Strengthening the Cancer Knowledge and Skills of the Social Work Labor Force

Strengthening the Cancer Knowledge and Skills of the Social Work Labor Force Maureen Y. Lichtveld, MD, MPH Alison P. Smith, BA, BSN, RN ©2009 National Association of Social Workers. All Rights Reserved.

501 (3) c (not for profit) organization Organization of leaders Private – pharma, biotech, insurance Public – federal, state, local health agencies Not-for-Profit – professional, advocacy, care-giving organizations Collaborate to address issues that can not be solved in isolation Work spans the continuum of research and care ©2009 National Association of Social Workers. All Rights Reserved.

Learning Objectives At the end of this session, participants will be able to: Articulate the significance of the health workforce shortages effecting people at risk for and living with cancer Identify priority areas for cancer competency among LCSW students and practicing clinicians Describe the practical utility and flexibility of the competency tools for strengthening social worker’s cancer knowledge and skills Apply competency-based methods and tools to develop cancer programs for social workers ©2009 National Association of Social Workers. All Rights Reserved.

Supply of Social Workers Health of the Profession - From NASW The social work labor force is older than most professions with nearly 30% of licensed social workers over 55 years of age Social workers employed in hospices are most likely to report vacancies as common(19%), followed by those in hospitals (14%) and health clinics (8%) They are more likely to serve clients of color than social workers overall (52% versus 43%) Significantly less satisfied with client access to mental health services than licensed social workers overall (43% versus 59%) Those practicing in rural areas are least satisfied with access to resources There are approximately 1500 oncology social workers ©2009 National Association of Social Workers. All Rights Reserved.

Supply of Cancer Team Members Shortage of cancer specialists: Social Workers Physicians / Oncologists Nurses Pharmacists Technologists Researchers Cancer Registrars ©2009 National Association of Social Workers. All Rights Reserved.

Demand for Cancer Services Cancer is the second most common cause of death by disease claiming the lives of more than half a million people per year (ACS, 2007) Cancer rates are expected to increase as baby boomers age (CDC, 2000) The lifetime probability of developing cancer is 1 in every 2 men and 1 in every 3 women (NCI, 2005) Five-year cancer survival rates have risen to 64% for adults (CDC, 2005) ©2009 National Association of Social Workers. All Rights Reserved.

Overview of Challenge Supply, Demand, & Action Widespread shortages across the cancer workforce Demand for cancer services exceeds current and projected needs Many organizations addressing discipline- or specialty-specific cancer workforce issues ©2009 National Association of Social Workers. All Rights Reserved.

Untapped Opportunity Oncology Specialists All Professionals 1,200 AOSW Members 380 APOSW Members 320, 000 Licensed Clinical Social Workers Social Workers 21,000Oncology certified 2,000,000Registered Nurses Nurses Illustrative ©2009 National Association of Social Workers. All Rights Reserved.

Cancer Core Competency Initiative Goal: Strengthen the basiccancer competency (knowledge, skills, and attitudes) of non-oncology health workforce ©2009 National Association of Social Workers. All Rights Reserved.

Competency Standards In order to reduce the nation’s burden of cancer, any health professional must be able, within the scope of his/her professional practice, to: Domain I – Continuum of Cancer Care Describe the components comprehensive cancer care, including team communication , diagnosis and treatment, palliative care, survivorship Describe cancer prevention guidelines (e.g., USPSTF, ACS) Direct an individual to resources for cancer prevention Domain II – Basic Cancer Science Define the purpose and requirements of cancer registries. Describe the clinical trial process beginning with informed consent Domain III – Communication & Collaboration Incorporate cross-cultural communication strategies in conveying cancer information Describe the contribution of each professional perspective in the development of a cancer care plan examples ©2009 National Association of Social Workers. All Rights Reserved.

Breadth & Depth of Competency Standards Work Setting Competency Standards Discipline Administration Ambulatory Clinics Academics Acute Care Clinics Cancer Centers Home Health Agencies Professional Societies Advocacy Organizations Allied Health Medicine Nursing Pharmacy Public Health Research Social Work StudentsResidents/FellowsField FacultyPracticing Professionals Domain I Continuum of Care Prevention / Early Detection Treatment / Survivorship Palliative Care Domain II Basic Cancer Science Etiology / Epidemiology Clinical Trials Cancer Surveillance Domain III Communication & Collaboration Interdisciplinary Care Psychosocial Communication Cross-Cultural Communication Grieving ©2009 National Association of Social Workers. All Rights Reserved.

Cancer Core Competency Initiative:Program Elements Planning Competency Standards Program design tools Implementation Educational encounter Evaluation Knowledge Skills Attitudes ©2009 National Association of Social Workers. All Rights Reserved.

Pilot Site Findings:Marshall University - Huntington, WV • Medical Students • Breast cancer screening & patient communication • Standardized patient examination & communication • Improvement in Knowledge: 119%  from pre-post test • Measureable clinical & interpersonal skill increases ©2009 National Association of Social Workers. All Rights Reserved.

Pilot Site Findings:California University of Pennsylvania - California, PA • Social Work Students & Field Instructors • Cancer-related Anxiety and Depression • Classroom, on-line, and standardized patients • Improvement in Knowledge: 136%  from pre-post test • Measurable increases in ability to recognize and manage anxiety and depression ©2009 National Association of Social Workers. All Rights Reserved.

Pilot Site Findings:Audrain Medical Center - Mexico, MO Public health nurses working in rural counties Skin cancer screening & early detection Course and clinical rotation Improvement in Knowledge: 39%  from pre-post test Measureable increases in differentiating between benign and malignant lesions ©2009 National Association of Social Workers. All Rights Reserved.

Pilot Site Findings:University of Pittsburgh Medical Center - Pittsburgh, PA • Primary care practitioners working in rural areas • Survivorship • Workshop, enduring Webcast, and toolkit • Improvement in Knowledge: 20%  from pre-post test • Measurable increases in ability to assess and manage survivorship issues ©2009 National Association of Social Workers. All Rights Reserved.

Pilot Site Findings: Qualitative Outcomes • Professional • Professional development • Learner • Increased knowledge • Increased confidence • Received tangible reference materials • Enhanced academic experience • Enhanced professional self-reflection • Institution • Enhanced visibility/ credibility • Provided foundation for future trainings • Community • Enhanced relationship with institution • Addressed needs • Benefits of better prepared/ increased workforce ©2009 National Association of Social Workers. All Rights Reserved.

Cancer Core Competency Initiative:Pilot Site Findings UTILITY Pilot sites found the cancer core competencies to be highly useful FLEXIBILITY Implementation of the competencies was feasible across cancer core continuum, professional settings, and disciplines ©2009 National Association of Social Workers. All Rights Reserved.

Anatomy of a Competency Standard Competency statements define what a professional should know or do: Define palliative and end-of-life care Targeted cancer content Level of complexity and/or independence Within context: Scope of Practice Level of Expertise Role and Responsibilities ©2009 National Association of Social Workers. All Rights Reserved.

Bloom’s Taxonomy Increasing level of independence EVALUATION SYNTHESIS ANALYSIS APPLICATION COMPREHENSION KNOWLEDGE

Adult Learning Practices Adult learning environments are designed to minimize dependence and maximize independence. Adult instructional strategies adapt to the learners’ previous experiences including skills and content. Faculty in adult learning settings function as both instructors and facilitators. ©2009 National Association of Social Workers. All Rights Reserved.

Competency to Curriculum Verb Instructional Design Learner Assessment Describe Dialogue Short Answer Apply Case Study Role Play Essay Question Synthesize Table Top Standardized Patients Evaluate Peer Review

Planning, Implementation & Evaluation Tools: Logic Model OUTCOMES INPUTS OUTPUTS Program resources Activities Participation Short Medium Long-term Efforts on the part of the program or intervention staff Changes in the participants Changes in the learner’s knowledge, attitudes, beliefs The logic model assures that all of the program resources directly support the achievement of the desired competency outcome. ©2009 National Association of Social Workers. All Rights Reserved.

Steps for Program Development Define Audience & Topic Area Evaluate and Interpret Data Refine Competency Focus Develop Logic Model & Validation Template Build a Balanced Leadership Team Sustain Efforts Through Sharing PLAN EVALUATE Complete Needs Assessment & Interpret Findings PLAN IMPLEMENT Implement & Manage with Attention to Details

Steps for Program Development Define Audience & Topic Area Build a Balanced Leadership Team Needs Assessment & Interpret Findings Are there colleagues who would benefit from a competency program?What cancer topic would help professionals meet the needs of clients/patients? Who are the topic experts?Who can foster support for the program? What will motivate participants?What will translate learning into practice? ©2009 National Association of Social Workers. All Rights Reserved.

Steps for Program Development Refine Competency Focus Logic Model & ValidationTemplate What do I want the professionals to know or do? What resources will support my program? What programmatic activities will occur?What are the desired changes in participants? Does IRB approval need to be obtained? Can CME/CEU credit be provided? Implement & Manage with Attention to Details ©2009 National Association of Social Workers. All Rights Reserved.

Steps for Program Development Sustain Efforts Through Sharing Evaluate and Interpret Data How can participants be evaluated through pre-post tests, skills tests, and/or participant perceptions? How can project activities be shared within and outside of the professional community? ©2009 National Association of Social Workers. All Rights Reserved.

Program Resources Pilot Site Report Universtiy of Pittsburgh Medical Center Pilot Site Report Marshall University School of Medicine Pilot Site Report California University of Pennsylvania School of Social Work Pilot Site Report Audrain Medical Center Addressing the Cancer Workforce Crisis Using a Competency-Based Approach with Non-Oncology Professionals Pilot Project Evaluation Report July 2008 Examples & Templates Overview & “How to” Guidance Summary Publications

Cancer Core Competency Initiative Summary Effective method to address the cancer workforce shortage Applicable in a variety of professional disciplines and settings Bolsters professional development and retention efforts Provides numerous resources for competency-based program development www.cancercorecompetency.org asmith@c-changetogether.org ©2009 National Association of Social Workers. All Rights Reserved. 1

Strengthening the Cancer Knowledge and Skills of the Social Work Labor Force