Facilitating Interprofessional Collaboration Among Those Who Provide Services to Children with Disabilities in the Community: Shifting Focus from Pathology to Participation

1
Facilitating 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

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Outline

• Current process of service delivery
• A new model for service delivery
• The University of Ottawa Interprofessional
  Rehabilitation University Clinic
• Case study

3
Present 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

4
Adoption 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

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Disability 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

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CAOTHealthy 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

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DCPFougeyrollas, 1998
Personal Factors
Oragnic Systems
Skills
Organic Systems
Skills
Oragnic Systems
Skills
Integrity ltgt deficiency
Capacities lt gt Incapacities
Integrity ltgt deficiency
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The 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

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Vision of the clinic
Interprofessionalism
Technology
SERVICES
Life habits / Social participation
2006
2010
2008
Ottawa
National
Near-North, Northern and Eastern Ontario
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Target 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

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Target 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

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Interprofessional services (2006-08)

• Collaboration between the various
• professions
• Audiology
• Kinesiology
• Medicine
• Nursing
• Occupational therapy
• Physiotherapy
• Speech-language pathology

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SCREENING 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
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Case 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

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Assessment 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

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Assessment 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

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Suggested Therapy Goals Following SLP Assessment

• Reformulating
• Modeling
• Forced choice making
• Vocabulary building activities
• NOTE
• No recommendation to consult occupational
• therapist, physiotherapists or other professional

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Results 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

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Results 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

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Results of the Clinic S-LP Assessment

• Speech and language assessment similar results
• Following the LIFE-H recommended consults in
  occupational therapy and physiotherapy

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Results 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

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Suggested 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

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Suggested 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

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Comparison 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

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Advantages of the Interprofessional Model

• Early diagnosis of more invasive disorders
• Achieve goals earlier
• Allows professionals to see more clients

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References

• 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.

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Service 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.

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CAOT 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)

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Interprofessional 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

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Obstacles to Interprofessional Collaboration

• Structure of the Health Care System
• Structure of the Education System
• Health Care and Education Professionals Working
  in Separate Systems