Rose Martini, PhD, OTReg (Ont), OT (C), Lynn Metthé, M.Sc.S., SLP, Reg. CASLPO Jacinthe Savard, MSc, OT(C) Claire-Jehan

1. Facilitating Interprofessional Collaboration Among Those Who Provide Services to Children with Disabilities in the Community: Shifting Focus from Pathology to Participation Rose Martini, PhD, OTReg (Ont), OT (C), Lynn Metthé, M.Sc.S., SLP, Reg. CASLPO Jacinthe Savard, MSc, OT(C) Claire-Jehanne Dubouloz, PhD, OT (C) Donna Klaiman, M.Ed, OTReg (Ont) OT(C) Occupational Therapy Program, University of Ottawa Canadian Association of Occupational Therapists Interprofessional Rehabilitation University Clinic in Primary Health Care, University of Ottawa

2. Outline • Current process of service delivery • A new model for service delivery • The University of Ottawa Interprofessional Rehabilitation University Clinic • Case study

3. Present Model of Health: Focus on Absence of Disease • School-Aged Children • First time expected to perform within a certain norm • For many, milieu where difficulties are confirmed or first identified • Traditional Biomedical Model • Impairment focused • Professionals tend to work independently • Negotiating the maze • Time and money

4. Adoption of More Health-Focused Models • A Call for More Health-Focused Models • Engel’s bio-psycho-social model • The Interactive Bio-psycho-social Model • International Classification of Function • Disability Creation Process • Failed to Replace Biomedical Model • Continued emphasis on disease • Health inadequately defined • Institutions are structurally rooted in the biomedical model • Shared vision of health and function needed • Structure that supports collaborative practice

5. Disability Creation Process(Fougeyrollas, 1997) • Adopted framework for The University of Ottawa Interprofessional Rehabilitation University Clinic • Service delivery focuses on: Promoting, maintaining and increasing the individual's social participation in life habits in relation to the social and physical environment

6. CAOTHealthy occupation for children and youth • Children and youth, regardless of age and ability, have the right to participate in healthy occupations • Healthy occupation is determined by a complex interaction of personal and environmental factors • Early detection and intervention is critical to healthy occupation

7. Risk Factors Risk Factors Risk Factors Causes Causes Causes Environmental Factors Facilitators < > Barriers Interaction Life Habits Social Participation < > Handicap Situation DCPFougeyrollas, 1998 Personal Factors Oragnic Systems Organic Systems Skills Skills Oragnic Systems Skills Integrity <> deficiency Integrity <> deficiency Capacities < > Incapacities

8. The University of Ottawa Interprofessional Rehabilitation University Clinic This clinic will offer services in French, in primary health care including rehabilitation using an interprofessional approach will participate in the professional and interprofessional education and training in health care for francophone students living in a minority setting and will become A centre for research on interprofessional health care and community-based rehabilitation services for the francophone community at the regional, provincial and national level

9. R E S E A R C H P L A C E C M E N T S Interprofessional rehabilitation university clinic in primary health care Vision of the clinic Interprofessionalism Technology SERVICES Life habits / Social participation 2006 2008 2010 Ottawa Near-North, Northern and Eastern Ontario National

10. Target Populations Survey completed by our partners identified 3 populations: • Adults 50+ • who have been discharged from a rehabilitation centre or a hospital and are awaiting services from the Community Care Access Centre • Who’s needs are not considered a priority for current out-patient services

11. Target Populations • Children 5+ • Identified with mild communication or developmental delays • Lack of : • services provided in schools • support for families to maintain achieved goals • support to teachers in elementary schools • Caregivers working with these two populations

12. Interprofessional services (2006-08) Collaboration between the various professions: • Audiology • Kinesiology • Medicine • Nursing • Occupational therapy • Physiotherapy • Speech-language pathology

13. SCREENING LIFE HABITS (LIFE-H / MHAVIE) DISCIPLINE SPECIFIC ASSESSMENT Referral Self-referral Health Professional Referrals Community referrals INTERPROFESSIONAL TREATMENT PLAN INTERVENTION interprofessional care plan with the client

14. Case Study • 5.5 year old girl • Mother calls the clinic and reports that her daughter, Sally, requires speech and language intervention. She was assessed by the School Board SLP – but no intervention was provided • As recommended by the school, she was also referred to the CCAC for occupational therapy (wait time – 1 year) • No concerns reported regarding gross motor

15. Assessment Results Pre-university Clinic Recommendations from report card: Sally would benefit from: • regular physical activity to improve gross motor skills • activities such as finger painting, stringing beads, and following mazes to improve fine motor skills • reading stories, reciting nursery rhymes, playing rhyming games, signing songs to improve overall expressive language skills

16. Assessment Results Pre-university Clinic S-LP Assessment • Severe expressive language delay characterized by limited vocabulary, reduced mean length of utterances, poor syntax and morphology • Moderate receptive language delay affecting vocabulary and understanding of complex syntax and grammatical markers

17. Suggested Therapy Goals Following SLP Assessment • Reformulating • Modeling • Forced choice making • Vocabulary building activities NOTE: No recommendation to consult occupational therapist, physiotherapists or other professional

18. Results of the LIFE-H / MHAVIE Nutrition: difficulty using utensils Physical Condition: clumsy, trips, difficulty with stairs, will sometimes fall off her chair Personal care: requires cueing with organization, difficulty with zippers, laces, buttons Communication: difficulty expressing her needs, following Commands Residence: not applicable

19. Results of the LIFE-H / MHAVIE Mobility: difficulty on uneven surfaces, trips frequently, difficulty getting on and off the bus Responsibilities: has not been given any by parents Interpersonal relationship: does not respect others personal space Community life: no concerns but limited involvement Education: requires assistance to complete homework Work: not applicable Leisure activities: no concern but again limited involvement

20. Results of the Clinic S-LP Assessment • Speech and language assessment: similar results • Following the LIFE-H: recommended consults in occupational therapy and physiotherapy

21. Results From Combined Occupational Therapy and Physiotherapy Assessment Movement Assessment Battery for Children (M-ABC) Manual dexterity: 5th percentile Ball activities: 5th percentile Standing balance: below 5th percentile Total score: 3rd percentile Test of Visual Motor Integration (VMI) Copying shapes and drawings: 12th percentile Visual-motor coordination: 58th percentile

22. Suggested Therapy Goals Following Interprofessional Assessment Communication and education (LIFE-H): Sally will • use proper pencil grasp and have good posture will working • be able to print the letters of the alphabet • be able to cut shapes with curves and angles • use action verbs appropriately • spontaneously and consistently use three word utterances • communicate her needs using the proper grammatical form

23. Suggested Therapy Goals Following Interprofessional Assessment Physical condition, mobility, leisure (LIFE-H): Sally will be able to • do the crab walk (5 meters) • catch a ball with both hands • maintain extension while lying down for 5 seconds • stand on one foot for 5 seconds Personal care (LIFE-H) Sally will be able to • tie a bow and fasten buttonsindependently

24. Comparison Between the Biomedical Model and Interprofessional Model All professions work collaboratively to achieve goals. OT: reinforces the use of the personal pronouns while working on fastening buttons PT: reinforces the use of action verbs while working on stamina S-LP: incorporates scissor and gluing activities while working on vocabulary building

25. Advantages of the Interprofessional Model • Early diagnosis of more invasive disorders • Achieve goals earlier • Allows professionals to see more clients

26. References Canadian Association of Occupational Therapists. (2004). Position statement on healthy occupations for children and youth. Retrieved on April 25, 2007 from http://www.caot.ca/default.asp?pageid=1138 Canadian Association of Occupational Therapists ( 2006) Position Statement on Primary Health Care” Ottawa: CAOT Publications. Retrieved on April 17, 2007 from  http://www.caot.ca/default.asp?ChangeID=188&pageID=188. Enhancing Interdisciplinary Collaboration in Primary Health (EICP) (2005). The principles an framework for interdisciplinary collaboration in primary health care. Retrievd on April 17, 2007 from http://www.eicp.ca/en/principles/sept/EICP-Principles%20and%20Framework%20Sept.pdf Engels, G. L. (1977).The need for a new medical model: A challenge for biomedicine. Science, 196, 129-136. Friend, M, & Cook, L. (2000). Interactions: Collaboration skills for school professionals (3 ed.). New York: Longman. Fougeyrollas et al. (1997). Revision of the Quebec classification : handicap creation process Lac St-Charles, Quebec : International Network on the Handicap Creation Process. Fougeyrollas et al. (1998). La Mesure des habitudes de vie (MHAVIE version 3.0). Lac St-Charles, Québec: Réseau international du processus de production du handicap. Fougeyrollas, P., Noreau, L. et al. (1999). Life habits : shortened version (LIFE H 3.0). Lac St-Charles, Québec : International Network on the Disability Creation Process. Henderson, S. E., & Sugden, D. A. (1992). Movement Assessment Battery for Children. Kent, UK: The Psychological Corporation. Labonte, R. (2000). Health promotion and the common good: Toward a politics of practice. In D. Callahan (Ed.), Promoting healthy behavior: How much freedom? Whose responisibilty? Washington, DC: Georgetown University Press. Lindau, s. T., Luamann, E. O., Levinson, W., Waite, L. J. ( 2003). Synthesis of scientific disciplines in pursuit of health: the interactive biospychosocial model. Perspectives in Bilogy and Medicine, 45, s74s86. McDowell, I., & Newell, C. (1996). Measuring health: A guide to rating scales and questionnaires (2nd ed.), New York: Oxford University Press. Missiuna, C., Moll, S., Law, M. King, S., & King, G. (2006). Mysteries and mazes: Parents’ experiences of children with developmental coordination disorder. Canadian Journal of Occupational Therapy, 73, 7-17. Morreim, E. H. (2000). Economic and other incentives to modify health behavior. In Promoting healthy behavior: How much freedom? Whose responisibilty? Washington, DC: Georgetown University Press. Paul, S. Peterson, C. Q. (2001). Interprofessional collaboration: Issues for practice and research. In Stanley Paul and Cindey Q, Peterson (eds), Interprofessional practice in occupational therapy. NewYork: Hawthorn press.

27. Service Delivery Models • Multidisciplinary Model** • Each professional does his or her work Separately • Interprofessional Model • Clients may be assessed separately or with other professionals, but an integrated plan is formulated • Transdisciplinary Model • Assessment, treatment plans and interventions are carried out jointly or by another professional on the team. **most adopted within a biomedical framework of service delivery

28. CAOT Interprofessional Collaboration • provide leadership for the Enhancing Interdisciplinary Collaboration in Primary Health (EICP) initiative • Determine how to enable health professionals to work together in an effective and efficient way for the benefit of individuals and families • Interprofessional collaboration refers to the « positive interaction of two or more health professionals, who bring their unique skills and knowledge, to assist patients/clients and families with their health decisions » (CAOT, 2006)

29. Interprofessional Collaboration • Is voluntary • Requires parity among professionals • Based on mutual goals • Depends on shared responsibility for participation and decision making • Share resources • Share accountability for outcome

30. Obstacles to Interprofessional Collaboration • Structure of the Health Care System • Structure of the Education System • Health Care and Education Professionals Working in Separate Systems