Older adults in the Rochester and surrounding Finger Lakes area report more “poor mental health” days than their peers across New York state, a fact compounded by a shortage of behavioral health providers in the region. But a new interprofessional collaborative program has the potential to better address seniors’ complex health needs.
A grant from the National Center for Interprofessional Practice and Education provides the initial start-up funding for an innovative geriatric home visit (GHV) initiative which will pair local nurse practitioner and medical students with social workers to provide in-home behavioral screenings to older adults, leading to the development of an integrated physical, behavioral, and social support care plan.
The project broadens access to behavioral health assessments among vulnerable older adults while building a workforce of health professionals better able to identify and collaboratively manage the population’s health needs using new models of care delivery.
“This is a very special opportunity to partner with older adults and their family members and collaborate across professions and organizations to break down silos and improve the integration of community-based care,” said Tobie H. Olsan, Ph.D., R.N., C.N.L., F.N.A.P., professor of clinical nursing at the University of Rochester School of Nursing and principal investigator on the grant. “Interprofessional teams are the key to safe, high-quality, patient-centered care. Our focus has been in the hospital. This initiative is about learning and working together to accelerate the use of best team practices in the home, which is increasingly where we are caring for older adults.”
“I am particularly excited about the proposed Geriatric Home Visit initiative because it will build on and powerfully extend what is already happening at Rochester to better meet the behavioral health needs of vulnerable elders in our community,” said Mark B. Taubman, M.D., C.E.O of the University of Rochester Medical Center (URMC) and dean of the School of Medicine and Dentistry. “The initiative reinforces efforts to reframe our academic community and culture to critically apply an integrated, holistic, patient- and family-centered lens to professional education and practice.”
The GHV initiative brings together nurse practitioner students from the UR School of Nursing, third-year medical students from the University of Rochester School of Medicine and Dentistry and community-based professional social workers from Lifespan, a local aging services agency for an in-home, interprofessional, team-based learning experience. The four-week cohort experience consists of five components: preliminary online training modules, in-home visiting, collaborative assessment and development of integrated care recommendations, follow-up contact, and a debriefing with supervising medicine and nursing faculty from the University of Rochester and social work faculty from SUNY Brockport’s College of Education and Human Development.
As many as 40 interprofessional teams will have the opportunity to participate over the course of the two-year project, which includes a $50,000 grant from the National Center and $200,000 in total funding, including matching resources from the partner organizations.
“This grant creates a wonderful opportunity for us to extend our previous work in interprofessional education – largely anchored in Strong Memorial Hospital and within the schools of medicine and nursing – to the community,” said Sarah Peyre, Ed.D., assistant dean for interprofessional education at URMC. “This is a novel, innovative program that will change, and determine, the course of interprofessional study for both our nursing and medical students moving forward.”
The Rochester team was one of 16 chosen by an advisory council of national leaders to receive funding for the Accelerating Interprofessional Community-Based Education and Practice program. Each recipient team is led by a graduate nursing program and includes one or more professional schools and a community partner.
“We are profoundly aware that the future of health professions education will necessarily be interprofessional, community-based, and community-driven,” said Kathy H. Rideout, Ed.D., P.P.C.N.P.-B.C., F.N.A.P., dean of the UR School of Nursing and vice president of URMC. “The GHV initiative moves forward our work in these domains, and excitingly, moves us to a new model for the involvement and co-education of our nursing and medical students, along with social work professionals, toward improved patient and family care and outcomes.”
“The College at Brockport is committed to playing an important role in developing this interprofessional model of in-home assessment to address the complex needs of our aging population,” added Thomas J. Hernandez, Ed.D., L.M.H.C., interim dean for the college of education and human development. “Each discipline—social work, nursing, and medicine, brings an equally important skillset to the table.”
Unmet behavioral health needs of older adults impose significant health, social and financial costs to communities. A 2016 report by the Finger Lakes Health Systems Agency noted that mental health and substance abuse disorders are associated with 45 percent of the region’s hospital admissions, and suicide ranks as the leading cause of years of potential life lost. Adults age 65 and older account for 15 percent of the region’s population with projections indicating that the number could reach 22 percent by 2025. Older adults already face severely constricted access to behavioral health services due to shortages in the number of providers, exacerbated by poorly integrated systems of physical and behavioral health care.
Lifespan social workers serve older adults who are among the most vulnerable and underserved in the region – 45 percent have income less than $15,000. The agency conducts an increasing number of behavioral health screens each year, totaling 426 in 2015.
“Across our programs, we see an escalating need for improved behavioral health identification and intervention. Daily, we hear from our clients and their families that they are struggling with complex behavioral issues,” said Ann Marie Cook, president and CEO of Lifespan, which assists 31,000 clients annually. “As profound as is the apparent need is the corresponding necessity for enhanced resources and professionals educated to meet it.”
“It is gratifying to see the return of home-based health care,” said Eric Caine, M.D., chair of the Department of Psychiatry at the UR School of Medicine and Dentistry. “Too often we wait for people to come to our hospital or clinic door. Now students will learn the skills of going to the doors of older people who face multiple health challenges — individuals who often do not have the ability or support to readily seek care. For persons with mental health concerns, this is especially important.”
The GHV program, which establishes the University of Rochester and its School of Nursing as a Nexus Innovations Network and part of a virtual national learning community with other funded programs, also dovetails with the University’s vision of advancing interprofessionalism through education, research, and practice. The University’s Institute for Innovative Education (IIE), formed in 2012, fosters educational improvement through interdisciplinary collaboration, the integration of emerging clinical and curricular innovations and technologies, and the team-based preparation of health care providers across the learning continuum, with a goal of improving the availability, quality and experience of medical care, particularly to the most vulnerable populations.
Funding for the National Center’s Accelerating Interprofessional Community-Based Education and Practice program was made possible by the support of the Robert Wood Johnson Foundation, The John A. Hartford Foundation, the Josiah Macy Jr. Foundation, and the Gordon and Betty Moore Foundation.
A complete list of grant recipients and additional information about the Accelerating program can be found on the National Center for Interprofessional Practice and Education website, www.nexusipe.org.