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Transdisciplinary Collaboration Project: Outcomes. Phyllis M. Connolly, PhD, RN, CS President, American Psychiatric Nurses Association http://www.apna.org Professor, School of Nursing, San Jose State University, San Jose, CA 95192-0057 408-924-3144; e-mail, ConnollyDr@aol.com.

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transdisciplinary collaboration project outcomes

Transdisciplinary Collaboration Project: Outcomes

Phyllis M. Connolly, PhD, RN, CS

President,

American Psychiatric Nurses Association

http://www.apna.org

Professor, School of Nursing, San Jose State University,

San Jose, CA 95192-0057

408-924-3144; e-mail, ConnollyDr@aol.com

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

Department of Occupational Therapy

Therapeutic Recreation Program

College of Social Work

Institute for Teaching & Learning

Faculty and Students

Revised 6/98

Transdisciplinary Collaboration Project

CA Dept.

of

Mental

Health

Santa Clara

County

Mental

Health

Santa Clara County

Alliance for the

Mentally Ill

Residents

Staff

Families

ALLIANCE for

Community Care

Zoe House

Crossroads Village

Casa Feliz

slide3

Project Goal

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.

theoretical frameworks
Theoretical Frameworks
  • Jeger & Slotnick’s Behavioral-Ecological Perspective Community Mental Health
  • Moller- Murphy: Relapse, Recovery, Rehabilitation
  • Omaha Nursing Documentation System
  • Deming’s Total Quality Management
  • Donabedian Quality: Structure, Process & Outcome
behavioral ecological model of community mental health
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

behavioral ecological perspective values interventions
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

definition collaboration
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)
transdisciplinary project
Transdisciplinary Project

Caring & Sharing

  • weekly
  • campus
  • case presentation
  • discipline information
  • discussion & feedback
  • 2 days/week
  • on-site
  • client contact
  • experience
  • implementation
  • evaluation
seminar format
Seminar Format
  • A student or staff from the designated discipline/program presents a client clinical setting focusing on the specific plan of care.
  • Students and staff from other disciplines assess for additional contributions or approaches.
  • Faculty offer consultation and clarification as needed.
  • Students may seek consultation from their own discipline faculty and/or other participating faculty.
seminar goals
Seminar Goals
  • Increased awareness of stigma in the lives of persons with a serious mental illness and their families, and its dehumanizing results.
  • Increased knowledge about psychotropic medications, usual side effects as well as client concerns.
  • Increased knowledge related to dual diagnoses--serious mental illness and substance abuse.
seminar goals continued
Seminar Goals Continued
  • Increased knowledge and skills in working with culturally diverse clients and families.
  • Increased knowledge about collaborating with clients and families.
  • Increased knowledge about other disciplines.
seminar goals continued1
Seminar Goals Continued
  • Increased knowledge about the effects of collaborating with other disciplines to meet the needs of clients.
  • Increased knowledge about the theoretical perspective of their own discipline.
  • Increased sense of professional identity.
collaborative assessment standards
Collaborative Assessment Standards
  • Authenticity
  • Convergence
  • Collaboration
  • Equity
  • Sensitivity
  • Congruence

Bagnato, Neisworth, & Munson, 1997

assessment tools
Assessment Tools
  • Pragmatic Protocol
  • Social Skills Rating Scale
  • Canadian Occupational Performance
  • Moller-Murphy Management Assessment

Tool

  • Omaha Nursing Classification System
collaborative teaching strategies
Collaborative Teaching Strategies
  • Orientation of students, Transdisciplinary Seminar
  • Orientation to teaching Wellness topics collaboratively
  • Pairing graduate Communication Disorders students and undergraduate nursing students
  • Students meet and review manual and topic
collaboration intervention principles

Client

Diagnosis effect

Medication effects

Secondary disorders

Collaboration Intervention Principles
  • Flexibility is KEY!
  • Expectations
  • Presentation
  • Distractions

Attention to

Communicative

Needs

Attention to

Non-Communicative

Needs

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

Approaches to Collaborative Outcomes
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

Weight Loss
slide22

Weight Loss

  • Therapeutic Recreation
    • Identify leisure activities that support positive weight management
    • Identify preferred leisure activities to manage weight
    • Food related activities
    • Establishing routine
slide23

Exercise

  • Therapeutic Recreation
    • Assess leisure interests related to physical activity
    • Develop appropriate routine (alone or with others)
    • Monitor for progress
slide24

Grooming

  • Therapeutic Recreation
    • Identify requirements for recreation participation
    • Reinforce routine
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

Stress Management
slide26

Stress Management

  • Therapeutic Recreation
    • Identify triggers
    • Identify and practice strategies to mange stress
    • Example: relaxation, exercise, visualization
slide27

Social Skills

  • Therapeutic Recreation
    • Assess preferred interactions (large or small group, one-to-one interactions)
    • Identify and develop needed skills for use in leisure time
    • Practice in the community
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

Memory
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

Speech (Dysarthria)
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

CCF # 9012, Problem 21, Speech, Communication, Spring 97
omaha nursing documentation system domains
Omaha Nursing Documentation System: Domains
  • I, Environmental
  • II, Psychosocial
  • III, Physiological
  • IV, Health Related Behaviors
domain ii psychosocial
Domain II. Psychosocial
  • 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
domain iv health related behaviors
Domain IV. Health Related Behaviors
  • Nutrition
  • Sleep and rest patterns
  • Physical activity
  • Personal hygiene
  • Substance use
  • Family planning
  • Health care supervision
intervention categories
Intervention Categories
  • I. Health Teaching/Guidance/Counseling
  • II. Treatments and Procedures
  • III. Case Management
  • IV. Surveillance
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

Targets
ccf 9012 problem 21 speech nursing spring 97
Knowledge: 2

Behavior: 2

Status: 3

Knowledge: 4

Behavior: 4

Status: 4

CCF # 9012, Problem 21, Speech, Nursing, Spring 97

Final Rating

Initial Rating

ccf 9012 problem 38 personal hygiene spring 97
Knowledge: 2

Behavior: 2

Status: 3

Knowledge: 4

Behavior: 4

Status: 4

CCF #9012, Problem 38, Personal Hygiene, Spring 97

Initial Rating

Final Rating

ccf 9068 problem 35 nutrition spring 97
Knowledge: 2

Behavior: 2

Status: 2

Knowledge: 4

Behavior: 4

Status: 4

CCF #9068, Problem 35, Nutrition, Spring 97

Initial Rating

Final Rating

ccf 9068 communication disorders spring 97
Difficulty with

Initiating conversation

Social interaction

Pragmatics

Semantics

Narrative discourse

Expanding utterances

Weight control

Increase in

Greetings

Staying on topic

Memory, recall

Details

Group participation

Weight

Loss 2 lbs.

Exercise program

Healthy diet

CCF # 9068, Communication Disorders, Spring 97

Assessment

Outcomes

ccf 9068 problem 37 physical activity spring 97
Knowledge: 2

Behavior: 2

Status: 2

Knowledge: 4

Behavior: 4

Status: 4

CCF# 9068, Problem 37, Physical Activity, Spring 97

Initial Rating

Final Rating

outcomes emotional stability zoe house s 95 f 96
Outcomes Emotional Stability:Zoe House S 95 - F 96

N = 21

N = 31

N = 7

N = 0

Note: Typical interventions: Health Teaching

Typical targets: Coping Skills, Interaction & Behavior Modification

outcomes interpersonal relations zoe house s 95 f 96
Outcomes Interpersonal Relations: Zoe House S 95 -F 96

N = 2

N = 15

N = 7

N = 27

Note: Typical interventions: Health Teaching & Surveillance

Typical targets: Interaction, Communication & Personal Care

outcomes interpersonal relations crossroads s 95 f 96
Outcomes Interpersonal Relations:Crossroads S 95 - F 96

N = 15

N = 34

N = 28

N = 20

Note: Typical interventions: Health Teaching & Surveillance

Typical targets: Communication & Interactions

outcomes fall 1993 spring 1998
OutcomesFall 1993 - Spring 1998

17,682 hours direct care

252 undergraduates

52 graduate students

9 faculty

cost savings study crossroads village 1993 94
Cost Savings StudyCrossroads Village: 1993-94
  • 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
evaluating student learning
Evaluating Student Learning
  • Transdisciplinary Seminar
  • Supervision Groups
  • Logs
  • Direct Observation
  • Process Recordings
  • Care Plans
  • One to one
evaluations of goals fall 97 n 22
Evaluations of Goals, Fall ‘97, N = 22

Agree and Strongly Agree all goals met except:

  • Increased knowledge related to clinical intervention research focused on outcome studies
  • Increased knowledge related to dual diagnoses--serious mental illness and substance abuse.
honors awards
Honors & Awards
  • APA Honorable Mention 1994
  • Innovative Research Teaching and Learning Award 1998
  • Outstanding Leadership in Collaboration, May 1998
  • Learning Productivity Grant 1998
challenges and issues
Challenges and Issues
  • Conflicts in missions
  • Supervision of non-nursing students on site
  • Staffing during non-academic times
  • Maintaining faculty interest
  • Role strain
  • Inequality of faculty workload
  • Students dropping clients
  • Inadequate space to meet with students
challenges and issues continued
Challenges and Issues (Continued)
  • 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
transdisciplinary team advantages
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
future plans
Future Plans
  • Nightingale Tracker Project 1998
    • http://con.ufl.edu/omaha/case19htm
  • Infrastructure
    • Institute for Teaching & Learning
    • Task force: Integration of Community Service Learning into the Curriculum
  • Campus Compact Network
outcomes of collaboration
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.

collaboration
Collaboration
  • Powerful human & social tool--changes people and systems
  • Framework for ethical care
  • Building healthy communities
    • Requires extensive collaboration among families, institutions, & Professionals
  • Disciplinary & personal agendas are secondary to shared goals