Transdisciplinary Collaboration: A Demonstration ProjectPhyllis M. Connolly, PhD, RN, CS Phyllis M. Connolly, PhD, RN, CS

Jean M. Novak, PhD, CCC-SLPJean M. Novak, PhD, CCC-SLP San Jose State University, San Jose, CA San Jose State University, San Jose, CA

Discuss the driving forces related to the need for

transdisciplinary collaborationRecognize discipline specific assessment tools and interventions

use for SJSU Transdisciplinary ProjectIdentify client specific outcomes based on the Omaha

Documentation System

ObjectivesObjectives

Societal Shifts

Nationalism replaced with global economy

Social ecology--needs for integration & connections

Social capital--networks, norms, trust, coordination & cooperation

TRENDS

New organizations New forms of delivery

systems-- managed care

New ways of relating to each other

Smaller companies Outsourcing Disease management

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

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

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.

Project Goal

Transdisciplinary Collaboration ProjectSan Jose State UniversitySan Jose State University

Office of Sponsored ProgramsOffice of Sponsored ProgramsCollege of Applied Sciences and ArtsCollege of Applied Sciences and Arts

School of Nursing School of Nursing Nurse Managed CentersNurse Managed Centers

Communication Disorders & Sciences:Communication Disorders & Sciences: Program & ClinicProgram & Clinic

Department of Occupational TherapyDepartment of Occupational TherapyDepartment of Recreation & Leisure Studies: TRDepartment of Recreation & Leisure Studies: TR

College of Social WorkCollege of Social WorkInstitute for Teaching & LearningInstitute for Teaching & Learning

Faculty and StudentsFaculty and StudentsRevised 5/99Revised 5/99

Psychosocial.Psychosocial.Occupational Occupational Therapy ClinicTherapy Clinic

Santa ClaraSanta ClaraCountyCountyMentalMentalHealthHealth

Santa Clara CountySanta Clara CountyAlliance for theAlliance for the

Mentally IllMentally Ill

ALLIANCE for ALLIANCE for Community CareCommunity Care

Zoe HouseZoe HouseCrossroads VillageCrossroads Village

Casa FelizCasa Feliz

ResidentsResidentsStaffStaff

FamiliesFamilies

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

LawsLaws

Administration ofAdministration ofJusticeJustice

CommunityCommunity

Friends and PeersFriends and Peers

LawsLaws

Mental Health Mental Health SystemSystem

Social PolicySocial Policy

LegislationLegislation

ChurchChurch

FamilyFamily

UniversityUniversity

Training ofTraining ofProfessionalsProfessionals

PersonPerson

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 lifeImproved quality of life

Competence Paradigm: Health Based

View of Families: CompetentEmphasis on: StrengthsRole of Professionals: Enabling AgentsAssessment: CompetenciesGoal of Interventions: EmpowermentModus Operandi: AdaptationPerspective: Ecological Framework

Transdisciplinary Project

S em in ar A M IM eetin g s

P rac ticu m

S TU D E N TS F A C U L TY S TA F F

•weekly•campus•case presentation•discipline information•discussion & feedback

Caring & Sharing •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 IV. Health Related Behaviors

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

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 4 5

Knowledge Noknowledge

Mini-mal

Basic Adequate Superior

Behavior Notappropriate

Rarely Incon-sistently

Usually Consis-tently

Status ExtremeS&S

SevereS&S

ModerateS&S

MinimalS&S

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 disciplinePrimary discipline Assess and evaluate

problems and needs Treat & evaluate Seek consultation &

referrals Collaborate

Supportive disciplineSupportive discipline 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

Knowledge: 2

Behavior: 2

Status: 3

Knowledge: 4

Behavior: 4

Status: 4

Initial Rating Final Rating

CCF #9513, Problem 21, Speech, Fall 98

Knowledge: 3

Behavior: 3

Status: 3

Knowledge: 4

Behavior: 4

Status: 4

Initial RatingInitial Rating Final RatingFinal Rating

CCF # 9073, Problem 30,Digestion-Hydration, Spring 99

Knowledge: 2

Behavior: 2

Status: 2

Knowledge: 4

Behavior: 3

Status: 3

Initial RatingInitial Rating Final RatingFinal Rating

CCF # 9033, Problem 21, Speech, Fall 98 - Spring 99

Knowledge: 2

Behavior: 2

Status: 3

Knowledge: 4

Behavior: 4

Status: 4

Initial RatingInitial Rating Final RatingFinal Rating

CCF #9075, Problem 07, Social Contact, Fall 98 - Spring 99

Knowledge: 1

Behavior: 2

Status: 2

Knowledge: 3

Behavior: 3

Status: 3

Initial RatingInitial Rating Final RatingFinal Rating

CCF #9012, Problem 38, Personal Hygiene, Spring 97

Knowledge: 2

Behavior: 2

Status: 3

Knowledge: 4

Behavior: 4

Status: 4

Initial RatingInitial Rating Final RatingFinal Rating

CCF # 9036, Problem 39, Substance Use, Spring 97

Knowledge: 2

Behavior: 2

Status: 2

Knowledge: 4

Behavior: 3

Status: 3

Initial RatingInitial Rating Final RatingFinal Rating

Outcomes Interpersonal Relations:Crossroads S 95 - F 98

0

1

2

3

4

5

S 95 F 95 S 96 F 96 F 98

Average Omaha Ratings All Contacts Across Semesters

KnowledgeBehaviorStatus

N = 15 N = 34 N = 28 N = 20

Note: Typical interventions: Health Teaching & SurveillanceTypical targets: Communication & Interactions

N = 5

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 StudyCrossroads 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

OutcomesFall 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 non-

nursing students on site Staffing during non-

academic 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.