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8/25/2016
1
M A R C I A S P I R A , P H . D , L C S W
L O Y O L A U N I V E R S I T Y C H I C A G O
THE IMPERATIVE TO PREPARE TO WORK WITH OLDER
ADULTS
Increased longevity
Increase from 12% to 20% of population
Demographic trends
Racial and ethnic diversity
Family structure
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ASA 2015
WORK FORCE DEVELOPMENT: THE EDUCATION
ARM
SOCIAL WORKERS
40% of schools lack faculty in aging
80% of BSW programs have no coursework in aging
29% of MSW programs offer aging focus
In the 1980s, almost half of MSW programs offered specialization in aging
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LOSING THE WORKFORCE?
INADEQUATE WORKFORCE?
Not Enough Specialists: Is it in the
training?~7,100 geriatricians and declining
~1,600 geriatric psychiatrists
Less than 1% of nurses and pharmacists and less than 4% of social
workers specialize in geriatrics
POINTS OF THE PRESENTATION
To incorporate the assessment of social sufficiency
and the social determinants of health into a transdisciplinary framework
of assessment
To understand the impact of the assessor on the assessment process
To describe the transdisciplinary assessment model and give examples
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DOMAINS FOR ASSESSMENT
M E D I C A L
P S Y C H I A T R I C
F U N C T I O N A L S T A T U S
P S Y C H O S O C I A L H I S T O R Y
S P I R I T U A L I T Y
F I N A N C I A L
E N V I R O N M E N T A L S A F E T Y
C U L T U R E
ASSESSMENT AND SOCIAL WORK
Mary Richmond was the pioneer of thoughtful assessment of the person in their
environment
Precursor of systems theory
Correspondence between client and environment
“But it is not enough to create a demand for trained service. Having created the
demand (and I think we may claim that our share in its creation has been
considerable), we should strive to supply it.”
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SETTING THE STAGE FOR SOCIAL SUFFICIENCY
What is SOCIAL SUFFICIENCY
HAVING RESOURCES (Relationships and organizations)
ACCESSING RESOURCES
USING RESOURCES
DEFINITION SOCIAL DETERMINANTS OF
HEALTH “The conditions in which people are born, grow, live, work and
age, including the health care system. These circumstances are shaped by the distribution of money, power and resources at global, national, and local levels, which are themselves influenced by policy choices. The social determinants of health are mostly responsible for health inequities—the unfair and avoidable differences in health status seen within and between countries.”
World Health Organization
http://www.who.int/social_determinants/en/
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SOCIAL DETERMINANTS OF HEALTH AS CORRELATES
OF SOCIAL SUFFICIENCY/A CONTEXT
Environmental
Social
Political
Cultural
Economic
Adverse social conditions
Social inequalities
WHAT DO THE SD’S HAVE TO DO WITH ASSESSMENT
IN PRACTICE?
Recognizes the complexity of people’s lives
Prioritizes over health
Lowers health status
Increases costs
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CURRENT PRACTICE IS OFTEN LIMITED
Less than 15% of preventable mortality is attributed to medical care alone.
Doctors recognize – but not trained to uncover – the link between social circumstances and disease
Social history focuses on health behaviors related to illness, not environmental contributions to the health condition
Public benefits programs designed to respond to social needs underlying health problems are inconsistently implemented
Lack of legal services attorneys to respond to overwhelming need
PERSONHOOD
Personhood is a central value in person –centered care
Person centered care is the response to the biomedical approach
Personal and social identities are interdependent/internal and external processes
Social sufficiency is interdependent with the outcomes of social relationships
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VIEWS OF THE PERSON IN RELATIONSHIP
The Person in
Relationship
Biology
Strengths and Competencies
Capacity for Creativity and
Choice
Beliefs: Sustaining
Constraining
Values
Spirituality
Needs / Demands
Recognizing a
client’s /relationship’s
ability to make
creative choices
Hopeful, Optimistic
and Positive toward
client, self, the
world, and other
people
Exploring
Client’s/Rela
tionship’s
strengths
gender, skin color,
temperament, height,
etc.
What do you Need/want?
What will make the
necessary different in your
life?
RELATIONSHIP-CENTERED CARE
Focus on the whole relational system
Paradigm shift from a nonperson focus (biomedical) to a one person focus (person
centered care) to a dyadic, triadic and multi person framework of care.
The mutually constructed relationship (s) become the focus of interest in
understanding the stories that are told by the patient
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ASSESSMENT IN RELATIONSHIP
Key to assess relationships
Centrality of the social relational context
Paying attention to the relationship narrative
Degree of trying to preserve the past
4 W’S OF RELATIONSHIPS
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WHAT EACH PERSON IN THE RELATIONSHIP
BRINGS
Impact of relationship on the person /on the assessment
An agenda from your discipline –everyone has a focus
Problem solving style as assessment style –COMPETITION, COLLABORATION,
COMPROMISE, AVOIDANCE, ACCOMODATION
Your personal biases –SOCIAL POSITIONING – WHERE ARE YOU IN THE
HIERARCHY-
POWER RELATIONSHIPS – HOW ABOUT HOW THIS TRANSLATES TO CLIENTS?
Adapted from Thomas/Kilmann Conflict Model Instrument, 1974
HOW DOES THIS APPLY TO
TRANSDISCIPLINARY ASSESSMENT
Everything/it takes a village and there is a place for everyone
The assessor/patient relationship matters
The interaction between professionals and client changes the discussion and the outcome –
The assessor is complicit in the facilitation as well as the avoidance of particular information
The interprofessional relationships matter
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PALLIATIVE CARE AND TRAINING
TO MEDICAL STUDENTS
Medical students surveyed:
20% received education
39% unprepared to address patient fears
About half unprepared for their own feelings
ELDER LAW
Law students not trained in management of emotions
Social determinants of legal issues
Knowledge of community resources
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POINTS TO COVER TODAY
TRANSDISCIPLINARY (RELATIONAL) APPROACHES –DEFINITION/RATIONALIE
A SOCIAL SUFFICIENCY MODEL OF GERIATRIC ASSESSMENT –BENEFITS AND
LIMITATIONS
EXAMPLES OF TRANSDISCIPLINARY CULTURES
LOOKING AT THE RELATIONSHIPS
What it tells us about TRANSDISCIPLINARY SUFFICIENCY
HAVING KNOWLEDGE OF THE OTHER PROFESSIONS
COLLABORATION WITH THE OTHER PROFESSIONS
Benefit for all
TURNING ISOLATION INTO INTERPERSONAL CONNECTION
TURNING RESIGNATION INTO HOPE
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TRANSDISCIPLINARY COMMUNICATION
Specific Interprofessional Communication Competencies:
CC1. Choose effective communication tools and techniques, including information systems and communication technologies, to facilitate discussions and interactions that enhance team function.
CC2. Organize and communicate information with patients, families, and healthcare team members in a form that is understandable, avoiding discipline-specific terminology when possible.
CC3. Express one’s knowledge and opinions to team members involved in patient care with confidence, clarity, and respect, working to ensure common understanding of information and treatment and care decisions.
CC4. Listen actively, and encourage ideas and opinions of other team members.
CC5. Give timely, sensitive, instructive feedback to others about their performance on the team, responding respectfully as a team member to feedback from others.
CC6. Use respectful language appropriate for a given difficult situation, crucial conversation, or interprofessional conflict.
CC7. Recognize how one’s own uniqueness, including experience level, expertise, culture, power, and hierarchy within the healthcare team, contributes to effective communication, conflict resolution, and positive interprofessional working relationships (University of Toronto, 2008).
CC8. Communicate consistently the importance of teamwork in patient- centered and community-focused care.
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VALUE OF COLLABORATIVE CARE
An outcome is positive
change that reflects the
influence of diverse
perspectives
BARRIERS TO INTEREST IN GEROPROFESSIONAL
\COLLABORATIONS
University/agency and student responsibilities
Starting at the end rather than the beginning of aging
Lack of training and supervision
Discontinuities in care
Defensive disengagement
Turf building – conflicting loyalties
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PROBLEM: SILOS
Lack of interdisciplinary collaboration
Misconception about other
professions
No referrals
EXAMPLES OF COLLABORATIVE WORK
MLP
Elder Justice
Palliative care
TIP
Non clinical Buddy
Public agencies
Senior housing
Dentist offices
Physician offices
Postal service
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SOCIAL WORK PERSPECTIVE
Added value of social work
Contextual view of human behavior and experience
Sustained empathy – distinct from “walking in the shoes of the other”
Relationship over time
Using relationship to intervene at multiple levels of care
SOCIAL WORK LEADERSHIP DEVELOPMENT IN A GERIATRIC PARTNERSHIP
Values:Identity as socialworker confidence
Skills:Vision, communication
Collaboration, integration
Knowledge:Broad definition of aging
in social work
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Legal•Loyola School of Law
•Equip for Equality
•Lawyers Committee for Better Housing
•Pro Bono
Social Work•Loyola University School of
Social Work
•Erie Behavior Health
Medical•Erie Family Health
Center
•Northwestern McGawFamily Community Medicine Residency
•Loyola School of Medicine
HEALTH JUSTICE PROJECT:
INTERDISCIPLINARY PARTNERSHIP
SOURCES OF LAW & SOCIAL SUPPORT: I HEAL Income
Public Benefits, Disability Income, Medical Debt Forgiveness
Housing & Tenant Rights
Evictions, Utilities, Poor Conditions, Foreclosures
Education
Special Education, Bullying in Schools, School Enrollment, Access to Education
Advocacy and Appeals
DHS Appeals (TANF, SNAP, Medicaid)
SSA Appeals (SSI, SSDI)
Legal Referrals
Legal Status (Immigration)
Personal Status (Powers of Attorney, Guardianship, Living Wills) and
Protection (Domestic Violence and Abuse, Orders of Protection)
Employment Law
Family Law
Criminal Law
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PARTNERSHIP LOGISTICS
Medical Provider Identifies SDH
Erie HJP Coordinator
Contacts Client for Additional Info
Referral to Behavioral
Health/SW
Referral to Legal for Assistance and Dr
Follow Up
Legal Educates Medical Provider on
SDH
SUMMER INSTITUTES AND MONTHLY SEMINARS
Seminar topics revolve around student and field instructor interest areas each year
Topic Examples:
Case Management
Living with Dementia
Aging Service Network and Policy
HIV/AIDS and Older Adults
Substance Abuse and Mental Health and Older Adults
Elder Abuse
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So why not transdisciplinary educational opportunities?
Fighting for territory? Room for all
Expensive? Expensive to not do it
Differential status? Really?
• H O W D O P R O F E S S I O N A L S E N G A G E W I T H E A C H O T H E R ?
1) Joint meetings in agency settings
2) Collaborative projects
Present work together at conferences – MLP
3) Usefulness to teaching and research goals
Cross Faculty traineeships
Collaborative teaching opportunities – Elder Law
It Takes Two to Tango
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FUTURE RELATIONSHIP CENTERED
ASESSMENTS
Social sufficiency to be assessed in the context of relationships
Assessment of transdisciplinary relationships
Understanding the interlocking systems of community health and social work
Getting buy in for collaboration from other professions
Limited resources – more consultation and communication between professions to
share resources
Ego out and efficiency in!
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