The Ottawa Hospital

1. The Ottawa Hospital Inter-Professional Collaboration: Spiritual Care and Social Work Karen Grant MA, RP Chaplain CASC Specialist Donna Bottomley MSW, RSW Social Worker Caring for the Human Spirit Conference 2016San Diego CA

2. Objective of this workshop To illustrate and demonstrate the practicality of Inter-Professional collaboration with team members, specifically social work, and to engage in best practices for both the client(s) and within our respective disciplines. It is our hope that after this workshop you will be able to reflect on your own practice, develop a greater understanding of Inter-Professional care and integrate these skills with other team members.

3. W.H.O. Cares • The World Health Organization: promotes collaboration world-wide. The WHO’s document: Framework for Action on Inter-Professional Education and Collaborative Practice examples this tenant. www.who.int/hrh/resources/framework_action • Canadian Inter-Professional Health Collaborative National Competencies: encourages the need to understand the roles of other health professions as well as their competencies www.cihc.ca/files/CIHC_IPCompetencies_Feb2010.pdf. • The Ontario Ministry of Heath and Long Term Care: is currently promoting Inter-Professional care as a way of organizing patient care to more effectively ‘manage increasing workloads, reduce wait times and increase safety.’ www.healthforceOntario.ca/PCProject • The Ottawa Hospital Inter-Professional Model of Care: A hospital based model of IPC is the first of its kind; promoting and improving staff cooperation and teamwork within the organization to enhance quality of patient care (Inter-Professional Model of Patient Care, The Ottawa Hospital, 2009)

4. Inter-ProfessionalEducation (IPE) Core Common Competencies for students of ALL health professions in 2015: Adapted from (Barnsteiner, Disch & Walton, 2014 and Hall, 2005) • Knowledge: of other health professional roles • Communication: between health care team members • Attitudes: of mutual respect of one another’s roles • Openness: to trust others’ roles on the team • Delivering: client-centred care • Working: as part of an inter-disciplinary team • Practicing: evidence-based medicine (therapies) • Focusing: on quality improvement • Using: information technology appropriately

5. What is Collaboration? • Collaboration is a “complex process requiring skills of competence, autonomy, mutual respect, self-confidence and commitment to all those involved.” (Inter-Professional Model of Patient Care: The Ottawa Hospital 2009) • Research has established that effective teamwork can reduce workloads, reduce staff stress and burnout and add to staff fulfilment and improve client satisfaction. (Teamwork in Healthcare: Canadian Health Services Research Foundation, 2006) • Competencies required for collaboration are aptitudes that are improved by wisdom and experience; skills take time to mature. (Inter-Professional Model of Patient Care: The Ottawa Hospital 2009)

6. Inter-Professional Collaboration (IPC) Common Competencies in IPC: • Open and outcome oriented communication: within the team structure as well as with/to our clients. • Shared decision-making: between the team member(s) and the client with honesty and with an open mind. • Collegial Trust: confidence in one another’s abilities. • Humility: recognizing the differences in training and perspective without thinking that one perspective is superior to the other; to demonstrate inclusiveness and invite others’ opinions. (Adapted from Barnsteiner, Disch & Walton, 2014)

7. IPC Perspectives • We all see the client from a different perspective. e.g.. Physical, Mental, Social and Spiritual. (Hall 2005) • Inter-Professional Collaboration will enhance client care experience and will allow client(s) to be more involved in their personalized care plan. • Inter-Professional Collaboration ensures that there is always at least one party who can provide support to the client(s). • Inter-Professional Collaboration promotes safe practices among health care professionals.

8. Collaborating together: Spiritual Care & Social Work The fundamental principle that drives our common and complementary competencies is a desire to provide charity, equality and compassion to those in need. These values between our disciplines are mutual and are focused on providing support based on our client’s autonomy and their beneficence. Donna Bottomley, Karen Grant

9. Purpose of Collaborating Personal: • History of working together • Why collaboration has not occurred in the past. Practical: • Cost effective=reduced duplication & efficient • Promotes safe(er) practices (boundaries) • Professional (scope of practice)

10. Spiritual Care: CASC Specialist Scope of Practice for IPC C. Standards of Practice - Specialists(Canadian Association of Spiritual Care: www.spiritualcare.ca) 1.Spiritual Assessment and Care: Spiritual Assessment and Care are distinct but inter-related activities. Spiritual Assessment is an extensive, in-depth, ongoing process of actively listening to and summarizing a client’s story, spiritual strengths, needs, hopes and coping strategies as they emerge over time. Spiritual Care is the professional relationship established with a client that provides a framework for ongoing assessment and Inter-Professional interventions that help meet the wellness needs and goals of the client. 1.1Relational Approach: Provides a relational and patient/family-centred approach to assessment and care that sensitively encounters the client(s) and engages them in their healing process. 1.2Assessment: Gains an understanding of a client’s source(s) of spiritual strength, hope, methods/ways of coping, needs, risks and wellness goals through encountering the client and integrating this knowledge with historical, theological, philosophical, socio-cultural and psychological theoretical frameworks of human development and transitions in life. 1.3 Planning: Co-develops with the client(s) a spiritual care plan that complements and is integrated with Inter-Professional care plan, treatment & interventions. 1.4Intervention: Provides a variety of interventions and approaches to spiritual care related to needs assessment and co- developed Inter-Professional care plans. 2.Self-awareness: Assesses the impact of one’s own spirituality, beliefs, values, assumptions and power dynamics in relationships with clients. 3. Spiritual and Personal Development: Continues to develop and maintain personal and professional growth, awareness and self-understanding and makes oneself appropriately accountable.

11. Standards of practice continued: 4. Multi-Dimensional Communication: Employs communication strategies that include active and attentive listening, awareness of the non-verbal, appropriateness, and relevant content. 5. Documentation and Charting: Documents clinical assessments, interventions and referrals in a way that is understood by members of the Inter-Professional team. Keeps records and statistics in a timely manner; demonstrates clarity, skill and appropriate confidentiality in all paper/electronic correspondence.  6. Brokering Diversity: Understands, values, promotes diversity and inclusion, and advocates for equitable care. Provides care that takes into account culture, bias, and the specific needs of clients. 7. Ethical Behaviour: Ethical behaviour is congruent with the values of the CASC/ACSS Code of Ethics reflecting justice, compassion and healing for all.  8. Collaboration and Partnerships: Is accountable to the public, faith communities, employers and professionals in all professional relationships. 9. Leadership: Exhibits leadership that provides advocacy and support as an integral team member. 10. Research: Sees research as integral to professional functioning and in keeping with one’s area of expertise.

12. Social Work: Scope of Practice There are considerable similarities between spiritual care and social work scopes of practice, however, these are some of the differences: • Focus on relationships between individuals, natural support resources, formal community structures, and societal and cultural norms and expectations. • Focus on social well-being and social functioning of the person in their environment. • Common specialties: child welfare, community organization, advocacy, social and political action, policy development, social justice, addictions, case management, discharge planning, social benefits, resource referrals, education and research. • Specific Specialties: POA/SDM/Wills/Consent & Capacity, EOL.(Ontario College of Social Workers and Social Services Workers at www.ocswssw.org)

13. Why We Collaborate The basic premises between us: • Our work is meaningful and purpose driven. • Client focused compassionate care. • Role appreciation and understanding. (Suter, et al, 2009) • Philosophy of team unity. • Modeling frequent, concise and accommodating communication between SC and SW. • Mutual Support for each other. • Willingness to break down traditional cultural barriers & silo practices. • Professional scope of practice and competencies.

14. Benefits to our Collaboration • Contribute to the client experience. • SC & SW are the consistent team members. • Both have the expertise and time to support the psycho/spiritual/social dimensions of the client. • Promote psycho/spiritual/social aspects of the client. • Collaboration and communication helps to mitigate role blurring and possible conflicts between us. • Saves $$$... due to reduction in service duplication as well as covering more ground in time efficient manner. • Support one another emotionally and minimize ‘burn out’ which reduces employer’s expenses. • Role model for the team in communication, holistic approach and mutual support.

15. How we Collaborate together Short case study(s) and examples of working in partnership with other team members will be provided.

16. Possible Barriers to Collaboration • Stereotyping by both disciplines of one another’s role. Social Work may be unaware of the Chaplain’s skill set or vice versa. • Poor communication practices. • Forgetting that the Chaplain is a team member and that referring parameters are the same as for any other team member. • When budgets are stretched both disciplines may feel threatened causing silo effect and possible interpersonal conflicts. • Budget cuts often result in decrease in both services due to lack of appreciation for our skill sets. • Role blurring due to similar values/scope of practice which can lead to conflict, competition, splitting and duplication of support. • Frustrations working within the medical model=cure vs heal.

17. Areas for improvement: Chaplaincy • At the training level: introduce a didactic about IPC as well as an understanding about attachment theory and the multi-generational effects of family systems on a client’s well-being which can have an impact on their health. • Ensure outcome oriented descriptions and client behaviors in your charting and oral communication. • Find a balance between communicating our work in a clear, concise and professional manner to your team without loosing spiritual terminology and meaning. • Assist team to identify how spirituality, religion and culture interact with client’s beliefs/QOL/EOL. • Sell yourselves by being present. Ensure attendance and participation in team activities such as Rounds, Lunch and Learns, Educational opportunities, Debriefing Team(s), Committees, and Social Events. • Exhibit confidence in yourself and your role and take your place on the team in your position as spiritual care providers.

18. Bibliography Barnsteiner, J., Disch, J. & Walton, M. (2014). Person and Family Centered Care. Indianapolis, IN: Sigma Theta Tau International. CanadianAssociation of Spiritual Care Competencies at www.spiritualcare.ca Canadian Inter-Professional Health Collaborative National Competencies: at www.cihc.ca/files/CIHC_IPCompetencies_Feb 1210.pdf Hall, Pippa. 2005. Inter-Professional teamwork: Professional cultures as barriers. Journal of Inter-Professional Care, Supplement 1: 188-196 Implementing Interprofessional Care in Ontario: Final Report of the Interprofessional Care Strategic Implementation Committee. Toronto, ON: May 2010. Available at: www.healthforceontario.ca/IPCfinalreport Health Force Ontario. Inter-Professional Care: A Blueprint for Action in Ontario. Toronto, ON: July 2008. Available at www.healthforceontario.ca/IPCProject Oandasan, I., G.R. Baker, K. Barker, C.Bosco, D. D’Amour, L. Jones, et al. 2006. Teamwork in Healthcare: Promoting Effective Teamwork in Healthcare in Canada. Ottawa: Canadian health Services Research Foundation. Ontario College of Social Workers and Social Services Workers at www.ocswssw.org

19. Bibliography Suter, E., Arndt, J., Arthur, N., et al 2009. Role Understanding and effective communication as core competencies for collaborate practice. Journal of Inter-Professional Care, 23 (1): 41-51. The Ottawa Hospital Inter-Professional Model of Patient Care. Ottawa, Ontario, Canada: 2009. The World Health Organization: Framework for Action on Inter-Professional Education & Collaborative Practice. Geneva, Switzerland: 2010, Available at: www.who.int/hrh/resources/framework_action