Hello and welcome to Listen Up People, a podcast
of the USC Suzanne Dworak-Peck School of Social Work.
I'm Dr. Eric Rice, professor and associate dean
for research. 58 million Americans are 65 years
old or older. Over the past decade, as baby boomers
have reached retirement age, we've seen a 40
% increase in the number of aging adults. My
guests today are part of the Interprofessional
Education and Collaboration for Geriatrics, a
USC program which is transforming the way that
services are delivered to the older adult population.
I'd like to welcome my colleague, Dr. Dawn Joosten-
Hagye, teaching professor and coordinator of
interprofessional and team -based education at
the USC Suzanne Dworak-Peck School of Social
Work. She's joined today by her colleague, Dr.
Tatyana Gurvich, Associate Professor for Clinical
Pharmacy at the USC Alfred E. Mann School of
Pharmacy and Pharmaceutical Sciences, a geriatric
clinical pharmacologist and clinical preceptor
at USC Mann UCI Medical Center Senior Health
Clinic. It's wonderful to have you both here
today to talk about this important topic. I love
to start these podcasts off by asking folks how
they got involved in the work. So maybe we can
turn to you first, Tatyana. How is it that you
got involved in wanting to do this kind of work?
I've been in geriatrics for over 30 years. And
I trained at USC. And when I did that about 30
years ago, interprofessional education was in
its infancy. And so I received a very interprofessional
training in my residency program. I worked in
a similar group of people, physicians, social
workers, psychologists, occupational and physical
therapists. speech therapist. So I received my
training in an interprofessional environment.
And I've been lucky enough to work in that kind
of environment. When I joined USC as faculty,
and I realized this program existed, it was just
such a natural transition into this. And so I
bring all this experience and background into
it. And I think all of us on our team are well
versed in interprofessional care. And so that's
why it's so much fun. That's great. That's great.
Dawn, how about you? How did you get involved
in this project? Yeah, so similar to Tatyana,
I've got a little over 25 years of experience
working as a medical social worker and in geriatrics.
And when I was working on my doctoral degree
over at UCLA, I started as a fellow in team based
education in a freshman cluster called the Frontiers
in Human Aging and fell in love with based in
a professional education. And then once I came
over to USC, I immediately started linking up
with other colleagues across the health sciences
and was introduced to the IECG program and IPE
Day here at USC. I would imagine most of our
listeners who tune in to hear about a variety
of different topics probably don't have a lot
of knowledge about the IECG program. Maybe the
two of you could give us some of the highlights
about what it is that you do, the mission, and
who you serve. And maybe we'll start with you,
Tatyana. Maybe you can give us a little bit of
an overview and Dawn, you can also contribute
to this as much as you feel. So this program
has been in existence for over 10 years. It involves
seven professional schools across USC, and we're
really lucky to have this breadth of education
at this institution. So we have... Pharmacy,
social work, medicine, occupational therapy,
physical therapy, psychology. We had dentistry
at one point. It's a lot of schools. Yeah, all
these schools get together and they provide students
from each school. And it's a six month program
that we teach where the students are broken up
into interprofessional teams with each of them
having a lead faculty person attached to them.
And we go to seniors homes throughout Los Angeles
and we visit them on a monthly basis over a six
-month period and each time we do a home visit
we explore different areas of what each discipline
does. For example, we're actually having a session
this afternoon and today's session in this program
will involve a medication reconciliation and
getting to know the older adult in their home
for the first time. And then the next time we'll
cover another topic and we kind of go through
each discipline and talk about what each discipline
will do with an older adult and they practice
it on the home visit. When you go to do these
home visits, do you have students from multiple
disciplines that are a part of the educational,
I guess, outreach moment in these folks' homes?
So yeah, so each team, each student team has
six or seven members. There's each profession
represented in that. And then there's a faculty
person attached to each team. And we each go
into a patient's home and do these educational
sessions and practice sessions with the older
adult while we're getting to know them. Very
cool. Very cool. Dawn, do you have anything that
you wanted to add to that about your experience
in this program so far? Yeah, I think Tatyana
summarized it really well. So the program emphasizes
these didactic interprofessional trainings. And
then there's this experiential learning that
happens when they go in these home visits with
the older adults and low income housing units.
And the beauty from the perspective of a social
worker is we're seeing the person in the environment
and we're able to see. what we learn, all of
us learn about social determinants of health.
And those become really apparent when you're
in someone's home and you see the community in
which they're residing and you see their level
of functioning as well. So it creates this really
unique opportunity for students to immerse themselves
in the environment in which the individual resides.
And that's a real strength of this program. Yeah,
it sounds like it's a fantastic opportunity for
people to to see a variety of different perspectives.
And that actually makes me think of something.
I've been told, Tatyana, that you like to refer
to healthcare for older adults as a team sport.
Can you tell us what you mean by that phrase?
Sure. All older adults are fairly complex. psychosocially
and medically. From a medical standpoint, they
kind of accumulate medical problems over a lifetime.
So it's not uncommon for them to have multiple
comorbidities, multiple medical conditions, physical
limitations, psychosocial issues. And so traditionally
the care people receive primarily comes from
a physician, right? Well, they can't possibly
address all of these concerns in a single older
adult. If one person is only taking care of that
older patient, a lot of things fall through the
cracks. So this is the opportunity for all of
us to get together and kind of provide our expertise
for each of the problems that present themselves.
So it's very much a team sport and we need each
other to provide better care. And the older adult
needs of us to receive that care. Yeah, it seems
like there's a, I suppose, a sort of humility
in having different disciplines come together
and acknowledge that they need one another in
order to do this work and do right by any one
older adult whose life is so complicated. I think
one of the things I've been interested in interdisciplinary
research for a long time myself, and I Definitely
have seen similar sorts of dynamics play out
where you have much more ability to address problems
when you have these variety of perspectives.
One thing I'm interested in picking your brain
about Dawn a little bit is the role that social
work plays in this, because I don't think that
a lot of people think about social work as maybe
being a part of health sciences or a part of
maybe these interdisciplinary teams. Maybe you
can address a little bit about how it is that
you see social work fitting into this. Yeah,
absolutely. Thank you for that. So social work
is important to include in collaboration of health
science professions because we have expertise
in the micromezzo and the macro systems, as well
as I mentioned, the person and the environment.
So we are often the profession that health professionals
will make referrals to when they recognize that
they have an older adult who is you know, experiencing
challenges like maybe with housing and finances
and transportation or food insecurity that's
interfering with their ability to manage their
health conditions that they're being treated
for, right? So, you know, with that piece of
it being global assessors, we're really key in
being able to address not only those, but also
any kind of emotional types of needs so that
the whole biopsychosocial spiritual cultural
model, right? Advocacy and improving access,
all of those types of things to really help improve
any of the disparities that are being experienced,
especially among vulnerable populations. Yeah,
that's such an interesting thing for you to bring
up. I think social work in some ways, and I think
pharmacy too, and I'll get to this in just a
second, are disciplines that people have very
stereotypical ideas about what those disciplines
might be about that may not reflect the richness
of the experience of what the disciplines bring
to the table and this idea of being this holistic
assessor role that social work plays is such
an important thing and you know our school for
the last few years we've had an interim dean
that is the also the dean of the School of Pharmacy,
and he's made me much more aware, Tatiana, of
the way in which I think we misinterpret pharmacy,
right? That I think a lot of people have this
very one -dimensional view of pharmacists as
being the sort of person that you see at a chain
drug store. But really, you know, when you are
going out into the community like this, your
role must be very different than that. Can you
maybe tell our listeners that are maybe more
in social work what it is that a pharmacist does
in especially this kind of context? What I do
is I go into a home and home visits are really
important for for pharmacy as well because you
get to see where all these medications are being
stored. How many vials are there of prescriptions?
You get to look at the medicine cabinet, the
bedside to see what all the over the counter
medications the patient is taking. One time we
went into one of the senior housing apartments
as part of this program. And we were actually
talking to a patient about nutrition. It wasn't
time to talk about meds. And he was saying, you
know, he doesn't have enough money for food.
And so we immediately went into his kitchen to
see what he was taking. and opened up his pantry
and found literally a pantry full of herbal products.
There was no food in there. It was just herbs,
supplements, thousands of dollars worth of supplements
at that point. And so those kinds of surprises
are really relevant to what I do. So when I collect
all the stuff the patient takes, we have a conversation
about each medication. how they take it, whether
the patient knows what it's for. I ask about
common side effects that these medicines can
cause. I screen to see if the patient has them.
Then I look at the medical condition, the dose,
whether or not they're tolerating it okay. you
know, depending on the setting, in this setting,
I would just make recommendations for them to
talk to their physician about some of this stuff.
In my clinic, I actually implement changes to
medication regimens and see patients over multiple
visits to titrate medications up and down, start
new ones. and kind of limit the polypharmacy
that happens in the management of older adults.
That's so interesting. I think most people don't
have a sophisticated understanding of how much
as we get older, there's this variety of medications
that were being prescribed by a bunch of different
providers and that there may not even be a person
like you who's who rarely is actually showing
up at someone's house to do this sort of this
kind of look. I mean, do you have a sense of
who the population of the folks that, I mean,
I know they're aging, but who are the folks that
you are going into the homes of when you're doing
these visits and how do they get involved in
this program that you all are working on? So
these patients live in low -income housing. Over
the years, Our program has developed relationships
with these communities. Some are in West LA,
some are in East LA, some are in LA in general,
and so we communicate with them. We make sure
that the housing management picks out seniors
for us to speak to. These patients volunteer,
or these clients volunteer their time. but I
think we build relationships with them. And so
what we found that even when our students leave
this program, they maintain a relationship with
some of these older adults over the years and
become friends with them. So it's a relationship
building activity as well as a learning opportunity
for students. And the older adults that we interact
with also get useful information about their
health care and hopefully a road going forward
to get better care out of their providers and
out of their situation. Yeah. So, Don, I want
to turn to you for a second as a follow -up to
this last point, which is about these home visits.
I know that home visits are sometimes more a
common place in social work, but can you talk
to us about the sort of the importance that home
visits have and what the social work role in
those home visits? is when you're coming into
these seniors homes? Yes, absolutely. So as a
member of this interprofessional team, the social
worker is, along with the team, engaging and
building rapport with the older adult, having
conversations with them, noticing any kind of
concerns with safety. So if there's a lot of
medications and pills and those types of things,
then we may work with the pharmacist and others
in the team to be able to help with setting up
some type of an organization. And in the past,
when I did home health, I would get sheets and.
have pictures of the medications and help them
with writing those down and work with the nurse
practitioner of setting that up. We do those
types of things, but then if there's a need for
any kind of equipment in the home. If physical
therapist and occupational therapy are looking
at the bathroom and they notice, boy, they really
could use some grab bars or a detachable shower
head or a grab bar next to the toilet. Social
workers will help with identifying community
-based resources to be able to come in and make
those kinds of modifications, helping with food
insecurity, screening and assessing for loneliness
and depression and anxiety. And as it relates
to medication, one of the common types of referrals
that social workers get as medical social workers
are referrals for addressing medication nonadherence.
And that may mean - Oh, you're right. not having
health insurance that covers the medications
because it's non -formulary out of their network,
not being able to make the co -payment or maybe
needing to work with pharmacy and the primary
care physician to look at other medications that
might be in their network that they can actually
afford to pay the co -payment for. A lot of times
as social workers, we help with making sure they
have access as well, any kind of supplies and
testing strips and all those other things. just
think of social work being there to really support
all the members of the team. And then also, of
course, having the older adult as the expert
over their lived experience and making sure they're
at the center and that we are partnering with
the older adult based on their strengths, based
on what matters with them, to address any unmet
needs. So helping them to age in place and have
all of their biopsychosocial. spiritual needs
met. I want to maybe take this as an opportunity
to then talk about the impact that all of this
great work you just have described to me has.
And I think one thing that's exciting for me
as the associate dean for research and somebody
who really cares about academic research is when
I get to see programs like this evaluated and
publications done on it. because I think that
oftentimes the proof of the value of a practice
-based program like this is how that education
impacts the real world and how you're actually
able to establish that. And I know that the two
of you were the first and second authors on a
study that was published last year in the Journal
of Interprofessional Care. And I'd love to hear
about what you... wrote about and maybe you could
describe to our audience the main findings of
this study that evaluated the program's impact.
Maybe we can turn first to you, Tatyana, and
then we'll have Dawn contribute to this conversation
as well. But I'd love to hear about what you
found. We basically surveyed participants of
this program three years after they've graduated
and collected the results. Like, how did this
program that they participated in as students
impact their current practice and the findings
were really encouraging. I mean, 81 % of the
graduates of the IECG program continue to work
in interprofessional teams. 80 % reported that
their experience in IEGC significantly impacted
their practice and they routinely use the tools
that we taught them to use in this program on
their patients. We collected multiple really
nice quotes about how impactful this program
was, how much it taught participants about the
other's professions and what they could do. And
I think that it possibly makes their job easier.
in the clinical world because they know what
to expect from each discipline. I have to tell
you these programs are really difficult to put
together. I mean every school has their own requirements
for things. Scheduling is different. Getting
these students together like this year we have
I think 130 students from different schools all
in one place. That it's very challenging and
every year Somehow we managed to do it and we
run it pretty successfully. We did it, we started
it pre -pandemic with a lot of years of experience
there. Then the pandemic hit, we turned it into
a completely virtual experience and then a hybrid
one and now it's all in person again. So we've
gone through these phases of history and time
and we've managed to keep it together and it's
grown actually. This is the largest class we've
had. Well, that's really cool. That's really
cool. Dawn, I know that Tatyana just gave us
some of the high level findings. Maybe you could
give us a sense of, from your perspective, what
some of the take home messages from this research
were from your perspective. Yeah, so we. engage
in medical education into professional education,
the whole goal of it is to prepare this collaborative
practice ready workforce, right? So we want them
to be able to take and learn about. So this is
the. The IECG program and all IPE programs are
competency based. So we have competencies from
the IPEC and all health sciences programs are
required to have IPE and we use these, it's competency
based, right? So we're really preparing these
students to understand the roles and responsibilities
of professionals to be able to have, to engage
with older adult partners and their families,
organizations. and communities with these competencies
of values and ethics and cultural humility and
responsiveness. All of those things are really,
really important. So preparing this workforce
is like a real key piece of it. And what we found
in our research is that a little over 79 percent
say IPG really had an impact on their daily practice
and that's what it's all about helping them while
they're in the programs be prepared to enter
the workforce to be able to be ready to have
that impact their practice and there's not a
lot of studies to date that have actually done
that. I'm kind of surprised to hear that there
hadn't been many other studies that did this
is it because you're these kinds of programs
are so rare? Or is it because there's just been
a lack of attention paid to actually collecting
evidence on their impact? Yeah, it's probably
a combination of both. Okay. Yeah. You know,
and like Tatiana said, you know, these programs,
we spend a whole year planning this program before
we launch it, right? So it's very time intensive.
And the fact that we had so many of the graduates
actually participate in this study, in our study,
speaks to, you know, the relevance of it and
how valuable it was to them also, right? So we
had a, you know, a good, good percentage of respondents
that actually participated. The value of the
program, I think, helps also because we had almost
a 59 percent response rate, which is pretty high
for 247 graduates that we sent the survey. That's
amazing. It certainly speaks to the power of
the program that you've got that kind of voluntary
response rate. I want to make sure that we get
a chance to ask you, Don, about a follow up to
this, which is that I know that you're involved
in an interprofessional certificate program at
the School of Social Work as well. How is that
connected to this and what is that about too?
The IECG program is actually separate from the
interprofessional certificate. So both are open
to all graduate health profession students. IECG
is a zero unit credit, no credit course. So that
occurs like Tatyana mentioned on six Fridays
between fall and spring semesters. The IPE caregiving
certificate requires completion of four three
-unit courses, one of which is a course that
emphasizes interprofessional education and trauma
-informed evidence -based team interventions,
specifically focusing on diverse caregivers through
a social justice and intercultural lens. So while
both provide social work and health affairs students
with IPE and team -based care and didactic and
experiential experiences, experiences, the certificate
is tailored to better prepare them for working
with diverse caregivers versus older adults.
Oh, I see. So it's a slightly different focus
in terms of the work that you're training people
for, but it's got a very similar character in
terms of this interprofessional focus. Exactly.
Go ahead, Tatiana, please. I think the other
unique piece of this program is that for most
of the students participating, this happens in
their preclinical years. So I think there's always
some interprofessional collaboration when students
go on rotation to hospitals, to clinics, because
they get together with other health professionals
to take care of patients. I don't think that's
that uncommon. But this is at least for pharmacy,
for medicine, it's pre -clinical. But at the
same time, it's not just didactic content. They're
not in the classroom learning about this stuff
without being able to practice it on a client
or a patient. And so this is what's unique about
it. It is six months long, which is very difficult
to put together. So that's unique too. There
are lots of interprofessional activities that
are six weeks, one day. you know, a month. This
is six months with the same person. You get,
you really get impactful and meaningful interaction
with the same older adult. And you, you know,
over time, students learn from each other. Yeah.
Well, it would sound like over six months, you
would get a chance to learn from one another,
as you said, but also I think you mentioned earlier
that sometimes the students build relationships
that endure past the training program with those
older adults, which also makes a lot of sense.
And I think it's interesting that you point out
that some of the other programs that you know
of are much shorter duration and probably, therefore,
much less meaningful. I think it's also great
to hear from both of you at the beginning of
our conversation how you each had pretty profound
interprofessional education experiences in your
own training and that that has, it would seem
to me, carried through in your career as now
people who are training the next generation to
do this kind of work that clearly you were inspired
by when you were doing your training. I learned
to talk to a patient from a social worker. When
I was a student and a resident, I would go on
home visits with a nurse, a social worker. and
me. And I watched that social worker interact
with a patient. And that's how I learned to talk
to patients. I mean, it was an amazing experience
that I carry with me. No, that's that's incredible.
I mean, I love that I had a similar experience
in my early training when I was a postdoc hanging
out with social workers that they really changed
the way that I interacted with people and thought
about things to their social work. It has had
some some pretty amazing tools for engaging with
people. But I'm also sure that likewise, pharmacy
has amazing tools for that social workers learn
from as well. collaborative, reciprocal places
where people learn. I think I want to close out
with any last thoughts that you might have for
our listeners about lessons learned from doing
this interprofessional education or from your
own experiences doing this kind of work that
you think would be worthwhile sharing with folks.
Maybe I'll start with Dawn and then let Tatiana,
you close us out. Dawn, anything you want to
share with our audience? Yeah, I think just in
listening to both of you talk, you know, coming
back to what interprofessional education is,
it is learning from with and about others together,
right? So. It's not coming in uniprofessionally,
right? So this holistic lens is key. Going out
into the community where our clients, where our
patients, where people actually live and reside,
that's going to become increasingly important
in being able to really address population health
in a meaningful way because Our clients don't
live in the office. Our clients don't live in
the hospital. They don't live in the clinic.
They actually live out in the community. And
when we're able to go out into the community,
we're able to just see this. whole different
type of perspective and really hear what's important
to, especially when we're talking about older
adults, what's important to them, what matters
to them, and then to be able to meet them where
they are and partner with them. So this is that
partnership of us as clinicians and them as the
person. And that's the important piece of it,
is being able to listen, hearing what their narrative,
what their needs, what their preferences are,
and being able to have that culturally responsive
types of approaches, especially in these diverse
communities and populations surrounding our campus.
parting thoughts for our audience? I think interprofessional
education is part of every health professional
program requirements. And a lot of this stuff
is just a box to be checked off. So some of the
some of the programs that are out there aren't
as meaningful as I think this is. And so, you
know, we have to continue to look for these long
term, thorough, in depth kinds of programs that
actually teach students something that they carry
with them. One challenge we faced over at least
the last couple of years is the lack of funding,
you know, and so I think Health professional
schools should really prioritize programs like
this to see that they not only succeed but are
able to continue. Having interprofessional centers
or having an interprofessional center at USC
would be wonderful because it could house a program
like this and many others that haven't even been
developed yet. If we're going to move our professions
forward and education forward, we have to think.
more globally, more interprofessionally. And
I hope the right people are listening. I'm sure
some of them are. I'm sure some of them are.
Well, thank you so much, Dawn and Tatyana, for
doing such incredible work out in the community
and also taking the time to talk to me and our
audience today about this work that you're doing.
If you, the audience, would like to learn more
about the IECG, as well as the research happening
at the USC Suzanne Dworak-Peck School of Social
Work, you can visit our school's website. And
if you have questions for the guests on our show,
or you want to support our transformative research
and programs, you can email us at listenuppeople
@usc.edu. And let me just say thank you one
more time to both of you. It was absolutely fabulous
to have you both here today. Thank you. Thank
you for the invitation.