Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Key partners in the detection of mental health concerns experienced by older adults have been primary care physicians and social service providers and their families. Limited information is currently available from the professional literature on the awareness that social service providers have related to mental health concerns and older adults, especially when within rural communities. Purpose: This exploratory study examined the perspectives of key partners in the multidisciplinary relationship who provide mental health assessment and treatment process for older adults. The study sought to identify if physicians, social service providers and social work practitioners had similar or different perspectives on assessment, intervention, and training issues, in an effort to build a model for multidisciplinary collaboration. Methods: Three sampling frames were used: 1) Physicians from a 27 county catchment area; 2) Social Service providers from a 27 county catchment area; and 3) Older adults attending senior nutrition sites from three area agency on aging regions. Samples: Providers: A 25 % stratified sample (n=250) was randomly selected from Southern Illinois, and administered a questionnaire that addressed providers' perceptions related to systems integration, screening/consultation and education/training. Physicians: All physicians practicing within Southern Illinois (N=87) were forwarded a mail survey(n=63). Consumers: Three nutrition sites were randomly selected from each of the Three area agency on aging regional areas nutrition sites. Seniors from sites were asked to participate in a survey. Surveys were either self-administered or administered in a face to face manner (n=187). Instrument: Although three separate instruments were developed, a common set of questions were administered to each sample group. Items related to “systems integration”; “assessment and intervention” and training needs were examined to identify common themes and differences between the groups who would need to collaborate with each other. Items were identified using a Liker format, and a qualitative content analysis was used to identify common themes within open ended questions. Analyses: Descriptive statistics and ANOVA tests were used to decide if there were identified differences in mean scores. Findings: Physicians were least likely to perceive that referrals and collaborations were possible to ensure a seamless service delivery system between mental health and aging (F=9.09, df=2, p<.001). A number of strategies were perceived to be important in strengthening systems of care for older adults at risk for mental illness to include collaboration with providers; local hospitals; continuing care units, mental health providers, gero-psych specialists. Training needs include reaching out to the faith based community and providing panel discussions showcasing how each discipline's unique roles to assure professionals are in the “same ball park”. Conclusions: Consistently on items where there are significant differences in outcomes, the providers or social workers have higher mean scores. Several areas of training needs are different across the three groups. Topics identified for training include substance use and overuse, elder abuse, referral and treatment, crisis intervention with older adults, medications and assessment tools for psychiatric issues in the elderly. Consumers feel that stigma is a tremendous barrier to seeking care, which requires mediation through policy and programmatic changes.