Hartford Geriatric Social Work Leadership Conference November 4 – 7, 2008 Chantilly, VA

1. Hartford Geriatric Social Work Leadership ConferenceNovember 4 – 7, 2008Chantilly, VA 1

2. National Initiative for the Care of the ElderlyInitiative nationale pour le soin des personnes âgées

3. Agenda • NICE: Context and Background • Goals of NICE • Knowledge Transfer Model • Knowledge Transfer Practice • Evaluating Knowledge Transfer • Lessons Learned • Implications for Others 3

4. NICE: Context & Background • Unprecedented growth in number and proportion of elderly in Canada • 2006, 4.3 million seniors, 13.7% of population1 • 2036, 9.8 million seniors; 24.5% of population1 • 2001 Census 7.2 % of older population belong to a visible minority2 • Shortage of professionals and students specializing in the care of the elderly • Gaps in interdisciplinary care of the elderly • Gaps in evidence-based care of the elderly 1. Statistics Canada (2007). Ottawa, ON: Statistics Canada, 2007, p. 5. 2. Ibid., p. 23; A. Bélanger and É. Caron Malenfant, Population Projections of Visible Minority Groups, Canada, Provinces and Regions: 2001 – 2017, Ottawa, ON: Statistics Canada, 2005. 4

5. Gaps in evidence-based care of the elderly • 30 to 45 percent of patients are not receiving care based on scientific evidence Graham et al., 2006 • 2 percent of social work research makes its way into direct practice Saini, 2007 5

6. NICE: A short history… • Funded through Networks of Centres of Excellence – New Initiative Grant • One of only 5 “New Initiative” networks funded • Incorporated non-profit, 2006 • Housed at Institute for Life Course and Aging, University of Toronto • One of only 3 networks awarded International Partnership Initiative Grant & IDRC (2007) • Established International Collaboration for the Care of the Elderly (ICCE) • Over 300 members • Diverse disciplines and professions 6

7. International Collaboration for the Care of the Elderly (ICCE) • Only NCE-NI to be awarded additional funding through International Partnership Initiative of NCE and International Development and Research Centre (IDRC) • New partnerships with researchers and organizations in: • Australia China • England Germany • India Israel • Scotland South Africa • Switzerland 7

8. ICCE: Context and Goals • Global aging • Economy of scale in world-wide knowledge on the care of the elderly • Canada’s growing older population • Collaborate with countries with longer histories of meeting the challenges of an aging population • Canada’s growing ethnically-diverse older population • Collaborate with countries with experience in the cultural issues of aging • Critical shortage of geriatric/gerontological professionals • Forum for interdisciplinary collaboration and training 8

9. NICE: Network Goals • Networking and Knowledge Transfer • Introduce evidence-based research into practice • Develop and disseminate interdisciplinary, team-based tools that are user-friendly • Improve training for current practitioners in the field • Improve education in geriatrics/gerontology • Attract and retain new students to the field • Effect positive policy changes 9

10. Central Committees Knowledge Identification Program Development Researcher Training Curriculum Development Professional Development Communications Advisory Committees Business Advisory Seniors Advisory International Committees Policy, Planning and Protocol ICCE Advisory Theme Teams Caregiving Dementia Elder Abuse End-of-Life Mental Health Structure 10

11. Knowledge Transfer • Knowledge transfer is used according to the CIHR as “…the exchange, synthesis and ethically sound application of knowledge within a complex system of interactions among researchers and users.” CIHR, 2006 • Knowledge translation usually refers to the scientific study of the methods for closing the knowledge-to-practice gap.” Davis, 2007 11

12. The OMRU Model 12

13. OMRU & RE-AIM • OMRU a framework for knowledge transfer • RE-AIM a framework for translational research • RE-AIM is a framework for doing research in a way to make it more easily transferred which is what we try to do after the fact 13

14. OMRU & RE-AIM 14

15. NICE “Theme Teams” • Caregiving, dementia care, elder abuse, end-of-life issues, mental health • Action towards interdisciplinary care: Forging unique links • Interdisciplinary teams • Medicine, nursing, social work, and others • Bridging research and practice • Develop user-friendly tools using evidence-based research, translate into practice • Easily accessible tools (pocket tools) 15

16. Theme Team Tools • Caregiving Theme Team • “Respect All” Poster • Designed for staff in long-term care facilities • Placed on facility walls for easy visibility • Suggestions are based upon research evidence • Distributed through Canadian Gerontological Nursing Association • Format & use are being evaluated 16

17. Theme Team Tools • Caregiving Theme Team • “Caring Calendar” • Designed for family members • Formatted with consideration of behaviour changes • One evidence based support strategy per month • URL linked to original research • Distributed through Alzheimer Canada • Format & use are being evaluated 17

18. Theme Team Tools • Elder Abuse Theme Team • Elder Abuse Suspicion Index (EASI) • Developed by Dr. Mark Yaffe, McGill University • Tool to screen for potential cases of elder abuse • Adapting for use with different health practitioners • Adapting for use in different countries (Israel, England) 18

19. Theme Team Tools • Elder Abuse Theme Team • Developed by Drs. Myrna Reis and Daphne Nahmiash • Caregiver Abuse Screen (CASE) and Indicators of Abuse Screen (IOA) • CASE: Screen caregivers for potential signs of abuse • IOA: Training practitioners to recognize the signs of potential elder abuse 19

20. Theme Team Tools • Elder Abuse Theme Team • In Hand (En Main) • Developed by Dr. Marie Beaulieu, University of Sherbrooke (Quebec) • A framework to guide health care professionals in decision-making around suspected/confirmed cases of elder abuse • Original devised in French, being translated/adapted for use with English audiences 20

21. Theme Team Tools • End-of-Life Theme Team • “Capacity & Consent” Tool • Quick reference tool to help health practitioners in understanding law and respecting seniors’ rights • First tool geared to Ontario • Additional tools in development for other provinces and territories 21

22. Theme Team Tools • End-of-Life Theme Team • “What to Expect” Brochure • Includes sections that describe • Physical Changes • Pain Control and Opiate Use • Advance Care Planning and Substitute Health Care Decision-making • Written for friends and family members of the dying person in a respectful and matter-of-fact tone • Could also comfort the dying • Will be placed in palliative care facilities across the country 22

23. Theme Team Tools • Mental Health Theme Team • Depression Assessment Screen • Based on guidelines of the Canadian Coalition for Seniors Mental Health • Tool for family physicians and teams to increase screening of older patients for symptoms of depression 23

24. Knowledge Transfer Events • Goal is to hold forums in various regions of the country to distribute tools, set up evaluation process and receive feedback about their use. • Each region has a “champion” and a student • This phase has just commenced 24

25. Evaluating Tools/Knowledge Transfer • Evaluations planned/started • Using a case study approach • Provide in-depth understanding of tool process • How tool was selected for development • How tool was developed • Context of tool development (social, cultural, political) • Stakeholder & user’s feedback on its use • Feedback on what worked/did not work • Potential for application of RE-AIM framework 25

26. Lessons Learned • The Challenges of Networking • The Challenges of Knowledge Transfer • The Challenges of Working in Teams 26

27. Networks: Thinking Outside of the Box • Model currently in Canada is the research network which has KT as an add-on • Transfer is NOT research • But…it can be the subject of research • Members have a very difficult time moving away from research to KT • Members are suspect because they don’t do research • How do you get academic or practice credit for knowledge transfer? 27

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29. Network • What kind of network? • 3 types models at minimum: • Communities of Practice (individuals who are self-organizing, non hierarchical, informal) • Knowledge Networks (formal groups of experts who work together on a common concern) • Soft networks (lists of members usually in an electronic directory) • Governance? Democracy or Dictatorship? - CHSRF, 2005 29

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31. Knowledge Transfer • Only about 20 percent of knowledge transfer gets through1 • There are at least 20 theories available2 • There are at 15 models for transfer-OMRU3 • Members aren’t sure what KT really is – which of the hundred definitions do you use? • How do you actually engage in evaluation if not a research network? 1Zwarenstein, 2007; 2 Estabrooks et al.,2006; 3Santesso et al., 2006 31

32. Knowledge Transfer continued • KISS principle • Guidelines and tools that are simple and observable were more effectively implemented1 • KISS principle makes colleagues laugh • 1Davis, D.A. and Taylor-Vaisey, A. (1997); Dawes, M. and Sampson, U. (2003).; Formoso, G., Marata, A., and Magrini, N. (2006); Grol, R. and Grimshaw, J. (2003). 32

33. Teams • What team? • What kind of team? • Old boys/girls networks • Who has time to process? • Teams grow too fast – require sub-teams 33

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35. RE-AIM • Four Ways to use RE-AIM • Criteria for choosing research at the outset; • A method for evaluating the effectiveness of NICE • It solves the ‘what next problem’ • Easy to use in other countries 35

36. NICE Knowledge Transfer • Website • www.nicenet.ca • NICENews • Available online • Workshops, Forums and Symposia • Annual NICE Knowledge Exchange • June 5 – 6, 2008: Toronto, Ontario The great aim of education is not knowledge but action. - Herbert Spencer 36