JCPSLP Vol 22 No 1 2020

Expanding possibilities: Foci on reading and interdisciplinary practices

What’s the evidence? Interdisciplinary service provision in community-based services for children with disabilities Stephanie Weir

Clinical scenario Jacquie works as a speech-language pathologist for a health service in regional Victoria that provides allied health services to children through both a community health team and an early intervention team. Up until recently, the early intervention team have provided service to families under the early childhood intervention scheme, working primarily with a transdisciplinary key worker model. Since starting at the health service 5 years ago as a new graduate, Jacquie has worked exclusively in the community health team, and has mainly seen clients under a unidisciplinary service delivery model. Recently, in response to changes in the funding environment for clients with a diagnosis of disability, there have been some structural changes within Jacquie’s organisation. To keep the waitlist moving, all clients are now being allocated to the first available clinician, regardless of whether the clinician sits within the community health team, or the early intervention team. As a result, Jacquie and her colleagues in the community health team are now seeing clients with complex and multiple disabilities for the first time, many of whom would benefit from augmentative and alternative communication (AAC) intervention – an area of practice in which Jacquie, and many of her colleagues, have had no clinical experience since graduating. As a first step to improving her knowledge and practice with this clinical population, Jacquie consults with some of her colleagues in the early intervention team. They tell her that providing therapy to young children with multiple areas of clinical need over many years has taught them the benefit of interdisciplinary collaboration between treating clinicians. One of Jacquie’s colleagues who also works at a rehabilitation service directs her to research that demonstrates clear benefits of interdisciplinary practice to clients in that setting (Giladi, Manor, Hilel & Gurevich, 2014; Peters et al., 2012). Jacquie knows that the early intervention team have gained this experience from working under a transdisciplinary key worker model, and that her current community health team is not equipped to provide a key worker service. So Jacquie asks her team leader, Karen, for some non-client attributable time to be allocated within her team to facilitate interdisciplinary collaboration, so that clients with complex disabilities and their families can be thoroughly and holistically supported by the whole team. Karen is supportive of Jacquie’s request, and asks her to put together a proposal outlining the case for non-billable time to be allocated for collaboration between therapists within a work day, so that she can advocate the case for a

change in service delivery to the management team. The proposal must be supported by research evidence, as well as clinical guidelines. Response Jacquie knows that her proposal needs to outline the best-available evidence to support service delivery to children with disabilities within the parameters of both her organisation and the National Disability Insurance Scheme funding structure. As a first step, she consults a seminally relevant book chapter on interdisciplinary practice as background, informative reading (Rokusek, 1995), and considers the best approach to conducting a focused search of the research evidence. Jacquie initially decides to focus her search on the impact of interdisciplinary practice on communication outcomes for children who use AAC, as it is the most complex and prevalent area of need for the new clients on her caseload. Jacquie considers the research question: “Does an interdisciplinary model of service provision enhance communication outcomes for children with disabilities using AAC in a community therapy setting?” Search strategy Jacquie searches eight databases (Scopus, Web of Science, EBSCO, Google Scholar, PubMed, CINAHL, Cochrane Library and SpeechBITE) to conduct her review of the research literature. The terms for the search are: • (interdisciplinary OR interprofessional) AND child* AND disab* AND (“augmentative and alternative communication” OR AAC) The search returns 13 relevant publications and, after removing duplicates, non-peer reviewed publications and non-English language papers, Jacquie retains six of these. She scans each title and abstract for relevance to service provision in community settings and in an Australian context. She makes this decision on the basis of ecological validity of service delivery, given that a higher intensity of intervention may be provided in settings such as a school or inpatient setting and would thus not necessarily be comparable. Similarly, she feels that appraisal of services provided outside of Australia would not provide a strong enough case that good outcomes are achievable under an Australian funding model. Unfortunately, Jacquie finds that none of the articles returned by her search meet her narrow inclusion criteria. Given this low return from her very targeted search, Jacquie decides to broaden her search strategy to draw

Stephanie Weir

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JCPSLP Volume 22, Number 1 2020

Journal of Clinical Practice in Speech-Language Pathology