EPISODE 27

[INTRODUCTION]

[00:00:00] DS: Do you enjoy listening to On The Ear, but wish you could earn ASHA CEUs for it? Start today. SpeechTherapyPD.com has over 175 hours of audio courses on-demand, with an average of 19 new audio courses released each month. Here’s the best part, each episode earns you ASHA Continuing Ed Credits. Oh, no wait, this is the best part: As a listener of On The Ear, you can receive $20 off in annual subscription when you use code Ear21. Just head to SpeechTherapyPD.com to sign up and use code Ear21, E-A-R-2-1 for $20 off your annual subscription.

You’re listening to On The Ear, an audiology podcast sponsored by SpeechTherapyPD.com. I’m your host, Dr. Dakota Sharp, Au.D, CCC-A, audiologist, clinical professor, and lifelong learner. While I primarily work with pediatric cochlear implants and hearing aids, I am absolutely intrigued by the many areas of audiology and communication in general. This podcast aims to explore the science of hearing, balance, and communication with a variety of experts in hopes of equipping you to better serve your patients, colleagues, and students. Let’s go. We are live in On The Ear, brought to you by SpeechTherapyPD.com.

[INTERVIEW]

[00:01:36] DS: One of the really fun things about being a clinician in communication disorders is the opportunity to collaborate with a lot of different professionals. Many audiologists and speech-language pathologists regularly work with physical therapists, occupational therapists, otolaryngologists, teachers, psychologists, nurses, dentists, pediatricians, early interventionists, the list could go on and on and on. How can we make the most of these relationships? Are we educating students in methods for best approaching interprofessional collaboration? Which is it? Is it IPC? Is it IPP? Is it IPE? What are we just supposed to call this also?

Today’s guest is going to help make all of this a lot more clear. Dr. Danika Pfeiffer is a postdoctoral fellow at Kennedy Krieger Institute Center for Autism and Related Disorders and Johns Hopkins University. She has clinical expense working with children in the school and private practice settings. Her research evaluates early language and literacy interventions for young children with language disorders, as well as interprofessional education, and practice in the field of speech-language pathology. She’s been an invited speaker on the topic of interprofessional practice at the state, national, and international levels and she recently started the About, From, & With podcast to share her SLP journey in academia as well as the journeys of other SLPs and their collaborators.

Just a couple of financial disclosures: I am the host of On The Ear and receive compensation from SpeechTherapyPD.com and Dr. Pfeiffer received compensation for this presentation from SpeechTherapyPD.com.

Danika, how are you doing? I’m so glad you’re able to join me. I’m so excited to talk about this a lot deeper.

[00:03:00] DP: Yes, it’s great to be here. Thank you so much for having me.

[00:03:04] DS: Of course. Maybe let’s start with the letter, because – okay, can I tell you what I think it is and then you tell me if this is right or wrong?

[00:03:11] DP: Yes.

[00:03:11] DS: Is IPE, interprofessional education, that’s how we teach students to collaborate with other disciplines? IPP, interprofessional practice is that in practice? Then IPC is just another name for it or is that wrong? What am I missing here? Help me out.

[00:03:30] DP: Yes. This is confusing because it’s actually changed a lot over time, especially in the past 10 years. You’re not along here with your confusion, but you are exactly right. Interprofessional education is really learning how to collaborate effectively. The World Health Organization defines it as, when two or more professionals are learning about, from, and with each other to really enable that effective collaboration. Then interprofessional practice is really the natural extension of that. Taking that learning of how to collaborate and learn with each other, and caring that now into the practice setting. Here, it’s really focused on providing comprehensive, and integrated care to our patients.

[00:04:18] DS: Got it. Clearly you do this for a living. Yeah, you put that into the perfect little bubble there. Actually, that’s one of the first things I wanted to ask you. You mentioned in the last 10 years, it’s changed a lot. Historically, did we approach this differently? I mean, it seems counterintuitive. Like, “Oh, yeah. We should definitely be learning from each other,” but obviously, that’s not always been the case. How did we get to this point, like what’s changed over time?

[00:04:39] DP: In 2011, there was the interprofessional education collaborative, was this organization that came together and said, “There’s this growing need that our professionals from different disciplines need to learn how to collaborate together, because they’re going out into the workforce and they’re working with patients that are really complex, and they need to be able to communicate effectively. What they did was they came together and they established four core competencies that are really important for interprofessional education.

Those core competencies now are really driving the work that’s done in interprofessional practice as kind of a guideline for how we can train our student in interprofessional education so that they can practice effectively on interprofessional teams. Those core competencies, there are four of them. The first is roles and responsibilities. Here, that’s really focused on understanding what your role is on a team and also the roles of others on a team. It’s really important that you know what those things are. I think sometimes we assume that we know, but we don’t always know. That’s the first one.

The second is interprofessional communication, just being able to communicate effectively and in a responsible and a respectable manner with others on your team. Also, values and ethics is the third competency, which is really about mutual respect and shared values. You need to make sure that your team members respect each other and that you have shared values for your work together. The last is teams and teamwork, which really focuses on relationship building. That is really key to being able to work on a team effectively, is to be able to establish a good, positive working relationship.

[00:06:18] DS: Cool! It’s a lot more formalized than I realize. I didn’t know that there was a summit on this to come up with these competencies. That’s a great idea for implementing programs like this. I don’t want to speak out of turn, but I’m pretty sure we didn’t have like an IPE class when I was in grad school or anything like. I mean, is this – I know that where I’m at now, we have something IPE. I’m not sure, I think it’s a class. I don’t teach it, but I’m involved in a twice a year, we do like in IPE event with other schools within the University. But is this like typically formally taught using those competencies? Has it historically been taught or is it just, you have to figure it out as you go? How are we starting to like teach this specifically now?

[00:07:00] DP: That is a great question, so this does really vary from university to university, because there’s not a whole lot of research out there right now to guide us on how to actually teach it. At some universities, it’s a one-day seminar, where they gather different students from different professions, and they all come together and they do some case studies together and they learn about in a professional practice. Other have a full semester experience where they’re placed on in an interprofessional team and they actually work clinically with that group. This really varies and I think at this point, we don’t really know the best way to teach it, but it we know that those four core competencies are really important for students to learn so that they’re ready to go out in the field and practice.

[00:07:45] DS: Got you. Yeah. It sounds like what we do is, they’re in a class for a semester without any involvement with each other. They’re just learning probably some of the information based on these competencies. Then the day that I’m involved with is like that single day. We actually bring in real patients, they sit in the room and then the students from all of the different departments kind of like round on this person. It’s really cool, like just as a – I’m not the student, like I’m just there to supervised and I’m like, “This is awesome to see you guys all taking this way with each other.” It’s really, really cool.

It’s good to see that we’re moving in that direction. I mean, where do you see the kind of education, the teaching of this? Do you think it t has to be that hands-on? Do you think we can kind of get some of the bulk information and more of like a lecture style? How do you see the teaching evolution happen?

[00:08:28] DP: We do know a little bit from some studies that have been done so far. We know that students do not learn by osmosis. You cannot stick them all in the same room and just say, “We did interprofessional education” because they all were in the same room. They don’t learn from each other that way. You really have to have some facilitated discussions for students to learn about each other’s roles and to build some kind of relationship so that they can practice together. 

We do know that this facilitated discussion is really important. Actually, I have done a study that examined a group of students that only received workshops about interprofessional education and then a group that actually received the workshop, plus had the hands-on practice. Where they got to go into schools and work on interprofessional teams. The only ones that said that they felt they actually established these competencies and grew in those four core competency areas where those that had the hands-on practice. I think that’s really where we need to spend our time. I think the workshops are important and it’s great to have that foundational knowledge, but we really need to some kind of practice component to be included for the students to really feel that they’re learning it, and to get that hands-on experience before they’re thrown into their professional working environment.

[00:09:40] DS: Absolutely. Yeah. I teach future SLPs as an audiologist. In the first day, we just talk about scope of practice, but I don’t think – it’s hard to say like, “Hey! Are you going to be on a team with all of these other disciplines?” Go ahead and look at their scope of practice, learn that. That way, you know when the time comes who to refer to and when it’s within your scope. I mean like, that would be ideal, but I don’t think that’s very realistic. But I do think being in the context of it happening, you get a much better sense of like what they do when they see someone for the first time. Maybe that can help you counsel that patient. “Oh! I’m nervous about my physical therapy appointment next week.” “Oh! Don’t worry, they’re great. They’re probably going to ask you to do a couple of things.”

It just gives you that kind of like – there’s a lot of skills that come from knowing what other people are doing.

[00:10:21] DP: Exactly. It’s so nice when you can articulate that to your clients and their families. It also just brings that sense of, you created a team, you’re on a team, you are communicating regularly with that other person. That creates such a better experience for the families as well. 

[00:10:37]DS: Absolutely. At this point, how do you personally define IPP? Because that’s the one we’re honing in on, right? That’s really the – is that like the granddaddy word of them?

[00:10:47] DP: Yes. Interprofessional practice is kind of the term that we have move towards now.

[00:10:52] DS: If we’re going to stick with that one, at least for a little while. 

[00:10:53] DP: Yes, and hopefully we will stay there. IPP, yes. That is what ASHA is using and so that is what I’m using now at this point. That’s just really when you have two or more professionals that are working together. They are committed to being on a team together to provide comprehensive care to their patients. That can be in a healthcare environment, that could be in a school environment, anywhere where you are collaborating with multiple professionals. You have to have some kind of regular communication for it to be an interprofessional team. It’s not just that you all are working with the same patient, but you actually are trying to provide that coordinated care and have that regular communication with your teammates.

[00:11:36] DS: Okay. Yeah. That makes sense. Is IPP now that we understand it this way, are there other ways of approaching – I mean, I have to think that historically, people have thought they were doing it the right way, a certain way and maybe it has name. Do you know what I mean? Like, just collaboration in general, it sounds like what you’re describing is IPP is kind of specific and that it needs that ongoing communication, building a relationship, all those competencies. Are there other ways that people say like, “Oh! I don’t want to do it that way. I want to approach collaboration this way”? Or even if they’re not, like historically maybe they approach it that way.

[00:12:07] DP: Yes. There’s are three key models now that we think about with collaboration. These terms are often used interchangeably, but they really should not be because they actually mean different things. The first one is, multidisciplinary, which you’ve probably heard that a lot, “I’m on a multidisciplinary team.” That means that there are several professionals that are all working with the same client, but there isn’t that shared communication built in, so there’s no agreement that we’re going to meet regularly to discuss this patient. We’re all working with that patient and we may share information from time to time, but we’re not scheduling that regular communication with each other.

The parent or the family is also sometimes included in decision making on these teams, but they’re not an explicit member of the team. All of the professionals. They establish their own goals for the client. They all work on those goals separately and they have their own treatments plans for the client. You all recommend the same patient that is shared, but otherwise, there’s not a lot of communication happening.

The other model that’s used a lot and the term that’s kind of thrown around a lot is interdisciplinary. That’s another great collaboration model. That is a little but more collaborative than multidisciplinary. In that model, you do typically have a regularly scheduled time where you come together to share information about the client. There are multiple professionals from different disciplines. They have that shared communication time. They typically do their assessments of the client separately, but they do share information about what they saw in those assessments. They’ll share their goals together, so they’ll let the other professionals know what they’re going to be targeting with the patient, which is great.

In that model, sometimes you might have the parent or the family included in the decision-making process. It does not always happen, but sometimes that will happen if you’re working on this interdisciplinary team. Then the most collaborative is what we know now is interprofessional. It used to be called transdisciplinary, and then so that terms have kind of changed and evolved over time. But now we know it as interprofessional, and that’s when you do have that regularly scheduled communication time, where you share information, but the unique thing about is that you can also, using this model, you also sometimes do what they call arena evaluations, where you all come together and you actually assess the patient or the client all at the same time so you’re working together during that assessment.

Also, you all take responsibility for the client’s goals. You do some role sharing when you’re using this model, where you all are aware of the client’s goals. Because of that, you can actually integrate some of those goals into your own therapy sessions with the client. You all take responsibility for the client’s full goals. Then the family is always included as a member of the teams using this model. You always want to be thinking about asking the family for their priorities and their needs. That gets integrated into the family and the patient’s service plan.

[00:15:11] DS: Wow! That’s really cool. I agree that I’ve always thought of those terms pretty interchangeably. But yeah, the way that you described it, it makes a lot of sense how distinct they are. Could you give me an example of an interprofessional team, kind of – especially, what was the last word you used? Arena? Is it a verb?

[00:15:29] DP: Arena evaluation.

[00:15:29] DS: Arena evaluation, okay. We’re arenaing on this one. Can you give me an example of that in practice, which kind of professionals you picture in that kind of set up or what those goals overlapping might look?

[00:15:40] DP: Sure. My background, I’ve worked in the school so that’s coming to mind. I was a preschool speech-language pathologist. In preschool, typically we’ll have the speech-language pathologist, the classroom, you would have the parent with you, you may have a special education specialist that’s in their classroom with you. Whatever assessments you would be doing. So maybe my discipline-specific assessments as a speech-language pathologist, whatever the classroom teacher would like to find out more information about, all of us would be communication about the information that we hope to collect before that evaluation occurs. 

We would come up with a plan, then we would have the child come in to our room and we would all take part in taking our own observations, doing our assessments and gathering information about the client all at once, instead of each doing our own assessment of the child separately. We only need to get case history from the parent one time because we’re all together in the same room. I might ask a question that the teacher was already had planned to ask or they might ask something that I hadn’t thought about. It’s a really nice time where we can all come together and we’re all working with the child at the same and getting to build off of each other’s expertise, which is something that’s really nice about interprofessional collaboration.

[00:16:56] DS: That’s awesome. The more you break it down, the more I’m seeing like, “Oh! That’s definitely like a timesaver” or the child won’t fatigue as bad if they’re in the situation or it’s easier to build trust if they already – they already really liked their SLP, but they struggle with their teacher. But then they see then like being friendly with each other in this setting and like maybe that’s helping build a relationship too. I can just see a lot of benefits here. I think probably, I was going to ask you. What do you think the challenges are of maintaining a model like that? Probably the biggest one is getting all of these people in the same room oftentimes at scheduling and stuff. That’s probably a little tough. 
What other challenges come to mind? The benefit seems very obvious for that kind of a model. 

[00:17:32] DP: Yes. Time is definitely always a challenge and having shared schedules where you could actually all be in the same room at the same time. Some professional say that they actually face some resistance from other professionals in wanting to do something like this, and actually collaborate. It does take time and it does take planning. It’s something that is viewed right now as being an extra thing, because a lot of people have not received this training in grad school. Just trying to wrap your head around what this would look like and how it should be done. It takes extra effort in planning, so some people are not necessarily open to that. Others will say that their administration is not supportive of this team kind of environment because of these challenges. They would then have to work with them to establish a shared planning time. Which might mean changing schedules. There are barriers there when it’s comes to – when you think about the logistics of everything.

[00:18:28] DS: Totally. I feel like maybe in some settings to, like who’s the billing provider at the same time. That’ probably gets pretty messy.

[00:18:36] DP: Yes. There are definitely still settings where it’s not possible because of billing, so we still have a ways to go with advocacy and trying to prove and show in the research the outcomes and how outcomes can improve for a patient that are receiving care on an interprofessional team. But the research is still kind of early on. We have been able to see some benefits in the research, but they definitely are still emerging, and so people are still really exploring what are the impact of our care on these patients when we’re working on these teams.

[00:19:09] DS: Yeah. I think you’re so right, that if someone hasn’t done this before, it’s like a total paradigm shift in your thinking and like how to approach a patient. Like you spend so much time on your own prepping what you’re going to ask history wise, what you’re going to evaluate. You just have to completely shift the way that you think about that to be like, “Okay. I need to incorporate what they’re going to do. How can I play off of that?” Which isn’t necessarily a bad thing. It’s just definitely like a shift in the way that we would typically approach this kind of appointment.

[00:19:34] DP: It is. It is really different. Again, I think it is really different because we don’t have that training. But I think if we could embed this into training more often, then it would just seem like the normal thing. This is just what we do. We collaborate when we do these kinds of evaluations, because why not. I think it really just has to start early and that makes it a lot easier. I think professionals are a lot more willing if they have that early training.

[00:20:01] DS: Yeah. I’m not an SLP, so I don’t know all of the terminology, but I have heard of like co-treat and co-treatment? Is that like in this vein of a model, because I think that’s normally like maybe of an OT and an SLP in the same appointment co-treating. Is that kind of another word in this realm?

[00:20:18] DP: Yes, it is. It can be any of those collaboration models that I told you about. When they are working together and they’re in the same room, they could be using any of those forms of collaboration if that makes sense. 

[00:20:30] DS: Okay. I see.

[00:20:31] DP: They might be collaborating interprofessionaly, but it might still just be more interdisciplinary. Maybe they are sharing information regularly, but they are still really only accountable for their own discipline-specific goals and they’re not really trying to target the other goals. If they’re in the same room and they’re really supporting one another, and targeting each discipline specific goals if that’s SLP targeted goals and OT targeted goals together and you see both professionals really helping to support the child in both of those areas, then that would be interprofessional collaboration. But if they’re in the classroom with the child and they’re both really – even though they’re together, they’re really only targeting their own discipline specific goals, then that would be more interdisciplinary. It can really fall into any of those kinds of models.

[00:21:17] DS: Yeah. That makes total sense. That makes total sense. I didn’t even think about that. But yeah, it totally depends on what your mentality is when you’re sharing the room. That’s what determines what’s going on here.

[00:21:26] DP: Exactly. But that’s why it’s so confusing because there’s all these terms that kind of sound the same. But yeah, they are a little bit different. There are some nuances.

[00:21:36] DS: Out of curiosity, what led you into this realm? I mean, this is not very SLP specific. I feel like any discipline could do IPP research. You know what I mean? But like, how did you get into this world?

[00:21:48] DP: When I was in grad school, I was a graduate assistant. My advisor that I was doing research with was doing an inter professional project. She brought me in and part of my role on that project was to go and meet with all the factory that were involved in this interprofessional project, then actually help facilitate some of the activities that the students would be doing when they met for their interprofessional training. Since she was doing it, I got to be part of it from the very start. It just got me really excited about it and I actually got to do some of the training as a student myself when I was in grad school. Then I started my clinical fellowship in the school and I was excited about collaboration, and ready to go out there and collaborate on teams.

I got into the school setting and I saw there really was not this collaboration happening. I was really disappointed and also very confused of like, “Why is this not happening?” as a fresh new clinician. Then I actually continued on into my PhD right away, so I was able to take that experience right into my PhD. I said, “I want to know more about this. Why is it not happening in schools?” That’s kind of what fueled my fire a little bit.

[00:23:02] DS: Really cool. Just like, happened to be a part of this seminar and then it just set a whole world in motion. I mean, that’s really cool. Where did you go, might I ask, for all of that great education?

[00:23:16] DP: James Madison University. Go Dukes!

[00:23:17] DS: Let’s go Dukes! That’s right. We’ve had so many JMU people on this podcast. People have got to be sick of JMU at this point. But hey, we got to keep them on the map. A lot of great people from JMU. But yeah, that’s really, really cool and I love that you’ve got the personal experience that you were there and you get to see how it didn’t work out so well. In your clinical experience, I don’t know now that you’re like post-doc how much clinic time you’re doing. But have you seen these models that work and working well?

[00:23:49] DP: I did some clinical experience in the school and then I went into a private practice. In the schools, collaboration was allowed. We could do it if we wanted to co-treat like you had just mentioned. We could take care our data, everything was fine. That does very, depending on what school system you’re in. Then I went into the private practice setting, where because of billing reasons, I was not allowed to collaborate with others. That was disappointing. I haven’t seen personally in my own clinical experience a team that’s done this well. I have met with others through my research that have done it and are doing it really well in schools and in other hospital setting. It does happen.

People that are doing it, they are so excited to talk about it because they see that it works. It’s always really inspiring to hear those stories. But clinically, I haven’t personally seen it upfront.

[00:24:39] DS: Got you. That’s really cool. The one that –I personally haven’t been part of a team like that, at that level. I do get to participate in a craniofacial clinic once a month, where all of the disciplines are kind of in a shared space. We’re all right next door to each other and there’s orthodontics, and speech, and audiology, and plastic surgery, and nursing and child psychology and there’s a pediatrician. There’s just like every kind of discipline you could think of. Then in that way, this child doesn’t have to have 10 appointments spread out over the year. They can have one appointment and kind of get a lot of the care. A lot of it is more like screening checking in. It’ really cool because at the very end, it could just be like, “Okay. I’ll see this kid. I’ll mark down on his sheet my recommendations. Make sure you go to this after you leave. All right. Next person.”

But what’s great is at the very end, we all meet, we eat like a pizza or something and then we pull up a photo one by one. “You, tell me what’s going on with this guy. What is it? Okay. Tell me more” and then we all make sure we’re all on the same page with each patient. It does feel like a set up that could work into that kind of a model at some point. You know what I mean? It’s not as regular as I think the interprofessional model that you mentioned would be, because you know there’s not like weekly meet. I don’t see this patient weekly. I see them like once a year. You know what I mean? But it still kind of has that, we are all on the same page. I do think we are one degree away from like, we are definitely all on the same page and like sharing goals kind of a thing. But it seems like something that could get there. I do feel like that’s a model.

If anyone else is on a craniofacial team, that seems like a good place to talk about this kind of idea for modeling your meetings.

[00:26:14] DP: Definitely. I think something that is something that people confuse a lot of times is that they think that professional collaboration has to happen when we’re all physically in the room together all the time. That’s not true. You do not have to physically be in the room with someone all the time to be on an interprofessional team with them. That’s great if you can be, but that’s just not realistic. The great thing is that there’s now so many tools online. There’s Google Drive. There’s email even that we can constantly communicate and we don’t have to do that on the same room all the time.

Even if that’s not possible for you. That doesn’t mean you can never collaborate on an interprofessional team. As long as you’re including the family in your conversations and you are regularly communicating with each other and trying to really provide this comprehensive care where you’re all taking part in making sure that this patient is getting the best care that’s really coordinated between your team members. Then you are on an interprofessional team. Don’t discount yourself or think, “I could never do this” because we’re not constantly seeing each other in person.

[00:27:21] DS: How cool! Okay. Maybe there’s people out there that are going to get inspired by that and hopefully, if they’re not quite there, being a little – I do think it just takes, if each person on the team has a shift in the way they think about what the team is doing, that’s all it takes. You have to better understand each other’s roles, make sure you’re on the same page with them. I don’t know if there’s like an accountability element that like you want to make sure they’re on track, and you’re on track and make sure to check in on me and make sure I’m doing the right goals here and stuff like that. But yeah, it seems very attainable. It doesn’t seem that far off at all.

[00:27:50] DP: Yeah. Just that – what I really think that’s great about it is that relationship-building piece where you come to work and you know that you don’t have to do everything. You have someone else or multiple other people on your team that are also all accountable for the same goals and for helping that child or that client reach all their goals. It’s not just you. I think that that really can take a lot of that, not burden but you do feel this responsibility that your client needs to meet all their goals. It’s nice that you know that others are there supporting you too, and you can share ideas with each other too. I think that’s something that’s really great about it.

[00:28:25] DS: Totally. Switching gears a little bit from in practice, thinking more about your research. Is your research – I’m sure it’s more specific than just like IPP. You know what I mean? Is it more like how students are trained in this way or like how it’s implemented in practice? Like what is your research kind of honing in on in the world of IPP?

[00:28:46] DP: I am really interested in how we train our SLP grad students to learn how to collaborate on interprofessional team. I have been really honing in on interprofessional education. When they’re in grad school, they’re getting some kind of practice experience, learning these skills, and competencies, and putting them into place. When I was doing my dissertation work, I did the study that I spoke about earlier, where I had the two groups of graduate students. One only received workshop training, one received workshop training, plus they get to practice it. 

From that experience and seeing that grad student really needs to have their hands-on kids and actually be collaborating with other professionals together to actually learn those competencies. That’s kind of where I see my research continuing to go, is now figuring out how much time do they need to be collaborating together and what does that practice need to actually look like, and figuring out this component. That’s really what I’m interested in now.

[00:29:47] DS: Cool! In your work so far, has here anything that’s kind of surprised you now that you started to dig into it a little bit?

[00:29:56] DP: Something that still surprises me is that, a lot of – I don’t want to say everyone, but a lot of people think that collaboration is something that just comes naturally, that we all just know how to do it and we don’t need training in it. It’s just something that, by the time you’re in grad school, you’re a grown up and you should know how to collaborate. That’s not true. It does really take practice, and it takes reflection and it takes guidance. I think that’s something that still surprises me, is that a lot of people just think that it’s something that comes easy and it’s not worth really spending the time on. 

[00:30:31] DS: Yeah. Wow! that’s a really good insight. That’s a really, really good insight. I see that sentiment a lot. I feel like that’s definitely the way I was sort of trained, is you figure it out as you go. But you’re right, there’s almost like a definite, almost like a code switching with different groups that you’re talking to, like I was never trained in how to talk to a really scary surgeon, whose very serious. You know what I mean? I also wasn’t trained in like how to really best communicate with teachers who use like a totally different language than I do when we’re talking about a child with hearing loss like and what their goals might be might be different too. I definitely see we’re a more formalized structure for teaching, because to be honest, you’re going to interact with a lot of the same kinds of professionals. 

This could be taught. It’s not like an infinite group. I’m sure there’s going to be some very random ones. It’s not always going to be the same, but you know what I mean. Like there’s a lot of groups that we kind of have a lot of overlap with. I feel like I had a lot of training in working with speech, right? Because our disciplines are so close signs are so close. But wow, when I finished grad school, I was fortunate I had a close friend who is in physical therapy school. Otherwise, I was like, “I don’t even know what physical therapy does.” I think when I graduated, I still didn’t know what occupational therapy. You know what I mean? Like until I was in a setting where there was occupational therapy down the hall and they were my friend now. Now, I know little bit about what they do. I’ll be honest, I’m still not totally sure on occupational therapy, but like I’m pretty sure I know. But you know what I mean?

It does definitely need to be formalized, like it has to be taught because some people, also, they – this is a soft skill. This is like not even that easily taught, but you have to be taught to even know, or you need feedback, you need structure.

[00:32:10] DP: I’m really glad that you brought up these languages that we all use as different professionals. That is something tat has come out in the research that we do know so far, is that grad students, undergrad students, they are so excited to learn all the jargon of their disciplines. It’s really great and really exciting. Then when they go to collaborate with other professionals, there are these communication breakdowns, because nobody knows what each other is talking about. That’s actually one of the recommendations and doing interprofessional education is to make that we’re teaching our students how to handle these communication breakdowns and not use jargon when we’re trying to communicate with each other because they will not know what we’re speaking about.

Oftentimes, we’re speaking about the same thing but we’re using different terms. That causes that communication breakdown. I’m glad you brought that up because that is one area that we do know it is worth spending the time doing that. Because just like you said, we end up in these situations where we don’t feel comfortable approaching another professional and really sharing information and we don’t feel like we know how to do that.

[00:33:16] DS: Yeah! Wow! I’m really glad that’s being examined though, because it makes a lot of sense. I’ll be honest, I definitely identify with the, “Oh! A new audiology term that I can like try to drop in casual conversation.” You know what I mean? We all love our jargon. Where do you feel like the research is heading in terms of IPP? What are the current goals to refine the practice or refine IPE, like how we’re teaching students? Where is it all heading?

[00:33:40] DP: What we know so far is that a lot of the times when we are doing interprofessional education and really trying to measure it in a research setting. We are oftentimes examining student’s knowledge, and did they have a change in knowledge from this experience. Are they more knowledgeable now about this content area because we’ve had this experience? We also a lot of the times focus on their beliefs. Do you now have more positive beliefs towards working collaboratively on teams? Oftentimes, we’re finding yes, they do. These experiences are successful in that area.

The third are that we focus on a lot are students’ attitudes. Are you more positive now about collaborating because you’ve had this experience? We often see that students are more positive about collaborating after this. Where we really need to go now and where the next steps are that a lot of people are talking about, that having a hard time measuring is, does this interprofessional education really change our grad student, our undergrad student, even our working professionals’ behavior? Do they actually – are they able to apply these skills when they’re working with another professional? That’s something that we need to know. We need to know if our training is effective and it is actually changing their behavior. But it’s really hard to measure, so we’re still trying to figure out the best measure for that.

Once it passed that, that we really are working toward as an end goal is then, if it does change our behavior, then are we able to have a positive impact on your patients, because we are working on an interprofessional team. Does it really matter if it’s on an interprofessional team or in an interdisciplinary team, or just working by ourselves? Does it really make any difference in our patients’ outcomes? That’s really the ultimate goal that we are working towards and hopefully we will make it there some day, but we’re not quite there yet.

[00:35:28] DS: Yeah. Wow! All of that makes total sense in terms of where we need to go next with this. I definitely see the – seeing if there’s actually a change in behavior being kind of important. Even if you see the value in it, if you don’t actually change how you practice like, “Well, it wasn’t that much value in it.” That’s a really good insight. I think one of the things I really enjoyed seeing with the students when we kind of have the debrief after our IPP day is, how much more confident they felt like in themselves as clinicians, like their own clinical knowledge once you have to explain what you’re doing to people who have zero idea what you’re doing. You realize, okay, maybe I do know what I’m talking about right now. This is pretty good.

I think that’s one of the other benefits here is that students kind of understand their own discipline a lot better and they have more confidence in their ability to practice clinically.

[00:36:22] DP: Yes. We have actually seen it go both ways. This is actually a debate in this are of research right now, is when do we start training our students in interprofessional education, because a lot of people have found that if you start too soon, then it may make the students feel more doubtful about knowing their own role if they don’t quite have a grasp on what their role is quite yet. Then when you introduce them to other professionals and they have to explain their role, they’re kind of like during the headlights, “I don’t really know yet.” That can then cause the opposite effect where they’re not as confident anymore.

There is a lot of talk about when to time this interprofessional education and what to focus on if we are going to start early when they’re undergrads. What can we have them work on early on so that they don’t feel that pressure to have to be on the spot, but they can still work as a team? There is a lot of thought in this area and I think that’s another thing we’re still trying to figure out.

[00:37:20] DS: Wow! Ah! I love this. I also think it’s just – one of our most recent episodes was being a research audiologist. Every time I talk to someone who’s a researcher, I’m like – you just said there is a debate going on right and I’m like, oh! How cool would that be to be like in the middle of this debate between ideas here. I mean, that’s really, really cool. If you’re already a clinician in practice or you’re a student who doesn’t have an opportunity to engage in this kind of thing, what can you do like now? You can listen to this podcast. That’s going to help. But other than that, are there resources? Are there like trainings in this kind of world? Because I think you’re right, that it does have to be like formally taught for people to really understand and implement these kinds of things.

[00:38:06] DP: Yes. A great place to start is the ASHA website. They recently have uploaded some really great resources for getting started and establishing an interprofessional team. I highly recommend going on their website. They have some great tools that you can use when you’re just getting started. Something that we know is that it’s so much easier if you just start with one person. When you are going into your workplace, who is that one person that you know would be open to collaborating? Maybe they’re already collaborating with someone. Someone that’s excited about it. They want to work with other people. Start with that person. Whoever you share clients with that you think is the most excited or would be the most open, start with them instead of trying to take on a full team of five, six people. That’s not necessary.

Also, you want to try to establish a relationship. Maybe there’s someone that works in your workplace that you know, but you don’t really have a working relationship with. That’s really going to be the foundation for how well you will be able to work together and help your clients. Really spend some time to form that relationship, just get to know them as a person. That will be really important in being able to work together. I think looking at these resources, kind of starting small. Then once you do have someone identified, coming up with a communication plan, with how you are going to communicate. Some people might just want to communicate weekly by email when they’re not working together. Others might want to have a shared planning time, where they can come together in person.

Really talk about your preferences and make sure that you have a plan for communication and also reflection. Because you’re going to be working together for a period of time, which could look different depending on what setting you’re in. But you should build in time to reflect on how things are going, and make sure that you are comfortable, and that you feel that this is actually benefiting the clients you’re working with. If you need to make changes, that should be something that is constantly revisited, whether that’s a change with your communication plan that you’ve set for each other or just your expectations on what this team is going to look like. It’s important to build in that reflection time.

[00:40:20] DS: Yeah. One of my questions was going to be, should we be monitoring our IPPness? Whoa! Wait. Is this something we should be monitoring, like how involved, how we maintain these relationships? Because I do feel like if you’re not constantly engaging with this or if that patient that you share moves or whatever, it can be really easy for these things to like, okay, I’ve got a million other notes to write. I got these other things. I can’t be in my constant communication with this person. Other than reflection, are there other ways that you recommend people kind of maintain that engagement? 

I like earlier how you mentioned it’s like, if you have that personal relationship. Maybe like none – hold on. I’m asking like three questions at once. Should this always remain like a very professional thing? Should you build like personal relationship? Like, “Let’s go for dinner” or something like, “Let’s get lunch.” Is that like going to muddy the water or maybe we don’t know. Or like, do you know what I mean? When it comes to maintaining this, it all comes back to that being my root question here. It’s like, what’s the best way to maintain these relationships so that they’re successful long-term?

[00:41:21] DP: I think that’s really up to what you and the other team members are hoping to get out of this collaboration. The goal is to help the clients at the end of the day. When I was in the schools and I was able to co-treat, I worked closely with an occupational therapist and I just approached her at the beginning of the year. We were both working with preschoolers and saw that we had several kids that we were both going to be seeing. We decided that we did want to get to know each other a little bit more. So yes, we would go out to lunch sometimes and just get to know each other one on one.

Then we also had our time where we were actually in the classroom together, in her therapy gym and working with the kids on the swings and all these things together. I think it’s really what you are comfortable with and knowing that at the end of the day, the goal is to help your clients and help the patients. Having that regular communication. If you can have shared planning time, that is something that comes up a lot as something that’s really helpful in maintaining your relationship because you’re brought together to sit down and look at, and be reminded of those goals that you’re working toward for both of you or three of you, however many are on the team. Those goals can really ground you as you’re planning. Making sure you have that planning time can be really helpful to make sure that this is a successful and an effective interaction. I would also recommend having that time.

[00:42:44] DS: Got it. Yeah. I love that you included your specific example there too, because I think that’s helpful for people to know it’s not so scary. Do you have tips for people who might have that kind of like professional shyness to reach out to –? For example, if I have – I have a kiddo on my caseload right now, she had meningitis as a baby. She works closely with a lot of different disciplines, but I hadn’t like had a direct connection with – I’m trying to remember the name of her specialist. Anyways, she went to a therapy place that had a lot of different disciplines all in one place. I’m far away. Like they drive an hour to see me and then the other place is right near their home.

I bet that that team is all very like well connected to each other. They’re all in the same building. Then I’m like sending my reports along like, “She’s doing great. How she doing over there?” You know what I mean? It’s not the same thing. Do you have any tips for kind of maybe the person who’s a little bit more shy or doesn’t know how to initially begin that conversation?

[00:43:42] DP: Yeah. If you are not comfortable or maybe you can’t like in your situation where you can’t just go up to their room, and go strike a conversation. Then I would say, just start with an email. I mean, in these days, everyone uses email pretty frequently. So you can always just start in an email and just saying that you’re interested in collaborating with this person because you’re really interested in what they’re doing and how you can better support what they’re doing. I think that most people would be excited about that, and just knowing that there is some extra support, and some extra help and that you’re willing to learn more about what they’re doing.

I think people often like to share information about themselves in what they’re doing in their career, and their passion. Even if there’s not a client that you’ve identified that you want to work with somebody with, that you might have a shared caseload with, just getting to know someone and then building that relationship can be a great idea because maybe there will be a client in the future that you can work with, and you already kind of have that relationship formed.

[00:44:43] DS: Yeah. That’s a great idea. One of the things I try to teach my students is, as soon as you graduate, it’s so important to like establish your network of professionals, meet some people in audiology, in OT, and PT, people that you can trust and that you like. Then I think this is just the next step for that, is taking it just from like having a network where, “Oh! You’re having difficulty with this? Well, I know a great pediatric SLP, feeding SLP, that kind of thing.” Taking it from that to, “She and I are on a team together and are in close contact.” You know what I mean? It’s like the next level from having a good network of people to having like a good interprofessional relationship with them. That’s awesome. It’s a great idea.

In your opinion, what looks like a great way to teach the next generation of clinicians how to engage in this? This is all just like your opinion. You don’t have to go straight, “Like the data says.” Maybe base it a little bit in the data, but like you’re a researcher making some insights. Do you think we should be starting at an undergraduate level? Do you think we need to be waiting or do we need to have the daylong seminar? What is an ideal program where this is taught look like to you?

[00:45:50] DP: That is great. I would love to just design my own program.

[00:45:53] DS: Here’s your opportunity.

[00:45:55] DP: I would say, definitely for me, I feel that we should start at the undergraduate level. I think it’s really important from day one that they just start learning about who these other professions are. I think even just as a student sometimes, we don’t get to learn what other professions are that we could pursue ourselves. I think just having exposure to that early on in undergrad would be really helpful as we do determine that we want to be speech-language pathologist or audiologist that we are just aware from the beginning. I think it can really help frame us early on in thinking about this from a team approach, and how we approach healthcare, or how we approach working in schools as seeing it from this team approach.

I definitely think., starting in undergrad is the way to go and then consistently having interprofessional education throughout your undergrad and grad school if you do continue on and that’s a profession that goes into grad school. I think that’s really important as well, just having that continued exposure and not necessarily just a one-day seminar. I really appreciate those one-day seminars. I’m so glad that people have them, because it’s better than nothing. I do think that we need more than just the one-day seminar. Having that constant exposure to other professionals, learning about them, practicing with them. I think like we talked about earlier, it gives us the confidence to want to keep doing that. I would say those continued experiences, I would advocate for.

[00:47:26] DS: Yeah. That’s awesome. Write it all down and submit it to a couple of schools. Just out of curiosity, what do you think – when you’re talking about the undergrad level, what you think that looks like? Is that like healthcare professionals’ day and it’s like sort of like a career fair, but like more overlap? What do you think that looks like in practice?

[00:47:48] DP: I actually had an opportunity when I was at JMU to teach an interprofessional course for undergrads. It was a new course that was being offered and it was for those that were majoring in speech-language pathology, and communication sciences and disorders, or those that were in education or special education majors. They all came together for one course and we introduced them to this concept of interprofessional practice. We built opportunities for them to learn about each other’s roles. As we were talking about? We also had to kind of teach them a little bit about their own roles because they were still undergraduate student. But we’ve built in opportunities for them to then go and shadow in a school that was collaborating, so that they could see what that looks like in practice.

I think that’s really important at the undergraduate level, just to show them what it looks like, and can look like, and what outcomes can come from it. I think that would be – I would advocate for either – I don’t think it needs to necessarily be a course. It could be like you said, a one-day seminar, but I would say just multiple one-day seminars that we could kind of ease them into all of the competencies. You can’t really learn all the competencies; I don’t think all at once and feel really confident that you can do them all from just a one-day seminar only one time.

You could build in some of those experiences where it’s a workshop that might happen repeatedly throughout their undergrad years, or having a course that brings them together with other majors, where they’re getting to learn about other professions early on.

[00:49:24] DS: Yeah. I’m a little jealous I didn’t get to take the class when I was there, because that’s awesome. My wife is a first-grade teacher. We would run in the same class, that would have been so cool. I really think that’s a really great idea and I love that model. I wasn’t sure. I was like, “Maybe this is like a career day,” but I do think I see it as a course, and everyone’s in the same room. At our school where I’m at now, they have the undergraduate major as just like public health. They don’t have CSD or like a lot of other things. There are students who want to be audiologists, and want to be SLPs, and want to be epidemiologists. There’d be like all kinds of different people and they take kind of like an intro class.

I don’t think the emphasis is on IPP per se, it’s more just like exposure, not necessarily like where those worlds collide. But I think if you were to introduce that and make it a little bit more formal, you’re already laying the groundwork for later on like, “Oh! It’s not so crazy” because I know they do this and I can have a relationship with that person.” That’s great.

[00:50:19] DP: Exactly. As faculty members, that’s something when I talk to other faculty, they ask me, “How can we do this in our department?” Thinking about creating a brand-new course that’s only interprofessional collaboration, it doesn’t fit with what they already have planned. When are they going to do that? The timing is not going to work out. Really, all I say is just build it into what you’re already doing. Just like you suggested, you can just – we already have this course that has these three or four disciplines in it. Now, we just need to build in the activities or take the activities that we’re already doing, but let’s approach it in a different way and think about how we can talk about collaborating here or build in these competencies here.

It’s something that I think comes off as seeming so hard and so big, but there’s ways to just start small and start planning the seed. It really doesn’t need to take so much work to just overhaul what you’re already doing. You can just build this into things that are already ongoing.

[00:51:16] DS: Yeah. That’s great. I think having those competencies established is so helpful, like you don’t have to come up with the grading criteria or the content, the curriculum for this. Like it already exists, you just have to think about how that can integrate with what you’re already teaching. That’s awesome.

I was wondering if you could tell me a little bit more about About, From & With, your awesome new podcast that I’ve had the chance to listen to for a little while. I mean, it’s been going for like –

[00:51:42] DP: Since June. It’s not too long ago.

[00:51:43] DS: I was going to say it’s like a couple of months now.

[00:51:45] DP: It is a couple of months, yes. Thank you to you because I had so many questions for you when I was getting started. But this podcast, I started because I was really interested in hearing more about SLPs’ journeys and how they got to where they are in the field. This podcast, I interview other SLPs and how they got to where they are now. Then I also have started to interview some of our collaborators, like teachers and audiologists. I also share some solo episodes on the podcast, where I talk about my journey as being a speech-language pathologist and pursuing a career in academia. Because I found as I’ve been navigating at it, sometimes it’s hard to find out what others have gone through on their path in academia. I was really interested in just sharing my story there so that others who are thinking about pursuing a PhD, going into academia that hopefully I could share some helpful tips for them.

[00:52:43] DS: Yeah, I really like that it kind of splits between those two. You’ve got the interviews and then the personal episodes. It’s like a good balance of the two. It is cool. I mean, everybody has such a unique different way that they got there and you learn a lot of cool things on the way. I’m trying to think of the – one of the earlier episodes that I listened to with Dr. Timler from JMU. She just had a really cool story of how she ended up in this world. I mean, it’s just so cool. It’s those stories that you’re lucky if you have a personal relationship with another professional that you get to hear, but it doesn’t always naturally come up like, “Oh! How did you get to be where you are today?” But everybody has such an interesting way that they got where they are, so it’s cool.

[00:53:19] DP: Exactly. Yes. I was trying to do some informational interviews last year when I was thinking about going on the job market and looking for a faculty position. I started just doing informational interviews with faculty members in CST departments to kind of hear their stories. I just started thinking, “Man, I wish I could share this.” There are so many gems here and so much wisdom. I’m hopeful that others find them helpful and get ideas. Sometimes you don’t even know of things that are out there in our field. Now, hopefully people will have some ideas and learn some new things, and new paths that they could pursue in the field.

[00:53:56] DS: That’s awesome. I know that you get the name from – is it the definition of IPP. I know it’s definitely related. We’re learning about people, and from them and with them. Is that like specifically tied in?

[00:54:05] DP: Yes, I did. That was intentional because of my research focus and how passionate I am about interprofessional practice, calling it About, From & With that is part of the definition of interprofessional education is learning About, From & With others. I did kind of steel that from there, because of my passion for interprofessional practice.

[00:54:26] DS: Cool! Where are you hoping to go in the future with it?

[00:54:29] DP: I right now, I am working on my first season. I am going to continue with my first season until the end of this year. Then I’m really hoping to get feedback on what people are liking if they want to keep hearing the solo episodes about my journey or would I just focus more on interviews if that was more helpful. In that way, I can kind of shape my next season for next year.

[00:54:53] DS: Sure. Awesome. I know that you’ve got some exciting guest on the docket. I mean, just unbelievably excited guests.

[00:55:01] DP: Yes. Someone named Dakota Sharp. I don’t know if you’ve heard of him.

[00:55:05] DS: Maybe a good appearance. That’s available on all – I listen to it on Spotify. I don’t know if it’s available in all the other ones.

[00:55:11] DP: It is, yes.

[00:55:12] DS: Yeah. Awesome. Cool. Danika, it’s been so great talking with you about all of this amazing information. It’s been very, like, helpful at a theoretical level just understanding content, but also, you’ve just made it very practical, very approachable. I’m excited to see how our students are better 10 years from now because of the developments you guys are making in your research. It’s really, really awesome.

[00:55:33] DP: Thank you so much. Thank you for having me. It’s been really great to talk with you and share this information and hopefully, others find it helpful.

[END OF INTERVIEW]

[00:55:42] DS: That’s all for today. Thank you so much for listening, subscribing, and rating. This podcast is part of an audio course offered for continuing education, through Speech Therapy PD. Check out the website if you’d like to learn more about the CEU opportunities available for this episode, as well as archived episodes. Just head to speechtherapypd.com/ear. That’s speechtherapypd.com/ear.

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