Patterns of interactions in multidisciplinary child protection teams in New Jersey

The work performed through interprofessional meeting discourse: an observational study

The effectiveness of work performed through interprofessional practice is contingent on the nature and extent of communication between professionals. To date, there is little research exploring how the patterns of communication may impact interprofessional work. This study focused on communication during interprofessional meetings to better understand the interprofessional work performed through these encounters. Specifically, it examined how interactional discourse, that is, the patterns of language, influenced work performed during interprofessional meetings. A series of four interprofessional meetings in a rehabilitation unit were observed. Twenty-one participants were observed, including medical, nursing, allied health clinicians, and health professions students. Follow-up stimulated-recall interviews were conducted with five meeting participants. The data collection consisted of video and audio recordings and detailed field notes. Data were analyzed using a combination of genre analysis, a form of discourse analysis, and activity system analysis, drawing on Cultural Historical Activity Theory. This facilitated an in-depth examination of the structure of discourse and its influence on meeting outcomes. The meeting structure was defined and predictable. Two distinct forms of discourse were identified and labeled scripted and unscripted. Scripted discourse was prompted by standardized documents and facilitated the completion of organizational work. In contrast, unscripted discourse was spontaneous dialogue used to co-construct knowledge and contributed to collaboration. There was constant shifting between scripted and unscripted discourse throughout meetings which was orchestrated by experienced clinicians. Rather than fragmenting the discussion, this shifting enabled shared decision making. This research provides further insights into the interprofessional work performed during interprofessional meetings. The scripted discourse was highly influenced by artifacts (communication tools) in meetings, and these were used to ensure organizational imperatives were met. Unscripted discourse facilitated not only new insights and decisions but also social cohesion that may influence work within and outside the meeting.

Safely Increasing Connection to Community-Based Services: A Study of Multidisciplinary Team Decision Making for Child Welfare Referrals

Initial child welfare screening decisions, traditionally made by an individual worker, determine if a family will receive further intervention by child protective services. A multi-disciplinary team (MDT) decision-making approach for child welfare referrals aims to provide a more thorough assessment of needs and strengths and to connect families to appropriate community-based providers. This study examined 159 child welfare referrals handled by MDTs compared to 331 referrals handled via the traditional screening approach. The study used a pseudo randomization procedure to assign referrals to the study conditions: Referrals logged on 2.5 days of the week were assigned to the treatment group; all others were assigned to the comparison group. Referrals handled by an MDT were more than four times as likely as those not handled by an MDT to be referred to community-based organizations (OR = 4.32, p < .001). There were no statistically significant differences in families' engagement with community-based organizations or child welfare outcomes. MDTs are a promising step in the initial process of connecting families to services, although they did not affect this study's longer-term outcomes.

Experience with outreach services of a multidisciplinary team for child abuse identification

BACKGROUND/PURPOSE

Identifying child abuse is sometimes challenging due to its various presentations. To facilitate timely identification of critical or complex cases of physical abuse outside our child protection center, we established an outreach multidisciplinary team (OMDT) to support Kaohsiung City Government in 2014. The objective of this study was to describe our experience of OMDT services during a 6-year period and examine its role in assisting law enforcement.

METHODS

We retrospectively analyzed all OMDT cases from January 2014 to January 2020. Clinical characteristics and OMDT reports were reviewed. After inspection by our OMDT, cases were determined as indicating either a high risk or low risk of child abuse. Associations among clinical characteristics, radiographic findings, OMDT decisions and case outcomes including law enforcement and prosecution were examined.

RESULTS

Thirty-two cases (22 [68.8%] males and 10 [31.2%] females; mean age 24.2 months) received OMDT service, of whom 28 (87.5%) were admitted to the pediatric intensive care unit. The victims had an average of 2.2 types of wounds in 3.4 locations. The most common finding on radiography was subdural hemorrhage (18, 56.3%), followed by subarachnoid hemorrhage (31, 31.3%). Law enforcement was activated in 20 (64.5%) cases, and was only associated with the high-risk group as determined by the OMDT (p < 0.05) but not with any other variables.

CONCLUSION

Our experience indicates that an OMDT can play an important role in child protection and activating law enforcement for children with complex or critical physical abuse. We suggest that in Taiwan, OMDT services should be incorporated into child protection centers, National Health Insurance system and governmental child protection policies.

Communication Adjustment in Engineering Professional and Student Project Meetings

Background: communication is important for project teams. There is a need to better understand how members respond to communication at project meetings, and how this affects the team roles the participants adopt. Methods: observational data were collected from (a) two engineering organisations and (b) five university engineering student teams. A mixed methods approach was used, comprising observations (recorded with the interaction diagram method), questionnaires and interviews. Results: participants adjusted their communication style to the behaviour of other people and to different communication settings. This happened with three different dynamics: micro-level (grounding processes in conversation), mezzo-level (emotional and rational regulation) and macro-level (over a period of time). Originality: a new theory was presented for the process of team behaviour during project meetings; specifically, role adoption and communication behavioural changes. Participants change their team roles within three different dynamics: at the macro-, mezzo- and micro-levels, corresponding to the organisation, project and meeting, respectively. The changing of team roles in project meetings arises from rational and emotional regulation. The findings have the potential to assist managers and supervisors to better understand and manage the team dynamics on their projects.

Successful strategies in implementing a multidisciplinary team working in the care of patients with cancer: an overview and synthesis of the available literature

In many health care systems globally, cancer care is driven by multidisciplinary cancer teams (MDTs). A large number of studies in the past few years and across different literature have been performed to better understand how these teams work and how they manage patient care. The aim of our literature review is to synthesize current scientific and clinical understanding on cancer MDTs and their organization; this, in turn, should provide an up-to-date summary of the current knowledge that those planning or leading cancer services can use as a guide for service implementation or improvement. We describe the characteristics of an effective MDT and factors that influence how these teams work. A range of factors pertaining to teamwork, availability of patient information, leadership, team and meeting management, and workload can affect how well MDTs are implemented within patient care. We also review how to assess and improve these teams. We present a range of instruments designed to be used with cancer MDTs - including observational tools, self-assessments, and checklists. We conclude with a practical outline of what appears to be the best practices to implement (Dos) and practices to avoid (Don'ts) when setting up MDT-driven cancer care.

The more, the better?

Purpose

– This paper seeks to explore vertical and horizontal leadership and the relationship of the form of leadership to effectiveness in Swedish cross-professional health care teams.

Design/methodology/approach

– Questionnaire data were collected from a sample of 47 teams and observation data from a sub-sample of 38 teams. Data on leadership were condensed to indices: directive and participative leadership (vertical leadership) and functional influence and self-regulation (horizontal leadership). Effectiveness was estimated using five measures: team climate, self-assessed effectiveness, teamwork organisation, assessments of results from a simulated case conference (case quality) and manager-rated effectiveness.

Findings

– Positive relationships were found between leadership and effectiveness with one exception: case quality was negatively associated with vertical leadership though positively to functional influence. When controlled for team climate the correlations between self-assessed effectiveness and leadership disappeared. However, it remained between vertical leadership and the assessment of teamwork organisation. The results suggest that hierarchical and horizontal/shared leadership are complementary forms.

Research limitations/implications

– The small number of teams together with the problem of causality in this cross-sectional study are the main limitations.

Practical implications

– One implication for practice is the need for clarification of how leadership and influence should be distributed from a contingency perspective.

Originality/value

– This study takes both horizontal and vertical leadership into account compared with previous studies often focusing on one facet. In addition, cross-professional health care teams with their special characteristics are underrepresented within research on team leadership.

Interprofessional psychiatric teams: is multidimensionality evident in treatment conferences?

Interprofessional teamwork is practised when the care needs of patients are complex. Little is known about the extent to which team competence really determines patient interventions. The aim of the study was to examine the degree of multidimensionality in patient discussions in psychiatry, and to how different professions contribute. Psychiatric teams were observed during 30 team meetings. A content analysis was used to examine the amount of attention given to medical, psychological and social aspects. The results indicated difficulties in achieving multidimensionality in patient discussions during team meetings. The descriptive element of the discussion was dominated by the social aspect, to which all professions contributed. The analytical element was dominated by the psychological aspect, also to which all the professions contributed. In suggesting interventions, medical interventions were emphasized, principally by the physicians. Decisions on interventions concerned equally medical, social and psychological aspects. An interprofessional composition of teams offers no guarantee that interventions will be of a multidimensional nature. The results are discussed in relation to previous research and practical implications.

Mental health professionals in children's advocacy centers: is there role conflict?

Two recent chapters in professional books have criticized children's advocacy centers for creating role conflict for mental health professionals because of their work with criminal justice and child protection professionals in children's advocacy centers as part of a coordinated response to child abuse. This article argues that these critiques misunderstand children's advocacy center practice and overestimate the risk of role conflict. Children's advocacy center standards set a boundary between forensic interviewing and therapy, which in most children's advocacy centers are done by separate professionals and never by the same professional for a given child. Many mental health professionals serve children's advocacy centers as consultants with no treatment role. Children's advocacy center therapists are rarely involved in investigation, and their participation in multidisciplinary teams focuses on children's interests and well-being.

All professionals are equal but some professionals are more equal than others? Dominance, status and efficiency in Swedish interprofessional teams

This study explored status differences in interprofessional teams and their link with efficiency. In total, 62 teams (423 individuals) from occupational health-care, psychiatry, rehabilitation and school health-care responded to a questionnaire. Fifty-four of those teams (360 individuals) also participated in an observation session simulating problem-solving team meetings. Data were reduced to a number of indexes: self-assessed/perceived equality, functional influence and efficiency; and observed verbal dominance/activity and problem-solving capacity. Perceived status differences within the teams appeared moderate, irrespective of professional belonging. With respect to verbal dominance during meetings, however, the findings revealed a hierarchy with psychologists, physicians and social workers at the top together with special education teachers. No relationship was found between self-assessed efficiency and actual problem-solving nor between observed verbal activity and problem-solving. The findings suggest that different problems may demand different prerequisites to be solved effectively: successful solving of simple convergent problems correlated negatively with equality, whereas functional influence was a predictor of success with respect to divergent, complex problem-solving. The findings raise questions about leadership and procedures during team meetings.

Do all health and social care professionals interact equally: a study of interactions in multidisciplinary teams in the United Kingdom

Problems around deficits in interprofessional collaboration have been identified since the National Health Service (NHS) was introduced. It is within the context of the current policy focus on improving collaborative working that this study was undertaken. A direct observational study using the Bales' Interaction Process Analysis tool was carried out in two older persons teams to explore patterns of interaction in the multidisciplinary team meetings. Analysis revealed some key differences in the way in which different professions interacted. Occupational therapists, physiotherapists, social workers (SW) and nurses rarely asked for opinions and for orientation. The consultant (the individual in charge of the medical team) tended to have high rates for asking for orientation, giving opinions and giving orientation. Although some nurses did have high individual rates for the giving of orientation. The data from the research has highlighted that therapists, SWs and nurses are reluctance to voice their opinions in multidisciplinary teams and thus conformity may dominate its culture. It is suggested that therapists, SWs and nurses need to cite their opinions in teams more effectively if they are to be competent and committed patient-centred practitioners.