Transdisciplinary Collaboration: A Demonstration Project Phyllis M. Connolly, PhD, RN, CS Jean M.
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Transcript Transdisciplinary Collaboration: A Demonstration Project Phyllis M. Connolly, PhD, RN, CS Jean M.
Transdisciplinary Collaboration:
A Demonstration Project
Phyllis M. Connolly, PhD, RN, CS
Jean M. Novak, PhD, CCC-SLP
San Jose State University, San Jose, CA
Objectives
Discuss
the driving forces related to the need for
transdisciplinary collaboration
Recognize discipline specific assessment tools and interventions
use for SJSU Transdisciplinary Project
Identify client specific outcomes based on the Omaha
Documentation System
Societal Shifts
Nationalism
replaced
with global economy
Social ecology--needs
for integration &
connections
Social capital-networks, norms,
trust, coordination &
cooperation
TRENDS
High-value
organizations depend
on and expect workers
at all levels to be
capable of making
decisions
Health care being
driven by changes in
industry
New
organizations
New forms of delivery
systems-- managed
care
New ways of relating
to each other
Smaller companies
Outsourcing
Disease management
Changing Work Environment
Technology
Demographics
Managed
Care
Purchaser’s Influence
Health Insurance
Industry
Changing Health
Systems
Telemedicine
Relationship to Health
Concern not only with costs & benefits but with
social, emotional, & physical health
Promoting health and providing health care, no
longer the exclusive domain of any discipline
Need for interdependence to improve population
health care outcomes
Primary Care:
Collaboration Needed
Anxiety disorders,
depression &
substance abuse
most frequently
misdiagnosed in
primary care
practices
Project Goal
Through collaborative efforts,
provide quality, cost effective
services for persons with serious
mental illness living in the
community while simultaneously
preparing future mental health
professionals for practice.
Transdisciplinary Collaboration Project
San Jose State University
Psychosocial.
Occupational
Therapy Clinic
Office of Sponsored Programs
College of Applied Sciences and Arts
School of Nursing
Nurse Managed Centers
Communication Disorders & Sciences:
Program & Clinic
Department of Occupational Therapy
Department of Recreation & Leisure Studies: TR
College of Social Work
Institute for Teaching & Learning
Faculty and Students
Santa Clara
County
Mental
Health
Revised 5/99
Santa Clara County
Alliance for the
Mentally Ill
Residents
Staff
Families
ALLIANCE for
Community Care
Zoe House
Crossroads Village
Casa Feliz
Definition Collaboration
A dynamic
transforming process of creating
a power sharing partnership for pervasive
application in health care practice,
education, research, & organizational
settings for the purposeful attention to
needs and problems in order to achieve
likely successful outcomes (Sullivan, 1998,
p. 6)
Transdisciplinary
Refers
to a relatively new model based on
the concept that the needs of the recipient
of services (student, patient, client, etc.)
dictates the roles to be performed by
members of the team. There can be much
overlap in individual job descriptions.
Transdisciplinary
Team Advantages
Individualized
rehabilitation plan-goals
Integrated service delivery
Role delineation
Reduction of redundant care
Increase of interaction between professionals
Generalization and maintenance of skills
Learning with and from each other
Sharing and growing
Improved quality of life
Cost effectiveness
Behavioral Ecological Model of
Community Mental Health
Laws
University
Administration of
Justice
Training of
Professionals
Community
Friends and Peers
Person
Church
Family
Laws
Social Policy
Mental Health
System
Legislation
Behavioral-ecological Perspective
Values & Interventions
Specific
values:
– Promoting individual competence
– Enhancing psychological sense of community
– Supporting cultural diversity
Interventions
seek to:
– Optimize human development
– Enhance coping and mastery skills
– Enhance organizational and community strengths
Improved quality of life
Competence Paradigm:
Health Based
View of Families:
Emphasis on:
Role of Professionals:
Assessment:
Goal of Interventions:
Modus Operandi:
Perspective:
Competent
Strengths
Enabling Agents
Competencies
Empowerment
Adaptation
Ecological Framework
Transdisciplinary Project
S TU D E N TS F A C U L TY S TA F F
S em in ar
AMI
M eetin g s
Caring & Sharing
•weekly
•campus
•case presentation
•discipline information
•discussion & feedback
P racticu m
•2 days/week
•on-site/campus
•client contact
•experience
•implementation
•evaluation
Assessment & Outcome Tools
Pragmatic
Protocol
Social Skills Rating Scale
Canadian Occupational Performance
Omaha Nursing Documentation System
Allen’s Cognitive Levels
Kohlman Evaluation of Living Skills
Psychosocial Assessment
CERT-Psych
Omaha Nursing Documentation System
Domains
Interventions
I.
Environmental
II. Psychosocial
III. Physiological
IV.
Health Related
Behaviors
I.
Health Teaching
Guidance,
Counseling
II. Treatments &
Procedures
III. Case Management
IV. Surveillance
Domain II. Psychosocial
Communication with
community resources
Social contact
Role change
Interpersonal relationship
Spiritual distress
Grief
Emotional stability
Human sexuality
Caretaking/parenting
Neglected child/adult
Abused child/adult
Growth & development
IV. Health Related Behaviors
Nutrition
Sleep and rest patterns
Physical activity
Personal hygiene
Substance use
Family planning
Health care supervision
Prescribed medication
regimen
Technical procedure
Targets
Behavior
modification
Caretaking/parenting
skills
Communication
Coping skills
Exercises
Food
Interaction
Wellness
Medication
action/side
effects
Nutrition
Rehabilitation
Relaxation/breathing
techniques
Safety
Signs/symptoms
Stress management
Omaha Rating Scale
Concept
1
2
3
Mini- Basic
Knowledge No
knowledge mal
4
5
Adequate Superior
Behavior
Not
appropriate
Rarely Inconsistently
Usually
Status
Extreme
S&S
Severe Moderate Minimal
S&S S&S
S&S
Consistently
No S&S
Issues for Collaboration
Health
Communication
Weight
loss
Exercise
Grooming
Safe sex
Nutrition
Stress management
Symptom
management
Memory
Cognition
Speech
Narrative discourse
Conversational skills
Social skills
Hearing
Literacy
Approaches to Collaborative
Outcomes
Primary discipline
Supportive discipline
Assess and evaluate
problems and needs
Treat & evaluate
Seek consultation &
referrals
Collaborate
Validate treatment
approach
Assess, treat,
recommend
Collaborate
Collaborative Interventions
Individual
–
–
–
–
One to one
Consultation
Case Management
Health teaching and
counseling/guidance
– Surveillance
– Treatments &
Procedures
– Referrals
Group
– Psychoeducational
classes
– Modules
– Activities
– Health teaching
– Advocacy
Weight Loss
Nursing
– Assess nutritional
status
– Assess eating
behaviors
– Assess environment
– Assess and establish
exercise program
– Teach appropriate food
selections
– Evaluate, weigh
weekly
Communication
Disorders
– Organizing a eating
schedule
– Categorizing
appropriate food
choices
– Follow up
comprehension
– Food preparation
Stress Management
Nursing
– Crisis intervention
»
»
»
»
Deep breathing
Self talk
Time out
Visualization
– Prevention
» Diet & nutrition
» Exercise
» Time management
Communication
Disorders
– Organizing and
creating schedules
– Follow up on
comprehension
– Routines
– Social skills
Memory
Communication
Disorders
interventions
–
–
–
–
–
–
–
–
Scheduling
Visual, writing notes,
Reminders
Calendars
Routines
Self generated strategies
Repetition
Rehearsals
Nursing interventions
– Assess for physiological
causes
– Assess for nutritional
status
– Assess medication
efficacy
– Develop collaborative
plan utilizing memory
enhancement strategies
Speech (Dysarthria)
Communication
Disorders
– Oral facial evaluation
– Oral motor exercises
» Voice
» Exaggerated
enunciation
» Oral facial awareness
» Rate of speech
Nursing
–
–
–
–
–
Assess AIMS
Assess medication
Assess oral hygiene
Assess dental hygiene
Assess nutritional
status
– Follow up on oral
motor exercises
CCF # 9012, Problem 21, Speech,
Communication, Spring 97
Difficulty
–
–
–
–
–
with
Intelligibility
Topic maintenance
Organizational skills
Withdrawal
Interventions
Outcomes
Decrease in rate of speech
Increased
– Intelligibility
– Narrative discourse,
expanded utterances,
increase volume
– Self expression
– Organizational skills
– Interaction
– Social interaction
– Attention and participation
CCF # 9012, Problem 21,
Speech, Nursing, Spring 97
Initial Rating
Final Rating
Knowledge:
2
Knowledge:
4
Behavior:
2
Behavior:
4
Status:
3
Status:
4
CCF #9513, Problem 21, Speech,
Fall 98
Initial Rating
Final Rating
Knowledge: 4
Knowledge:
3
Behavior:
3
Behavior:
4
Status:
3
Status:
4
CCF # 9073, Problem 30,
Digestion-Hydration, Spring 99
Initial Rating
Final Rating
Knowledge:
2
Knowledge:
4
Behavior:
2
Behavior:
3
Status:
2
Status:
3
CCF # 9033, Problem 21,
Speech, Fall 98 - Spring 99
Initial Rating
Final Rating
Knowledge:
2
Knowledge:
4
Behavior:
2
Behavior:
4
Status:
3
Status:
4
CCF #9075, Problem 07, Social
Contact, Fall 98 - Spring 99
Initial Rating
Final Rating
Knowledge:
1
Knowledge:
3
Behavior:
2
Behavior:
3
Status:
2
Status:
3
CCF #9012, Problem 38, Personal
Hygiene, Spring 97
Initial Rating
Final Rating
Knowledge:
2
Knowledge:
4
Behavior:
2
Behavior:
4
Status:
3
Status:
4
CCF # 9036, Problem 39,
Substance Use, Spring 97
Initial Rating
Final Rating
Knowledge: 2
Knowledge: 4
Behavior:
2
Behavior:
2
Status:
Status:
3
3
Outcomes Interpersonal Relations:
Crossroads S 95 - F 98
Average Omaha Ratings All Contacts
Across Semesters
5
4
3
Knowledge
Behavior
Status
2
1
0
S 95
N = 15
F 95
S 96
F 96
N = 34
N = 28
N = 20
F 98
N=5
Note: Typical interventions: Health Teaching & Surveillance
Typical targets: Communication & Interactions
Additional Resident Outcomes
Decrease
in symptoms
Community tenure
Increased use of
community resources
Attendance at OT
Clinic on campus
Increased use of City
& University libraries
Employment
More independent
housing
Participation in City
Recreation Program
Enrollment in College
and University
Volunteer jobs
Cost Savings Study
Crossroads Village: 1993-94
N=25
(9 -12 month)
By using Crossroads Village,
25 persons achieved tenure with total
savings of $369,471 in the following areas:
–
–
–
–
Locked facility costs
Emergency psychiatric services costs
Acute in-patient psychiatric services costs
Contract services costs
Outcomes
Fall 1993 - Spring 1999
22,837 hours direct care
321 undergraduates
59 graduate students
10 faculty
Evaluating Student Learning
Transdisciplinary
Seminar
Supervision Groups
Logs
Direct Observation
Process Recordings
Care Plans
One to one
Challenges and Issues
Conflicts in missions
Supervision of nonnursing students on site
Staffing during nonacademic times
Maintaining faculty
interest
Role strain
Students dropping clients
Inadequate space to meet
with students
Lack of university support
Staff turnover
Client hospitalizations
Communications
Cutbacks in county
funding
Obtaining permission to
provide services from
conservators and case
managers
Conflicts with OT clinic
schedule
Outcomes of Collaboration
Clearly, the closer educators, researchers,
consumers, practitioners, and families
come together in the service area, the
more likely that curricula will be reality
based and congruent with clients’ needs.
At the same time, the possibility of
improving the quality of life increases.