June 1, 2013 Features

On-The-Job Cross Pollination

How are you supposed to learn about interprofessional teaming if your graduate program didn’t model it? Never fear. More employers are offering ways for staff to learn about one another’s disciplines—together. Here’s a first-hand look at some of them.

130601_cross_pollination.jpgIt's the new buzzword that's everywhere: "interprofessional." In health care, providers from different disciplines increasingly collaborate to provide the quality, patient-centered care called for in the Affordable Care Act. In K–12 schools, teachers and other specialists have long worked together on students' individualized education programs. And in graduate programs, faculty are stepping up efforts to offer training with other departments.

But what if you didn't get interdisciplinary training in your graduate program? And even if you did, did you get enough to feel prepared for teamwork? Here's where continuing education comes in: Many of us rely on formal and informal CE opportunities to learn about—and with—other professionals. Real-world experience is, after all, a highly effective teacher.

Not that workplace learning in interprofessional teams is anything new. Interprofessional diagnostic and treatment teams are a fixture in hospitals and clinics, as are IEP teams in schools. However, the best interprofessional teams don't just work together—they learn together by constantly interacting, giving feedback, honing skills together, learning from one another and sharing information.

It doesn't end there: Many work-based teams also take CE courses together to boost others' buy-in to new techniques and information. We've all been excited to try something we learned at a CE workshop, only to find that colleagues who didn't attend the workshop don't share our enthusiasm.

Recognizing that joint learning helps break down such barriers, more employers offer ways for staff to learn about one another's disciplines elbow-to-elbow. Here's a look at some of these opportunities offered by ASHA's approved CE providers.

Ellen Fagan, EdD, CCC-SLP, ASHA director of continuing education

  • efagan@asha.org

Using IPE to Develop Clinicians

"Mary" was readmitted to Genesis Rehab Center after a recent hip fracture. Evaluators at the assisted living center ordered physical therapy and speech-language treatment to address her disorientation and inability to communicate basic needs. She had a medical history significant for Parkinson's disease, dementia and depression. She had refused speech and physical therapy services in the past.

To assess Mary's current functioning, the speech-language pathologist and physical therapist used tools they had learned together recently in a foundations course on dementia. The SLP administered the Brief Cognitive Rating Scale, which revealed Mary was functioning at a Global Deterioration Scale stage 4, moderate cognitive decline. She shared this finding with the PT so that together they could establish a plan for Mary's care based on her stage.

All our clinicians—including SLPs, occupational therapists, PTs and respiratory therapists—take the dementia course that informed this SLP's and PT's approach, because all members of the rehabilitation team need to have a common understanding of the needs of residents with dementia.

The course is taught by an interdisciplinary team to interdisciplinary teams to ensure a consistent approach to care. Participants learn to identify dementia-related behavioral and functional performance changes according to the Global Deterioration Scale. They also learn to use the GDS and other staging tools to identify stages of dementia and appropriate discipline-specific interventions.

This joint training benefits clinicians and patients alike, as illustrated in Mary's case: Based on what they've learned in the course, the SLP and PT understood that patients at Mary's stage of dementia typically deny services, demonstrate flattened affect, quickly become anxious or angry, and appear depressed. However, Mary should still understand the essential focus of a therapy program. She can be goal directed and can understand the basics—and complete some steps—of familiar tasks and activities. However, due to increased rigidity and reduced ability to solve problems, she needs a highly structured, familiar routine and to develop trusting relationships with clinicians before being open to treatment.

The SLP and PT realized that if they provide treatment in places where Mary feels comfortable—her apartment or the activities room instead of the therapy gym—she is perfectly receptive to regular physical therapy and speech-language treatment.

In addition to the joint training on dementia, we provide clinicians tools and training to help with supervision and mentoring. This training course is approved for 0.2 ASHA CEUs. We've run into some difficulties trying to support clinicians' supervision efforts across varying disciplines, because each discipline requires different amounts of supervisory episodes and site visits. So, in an attempt to reduce frustration, we've set up post-training follow-up calls to field clinicians' concerns. We've also established pages on our internal website to update clinicians on requirements in their respective areas.

Through these varying IPE efforts, we empower clinicians to better collaborate and successfully meet the challenges of the geriatric population.

Erin Knoepfel, MS, CCC-SLP, BRS-S, director, speech-language pathology clinical services, Genesis Rehab Services

  • erin.knoepfel@genesishcc.com

Learning Has No Boundaries

I have often joked, or maybe bragged, that I must be the most well-versed SLP in the world on rehabilitation topics such as amputations, upper-extremity robotics or bladder management following spinal cord injury. But in all seriousness, as a rehab director, I need this knowledge to lead my team. 

Members of the rehab team need to appreciate one another's contributions to the clinical and professional work provided at our institution. To this end, my director colleagues and I have built a CE model at Frazier Rehab Institute that offers onsite courses as an employee benefit. We also encourage staff to collaborate as faculty on our internally produced courses. 

Many of our courses are relevant to the interprofessional team. For example, in early 2013 we brought in Joe Giacino, a leading authority on disorders of consciousness, to train our brain injury team on best practices. Attendees included SLPs, occupational and physical therapists, psychologists, neuropsychologists, nurses, admission liaisons, and physiatrists. Based on this training, all our team members now use a battery of evidence-based assessments for differentially diagnosing state of consciousness. Additionally, the interprofessional team administers the Confusion Assessment Protocol on all patients admitted to our brain injury program.

We've also added a cross-disciplinary bent to our CE on student development, tapping instructors from the American Physical Therapy Association's Credentialed Clinical Instructor Program. APTA originally designed the course for physical therapy professionals, but we've seen this learning gap across professions, and the course has bridged it. APTA's course covers such concepts as parallels between being a practitioner and a clinical educator; identifying student learning needs; designing quality learning experiences; and using effective teaching, supervisory and evaluation techniques. Participating SLPs and OTs are not credentialed by APTA, but they report feeling more qualified to teach students, better prepared, and more satisfied with their experiences. 

In fact, since introducing interprofessional CE, we've seen overall improved recruitment and retention among staff. Of course, interprofessional teaming can also have its challenges, including concerns about encroachment, territoriality, scope of practice and the like. So some of the interprofessional education instructors clearly indicate whose role it is to conduct a specific clinical function—for example, it is the physician's responsibility to conduct the brain stem reflex assessment on the Coma Recovery Scale. In cases in which delineations are not as clear, the team discusses which professionals are most qualified to perform specific tasks. Such open discussions tend to keep territorial issues at bay. 

In these days of short stays for severely impaired patients, it is more important than ever that we co-treat patients effectively, clearly sharing our understanding of the clinical issues with one another, as well as with patients and their families. This collaboration reaps mutual respect that naturally evolves and strengthens the team.

Kathy Panther, MS, CCC-SLP, director, inpatient therapies (brain injury and stroke rehab programs), Frazier Rehab Institute, Louisville, Ky.

  • kathypanther@kentuckyonehealth.org

As We Work, So We Learn

Jeremy has a complex cardiac condition, sensorineural hearing loss, fine and gross motor delays, and a severe speech sound disorder associated with a genetic syndrome. Michael has cleft palate, Pierre Robin sequence, and a host of feeding and developmental issues related to prematurity. Reed is ventilator-dependent after complex cardiac surgery and needs augmentative communication assistance while in the pediatric intensive care unit.

These children have complex conditions and multiple treatment needs. And they are the norm at St. Louis Children's Hospital, a tertiary pediatric medical center where there is no such thing as an "easy" patient with a "simple" problem. That's why no professional here works in isolation. Every child receives care from a team of professionals that can address a spectrum of needs.

The team approach carries over to our CE offerings. Each month we conduct multidisciplinary grand rounds lectures and journal clubs, in which we discuss recent pediatric journal articles. Audiologists and SLPs attend these functions side by side with colleagues from medicine, surgery, nursing, psychology, dentistry, pharmacy, nutrition, library, education, information technology and other specialties.

At a recent craniofacial grand rounds, for example, ASHA members, along with craniofacial surgeons, neurosurgeons, psychologists and nurses, explored the effects of changes in cranial volume following craniosynostosis surgery. And in a recent journal club, audiologists and otolaryngologists evaluated the evidence base regarding effects of frequency compression algorithms on amplification in children with high-frequency hearing loss.

Interestingly, turf issues are less of a problem in our pediatric area than in adult medicine. No one seems to take offense when I ask a nurse or a surgeon, "Why do you do it that way? Why not ... ?" Likewise, I find that when a surgeon or nurse asks such a question of me, I often gain a fresh insight. My colleagues in feeding and swallowing have experienced some division-of-labor issues with OTs, but our joint-practice teams hashed that out, setting a mutually agreed-on hospital policy on who does what. Everything now seems to be going smoothly.

For many outside the medical setting, this shared method of learning may not seem entirely relevant to our work as CSD professionals. How does knowing about surgery for the skull affect the treatment we provide? In what way does knowing measures of radiation safety affect our evaluations of a patient? When we work and study side by side with other professionals, we bring a new perspective to what they do, and vice versa. Shared learning experiences build effective teams, and effective teams provide excellent patient care.

Lynn Marty Grames, MA, CCC-SLP, clinician at the St. Louis Children's Hospital Cleft Palate and Craniofacial Institute, St. Louis, Mo.

  • lynnmg@bjc.org

Ellen Fagan, EdD, CCC-SLP, ASHA director of continuing education efagan@asha.org

Erin Knoepfel, MS, CCC-SLP, BRS-S, director, speech-language pathology clinical services, Genesis Rehab Services erin.knoepfel@genesishcc.com

Kathy Panther, MS, CCC-SLP, director, inpatient therapies (brain injury and stroke rehab programs), Frazier Rehab Institute, Louisville, Ky. kathypanther@kentuckyonehealth.org

Lynn Marty Grames, MA, CCC-SLP, clinician at the St. Louis Children’s Hospital Cleft Palate and Craniofacial Institute, St. Louis, Mo. lynnmg@bjc.org

cite as: Fagan, E. , Knoepfel, E. , Panther, K.  & Grames, L. M. (2013, June 01). On-The-Job Cross Pollination. The ASHA Leader.

  

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