kathy l. bradley-klug, ph.d., jennifer cunningham, ma

Promoting Integrated Healthcare through Interdisciplinary Collaboration:

The Tipping Point between Primary Care & Education

Kathy L. Bradley-Klug, Ph.D., Jennifer Cunningham, MAJoshua Nadeau, MA, Ashley Sundman-Wheat, MA

Julia Ogg, Ph.D., Kendall Jeffries, MAAudra St. John Walsh, MS

School Psychology ProgramUniversity of South Florida

Collaborative Family Healthcare Association 13th Annual ConferenceOctober 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

Session # H2October 28, 20111:30 PM

Faculty Disclosure

Please add the commercial interest disclosures that you reported on your signed Disclosure

form:I/We have not had any relevant financial

relationships during the past 12 months.

Need/Practice Gap & Supporting Resources

Chronic illness not only impacts children’s physical well-being, but also affects learning, behavior, and social performance in both home and school settings. The need for collaboration and comprehensive services has grown due to increasing numbers of youth who survive chronic illness and subsequently experience problems adapting to the school environment (McMenamy & Perrin, 2002). The multi-faceted impact of chronic illness has created the need for school personnel, specifically school psychologists, and pediatricians to engage in collaborative problem-solving to develop and monitor effective, ecologically-based interventions (Bradley-Klug, Sundman, Nadeau, Cunningham, & Ogg, 2010). A national survey investigating the communication and collaborative practices of school psychologists and pediatric professionals will inform methods to enhance integrated healthcare practices.

ObjectivesObjective #1: Identify preferred forms of communication (i.e.,

methods, frequency, contact persons) to promote integrated healthcare.

Objective #2: Compare and contrast perceived benefits and barriers to systems level collaboration between pediatricians and school psychologists, and use this information to improve collaborative efforts.

Objective #3: Understand the different perceptions of specific health conditions and how these impact the collaborative relationship.

Objective #4: Describe demographic factors that impact interdisciplinary collaboration between pediatricians and school psychologists.

Expected Outcome

Participants will learn strategies to promote integrated healthcare for youth with chronic illness based upon factors such as preferred forms of communication (i.e., methods, frequency, contact persons) of pediatricians and school psychologists, reported benefits and barriers to systems level collaboration, the different perceptions of specific health conditions across professions, and the relationship of demographic factors to interdisciplinary collaboration.

Learning Assessment

A learning assessment is required for CE credit.

Attention Presenters:Please incorporate audience interaction through a

brief Question & Answer period during or at the conclusion of your presentation.

This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to

satisfy accreditation requirements.

Promoting Integrated Healthcare through Interdisciplinary

Collaboration: The Tipping Point between Primary Care & Education

Kathy L. Bradley-Klug, Ph.D., Jennifer Cunningham, MA

Joshua Nadeau, MA, Ashley Sundman-Wheat, MA

Julia Ogg, Ph.D. & Kendall Jeffries, MA

Audra St. John Walsh, MS

School Psychology Program

University of South Florida

Presented at the Collaborative Family Healthcare Association

13th Annual Conference

Philadelphia, PA

October 28 , 2011

Presentation Outline

• Overview and Rationale for the Study

• Methods• Survey development• Selection of participants• Procedures

• Results• Comparisons with Pediatrician

Survey• Implications for Practice• Directions for Future Research

Statement of the Problem

• Chronic illness not only impacts children’s physical well-being, but also affects learning, behavior, and social performance in both home and school settings (Grier & Bradley-Klug, 2011)

• The multi-faceted impact of chronic illness has created a need for school and medical personnel to engage in collaborative problem-solving to develop and monitor effective, ecologically-based interventions (Bradley-Klug, Sundman, Nadeau, Cunningham, & Ogg, 2010)

Rationale

• With increasing emphasis on integrated healthcare, and the shift from behavioral healthcare and medical care providers operating in silos to an interdisciplinary approach to service provision, we are obligated to develop strategies to enhance communication and collaboration

• We need to gain perspectives from both systems to inform training programs and promote professional development

Rationale• Although there is a recognized need for

interdisciplinary communication and collaboration across the educational and medical systems, a paucity of research exists that examines:

• Perceived necessity

• Content

• Frequency

• Benefits and Barriers

Rationale

• Recent study assessed pediatricians’ perceptions of communication and collaboration with school personnel (Bradley-Klug et al., 2010)

• The purpose of the present study was to gain insight into school psychologists’ experiences collaborating with pediatric professionals on behalf of youth with chronic illness

• Data from these two studies are compared and used to develop strategies to promote effective and efficient interdisciplinary practices

Research Questions• Do school psychologists collaborate with pediatric

professionals? If so, with whom?

• What is the frequency of communication and collaboration between school psychologists and pediatric professionals?

• What do school psychologists perceive as the benefits of, and barriers to, collaboration with pediatric professionals?

• Do school psychologists utilize e-Health technologies to facilitate communication/collaboration with pediatric professionals?

• What are the implications for training and practice to improve interdisciplinary communication & collaboration?

Methods

• Developed cover letter and survey to be administered nationally to school psychologists

• Cover letter and survey reviewed and approved by Institutional Review Board

• Cover letter and survey submitted to National Association of School Psychologists (NASP) Research Committee• Revisions requested• Cover letter and survey resubmitted and approved• Access to NASP database granted

Participants

• 1,000 School Psychologists

• Members of National Association of School Psychologists (NASP)

• Geographically stratified random sample

• School-based practitioners

Procedures

• Purchased database from NASP• All names assigned code for

database• All surveys sent by US Postal Service• Mailing #1:

• August 11, 2011• Mailing #2:

• September 12, 2011

Results• 1,000 surveys mailed

• 0 ‘Return to Sender’ by post office

• 340 Completed surveys returned

• 34% return rate

Demographics of Sample

Sample Demographics: Race/Ethnicity

Pediatricians

1%10%4%

4%0%

78%

2% 1%

American Indian/Alaskan Na-tiveAsian

Black/African-American

Hispanic/ Latino(a)

Hawaiian/Pacific Is-landerWhite

Mutli-racial

Other

3% 1%

96%

Asian

Black/African-American

White

School Psychologists (Race Only)

Sample Demographics: Gender

Pediatricians

Male45%Female

55%

Male

Female

School Psychologists

18%

82%

MaleFemale

Sample Demographics: Age Ranges

Pediatricians

14%

40%26%

15%

5%<25

26-34

35-44

45-54

55-65

>65


0%

30%

24%

18%

25%

2%

< 2526-3435-4445-5455-65> 65

InterdisciplinaryCommunication

For the purposes of both surveys, ‘communication’ was defined as:

A one-time, unidirectional sharing of information regarding student status. Examples may include a brief phone call or

letter. Non-examples may include multiple, on-going bi-directional problem-solving efforts.

Frequency of Communication Between Systems

Pediatricians

8.32

42.5321.1

7

11.72

16.26

Never

A Few Times per Year

Once per Month

Once per Week

More Than Once per Week


13.33

60.63

18.1

6.671.27

NeverA Few Times per YearOnce per MonthOnce per WeekMore Than Once per Week

Reasons for Communication

Request In-formation

Provide In-formation

Intervention Development

Progress Mon-itoring*

Other0

20

40

60

80

100

PediatricianSchool Psy-chologist

Most Effective & Efficient Method

of CommunicationPediatricians

41.86

16.864.84

18.8

9.113.29 5.23

Phone Call

Written Report

Face-to-Face Discussion

Handwritten or Typed Note

Email

Disease-Specific Action Plan

Other


5816.73

1.86

10.41

6.69

6.32

Phone Call

Formal Report



Email

Other

Preferred Method of Communication

Pediatricians

36.99

22.165.2

14.26

14.64

1.93000000000

001 4.82

Phone Call

Written Report



Email

Disease-Specific Ac-tion Plan

Other


60.2915.81

3.31

6.62

11.76

2.21 Phone Call

Formal Report



Email

Other

Primary Contact for Communication

Pediatricians

4.96

35.32

8.535.16

39.48

3.97 0.2 0.2 2.18

Principal

Classroom Teacher

School Psychologist

Guidance Counselor

School Nurse

School Social Worker

Speech/Language Pathologist

Physical/Occupational Therapist

Other


35.14

1.618.534.7

9

35.78

4.15PhysicianPhysician's AssistantNurseNurse TechnicianCase ManagerSecretarial StaffOther

Interdisciplinary Collaboration

For the purposes of both surveys, ‘collaboration’ was defined as:

Ongoing, bi-directional sharing of information by two or more people who are working together to plan and

problem-solve to promote positive outcomes for a third party.

Frequency of Collaboration

Pediatricians

21.6

38.2716.67

11.73

11.73Less Than a Few Times a Year

A Few Times a Year

Once per Month

Once per Week

More Than Once per Week


22.54

28.5733.97

11.11

NeverLess Than a Few Times a YearA Few Times a YearOnce per MonthOnce per WeekMore Than Once per Week

With Whom Pediatricians Collaborate

0

20

40

60

80

100

C o lu mn 1

With Whom School Psychologists Collaborate

0

20

40

60

80

100

Physician Nurse Case Manager Other Physician'sAssistant

NurseTechnician

Perceived Benefits of Collaboration

0

20

40

60

80

100

ImprovedStudent

Outcomes

Cross-disciplinary

ProblemSolving

AssessingProgress

acrossSettings

ShareReources

AvoidDuplicating

Services

FeelingValued forExpertise

Other

PediatricianSchool Psychologist

Perceived Barriers of Collaboration

0

20

40

60

80

100

Time Personnel areInaccessible

NoReimbursement*

ParentPermission*

Don't know whoto Collaborate

With

Different Viewson Child

Development

Other Not Beneficial

Pediatrician

SchoolPsychologist

Anecdotal Comments

From School Psychologists

Benefits of Collaboration

“Collaborating with physicians of whatever specialty is highly ethical, practical, and needed to assist students in being successful in schools. Interdisciplinary system of care is the optimal method of meeting kids’ health & mental health issues that affect school performance.”

“Excellent study. I have worked closely with hospital education specialists and they have provided me with excellent resources so that I can better support and advocate for my students.”


“Increased collaboration would benefit many children in public education systems. Both pediatricians and school psychologists have unique knowledge and skills to offer students.”

“Collaboration between school psychologists & pediatric professionals would absolutely be valuable for the students receiving special education assistance.”

“Extremely valuable when planning for the needs of the whole student!”


“This is an extremely important subject. I want more collaboration with the medical field. I often send a records release along w/ a form to gain physician input. It is extremely helpful but I wish I had more access to physicians.”

“I believe the student outcomes from collaboration between health providers and school personnel including school psychs could be tremendous! With fewer school nurses I believe everyone needs to understand that the roles people used to play (school psychs only doing assessments) no longer exist.”

Barriers to Collaboration &

Suggested Solutions• Barrier“Pediatric professionals rarely seek out education

team members for consultation/collaboration.”

• Solutions“Identifying ways to get pediatric professionals

involved in school-based committees or to have them call us w/ concerns, issues, or suggestions related to students in their care would be exciting.”

“…I would love to have a working relationship with the local peds. I feel the job of opening the lines of communication should fall upon the SPED director who often does not have the time.”


Suggested Solutions• Barrier“Biggest challenge is pediatricians not being

aware of school constructs/methodology (i.e., RtI). Many times have received prescription for ‘self-contained spec. ed setting’ or IEP – not how we do things!”

• Solution“I believe it is in the

child’s/family/school’s/professional’s best interest to have such collaboration. The medical model is a has-been with the view that the patient has a problem/issue. Educational model views that instruction, curriculum, & environment are often aspects of the situation. So, the solution involves all those as well, not just the patient/child.”


Suggested Solutions• Barrier“HIPPA makes it difficult to exchange information

with physicians. Most often the exchange is facilitated through the parent.”

• Solution“In many cases we do not have consent to speak

with pediatric professionals. This survey has made me think about the possibility that I could ask for consent and elicit communication with pediatric services.”

Summary of Findings

• Do school psychologists collaborate with pediatric professionals? If so, with whom?School psychologists are most likely to contact the physician (~60%) followed by the nurse (~35%).

• What is the frequency of communication and collaboration between school psychologists and pediatric professionals?Communication: Approximately 75% of school psychologists communicate with pediatric professionals a few times per year or less Collaboration: 86% of school psychologists collaborate with pediatric professionals a few times per year or less

Summary of Findings

• What do school psychologists perceive as the benefits of, and barriers to, collaboration with pediatric professionals?Benefits: Assessing student progress across settings,cross-disciplinary problem solving, improved student outcomes, share resources, avoid duplication of services Barriers: Personnel are inaccessible, time

• Do school psychologists utilize e-Health technologies to facilitate communication/collaboration with pediatric professionals?Based upon the results of this survey, 93% of respondents had never used eHealth as a means to communicate or collaborate with pediatric professionals.

Implications for Training & Practice

• Provide in-service training for medical professionals on contemporary educational practices (i.e., Problem-solving and Response to Intervention, tiered intervention strategies, data-based decision making, etc.)

• Share with pediatric professionals the type of information that would be helpful to support the educational needs of youth

• Increase school psychologists’ and pediatric professionals understanding and utilization of eHealth to facilitate interdisciplinary communication

Implications for Training & Practice

• Develop outreach strategies to build partnerships between school staff and pediatricians in the community

• Inquire about and attend to preferred methods of communication

• Share in the responsibility of informing parents of the importance of collaboration across multiple systems

Directions for Future Research

• Conduct interdisciplinary focus groups to further explore facilitators to collaboration and problem solve barriers

• Investigate pre-service training models to promote interdisciplinary collaboration

• Explore how eHealth may be used to enhance interdisciplinary communication & collaboration

kathy l. bradley-klug, ph.d., jennifer cunningham, ma

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