Transdisciplinary Team Approach Effective in Schools
Transdisciplinary Team Approach Effective in Schools
ADVANCE Contributing Editor
A transdisciplinary treatment team can provide a comprehensive, functional education program for students who need several services, including speech-language pathology and physical and occupational therapy.
"Trans" is a Latin prefix that denotes "across," suggesting that members of transdisciplinary teams exchange ideas and skills across disciplines. This model stresses integration, in which several professionals develop the group program, and then only one or two members implement it with the child.
"You have the benefit of true teamwork and the sharing of expertise, which may or may not occur in other teaming models," such as interdisciplinary or multidisciplinary approaches, explained Bruce Baker, PT, of the Experimental Education Unit at the University of Washington in Seattle.
"One of the benefits is that the team members are considered to be equal, so there is a level playing field among disciplines. Basically, the idea is that many heads are better than one, so it increases the amount of solutions that may be generated for problems," he said.
The team is organized according to an individual student's needs. Its members may be speech-language pathologists, occupational therapists and physical therapists, among others.
Generally, the parents and the teacher and/or teaching assistant also are included. Frequently, Baker said, the actual intervention is provided by the teacher or teaching assistant.
"That's a team decision," noted Shelley Mulligan, MS, OTR. She explained that one of a multitude of decisions the group makes is choosing which member of the team should be designated to provide direct care.
After the service designate is chosen, other members instruct that person on what services to provide and how to provide them. The physical therapist on the team may instruct the designate on walking, transferring and moving, while the speech-language pathologist may demonstrate how to use a communication device.
Likewise, a teaching assistant may instruct allied health professionals how to relate to the child, how the child's day progresses, and what goes on in the classroom.
Ms. Mulligan, who is enrolled along with Baker in the joint special education/rehabilitation doctoral program at the University of Washington, added that the role of service designate may be assumed by a allied health professional if the child's needs call for it. "For a younger child whose program is largely based on motor skills and motor development, for instance, it could very well be the physical therapist who might be the designate."
That isn't to say the direct service is never provided by anyone but the service designate, she noted. If the teacher is appointed to that role yet specific therapy is needed at some point, a health care practitioner can step in.
A practitioner providing treatment within an interdisciplinary model might spend 75 percent of the time in direct service to children and 25 percent in consultation, Baker estimated. Those ratios may be reversed in the transdisciplinary model.
The benefits to the transdisciplinary model are many, Ms. Mulligan explained. The model is efficient because it is designed to minimize overlap and inconsistencies in services delivered. The program developed by the group is comprehensive and unified, which reduces the confusion and frustration felt by the parents and child.
Moreover, the child is able to increase skill generalization, noted Baker. Instead of learning a specific skill in a specific environment, such as the therapy room, a child served by a transdisciplinary team learns skills throughout several environments, including the classroom, therapy room, play court or lunchroom. Therefore, the child is able to apply those skills in a generalized way.
"If you have one person doing everything, they know about all aspects of the program and it flows much better than pulling a child out (of class) all the time—provided that one person is getting ongoing support from everybody else in the group," stated Ms. Mulligan.
Within the group the transdisciplinary format provides for a variety of perspectives and expertise, which increases both the information available for decision-making and the number of potential solutions generated, Baker said.
Ms. Mulligan said transdisciplinary teaming benefits therapists by allowing them to take on new roles and learn new skills from other members in the group.
She said the collaborative effort is "a real strength. When you have all these people making decisions together, your output is better for the student."
While the transdisciplinary model was first used in early intervention, teams that follow this approach are effective in working with children who have severe or profound mental or physical disabilities.
"When you're looking at infants and pre-schoolers at that level, it's harder to separate out different skill areas," explained Ms. Mulligan. "It's better to address their needs as a whole person and not to divvy out separate areas."
The transdisciplinary process begins with team members, including parents, working together to develop an individualized education plan (IEP).
"The IEP begins with an assessment of the child's status, as well as an assessment of family needs and concerns using anything from standardized norm reference tests to family interview and clinical judgment," Baker said.
Usually the assessment, which emphasizes functional skills, is done in arena fashion with all the team members at once so the child is not subjected to repeated testing sessions. The team then prioritizes areas of strength and concern. From this evaluation team members develop recommendations, goals and objectives.
"The idea is to prioritize goal areas with an emphasis on writing objectives that are functional, educationally relevant, of concern to family and professionals alike, as well as being measurable and objective for purposes of monitoring progress," the physical therapist said.
As the IEP cycle progresses, the team makes ongoing assessments through data provided by the primary service designate. These data are compared to the initial goals, and the team determines if criterion levels are being reached.
"If so, new goals are written as a team to continue with the progress that is being made," he said. "If not, the team can ask whether or not the goal is realistic. Is the goal too hard for the child or has the team not really addressed that goal area?"
A transdisciplinary team that functions well is comprised of members who can handle role release, a concept that emphasizes sharing expertise and learning and relinquishing traditional responsibilities.
Potential trouble spots that team members should be aware of are scheduling and billing issues. Ms. Mulligan cautioned that these issues can cause complications, and different situations require different resolutions.
In addition to the school population, the transdisciplinary team model could have applications in other areas. Baker suggested that the model could be applicable in community integration programs, such as a program for post-traumatic brain injury.
Other practice areas that may be appropriate for a transdisciplinary approach include geriatric rehabilitation and post-CVA programs that require substantial functional skill training.
While Baker noted that the transdisciplinary model is not necessarily better than other approaches, it is an effective option that practitioners should consider. "Therapists need to keep an open mind regarding different approaches to working with children," he said.
He encouraged health care professionals to continue investigation and research in this area.
"We really don't have research evidence of any one model being superior to any other model," he commented, "and that's an area of need. I would love to see more research to substantiate the use of this model in a school setting. That would give our therapeutic community a lot to go on."