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Enhancing Interdisciplinary Knowledge of Allied Health Students through Communitybased Programming


The team model preference of students for effective community-based programming ... Trudel, T.M., Nidiffer, F.D., & Barth, J.T. (2007) ... – PowerPoint PPT presentation

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Title: Enhancing Interdisciplinary Knowledge of Allied Health Students through Communitybased Programming

Enhancing Interdisciplinary Knowledge of Allied
Health Students through Community-based
University of New Hampshire
  • Helmi Churcher, B.S. Michael Fraas, PhD
  • University of New Hampshire
  • Department of Communication Sciences Disorders

  • Participants will learn about..
  • A community-based program for adults with ABI
  • Students definitions of teamwork and
    community-based rehabilitation
  • The team model preference of students for
    effective community-based programming
  • Students perceptions of advantages and
    disadvantages of teamwork
  • Students choice for leadership in the stroke
    rehabilitation team
  • Students perception of the SLP role in
    rehabilitating adults with ABI

Mission and Vision
  • Mission dedicated to improving the lives of
    people living with brain injury from trauma,
    tumor or stroke.
  • You are not who you were, be who you are.

Needs Assessment
  • NH needs assessment found little support in the
    New England region.
  • TKBIF needs assessment found
  • Lack of recreation
  • Impaired social relations
  • Difficulties with friendship
  • Depression/Anxiety
  • Decreased substantial gainful activities
  • employment, education, volunteerism

  • Established in 2000, designed to meet long term
    needs of persons living with ABI and to integrate
    them into their community and society.

The Beginnings
  • Reciprocal relationship between SS the
    University of New Hampshire
  • Began in 2000 with OT department
  • 6 Student interns 1 faculty member

The Relationship Now
  • UNH departments
  • Occupational Therapy
  • Communication Sciences Disorders
  • Therapeutic Recreation
  • Social Work
  • Family Studies
  • Psychology
  • Whittemore College of Business
  • Fall 2008 40 student interns 10 UNH faculty
  • Along with community volunteers, they help
    provide 8600 in-kind volunteer hours

Student Benefits
  • Client centered model
  • Team approach
  • Practice assessment tools
  • Develop professional documentation skills
  • Become comfortable with addressing emotions
  • Role reversal learning from members

Student Benefits
  • Develop knowledge of the roles of colleagues in
    allied health professions (AHP)
  • Facilitate group activities
  • Flexibility - expecting the unexpected.
  • Develop adaptations to meet individual needs.
  • Insight into QOL following traditional rehab
  • Learn to establish professional boundaries

Introduction to Study
  • Purpose Determine if academic experience as
    teams in an interdisciplinary setting influences
    AHP students thinking regarding teamwork and the
    SLP role.
  • Long-term support for survivors of ABI can be met
    through community-based programming 1, 2
  • Programs should provide a comprehensive and
    holistic approach 1, 3
  • Effective rehabilitation requires AHP to
    consistently cooperate and coordinate treatment
    4, 5

Introduction to Study
  • Role overlaps possibly perceived as an
    intrusion of autonomy rather than leading to
    collaboration 6
  • Previous studies found role confusion
    regarding amnesia OT and SLP students
    differing opinions regarding SLPs involvement
  • Felcher and Ross - majority of AHP felt lack of
    knowledge of other team members roles
    detrimental to teamwork 8.
  • AHP knowledge of one anothers roles is
    imperative to effective teamwork

  • Students were enrolled in occupational therapy,
    communication sciences and disorders, and
    therapeutic recreation courses.
  • Courses educated them about therapeutic
    techniques for meeting the long-term needs of
    individuals with ABI.

  • Survey
  • 90 item survey modified from versions by Felcher
    Ross 8 and Insalaco 6
  • Likert Scale responses (1 Strongly Disagree, 2
    Disagree, 3 Undecided, 4 Agree, 5
    Strongly Agree)
  • Open-ended questions requesting comments

  • Procedure
  • Surveys were administered pre and post
    involvement in a community-based rehabilitation
    program for adults with ABI
  • Semester-long internship
  • Student teams facilitated group activities that
    addressed long-term needs of ABI survivors.
  • Meetings highlighted AHP roles, teamwork models,
    goals and outcomes of daily group activities.

  • Quantitative responses were analyzed using SPSS
  • Mean scores were calculated from Likert Scale
  • Nonparametric tests Wilcoxon, Kruskal-Wallis,
    Chi-Square analysis to determine significant
  • Qualitative responses underwent thematic analysis
    and examination for intercoder agreement.

Results Biographical Data
  • Previous academic exposure to teamwork approaches

Results Qualitative Findings
  • Students definition of community-based
    rehabilitation identified four themes
  • utilizes the local community (55)
  • holistic (49)
  • functional skill restoration (49)
  • collaborative (35)

Student Definition of Community-based
  • Community centered rehabilitation can focus not
    only on the individual with the disability, but
    family members also. Looks at many aspects of
    life. It can be all encompassing emotional,
    social, ADL, community support and awareness.
    Focus is not always direct rehab, but how the
    disabled individual and the community can work
    together towards a common goal of help, support
    and acceptance.
  • - SLP undergraduate student

Results Qualitative
  • Student Definition of Teamwork
  • 96 of students made reference to the
    collaborative nature of teamwork in their
  • The most commonly used phrase was working
    together for a common goal.
  • Sharing knowledge and the need for communication
  • Varied disciplines and different skill sets
    coming together (33)

Student Definition of Teamwork
  • A common goal, without discipline, where each
    member plays a role and understands the role of
    all other members through communication and
  • Commenting on the internship experience, the
    student noted
  • I think that the SteppingStones experience of a
    transdisciplinary team could be made better if
    each discipline had a clear understanding of the
    others before the semester started.
  • - SLP graduate student

Team Models
Autonomy Collaboration 6
  • Interdisciplinary
  • Professionals independently assess and treat
  • Communication to coordinate services (sometimes
    directed by one professional)
  • Each professional may not always be directly
    involved with client
  • Transdisciplinary
  • Professionals share knowledge and skills
  • across disciplines
  • Help each other
  • perform activities
  • Work together while performing
  • assessments
  • One team member may perform the treatment
  • plan issued by the group
  • Multidisciplinary
  • Professionals independently assess and treat

In a community-based rehabilitation setting,
students clearly preferred models characterized
by collaboration over autonomy.
Student Comments on the Transdisciplinary Model
  • In a transdisciplinary approach, different
    disciplines can be working on different goals
    through the same activity. This is optimal
    especially in a rehab hospital where lengths of
    stay are shorter.
  • - TR graduate student

A Hindrance to Achieving the Transdisciplinary
  • Lack of knowledge of other disciplines expertise
    and function.
  • I would love to say that Transdisciplinary would
    work best, but each different discipline has
    specific knowledge of their own field and, in my
    experience, do not always have respect for the
    other fields. My own belief is that this is due
    to ignorance of the training, education, and
    experience that the members of the other fields
    have and misunderstanding just what the field
  • - TR undergraduate student

  • Increased awareness of advantages and
    disadvantages of teamwork
  • Post scores were subtracted from pre.
  • Negative mean change scores indicate Likert
    scale means were closer to agree in the post
  • Wilcoxon tests found a significant rise in the
    perception that teamwork is advantageous in two
  • Pre and post students agreed with all
    advantages, showing their belief teamwork is

  • Greatest increase in awareness of professional
  • Disadvantages with highest post means
  • Communication problems (3.9)
  • Lack of knowledge of others roles (3.8)

Stroke Rehabilitation Team Leadership
  • Case Study Patient X
  • 55 year old male who suffered a stroke (left
    cerebral hemorrhage).
  • Right hemiplegia
  • Very limited expressive language
  • Alexia
  • Agraphia
  • Severe depression.
  • Who in your opinion should be primarily in charge
    of the stroke rehabilitation team for patient X?

Shared Leadership Preferred in Pre and Post
Tests SLP 83, 78 OT 77, 71 TR 79, 79
Who Should Lead the Rehabilitation Team?
  • Rehabilitation from a stroke is definitely a
    team process, and it should involve many
    individuals, so the patient has the best chance
    of achieving success. SLP graduate
  • By working together the professionals can
    reinforce each others goals in their own
    programs. If the OT wants the patient to work on
    fine motor skills, the TR can come up with
    activities that involve fine motor skills. If
    everyone works together and shares the
    leadership, the patient gains more in the end.
    TR undergraduate
  • As the pt's abilities and life experiences
    change, so shall the leaders. SLP undergraduate

Territorial Disputes?
  • OT has a holistic approach covering all
    performance areas that are affected. OT
  • OT would be able to focus on the person as a
    whole and would address the depression as well as
    the issues regarding loss of movement and some
    communication problems. The speech therapist
    would be important for communication issues,
    however, wouldnt address the other aspects.
    OT undergraduate

  • As a whole, participants became more aware of
    SLP involvement in treatment of these disorders.
  • Wilcoxon test found significant amount of change
    pre to post for hemianopsia, amnesia, and
  • Amnesia had the greatest mean change to more
    agreement that it is part of the SLP role.

Perception of Amnesia and the SLP Role
  • Increase in groups awareness of SLP treatment of
    amnesia pre mean 3.40 to post 4.06 (undecided to
  • Previous studies have found that amnesia is a
    place of role confusion as OT and SLP students
    often had differing opinions as to the SLPs
    involvement in treatment of memory impairment
  • OT became more aware of amnesia in the SLP role,
    but not to the same degree as SLPs
  • Post-test SLP strongly agree, (mean 4.78)
  • Post-test OT agree (mean 3.60)
  • OT perception of SLP treatment of amnesia
    improved from undecided (pre mean 2.87).

Student Value of Academic Preparation Regarding
  • For professionals to be able to work together as
    a team, they need to work together as students.
  • Pre and post test means Agree
  • Teamwork is essential in the professional
    world, and working together as students helps
    build those skills. OT undergraduate

  • Results show changes in students thinking after
    academic experience as teams in an
    interdisciplinary setting.
  • Teamwork model
  • Advantages and disadvantages of teamwork
  • SLP Role
  • Co-treating and group discussions that occurred
    at the SteppingStones internship likely
    influenced students thinking.

  • This generation of AHP is very partial to
    collaboration and cross-training.
  • Majority of students preferred a
    transdisciplinary approach and shared stroke team
  • Insalaco et al. similarly found OT and SLP
    preference of collaborative models 6
  • Our students comments indicate a desire to
    better understand one anothers roles and how to
    function as a team.

Implications for the Future
  • Enhancing AHP training programs to address the
    need for greater interdisciplinary awareness
  • Increased interdepartmental research, coursework,
    and clinical practice among students and faculty
  • AHP scopes of practice and overlaps outlined to
  • Role clarification for disorders and
    responsibilities often in question, e.g.,
  • Teach benefits of and appropriate circumstances
    for each team model, i.e., multidisciplinary,
    interdisciplinary, and transdisciplinary
  • Teach interpersonal communication and conflict
    resolution skills to overcome disadvantages of
  • Community-based rehabilitation programs
  • Extend services for survivors of ABI
  • Setting conducive to collaboration, where
    students gain knowledge of teamwork and
    colleagues roles
  • More interdisciplinary AHP academic programs
    should be implemented and made available to all

Benefits of AHP training program enhancements
  • Better professional teams that in turn benefit
    rehabilitation patients
  • Shared information regarding assessment and
    treatment activities
  • Increased respect and understanding

  • Fraas, M., Balz, M., Degrauw, W. (2007).
    Meeting the long-term needs of adults with
    acquired brain injury through community-based
    clubhouse programming. Brain Injury, 27 (12)
  • Glenn, M. B., Goldstein, R., Selleck, E. A.,
    Rotman, M. (2004). Characteristics of
    facility-based community integration programs for
    people with brain injury. J Head Trauma Rehabil,
    19(6), 482-493.
  • Trudel, T.M., Nidiffer, F.D., Barth, J.T.
    (2007). Community-integrated brain injury
    rehabilitation Treatment models and challenges
    for civilian, military, and veteran populations.
    Journal of Rehabilitation Research Development,
    44 (7) 1107-1016.
  • Tervo, R. C., Palmer, G., Redinius, P. (2004).
    Health professional student attitudes towards
    people with disability. Clin Rehabil, 18(8),
  • Corrigan, J. D., Whiteneck, G., Mellick, D.
    (2004). Perceived needs following traumatic brain
    injury. J Head Trauma Rehabil, 19(3), 205-216.
  • Insalaco, D., Ozkurt, E., Santiago, D. (2007).
    The perceptions of students in the allied health
    professions towards stroke rehabilitation teams
    and the SLP's role. J Commun Disord.
  • Insalaco, D., Ozkurt, E., Santiago, D. (2006).
    Attitudes and knowledge of students in the allied
    health professions toward their future
    professional team members. J Allied Health,
    35(3), 142-146.
  • Felsher, L., Ross, E. (1994). The knowledge and
    attitudes of occupational therapy, physiotherapy
    and speech-language therapy students, regarding
    the speech-language therapist's role in the
    hospital stroke rehabilitation team. S Afr J
    Commun Disord, 41, 49-63.
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