Literatur ure Literatur ure Effective teamwork = better work - PDF document

How do you feel when you have to go Interprofessional to home affairs/licensing collaboration and dept/municipality? education of speech- language & occupational therapy students in a low- resourced community Maretha Bekker Renata Mosca UNIVERSITY OF PRETORIA 1 2 Literatur ure Literatur ure Effective teamwork = better work environment especially • IPC/E/L when resources are lacking • Verma et al. (2006) • Bridges et al. (2011) • Underpinned by theories in education, • Stages in a competency: – Responsibility psychology and sociology (Thistlethwaite, – Communication – Accountability 2012) – consultation, – Coordination • Fundamental principles: joint communication – cooperation – Communication and each members’ contribution – Coordination – Cooperation – Collaboration – Assertiveness • Attitudes of members towards themselves and – Collaborative practice – Autonomy others (Sheehan, Robertson & Ormond, 2007). – Mutual trust and respect 3 4 MAGP GPIE (Cahill et al., 2013; Queensland-Health, 2008) Da Daspo poort Poli Cl Clini nic Meet • Daspoort Clinic started as an UP Medical Student Initiative • A clinic by students, for students and the Evaluate Assess community • Daspoort opened 7 August 1964, 54 years ago • In 1967 social workers, SLT and PT become involved • Currently: interdisciplinary clinic and COPC site Implement Goal • Supported by Tuks Rag and the Faculty of Health Science of the UP, in cooperation with Gauteng DoH Plan 5 6 1

OT Da Daspo poort Co Cont ntext for chang nge SLT Hygienists • As a CBR, change was needed • Collaboration had to be more than referral and discussion Dentists SW • ICF considerations (WHO, 2001) & TRUE smart goals • In a low resourced health environment, teamwork may Family be essential to maintain a motivated workforce (Sheehan, Robertson & Ormond, 2007) • The caseload is growing CHW PT • Complexity of the cases is increasing • Time constraints: both families and professionals (Nugus et al., 2010) HN Dr • Quality of life outcomes Nurses 7 8 Case overview: J.L Ca • Date of birth : 21 August 2012 • Age : 5 years 1 month • Diagnosis : Not available • Mother works part time and is completing her law degree at Unisa. • Father is absent. • Sister in Grade 1. • Maternal grandparents very involved with the family. • Evaluated to be admitted to a school for children with special needs. 9 10 Cons Co nsiderations ns before the • Low postural MT → difficulties with session – Proprioceptive feedback – Gross and fine motor coordination • GDD – Bilateral integration • General movement difficulties – Postural endurance – oral muscles – Balance – communication intent – Praxis – speech production – Visual-motor integration (with visual difficulties) – feeding • Receptive language better than expressive • Needs additional support for stability → working • Cognitive function should not be judged based on level controlled in the midline of expressive language • Enjoy exploration (destructive active) but moving • Home programmes: functional and include the whole towards constructive action family (sibling) 12 2

Activity – wa water gun un Needs ds • SLT will provide strategies to facilitate • To introduce a therapeutic feeding program: – Multi step directions (receptive language) – positioning – Vocabulary expansion (receptive language) – facilitating mouth closure – Requesting (expressive language and pragmatics) – oral movements: chewing and speech production – Sequencing (cognitive/executive function) – Directional concepts (receptive and expressive language) • Oral secretions and care • OT will provide strategies to facilitate • Possible future use of AAC – Positioning by facilitating postural tone through • To improve abilities → improving occupations: proprioceptive feedback ADLs, play, pre-school/education and social – Increased midline stability and bilateral integration participation – A firm base of support for balance and functional mobility around the home • Facilitate the process of correct school placement 13 14 Activity – clothing g pegs gs • SLT will provide strategies to facilitate - Multi step directions (receptive language) - Vocabulary expansion (receptive and expressive language) - Requesting and responding (Language and pragmatics) - Sequencing (cognitive/executive function) - Joint attention • OT will provide strategies to facilitate - Optimal positioning - Midline stability to grasp the peg - Crossing of the midline - Visual sequencing (as part of spatial relations) - Motor planning when positioning the peg 15 16 Cons Co nsiderations ns before the Ca Case overview: G session • Date of birth : 6/03/2013 • Cognitive impairment → selection of activities, importance of repetition • Age : 4 years 6 months • Parents’ challenges limit carry over at home • Diagnosis : Severe microcephaly, learning difficulties, communication delay, hyperactivity and club foot • Mother is very positive and an asset in treatment • Both parents are unemployed • Very distractible → limits number of activities to be used in one session • Father is blind • Present with repetitive behaviour • Mother is partially sighted • Postural stability is extremely important • Older brother in Grade 1 • Spectacles were prescribed for but seldom wears them 17 18 3

Needs ds Activity – body dy puz uzzl zle • To experience sufficient destructive activities in • SLT will provide strategies to facilitate order to progress to more constructive actions - Shared attention (pragmatics) - Increased reciprocity (verbal and non-verbal) (language • For parents to identify new ways of how to handle and pragmatics) and stimulate G at home - Receptive and expressive language expansion • For G to use exploration so that he can learn more - Word approximations (expressive language) about his environment → communication - Eye contact (pragmatics) • For G’s parents to decide (in collaboration with the • OT will provide strategies to facilitate SLT and OT) on a school which would cater for G’s - Eye contact (pragmatics) needs - Correct positioning (initially on mother’s lap with increased proprioceptive feedback) - Manipulation of objects in the midline - Constructive use of objects 19 20 Activity - barley • SLT will provide strategies to facilitate - Explorative play - Commenting (expressive language) - Shared attention (pragmatics) - Sound production (speech) - Vocabulary expansion (receptive and expressive language) - Requesting (expressive language and pragmatics) • OT will provide strategies to facilitate - Sensory stimulation by introducing a different texture - Sensory discrimination - The use of both hands in the activity 21 22 Cons Co nsiderations ns after the Be Benefits of IPC: C: stud udent perspective sessions OT students SLT student Collaboration in planning the sessions was Two heads are better than one, four hands are OT positive better than two! perceptions It felt like ‘we were complimenting’ one “Hands - on” collaborative sessions helped us to Good working another better understand the needs and function level relationship of the clients Understood joint goals SLT = strategy focus Provided the opportunity to improve Increased professional skills OT = activity based interpersonal and professional skills Functional activities Both disciplines learned how to work Problem solving in real time Carryover to home towards a common goal, by discussion and environment problem solving. SLT Good collaboration lead to effective service Consistent expectations across therapists and perceptions delivery environments for the parents and child 23 24 4