The combined USF/Tampa VA GPE geropsychology post-doctoral fellowship focuses on training in public sector service delivery across diverse long term care (LTC) and rehabilitation settings. Addressing the bio-psycho-social needs of frail, poor, and minority older adults within a multi-disciplinary framework allows students to understand the complex nature of mental health problems of older adults and the need for collaborative efforts across professional lines. The program provides an integrated framework to achieve clinical, didactic, program evaluation, and advocacy goals: 1) delivery of state-of-the-art evidence-based psychological services to disadvantaged older adults in geriatric public sector sites; 2) mastery of the knowledge base on diversity and interdisciplinary teamwork as they relate to providing services to older adults; 3) gaining competence in the evaluation of services to disadvantaged older adults; and 4) experience in public health advocacy for improvement of the LTC mental health system. The organizational structure of the Post-doctoral program supports the advanced training needs of geropsychology Fellows at a variety of levels via supervised experiences and exposure to hospital-based (VA Spinal Cord Injury), institutional (VA nursing home) and community (Health Resources Alliance) multi-disciplinary, primary care geriatric clinical settings that serve poor, minority and frail older adults; exposure to psychology, primary care health professionals, gerontology, medical/nursing, social work, legal, and public health policy multi-disciplinary faculty and supervisors; exposure to an array of applied gerontological research investigations with poor, minority & frail older adults; and exposure to cutting-edge advocacy effort within the context of legislative endeavors reflecting a major mission of the administrative site (FMHI) of the program.

SUMMARY OF THE TRAINING PROGRAM

A. Purpose, Need, Rationale:Research documents the rising need for mental health services for older adults, particularly those who are poor, minority, rural, and/or among the oldest-old residing in LTC settings. The training of geropsychologists to address the mental health needs of these disadvantaged older adults has not kept up with the rising demand. Education at the post-doctoral level is particularly important to develop a cadre of specialists in the field to teach generalists to provide state-of-the-art geropsychology services at the graduate, internship and continuing education levels. Such training is consistent with Federal and State of Florida initiatives regarding providing optimal services to disadvantaged older adults in multidisciplinary primary care settings.

B. Objectives :

1. Clinical:Train post-doctoral Fellows in the delivery of psychological services to disadvantaged minority, rural older adults in multidisciplinary, primary care geriatric public sector sites;

2. Didactic: Educate post-doctoral Fellows in the latest knowledge base regarding serving disadvantaged older adults in interdisciplinary settings within our public health system via coursework and seminars on diversity, team building, multi-cultural competence, public health & aging, and socio-cultural gerontology;

3. Program Evaluation: Teach post-doctoral Fellows to evaluate public sector programs serving disadvantaged older adults via coursework on research methodology;

4. Advocacy: Provide post-doctoral Fellows with experience in public health advocacy for the improvement of disadvantaged older adults, particularly relating to the long term care system.

C. Methodology: To address the bio-psycho-social needs of frail, poor, and minority older adults within a multi-disciplinary framework, this grant proposes a partnership between three major entities, University of South Florida's (USF) Dept of Aging and Mental Health @ Florida Mental Health Institute (FMHI), USF's School of Aging Studies, and the Tampa VA, all of which have had longstanding experience in training interns (FMHI, Tampa VA), geropsychology post-doctoral Fellows (Tampa VA), and gerontology students (Masters in Gerontology & PhD in Aging Studies program in the School of Aging Studies). It also includes collaboration with a community primary care center, community nursing homes, and a hospice. The program incorporates 4 main components: 1) Clinical, 2) Didactic, 3) Program Evaluation, and 4) Advocacy.

1 - Clinical: Fellows will be trained in providing mental health services to older adults with co-morbid health conditions in medical inpatient and outpatient (VA, Moffit Cancer Center), primary care (VA, Health Resources Alliance), community (Health Resources Alliance, Weinberg Village ALF) and long term care (VA, Weinberg Village ALF) settings. The great majority of the clinical experiences in these sites will be with public sector patients, and in all of the sites Fellows will gain experience in providing services to poor, disadvantaged, minority older adults. Fellows will gain experiences with both older males (VA) and older females (Health Resources Alliance, Weinberg Village ALF). Fellows will be exposed to a variety of professions including primary care physicians, geriatricians, physiatrists, physician assistants, nurse practitioners, nurses, social workers, physical therapists, occupational therapists, recreational therapists, kinesiotherapists, dieticians, and pharmacists.

2 - Didactic: Fellows will develop an understanding of the latest knowledge base regarding providing mental health services to disadvantaged older adults in public sector and multidisciplinary settings via diversity seminars (FMHI training program), interdisciplinary team-building module (Dr. Hyer), an 'aging and public health' course (School of Public Health), and a 'socio-cultural gerontology' course (School of Aging Studies). A unique element of this didactic component will be training in the provision of telemedicine to rural and long term care older patients (AMH).

3 - Program Evaluation: Fellows will be taught how to evaluate public sector program services and conduct applied gerontological research via a course on program evaluation (taught by FMHI faculty). Fellows may choose to work on one of a variety of projects being conducted by faculty from USF and the Tampa VA representing psychology, gerontology, nursing, law, engineering, bio-statistics, or public health.

4 - Advocacy: Fellows will be taught how to conduct advocacy for the improvement of mental health services for disadvantaged older adults in long term care facilities. They will participate in a year-long policy seminar and have the opportunity to take a course in 'Social policy and aging' (School of Aging Studies) and to become involved with a variety of professionals (gerontologists, social workers, psychologists, mediators) trying to influence public policy for the betterment of older Floridians though the Florida Coalition for Optimal Mental Health (comprised of a diverse group of mental health professionals including nurses, social workers) and the Florida Health Care Coalition (represented by nurses, social workers, nursing home administrators, and other health care professional etc.).

D. Evaluation: By the end of this program, Fellows will achieve competency across four broad levels of the clinical, didactic, research, and public advocacy objectives of psychological care for older adults:

1 - Clinical: Fellows will be competent in the delivery of psychological services (assessment, treatment, consultation) for older adults in geriatric public sector and primary care sites. They will be competent in the assessment, treatment, and consultation of the mental health problems of older adults in multi-disciplinary settings. They will have particular expertise and interest in serving poor, minority older adults living in rural areas. They will provide services to at least 10 disadvantaged older adults across at least two multidisciplinary sites. In addition to competence in the 7 broad areas of competence outlined by the APA interdivisional task force (normal aging, assessment, treatment, prevention and crisis intervention, consultation, interface with other disciplines, and special ethical issues), Fellows will earn satisfactory ratings demonstrating entry-level proficiency in the 6 core areas of competence outlined by the Tampa VA Training committee (psychological assessment, interventions, supervision/teaching, research & scholarly activity, administration & professional development, and ethics, law & diversity issues)

2 - Didactic: Fellows will gain an in-depth empirically-informed knowledge base of how to provide cost-effective mental health services in multidisciplinary primary care and public health settings to disadvantaged older adults. In addition to the intern seminar offerings at the Tampa VA and FMHI, the Fellow will attend the diversity seminar, attend the team building module, receive at least a 'B' grade in either one of the courses they choose ('Aging & Public Health course' or the 'Socio-cultural Gerontology' course), and achieve satisfactory performance on the 'Cultural Competent Practice' rating developed for the FMHI multi-cultural interns.

3 - Program Evaluation: Fellows will know how to evaluate public sector programs serving disadvantaged older adults, and will feel competent in conducting applied gerontological research reflected in formulating their own potential research program. The Fellows will make at least a 'B' in the FMHI program evaluation course, and become involved in one applied gerontological project of their choosing. Fellows will present at least once at a local, state or national conference; and assist with the write-up and publication of a research project.

4 - Advocacy: Fellows will learn the most effective ways to advocate for the improvement of mental health services for disadvantaged older adults, particularly for the frailest long tem care residents. The Fellow will attend and actively participate in the FMHI public policy seminar and advocacy-based conferences sponsored by the Florida Coalition for Optimal Mental Health in Aging or the Florida Health Care Association; or they will make at least a 'B' in the 'Social policy and aging course'.