Kyrsten Theodotou, MA, CCC-SLP offered some insights that helped us better understand why a team approach to speech therapy results in the best outcomes. Theodotou works as a pediatric Speech-Language Therapist at the University of Minnesota Pediatric Rehabilitation Clinic, and has also worked on the Pediatric Brain Injury Team and the Growth and Nutrition Team at Hennepin County Medical Center in Minneapolis, Minnesota.
If you’re human, chances are you’ll eventually be tempted to play the hero in someone else’s story. If you’re in healthcare, chances are good that will happen many times.
You may even hope to become a more personable and less self-destructive version of House … a Netflix series bearing your name one day— yeah, that could work.
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In the real world, though—you know, the one that you’ll be spending the next forty-odd years of your life working in—being the lone, individualistic hero who plunges ahead while eschewing opinions of others is one of the attributes most likely to hurt the very people you’re responsible for helping.
As you step into your practice, intentionally choosing to take part in interprofessional collaboration with professionals in the other disciplines, this has the potential to not only improve the care you offer patients, but also to make you a more skilled practitioner overall.
“A day does not go by that I’m not having a conversation with someone outside of my speech discipline.”
-Kyrsten Theodotou, MA, CCC-SLP of the University of Minnesota Pediatric Rehabilitation Clinic.
In both her previous hospital-based work with acute cases and current work with more standard speech and feeding issues, Theodotou not only gives guidance to those in other medical specialties, she has come to rely on them to work with her to ensure the best outcome for patients.
This willingness to see herself as part of a team both protects Theodotou’s patients from medical error and improves her skills as a pediatric SLP. In fact, across healthcare professions the importance of interprofessional collaboration is making it’s way to the forefront as new research points to the team approach being hands down the most effective approach.
Collaboration Decreases the Likelihood of Serious Mistakes
Did you know that 70 to 80 percent of serious medical errors result from teamwork failures? By plowing ahead without taking time to listen to those from other disciplines, practitioners make mistakes that can alter the course of someone’s life.
But what does this have to do with you, the SLP? You aren’t passing medications or performing surgeries. Consider these situations:
- In a hospital setting, poor interprofessional communication has resulted in patients aspirating on liquids that were too thin and dying.
- In clinical settings, children with speaking disorders have sometimes been misclassified as developmentally delayed and removed from mainstream classrooms. At times it has taken years before professionals realized that a child simply needed speech intervention and has no cognitive difficulties. That is years a child lost in foundational classroom learning.
- You as an SLP might rely on other specialists to clarify your diagnosis: Is it childhood apraxia of speech or autism? Primary progressive aphasia or Alzheimer’s? Is a co-occurrent disorder like ADHD affecting your ability to give a correct diagnosis?
Getting the right diagnosis informs your plan of therapy and can save months or even years of work.
A Team Approach Helps You Do Your Job Better
Ever heard of the term profession-centrism?
As an SLP, you’ll see problems that arise through an SLP lens. A neuropsychologist will see the same problem through a neuropsychology lens. An occupational therapist will see it through an occupational therapy lens.
While each of these lenses has areas of overlap, there is part of the picture that each of you can’t see without the others.
A strong supporter of interprofessional collaboration, ASHA recently highlighted a unique approach implemented by the Kennedy Krieger Institute in Maryland.
Here, a variety of professionals regularly connect for a round table discussion to address the needs of specific children.
“We’re talking about this child and the reason we’re all here together is because we all know this child really well,” says Limor Rauer, MS, OTR/L. “We’re not talking about it from our OT/PT/SLP lens, we’re just talking about it from ‘this is a kid that we know and based on that we want him to achieve certain things’, and then [we] bring in the professional piece secondary to that.”
Theodotou agrees that this sort of approach can be ideal. “I’m all for collaboration all the time. It even helps me learn as a professional.”
She explains that understanding the goals her colleagues have for a given patient gives her a wider view of the situation and informs how she thinks about working with the child, improving her ability to create a plan of therapy.
Working with Trusted Co-Therapists Keeps You in the Game Longer
New practitioners often jump into their careers full of energy and excitement to start making a difference in people’s lives.
Unfortunately, the same zeal that makes you an excellent practitioner can sometimes lead to burnout.
The Canadian Health Services Research Foundation found that one of the key elements to preventing burnout in the healthcare industry is teamwork.
“One of my favorite things about the IPP [Interprofessional Practice] model is that I didn’t have to be the expert in everything anymore,” say special educator Kathryn Henry, another member of the Kennedy Krieger Institute. “I was able to go to my speech language pathologist and my occupational therapist to ask questions and to get advice on different programs and things to do with the kids in the classroom.”
Theodotou agrees, one area where she sometimes needs to take a step back is when it comes to dealing with behavioral issues. While addressing these issues can be a part of the job, “if it’s not allowing me to work on my goals then I need to refer elsewhere,” she explains.
In this case, a behavioral intervention specialist works with the child until they reach the point where Theodotou can step back in. By doing this, she lets someone who specializes in behavior take the weight of addressing it, and then she is more empowered to do her own part well.
“[Collaboration] helps take pressure off of me because I can’t fix everything,” she says.
A Team Approach Makes Your Patients Happier
Interestingly, research also shows that collaboration produces higher levels of patient satisfaction and happiness.
When you collaborate with other professionals, the nature of that collaboration promotes patient-centered care.
“It’s about the student and it’s about what we want for them to achieve rather than what I as a clinician want to see happen this year. And if you can be open to doing that then I think you’ll create really great plans,” says Rauer, of Kennedy Krueger.
Instead of looking at your plan and trying to check off the list of what you want to see achieved, the process of discussion turns the focus to the patient, with all their needs taken into consideration such that they are benefitting from a whole person therapeutic approach.
What Collaboration Looks Like
In addition to the healthcare industry’s increasing recognition of the benefits of collaboration, ASHA’s Envisioned Future: 2025 statement emphasizes the importance of collaboration and ASHA is taking steps to increase the visibility of this issue. Everyone seems to agree: in the coming years you’ll likely see a lot more in the way of therapeutic collaboration.
This means SLPs will frequently be working in collaboration with:
- Behavioral Intervention Specialists
- Child-life Specialists
- Classroom Teachers
- Doctors in Residence
- ESL Teachers
- Family Members
- Home Visiting Nurse
- Mental Health Case Managers
- Occupational Therapists
- Physical Therapists
- Registered Dietitians
- School Psychologists
- Social Worker
- Special Ed Teachers
So what does interprofessional collaboration and teamwork look like in practice? Well, it all depends on the setting.
During Theodotou’s time in the NICU, collaboration could be very hands-on.
“I would work on the bottling and the occupational therapist would help with maximal positioning, because sometimes their [the infant’s] success in bottling was based on their positioning. So we are both there at the same time,” she says.
In the pediatric ICU, a social worker coordinated teams that could involve half a dozen or more professionals. This person worked as a point person for all of the other professionals, watching over the big picture and making sure that important information was communicated effectively.
“She made sure we were able to follow up with our patients and then coordinate care plans together,” Theodotou explains.
You may also work with those in brain-based medicine. Theodotou says that she relied heavily on the neuropsychologists and the psychologists who both helped children process trauma and also helped to differentiate between a child’s baseline versus what issues might be new as a result of a concussion or other brain injury.
In the Clinic
Your clinical collaboration can vary depending on the type of clinic and the populations you serve most. You’ll probably collaborate heavily with occupational therapists and physical therapists, but they aren’t the only ones.
Registered dietitians can play a key role in therapy, both in clinical and hospital settings.
If a child’s weight is good, you can encourage more experimentation and advancement with textures and consistency during feeding therapy. With underweight children, though, you’ll want to focus on getting the child well-fed before moving into wider experimentation.
You may also find yourself working with those in the social services.
“I’ve relied a lot on social workers and the child-life specialists, especially for more complex social cases, because they can provide insight into what the family’s experiencing,” Theodotou says.
These interactions can range from emails and phone calls to in-person discussions.
If you’re a school-based SLP, you’ll definitely be meeting with classroom and Special Ed teachers. Students have Individual Education Plans (IEP’s), and you may be called in to IEP meetings with the Special Ed teacher in order to help clarify needs and goals.
Sometimes, you’ll remove a student from the classroom for specific speech work. In other situations you may actually work with that student right in the classroom, in conjunction with the teacher.
If you’re lucky enough to work in an environment that operates similarly to the Kennedy Krieger model, you’ll have regular, face-to-face meetings with the child’s whole action team. Unfortunately this model isn’t yet the standard, so it’s less common.
Because Even the Real “House” Learned From Collaboration
You may or may not know that the classic series House is actually based on a real doctor: Thomas Bolte of New York.
Known for his intelligence and ability to solve some of the toughest medical mysteries, Bolte didn’t gain this reputation from being a lone wolf.
Bolte believed that “you should try to learn from as many [doctors] as possible,” Discover Magazine reports. He worked multiple medical jobs at a time and even apprenticed alongside some big names in the fields of nutrition and alternative medicine.
It’s this insatiable curiosity and desire to learn from others that made the real-life House the medical detective he is today.
Ultimately, by learning from and actively collaborating with other professionals you create the kind of environment necessary for patients to flourish and for you to become an outstanding practitioner who can respond well to even the toughest cases.
As Theodotou stresses, there are other professionals out there who can fill in your knowledge gaps. “Use them,” she says, “they have strategies to help.”