Multidisciplinary Teaming: Enhancing Collaboration through Increased Understanding

Effectiveness of Distance Educational Programs for parents of children diagnosed with Autism Spectrum Disorder: an integrative review

OBJECTIVE

to analyze the scientific literature on distance education programs for parents/caregivers in the development of children with Autism Spectrum Disorder (ASD).

RESEARCH METHOD

the PICO strategy was used to identify the research problem. The databases Medline, ERIC, LILACs, EMBASE, CINAHL, Web of Science, and Scopus were searched using specific descriptors and free terms. There were no restrictions on time or language. Articles on online educational programs for parents of children with ASD were selected, focusing on the impact of these programs on the development of children up to six years old.

SELECTION CRITERIA

studies were selected based on standard eligibility criteria, including full-text reading after initial screening using the RAYYAN software. Primary studies such as clinical trials and systematic reviews evaluating distance education programs for parents of children with ASD were included.

DATA ANALYSIS

the RAYYAN software was used for initial study selection. Articles were hierarchically organized based on title and abstract, followed by full-text reading to apply eligibility criteria.

RESULTS

the initial search yielded 1019 articles, of which 192 were identified as duplicates. After initial screening and full-text reading, 37 articles were analyzed, of which six were deemed eligible to answer the research question. Among the eligible studies, one was a systematic review and five were experimental studies. Experimental studies highlighted positive impacts on areas such as daily routines, behavioral flexibility, and communication. The systematic review provided preliminary evidence that distance education programs for parents can enhance knowledge about ASD, increase adherence to interventions, and foster the development of social and communication skills in children.

CONCLUSION

the findings suggest that remote parent guidance programs may effectively improve knowledge about ASD, increase parent adherence to interventions, and promote the development of social and communication skills in children with ASD.

Occupational therapy experiences of interprofessional collaboration in the support of autistic children

INTRODUCTION

Autistic children commonly receive simultaneous services from various health-care and other professionals, including occupational therapy, throughout their journey of diagnosis and consequent therapeutic support. Current best practice guidelines for supporting autistic youth emphasise the importance of interprofessional collaboration. Despite this, collaboration among health-care professionals does not always occur, and little is understood about clinicians' experiences of collaborative care. The aim of this study was to explore Australian paediatric occupational therapists' experiences of interprofessional collaboration and their perception of factors influencing collaboration when supporting autistic children.

METHODS

This study employed an exploratory qualitative descriptive design. Semi-structured interviews were conducted with 13 Australian paediatric occupational therapists involved in service provision to autistic children. Questions explored clinicians' experiences and perceptions of interprofessional collaboration. Reflexive thematic analysis was used to inductively analyse data.

CONSUMER AND COMMUNITY CONSULTATION

This study was conceptualised and conducted by a team of researchers with a range of personal and professional experiences with the autistic community. The research design was strongly informed by the Autism CRC'S research guidelines.

FINDINGS

Three themes were generated highlighting factors that influence collaboration between occupational therapists and other professionals. The first emphasised that 'clinicians' capacity to collaborate' at both organisational and individual levels was understood to be greatly influenced by funding structures. The second emphasised that 'relationships are key to collaboration' with these often established through shared workplaces or clients. The third, 'shared perceptions make collaboration easier' described how shared perceptions of collaboration, the occupational therapy role, and autism-related frames of reference were perceived to influence interprofessional collaboration.

CONCLUSION

Findings indicate that, while occupational therapists perceive interprofessional collaboration as valuable in the support of autistic children, there are barriers to effective collaboration, particularly in the context of a marketised service delivery model.

PLAIN LANGUAGE SUMMARY

This study looked at how Australian occupational therapists work with other professionals to support autistic children. Even though it is recommended that professionals work together to support autistic children and their families, this does not always happen. In this study, researchers interviewed 13 occupational therapists and asked what it is like working with other professionals, what is helpful, and what makes working together difficult. From these interviews, it was found that many things affect how well occupational therapists can work with other health professionals and teachers to support autistic children. Factors like funding and workplace rules affect how professionals work together. Having someone take on the role of leader and having good relationships between professionals made it easier to work together. It was also helpful when occupational therapists and other professionals shared similar ideas on how to support autistic children. The study could be improved if it had gathered more information about the occupational therapists' education and what they have learnt about working with other professionals. Overall, the therapists in this study believed that working together to support autistic children and their families was important, but that there are many challenges to making this happen. More research on this topic would be helpful.

Assessing the Impact of Multidisciplinary Collaboration on Quality of Life in Older Patients Receiving Primary Care: Cross Sectional Study

The growing aging population presents unique challenges in maintaining their quality of life (QoL), which encompasses physical, psychological, and social wellbeing. This study aimed to assess the impact of multidisciplinary collaboration on QoL among older patients receiving primary care. A cross-sectional study was conducted involving a purposive sampling of 200 participants aged 60 years and above from Primary Healthcare Centers in Al-Ahsa, Saudi Arabia, between March and May 2024. Data were collected using standardized tools: SF-36 for health-related QoL, Multidisciplinary Collaboration Evaluation Tool (MCET), and Lubben Social Network Scale (LSNS). Multivariate regression analyses were performed to examine the associations between multidisciplinary collaboration, social support, and QoL outcomes. Multidisciplinary collaboration exhibited a significant positive association with improvements in physical functioning (β = 2.35, p < 0.001), mental health (β = 3.01, p < 0.001), and general health perceptions (β = 2.12, p < 0.001). Key drivers of effective collaboration included effective communication (β = 0.48, p < 0.001), coordination (β = 0.42, p < 0.001), and patient involvement (β = 0.40, p < 0.001). Social support, particularly from friends (β = 0.33, p < 0.001) and family (β = 0.28, p < 0.001), was also a robust predictor of better QoL. Younger age, female gender, married status, and absence of chronic conditions were associated with greater QoL improvements from multidisciplinary care. Multidisciplinary collaboration and social support networks significantly enhance QoL among older primary care patients. Healthcare systems should prioritize developing collaborative care models, fostering interdisciplinary teamwork, and integrating strategies to promote social connectedness for the aging population.

The Ethical Obligations, Barriers, and Solutions for Interprofessional Collaboration in the Treatment of Autistic Individuals

With an estimated 1 in 44 children having been diagnosed with autism and given the variety of types of service providers that treat autism, collaboration among these professionals is a necessary part of the overall treatment package for an autistic individual. However, like with any professional skill, competence in collaborating effectively must be developed, especially because behavior analysts have been criticized for being resistant to collaboration. Competence with collaboration may be developed through coursework, professional development opportunities, and supervision by someone who has demonstrated competence with collaboration. With the 2020 update to the Ethics Code for Behavior Analysts, the behavior analyst's role in collaborating with other professionals has been clarified by several expectations. Current literature also provides additional guidance on the potential barriers to collaboration as well as recommendations for how to support a collaborative team. In order to facilitate successful collaboration, it is also important to evaluate the effectiveness of the collaborative team and to take advantage of opportunities to learn about the methodologies and perspectives of the other professionals to ensure that the client's best interests are met.

Promoting Reciprocal Relations across Subfields of Behavior Analysis via Collaborations

Several barriers may inhibit the growth of behavior analysis as a more integrated and collaborative field. Two such barriers are siloed environments that reinforce a basic-applied distinction, and a lack of translational research pathways. We describe the perils of silos, and elaborate on potential solutions to increase reciprocal relations among subfields in behavior analysis. We promote a five-tiered system to classify research in behavior analysis, and discuss literature on cultivating effective intra and cross-disciplinary collaborations, including using the framework of metacontingencies to understand collaborations. We also propose quantitative and qualitative measures to examine whether the potential solutions increase intra and interdisciplinary interactions. These measures include bibliometric (e.g., citations across fields), sociometric (e.g., social network analysis), and narrative analysis. We apply some of these measures to publications from 2011-2022 from the Journal of the Experimental Analysis of Behavior and Journal of Applied Behavior Analysis, and argue that behavior analysis overall may benefit from a more collaborative approach.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40614-023-00386-x.

Understanding how behaviour therapists use autism spectrum disorder diagnostic information for intervention planning

Understanding how behaviour therapists incorporate diagnostic assessments into their intervention planning can help to streamline assessment procedures and facilitate communication. The objectives are to identify what information from the diagnostic assessment is received by behaviour therapists and which assessment elements are most important and relevant for treatment planning. Behaviour therapists, identified through Ontario registries, were surveyed about their use of diagnostic information in treatment planning. Seventy-one behaviour therapists completed the survey (response rate = 35.5%). The diagnostic information most frequently received by respondents included brief (69%) and detailed (49.2%) physician/psychologist report, speech/language assessment report (52.1%) and individualised education plan (50.7%). Most respondents indicated that information from the physician/psychologist report is often out-dated (74.6% Agree/Strongly Agree). There was variable agreement that the information in the diagnostic package influences the type and quantity of treatment. These findings demonstrate that while diagnostic assessments received by behaviour therapists are important to their planning, other independently obtained sources of information, such as client interviews, are relatively more important to this process. The diagnostic assessment is one tool to inform treatment planning; however, up-to-date information about the child's needs is likely to be more informative.

Examination of Ethical Decision-Making Models Across Disciplines: Common Elements and Application to the Field of Behavior Analysis

Human service practitioners from varying fields make ethical decisions daily. At some point during their careers, many behavior analysts may face ethical decisions outside the range of their previous education, training, and professional experiences. To help practitioners make better decisions, researchers have published ethical decision-making models; however, it is unknown the extent to which published models recommend similar behaviors. Thus, we systematically reviewed and analyzed ethical decision-making models from published peer-reviewed articles in behavior analysis and related allied health professions. We identified 55 ethical decision-making models across 60 peer-reviewed articles, seven primary professions (e.g., medicine, psychology), and 22 subfields (e.g., dentistry, family medicine). Through consensus-based analysis, we identified nine behaviors commonly recommended across the set of reviewed ethical decision-making models with almost all (n = 52) models arranging the recommended behaviors sequentially and less than half (n = 23) including a problem-solving approach. All nine ethical decision-making steps clustered around the ethical decision-making steps in the Ethics Code for Behavior Analysts published by the Behavior Analyst Certification Board (2020) suggesting broad professional consensus for the behaviors likely involved in ethical decision making.

Center the margin: Equity-Based Assessment and Response Strategies to Reach Underserved Communities Using a Telehealth Service Delivery Model

While the COVID-19 pandemic has initiated drastic personal, social, organizational, and governmental level changes, it also sparked a unique opportunity. More Behavior Analysis providers had the option to respond to this crisis by offering telehealth services. As providers address their ability to conduct sessions using electronic delivery methods, there is also a need to prioritize those who historically have been forgotten in the formation of systemwide change: Black Indigenous People of Color (BIPOC). This paper outlines barriers to accessing telehealth treatment and includes options for individual providers and organizations to address disparity and other relevant contextual variables within their telehealth models.

Humble Behaviorism Redux

The need to bring behavior analysis to scale is no more obvious or urgent than now. Collaboration between behavior analysts and healthcare workers, educators, policymakers, mental health clinicians, social workers, and so many other professionals is critical to reaching under-resourced and traditionally marginalized populations. First, however, interprofessional collaboration must be adopted widely and reinforced within the behavior analytic community. Disciplinary centrism and hubris pose barriers to effective interprofessional collaboration, leading one to assume the position that practitioners of the same discipline are better trained and smarter than those of a different field. However, cultural humility (Wright, Behavior Analysis in Practice, 12(4), 805-809, 2019) is an alternative to disciplinary centrism that allows professionals to retain identities born of cultural histories and training (Pecukonis, Journal of Teaching in Social Work, 40(3), 211-220, 2020). Furthermore, cultural reciprocity is a process of self-observation and collaborative inquiry that involves questioning one's own assumptions and forces individuals (and professions) to confront the contradictions between their values and their practices (Kalyanpur & Harry, 1999). In this paper, we revisit the call for Humble Behaviorism first made by Alan Neuringer in 1991 and the recommendations of fellow behavior analysts since. Specifically, we introduce a framework of cultural reciprocity to guide humble behaviorists as they acquire behaviors necessary to establish and maintain productive interprofessional relationships. We encourage them to act on their ethical and moral duties to address social problems of global concern and bring behavior analysis to scale.

Workplace Conflict in Applied Behavior Analysis: Prevalence, Impact, and Training

Conflict, albeit normal in every relationship, can increase stress and tension. Workplace conflict is highly prevalent in the field of health care and has been correlated with lowered job satisfaction and burnout. However, little is known about workplace conflict for practicing Board Certified Behavior Analysts® (BCBAs®). We distributed an electronic survey through the Behavior Analysis Certification Board® (BACB®⁾ to determine the impact and prevalence of workplace conflict for practicing BCBAs. Most of our participants reported various levels of conflict with different workplace professionals including teachers, caregivers, colleagues, and supervisees. We found that a high proportion of practitioners reported losing cases and wanting to leave their jobs because of workplace conflict. Most of our participants did not feel that they had the training they needed to have sufficient skills to resolve workplace conflict effectively. Therefore, in this article we outlined the component skills necessary to manage conflict effectively and made recommendations for training these skills.

Interdisciplinary Collaboration Training: An Example of a Preservice Training Series

In recent years, there has been discussion of the need for training behavior analysts in collaboration skills. There is some consensus that these skills are needed to improve outcomes with clients and with colleagues. Specifically, students of behavior analysis and behavior-analytic practitioners need to learn the skills associated with functioning effectively in interdisciplinary teams. At Melmark, a model of training in this skill set has been developed and integrated into supervision modules for those seeking Board Certified Behavior Analyst certification. In this model, supervisees are exposed to information about the expertise and value of the allied professions of speech-language pathology, occupational therapy, physical therapy, and developmental pediatrics. Rotations are done within these fields to expose trainees to the expertise of these fields and to build skills in collaboration with members of those professions. Trainees are also assigned tasks that require them to identify the contributions of other professions and display appropriate collaborative behavior. Future directions for the model are discussed, including extending it across the organization and developing performance-based assessments and social validity measures.

Standards for Interprofessional Collaboration in the Treatment of Individuals With Autism

Interprofessional collaboration has become an essential component in the treatment of individuals with autism spectrum disorder, as practitioners from a range of disciplines are often necessary to address the core features and co-occurring conditions. Theoretically, such cross-disciplinary collaboration results in superior client care and maximal outcomes by capitalizing on the unique expertise of each collaborating team member. However, conflict in collaborative practice is not uncommon given that the treatment providers come from varying educational backgrounds and may have opposing core values, fundamental goals, and overall approaches. Although the overarching interest of each of these professionals is to improve client outcomes and quality of life, they may be unequipped to effectively navigate the barriers to collaboration. This article reviews the potential benefits and misconceptions surrounding interprofessional collaboration and highlights common sources of conflict. As a proposed solution to many of the identified issues, we offer a set of standards for effective collaborative practice in the interprofessional treatment of autism spectrum disorder. These standards prioritize client care and value each discipline's education and unique contributions. They are intended to function as core standards for all treatment team members, promote unity, prevent conflict, and ultimately help practitioners achieve the most integrated collaborative practice among professionals of varying disciplines.

A Behavior-Analytic Perspective on Interprofessional Collaboration

Collaborative service delivery models have gained considerable popularity in health care, education, and clinical settings. Despite the unique opportunity that this new popularity provides for the dissemination of applied behavior analysis, the majority of practicing behavior analysts have received little or no formal professional development on how to participate in teams with nonbehavioral colleagues. The purpose of this article is to elucidate the larger movement toward collaborative service delivery with an emphasis on interprofessionalism. The four core competency domains presented by the Interprofessional Education Collaborative (IPEC) Framework are interpreted through a behavior-analytic lens. This article is an initial attempt to operationalize constructs commonly associated with interprofessional educational and collaborative practices including (but not limited to) cultural sensitivity and responsiveness, cultural humility and reciprocity, empathy, and compassion.

Ethical Considerations of Behavioral Feeding Interventions

Children with autism spectrum disorder (ASD) often display repetitive and restrictive patterns of behavior, which can be seen in food selectivity and other feeding problems. Feeding problems in children with ASD not only lead to medical complications for the child but also can lead to increased caregiver stress. In order for behavior analysts to ensure adherence to the Professional and Ethical Compliance Code for Behavior Analysts, many factors need to be addressed prior to and during feeding assessments and interventions. The need for interdisciplinary collaboration and ethical situations that may arise are reviewed. The purpose of this article is to assist the behavior analyst in determining best practices for feeding assessments and interventions while maintaining ethical compliance.

Collaboration between Behavior Analysts and Occupational Therapists in Autism Service Provision: Bridging the Gap

Interdisciplinary collaboration is challenging, but necessary, to meet the needs of individuals with autism spectrum disorder. Among the dyadic interactions in interdisciplinary teams, the relationships between occupational therapy practitioners and board certified behavior analysts are uniquely challenging. The disciplines define evidence-based practice differently and approach intervention from different angles. Furthermore, there are fundamental differences in worldview between the disciplines. Both disciplines offer necessary treatment, and successful collaboration between these disciplines is essential for maximizing outcomes. Hence, finding ways to help bridge the gap between these professions, in particular, is essential. Common barriers to developing collaborative alliances include misperceptions of the other discipline, differences in terminology, and unprofessional behavior. This article reviews the history and foundational concepts of both disciplines, and the common approaches associated with each. In addition, models of collaboration are discussed, with suggestions for enhancing interdisciplinary communication and treatment. Successful collaborative treatment is predicated on an understanding of the value and expertise offered by different disciplines, and requires mutual respect and professional dialogue.

Talking the talk in junior interprofessional education: is healthcare terminology a barrier or facilitator?

BACKGROUND

Use of healthcare terminology is a potential barrier to interprofessional education (IPE). This study describes how junior learners perceive and classify healthcare terminology in IPE settings.

METHODS

We conducted a mixed methods study involving 29 medical, 14 nursing, and 2 physician assistant students who had previously attended or were registered to participate in educational activities at McMaster University's Centre for Simulation-Based Learning. 23 participants identified "inclusive" or "exclusive" terminology in a series of scenarios used for IPE workshops using an online survey. We collated lists of "inclusive" and "exclusive" terminology from survey responses, and characterized the frequencies of included words. 22 students participated in focus group discussions on attitudes and perceptions around healthcare terminology after attending IPE workshops. We identified themes through an iterative direct content analysis of verbatim transcripts.

RESULTS

Students analyzed 14 cases, identifying on average 21 terms per case as healthcare terminology (28% of overall word count). Of the 290 terms identified, 113 terms were classified as healthcare terminology, 46 as inclusive and 17 as exclusive by > 50% of participants. Analysis of focus group transcripts revealed 4 themes: abbreviations were commonly perceived as complex terminology, lack of familiarity with terminology was often attributed to inexperience, simulation was considered a safe space for learning terminology, and learning terminology was a valued IPE objective.

CONCLUSIONS

While students perceive a lot of healthcare terminology in IPE learning materials, categorization of terminology as "inclusive" or "exclusive" is inconsistent. Moreover, healthcare terminology is perceived as a desirable difficulty among junior learners, and should not be avoided in IPE.

Ethical Considerations in Clinical Supervision: Components of Effective Clinical Supervision Across an Interprofessional Team

Within the practices of behavior analysis, education, occupational therapy, physiotherapy, speech-language pathology, and other health professions, professional practice focuses on each discipline's ethics, assessment, and treatment practices. However, maximizing outcomes for some clients is achieved only by combining the strengths of multiple disciplines to include all the competencies required for comprehensive client care. Thus, understanding and acquiring the core competencies for working collaboratively within an interprofessional framework is essential for working together effectively to garner the best outcomes for clients. Furthermore, the interprofessional team clinical supervisor has the added responsibility of ensuring optimal client outcomes while managing a diverse group of professionals, each with their own set of perspectives, clinical training, and evidence-based practices. In many areas of applied practice, the behavior analyst assumes the role of interprofessional clinical supervisor, which necessitates additional training in collaboration, supervision of allied professionals, and ethics. Successful interprofessional and collaborative working relationships require a number of key competencies and subcompetencies as outlined by the Interprofessional Education Collaborative, as well as knowledge of others' ethical and professional codes and/or guidelines for professional conduct, along with additional training and resources in the navigation and handling of ethical dilemmas among disparate team members. Working together and maintaining professional relationships within an interdisciplinary team are fraught with barriers and issues that may impede collaboration. The interprofessional team clinical supervisor requires various strategies, processes, and resources to enable them to navigate challenges and assist the team in working cohesively to achieve more positive client outcomes.

A comparison of intervention for problematic speech using reinforcement with and without preferred topics

Previous research has shown that responding to the appropriate and problematic speech of individuals diagnosed with developmental disabilities with interested and uninterested listener responses, respectively, can promote more appropriate conversational engagement. However, Fisher et al. (2013) also responded to appropriate speech with access to preferred conversational topics. This study examined the influence of listener interest on the problematic speech of 8 participants and tested the additive effects of (Study 1) and participant preference for (Study 2) delivering preferred topics as reinforcement for appropriate speech. Interventions were equally effective with or without arranging access to preferred topics, but a majority of participants demonstrated a preference for intervention with contingent access to preferred topics. Caregivers and speech-language pathologists rated the intervention procedures as acceptable and changes in participants' speech satisfactory.

Branching Out: Finding Success in New Areas of Practice

In recent years, researchers and practitioners in behavior analysis have called for expanding the application of the science to new, socially relevant areas. The authors of this article work in the areas of applied animal behavior and organizational behavior management, and we are often asked for guidance and mentoring to help behavior analysts transition into our domains. Here, we offer actionable guidance for bridging the gap between behavior analysis graduate training and career paths that are not yet common for behavior analysts. Working in new practice areas involves a great deal of problem solving without much support. Thus, obtaining high-quality, in-depth training in behavior analysis is essential. We recommend building competence in a new area of practice by finding a mentor or community of practice and then seeking paid employment in that area as soon as possible. Finally, when one begins to work in a new area, it is essential to be realistic and humble. We offer practical advice for implementing each of these suggestions.