Scott Miyake Geron

Integrating Social Workers into Primary Care: Physician and Nurse Perceptions of Roles, Benefits, and Challenges

The primary aim of this article is to identify, from the perspective of primary care physicians and nurses, the challenges encountered in provision of health care to older adults and to identify potential roles, challenges, and benefits of integrating social workers into primary care teams. As more older adults live longer with multiple chronic conditions, primary care has been confronted with complex psychosocial problems that interact with medical problems pointing to a potential role for a social worker. From a policy perspective, the lack of strong evidence documenting the benefits that will accrue to patients and providers is a key barrier preventing the wider use of social workers in primary care. This article presents findings from three focus groups with primary care physicians and nurses to examine the perspectives of these key providers about the benefits and challenges of integrating social workers into the primary care team.

Infusing Aging Skills Into the Social Work Practice Community: A New Look at Strategies for Continuing Professional Education

As social work advances into the 21st century, dramatic increases in the aging of the U.S. population, shifting policy imperatives, and the emergence of new technologies have transformed the professional landscape in which social workers operate. To survive in todays world, social workers must be able to learn new skills and adapt to change. This article reviews the challenges facing the profession in transferring practice skills to social workers and describes the strategies of the Institute for Geriatric Social Work (IGSW) that address them. Well-designed training should provide a learning experience that is affordable, accessible and grounded in skill-based competencies. The challenge facing IGSW—and the broader social work community—is how to promote continuing education that maximizes these ends.

Cultural competence in nursing homes: issues and implications for education.

Abstract A research and intervention project to enhance cultural competence (CC) within nursing home staff is described, with particular emphasis on the qualitative findings generated during baseline assessments of 10 participating facilities. These findings, developed from an analysis of transcripts of 56 focus groups, suggest the importance of five CC concerns in the nursing home setting: (1) uneven staff awareness of cultural differences among residents; (2) challenges in both verbal and non-verbal communication; (3) minimization/generalization of recognized differences; (4) overtly discriminatory actions/comments; and (5) inadequate organizational response to such actions. Educational approaches to and implications of these concerns for staff development within the nursing home setting are explored.

TEACHING NOTES: SOCIAL WORK AND PUBLIC HEALTH: COMPARING GRADUATES FROM A DUAL-DEGREE PROGRAM

This study compared dual-degree master of social work/master of public health (MSW/MPH) and MSW-only graduates with 3 or more years of postgraduate experience. Thirty graduates from an MSW/MPH program were matched with 30 MSW-only graduates. All subjects were randomly selected from the alumni directory and interviewed via telephone. Results showed few differences between the groups, including no significant salary differences. Both groups enjoyed high career satisfaction and were similar on measures of social work professionalism. More research is needed to study the experiences of MSW/MPH professionals and their impact on the field of social work.

Country of origin and racio-ethnicity: are there differences in perceived organizational cultural competency and job satisfaction among nursing assistants in long-term care?

Background: Long-term care facilities nationwide are finding it difficult to train and retain sufficient numbers of nursing assistants, resulting in a dire staffing situation. Researchers, managers, and practitioners alike have been trying to determine the correlates of job satisfaction to address this increasingly untenable situation. One factor that has received little empirical attention in the long-term care literature is cultural competence. Cultural competence is defined as a set of skills, attitudes, behaviors, and policies that enable organizations and staff to work effectively in cross-cultural situations. Purpose: To examine organizational cultural competence as perceived by nursing assistants and determine if this was related to differences in job satisfaction across countries of origin and racio-ethnic groups. Methods: Primary data collected from a cross-section of 135 nursing assistants at four New England nursing homes. Demographics, perceptions of organizational cultural competence, and ratings of job satisfaction were collected. A multivariate, generalized linear model was used to assess predictors of job satisfaction. A secondary analysis was then conducted to identify the most important components of organizational cultural competency. Results: Perception of organizational cultural competence (p = .0005) and autonomy (p = .001) were the strongest predictors of job satisfaction among nursing assistants; as these increase, job satisfaction also increases. Neither country of origin nor racio-ethnicity was associated with job satisfaction, but racio-ethnicity was associated with perceived organizational cultural competence (p = .05). A comfortable work environment for employees of different races/cultures emerged as the strongest organizational cultural competency factor (p = .04). Recommendations: Developing and maintaining organizational cultural competency and employee autonomy are important managerial strategies for increasing job satisfaction and improving staff retention. Toward this end, creating a comfortable work environment for employees of different races/cultures is an integral part of the process. Managerial recommendations are discussed.

Patient-Centered Approach to Building Problem Solving Skills Among Older Primary Care Patients: Problems Identified and Resolved

This article describes problems identified by older primary care patients enrolled in Problem Solving Therapy (PST), and explores factors associated with successful problem resolution. PST patients received 1 to 8, 45-min sessions with a social worker. Patients identified problems in their lives and directed the focus of subsequent sessions as consistent with the steps of PST. The 107 patients identified 568 problems, 59% of which were resolved. Most commonly identified problems included health related issues such as need for exercise or weight loss activities, medical care and medical equipment needs, home and garden maintenance, and gathering information on their medical condition. Problems identified by patients were 2.2 times more likely to be solved than those identified by a health care professional. Using PST in primary care may facilitate patients in addressing key health and wellness issues.

Moving Evidence-Based Interventions to Populations: A Case Study Using Social Workers in Primary Care

SUMMARY This article describes a study to expand a proven evidence-based practice for depression to a population-based intervention for frail older adults. Problem-Solving Therapy (PST) has been proven effective in reducing depression and other mental health conditions in cognitively intact adults in many studies. The current study employs a randomized controlled trial to test the effectiveness of a social work intervention for frail older adults that uses PST to address depression and other psychosocial issues. The intervention employs Masters trained social workers integrated into a large primary care practice. The study population is comprised of home-dwelling older adults with multiple chronic conditions, a recent history of unnecessary hospitalizations, and no more than mild cognitive impairment.

The Other Sorrow of Divorce

This paper explores the effects of divorce on an elder- ly parent or parents when an adult child divorces. The losses and changes that occur naturally in old age are compounded by losses associated with divorce. Divorce entails a rupture in the changing roles assumed by parents and adult children as they age, and often thrusts one or both grandparents and their children into earlier par- ent-child relationships. These processes, and the issues they evoke in grandparents, are reviewed. Lntervention strategies to support grand- patents during the divorce process are explored and model support group intervention is proposed.

Social Work Continuing Education: A Statewide Case Study.

ABSTRACT This article presents findings from a 2013 qualitative study of social work continuing education (CE) in Massachusetts. Eleven focus groups were conducted with 75 participants from key stakeholder groups: practitioners, educators, licensing board members, and agency administrators. Although positive perspectives surfaced—such as diversity of CE options—thematic analysis nonetheless reflected considerable frustration with the current system. CE concerns included lack of access, cost, missing CE content areas, quality control issues, and lack of employer support. Participants also noted the need for enhanced transfer of CE-derived knowledge and skills in the workplace. Greater attention to this crucial aspect of professional development is therefore needed.

Evaluation through collaboration: a model program of agency-based training in geriatric social work.

Abstract The Institute for Geriatric Social Work (IGSW), located at Boston University School of Social Work (BUSSW), formed a collaborative partnership with Elder Services of the Merrimack Valley (ESMV), a large urban Area Agency on Aging (AAA) near Boston to design, implement, and evaluate an innovative model program of agency-based training for practicing social workers. The collaboration facilitated and strengthened the development of a program that benefited the university-based program and the community-based agency. The training program comprises a “blended” model of core and elective online courses combined with face-to-face training. Evaluation of the model program is integral to its design, and includes a randomized control trial to test the effectiveness of the training program in increasing practice competencies.