Using a classification of public policy developed by Matland, we examine implementation of policy on adult protection as outlined in 'No Secrets', the government's guidance to local agencies. This policy appears to exemplify a 'high-ambiguity/low-conflict' model. Detailed interviews with staff charged with developing multi-agency procedures, in local authority departments, health authorities, the police and the voluntary sector, confirmed the ambiguity of the policy and the uncertainty experienced by staff as a consequence. However, the interviews also revealed a number of areas of conflict, particularly as people gave precedence to their own professional norms and organizational priorities over partnership working.

There is a well-described need to increase the competence of the primary care workforce in the principles of geriatrics and palliative care, and as value-based payment models proliferate, there is increased incentive for the acquisition of these skills. Through a Geriatric Workforce Enhancement Program grant, we developed an adaptable curriculum around commonly encountered topics in palliative care and geriatrics that can be delivered to multidisciplinary clinicians in primary care settings. All participants in this training were part of an Accountable Care Organization (ACO) and were motivated to improve to care for complex older adults. A needs assessment was performed on each practice or group of learners and the curriculum was adapted accordingly. With the use of patient education and screening tools with strong validity evidence, the participants were trained in the principals of geriatrics and palliative care with a focus on advance care planning and assessing for frailty and functional decline. Comparison of pre- and post-test scores demonstrated increased confidence and knowledge in goals of care and basic geriatric assessment. Participants described feeling more able to address needs, have conversations around goals of care, and more able to recognize patients who would benefit from collaboration with geriatrics and palliative care.

P h i lli p G. Cla r kRh od e Isla nd Ger iat ric E du ca t ion Cen t er, U n iver sity of Rh ode Islan d, Kin gst on , Rh ode Isla n d, U SA Ma r ie M. Lei n h a a sRh od e Isla nd Ger iat ric E du ca t ion Cen t er, U n iver sity of Rh ode Islan d, Kin gst on , Rh ode Isla n d, U SA Ra c h el Fi lin s onRh ode Isla n d College, P roviden ce, Rh ode Isla n d, U SA The training of clinicians in working together as an interdisciplinary team has received growing support in geriatrics. Most teamwork training programs have focused on group process and development as the core competencies of team practice necessar y to improve levels of team functioning. The experience of the Rhode Island Geriatric Education Center (RIGEC) in developing and implementing an ongoing teamwork training program, including the training of severa l geriatric teams from a variety of health care settings, sugges ts that additional objectives should include the empowerment of teams for advocacy in rapidly changing health care settings increasingly shaped by economic forces. The lessons An ea r lier version of t h is a rt icle wa s pr esen t ed a s a pa per in a Sym posiu m on ''In terdisciplina ry Ger iat r ic E du ca t ion in Hea lt h Ca re P r ofession s: Develop m en t , Implem en t a t ion , a n d E va lu a t ion of New P r ogr a m s'' a t t h e 52n d An n u a l Scien t i c Meeting of t h e Ger on t ologica l Society of Am er ica , Sa n F r a n cisco, CA, Novem ber [19][20][21][22][23] 1999 . This wor k wa s su ppor t ed by gr a n t No. 5 D31 H P 70073 fr om t h e Bu rea u of H ea lt h P r ofession s, H ea lt h Resou r ces a n d Ser vices Adm inist r a tion , U.S. Depa rt m en t of H ea lt h a n d Hu m a n Ser vices.Address cor r es pon den ce t o P h illip G. Cla r k , Un iver sit y of Rh ode Isla n d, P r ogr a m in Ger on t ology, Kin gst on , RI 02881 . E -m a il: a gin g@ur i.edu E du ca t ion a l Ger on t ology, 28: 491-510, 2002 Copyr igh t # 2002 Bru n n er -Rou t ledge learned by RIGEC for the development and implementation of teamwork training include the importance of de ning team membership, dealing with the shifting shoals of the health care system, understanding individuals and systems under stress, and rede ning the objectives of teamwork training.Ca lls for increa sed in t er disciplin a r y colla bor a t ion or t eam wor k a m on g h ea lth ca r e pr ovider s a r e being m a de wit h gr owin g fr equ en cy a n d visibilit y by a n u m ber of n a t ion a l or ga n iza t ion s. F or exam ple, t h e J oin t Com m ission on t h e Accr edita t ion of H ea lt h Ca r e Or ga n iza t ion s (J CAH O) n ow r equ ires eviden ce of in t er disciplin a r y colla bor a t ion in h ospita ls, n u r sin g h om es, a n d clin ics a s par t of its a ccr edit a t ion pr ocess. Th e N a t ion a l Com m itt ee for Qu a lit y Assu r a n ce St a n da r ds for Accr editin g H ea lth P la n s a n d beh a vior al h ea lth m a n a ged ca r e or gan iza t ion s r equ ir es coor dina t ion of ca r e bet ween pr im a r y ca r e ph ysician s a n d beh ...

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