The Value of a Collaborative Approach

Author: Kendra Wormald, Reg. CASLPO Speech Language Pathologist
Date: Wednesday, January 31, 2024

Table of Contents

1. What is Team Collaboration?

2. History

3. Types of Collaboration

4. Benefits of Collaboration

5. Barriers to Collaboration

6. SLP Scope of Practice

7. SLP Collaboration

8. Case Study

9. Summary

What is Team Collaboration?

A collaborative approach focuses on bringing different professionals together from diverse backgrounds to achieve a common goal. In consideration of a clinical healthcare setting, a collaborative team is a group of unique healthcare professionals from various fields that support a client's care and plan (Taberna et al., 2020). A health professional is a uniquely skilled service provider who has undergone countless hours of academic work, who supports human health through the application of evidence based practice. 

Working with one healthcare professional may be warranted and feel supportive enough for mild or acute challenges however, no matter the degree or severity of challenges, a multidisciplinary approach may support optimal progress and results. 

"... many auditory, communication and swallowing disorders result from a number of etiologies and occur in the presence of a wide variety of deficits which require interprofessional involvement."(CASLPO, 2018)

History

The idea of a multiple disciplinary team approach originated with the Mayo brothers in the 20th century. The Mayo Clinic Model of Care is based on these principles specifically to deliver coordinated and improved patient care outcomes. In the 1990s, the multiple disciplinary team expanded to include non-medical professionals such as social workers and case managers. 

Research indicates that integrated care is especially suitable for people with complex needs and long-term conditions. This collaboration is a flexible and adaptable approach that has shown to be effective for a wide range of populations and demographics including mental health challenges. 

Types of Collaboration

(ASHA 2023)

Multidisciplinary Teams

• Professionals work separately and independently

• Come together to report assessment results and intervention outcomes from the perspective of their own discipline

• Draws on knowledge from various disciplines but stays within their own boundaries 

• Does not engage in joint planning or intervention

Interdisciplinary teams

• Discusses and shares perspectives to set goals and identify intervention priorities

• Analyzes, synthesizes and harmonizes links between disciplines into a coordinated and coherent whole

• Collaborate and communicate for assessment and intervention

• Aim to provide less fragmentation of services

Transdisciplinary teams

• Coordinate and collaborate for assessment and intervention frequently and consistently

• Blends professional boundaries

• Integrates the natural, social and health sciences in a humanities context, and transcends their traditional boundaries.

• Offer flexible professional roles; may have role release, where some of the responsibilities are shared across disciplines

• Share information for planning and intervention

• Determine intervention goals jointly

• Share responsibility for documenting student outcomes

ASHA (2023) outlined the recent terminology shift to interprofessional education (IPE) or interprofessional practice (IPP), and reinforced the idea that working in a collaborative team is a necessary skill for speech-language pathologists. IPP isn’t simply having more meetings or sending more emails. It’s an intentional approach to collaboration (ASHA, 2023). The objective is to solve real world and complex problems with consideration of different perspectives, defining clinical terms and guidelines and to provide a holistic and comprehensive care plan for a specific client.

Successful interprofessional practice teams should consider the following actions: 

• Identify the shared goal or objective 

• Denote someone to be the team facilitator 

• Clearly define the roles of all team members 

• Develop a communication plan 

• Plan time for reflection and documentation 

• Plan how to resolve disputes or conflicts within the team 

Team members need to respect and trust others and optimize the skills mix within the team, maximize collective intelligence, and promote inclusive collaboration. A mentality of equality across all professions is needed in order to have a successful multiple professional team. All of these considerations need to be made with the client's best interest in mind at all times (Mayo and Woolley, 2016). 

Benefits of Collaboration

70% of serious medical errors are from teamwork failures; collaboration decreases the likelihood of oversight and mistakes (Theodotou, 2020). All professionals may look at the same case, but with a unique lens, seeing a part of the picture one team member may not recognize. Research also shows high patient satisfaction and happiness with a collaborative approach (Theodotou, 2020). 

Use of an IPP framework continues to increase due to limitations of the existing healthcare model. The old framework led to challenges where professionals were not seen as equally valuable, increased number of medical errors occurred, and promoted an environment for consistent and detrimental overuse, misuse and underuse of services (ASHA, 2017).

Barriers to Collaboration

According to ASHA's 2019 Interprofessional Practice Survey, SLPs think collaborative work can be challenging to implement due to heavy workloads, limited time and resources and organizational culture. Research found that SLPs believe access to be the top barrier to collaboration with audiologists, while audiologists believe that attitudes and perception took first place (Tara et al., 2021). Barriers may be overcome if all team members target individual and collective characteristics such as teamwork, personality, shared responsibility and open communication. 

Collaboration barriers, while common, may be overcome if both individual and collective characteristics, such as personality, teamwork, and shared responsibility, discussed previously, are present.

SLP Scope of Practice

(CASLPO, 2007)

The scope of a Speech-Language Pathologist is vast and often shares similar responsibilities with other healthcare professionals. The roles may include but are not limited to:  

• Clinical Services: Screening of hearing, communication and swallowing to determine need for services, conduct assessments and implement intervention plans, measure client outcomes, consultation with and referral to other professionals 

• Prevention, Promotion and Advocacy: Prevention counseling and education to clients and their families/caregivers, other professionals and the public, advocacy for the profession and for those with communication and swallowing challenges and those at risk

• Education and Research: Conduct research in communication, swallowing and related areas, education and training of health assistants, students and other professionals 

• Administration: Development and implementation of programs, policies, guidelines and standards, maintenance of competency and quality improvement 

SLP Collaboration

Collaboration with the clinician and client during treatment goal development is necessary to facilitate client motivation and functional outcomes (Brown et al., 2021). The clinician will offer evidence based intervention options however it's imperative for the client to clearly discuss what's important to them. A client can share about their everyday routine which the clinician can specifically choose goals to support engagement for. Providing feedback to the clinician is vital to ensure your expectations are being met and that you feel supported and informed throughout the entire process. 

Examples

• A speech-language pathologist and an audiologist both providing rehabilitation for hearing and listening understanding

•  A speech-language pathologist treating a swallowing disorder and another speech-language pathologist treating language and communication

• A child receives school board speech language pathology services and the parents also employ a private speech-language pathologist

• A speech- language pathologist is working with patient in a pre-school or school setting and coordinated with the teacher's education plan

• A speech-language pathologist works with the dietician's recommendations for diet, as they address food textures and drink thickness. 

• A speech-language pathologist creates a voice care plan in coordination with an ear nose and throat doctor (ENT) regarding findings of vocal fold nodules

• A speech-language pathologist educates therapists on the client's team how best to communicate with the client. (e.g Slow and direct speech, key wording, visual supports)   

• A speech-language pathologist informs the team of the best ways to communicate with the client 

Case Study

(Excerpt retrieved from ASHA, 2023)

"An interprofessional practice (IPP) rehabilitation team developed a treatment plan for a 55-year-old man with memory and hearing loss, tinnitus, episodic vertigo, and headaches following a closed head injury. "

Each team member would assess the patient independently within their specialty, then share their findings. 

IPP Team:  

• Audiologist: Enrolled the patient in sound therapy and fit him for hearing aids, 

• Speech-Language Pathologist: Targeted word finding and memory strategies for 3 months

• Occupational Therapist: Educated on tree safety and helped find a suitable harness to prevent further falls 

• Physical Therapist: Conducted repositioning therapy 

• Neurologist: Followed up as needed  

• Primary Care Physician: Team facilitator, communicated assessment results and plans with other team members 

• Patient: Provided ongoing consent, asked questions about care, reported on progress

You and your caregiver(s) are integral members of your healthcare team. It is within accordance with practicing standards that the client be fully informed and involved in discussions and decision making  

The timing of intervention and concurrent interventions taking place are also important to consider. 

"When patients have complex needs, they must also take into consideration the timing of intervention. In such cases developing an intervention plan also involves considering competing priorities and collaborating with other involved professionals. Similarly, members must inform other professionals regarding the hearing, communication and/or swallowing needs to ensure appropriate integration for the patient." (CASLPO, 2018).

Summary

A collaborative approach has been seen to promote client and patient outcomes while minimizing errors and oversights, duplication of services and enhancing mutual respect between professionals. Clinicians and clients should reflect on the degree of interprofessional practice within their teams and consider enhancing their collaborative approaches to overall promote successful outcomes with a holistic lens.

To speak with a psychotherapist or one of the speech-language pathologists at Well Said: Toronto Speech Therapy, schedule an initial consultation by clicking the link below or calling (647) 795-5277.