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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.

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Transdisciplinary Collaboration Project: Outcomes

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  1. 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

  2. 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

  3. 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.

  4. 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

  5. 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

  6. 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

  7. 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)

  8. Competence Paradigm: Health Based

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

  10. 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.

  11. 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.

  12. 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.

  13. 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.

  14. Collaborative Assessment Standards • Authenticity • Convergence • Collaboration • Equity • Sensitivity • Congruence Bagnato, Neisworth, & Munson, 1997

  15. Assessment Tools • Pragmatic Protocol • Social Skills Rating Scale • Canadian Occupational Performance • Moller-Murphy Management Assessment Tool • Omaha Nursing Classification System

  16. 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

  17. 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

  18. Health Issues for Collaboration • Weight loss • Exercise • Grooming • Safe sex • Nutrition • Stress management • Symptom management

  19. Communication Issues for Collaboration • Memory • Cognition • Speech • Narrative discourse • Conversational skills • Social skills • Hearing • Literacy

  20. 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

  21. 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

  22. Weight Loss • Therapeutic Recreation • Identify leisure activities that support positive weight management • Identify preferred leisure activities to manage weight • Food related activities • Establishing routine

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

  24. Grooming • Therapeutic Recreation • Identify requirements for recreation participation • Reinforce routine

  25. 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

  26. Stress Management • Therapeutic Recreation • Identify triggers • Identify and practice strategies to mange stress • Example: relaxation, exercise, visualization

  27. 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

  28. 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

  29. 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)

  30. 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

  31. Omaha Nursing Documentation System: Domains • I, Environmental • II, Psychosocial • III, Physiological • IV, Health Related Behaviors

  32. 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

  33. Domain IV. Health Related Behaviors • Nutrition • Sleep and rest patterns • Physical activity • Personal hygiene • Substance use • Family planning • Health care supervision

  34. Intervention Categories • I. Health Teaching/Guidance/Counseling • II. Treatments and Procedures • III. Case Management • IV. Surveillance

  35. 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

  36. Omaha Rating Scale

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

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

  39. Knowledge: 2 Behavior: 2 Status: 2 Knowledge: 4 Behavior: 4 Status: 4 CCF #9068, Problem 35, Nutrition, Spring 97 Initial Rating Final Rating

  40. 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

  41. Knowledge: 2 Behavior: 2 Status: 2 Knowledge: 4 Behavior: 4 Status: 4 CCF# 9068, Problem 37, Physical Activity, Spring 97 Initial Rating Final Rating

  42. 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

  43. 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

  44. 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

  45. OutcomesFall 1993 - Spring 1998 17,682 hours direct care 252 undergraduates 52 graduate students 9 faculty

  46. 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

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

  48. 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.

  49. Increased awareness of stigma and dehumanizing results, N = 22

  50. Honors & Awards • APA Honorable Mention 1994 • Innovative Research Teaching and Learning Award 1998 • Outstanding Leadership in Collaboration, May 1998 • Learning Productivity Grant 1998

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