Transdisciplinary Collaboration
Project: Outcomes
Phyllis M. Connolly, PhD, RN, CS
President,
American Psychiatric Nurses Association
http://www.apna.org
Professor, School of Nursing, San Jose State University,
San Jose, CA 95192-0057
408-924-3144; e-mail, ConnollyDr@aol.com
Transdisciplinary Collaboration Project
San Jose State University
CA Dept.
of
Mental
Health
Office of Sponsored Programs
College of Applied Sciences and Arts
School of Nursing
Nurse Managed Centers
Communication Disorders & Sciences Program
Department of Occupational Therapy
Therapeutic Recreation Program
College of Social Work
Institute for Teaching & Learning
Faculty and Students
Santa Clara
County
Mental
Health
Revised 6/98
Santa Clara County
Alliance for the
Mentally Ill
Residents
Staff
Families
ALLIANCE for
Community Care
Zoe House
Crossroads Village
Casa Feliz
Project Goal
Through collaborative efforts,
provide quality, cost effective
services for persons with serious
mental illness living in the
community while simultaneously
preparing future mental health
professionals for practice.
Theoretical Frameworks
 Jeger
& Slotnick’s Behavioral-Ecological
Perspective Community Mental Health
 Moller- Murphy: Relapse, Recovery,
Rehabilitation
 Omaha Nursing Documentation System
 Deming’s Total Quality Management
 Donabedian Quality: Structure, Process &
Outcome
Behavioral Ecological Model of
Community Mental Health
Laws
University
Administration of
Justice
Training of
Professionals
Community
Friends and Peers
Person
Church
Family
Laws
Social Policy
Mental Health
System
Legislation
Behavioral-ecological Perspective
Values & Interventions
 Specific
values:
– Promoting individual competence
– Enhancing psychological sense of community
– Supporting cultural diversity
 Interventions
seek to:
– Optimize human development
– Enhance coping and mastery skills
– Enhance organizational and community strengths
Improved quality of life
Definition Collaboration
 A dynamic
transforming process of creating
a power sharing partnership for pervasive
application in health care practice,
education, research, & organizational
settings for the purposeful attention to
needs and problems in order to achieve
likely successful outcomes (Sullivan, 1998,
p. 6)
Competence Paradigm:
Health Based
View of Families:
Emphasis on:
Role of Professionals:
Assessment:
Goal of Interventions:
Modus Operandi:
Perspective:
Competent
Strengths
Enabling Agents
Competencies
Empowerment
Adaptation
Ecological Framework
Transdisciplinary Project
S TU D E N TS F A C U L TY S TA F F
S em in ar
AMI
M eetin g s
Caring & Sharing
•weekly
•campus
•case presentation
•discipline information
•discussion & feedback
P racticu m
•2 days/week
•on-site
•client contact
•experience
•implementation
•evaluation
Seminar Format
 A student
or staff from the designated
discipline/program presents a client clinical
setting focusing on the specific plan of care.
 Students and staff from other disciplines
assess for additional contributions or
approaches.
 Faculty offer consultation and clarification as
needed.
 Students may seek consultation from their
own discipline faculty and/or other
Seminar Goals
 Increased
awareness of stigma in the lives
of persons with a serious mental illness and
their families, and its dehumanizing results.
 Increased knowledge about psychotropic
medications, usual side effects as well as
client concerns.
 Increased knowledge related to dual diagnoses-serious mental illness and substance abuse.
Seminar Goals Continued
 Increased
knowledge and skills in
working with culturally diverse clients
and families.
 Increased
knowledge about
collaborating with clients and families.
 Increased
knowledge about other
disciplines.
Seminar Goals Continued
 Increased
knowledge about the effects
of collaborating with other disciplines to
meet the needs of clients.
 Increased
knowledge about the
theoretical perspective of their own
discipline.
 Increased
sense of professional
Collaborative Assessment Standards
 Authenticity
 Convergence
 Collaboration
 Equity
 Sensitivity
 Congruence
Bagnato, Neisworth, & Munson, 1997
Assessment Tools
 Pragmatic
Protocol
 Social Skills Rating Scale
 Canadian Occupational Performance
 Moller-Murphy Management Assessment
Tool
 Omaha
Nursing Classification System
Collaborative Teaching Strategies
 Orientation
of students, Transdisciplinary
Seminar
 Orientation to teaching Wellness topics
collaboratively
 Pairing graduate Communication Disorders
students and undergraduate nursing students
 Students meet and review manual and topic
Collaboration Intervention Principles
Attention to
Communicative
Needs
Flexibility is KEY!
•Expectations
•Presentation
Attention to
•Distractions
Non-Communicative
Needs
Client
Diagnosis effect
Medication effects
Secondary disorders
Health Issues for Collaboration
 Weight
loss
 Exercise
 Grooming
 Safe sex
 Nutrition
 Stress management
 Symptom management
Communication Issues for
Collaboration
 Memory
 Cognition
 Speech
 Narrative
discourse
 Conversational skills
 Social skills
 Hearing
 Literacy
Approaches to Collaborative
Outcomes
Primary discipline
Supportive discipline
Assess and evaluate
problems and needs
 Treat & evaluate
 Seek consultation &
referrals
 Collaborate


Validate treatment
approach
 Assess, treat,
recommend
 Collaborate
Weight Loss
 Nursing
– Assess nutritional
status
– Assess eating
behaviors
– Assess environment
– Assess and establish
exercise program
– Teach appropriate food
selections
– Evaluate, weigh
weekly
 Communication
Disorders
– Organizing a eating
schedule
– Categorizing
appropriate food
choices
– Follow up
comprehension
– Food preparation
Weight Loss

Therapeutic Recreation
– Identify leisure activities
that support positive
weight management
– Identify preferred leisure
activities to manage
weight
– Food related activities
– Establishing routine
Exercise

Therapeutic Recreation
– Assess leisure interests
related to physical activity
– Develop appropriate
routine (alone or with
others)
– Monitor for progress
Grooming

Therapeutic Recreation
– Identify requirements for
recreation participation
– Reinforce routine
Stress Management
 Nursing
– Crisis intervention
»
»
»
»
Deep breathing
Self talk
Time out
Visualization
– Prevention
» Diet & nutrition
» Exercise
» Time management
 Communication
Disorders
– Organizing and
creating schedules
– Follow up on
comprehension
– Routines
– Social skills
Stress Management

Therapeutic Recreation
– Identify triggers
– Identify and practice
strategies to mange stress
– Example: relaxation,
exercise, visualization
Social Skills

Therapeutic Recreation
– Assess preferred
interactions (large or
small group, one-to-one
interactions)
– Identify and develop
needed skills for use in
leisure time
– Practice in the
community
Memory
 Communication
Disorders
interventions
–
–
–
–
–
–
–
–
Scheduling
Visual, writing notes,
Reminders
Calendars
Routines
Self generated strategies
Repetition
Rehearsals

Nursing interventions
– Assess for physiological
causes
– Assess for nutritional
status
– Assess medication
efficacy
– Develop collaborative
plan utilizing memory
enhancement strategies
Speech (Dysarthria)
 Communication
Disorders
– Oral facial evaluation
– Oral motor exercises
» Voice
» Exaggerated
enunciation
» Oral facial awareness
» Rate of speech
 Nursing
–
–
–
–
–
Assess AIMS
Assess medication
Assess oral hygiene
Assess dental hygiene
Assess nutritional
status
– Follow up on oral
motor exercises
CCF # 9012, Problem 21, Speech,
Communication, Spring 97
 Difficulty
–
–
–
–
–
with
Intelligibility
Topic maintenance
Organizational skills
Withdrawal
Interventions
Outcomes

Decrease in rate of speech

Increased
– Intelligibility
– Narrative discourse,
expanded utterances,
increase volume
– Self expression
– Organizational skills
– Interaction
– Social interaction
– Attention and participation
Omaha Nursing Documentation
System: Domains
I,
Environmental
II, Psychosocial
III, Physiological
IV, Health Related Behaviors
Domain II. Psychosocial












Communication with community resources
Social contact
Role change
Interpersonal relationship
Spiritual distress
Grief
Emotional stability
Human sexuality
Caretaking/parenting
Neglected child/adult
Abused child/adult
Growth & development
Domain IV. Health Related
Behaviors
 Nutrition
 Sleep
and rest patterns
 Physical activity
 Personal hygiene
 Substance use
 Family planning
 Health care supervision
Intervention Categories
 I.
Health Teaching/Guidance/Counseling
 II. Treatments and Procedures
 III. Case Management
 IV. Surveillance
Targets
 Behavior
modification
 Caretaking/parenting
skills
 Communication
 Coping skills
 Exercises
 Food
 Interaction
 Wellness
 Medication
action/side
effects
 Nutrition
 Rehabilitation
 Relaxation/breathing
techniques
 Safety
 Signs/symptoms
 Stress management
Omaha Rating Scale
Concept
1
2
3
Mini- Basic
Knowledge No
knowledge mal
4
5
Adequate Superior
Behavior
Not
appropriate
Rarely Inconsistently
Usually
Status
Extreme
S&S
Severe Moderate Minimal
S&S S&S
S&S
Consistently
No S&S
CCF # 9012, Problem 21,
Speech, Nursing, Spring 97
Initial Rating
Final Rating
 Knowledge:
2
 Knowledge:
4
 Behavior:
2
 Behavior:
4
 Status:
3
 Status:
4
CCF #9012, Problem 38, Personal
Hygiene, Spring 97
Initial Rating
Final Rating
 Knowledge:
2
 Knowledge:
4
 Behavior:
2
 Behavior:
4
 Status:
3
 Status:
4
CCF #9068, Problem 35,
Nutrition, Spring 97
Initial Rating
Final Rating

Knowledge: 2

Knowledge: 4

Behavior:
2

Behavior:
4
2

Status:
4
 Status:
CCF # 9068, Communication
Disorders, Spring 97
Assessment

Difficulty with
–
–
–
–
–
–

Initiating conversation
Social interaction
Pragmatics
Semantics
Narrative discourse
Expanding utterances
Weight control
Outcomes
 Increase
–
–
–
–
–
in
Greetings
Staying on topic
Memory, recall
Details
Group participation
 Weight
– Loss 2 lbs.
– Exercise program
– Healthy diet
CCF# 9068, Problem 37,
Physical Activity, Spring 97
Initial Rating
Final Rating

Knowledge: 2

Knowledge: 4

Behavior:
2

Behavior:
4

Status:
2

Status:
4
Outcomes Emotional Stability:
Zoe House S 95 - F 96
Average O m aha R atings All C ontacts
Across Sem esters
5
4
3
K no w le dg e
B e ha vio r
Sta tus
2
1
0
S 95
F 95
S 96
F 96
N=0
N = 21
N = 31
N=7
Note: Typical interventions: Health Teaching
Typical targets: Coping Skills, Interaction & Behavior Modification
Outcomes Interpersonal Relations:
Zoe House S 95 -F 96
Average O maha R atings All C ontacts Across
Semesters
5
4
3
K no w le dg e
2
B e ha v io r
S ta tus
1
0
S 95
N=2
F 95
N = 15
S 96
N=7
F 96
N = 27
Note: Typical interventions: Health Teaching & Surveillance
Typical targets: Interaction, Communication & Personal Care
Outcomes Interpersonal Relations:
Crossroads S 95 - F 96
Average Omaha Ratings All Contacts
Across Semesters
5
4
3
Knowledge
2
Behavior
Status
1
0
S 95
N = 15
F 95
N = 34
S 96
F 96
N = 28
N = 20
Note: Typical interventions: Health Teaching & Surveillance
Typical targets: Communication & Interactions
Outcomes
Fall 1993 - Spring 1998
17,682 hours direct care
252 undergraduates
52 graduate students
9 faculty
Cost Savings Study
Crossroads Village: 1993-94
 N=25
(9 -12 month)
By using Crossroads Village,
25 persons achieved tenure with total
savings of $369,471 in the following areas:
–
–
–
–
Locked facility costs
Emergency psychiatric services costs
Acute in-patient psychiatric services costs
Contract services costs
Evaluating Student Learning
 Transdisciplinary
Seminar
 Supervision Groups
 Logs
 Direct Observation
 Process Recordings
 Care Plans
 One to one
Evaluations of Goals, Fall ‘97,
N = 22
Agree and Strongly Agree all goals met
except:
– Increased knowledge related to clinical
intervention research focused on outcome
studies
– Increased knowledge related to dual
diagnoses--serious mental illness and
substance abuse.
Increased awareness of stigma and
dehumanizing results, N = 22
100
90
80
70
60
50
40
30
20
10
0
STRONGLY
AGREE
TOTAL
Fall 97
Honors & Awards

APA Honorable Mention
1994

Innovative Research
Teaching and Learning
Award 1998

Outstanding Leadership in
Collaboration, May 1998

Learning Productivity Grant
1998
Challenges and Issues
 Conflicts
in missions
 Supervision of non-nursing students on site
 Staffing during non-academic times
 Maintaining faculty interest
 Role strain
 Inequality of faculty workload
 Students dropping clients
 Inadequate space to meet with students
Challenges and Issues (Continued)
 Lack
of university support
 Staff turnover
 Client hospitalizations
 Communications
 Cutbacks in county funding
 Obtaining permission to provide services
from conservators and case managers
 Conflicts with OT clinic schedule
Transdisciplinary
Team Advantages
 Individualized
rehabilitation plan-goals
 Integrated service delivery
 Role delineation
 Reduction of redundant care
 Increase of interaction between professionals
 Generalization and maintenance of skills
 Learning with and from each other
 Sharing and growing
 Improved quality of life
 Cost effectiveness
Future Plans
 Nightingale Tracker
Project 1998
– http://con.ufl.edu/omaha/case19htm
 Infrastructure
– Institute for Teaching & Learning
– Task force: Integration of Community Service
Learning into the Curriculum
 Campus
Compact Network
Outcomes of Collaboration
Clearly, the closer educators, researchers,
consumers, practitioners, and families
come together in the service area, the
more likely that curricula will be reality
based and congruent with clients’ needs.
At the same time, the possibility of
improving the quality of life increases.
Collaboration
 Powerful
human & social tool--changes
people and systems
 Framework for ethical care
 Building healthy communities
– Requires extensive collaboration among
families, institutions, & Professionals
 Disciplinary
& personal agendas are
secondary to shared goals