Transcript Slide 1

Team Form & Functions: From Multi-Disciplinary
to Interprofessional Collaborative Geriatric TeamsAssessment & Educational Models
Debra Fromm Faria
Marla Berg-Weger
V. Associate Professor, Social Work
Professor, School of Social Work
Co-Director Center for Excellence in
Gerontological Social Work
College at Brockport, State University
of New York
[email protected]
Executive Director, Geriatric
Education Center
Saint Louis University
[email protected]
Webinar
October 23, 2012
The Presenters also wish to acknowledge a collaborative input for some of the health care slides by Assistant
Professor Thomas Caprio, MD,MPH, FACP, University of Rochester Medical Center , School of Medicine, Division
of Geriatrics
Objectives
1.
Define
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types of teams
Multidisciplinary
Interdisciplinary
Interprofessional
Transprofessional
2.
Understand the roles of interprofessional team members
3.
Describe the value of interprofessional geriatric assessment
4.
Introduce model of using interprofessional education in clinical
settings and courses to prepare the next generation of
interprofessional team members
5.
Provide resources for future use
2
What are the differences and similarities
with types of teams?
 The terms multidisciplinary, interdisciplinary,
interprofessional and transdisciplinary often are used
interchangeably.
 It is useful to understand definitions, and assess how
our teams are functioning
www.asha.org/uploadedFiles/aud/TeamApproac
hes.pdf
Multidisciplinary Team Approach
 Professional Silos are common
 “A multidisciplinary approach to service delivery means
that persons from several disciplines are involved in the
delivery of services.
 The approach, however, is discipline-oriented with each team
member responsible only for the activities related to his or her
own discipline (Melvin, 1989; Rothberg, 1981).
 One team member is affected very little by the efforts of the
other team members..”
Melvin, J. L. (1989, April). Status report on interdisciplinary medical education. Archives of Physical Medicine
and Rehabilitation, 70, 273–276.
Rothberg, J. (1981, August). The rehabilitation team: Future direction. Archives of Physical Medicine and
Rehabilitation, 62, 407–410.
as cited in Catlett, C. & Halper, A. (1992, Summer). Team Approaches: Working Together to Improve Quality
ASHA Quality Improvement Digest. http://www.asha.org/uploadedFiles/aud/TeamApproaches.pdf
Interdisciplinary Team
 An interdisciplinary approach to service delivery
requires
 Interaction among the disciplines.
 Not only are individuals from several disciplines working
toward a common goal, but the team members have
the additional responsibility of the group effort
(Rothberg, 1981).
 Effective communication is required among those
involved (Melvin, 1989).
 The team includes the patient/client and his/her family
Melvin, J. L. (1989, April). Status report on interdisciplinary medical education. Archives of Physical
Medicine and Rehabilitation, 70, 273–276.
Rothberg, J. (1981, August). The rehabilitation team: Future direction. Archives of Physical Medicine
and Rehabilitation, 62, 407–410.
as cited in Catlett, C. & Halper, A. (1992, Summer). Team Approaches: Working Together to Improve
Quality ASHA Quality Improvement Digest. http://www.asha.org/uploadedFiles/aud/TeamApproaches.pdf
Transdisciplinary Team Model
“A transdisciplinary model includes the following
components:
• one person can perform professionals’ roles by providing services
to the patient/client under the supervision of the individuals from
the other disciplines involved.
• Disciplines work together in the initial evaluation and care plan, but
only one or two members actually provide the services.
• Professionals are still accountable for areas related to their
specific discipline and for training the team member delivering
the service” (e.g., ACT).
Bailey, D. B., & Wolery, M. (1989). Assessing Infants and Preschooler With Handicaps. Columbus,
OH: Merrill Publishing Co.
Connor, F. P., Williamson, G. G., & Stepp, J. M. (1978). Program Guide for Infants and Toddlers With
Neuromotor and Other Developmental Disabilities. New York: Teachers College Press.
as cited in Catlett, C. & Halper, A. (1992, Summer). Team Approaches: Working Together to
Improve Quality ASHA Quality Improvement Digest.
http://www.asha.org/uploadedFiles/aud/TeamApproaches.pdf
Example of Transdisciplinary
Team in Behavioral Health
 Assertive Community Team (ACT)
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Evidence–Based Practice Model designed to provide treatment,
rehabilitation and support services to individuals
 diagnosed with a severe mental illness
 whose needs have not been met with traditional mental health services
 ACT team:
 psychiatry, nursing, psychology, social work, substance abuse & vocational
rehabilitation.
 Based on respective areas of expertise, team members collaborate to
deliver integrated services of the recipients' choice,
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assist in making progress towards goals,
 adjust services over time to meet recipients' changing needs and goals.
NYS Office of Mental Health, Assertive Community Treatment
http://bi.omh.ny.gov/act/index
www.socialworkleadership.org
Definition of Interprofessional Team
Collaboration
“ Interprofessional collaboration
is a ‘partnership’ between a
team of health providers and a
client in a participatory
collaborative and coordinated
approach to shared decision
making around health and
social issues.”
Canadian Interprofessional Health Collaborative. A national interprofessional competency framework.
February 2010. Available from: http://www.cihc.ca/files/CIHC_IPCompetencies_Feb1210.pdf
Interprofessional Collaborative Practice
Principles
 A process by which professionals:
 Reflect on and develop ways of practicing that provides an
integrated and cohesive answer to the needs of the
client/family/population.
 Involves continuous interaction and knowledge sharing between
professionals.
 Organized to solve or explore care and social issues while
seeking to optimize the patient’s participation.
Sources: Core Competencies for Interprofessional Collaborative Practice . Report of an Expert Panel,
May 2011, Sponsored by the Interprofessional Education Consortium, p 8 .
http://www.aacn.nche.edu/education-resources/ipecreport.pdf
Morrison S. Working together: why bother with collaboration? Work Bas Learn Prim Care. 2007;5:65–70.
Benefits of an Interprofessional
Team Approach
 Interprofessional approaches
to health and social care are
linked to improved clinical
services and enhanced
problem-solving
(Mitchell, Parker& White, 2010)
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Characteristics of Effective Collaborative
Interprofessional Teams
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Belief that the team is important to the outcome
Open communication
Equality of resources
Respect
Shared decision making
All members feel valued
Meet Mrs. C.
Mrs. C. Social History Data
 92-year-old woman lives alone
 Widowed 14 years ago; daughter lives locally and
son lives in Arizona
 Worked for 15 years as an executive secretary at a
local company
 Active in her faith community all her life
 Volunteers in a children’s reading program at the
local library
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Case Presentation - Mrs. C.
Health History
 Multiple chronic health
problems (Cardiac,
Pulmonary, Diabetes,
Arthritis)
 Hospitalized for
shortness of breath and
chest pain twice in the
last 3 months
14
Acute Incident
 Falls at home
 paramedics arrive and
find her with right leg pain
and unable to walk
 Taken by ambulance to
the hospital
Diagnosed with Hip Fracture
Admitted for surgery and day #2 develops worse
shortness of breath, complaints of pain, nausea, and
constipation
Mrs. C. - Discharge Planning
 Fearful of falling, hard
time using walker
 Discharged to a
skilled nursing facility
for rehabilitation
18
Mrs. C. - Rehab Update
 4 weeks of rehabilitation: family is
concerned about her returning home
alone
 They report Mrs C. has a history of
several falls at home without injury
 Family is concerned she is
 “taking her medications wrong”
 sometimes they notice “she is wearing
clothes that have stains and appear dirty”
19
Mrs. C. - Rehab Discharge Outcome
 Discharged back
home after 6 weeks
 Plan includes:
 Home Care Aids 4
hours per day
 Weekly nursing
visits
 Referral to
outpatient PT
 Daughter plans on
shopping weekly
and setting up
mediset
Mrs. C. - Five days later…..
 Family brings Mrs C back to hospital
Emergency Department
 Increased confusion, not eating/drinking
 Found on the floor where it appeared she
had been for many hours after aide left in
morning and daughter visited at night
 Admitted to the hospital with pneumonia,
dehydration, and “failure to thrive”
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With which health care teams did
Mrs. C. interface?
 Hospital: Multi-Disciplinary?
 discipline-oriented with each team member responsible only for the
activities related to his or her own discipline. Communicate with one
another through chart documentation and unit reports.
 Rehabilitation Nursing Home Stay?
 Likely interdiscplinary / perhaps interprofessional
 Discharge Home?
 Multi-Disciplinary
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PCP for medical Care
Home Care agency
Outpatient PT clinic
Family
Mrs. C.’s Story: Important to Assess how team
function can improve across service sectors
 Next steps in management?
 How could this have been prevented?
 How can the team think about?
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Prior level of function at home
Hospital management
Rehabilitation course in nursing home
Home Care Plan and safeguards
 What about:
 Cognitive & psychosocial strengths and challenges
 Family caregiving & interface with the formal care system
 Functional & Environmental Factors
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Why the need for interprofessional
collaboration and effectiveness?
 Population is
Aging:
 Largest
increase
in Age > 85
 Older adults are
seen as
patients/clients
in all health
care settings
Source: Administration on Aging, January 2004
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Where are older adults interfacing with
service providers?
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Home (independent in the community)
Home (with Home Care Services)
Independent or Senior Housing
Assisted Living Facilities
Adult Day Care Programs
Long-Term Care Facilities (Nursing Homes)
Rehabilitation Centers
Hospitals
Community Retail Providers (Pharmacy )
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What challenges do older adults
experience as they age?
 Disability (loss of function)
 Comorbidity (chronic medical conditions)
 Frailty (vulnerability)
 Multiple Losses (compounding effect)
26
Why is assessment important?
 Goal: decrease disability
and dependence
 Identify “pre-clinical”
disability
 Majority older adults
live independently
 50% Lifetime Risk of
nursing home placement
27
Geriatric Syndromes
 Broad categories of signs and symptoms
common in the geriatric population
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Vision impairment
Hearing loss
Incontinence
Falls/Mobility
Depression
Memory disorders
HELP!
28
What is geriatric assessment?
 Method to identify problems/challenges early
 Goal to maintain or improve FUNCTION
 Screen for common problems of aging (geriatric syndromes)
 Identifies the strengths/resilience of the individual and family
system
 Performed by interdisciplinary/interprofessional team
 Focus on chronic disease management and effective
resource utilization to enhance quality of life
29
*
Geriatric Assessment:
Interprofessional Team Interface
 Comprehensive assessment is performed by an
interdisciplinary/interprofessional team
 Each team member’s professional domain knowledge is
recognized. Collaborative team practices are central to the
model. Allowing for contextual understanding of complex
issues.
Geriatricians
Social Workers
Patient/Family
Neuropsychologists
Nurses
Pharmacists
30
Addressing Complexities Through an
Interprofessional Approach
Interface of
Medicine
Nursing
Social Work
Association of American Medical Colleges
/ John A. Hartford Foundation, Inc. July
2007 Consensus Conference on
Competencies in Geriatrics Education
Academic Medicine. 84(5):604-10, May
2009.
John A. Hartford Foundation
Institute for Geriatric
Nursing,2002
Geriatric Social Work Competency
Scale II with Life-long Learning in
Relationship to Leadership Skills
Demonstrate
within care plan
appropriate
intervention to
promote function
in response to
change in ADLS
and IADLS
Conduct a
comprehensive
biopsychosocialspiritual assessment
identifying older adults
strengths and problems,
social supports, social
functioning, ADL and
IADLs
Geriatric
Assess & describe
Competencies baseline and current
functional abilities in an
older patient
Functional
(ADLs/IADLS) by
Assessment collecting historical data
and performing a
confirmatory physical
exam
http://www.pogoe.org/sites/defa
ult/files/Minimum%20Geri%2
0Competencies%202.0%20w%
20narr%20AcademMed%2039-09_0.pdf
http://www.pcssprimarycare.org/nsw/com
petencies/competencies.php#
http://hartfordign.org/uplo
ads/File/competencies.p
df
31
http://www.pharmacist.com/sites/default/files/files/core_elements_of_an_mtm_practice.pdf
Interface of Competencies
Medication
Management
Medicine
Pharmacist
Nursing
Association of American Medical
Colleges / John A. Hartford
Foundation, Inc. July 2007
Consensus Conference on
Competencies in Geriatrics
Education Academic Medicine.
84(5):604-10, May 2009.
Medication Management Therapy in
Pharmacy Practice, (2008).
http://www.pharmacist.com/sites/default/fi
les/files/core_elements_of_an_mtm_prac
tice.pdf
Geriatric Social Work Competency
Scale II with Life-long Learning in
Relationship to Leadership Skills
Explain impact of agerelated changes on drug
selection and dose
based on knowledge of
age related changes in
renal & hepatic
function, body
composition & CNS
sensitivity
Perform basic elements
of geriatric
pharmacotherapy
assessments, interpret
physical, laboratory and
diagnostic test results,
monitor drug therapy,
provide medication
counseling
Assess barriers, drug
interactions, … that
impact patients’
understanding of
information, following
directions and making
needs known.
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Components of Geriatric
Assessment
 Medical
 Functional
 Psychological
 Cognitive
 Social
 Economic
 Family
Dynamics
33
Dimensions of Geriatric Assessment:
Medical Assessment
 Geriatric Syndromes:
 Past Medical and
Surgical Histories
 Vision & Hearing
 Family History
 Incontinence
 Falls/Mobility
 Physical Exam
 Memory/Mood
 Review Medications:
 Nutrition
 Polypharmacy
 Pain
 “Bad Drugs”
34
*
Medication Review: Medicine, Nurse
Practitioners and Pharmacy
While Social Workers are not
the primary profession dealing
with medication review,
observations from home
assessments, knowledge of
environmental issues such as
finances can inform the
interprofessional team
 Drug distribution and
metabolism altered with
aging
 Adverse Drug Reactions &
Drug-Drug Interactions
 Number of medications
 OTC and herbal/dietary
 “Inappropriate” Meds:
falls, urinary problems,
delirium, hospitalizations
35
Functional Assessment:
Activities of Daily Living (ADL)
 Dressing
 Toileting
(+/- continence)
 Eating
 Bathing/Hygiene  Mobility
 Ambulating
(personal care)
 Transferring
36
Instrumental Activities of
Daily Living (IADLs)
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Shopping
Housekeeping (cleaning, laundry)
Finances
Cooking
Using telephone
Medications
Transportation (driving, buses, etc.)
37
Psycho-Social
 Social History
 Contextual understanding of who the patient is
 Presenting Challenges & Goals
 Patient perspective
 Family perspective
 Mental Health Assessment
 Coping skills, stressors, risk factors,
depression screen
 Social Functioning Assessment
 Social skills, social activity level, social
supports
 Caregiver Needs/Levels of Stress
*
38
Assessment Cognitive Function
Dementia
Normal
Aging
Mild Cognitive
Impairment
Alzheimer’s
Disease
39
DEMENTIA
Cognition
Behavior
Function
Geriatric Assessment
Assessments depend on context and
location:
 Hospital – discharge planning
 Clinic/office – comprehensive assessment
 Nursing Home – improve or maintenance
 Home – mobility and safety
 Rehabilitation – improve function
41
Core Areas
 Functional assessment (observations)
 Areas of concern (mobility impairment,
weakness, ROM, falls, etc.)
 Medical Conditions (dementia, CHF, etc.)
 Rehabilitation tolerance and potential
 Psycho/Social Assessment
42
Establishing Goals
with Older Adults
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Individualized and person-centered
Maintain independence longer
Reduce stress or burden on caregivers
Gradual or stepwise loss of function common
in patients
 Some older adults’ function may “plateau”
after an illness or injury
 Small improvements in physical function go a43
long way (high “investment payoff”)
*
Functional Decline:
Illness
Function
Good Health
Functional
Impairment
Rehab
Threshold
Disability
Time
Hospitalizations
Nursing
Home
Family &
Caregiver
Stress
Summary
 Interprofessional team collaboration
improves communication and patient/client
outcomes
 Geriatric assessment emphasizes
functional status and the goal of
maximizing independence and quality of
life
 Loss of function is common but small
improvements go a long way
 Person-Centered Approach
45
Next Steps: Workforce Preparation through
Interprofessional Educational Models
 Interprofessional educational models
 Engaging students across professional
disciplines
Source: Core Competencies for Interprofessional Collaborative
Practice . Report of an Expert Panel, May 2011, Sponsored by
the Interprofessional Education Consortium, cover page picture.
www.socialworkleadership.org
What is Interprofessional
Education?
When “students” from two or more professional
learn about, from, and with each other to
enable effective collaboration and to improve
health outcomes
Framework for Action on Interprofessional Education & Collaborative Practice,
World Health Organization, 2010
www.socialworkleadership.org
Educational Models
to Prepare Competent Interprofessional
Practitioners
 “The transformation
envisioned would enable
opportunities for health
professions students to
engage in interactive
learning with those
outside their profession
as a routine part of their
education”
Source: Core Competencies for Interprofessional Collaborative
Practice . Report of an Expert Panel, May 2011, Sponsored by
the Interprofessional Education Consortium, p3.
http://www.aacn.nche.edu/education-resources/ipecreport.pdf
Educational Strategies in Fostering
Interprofessional Collaborative Practice
 Patient/family centered
 Community/population oriented
 Relationship focused
 Process oriented
 Linked to learning activities, educational strategies, and behavioral
assessments that are developmentally appropriate for the learner
 Able to be integrated across the learning continuum
 Sensitive to the systems context/applicable across practice
settings
 Applicable across professions
 Stated in language common and meaningful across the
professions
 Outcome driven
Source: Core Competencies for Interprofessional
collaborative Practice
Report of an Expert Panel, May 2011, Sponsored by the
Interprofessional Education Consortium
http://www.aacn.nche.edu/education-resources/ipecreport.pdf
Competencies in the Care of Older Adults at the
Completion of the Entry-level Health Profession
Partnership for Health in
Aging (PHA)
 Representing 10 Health Care
Professions
 Developed broad
competencies in six domains
to provide a baseline for
geriatrics and gerontology
training
To Access competencies:
http://www.americangeriatrics.org/files/docu
ments/health_care_pros/PHA_Multidisc_Co
mpetencies.pdf
www.socialworkleadership.org
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Dentistry
Medicine
Nursing
Nutrition
Occupational Therapy
Pharmacy
Physical Therapy
Physician Assistants
Psychology
Social Work
Competencies in the Care of Older Adults at the
Completion of the Entry-level Health Profession
Domains:
1. Health Promotion and Safety
2. Evaluation and Assessment
3. Care Planning and Coordination Across the
Care Spectrum
4. Interdisciplinary and Team Care
5. Caregiver Support
51
6. Healthcare Systems and Benefits
Source: Partnership for Health in Aging Workgroup on Multidisciplinary Competencies in
Geriatrics
http://www.americangeriatrics.org/files/documents/health_care_pros/P
HA_Multidisc_Competencies.pdf
Endorsements
Competencies in the Care of Older Adults at the
Completion of the Entry-level Health Profession
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Alliance for Aging Research
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American Academy of Nursing – Expert Panel on
Aging*
Association of Directors of Geriatric Academic
Programs
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Association for Gerontology in Higher Education
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American Academy of Physician Assistants
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Council on Social Work Education
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American Assisted Living Nurses Association*
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American Association of Colleges of Pharmacy
Gerontological Advanced Practice Nurses
Association*
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American Association for Geriatric Psychiatry
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Gerontological Society of America
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American Association for Long Term Care Nursing*
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The Hartford Institute for Geriatric Nursing*
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American Association of Nurse Assessment
Coordinators*
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National Association for Geriatric Education
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National Association of Geriatric Education Centers

National Association of Directors of Nursing
Administration in Long Term Care*

National Association of Professional Geriatric Care
Managers
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American College of Clinical Pharmacy

American Dental Association
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American Dietetic Association
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American Geriatrics Society
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National Gerontological Nursing Association*
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American Occupational Therapy Association
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American Pharmacists Association
New York Academy of Medicine/Social Work
Leadership Institute
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American Physical Therapy Association
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PHI – Quality Care through Quality Jobs
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American Society on Aging
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American Society of Consultant Pharmacists
www.socialworkleadership.org
Lessons Learned….
 Social workers are experts on interprofessional
collaboration so should be at the forefront
 Review the Core Competencies for Interprofessional
Collaborative Practice http://www.aacn.nche.edu/education-resources/ipecreport.pdf
 Utilize the Partnership for Health and Aging (PHA) Core
Competencies to establish dialogue with other
professions in exploring interprofessional educational
opportunities
 Remember: Interprofessional Education as a model is a
long term “process”
 Seek funding
www.socialworkleadership.org
Getting Started….
 Determine your goals for interprofessional education
 Gain support from university leadership at all levels
 Conduct syllabus audit to identify strengths and areas for
change related to interprofessional content
 Document and promote the interprofessional
collaboration strengths of the social work profession
www.socialworkleadership.org
Getting started…
 Curricular interventions:
 Integration into existing courses (including practicum
seminar)
 Cross-listing courses
 Co-teaching courses
 Certificate/minor/specialization
 If your university has no health professions,
consider reaching out to the community
www.socialworkleadership.org
Resources: Interprofessional Teams, Assessment
& Instruction Tools

King, G., Shaw, L., Orchard, C., & Miller, S. (2010). The
interprofessional socialization and valuing scale: A tool for
evaluating the shift toward collaborative care approaches in
health care settings. (35 ed., pp. 77-85). IOS Press.

Team Fitness Test (GITT) Geriatric Interprofessional Team
Tools) available
www.gittprogram.org/files/team_fitness_test.doc

Models of Care and Inter-Professional Care Related to
Complex Care of Older Adults by Sharon Stahl Wexler pdf
download available at :
hartfordign.org/uploads/File/.../gnec_interdisciplinary_care.pdf

GITT video on You Tube available: available at
http://www.youtube.com/watch?v=YrpPcgk99l8

Interprofessional Care and Training ( Pharmacy & Medicine)
University of Pittsburgh available at
http://www.youtube.com/watch?v=OTqJxneLRtQ
www.socialworkleadership.org
Resources: Interprofessional Teams, Assessment
& Instruction Tools

Online training module on Interprofessional Geriatric
Assessment available from the Finger Lakes Geriatric Center
(Includes Social Work)
http://www.nptrainingworks.com/flgec

The Center for Interprofessional Education and Research,
Saint Louis University ipe.slu.edu

The National Coordinating Center for Interprofessional
Education and Collaborative Practice, University of
Minnesota
For information on this new project, contact: Barbara F. Brandt;
[email protected]; 612/625-3972
www.socialworkleadership.org
Resources: Interprofessional Teams, Assessment
& Instruction Tools

American Association of Colleges of Pharmacy (AACP)*
http://www.aacp.org/resources/education/Pages/IPEC.aspx
*See Core Competencies for Interprofessional Education

Framework for Action on Interprofessional Education &
Collaborative Practice
http://www.who.int/hrh/resources/framework_action/en/
www.socialworkleadership.org