Collaboration: It Takes A Village
By: Holly Brown, Summer Intern
“It takes a village.”
Growing up, the saying was commonplace around my house–grandparents, neighbors, family friends, friends of those family friends, and even several unsuspecting nannies all played a role in looking after my two brothers and I.
Beyond the sphere of caregiving, this proverb has a place when it comes to early intervention as well. Just as many people tend to collaborate on a single child’s upbringing, several different therapists, physicians, and other healthcare professionals make up the care team responsible for guiding a child’s development.
Building a purposeful network within these care teams requires intentionality and commitment from all involved. To begin, as the caregiver is always the expert of their child, parents play a central role in the team’s success. Empowered caregivers are equipped to advocate and are unafraid to report changes that healthcare providers may not be aware of, given the limited time each week they have with the child. In turn, empowering caregivers is a responsibility of pediatric healthcare providers. By building a trusting relationship that allows for parent coaching, professionals can make significant progress in this area.
From a therapist’s perspective, making your presence known to physicians by being hyper-accessible–talking over the phone, visiting them in their office, and attending their conferences–results in better outcomes for patients. This interface should not stop when a patient is steadily improving, either. Sharing the good is just as important as sharing the not-so-good. Further, in the most successful collaborative partnerships, professionals work on “identifying [their] scope separately but also together” (Dawson & Forward, 2021). Being willing to learn together ensures that involved parties are working towards accompanying rather than conflicting goals for a shared patient. Ultimately, when the patient is held at the center, interdisciplinary care becomes a dynamic and rewarding tool.
In this collaborative space, a therapy delivery method known as co-treatment thrives. To clear up potential confusion, co-treatment differs from what is known as concurrent treatment–where one therapist is treating multiple patients within a single scheduled session–in that there is still just a single patient involved. Most simply, co-treatment is when two (or more) disciplines simultaneously treat one patient within a single session. In practice, it has the potential to become much more. Co-treatment takes a holistic approach to a child, recognizing that multidisciplinary collaboration is required to offer solutions that address the diverse needs of the patient as well as their support system. Within one session, overlapping areas of difficulty are able to be grouped rather than isolated.
The potential cross-discipline combinations for a co-treat are extensive. As Physical Therapists often share a natural overlap in treatment goals of “neuromuscular and orthopedic deficit remediation” (Mastrangelo, 2016) with Occupational Therapists, co-treatments between Speech-Language Pathologists and either of these two disciplines tend to be most common. These pairings allow for multiple therapy objectives involving different pathways to be targeted at the same time.
To better illustrate what this looks like in practice, let’s explore a few examples of appropriate co-treatment sessions. Given a child who would benefit from feeding interventions, an Occupational Therapist would be able to focus on his or her posture (amongst other motor control factors) throughout the session, while one area of expertise that a Speech-Language Pathologist would emphasize would be reducing the risk of sucking food into the airway. In another scenario, a Speech-Language Pathologist may choose to co-treat with a Physical Therapist to build on a patient’s expressive and receptive language formation during movement-based activity (Mastrangelo, 2016).
As shown by these examples, while there is still great value in single-therapist treatment, a significant benefit of co-treatment is its ability to simulate real-world settings. Without a doubt, every child, at some point in their life, is likely to encounter distracting environments–ones where precise movements (say, writing or walking) and communication (verbal or nonverbal) must happen simultaneously. Co-treatment sessions are practice for these settings; they excel at equipping patients to transfer learned skills into their everyday lives.
Similarly, a notable advantage of the technique is that it encourages “the generalization of skills” (Weichman, 2014). In other words, co-treatment patients are constantly being asked to use new abilities with multiple people and in new settings, ensuring that the individual applies their learning.
This application is then an important step towards the eventual mastery of a skill, which suggests another reason co-treatment should be considered: it offers more effective competency achievement. It is important to note that co-treatment should never be used as a tool to ease scheduling difficulties, but, when it is an appropriate course of treatment for your child, it does provide a solution when the attention demands of back-to-back sessions proves challenging. Children are able to still receive the treatment they are require while therapists are able to make strides towards multiple “disciplines’ goals in a shorter period of time” (Weichman, 2014).
The benefits of this approach are not limited to the child, though. As this method promotes an interdisciplinary connection, therapists walk away able with a better understanding and respect for other expertise’s contributions to the growth and success of a child. As an aspiring Physical Therapist spending my summer here with the AID-L, I can attest to this learned appreciation firsthand. Every observation has left me with new insight into the breadth of the field of speech and feeding therapies, and I have no doubt that this experience is preparing me to be a better advocate and more knowledgeable provider for my future patients.
Within the neurodivergent community, co-treatment has proven a research-backed treatment plan with diagnosis-specific applications and benefits. To begin, for children with Autism Spectrum Disorder, a “highly effective” treatment strategy presents the opportunity to craft “treatment priorities” around social skill development and integrate “sensory strategies into communication” (Jordan & Loftland, 2015). This can be successfully accomplished through collaboration between SLPs and OTs–having both therapists present working towards their separate but interconnected goals provides engaging social interaction better than either alone.
Co-treatment proved optimal for individuals with Down's Syndrome as well. Especially in “vocabulary building, particularly [in] those with relatively high nonverbal intelligence,” this combined setting resulted in the most consistent word recall in an experiment assessing concept development (Lund et al., 2019).
Developmental intervention therapists also promote co-treats, finding that they are able to fully facilitate “the adjustment and coping of the families” in creative ways (Laadt-Bruno et al., 1993). Collaboration is essential when it comes to fully addressing the varied and often unpredictable needs of both the child and his or her support system.
Lastly, for patients with Cerebral Palsy, several studies solidified that “development within different domains, including motor, communication, and object exploration, appear to be interrelated so that gaps in one domain (motor) may impact on development in other domains (communication and object exploration)” (Pinder & Olswang, 1995). This finding is a strong incentive for a team-based, simultaneous treatment approach.
In conclusion, the co-treatment method is just one of several ways the Advanced Institute for Development and Learning is able to incorporate multiple disciplines directly into a treatment plan for your child. As a clinic, we work hard to build relationships across all fields of providers, and are grateful for the opportunity to work alongside them to ensure the best outcomes for our patients. Collaboration as a practice is valued in every field, and, as the AID-L takes a patient-centered approach to treatment, we recognize the importance of ingrained collaboration across disciplines.
All that to ask: who will you choose to include in your village?
Resources
Dawson, M & Forward, E. (Hosts). (2021, Sep 3). A Functional Pediatric How-To-Guide in Collaborating Between OT and SLP with Karen McWaters (No. 160). [Audio podcast episode]. In First Bite. SpeechTherapyPD. https://www.speechtherapypd.com/podcasts/Firstbite.
Jordan, K. A. & Loftland, K. B. (2015). Collaborative teaming: OT and SLP co-treatment of autism spectrum disorder. Technology and the Treatment of Children with Autism Spectrum Disorder, 49–57. https://doi.org/10.1007/978-3-319-20872-5_5.
Laadt-Bruno, G., Lilley, P. K., & Westby, C. E. (1993). A collaborative approach to developmental care continuity with infants born at risk and their families. Topics in Language Disorders, 14(1), 15–28. https://doi.org/10.1097/00011363-199311000-00004.
Lund, E., Young, A., & Yarbrough, R. (2019). The effects of co-treatment on concept development in children with down syndrome. Communication Disorders Quarterly, 41(3), 176–187. https://doi.org/10.1177/1525740119827264.
Mastrangelo, K. (2016). Therapy Co-Treatment Scenarios and Documentation, Harmony Healthcare International Blog, https://www.harmony-healthcare.com/blog/therapy-co-treatment-scenarios-and-documen tation.
Pinder, G. L. & Olswang, L. B. (1995). Development of Communicative Intent in Young Children With Cerebral Palsy: A Treatment Efficacy Study. Infant-Toddler Intervention: The Transdisciplinary Journal, 5(1), 51-70.
Weichman, L. (2014). Co-treating: What is it and what are the benefits for your child? North Shore Pediatric Therapy. https://www.nspt4kids.com/therapy/co-treating-what-is-it-and-what-are-the-benefits-for-y our-child/.
