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a School of Social Work, University of Hawaii, Honolulu
b Center on Aging, John A. Burns School of Medicine, Honolulu, HI
Correspondence: Colette V. Browne, MSW, DrPH, University of Hawaii, School of Social Work, 1800 East West Rd., Honolulu, HI 96822. E-mail: cbrowne{at}hawaii.edu.
Decision Editor: Eleanor S. McConnell, RN, PhD
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Abstract |
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Key Words: Curricula • Diversity and aging • Interdisciplinary education
Social workers are key professionals working with the nation's dramatically growing numbers of older adults. Adopting the ecological model of practice, social workers emphasize the assessment of older adults within their environment, acknowledging the impact of ethnic minority status on psychological changes, health and income status, and service utilization rates (Hooyman and Kiyak 1999
). Similar to other gerontologically educated professionals, social workers recognize the interdisciplinary nature of their work, and understand that their effectiveness is compromised without knowledge of and working relationships with other health and social professionals (Estes and Weiler 1989; Mellor and Soloman 1992; Salz 1992).
Despite the recognized value of professional social work services (Damron-Rodriguez and Lubben 1997; Scharlach, Damron-Rodriguez, Robinson, and Feldman 2000), there exists a national shortage of social workers trained to work with older adults (Lennon 2000). The Blueprint for the New Millennium (supported by the John A. Hartford Foundation in New York City) estimated that 60,000 to 70,000 trained social workers will be needed by the year 2020 (Council on Social Work Education [CSWE], 2001). But, although 62% of social workers surveyed by the National Association of Social Workers stated that geriatric knowledge was required in their work, less than 3% of students in master's degree social work programs chose an aging concentration or specialization. Of the remaining 97%, less than 2% took any courses in gerontology in their graduate program (Damron-Rodriguez and Lubben 1997).
Compounding this problem is the continuing unevenness of national and state leadership in gerontological social work education (CSWE 2001). Cuts in the Administration on Aging and other federal training funds in aging led to declines in support to geriatric social work education beginning in the 1980s. With the urging of a number of social work leaders (see Damron-Rodriguez and Lubben 1994; Fahey 1996; Salz 1995; Scharlach et al. 2000), the John A. Hartford Foundation 1998 began to provide leadership and support for the education of geriatric social workers in the late 1990s. Nonetheless, this 20+ period of neglect took its toll. During this time frame, the older adult population has grown dramatically and is increasingly ethnically and culturally diverse. Although ethnic minority populations comprise 15% of older adults today, projections state that the proportion of older adults is expected to increase at a higher rate for the non-White population than for Whites (Hooyman and Kiyak 1999). This has important practice, policy, research, and educational implications for ethnogeriatrics and culturally competent practice (Yeo, David, and Llorens 1996). An additional focus for social workers is in interdisciplinary education. Research and practice have provided evidence that quality elder care demands collaboration among individuals trained in a variety of health disciplines, necessitating knowledge and skill development of interdisciplinary team work roles and functions (Administration on Aging 2000; Berkman, Dobrof, Damron-Rodriguez, and Harry 1997; Damron-Rodriguez and Lubben 1994; Hooyman and Kiyak 1999; Scharlach et al. 2000). Rarely do social workers receive this kind of training (CSWE 2001; Hodges, Mellor, and Soloman 1996). Thus, gerontological social work education programs need to be supported in enhancing curricula to educate students in cultural competence and interdisciplinary practice, in addition to specific knowledge about aging processes, skills in geriatric assessment, and good command of interventions at the individual, family, community, program, and policy levels.
In this article, we report on a model, multisite, university–community collaboration in gerontological social work education that emphasized cultural competence and interdisciplinary practice. This program is successful in increasing the numbers of trained gerontologically trained social workers in Hawaii and for supporting the continuing education needs of professional social workers and students. Recommendations are offered for project replication in other communities and universities.
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Methods |
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Master's degree students in social work must spend 16–20 hr per week in a field (practicum) site supervised by a Master's trained professional social worker as part of their degree requirement. The social work curriculum, then, is both university and community based. Through interviews with field (practicum) instructors, leaders in community sites, and faculty teaching aging in other departments on campus, we determined that the social work curriculum (both at the academy and in the community) needed to: (a) direct more attention to student recruitment, including the development of financial incentives, (b) provide greater emphasis on interdisciplinary team work and cultural competence in classroom and practicum education, (c) provide in-depth educational support to practicum instructors, (d) enhance peer support for students in practicum, and (e) standardize curricula and student learning outcomes across practicum sites. The last category was especially critical, as we found that not all practicum sites provided students with an interdisciplinary setting within which to practice, some lacked population heterogeneity, and some did not expose students to the continuum of care but rather focused on only part of the continuum (e.g., nursing home care).
Project Leadership
The project adopted two key strategies: university–community collaborative approaches and the train-the-trainer approach to gerontological social work education. In recognition of the critical role of university–community collaboration in educational leadership (Browne, Smith, Ewalt, and Walker 1996; Mokuau and Ewalt 1993), we formed and maintained two councils to give guidance to the project and to ensure that practitioners' concerns were addressed. The Advisory Council, led by the project's Principal Investigator (Colette V. Browne), was composed of community leaders and the heads of selected community-partner agencies. The Consortium Council, the project's working group, was composed of practicum instructors from community-partner agencies and project faculty and staff. Community-partner agencies met at least two of three criteria: (a) the agency was considered to provide excellent service to the aged, (b) it used an interdisciplinary team practice approach, and (c) at least 50% of its clientele was from minority cultures. Community partners included the State Unit on Aging, the Department of Human Services, the Veterans Administration, the Geriatric Education Center, a community-based case management program, and social work departments at two local hospitals. All agreed to commit themselves for 2 years to this project and support its goals and objectives. The widely acknowledged shortage of geriatric-educated social workers in the community was a strong incentive among community members and one reason that accounted for their enthusiastic support.
The second key project strategy was the train-the-trainers approach to the teaching of gerontology to social work students and community social workers. This strategy acknowledged the university's responsibility to the continuing education of its constituents in the promotion of research and evidence-based practice methods in aging, as well as supporting the community's work as university-partners in the education of future gerontological social workers.
Implementation
The Consortium Council specified four areas of work: (a) practicum curricula development, which focused on establishing mechanisms for continuing education for practicum instructors and developing field curricula materials built on agreed-upon social work educational performance competencies; (b) university curricula development, which focused on methods to improve and enhance school curricula in geriatric and gerontology social work practice and to integrate further school and field site learning objectives; (c) student recruitment support, which focused on strategies to recruit, to educate, and to support further students who would work in geriatric and/or gerontological social work, using methods such as recruitment brochures, continuing education, tutorials, and stipends; and (d) research development, which focused on strategies to involve faculty, practicum instructors, and students in research that would expand knowledge about ethnic minority populations served and intervention effectiveness.
The project was organized into two phases. In Phase 1, the Consortium Council developed standardized learning competencies and employed a train-the-trainers approach through which community-based social workers could receive education in interdisciplinary practice and cultural competency, thereby enhancing their ability to train social work students assigned to them. We determined a train-the- trainers approach to be the most effective and immediate way to reach the practicum instructors, who, in turn, have the greatest potential to reach and teach the students in their sites. On the basis of the standardized competencies developed in Phase 1 and new knowledge among Consortium members, Phase 2 work entailed the implementation of the student practicum curriculum education program, the strengthening of school-curriculum content in cultural competence and interdisciplinary practice, student recruitment and support, and increased research opportunities. Some aspects of this educational program ran concurrently for the two years of this project. However, Phase 1 emphasized the education of practicum instructors whereas Phase 2 emphasized student education in our enhanced curriculum.
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Results |
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method of constant comparative analysis in which qualitative data are coded as new data emerge that fit an existing category. In the first step, Colette V. Browne and Linda McLaughlin individually and collectively reviewed all 120 originally identified competencies and deleted those items for redundancy. Next we involved the Consortium Council in three consecutive meetings, whereby we identified general themes from the remaining 75 (e.g., interventions, knowledge on aging, community resources). Then we coded the competencies by these themes, in some cases adding new competencies as suggested by council members. Lastly, after we grouped and coded each competency according to a generalized theme, we prioritized each item in each grouping according to council consensus, eventually ending with 13. We provided a time frame of 6 months for this process. We revisited numerous drafts at each Consortium Council meeting and, in this process, one additional competency on legal issues emerged and was eventually added. Finally, with full agreement by all council members, we confirmed the final fourteen standardized learning competencies. This was a time-consuming approach that would have taken less time if project faculty alone had identified them. Such a process, however, would have not allowed for participant buy in nor would the project have benefited from the wide range of expertise that was shared over these 6 months of meetings. We arranged meetings with easy parking, lunch, and preorganized teaching tools (e.g., books and reading materials, PowerPoint graphics, large sheets of paper, markers). Furthermore, all meetings kept to their prior agreed-upon time schedule, with the specific intent to acknowledge and respect their contributions and schedules.
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Fourth, the project's Principal Investigator, coordinator, and consultant on cultural competence (Noreen Mokuau) authored a 125-page practicum curriculum handbook with Advisory and Consortium Council input. The handbook's curriculum included three modules:
Although developed for Hawaii, the curriculum is easily adapted to other sites that desire to enhance their knowledge and skills in working with an increasing diverse elder population. The exercises are intended to be interactive, and an instructor's guide and a complete listing of references are included.
Finally, the Consortium Council, which successfully guided and supported this project, decided to continue their work as Hawaii's first Consortium for Gerontological Social Workers.
Curricula Development
Social work students who have selected aging as their area of concentration are required to take two graduate courses in working with older adults. Under this component, we reconceptualized these two required courses in aging and updated them to include content on diversity issues and interdisciplinary team approaches. Every class session, from knowledge of normative aging to assessment and intervention methods and skills, was taught from a diversity perspective. A session on dementia, for example, included readings that discussed how culture impacts the views of dementia and help-seeking patterns and proposed strategies for ensuring improved access to elder care services by Asian and Pacific Islanders based on an understanding of these culturally linked values and behaviors (Braun and Browne 1998). The courses also articulated the structural barriers and disadvantages and advantages across the life course that result in differential access-to-service patterns and documented health disparities among ethnic groups. Additionally, we developed a new elective course titled Diversity and the Aging Experience and offered it during summer session. In both the reconceptualized courses and the new elective course, we found case vignettes from real life experiences that represented diverse elder experiences to be especially helpful.
Student Recruitment and Support
We employed a number of strategies to improve student recruitment. We developed a recruitment brochure and disseminated it to potential students. A $30,000 grant from a local foundation allowed us to offer stipends to gerontology students. The new elective course also served as a recruitment tool, as many students are interested in diversity. We also invited students to participate in workshops with nationally recognized scholars in gerontology. Finally, in conjunction with the University's Center on Aging, we established a chapter of the national gerontology honor society—Sigma Phi Omega—and recognized excellence in our students.
Research Development Plan
The project's research program initially has focused in two areas: (a) review and conduct of research designed to improve the cultural competency of service for older adults and their families, and (b) formative and summative evaluation of university curricula in aging. In the first area, we began with a comprehensive review of the cultural competence literature in general, and with older adults, using Medline, Healthstar, Sociofile, Psychlit, and SocialWork. From here, we identified culturally competent skills needed with specific older ethnic groups and then conducted a community assessment of culturally competent approaches used by agencies and/or organizations that work with older adults, using the conceptual framework developed by Brach and Fraser 2000. On the basis of the cultural competence and health disparity literature, these researchers identified nine major cultural competency techniques: (a) interpreter services, (b) recruitment and retention policies, (c) training, (d) coordination with traditional healers, (e) use of community health workers, (f) inclusion of family and/or community members, (g) culturally competent health promotion, (h) immersion into another culture, and (i) administrative and organizational accommodations. We asked community professionals which of these services or accommodations were currently used at their work site and by whom and asked them to identify what outcomes may have been achieved by the use of these services. We have summarized data to provide the project with beginning information on the techniques and/or strategies used in this community. From here, we will engage in further study that examines the effectiveness of specific interventions with ethnic older adults in Hawaii.
We also work with students to foster an increased interest in research, and this has led to a number of student research projects. Student research projects have examined such diverse topics as service preferences among Filipina caregivers, public satisfaction with Japan's new long-term care system, and the effectiveness of life review with ethnic and/or minority older women.
Project Evaluation
The project proposed a number of process and outcome objectives. To determine if we met objectives, an external evaluator reviewed program documents and analyzed data gathered through interviews with us, other project participants, and questionnaires developed specifically to determine program impact. We met or exceeded all project objectives. An independent consultant evaluated student knowledge and skills by gathering data from the 12 students enrolled under the new curriculum in 2000–2001. Students completed a pretest on the first day of class and completed an identical posttest on the last day of class 9 months later. The questionnaire included 39 items tapping mastery of content and skills in the seven competency areas (measured on a 5-point Likert scale). For example, in the area of cultural competency, 100% of students upon posttest felt competent intervening with Asian and Pacific Islander elders and older women and believed that their style of practice was culturally competent. All 12 (100%) felt confident about their role on an interdisciplinary team, about their role as advocate, and about their interviewing and assessment skills. All 12 (100%) agreed that they understood normal aging, major psychosocial issues faced by elders and how to apply the ecological model, empowerment theory, and the strengths' perspective in their work. Most (11 of 12) agreed that they were knowledgeable about common ethical dilemmas faced in elder care and understood their roles in policy analysis, program evaluation, and resource development. Fewer students (7 of 12) felt competent to assess elder abuse and felt knowledgeable about the full range of social work interventions, which might be expected as practicum sites differed in opportunities to assess elder abuse and practice a full range of interventions. The curriculum has since been modified to expand opportunities for students to master these objectives. Consortium Council members also completed surveys in May 2001, which indicated a high level of satisfaction with all project activities, especially continuing educational offerings, the student recruitment strategies, and the consortium's decision to sustain itself after the project's end.
The project was successful because of strong commitment with our community partners. All project participants recognized the need to support the recruitment of gerontological social work students and the continuing education of social workers in the community with up-to-date aging knowledge and skills. Nonetheless, sustaining a project such as this one requires an infusion of monies that in turn can support the work of community social workers, busy and often understaffed professionals in their own work settings. The infusion of extramural funds provided replacement monies that allowed the school faculty to be released from some instructional responsibilities and also allowed the hiring of a doctoral student as part-time project coordinator to manage multiple tasks. Because we made sure that community field site participants had their parking prearranged, their lunch served, their books and other teaching tools provided, and their work well organized, they offered their continued support for the project.
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It is important to emphasize that any successful collaboration requires that all involved—faculty, community, and students—see the potential benefits of collaborative work to their research, practice, and education. Equally important is that project participants recognize the need that the project can address (the shortage of gerontologically trained social workers) and that additional funds are available to support the project's endeavors. Taken together, project products and outcomes provide evidence that this university–community collaborative project in gerontology social work education with emphases on interdisciplinary practice and cultural competence has enhanced the quality of geriatric care in Hawaii to older adults and their families.
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Acknowledgments |
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Received for publication July 13, 2001. Accepted for publication April 19, 2002.
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This article has been cited by other articles:
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  S. M. Schim, A. Z. Doorenbos, and N. N. Borse Enhancing Cultural Competence Among Hospice Staff American Journal of Hospice and Palliative Medicine, October 1, 2006; 23(5): 404 - 411. [Abstract] [PDF]
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