The Mental Health and Substance Use Workforce for Older Adults In Whose Hands? (2012) / Chapter Skim
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Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers
Appendix C: Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers
Pages 313-358
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Appendix C Required Knowledge, Skills, and Training for Mental Health, Substance Use, and Geriatric Care Providers 313
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334 Gerontological Nurses 336 Psychiatric and Mental Health Nurses 336 Advanced Practice Registered Nurses (Master's and Doctoral) 336 Acute Care Nurse Practitioners 336 Adult Psychiatric-Mental Health Nurse Practitioners 338 Adult-Gerontology Primary Care Nurse Practitioners 338 Adult-Gerontology Clinical Nurse Specialists 338 IV.
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OCCUPATIONAL THERAPISTS 350 Occupational Therapy Assistant 350 Occupational Therapist (Master's and Doctoral) 352 Gerontology 354 Mental Health 354 IX.
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b Responsibility for the total health care Must have instruction None of the individual and family, taking and development of into account behavioral dimensions; skills in the diagnosis Family-oriented comprehensive care and management of experience, including individual behavioral alcoholism and other counseling and family counseling; substance abuse. knowledge and skills in human behavior and mental health should be acquired through a program in which behavioral science and psychiatry are integrated with all disciplines throughout the total educational experience; skills in the diagnosis and management of psychiatric disorders in children and adults, emotional aspects of nonpsychiatric disorders, psychopharmacology, the physician– patient relationship, patient interviewing skills, and counseling skills.
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requiring home care and care in long-term care facilities; nursing home experience must consist of at least two patients as a continuity experience over a minimum of 24 consecutive months, in addition to rotation; must perform at least two home visits with at least one being for an older adult continuity patient; educational experiences must be in both common and complex clinical problems of older patients; training must include the appropriate preventive modalities, functional assessment, and the physiologic and psychologic aspects of senescence; supervised clinical experiences dealing with common acute and chronic diseases of aging; learn about, and practically apply, a multidisciplinary approach to the care of older patients in the hospital, the family medicine center (FMC)
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and SU Geriatric Family Medicine (MD)
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Primary specialty. Ambulatory care None None experience must be designed to provide care, in a geriatric clinic or family medicine center, to elderly patients who may require the services of multiple medical disciplines, including psychiatry and social work; experience in relevant ambulatory specialty and subspecialty clinics (e.g., geriatric psychiatry and neurology)
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and SU Internal Medicine (MD) d Clinical experience must include None None opportunities for experience in psychiatry.
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Primary specialty. Formal instruction in None None physical and mental examination, topics of special interest to geriatric medicine, including, but not limited to, cognitive impairment, depression and related disorders, psychosocial aspects of aging, including interpersonal and family relationships, living situations, adjustment disorders, depression, bereavement, and anxiety, and behavioral sciences such as psychology/social work; ambulatory care experience must be designed to provide care in a geriatric clinic or internal medicine center to elderly patients who may require the services of multiple medical disciplines, including psychiatry and social work; experience in relevant ambulatory specialty and subspecialty clinics (e.g., geriatric psychiatry and neurology)
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i,j,k Take a comprehensive history (including Population health None symptoms, psychological factors, and concepts and social factors) ; perform a standard history patients with and physical examination, including mini- presentations related mental and basic neurologic examinations; to health promotion, understand the concepts and principles of chronic disease social and behavioral sciences and apply management, and these to the understanding, management, human development, and treatment of patient presentations.
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(SU) and SU management of elderly patients must include understanding of the behavioral aspects of illness; identifiable structured didactic and clinical experiences in geriatric psychiatry must be included in the program of each Fellow.
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l Must maintain current knowledge of Program must include behavioral medicine that reflects the training in behavioral majority of patient care issues that present science, which at to osteopathic family practice settings; a minimum shall training in behavioral science, which at include the treatment a minimum shall include psychiatric and of substance abuse; psychological diagnoses common to 50 hours or 2 weeks family practice, didactic instruction and of documented clinical experiences, interviewing skills, training in community counseling skills, psychopharmacology, medicine, which may and physician well-being; 50 hours include time spent or 2 weeks of documented training in in drug and alcohol community medicine, which may include treatment centers. time spent in occupational health, mental health agencies, communitybased screening programs, public health agencies, community health centers, free clinics, or homeless shelters.
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COMLEX-USA covers population health concepts and patients with presentations related to health promotion, chronic disease management, and human development, including aging physiology; endof-life management. At least 100 hours or 1 month of training in the care of the geriatric patient, in addition to training that occurs in the continuity of care site or general internal medicine rotations, which at a minimum shall include physiological changes of aging, pharmacokinetics in the elderly, functional assessment of the elderly, extended care facility management, hospice, home care; competencies in providing acute care, chronic care, and preventive care across the full spectrum of ages and genders; awareness and proper attention to issues of age; patient population of the continuity of care site must include a variety of patients in terms of age.
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and SU Addiction in Family Medicinen Scope of training must include additional Primary specialty. None training in all branches of psychiatry that are of special concern in the addicted patient.
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N/A None None None None None None None Primary specialty. Base institution or an Mental health None affiliate must have disorders, rehabilitation and including psychiatry services; substance biopsychosocial disorders and components of aging, the appropriate including normal treatment physiological age options.
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r N/A N/A N/A Addiction Psychiatry (DO) s Primary specialty.
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N/A Primary specialty. Diagnosis, Diagnosis, treatment, and treatment, and epidemiology epidemiology of all major of all major psychiatric psychiatric disorders seen disorders seen in the elderly, in the elderly, including typically including substance abuse but not limited disorders.
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and SU and other psychiatric disorders; clinical experience must include evaluation, consultation, and treatment of psychiatric inpatients and outpatients with chemical dependencies and comorbid psychopathology, to include a broad range of psychiatric diagnoses; curriculum should emphasize functional assessment, signs and symptoms of neuropsychiatric impairment associated with substance abuse; knowledge of the signs and symptoms of the social and psychological problems as well as the medical and psychiatric disorders that often accompany the chronic use and abuse of the major categories of drugs; experience in the use of psychoactive medications in the treatment of psychiatric disorders often accompanying the major categories of substance. II. PHYSICIAN ASSISTANTSt Instruction in the social and behavioral Instruction in the None sciences as well as normal and social and behavioral abnormal development across the life sciences as well as span, including psychiatric/behavioral normal and abnormal conditions; supervised clinical practice development experiences must provide sufficient across the life span, patient exposure to care for behavioral including detection and mental health conditions; supervised and treatment of clinical practice experiences should occur substance abuse.
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Instruction in the Instruction in the social Instruction in None provision of clinical and behavioral sciences the social and medical care across as well as normal and behavioral the life span, including abnormal development sciences as preventive, emergent, across the life span, well as normal acute, chronic, including psychiatric/ and abnormal rehabilitative, palliative, behavioral conditions. development and end-of-life care across the life relevant to adult and span, including elderly populations; detection and supervised clinical treatment of practice experiences substance abuse.
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and SU III. NURSES Licensed Practical Nurses/Licensed Vocational Nursesu Identify client risk factors for abusing Identify signs None or neglecting others; identify signs and and symptoms of symptoms of physical, psychological, substance abuse/ or financial abuse in client; recognize chemical dependency, risk factors for domestic, child and/or withdrawal or toxicity; elder abuse/neglect and sexual abuse; plan and provide care monitor client appearance, mood, and to client experiencing psychomotor behavior and observe for substance-related changes; assist client with achieving withdrawal or toxicity self-control of behavior; assist client in (e.g., nicotine, opioid, using behavioral strategies to decrease sedative) ; reinforce anxiety; assist in or reinforce education provided information of caregivers/family on ways to manage on substance abuse client with behavioral disorders; diagnosis and participate in behavior management treatment plan to program by recognizing environmental client; encourage stressors and/or providing therapeutic client participation environment; participate in reminiscence in support groups therapy, validation therapy, or reality (e.g., Alcoholics orientation; participate in client group Anonymous, Narcotics session; reinforce client participation in Anonymous)
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process and assist in reinforcing teaching on expected changes related to aging; provide care that meets the special needs of adults ages 65 to 85; provide care that meets the special needs of adults greater than age 85; assist client with expected life transition (e.g., retirement) ; modify approaches to care in accordance with client development stage; identify client end-of-life needs; identify client ability to cope with end-of-life interventions; provide care or support for client/family at end of life; assist client in resolution of end-of-life issues.
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; provide in group sessions; incorporate behavioral information on management techniques when caring substance abuse for a client; evaluate client response to diagnosis and treatment plan; assess client reaction treatment plan to to diagnosis of acute or chronic mental client; encourage illness; provide information to client on client to participate stress management techniques; assess the in support groups potential for violence and initiate/maintain (e.g., Alcoholics safety precautions; identify client in crisis; Anonymous, Narcotics use crisis intervention techniques to assist Anonymous) ; evaluate client in coping; apply knowledge of client client response to psychopathology to crisis intervention; treatment plan and guide client to resources for recovery from revise as needed.
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(SU) and SU Assess client reactions Identify risk factors None None to expected age-related for elder abuse/ changes; provide care neglect; evaluate client and education that abnormal response to meets the special needs the aging process (e.g., of adults ages 65 to depression)
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Assumes mastery of baccalaureate None None essentials; advanced health/physical assessment, including psychological assessment; knowledge and skills to identify signs and symptoms of common emotional illnesses. Acute Care Nurse Practitionersaa Performs evaluations for substance use, Diagnoses common Diagnoses common violence, neglect, and abuse; assesses the substance use or mental health and impact of an acute, critical, and/or chronic addictive disorder/ substance use or illness or injury on the individual's disease, such as addictive disorder/
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Assumes mastery of Assumes mastery of None None baccalaureate essentials; baccalaureate essentials. knowledge and skills to compare and contrast physiologic changes over the life span and analyze the relationship between normal physiology and pathological phenomena produced by altered states across the life span.
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Adult Psychiatric-Mental Health Nurse Practitionersbb Primary specialty. Because substance- None related disorders are one of the DSM-IV-TR Axis I diagnoses, they have been included as a psychiatric disorder in these standards.
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Primary specialty. Assesses the interaction Evaluates for None between acute and common mental chronic physical and health disorders mental health problems; such
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and SU IV. PSYCHOLOGISTSee Primary specialty. Behavioral genetics, Behavioral genetics, transmission and transmission and expression of genetic expression of genetic information and information and its modification its modification and the role of and the role of this information this information in understanding in understanding diseases and diseases and disorders (e.g., disorders (e.g., substance abuse substance abuse disorders)
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on illness with beliefs/cognitions substance abuse, and behaviors; comorbidity normal growth and rates, age ranges development across affected. the full life span; family development and functioning and its impact on the individual across the full life span; normative and nonnormative life
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and SU population differences population differences in genetic information. in genetic information; comorbidity of mental illness with substance abuse, comorbidity rates, age ranges affected.
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N/A Sensitivity to and None None skills in dealing with multicultural/ diverse populations, including broad scope of age; perform interventions that may reflect any modality of psychotherapy or environmental modification and may come from any developmental level across the life span. N/A Knowledge in life span None None human development; assessment procedures should be appropriate for the client's developmental age and stage of lifecycle; use of instruments that have normative data from age-appropriate samples; interpretations and conclusions take into account couple/ family/identified patient uniqueness (developmental age and stage of lifecycle)
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, and interpretation of standardized tests, behavioral observations, and/ or clinical interviews, given the needs of the patient/ client, upon which recommendations are made and communicated to promote useful outcomes in the assessment of substance use/ abuse identification; effective consultation with other professionals appropriate to the needs of the client in ways that will promote useful outcomes for the patient/client in substance abuse identification and management. V. LICENSED COUNSELORS Rehabilitation Counselingjj Recognize individuals with a disability Describe different None who demonstrate psychological or recovery models that mental health-related problems and apply to substance make appropriate referrals when abuse treatment and appropriate; analyze diagnostic and rehabilitation; identify assessment information (e.g., vocational and recommend and educational tests, records, and treatment options psychological and medical data)
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. Identify the influences None None None of aging differences and integrate this knowledge into practice; articulate a working knowledge of human development and the needs of individuals with disabilities across the life span.
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Recognize the potential for addictive disorders to mimic a variety of medical and psychological disorders and the potential for medical and psychological disorders to coexist with addiction and substance abuse; provide appropriate counseling strategies when working with clients with addiction and co-occurring disorders; screen for co-occurring mental and/or addictive disorders; knowledge of the impact of co occurring addictive disorders on medical and psychological disorders; demonstrate appropriate use of diagnostic tools, including the current edition of the DSM IV-TR, to describe the symptoms and clinical presentation of clients with addictive disorders and mental and emotional impairments. Clinical Mental Health Counseling Primary specialty.
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(SU) and SU N/A None Core curricula None for all counselors should include theories of individual and family development and transitions across the life span; theories for facilitating optimal development and wellness over the life span.
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dynamics of grief and loss; indicators and dynamics of abuse; psychopharmacology; components of a biopsychosocial history; symptoms of mental and emotional illness; indicators of psychosocial stress; indicators of traumatic stress and violence; current Diagnostic and Statistical Manual diagnostic framework and criteria; components and function of the mental status examination; indicators of client danger to self and others; use of cognitive behavioral techniques. Clinical Social Worknn Primary specialty.
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dynamics, and impact of sexual abuse, emotional abuse, neglect, physical abuse, intimate partner violence, and other forms of exploitation across the life span; the dynamics and effects of life stage and lifecycle crises; the effect of the client system's life stage on the selection of an intervention. Aging processes; None None None influence of age on behaviors and attitudes.
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. standards established by national accrediting and regulatory agencies as related to practice in health care settings (e.g., mental health, substance abuse)
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. Demonstrate knowledge Curriculum must None None and understanding of prepare students to human development work with a variety of throughout the life span populations, including
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The curriculum must prepare students None None to work with a variety of populations, including, but not limited to, children, adolescents, adults, and elderly persons in areas of physical and mental health; course content must include, but is not limited to, developmental psychology; demonstrate knowledge and understanding of the concepts of human behavior to include the behavioral and social sciences. Course content must include, but is not limited to, introductory psychology, abnormal psychology, and introductory sociology or introductory anthropology; analyze the effects of physical and mental health, heritable diseases, and predisposing genetic conditions, disability, disease processes, and traumatic injury to the individual within the cultural context of family and society on occupational performance; express support for the quality of life, well-being, and occupation of the individual, group, or population to promote physical and mental health; consider client factors, including body functions (e.g., cognitive, mental)
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Demonstrate knowledge The curriculum must None None and understanding of prepare students to human development work with a variety of throughout the life populations, including span (including elderly persons, in areas elderly persons) ; of physical and mental select appropriate health.
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b Program Requirements for Graduate Medical Education in Family Medicine, ACGME 2007. c Program Requirements for Graduate Medical Education in Geriatric Medicine, ACGME 2006.
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None None None None f Program Requirements for Graduate Medical Education in Psychiatry, ACGME 2007. g Program Requirements for Graduate Medical Education in Geriatric Psychiatry, ACGME 2003.
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2011. Basic standards for fellowship training in geriatrics in osteopathic family medicine and manipulative treatment.
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. tt Competencies, Criteria, and Client Outcomes: Gerontology Board Certification, AOTA 2009.
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