Bridging the Professional Divide Along with clear benefits, interprofessional collaboration can bring misunderstandings. Six bridge-builders share their strategies. Features
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Features  |   November 01, 2016
Bridging the Professional Divide
Author Notes
  • Nancy Volkers is a freelance medical writer based in Vermont. nvolkers@nasw.org
    Nancy Volkers is a freelance medical writer based in Vermont. nvolkers@nasw.org×
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Swallowing, Dysphagia & Feeding Disorders / School-Based Settings / Healthcare Settings / Professional Issues & Training / Features
Features   |   November 01, 2016
Bridging the Professional Divide
The ASHA Leader, November 2016, Vol. 21, 40-50. doi:10.1044/leader.FTR1.21112016.40
The ASHA Leader, November 2016, Vol. 21, 40-50. doi:10.1044/leader.FTR1.21112016.40
There’s no argument that interprofessional practice is key to better serving patients—a top priority for audiologists and speech-language pathologists.
School-based audiologists and SLPs, obviously, collaborate constantly with teachers, counselors, administrators and other school staff. And the same is true in health care: Eight out of 10 health care–based SLPs collaborate with other health care professionals in some way, according to a 2015 ASHA survey, and almost all of them are part of team meetings, patient and family meetings, and teams that develop treatment plans.
Meanwhile, more than half of audiologists in a 2014 ASHA survey reported daily or weekly work with other professionals on diagnosis and treatment. But when people across different professions work together, let’s face it: Sometimes, there can be tension. Territoriality, systemic failures, silos and lack of familiarity with other professions are some factors that can interfere with successful collaboration.
So how do you turn that tension into harmony? How do you tackle obstacles without causing offense? We talked with six communication sciences and disorders professionals to find out how they address differences of opinion and build trust.
Leslie Roerk, MS, CCC-SLP
Esophageal and Lung Institute, Pittsburgh
Team divider:
“I don’t know what you do.”
Bridge builder:
Regular face-to-face meetings
Early in her career, Leslie Roerk moved frequently, so she was often the “new kid” on the job. When she started a new position, Roerk would schedule two 15-minute in-service presentations on payday to explain what she did and why.
“This was before direct deposit,” she notes. “I knew that on payday, people would be available to pick up their checks. They were much more responsive once they understood the basics, and more likely to listen to my recommendations.”
When Roerk worked at a small rehab facility, the team held weekly meetings that lasted about an hour. “We’d review patients and talk about why we were doing what we’re doing. The social worker might say ‘OK, this patient is going home without care.’ And I’d say, ‘Well, I think they need care, and this is why.’ And we could talk about it,” she says.

“If a physician understands why we’re doing something and knows we’re putting the patient first, there is very little resistance.”

Roerk’s director and the facility’s administrator supported the meetings. “And our regional director supported it, because he saw the benefit—it would actually save us time, if we came prepared and made decisions.”
The meetings also built relationships and trust. “I can’t think of a time there that a physician ever went against one of my recommendations,” Roerk says. “I think the greatest strategy in any setting is building relationships.”
Roerk is starting up head and neck cancer outpatient clinics at two hospitals. The clinics will work with newly diagnosed head and neck cancer patients to help them maintain the ability to chew and swallow. The idea came from the “well-researched” spouse of a patient, who wanted her husband to have speech-language services during treatment for tongue cancer.
Working with other SLPs, Roerk put together a protocol, then met with physicians in the otolaryngology and oncology departments at both hospitals. “I had to meet the physicians face to face so they could trust me and understand what I do,” she says.
“We have to get out there and educate other professionals. If a physician understands why we’re doing something and knows we’re putting the patient first, there is very little resistance.”
Anna Meehan, AuD, CCC-A
Lovelace Respiratory Research Institute, Colorado Springs
Team divider:
Incorrect assumptions
Bridge builder:
Diplomatic fact-finding
As a contractor for the Department of Defense, Anna Meehan is the lead clinical research audiologist on an investigation into the effects of hyperbaric oxygen treatment for soldiers with traumatic brain injury. She has been working on the study since earning her AuD in 2011.
To establish trust, Meehan strives for clear communication. “One thing I found important was making my piece of the study understandable to everybody, from the person I’m testing to other medical colleagues to the military client to the people who are dealing with paperwork,” she says.
Meehan also has worked to establish her authority. “It’s important that I own my piece of the study—I’m the expert in the auditory-vestibular realm,” she says. “When I approach my team with information, the other members need to trust that I’m using my training and knowledge and making an appropriate decision.”

“I had to make sure I approached this person tactfully and did not discredit their opinion.”

Meehan has had differences of opinion with colleagues. She noticed that a study participant had some motor abnormalities of the eyes that could suggest a rare condition. When she brought her observations to the larger group, the study’s neurologist didn’t share her concerns.
“I don’t have an MD or a PhD and I’m the youngest person on the team, so my opinion is less valued,” Meehan says. “I said I didn’t agree, but I let it go. Then I did more research and presented the neurologist with raw data and a video. We scheduled a re-examination of the participant with the neurologist there.”
After a couple of weeks of Meehan’s persistence, the neurologist agreed to a referral for testing.
In the end, the data and the study participant’s needs trumped any differences of professional opinion. But Meehan notes that diplomacy was key. “I had to make sure I approached this person tactfully and did not discredit their opinion—they were older, had been practicing longer, had a higher degree than I did,” Meehan says. “It went from us working on a research study to us taking care of that one person.”
Ken Anderson, MS, CCC-SLP
South Huntington Schools, Long Island, New York
Team divider:
Silo-ed treatment
Bridge builder:
Adjoining offices
Ken Anderson finds that something as simple as office location can create roadblocks to collaborative treatment. For school-based SLPs who work closely with other staff, Anderson notes that adjacent offices can make everything easier.
Anderson was seeing a student diagnosed with autism spectrum disorder as well as anxiety and depression. By chance, he discovered that she loved to draw. “One day she drew a picture of herself with a thought bubble, and the thoughts were about how sad she was,” he says. “She wouldn’t express how she was feeling, but she would draw it.”
The school counselor’s office was right next to Anderson’s; he shared the drawing with her. After some discussion, the school incorporated art therapy into the student’s treatment. Another teacher (also with an office near Anderson’s) set up a “drawing desk” where the student could go if she felt overwhelmed.

“I’m not sure what would have happened if we were all spread out.”

Two years later, “it was night and day,” Anderson says. “She ate lunch with kids, joined some clubs. It was great to see.”
Given the workloads and schedules of all involved, Anderson admits that if the counselor’s office hadn’t been right next door, the opportunity to try something new with the student might have been delayed—or missed altogether.
In another case, a student was diagnosed with Usher syndrome, a rare condition that affects hearing and vision over time. Anderson and other school professionals had to work together closely and frequently, not only to fully understand the condition but also to ensure the student received the proper services, including a captionist and devices that would magnify her school materials.
“Our offices were all right next to each other, and it worked,” Anderson says. “I’m not sure what would have happened if we were all spread out.”
Carole Shepard, MS, CCC-SLP
Pittsburgh, private practice health care consultant
Team divider:
Insensitivity to patient needs
Bridge builder:
Show, don’t tell
Carole Shepard has been a practicing SLP for 36 years. She has 22 years of experience in long-term care, specializing in dysphagia, and is now in private practice as a consultant for elderly clients and their families.
Whenever she begins a new position or job, Shepard starts by building a team, remembering that everyone wants to feel respected. She works to make the most efficient use of everyone’s time. “Any time I interact with any other staff member, it’s about functional outcomes and making their job easier,” she says.
Rather than giving orders, Shepard asks for help. She also finds creative ways to educate her co-workers.

“Any time I interact with any other staff member, it’s about functional outcomes and making their job easier.”

For example: When she worked in a clinical setting, she would sometimes notice that patients recovering from stroke were expected to sit up and eat in bed. Rather than lecturing staff members, Shepard would bring a bed into an in-service and ask a certified nursing assistant to lie in it and assume the role of a patient who’s had a stroke. Then she would set up a tray of food and encourage them to eat.
“I haven’t said anything, or criticized anyone,” she says. “Usually the person starts laughing and says, ‘I can’t do this!’ And I say, ‘Well, you’re healthy and you can’t feed yourself, so certainly the patient can’t.’”
In patients with dysphagia, weight loss is a real risk. Staff members track the percentage of each meal that a patient eats, but Shepard noticed that they tended to overestimate what was eaten.
“If the patient eats less than 25 percent of a meal, then [a staff member] needs to make a referral to occupational therapy or a speech-language pathologist,” Shepard says. But because that’s more work added to an already busy shift, “in their minds, people are eating enough.”
To face this challenge, Shepard used her smartphone to take “before” and “after” photos of different meals at various stages of completion. Then she ran a “Guess How Much Was Eaten” contest among staff members.
The patients’ best interests come first. One patient is on a pureed diet, with each serving formed into a shape that resembles the original food. The patient also has dementia, and has started to believe that the skilled nursing facility is putting chemicals into the formed food. “I’ve spent time with the facility, explaining that he wants his food runny in a bowl, not formed,” she says. “You have to communicate and advocate for the individual needs of the patient, as much as possible.”
Ilyse Leibowitz, MA, CCC-SLP
Nassau County Public Schools, Long Island, New York
Team divider:
Perceived interference
Bridge builder:
Supporting others’ work
When Ilyse Leibowitz first switched from a special needs elementary school to a public high school, she felt she needed to change the way the teachers viewed her role.
“When I worked in the special needs school, everyone knew what the speech-language pathologists did,” she says. “When I came to the high school, I realized that no teachers really knew what I did. They just knew I pulled kids out of their class, which they weren’t happy about.”
As a member of the school’s professional development committee, Leibowitz was always looking for speakers to host professional development workshops. So she volunteered herself, and spoke about what SLPs do.

“Sometimes I co-teach. Or I ask the teacher ahead of time what they’ll be working on, and I bring strategies or visual supports for my student.”

“People think, ‘Oh, a student stutters or can’t pronounce the ‘s’ sound and that’s all we do,’” she notes. “But I don’t just ‘do speech’—I work on reading comprehension, strategies for breaking down test questions, how to define a word if you don’t know it. I also work on writing skills. In my workshop, I shared strategies that teachers could use in their classrooms.”
Leibowitz got plenty of positive feedback after her workshop, and teachers began implementing her suggestions and strategies. Some even asked her to work with them. She also gave a presentation to more than 200 school-based SLPs about how to inform and educate other school staff.
Besides educating teachers, Leibowitz looked for other ways to improve the system—always for the students’ benefit.
“Just pulling kids out of class to work with me wasn’t appropriate,” she says. “I thought they needed to integrate the skills into the class. I also felt that if I’m in the classroom, I can better understand what the child needs.”
So Leibowitz changed some students’ protocols so that she pulls them out of class only once a week. She spends the other session helping students in the classroom. But she doesn’t stop there.
“Sometimes I co-teach. Or I ask the teacher ahead of time what they’ll be working on, and I bring strategies or visual supports for my student,” she says. “Sometimes the teacher asks for enough copies for the whole class.”
Carmin Bartow, MS, CCC-SLP
Vanderbilt University Medical Center, Nashville, Tennessee
Team divider:
Inconsistent care
Bridge builder:
Champion a protocol
Carmin Bartow takes every opportunity to share what she does at the varied settings associated with her medical center, whether it’s an informal chat at a patient’s bedside or a more formal in-service workshop.
“If there’s one department or floor that is underutilizing your services, or continually questioning what you’re doing, seek out an opportunity to talk with them,” she says. “Get in touch with the nurse educator or the director and ask if there’s a way for you to provide 15 minutes or 30 minutes of in-service. That gets your foot in the door.”
She suggests taking the same initiative to fix systemic issues. Several years ago, Bartow and other SLPs noticed inconsistencies in Vanderbilt’s management of patients with tracheostomy tubes. Tube sizes were different. There were no standards about when to add a speaking valve. Some patients were given swallowing exercises; others weren’t.

“If a system isn’t working, go to Plan B—or Plan C. Be persistent. Don’t give up.”

“I felt we needed improved management to improve overall care, patient quality of life, and nursing knowledge and comfort with managing these patients,” Bartow says.
So she spearheaded the development of a trach team at Vanderbilt, which was established in 2015. The interdisciplinary group of hospital staff manages all patients who have trach tubes.
“Many hospitals do not have trach teams,” she notes. “But research shows they provide cost savings and lead to fewer ICU days, quicker decannulation, fewer transitions back to the ICU—in general, improved patient care.”
To start a team as an SLP in a large medical center, Bartow needed support from a physician champion. She found such a champion—but after two years, before the team had been fully established, that physician left Vanderbilt.
Bartow didn’t give up, but she did take a break. “I needed a bit of a breather,” she says. “I had to think about who else would champion this. Everybody is busy, every day. To take on a huge project like this is a time commitment.”
During her break, Bartow saw the inconsistencies and problems continue, and that spurred her to action. “I knew we could do better,” she says. “I started knocking on doors.”
The team was established less than a year later: At Vanderbilt, tracheostomy tubes are now managed by one service in a standardized way. “It’s led to improved care and fewer complications, with less work,” Bartow says.
Her advice? “If a system isn’t working, go to Plan B—or Plan C. Be persistent. Don’t give up.”
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November 2016
Volume 21, Issue 11