Defining The Multidisciplinary Care Team

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A Training Curriculum for Community Health Workers Core CompetenciesDefining the Multidisciplinary Care TeamOBJECTIVESAt the end of this unit, participants will be able to:§ Describe the characteristics of the multidisciplinarycare team§ Compare the traditional approach versus themultidisciplinary approach to health care§ Identify the roles of multidisciplinary care team membersINSTRUCTIONS1. Before the session, review PowerPoint slides andnotes. Print out copies of slide 9—the blank table withmultidisciplinary team roles—for small group activity.2. Welcome participants, review the session’s objectives,and ask questions about multidisciplinary teams (slide 2).3. Review characteristics of a multidisciplinary care team inthe clinic setting (slides 3–4).4. Review the traditional vs. multidisciplinary approach(slides 5–8). Ask questions and write responses onflip chart.Related C3 RolesCare coordination, case management andsystem navigationRelated C3 SkillsCommunication skills, interpersonaland relationship building skills, servicecoordination and navigation skillsMethod(s) of InstructionLecture, group discussion, small groupactivityFacilitator’s note: This session can bedelivered to both CHWs and supervisorstogether.Estimated time30 minutesKey Concepts5. Facilitate activity: Role of Multidisciplinary Team Members(slide 9).Team, multidisciplinary6. Wrap Up. Review answers on slide 10, noting thesimilarities and differences in team member roles whencompared to the participants’ responses. Ask participantsto share what they learned from this session that theycould apply to their teams.Materials§§§§Computer with internet access andprojectorPowerPoint slidesFlip chartMarkersResourcesRole of Multidisciplinary Team Tasks eer-training-core-peer-role2.pdfAllen, C. G., Escoffery, C., Satsangi, A.,& Brownstein, J. N. (2015). Strategies toImprove the Integration of Community HealthWorkers Into Health Care Teams: “A LittleFish in a Big Pond.” Preventing ChronicDisease, 12, E154.

Defining the Multidisciplinary Care TeamSLIDE 1Defining the MultidisciplinaryCare TeamBoston University School of Social WorkCenter for Innovation in Social Work & HealthDefining the Multidisciplinary Care TeamObjectivesBoston University Slideshow Title Goes HereAt the end of this unit, you will be able to:§ Describe the characteristics of the multidisciplinary care team.§ Compare the traditional approach versus the multidisciplinary approachto health care.§ Identify the roles of multidisciplinary team members.SLIDE 2Review the objectives.Ask, “What is your experience with care teams in your organization? What are thecharacteristics of a multi-disciplinary care team?”Write answers on flip chart.Defining the Multidisciplinary Care TeamWhat is a Multidisciplinary Team?Boston University Slideshow Title Goes Here§§§§§A group of professionalsMade up of diverse disciplines, skill sets, perspectivesCome together for a common goalProvide comprehensive assessments and consultationEach member has a role that is valued by the othermembers on the teamSLIDE 3Let’s review the basic characteristics of a multidisciplinary care team.Review the slide or ask for volunteer readers.Share the following observations about multidisciplinary care teams:§ Multidisciplinary teams are groups of professionals from diverse disciplines whocome together to provide comprehensive assessments and consultation for acommon goal (client/patient).§ Multidisciplinary teams members do not have to be all located at the sameagency/clinic, but are connected in the provision of services to the same client/patient.§ Multidisciplinary teams are more prominent in health care: hospitals, clinics, andat social services agencies. They are also present in nonprofit, community-basedorganizations and state funded agencies.§ Multidisciplinary teams are present in the business field and at schools, butoften times the title of the team is different; however they include professionalsfrom diverse disciplines coming together to provide assessments for a commonpurpose. An example in business would be a proposal to bid on a construction jobwhere the marketing department, sales, mechanical and electrical engineers, andother team members would be involved. Another example is in a school setting,where helping a student excel could include the school counselor, the schoolnurse, and the home room teacher.2

Defining the Multidisciplinary Care TeamSLIDE 4Defining the Multidisciplinary Care TeamIn the Clinical SettingBoston University Slideshow Title Goes Here§ Common goal§ Assess client needs§ Develop plan betweenclient and team§ Holistic approach§ Case conferences§ Meet Let’s focus on multidisciplinary teams in the clinical setting.§ The goal of the team is to assess a client’s needs and develop a care plan.§ Teams take into consideration the whole person and all their needs. Thisrequires different perspectives from diverse disciplines. Diverse disciplinesinclude social workers, case managers, physician, nurses, psychiatrist or mentalhealth representatives, peer educators, and others depending on the number ofdisciplines/services offered at the hospital or clinic.§ Multi-disciplinary team meetings typically occur in HIV clinics.§ Ask, “How many of you typically meet as team with physicians, nurses, casemanagers, or maybe even behavioral health specialists or nutritionists?”§ Ask, “How often does the multi-disciplinary team meet?”§ Note that many teams meet at least weekly, some monthly, some havedaily huddles.Ask, “Who is invited to team meetings? How do you determine which cases todiscuss at team meetings?”Points to share:How the team decides which case to conference varies. Some cases maybe chosenbecause of multiple agencies involved in providing services to the client, the client isat risk of losing housing or insurance, the client has not had a case conference in sixmonths, or the client is coming in for a medical appointment and there is suspicion ofsubstance abuse that is affecting adherence to medications, etc.Ask, “How can CHWs and supervisors prepare for case conferences and teammeetings?”Points to share:All disciplines are encouraged to share information they know about the case tosupport a holistic assessment and explore options for resolution at the client caseconference.SLIDE 5Defining the Multidisciplinary Care TeamTraditional ApproachDoctorBoston University Slideshow Title Goes HereNurseSocial WorkerCase ManagerCommunityHealth WorkerNow that we have defined the characteristics of a multi-disciplinary team, let’s focuson how working in teams changes our approach when working with clients andother team members. We’ll do this by comparing the multidisciplinary approach to atraditional approach to care.Ask, “What are the characteristics of a traditional approach?”Points to share: In the traditional approach, usually the team consists of the doctors,nurses, and social workers who give direction to the CHW. Not much information isshared across the team members. The approach to service delivery is not consideredto be holistic.3

Defining the Multidisciplinary Care TeamSLIDE 6Defining the Multidisciplinary Care TeamMultidisciplinary ApproachBoston University Slideshow Title Goes HereReview the slide.DoctorAsk, “How is the multidisciplinary approach different from the traditional rSLIDE 7Defining the Multidisciplinary Care TeamTraditional vs. Multidisciplinary ApproachesBoston University Slideshow Title Goes HereTraditional§ Providers only§ CHW is bonus§ Communication style directive§ Service delivery is goalPoints to share:§ In the multidisciplinary approach we see that the client is at the center with alldisciplines, including the CHW, sharing information and providing a team approachto delivery of services.§ The CHW is vital to the connections between the client and the multiple serviceproviders.Multidisciplinary§ CHW is center of theteam§ CHW is vital toconnection betweenclient and providers§ Communication style holisticDefining the Multidisciplinary Care TeamTraditional vs. Multidisciplinary ApproachesBoston University Slideshow Title Goes Here“I feel like my voice is heard but . . . it’s like I’m a little fish in abig pond because there are so many other things that they’refocusing on right now, that sometimes my role and positiongets put on the back burner. I think that’s the biggest issue thatI’m having here, now, is that they adopted the concept here —it’s a great concept, but my role won’t thrive unless I have thesupport that I need.”Quote from CHW in article – Strategies to Improve the Integration ofCommunity Health Workers Into Health Care Teams: “A Little Fish in a BigPond”Now, let’s compare the and contrast the difference between the two approaches.Ask participants the following questions and facilitate discussion.§ What are the major differences between the traditional approach versus the multidisciplinary approach of collaborating with clients?§ What are some of the benefits to the multidisciplinary approach?§ What could be some challenges in working as a team?SLIDE 8Ask a volunteer to read the quote.Ask, “Is this something a CHW from your organization might say? Why or why not?”Ask, “How do you ensure that each discipline’s role on the multidisciplinary teamis valued?”Write responses on flip chart.4

Defining the Multidisciplinary Care TeamSLIDE 9Defining the Multidisciplinary Care TeamRoles of Multidisciplinary Team MembersCHWSupervisorPhysicianBoston University Slideshow Title Goes HereNurseBehavioralHealthTherapistCaseManagerRoles of Multidisciplinary Team Members ActivitySay, “We will now do an exercise on defining the roles of multidisciplinary teammembers. Understanding the roles of co-workers is essential for a multidisciplinaryteam to work well together.”Break into small groups.Give each group a flip chart sheet and markers, and a copy of this slide. Ask the groupto make a table like the one shown on the slide.Each group will identify tasks for each team member. Have one person in each groupwrite the tasks on the flip chart sheet. Remind participants that some tasks will beshared and some will be unique to that team member. Groups should put a star nextto shared tasks.Remind participants that since we have already spent time on the CHW’s role, theyshould do that part quickly and then spend most of their time on the other teammember’s roles.Allow 15 minutes for the groups to write down their responses.Ask the groups to present their lists.Discuss any differences in the assignment of tasks between the groups.Ask participants to comment on tasks that are shared by different team members(e.g. “listen to patient concerns”) as well as tasks that are unique to CHWs ormedical personnel. Mark shared tasks among all job titles with asterisks using coloredmarkers. Then emphasize unique tasks for CHWs.SLIDE 10Defining the Multidisciplinary Care TeamRoles of Multidisciplinary Team MembersCHWSupervisorPhysicianNurseBoston University Slideshow Title Goes Here Counsel Advocate Listen toconcerns Motivate Empower Advise Refer Identifybarriers Educate Follow-up Identify withClient Navigate Counsel Advocate Listen toconcerns Motivate Empower Advise Refer Identifybarriers Educate Manage staff Administrate Counsel Advocate Listen toconcerns Motivate Empower Advise Refer Identifybarriers Educate Examine Diagnose Show how totake meds Discharge Counsel Advocate Listen toconcerns Motivate Empower Advise Refer Identifybarriers Educate Vital signs Review orders Show how totake meds DischargeBehavioralHealthTherapist Counsel Advocate Listen toconcerns Motivate Empower Advise Refer Identifybarriers Educate Follow-up DischargeCaseManager Counsel Advocate Listen toconcerns Motivate Empower Advise Refer Identifybarriers Educate Follow-up Help withentitlementsShare the activity answer key. Note similarities and differences between the answerkey and the participants’ versions of the chart. Note that answers can differ dependingon the organization.5

Defining the Multidisciplinary Care TeamAcknowlegementsThis curricula draws from and is adapted from other training curricula for peereducators and community health workers, such as the Building Blocks to Peer ing-toolkit) and the Community CapacitationCenter, Multnomah County Health Department y-capacitation-center)TeamSerena RajabiunSimone PhillipsAlicia DownesMaurice EvansLaTrischa MilesJodi DavichBeth PoteetRosalia GuerreroPrecious JacksonMaria Campos RojoThis project is/was supported by the Health Resources and Services Administration(HRSA) of the U.S. Department of Health and Human Services (HHS) under grantnumber U69HA30462 “Improving Access to Care: Using Community HealthWorkers to Improve Linkage and Retention in HIV Care” ( 2,000,000 for federalfunding). This information or content and conclusions are those of the authorand should not be construed as the official position or policy of, nor should anyendorsements be inferred by HRSA, HHS or the U.S. Government.Suggested Citation:Boston University Center for Innovation in Social Work & Health. (2019). A TrainingCurriculum for Using Community Health Workers to Improve Linkage and Retention inHIV Care. Retrieved from:

Before the session, review PowerPoint slides and notes. Print out copies of slide 9—the blank table with multidisciplinary team roles—for small group activity. 2. Welcome participants, review the session's objectives, and ask questions about multidisciplinary teams (slide 2). 3. Review characteristics of a multidisciplinary care team in

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