Providing Team-Based Care in a School Setting

Case Study: Providing Team-Based Care in a School Setting

Sarah Edwards is an 8-year-old girl who was born prematurely in a complicated birth to a mother who was addicted to drugs. She lives with her grandmother, who is her legal guardian. Sarah has multiple physical, emotional, and cognitive challenges. She has limited verbal ability to express her needs and is prone to behavioral outbursts. She attends special education classes in her community school. The interprofessional team includes her special education teacher, instructional paraprofessionals, the school nurse, the case manager/social worker, a behaviorist, a speech therapist, an occupational therapist, and a school psychologist.

Sarah’s physical, emotional, and psychological well-being is the focus for all team members. The team works together effectively to address behaviors and implement strategies to improve the fluctuating challenges in the classroom and at home. There are no turf battles; rather the team cohesively discusses and makes recommendations, easily shifting the leadership role depending on the situation. Working in teams involves sharing expertise and relinquishing some professional autonomy to work closely with others to share the care and improve the client’s outcomes. The entire team is valuable and provides essential resources in their area of knowledge. For example, adjustments in Sarah’s medication may require the nurse or case manager to intervene. The behaviorist may change the behavioral management program, whereas the remaining team members implement the plan and provide feedback on its effectiveness. If the team determines that Sarah’s increasing outbursts stem from frustration with a limited ability to express her needs, the speech therapist takes the lead and works closely with the teacher, paraprofessionals, and family to identify the most appropriate communication strategies. The team integrates individual expertise of all members in shared planning to develop, implement, and reinforce team-based care.

By working closely together, the team members are aware of one another’s plans and can transition activities more smoothly. For example, one day the speech therapist was running late because of a team meeting for another student. The occupational therapist realized this, and rather than ending the therapy session on time and leaving Sarah to wait for the speech therapist, the occupational therapist continued to work on team goals by incorporating goals both the occupational therapist and speech-language pathologist were addressing. The occupational therapist made use of the extra time to address communication and recognition of objects along with the motor skills practice of reaching and grasping objects. This creative use of time helped Sarah smoothly transition to her speech therapy session.

At a team meeting, the team discusses a concern raised by Sarah’s grandmother about recent behavioral problems at home that seem to stem from her school day. Sarah’s grandmother reports that for the past few weeks, Sarah has been agitated and prone to outbursts when she arrives home from school. Team members share their experiences related to circumstances throughout the day that seem to trigger outbursts in Sarah and what strategies help in calming her. The special education teacher notes that unexpected schedule changes and disrupted routines are especially challenging for Sarah. The behaviorist and the paraprofessionals reports that fatigue, hunger, and toileting needs commonly lead to emotional outbursts. The occupational therapist shares observations from her sessions working on sensory integration that loud noises trigger strong emotional responses from Sarah and disrupt her ability to participate in activities. The speech-language pathologist notes that Sarah seems relaxed and calm when reading in a quiet environment. The team works together, troubleshooting to determine how to reduce potential triggers. The team recommends changing Sarah’s schedule during the last period of the school day from a group physical activity held in the combined classroom with multiple students to quiet reading time to help Sarah adjust to the end of the school day transition to home.

Discussion Questions

This case study illustrates how each member of the healthcare team, from the teacher to the paraprofessionals to the speech therapist, was able to integrate the knowledge and experience of others to make decisions about Sarah’s plan of care.

1. Why is interprofessional collaboration important in this case study?
2. Identify at least two of the practices that support effective teams that are illustrated in this case study.
3. Refer to Chapters 13 and 14. Who do you believe is the team leader in developing Sarah’s plan of care? Explain your reasoning.
4. Give an example of a situation described in the case study in which leadership appropriately shifts from one team member to another member.
5. Who should be included in problem solving and planning related to Sarah’s care? Can you suggest other healthcare professionals and other professionals who should be part of the team?
6. Describe how team members’ roles in the school setting differ from other settings.

1. Interprofessional collaboration is crucial in this case study because Sarah’s needs are multifaceted. Her challenges encompass physical, emotional, and cognitive aspects, requiring input from various professionals with different expertise to address these complex needs comprehensively.
2. Two practices supporting effective teams in this case study are:

   a. Shared Expertise: Each team member contributes their specialized knowledge and skills to create a comprehensive plan for Sarah. The team recognizes the value in sharing expertise and working collaboratively, leveraging the strengths of each member for the benefit of Sarah.

   b. Flexible Leadership: There’s a fluidity in leadership roles within the team. Depending on the situation or the aspect of Sarah’s care being addressed, different team members take the lead. This flexible approach ensures that the most relevant expertise guides decision-making at any given time.

3. In developing Sarah’s plan of care, it appears that there isn’t a single designated leader. Instead, the leadership role shifts based on the expertise required for a specific issue. For instance, when addressing Sarah’s frustration due to communication limitations, the speech therapist takes the lead. When managing behavioral concerns, the behaviorist might lead. Therefore, the team functions in a collaborative manner where leadership is distributed based on the needs at hand.
4. An example of appropriate leadership shifting is when the occupational therapist seamlessly incorporates speech therapy goals into the session when the speech therapist is running late. By recognizing the shared objectives and using the available time effectively, the occupational therapist temporarily takes on the leadership role in addressing multiple aspects of Sarah’s needs.
5. Beyond the current team members involved, including Sarah’s grandmother and potentially a pediatrician or a developmental pediatrician could be beneficial. Additionally, involving a mental health counselor or a psychiatrist specializing in pediatric cases might provide further insights into managing Sarah’s emotional and behavioral challenges.
6. In a school setting, team members often work more closely and frequently interact with each other, as they’re involved in the child’s daily activities. They’re also more likely to collaborate with family members, like Sarah’s grandmother, as a key part of the support system. Contrastingly, in other healthcare settings, professionals might not have as consistent or direct contact with the patient throughout the day, making coordination more challenging. Additionally, in a school setting, the team might focus on integrating care within the school environment, considering factors like classroom routines and activities in their planning and interventions.