Appendix D: Project Summary
Project Title: Creating Interprofessional Collaborative Teams For Comprehensive Mental
Health Services
1. Mandate of the primary applicant organization: UWO is a centre of learning with more
than 60 different degree and diploma programs. Research is an integral part of the University’s
mission and external support for research projects totals approximately $141.5 million per year.
2. List of partners with whom the organization will work on this project and their roles:
a) Schulich School of Medicine & Dentistry (includes psychiatry), Faculty of Health Sciences,
School of Social Work, and the Department of Psychology. Roles: To develop curriculum; to
help students learn core concepts relating to patient-centred collaborative interprofessional (IP)
teamwork through simulation and practice opportunities b) Consortium of Applied Research and
Evaluation in Mental Health (CAREMH), Community University Research Alliance (CURA) on
Housing and Mental Health, and Victorian Order of Nurses (VON): To guide the steering
committee; to mentor and educate students and to provide community practice opportunities for
student teams.
3. Objectives of the project: 1) Socialize health care faculty, students, and practitioners in
client-centred IP collaborative practice, specifically focussing on comprehensive mental health
services to a vulnerable population; 2) Stimulate networking and sharing of best educational
approaches for collaborative client-centred practice; 3) Increase the number of educators
prepared to teach from an IP collaborative client-centred perspective; 4) Increase the number of
health professionals trained for collaborative client-centred practice before and after entry into
practice. Longer-term goals: 5) Facilitate IP collaborative care in both education and practice
settings 6) Augment the work toward provincial priorities, including: mental health care reform;
care of the homeless; and development of Local Health Integration Networks (LIHNs).
4. Major activities required to achieve these objectives: 1) Half-day retreat for student
leaders, community partners, consumers and faculty members 2) Development and teaching of
core concepts of IP within own disciplines 3) Workshops and simulation exercises for students;
online modules for self-directed problem- based learning 4) Team collaboration in community
settings 5) Evaluation at different phases involving micro (at each phase) and macro approaches.
5. Expected results of the project: Creation of sustainable infrastructure and curriculum to
support IP education at UWO to influence successful IP education and practice through training
faculty, students and community partners.
6. Methods that will be used to evaluate both the process and the outcomes of the project:
Focus groups, various assessment tools, scales and surveys.
7. List of the project deliverables with timelines: i) Increase in the number of educators
prepared to teach from an IP collaborative client-centred perspective; ii) Increase the number of
health professionals trained for collaborative client-centred practice before, and after entry into
practice (end of project term); ( iii) Development of tools (curriculum and methods) to facilitate
inter-professional collaborative care in both education and practice settings (throughout the
project); iv) Evaluation of implementation and short-term outcomes (throughout the project).
8. Dissemination plan: a) To the public: Communication through UWO Communications staff;
columns in regional and local newspapers and the Internet. b) To administrators and Boards of
Health: web-pages linked to key sources such as Health Canada; print newsletters from CIPHER
(The title of Consortium for Interprofessional Health Education and Research is being
considered); conferences; booths at health fairs c) To researchers, professors and practitioners:
Papers and posters at local, regional and national conferences, through project team network.
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6.1
PRIMARY APPLICANT ORGANIZATION
The University of Western Ontario (UWO) is a vibrant centre of learning with 1,164
faculty members and almost 29,000 undergraduate and graduate students. Through its 12
Faculties and Schools, and three affiliated Colleges, the University offers more than 60 different
degree and diploma programs.
UWO has demonstrated ability in introducing and successfully running innovative
programs: the Scholar’s program, an undergraduate interdisciplinary educational program for
exceptional students; and the Transdisciplinary Understanding and Training on Research Primary Health Care (TUTOR-PHC) -- a Canadian Institutes of Health Research (CIHR) funded
national program in training in primary health care research to meet the immediate need for
research capacity in this field, are two examples. TUTOR's objectives are to build a critical mass
of skilled, independent researchers through student opportunities and faculty (supervisor)
development and to increase the interdisciplinary and transdisciplinary focus in primary health
care research. The trainees include mid-career clinicians (family physicians, psychologists,
nurses and social workers returning to/beginning a research career), post-doctoral fellows and
graduate students in family medicine, nursing, psychology, social work, epidemiology and
sociology. Project team members, Drs. Carol McWilliam (Nursing), Evelyn Vingilis (Family
Medicine and Epidemiology and Biostatistics), and Graham Reid (Psychology) are mentors and
educators with this program. This is not unusual. A number of UWO faculty members have
cross-appointments in two or more disciplines and many also work collaboratively on research
projects.
UWO has excellent teaching facilities that incorporate state of the art technological
design to help simulation and learning to prepare students for real practice settings. For example,
the medical school has a multimedia facility that provides self instructional resources. A new
clinical skills facility opened in January 2005 with 16 offices and small group meeting rooms
with 2 way mirrors and videotaping capabilities. These facilities will be used in this project to
encourage self-directed team based learning. The new home for the Faculty of Health Sciences,
the South Valley Building, also contains a Clinical Education Suite that has meeting rooms
suitable for the small group team learning activities.
Research is an integral part of the University’s mission, and external support for research
projects totals approximately $141.5 million per year. UWO has a reputation for leadership in
patient-centred and community-oriented medical education and for innovation and excellence in
research. UWO also has a strong track record in community based mental health care and
research. One of the assets in this community is the existence of a Community-University
Research Alliance (CURA) on Housing and Mental Health, which is funded through SSHRC and
is in its fourth year of five year funding. This CURA came together as an initiative from
community organizations in London, Ontario, to build the capacity of the community to create,
support, and evaluate housing for psychiatric consumers/survivors.
The combination of excellence in teaching, research, facilities, collaborative working
arrangements and proven capabilities in administering interdisciplinary research and teaching,
demonstrate UWO’s capacity to capably deliver interprofessional education for collaborative
practice. This, coupled with the project team’s strong network of community partners who are
willing to mentor and offer practice opportunities for students in mental health services – an area
that offers plenty of opportunity for interprofessional client-centred collaborative practice for
student teams comprising medical, nursing, psychology, social work, occupational and physical
therapy disciplines – is a great combination which will help build the evidence for IECPCP.
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6.2
PARTNER ORGANIZATIONS
The Schulich School of Medicine and Dentistry (SSoMD) was founded in 1912 and currently
enjoys a world class reputation for its teaching and research. Its mission is to be internationally
recognized for: leadership in patient-centred and community-oriented medical and dental
education and for innovation and excellence in research. The SSoMD offers professional
degrees in dentistry, undergraduate and postgraduate MD degrees, including psychiatry. The
academic and clinical enterprise for the Department of Psychiatry spans early childhood to
geriatrics, comprises acute care and psychosocial rehabilitation, general psychiatry and specialty
care and is a resource for the Southwestern Ontario Region (particularly for specialized care). In
addition to outstanding teaching and research, the SSoMD offers state of the art teaching and
research facilities, to be discussed later. As partner in this project, faculty members from the
SSoMD will serve on the Steering Committee and work with other partners in this project to
develop curriculum and to train and mentor students. The SSoMD has committed to providing
financial resources to ensure sustainability of this project (see budget note in Appendix A)
The Faculty of Health Sciences comprises five Schools - Communication Sciences & Disorders
(CSD), Kinesiology, Nursing, Occupational Therapy (OT) and Physical Therapy (PT), and two
multidisciplinary degree programs - the undergraduate Bachelor of Health Sciences (BHSc) and
the Doctoral Program in Rehabilitation Sciences.
The Schools of Nursing, OT and PT will be involved in this project. All three have
outstanding national teaching reputations. The Faculty’s graduate and graduate professional
programs are among the most research-intensive in Canada. While quality and tradition are an
integral part of the Faculty, innovation and change are also key to maintaining its place at the
forefront of health sciences education. The Schools of Occupational and Physical Therapy have
replaced their post-degree undergraduate professional programs with Master of Science
(MSc[OT]) and Master of Physical Therapy (MPT) degrees respectively, and the School of
Nursing has combined with London's Fanshawe College to introduce the Western-Fanshawe
Collaborative Bachelor of Science in Nursing program. In addition, students in the new
Compressed Time-Frame program will be invited to participate.
The Faculty’s many Schools, programs, research laboratories, and community clinics dot
the UWO campus, with locations in the South Valley Building, the Health Sciences Addition
(Nursing), Thames Hall/3M Centre (Kinesiology), and Elborn College (CSD, OT, PT,
Rehabilitation Sciences). The new South Valley Building provides state-of-the-art facilities
(simulated hospital ward, simulated home care unit and virtual theatre) for collaborative teaching
and research.
As partner in this project, faculty members from the Faculty of Health Sciences have
committed involvement in the Steering Committee, in working together with other partners in
this project to develop curriculum, and facilitate the development and guidance, with project
staff, for participating students. The Faculty of Health Sciences will also be providing financial
resources. Together with the SSoMD, it has committed to providing sustaining funds in support
of the project (see budget note in Appendix A).
The School of Social Work, located within King’s University College at UWO provides a
learning environment characterized by excellence in social work education. Its undergraduate
and Masters level programs are directed towards developing and fostering principled and
competent professional practitioners who recognize the interrelatedness of human needs, social
structures and oppressive conditions in their work with diverse populations. Specific objectives
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of the program include education for Social Work practice with individuals, families, groups and
communities, emphasizing the social and organizational contexts of practice. Students are given
opportunities to develop practical skills by participating in a variety of practicum settings, under
professional supervision, throughout Southwestern Ontario.
As a partner in this Interprofessional Collaborative Team, the School of Social Work is
committed to involvement in planning, developing conjoint curriculum, as well as opening
courses in our undergraduate and graduate program to students from other disciplines,
integrating our established community placements, contacts and resources with other faculties
while assisting in developing new and innovative local and international practicum opportunities.
As well, faculty time will be allocated to allow for active participation in workshops, mentoring
students from other fields and engaging in outcome evaluation.
The Department of Psychology, in Social Sciences, offers a comprehensive undergraduate
program in general psychology and has affiliations with a number of researchers in various
hospital and clinical settings. The Graduate Program in Psychology may involve experimentation
in the laboratory, observation in a school, agency, or other setting, or clinical internships.
Graduate-level training in clinical psychology involves two types of training – a graduate
program at UWO in clinical psychology at the PhD level with graduate course work and practica
placements, and essentially postgraduate training (internship program for clinical graduate
students). As a partner in this project, Faculty and students will participate in workshops, and
advise and mentor student teams.
Dr. Ian Nicholson, Professor and Director of Psychology Training and Professional
Practice Leader at the London Health Sciences Centre (LHSC) will help formalize the support
for collaborative teams that is now encouraged, but not structured.
The Community University Research Alliance (CURA) on Housing and Mental Health
focuses on building capacity and uses a participatory research approach to: evaluate existing
models of supported housing; enable information sharing between community and academic
partners; give voice to the consumers (residents) of supported housing; and to develop working
relationships among partners in the community. This alliance taps into the collaborative
resources of four universities and eight community organizations. It seeks to promote
understanding of the housing situation for psychiatric survivors on an individual, community,
and societal level, and through this work to promote positive change in the quality of life for
psychiatric survivors.
The academic director of the CURA is Dr. Cheryl Forchuk, School of Nursing, Faculty of
Health Science, University of Western Ontario and the community co-directors are Susan Ousley
and Betty Edwards of Canvoice. Canvoice is a psychiatric consumer/survivor group. The CURA
project operates from a Community Economic Development (CED) model that is supported and
guided by a broad-based advisory committee. A community advisory group of major
stakeholders (psychiatric consumer/survivors, mental health service-providers, housing
providers, policy/decision-makers, income support staff and academics) and subcommittees
oversee different aspects of the CURA project.
Researchers from various disciplines participate on the CURA: nursing, psychology,
social work, geography, law, political sciences, economics, psychiatry, and epidemiology. There
are numerous opportunities for students to participate. Both nursing and social work students
have participated in the community development aspect of the work as practica. Law students
have had pro bono placements assisting with policy issues. Undergraduate and graduate nursing
students have had research placements with the project. Medical students have also participated
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
4
through the summer research training program at UWO as well as international research
exchange medical students from Spain, Greece, and Germany. Many of these students as well as
media studies students participated in the annual conferences.
The links between researchers/faculty and community agencies will be extended to create
the opportunity for practice settings for multidisciplinary student teams for this project. CURA
members will serve on the steering committee, attend workshops and help mentor and guide
interdisciplinary student teams working in mental health services for disadvantaged client
groups. Dr. Cheryl Forchuk is co-chair of this project.
The Consortium of Applied Research and Evaluation in Mental Health (CAREMH), headed
by Dr. Evelyn Vingilis, is currently funded from a CIHR Interdisciplinary Capacity
Enhancement Team grant. The original purpose of CAREMH was to research psychiatric deinstitutionalization using primarily Southwestern Ontario as a "natural laboratory." To ensure
this group’s work would, both – accurately describe and anticipate the impacts of mental health
reforms; and be useful to, and used by, potential knowledge users – CAREMH developed
strategies to encourage collaboration and knowledge translation among researchers from
different disciplinary perspectives, practitioners, administrators and consumer/survivors.
CAREMH embraces an interdisciplinary approach and includes the areas and disciplines of
correctional services, economics, epidemiology, family medicine, law, nursing, police services,
political science, psychology, psychiatry and social work. It includes researchers, service
providers, administrators, and policy planners.
CAREMH’s role in this project is to guide the experience of interdisciplinary teams in
mental health services; to help in planning and curriculum development, and to help students
find practice settings through its network of community partners. Dr. Evelyn Vingilis is director
of this project.
Victorian Order of Nurses (VON): VON Canada is a charity guided by the principals of
Primary Health Care and works in partnership with Canadians for a healthier society through
leadership in community based care, delivery of innovative, comprehensive health and social
services and influence in the development of health and social policy. Since 1995 VON
Middlesex Elgin site has been providing charitable nursing to the Salvation Army shelter. Five
years ago, two charities – the VON and The Salvation Army – in response to identified needs
formed a partnership to work together and involve the community, where possible, to improve
the health and social outcomes for the most marginalized of our citizens, those who are homeless
and those with mental health problems. The partnership focused on the addition of social,
rehabilitation and educational resources to a small medical team of nurses and doctors working
with the homeless, many of whom have been diagnosed with one or more significant psychiatric
and physical illnesses. This population is growing, its needs are increasing and they need the
social and rehabilitation supports on site.
VON supports the need for the development of interdisciplinary teams to deliver mental
health services and welcomes the opportunity to mentor and guide student teams through
practice opportunities. Both VON and the Salvation Army have been active members of the
CURA and will participate in workshops and serve on the Steering Committee on this project.
6.3
PATIENTS/CLIENTS & LEARNERS
Patients/Clients: Table 1 (below) contains patient/client demographics based on a sample of 300
in London, Ontario. It has been compiled from data collected by the CURA on Housing and
Mental Health (Nelson, Hall & Forchuk, 2003).
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Table 1 Comparison of Residents of Different Types of Housing on Demographic Variables
Type of Housing
Demographic Variables
and Psychiatric History
Homes for
Special
Care
Shelter
Supportive
Housing
Own
apartment/
house
Statistic
Demographic variables
Age
43.1 (12.5)
41.3 (11.7)
41.1 (14.1)
38.6 (13.4)
not significant
Number of housing moves in past 5
2.2 (4.1)
3.4 (4.5)
.8 (1.4)
2.4 (3.0)
F (3,279) = 4.4a
years
χ2 (3) = 19.5a
Gender
38 (42%)
54 (66%)
25 (60%)
27 (35%)
Men
53 (58%)
28 (34%)
17 (40%)
51 (65%)
Women
χ2 (6) = 18.5a
Marital status
7 (8%)
4 (5%)
1 (2%)
12 (15%)
Married/widowed
17 (19%)
21 (26%)
11 (26%)
29 (37%)
Separated/divorced
67 (73%)
57 (69%)
30 (72%)
37 (48%)
Single/never married
χ2 (6) = 30.5a
Education
13 (14%)
14 (17%)
13 (30%)
30 (38%)
University or college
53 (58%)
60 (73%)
25 (60%)
42 (54%)
High school
25 (28%)
8 (10%)
4 (10%)
6 (8%)
Elementary school
χ2 (6) = 16.5a
Employment status
21 (15%)
13 (16%)
13 (31%)
6 (8%)
Employed part-time or full79 (85%)
67 (84%)
29 (69%)
72 (92%)
time
Not employed
χ2 (9) = 58.4a
Psychiatric history
Primary psychiatric diagnosis (self51 (56%)
9 (11%)
20 (48%)
26 (33%)
reported)
15 (17%)
40 (49%)
9 (21%)
29 (37%)
Schizophrenia
20 (22%)
19 (23%)
13 (31%)
20 (26%)
Mood disorder
5 (5%)
14 (17%)
0 (0%)
3 (4%)
χ2 (3) = 48.1a
Other
Unknown
85 (93%)
46 (56%)
40 (95%)
66 (85%)
Currently taking psychiatric medication
6 (7%)
36 (44%)
2 (5%)
12 (15%)
Yes
No
a p < .01. Note that for age and number of housing moves, means and standard deviations are reported, while for the categorical
variables, frequencies and percentages are reported.
First Nations
Arabic/West Asian
Black/African
Ontario
N=11,285,550
188,315
(0.017%)
155,645
(0.014%)
411,095
(0.036%)
White
Multi-Racial
Multi-Cultural
Other
121,290
(0.011%)
CURA
N=318 (100%)
17
(5.3%)
2
(0.6%)
5
(1.6%)
249
(78%)
18
(5.7%)
4
(1.3%)
24
(7.5%)
Homeless
n=132 (100%)
12
(9%)
2
(1.5%)
3
(2.3%)
97
(74%)
7
(5.3%)
2
(1.5%)
9
(6.8%)
LEARNERS
In this project everyone is a learner – faculty members, students, community agency
participants and clients -- in sharing knowledge of professions and disciplines other than one's
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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own, in working together and sharing expertise within interprofessional collaborative teams,
whether in curriculum development, professional guidance, mentoring of student teams or taking
courses. Community agency partners will contribute to the learning in workshops and
conferences. Student teams’ learning will be tied to curriculum. All learners will contribute to
evaluation and assessment of the learning process from the workshops to the practice settings in
surveys or focus group discussions. Collectively, the experiences will help build the evidence
for interprofessional education for collaborative practice that is client-centred.
Making it work
Informal interdisciplinary education will be promoted by publicizing, more widely, department
seminars and workshops that are normally publicized only within departments, to encourage
participation from other disciplines. Formal interdisciplinary education will be organized through
CIPHER (the title of Consortium for Interprofessional Health Education and Research is being
considered), where students from the different disciplines will be given the opportunity to take
elective courses in interprofessional collaboration, which will include classroom instruction and
opportunities to collaborate in interdisciplinary teams in simulated as well as real practice
situations in the community. While that can be a challenge, given the differing program
structures and curriculum demands, the deans and department heads agree that interprofessional
collaboration should be encouraged and have given their commitment to helping make this work.
In addition, most faculties currently try to encourage interprofessional collaboration in practica
in various ways – this initiative will help formalize the process by enhancing training, tracking
and evaluation opportunities. Below is a description of program and time commitments for
students in each faculty/school to illustrate how student participation in interprofessional team
collaboration could be feasible. We estimate approximately 30 student teams would avail
themselves of the opportunity in a year (see also Exhibit # 2: Learning Foci for Interdisciplinary
Teams – page 30).
Medicine: The undergraduate Medical Program is a four year course with the first two years
largely devoted to knowledge skills and attitude development delivered in a combination of
lecture, and small group formats. The latter two years are composed of the clinical clerkships,
clinical electives and a small return to classroom component. Class size is 133. A course titled
"Community Medicine" runs through first and second year of the program and already has a
community placement component which would be compatible with the module being proposed
in this submission. In psychiatry, both the clerkship rotations and the residency program include
added opportunities for interprofessional training and education through the didactic teaching,
small group learning and psychiatric team learning. Further support of these themes would occur
during the five weeks of Psychiatry and Behavioural Science teaching in Year 2.
Psychology: Psychology students have very heavy curriculum demands to meet various stringent
professional licensing requirements. Psychology students will be involved in this project via the
Internship program (supervised by Dr. Ian Nicholson) and the Graduate program. Both programs
are small – with about 6 students each admitted each year. The Internship program students may
be from anywhere in America, whereas the Graduate program involves students specifically
from UWO. Psychology student involvement in practica would be in settings that are overseen
by a licensed supervising psychologist.
Nursing: The BScN is offered in three program options: a) a four year undergraduate program
offered in a collaborative partnership at two sites (UWO and Fanshawe College), and b) a 19
month compressed time-frame at the UWO site, with an enrollment of 35 students. In a) students
are divided between the two sites for the first two years of the program but then merge at the
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UWO site in the 3rd and 4th years. Community nursing and health promotion is offered during
the 3rd year. Class size is up to 240. Community-mental health placements with
interprofessional teams will be accommodated as an alternate to the traditional nursing aggregate
group placements. In b) and c) students can utilize the same placements during the spring
semester.
Physical Therapy: The Master of Physical Therapy (MPT) is a two-year professional graduate
program with 44-48 students in each year. In both years of the program, there is a required
course in community-based physical therapy. Students in the second year of the MPT program
will participate, with the activities forming an assignment in the Physical Therapy in Community
Settings II course.
Occupational Therapy: The Master of Science in Occupational Therapy MSc(OT) is a two year
program which admits 48 students each year (this will increase to 50 starting next year). During
the two years the students undertake 4 clinical placements. In year one, they are on placement in
January and then again in either May and June or June and July. In year two they are on
placement for January and February and then again in May and June. There are several
community based components of the curriculum that would support this initiative.
Social Work: Affiliated with the Faculty of Graduate Studies at UWO, the School of Social
Work at King’s University College offers a part-time, Advanced Generalist Master of Social
Work program for those who already have a Bachelor of Social Work degree, are members of
the Ontario College of Social Service and Social Workers and have had formal practice
experience. The MSW program is course-based with an advanced practicum which is sequenced
over a three year period that permit students to maintain full-time employment; for example,
evening classes and compressed courses in the summer term. 20 – 25 students are admitted each
year into this program. The School of Social Work has practica in a variety of hospitals, mental
health, and community social service agencies that also use other health care disciplines. An
opportunity to integrate learning and bring teams together at both the school and the field exists.
STEERING COMMITTEE (See Exhibit #4 – page 34)
A project Steering Committee will be established at the inception of this project. This
committee will be accountable for the planning, implementation, and evaluation of this project.
The Steering committee will be composed of the two project co-chairs (Drs. Cheryl Forchuk and
Evelyn Vingilis), 7 faculty member representatives from the participating disciplines (nursing,
medicine, psychiatry, psychology, occupational therapy, physical therapy and social work), 5
student representatives (one from each participating discipline), 4 mental health community
agency representatives (CURA, CAREMH, VON, Salvation Army), and 4 consumer
representatives (one representing the CURA, Can-Voice, VON, and Salvation Army). The
Deans from the Schulich School of Medicine and Dentistry, Faculty of Health Sciences, and the
project coordinator, will be ex-officio.
The Steering Committee (See Exhibit #4 for terms of reference, page 34) will have four
working groups: a) the Curriculum Working Group; b) the Practice site Working Group; c) the
Education Program Development Group; and d) the Evaluation Working Group. These working
groups will focus on key component areas of the project and report to the Steering Committee
who will in turn provide direction and guidance to their work. The major development work of
(a), (b), and (c) will occur in the first half of year one of the project. Implementation of the
project will be carried out through a partnership between (a), (b) and (c) and will occur during
the second half of year one and into the first half of year two, as outlined in phases 3,4,5, and 6.
6.4
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The Evaluation Working Group (d) will focus on the evaluation plan and ensure that all data are
brought forward for of the formative evaluation during phase 7, occurring during the final 6
months of the project. The results from the formative evaluation of the project reported by (d)
will be used to make revisions and recommendations to the Coordinator of CIPHER to assist in
transitioning the project to regular offerings within the partnership. Since this program will be
two years in length, a summative evaluation will not be feasible, as the first two years will focus
on program development and implementation.
The Steering Committee during the first year will also work to create a permanent
structure within UWO charged with on-going evolution of interprofessional education within the
health professional programs. A draft set of goals and membership is appended (Exhibit #1 –
page 25). Steering Committee members will collaboratively develop CIPHER and UWO will
commit to providing the funding to sustain and foster its integration into the university through
appointment of a part-time director and a secretary when this project ends.
Day-to-day management of this project will be provided through a full-time project
coordinator hired within the first 3 months of the project’s inception (Phase 1). A full time
research associate will also be hired to manage the evaluation of the project. The project
coordinator and research associate will report to the project co-chairs. The research associate
will chair the Evaluation Working Group and the project coordinator will chair the Education
Program Working Group.
PROJECT STEERING COMMITTEE
CURRICULUM
WORKING GROUP
EDUCATIONAL
PROGRAM
WORKING GROUP
PRACTICE SITE
WORKING GROUP
EVALUATION
WORKING GROUP
CONSORTIUM FOR INTERPROFESSIONAL HEALTH EDUCATION AND
RESEARCH (CIPHER)
PROJECT MANAGEMENT STRUCTURE
A matrix management structure is proposed to support this project. The Secretary will be
accountable to the Project Coordinator for work assignment and completion but will also provide
secretarial support to the research associate and the project coordinators. The research associate
will work under the direction of the project co-chairs but also with the project coordinator for the
integration of the evaluation activities into the implementation of each phase of the project.
PROJECT CO-CHAIRS
SECRETARY
PROJECT COORDINATOR
RESEARCH ASSOCIATE
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Co-chairs
Dr. Evelyn Vingilis is Director of the Population and Community Health Unit and Professor
with the Departments of Family Medicine and Epidemiology and Biostatistics in the Schulich
School of Medicine and Dentistry, and the School of Nursing in the Faculty of Health Sciences,
at The University of Western Ontario. Moreover, she is leading a steering committee to develop
a proposal for an inter-disciplinary, multi-faculty graduate program in health studies to support
inter-disciplinary education and research. She is a member of the CIHR-funded TUTOR-PHC
training grant. Dr Vingilis teaches interdisciplinary courses which include students from
nursing, medicine, psychology and political science. She is also Director of CAREMH and PI
of a CIHR Interdisciplinary Capacity Enhancement -Team Grant. This research interdisciplinary
program includes educational and mentoring components with the purpose to enhance the
research and knowledge uptake in the area of mental health reform. She has received 25
research grants in the past five years and is on the editorial board of two international journals.
Dr. Cheryl Forchuk's primary appointment at UWO is in the School of Nursing, Faculty of
Health Sciences with a cross appointment in the Department of Psychiatry, Faculty of Medicine
and Dentistry. She is involved in teaching in both the undergraduate and graduate programs in
nursing and regularly has medical students work with her for research experiences. Her program
of research focuses on therapeutic relationships and systems issues related to individuals
diagnosed with a chronic mental illness. Her work involves participatory research approaches
and she currently has a CURA on Housing and Mental Health that includes multiple partners:
major housing providers, shelters, psychiatric survivors, mental health agencies, policy decision
makers and researchers. The CURA involves interdisciplinary education as well as research. Dr.
Forchuk also has a project funded through CIHR related to best discharge practices from
psychiatric wards. That project is a collaborative endeavour with 6 Ontario hospital sites, sites in
Scotland and Finland, and over 20 psychiatric consumer groups participating. She is the program
leader for the Health Systems and Outcomes group at Lawson Health Research Institute (LHRI)
which includes 137 researchers. Dr. Forchuk is on the editorial board of The Journal of
Psychiatric & Mental Health Nursing (UK) and Archives of Psychiatric Nursing (US) as well as
a reviewer for several other journals.
6.5 PROJECT DESCRIPTION
a) TITLE: Creating Interprofessional Collaborative Teams For Comprehensive
Mental Health Services.
b) PROJECT OVERVIEW
“Imagine a world where each group’s expertise is held in regard, offered, and shared as the
need arises. Imagine a time when the patient can determine which kinds of practitioners he or
she needs or wants, and then imagine a system that makes those professionals available.”
- Carroll-Johnson, 2001, p.619
This proposed project will bring together faculty members and students from the UWO
Schulich School of Medicine, including psychiatry; Faculty of Health Sciences, including
Nursing, Occupational Therapy and Physical Therapy; School of Social Work, Department of
Psychology; community agencies, and patients, to introduce, develop, monitor and evaluate
changes in interprofessional education and interdisciplinary practice. The project will
specifically focus on the provision of mental health services, creating a culture of
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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interdisciplinary education and practice through a phased change process: sensitization of
faculty, students, community partners and clients on the need for and benefits of
interprofessional collaboration (Phases 1 and 2); exploration of interprofessional education and
interprofessional practice opportunities, using simulation and problem based learning tools
(Phases 3, 4 and 5); intervention with student teams working in practice settings (Phase 6) and
evaluation to measure short-term outcomes against objectives (Phase 7). The results will
increase awareness, broaden the network, develop curriculum and get more students, faculty and
communities involved in sustained education and practice of interprofessional comprehensive
mental health services, including services to the homeless and other disadvantaged groups.
There are two reasons for the selected focus: i) The target group has limited access to care even
while suffering multiple social, mental and physical problems. Interprofessional teams are
essential for provision of care to this group of persons, so student teams would have ample
opportunity to get practical experience working collaboratively. ii) The UWO project team
comprises considerable teaching and research expertise in mental health, homeless issues and
interdisciplinary team development, and it also has strong links with community agencies which
will enable placements, role models and guidance for student teams affording the foundation
required to ensure project success.
Rationale
Health care, as currently practiced, is delivered by health professionals who work within
disciplinary “silos” that usually operate within a hierarchy, with power imbalances even when
groups work as teams. Such power imbalances can lead to "divisiveness and conflict … for each
discipline but… even higher costs for society in duplication of effort, unnecessary conflict,
energy-depleting discord, and the potential for greater risks to patients" (Fagin, 1992, p. 296).
This is particularly true in the provision of mental health services, where clients suffer low
access to care, and whose needs are complicated by multiple social, mental and physical
problems that require coordinated medical care, psychiatric counselling, and social advocacy if
they are to be fully addressed.
A further power imbalance exists between the health care system and the client who is
generally not consulted in the process of planning for, implementation of, and evaluation of
health decisions made on his or her behalf. This is particularly so in the case of persons needing
mental health services. If mental health care is delivered in a fragmented way by each profession
treating the patient within his/her expertise, there is a danger that the needs of the patient may be
inadequately addressed, and may be lacking continuity of care, possible duplication of effort and
miscommunication of needs.
In the final report of the Commission on the future of health care in Canada, Romanow1
challenged the health care professions to move towards “teamwork and interdisciplinary
collaboration… from health care providers either working in primary health care organizations or
participating in networks of providers” (Commission Report, p. 117). Teamwork and
interdisciplinary collaboration are admirable goals, but moving to a system which understands
and values interdisciplinary practice will need a change in the current culture of healthcare
systems. The process of change has to begin with education of health professionals to sensitize
them to the need for interdisciplinary client-centred care; to teach them tools to work in an
1
Romanow, R.J. 2002. Building of Values: The Future of Health Care in Canada. Royal Commission on the Future
of Health Care in Canada. http://www.hc-sc.gc.ca/english/pdf/romanow/pdfs/HCC_Final_Report.pdf
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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environment that supports team work and collaboration. If successful, it could help influence
practice in the long term.
Interdisciplinary care provides for “a partnership between a team of health professionals
and a client in a participatory, collaborative and coordinated approach to share decision-making
around health issues” (Orchard & Curran, 2003). Moving towards interdisciplinary collaborative
practice requires a cultural shift away from current power imbalances, competition, distrust, and
underdervaluing the educational knowledge and expertise of other professions. A change to
nterdisciplinary practice requires alterations in health professionals’ existing values,
socialization, and workplace organizational structures. This will only be possible with
encouragement of a new culture in health systems that support trust among health professionals,
willingness to share in patient care decision-making, and inclusion of patients and/or relatives in
discussions about their care.
c) CONCEPTUAL FRAMEWORK OR LOGIC MODEL
STRATEGIES
ASSUMPTIONS
Faculty conference to discuss strategies and
develop road map. “Lab” days to enhance
discussion of issues. Self-directed participatory
student team projects. Prepare educators, students
and practitioners for ICP*
1. Workshops 2. Simulated practice
3.Community practice 4. Self-directed
problem-based learning will encourage
success of team collaboration.
PROBLEM OR ISSUE
INFLUENTIAL
FACTORS
- Kirby/Romanow report
calling for change.
- organizational
structuralism
- power imbalances
- role socialization
- role clarification
- role valuing
- trusting
relationships
- team
effectiveness
- team outcomes
Complexity of mental health needs requires
interdisciplinary skills and integrated teams to
provide range of services. Focus on patient
centred care requires collaboration among
interprofessional teams. Pre-and post licensure
education does not currently provide training for
ICP.
COMMUNITY NEEDS/ASSETS
1.UWO has teaching and research programs in
medicine including psychiatry, nursing, OT, PT,
psychology, social work 2. CAREMH and
CURA successful IDP* research collaboration.
3 Community partners. 4. Teaching modules
available. 5. New clinical skills facilities 6.
Standardized patient program 7. Health Zone
initiative in Nursing.
DESIRED RESULTS
(Outputs, & Outcomes
And Impact)
1.Socialize health care
providers in working
together.
2.Instill requisite
competencies for
collaborative practice
3.Promote patient
centred collaborative
teamwork.
*IDP—Interdisciplinary practice *IPC—Interprofessional collaboration
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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The proposal has adopted the Kellogg Logic Model2 for program planning and development to
present, in a systematic way, the relationships among the resources we have, the strategies we
will use to bring about change and the outcomes we hope to achieve. The strategies focus on the
educational system – the left side of the D’Amour/Oandasan model3 of Interprofessional
Education for Collaborative Patient-Centred Practice.
Strategies
Promotion of interprofessional education for collaborative practice will require a change
in management process which must address the two separate aspects which are interdependent:
Interprofessional education to enhance learner outcomes4 and Collaborative practice5 to
enhance client care outcomes.
This proposal focuses on development of interprofessional education through a change
process that creates a culture for interdisciplinary collaborative client-centred practice using
Orchard’s Conceptual Framework (2005) [See Exhibit #3: Outline for Team Process Modules –
page 32].
Faculty from participating disciplines as well as community agency partners will act as
mentors, monitors and facilitators to guide student learning and practice6. Faculty and agency
partner workshops, in addition to sensitization, will collaboratively develop a “road-map” that
shows the “destination.” Thus, the conference and the workshops will have the following
objectives – to discuss content, to define process, and to set common goals7.
We recognize that obstacles exist to having students from different programs work
collaboratively, including logistical and attitudinal factors. The coordination of interactive
opportunities among the different disciplines will require creativity and commitment. All
faculties/schools are deeply committed to moving this agenda forward 8. The Directors of the
various academic programs recognize the need for promoting interdisciplinary collaborative
client-centred care, and are committed to collaboratively supporting this initiative (see attached
letters of commitment by Program Directors).
A goal driven approach will be encouraged. Student teams will direct their learning
through self-directed participatory teamwork9. This approach has been chosen based on the
assumption that in giving students control over their time and resources it will encourage them to
take ownership of their learning, driven by goals and objectives against which they can evaluate
their achievement. A rapidly changing health care environment requires students to be prepared
as self-directed life long learners. This approach will also enable them to see challenges as
opportunities and be equipped to address these challenges faced by their clients10. Self-directed
2
W.K. Kellogg Foundation. 2001. Logic Model Development Guide: Using Logic Model to Bring Together
Planning, Evaluation, & Action. Chapter 3. Program Planning Template. p 33.
http://www.wkkf.org/Programming/ResourceOverview.aspx?CID=281&ID=3669
3
Health Canada. (2004) Interdisciplinary Education for Collaborative Patient-Centred Practice. Research and
Findings Report. February 20, 2004. Project leader: Ivy Oandasan. Framework P 64.
D'Amour, Oandasan Model – Teaching factors: Learning context → learner outcomes
D'Amour, Oandasan Model – Organizational factors → patient outcomes
6
D'Amour, Oandasan Model – Structuring clinical care
7
D'Amour, Oandasan Model – Sharing goals/vision
8
D'Amour, Oandasan Model – Institutional factors: leadership resources
9
D'Amour, Oandasan Model – Sense of belonging → Professionals satisfaction, well-being
10
D'Amour, Oandasan Model – Patient: task complexity → Patient quality of care/satisfaction
4
5
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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educational approaches are formed around case based discussions that are student driven and
related to the learning needs identified by the students (Woods, 1994). Students determine which
problems they will address and when they have reached a satisfactory conclusion to their
discussion11. Throughout this, and other related processes, students are encouraged to identify
learning needs and research these needs thus promoting divergent thinking. In addition students
are required to identify a solution to a problem or situation posed in the case promoting
convergent thinking (Woods, 1994). Throughout a health based curriculum there is opportunity
for self-evaluation and the expectation that the students will utilize their strengths in order to
develop areas in which they are less accomplished. This process echoes the one the students will
be required to apply in practice (School of Occupational Therapy, 2004).
Before students set up their teams, they will be required to attend introductory workshops
to sensitize them to the issues related to working in teams with clients needing mental health
services (See Exhibit #3: Outline of Team Process Modules – page 32). Early in the project there
will be simulated learning – student teams will conduct an interview with a Can-voice12 member
to learn first hand, the range of problems experienced by consumer mental health survivors13.
Students will be given as much as one year to set up, work at, and evaluate their efforts against
the objectives they set at the outset.
Assumptions
The strategies we have chosen ---to enhance student team learning through self-directed,
problem based learning, and to focus on mental health services, are based on the following
assumptions:
1) That the workshops will bring together a diverse community of faculty, students, community
leaders and clients to provide a sensitization to the issues of interprofessional collaboration in
mental health services and will help us define and refine the infrastructure and supports and
processes. That the Consortium for InterProfessional Health Education and Research
(CIPHER14) will be adopted and given a structure and purpose.
2) That simulated practice, using the advanced learning tools we have to offer our students, will
achieve its goal in helping students understand the principles of team dynamics and mental
health services and prepare them for practice in the community15.
3) That the community practice settings available through our partners will give students good
opportunities to put their learning in the classroom to good use with the help and support of
faculty and community mentorship16.
D'Amour, Oandasan Model – Learning context → Learner outcomes; competencies
Can-voice is a psychiatric consumer/survivor Community support service. Can-voice is one of the partners in the
CURA on Mental Health and Housing.
13
D'Amour, Oandasan model: Patient: sharing goals/vision → Patient quality of care.
14
D'Amour, Oandasan model: Institutional factors: leadership/resources: administrative processes
15
D'Amour, Oandasan model: Teaching factors: structuring clinical care
16
D'Amour, Oandasan model: Organizational factors: structuring clinical care: interactional factors → patient
provider outcomes
11
12
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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4) That the Council of Ontario Universities (COU) online learning modules will be available
through a project initiated by Dr. Carole Orchard17 that has been funded by Health Canada in the
first phase of this call.
5) That self-directed problem-based learning will achieve the goals of helping students work
collaboratively in teams by giving them ownership of their learning in an enabling
environment18.
Influential Factors
Conflict exists between the traditional role that consumers of services play in shaping
their receipt of services and the value which health professionals place in a client-centred system
of service delivery (Orchard & Curran, 2003). There is no area of health care that is affected
more than the mental health sector.
The recent Romanow Commission (2002) and Kirby (2002) reports stress the need for
Canada’s Health System to move towards a primary health care model. This model of care has
also been proposed by the World Health Organization (WHO). Such a model, however, requires
a significant change in the organizational structure of the system, in the power relationships
among the health disciplines, and the patterns of socialization of health professionals and
consumers of health services19. The health care system has become very complex over the past
number of decades, largely because of the rapid progress of medical science and the
accompanying emergence of medical and health care specialists from multiple disciplines
(Drinka, 1996). This has led to consultation being the hallmark of current practice. This
consultation and specialization has resulted in a fragmented level of care and dwindling
opportunities for interdisciplinary exchange.
Problem or Issue
Mental illness is a common health condition that leaves few families untouched. The best
epidemiological estimate from the World Health Organization (2001) is that one in five persons
suffer from a diagnosable mental disorder in any one year. Moreover, findings from the largescale Global Burden of Disease study, conducted by the World Health Organization, the World
Bank and Harvard University, indicate that mental illness is in second position among disease
burdens in developed economies (Murray & Lopez, 1996). The estimated economic burden of
mental illness in Canada in both direct and indirect costs in 1993 was $7.8 billion (Moore et al.,
1997). More recent work, addressing some limitations of the previous research, found that in
1998 the direct and indirect cost estimates of total economic burden of mental health problems
was $14.4 billion (Stephens & Joubert, 2001). Because of this high prevalence and economic
burden, the mental health care system has been under exceeding pressure to deliver services of
high quality against fiscal restraints.
Mental health care reform and the de-institutionalization movement has been underway
in Europe and North America for a number of years. Three factors, relating to monetary and
ethical issues, have been driving this movement. First, the economic burden of mental health
care is extremely high. For example, in Canada mental illness has been ranked as second highest
17
IECPCP Project: Institute of Interprofessional Health Sciences Education. Related to teaching factors in D'Amour
Oandasan model: learning context; faculty development → competencies.
18
D'Amour, Oandasan model: competencies: sense of belonging.
19
D'Amour, Oandasan model. Organizational Factors.
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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in hospitalization costs only surpassed by cardiovascular illness (Wigle et al., 1986). Over half of
hospital days have been in the psychiatric hospital system, in which a small number of people
with chronic mental illness experience lengthy hospitalizations (Randhawa & Riley, 1996).
Clearly the discovery of medications that manage the symptoms of many psychiatric illnesses
provided a major stimulus for reform and de-institutionalization as persons with mental illness
could now function in the community. A second driving force has been humanitarianism, where
we have moved from a silo approach to mental health to a more community based, humane
manner of providing services. The third force has been consumer advocacy. The consumer
advocacy movement has focussed on rights of individuals and pressing for different practice
approaches which helped providers recognize the need for reform.
Mental health reform and de-institutionalization have major implications for how we
educate health care professionals. The reality of mental health reform and de-insitutionalization
is that society is creating a “virtual” hospital, where the needs of persons with serious mental
illness are more likely to be met outside of hospital walls. However, the development and
management of a virtual hospital and community-based care poses challenges because of the
need to: (a) coordinate the multiple health service functions and (b) coordinate other non-health
care functions. This first challenge relates to the integration of multiple functions of assessment,
treatment and rehabilitation, which previously was provided within hospital walls. As services
are moved to community-based treatment, the services that used to be provided by a number of
different components within a service system may no longer be as accessible. The challenge
occurs because of the increased complexity of the service system, where the person providing the
assessment, for example a family physician or nurse in a family practice centre, may also need to
be delivering some of the treatment, or rehabilitation functions that would have been provided by
specialized mental health care providers in psychiatric and other hospitals. This highlights the
need for interprofessional education and knowledge.
The second challenge relates to coordination of added functions that are not specifically
health care services, such as income support, appropriate housing and nutrition, recreation and
leisure activities, legal advice, etc. This further complicates what used to happen in a hospital in
a fairly integrative way, as it was easier to co-ordinate and integrate those functions for people
who were all together and across the hall from one another, where the meals came on the food
tray, recreational activities were in the common room and most other services were available in
situ.
The new approach to community-based care requires interdisciplinary skills and
integrated teams to provide a full range of health and other services to persons with mental
illness. Moreover, since small core groups of specialized mental health professionals are no
longer working in provincial hospitals and providing the majority of care to persons with mental
illness, there is a fundamental need to develop programs for interprofessional education for
collaborative care that focus on the unique issues and needs of persons with mental illness
(client-centred care).
Client-centred practice is an important concept in many health professions including
medicine, nursing, occupational therapy and physical therapy but limited research has been done
to elucidate the implications for clients with a mental illness (Bishop 2001). It is important to
understand how the concepts within a client-centred approach can be effectively applied to
enable patients affected by deinstitutionalization to thrive outside of the hospital. Research has
shown that clients can be engaged in meaningful community lives and that client-centred
practice facilitates this success (Krupa & Clark, 2004). Additional research has also shown that
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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clients in mental health programs value a client-centred approach and the opportunity to be at the
centre of the intervention enhances their potential for rehabilitation. (Corring & Cook, 1999;
Rebeiro, 2000; Sumsion 2004). A client-centred approach does not negate the importance of the
professional’s expertise but it does enable clients with a mental illness to explain their goals and
plans and to seek meaning in their lives. Health practitioners aim to empower clients and
facilitate a sense of control and fulfillment through the application of this approach (Dressler &
MacRae, 1998). Client-centred practice supports the concept of recovery, which enables people
to become actively involved in their communities despite the presence of pervasive and
continuous mental illness (Krupa & Clark, 2004). Therefore, it is important to investigate
opportunities to enhance the application of client-centred practice in order to address the rising
costs of mental illness.
Community Needs/Assets
In developing a culture of interprofessional collaboration, there are multiple needs for
appropriate teaching tools, mentors to guide and practice settings to support learners.
Development of education for interprofessional client-centred collaboration will need a number
of adjustments to the traditional methods of teaching and working. Fortunately, at UWO, there
are a number of assets in place already that can be drawn upon or adapted to a wider purpose.
i. Specialized Learning Resources20
Learning Resource Centre (LRC): The Schulich School of Medicine and Dentistry has a
multimedia facility which provides self-instructional resources. The resources available within
the Centre include: 80 networked computer workstations (34 of these located in the computer
based learning centre (CLBC)), nine laptop ports, three laser printers, scanner, information desk,
clinical skills room, mannequins for practicing various physical exam and procedure skills,
videotapes, reference books, radiographs, pathology specimens, anatomical models, and the LRC
website at http://www.fmd.uwo.ca/cblc/. The LRC computer network provides Internet and
WebCT access, a variety of office software and medical education software. The Schulich
School of Medicine has just completed the building of a set of physician office learning units that
are designed to assist in teaching/learning assessment and interviewing skills.
Located within the LRC is a teaching facility, the CLBC, available for instructional and
examination purposes. The CBLC may be reserved for class use in the programs of medicine,
dentistry and nursing. It is also available on an individual basis by medical, dental and nursing
students when not reserved for teaching.
The South Valley Building (SVB, that opened in January 2005, is home to the Faculty of
Health Sciences. This state-of-the-art four-storey 80,000 square foot structure houses six general
use classrooms - with seating capacities of 50 (2), 150 (3), and 500 (1) students - and three 50seat general use student computer labs/classrooms on its first and second floors.
Two uniquely designed facilities in the building place the Faculty and its programs at the
forefront of clinically-based education. A clinical education suite, located on the building's third
floor, incorporates a nine-bed simulated hospital, and is equipped with programmable simulated
mannequins, a bachelor-apartment style simulated home unit, four computer-based learning
pods, one small group learning area, and a unit charting station. A further simulated learning
laboratory will be available in the School of Nursing in September 2005. These learning
facilities will provide a resource for interprofessional student groups working within intranets, on
20
D'Amour, Oandasan model. Institutional Factors: Leadership/Resources.
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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case studies, to develop their teamworking skills in sharing their knowledge and skills in arriving
at client-centred care decision-making. These new facilities will improve and enhance the current
clinical instruction studios in the Schools of Nursing, Occupational Therapy and Physical
Therapy, and in combination with the Speech and Hearing clinics in the School of
Communication Sciences and Disorders, will further strengthen the Faculty's profile for on-site
clinical education.
Additionally, the SVB's third floor will be the Faculty's virtual reality theatre. This 50seat facility will offer state-of-the art instruction in the study of anatomy to students in all of the
Faculty's Schools and Programs, and will open the door to more creative and imaginative
approaches to the study of health care. It will facilitate collaborative and interprofessional
learning and research that will take place amongst and between students and faculty, will lead to
generations of better educated health care professionals, and by extension, a more healthy and
prosperous Canada.
The standardized patient (SP) program: in the Schulich School of Medicine & Dentistry
simulates an actual patient; not just the history, but the body language, the physical findings, and
the emotions and personality characteristics as well. SPs are laypeople who may or may not have
any medical knowledge. Some SPs are actors, but most are not. SPs are from all walks of life, of
all ages and educations. The common thread among all our SPs is an interest in helping others.
The SP offers a readily available and standardized tool for teaching new skills, refining old skills
and evaluating learner performance. This allows for teaching and assessment of skills in an
experiential and problem based manner. UWO’s current Standardized Patient base exceeds 200
Standardized Patients, ages 12 - 90. On previous studies of Dr. Forchuk, Can-Voice members,
who are mental health consumer survivors, have acted as standardized patients. This is a resource
we can draw upon for this project.
The School of Nursing has an innovative program called “The Health Zone” – a primary
care initiative funded by the T.R. Meighan Foundation and the Nursing Alumni, started in
September 2004. The UWO School of Nursing, Merrymount Children’s Centre and the
Middlesex-London Health Unit formed a collaborative partnership to guide the development of
this initiative. This program within the initiative of The Community Nursing Resource Centre
(CNRC) is an accessible, community-based nurse-managed health centre with three
interdependent components - research, education and service.
Dr. Carole Orchard, is a co-chair of the IECPCP funded project through the Council of
Ontario Universities, entitled “Institute of Interprofessional Health Sciences Education.” In this
role, she will develop a set of modules for team process development that UWO will utilize (See
Exhibit #3, p. 32): 1) Awareness of the realities of clinical practice and its limitations to
interprofessional collaborations; 2) Helping groups re-conceptualize the way they wish to view
and enact interprofessional practice; 3) Developing norms for interdisciplinary collaborative
teams and their practice; and 4) Creating means for testing the model with patient groups, which
will be available for this project.
ii. Interdisciplinary research and programs21
UWO has a strong track record in community based mental health care and research. As
mentioned before (in section 6.2 – page 2) one of the assets in this community is the existence of
a CURA on Housing and Mental Health. The links between researchers/faculty and community
agencies can be extended to create the opportunity for placements for multidisciplinary student
21
D'amour , Oandasan model. Health professional/learner outcomes: Patient/provider outcomes.
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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teams. The shift in curriculum is that these placements would focus on the process of
interdisciplinary teams as well as the content of mental health and housing.
CAREMH. headed by Dr. Evelyn Vingilis, is another resource at UWO whose expertise
and community contacts can be drawn upon for this project. CAREMH has experience in
encouraging collaboration and knowledge translation among researchers from different
disciplinary perspectives, practitioners, administrators and consumer/survivors.
The successes of both CURA and CAREMH result from fostering interprofessional
collaboration through creating interprofessional collaborative teams for comprehensive mental
health services and/or research. Together, these formalized alliances afford an infrastructure
upon which we can build a sustainable interprofessional education program for collaborative
client-centred practice in community-based mental health care.
UWO has a legacy of innovative and successful interdisciplinary training programs. For
example, Transdisciplinary Understanding and Training on Research - Primary Health Care
(TUTOR-PHC) is a CIHR funded national program in training in primary health care research to
meet the immediate need for research capacity in this field. The teaching methods developed and
used and experiences garnered to enhance interdisciplinary learning in TUTOR will provide
much shared learning to the proposed interprofessional education program. This program has
educated 36 clinical researchers from more that eight professions from across Canada. The team
of 18 co-investigators represent six professions and have created symposia, workshops,
interdisciplinary lab discussion groups and transdisciplinary concept papers to enhance
interprofessional education of future researchers.
Additionally, an on-going UWO initiative is to develop an interdisciplinary health studies
graduate program which will include departments and schools in the Faculty of Health Sciences,
the Schulich School of Medicine and Dentistry, and the Faculty of Social Sciences, headed by Dr
Evelyn Vingilis. This initiative has the support of many Faculties across UWO, including
faculty, schools and departments listed within this proposal. The strategies and successes
obtained in this initiative can inform and support the proposed program.
Desired Results, Outputs, and Short-term Outcomes
See 6.6 for a listing of project objectives and Exhibit #5 (page 36) that presents a table linking
objectives to process outputs, workplan/implementation and evaluation and assessment.
6.6 PROJECT OBJECTIVES
The objectives of this project are to:
1) Socialize health care faculty, health professional students, and practitioners in working
together, with shared problem solving and decision making, toward enhancing benefits
for people receiving community-based health services;
2) Stimulate networking and sharing of best educational approaches for collaborative clientcentred practice;
3) Increase the number of educators prepared to teach from an interprofessional
collaborative client-centred perspective;
4) Increase the number of health professional students trained for collaborative clientcentred practice before, and after entry into practice;
Longer term goals:
5) Facilitate inter-professional collaborative care in both education and practice settings;
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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6) Augment the work toward provincial priorities, including: mental health care reform; care
of the homeless; development of Local Health Integration Networks (LIHNs) and Family
Health Teams.
6.7 WORK PLAN AND TIMELINES (see Exhibit #6 – page 39)
A rough outline of the structure under which this project will operate is presented in
Exhibit # 1 (p. 29). The actual structure will be decided upon at the first workshop involving
faculty, community members, students and clients. CIPHER is using a team-development
model (Forming, Storming, Norming, Performing) originally developed by Tuckman (1965) and
used extensively in business and educational environments (e.g. The Stanford Center for
Innovations in Learning, 2002; The University of Queensland, 2002; University of Alaska
Anchorage, 2004) to realize the work plan and timelines.
Sensitization
Phase 1: Development of Infrastructure (January – April, 2006)
Steps:
 Officially launch the UWO Interprofessional Education and Research Group
 Hire a coordinator and secretary *
 Create the Steering Committee
 Organize a half-day retreat for health professional student leaders, community partners,
consumers, faculty members to consolidate a shared vision and common expectations.
Create a permanent CIPHER and refine its functioning, interprofessional education
structure and membership.
Phase 2: Sensitization and Integration of Leaders and Mentors (April 2006 through project
end)
Steps:
 Organize a workshop for facilitators (community partners and faculty members) to “train
the trainers,” to expose each to the elements of inter-disciplinary practice, to discuss their
application within each specific organization.
 Build in sustainability of partners by assisting community agencies in the capacity to
participate and collaborate.
Phase 3: Community Experiences (June 2006-March 2007) [See Exhibit #2 – page 30]
Steps:
Building on the work already done by the Applied Health Science Education Task Team
(1995) and the current informal interdisciplinary activities organized by the different faculties
and schools, the leaders and mentors will formalize interdisciplinary opportunities for students
within the different practica, internship and residency settings.
 Student teams will interface with patients in the community. The length of the
community experience will depend on the specific goals set out in the learning contract
(1-3 visits would allow assessment of progress towards a trusting relationship).
 Faculty mentors will meet with student teams for consolidation of learning regarding
interprofessional team practice.
Phase 4 Development of Integrating Components (April 2006- end)
Steps:
A number of faculties/schools/departments are undergoing or have recently undergone
curriculum renewal. Informed by the respective curriculum renewal committees, CIPHER will
identify learning and curriculum module needs and develop knowledge modules of use for the
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
20
various committees. Thus, the following steps are flexible so that CIPHER can be responsive to
the needs of the different curriculum renewal groups.
 Working groups develop and support placement of core knowledge modules online
(communication skills; ethics; team dynamics, incorporating use of COU online team
development modules (see Exhibit #3).
 Use expertise from the UWO Faculty Development Centre and the various curriculum
renewal groups to develop online problem based learning modules specific to mental
health services.
 Planning committees determine selection of participants and assignments into
interprofessional teams and development and testing of case studies in conjunction with
curriculum renewal committees, consumers and community partners.
Role Clarification, Trusting Relationships, Shared Decision-Making
Phase 5: Development of Student Teams (September-December 2006)
Steps:
 Curriculum steering committee (comprising student members as well as faculty) prepares
self-directed learning modules in WEBCT, so students who elect to do this can work at
their own pace in September.
 Elements of interprofessional collaboration will be introduced into lectures and
discussions when relevant. For example, in medicine, in 2005/2006, Year 1 students will
have a lecture on the mental health team.
 Department seminars relevant to interdisciplinary interest publicized more widely to
encourage participation from other disciplines and professions.
Teaching methods & tools for Phases 1, 2, 3, 4: Presentations, small group discussion, online
learning modules.
Parties responsible: Co-chairs of project; project coordinator; working groups; faculty in
individual disciplines; community agencies to present realities; steering committee to guide;
student leaders; CURA & CAREMH to share learning relating to inter-disciplinary research
teams, some of which could apply to practice.
Exploration
Phase 6: Further Development of Student Teams Using Peer Support (January 2007)
Steps:
 Standardized patient exercise
 Problem based learning – communication skills and practice, evidence based practice,
ethical practice, relationship based practice.
 Development of common format/guidelines for learning contract with student teams,
faculty mentor and community partner
Intervention
All activities done in the 2 years, including planning and steering committee work.
Teaching methods & tools for phases 5, 6: Learning by doing: a) simulation and role-playing
(see above); two way mirror interviewing/clinical skills development, b) working in teams with
real patients in practice settings, c) consultations with faculty and community mentor.
Parties responsible: Student teams, student mentors, faculty mentors, community mentors,
patients, steering committee
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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Evaluation
Phase 7: Evaluation of site visits & CQI (on-going) [See Exhibit #2 – page 30 and Exhibit #5
– page 36]
Steps:
 Evaluation of community experience
 Analysis of evaluative data
 Formulation of findings against desired results
 Make recommendations for curriculum or organizational improvement
Tools: See section 6.8
Evaluation will be ongoing throughout the project. In phase 7, evaluation will be of site visits to
enable continuous quality improvement (CQI). See section 6.8 for more.
Parties responsible: As in phase 6 above.
6.8 EVALUATION PLAN (See Exhibit #5 – page 36)
The steering committee will appoint an evaluation-working group composed of
representatives from each of the health disciplines, partnering agencies and student
representatives at the outset of the project. Although this group will oversee the evaluation
procedures, including qualitative and quantitative data collection, analyses and knowledge
translation, the evaluation will inform program development and implementation for continuous
quality improvement. A Research Assistant will be assigned to the committee chair to assist
with all components of the evaluation. Ethics review of the evaluation plan will be submitted to
the UWO Health Sciences Ethics Review Board. The University of Western Ontario will provide
office space to support the work of this group and also a repository for secured storage of all
data. This office will be equipped with high-speed computers, a scanner, printer and lockable
file cabinets.
Formative evaluation will include assessment of program processes, using quantitative
and qualitative measures. Summative evaluation of program outcomes will not be possible in the
nineteen month duration of this proposal, as only one cycle of student teams will go through the
program in that time. Whenever possible, data collection for the project evaluation will be
integrated with assessment of learning by participants in the various project activities. In this
very short time frame for program development and implementation, only shorter term outcomes
and impacts can be reasonably expected.
All data will be collected in conjunction with the appropriate phases of the project (as
outlined below). Evaluation results will be brought to the attention of the project Steering
Committee by the Evaluation Working Group (EWG) at the completion of each component of
the evaluation. This committee will determine if changes in actions or materials are needed for
subsequent phases. If changes are required, the Steering Committee will direct the appropriate
working group to take action. A final evaluation report of the project will be prepared to present
to the Steering Committee for final approval and then forwarded to Health Canada and all the
project partners.
Phase 1-4: Using instruments selected to measure the project outputs and outcomes, all
as specified in Section 6.7, baseline data (T1 outputs and outcomes) will be obtained from
student leaders (n = 75), community partners (n=40), consumers (n=15), faculty members (n=30)
who agree to participate in the half-day retreat. Exhibit #5 presents a table of these instruments,
complete with descriptions and details regarding source, validity and reliability. However, as this
program is in development, program changes may necessitate the use of other instruments.
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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However, care will be taken to ensure that valid and reliable measures are used. Demographic
data on all participant groups will also be collected to facilitate sub-analyses, as appropriate.
Members of the EWG will also conduct focus groups involving participants from each of
the participant groups (n=15). Semi-structured focus group guides will be developed in
consultation with Steering Committee Members to obtain qualitative formative evaluation data
on: (a) what constitutes interdisciplinary collaborative practice; (b) attitudes toward
interprofessional learning about health teams; and (c) barriers, facilitators and strategies for
achieving practice within interdisciplinary collaborative teams. Focus groups will be taperecorded and transcribed verbatim and the data analyzed to identify themes and patterns that may
inform sensitization and role clarification endeavours.
Phase 4 - 6: Student team experiences will be captured (n=15) using a mix of focus
group sessions and a reflective summary of team experiences. The Team Climate Inventory, an
instrument developed for use in the TUTOR-PHC project will be adapted for use with these
student teams to capture pre-and post collaborative data. Areas for reflection will include:
understanding of the nature of the collaboration; expectations related to roles/responsibilities;
experience with collaborating; and personal feelings about participation in project.
Phase 7: All participating institutions will be asked to retain annual records of measures
of impact, including: numbers of faculty participating in the project; numbers of students
participating in the project; numbers of clients served by the interprofessional collaborative
practice teams; self-directed learning materials and forums developed; workshop and conference
agendas and participation rates; and documents reflecting the contributions of the project to
mental health reform and the development of the local Health Integration Network. These
numerical data will afford measures of project impact in the longer term.
A maximally varied purposive sample of students (ensuring a representative sample
across the participating health professions), mentors, and leaders will be selected to participate in
taped focus group interviews (approximately 5 – 7 learning/teaching teams) to discuss the
meaning of their interprofessional learning and interdisciplinary practice experiences. Qualitative
data transcripts will be analyzed for themes and patterns affording insights into how best to
promote success in the sustained interprofessional collaborative educational program and service
delivery.
6.9 KNOWLEDGE TRANSFER, NETWORKING AND DISSEMINATION
The introduction of interdisciplinary practice requires re-orientation to the way the public
accesses and uses health professionals. We will implement, through the UWO communications
staff, a consistent communication plan to educate the public about this form of practice and
provide frequent reminders through updates highlighting successes.
Administrators and Boards of health agencies equally will need to be convinced that
movement into interdisciplinary practice will not cost the system more and at the same time
provide higher quality of service outcomes. Hence, we will utilize multiple means to
communicate messages that are appropriately formulated at key literacy levels and to integrate
cultural awareness. Communication would include web-pages linked to key sources such as
Health Canada; internet public education programs on interdisciplinary practice; newsletters;
public service columns in regional and local newspapers; regular programming on community
TV channels; annual public conferences on functioning interdisciplinary teams and their
benefits; booths at health fairs, etc.
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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Faculty collaborators associated with this project will present papers and posters at local,
regional, and national conferences on the process. We hope Health Canada will host annual
conferences ‘showcasing’ interdisciplinary practice models and outcomes once models and
results of outcomes begin to emerge.
Knowledge transfer is a complex process that has explicit methods of dissemination, but
it has a tacit component that is difficult to define or to measure. This project has both the explicit
and tacit communication built into knowledge translation because of the involvement and
exchange between professionals, academics, students from different disciplines, clients and
community agencies. External transmittal of knowledge and addressing the tacit knowledge
issues in this domain will be addressed through inviting student alumni, professional practice
leaders from hospitals and community agencies affiliated with UWO, and policy makers from
local, provincial and national levels to serve on an Advisory Committee to CIPHER. This will
have the benefit of having knowledgeable input from those working in the field, while informing
them (and their affiliated organizations) of developments in CIPHER that may have wider
benefit and application.
Drs. Carole Orchard and Carol Herbert are UWO representatives on the Management
Structure in the Canadian Interprofessional Health Network (CHIN), a national network for
interprofessional health practice, led by the University of British Columbia, which has recently
applied for funding to the National Centres of Excellence-NI call for proposals. If funded, this
would be yet another valuable knowledge dissemination and knowledge sharing opportunity.
6.10 SUSTAINABILITY PLAN
At UWO, there has already been considerable investment in state of the art learning
resources, like the “standardized patient program,” the new clinical skills facilities, and computer
resources that encourage collaborative and self-directed problem based learning. The Deans of
the Faculty of Health Sciences and the Schulich School of Medicine and Dentistry have
additionally pledged support for the project, beyond the 2 year term, in the amount of $53,000
each. These funds will contribute towards the ongoing administrative needs of CIPHER, which
should have moved beyond the time and resource intensive start up stage into a maintenance
phase. We expect that evaluation and active knowledge dissemination and transfer will increase
buy-in to CIPHER and help to leverage additional funding to accommodate more practice sites
and include more students, faculty and community agencies.
Sustainability will also be built in through the Advisory Committee (mentioned above),
and especially through having alumni who have graduated from CIPHER active in guiding and
learning in a continual relationship with CIPHER, as well as participation in the NCE-NI
national collaboration, if funded.
6.11 DETAILED PROJECT BUDGET
i) Administration: In keeping with the stipulations of the collective agreement, the co-chairs
of the project will be paid $10,000 each per annum, or they will be given an alternate workload
and the Schools will use the $10,000 for teaching buy-out. A project coordinator will be hired for
the duration of the project with a salary of $70,000 ($50,000 plus benefits). A secretary will be
hired to help with administration of the project, at a cost of $40,000 per annum ($35,000 plus
benefits). A full-time research associate will be hired at a cost of $70,000 ($50,000 plus
benefits) to manage the evaluation of the project.
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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ii) Workshops and Retreats:
Two half-day workshops will be held per year. All the
workshops will give faculty, student leaders, and community agency members a chance to
attend. We estimate that on average, 30 faculty members and 40 community members may
attend in addition to student leaders and client representatives. In the first year the workshops
will encourage sharing of view points on interprofessional client-centred care and mental health
services and to collaborate on the structure and mandate of CIPHER. In year 2, the workshops
will include evaluation and encourage sharing ideas on improving the program. Steering
committee retreats include those held by the 4 working groups. The workshop and retreat costs
include rental of a facility, materials, and compensation for community member participants'
time.
iii) Mentors: The budget for community agencies includes supervision, mentoring and
paperwork in connection with student team visits. It also includes a budget for a community
agency member’s workshop attendance or steering committee retreat participation. Many
community agencies have very few staff to spare. If a staff member is away, the office must
either close for the duration or employ a replacement person for that time. Since community
agency participation is a very important component of this project, the budget factors in those
costs. A rough calculation is $2,000 per community agency member per year and the total is
based on 40 members participating per year. These are start-up costs when commitments for
participation in workshops will be higher.
iv) Teaching resources: The consultant fee ($2,000) is allowed for a programmer or student
research assistant to help create and maintain online learning modules. The annual standardized
patient budget is based on putting 15 students groups through the simulated training exercise,
estimating 8 hours per group, at $100 per hour). The same amount would be paid for Can-voice
members or the UWO standardized patient program. The budget estimates that six faculty
members from each of the disciplines will serve as leaders and mentors to students. Stipends for
6 faculty leaders’ time in Phase 4 activities are budgeted at $3,500 per faculty member, for a
total of $21,000.
6.12 ETHICS REVIEW
Curricular modifications are not usually sent for approval to the Ethics Review Board
(ERB), but because this represents a new teaching model which we intend to assess and write
about, we will seek ethics review of the evaluation plan, which will be submitted to the UWO
Health Sciences Ethics Review Board. A key element in having students work in community
practice settings is the degree to which patients need to be informed and agree to their
involvement in a teaching enterprise. For that we will follow the procedures we use for clinical
placements. The University of Western Ontario will provide office space to support the work of
this group and also a repository for secured storage of all data. This office will be equipped with
high-speed computers, a scanner, printer and lockable file cabinets.
CONCLUDING REMARKS
We hope that encouragement and formalization of interdisciplinary education and collaborative
practices between faculties and departments at UWO will influence practice post licensure. In
focussing on the needs of mental health clients and in promoting self-directed learning, we hope
interprofessional teams will have the opportunity and motivation to learn together. Our leaders
think this approach of sufficient importance to commit financial and in-kind resources to this
proposal. We thank Health Canada for supporting this important initiative.
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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EXHIBIT 1: Proposed Structure For Consortium For Interprofessional Health Education
And Research (CIPHER)
The Consortium for Interprofessional Health Education and Research is an affiliation of Schools
and Departments in the University of Western Ontario with an interest in interdisciplinary
education and research including: Medicine & Dentistry (which includes psychiatry), Nursing,
Occupational Therapy, Physical Therapy, Communication Sciences and Disorders, Social Work
and Psychology.
The goals of the CIPHER are: 1) To provide a forum for fostering interprofessional education
and practice among health professional students; 2) To provide a forum for faculty to discuss
health issues that relate to interprofessional study; 3) To support development of
interprofessional curricular modules for the undergraduate and graduate levels for health
sciences students; 4) To provide workshops to assist faculty wishing to teach interprofessional
practice in the university 5) To facilitate development of practice areas both on the campus and
in the community in support of interdisciplinary collaborative professional practice; 6) To
sponsor continuing education offerings on interdisciplinary professional practice topics for
practicing health professionals in the southern Ontario area; 7) To provide a means for educating
the public in the southern Ontario area on the benefits of interdisciplinary collaborative
professional practice; 8) To support studies related to evaluation of interdisciplinary
collaborative professional practice in the community; 9) To support student projects using
interdisciplinary collaborative practice approaches; 10) To provide a forum for discourse around
the merits of interdisciplinary collaborative practice.
Membership: All faculty in the affiliating schools are eligible for membership in the CIPHER.
All students admitted to programs in the affiliated schools are eligible to be student members of
CIPHER.
Programs: (suggested examples)
 Orientation to the conceptual underpinnings for interdisciplinary collaborative
professional practice
 Interprofessional course teaching strategies for faculty
 Learning in an interprofessional collaborative environment for students
 Practicing in an interdisciplinary collaborative team
Funding: An agreed upon sharing from each of the participating faculties will be provided on an
annual basis to support the functioning of the CIPHER
Organizational Structure: The CIPHER will be managed initially by one of the project coChairs and after the project period by an appointed Director. The Director will report to a
council composed of one faculty member and one student member from each of the affiliated
Schools/Departments..
The council will have a representative from each of the affiliated
community agencies and consumer representatives.
Strategic Planning: The CIPHER Council will develop a strategic plan for interdisciplinary
health education and research initially focusing on undergraduate health professional and
continuing professional education. Inclusive in this plan will be development of a program logic
model for evaluation of actions taken.
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Exhibit 2: Learning Foci for development of inter-disciplinary practice applied to mental health services in the community
(Adapted from Orchard & Curran, 2003)
Health Promotion
Health
Focus
Setting
Settings will include
emergency shelters,
emergency rooms, homes for
special care and subsidized
housing provided by the
following agencies and
through project partner
CURA and CAREMH
community links including:
Issues
Social (housing, income)
Behavioural
Medical (nutrition, oral,
physical hygiene, AIDs,
Hepatitis, other illnesses and
disorders)
Learning










Mission Services, London

Prevention
Homes for Special Care
Salvation Army
Intervention
London Health Sciences
Centre, Mental Health Care
Program
Women’s Community House
St. Joseph’s Health Care,
Regional Mental Health
Care, London
Counselling/ working with
client and families to
address social issues.
Evaluating strategies to
promote compliance with
medical regimes prescribed
to prevent clients readmitting to hospitals or on
the street.
Locating accommodation or
other special services
Counselling client/families
Treatment for physical
problems













Determination of Cultural issues
Identification of Community political issues
Identification of health status of community members
Identification of environment within the community (water, food,
air)
Assessment of determinants of health within setting
Identification of issues impacting on determinants of health
Working within community groups
Development of plan, in consultation with community leaders, to
address issues leading to problems in meeting determinants of
health
Setting of indicators to measure impacts of interventions
Evaluation of indicator achievement
Assessment of health problems within a community setting through
use of existing data bases.
Exploration within inter-disciplinary group of all aspects associated
with the development of the health problem
Identification of aspects leading to development of health problem
Selection of strategies that can reduce incidence of health problem
within community
Development of action plan to implement strategies identified
Identification of indicators to assess success of implementation plan
Evaluation of outcome of interventions over time.
Identification of health promotion needs within community to
support alleviation of health problem.
Communication skills with patients
Counselling skills with patients
Health/physician assessment skills with patients
Social assessment with patients and families
Environmental assessment with patients and families
Patient teaching with patients and families
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Restoration
Health
Focus
Setting
London Mental Health Crisis
Centre
Issues
Learning




Evaluation of outcomes of interventions
Revision of intervention plans of care
Patient teaching with clients and families around prevention of
recurrence of problem(s)
Counselling on wellness approaches to restore appropriate levels of
health
Rehabilitation
Emergency Rooms




Evaluation of progression towards outcome goals
Revision of plan of care and expected short-term goals based on
evaluation
Patient teaching with clients and families toward next set short-term
goal
Counselling regarding impact of recovery phase on family, and
normal roles
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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Exhibit 3: Outline for Team Process Modules
(1)
Awareness of the realities of clinical practice and its limitations to interprofessoinal
collaborations
This module will focus on three broad barriers to interprofessional collaborations:
organizational structuralism, power imbalances, and role socialization.
In the sub-unit on organizational structuralism learners will explore how organizations
are seen to be just; in particular how health professionals view both distributive and
procedural justice and expand this to the extent that patients’ have the right to selfdetermination. Finally, learners will explore the extent to which organizations share
power with patient and health professionals.
In the sub-unit on power imbalances learners will explore four groups of conflicts: role,
goal, between health professional and others, and among health professionals. They will
discuss accountability issues, role overload, and role ambiguity that lead to role conflicts,
then health professionals’ dissimilar philosophies, beliefs, and professional socializations
that cause goal conflicts. Further discussion will focus on group differing values, work
styles, personality traits that can lead to conflicts between health professionals and other.
Finally, learners will explore how professional isolation within each health discipline and
approaches to assessing clients can lead to conflicts among health professionals.
In the third sub-unit leaders will explore how they have been socialized into each of their
health professions. They will focus on their patterns of practice that are shaped by their
occupational knowledge (patterns of language, modes of dress, demeanor, norms of
behaviour) and their occupational orientation (e.g. views regarding leadership, authority,
collegialism, preference or working within organizational structures).
(2)
Helping groups re-conceptualize the way they wish to view and enact interprofessional
practice. Sub-units will address the questions: (a) Whose knowledge and skill is it
anyway – boundaries of practice; and (b) What value does each health professional bring
to interdisciplinary practice?
Learners will begin by working on role clarification within their own health profession
developing a clear understanding of their own roles and expertise, gaining confidence in
own abilities, recognizing boundaries of their own discipline, committing to the values
and ethics of their own profession, and gaining knowledge of their own disciplinary
practice standards.
Whose knowledge and skill is it anyway – Boundaries of practice?
Learners will explore the boundaries that control their practice that arise from
various sources including: between professional groups, inter-agency, between
health and social care, between responsibility of service users and health care
professionals, between proximal and distal knowledge
What value does each health professional bring to interdisciplinary practice?
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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Learners will discuss how to show respect for knowledge and contributions all
members bring to the group, including development of clear understandings of
unique contributions each will bring, and then how each will share self, ideas,
responsibilities, aspirations, disagreements. They will further explore how to
effectively negotiate within a team while ensuring that the contributions of all
members are valued through openness, respect, safe expression of opinion and
feelings without retribution.
(3)
Developing norms for interdisciplinary collaborative teams and their practice
Learners, working in teams will establish their norms for functioning that facilitate power
sharing based on individual’s knowledge and expertise, including how to ensure that
trusting relationships guide functioning including: how to cooperate and share
responsibility for patients’ care from planning to decision-making. Teams will consider
how they will work collaboratively in: assessing patients, exploring options for
care/services, selecting choices from among alternatives, processes for implementing the
plan, and acceptance of individual responsibility for the plan. Finally, learners will create
operational procedures that reflect team effectiveness including: setting a shared vision,
goals, roles among professionals, management of decision making; creating patterns of
functioning around task accomplishment, leadership, goals settings, influencing, role
negotiating, trust building, problem solving problem setting; inter-group communications
including information around meetings, and other methods, and handling (managing) of
disagreements and conflicts including acceptance of disagreements, identifying issues
that are likely to cause dissent, and developing methods for dealing with conflict.
(4)
Creating means for testing the model with patient groups (e.g. assessing outcomes in
interdisciplinary practice – health professionals and patients perspectives).
Learners will explore how to set results for each patient group including improvement in
their health outcomes and satisfaction with their involvement in their care and assess
achievement as well. Both learners and patient groups will be asked to assess their
empowerment through interprofessional practice. Teams will explore various instruments
available to measure outcomes of their practice and how to track the continuity of actions
in support of agreed upon plan of care/services for patients.
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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Exhibit 4: Project Steering Committee
Purpose: To provide ongoing collaborative input to and decision making for project activities
including monitoring of phase planning, implementation, evaluation and creation of a permanent
sustainable structure for interprofessional education and research.
Structure: There will be an overall Steering Committee with four working groups: (a) the
Curriculum Working Group; b) Practice Site Working Group; (c) Education Program
Development Group; and d) Evaluation Working Group. Each working group will have a
member of the Steering Committee who will either act as chair or participate to provide a
communication linkage between the Project Steering Committee and the work within each
working group.
Reporting relationships: The Steering Committee is accountable to the Deans of the Faculty of
Health Sciences and the Schulich School of Medicine & Dentistry of the University of Western
Ontario (principal applicant).
Specifically:
1.
To plan, develop, implement, and evaluate learning opportunities that will socialize
health care providers’ interprofessional education and practice among health
professional students;
2.
To provide for faculty and health professionals to discuss health issues that relate to
interprofessional study and practice;
3.
To support development of interprofessional curricular models, at pre-licensure and
post-licensure levels for health professional students;
4.
To provide workshops to assist faculty wishing to develop interprofessional
teaching/learning strategies in the educational settings;
5.
To facilitate collaborative development of practice areas, simulated and actual, on the
university campus and in participating community agencies that support clientcentred interdisciplinary collaborative professional practice;
6.
To sponsor continuing education offerings on client-centred interdisciplinary
professional practice topics for practicing health professionals in partnering agencies
7.
To provide a means for educating the partnering agencies about their role
involvement in interdisciplinary collaborative practice;
8.
To support studies related to evaluation of client-centred interdisciplinary
collaborative professional practice;
9.
To support student and health professional projects using client-centred
interdisciplinary collaborative practice approaches;
10.
To provide health professional students, faculty and practitioners for an opportunity
for discourse around the merits of interdisciplinary collaborative practice;
11.
To review and approve reports prepared for the funders and partners in this project as
agreed to in the project plan.
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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Members
2 project Co-chairs
5 faculty members (each representing a participating health professional group)
5 students (each representing a participating health professional group)
4 community health agency representatives (from partnering agencies)
4 consumer representatives (from partnering agencies)
1 Project coordinator (ex-officio)
1 Research Associate (ex-officio)
1 Dean Faculty of Health Sciences (ex-officio)
1 Dean Faculty of Medicine & Dentistry (ex-officio)
Meetings: During the first 6 months of the project the Steering Committee will meet monthly
and then bi-monthly throughout the duration of the project.
Documentation and decision-making: Summaries of all meeting discussions and decisions
will be recorded as minutes by the project coordinator. Decision making will be arrived at
through consensus of all participants.
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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Exhibit 5: Monitoring & Formative Evaluation
#1 Socialize health care faculty, students, and practitioners in working together, with shared
problem solving and decision making, toward enhancing benefits for people receiving
community-based health services.
OBJECTIVES
PROCESS
OUTPUTS
Sensitization of
faculty and
students to the
issues,
disciplinary
norms,
administrative
structures and
power
imbalances that
undermine IP
client cenrred
practice
Role
Clarification,
Trusting
Relation-ships
and Shared
decision-making
in planning and
implementing IP
self-directed
teams learning
contracts.
WORKPLAN/
IMPLEMENTATION
Phases 1,2,3,4 (T1, T2)*
- Appoint steering committee
- Development of infra-structure.
- Launch and develop structure of
CIPHER
- Workshop for leaders/ mentors/
students/ community partners.
- Development of curriculum
Phase 4,5 – Development of
Learners (T1, T2)*
- Core concepts of IP introduced
within own disciplies
- Train mentors
- Online modules: conflict
resolution, critical appraisal,
communicaton skills, ethical
practice
- Simulation. Standardized
patient exercise [SP]
- Clinical skills facility
- self-directed problem based
learning skills
- Development of learning
contract with learner teams,
faculty mentor and community
partner.
EVALUATION/ASSESSMENT
[Reliability and Validity Indices]
For Leaders, Mentors & Learners
Focus Group Semi structured Interviews
Faculty set criteria for evaluation of learning contracts.
Focus groups addressing facets of collaboration and sharing that are necessary for
teams offering mental health services and clients; visions, roles, approaches, and
contributions needed to improve team collaboration for mental health care.
TUTOR – PHC Team climate inventory (adapted: [Thames Valley Family Practice
Research Unit (June 2004)] based on [Anderson, N. & West, M. A. [1998]);
administered pre- and post- collaboration.
[The 5 factor 38-item summarized version, as reported by Anderson et al.
demonstrated robust psychometric properties, with acceptable measure of reliability
and validity. Alpha coefficients range 0.84 and 0.94 indicating acceptable levels of
internal homogeneity and reliability for all factors]
Evaluation of workshop experience through post workshop reaction sheets.
Focused interviews of learners, community leaders and mentors to assess process
outcomes indicating progress toward trusting relationships (i.e. rapport, feeling of
caring/being cared about, experience of hope for a better service).
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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#4: Increase the number of health professionals trained for
collaborative client-centred practice before, and after entry
into practice
#3: Increase the number of educators prepared to teach from
an inter-professional collaborative client-centred perspective.
#2: Stimulate networking and sharing of best
educational approaches for collaborative
client-centred practice
OBJECTIVES
PROCESS
OUTPUTS
Networking
amongst faculty,
students,
agencies and
consumers of
health and social
services
Activities to
promote
collaborative IP
client-centred
education for
mental health
care and
practice for
mental health
services delivery
WORKPLAN/
IMPLEMENTATION
EVALUATION/ASSESSMENT
[Reliability and Validity Indices]
Phases 1,2,3,4,5,6 (T1, T2)*
This will be done in all phases
through workshops, knowledge
dissemination strategies and
utilizing faculty, students, clients
and community agencies to mentor
and advise.
For Learners
Focus Group interviews, with, purposefully selected, 5- 7 learning/teaching teams,
containing both learners and mentors/leaders to discuss the meaning of their
interprofessional learning to discover what each learned about roles that other health
discipline professionals can provide within mental health services; what increase in
personal learning exposure to this training; how it will further professional practice?
In addition to implementation as
outlined in Phases 1,2,3,,4 and 5
above, Phase 6 will involve
student practice teams experience
of working with clients in a
community setting.
Analysis of reflective summary of experiences recorded by participants.
Phase 7 (T1, T2, T3)*
Evaluation of site visits
Evaluation of process
For Educators/Health Professionals
Interprofessional Education Perception Scale (Ducanis & Golin, 1981)
[Content validity established by direct nature of questions. Reliability established
through test-retest procedure over three weeks. Exact agreement ranged from 72% to
86%.]
Interprofessional Team Performance Scale (Temkin-Greener et. al, 2004)
[Reliability range from .76 to .89 (Cronbach’s ); construct validity demonstrated
through results of regression analysis]
Make recommendations for
curriculum or organizational
improvement.
For Organizers/Administrators
Data on health outcomes as established by partner agencies
Data on client safety identified in collaboration with Steering Committee
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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LONGER TERM GOAL:
#6: Augment the work toward provincial priorities, including: mental
health care reform; care of the homeless; development of Local Health
Integration Networks (LHINs)
LONGER TERM GOAL #5:
Facilitate inter-professional
collaborative care in both
education and practice settings
OBJECTIVES
PROCESS
OUTPUTS
WORKPLAN/
IMPLEMENTATION
System:
Incorporate
learning of
mental health
care practical
knowledge
gained in
community to
classroom, to
refine practice
definitions.
Sharing in workshops, labs.
Transfer learning to student
groups, steering committee for
development of future teams.
Changes in
mental health
care service
provision.
Phase 7, (T1, T2, T3)*
As well as ongoing knowledge
dissemination and transfer
strategies involving, via various
communication means, all
stakeholders and decision-makers
to increase impact on system
EVALUATION/ASSESSMENT
[Reliability and Validity Indices]
Varied purposeful sample of learners, mentors, and leaders will be selected to
participate in taped focus group interviews to discuss the meaning of their
interprofessional learning and interdisciplinary practice experiences. Qualitative data
transcripts will be analyzed for themes and patterns affording insights into how best to
promote success in the sustained interprofessional collaborative educational program
and service delivery.
All participating institutions will be asked to retain annual records. The following
will afford measures of impact:
- numbers of faculty participating in the project;
- numbers of students participating in the project;
- numbers of clients served by the interprofessional collaborative practice teams;
- self-directed learning materials and forums developed;
- workshop and conference agendas and participation rates; and
- documents reflecting the contributions of the project to mental health reform and
the development of the local Health Integration Network
*[T1 =Baseline data, T2 = post simulated learning data, T3 = post practice data]
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UWO, Creating Interprofessional Collaborative Teams for Comprehensive Mental Health Services
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Exhibit 6: WORKPLAN TIMELINE
ACTIVITY
2006
2007
JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC JAN FEB MAR APR MAY
PHASE 1: Infrastructure Development (CIPHER)
PHASE 2: Workshop (which begins the formal
process of sensitization of leaders and mentors
that will continue throughout the project)
Sensitization of leaders and mentors continues to the end using feedback
from focus groups and other feedback.
PHASE 3: Community experiences
PHASE 4: Development of integrating components
PHASE 5: Development of student teams (Role
clarification, trusting relationships, shared
decision-making
PHASE 6: Further development of student teams
(Where students play a major role in developing
and driving the process)
PHASE 7: Evaluation of site visits and CQI
NOTE: While evaluation in Phase 7 refers to site visits and related CQI, evaluation will be part of every phase.
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