MI-LEND Video Resource: Interprofessional Teams (Week 8)

Summary

This session, led by Abby Johnson and Jenny Mendes, focused on the importance of interprofessional teams in healthcare. The discussion started with definitions of multidisciplinary, interdisciplinary, and interprofessional practices, emphasizing collaborative care as defined by the World Health Organization. Through a team-based exercise, participants explored the roles within interprofessional teams and addressed a fictional case study, highlighting the benefits and challenges of such collaborative efforts in improving healthcare outcomes and patient satisfaction.

Highlights

• Abby Johnson and Jenny Mendes led the discussion on interprofessional teams in healthcare. 🎤
• The session emphasized the World Health Organization's definition of collaborative care. 🌎
• A fictional case study provided practical insights into team dynamics and problem-solving. 💡
• Participants explored various professional roles and their contributions to patient care. 🏥
• The session concluded with a focus on clear communication and role understanding. 🗣

Key Takeaways

• Interprofessional teams improve healthcare outcomes by combining diverse expertise. 🤝
• Collaborative practice reduces medical errors and enhances patient safety. 🔍
• Understanding roles and respecting limits are crucial for teamwork. 🧩
• Effective communication among team members is key to success. 📢
• Teaching interprofessional skills early is essential for future healthcare providers. 📚

Overview

This insightful session, orchestrated by Abby Johnson and Jenny Mendes, introduced the crucial concept of interprofessional teams in healthcare, shedding light on multidisciplinary, interdisciplinary, and interprofessional practices. As defined by the World Health Organization, collaborative practice involves the coordinated efforts of healthcare professionals from diverse backgrounds, working together to improve patient care and outcomes.

During the session, participants engaged in a detailed examination of a fictional case study involving a young patient named Janie. Through role-playing, team members assumed the roles of various healthcare professionals, learning firsthand the challenges and rewards of working within an interprofessional team. This hands-on exercise demonstrated the importance of effective communication, understanding of roles, and the integration of diverse expertise in healthcare settings.

Concluding the session, the facilitators highlighted the key competencies required for successful interprofessional practice: clear communication, understanding of professional roles and responsibilities, and ethical collaboration. Emphasizing the need for early education in interprofessional skills, the session underscored the value of teamwork in reducing medical errors and enhancing the overall safety and quality of patient care.

Chapters

• 00:00 - 00:30: Introduction and Speaker Introduction The chapter introduces the speakers, Abby Johnson and Jenny Mendes. Abby Johnson is an assistant professor in physical medicine and rehabilitation at the University of Michigan and serves as a rehab psychologist and neuropsychologist. Jenny Mendes is an assistant professor at Wayne State University School of Medicine, where she directs community engagement programs.
• 00:30 - 01:00: Seminar Focus and Structure Overview This chapter introduces the unique focus and structure of today's seminar. It begins with an orientation on key definitions related to multi-disciplinary, interdisciplinary, and interprofessional practices. Following the definitions, the seminar will address a case that participants were sent prior to the meeting, culminating in presentations from the attendees.
• 01:00 - 01:30: Definitions and Concepts Introduction The chapter titled 'Definitions and Concepts Introduction' focuses on setting up a productive discussion around certain topics. Jenny is tasked with providing additional information about the structure as they proceed. The chapter encourages immersive discussion, with the main goal being to explore the case and the reactions to it. There is a possibility of additional information being shared via a PowerPoint presentation if time permits.
• 01:30 - 02:00: Interprofessional Collaborative Practice and Team-Based Care The concept of Interprofessional Collaborative Practice (IPC) defined by the World Health Organization involves multiple health workers from different professional backgrounds collaboratively providing care to patients, their families, caregivers, and communities. This practice is considered crucial for delivering the highest quality of care.
• 02:00 - 02:30: Discussion on Interprofessionality and Its Importance The chapter titled 'Discussion on Interprofessionality and Its Importance' focuses on the concept of interprofessional collaborative practice as defined by the World Health Organization. It highlights the necessity of interprofessional team-based care, which involves small, intentionally created groups in healthcare that possess a collective identity and shared responsibility for patient care. The concept of identified teams is discussed, which can take various forms such as palliative care teams or primary care groups.
• 02:30 - 03:30: Experience Sharing: Interprofessional Care Example The chapter discusses the concept of interprofessionality within the context of healthcare. It highlights a significant paradigm shift in professional practice, emphasizing the importance of collaborative work starting from early training. The focus is on moving away from practicing as individual providers to working effectively as part of a care team, such as a rapid response team. This shift promotes better patient care through teamwork and shared expertise.
• 03:30 - 04:30: Inpatient Unit Challenges and Interprofessional Collaboration The chapter focuses on the challenges faced within inpatient units and highlights the importance of interprofessional collaboration to address these issues. A professional consensus group has been established to develop standards for interprofessional care and learning. It emphasizes the necessity to educate individuals at all educational phases on working within these teams, aiming to equip them with the skills essential for interprofessional practice upon entering their professions.
• 04:30 - 05:00: Optimal Healthcare Outcomes Through Teamwork The chapter titled 'Optimal Healthcare Outcomes Through Teamwork' begins with an introduction to the concept of interprofessional practice and experience, focusing on collaborative care in the medical field. It encourages participants to share their existing experiences in interprofessional collaborative care as a starting point for discussion. Dr. Mes and the medical school initiatives are mentioned as part of setting up interprofessional practices.
• 05:00 - 07:00: Virtual Team Discussion: Roles and Preparation The chapter titled 'Virtual Team Discussion: Roles and Preparation' focuses on the interprofessional team visit program where second-year medical students participate. During these visits, students work alongside various professionals, such as social work and occupational therapy students, to gain practical experience and insight into different roles within a healthcare team. The text alludes to a visit to an older person's home, suggesting a real-world application of skills and collaboration among different healthcare disciplines.
• 07:00 - 10:00: Virtual Team Discussion: Team A Case Discussion The chapter discusses a case discussion involving Team A, where each team member had distinct roles during a visit. The narrator performs an eye exam and nutritional assessment on an older person. Meanwhile, a social work student examines the individual's relationships and support systems. An occupational therapy student's role is also mentioned but not detailed.
• 10:00 - 15:00: Virtual Team Discussion: Team B and C Case Discussion The chapter titled 'Virtual Team Discussion: Team B and C Case Discussion' explores the analysis of a house environment with regards to its safety features. The focus is on determining whether the setting poses a fall risk, and various measures such as installing a railway or handle by the front door are considered. The discussion provides insights into the approaches taken by different professions in assessing and enhancing home safety, highlighting a collaborative effort towards creating safer living spaces.
• 15:00 - 18:00: Virtual Team Discussion: Developing a Treatment Plan The chapter discusses the case of an older adult who has never experienced interprofessional care, highlighting the lack of coordinated efforts among healthcare providers such as physicians, pharmacists, and social workers. The narrator reflects on how this absence of teamwork affects the management of the patient's care.
• 18:00 - 20:00: Team Communication and Family Involvement The chapter emphasizes the importance of team communication and family involvement in patient care. It highlights how interacting with other providers gives a comprehensive view of the patient's condition. The narrator notes that when working alone, there may be gaps in information due to not knowing which questions to ask. Learning from others' questionnaires and curiosity helps in obtaining a holistic understanding of the patient's needs and situation. This collaborative approach ensures that essential aspects of patient care are addressed thoroughly.
• 20:00 - 22:00: Virtual Team Discussion: Identifying Team Roles and Strategies The chapter titled 'Virtual Team Discussion: Identifying Team Roles and Strategies' discusses the importance of collaboration in providing optimal care. It emphasizes understanding the entire situation to improve diagnostic formulation. Within the context of a psychiatric inpatient unit, team members like case managers, psychologists, and educational specialists (especially for child patients) are highlighted as crucial collaborators. The discussion underscores the value of diverse team roles in enhancing the effectiveness of patient care strategies.
• 22:00 - 24:00: Insights and Reflections on Roles from Participants In this chapter, the participants discuss the interdisciplinary approach within the psychiatric unit. They elaborate on the roles of different professionals such as nurses and internal medicine physicians in team meetings. These meetings, which are crucial in addressing any medical concerns, involve collaboration between various specialists to ensure comprehensive care and accurate diagnosis for patients. This dialogue reflects on the importance of teamwork and the collective responsibility shared among healthcare professionals in providing effective psychiatric care.
• 24:00 - 26:00: Insights and Reflections: Mentor Input In this chapter "Insights and Reflections: Mentor Input", the discussion focuses on the decision-making process within a healthcare team working on a child inpatient unit. A fellow typically leads the team, which collaboratively discusses patient dispositions, shares concerns, and inputs from each member. They also address patient discharge plans and interactions with the patient's family.
• 26:00 - 28:00: Discussion on Interprofessional Team Challenges and Benefits Chapter Title: Discussion on Interprofessional Team Challenges and Benefits
• 28:00 - 32:00: Interprofessional Values and Ethics Discussion The chapter focuses on the interactions within a multi-disciplinary team led by a rehabilitation psychologist. The team meets weekly to discuss and address intertwined issues across different disciplines such as Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy. Behavioral issues are highlighted as potential barriers affecting assessments and treatments. Communication among providers is crucial for addressing these challenges.
• 32:00 - 36:00: Communication Competencies and Role Definitions The chapter discusses the significance of effective communication competencies and clear role definitions in healthcare settings. Emphasizing the barriers to efficient work, it highlights the importance of setting treatment goals and understanding the patient's psychological and behavioral disposition before and during inpatient care. The exchange of valuable input among healthcare providers leads to more efficient workflows and improved patient outcomes. Ramsey and Erica contribute insights into optimizing provider cooperation for the patients' benefit.
• 36:00 - 39:00: Interprofessional Practice Core Competencies and Strategies The chapter discusses the significance of interprofessional practice core competencies in achieving optimal health care outcomes. It emphasizes that incorporating a diverse team of professionals leads to a more comprehensive understanding of patient conditions. By integrating insights from multiple specialists, such as acknowledging behavioral problems that may impact other disciplines like occupational therapy, healthcare providers can offer more complete and effective care solutions.
• 39:00 - 41:00: Case Demonstration and Teamwork Principles This chapter focuses on the interplay between psychological interventions and occupational therapy (OT) in clinical settings. The discussion highlights how psychological insights can enhance the observations made by occupational therapists, and vice versa, leading to better healthcare outcomes. The chapter also introduces the concept of virtual team collaboration to illustrate these principles.
• 41:00 - 43:00: Conclusion and Participant Reflections The chapter covers the conclusion and participant reflections on a treatment planning exercise for Jennie. Each team member is required to ask questions to the parents from a perspective different from their own discipline. Nine trainees participate, each assigned a role from a discipline they are unfamiliar with, to foster diverse perspectives and learning.
• 43:00 - 45:00: Closing Remarks and Acknowledgements The chapter 'Closing Remarks and Acknowledgements' starts by highlighting the efforts of team members who adapted to unfamiliar roles, emphasizing their research and preparation. It mentions the established ground rules for role-playing, such as maintaining character authenticity, regardless of the person's actual profession. This ensures that participants stay committed to their assigned roles, such as a social worker playing a physician, for the duration of the exercise.

MI-LEND Video Resource: Interprofessional Teams (Week 8) Transcription

• 00:00 - 00:30 hi this is Abby Johnson I am an assistant professor in physical medicine and rehabilitation at University of Michigan and I am a rehab psychologist neuros psychologist I'm Jenny Mendes and I'm from Wayne State University School of Medicine I'm an assistant professor there and I direct our community engagement programs
• 00:30 - 01:00 so I know Kay give you gave you all a heads up that today is going to run a little bit differently I'm going to start today by just orienting you to some of the definitions we use the focus of today's uh module and today's seminar is really multi-disciplinary practice interdisciplinary practice and interprofessional teams so we're going to start by doing some definitions and then we're going to talk about the case that you were all sent um and we will have you we will have you present your
• 01:00 - 01:30 information and Jenny is going to give you a little bit more information about the structure of that as we move forward uh our focus is really having you a productive discussion around these things so if that takes the whole time great uh we'll like that uh and we'll discuss both the case and also some reactions to the case today and if we have time we do have a little bit more information for you that will come across in the PowerPoint and if we have time today we'll touch on it
• 01:30 - 02:00 so the World Health Organization has defined interprofessional collaborative practice and you'll see the acronym IPC in some of our documentation and and certainly throughout the Lend curriculum what IPC is is when multiple health workers from different professional backgrounds are all working together for patients families caregivers and the communities that they live in and this really is felt to be the the way to deliver the highest quality of care um so that was defined
• 02:00 - 02:30 by the World Health Organization in order to do interprofessional collaborative practice we need to have interprofessional team-based care and so their definition of team-based care is care delivered by an intentionally created usually small work group in healthcare who are recognized by others and by themselves as having a collective identity and shared responsibility for a patient group so this is an identified team and it can take many forms things like a paliative care team a primary
• 02:30 - 03:00 care team or a ra rapid response team another concept came out of some of this discussion that's called interprofessionality and the idea here I've have I have the long definition up there which I won't read to you but the main key idea is that this is a paradigm shift in professional practice at as early as you start training it's important to recognize that the days of practicing as a loan provider
• 03:00 - 03:30 uh are long gone and so the mission and there's been a professional consensus group working together to De develop uh a standard of practice for interprofessional care and interprofessional learning because what's necessary is to teach people at All Phases of their education how to work in these teams how to build these skills so that they're ready for this interprofessional practice when they enter practice so we wanted to get
• 03:30 - 04:00 a sense from you about what kinds of interprofessional practice and interprofessional experience you've already had even as mentees so this is an opportunity for folks to raise their hand and share with us some experiences that you're already coming into this uh discussion with in terms of interprofessional collaborative care um hi everyone um so at uh the medical school uh Dr mes set up a
• 04:00 - 04:30 program um the interprofessional team visit program and um all second year medical students participate so I had my visit and we went to an old um an older person's home and um we did it with various professions so I did my visit with a social work student and then um also an occupational therapy student M uh can you give an example of what you did as part of your WI visit and what
• 04:30 - 05:00 your team members did yeah um so my part of the visit um I gave the older person an eye exam and then went through various aspects of um Eye Health and um I also did a nutritional assessment and then um the social work student looked at um their relationships and um their support systems that they have and then the occupational therapy student looked at
• 05:00 - 05:30 um various um aspects of their house um analyzing if it was a safe environment if there were indications um to prevent if they were at a fall risk um so things like you know having a railway or a handle um by their front door um so it was really interesting to get to see what those professions would do and um yeah it was very interesting because my
• 05:30 - 06:00 older adult um had never had um any interprofessional care um so I thought that was very interesting that she had never really had um you know her physician her pharmacist her social worker anything like that work together um to benefit her care and as a provider what was how did that does it feel different in terms of your management of
• 06:00 - 06:30 your patient with those other providers there I thought that it was more efficient and I got to see more of a whole picture um I think if um it was just me I feel like there's gaps that maybe you don't think to ask about certain questions um so I think learning from you know their questionnaires and things that they wanted to know I I just got to see more of a whole picture so I
• 06:30 - 07:00 feel like you'd better be able to provide the best care to really know the whole situation absolutely it sounds like you had more information to use in your diagnostic formulation thanks Molly other comments yeah um I guess the place that I think about using the most um collaboration with other individuals is when I'm an impatient unit in patient psychiatric unit of course we work with case managers um psychologist there's educational Specialists if it's a child
• 07:00 - 07:30 unit um the tech the nurses um Us in Psychiatry you know we we do I guess a variety of that on the adult Unit A lot of times they will bring in um Internal Medicine Physicians and we'll have a team meeting that involves them uh at least initially if there's any medical concerns too which is helpful so you have in your team meeting are all the professionals there yes and are you making your diagnostic uh
• 07:30 - 08:00 decisions as a group or is somebody leading that team how that work yeah usually um as a fellow we're um kind of responsible for leading that team on the child impatient unit um so the whole group kind of sits around and um we start by kind of talking about what we feel like is going on and what our disposition is for the patient if we have any questions or concerns then everyone else can kind of put in their input sometimes we'll talk about discharge and those types of things too ER do you have family or the patient
• 08:00 - 08:30 involed um the patient and family aren't in those team meetings we have separate team meetings that um like a like during a a discharge time where the um social worker and the educational specialist and myself usually are present for like a discharge meeting where we go through some of this stuff as a team thank you hi everybody um I just want to piggyback on Erica's comments I also work in an inpatient unit and work within a
• 08:30 - 09:00 multi-disciplinary team as a rehabilitation psychologist and we meet weekly and discuss cases that are in the unit um and the energy that's created and the issues that are discussed a lot of times are intertwined so for instance um there might be behavioral issues getting in the way of PT and OT uh assessment which is very important uh or even speech um so when you hear comments from other providers
• 09:00 - 09:30 and what's getting in the way of their work it helps you build treatment goals for your own work and then uh your own input about the psyche or the behavioral dispositions either prior to becoming an inpatient or during the inpatient could be very helpful in helping other providers do their work more efficiently and uh most importantly it leads to better benefit for the patient absolutely thanks Ramsey I think what you and Erica are both touching on
• 09:30 - 10:00 is this idea that's the third point on our slide here that really getting Optimal Health Care outcomes in a variety of different ways changes when you bring in the whole team when you're gathering information from multiple professionals you get a more complete conceptualization of what's going on of the patient and then just as the example you gave you know a behavioral problem that's affecting an assessment of a different specialty like a p ological problem that's affecting an occupational
• 10:00 - 10:30 therapy evaluation um you're getting good clinical information for your treatment of a patient as a psychologist by hearing from the OT their perception of what's happening at the same time using a psychological intervention is going to give the occupational therapist a much cleaner observation of what the patient's true capacity is and so it works both ways to improve optimal healthare outcomes okay well we're going to now take you into a virtual uh Team
• 10:30 - 11:00 discussion so we had developed um uh some treatment goals and a basic treatment plan for Jennie and a discussion will move around uh each team where they are going to ask their own team members and the parents' questions um each of the nine trainees were given a role to play which wasn't from their own discipline we selected disciplines for the that they're probably not too
• 11:00 - 11:30 familiar with so they had to spend a little time researching what questions that team member would have asked if um that team member was part of this we have a couple ground rules that um we asked them and that was they should not get out of character they would stay in the character uh example if the person was given the role of a physician but is really a social worker the person was playing the role of a pH physician stays
• 11:30 - 12:00 in the role of a physician they need to be respectful in their communication so if there's a disagreement um go through the process of asking more questions in order to come up with a consensus of the whole team each team has been told that they have approximately 3 minutes to discuss their questions with their team or to be asking us uh others on this um webinar questions our um focus areas
• 12:00 - 12:30 for them to think about was the impact of conducting an assessment as part of a team and what does that have um the impact on the team the patient and other members of the team or the family additionally they had to identify factors that determin successful funding um functioning of a team example uh disagreement questioning um when and
• 12:30 - 13:00 where things would happen so Ramsey and Erica both mentioned that many of you have experience in treatment teams what we're asking you to do is this is a treatment team for our fish fictional patient some of you have had interactions in your small groups already none of you have had a chance to discuss Genie's case as a whole group yet and so today we want you to work together to
• 13:00 - 13:30 identify three main treatment recommendations as a team for Janie and make a plan for how you're going to discuss this with her family and then also identify what are the three main questions or clarifications that you're seeking from the family in order to help further guide your treatment with her so in your roles or as a group we're going to open this up for presentation and discussion and we're going to give you
• 13:30 - 14:00 um a good chunk of time here so it's okay if it takes a majority of the time uh but we'll have you move forward and and come to a consensus on these key things I'm going to read out the uh the case uh the trines have seen this but fathers on this uh webinar Jenny is a 10-year-old with diagnosis of a ASD and intellectual disability goes to her doctor for concerns of stomach ache and wave complaints of illness she has a history of seizures
• 14:00 - 14:30 that has been difficult to control but stable for the past six month she goes to school with the assistance of an aid because of her risk of seizures and her difficulty with communication so um whoever was the psychologist speech pathologist here would you start us off and if you weren't maybe the next one was the medical student and then we have a psychologist on this one and actually
• 14:30 - 15:00 if you wouldn't mind just when you start talking identify what your role is just so that everybody's clear okay I just have a quick question I'm not sure are we just asking the questions that we prepared for the PowerPoint slide or yes yep these are what we have posted here are the ones that you prepared and I I think if you have other questions that you would ask of the team or that you would use in this team meeting that's allowed as well but these are your these are the starter
• 15:00 - 15:30 questions that we asked you to think about okay so I'll start since I'm at the top of the PowerPoint I'm Ali and I was the speech pathologist um so a question that I would want um to ask the parent I can also read you my uh just two sentences that I was given in additional to the case is that uh Jamie works with the Speech Pathology just to improve her
• 15:30 - 16:00 articulation and control her voice and that the mom has expressed concerns about swallowing and her picky eating habits um so a question I would have for her mom um is to ask what are her goals for Jeanie's articulation and communication um I think I need to understand her goals before um coming up with a specific plan and then my questions to my team members was besides the diagnosis of ASC and intellectual
• 16:00 - 16:30 disability um if there was any other pertinent medical history that I should be aware of okay and then uh I am Alyssa and I was assigned the medical student role and uh based on the variety of issues uh for the stomach as well as seizure um I had the question for the parent um would you describe what Janie's diet currently look looks like throughout a typical day and whether any
• 16:30 - 17:00 of particular Foods seem to preed the stomach issues that she reports and then for the team um I would ask what type of testing has been completed by the spe the speech pathologist as well as others including the psychologist to determine Jan's um level and forms of communication in her school Home and Community settings soal as a speech pathologist can you respond back to
• 17:00 - 17:30 Alysa um yeah so I looked into uh certain areas of testing um so um things that I would do um would would be to look at the development um and how these symptoms progressed and also look at the strength and movement of the muscles involved with swallowing I'd also want to do like observe a
• 17:30 - 18:00 feeding uh to see Janie's posture behavior and oral movements during eating and drinking and um additionally I'd want to know if she was really picky or if there was some underlying cause um such as why she couldn't eat salads or liquids um and special tests that I might be that might have been performed is a modified barium swallow um which is where the child would eat or drink food or liquid with theum in it um and then the
• 18:00 - 18:30 swallowing process would be viewed on an X-ray um or use an endoscopy assessment um which is a lighted scope inserted through the nose and then observe the child swallowing um on a screen great um Alissa uh you were the medical student and uh Molly as a speech pathologist has asked what are the other pertinent medical history that she should be aware of so what did you
• 18:30 - 19:00 determine well I felt that the information we were given was pretty limited so I guess I could just say what information I would have looked into um so I definitely look into the nutritional and diet components of the medical history as well as her seizure history um and if it hadn't been completed before I would have um a neurological evaluation um including an EEG to see if we uh see patterns and um
• 19:00 - 19:30 where we can go from there but like I said it's kind of limited to what medical history I was given uh we are asking Alyssa and Molly to take the role of one of them take the role of the psychologist and speak on behalf of the questions related to parents and the other the questions related to the team okay I can start with the parent question for the psychologist so she stated I understand that Janie has had some trouble with bullying at school do
• 19:30 - 20:00 you feel as though there are any specific actions that her peers seem to use to intentionally trigger an aversive reaction from JY are there any or excuse me are there specific learning situations that increase these behaviors from other students and how does Janie react to the bullying from her classmates and then uh the psychologist question to the team is my understanding is that Janie has a long history of difficulty with explaining her feelings
• 20:00 - 20:30 I understand that Janie is currently receiving ABA therapy at this time are any of her therapy goals focused on increasing emotional awareness and communication and I guess uh my response as the speech pathologist to that um would be based on whatever the mom's goals with um the articulation um I would want to pinpoint areas to work on
• 20:30 - 21:00 um her articulation and communication um with jie um such as expressive language skills receptive language skills uh Speech fluency or stuttering um social or pragmatic language um cognitive communication skills um and also education and empowerment of je Jie's mom to the help
• 21:00 - 21:30 her and I think I would just add briefly to that that I'd make sure that um there are no medical barriers to completing um any of the communication or therapy goals excellent so you are both correct there's a lot that's not known and yet you have some some nice working hypotheses and treatment goals anything else that you would add in your
• 21:30 - 22:00 team uh for the treatment team for the rest of the treatment team you mean other uh disciplines uh well before we move to some of the other disciplines that are going to talk right is there any I guess other comments that you would make in terms of your conceptualization for Jamie or other questions for team members I think you covered a lot yeah I
• 22:00 - 22:30 Mo long okay so Team B is going to be up next um and we'll let you guys approach it how however you feel most comfortable um on Team B we have a physician a teacher and a rehabilitation engineer Michael what role did you have uh I was given the role of uh Rehabilitation engineer I had no idea PRI to this what this was but um my question to uh Jan's
• 22:30 - 23:00 parents were what kind of uh assistive Technologies uh have they used with Janie in the past other than what she's currently using which is an iPad and what kinds of issues or successes did she have with those other kinds of assisted Technologies uh and then my question to the team members was uh how are Jan's current motor skills both uh gross motor
• 23:00 - 23:30 and fine motor and what background were you given as the rehab engineer uh what I was told one second I was told that her speech intellig intelligibility is low and she uses her iPad to help her communicate and Erica what role did you play I played the role of the teacher um so my question to jam parents were um was about um whether or not her
• 23:30 - 24:00 experiences at home were similar to the difficulties that she was experiencing at school so whether or not there was something in the school specifically um that could be kind of creating some of these challenges for her um that we we maybe need to work on um and then my question to the team members were um Can what accommodations or alterations can could we come up with that could potentially help her to become more more successful at
• 24:00 - 24:30 school great you're we have one person who's missing is anybody able to report for that person from your team I had a little bit of discussion so I can um kind of talk about her questions to the parents and then um maybe you can talk about her questions to the team members uh I know that um she had talked about um the question to the parents is um kind of indicating maybe how frequently she's having bowel movements has she had problems with
• 24:30 - 25:00 constipation in the past um to see if her abdominal pain maybe had something to do with that and exploring that a little bit more and then the question that she had for uh the team members was does Janie complain of belly pain during activities that she dislikes participating in um I think the reasoning behind it was perhaps she is trying to get out of doing work that she doesn't like to
• 25:00 - 25:30 do interesting so before we move forward I guess I want to pause and say is anything do you have anything to report to our previous team a um based on some of the things that you've heard from them a report to them like about our kind of
• 25:30 - 26:00 information yeah in well I guess I'm looking at you know you've heard from a speech pathologist and a psychologist I think you just brought a really good point up about potential avoidance of activity um so another another thing I'll throw to the group for discussion is team a do either of you want to raise your hands do you have a comment based on any of the information that you've heard from Team B
• 26:00 - 26:30 and I guess I'm not sure if my kind of information as the teacher I was given additional information that the school team had concerns of ADHD poor concentration frequently off task um behaviors P your eye contact not following directions and ignoring others so I think that's where some of this stuff came from um with you know is there something else going on and I think with a little bit of the other um additional pieces of information too that we were maybe queued into maybe
• 26:30 - 27:00 there's some avoidance or some you know dislike with the bullying and things too so maybe that's where the psychologist could come in too good point to team C okay um I can go ahead and start I was assigned the role of audiologist um and my question to team members would be how does Janie communicate her wants in needs at home and in the classroom and has she tried
• 27:00 - 27:30 other forms of communication um such as PEC um it's kind of what I want to ask both um the parents and the team members because um the additional information I was given was that Janie has poor attention in the classroom and poor performance on a hearing evaluation mom has frustration at home related to Janie not following directions not orienting to her name and ignoring others so I kind of just want to get a feel on how um she's
• 27:30 - 28:00 communicating her wants and needs and that might um go ahead and tell me how I can help test her or how I can help um figure out her listening needs Ramsey I can yeah um so the additional information that I got was as a patient care attendant I spent a lot of time with I help her with physical navigation
• 28:00 - 28:30 riding the bus um give her scheduled medications and my goal with her is just to promote more Independence and just to be there as an aid uh from my experience he is very social uh she likes to socialize and talk more than engage in school workor um she can be somewhat combative and avoidant when engaging in activities that are not inherently uh uh stimulating for her um and she
• 28:30 - 29:00 tends to have difficulties with reading social cues and uh the pragmatics of social situations so as a patient care attendant um I wanted to ask the parent um what have they found helpful at home when redirecting Janie to tests that are not enjoyable for her um to kind of help me uh use some of those uh Str stry and for the team I wanted their Collective
• 29:00 - 29:30 input in helping develop a behavioral or intervention plan that can promote greater collaboration and consistency uh between School staff and um her parents because J does respond well to structure and consistency and when things are change that's when sometimes I see her excellent is anybody able to report for Zara as the social worker today from
• 29:30 - 30:00 teamc oh yeah I could read her questions for you um she wants to know um if she's asked about a possible FM system uh for hearing support because that can help with attentiveness um and that I'm not sure that question that uh for the parents was the one that she provided for me so I'm going to pull up um the previous slide and see if that's different
• 30:00 - 30:30 okay thanks for that Ramsey meanwhile while she's doing that what are some of your comments to the other team a and Team B um I think uh we're hitting on a theme that communication could be a source of difficulty for her so if we try to when thinking about possible treatment goals um what additional strategy these can we use to promote better communication or
• 30:30 - 31:00 develop better communication skills for Jamie um if uh since she's using the iPad as a primary source of improving communication and she's still having these issues are there other uh strategies that we can Implement to um have her communicate her needs effectively okay Hannah do you have the other section um yeah Zara also wanted to ask
• 31:00 - 31:30 um what resources are available um in the elementary school for children with autism and intellectual disability um again playing off that theme of what other what else can we do to help her communicate her wants and needs excellent any comments that you guys would share or Hannah Ramsey just said some but Hannah anything that you would add for for team a or Team B since you've heard the report at this point um
• 31:30 - 32:00 just going back to that speech pathologist or and um the rehabilitation engineer is how successful is she with that the iPad system and um could we use it in a more productive way excellent thank you guys this these were wonderful team reports now this is do A and B have any questions for C uh I would just add that uh with iPad I
• 32:00 - 32:30 believe reading that she didn't use the device across her settings so those skills are usually not going to generalize without teaching um I know this isn't my role directly as medical student but as someone who has worked with children on communication deficits um that would be something I would be worried about that you know if we're only using the device at school um that might be why we're seeing a lot of troubles in other settings thank you I'm just going to interject
• 32:30 - 33:00 and um please say your name when you start talking just so that we know who's speaking up and what role you're speaking about that's a really good point uh what I'm going to do is Advance the slide here be because what I want to do is open this up for a real discussion as a team you've all reported your questions to one another as a team and it's true that because you don't have Janie and her family here and because Jenny and I have not given you any answers yet um
• 33:00 - 33:30 there's more questions than there are answers so take let's take a few minutes here and prioritize as a team and come up with a strategy for how we'll build a treatment plan for Jamie knowing what we know right now and all six of you can uh speak but please let us know who's speaking this is Alyssa I'm just confused how we're developing a treatment plan if we don't have the all
• 33:30 - 34:00 the information I I don't know exactly what you're looking for if we can clarify that a little bit sure so I think what you have is incomplete information but everybody on the team has certain pieces that they've presented and certain pieces that they know and so what what we'd like you to try and figure out is what are the the three main things that you would do next as a treatment team and that can be asking questions but we've come up with any more than three questions here um
• 34:00 - 34:30 and then so the first point is what are your first recommendations that of things that you would want to do to answer some of your questions the second part is how are you going to communicate this to the family and then because there are a lot of open questions there's probably going to be some things that are not recommendations but are clarification questions for the family and so if we you know if Jenny and I were the family we're feeling pretty overwhelmed right now and we'd like you
• 34:30 - 35:00 to streamline it for us I think one of the main treatment things that I kept hearing as a theme is is communication ability for her to communicate and how we can um kind of help her in that area so I think that might be uh one of the main treatment goals is how we can come up with a a good or a better way for her to communicate if I can I I mean given that there is a scant
• 35:00 - 35:30 information uh but there's a lot of information that's spread out across the teams and one thing that has come up is that we are still trying to understand whether um some of the uh issues that she's facing with stomach aches and other medical issues that don't seem to be um medically documented and we're trying to understand what are those are behavioral um maybe uh another good goal to have is to do possibly more
• 35:30 - 36:00 evaluation to understand the context of uh her inconsistent Behavior across settings Mrs Molly um going off of that um as the speech pathologist I would want to also know what medications she was in um is I know some seizure medications have a stomach ache the stomach upset as a side effect
• 36:00 - 36:30 um so I don't know if it's Behavioral or if it's something else or if it's just a side effect of a medication so I guess finding the cause of the stomach problems about the teacher what are your concerns as did you say the teacher yes okay so I'm Eric I'm I am the teacher
• 36:30 - 37:00 and did you mean like my concerns with um her kind of behavior functioning right and what you communicate how would you communicate the family um so I mean I guess um kind of asking the question I mean and I did get a little bit more information just from the other um team members as to like the aid and things that her behavior at home seems to be quite difficult especially around um tasks and things related to things that she doesn't want to do so whether I mean I guess my recommendation
• 37:00 - 37:30 would be whether or not we can maybe Implement some type of reward system or you know whether or not I'm giving too much information or more complicated information than I should be giving for her level um or if there's you know other things that are are factors there that should be looked at more such as um if she has ADHD is you know should that be treated so Alissa as the psychologist what would you you respond back to uh
• 37:30 - 38:00 our teacher here good this is Alyssa did you say you wanted me to speak as Maddie for the psychologist role yes okay um I would my next step in this process um would be to actually observe uh Jamie in several different environments um after medical rule out was completed so the teacher just made a point about um whe what system she could
• 38:00 - 38:30 put into place and that would be determined by the function of her behavior so if she was doing these types of things to escape activities such as making stomach complaints um we would look at treating it based on Escape whereas if she was doing it to get the attention of her parents teachers or peers um we would have a different type of intervention so I would definitely need to do um a full functional Behavior assessment as my next step
• 38:30 - 39:00 okay any other comments from team members about the main treatment goals or the main steps um yeah I have a couple questions um as an audiologist I would just like to know if the core performance on her previous hearing evaluation um is due to behavior um during the appointment or if it's actually because she has a hearing lost um and that could then clarify what our
• 39:00 - 39:30 communication goals need to be um if we need to retest her to maybe see if it's she's not hearing anything instead of an attention um disorder excellent point so I I think the the main themes that you're hitting on as a team I'm just going to take a moment and summarize the key strategy that I think I'm hearing you report sounds like uh there's a need for more medical evaluation and that's to to try and
• 39:30 - 40:00 determine a few different things one being the possibility of seizure activity or medication side effects or her hearing loss versus um other causes of her behavior so a more comprehensive medical workup would be one of the first steps one of the second steps would be understanding what her true communication skills are and so that
• 40:00 - 40:30 would involve a much more comprehensive assessment of her speech and language abilities hearing and also working with a rehab engineer to optimize her uh communication devices but then there's this third goal of understanding her uh Behavior versus her ability and that that's interrupting in the class class room and making it hard to tell what's hearing what has she heard versus what
• 40:30 - 41:00 has she not attended to or not heard um as well as what is she avoiding in class because of lack of motivation or other uh behavioral issues as opposed to difficulty attending and communicating well and so I would sort of summarize that as basically three different arms of treatment one being medical one being focused on communication and the third being focus on identifying behavioral pieces am I hearing that
• 41:00 - 41:30 right yes yeah I think I would agree yeah so how are you going to communicate this to the family I think uh you know as we've talked in previous weeks um the first step is really to align with the family and to let them know that you're hearing their concerns and that there are multiple few members that are trying to up with a comprehensive approach to
• 41:30 - 42:00 meeting Janie's needs um and then we can discuss as we just reviewed these initial treatment goals and see um what their thoughts are on it and who's the Wii that we're talking about I think that's a that's an excellent point that we want to Ally with them and present to them so in team C Ramsey who would take the role here to communicate
• 42:00 - 42:30 this um it could be it could be uh either uh the psychologist or um the social worker or even um um yeah I think those I would say probably one of those two would be um yeah would be a good team to initiate the communication but emphas that it's
• 42:30 - 43:00 there's an entire team working together um yeah I would agree that it a social worker would be a good person to start out with because they might get a more comprehensive picture of everything that's going on with Janie um they might know where to start that's a good point any other team members that you think would be important
• 43:00 - 43:30 yeah I would think a physician as the primary person to see Janie um would be a good person to talk to them about it as well because they might have an understanding of Jan's overall needs so it SS like you've identified some some kind of natural team leaders to present some of the
• 43:30 - 44:00 overarching um How would how can some other team members help support this effort for example a rehab engineer you might not be the first person to talk to the family but how might you work towards these treatment goals with a family I think that that talking with the other professionals and and giving getting them uh get giving them good idea of of the things that I would say
• 44:00 - 44:30 to the parents if I'm not going to be the person directly talking to them um and making it making it so that the person who is talking to them understands what my concerns were and what kind of explanations I would have I guess sure if if a physician doesn't know about a certain assistive technology and I just were to say go
• 44:30 - 45:00 tell them to go that we should use this one the physician has no idea what I'm talking about perhaps I think it would be better if I took the time to explain why I'm picking that particular device and um what that device looks like and what it does so on and so forth so that the physician isn't kind of going in blind excellent point so even if the whole team can't be there there to communicate it's really important that there's streamlined communication going
• 45:00 - 45:30 into those conversations um I want to know what the aid would do here because the aid is spending so much time um during the day with jany so what would the aid be doing here to help the family and the teacher yeah I think as an aid um you know I'm uh you can say where the rubber meets the road and I see similar challenges that the parents see um and
• 45:30 - 46:00 what I can do is help facilitate uh communication as well um with just reporting what I'm seeing and given what the parents are seeing and trying to understand from the parents what they are learning from other providers of what the plan is and ultimately um I will just uh keep in touch to help uh create a a consistent plan of uh and
• 46:00 - 46:30 Implement some of the interventions that will come out absolutely so the kind of the last piece on here to try and address is what do you need from the family at this stage so we've laid out some basic arms of treatment and we've identified that the social worker the psychologist and the physician may be our leaders of communicating that but everyone has a role in supporting that uh what what do you need from the family
• 46:30 - 47:00 right now I this is Molly I think one thing that's very important is to understand um sort of their schedule um I don't know if Janie has a single mom or um if both parents work but possibly you know these uh office visits would have to take place you know after 5:00 pm if it's just Janie's mom um so I think
• 47:00 - 47:30 understanding their schedule um definitely plays a role into the treatment good any I think another thing that might be helpful is you know we all as a treatment team have our own kind of goals and what we feel are the issues and things that need to be worked on but really kind of figuring out what the family's goals and their priorities are uh because if they're not in line that's going to that's going to create problems
• 47:30 - 48:00 too absolutely I'm going to advance the slide here we've already been having this discussion I had some prompts up still well we at this point we would like to hear from other members on this uh webinar this is the point where we'd like the mentors to get involved hello this is Ed heritz hi so you know just listening through I I wanted to say that uh you know in my
• 48:00 - 48:30 experience it's it's always very important to understand I heard some of this coming out in the themes it's always very important to understand what uh medical problems might be contributing to uh behavioral and learning issues and then what behavioral problems might be presenting themselves as as medical problems so one thing I really enjoyed hearing was how the this interprofessional discussion and this kind of thing we try to do really really brings out this point um you know it's very easy to look at a patient I see a
• 48:30 - 49:00 lot of patients with chronic pain some of them have tethered cords and other reasons for actual pain and some of them have family situations that contributes to chronic pain uh and so there's always a real need to put everybody's head together and think about uh what's the best way to do this the other thing I want to say is uh you know again an interprofessional interprofessional approach you know there I I was hearing like it'll be up to the re engineer to try and think about what's the best
• 49:00 - 49:30 technology for this and those of us who you I know everybody here works with technology we know that really it's very much a team effort our our ADV communication Clinic it's Rehabilitation engineering uh OT and and speech language pathology and the physical therapist often gets involved as as I do so uh it it really it takes a team to uh to to do many of these things with the uh populations that we're talking about about here excellent point certainly
• 49:30 - 50:00 team roles blend when you get true interprofessional practice going so edit mentioned some possible medical underlying causes one that came up or one that we put out there on purpose is this idea of seizure medicine side effects for stomach aches versus a behavioral stomach ache complaints um what were some of the other kind of conflicting themes or did anybody else have working hypothesis of what they think might be going on for
• 50:00 - 50:30 Janie diagnostically there were a lot of questions about attention and ADHD can anybody did anybody identify other possible things that were uh that could present that way um it's uh given that she's 10 years old I I wonder about the the way these problems have manifested over time is she in a setting now where it is more demanding than it has been before
• 50:30 - 51:00 um and that could maybe she's uh she's uh coming into contact with things that exceed her coping and skill set ah so what behaviors might you see if that was going on it could very much look like distractability in attentiveness and you can see Escape behaviors as well exactly so we might be seeing some kind of Escape or behavioral avoidance that's presenting as distractability there's
• 51:00 - 51:30 another important rule out for her distractability that uh one of our team members presented did anybody catch what that one was Erica you had a comment oh um yeah my comment was just um about the kind of medical causes from before so I didn't know if you wanted me to say that now or wait until he was done with her Point sure you can we can go back to medical causes um I think that the other medical causes that I was thinking about um is I know she's on some anti-seizure
• 51:30 - 52:00 medication and I know that a lot of those medications can cause a lot of cognitive issues and um you know that can present A lot of times as inattention or being off task and not being able to focus just because of those particular medications how they work absolutely so cognitive slowing or fatigue or physical discomfort related to side effects all could present as a decrease in your attention resources so
• 52:00 - 52:30 we could have something that really looks like an ADHD but it's coming from a medical perspective our audiologist I'm hoping can comment on the other thing I'm thinking about go ahead Hannah and please unmute your own microphone oh sorry I muted myself on accident um
• 52:30 - 53:00 but but as an audiologist um hearing loss can manifest itself as um attention disorders um a mild hearing loss can cause um a lot more um effort to be put into listening um so if she even has like a mild form of hearing loss it could be that she's not hearing as well as she used to um and so she's having to put more effort into hearing and so by the end of the day she her behavior Can
• 53:00 - 53:30 decline exactly right so the overlap between inattention hearing loss and behavior because of lack of motivation or feeling overwhelmed or not coping well can be really hard to distinguish for patients uh you add to that poor social skills which is characteristic of someone diagnosed with an Autism Spectrum Disorder or ined expr Ive language which I know our speech pathologist talked
• 53:30 - 54:00 about it'd be important to know the nature of the speech language problem um and all of a sudden all of these things are overlapping really closely excellent any other comments for discussion wise things that folks noticed um this is probably outside of my hat um that's okay um but you know in in line of the medical lens um her
• 54:00 - 54:30 seizures were not uh properly controlled for some time not until six months ago and now they've uh um achieved better control but just because there's um behaviorally and maybe even some neurological findings that show better control uh does not mean that there may have been decline given the poor control before that could also manifest in these new uh well they're new new onet difficulties absolutely and and you've
• 54:30 - 55:00 brought up two key things that we don't know for sure about Janie right now um she has had good seizure control for six months so but we don't know what her real profile was at the time that she obtained that good seizure control the other thing is we don't actually know if she has good seizure control right now um certainly folks can have a period of ility and then break through seizures and that goes back to that first medical
• 55:00 - 55:30 question we are mindful of time and so there's we're going to shift gears in our discussion a little bit I think everyone did an excellent job presenting within their roles we had everybody actually had to step up and also present for their team members which is quite common in interprofessional care so I think that was a unexpected uh extra bonus piece uh but you've all had
• 55:30 - 56:00 the opportunity to really step out of your comfort zone a little bit and conceptualize a case from a different point of view I I am very impressed that you've hit the key discussion points and the con key conceptualization points that that we were trying to lay out for you we want to switch gears in our discussion now and take a step back and talk about this at the level of interprofessional practice and what this inner professional virtual webinar driven team discussion felt like so now
• 56:00 - 56:30 we want you to go back into your own role as professionals and tell us your understanding of what you felt like when you had to change your role in this discussion and what were your attitudes and feelings you had about working in an interprofessional team this is a point where you to us about your own professional role and what you would have added to this case I can share uh my reflection um my
• 56:30 - 57:00 role as a rehabilitation psychologist neuros psychologist and then my roleplay role was a patient attendant so um in light of the Oscars I really try to channel my uh inner acting skills and uh I I felt um as a patient attendant that I needed help and I needed you know answers and um but
• 57:00 - 57:30 didn't have the expertise or um uh their resources really to implement so I felt somewhat uh at at the mercy I guess of other professionals to give me um Direction good point on the team that had a road that they were not comfortable with what did you have to search for online to answer these questions that we had thrown at you since they were outside of your
• 57:30 - 58:00 professional role I had to look up what a rehab engineer was in general I had prior to that I thought it was a madeup role when I first heard um so it was interesting seeing that there is there's actually a whole field out there that that focuses on assisted Technologies and how they can make them better specific for the people that they're working with what did you find in terms of the
• 58:00 - 58:30 qualifications for somebody in that role to get a job um that was a little harder to find actually where it there's no like you can't get a master's degree and as far as I I searched you can't get a master's degree in Rehabilitation engineering you have to go through um a other avenues and kind of piece it together as as at least what I've found
• 58:30 - 59:00 how about speech pathologist Molly you had that role I was surprised when I looked into this exactly how much they do um I didn't realize how in-depth with the feeding I I just thought it was communication and more language skills um I didn't realize they did specialize in feeding and swallowing disorders um I guess I found a lot of variability um
• 59:00 - 59:30 in terms of what how you can become uh an aid uh certain positions require some certifications and trainings and like patient safety or um confidentiality and then there are others where there's you just need a high school diploma or G and you're willing to be trained um so there was quite a range and given the responsibilities that they have it's uh somewhat surprising that there's less
• 59:30 - 60:00 structure um in terms of what is required um and there was really no particular um uh Pathways when you're working with different uh populations whether it's uh developmental disabilities or with the elderly um anyone I guess could be in attendant um and the responsibility are uh great that was that was um just
• 60:00 - 60:30 to see how much they actually do hands on um that you don't normally think about when you make recommendations for a PA Alissa what about you as a medical student I'm I don't know which what more you want me to just said my qualifications or what did you find out when you were trying to play the role of a medical student ver your own professional role um well as a medical student um you
• 60:30 - 61:00 can have a variety of Specialties um so in my questions for the team and for the family I kind of focused on a variety of um information including uh nutrition seizures I didn't know which part like neurology or um dietary or anything like that so A student usually ends up focusing their studies more toward the end of um their education but um I wasn't exactly sure at which point they
• 61:00 - 61:30 were in that role or what so I just had it much more broad understanding what about your own professional role if you were in that particular role for yourself in this case what would you be feeling about this team that you had with you and the case itself so I spoke to that a little bit as actually when I spoke for Maddie as a psychologist um because I am uh behavior analyst which is psychology um but um so in that role
• 61:30 - 62:00 where I was speaking is that that would be my feelings on the situation but um I know I've definitely worked on as part of an interdisciplinary team and I think having all these people present and willing to communicate with the family is essential is that a challenge for you to stay sort of in your lane as the medical student versus the psychologist I mean I know we asked you both but was it hard to kind of keep your psychology Brin out of your medical conceptualization um a little bit um but
• 62:00 - 62:30 something I found um as a behavior analyst is that I always do a medical rule out first um so I rely on the medical professionals to do that initial step um so I tried to think of it as this is you know the first step we're taking um as the medical student and later on I would go into the psychologist role and because I've seen too many times where we haven't done you know the hearing test or the medical Ru out or the dental rule out and that ends
• 62:30 - 63:00 up causing a lot of the problem behaviors that we see and we just didn't rule those out to start with perfect Erica what about you um so I think with the teacher I mean I feel like in in my profession I I'm able to kind of talk with the teacher a bit so I think that was helpful to bring that to the table and then my um you know my mentor and I kind of came up with a little bit too um so I think kind of just um putting myself in that particular role for this
• 63:00 - 63:30 and looking at it from that view exclusively was kind of interesting um and I think that uh in my own profession um as a child psychiatrist and in a fellow right now I think it's very interesting to kind of see how this whole case kind of came together with all of the different teams and not having any information from what what everybody else is doing or what you know what kind of role people are playing and and all the support that they have so I
• 63:30 - 64:00 think putting that all together and kind of trying to figure out what information everybody else has and what what you have that they don't know is almost like how it is every day so I think that's interesting to see how that played out it's true every discussion you have in a team has information you know and all the information you don't know yet well I would like to move on and thank our traines for this component of it now we're going to move on to ask our mentors what they see our advantages and
• 64:00 - 64:30 challenges of working in a team since this is something they probably have some experience with um and also what are the uh roles that they see for an efficient team and what kind of leadership roles are needed you can go back to the case for Jenny or come up with something that you have experienced recently or in the past um that our traines could benefit from there's obviously lots of advantages of
• 64:30 - 65:00 working in a team and that people bring different perspectives and different skill sets to apply to helping a particular client one of the challenges though is we oftentimes have different languages different expectations and different roles we have to talk about and it really helps oftentimes to be real clear about uh idiosyncratic profession specific language that people talking about so that can help with kind of a kind of almost a glossery about how
• 65:00 - 65:30 to talk about things so we're all agreeing to the same issues the other thing that would be really helpful is moving down to the the roles here about leadership roles one of the challenges of working with a multi-is team is trying to get some consensus either on your assessment and case conceptualization or on your course of of treatment and who's going to have which roles and in particular how people
• 65:30 - 66:00 are going to monitor progress and people will have different uh profession specific uh measures and expectations of clinical progress that can be shared with each other and people also sometimes have different interventions that either facilitate or sometimes even interfere with another discipline's efforts to uh come up with some sort of an intervention so all those things need to
• 66:00 - 66:30 be talked through in terms of getting consensus understanding who has what role who facilitates or potentially interferes with other disciplines and in particular how all these different disciplines are going to collaborate together to monitor some sort of uh clinical progress this is Abby I'm gonna speak as a mentor for a second and just Echo off of what Wayne was just sharing you know part of the challenge of finding a consistent communication
• 66:30 - 67:00 and finding and not stepping on each other's feet in terms of roles and ex and uh interventions comes from having a a leadership structure within your team and one thing that I noticed in our uh in our mock here in our virtual team that I think is really really common in real life is that the natural leader is unclear and it's because we all bring leadership roles um so trying to find a direction
• 67:00 - 67:30 for care and trying to come up with a a focus and a consensus at at the end of a meeting can be a real challenge um so I think having a communicator a leader uh that can help move the direction forward is sometimes a really important thing to Define when you have a team of experts I just as Wayne said you have to have consensus and in terms of team members
• 67:30 - 68:00 expertise their roles and the different communication styles are important for us to keep in mind uh when you're trying to get um the best out of your team for the family for the child and uh the next steps in terms of the treatment plan uh for the individual that you're caring for our next um SL so I think our goal here today was to
• 68:00 - 68:30 demonstrate why interprofessional care is important um as some people have already reflected and brought up there's a lot more complete understanding of a patient that you get when you're working in an interprofessional care team it does get complicated to put together all of the information and it does take extra time to make sure you're understanding what's being communicated but for example each one of you had a limited view of where Jenny's problem or
• 68:30 - 69:00 Dan's problem was coming from and could easily have head down a different diagnostic path and would be appropriate um so that's one clear example of interprofessional care this has actually been looked at widely though and there's been a consensus group that's examined why interprofessional care is important and so uh we know pretty
• 69:00 - 69:30 clearly that there are advantages of cons uh conducting the assessment as part of a team your quality of care goes up the safety of care for the patient goes up however redundancy will go down and the cost of care will go down and I think our team ab and C very clearly demonstrated that when they were discussing their own roles as well as the role play that they had how they would be able to provide better care for
• 69:30 - 70:00 Jimny the other advantages that um we wanted to make sure that we communicate with you was the errors going down and fewer gaps in care the improved communication between the team as you saw from when they were playing their role they were a little less open about what they would like to have happen versus when each team member spoke about it from their own profession they were
• 70:00 - 70:30 more open and able to share more of their own experiences for it but as a uh team members or traines um focus was the person which was jany as the center of their um plan treatment plan and they were all in concerned about the satisfaction and the learning that her family would have the
• 70:30 - 71:00 teacher would have the aid would get out of being a part of this team um some of the competencies that across professions that we need to make sure we communicate with you are the values and ethics as Wayne brought it up and I think Ed brought that up as well um for interprofessional practice keeping your own ethical uh roles and your discipline
• 71:00 - 71:30 specific um practice values is going to be your number one um focus your next would be your own responsibility as that profession in professional in the team making sure the communication is clear and is uh team and teamwork going on in order to do that um we're going to go a little bit into some of the values and ethics for interprofessional practice Yeah and I
• 71:30 - 72:00 don't have a complete list up here but what this is coming from I'd be happy to share with anybody we can put it up on blackboard this is the core competencies for interprofessional collaborative practice and this was an expert panel group from 2011 when these were first laid out and so what they did as a consensus team of experts was identify the kinds of competencies that should be focused on still while professionals are
• 72:00 - 72:30 still in training and so that that applies to all of you in this program um and there isn't a chapter to read on it but what it is is practicing and working with your mentors and working with your teams to understand how to how to use these values and ethics when you're working with other professionals so I've just highlighted a few of them here but it's it's valuing and intentionally valuing patients and populations as the center of care intentionally creating
• 72:30 - 73:00 respect and dignity and privacy for patients because team communication is complicated we talk a lot about valuing cultural diversity and individual differences um and then a lot of the other the other three uh really talk about the values and ethics of a team so working in cooperation with others implicit in that is valuing the
• 73:00 - 73:30 expertise of others and uh valuing their role within the team developing a trust relationship and this has been a theme of many of the modules that have come before us but that that trust relationship has to exist at the level of patients families and other team members uh and then there has to be a commitment to managing ethical dilemmas specific to interprofessional professional practice so conflicts between caregivers and
• 73:30 - 74:00 between professionals will happen and they need to be managed there are times when it will be tempting to work in opposition of a team goal as an individual provider and so it's an it's a value you have to maintain to be part of the team um today that really didn't come up everybody was a very respectful team member today um so in order to make sure that our team was open uh we asked them
• 74:00 - 74:30 to be um respect uh receptive of what was being discussed to display interest which they all did they were actively listening I don't think I heard anyone using any jarin so those were our ground rules that we had given our traines and they conveyed that very well as part of the exercise today and happens to fall right in line with the competencies for communication um another set of
• 74:30 - 75:00 competencies Is Knowing Your Role and your responsibility and so our goal today was to test that a little bit by giving you a new role um part of your value part of valuing working in a team is understanding not just what you can bring but also what other people bring and what your responsibilities are as well as what other responsibilities are um so you'll see there's a theme here with each of these points but the idea being that you have to use the full scope of knowledge skills and abilities
• 75:00 - 75:30 among your team and so it's essential to a healthy team practice to respect and acknowledge when a different professional has a deeper set of skills than than your own role um so an example of that is that there are often overlapping skill sets within teams um a common one that I run into as a psychologist is that Speech Pathology and psychology have some overlapping uh expertise areas in
• 75:30 - 76:00 assessment and assessment of cognition it's tempting to get into uh debates about whose role is what but another another way to recognize that is to have respect for the different scope of practice of assessment of both of those expertise areas and really understand how to get that full set of knowledge uh available to the patient
• 76:00 - 76:30 who's the center of the Care uh so in Janie's example really the behavioral and emotional assessment is something that the psychologist might have unique expertise on uh many aspects of the communication and some of the subtleties of expressive language versus receptive language versus a more of an articulation communication problem would certainly fall more in the realm of Speech Pathology and then there's a a gray area in the Middle where the two can come
• 76:30 - 77:00 together so understanding and respecting these things are core to interprofessional practice and the last core set of competencies and again I this isn't exhaustive but this is just to give you a flavor for it has to do with understanding how teams work so up at the top there is something I mentioned a little bit earlier the process of develop in a team and defining roles and practices of effective teams is an important piece to
• 77:00 - 77:30 healthy team development knowing how to engage other health professionals in shared patient centered problem solving skills meaning it's important to work with one another around the same problem and that might mean going as slowly as Divi defining the language you're using for the purpose of the meeting to get around problems of different vocab Aries or jargon um applying leadership leadership practices and understanding that in some
• 77:30 - 78:00 teams you may be a defined leader and in some teams there may be a hierarchy where you are not the defined leader but you're collaborating with them in the spirit of clear communication shared accountability is another one that I think is important to highlight um and that professions patients and communities all share that accountability so sometimes especially on a pediatric team we feel very uh responsible for all of the
• 78:00 - 78:30 patient behaviors and there sometimes can be a lack of recognition that the family and the patient themselves also share that responsibility and accountability with us so understanding that the patient and the family are part of the team um and how that Dynamic works is another important one that I'll highlight so like I said we can share these cor competencies with with you in totality I what we are going to do and
• 78:30 - 79:00 what we'd like to you to reflect on moving forward um is the ways in which this plays out in your everyday Clinic practices and how you can be mindful of your roles and responsibilities your team work your communication and your values and ethics within the teams that you're already involved in and a last but not least the slide that our whole program for lend is based on his leadership
• 79:00 - 79:30 interdisciplinary family centered care and equity and I think this case demonstrated um this very well for you uh in roles that you played as leaders of the team or in as members of the interdisciplinary team also F focusing your treatment options on the family Cent care and being of equity to to everyone not just to your team members but to the family and um we'd like to
• 79:30 - 80:00 say thank you for participating and being a member of the life considerations and the interprofessional module that we just presented to you uh we're open to questions yeah nice set of materials and I especially like the guidelines for teamwork um let me just add an an observation about how challenging this can be uh about 15 years ago The Institute of medicine
• 80:00 - 80:30 produced a uh a report called to air is human and it was all about medical errors that were supposedly contributing to about 990,000 unnecessary deaths per year and to put that into perspective that's essentially 300 deaths per day like a 747 crashing every single day of the entire year just about so it's a serious issue and when looked at the causes the root causes of some of these medical errors a significant
• 80:30 - 81:00 portion of them had to do with interdisciplinary and Inter team communication with people not doing a good job with handoffs or communicating uh when someone was about to give a wrong medication dosage for example and part of this has to do also with the very nature of some Medical Teams where it sometimes is very hierarchical with one person being the authority figure and other people sometimes being afraid to challenge the authority figure so the reason I'm
• 81:00 - 81:30 pointing that out is just to illustrate that uh while those guidelines sound fantastic and they are fantastic real challenges how do you put these into effect and get team members to be less Territorial and more focused on what is how do they contribute to the benefit of the person they're supposed to be serving and how do they politely uh and tactfully raise concerns
• 81:30 - 82:00 if someone else is doing something that might be not beneficial or how do you make sure that people are following through on the full range of obligations um so it's just an observation that sometimes these things take a fair amount of application in practice uh I have seen people use things like simulation Based training to improve team communication and reduce errors and improve uh kind of
• 82:00 - 82:30 collaboration between members so those are some things that might be thought through as people are taking these really good guidelines and beginning to apply them in their own context Absolutely I'll Echo that Jo has actually reported statistics that errors can be reduced by More than 70% with interprofessional communication structures in place so it's something that when it can run well you're absolutely right can vastly reduce
• 82:30 - 83:00 things like medical errors um the other part of this consensus statement that I think you're exactly touching on is that it it takes teaching professionals at the level of Education before they're even in practice to start to build te recognition of the importance of a team and skills like listening and respecting team member roles and so each one of you
• 83:00 - 83:30 if you haven't already will have experiences where you're working with professionals who are very comfortable operating on their own and are not comfortable and not well trained at operating in a team um and and I you're right I don't have a a magic practice solution for that other than as you said having these kinds of values and structures in mind but knowing it will take time and um culture change essentially in order to to start to
• 83:30 - 84:00 Foster these things I I was impressed uh with two uh medical students at Wayne um this fall they conducted the home visit as Molly mentioned earlier with an older adult and uh couple weeks ago came to me and asked if they could create uh scenarios that they could talk about handoffs and what happens in the emergency room um because that's another
• 84:00 - 84:30 area of a lot of medical errors occurring and they are currently writing up two cases that they will be using this summer to um pilot of between medicine Pharmacy nursing and Pa students so there'll be four disciplines uh in these scenarios and they want to implement it for all year three medical students at Wayne and so this was just one example of how you can impact by a
• 84:30 - 85:00 small little program uh and get them thinking about other ways and means in which they can uh further the um teamwork and roles and responsibilities as students or trainees in these programs well our traine has worked really hard in our virtual team discussion today this it's a much more active role for them so we are happy to give you the gift of time for the last
• 85:00 - 85:30 half hour if there are no other questions or comments so we'd like to say thank you to everyone and be safe good night