5. Collaboration Tips from Parents, Youth, and Providers
Know Your Partners: Tips from Parents, Youth, and Providers to Facilitate Collaboration
The likelihood of a successful collaboration is enhanced when participants recognize and appreciate the elements of a working relationship valued by the other individuals involved.
With this in mind, the Connecting to Care Family Care Connections Workgroup conducted qualitative interviews and stakeholder focus groups to gain insights about catalysts for partnership and teamwork from those essential in the care of children and adolescents experiencing behavioral health challenges, including input from adolescents themselves.
Tips from Parents/Caregivers and Youth for Pediatric, Behavioral Health, and School Practitioners
Tips from Parents and Caregivers
- Display empathy: Families identify empathy as fundamental to quality care due to its role in establishing trust, feelings of being understood, comfort, greater openness, a commitment to following through on recommendations, and better outcomes.
- Ask how you can be helpful: For example, Would you like me to simply listen? Would you like me to suggest resources? Do you want my help in solving the issue? Do you want me to talk with ‘the school/pediatrician/behavioral health provider?
- Listen attentively, reflect back what you have heard to ensure accurate understanding, and validate concerns.
- Speak clearly and transparently, ‘with,’ not ‘at,’ families – and avoid jargon.
- Take the time needed to understand and respond to the family’s concerns: If time runs short, resist rushing and instead schedule a follow-up visit/meeting or call.
- Consistently treat all family members with respect, maintaining a non-judgmental attitude, recognizing that words matter, and asking for their opinions.
- Recognize that parents/caregivers are the experts about their children and serve as their children’s primary support system, historians, observers of progress, and advocates.
- Practice culturally-responsive care: Be curious about the family’s beliefs, practices, fears, and customs; take communication cues from the family regarding etiquette, e.g., for distance, eye contact, touch; when in doubt, ask – do not make assumptions; conduct visits in the family’s primary language, using interpretation services when needed.
- Practice trauma-informed care: Provide a physically and emotionally safe environment that is sensitive to potential triggers, equipped to help manage emotions and build coping skills, welcoming of family decision-making about care, and routinely offers options.
- Attend to health literacy needs: Ensure that written materials are translated into the primary language of families; consider the font in written materials given to parents with dyslexia.
- Address family concerns about stigma associated with behavioral health challenges and treatment.
- Provide options for preferred modes of communication that are HIPAA-compliant/respectful of privacy rights, including text messaging, emailing, phone calls, written documents, and patient portals with messaging.
- Check-in with families between appointments as needed, and respond in a timely manner when a family reaches out with a question or request
- Acknowledge when you ‘slip up,’ for example, by making an assumption, failing to ask the right questions, or misunderstanding, and apologize (families will appreciate your sincerity and good intentions).
- Celebrate family successes: parents/caregivers particularly appreciate when providers initiate contact solely to provide unsolicited positive feedback.
Tips from Youth
- Create a welcoming and comfortable atmosphere where adolescents feel safe to express their thoughts, feelings, and viewpoints by actively seeking their ideas, feedback, and preferences, and engaging in attentive and respectful listening, remaining open-minded, and displaying empathy.
- Be authentic in all interactions with adolescents by demonstrating transparency and honesty in communications, a willingness to learn, self-awareness (e.g., acknowledging limits of expertise), and acceptance of responsibility for actions.
- Recognize the value of understanding the subjective experiences of adolescents.
- Restate the young person’s input to confirm a clear understanding.
- Validate the adolescent’s emotions and experiences without judgement.
- Provide explanations and guidance in easily understood terms, steering clear of jargon – and invest the time needed to ensure they fully grasp the information presented.
- Consistent with the adolescent mantra, ‘Do not make decisions for us without talking with us,’ empower adolescents to engage in informed problem-solving and decision-making about their own care and education.
- Review and discuss the information to be disclosed to others involved in the adolescent’s care, respecting privacy preferences whenever possible.
- Recognize the individual needs of each adolescent and tailor recommendations and interventions accordingly.
- Be responsive when adolescents seek support by promptly returning calls, answering encrypted text and patient portal messages, and scheduling appointments.
- Demonstrate sensitivity and respect for the individual identities of all youth.
- Highlight an adolescent’s strengths, encouraging and acknowledging achievements.
From Providers, For Providers: Cross-Sector Tips for Collaboration
The tips and recommendations our team received from across child-serving disciplines and fields were remarkably consistent, so rather than provide input from each discipline separately, we combined common recommendations here.
Consensus on Overall Strategies
The pediatric, behavioral health, and school practitioners we consulted with when developing this toolkit generally agreed that the following overall strategies can enhance interprofessional collaboration:
- Establishment of clearly defined expectations for engagement in collaboration within each sector
- Implementation of systematic and universally accepted practices for interprofessional communication and teamwork
- Efficient and robust utilization of technology
- Hosting cross-sector training and networking events to cultivate relationship-building
- Allocation of dedicated time for collaboration in all settings
- Availability of reimbursement opportunities for collaborative efforts
- Appointment of liaisons to facilitate collaboration within each setting
Specific Tips to Promote Effective Interprofessional Collaboration
- Despite a shared desire to engage in collaboration, time constraints pose a significant challenge for all professional sectors, making concise and timely professional communications critical.
- Professionals from all sectors would embrace synchronous electronic communication using HIPAA-compliant videoconferencing tools for activities such as virtual team meetings and warm handoffs between disciplines and across levels of care (e.g., when a child is transferred from a Partial Hospital Program to outpatient behavioral health services). Furthermore, in each discipline, some providers would welcome cell phone calls, contingent upon the establishment of clear guidelines.
- Professionals from all sectors support asynchronous electronic communication in the form of encrypted email and text messaging and whenever possible, through shared (or interoperable) Electronic Health Record platforms. Asynchronous communication is highly valued for its ability to accommodate the diverse schedules of pediatric, school, and behavioral health providers.
- Cross-sector training is considered a valuable strategy to promote active engagement in interprofessional teamwork aimed at addressing the needs of children and adolescents with behavioral health challenges. For example, pediatric and community behavioral health providers equipped with a deeper understanding of the tiered intervention approaches implemented by school district personnel could offer better informed and effective strategies to support classroom behavior and academic achievement. Likewise, a comprehensive understanding of the intricacies within a Section 504 Plan could empower pediatric providers to suggest more impactful accommodations.
- All professional disciplines should share responsibility for obtaining and distributing signed authorizations for information disclosure. This approach would reduce delays in interprofessional collaboration as well as free parents/guardians from serving as the primary conduits for communication across providers. To achieve widespread acceptance and consistent implementation, it is essential to establish streamlined and straightforward protocols for securing and subsequently sharing informed consent. Technology solutions can be harnessed to make this practice a standard of care.
- Establishing uniform communication standards across sectors that offer guidance for the timing and content of such communication is of paramount importance to all sectors.
- Regularly scheduled team check-ins (e.g., bi-weekly or monthly) to review the progress of children and adolescents with more complex or intensive behavioral health challenges are viewed as helpful in promptly identifying emerging concerns and preventing setbacks.
- Every sector would like the inclusion of care coordination support within their individual settings.
- Creating reimbursement opportunities for collaborative activities would not only validate and endorse their significance but also increase the likelihood of sustained participation.
- An online platform with user-friendly, comprehensive, and up-to-date contact information for mental health providers would be welcomed by both pediatric primary care providers and school staff, simplifying the referral process. Networking meet and greets with behavioral health providers would also be valued as a means to foster working relationships.
- Designating staff as point persons or liaisons within each setting could significantly increase interprofessional collaboration. For instance, in pediatrics, this role could be served by a nurse, care coordinator, embedded behavioral health provider, or an APRN with expertise in behavioral health and/or education. Within a school setting, a nurse, social worker, or school psychologist could assume this responsibility, while care coordinators might carry-out this role within mental health clinics. Dedicated time would need to be allocated for any staff member assigned as a liaison. Their primary function would not involve direct collaboration, but rather, would focus on facilitating interprofessional communication through ensuring timely transmission of information and responses to requests from other sectors.