Transdisciplinary Practice in ALS Elizabeth Baron, RSLP and Kathleen Beggs, RD 2016 BCASLPA Conference October 21, 2016 Agenda Team Healthcare Models Advantages and Challenges of Transdisciplinary Teams The ALS Clinic An Example of a Transdisciplinary Team Dysphagia Practice on our team Case Example(s) 1
Team Healthcare Models Unidisciplinary Teams Teams made up of providers from a single background Intradisciplinary Teams Composed of professionals from one discipline but include team members from different levels of training and skill within the discipline Not typical in our practice Multidisciplinary Teams Composed of members from more than one discipline Team members work independently and interact formally Client s problems are subdivided and treated in parallel with each professional focusing only on their area 2
Interdiscipinary Teams Multiple professionals from several disciplines working interdependently in the same setting with both formal and informal interactions Separate assessements are conducted to achieve a common goal Information is communicated and problems are solved in a team oriented way More commonly seen in healthcare settings 3
Transdisciplinary Teams An interdisciplinary team whose members have developed sufficient trust and mutual confidence to engage in teaching and learning across disciplinary boundaries In addition to collaborating, team members entrust, prepare, and supervise the sharing of disciplinary functions while retaining ultimate responsibility for services within their exclusive scope of practice. Transdisciplinary Teams cont d Multiple professionals from several disciplines who are sufficiently familiar with the concepts and approaches of their colleagues allowing the disciplinary bounds to blur, enabling the team to focus on the problem in a broader context As this happens discipline boundaries become less important and the problem and its context guide an appropriately broader and deeper analysis 4
Transdisciplinary Teams cont d The transdisciplinary team approach is based on the premise that one person can perform several roles by providing services to the patient under the supervision/support of other disciplines involved. This approach represents the concept of a multi-skilled health practitioner. Examples of Successful Transdisciplinary Teams 5
Advantages of Transdisciplinary Teams The transdisciplinary approach is considered to be best practice because: Working as a transdisciplinary team reduces the likelihood of confusion and fatigue for clients by reducing the number of people and disciplines they interact with Enhances the relationship between the individual team members and the client Increases collaboration and communication amongst team members Reduces duplication Advantages of Transdisciplinary Teams Cont d The transdisciplinary approach is considered to be best practice because: Promotes consistent messaging for the client Ensures that all team members are working on the same outcomes and strategies Transdisciplinary documentation (avoids duplication, produces comprehensive reports) 6
Challenges in Transdisciplinary Teams Challenges of Transdisciplinary Teams Scope of Practice Territory Confidence/Trust Communication Shared expertise in a common area is needed (e.g. ALS) 7
Challenges in Transdisciplinary Teams Intrapersonal Interpersonal Environmental Intrapersonal Challenges Identity Issues ownership/territory of practice Increased work demands Increased demands of broader disciplinary content Increased knowledge needs 8
Interpersonal Challenges Communication Establishing common ground, developing consensus, understanding professional boundaries and areas of overlap Developing shared language Understanding disciplinary differences and boundaries (? roles) Respecting contributions across all disciplines Satisfaction, appreciation and reward Environmental Challenges Communication Needs Formal and informal, email, office chat, electronic chart Need to share materials and education tools Need for shared space to preserve informal brain storming, assistance and relationship building 9
Strategies for Overcoming Barriers on Transdisciplinary Teams Intrapersonal: Characteristics of Success Cognitive Flexibility Tolerance for Ambiguity Plays well with others Socially focused Committed to team Social Intelligence Respect for others views Inductive Thinking Abstract thinking Selflessness Assertiveness Intellectual curiosity Good communication skills Openness to new ideas Feels supported by the team and institution 10
Interpersonal Strategies Creating Collaboration processes, policies and guidelines Takes time up front but saves time in the long run Increases trust and collaboration Facillitates cultural exchange Role descriptions/definitions Regular Meetings Engage in visioning activities that allow for brain storming and appreciate inquiry Planning Day Team building activities Positive and safe communication environment Interpersonal Strategies Cont d Develop shared language Common terms and abbreviations Common processes for non discipline specific tasks (e.g. death notices) 11
Environmental Challenges Ensure access to efficient communication tools to ensure easy access and communication Phone (? mobile/text, FH Vocera badge (paging system, email, voicemail) Resources Central access to equipment and education tools for care delivery Space issues Open concept offices, closer proximity and larger spaces increase productivity. Less privacy. Types of teams that best fit a Transdisciplinary Approach Specialized populations Skilled clinicians who are: Good communicators Flexible Open to learning Comfortable in professional boundaries as well as areas of collaborative practice 12
The ALS Centre GF Strong Rehab Centre Our example of successful transdisciplinary practice. Clinic Structure: Outpatient and outreach clinic specializing in ALS clients Clients come to see us for confirmation of diagnosis and are then followed up every 3 months Clients are followed from initial confirmation through end of life Home Visits, Case Conferences, Inservices scheduled as needed Consultation and liaising ongoing with Home Health Care, palliative care, and residential care Team members (OT, PT, SW, RN, RD, SLP, Neurologist) 13
Our Team: We are a trans-disciplinary team that provides education and support around the following: PT: transfers, positioning, respiratory interventions, gait aides, and exercise recommendations. OT: maximizing independence through the use of equipment, and environmental adaptations RD: optimizing nutritional status given changes given disease progression SLP: swallowing assessments, food modifications, and communication strategies SW: assisting with disease meaning and understanding, decision making, advance care planning, and coping and adjustment, grief and loss, and palliative care RN: EDU; disease and medications, symptom management, and assists with accessing prescriptions and supports. Team Functioning: ALS specific learning and cross disciplinary education occurs such that all team members can provide general information across disciplines as well as their own discipline specific assessment, education and intervention. Team members are able to address common client questions and needs and redirect/refer on when discipline specific support is needed. 14
Dysphagia Management An Example Addressed in joint session between SLP and RD Interview and clinical exam Reduces duplication (similar questions for different purposes) Time efficiency Related topics like saliva management and aspiration also overlapped by nursing Joint education, recommendations and information sharing Backfill and coverage Joint electronic charting Screening for other needs/other team members Other Team Based Examples: OT/PT see clients in joint sessions and provide backfill for one another much like SLP and RD Mobile Clinics Partial team only, represents entire team, addresses needs where possible and brings all client issues back to specific team members as needed 15
What Works Well? Client focussed Less confusing for clients (more problem focused than discipline focused) Less duplication/increased efficiency Comprehensive assessment of problem and generation of solutions All inclusive care for clients coverage and screening provided by all team members (less is missed) Creates transdisciplinary research opportunities What Presents Challenges? Creating a comfort zone with professional boundaries and transdisciplinary practice Joint expertise (cross disciplines) on the topic of ALS General knowledge of other team members areas of practice (*not specific but able to cess out and bring other discipline based concerns back to appropriate team members) Developing trust and communication within your team 16
What Presents Challenges? Cont d Need for creativity when discipline specific/time sensitive issues arise and other discipline(s) may not be there. Phone calls? Telehealth? Liasing with other community partners? (e.g. home visits) Appropriate awareness of when specialized involvement from individual team members is needed. Case Examples 17
Contact Us Anytime Reception: (604) 737-6320 fax: (604) 737-6234 Kathleen Beggs, RD (604) 737-6229 Kathleen.Beggs@vch.ca Simone Hartman, OT (604) 734-1313 - Local 2324 simone.hartman@vch.ca Marife Fabros, RN (604) 737-6319 Marife.Fabros@vch.ca Gwyn Moe, PT (604) 734-1313 - Local 2108 Gwyneth.Moe@vch.ca Elizabeth Baron, M.S.L.P., RSLP (604) 734-1313 - Local 2113 elizabeth.baron@vch.ca Manisha Motha, MSW (604) 734-1313 Local 2165 manisha.motha@vch.ca Thank you! Questions? 18