Phyllis M. Connolly, PhD, RN, CS Jean M. Novak, PhD, CCC-SLP San Jose State University, San Jose, CA Transdisciplinary Collaboration: A Demonstration Project Phyllis M. Connolly, PhD, RN, CS Jean M. Novak, PhD, CCC-SLP San Jose State University, San Jose, CA u Discuss the driving forces related to the need for transdisciplinary collaboration u Recognize discipline specific assessment tools and interventions use for SJSU Transdisciplinary Project u Identify client specific outcomes based on the Omaha Documentation System Objectives

Societal Shifts u Nationalism replaced with global economy u Social ecology--needs for integration & connections u Social capital-- networks, norms, trust, coordination & cooperation

TRENDS u New organizations u New forms of delivery systems-- managed care u New ways of relating to each other u Smaller companies u Outsourcing u Disease management u High-value organizations depend on and expect workers at all levels to be capable of making decisions u Health care being driven by changes in industry

Changing Work Environment u Technology u Demographics u Managed Care u Purchaser’s Influence u Health Insurance Industry u Changing Health Systems u Telemedicine

Relationship to Health u Concern not only with costs & benefits but with social, emotional, & physical health u Promoting health and providing health care, no longer the exclusive domain of any discipline u Need for interdependence to improve population health care outcomes

Primary Care: Collaboration Needed Anxiety disorders, depression & substance abuse most frequently misdiagnosed in primary care practices

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

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 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 CountyMentalHealth Santa Clara County Alliance for the Mentally Ill ALLIANCE for Community Care Zoe House Crossroads Village Casa Feliz ResidentsStaffFamilies

Definition Collaboration u 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)

Transdisciplinary u 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.

Transdisciplinary Team Advantages u Individualized rehabilitation plan-goals u Integrated service delivery u Role delineation u Reduction of redundant care u Increase of interaction between professionals u Generalization and maintenance of skills u Learning with and from each other u Sharing and growing u Improved quality of life u Cost effectiveness

Behavioral Ecological Model of Community Mental Health Laws Administration of Justice Community Friends and Peers Laws Mental Health System Social Policy Legislation ChurchFamily University Training of Professionals Person

Behavioral-ecological Perspective Values & Interventions u Specific values: –Promoting individual competence –Enhancing psychological sense of community –Supporting cultural diversity u Interventions seek to: –Optimize human development –Enhance coping and mastery skills –Enhance organizational and community strengths Improved quality of life

Competence Paradigm: Health Based

Transdisciplinary Project weekly campus case presentation discipline information discussion & feedback Caring & Sharing 2 days/week on-site/campus client contact experience implementation evaluation

Assessment & Outcome Tools u Pragmatic Protocol u Social Skills Rating Scale u Canadian Occupational Performance u Omaha Nursing Documentation System u Allen’s Cognitive Levels u Kohlman Evaluation of Living Skills u Psychosocial Assessment u CERT-Psych

Omaha Nursing Documentation System Domains Interventions u I. Environmental u II. Psychosocial u III. Physiological u IV. Health Related Behaviors u I. Health Teaching Guidance, Counseling u II. Treatments & Procedures u III. Case Management u IV. Surveillance

Domain II. Psychosocial IV. Health Related Behaviors u Communication with community resources u Social contact u Role change u Interpersonal relationship u Spiritual distress u Grief u Emotional stability u Human sexuality u Caretaking/parenting u Neglected child/adult u Abused child/adult u Growth & development u Nutrition u Sleep and rest patterns u Physical activity u Personal hygiene u Substance use u Family planning u Health care supervision u Prescribed medication regimen u Technical procedure

Targets u Behavior modification u Caretaking/parenting skills u Communication u Coping skills u Exercises u Food u Interaction u Wellness u Medication action/side effects u Nutrition u Rehabilitation u Relaxation/breathing techniques u Safety u Signs/symptoms u Stress management

Omaha Rating Scale

Issues for Collaboration Health Communication u Weight loss u Exercise u Grooming u Safe sex u Nutrition u Stress management u Symptom management u Memory u Cognition u Speech u Narrative discourse u Conversational skills u Social skills u Hearing u Literacy

Approaches to Collaborative Outcomes Primary discipline u Assess and evaluate problems and needs u Treat & evaluate u Seek consultation & referrals u Collaborate Supportive discipline u Validate treatment approach u Assess, treat, recommend u Collaborate

Collaborative Interventions u Individual –One to one –Consultation –Case Management –Health teaching and counseling/guidance –Surveillance –Treatments & Procedures –Referrals u Group –Psychoeducational classes –Modules –Activities –Health teaching –Advocacy

Weight Loss u Nursing –Assess nutritional status –Assess eating behaviors –Assess environment –Assess and establish exercise program –Teach appropriate food selections –Evaluate, weigh weekly u Communication Disorders –Organizing a eating schedule –Categorizing appropriate food choices –Follow up comprehension –Food preparation

Stress Management u Nursing –Crisis intervention »Deep breathing »Self talk »Time out »Visualization –Prevention »Diet & nutrition »Exercise »Time management u Communication Disorders –Organizing and creating schedules –Follow up on comprehension –Routines –Social skills

Memory u Communication Disorders interventions –Scheduling –Visual, writing notes, –Reminders –Calendars –Routines –Self generated strategies –Repetition –Rehearsals u Nursing interventions –Assess for physiological causes –Assess for nutritional status –Assess medication efficacy –Develop collaborative plan utilizing memory enhancement strategies

Speech (Dysarthria) u Communication Disorders –Oral facial evaluation –Oral motor exercises »Voice »Exaggerated enunciation »Oral facial awareness »Rate of speech u Nursing –Assess AIMS –Assess medication –Assess oral hygiene –Assess dental hygiene –Assess nutritional status –Follow up on oral motor exercises

CCF # 9012, Problem 21, Speech, Communication, Spring 97 u Difficulty with –Intelligibility –Topic maintenance –Organizational skills –Withdrawal –Interventions Outcomes u Decrease in rate of speech u Increased –Intelligibility –Narrative discourse, expanded utterances, increase volume –Self expression –Organizational skills –Interaction –Social interaction –Attention and participation

CCF # 9012, Problem 21, Speech, Nursing, Spring 97 u Knowledge: 2 u Behavior: 2 u Status: 3 u Knowledge: 4 u Behavior: 4 u Status: 4 Initial Rating Final Rating

CCF #9513, Problem 21, Speech, Fall 98 u Knowledge: 3 u Behavior: 3 u Status: 3 u Knowledge: 4 u Behavior: 4 u Status: 4 Initial Rating Final Rating

CCF # 9073, Problem 30, Digestion-Hydration, Spring 99 u Knowledge: 2 u Behavior: 2 u Status: 2 u Knowledge: 4 u Behavior: 3 u Status: 3 Initial Rating Final Rating

CCF # 9033, Problem 21, Speech, Fall 98 - Spring 99 u Knowledge: 2 u Behavior: 2 u Status: 3 u Knowledge: 4 u Behavior: 4 u Status: 4 Initial Rating Final Rating

CCF #9075, Problem 07, Social Contact, Fall 98 - Spring 99 u Knowledge: 1 u Behavior: 2 u Status: 2 u Knowledge: 3 u Behavior: 3 u Status: 3 Initial Rating Final Rating

CCF #9012, Problem 38, Personal Hygiene, Spring 97 u Knowledge: 2 u Behavior: 2 u Status: 3 u Knowledge: 4 u Behavior: 4 u Status: 4 Initial Rating Final Rating

CCF # 9036, Problem 39, Substance Use, Spring 97 u Knowledge: 2 u Behavior: 2 u Status: 2 u Knowledge: 4 u Behavior: 3 u Status: 3 Initial Rating Final Rating

Outcomes Interpersonal Relations: Crossroads S 95 - F 98 N = 15 N = 34N = 28N = 20 Note: Typical interventions: Health Teaching & Surveillance Typical targets: Communication & Interactions N = 5

Additional Resident Outcomes u Decrease in symptoms u Community tenure u Increased use of community resources u Attendance at OT Clinic on campus u Increased use of City & University libraries u Employment u More independent housing u Participation in City Recreation Program u Enrollment in College and University u Volunteer jobs

Cost Savings Study Crossroads Village: u N=25 (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

Outcomes Fall Spring ,837 hours direct care 321 undergraduates 59 graduate students 10 faculty

Evaluating Student Learning u Transdisciplinary Seminar u Supervision Groups u Logs u Direct Observation u Process Recordings u Care Plans u One to one

Challenges and Issues u Conflicts in missions u Supervision of non- nursing students on site u Staffing during non- academic times u Maintaining faculty interest u Role strain u Students dropping clients u Inadequate space to meet with students u Lack of university support u Staff turnover u Client hospitalizations u Communications u Cutbacks in county funding u Obtaining permission to provide services from conservators and case managers u Conflicts with OT clinic schedule

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.