The Graying of Social Work Education — Aging Curriculum Matures
By Dan Orzech
Social Work Today
Vol. 6 No. 5 P.

Educators strive to prepare students to meet the needs of a burgeoning older adult population.

When she finished graduate school nearly 10 years ago, Philadelphia-based social worker Susan Bash, MSW, LCSW, didn’t plan to work with older adults, and her master’s degree studies didn’t include any courses on aging. After more than six years as a therapist for women with eating disorders, however, Bash began working as a social worker at an independent living facility for older adults last year. Her responsibilities now include helping a 93-year-old woman with failing sight and hearing take care of daily tasks and helping another client—who recently turned 98—deal with the loss of her son.

Bash’s experience is not uncommon, says Nancy Hooyman, PhD, professor of gerontology and dean emeritus at the University of Washington School of Social Work. “Seventy-five percent of social workers end up working with older adults, even though they might not have thought they would,” she says. “Regardless of practice setting, you’re likely to encounter older adults.”

Population Boom
Like Bash, the majority of social work students don’t receive specific training for working with older adults, but the need for those skills is increasing. The group aged 85 and older is now the fastest growing segment of the U.S. population, according to the National Institute on Aging, and the older adult population will surge even more in the future as the first of the Baby Boomers—the generation born in the two decades following World War II—turns 60 this year. By 2030, nearly one of every five people—approximately 72 million Americans—will be aged 65 or older.

Without specific training, says Hooyman, many social workers are not prepared to work with aging clients. “They don’t know how to do an assessment with an older adult,” she says, “how to tell what normal age-related changes are, or how to communicate with someone who’s got vision and hearing impairment.”

This education gap is creating a pressing demand to train more social workers to handle an aging population, says Hooyman. Since the late 1990s, a major initiative by the New York City-based John A. Hartford Foundation has been helping do just that. The foundation’s Strengthening Geriatric Social Work Initiative is helping social work programs prepare aging-savvy social workers by training faculty leaders in gerontology and supporting master’s- and doctoral-level students interested in the field. Equally important is the foundation’s work to make training in aging part of the education of all social work students, not just a specialization for a few.

Many of those involved with the initiative believe the Hartford Foundation’s support—it has invested more than $40 million in the initiative over the last eight years—is having a significant impact on how social workers are educated about aging. One decade ago, “geriatrics was in a dismal condition,” says Barbara Berkman, DSW, MA, a Columbia University social work professor and editor of the Oxford Handbook of Social Work in Health and Aging. The Hartford Foundation’s initiative, she says, “is changing the face of social work education.”

While the Hartford Foundation is providing the bulk of the funding, the social work programs involved have raised millions of dollars in matching funds and other foundations have joined the effort. And it is social work educators who are actually providing direction for the programs, according to James O’Sullivan, program officer at the Hartford Foundation.

“None of these programs were created by the Hartford staff,” O’Sullivan says. “Mostly, they emerged from academic papers that were considering how to advance the profession, how to help social workers be ready to support emerging client needs.”

In the late 1990s, the Hartford Foundation held a series of forums with social work leaders and commissioned white papers by senior social work professors such as Berkman, designed to determine how to best prepare social workers for an aging population and craft a program to help do that.

Not Just for Specialists
One major recommendation to emerge from the process was the need to expose all social work students to information about aging. Relatively few MSW students—typically 10% or less in any given year—choose to specialize in geriatrics. But because most social workers, regardless of their practice area, are likely to find themselves working with older people, it’s “absolutely essential” that all students have some grounding in the area, says Berkman.

Social workers going into a field such as children’s services, for example, may still find themselves working with aging clients. “There’s a significant and growing number of children who are being taken care of by grandparents,” says Berkman. “Their parents may be incarcerated, or might have died because of AIDS, so it falls on the grandparents to pick up the pieces. But the grandparents have their own needs, and those needs can become exacerbated under the stress of caregiving in older age. We have to understand the gerontological issues that these people face.”

Myth Busters
One project the Hartford Foundation is funding is aimed specifically at helping social work schools prepare all students to work effectively with older adults and their families. Rather than create separate classes or modules on aging, the project, which is called the National Center for Gerontological Social Work Education (Gero-Ed), is working with faculty at 72 different social work programs to infuse content on aging throughout their core curriculum.

“We’d like to avoid what has often happened in the past where aging just gets tacked on in a human behavior course, more often than not in the context of a discussion of death and dying,” says Hooyman, who is one of the project’s coprincipal investigators. “We’re trying to find ways where it can become embedded in a range of courses. My hope is that content on older adults will come to be seen as business as usual, just as no one thinks twice about including content on children and family.”

One MSW program where that’s happening is at the State University of New York at Albany (SUNY Albany), where students in the first-year human behavior courses watch films such as Big Mama, an Academy Award-winning documentary about a grandmother raising her orphaned grandson. “A lot of social work students want to work with children and families,” says Linda Mertz, MSW, the project coordinator for the school’s Internships in Aging project, “and showing them this can help expand their concept of who’s included in the family and what their needs might be.”

SUNY Albany students also watch Ruth Ellis at 100, a video about an African American lesbian woman. “Ruth Ellis is definitely not who you might think of when you think of someone elderly,” Mertz says. “She’s very social, very lively, and very much alive. These intergenerational films are kind of myth busters around what it means to be aging.”

Recognizing that many social work faculty members don’t have the time or energy to revamp their courses on their own, the Gero-Ed project is making it as easy as possible to incorporate material on aging. For example, the project is taking advantage of a previous Hartford-funded program, Gero-Rich, where faculty members at 67 social work schools developed course material on aging.

“Those 67 programs developed some wonderful case studies, in-class exercises, and other teaching materials,” says Hooyman. “Those materials are readily available to faculty members through our Web site, www.Gero-EdCenter.org, which is helping reduce some of that feeling that ‘I don’t have time to deal with this.’”

Gero-Ed is also trying to ease faculty members’ jobs by looking for ways course material on aging can complement other subjects, rather than replace them. “We’re trying to build intersections with other content areas,” Hooyman says, “so material on aging is not competing with other substantive areas. In cultural diversity courses, for example, they might have a case study of an older African American woman, which could illustrate the intersections of race and gender and poverty and age.”

To help reach social work professors, Gero-Ed has held a number of one-day faculty development seminars. While that has been helpful, says Hooyman, most faculty have found it far more useful to work with a Gero-Ed faculty mentor. The mentors, typically from another social work program in the region, are professors who have already successfully infused aging into their curriculum, many of them with help from the earlier Gero-Rich program.

The Gero-Ed program is also working with some authors of foundation social work textbooks, says Hooyman, to include more content on aging. “We’ve done a thorough content analysis of the 19 most frequently used foundation textbooks,” she says, “and we’ve found that only 3% of the content included any mention of age or aging.” Gero-Ed is making resources on aging available to the authors to make it easy for them to include more content on aging as they make revisions for future editions.

Aging Specialists
While the Hartford Foundation’s initiative hopes to provide all social work students with training to work with older adults, it also hopes to increase the number of students who specialize in aging.

To do that, says O’Sullivan, it has created a practicum program designed to give MSW students broad exposure to the issues involved in caring for older adults. Rather than the students doing an entire practicum at one agency, students in the Practicum Partnership Program rotate through a range of different assignments, spending one or two months at each.

Students in the program “might start in an adult protective services agency for a month or two,” says O’Sullivan, “and then spend some time at an adult day program and then in a nursing home. They might also spend time in a hospital setting, which exposes them to issues such as discharge planning, making sure that once clients leave the hospital they have everything they need at home from their prescription drugs to food. For older patients, this often involves some support for the caregiver—usually the spouse—because they may have their own health problems.”

More than just providing a smorgasbord of experiences, says O’Sullivan, the practica are structured to ensure that the students’ field experiences are linked to their classroom curriculum, so the theoretical and practical aspects complement each other. They’re also designed to build cooperative networks of agencies and schools interested in geriatrics. In southern California, for example, social work departments at four universities—the University of California, Los Angeles; the University of Southern California; and the California State Universities at Long Beach and Long Angeles—have partnered with 40 partner agencies concerned with aging issues. These school-community partnerships work together to design and oversee the practicum experiences.

New Demands From the Baby Boomers
Is all this making a difference in how prepared social work students are to help older adults? While empirical data is being collected, many educators involved in the initiative believe the evidence is clear. Katharine Briar-Lawson, dean of the School of Social Welfare at SUNY Albany, calls the impact of the Hartford Initiative “transformational” while Berkman speaks of a burgeoning “gerontological social work movement.”

At SUNY Albany, Mertz believes the changes are coming none too soon, as Baby Boomers begin making new demands on the social work profession. “The current generation which is in their 80s are not social service users until they’re really having difficulties or literally on death’s door,” she says. “As the Baby Boomers come along, they use services very differently and expect very different things from our profession. They’re going to be online and looking up all the evidence-based treatment, before they walk in our doors. Today’s 80-year-old senior has probably never seen a therapist and doesn’t want to see a therapist, where somebody who’s turning 60 now may be on [his or her] third therapist.”

— Dan Orzech is a Philadelphia-based freelance writer and editor of “Mindfulness Update,” a newsletter for mindfulness-based stress reduction practitioners.

The word geriatrics is traditionally used when talking about the aging process and is used more in the medical and nursing professions. Gerontology refers to psychological, sociological, and biological phenomena associated with aging. “I frequently use both terms,” says Berkman, “because I feel that social workers in healthcare have to understand and be involved in geriatrics as well as gerontology.”

— DO