Research Priorities for Gerontological Social Work: Researcher and Practitioner Perspectives Nancy Morrow-Howell, Denise Burnette, and Li-Mei Chen
This article describes a Delphi study to identify research priorities of gerontological social work practitioners and to compare these priorities with those of social work academic researchers. A national expert panel of 52 gerontological social work practitioners completed questionnaires to delimit a set of high-priority research topics. Findings were compared with a similar Delphi study conducted with academic social work researchers. The researcher panel and the practitioner panel endorsed a need for intervention research. Practitioners also identified several unique priorities, including income security and long-term care pohcies, decision making, and planning for later life. The authors suggest four substantive areas (housing and transitions in living arrangements, family caregiving, health and mental health, and workforce) and four crosscutting themes (intervention research, social poHcy, service delivery, and capacity building) as a potential organizing framework for a research agenda for gerontological social work. KEY WORDS: Delphi method;gerontological social work; intervention research; research agenda; research priorities
n appointing the Task Force on Social Work Research in 1988, Lewis L.Judd, then director of the National Institute of Mental Health (NIMH), charged the group to analyze the state of research education, research resources, and research development in social work. Among its key findings, the Task Force on SocialWork Research (1991) identified a significant lag in the contributions of practice-relevant research to the knowledge base of social work.The profession has since responded with an increased emphasis on building knowledge for services and policies.There is, for example, growing attention to developing models of social work practice that emphasize the importance of evidentiary knowledge bases (Rosen & Proctor, 2003) and guidelines for applying knowledge in practice (Holosko, 2003; Howard & Jenson, 1999). Such models provide a framework for structuring the development and application of knowledge. However, as Austin (1998) observed, the domain-specific nature of knowledge development and practice argues for a strategic approach to social work research that is based on fields of expertise, for example, child welfare, health, mental health, and gerontology.The author recommended that social work researchers critically assess the
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knowledge base, identify knowledge gaps, and establish research priorities to address those gaps in each of its substantive domains. Rosen and Proctor (2003) echoed this call for a more systematic approach to knowledge development. They argued that to escape the profession's piecemeal approach, social work needed to formulate a clear, comprehensive, long-range agenda for intervention research. Responding to the need for a methodical approach to developing social work knowledge, the John A. Hartford Foundation sponsored an effort to develop research priorities to help focus and organize social work research in the field of gerontology (Burnette, Morrow-Howell, & Chen, 2003). Using a Delphi methodology, this project aimed to gain consensus from two national panels, one of academic researchers and one of expert practitioners, on research priorities for this field. Delphi techniques provide a structured process to elicit and correlate expert panelists' informed opinions on a particular topic. Data are collected through the iterative administration of three or four questionnaires, interspersed with controlled feedback. The goal is to achieve consensus, typically on 10 to 15 top priority topics.
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An earlier article detailed findings from the researcher panel (Burnette et al., 2003).We summarize those fmdings and then present results from the practitioner panel with an eye to comparing the two panels. ACADEMIC RESEARCHER PANEL
We began the two-phase Delphi project by identifying a panel of 46 gerontological social work academic researchers through the John A. Hartford Foundation's Geriatric SocialWork Faculty Scholars Program. We then designed and used a Webbased platform to collect three iterative waves of data via e-mail. The panel identified 49 research topics that reflect the range and diversity of gerontological social work and encompass core elements of the knowledge base for practice and policy in this field. Finally, we calculated priority and consensus scores for each of the 49 topics and then designated the 16 topics that achieved the highest priority and consensus ratings as topmost priorities.The researcher panel's highest-ranked priority, by a large margin, was developing and testing psychosocial interventions across specific populations and conditions. These 16 priority topics overlap and complement other national research agendas, including the National Institutes of Health Roadmap (see http:// nihroadmap.nih.gov), the National Institute on Aging (NIA) Strategic Plan (2001-2005) (NIA, 2000), and the National Research Council (NRC) report on the NIH Committee on Future Directions for Behavioral and Social Science Research (Singer & Ryff, 2001). Social work researchers are well positioned to make unique contributions to advancing these national agendas while addressing the profession's own knowledge needs. For instance, social work expertise in individual, family, group, and community services to older adults and their families in a wide range of settings affords them a distinctive perspective on the knowledge needs and practice competencies required for grounded research (Schneider, 1995). Likewise, social workers' expert knowledge about eligibility, availability, quality, and barriers to health and social services is key to intervention and services research. Social workers also bring a psychosocial perspective to interdisciplinary teams in medical, psychiatric, and long-term care settings, and they play an important role in formulation and analysis of public policy. Yet, the potential contributions of social
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workers to national and professional research agendas, including those focused on gerontology, are yet to be fully realized (Morrow-Howell & Burnette, 2001; Scharlach, Damron-Rodriguez, Robinson, & Feldman,2000). To incorporate this source of expertise, we conducted a second Delphi panel with expert practitioners. Earlier Delphi studies that aimed to establish priorities emphasized the need to represent the views of stakeholders, including researchers, practitioners, administrators, policymakers, grantmakers, educators, and consumers (Davidson, Merritt-Gray, Buchanan, & Noel, 1997; Kinder & Cashman, 1998; Ventura &Waligora-Serafin, 1981). Indeed, identifying topics that reflect common practitioner and academic priorities may help close the "bench to trench" gap that undermines the use of research by social work practitioners (NIMH, 1999). METHOD Expert Practitioner Panel In concluding the researcher panel, we asked the panelists to nominate up to five expert gerontological social work practitioners who might participate in a replication of the process. To not unduly constrain or overly determine the range of expertise, we set limited nomination criteria. Participants could be either current or recent past practitioners and must have had at least five years of social work practice experience with older adults and demonstrated leadership in the field, for example, community involvement, conference presentations, elected positions, or various forms of publication. Researcher panelists nominated 93 practitioners: 72 agreed to participate and received the first questionnaire, and 52 completed round 1. Nonrespondents were contacted about three weeks after the survey was mailed, and most who declined participation reported lack of time as the reason. Eighty-one percent of the 52 panelists were female. They were from 18 states (Mid-Atlantic = 14; Midwest = 25; Northwest = 3; Southeast = 3; West Coast = 7) and represented a range of social \vork settings and functions. Located in local and state public agencies and private profit and nonprofit organizations, they were practicing in hospitals, health clinics, home health agencies, hospices, residential and nursing homes, senior centers, family services agencies, psychiatric services. Area Agencies on Aging, private counseling and case management services. Program of All Inclusive
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Care for the Elderly (PACE) work, and education and advocacy associations such as the Alzheimer's Association. We collected three rounds of data, interspersed with controlled feedback. As several practitioners reported discomfort with Web-based questionnaires, we used postal mail. Strategies to maintain the panel included e-mail and phone reminders and second mailings at each round. Of the 72 practitioners who agreed to participate, 52 (72%) completed round 1. Of these 52 panelists, 42 (81%) completed round 2, and all 42 (100%) completed round 3. Procedures We used the same protocols and instruments developed and tested for the researcher panel with practitioners, with slight modifications for postal mailing. In round 1, panelists were asked to list up to five high-priority research topics; the 52 practitioners submitted a total of 253 topics. Next, two of the authors and two graduate social work students specializing in gerontology independently identified unique topics among the 253 submitted. The authors considered the four lists of topics developed by the independent coders, discussed and resolved inconsistencies, and distilled the list of 253 topics into 55 discrete topics. We erred in favor of more rather than fewer topics, and some overlap was inevitable. For example, to preserve the original topics submitted by panelists, two that are very similar but distinct—mental health: detection and treatment and depression assessment and treatment—are retained. In addition, to avoid altering topics put forth by practitioners, we attempted to retain the original level of abstraction.Thus, some topics are stated more broadly than others. In round 2, we asked paneUsts to rate the importance of each of the 55 discrete topics, defined as "a topic's priority as an area in need of knowledge development for the field of aging." We also asked them to select and rank order the five topics they judged to be highest priority. We then calculated descriptive statistics on round 2 ratings. To further reduce the Ust of topics and move toward consensus, we eliminated 15 items with the lowest endorsement. In round 3, panelists received the remaining list of 40 topics and descriptive statistics on the priority ratings derived from round 2. At this point, we also reorganized the presentation of topics to fa-
cilitate conceptual clarity by listing them under broader categories, such as mental health and social policy. We then asked panelists to again rate each topic and select and rank order five topics of highest priority. We also invited them to register and explain opinions that diverged from majority consensus at this final stage, although few did so. This final round of data analysis aimed to derive priority and consensus scores for each topic. With respect to the one-to-five priority ratings, we used a procedure that treats nominal scale data as interval; that is, we grouped numeric priority ratings by dividing the sum of the scaled values by the number of ratings. We treated the value 2.5 as a neutral point, with boundaries distributed accordingly to avoid polarization of scores (Linstone & TurofF, 1975). As a result, mean priority ratings were grouped as highest (1.0-1.49), high (1.5-2.49), moderately high (2.5-3.49), moderately low (3.54.49), or low (4.5-5.0). In the final analytic step, we calculated a consensus score for each topic using the quartile deviation. Consensus scores were calculated for each of the 40 topics in round 3 by determining the quartile range, subtracting the lower boundary of the range from the full value of the range, and then dividing the difference by 2 (Raskin, 1994). Consensus on a topic was deemed when all responses on the topic fell within the interquartile range, or between the 25th and 75th percentOe estimates in the frequency distribution. Given the close clustering of scores with a deviation of less than one point on a fivepoint Likert scale, a quartile deviation less than 1.00 conventionally indicates group consensus. Examining the distribution of scores in this project, topics with a quartile deviation less than .60 were deemed high consensus, those equal to or more than .60 and less than 1.00, moderate consensus and those equal to or more than 1.00, low consensus (Faherty, 1979; Raskin). For example, the consensus score for "family interventions" was 0.5 (interquartile range 2.00—3.00), indicating that by the third and final round of data collection, panelists reached high consensus on their ratings of this topic. Each topic was evaluated on two criteria to determine its priority: priority (highest, high, moderate, low, or lowest) and consensus (high, moderate, or low) ratings.These two criteria yielded a matrix of 15 possible combinations of endorsement levels for each topic.
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endorsing the topic among their top five, and that this rating does not necessarily correspond with other assessments. For example, two of the highest rated topics,"determining best practices" and "gerontology education in social work," were also
FINDINGS Table 1 presents the 55 topics identified in round 1 and descriptive statistics for each topic generated from information collected in round 2. Mean priority ratings reflect the percentage of respondents
Table 1: Descriptive Statistics on 55 Issues Rated by Social Work Practitioners in Round 2
Issue item
% Endorsing Issue as One of Top 5 Research Priorities (n = 42)
M
Summary of Priority Ratings (1 = highest to 5 = lowest) Interquartile SO Mdn Range 1.05
2.00
1.00-3.00
0.94
3.00
2.00-3.00
0.88
2.00
2.00-3.00
0.92
3.00
2.00-3.00
1.05
2.00
2.00-3.00
0.90
2.00
1.00-3.00
0.87
2.00
1.00-2.25
1.68
0.82
1.00
1.00-2.00
2.4
2.14 3.43 2.71 2.52
0.95 4.92 0.92 0.83
2.00 3.00 3.00 2.50
1.00-3.00 2.00-3.00 2.00-3.00 2.00-3.00
13. Empowerment strategies (locus of control, asseniveness, and self-advocacy) 14.3 14. Ethnic-sensiti%'e interventions 9.5 0.0 15. Falls
2.20 2.19 3.12
1.01 0.89 1.06
2.00
1.00-3.00 1.75-3.00 2.00-4.00
1.90 2.07 1.74 2.36 2.50 2.83 2.43 2.62 2.79 2.50 3.20 1.81 1.95 2.76 2.02 2.45 1.93 2.81 2.52 2.50
0.92 0.75 0.80 0.96 0.99 0.99 1.04 1.10 0.84 1.06 0.98 0.80 0.91 1.03 0.81 0.92 0.81 0.86 1.02 1.06
2.00
1. Access and barriers to service use
23.8
2. Bereavement and loss
2.4
3. Case/care management models
7.1
4. Changing family forms
2.4
5. Consumer-directed services
4.8
6. Death and dying: End-of-life issues
9.5
7. Depression assessment and treaunent 11.9 8. Determining best practices and effective interventions (especially for subpopulations and specific conditions) 23.8 9. Developing tools for assessment of values and preferences of older adults 7.1 10. Discharge planning 4.8 11. Education of older aduirs regarding needs and services 2.4 12. Elder maltreatment (abuse and neglect)
16. Family caregiving (including grandparent caregiving and caregiving for individuab with developmental disabilities) 19.0 17. Family interventions 18. Gerontology education in social work 19. Health policy
7.1 28.6 4.8
20. Health promotion and prevention ' 21. HIV and aging
7.1 2.4
22. Housing options ' 23. Income security
4.8 4.8
, 24. 25. ' 26. 27. 28. 29. 30.
latergenerational issues Interdisciplinary team practice International comparative research living with disability and chronic illness: Quality of life Long-term care policy Managed care Management of dementia
31. Medication use and management 32. Mental health: Detection and treatment
0.0 11.9 2.4 11.9 16.7 0.0 14.3 4.8 21.4
33. Naturally occurring retirement communities (NORCS) 2.4 34. Needs of older gay and lesbian poptdacions ; 35. Normal and successful aging
4.8 , 4.8
1.95 2.50 2.38 2.90 2.49 2.14 2.02
2.00 3.00
2.00 2.00 2.00 3.00 3.00 2.00 3.00 3.00 3.00 3.00 2.00 2.00 3.00 2.00 2.00 2.00 3.00 2.00 3.00
1.00-3.00 2.00-3.00 1.00-2.00 2.00-3.00 2.00-3.00 2.00-4.00 2.00-3.00 2.00-3.00 2.00-3.00 1.75-3.00 3.00-4.00 1.00-2.25 1.00-2.25 2.00-4.00 1.00-3.00 2.00-3.00 1.00-3.00 2.00-3.00 2.00-3.00 2.00-3.00 (continued)
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Table 1: Continued
Issue Item
% Endorsing Issue as One of Top S Research Priorities (n = 42)
M
16.7
2.02
0.84
2.00
1.00-3.00
9.5
2.00 2.60
0.77 1.04
2.00 3.00
1.00-2.50 2.00-3.00
2.45 2.86
0.92
2.50
2.00-3.00
1.03 0.94
3.00
2.00-4.00
2.00 2.00
1.00-3.00
36. Nursing home improvement: Adjustment, afFordabilicy, and quality 37. Outreach and service planning/delivery for underserved elderly population • 38. Pain management I 39. Planning for later life: Individuals and families
7.1 9.5
'
40. Professional social work issues (licensing, emerging roles) 9.5 41. Quality of life in long-term care 21.4 ' 42. Self-determination, decision making, and autonomy 43. Service integration 44. Service needs of baby boom generation 45. Services to maximize aging in place 46. Serving low-income elders 47. Serving well elders 48. Social support and social integration 49. Spirituality 50. Substance abuse
U.9 7.1 14.3 16.7 2.4 0.0 2.4
51. Transitions in living environments 52. Transportation 53. Use of technology in serving older adults 54, Work, retirement, and leisure 55. Workforce preparation
among respondents' top five priority topics. However, although the priority ranking for "living v^^ith disability and chronic conditions" was very high, only 11.9% of respondents selected this topic among their top five. Indeed, respondents could rate a topic important but not select it among the five most important. These two types of strategies for assessing the importance of research topics, both represented in the Delphi literature, yield valid but somewhat discordantfindings.We present both in Table 1 but rely on the priority ratings for further assessment and reduction of topics for a final set of priorities. Table 2 depicts the 40 topics rated by panelists in round 3. Topics are grouped by substantive area, and consensus and priority levels are presented for each topic. Given our goal of producing a refined set of research priorities, we needed to further reduce the list of topics from round 3 of the practitioner panel, all of which attained a high or moderately high priority rating.Therefore, we chose only topics that
4.8 2.4 7.1 7.1 9.5 0.0 4.8
1.90
Summary of Priority Ratings (1 = highest to 5 = iowest) Interquartile Udn SD Range
1.98 2.24 2.12
0.81 0.82 0.94
2.00
2.00-3.00
2.00
1.00-3.00
2.15 2.31
0.98 0.84
3.17
0.79 0.97 0.99 1.02
2.00 2.00 3.00
1.00-3.00 2.00-3.00 3.00-4.00
3.00 2.50
2.00-3.00 2.00-3.00 2.00-3.00
1.01 1.01
3.00 3.00 2.00 3.00 3.00
1.38
3.00
2.93 2.50 2.57 2.57 2.33 2.64 3.17 3.12
0.74 1.10
1.00-3.00
2.00-3.00 1.00-^3.00
2.00-3.00 3.00-4.00 2.00-4.00
achieved a high priority rating and then refined the list further by excluding topics that achieved only low consensus. This decision-making strategy yielded a final list of 16 topics. (Figure 1 presents topics from the practitioner panel that achieved moderately high or high consensus and high priority along with the similarly derived topics from the researcher panel.) To facilitate comparisons of the academic researcher and practitioner panels, we listed equivalent topics on the same line.The researcher panel's priority "developing and testing ethnic-sensitive assessment and interventions" is listed, for example, alongside the practitioner's topic on ethnic-sensitive interventions. In other instances, topics may not be identical but can be conceptualized under the same broad rubric. For example, although the practitioners' priority "outreach and service planning/delivery for underserved elders" lacks a precisely analogous priority on the researcher panel, it is subsumed under "Service Delivery" along with closely matched issues from the researcher panel.
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Table 2: Endorsements, Consensus, and Priority Ratings on 40 Research Issues in Round 3 Consensus Priority Rating Rating Issue Service delivery 1. Access and barriers to service use 2. Service integration 3. Outreach and service planning/delivery for underserved elderly people 4. Service needs of baby boom generation 5. Services to maximize ^ing in place 6. Discharge planning Family 7. Family interventions 8. Family caregiving (including grandparents and caring for individuals with developmental disabilities 9. Intergenerational issues Health 10. Health promotion and disease prevention 11. Living with disability and chronic illness: Quality of life 12. Medication use and management 13. Pain management Housing and living arrangements 14. Transitions in living environments 15. Housing options Policy 16. Health policy 17. Long-term care policy 18. Income security Mencal health 19. Substance abuse 20. Mental health: Detection and treatment 21. Depression assessment and treatment 22. Management of dementia Intervention research 23. Ethnic-sensitive interventions 24. Determining best practices and effective interventions (especially for subpopulations and specific conditions) Nursing homes 25. Nursing home improvement: Adjustment, aflfordability, and quality 26. Quality of life in long-term care Practice models 27. Interdisciplinary team practice 28. Consumer-directed services • 29. Case/care management models Discrete topics (not grouped with other topics) 30. Gerontology education in social work 31. Death, dying, bereavement: End-of-life issues 32. Planning for later life: Individuals and families 33. Normal and successful aging 34. Self-determination, decision making, and autonomy 35. Empowerment strategies (locus of control, assertiveness, and self-advocacy) 36. Transportation 37. Needs of older gay and lesbian populations 38. Spirituality 39. Uses of technology in serving older adults 40. Developing tools for assessment of values and preferences of older adults
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Low Low High High Low High
High High High Moderately high High Moderately high
High
High
High High
High Moderately high
Low Low High High
High High Moderately high Moderately high
High High
High Moderately high
Low Moderate High
High High High
High High High High
Moderately high High High High
Moderate
High
Low
High
Low Moderate
High High
Moderate High High
Moderately High Moderately High Moderately High
High Low Moderate High High High High High High High High
High High High High High High Moderately Moderately Moderately Moderately Moderately
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high high high high high
DECEMBER 2005
Figure 1: Comparison of Priorities of Researcher and Practitioner Panels Researcher Panel
Practitioner Panel
Intervention research i I I I
1. Developing and testing psychosociai interventions across populations and conditions 2. Developing and testing ethnic-setisitive assessment and interventions
3. Developing psychosociai outcome measutes i 4. Developing and testing psychosociai and ecological ; interventions for cognitive and mental disorders Housing and living arrangements
1. Family interventions 2. Ethnic..sensitive interventions
3. Management of dementia
5. Maximizing housing/living arrangement options for aging in place { 6. Transitions and adjustments across care settings and i environments Service delivery
4. Transitions in living environments
7. Coordination and integration of health, mental health, and social services systems 8. Utilization and barriers to health, mental health, and social services 9. Interface between informal and formal care 10. Service use by ethnic elderly people 5. Outreach and service planning/delivery for underserved elderly people Detection and assessment 11. Determining needs of ethnically diverse elderly people Family caregiving 12. Effective services to family caregivers i
13. Understanding specific caregiver population
6. Family caregiving, including grandparent caregiving and caregiving to developmentally disabled individuals
Health/mental health 14. Chronic illness, disability, and rehabilitation: quality of life and psychosociai well-being :
15. Detection, assessment, and treatment of late-life depression
7. Depression assessment and treatment 8. Mental health assessment and treatment
Workforce 1 16. Recruitment and education of professional workforce I for an aging population Social policy
9. Gerontology education in social work
10. Income security 11. Long-term care policy Capacity building 12. Self-determination, decision making, and autonomy 13. Empowerment strategies (locus of control, assertiveness, and self-advocacy) 14. Planning for later life: individuals and families 15. Normal and successful aging 16. Quality of life in long-term care Note: Shaded boxes are items that were found to be similar in both panels.
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Finally, the practitioners identified several unique topics, categorized as social policy and capacity building. There is considerable overlap in research priorities identified by the researcher and practitioner panels. Coincidentally, 16 topics from each panel achieved both highest or high priority and high or moderate consensus ratings. Nine topics (62%) were similar in content (or in the case of "outreach and service planning for underserved elders" classified in the same broad category).The researcher panel used broader conceptualizations that could easily accommodate the knowledge needs identified by practitioners. For example, researchers endorsed "developing and testing psychosocial and ecological interventions for cognitive and mental disorder," whereas practitioners endorsed "management of dementia." Likewise, we categorized "family interventions" on the practitioners' list with the researchers' topic "developing and testing psychosociai interventions across populations and conditions." DISCUSSION Others have described the pros and cons of Delphi techniques (Adler & Ziglio, 1996; Dietz, 1987; Woudenberg, 1991). Advantages include minimizing group pressure and equalizing opportunity for influence, two obvious pitfalls of group discussion. Also, panelists can be geographically distant from each other. Limitations, some of which are relevant to the present study, include the use of subjective judgments rather than objective data, lack of certainty about who qualifies as an expert, and less scientific rigor than other methods.Van Dijk (1990) argued that different techniques may yield different responses, and indeed, in the case of this study, a different group of practitioners could lead to different findings. This study has several other limitations. First, the expert practitioners were referred to us by the academic researchers in our Delphi study on research priorities (Burnette et al., 2003). It is difficult to know the extent to which the practitioners are representative, because they were not randomly selected. Furthermore, the practitioner and academic panels were not independent.The extent to which the participants from the two panels are colleagues and like-minded may render findings from the two panels more similar than if the panels had been independent. Finally, the expert practitioners from
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the Northeast and Midwest regions of the country were overrepresented, and the extent to which this uneven geographic dispersion affects the findings is not known. Comparison of Panels The overlapping topics represent consensus areas between gerontological social work researchers in academic settings and experts who are currently practicing in thefield.Consistent with the researcher panel, three practitioner topics relate to intervention research. Both groups endorse a need for more systematic development and testing of interventions. A recent review of social work research in gerontology published over the past five years revealed few effectiveness studies (Morrow-HoweU & Burnette, 2001), further highlighting the gap between social work contributions in the practice arena and research contributions to practice. The panels' consensus on the need for intervention research also fits within a wider call by the NIMH (1999) and movement within the profession toward practice guidelines and evidence-based practice modalities (Rosen & Proctor, 2003). The two panels also agreed about the need for research on workforce issues in an aging society. The researcher panel called for knowledge development in the recruitment and retention of professionals more generally; practitioners focused on social work. Indeed, practitioners identified gerontology social work education as the top research priority. This priority reflects a long-standing and increasingly urgent concern that the social work profession is not educating enough practitioners to meet the demands of rapidly changing demographics in our society (Hudson, Gonyea, & Curley, 2003). Practitioner panelists are also likely to experience the lack of trained colleagues more directly in their agencies and communities. The practitioner panel suggests that this workforce crisis be addressed through research. Studies have explored related issues, including gerontological interest in professional organizations and student bodies, the social work labor market in aging-related jobs, and the number of schools that offer an aging specialization (Gibelman & Schervish, 1997; Rosen & Zlotnik, 2001). Demonstration projects that assess training curriculums are also underway (Scharlach et al., 2000). These research efforts have heightened attention to gerontological social work education, and the profession is now
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benefiting from developmental efforts by several foundations (see Hudson et al., 2003 for a brief overview of these efforts). However, demonstrable outcomes on the social work workforce are yet to be realized, and the practitioner panel suggests ongoing need to answer questions such as: What strategies are effective in recruiting and retaining social workers in gerontology? What course and fieldwork experiences and continuing education opportunities are most effective? What entry-level and advanced career opportunities exist?What reimbursement policies best support gerontological social work services? What practice boundaries between geriatric social work and other health care professions are firm and which are mutable (Hudson et al., 2003)? Both panels also ranked family caregiving as a top priority. Although most research published by gerontological social workers addresses family caregiving (Morrow-HoweU & Burnette, 2001), neither panel suggested confidence that knowledge needs concerning caregiving are satisfied.This finding may reflect a gap between the production of knowledge on caregiving and its dissemination and use in the field; or it may signify a concern that research is not addressing practice-relevant questions. Both panels called for general intervention research on caregivers as well as studies targeted toward subgroups of caregivers, notably grandparent caregivers and caregivers for people with developmental disabilities. In identifying mental health as a research priority, both panels echoed warnings of an impending crisis in geriatric mental health.Jeste and colleagues (1999) cautioned that the United States faces "an unprecedented explosion" of older adults with disabling mental disorders, with the number of elderly people with significant mental disorders expected to nearly quadruple between 1970 and 2030. The surgeon general has declared the health care needs of the elderly population a national priority (U.S. Department of Health and Human Services, 1999), and an expert consensus group has recommended a 15- to 25-year plan for research on mental disorders of elderly people Qeste et al., 1999). Social workers practice with a disproportionate number of older adults with mental disorders in settings such as hospitals, home health agencies, day care centers, and nursing homes (Alexopoulos, Katz, Reynolds & Ross, 2001; Bruce et al., 2002; Morrow-HoweU et al., 2002).They are also often the
primary care providers for older adults whose living arrangements and family dynamics are strained by mental disorder. Social workers can certainly make important contributions to the development and implementation of knowledge on mental health and aging. Both researchers and practitioners identified transitions in living arrangements as a high priority for knowledge development.This topic is particularly germane for the many social workers who practice at the intersections of community and residential care, acute and long-term care, and formal and informal care. Social workers play a key role in the admission and discharge of older adults from nursing homes, residential facilities, and day care centers and are responsible for discharge planning in hospitals and psychiatric facilities. They also help older people and their families obtain home care and initiate new routines. Indeed, social workers are proficient in managing the chaUenges of making the transition between and adjusting to different environments. Given that this transitional phase of care often shapes experience and outcomes in the service setting, research is needed to improve knowledge about this function. There are also several notable differences between priorities identified by the two panels.The researchers endorsed the need for intervention research and for research on the service delivery system with greater specificity and breadth. Indeed, they identified four topics related to service delivery, whereas the practitioner panel identified only one related but distinct topic—"outreach and service planning/ dehvery for underserved populations." Perhaps academic researchers are more attuned to larger service delivery issues, such as access and integration, because of greater familiarity with a burgeoning multidisciplinary literature on these topics; whereas practitioners have a more immediate perspective geared toward identifying and meeting the service needs of older adults. Given that outreach, multidimensional assessment, and access and delivery of services to vulnerable elderly people is a haUmark of gerontological social work, social work researchers should lead efforts to formulate key research questions, design studies to address these questions, and disseminate practice-relevantfindingsto people in the service delivery system. The practitioner panel endoned seven unique topics.Two topics, income security and long-term care policy, are classified as social policy research.
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Gerontological social work researchers raise policy implications in their studies but have yet to assume a leadership role in documenting or analyzing the effects of policies (Morrow-Howell & Burnette, 2001). Perhaps social work researchers are not as well versed in policy research, or perhaps they view aging policy analysis as the responsibility of other disciplines. But, practitioners routinely experience the impact of policies on the daily lives of older adults and their families, and they more clearly express the need to advance policy research. Indeed, social workers should bring firsthand knowledge to the formulation and evaluation of social and health policy (Fahey, 1996). Researchers should respond to this challenge with rigorous investigations of all aspects of public policy and should bring this knowledge to public debates through timely and creative methods of dissemination. The practitioner panel also identified three topics related to gerontological social work processes, which we categorized as capacity building: selfdetermination, decision making, and autonomy; empowerment strategies; and planning for later life with individuals and families. Academic researchers may not conceptualize these processes as standard research topics; yet, these topics are central to the daily work of practitioners and to the profession's code of ethics. The concept of capacity building in social work is under development (McMillen, Morris, & Sherraden, 2002; Morris, Sherraden, & McMillen, 2002). From this perspective, social workers enter into partnerships with individuals, families, and communities to increase their capacities to reach their goals. Capacity building principles include recognition of current and potential capabilities of clients; importance of articulating desired outcomes; development of client's knowledge, skills, and resources to pursue these outcomes; and creation of conditions that allow people to fulfill their capabilities. Clearly, the development of decision-making abilities and planning for future eventualities fit with these capacity-building principles. The practitioner panel also endorsed quality of life in long-term care as a priority topic. It was surprising that the researchers did not endorse this topic as strongly: It was on their final list of high priority topics but did not achieve sufficient consensus. Practitioners identified normal and successful aging as a high-priority topic. Because a primary function of social work researchers is to
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formulate and investigate researchable questions on social problems, it is not surprising that they did not see normative processes of aging as a priority. Practitioners, on the other hand, may have more opportunities to interact with highly functioning older adults and, in community settings, to witness and participate in their decline over time. They also may sense that greater emphasis on productive aging would help dispel some of the myths, stereotypes, and stigma associated with the aging process. Finally, we note a few general patterns in data from the two panels. First, the practitioners identified more topics than the researchers (235 original responses reduced to 55 topics compared with 181 reduced to 49 topics).The practitioners are likely to bring more diverse perspectives to a panel because they practice in a variety of settings, whereas all academic researchers were in university-based social work programs. Second, practitioners tended to assign higher, less variable ratings. In part, this may be because they regard their priorities as more urgent in their daily work. And researchers are also trained to be more sensitive to variation in measures. CONCLUSION AND FUTURE DIRECTIONS
As in most stakeholder research, we conclude that researchers and practitioners express both convergent and divergent perspectives on knowledge needs for gerontological social work—and that both perspectives are valid.The next step in developing a unified research agenda is to combine both sets of priorities. We suggest that four broad substantive areas appear in both panels: housing and transitions in living arrangements; family caregiving; health and mental health; and workforce for an aging society.These are key areas for a social work research agenda and interdisciplinary agendas, such as those posed by the NIA and the NRC. Furthermore, there are four crosscutting themes that derive from the panels: intervention research, social policy, service delivery, and capacity building. Approaching the study of substantive areas with research questions that address these themes brings the unique perspective of social work to the forefront. Many disciplines conduct research on housing and living arrangements, for example, but social workers bring unique expertise on interventions, policy, service delivery, and capacity building to this
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topic. They migbt implement psychosocial interventions to ease the transition to a new living arrangement or to enhance adjustment to a residential setting. Such interventions are not yet well developed, rigorously tested, or widely documented. However, social work researchers should lead efforts to develop knowledge on these aspects of housing and living arrangements. Social workers are also knowledgeable about how social policies shape access to different types of housing and living arrangements.They are familiar with the fragmentation that characterizes service delivery in housing complexes and naturally occurring retirement communities and with barriers to service use within a geographic area. Finally, social workers routinely engage older adults and families in capacity building as they seek to maximize autonomous decision-making and planning processes regarding living arrangements. Social workers bring specialized practice and policy experience and unique research perspectives to the substantive topic of housing and living arrangements.
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Brown School of Social Work, Washington University, Gampus Box 1196, St. Louis, MO 63130; e-mail:
[email protected]. Denise Burnette, PhD, ACSVf^is associate dean, School of Social Work, Golumbia University, NewYork. Li-Mei Chen, PhD, MSWf is assistant professor, George Warren Brown School of Social Work, Washington University, St. Louis. This study was funded by the John A. Hartford Foundation, Geriatric Social Work Faculty Scholars Program. Findings from this study were presented at the Society for Social Work and Research annual conference, January 2003, Washington, DG.
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Original manuscript received December 1, 2003 Finai revision received July 23, 2004 Accepted January 7, 2005
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