Multidisciplinary Teaming: Enhancing Collaboration through Increased Understanding

Abstract

In an effort to provide clarity about the unique contributions of several professions within the context of multidisciplinary treatment, we reviewed the definitions, philosophical underpinnings, and national requirements pertaining to both scopes of practice (i.e., model licensing acts, legislation, and regulatory boards) and training (i.e., task lists, accreditation standards and course requirements, and exam blueprints) of 4 behavioral health professions. The professions we selected (behavior analysis, psychology, speech-language pathology, and occupational therapy) are likely to provide treatment alongside one another and often to the same clients. In a review of documents pertaining to scopes of practice and training for each profession, we found overlapping content. However, the similarities between professions diminished when we reviewed more specific guidelines such as learning objectives, educational requirements (i.e., coursework), supervised clinical experience (e.g., internships), and national examinations. This was especially true when considering each profession’s underlying approach to treatment (i.e., philosophical underpinnings) and, hence, service activities. We discuss our findings in light of service overlap and make a call for greater collaboration between professions, as related to the separate content knowledge and expertise of professionals in each field and the impact on client outcomes.

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Notes

  1. 1.

    Although we discuss service delivery in the context of collaboration with other professionals with differing training backgrounds, it should be emphasized that we do not support, nor are we making appeals for, the implementation of eclectic intervention. Rather, information about the scopes of practice and training reviewed for each profession in this paper is offered as a means of achieving greater clarity, delineating limitations of competency and expertise, and promoting more effective collaboration to maximize treatment effectiveness. We posit that genuine multidisciplinary collaborative programming is not the same as eclectic intervention. When services are provided collaboratively, seamless programming and more effective outcomes may ensue while the likelihood of intervention strategies being implemented out of context, or in a contraindicated fashion, is simultaneously minimized.

References

  1. Accreditation Council for Occupational Therapy Education. (2011). Standards and interpretive guide (effective July 31, 2013) April 2017 interpretive guide version. Retrieved from https://www.aota.org/-/media/corporate/files/educationcareers/accredit/standards/2011-standards-and-interpretive-guide.pdf.

  2. Alarcon, N., Scheer-Cohen, A., & Sisskin, V. (2015). The clinical fellowship experience: What you need to know. Paper presented at the American speech and hearing association conference, Denver, Colorado.

  3. American Occupational Therapy Association. (2010). Standards of practice for occupational therapy. American Journal of Occupational Therapy, 64, S106–S111. https://doi.org/10.5014/ajot.2010.64S106.

    Article  Google Scholar 

  4. American Occupational Therapy Association. (2011). The philosophical base of occupational therapy. American Journal of Occupational Therapy, 65, S65. https://doi.org/10.5014/ajot.2011.65S65.

    Article  Google Scholar 

  5. American Occupational Therapy Association. (2013). Standards of practice for occupational therapy. Retrieved from https://www.aota.org/~/media/Corporate/Files/AboutAOTA/Core/Standards%20of%20Practice%20for%20Occupational%20Therapy%20FINAL.pdf.

  6. American Occupational Therapy Association. (2014). Overview of the OT practice framework: Part I. Retrieved from http://www.aota.org/~/media/Corporate/Files/Secure/Publications/SIS-Quarterly-Newsletters/AM/AMMAR03.pdf

  7. American Occupational Therapy Association. (2015). Standards of practice for occupational therapy. American Journal of Occupational Therapy, 69, 6913410057p1–6913410057p6. https://doi.org/10.5014/ajot.2015.696S06.

    Article  Google Scholar 

  8. American Occupational Therapy Association. (2016). 2011 Accreditation Council for Occupational Therapy Education (ACOTE) standards and interpretive guide. Retrieved from http://www.aota.org/~/media/Corporate/Files/EducationCareers/Accredit/Standards/2011-Standards-and-Interpretive-Guide.pdf?la=en.

  9. American Psychological Association. (2010). Model act for state licensure of psychologists. Retrieved from http://www.apa.org/about/policy/model-act-2010.pdf.

  10. American Psychological Association. (2013). Guidelines and principles for accreditation of programs in professional psychology (G&P). Retrieved from http://www.apa.org/ed/accreditation/about/policies/guiding-principles.pdf

  11. American Psychological Association. (2017). Divisions. Retrieved from www.apa.org/about/division/

  12. American Psychological Association Commission on Accreditation. (2015). Standards of accreditation for health service Psychology Retrieved from http://www.apa.org/ed/accreditation/about/policies/standards-of-accreditation.pdf

  13. American Speech-Language-Hearing Association. (n.d.). Speech-language pathology exam (5331) content. Retrieved from http://www.asha.org/Certification/praxis/Speech-Language-Pathology-Exam-5331-Content/

  14. American Speech-Language-Hearing Association. (2007). Scope of practice in speech-language pathology. Retrieved from http://www.asha.org/uploadedFiles/SP2007-00283.pdf

  15. American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology. Retrieved from www.asha.org/policy

  16. Association for Behavior Analysis International. (2015). Guidelines for accreditation and reaccreditation of programs in behavior analysis. Retrieved from https://www.abainternational.org/media/96351/abai_accreditation_manual_2015.pdf

  17. Association of State and Provincial Psychology Boards. (2015). EPPP candidate handbook: Examination for professional practice in psychology (EPPP). Retrieved from http://c.ymcdn.com/sites/www.asppb.net/resource/resmgr/EPPP_/EPPP-Cand-Handbook-June_2015.pdf

  18. Baer, D. M., Wolf, M. M., & Risley, T. R. (1968). Some current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 1(1), 91–97. https://doi.org/10.1901/jaba.1968.1-91.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Baer, D. M., Wolf, M. M., & Risley, T. R. (1987). Some still-current dimensions of applied behavior analysis. Journal of Applied Behavior Analysis, 20(4), 313–327. https://doi.org/10.1901/jaba.1987.20-313.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Behavior Analyst Certification Board. (n.d.). Fourth edition task list. Retrieved from http://www.bacb.com/Downloadfiles/TaskList/BACB_Fourth_Edition_Task_List.pdf

  21. Behavior Analyst Certification Board. (2012). Model act for licensing/regulating behavior analysts. Retrieved from http://www.bacb.com/Downloadfiles/BACB_Model_Act.pdf

  22. Behavior Analyst Certification Board. (2014). Professional and ethical compliance code for behavior analysts. Retrieved from http://www.bacb.com/Downloadfiles/BACB_Compliance_Code.pdf

  23. Bloom, L., & Tinker, E. (2001). The intentionality model and language acquisition. Monographs of the Society for Research in Child Development, 66(4), 1–91. https://doi.org/10.1111/1540-5834.00162.

    Article  Google Scholar 

  24. Bonvicini, K. A., Perlin, M., Bylund, C., Carroll, G., Rouse, R. A., & Goldstein, M. G. (2009). Impact of communication training on physician expression of empathy in patient encounters. Patient Education and Counseling, 75, 3–10. https://doi.org/10.1016/j.pec.2008.09.007.

    Article  PubMed  Google Scholar 

  25. Brodhead, M. T. (2015). Maintaining professional relationships in an interdisciplinary setting: Strategies for navigating nonbehavioral treatment recommendations for individuals with autism. Behavior Analysis in Practice, 8(1), 70–78. https://doi.org/10.1007/s40617-015-0042-7.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Bruce, M. A. G., & Borg, B. A. (2002). Psychosocial frames of reference: Core for occupation-based practice (3rd ed.). Thorofare, NJ: SLACK.

    Google Scholar 

  27. Bruner, J. (1981). The social context of language acquisition. Language & Communication, 1(2–3), 155–178. https://doi.org/10.1016/0271-5309(81)90010-0.

    Article  Google Scholar 

  28. Cawthorpe, D. (2017). Comprehensive description of comorbidity for autism spectrum disorder in a general population. The Permanente Journal, 21, 86–90. https://doi.org/10.7812/TPP/16-088.

    Article  Google Scholar 

  29. Centers for Disease Control and Prevention. (n.d.). Data & statistics. Retrieved from https://www.cdc.gov/ncbddd/autism/data.html

  30. Chiesa, M. (1994). Radical behaviorism: The philosophy and the science. Boston, MA: Authors Cooperative.

    Google Scholar 

  31. Chomsky, N. (1982). Lectures on government and binding. New York, NY: Foris.

    Google Scholar 

  32. Cooper, J. O., Heron, T. E., & Heward, W. L. (2007). Applied behavior analysis (2nd ed.). Upper Saddle River, NJ: Pearson Education.

    Google Scholar 

  33. Coulehan, J. L., Platt, F. W., Egener, B., Frankel, R., Lin, C.-T., Lown, B., & Salazar, W. (2001). Let me see if I have this right . . . : Words that help build empathy. Annals of Internal Medicine, 135(3), 221–227.

    Article  PubMed  Google Scholar 

  34. Council for Clinical Certification in Audiology and Speech-Language Pathology of the American Speech-Language-Hearing Association. (2013). 2014 standards for the certificate of clinical competence in speech-language pathology. Retrieved from http://www.asha.org/Certification/2014-Speech-Language-Pathology-Certification-Standards/

  35. Council on Academic Accreditation. (2017). 2017 standards for accreditation. Retrieved from http://caa.asha.org/reporting/standards/2017-standards/

  36. Council on Academic Accreditation in Audiology and Speech-Language Pathology. (2014). Standards for accreditation of graduate education programs in audiology and speech-language pathology (2008, revised 2014). Retrieved from http://www.asha.org/uploadedFiles/Accreditation-Standards-Graduate-Programs.pdf

  37. Cox, D. J. (2012). From interdisciplinary to integrated care of the child with autism: The essential role for a code of ethics. Journal of Autism and Developmental Disorders, 42, 2729–2738. https://doi.org/10.1007/s10803-012-1530-z.

    Article  PubMed  Google Scholar 

  38. Critchfield, T. S., Doepke, K. J., Epting, L. K., Becirevic, A., Reed, D. D., Fienup, D., & Eccot, C. L. (2017). Normative emotional responses to behavior analysts or how not to use words to win friends and influence people. Behavior Analysis in Practice, 10, 97–106. https://doi.org/10.1007/s40617-016-0161-9.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Dillenburger, K., Röttgers, H.-R., Dounavi, K., Sparkman, C., Keenan, M., Thyer, B., & Nikopolous, C. (2014). Multidisciplinary teamwork in autism: Can one size fit all? Australian Journal of the Educational and Developmental. Psychologist, 10, 1–16. https://doi.org/10.1017/edp.2014.13.

    Article  Google Scholar 

  40. Doshi-Velez, F., Ge, Y., & Kohane, I. (2014). Comorbidity clusters in autism spectrum disorders: An electronic health record time-series analysis. Pediatrics, 133(1), e54–e63. https://doi.org/10.1542/peds.2013-0819.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Educational Testing Service Praxis. (2017). The Praxis study companion: Speech-language pathology. Retrieved from https://www.ets.org/s/praxis/pdf/5331.pdf

  42. Epstein, R., Campbell, T. L., Cohen-Cole, S. A., Whinney, I. R., & Smilkstein, G. (1993). Perspectives on patient-doctor communication. The Journal of Family Practice, 37(4), 377–388.

    PubMed  Google Scholar 

  43. Fidler, G. S. (1996). Life-style performance: From profile to conceptual model. American Journal of Occupational Therapy, 50, 139–147. https://doi.org/10.5014/ajot.50.2.139.

    Article  PubMed  Google Scholar 

  44. Fodor, J. (1983). The modularity of the mind: An essay on faculty psychology. Cambridge, MA: MIT Press.

    Google Scholar 

  45. Forsyth, K., & Kielhofner, G. (2006). The model of human occupation: Integrating theory into practice. In E. A. S. Duncan (Ed.), Foundations for practice in occupational therapy (4th ed.). London, UK: Elsevier.

    Google Scholar 

  46. Gerber, S. (2003). A developmental perspective on language assessment and intervention for children on the autistic spectrum. Topics in Language Disorders, 23(2), 74–94. https://doi.org/10.1097/00011363-200304000-00003.

    Article  Google Scholar 

  47. Hardee, J. T. (2003). An overview of empathy. The Permanente Journal, 7(4), 51–54. https://doi.org/10.7812/TPP/03-072.

    Article  PubMed Central  Google Scholar 

  48. Howard, J. S., Sparkman, C. R., Cohen, H. G., Green, G., & Stanislaw, H. (2005). A comparison of intensive behavior analytic and eclectic treatments for young children with autism. Research in Developmental Disabilities, 26(4), 359–383. https://doi.org/10.1016/j.ridd.2004.09.005.

    Article  PubMed  Google Scholar 

  49. Howard, J. S., Stanislaw, H., Green, G., Sparkman, C. R., & Cohen, H. G. (2014). Comparison of behavior analytic and eclectic early interventions for young children with autism after three years. Research in Developmental Disabilities, 35(12), 3326–3344. https://doi.org/10.1016/j.ridd.2014.08.021.

    Article  PubMed  Google Scholar 

  50. Hunt, P., Soto, G., Maier, J., & Doering, K. (2003). Collaborative teaming to support students at risk and students with severe disabilities in general inclusive classrooms. Council for Exceptional Children, 3, 315–332. https://doi.org/10.1177/001440290306900304.

    Article  Google Scholar 

  51. Jacobs, K., & Jacobs, L. (2004). Quick reference dictionary for occupational therapy (4th. ed.). Thorofare, NJ: SLACK.

    Google Scholar 

  52. Kazdin, A. E. (2011). Single-case research designs: Methods for clinical and applied settings (2nd ed.). New York, NY: Oxford University Press.

    Google Scholar 

  53. Kelly, A. M., & Tincani, M. (2013). Collaborative training and practice among applied behavior analysts who support individuals with autism spectrum disorder. Education and Training in Autism and Developmental Disabilities, 48, 120–131.

    Google Scholar 

  54. Kielhofner, G. (2008). Model of human occupation theory and application (4th ed.). Baltimore, MD: Lippincott Williams & Wilkins.

    Google Scholar 

  55. Koenig, M., & Gerenser, J. (2006). SLP-ABA: Collaborating to support individuals with communication impairments. The Journal of Speech and Language Pathology – Applied Behavior Analysis, 1(1), 2–10. https://doi.org/10.1037/h0100180.

    Article  Google Scholar 

  56. Matson, J. L., & Nebel-Schwalm, M. S. (2007). Comorbid psychopathology with autism spectrum disorder in children: An overview. Research in Developmental Disabilities, 28, 341–352. https://doi.org/10.1016/j.ridd.2005.12.004.

    Article  PubMed  Google Scholar 

  57. Matson, J. L., & Williams, L. W. (2013). Differential diagnosis and comorbidity: Distinguishing autism from other mental health issues. Neuropsychiatry, 3(2), 233–243. https://doi.org/10.2217/NPY.13.1.

    Article  Google Scholar 

  58. McClelland, J., & Rummelhart, D. (1986). Parallel distributed processing (Vol. 2). Cambridge, MA: Bradford.

    Google Scholar 

  59. McLeod, S. (2009). Jean Piaget’s theory of cognitive development. Retrieved from http://www.simplypsychology.org/piaget.html

  60. Muma, J., & Cloud, S. (2008). Evidence-based practices: Rational evidence. Retrieved from https://www.asha.org/Events/convention/handouts/2009/1353_Muma_John/

  61. National Board for Certification in Occupational Therapy. (2013). 2012 practice analysis of the occupational therapist registered: Executive summary. Retrieved from http://www.nbcot.org/assets/candidate-pdfs/2012-practice-analysis-executive-otr

  62. National Board for Certification in Occupational Therapy. (2018). Professional practice standards for OTR®–occupational therapist registered® and candidates seeking the OTR designation. Retrieved from https://www.nbcot.org/-/media/NBCOT/PDFs/Practice-Standards-OTR.ashx?la=en

  63. National Board for Certification in Occupational Therapy. (2019). Occupational therapy registered OTR® certified occupational therapy assistant COTA® certification exam handbook. Retrieved from https://www.nbcot.org/-/media/NBCOT/PDFs/Cert_Exam_Handbook.ashx?la=en

  64. Newhouse-Oisten, M. K., Peck, K. M., Conway, A. A., & Frieder, J. (2017). Ethical considerations for interdisciplinary collaboration with prescribing professionals. Behavior Analysis in Practice, 10, 145–153. https://doi.org/10.1007/s40617-017-0184-x.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Pollock, N. (2016). Sensory integration: A review of the current state of evidence. Occupational Therapy Now, 11(5), 6–11.

    Google Scholar 

  66. Ramafikeng, M. (2011a). Model of human occupation. In Conceptual frameworks (2nd ed., Lecture 1). Retrieved from https://vula.uct.ac.za/access/content/group/9c29ba04-b1ee-49b9-8c85-9a468b556ce2/Framework_2/lecture1.htm

  67. Ramafikeng, M. (2011b). The person environment occupation model. In Conceptual frameworks (2nd ed., Lecture 3). Retrieved from https://vula.uct.ac.za/access/content/group/9c29ba04-b1ee-49b9-8c85-9a468b556ce2/Framework_2/lecture3.htm.

  68. Ramafikeng, M. (2011c). Ecology of human performance. In Conceptual frameworks (2nd ed., Lecture 7). Retrieved from https://vula.uct.ac.za/access/content/group/9c29ba04-b1ee-49b9-8c85-9a468b556ce2/Framework_2/lecture7.htm

  69. Satink, T., Winding, K., & Jonsson, H. (2004). Daily occupations with or without pain: Dilemmas in occupational performance. OTJR: Occupation, Participation and Health, 24(4), 1–7. https://doi.org/10.1177/153944920402400404.

    Article  Google Scholar 

  70. Scheibel, G., & Watling, R. (2016). Collaborating with behavior analysts on the autism service delivery team. OT Practice, 21(7), 15–19 Retrieved from http://www.aota.org/Publications-News/otp/Archive/2016/4-25-16-facts/Behavior-Analysts-Autism.aspx#sthash.Fm4ibUGW.pdf.

    Google Scholar 

  71. Sidman, M. (1960). Tactics of scientific research: Evaluating experimental data in psychology. New York, NY: Basic Books.

    Google Scholar 

  72. Skinner, B. F. (1957). Verbal behavior. New York, NY: Appleton-Century-Crofts.

    Google Scholar 

  73. Skinner, B. F. (1974). About behaviorism. New York, NY: Alfred A. Knopf.

    Google Scholar 

  74. Sperber, D., & Wilson, D. (1986). Relevance: Communication and cognition. Cambridge, MA: Harvard University Press.

    Google Scholar 

  75. Sumison, T., & Law, M. (2006). A review of evidence on the conceptual elements informing client-centered practice. The Canadian Journal of Occupational Therapy, 73(3), 153–162. https://doi.org/10.1177/000841740607300303.

    Article  Google Scholar 

  76. Weissman, A. S., & Bates, M. E. (2010). Increased clinical and neurocognitive impairment in children with autism spectrum disorders and comorbid bipolar disorder. Research in Autism Spectrum Disorders, 4(4), 670–680. https://doi.org/10.1016/j.rasd.2010.01.005.

    Article  Google Scholar 

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Acknowledgments

The authors would like to thank Dr. Linda LeBlanc for the generosity of her time, her excellent suggestions, and her expert guidance throughout the revisions process.

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Danielle LaFrance declares that she has no conflict of interest. Ellie Kazemi declares that she has no conflict of interest. Mary Jane Weiss declares that she has no conflict of interest. Joanne Gerenser declares that she has no conflict of interest. Jacqueline Dobres declares that she has no conflict of interest.

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LaFrance, D.L., Weiss, M.J., Kazemi, E. et al. Multidisciplinary Teaming: Enhancing Collaboration through Increased Understanding. Behav Analysis Practice 12, 709–726 (2019). https://doi.org/10.1007/s40617-019-00331-y

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Keywords

  • Scope of practice
  • Scope of training
  • Practice documents
  • Treatment
  • Multidisciplinary teams
  • Collaboration