policies responding to ever changing service systems in order to promote coordinated, optimal services for older persons.  Build collaborations across disciplines and the service spectrum to assess access, continuity, and reduce gaps in services to older adults.  Manage individual (personal) and multi-stakeholder (interpersonal) processes at the community, interagency, and intra-agency levels in order to inspire, leverage power, and resources to optimize services for older adults. Council on Social Work Education and the Social Work Leadership Institute. (2009)

University of Utah IPE and Geriatrics – Initial Steps  Feb 2011: Dr Farrell and I served together on a geriatrics conference steering committee.  Dec 2011: We reconnected to explore collaborating on a CMS grant proposal related to care transitions.  Jan 2012: Based on a shared commitment to geriatric interprofessional education, we began to identify strategies for including MSW students in Dr Farrell’s GACA OSVE project.  July 2012: We co-presented on IP Competencies for the Reynolds Western Regional meeting.  November 2012: OSVE pilot is underway; scheduling is challenging….

GT-OSVE (Geriatric Transitions Objective Structured Video Examination)*  IP trainees view a 10-minute video clip of a transition of care  Team leader (usually FM resident) formulates plan of care with assistance of IP team  Team leader presents plan of care to faculty  Assessment instrument:  Transitions domains  Team leadership domains *Funded by HRSA Geriatric Academic Career Award (GACA) grant # K01HP20487

GT-OSVE

 Relationship to IPE best practices  Culture: Developed from the inside out  Context: Delivered within clinical settings  Scheduling: Eased by video format  Preliminary lessons learned  Most team functioning assessment instruments assume a long-standing team.  Use of existing infrastructure eases implementation.  Engagement of non-resident learners is essential.

References  Council on Social Work Education (CSWE) & the Social Work Leadership Institute. (2009). Advanced gero social work practice. Alexandria, VA: CSWE.  Farrell T & Luptak M. (July 13, 2012). Interprofessional Competencies in Geriatrics. Western Regional Reynolds Meeting, Newport Beach, CA.  Helmreich RL, Merritt AC, Wilhelm JA. (1999). The evolution of crew resource management training in commercial aviation. International Journal of Aviation Psychology, 9(1): Available at: ications/pubfiles/Pub235.pdf. Accessed May 27, ications/pubfiles/Pub235.pdf  Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, DC: Interprofessional Education Collaborative.

References (cont)  JA Hartford Foundation. (2001). The John A Hartford Foundation geriatric inter-disciplinary team training (GITT) Program: Implementation manual. NY: Author.  Partnership for Health in Aging. (2008). Multidisciplinary Competencies in the Care of Older Adults at the Completion of the Entry-Level Health Professional Degree. Available at: A_Multidisc_Competencies.pdf. Accessed May 27, A_Multidisc_Competencies.pdf  Partnership for Health in Aging. (2010). Position Statement on Interdisciplinary Team Training. Available at: Accessed May 27,  Reeves S, Lewin S, Espin S, & Zwarenstein M. (2010). Interprofessional Teamwork for Health and Social Care. Ames, IA: Blackwell Publishing Ltd.  Rush University Medical Center Geriatric Integrated Team Training. Available at: Accessed June 1,