A behavior analysis perspective on interprofessional collaboration in the field

A behavior analysis perspective on interprofessional collaboration in the field

Writer: Lina Selim – Lilith Reuter Yuel

translation: Khadija Al-Asmari

Conclusion

Collaborative service delivery models have gained popularity in healthcare and education in clinical settings. Despite the unique opportunity provided by this new popularity to disseminate applied behavior analysis, The majority of practicing behavior analysts have received little or no formal professional development on how to participate in a group setting with non-behavioral colleagues. The purpose of this article is to illustrate how collaborative services are delivered with an emphasis on interprofessionalism. The four core competency areas offered by the Collaborative Learning Framework are interpreted through the lens of applied behavior analysis.

key words: cooperation , professional overlap, interprofessional education, professional practice, Interprofessional cooperative education, Interprofessional collaborative practice.

the introduction

Since the establishment of national accreditation for applied behavior analysts by the Applied Behavior Analysts Certification Board (BACB) in 2000, the number of accredited providers and access to applied behavior analysis services has increased dramatically. The benefits of applied behavior analysis are well known for individuals with autism spectrum disorder, and in other areas of social importance (LeBlanc et al., 2012).

Applied Behavior Analysis practitioners are likely to find themselves working closely with non-behavioral colleagues such as speech and language pathologists, occupational therapists, teachers, clinicians, etc. in their clinical work.

Although there are many potential benefits to collaborating within a multidisciplinary team, Behavior analysts may face barriers to working effectively among professionals with different skills, professional ethics, and intervention methods. As practitioners of applied behavior analysis, We need to realize that ineffective professional cooperation can lead to (aggressive competition, Loss of communication and tense professional relationships, etc.) as it can damage credibility with colleagues and clients. and, most importantly, Evidence suggests that poor collaboration may also negatively impact the rehabilitation process and clinical outcomes for clients.

This interest in effective collaboration and relationship building should not be viewed as an abstract concept. Taylor et al (2018) point out that applied behavior analysts “do not always establish collaborative relationships that need to be maintained.” These perceived deficiencies can negatively impact rehabilitation delivery and client outcomes and reduce the opportunities for dissemination of applied science of ABA.

Despite the prevalence of multidisciplinary teams and the high cost of ineffective interprofessional collaboration, Applied behavior analysts struggle with how to work successfully with professionals outside the field.

The purpose of this article is to illustrate the big picture of collaborative service delivery by providing practitioners with a historical context and description of shared collaborative models with an emphasis on interprofessionalism. A behavior-analytic interpretation of leading guidelines on interprofessionalism is provided through the IPEC framework and related terminology.

Collaborative service delivery models

Collaborative service delivery has been a topic of interest in medicine for several decades. Whereas, with the increasing interest in rehabilitation services and rehabilitation services such as speech and language therapy services, Occupational therapy, physical therapy, social work, and behavioral therapy. A variety of organizations have investigated and sought to enhance collaborative service delivery models, Including the Institute of Medicine (now called the National Academy of Medicine) and the Institute for Healthcare Improvement (IH, 2008). The IOM Committee on Quality of Health Care in America, Both organizations have done significant work to establish standards to guide the delivery of interprofessional collaborative services.

In 2016, The International Program on the Elimination of Child Labor reviewed the core competencies while the IPEC work identifies the competencies needed to build an IPCP/IPP.

There are many business models for cooperation, Including a multidisciplinary team (interdisciplinary team, and a cross-disciplinary team, and multidisciplinary). Before we get into a detailed discussion of how competencies can be considered part of the professional development of applied behavior analysts, It is first important to understand the forms that cooperation may take.

1- Multidisciplinary model

The oldest model of teamwork, Which emerged after legislative mandates for team evaluation. Assessment and treatment are discipline-oriented, Professionals are self-reliant and bear individual responsibility for therapeutic activities related to their specialty. Providers act independently and make independent decisions for treatment programming.

Collaboration occurs by sharing information about the plan with other team members, Collection is not required for treatment decisions, Family involvement is not considered important within the multidisciplinary team. Professionals may be combined, But there is minimal information exchange or interaction between disciplines. Catlett and Harper (1992) suggest that this is the easiest model to implement because it maintains a high level of professional autonomy. Professional independence may speed up the process of expert evaluation and decision-making. However, a lack of information sharing and setting common goals may lead to disjointed treatment plans and less productive treatment sessions that lack continuity. The multidisciplinary approach also leads to fragmentation of treatment that may cause additional burden on the family.

2-Interdisciplinary model

It represents a more collaborative framework. Independent, occupation-specific roles are maintained during the evaluation period. Formal meetings are held to share the evaluation results. Professionals work as a cohesive unit to make collaborative decisions about treatment plans and intervention goals. Each team member brings discipline-related information and contributes to the “overall plan” based on strengths and needs (Foley, 1990).

This model represents the middle position in the cooperation continuum. There is a presumption of interaction between disciplines such that formal opportunities for information exchange are created, Role boundaries are more flexible. Families and caregivers reported feeling more involved in treatment planning and fostering a stronger relationship with the service provider. Therefore, this model also has the potential for misunderstanding, competition, lack of consistency, Different specialties may lead to conflicting recommendations that lead to undesirable clinical outcomes. However, the interdisciplinary model seeks to promote fruitful information exchange and collaborative environments. This model requires a strong set of interpersonal skills to facilitate successful interactions and prevent overreach and frustration.

3- Interdisciplinary model

The interdisciplinary model is much more advanced than other models and is well recognized and validated in the field of early intervention. It is a highly participatory system that includes the distribution of professional roles and scope of practice. The degree of service coordination at this level requires commitment from each team member throughout the assessment and treatment phases of rehabilitation, learning and working together.

There are three basic features: environmental assessment, Distribution of roles, Continuous and intense interaction between group members.

1. Environment assessment: It is an alternative to discipline-specific assessment practices. One provider facilitates the assessment while other team members observe the interaction to gain information. This approach has some important advantages. Firstly, Since all professionals observe the same behavior, This shared sample of behavior may create a common baseline for monitoring ongoing progress. secondly, Evaluating the environment reduces communication breakdowns or disagreements that may occur with independent observations. finally , This approach creates an opportunity to exchange experiences.
2. The distribution of roles is: Occurs when team members issue rules of discipline to the responsible professional on the treatment team who will provide all direct services to the family. The specialist is supported by other team members through training, information exchange and regular communication during qualification. This approach has significant benefits for all team members. The professionals serving the particular client learn more about their specialty and clinical skills. Specialists experience significant professional development by learning about other professions and expanding their clinical skills.
3. Intense ongoing interaction between group members: Technology and performance standards such as quality, quantity, timeliness, and frequency may enable increased adoption of collaborative service delivery models.

Interprofessional/professional

Farrell (2016) noted that it is a process in which professionals from different disciplines actively engage in collaborative practice that is enhanced by establishing a foundation of shared ethical standards and values ​​and adopting a vision of an “inclusive” clinical culture. An inclusive culture is one that is open to, respects and welcomes a team approach by embracing the contributions of each professional team member. Key concepts of interprofessionalism and shared decision-making that enhance IPCP/IPP are presented, including information exchange, clarification of values ​​and preferences, openness to options, and preferred and actual options. By working effectively in a client-centred, interdisciplinary team-based manner, the team may develop a comprehensive, integrated, collaborative practice to meet the needs of their clients. Professionalism has been associated with:

• Increasing the quality of health care delivery
• Improving health outcomes for clients
• Improving the working life of caregivers, As well as strengthening partnerships with professionals, families and stakeholders
• Cost of care is optimized

A critical component of interprofessionalism is a unified conceptual framework of shared ethical principles to which members of an interdisciplinary team adhere to interprofessional practice. These agreed principles provide a code of conduct and form the basis of shared language, motivations and contingencies that practitioners encounter during their multidisciplinary team practice and may assist in shared ethical decision making and problem solving (Cox, 2012 ).

An educational framework for building professional practice

Although the idea of ​​enhanced collaboration may seem highly laudable among members of a multidisciplinary team, Since there is strong evidence showing the effectiveness of this approach, Training in this field represents an ongoing challenge for all health specialties. Including applied behavior analysis. The International Program on the Elimination of Child Labor (IPEC) provides a competency framework for moving towards interprofessionalism which we will discuss in relation to its practical adoption as part of the professional development of applied behavior analysts.

The International Program on the Elimination of Child Labor (IPEC) framework consists of four areas of interprofessional core competencies that already align well with the principles adopted by Applied Behavior Analysis licensing bodies (e.g. Client and family centered, community oriented, based on relationships, (and developmentally appropriate recommendations that take into account differences in practice and outcomes) The areas of the International Program on the Elimination of Child Labor emphasize “the basic behavioral sets of knowledge, skills, attitudes and values ​​that constitute the collaborative environment ready for professional practice.”

The four core competency areas include:

1. Values ​​and Ethics (VE): Working with individuals from other professions to maintain a relationship of mutual respect and shared values.
2. Roles and Responsibilities (RR): Participate within a multidisciplinary team and take into account the capabilities of team members.
3. Interprofessional Communication (CC): communicate quickly, Responsive and responsible supports the team approach to rehabilitation.
4. Team and Teamwork (TT): Applying the values ​​and principles of relationships and team building.

Each of these areas includes a number of sub-competencies. These sub-competencies provide specific guidance on the skills and competencies that promote effective collaboration, and promotes team-based practices, It strengthens partnerships between professionals and families.

The areas of the International Program on the Elimination of Child Labor (IPEC) framework align with the mission of the field of applied behavior analysis to disseminate science widely and efforts to achieve relevance and acceptability.

Core collaborative competencies of the International Program on the Elimination of Child Labor (IPEC) through a behavioral analytical lens

Although behavior analysts share other professionals’ interest in improving outcomes for their learners, However, they may face barriers to effective collaboration. It is essential for applied behavior analysts to build the necessary collaborative skills and demonstrate both effective interpersonal skills and professional humility.

It includes many common skills associated with cooperation, effective communication, and interpersonal skills such as empathy, compassion, common moral principles and values, and professional humility (Brodhead, 2015).

Values ​​and Ethics (VE)

Work with individuals in other professions to maintain a level of mutual respect and shared values. The field of interprofessional education may be well suited to the concept and construction of a “culture” that embodies a shared understanding of interprofessional education and collaborative principles.

Includes 10 sub-competencies that meet the need of practitioners to develop a culture that supports IPCP/IPPs by:

• The customer is in the center.
• Adopting a shared understanding of moral values.
• Commitment to high standards of ethical behavior and quality of care.
• Act with honesty, dignity and integrity.
• Respect others who differ in race or culture.
• Respect differences and value the expertise of other health professionals.
• Accept cultural diversity and individual differences.
• Work collaboratively by acknowledging differences in opinions while finding common points and common goals.
• Manage ethical issues by reaching consensus and establishing common points and common goals.
• Maintain proficiency within scope of practice.

Aligned with the founding principles in the new BACB Code of Ethics.

(BACB.2020)

VE sub-competencies can be achieved by engaging in culturally aware practices, cultural humility, And reciprocity while building a culture that embraces and enhances cooperation between professionals from different disciplines.

Culture may reflect a set of common verbal and nonverbal behaviors that are learned and maintained through a range of similar social and environmental contingencies (i.e. learning history), Which occurs (or does not occur) through actions and objects (i.e. stimuli) that define a particular environment or context.

Additional ethics that play a critical role in building collaborative relationships but need clear operational definitions include:

1. Cultural sensitivity and responsiveness: One is aware of the contextual conditions in which each person/professional works, He makes appropriate changes to create enhancing conditions that may reinforce behaviors to support positive and effective relationships.
2. Cultural competence: This is achieved through mastery of cultural competency skills in didactic and clinical training. An individual cannot achieve mastery in cultural competence given that the words, knowledge, and training he or she receives do not necessarily translate into a full understanding of the cultural norms and contingencies in which members of that culture behave. In this way, Kalyanpour and Hari (2012) argued that for an individual to be culturally competent, The individual needs to engage in cultural humility and cultural reciprocity.
3. Cultural humility: The individual is aware of his or her limitations and seeks increased awareness, understanding, and respect for other people’s cultures to overcome these limitations. It is important to note that cultural humility is a difficult construct to establish as “our behaviors, biases, assumptions, the ways we perceive the world, and the decisions we make are all conditioned and influenced by our learning history and experiences.” It requires the individual to demonstrate self-awareness regarding their own cultural biases. specially, Identifying and recognizing the presence of implicit biases requires an individual to be aware of the impact these biases have on listener responses, which may affect the quality of conversations exchanged and the speaker-listener relationship. For example, An applied behavior analyst collaborates with a speech and language therapist to implement a treatment program for the child. The applied behavior analyst first develops his or her own ideas regarding assumptions they may have about the skill competency and characteristics of the speech-language pathologist. The applied behavior analyst then explains the following contribution to the goals of treatment.

The applied behavior analyst then seeks to understand how the speech-language pathologist’s role and experience can integrate with their skills to enhance the treatment plan. The practitioner may begin this discussion by asking clarifying questions. Questions must be asked clearly while remaining flexible to make adjustments when choosing the goals and intervention required. Instead of saying, “Let me show you what you can do” or “My intervention plan works best,” consider alternatives such as “I’m interested in hearing what you find in your assessment,” “I’m interested in observing how you address this feeding problem, and I’d like to share some strategies.” Which I find helpful (such as fading and fading actions) “Is there anything you recommend I do or avoid when implementing my strategy” and “What is the best way to contact you to discuss our plan and share data (regarding data analysis and progress monitoring)?”

4- Cultural exchange: This represents an openness to embrace mutual learning opportunities by respectfully engaging in dialogue and sharing information. Cultural exchange can be viewed as cultural humility in action. According to Kalyanpur and Hari (2012), Harry et al. Cultural exchange is achieved by engaging in four steps:

• Self-reflection by recognizing the influences of personal biases, assumptions, and discipline-specific professional culture discussed in the IPECS VE field within the construct of “culture.”
• Listen, advocate, respect, Recognizing differences in others’ theoretical and cultural assumptions, beliefs, And definitions, Interpretations have been discussed in the areas of the International Program on the Elimination of Child Labour, RR and CC are within the areas of “competence and communication”.
• Validating and engaging in mutual conversations to explain and understand each other’s theoretical and cultural assumptions and beliefs and eliminate incorrect assumptions or potential misunderstandings is addressed in the areas of IPEC, CC within the “Communication” construct.
• cooperation and compromise, and reach consensus, and the establishment of common foundations and common goals (addressed in the areas of the International Program on the Elimination of Child Labor (IPEC) within the concept of “cooperation”.

Roles and Responsibilities (RR)

Participate by acknowledging the roles and capabilities of team members. The field of RR may be closely related to the concept of “competence” and its construct, which embodies common respect, valuable contribution, and integrating discipline-specific skills and expertise into interprofessional education and collaborative practices.

It includes sub-competencies that address the need for practitioners to ensure their competence and act safely by:

• Communicate with team members their roles and responsibilities, and the valuable experience they can provide, and ways in which they can contribute to collaborative practice.
• Engaging in cultural humility and self-reflection through awareness of one’s limitations in skill, knowledge and abilities.
• Understand and explain the roles and responsibilities of other team members.
• Provide ongoing clarification of roles and responsibilities for each element of the comprehensive treatment plan.
• Invite and engage competent professionals.
• Integrating the experience, skill and competence of team members to ensure effective performance.
• Establishing interconnected relationships between team members.
• Incorporates the effective and complementary skills of other team members into the individual’s treatment plan.
• Integration into continuing professional development.
• Describe the cooperation and integration of professional disciplines.

Aligned with the founding principles in the new BACB Code of Ethics (BACB.2020).

Sub-competencies can be achieved by acting with humility and respecting cultures by recognizing limitations in skill, knowledge and abilities, By seeking to increase understanding of the roles and responsibilities of other team members to benefit others. Furthermore it, Striving to understand team members’ discipline-specific assumptions, opinions, theoretical and cultural values ​​will enhance the collaborative relationship by creating a shared understanding of the value that each team member’s competence brings.

According to Brodhead et al.(2018) he refers to the scope of competency as “the activities that a practitioner can perform at a certain standard level”. In other words, professional practitioners within their jurisdiction perform their activities and procedures at a level that meets a defined standard and standard of excellence.

Interprofessional Communication (CC)

Communicate in a responsive manner that supports the team’s vision for treatment. Interprofessional communication includes ethics such as communication, perspective taking, empathy and compassion. Which includes expressing oneself in a respectful and clear manner while also showing respect for the ideas and communication needs of the team, All in support of a larger goal of effective teamwork among professionals.

Interprofessional Communication includes eight sub-competencies that address the need for applied behavior analysts to practice professional communication techniques—oral, written, and gestural—in a way that enhances teamwork and interprofessional practice.

The following sub-competencies are distinguished:

• Choose effective tools and technology.
• Replace discipline-specific jargon with language understood by the team.
• Clearly expressing knowledge and ideas and listening actively.
• Encouraging ideas and engaging in real and honest conversations that reinforce shared values ​​and maintain mutual respect.
• Respect and communicate with consideration in ways that meet the needs of colleagues, team and customers.
• Giving and asking for feedback in a polite manner, Educational and respectful.
• Ask about preferred methods for providing feedback.
• Recognizing the value and impact of one’s professional background and the background of others and their contributions to the team and integrating effective communication skills that enhance problem solving (e.g., Concluding agreements and resolving disputes) Including oral, written, gestural and physical situations.

Aligned with the founding principles in the new BACB Code of Ethics (BACB.2020).

communication: Extensive work has already been done in the operational analysis of communication starting with Verbal Behavior (BF Skinner 1957, 2020)

His work provided a method for analyzing behaviors mediated by social skills by classifying them into specific behavioral-environment relationships called verbal factors. These functional behavior modules provide an alternative to communication and have been the basis for an important area of ​​applied research and practice to improve language rehabilitation and rehabilitation.

Taking into account: It requires many of the most important components of effective interprofessional collaboration – empathy, compassion, and cooperation. The concept of consideration, In itself it is very complex at the behavioral level. specially, To integrate into an effective consideration includes the following steps:

The listener (a) knowing his or her personal feelings, thoughts, and assumptions (b) paying attention to the speaker’s audio-visual responses (c) making inferences about the speaker’s thoughts and feelings to explain his or her behavior (d) trying to understand the speaker’s perspective on a situation by trying to reflect a similar emotional response elicited by a personal experience (e) Anticipating the speaker’s behavioral response (and) finally checking for accuracy.

Empathy: Empathy includes a cognitive component (i.e., subtle verbal behavior), Which consists of perceiving and directing others’ desires or emotional responses and responding emotionally (i.e., overt verbal behavior). This response is usually from thinking about one’s experiences that may elicit similar emotional responses. For example, A parent explaining concern about a child’s self-injurious behavior may scrunch their eyebrows together, He tightened his facial muscles, Increasing the pitch of his voice while reducing the volume.

Signal detection occurs when the doctor states, “I understand this is very difficult to talk about.” The physician’s statement may be a member of the functional response class that is maintained through negative reinforcement, i.e (conjunction) Empathy involves alleviating a person’s suffering. Empathy is “the recognition and validation of the needs and concerns of others.” In addition to measures to mitigate it.

Team and Teamwork (TT)

Apply values ​​and principles of relationships and team building relevant to the concept of evidence-based practice and building “collaboration,” Which embodies shared values, goals and decision-making processes based on team standards and principles including the client’s values, preferences and circumstances.

Includes sub-competencies that seek engagement from all team members and by developing a shared understanding of ethical practice guidelines.

The following competencies are highlighted:

• Describe the process and systems that promote team development.
• Develop and implement practices based on a shared understanding of ethical practice guidelines.
• Integration into joint problem solving.
• Integrating knowledge and experience with client values ​​and preferences.
• Integrate into leadership practices by seeking to involve all team members.
• Contribute to constructive resolution of disagreements by respectfully reaching consensus.
• Integration into common issues with team members.
• Reflect on and present individual and group performance for improvement.
• Use feedback to improve process performance to increase effectiveness.
• Use available evidence and data-based processes to inform teamwork, effective practices, ethical performance, efficiency and effectiveness within teams and within different team roles.

Ethical guidelines have been cited as an important starting point for establishing standards and expectations to guide professional conduct in practice. Evidence-based practice is an ethical framework and principle espoused by the health, social sciences and medical professions that practitioners must adhere to to ensure optimal and safe health outcomes for the client.

A shared understanding of evidence-based practice is fundamental to shared, effective and cohesive teamwork practices that are consistent with the principles of applied behavior analysis. Evidence-based practice is a collaborative approach to decision-making in which practitioners integrate the best available external scientific evidence (empirical evidence), internal evidence (informed by data and assessment of client performance), clinical expertise and client perspectives, values ​​and preferences.

Evidence-based practice involves flexible and dynamic processes, They are based on evidence that evolves with new scientific discoveries and client progress. This evidence-based practice framework is the foundation of the technology transfer area of ​​collaborative practice and is aligned with the core principles in the new BACB Code of Ethics (BACB.2020). The BACB requires practitioners to apply evidence-based practice with cultural humility and demonstrate consideration and responsiveness to the team and client. Evidence-based practice assumes both individual and shared accountability for decision-making. Gaining professional coaching competency depends on successful performance as an individual practitioner and as a team member.

cooperation: The term “collaboration” is commonly used in clinical practice, research, organizations, and health professional education. Collaboration is a process by which two or more people or organizations work together to complete a task, achieve a common goal, or engage in joint decision-making processes to solve complex problems (Green & Johnson, 2015). Taking into account integration will enhance cooperation, It promotes self-reflection, active listening, understanding, and validating the perspectives of colleagues and other team members.

The conceptual definition of the term “cooperation” includes a set of behaviors that are observed as an extension of communicative acts and involve the interaction of complex intraverbal behaviors between two or more people. Members of a cooperative relationship whose behaviors are reinforced by culture and society may be referred to as a “team.” The quality of interactions and broader relationships is enhanced by enhancing the influence of team members’ ethical principles, values, and contextual and motivational variables.

Collaborative Practices: Effective collaborative practices require interdependence and application of the knowledge, skills, and contributions of each team member to implement a cohesive, integrated plan of care (Paulenko, 2005). The collaborative relationship embodies the principle of equality for the practitioner and is neither hierarchical nor competitive.

Discussion

This conceptual article is the first attempt to operationalize and highlight the potential importance of the Collaborative Learning Framework as a viable framework that applied behavior analysts may use to establish standards of competency that are indicators of cultural humility, cultural awareness, and responsive professional collaboration.

The literature points to the general benefits of interprofessionalism, Such as achieving more effective and positive customer outcomes and improving personal and professional growth. Research on the application of professional skills, relationship building skills, and collaborative competencies, although emerging, provides opportunities for empirical validation to identify variables that influence collaboration. Once these variables are determined, Can support the development of organizational systems to build cultural awareness, responsiveness and collaborative competencies in the field of applied behavior analysis.

Although the skills associated with building relationships and fostering collaboration require further empirical validation, However, it is the responsibility of professional behavior analysts to demonstrate responsiveness to the changing environmental factors and educational landscape of the helping professions, as this can be achieved through professionalism.

Until now, Research has not systematically evaluated the relative value of collaborative systems between different disciplines in education or practice. For researchers to make these assessments, Applied behavior analysts have a responsibility as practitioners to act professionally by adopting evidence-based practices, And strive to continue professional development activities, And build a collaborative culture among professionals. Aside from the prospects for professional and personal development, Culturally responsive IPCP/IPPs may improve client outcomes and enhance clinical care through team-based decision-making processes.

There are already established benefits from IPCP/IPPs for clients’ overall health outcomes. specially, Preventing unnecessary, redundant, inconsistent, or conflicting treatments can reduce the cost of care and improve the quality of service delivery. Furthermore it, IPCP/IPP has been shown to enhance professional development and foster positive interpersonal relationships among colleagues.

Although scientific and experimental investigations must be carried out, However, professional conduct is well aligned with the founding principles in the new BACB Code of Ethics (BACB.2020) and can enhance the public image of ABA as a discipline that values ​​collaborative, interprofessional and culturally responsive practices. This will ultimately enhance the mainstream relevance of applied behavior analysis and increase opportunities to impact and benefit society in long-term, scalable ways and goals.

Ref

A Behavior-Analytic Perspective on Interprofessional Collaboration – PMC (nih.gov)