The Hartford Partnership Program for Aging Education Institutional Outcomes and Implications for Policy Linda Weiss, Ph.D. Patricia Volland, MSW, MBA Victoria M. Rizzo, Ph.D., LCSW-R

Webinar Agenda Introductions Overview of HPPAE Institutional Data Report on the Impact of HPPAE The trained workforce and the effectiveness of social work interventions in aging

Overview of HPPAE Institutional Data Linda Weiss, Ph.D. Director, Center for Evaluation and Research New York Academy of Medicine

Institutional Level Data Overview Data were collected through two surveys, which are included in the HPPAE multisite evaluation document: –Site profile –Institutional Impact Institutional level data can be used to predict outcomes (e.g. is a particular rotational model associated with better student outcomes) Institutional level data can be the outcome of interest (e.g. was there a sustained change in social work education as a result of the HPPAE)

Site Profile Survey (see p. 30) Completed at the end of years 1 and 2 of the grant period by a faculty member. Covers: Program description –Number of students –Admission criteria –Application process University-Community partnership –Structure –Function –Roles Responsibilities

Site Profile Survey (continued) Competency driven education –Use of GSW competencies in HPPAE program –Student seminars –Aging enhanced curriculum –Micro/Macro project requirements Fieldwork rotations –Sequential or concurrent, internal or external –# of rotations –Types of agencies

Site Profile Survey (continued) Expanded field instructor role –Training –Number –Role Recruitment of students –Strategies and their effectiveness –Number of students applying, accepted, enrolling, completing –Stipends: number, amount, source –Career development activities

Site Profile (continued) Other –Website, evaluation, staffing (and funding sources for staff) –Sustainability –Benefits, challenges, adaptations

Institutional Impact Survey Completed at the end of the grant period by a faculty member. Covers: –University and Social Work program information Academic programs Gerontological resources Faculty (# and # with aging expertise) Students (# and # concentrating in aging) Aging coursework Hartford funding received

Institutional Impact (continued) Field education –# Faculty, # faculty designated to work in aging –# of agencies, # of aging agencies –# students, # of student in aging placements

Institutional Impact (continued) 11 Likert scale questions on program impact. Questions cover perceptions of: –Increased knowledge, interest, and skills related to aging among students –Increased interest in aging among faculty –Improved linkages to and capacity of field agencies –Greater emphasis on student leadership –Sustainability and expansion of the consortium, the rotational model, and the GSW competencies Additional questions related to impact on the school and services available to older adults

To access data De-identified data from these surveys are available from The New York Academy of Medicine. To request data, –Bert Chantarat –Linda Weiss

Impact of HPPAE Patricia Volland, MSW, MBA Director Social Work Leadership, Institute Silberman School of Social Work at Hunter College

HPPAE Outcomes  The 72 funded programs graduated over 2,600 students by spring 2012  The HPPAE has been initiated in a total of 97 programs in 37 states  92% of HPPAE graduates completing the Career Tracking survey were employed,75% in age-related positions  25% were working in one of their HPPAE placement sites following graduation  The majority indicated that participation in HPPAE increased their interest in working with older adults and that HPPAE was important in preparing them for their career  95% would recommend the Hartford Internship to other students in aging

HPPAE Impact Deans and Directors  The National Association of Deans and Directors (NADD) Gerontological Social Work Survey  Majority of schools report HPPAE had a positive impact on:  Student learning opportunities  School and agency collaboration  Field instruction  Curriculum development  Image and reputation of MSW program

HPPAE and Student Recruitment  91% agreed that their personal goals in learning to work with older persons and their families were achieved in their field practicum  Aging knowledge increased significantly from pre- to post- test  92% agreed that rotations enabled them to learn about the range of services to older people  91% agreed that having experiences in more than one field agency or department was useful  Synergistic relationship with field agencies is advantageous for students’ education and career development

Impact on Social Work Schools and Education University – Community Partnerships  Increased collaboration and communication  Schools reported an average of between five and 25 agencies in the partnership  Most schools met with partner organizations quarterly or monthly  Partnership functions included the following in order of frequency:  Program planning & oversight  Student selection  Evaluation  Student recruitment  Curriculum development  Fundraising

Impact on Social Work Schools and Education  2000, core geriatric social work competencies developed  Measure students pre and post competencies in aging field education  Refined to create Geriatric Social Work Competencies Scale II  Used by Council on Social Work Education (CSWE) in adoption of competency-based education in 2008 Policy and Accreditation Standards (EPAS)

HPPAE Sustainability and Institutionalization  76% of adoption schools report that the rotational model will be sustained  37% of adoption schools report that the rotational model will be expanded  Development of interprofessional collaboration across university campuses  Institutionalization of HPPAE within CSWE and the Gero Ed Center

VA/GRECC & HPPAE Initiative  New collaboration launched in 2012 with John A. Hartford Foundation, Veterans Administration (VA) Geriatric Research and Clinical Centers (GRECC), and SWLI to implement HPPAE in select VA/GRECCs and schools of social work  VA is the largest employer of social workers in the country currently 11,000 social workers  Stipends secured for MSW students placed at VA/GRECCs and a number of VA hospitals concurrently enrolled in HPPAE

VA/GRECC & HPPAE Initiative  Partnerships developed between the school of social work, the VA/GRECC and HPPAE model  VA/GRECC provides a breadth of services – offering a broad experience for students participating in internal rotations  High quality services provided at the VA/GRECC to veterans and their families plus inter-professional collaboration in education

VA/GRECC & HPPAE Year Student Outcomes  10 MSW students graduated from the 3 pilot sites in spring 2013  Salt Lake City, Utah VA/GRECC  Birmingham, Alabama VA/GRECC  Madison, Wisconsin VA/GRECC  Results from the pre to post tests showed an overall improvement in HPPAE student’s knowledge of aging  A significant improvement in competency levels in all 4 Domains: 1)Values, Ethics and theoretical perspectives 2)Assessment 3)Intervention 4)Aging services, programs and policies

VA/GRECC & HPPAE Student Outcomes  Majority of students agreed that their personal goals in learning to work with older persons and their families were achieved in their field practicum  Majority of students agreed that rotations enabled them to learn about the range of services to older people  Majority of students agreed that having experiences in more than one field agency or department was useful

VA/GRECC and HPPAE Year VA/GRECC, VA and HPPAE sites  Orientations conducted at VA Medical Centers:  Baltimore VA/GRECC  New England, Boston and Bedford VA/GRECC  San Antonio, VA/GRECC  Northport, LI, VA  4 new schools of social work adopt HPPAE  9 trained mentors from 7 HPPAE grantee programs  12 students recruited for academic year

VA/GRECC and HPPAE Year  Orientations to be conducted at VA Medical Centers:  Puget Sound VA/GRECC  Palo Alto VA/GRECC  Gainesville, VA/GRECC  San Francisco, VA  3/4 schools of social work new to HPPAE identified  8 mentors identified from 7 HPPAE grantee programs  Students to be recruited for academic year

VA/GRECC and HPPAE Year  3 new VA/GRECC sites to be identified  1 new VA site to be identified  New schools invited to adopt HPPAE  New mentors from grantee schools collaborate in partnerships

The Trained Workforce and the Effectiveness of Social Work Interventions in Aging Victoria M. Rizzo, Ph.D., LCSW-R Interim Department Chairperson & Associate Professor, Binghamton University

Acknowledgements The work presented here is based on two systematic reviews: Rizzo, V., & Rowe, J. (2006). Studies of the efficacy of social work services in aging with a focus on cost outcomes: A review of the literature. Research on Social Work Practice, 16, Rizzo, V., & Rowe, J. (2013). Studies of the cost- effectiveness of social work services in aging: An updated review of the literature. White Paper.

Background Systematic Review Published in Research on Social Work Practice Included 40 articles reporting results of 34 studies published from 1987 to 2003 Review revealed social work (SW) interventions can have positive impact on quality of life, health care costs, & use of health care services 1/3 of articles included cost outcomes

2013 Update of Study Precipitating Events Passage of the Affordable Care Act (ACA) Completion of the Hartford Social Work Geriatric Initiative (HGSWI)

2013 Update of Study: Research Questions 1)What is the current knowledge of the efficacy and cost-effectiveness of social work interventions in aging? How is the current knowledge the same/different from the results of the first systematic review? 2) Does the current empirical evidence demonstrate the unique contribution of social work to the efficacy and efficiency of interventions in aging?

2013 Update of Study: Research Questions 3)Can the social work profession make a convincing argument to policymakers about the importance of social work interventions in aging using the current empirical evidence under ACA? In other words, does the current literature provide the empirical evidence the social work profession needs to make the case for more flexible Medicare/Medicaid reimbursement of social work services?

Results 45 articles report results of 43 studies in 7 categories: 1)Care coordination/case management/care management (12 articles/9 studies) 2)Depression/mental illness (7 articles/studies) 3)Transitions in care (4 articles/studies) 4)End-of-life/palliative care/advanced illness (10 articles/studies) 5)Caregiving (3 articles/studies) 6)Disease management/other (4 articles/studies) 7)Geriatric evaluation and management (5 articles/studies)

Quality of Life Outcomes 1)63% of articles (n =28) reported at least 1 positive QOL outcome (i.e., general health, mental health, mortality). 2) 25% (n = 11) reported positive outcomes for treatment planning and/or adherence. 3) 1 study reported impact of social work processes in Hospice setting on patient outcomes

Cost Outcomes 1)47% (n = 21) included cost outcomes. 2)27% (n = 12) used direct cost outcomes. 3)15.5% (n = 7) used indirect measures for which costs could be calculated 4)4.4% (n = 2) used both direct and indirect measures.

Quality of Life Outcomes 13 articles in 4 intervention categories [care coordination (n = 6), end-of- life/palliative care/advanced illness (n = 5), caregiving (n = 1), & GEM (n = 1)] reported positive & significant cost outcomes.

Quality of Life Outcomes Outcomes included: 1.Decrease in hospital admissions 2.Decrease in length of stay 3.Decrease in cost of care 4.Decrease in ED visits 5.Decrease in service utilization 6.Decrease in nursing home placement/length of stay/costs

Discussion Question #1 1.Results demonstrate SW interventions can have positive & significant impact on QOL & cost outcomes. 2.# of published outcome studies increased by 10% since last review. 3.50% focus on care coordination and end-of- life/palliative care/advanced illness. Caregiving and GEM predominate in original review. 4.47% include cost outcomes compared to 33% in previous review. 58% include direct cost outcomes compared to 64.3% in original review.

Discussion Question #2 1.Only 3 studies focused on the specific contributions of social work in the intervention. 2.Authors excluded 2 articles in social work journals because interventionists were not identified as social workers. 3.One article the authors knew included social work interventionists was excluded because social workers were not identified in article. 4.We must be able to explain the unique contribution of social work with research evidence to be taken seriously.

Discussion Question #3 Answer is complex. There is evidence social work can make an impact. BUT... Unique social work contribution is not easily identifiable because (1) specific contributions of social work are not defined OR measured.

HPPAE & Effectiveness 1.GSWI has developed a trained workforce and scholars. We can use this to develop evidence for the effectiveness and efficacy of social work interventions. 2.Professional development training is needed to educate practicing social workers so they understand value of intervention/applied research in practice not just academia. The John A. Hartford Foundation initiatives support focusing on practice – the frontline workforce.