Enhancing Interdisciplinary Knowledge of Allied Health Students through Communitybased Programming

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Enhancing Interdisciplinary Knowledge of Allied
Health Students through Community-based
Programming
University of New Hampshire
SteppingStones

• Helmi Churcher, B.S. Michael Fraas, PhD
• University of New Hampshire
• Department of Communication Sciences Disorders

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Objectives

• 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

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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.

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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

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SteppingStones

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

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The Beginnings

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

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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

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Student Benefits

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

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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
  services.
• Learn to establish professional boundaries

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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

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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
  7.
• 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

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Subjects

• 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.

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Methods

• 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

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Methods

• 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.

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Statistics

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

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Results Biographical Data

• Previous academic exposure to teamwork approaches

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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)

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Student Definition of Community-based
Rehabilitation

• 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

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Results Qualitative

• Student Definition of Teamwork
• 96 of students made reference to the
  collaborative nature of teamwork in their
  definition.
• The most commonly used phrase was working
  together for a common goal.
• Sharing knowledge and the need for communication
  (13)
• Varied disciplines and different skill sets
  coming together (33)

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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
  education.
• 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

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Team Models
Autonomy Collaboration 6

• Interdisciplinary
• Professionals independently assess and treat
  client
• 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
  client

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In a community-based rehabilitation setting,
students clearly preferred models characterized
by collaboration over autonomy.
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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

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A Hindrance to Achieving the Transdisciplinary
Model

• 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
  does.
• - TR undergraduate student

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• 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
  test.
• Wilcoxon tests found a significant rise in the
  perception that teamwork is advantageous in two
  ways.
• Pre and post students agreed with all
  advantages, showing their belief teamwork is
  beneficial.

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

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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?

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Shared Leadership Preferred in Pre and Post
Tests SLP 83, 78 OT 77, 71 TR 79, 79
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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

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Territorial Disputes?

• OT has a holistic approach covering all
  performance areas that are affected. OT
  undergraduate
• 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

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• 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
  proprioception.
• Amnesia had the greatest mean change to more
  agreement that it is part of the SLP role.

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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
  agree)
• 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
  5.
• 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).

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Student Value of Academic Preparation Regarding
Teamwork

• 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

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Discussion

• 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.

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Discussion

• This generation of AHP is very partial to
  collaboration and cross-training.

• Majority of students preferred a
  transdisciplinary approach and shared stroke team
  leadership
• 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.

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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
  8
• AHP scopes of practice and overlaps outlined to
  students.
• Role clarification for disorders and
  responsibilities often in question, e.g.,
  amnesia.
• 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
  teamwork.
• 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
  students

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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

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References

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• Trudel, T.M., Nidiffer, F.D., Barth, J.T.
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• Insalaco, D., Ozkurt, E., Santiago, D. (2007).
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• Insalaco, D., Ozkurt, E., Santiago, D. (2006).
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• Felsher, L., Ross, E. (1994). The knowledge and
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