Running Head: SPEECH LANGUAGE PATHOLOGIST

Speech-Language Pathologist Interview

Assignment 1: Interprofessional Collaboration Interview

Melissa Ackerly

SUNY Delhi

NURS-604-11235-201802

Kirsty Digger

Graduate Practicum I

February 10, 2018

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Abstract

This paper will present the multiple avenues a speech-language pathologist has in the healthcare

and educational settings. Healthcare and education are known to be intertwined in the clinical or

in the educational setting. Improving individual, community, and population health relies on the

ability of healthcare professionals of all disciplines to engage in interprofessional collaboration

(IPC) to achieve the goals of the triple aim. The IPC team as a unit is the most productive and

valuable resource for improving health, experiences, and reducing costs to reaching these goals

(Institute for Healthcare Improvement (IHI), 2018).

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Speech Language Pathologist Interview

Amanda Lewis, MS, CCC-SLP is a master’s prepared speech-language pathologist (SLP)

who has also earned her “Cs” which is a certificate of clinical competency (CCC). As an SLP

Lewis is certified to teach, evaluate, and diagnose clients/patients in a multitude of settings. An

SLP can prescribe and perform treatment modalities for clients in all stages of the lifespan. She

is employed full time at a small rural public school with a high number of students in need of

speech services. She is also employed to do itinerate work for the local county public health

department for infants and pre-school aged children in need of early intervention evaluations (EI)

or speech services for a previously identified diagnosis.

An SLP is a primary resource on the healthcare team with medical conditions which can

impede the client’s ability to communicate and impair clients’ nutritional status. Aphasia,

dysphasia, and dysarthria are a few of the most common disorders of adulthood. Difficulty

speaking and processing conversations, chewing and swallowing difficulty are associated with

aphasia and dysphagia. Degenerative brain diseases can damage peripheral nerves leading to

speech and swallowing impairments. Disorders can be related to organic physical defects,

stroke, long term disease processes such as Parkinson’s, or traumatic brain injuries (TBI) from

other sources. Healthcare concerns of children often include developmental disabilities that fall

on the autism spectrum disorders. Communication and language can be significantly impaired in

the autism client and neurological function is evaluated closely (Bastable, 2016).

Interview Questions

 Where do your referrals come from?

 How are you perceived in your work environment at the school? As a healthcare provider

or other? Explain.
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 How does the SLP role fit with healthcare needs of your clients?

 Have you had findings requiring referral to other healthcare providers? Examples?

 How does the SLP integrate values and ethics into your practice?

 What does the SLPs team and teamwork look like in your work environments?

Interprofessional Collaboration Domain and the Triple Aim

The Interprofessional Education Collaborative (IPEC) (2017) and the core competencies

of IPEC promote the value of interdisciplinary team work for a common goal to improve

healthcare delivery to patients. However, the 2016 update of IPEC recognized the four core

competencies of values/ethics, roles and responsibilities, interprofessional communication, and

team and teamwork would not be individual domains, rather categories with sub-categories

which should lie under the overarching domain of interprofessional collaboration. This change

provides a more direct imperative for healthcare professionals to work together toward the triple

aim to improve healthcare experiences, improve the populations’ health, and reduce costs

(Institute for healthcare Improvement (IHI), (2018). Historically, the U.S. healthcare system is

costly, inefficient, and not proactive in disease prevention. Interprofessional collaboration can

expedite a patient’s ability to achieve an optimal level of functioning, thus reducing costs and

providing a positive care experience.

Values and Ethics

The SLP has the same responsibility to adhere to HIPPA regulations as any other member

of the healthcare profession. Lewis (A. Lewis, personal interview, February 7, 2018) spoke of

how privacy, respect and ethical treatment sometimes goes beyond her care of individual clients.

She advocates to raise awareness of various conditions in the broader community, most often

autism spectrum disorders (ASD). Many of her clients are undiagnosed or in the process of a
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diagnosis of autism or other syndrome-like conditions. Lewis (A. Lewis, personal interview,

February 7, 2018) gave an example of a pre-school child in a classroom of 12 running wildly in

circles around the room making repetitive noises. This occurred while the others were sitting in

seats with their parents beside them. The parents of the running child sat unaffected by the

behavior of their child. She reported that this child was swimming in the autism spectrum, but

the parents refused formal evaluation.

Lewis (A. Lewis, personal interview, February 7, 2018) reports it is not unusual for

parents to deny their child is different, especially if there is an indication the parent(s) may be on

the spectrum themselves or have sentimental or cultural barriers promoting avoidance/denial

behaviors. Over time, she says the parents have been persuaded to have the evaluation in the

best interest of their child’s educational needs. If there is reluctance, the parents can be charged

with educational neglect. The final diagnosis often leads to IPC treatments. Strunk, Leisen, and

Schubert (2017) confirm the value of IPC approach to managing ASD. There is a greater risk for

unmet healthcare needs and family support for the ASD patient and family. The myriad of

symptoms associated with ASD include the need for treatments from multiple professions such

as: social, psychological, neurological and physical. This study reports IPC is not well

coordinated in this particular population and in need of improvement. Different disciplines may

not accept or recognize the value of another in treatment of ASD and provide care in isolation.

There must be willingness to reach out and collaborate or the care may conflict with

recommendations from other healthcare specialists. The values included in use of the IPEC core

competencies provide a framework to recommend specific education for IPC of the ASD client

needs.

Roles and Responsibilities

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Lewis (A. Lewis, personal interview, February 7, 2018) had positive comments and some

challenges she has encountered with IPC during our interview. Most of her referrals come from

an early intervention (EI) evaluation or the school psychologist. Her role is perceived differently

in both of her work environments. At the school her role is more of a teacher and less healthcare

related such as the occupational or physical therapists are. The needs of the school-age children

for SLP services are more academically driven than for healthcare needs. As an SLP for early

intervention (EI) evaluation and treatment, the opposite is true. Referrals are primarily initiated

based on healthcare concerns for impaired communication or gastrointestinal difficulties. Most

of these come from the medical providers and linked to developmental problems.

An SLP is a specialist in the healthcare field and responsible to provide current and

effective treatment based on evidence according to Torrence, Baylor, Yorkston, and Spencer

(2016). The concept communicative participation requires the SLP to identify client strengths

and find methods to enhance their communication skills in order to improve their daily lives

when significant impairment is present. Dysarthria and laryngectomy are examples of conditions

which impede client communication. Clients/patients with impaired speech can work with the

SLP to set goals to practice or participate in real-life application of skill techniques to improve

client’s ability to communicate with their IPC team. The SLP role includes assessment of the

client for prescribing appropriate communication tools as discussed by Vento-Wilson, McGuire,

and Ostergren (2015). Augmented and alternative communication methods (AAC) for the

patient/client to communicate their needs and wishes to the healthcare team is critical to optimize

patient outcomes. The patient with severe communication deficits (SCD), such as ventilated

patients or stroke victims can require temporary or long term needs for communication of their

healthcare wishes. The SLP can provide the healthcare team with low tech education of
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communication tools for short term or determine long term needs and provide education and

options for augmented means of communication. This study used student nurses to educate on

AAC, but could be applied to other healthcare disciplines.

Interprofessional Communication

Lewis (A. Lewis, personal interview, February 7, 2018) states she refers her school-based

clients to a number of other healthcare specialists including; orthodontists, developmental

pediatricians, neurologists, and ENTs. She states there are problems with communication and

getting feedback after referrals. Relying on the family member’s recall of the visits is not an

option, but getting the actual record of the specialist visit can cause a delay in care and be a

frustrating experience. Lewis reports she rarely has to refer the EI children to an outside

specialist. The system for EI services encompasses all of the healthcare disciplines needed for

that child and shares health records and evaluations.

Eaton and Regan (2015) explored factors which contributed to improved IPC

effectiveness in delivery of client care. Much of the reason the care was improved was reported

as simply respectful interactions and knowledge of the scope of practice for differing healthcare

professions. Healthcare professions integrating IPC in their education need to include effective

communication as vital component to establishing consensus and achieving collective goals for

improving patient outcomes. There are a number of challenges to realizing effective IPC. The

IHI (2018) encourages IPC to support successful patient-centered care by sharing knowledge and

strengths. Assessment of the effectiveness of the IPC team interventions and communicate

openly when adjustments need to be made whether through technology or in team meetings is

important.

Team and Teamwork

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An IPC team will have a variation of specialists selected based on the individual client

needs. The team shares a common goal and therefore must be considerate of the culture other

team members may hold related to professional values and beliefs. Healthcare needs of a

client/patient are not always a medical priority and a team can be led by other than the medical

provider. The patient and or their family are also a part of the team, so teamwork must include

them. Teamwork includes each specialty to provide their treatment options and opinion of the

clients anticipated response to the method(s). Successful teamwork explores options together

and can overcome boundary issues if and when services overlap (Eaton & Regan, 2015).

During the interview with Lewis (A. Lewis, personal interview, February 7, 2018) she

presented her two IPC team memberships. She states there are ad hoc teams she is also regularly

included on such as; development of policies and plans as mandated by governmental regulatory

changes. An example is the concussion program developed by an IPC team at the school. The

referral generally comes to the school psychologist from the child’s medical provider and the IPC

team is charged with implementing an appropriate return to learn or return to play plan. As a

school-based SLP the IPC team develops individualized education plans (IEPs). The family is

actively involved on the team and provides valuable information in development of treatment

modalities which will be most effective. In her school-based role as an SLP, children may enter

school with established diagnosis and services, but frequently, the need for intervention is

apparent upon entry and appropriate evaluations are implemented. The IEP teamwork includes

helping families overcome resistance to accepting services. There are times the IEP team

recommends the family to seek further professional evaluation and can facilitate scheduling. She

says she has noticed delays in recognizing the need for services does cause the need for extended

treatments.
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The IPC team in EI tends to have more community and social team members. The

referrals are generally received from the child’s medical provider, but may have been initially

generated from a social worker involved with the family. A vital component of effective

treatment is the IPC team working together and regularly sharing evaluations and notes from

treatment sessions. Sharing documents is extremely helpful when multiple sets of eyes are on

the client in establishing consensus for discharge plans or revising a plan to best meet the needs

of the kid or family. In her experience in school-based SLP, the EI kids are more frequently

discharged from SLP care in their elementary years of schooling (A. Lewis, personal interview,

February 7, 2018).

Conclusions

First and foremost, the IPEC (2017) updates for 2016 provides a directive to promote IPC

at all levels of education for students pursing a health-related profession. There is a clear

pathway presented to optimize the value of an IPC team to effectively reach the goals of the

triple aim in reducing costs, improving the healthcare experience, and improve the health of the

population. Teaching in the nursing labs, we have included IPC in the students’ educational

activities. Team and teamwork is an important part of learning to be a nurse.

The plan of care from an IPC team is only as good as the individual member’s ability to

identify the client needs and resources to target appropriate interventions (Torrence, Baylor,

Yorkston & Spencer, 2016). If the client or family are not willing or not able to participate in the

recommendations for treatment, it is apparent the plan needs revision. Working as a team to

assist each other to overcome barriers to effectively communicate and prevent conflict will

require each specialty to educate the other professionals of their specific roles and functions of

their discipline (Eaton & Regan, 2015). It was interesting to discover how the SLP role on an
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IPC team can influence client outcomes. The concussion program discussion with the

interviewee was enlightening. There has been increased awareness in the last couple years of

healthcare issues which have previously not been addressed or recognized due to concussion

injuries. Sharing this kind information with the IPC team is exactly what is needed to develop

the most effective patient-centered and population-based improvements in healthcare.

References

Bastable, S. B. (2016). Nurse as educator (4th ed.). Sudbury, MA: Jones and Bartlett.
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Eaton, B., & Regan, S. (2015). Perspectives of speech-language pathologists and audiologists on

interprofessional collaboration. Canadian Journal of Speech-Language Pathology &

Audiology, 39(1), 6-18. Retrieved from http://www.caslpa.ca

Institute for Healthcare Improvement (IHI) (2018). The IHI triple aim. Retrieved from

http://www.ihi.org/engage/initiatives/TripleAim/Pages/default.aspx

Interprofessional Education Collaborative (IPEC) (2017). Core competencies for

interprofessional collaborative practice: 2016 update. Retrieved from

https://www.ipecollaborative.org/resources.html

Strunk, J., Leisen, M., & Schubert, C. (2017). Using a multidisciplinary approach with children

diagnosed with autism spectrum disorder. Journal of Interprofessional Education &

Practice, 860-68. doi:10.1016/j.xjep.2017.03.009

Torrence, J. M., Baylor, C. R., Yorkston, K. M., & Spencer, K. A. (2016). Addressing

communicative participation in treatment planning for adults: A survey of U.S. speech-

language pathologists. American Journal of Speech-Language Pathology, 25(3), 355-370.

doi:10.1044/2015_AJSLP-15-0049

Vento-Wilson, M. T., McGuire, A., & Ostergren, J. A. (2015). Role of the speech-language

pathologist. Dimensions of Critical Care Nursing, 34(2), 112-119.

doi:10.1097/DCC.0000000000000094