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Introduction: Social Work Practice in Aging: A Competency-Based Approach for the 21st Century

JoAnn Damron-Rodriguez

Foundations of Social Work Practice in the Field of Aging

A Competency-Based Approach

A competency-based approach to social work practice in the field of aging requires practitioners, educators, and students to be grounded in the requisite knowledge and offer evidence of the effectiveness of their work. The Geriatric Social Work Competencies, developed through the collaboration of the John A. Hartford Foundation Geriatric Social Work Initiative programs—the Council on Social Work Education (CSWE) first Strengthening Aging and Gerontological Education in Social Work (SAGE–SW) Gero-Rich and now the National GeroEd Center and the New York Academy of Medicine (NYAM) Practicum Partnership Program (PPP), are now nationally adopted and have been incorporated in this text (see Appendix). This introduction familiarizes the reader with these competencies and addresses the need for social workers to

  • prepare for practice in a 21st century aging society
  • access knowledge for contemporary practice
  • define social work practice in aging
  • identify evidence of the effectiveness of social work in the field of aging
  • develop a competency-based approach to learning
  • recognize core geriatric social work competences
  • self-assess individual growth in social work competence in aging.

The rationale for competency-based education and the need for students and practitioners to evaluate the effectiveness of their interventions are also discussed. The introduction advocates the use of the most current knowledge and best practices in the field of aging.

The text provides a strengths-based multisystemic orientation to foundation social work content for all social workers as well as those concentrating on the field of aging. Each chapter opens with the
geriatric social work competencies thought necessary to carry out effective practice and issued by the CSWE Gero-EdCenter (www.Gero-EdCenter.org).

Chapter 1 discusses the present context of social work practice in the field of gerontology. Chapter 2 provides theoretical constructs to guide geriatric practice, and chapter 3 describes the heterogeneity of the aging population; chapters 4, 5, and 6 focus on the individual, families, and informal support systems. The orientation in chapter 7 is on group work. Chapter 8 on case management discusses both direct individual and family practice skills as well as the need to be able to navigate the services system at the organizational level. Chapters 9 and 10 relate to macro practice within organizations and the community. Finally, chapter 11 addresses policy practice at the state and national level. These chapters further describe the impact of an aging society on its institutions and culture, including family structure, intergenerational and gender roles, work and retirement, dependency ratios, community engagement, and health and social services.

Factors Effecting Geriatric Social Work Practice in the 21st Century

Increased Life Expectancy

Educators have developed geriatric social work competencies in large measure as a response to the changing context of social work practice. Social work practice in the 21st century takes place in the midst of two major societal changes. First is the dramatic increase in life expectancy and the aging of society. Increased human longevity, a hallmark achievement of the 20th century, will have worldwide impact in the 21st century. The 28-year gain in average life expectancy since 1900 is unprecedented over the preceding 5,000 years of human history (see chapter 1). It is not only the dramatic increase in the number of older people that presents an imperative for social work practice in aging, but also the increased diversity of the older population in chronological age (65 to 120 years), birth cohort, race and ethnicity, socioeconomic status, immigration status, functional level, and cognitive capacity that require psychosocial assessment, intervention planning, program development, and policy advocacy (Torres-Gil & Moga, 2001; see chapter 2).

The aging of societies is a global phenomenon. The United Nations International Year of Older Persons in 1999 proclaimed that with thoughtful planning an aging society could become a “society for all ages” that would embrace multigenerational equity and meaningful involvement at all life stages. A society for all ages would acknowledge the interdependence of the individual and society (Lubben & Damron-Rodriguez, 2006). Scharlach and colleagues (2000) stated: “Overarching social work goals in an aging society include preservation of maximum independence, optimal functioning, dignity, and quality of life, through personal empowerment and effective and efficient service utilization” (p. 525).

Increase in Knowledge

The second societal change affecting contemporary social work practice is the exponential increase in knowledge. The explosion of knowledge about the human condition, particularly the aging process, forms the context for the competency-based approach for contemporary practice.

The Knowledge Age

The 21st century following the Industrial Revolution and the brief transitional period of the “information age” of the late 20th century has been conceptualized as the “knowledge age” (Haag, Cummings, McCubbrey, Pinsonneault, & Donovan, 2006). Social work practitioners entering the workforce or continuing to work in the knowledge age must be equipped with distinct professional knowledge and the skills and the ability to acquire more knowledge continuously to serve their clients and society best.

In the knowledge age, information is often disseminated by technology. Computer technology and the Internet make the acquisition of information or the “use of science” more available for practitioners. Thus, social work education must prepare practitioners to be intelligent consumers of research. Using science also requires that the nuance and contextual application of findings be put into practice (Webb, 2001).

Individuals are living longer and healthier lives in part because of the extraordinary growth of biomedical knowledge and public health initiatives. The confluence of the rapid and large increase of the older population and the exponential increase in the dissemination of knowledge create an imperative for social workers to employ the most recent advances in knowledge in their practice with people living increasingly longer lives.

Developing countries cannot age successfully without the use of public health initiatives and population-based interventions such as improved sanitation methods and immunizations. It is these fundamental public health interventions that lead to the increased well-being of the populations of less-developed countries. Their demographic transition involves a shift from high fertility and mortality rates to those of more developed societies with lower fertility and mortality rates (Lubben & Damron-Rodriguez, 2006). This developmental transition takes place in two major stages (Rowe & Kahn, 1999). The first is a marked reduction in infant mortality and early childhood death rates; the second is a significant decrease in death rates among middle-aged and older adults. This reduction of mortality is attributable to an expansion of public health, nutrition, and health care. In an aging society, therefore, individuals have the potential to live longer and healthier lives (see chapter 1 for the use of knowledge and scientific thinking).

Social Workers as Knowledge Workers

Social workers are after all specialized knowledge workers. Over 30 years ago, Drucker (1998) defined knowledge workers as those who develop and use knowledge to accomplish their work. Social work can be defined by its specialized knowledge, values, and competencies, and social workers can be recognized as a special subset of knowledge workers with the requisite professional knowledge to create and improve policies, programs, and services for communities and individuals.

Drucker (1998) further stated that knowledge workers add value by processing existing information to create new information that can be used to define and solve problems better. Reflective practice, program evaluation, and social work research are good examples of this. Social work may be considered a problem-solving profession with practitioners using applied knowledge. According to Western Management Consultants (2002), the practitioner may be thought of as

  • a problem solver rather than a production worker or functionary
  • a person who uses intellectual rather than manual skills to earn a living
  • an individual who requires a high level of autonomy
  • a manipulator of symbols; someone paid for quality of judgment
  • someone who possess un-codified knowledge which is difficult to duplicate
  • someone who uses knowledge and information to add to deeper knowledge and information (Western Management Consultants, 2002).

Definition of Social Work in Aging

The development of geriatric social work competencies coincides with the profession’s interest in defining our practice domain. The bureau of health professions white paper definition of social work in aging is based on the generic description of the profession as described in the national association of social workers’ (NASW) (1981) Standards for the Classification of Social Work Practice (see Berkman, Dobrof, Damron-Rodriguez, & Harry, 1997). This definition of social work in aging relates essential social work roles to the needs of older people and their families as is described in the purposes of geriatric social work practice section. Terms for professional practice with older adults used throughout this book are “gerontological” (founded in knowledge of the aging process) and “geriatric” (based in interventions with older people with health-related issues), sometimes used interchangeably.

Geriatric practice is consumer directed, with the client given the choice in type of service, provider, and timing of care provision (Benjamin, 2001). It focuses on family caregiving. Although 80 percent of the care of older adults is provided by their informal support systems, social workers play a key role in assisting families in their caregiving role (Rizzo & Rowe, 2005; Stone, Reinhard, Achemer, & Rudin, 2002). Another major emphasis is on community care by hospitals or institutions or homes and communities.

Purposes of Geriatric Social Work Practice

Gerontological social workers should have the professional competence to

  • enhance developmental, problem solving, and coping capacities of older adults and their families
  • promote effective and humane operation of delivery systems that provide resources and services to older people and their families
  • link older clients with systems that provide them with resources, services, and opportunities
  • contribute to the development and improvement of social policies that enhance individual functioning throughout the life span. (Berkman et al., 1997)
Values of Geriatric Practice

In addition to having specialized professional knowledge, social work practice in the field of aging embodies values unique to the profession, adding a dimension that is a signature element of the profession as described in the book. These professional ethics and values are delineated in the Code of Ethics of the National Association of Social Workers (NASW, 2000) and are used along with knowledge and skills to accomplish the mission of the profession—“to enhance human well-being and help meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty” (p. 1).

The resilience-enhancing model (REM) (Greene, 2002) that forms the conceptual foundation for this text develops the new tenets of practice in aging for the present era and a philosophy for a new gerontology. Rather than an “aging as a problem” perspective of earlier gerontology and geriatric practice, resilience interventions are based on the self-direction and self-advocacy of older adults.

Evidence of Effectiveness

Social work decisions should be based on the best available evidence. The development of geriatric social work competencies is congruent with the profession’s interest in providing consumers with evidence of effectiveness. Social work is garnering evidence of the value added by the profession’s interventions to older adults’ quality of life (Duke, 2005; Grimier & Gorey, 1998; Morrow-Howell & Burnette, 2001). Rizzo and Rowe (2005) in a comprehensive review of research on social work intervention with older people reported the following intervention outcomes: shorter lengths of hospital stays; decrease in inappropriate use of emergency rooms; overall better coordination of health care; and greater ability of caregivers to cope. Several terms are used to describe the optimal use of outcomes research in practice. Evidence-based practice, practice guidelines, and best practices are types of knowledge (research) that can be applied to interventions.

Evidence-Based Practice

Evidence-based practice is

  • practice supported by research findings and demonstrated as being effective through a critical examination of current and past practices (www.cona-nurse.org/standards/glossary.htm)
  • clinical decision making based on a systematic review of the scientific evidence of the risks, benefits, and costs of alternative forms of diagnosis or treatment
    (www.moh.govt.nz/moh.nsf/0/15f5c5045e7a1dd4cc256b6b0002b038)
  • an approach to decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide on which course of action suits the patient best (www.nhstayside.scot.nhs.uk/FoISA/Glossary.htm)

For example, the evidence of the effectiveness of community-based case management is based on its relatively low cost and the improved quality of life it provides for the frail elderly population (Duke, 2005).

Practice Guidelines

Practice guidelines are systematically developed statements to assist practitioners and patients in making decisions about appropriate health care for specific clinical circumstances (Institute of Medicine, Committee to Advise the Public Health Service on Clinical Practice Guidelines, 1990). Sets of practice techniques that have been evaluated and proved efficacious are practice guidelines.

Best Practices

Best practices are those that have been systematically identified, described, combined, and disseminated as effective and efficient clinical or management strategies for practicing clinicians (Mold & Gregory, 2003).

Competency Approach

A competency-based approach requires the demonstration of core knowledge, values, and skills in social work practice (Vass, 1996). Competency is measured along a continuum or a range of skill levels. The competence level can be adequate or highly qualified in a skill domain. Competency-based education and evaluation (CBE) as defined by Bogo and colleagues (2002) first requires an adoption of a set of defined skills as described in the Development of Geriatric Social Work Competencies section. A CBE approach also leads to the establishment of learning goals and the measurement of their achievement in classroom and field education (Bogo et al.).

Geriatric Social Work Competencies

The social work profession did not recognize the need for specific gerontological or geriatric knowledge until the mid-20th century. Lowy (1979) acknowledged that “prior to 1945, not much had been happening in social work with the aging” (p. 9). Social welfare was initially founded to carry out child welfare functions. It was not until the late 1960s and early 1970s that older people were considered a target population. This was a time when many professions began to recognize that specialized knowledge and training were required to serve older people (Damron-Rodriguez, 2006).

In 1995 the Bureau of Health Professions held a National Forum for Geriatric Education in which social work was one of the key professions. Each profession produced a white paper outlining a strategy for education and training (Berkman et al., 1997). In the late 1990s, the John A. Hartford Foundation, whose goal is to improve the care of older people by strengthening geriatrics in the health professions, turned its attention to social work continuing to fund projects in medicine and nursing geriatric education. Through forums with social work leaders and production of white papers (Scharlach et al., 2000), the Hartford Geriatric Social Work Initiative was crafted. This initiative has had a major impact on the field of geriatric social work (Robbins & Rieder, 2002).

The Council on Higher Education Accreditation (CHEA), which oversees standards for 76 different specializations and professions including nursing, public health, pharmacy, medicine, counseling, education, pastoral care, and social work, reported that nationally 46 percent of these schools are competency based. The CHEA has now adopted a competency-driven model for accreditation of all professional schools (National Center for Higher Education Management Systems, 2000). Competence is used not only as a measure of education and training, but also as a measure for accreditation. The Joint Commission on Accreditation of Healthcare Organizations (2001), for example, stressed the value of competency-based geriatric education in preparing professionals for practice in health care. By establishing geriatric competencies, the field could shape curriculum, field training, and continuing education to prepare practitioners effectively to address the needs of older adults and their families.

Development of Geriatric Social Work Competencies

Research Development

Gerontological social work competencies have been developed over a multiyear period through several of the John A. Hartford social work initiatives. In 1999, CSWE received a grant, SAGE-SW. The project delineated 65 competencies based on a literature review, expert opinion, and a comprehensive survey of the field (Rosen, Zlotnik, & Singer, 2002). These competencies have been applied to aging curriculum development (Greene & Galambos, 2002). In 2000 competencies were being developed for the measurement of geriatric social work enhanced field education (Fortune & Damron-Rodriguez, 2002) by the NYAM PPP and resulted in the PPP Geriatric Social Work Competency Scale I. Scale I incorporated and condensed SAGE-SW competencies and focus group feedback from providers (Naito-Chan, Damron-Rodriguez. & Simmons, 2004). The Geriatric Social Work Competency Scale II is the most recent shorter measurement tool and is presented at the end of this chapter for use in the measurement of student’s assessment of skill level (see chapter appendix for Scale II). The Gero-Rich program and now the National GeroEd Center has brought the competencies to curriculum infusion for generalist practice (Hooyman, 2006).

The Hartford Geriatric Social Work Initiative has coalesced the multiple programs. Statistical measures and national advisory boards synthesized and adopted a common list of geriatric competencies composed of knowledge, skills, and values in four domains. These competencies, whether stated as learning objectives (GeroEd) or measurable skills (PPP), are the adopted skills set now available to guide curriculum development at schools and departments of social work (www.Gero-EdCenter.org and www.socialworkleadership.org. The four domains of competencies are (1) values, ethics, and theoretical perspectives; (2) assessment; (3) intervention; and (4) aging services, programs, and policies. The competencies are presented in their totality in chapter 1 and the appropriate competencies are listed at the beginning of each chapter of the book to guide course development and discussion.

Classroom Infusion and Integration

Competencies have been related to curricula in the following ways:

  • Basic course descriptions are stated in competency-based terms.
  • Course objectives now specify competencies are targeted for aging infusion.
  • Aging content in courses support geriatric competencies.
  • GeroEd teaching resources are used for educational supports and activities.
  • Assessments of skill development are identified and a part of each course.

Student Assessment: Geriatric Social Work Competency Scale II

To assess student competency, instructors must distinguish the level of student performance. Students may also assess their own progress by using the PPP Geriatric Social Work Competency Scale II provided in the Appendix (Chung, Damron-Rodriguez, Lawrance, & Volland, 2007; Damron-Rodriguez, 2006). The PPP Geriatric Social Work Scale II is a self assessment of skill that is currently used in more than 35 schools of social work for measurement of competence. These evaluations at the various PPP sites have consistently demonstrated student increase in geriatric competence over the training period (Damron-Rodriguez, Lawrance, Barnett, & Simmons, 2007). The five levels of social work competence are categorized as

  1. not skilled at all (I have no experience with this skill)
  2. beginning skill (I have to consciously work at this skill)
  3. moderate skill (This skill is becoming more integrated in my practice)
  4. advanced skill (This skill is done with confidence and is an integral part of my practice)
  5. expert skill (I complete this skill with sufficient mastery to teach others).

Thus, evaluation and measurement are central dimensions of competency development. The Geriatric Social Work Competency Scale II can also be used to enrich field experience to

  • define learning objectives based on outcomes
  • structure student contracts identifying competencies
  • design field rotations to enhance experiences for competency development
  • develop or use modules and teaching resources to link field and classroom
  • provide integrative seminars
  • train field instructors to use competencies in structuring field experience.

Further Measurement

The validity of assessment of competency through self-efficacy measures has been substantiated through research (Holden, Meenaghan, Anastas, & Metry, 2002). Bandura (1997) defined self-efficacy as belief in one’s capability to perform actions required to produce certain results or outcomes. Self-efficacy has been established as a reliable and valid construct for predicting performance in a variety of health disciplines. Self-efficacy is conceived to be task or domain specific. It is not measured by the number of skills acquired, but by the level of confidence felt necessary to accomplish specific outcomes. It requires organizing many subskills, including ones that are cognitive, social, emotional, and behavioral, into the competence to meet goal-directed outcomes (Bandura). Self-efficacy has a positive and significant relationship to academic performance and consistent goal accomplishment across multiple research studies (Multon, Brown, & Lent, 1991). The further development of this and other constructs to measure educational outcomes is imperative (Holden et al.; McKinley, Fraser, & Baker, 2000).

Other more objective measures are needed as the profession continues on the path of competency-based education (Bogo et al., 2002). Practice for the 21st century will require knowledge utilization at an unprecedented level. Competency-based evaluation of educational outcomes is therefore an important aspect of the movement toward best practices in aging. It can be used in educational planning for setting educational goals. Collaboration with and learning from other professions as they move toward geriatric competency measurement will be beneficial as well as provide additional benefits for social work education (American Geriatrics Society, 2000). As CSWE continues its revision of the Educational Policy Statement and Accreditation Standards, it is anticipated that social work educators will join the ranks of those using a competency-based approach. This book is intended to contribute to that endeavor.

Suggested Web Sites:

  • Projects funded by the Hartford Geriatric Social Work Initiative may be accessed at http://www.jhartfound.org.
  • The CSWE Gero-Ed Center funded by the John A. Hartford Foundation provides extensive resources for infusing content on gerontology in the social work curriculum and can be accessed at www.Gero-EdCenter.org.
  • The Social Work Leadership Institute of the New York Academy of Medicine provides access to evidence-based practice for geriatric social work through the Center for Aging Policy Evidence Database and Public Policy Clearing House at www.socialworkleadership.org.
  • The California Social Work Center Aging Initiative, a consortium of California schools that have developed an aging competency-based curriculum for social work students. Their work is described at http://calswec.berkley.edu/aging_post04summit_execsummary.pdf.

The author wishes to acknowledge the contributions to the competency model of Patricia J. Volland, MSW, MBA, principle investigator of the Social Work Leadership Institute PPP and vice president, New York Academy of Medicine, and Frances P. Lawrance, consultant on the evaluation of PPP.

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