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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!