Kathy L. Bradley-Klug, Ph.D., Jennifer Cunningham, MA

1. Session # H2 October 28, 20111:30 PM Promoting Integrated Healthcare through Interdisciplinary Collaboration: The Tipping Point between Primary Care & Education Kathy L. Bradley-Klug, Ph.D., Jennifer Cunningham, MA Joshua Nadeau, MA, Ashley Sundman-Wheat, MA Julia Ogg, Ph.D., Kendall Jeffries, MA Audra St. John Walsh, MS School Psychology Program University of South Florida Collaborative Family Healthcare Association 13th Annual Conference October 27-29, 2011 Philadelphia, Pennsylvania U.S.A.

2. Faculty Disclosure Please add the commercial interest disclosures that you reported on your signed Disclosure form: I/We have not had any relevant financial relationships during the past 12 months.

3. Need/Practice Gap & Supporting Resources Chronic illness not only impacts children’s physical well-being, but also affects learning, behavior, and social performance in both home and school settings. The need for collaboration and comprehensive services has grown due to increasing numbers of youth who survive chronic illness and subsequently experience problems adapting to the school environment (McMenamy & Perrin, 2002). The multi-faceted impact of chronic illness has created the need for school personnel, specifically school psychologists, and pediatricians to engage in collaborative problem-solving to develop and monitor effective, ecologically-based interventions (Bradley-Klug, Sundman, Nadeau, Cunningham, & Ogg, 2010). A national survey investigating the communication and collaborative practices of school psychologists and pediatric professionals will inform methods to enhance integrated healthcare practices.

4. Objectives Objective #1: Identify preferred forms of communication (i.e., methods, frequency, contact persons) to promote integrated healthcare. Objective #2: Compare and contrast perceived benefits and barriers to systems level collaboration between pediatricians and school psychologists, and use this information to improve collaborative efforts. Objective #3: Understand the different perceptions of specific health conditions and how these impact the collaborative relationship. Objective #4: Describe demographic factors that impact interdisciplinary collaboration between pediatricians and school psychologists.

5. Expected Outcome Participants will learn strategies to promote integrated healthcare for youth with chronic illness based upon factors such as preferred forms of communication (i.e., methods, frequency, contact persons) of pediatricians and school psychologists, reported benefits and barriers to systems level collaboration, the different perceptions of specific health conditions across professions, and the relationship of demographic factors to interdisciplinary collaboration.

6. Learning Assessment A learning assessment is required for CE credit. Attention Presenters: Please incorporate audience interaction through a brief Question & Answer period during or at the conclusion of your presentation. This component MUST be done in lieu of a written pre- or post-test based on your learning objectives to satisfy accreditation requirements.

7. Promoting Integrated Healthcare through Interdisciplinary Collaboration: The Tipping Point between Primary Care & Education Kathy L. Bradley-Klug, Ph.D., Jennifer Cunningham, MA Joshua Nadeau, MA, Ashley Sundman-Wheat, MA Julia Ogg, Ph.D. & Kendall Jeffries, MA Audra St. John Walsh, MS School Psychology Program University of South Florida Presented at the Collaborative Family Healthcare Association 13th Annual Conference Philadelphia, PA October 28 , 2011

8. Presentation Outline Overview and Rationale for the Study Methods Survey development Selection of participants Procedures Results Comparisons with Pediatrician Survey Implications for Practice Directions for Future Research

9. Statement of the Problem Chronic illness not only impacts children’s physical well-being, but also affects learning, behavior, and social performance in both home and school settings (Grier & Bradley-Klug, 2011) The multi-faceted impact of chronic illness has created a need for school and medical personnel to engage in collaborative problem-solving to develop and monitor effective, ecologically-based interventions (Bradley-Klug, Sundman, Nadeau, Cunningham, & Ogg, 2010)

10. Rationale With increasing emphasis on integrated healthcare, and the shift from behavioral healthcare and medical care providers operating in silos to an interdisciplinary approach to service provision, we are obligated to develop strategies to enhance communication and collaboration We need to gain perspectives from both systems to inform training programs and promote professional development

11. Rationale Although there is a recognized need for interdisciplinary communication and collaboration across the educational and medical systems, a paucity of research exists that examines: Perceived necessity Content Frequency Benefits and Barriers

12. Rationale • Recent study assessed pediatricians’ perceptions of communication and collaboration with school personnel (Bradley-Klug et al., 2010) • The purpose of the present study was to gain insight into school psychologists’ experiences collaborating with pediatric professionals on behalf of youth with chronic illness • Data from these two studies are compared and used to develop strategies to promote effective and efficient interdisciplinary practices

13. Research Questions Do school psychologists collaborate with pediatric professionals? If so, with whom? What is the frequency of communication and collaboration between school psychologists and pediatric professionals? What do school psychologists perceive as the benefits of, and barriers to, collaboration with pediatric professionals? Do school psychologists utilize e-Health technologies to facilitate communication/collaboration with pediatric professionals? What are the implications for training and practice to improve interdisciplinary communication & collaboration?

14. Methods Developed cover letter and survey to be administered nationally to school psychologists Cover letter and survey reviewed and approved by Institutional Review Board Cover letter and survey submitted to National Association of School Psychologists (NASP) Research Committee Revisions requested Cover letter and survey resubmitted and approved Access to NASP database granted

15. Participants 1,000 School Psychologists Members of National Association of School Psychologists (NASP) Geographically stratified random sample School-based practitioners

16. Procedures Purchased database from NASP All names assigned code for database All surveys sent by US Postal Service Mailing #1: August 11, 2011 Mailing #2: September 12, 2011

17. Results 1,000 surveys mailed 0 ‘Return to Sender’ by post office 340 Completed surveys returned 34% return rate

18. Demographics of Sample

19. Sample Demographics: Race/Ethnicity Pediatricians School Psychologists (Race Only)

20. Sample Demographics: Gender Pediatricians School Psychologists

21. Sample Demographics: Age Ranges Pediatricians School Psychologists

22. InterdisciplinaryCommunication For the purposes of both surveys, ‘communication’ was defined as: A one-time, unidirectional sharing of information regarding student status. Examples may include a brief phone call or letter. Non-examples may include multiple, on-going bi-directional problem-solving efforts.

23. Frequency of Communication Between Systems Pediatricians School Psychologists

24. Reasons for Communication

25. Most Effective & Efficient Method of Communication Pediatricians School Psychologists

26. Preferred Method of Communication Pediatricians School Psychologists

27. Primary Contact for Communication Pediatricians School Psychologists

28. Interdisciplinary Collaboration For the purposes of both surveys, ‘collaboration’ was defined as: Ongoing, bi-directional sharing of information by two or more people who are working together to plan and problem-solve to promote positive outcomes for a third party.

29. Frequency of Collaboration Pediatricians School Psychologists

30. With Whom Pediatricians Collaborate

31. With Whom School Psychologists Collaborate

32. Perceived Benefits of Collaboration

33. Perceived Barriers of Collaboration

34. Anecdotal Comments From School Psychologists

35. Benefits of Collaboration “Collaborating with physicians of whatever specialty is highly ethical, practical, and needed to assist students in being successful in schools. Interdisciplinary system of care is the optimal method of meeting kids’ health & mental health issues that affect school performance.” “Excellent study. I have worked closely with hospital education specialists and they have provided me with excellent resources so that I can better support and advocate for my students.”

36. Benefits of Collaboration “Increased collaboration would benefit many children in public education systems. Both pediatricians and school psychologists have unique knowledge and skills to offer students.” “Collaboration between school psychologists & pediatric professionals would absolutely be valuable for the students receiving special education assistance.” “Extremely valuable when planning for the needs of the whole student!”

37. Benefits of Collaboration “This is an extremely important subject. I want more collaboration with the medical field. I often send a records release along w/ a form to gain physician input. It is extremely helpful but I wish I had more access to physicians.” “I believe the student outcomes from collaboration between health providers and school personnel including school psychs could be tremendous! With fewer school nurses I believe everyone needs to understand that the roles people used to play (school psychs only doing assessments) no longer exist.”

38. Barriers to Collaboration & Suggested Solutions Barrier “Pediatric professionals rarely seek out education team members for consultation/collaboration.” Solutions “Identifying ways to get pediatric professionals involved in school-based committees or to have them call us w/ concerns, issues, or suggestions related to students in their care would be exciting.” “…I would love to have a working relationship with the local peds. I feel the job of opening the lines of communication should fall upon the SPED director who often does not have the time.”

39. Barriers to Collaboration & Suggested Solutions Barrier “Biggest challenge is pediatricians not being aware of school constructs/methodology (i.e., RtI). Many times have received prescription for ‘self-contained spec. ed setting’ or IEP – not how we do things!” Solution “I believe it is in the child’s/family/school’s/professional’s best interest to have such collaboration. The medical model is a has-been with the view that the patient has a problem/issue. Educational model views that instruction, curriculum, & environment are often aspects of the situation. So, the solution involves all those as well, not just the patient/child.”

40. Barriers to Collaboration & Suggested Solutions Barrier “HIPPA makes it difficult to exchange information with physicians. Most often the exchange is facilitated through the parent.” Solution “In many cases we do not have consent to speak with pediatric professionals. This survey has made me think about the possibility that I could ask for consent and elicit communication with pediatric services.”

41. Summary of Findings Do school psychologists collaborate with pediatric professionals? If so, with whom? School psychologists are most likely to contact the physician (~60%) followed by the nurse (~35%). What is the frequency of communication and collaboration between school psychologists and pediatric professionals? Communication: Approximately 75% of school psychologists communicate with pediatric professionals a few times per year or less Collaboration: 86% of school psychologists collaborate with pediatric professionals a few times per year or less

42. Summary of Findings What do school psychologists perceive as the benefits of, and barriers to, collaboration with pediatric professionals? Benefits: Assessing student progress across settings, cross-disciplinary problem solving, improved student outcomes, share resources, avoid duplication of services Barriers: Personnel are inaccessible, time Do school psychologists utilize e-Health technologies to facilitate communication/collaboration with pediatric professionals? Based upon the results of this survey, 93% of respondents had never used eHealthas a means to communicate or collaborate with pediatric professionals.

43. Implications for Training & Practice Provide in-service training for medical professionals on contemporary educational practices (i.e., Problem-solving and Response to Intervention, tiered intervention strategies, data-based decision making, etc.) Share with pediatric professionals the type of information that would be helpful to support the educational needs of youth Increase school psychologists’ and pediatric professionals understanding and utilization of eHealth to facilitate interdisciplinary communication

44. Implications for Training & Practice Develop outreach strategies to build partnerships between school staff and pediatricians in the community Inquire about and attend to preferred methods of communication Share in the responsibility of informing parents of the importance of collaboration across multiple systems

45. Directions for Future Research Conduct interdisciplinary focus groups to further explore facilitators to collaboration and problem solve barriers Investigate pre-service training models to promote interdisciplinary collaboration Explore how eHealth may be used to enhance interdisciplinary communication & collaboration