Transdisciplinary Collaboration: A Demonstration Project Phyllis M. Connolly, PhD, RN, CS Jean M. Novak, PhD, CCC-SLP San Jose State University, San Jose, CA

1
Transdisciplinary Collaboration A Demonstration
ProjectPhyllis M. Connolly, PhD, RN, CS Jean M.
Novak, PhD, CCC-SLP San Jose State University,
San Jose, CA
Objectives

• Discuss the driving forces related to the need
  for
• transdisciplinary collaboration
• Recognize discipline specific assessment tools
  and interventions
• use for SJSU Transdisciplinary Project
• Identify client specific outcomes based on the
  Omaha
• Documentation System

2
Societal Shifts

• Nationalism replaced with global economy
• Social ecology--needs for integration
  connections
• Social capital--networks, norms, trust,
  coordination cooperation

3
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

4
Changing Work Environment

• Technology
• Demographics
• Managed Care
• Purchasers Influence
• Health Insurance Industry
• Changing Health Systems
• Telemedicine

5
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

6
Primary Care Collaboration Needed

• Anxiety disorders, depression substance
  abuse most frequently misdiagnosed in primary
  care practices

7
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
8
Transdisciplinary Collaboration Project
San Jose State University Office of Sponsored
Programs College of Applied Sciences and
Arts School of Nursing Nurse Managed
Centers Communication Disorders Sciences
Program Clinic Department of Occupational
Therapy Department of Recreation Leisure
Studies TR College of Social Work Institute for
Teaching Learning Faculty and Students Revised
5/99
Psychosocial. Occupational Therapy Clinic
Santa Clara County Mental Health
Santa Clara County Alliance for the Mentally Ill
ALLIANCE for Community Care Zoe House Crossroads
Village Casa Feliz
Residents Staff Families
9
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)

10
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.

11
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

12
Behavioral Ecological Model of Community Mental
Health
Laws Administration of Justice
University Training of Professionals
Community Friends and Peers
Church Family
Person
Laws Mental Health System
Social Policy Legislation
13
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 life

14
Competence Paradigm Health Based
15
Transdisciplinary Project
Caring Sharing

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

• 2 days/week
• on-site/campus
• client contact
• experience
• implementation
• evaluation

16
Assessment Outcome Tools

• Pragmatic Protocol
• Social Skills Rating Scale
• Canadian Occupational Performance
• Omaha Nursing Documentation System
• Allens Cognitive Levels
• Kohlman Evaluation of Living Skills
• Psychosocial Assessment
• CERT-Psych

17
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

18
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

19
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

20
Omaha Rating Scale
21
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

22
Approaches to Collaborative Outcomes

• Primary discipline
• Assess and evaluate problems and needs
• Treat evaluate
• Seek consultation referrals
• Collaborate

• Supportive discipline
• Validate treatment approach
• Assess, treat, recommend
• Collaborate

23
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

24
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

25
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

26
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

27
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

28
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

29
CCF 9012, Problem 21, Speech, Nursing, Spring 97
Final Rating
Initial Rating

• Knowledge 2
• Behavior 2
• Status 3

• Knowledge 4
• Behavior 4
• Status 4

30
CCF 9513, Problem 21, Speech, Fall 98
Initial Rating
Final Rating

• Knowledge 4
• Behavior 4
• Status 4

• Knowledge 3
• Behavior 3
• Status 3

31
CCF 9073, Problem 30,Digestion-Hydration,
Spring 99
Final Rating
Initial Rating

• Knowledge 2
• Behavior 2
• Status 2

• Knowledge 4
• Behavior 3
• Status 3

32
CCF 9033, Problem 21, Speech, Fall 98 - Spring
99
Final Rating
Initial Rating

• Knowledge 2
• Behavior 2
• Status 3

• Knowledge 4
• Behavior 4
• Status 4

33
CCF 9075, Problem 07, Social Contact, Fall 98 -
Spring 99
Initial Rating
Final Rating

• Knowledge 3
• Behavior 3
• Status 3

• Knowledge 1
• Behavior 2
• Status 2

34
CCF 9012, Problem 38, Personal Hygiene, Spring 97
Initial Rating
Final Rating

• Knowledge 4
• Behavior 4
• Status 4

• Knowledge 2
• Behavior 2
• Status 3

35
CCF 9036, Problem 39, Substance Use, Spring 97
Initial Rating
Final Rating

• Knowledge 2
• Behavior 2
• Status 2

• Knowledge 4
• Behavior 3
• Status 3

36
Outcomes Interpersonal RelationsCrossroads S 95
- F 98
N 15
N 34
N 28
N 20
N 5
Note Typical interventions Health Teaching
Surveillance Typical targets Communication
Interactions
37
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

38
Cost Savings StudyCrossroads Village 1993-94

• N25 (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

39
OutcomesFall 1993 - Spring 1999

• 22,837 hours direct care
• 321 undergraduates
• 59 graduate students
• 10 faculty

40
Evaluating Student Learning

• Transdisciplinary Seminar
• Supervision Groups
• Logs
• Direct Observation
• Process Recordings
• Care Plans
• One to one

41
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

42
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.