Title: Facilitating Interprofessional Collaboration Among Those Who Provide Services to Children with Disabilities in the Community: Shifting Focus from Pathology to Participation
1Facilitating Interprofessional Collaboration
Among Those Who Provide Services to Children with
Disabilities in the Community Shifting Focus
from Pathology to Participation
- Rose Martini, PhD, OTReg (Ont), OT (C),
- Lynn Metthé, M.Sc.S., SLP, Reg. CASLPO
- Jacinthe Savard, MSc, OT(C)
- Claire-Jehanne Dubouloz, PhD, OT (C)
- Donna Klaiman, M.Ed, OTReg (Ont) OT(C)
- Occupational Therapy Program, University of
Ottawa - Canadian Association of Occupational Therapists
- Interprofessional Rehabilitation University
Clinic in Primary Health Care, University of
Ottawa
2Outline
- Current process of service delivery
- A new model for service delivery
- The University of Ottawa Interprofessional
Rehabilitation University Clinic - Case study
3Present Model of Health Focus on Absence of
Disease
- School-Aged Children
- First time expected to perform within a certain
norm - For many, milieu where difficulties are confirmed
or first identified - Traditional Biomedical Model
- Impairment focused
- Professionals tend to work independently
- Negotiating the maze
- Time and money
4Adoption of More Health-Focused Models
- A Call for More Health-Focused Models
- Engels bio-psycho-social model
- The Interactive Bio-psycho-social Model
- International Classification of Function
- Disability Creation Process
- Failed to Replace Biomedical Model
- Continued emphasis on disease
- Health inadequately defined
- Institutions are structurally rooted in the
biomedical model - Shared vision of health and function needed
- Structure that supports collaborative practice
5Disability Creation Process(Fougeyrollas, 1997)
- Adopted framework for The University of Ottawa
Interprofessional Rehabilitation University
Clinic - Service delivery focuses on
- Promoting, maintaining and increasing the
individual's social participation in life habits
in relation to the social and physical
environment
6CAOTHealthy occupation for children and youth
- Children and youth, regardless of age and
ability, have the right to participate in healthy
occupations - Healthy occupation is determined by a complex
interaction of personal and environmental factors
- Early detection and intervention is critical to
healthy occupation
7DCPFougeyrollas, 1998
Personal Factors
Oragnic Systems
Skills
Organic Systems
Skills
Oragnic Systems
Skills
Integrity ltgt deficiency
Capacities lt gt Incapacities
Integrity ltgt deficiency
8The University of Ottawa Interprofessional
Rehabilitation University Clinic
- This clinic will offer services
- in French,
- in primary health care including rehabilitation
- using an interprofessional approach
- will participate
- in the professional and interprofessional
education and training in health care for
francophone students living in a minority setting - and will become
- A centre for research on interprofessional health
care and community-based rehabilitation services
for the francophone community at the regional,
provincial and national level
9Vision of the clinic
Interprofessionalism
Technology
SERVICES
Life habits / Social participation
2006
2010
2008
Ottawa
National
Near-North, Northern and Eastern Ontario
10Target Populations
- Survey completed by our partners
- identified 3 populations
- Adults 50
- who have been discharged from a rehabilitation
centre or a hospital and are awaiting services
from the Community Care Access Centre - Whos needs are not considered a priority for
current out-patient services
11Target Populations
- Children 5
- Identified with mild communication or
developmental delays - Lack of
- services provided in schools
- support for families to maintain achieved goals
- support to teachers in elementary schools
- Caregivers working with these two populations
12Interprofessional services (2006-08)
- Collaboration between the various
- professions
- Audiology
- Kinesiology
- Medicine
- Nursing
- Occupational therapy
- Physiotherapy
- Speech-language pathology
13SCREENING LIFE HABITS (LIFE-H / MHAVIE)
Referral
DISCIPLINE SPECIFIC ASSESSMENT
Self-referral Health Professional
Referrals Community referrals
INTERPROFESSIONAL TREATMENT PLAN
INTERVENTION interprofessional care plan with
the client
14Case Study
- 5.5 year old girl
- Mother calls the clinic and reports that her
daughter, Sally, requires speech and language
intervention. She was assessed by the School
Board SLP but no intervention was provided - As recommended by the school, she was also
referred to the CCAC for occupational therapy
(wait time 1 year) - No concerns reported regarding gross motor
15Assessment Results Pre-university Clinic
- Recommendations from report card
- Sally would benefit from
- regular physical activity to improve gross motor
skills - activities such as finger painting, stringing
beads, and following mazes to improve fine motor
skills - reading stories, reciting nursery rhymes, playing
rhyming games, signing songs to improve overall
expressive language skills
16Assessment Results Pre-university Clinic
- S-LP Assessment
- Severe expressive language delay characterized by
limited vocabulary, reduced mean length of
utterances, poor syntax and morphology - Moderate receptive language delay affecting
vocabulary and understanding of complex syntax
and grammatical markers
17Suggested Therapy Goals Following SLP Assessment
- Reformulating
- Modeling
- Forced choice making
- Vocabulary building activities
- NOTE
- No recommendation to consult occupational
- therapist, physiotherapists or other professional
18Results of the LIFE-H / MHAVIE
- Nutrition difficulty using utensils
- Physical Condition clumsy, trips, difficulty
with stairs, will - sometimes fall off her chair
- Personal care requires cueing with organization,
difficulty - with zippers, laces, buttons
- Communication difficulty expressing her needs,
following - Commands
- Residence not applicable
19Results of the LIFE-H / MHAVIE
- Mobility difficulty on uneven surfaces, trips
frequently, difficulty getting - on and off the bus
- Responsibilities has not been given any by
parents - Interpersonal relationship does not respect
others personal - space
- Community life no concerns but limited
involvement - Education requires assistance to complete
homework - Work not applicable
- Leisure activities no concern but again limited
involvement
20Results of the Clinic S-LP Assessment
- Speech and language assessment similar results
- Following the LIFE-H recommended consults in
occupational therapy and physiotherapy
21Results From Combined Occupational Therapy and
Physiotherapy Assessment
- Movement Assessment Battery for Children (M-ABC)
- Manual dexterity 5th percentile
- Ball activities 5th percentile
- Standing balance below 5th percentile
- Total score 3rd percentile
- Test of Visual Motor Integration (VMI)
- Copying shapes and drawings 12th percentile
- Visual-motor coordination 58th percentile
22Suggested Therapy Goals Following
Interprofessional Assessment
- Communication and education (LIFE-H)
- Sally will
- use proper pencil grasp and have good posture
will working - be able to print the letters of the alphabet
- be able to cut shapes with curves and angles
- use action verbs appropriately
- spontaneously and consistently use three word
utterances - communicate her needs using the proper
grammatical form
23Suggested Therapy Goals Following
Interprofessional Assessment
- Physical condition, mobility, leisure (LIFE-H)
- Sally will be able to
- do the crab walk (5 meters)
- catch a ball with both hands
- maintain extension while lying down for 5 seconds
- stand on one foot for 5 seconds
- Personal care (LIFE-H)
- Sally will be able to
- tie a bow and fasten buttons independently
24Comparison Between the Biomedical Model and
Interprofessional Model
- All professions work collaboratively to
- achieve goals.
- OT reinforces the use of the personal pronouns
while working on fastening buttons - PT reinforces the use of action verbs while
working on stamina - S-LP incorporates scissor and gluing activities
while working on vocabulary building
25Advantages of the Interprofessional Model
- Early diagnosis of more invasive disorders
- Achieve goals earlier
- Allows professionals to see more clients
26References
- Canadian Association of Occupational Therapists.
(2004). Position statement on healthy occupations
for children and youth. Retrieved on April 25,
2007 from http//www.caot.ca/default.asp?pageid11
38 - Canadian Association of Occupational Therapists (
2006) Position Statement on Primary Health Care
Ottawa CAOT Publications. Retrieved on April 17,
2007 from http//www.caot.ca/default.asp?ChangeID
188pageID188. - Enhancing Interdisciplinary Collaboration in
Primary Health (EICP) (2005). The principles an
framework for interdisciplinary collaboration in
primary health care. Retrievd on April 17, 2007
from http//www.eicp.ca/en/principles/sept/EICP-Pr
inciples20and20Framework20Sept.pdf - Engels, G. L. (1977).The need for a new medical
model A challenge for biomedicine. Science, 196,
129-136. - Friend, M, Cook, L. (2000). Interactions
Collaboration skills for school professionals (3
ed.). New York Longman. - Fougeyrollas et al. (1997). Revision of the
Quebec classification handicap creation process
Lac St-Charles, Quebec International Network on
the Handicap Creation Process. - Fougeyrollas et al. (1998). La Mesure des
habitudes de vie (MHAVIE version 3.0). Lac
St-Charles, Québec Réseau international du
processus de production du handicap. - Fougeyrollas, P., Noreau, L. et al. (1999). Life
habits shortened version (LIFE H 3.0). Lac
St-Charles, Québec International Network on the
Disability Creation Process. - Henderson, S. E., Sugden, D. A. (1992).
Movement Assessment Battery for Children. Kent,
UK The Psychological Corporation. - Labonte, R. (2000). Health promotion and the
common good Toward a politics of practice. In D.
Callahan (Ed.), Promoting healthy behavior How
much freedom? Whose responisibilty? Washington,
DC Georgetown University Press. - Lindau, s. T., Luamann, E. O., Levinson, W.,
Waite, L. J. ( 2003). Synthesis of scientific
disciplines in pursuit of health the interactive
biospychosocial model. Perspectives in Bilogy and
Medicine, 45, s74s86. - McDowell, I., Newell, C. (1996). Measuring
health A guide to rating scales and
questionnaires (2nd ed.), New York Oxford
University Press. - Missiuna, C., Moll, S., Law, M. King, S., King,
G. (2006). Mysteries and mazes Parents
experiences of children with developmental
coordination disorder. Canadian Journal of
Occupational Therapy, 73, 7-17. - Morreim, E. H. (2000). Economic and other
incentives to modify health behavior. In
Promoting healthy behavior How much freedom?
Whose responisibilty? Washington, DC Georgetown
University Press. - Paul, S. Peterson, C. Q. (2001).
Interprofessional collaboration Issues for
practice and research. In Stanley Paul and Cindey
Q, Peterson (eds), Interprofessional practice in
occupational therapy. NewYork Hawthorn press.
27Service Delivery Models
- Multidisciplinary Model
- Each professional does his or her work
- Separately
- Interprofessional Model
- Clients may be assessed separately or with
- other professionals, but an integrated plan
- is formulated
- Transdisciplinary Model
- Assessment, treatment plans and
- interventions are carried out jointly or by
- another professional on the team.
28CAOT Interprofessional Collaboration
- provide leadership for the Enhancing
Interdisciplinary Collaboration in Primary Health
(EICP) initiative - Determine how to enable health professionals to
work together in an effective and efficient way
for the benefit of individuals and families - Interprofessional collaboration refers to the
positive interaction of two or more health
professionals, who bring their unique skills and
knowledge, to assist patients/clients and
families with their health decisions (CAOT,
2006)
29Interprofessional Collaboration
- Is voluntary
- Requires parity among professionals
- Based on mutual goals
- Depends on shared responsibility for
participation and decision making - Share resources
- Share accountability for outcome
30Obstacles to Interprofessional Collaboration
- Structure of the Health Care System
- Structure of the Education System
- Health Care and Education Professionals Working
in Separate Systems