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Guidelines for the Structure and Function of an Interdisciplinary
Team for Persons with Brain Injury
These guidelines are an official statement of the American Speech-Language-Hearing
Association (ASHA). They provide guidance on the procedures for the structure
and function of an lnterdisclplinary team for persons with brain injury,
but are not official standards of the Association. They were developed
by the Joint Committee on lnterprofessional ReIations between Division
40 (Clinical Neuropsychology) of the American Psychological Association
(APA) and the American Speech-Language-Hearing Association: Thomas Campbell
(ASHA chair), Malcolm McNeil, Richard Peach, Reg Warren, Diane Paul-Brown
(ASHA ex officio), Diane Eger and Crystal Cooper (ASHA monitoring vice
presidents), Byron Rourke (APA Division 40 Chair), Llnas Bleliauskas, and
This document is intended to provide general guidelines for interdisciplinary teams for the clinical management of people with brain injury, including but not limited to, traumatic head injury, vascular disease (e.g., stroke), and progressive neurological disease. Minimum guidelines are needed regarding team membership, team leadership, and the interdisciplinary process to ensure that people of all ages and levels of severity of disability receive necessary, appropriate care, given a relatively high incidence of acquired and progressive neurological brain injury in patients who require rehabilitation services.In this context, the objective of rehabilitation by the interdisciplinary team is to maximize each person's potential for recovery so he or she may achieve the highest possible level of functional independence. These guidelines apply to interdisciplinary teams functioning in a variety of settings, including inpatient and outpatient hospital and rehabilitation, and school- and community-based institutions.
Each interdisciplinary assessment team member is responsible for a component of the integrated goals designed to achieve the best functional and socially valid outcome possible for a person with disability. In the interdisciplinary structure, multiple behavioral , cognitive, communication., and physical issues are addressed without unnecessary duplication of services. This document is organized around three basic
dimensions of the interdisciplinary team: (1) team membership, (2) team coordination, and (3) interdisciplinary team function.
The use of the term interdisciplinary” rather than multidisciplinary or transdisciplinary has been selected for these reasons:
* Efficiency and accountability for cost necessitate the integration of areas of intervention that inevitably overlap among disciplines
* The assessment and treatment of specific impairments should be provided within an integrated and functional context.
* The reduction of disability that results in functional independence of the person in his or her learning, living and working environment requires the expertise of professionals in a variety of disciplines,
* A framework is needed to overcome the traditional and fragmented delivery Of specialized services by individual disciplines. It is believed that an interdisciplinary approach can facilitate the acquisition, maintenance, and generalization of skills from the learning to the living environment.
This document was developed by the Joint Committee on Interprofessional Relationships between Division 40 (Clinical Neuropsychology) of the American Psychological Association and the American Speech-Language-Hearing Association to provide general guidelines regarding the structure and function of the interdisciplinary team. The following are general guidelines and they are not intended to constitute a mandate for a specific delivery model for rehabilitation.
MEMBERSHIP OF THE INTERDISCIPLINARY TEAM
An interdisciplinary team shoud include the person with brain injury (when appropriate), selected members of that person's family, a coordinator, and those professionals from varied disciplines necessary for the individual's comprehensive assessment and treatment. Including the person with brain injury and selected members of his or her family is necessary to promote social and ecological validity of the rehabilitation objectives.
Team membership may include, but is not limited to, these people: audiologist, behavioral specialist, dietitian, educator, family members, neuropsychologist, occupational therapist, physical therapist, patient (when possible), physician, rehabilitation nurse, social worker, speech-language pathologist, therapeutic recreation specialist, and vocational rehabilitation counselor. When cognitive, communication, and psychosocial domains are affected, the team should include at least a clinical neuropsychologist, speech-language pathologist, and audiologist. Team membership varies with age of the persons served, the level of disability, the stage of recovery, and the special training of team members.
COORDINATION OF THE INTERDISCIPLINARY TEAM
The team coordinator or case manager serves as team administrator and facilitator and is responsible for ensuring interdisciplinary team function. The selection of the team coordinator should be based on the person's case management skills and clinical and leadership abilities; selection should not be based solely on an individual's academic degree or professional discipline. More specifically, the coordinator should exhibit:
1. Appreciation of and respect for the expertise of team members as they contribute to the overall rehabilitation plan. Such a perspective facilitates negotiation and compromise among team members.
2. Familiarity with various domains of brain-behavior relations and their manifestations following brain injury (e.g., cognitive, communication, medical, neurological, orthopedic, and psychosocial).
3. Ability to allocate responsibility to appropriate team members, to recognize the team as a decision-making body, and to foster the professional growth and education of team members
4. Ability to allocate team resources within clinical, financial, and logistical constraints of the rehabilitation setting.
5. Ability to formulate and communicate treatmentgoals and to integrate clinical objectives.
6. Knowledge of measurement systems to determine treatment efficacy, efficiency, and outcome. Outcome is defined here as a measurable reduction in the impairment, disability, or handicap associated with rehabilitation. These changes should result in improvement in the patient's efficiency or independence in the educational, living, and working settings.
7. Ability to educate administrators, colleagues, families, primary caregivers, the community, and other individuals about persons with brain injury and disease and to promote factors that lead to prevention of brain injury and disease.
PROCESS THAT FACILITATES INTERDISCIPLINARY TEAM FUNCTION
The fundamental purpose of the brain injury team is to provide the most effective services available to maximize the recovery of the person with brain injury. The rehabilitation process should include the following basic components:
1. Integration of information known to affect behavior and outcome, such as (a) age and levels of functioning; (b) effects of medications on behavior;
(c) potential medical complications and their effect on behavior; (d) differing linguistic and cultural needs; and (e) various service delivery models.
2. Establishment and integration of specific discipline assessments and plans of care.In this connection, the following are usually thought to be necessary:
A. Collection can serve of a complete history and interview of patient/family that as a basis for structuring each assessment.
B. Discipline-specific assessments conducted individually or together in order to construct a set of observations. These assessments should result in appropriate diagnosis and a framework for establishing a plan of care.
C. Inclusion of the family and person with brain injury in the development of treatment objectives.
3. Determination of differential diagnoses after all observations are analyzed and integrated during clinical discussion.Requisites for this would include the following:
A. An initial assessment meeting to report strengths and deficits in a format that focuses on the mechanisms and processes necessary to develop functional skills in daily living, education, leisure, personal relationships, and work.
B. Although a specific discipline may assume primary responsibility for assessing a functional area, observations and assessments by other disciplines are communicated to help determine the overall reliability and consistency of assessment; this process illustrates the interdisciplinary nature of team decision-making.
c. Meetings to integrate clinical findings into a plan of care. Meetings should be structured to facilitate an exchange of all opinions, including those of the patient and family to enhance positive treatment outcomes, and to avoid negative treatment outcomes.
4. Development of a plan of care to provide well-defined, attainable goals, with their relevance for eventual functional treatment outcomes. Such a plan should include the following:
A. Clearly defined goals in various functionat skill areas within specified time frame.
B. Provision for regular review and appropriate alteration of goals.
C. Discharge planning and a statement of functional independence/ dependence. This is necessary to assure that the discharge plan proposed at admission remains consistent with the patient's skill level at discharge from rehabilitation.
D. The necessary structure and content to comply with the appropriate regulatory agency standards and guidelines.
5. Involvement of the patient and family as integral members of the interdisciplinary team. In this connection, the following points should be emphasized:
A. Differing opinions about diagnosis and treatment planning (including those of the patient and family) should be discussed when the team develops a treatment plan.
B. Open discussion with family and the person with brain injury reinforces the membership within the interdisciplinary team and the mutual responsibility for decision-making,
C. Provisions for education, training, support, and counseling for the family and the person with brain injury should be clearly identified in the plan of treatment.
6. An understanding among team members of the relationships among different stages of assessment (World Health Organization, 1980). Important issues to consider may include but are not limited to the following points;
A. In addition to appropriate assessment conducted by each discipline, the team conducts an overall assessment of functional independence at admission, at discharge, and a predetermined period after discharge from rehabilitation. A functional measure of outcome demonstrates the impact of the rehabilitation process on the person's impairment and disability and, in some instances, handicap.
B. Discussion of observations of patient behavior among various team members to assure reliability of assessment.
C. The establishment of appropriate discharge criteria and the adoption of procedures to facilitate necessary modifications of the program as progress is observed.
7. A measurement system for determining treatment outcome. Certain settings require use of treatment designs that permit the clinician t o
establish a relationship between the gain experienced during rehabilitation and the treatments rendered (e.g., pre- and post-treatment designs, single-subject experimental designs).
This report provides guidelines for the structure and function of interdisciplinary teams assembled for the delivery of clinical services to individuals with brain injury. Specifically, the report addresses issues concerning team membership, skills required of the team coordinator, and the processes that facilitate the attainment of team goals. These general suggestions are designed to give rehabilitation professionals and health care administrators some guiding principles for interdisciplinary teams involved in the clinical management of individuals with brain injury.
World Health Organization. (1980). International Classification of Impairments,
Disabilities and Handicaps. Geneva: WHO.
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