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
Marilyn.Luptak@socwk.utah.edu
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:
http://www.healthcaresafetysolutions.com/pg_teamtrain_sol_more.html
 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 Characteristic
1980s
2000s
Team composition
Pilots only
Pilots, flight
attendants, ground
crew
Educational focus
Team members’
personalities
Team members’
interactions
Training activities
Unrelated to aviation
Related to aviation
Duration of training
One-time experience
Longitudinal
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 pilots
Often ridiculed
Widespread
acceptance
3 Types of Professional Competencies
Common
Competencies
Complementary
Competencies
IP Collaborative
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 1 2012)
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:
Domain 2:
Domain 3:
Domain 4:
Values/Ethics for IP Practice
Roles/Responsibilities
IP Communication
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 EntryLevel 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 Domain
PHA Domain
PHA Subdomain
Values/Ethics
Multiple
2.1, 3.1, 4.1, 4.2
Roles/Responsibilities
Evaluation and
Assessment
2.1
Communication
Care Planning and
Coordination Across the
Care Spectrum
3.4
Teams and Teamwork
Interdisciplinary 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 competencybased 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
0 ----------------- 1 ------------------ 2 ------------------ 3 ---------------- 4
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
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. Presentation @ 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): 19-32. Available at:
http://homepage.psy.utexas.edu/homepage/group/helmreichlab/publ
ications/pubfiles/Pub235.pdf. Accessed May 27, 2012.
 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:
http://www.americangeriatrics.org/files/documents/health_care_pros/PH
A_Multidisc_Competencies.pdf. Accessed May 27, 2012.

Partnership for Health in Aging. (2010). Position Statement on
Interdisciplinary Team Training . Available at:
www.americangeriatrics.org/pha. Accessed May 27, 2012.

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:
http://www.rush.edu/professionals/training/geriatrics/index.html.
Accessed June 1, 2012.