Growing Together, Interprofessionally At a recent ASHA online conference, attendees chatted with Bill Ogletree—a proponent of collaborative, team-based solutions—about the opportunities and challenges inherent in interprofessional practice. The Leader was there. Overheard
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Overheard  |   September 01, 2014
Growing Together, Interprofessionally
Author Notes
  • Bill T. Ogletree, PhD, CCC-SLP, is professor and head of the Department of Communication Sciences and Disorders at Western Carolina University. ogletree@email.wcu.edu
    Bill T. Ogletree, PhD, CCC-SLP, is professor and head of the Department of Communication Sciences and Disorders at Western Carolina University. ogletree@email.wcu.edu×
Article Information
ASHA News & Member Stories / Overheard
Overheard   |   September 01, 2014
Growing Together, Interprofessionally
The ASHA Leader, September 2014, Vol. 19, online only. doi:10.1044/leader.OV.19092014.np
The ASHA Leader, September 2014, Vol. 19, online only. doi:10.1044/leader.OV.19092014.np
Liz Ehrstein: Interprofessional education sounds like a good idea. Interprofessional practice, however, is a challenge. What are some suggestions for getting started when days are so busy?
Bill Ogletree: I know how busy things can be. My suggestion is to start with low-hanging fruit: find a couple of peers in your setting that are willing to set some modest goals around collaborating. I have seen this work and turn into bigger opportunities.
Kathleen Thompson: To tag along with that, how are people charging so it does not look like duplication?
Ogletree: I work in a setting where this is not an issue—the university. That said, I know the real world requires us to charge and pay our way. I would like to hear from others, but my thought is that working together—but from different points of view—would be billable.
Kristyn Nunes: I would think that each discipline would be able to bill. Each clinician is still providing a service.
Ogletree: I agree with this. I’m wondering if Diane [Paul] has an opinion here as an ASHA expert.
Diane Paul: For resources related to billing and reimbursement, I suggest going to on.asha.org/asha-reimburse. You may want to contact Janet McCarty directly at jmccarty@asha.org. She is ASHA’s private health plans advisor. [And] I found some information about reimbursement and billing that is more specific to interprofessional collaboration: a Leader article, “How Do We Make Interprofessional Collaboration Happen?” from the June 2013 issue.
Lindsey Broom: In my district, we were told that it is OK to co-treat as long as we are working on different goals during that time. So we address each other’s goals together through our activities, but write the progress and activities to address our own goals in our notes in the system when we bill Medicaid.
Nunes: Parental involvement in goal-setting, treatment sessions and carryover into the home is essential. I feel that lots of the time parents and caregivers feel overwhelmed when they are asked to a team meeting. What are some ways to get parents more involved in the process?
Ogletree: Parent involvement starts early, with how you engage the parent. With your nature as you bring them in as team members. If you are invested in them, they will invest in you and be a part of solutions from that point on.
Paul: There is a Leader article from Nov. 2013, “Overheard: Getting Parents on Your Side,” by Joni Alberg and Tamala Bradham, which provides some useful strategies to increase parental engagement.
Ehrstein: Do you have suggestions for ways to deal with service breaks—different providers, different schools, more and less investment?
Ogletree: That is such a real-world situation. I know that I have served so many children that have moved from my area. I have also seen providers change. I think the answer is to work to assist one another in transitions. A lot of the strands in [this conference] have been devoted to using technology to do this type of thing. Of course, we can do the easy thing like make a call to a former provider, and keep in contact with the parents in transition.
Ogletree: I have a question for the group: I wonder just how prepared folks feel to work with other professionals. Are you getting trained to do this?
Jody Terry: I was not trained so much, but my first job included work with cleft palate teams and there it is clear what you do, who does what and that the goal is—always a plan for the child.
Ogletree: I think you are the norm—training on the job. David Westling [of Western Carolina University] said that he encounters too many professionals that just do not know enough to work together. I think that is a call for [conferences] like this and for more pre-service training in prep programs and grad schools.
Megan McCall: I also just learned on the job in a setting for children with multiple impairments.
Ogletree: Wow … now that is a challenging setting to learn to work with others. As long as team members don’t own their turf you can get it done. That is a big part of success with learning interprofessional work on the job: being open to each other, not worrying about making a mistake, growing together.
Kristy Davies: I have never heard of a training or class on learning to work with other professionals, and it’s just been “each year teaches for the next” and “collaboration with supervision as to best practice” and such—that is, how to communicate and interact with other professionals.
Ogletree: Universities are now moving to interprofessional education. My university’s college of health now requires cross-disciplinary training on certain cases. It is great and a little scary. The end product is that we know more about each other, and we are ready to work together as folks finish.
Christina Stauble: I worked with an occupational therapist and physical therapist trained in neurodevelopmental treatment, which helped with arm and hand movements to use Dynavox [a speech-generating device].
Ogletree: I’m sure that was very helpful.
Kathleen Cassidy: We use an integrated therapy model that puts us directly in the classroom with the teacher and other professionals. This model—along with professional development with other professionals—and weekly team meetings provide on-the-job training for all of us.
Ogletree: That is ideal. You clearly have a group of administrators that value the benefits of interprofessional work. Did you know that there is a growing literature saying that client satisfaction goes up with this type of work? Also there can be more effective and efficient outcomes.
Melony Anne O’Flaherty: I think it depends on the people you are involved with, too—whether co-treatment is comfortable or not. I know that I feel more secure with students when I have multiple sources of information from various professionals.
Ogletree: Absolutely. Two heads are typically better than one, especially when those two heads have been trained to look at things differently. I think we often get a little too discipline-specific and narrow with the problems we see. Especially with this population.
Jennifer Greenfeld: When I started working out of school in a public special center, it took a while to get used to teaming and not existing with only my own goals. Probably over the course of the first semester it was a learning curve, but now I cannot imagine having to go back to treating on my own. Everyone has a different perspective that seems to make all treatments much more valuable to the student.
Ogletree: I think this is pretty typical. My wife co-treats with a wonderful physical therapist. The things they do together, they could not do alone. Much of their activities involve movement with big kids. The physical therapist is all about making the movement efficient and my wife is all about promoting communication. What they tell me is that after a while, you can’t tell them apart. They are working on each other’s goals as well as their own.
Sandra Crawford: I would like to ask the folks who do work as a team, how they work with very different interpretations of the learner’s behavior and what it means or, put another way, different interpretations of what he needs to learn. Does that ever happen in your team?
Ogletree: This has happened to me a lot. I have viewed behavior as communication, for example, and a psychologist has viewed it as something to get rid of. I think the key is to communicate. You have to have literature to back up your point of view. But you also have to listen to others’ points respectfully. Maybe this has happened a lot to me because I’m wrong a lot, LOL.
Nunes: Wouldn’t you think that using an integrated therapy approach would increase generalization across all school settings?
Ogletree: You would think so. I think the variation in trainers and settings would work to help skills generalize. This is another good reason to collaborate and push treatment out across providers and settings.
Christina Stauble: Yes! After so many of these chats I’m looking at charting behavior to determine communicative patterns.
Ogletree: Behavior is a big area that is misunderstood. We have to remember that all behavior may not signal communicative intent. That said, looking at what occurred before and after the behavior can really help us generate some solid conclusions.
Judy Price: I do not think that speech-language pathologists have done enough to educate other disciplines about our areas of knowledge and expertise. I am surprised at how many teachers have no idea of the kind of training we go through. An extreme example is that one teacher thought that as an SLP, I was an instructional aide. This was before schools started having speech-language pathology assistants. I have found that once other professionals have an inkling of what we know and what we can do, they are much more willing to listen and collaborate.
Ogletree: I know we can do more. Part of that is on us. We have to get the word out about what we do and how it impacts this population. Part of this is on organizations like ASHA. I have to say that they do a great job. That said, we need more venues to share what we do.
Audra Vanderland: I have been a special education teacher for 10 years, but now am a mom to an 8-year-old with multiple disabilities that I adopted. It has been really difficult to get her staff to think in a transdisciplinary way, and to work together on all the goals, even though she has physical therapy, occupational therapy, speech and vision—all of which are needed on everything she works on. Even harder, though, has been to hear my voice shut down or belittled, because I am the parent and I “do not know.” I was trained in interdisciplinary [work], but I don’t think I was trained enough in really valuing and placing families at the center. How can we help our team members see the value of what parents know about their child—and want for their child?
Ogletree: Wow. I think you are probably dealing with a team that works in separate silos. My best recommendation is to bring it all back to the child. I bet a refocus on the child could move folks to be more collaborative. Could you call a meeting and bring these issues up within the context of establishing a better-working team?
Judy Price: Audra’s experience is not unique, but rather the norm. I also have a child with special needs, and even professionals who really do care can be extremely insensitive and dismissive of parents.
Ogletree: I think person-centered planning is probably a place to start with these teams that are not working well. Get the eyes back on the prize. [A reminder that] we are not in this for the money, we are in this because this population is important to us. A refocus could help teams get more invested.
Katie Samuelson: I work in human services with adults with disabilities, and I am wondering if you have any tips on how to collaborate with residential and day program staff. Many staff are wonderful advocates but have little formal education beyond high school working with people with disabilities.
Ogletree: I’m involved with a study now in my state. We are using Communication Partner Instruction—a training model by McNaughton and Kent-Walsh. I think it is a great structure to train folks from all walks. We have a pastor in the study, a direct care staff person, an SLP and a social worker. All of these guys are training on AAC applications together—check this out.
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