Intra-Professional Issues and Collaboration at Tier III Level

Purpose

The purpose of this module is to learn about collaboration in school mental health. You will explore the different models and learn about the specific challenges and some strategies for overcoming barriers to collaborating in schools.

Retrieved from: TOT 3: Intra-Professional Issues and Collaboration at Tier III Level (2019)

Schools rely on supportive service providers (includes professionals of varied backgrounds) to work closely with one another. Collaboration is a crucial dimension of planning, delivering, and evaluating special education supports and programs and related services (Friend, 2011). Collaboration among different professionals has become a necessary service delivery option to best serve students at risk for learning difficulties secondary to social, emotional, and /or behavioral disorders and problems. According to Cross et al. (2004), it is considered best practice in serving students with emotional and behavioral disorders.

There is growing recognition that student learning and social, emotional and behavioral problems go hand in hand and that it is shortsighted to address one and ignore the other (Nelson & Scott, 2004; Gablel & Mostert, 2004).

The resulting press on schools to deliver more efficient and effective services has placed professional collaboration center stage and increased the importance of documenting the capability to produce positive student outcomes.

Conversely, poor collaboration among related services personnel has been shown to negatively impact the effectiveness and quality of services provided to students with special needs (Murawski & Hughes, 2009).

Working together

Positive interdependence among team members who agree to pool and ration their resources and skills
Working together from a foundation of shared values
Professionals from different fields coming together when a sense of functionality is bestowed upon them
Collaborating or “teaming” across discipline specific boundaries
Characterized by parity, reciprocity, shared participation, decision making, and resources
A style for direct interaction between at least two co-equal partners voluntarily engaged in shared decision making as they work towards a common goal

Different approaches to collaboration exist. Each approach depends largely on how individual staff members relate and interact with one another and how they provide interventions and services. In school-based practice, three common models of collaboration are: multidisciplinary, interdisciplinary, and transdisciplinary. Each approach is based on different underlying assumption that guide team actions.

Retrieved from: TOT 3: Intra-Professional Issues and Collaboration at Tier III Level (2019)

General Discussion Post:

Take some time to look up each of these models in the context of school-based practice and providing special education services. Post in the discussion thread some of the key differences you find between each approach. Then, comment on why you think transdisciplinary approaches have been identified as the most effective (Hernandez, 2013). Give an example of what this might look like from the perspective of OT working with another traditional school mental health provider.

Some of the main differences I gathered from exploring and researching these different models comes down to one main concept: timing. The important factor between these three models seems to be when the team begins their collaboration, rather than who sees them first and the other members chime in. In the multidisciplinary model, it looks like a variety of team members take their own path to provide information on what might be best for the client. Nobody seems to truly collaborate because one specialty is already in too deep. Other team members just provide their insight to the case and give supporting knowledge from their field for one person to make the ultimate decision. In the interdisciplinary team it seems more similar to the multidisciplinary team where people from different teams collaborate but also stay in their own lanes. They don’t provide much support for the other areas of practice but rely on their own information to make an educated decision. The Transdisciplinary team, however, seems to be the best option because the team comes together at the beginning and they all work hard to make sure the client is being seen by all of the medical team and all of the opinions are welcome. This model allows for the most collaboration to occur and for the medical team to decide collectively where they are heading for the best and most optimal treatment plan. I think OT can have a really important role on the transdisciplinary team because as OT’s, we can see beyond the medical diagnosis. I think we are the most humanitarian members of the team. We can see the emotional and physical side of the impairment or disability and how it affects the persons everyday life. Some medical professionals can’t see past the symptoms, whereas, OT see the person first and the symptoms second. We try to decrease the environmental, psychological, occupational, etc. obstacles before we treat the symptoms. On a medical team, I think this is so important to make sure we are keeping the patient’s people and not just another case that walks through the door.

An example of an OT working with another traditional mental health provider in the schools would include a student who has a potential suicide risk. The OT and the MH providers would come together to establish a plan of action that would most benefit the student. The OT would look at the environment, the student’s home life, school life, SES, friends, siblings, extracurricular activities, etc. to see if there are any mismatches between his behavior and his environment, as well as his volition to participate in other activities to help identify the student’s occupational identity. The MH provider would also be looking at the more psychological reasonings behind his behaviors, such as bullying at school, stress, abuse at home, drug use, etc. that might be affecting his mind. Once the team develops a solid background and understanding of the student, they can collaborate to find the best method to approach the situation and treat.

Collaboration is a significant component of Tier 3 services; school professionals must be skilled in collaboration to effectively meet students’ needs at Tier 3. Many of the collaborative efforts/approaches used in Tiers 1 and 2 are continued (perhaps intensified) for students who are receiving Tier 3 services. Remember, Tier 3 is for those students who did not make enough progress from Tier 1 and Tier 2 interventions. As such, it is often the case that in Tier 3, additional personnel may be directly involved in supporting students, particularly those professionals who can provide intensive behavioral and psychosocial interventions and those professionals who may be involved in providing wraparound services. Parents are also typically invited to become involved in more meaningful ways for students receiving Tier 3 supports.

Successful collaboration in practice depends on:

Mutual respect for every member’s skills
Mutual respect for each profession’s distinct value or contribution
Mutual understanding about the strengths, needs, and interventions for students (with mental health needs)
A shared perspective (on the necessity for addressing student mental health in the schools)

According to Law (2000), collaboration between teachers and therapists can be effective, particularly when professionals involved have a clear understanding of each other’s roles. Collaboration is also enhanced when therapists are prepared and willing to take account of the educational context and fully explain to other professionals how occupational performance issues relate to student role and academic performance. Lastly, collaboration between supportive staff (including teachers) is enhanced when school systems support therapists’ involvement.

Retrieved from: TOT 3: Intra-Professional Issues and Collaboration at Tier III Level (2019)

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