Professional consultants are strengthening their presence in a variety of settings, including nonprofit organizations, clinics, private practice groups, schools, hospitals, and state and federal vocational rehabilitation centers. In these situations, counselors are likely to work with other health professionals for the benefit of their clients. Some of these other professionals involved in caring for clients may be doctors, speech therapists, occupational therapists, and case managers. As we enter new areas, our ability to serve the consulting profession is essential. Nevertheless, many consultants will ask how this is done when working in interdisciplinary teams.
One way in which advocacy can be achieved in an interdisciplinary team is to actively implement a common decision model. According to research by France Légaré in 2011, common decision-making models have historically focused on the patient-physician dyad.
Both medical professionals and professional counselors are trained to make decisions for the benefit of their clients. However, counselors are typically trained to apply an ethical decision model such as Holly Forester-Miller and Thomas Davis in seven steps:
1) Identify the problem.
2) Apply the ACA Code of Ethics.
3) Determine the nature and extent of the dilemma.
4) Generate possible options for action.
5) Consider the possible consequences of all options and determine a course of action.
6) Evaluate the chosen procedure.
7) Implement procedure.
On the other hand, physicians can be trained to use a medical decision model. This model includes 1) the number of potential diagnoses and management options that need to be considered during an encounter, 2) the amount and complexity of the data to be reviewed as a result of the encounter, and 3) the risk of complications, morbidity, and mortality with the encounter.
Alternatively, physicians can use a common decision model. This model first determines whether the decision is ethically correct. Next, treatment options are provided to the patient so that the patient can make an informed decision. The consent is then obtained. This model helps to overcome health inequalities by involving patients in many aspects of treatment, including the informed decision-making process.
All of these decision-making methods have similarities, including the emphasis on four common principles: autonomy, justice, charity, and non-error. Both the ACA Code of Ethics and the American Medical Association Code of Ethics seek to protect the confidentiality of the client / patient. In the 2016 American Journal of Emergency Medicine, Chadd Kraus and Catherine Marco defined joint decision-making as a collaborative process that enables patients (or their alternates) and clinicians to make joint healthcare decisions, taking into account the best available scientific evidence. as well as the values, goals, and preferences of the patient.
Therefore, a professional adviser in an interdisciplinary team can provide a unique perspective for the benefit of the client or patient. This can lead to consultants advocating for themselves and their profession. The question is how we can identify these differences in decision models based on a health professional training program and how to effectively train and implement these approaches for both new and experienced healthcare professionals.
Classroom
Vocational identity and ethical decision-making begin early in the academic career of counselor-in-training and are specifically strengthened in CACREP-accredited graduate colleges. These programs consist of core courses (eg ethics, counseling techniques, assessment) that enable students to research and implement the skills needed to deal with ethical dilemmas. At this stage of professional development, doctoral students establish ethical decision-making practices and the principles of autonomy, non-abusive, charitable and justice that are strengthened throughout their academic career (eg internship, internship).
There is also the opportunity to practice the implementation of a common decision-making model in a classroom by having students participate in activities or courses in which they partner with students from other disciplines to approach a case study and propose a holistic treatment plan this addresses the field of practice of each discipline. Involving students in this practice can be helpful in post-graduate work, giving them a new perspective and appreciation for different therapy providers who may serve their clients.
Unless a student is accommodated at an internship or internship site where multiple disciplines provide services, the student may receive little guidance for working in an interdisciplinary team. That's why we recommend consulting training programs to build relationships with potential internships with multiple disciplines so that students can learn about the benefits and challenges of working in interdisciplinary teams. Alternatively, students could be placed in internships that actively engage with other practitioners outside the internship position.
Postgraduate
Think back to your first job after graduation or even back to your current job. Does your agency offer the possibility of interdisciplinary consultation or encourage you to consult with a client's treatment team in another healthcare environment? As an entry-level consultant, did you discuss your treatment recommendations with another specialist?
As members of interdisciplinary teams, consultants should not only understand the challenges, but also the benefits of common decision-making models in conjunction with an ethical decision model of their choice. Each of these models benefits the client and the consulting field.
Implementation Model and Consulting
Many people are trained to interact with the identified client in the graduate school, but may have limited contact with working in an interdisciplinary or interprofessional team. However, the reality is that the customers we see today may have a variety of treatment providers (speech therapists, occupational therapists, caseworkers, doctors, psychologists, etc.). It takes practice and experience to maintain the identity of our consultant while keeping in touch with other practitioners. Examining cases where counseling is needed and how it is done can help ensure and support high quality holistic treatment for clients.
The consultation first requires knowledge of the treatment team. With whom does the client work outside of your agency or clinic? Do you have the consent to speak with this person in accordance with the Health Insurance Portability and Accountability Act (HIPAA) considerations? Counselors need to think about how counseling with the treatment provider would help treat the client. Sometimes we consult to share the treatment goals or treatment progress with you. At other times, however, we consult to obtain information about the goals, methods or protocols of another professional. Once a working relationship has been established, the consultant can initiate the first phase of the consultation.
Step One: The first phase of the consultation should include the preparation of the call, including ensuring that all proper HIPAA publications of information and regulatory documentation have been completed. The adviser should be prepared with a precise but well-reasoned request for consultation. What information would the consultant request or request? The counselor may also want to consider whether the person being consulted understands that the counselor is also working with the person, and how the role of the counselor is related to the person's treatment.
Step two: The consultant should contact the consulting agency, provide the release of information, and schedule a consultation. Scheduling can be crucial as many professionals are employed and may not be readily available. Sometimes, numerous phone calls are required to contact the provider. Even if the vendor is available, it may not have the customer's chart or review the information, which can potentially lead to frustration and delays. Therefore, when a call is pending, all parties should be ready to participate fully.
Step three: The requesting provider should be well prepared with information that could be shared or requested during the consultation. A quick overview of how the client came to receive services from the consultant and what services the consultant provides is a good start. Subsequently, the client's condition, interventions, common treatment goals, treatment plan / frequency, prognosis and expected duration of treatment should be discussed. Sometimes professionals have similar treatment goals for the client but may use other interventions or approaches. It is important to realize that there may be overlaps in the knowledge and skills of each provider. In such cases, it may be necessary to discuss why the providers and treatment modalities are of mutual benefit to the customer. In counseling, it may also be important to consider alternative or complementary therapies.
The Advisor may see the client more often than the other provider. Therefore, a general impression of the current condition and presentation of the client may be helpful to the entire treatment team. The counseling session should allow the counselor to ask questions to the other providers and vice versa. Consultations may be conducted individually or with all members of the treatment team, depending on the level of intervention and the specific consultation questions that are asked.
Treatment teams may need to determine who is responsible for which treatment goals or goals. (Note: Professional counselors must be sure that they are clearly in their area of activity.) At this point it may also be important to arrange a follow-up visit as needed and to determine which of the clinicians will initiate the call. Follow-up consultations work best when they are planned, planned and predictable. This allows providers to tailor treatment goals and outcomes.
Step Four: The consultant should document the consultations in the customer file. The advisory notes should include the name of the customer, the date and time of the call, and the duration of the call. The purpose of the call should also be clear and supported by the publication of information documentation by the HIPAA. We also recommend including a place for a narrative on the consultation documentation form that reflects the overview and outcome of the consultation.
Case Study
Sally is a 12-year-old woman who visits a licensed professional counselor to relieve her anxiety symptoms. First, a licensed clinical psychologist at Sally diagnosed a Generalized Anxiety Disorder (GAD) and a speech disorder and then referred her to the Department of Language, Counseling and Medication Assessment. Sally lives at home with her parents and has no siblings. The counselor wants to talk to Sally's psychologist, school counselor, speech therapist and child psychiatrist. The counselor asked Sally's parents to sign HIPAA forms during the first session.
Step One: After Sally has been treated for two to three sessions, the consultant formulates consultation questions for each provider that deals with Sally. The counselor first wants to know from the psychologist if Sally has pedagogical limitations that would prevent her from attending cognitive-behavioral therapy. Second, the counselor wants to know how the school treats Sally's symptoms to the GAD, whether a plan for Sally was or was made, and whether the school advisor works with Sally weekly. Third, the counselor wants to know if the speech therapist will notice signs of GAD during sessions with Sally, and if so, how the speech therapist will treat those symptoms. Finally, the counselor wants to know the psychiatrist's recommendations and provide the psychiatrist with information about Sally's progress and the techniques used in the counseling sessions.
Step Two: The Advisor will contact each of the provider's four agencies to submit a backquest request. The consultant securely scans or faxes the HIPAA release to each provider.
Step Three: The counselor reviews the file, treatment goals, progress and schedule / frequency of treatment for Sally. The counselor should have questions prepared or explained for each of the counseling sessions. It will be important for members of the Sally treatment team to think about how the different treatments can support each other, be similar or different. The team should also consider how often consultations must take place and who is responsible for planning. For example, the psychologist may not have additional family contact and does not need further communication with the treatment team. However, the school counselor and the speech therapist may be in contact with Sally on a weekly basis, much like the counselor. Therefore, frequent contact between these three providers may be required. Finally, the psychiatrist can request information just before Sally's next appointment.
Step Four: The adviser will document each consultation. The note should include the date and time of each consultation, a summary of the consultation and the next planned consultation.
Conclusion
Using the above instructions in consultation with other healthcare professionals may be helpful in applying a decision-making model that continues to benefit the clinician, the client, and the consulting profession as we adapt and improve our treatment to the population we serve.
As a professional consultant, we may work with other professionals who have a higher degree. Regardless, it is important for us to maintain our advisory identity, to adhere to our Code of Professional Ethics, and to work for the benefit of our clients. When working in interdisciplinary teams, it is essential that we be able to work in our field of activity as consultants and clearly explain the reasons for the interventions we provide in therapy. Implementing a common decision-making model also gives us the opportunity to engage with our profession and our clients in an interdisciplinary environment.
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Princess Lanclos is a Doctoral Candidate in Counseling and Supervision at the University of Holy Cross, New Orleans. She is a certified consultant, a certified rehabilitation consultant and a provisionally licensed consultant. Her focus is drug abuse, counseling ex-perpetrators and multicultural counseling. Contact her at [email protected].
Krystal Vaughn is a licensed professional consultant specializing in working with children aged 2 to 12 years. As an Associate Professor at the Louisiana State University Health Sciences Center, New Orleans, she is pleased to teach and provide clinical services. Her research interests include supervision, play therapy and psychological counseling. She has extensive experience in psychiatric counseling in day care centers, private schools and local charter school systems. Contact them at [email protected].
Knowledge Share articles were developed from sessions presented at the American Counseling Association conference.
Letters to the Editor: [email protected]
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The opinions and statements expressed in CT Online Articles do not reflect the opinions of the editors or guidelines of the American Counseling Association.
