2. The Why, What, How and When of Effective Collaboration
What is Interprofessional Practice and Why is it Important?
As defined by the World Health Organization (WHO), interprofessional practice involves “Multiple health workers from different professional backgrounds providing comprehensive health services working with patients, their families, caregivers, and communities to deliver the highest quality of care across settings.” (WHO Framework for Action on Interprofessional Education and Collaborative Practice, 2010).
The delivery of high-quality care to children, youth, and families managing behavioral health challenges requires active family engagement and collaboration across service sectors. Collaboration, grounded in trust and maintained over time, can assist in developing comprehensive child/family-centered care plans, tracking progress across different settings, and timely adjustments in intervention planning and implementation.
In this section of the toolkit, you will find best practices, tips, and strategies for effective interprofessional collaboration and communication among pediatric medical providers, behavioral health providers, school staff, and families. You will also find sample communication forms that can be customized for your practice/organization.
Strategies for Being an Effective Collaborator
Key Characteristics of Effective Interprofessional Teams
Guidance to enhance interprofessional collaboration that facilitates optimal child/adolescent outcomes is found in the 2023 Interprofessional Education Collaborative (IPEC) Core Competencies for Interprofessional Collaborative Practice. The IPEC has organized 33 sub-competencies into four domains: values & ethics, roles & responsibilities, communication, and teams & teamwork.
In essence, effective teams, whether co-located or collaborating virtually across separate systems, possess the following key characteristics:
- Respect for Cultural Diversity: The team acknowledges and values the diverse cultural backgrounds and unique qualities of both family members and professionals on the team.
- Shared Understanding of Roles and Responsibilities: Each team member understands and accepts their respective roles and responsibilities within the team.
- Recognition of Limits: Every team member is aware of the boundaries of their personal knowledge and skill sets.
- Clear and Respectful Communication: The team engages in transparent, accurate, and timely communication, utilizing agreed-upon methods while respecting the privacy preferences of families.
What Does Effective Collaboration Look Like?
Successful collaboration to address the behavioral health needs of children and adolescents relies on the active engagement of both family members and professionals, each bringing their distinct viewpoints and expertise to the processes of assessment, treatment planning, and intervention.
By working together, families and providers can identify and manage behavioral health issues more quickly and comprehensively, potentially preventing budding concerns from escalating into more serious challenges. Applying intervention strategies consistently across settings, including home, school, and the community, can also result in improved child and adolescent outcomes.
Genuine collaboration extends beyond information sharing, encompassing active participation in joint problem-solving and decision-making. Effective collaborators establish a mutual understanding regarding the content of information to be exchanged, as well as the preferred terminology, frequency, and timing of communication. For collaborative processes to be consistently applied, they must be integrated into the workflows of all providers and align with the family’s schedule and preferences.
While technological platforms can streamline and expedite productive collaboration, institutional support is pivotal in ensuring consistent implementation of this practice.
In essence, effective routine collaboration thrives within an environment that provides the necessary time, structured processes, and appropriate tools for fostering meaningful connections and teamwork.
5 Principles of Effective Remote (At-a-Distance) Collaboration
Adapted from Mitchell, et al:
- Shared Goals: The virtual team, including the parent/caregiver and youth (where appropriate), works to establish shared goals that reflect the child’s and family’s priorities and can be easily articulated, understood, and supported by all members.
- Clear Roles: Every team member has well-defined roles and responsibilities that contribute to enhanced efficiency. This enables the team to leverage specialization and accomplish more collectively than what individual providers working in isolation could achieve.
- Mutual Trust: Collaborators earn each other’s trust, creating strong norms of reciprocity and opportunities for shared achievement.
- Effective Communication: Team members prioritize and continuously refine their communication skills, procedures, and tools.
- Measurable Processes and Outcomes: The team establishes reliable and prompt feedback mechanisms for acknowledging both successes and setbacks in team functioning and goal achievement.
How to Establish and Maintain Remote Cross-Sector Working Relationships
Building and sustaining relationships with remote team members is critical for effective behavioral health care treatment planning, execution, and management. While networking requires an investment of time, it proves invaluable for fostering relationships and enhancing patient care.
Interprofessional Relationship Building Strategies and Ideas
Create opportunities for networking with local professionals from other disciplines. Here are some ideas to get you started:
- Hold virtual or in-person “meet & greets” hosted by one sector (e.g., pediatric practice, behavioral health clinic, school)
- Share electronic staff directories that include photographs, brief biographies, and contact information for all providers
- Offer virtual or in-person mini-trainings on topics of mutual interest conducted by providers from one or more disciplines during informal breakfast, lunch, or evening learning sessions
- Visit one another’s work settings to learn about the culture of each practice, including priorities, workflows, and challenges
- Establish a cross-sector provider email listserv to foster relationships by exchanging information about new services, upcoming educational events, the latest research, and facilitating informal, patient non-specific consultation
Tips for Behavioral Health Clinicians Seeking to Cultivate Relationships with Pediatric Primary Care Providers
- Reach out to primary care providers who have mutual patients to inform them of your areas of specialization, the age demographics you serve, accepted insurance plans, and the best ways to contact you.
- Network with pediatric practices in your vicinity that share similar interests and objectives. Consider arranging a case consultation meeting about a complex shared patient or offering to conduct in-service trainings on “hot” topics.
- Present at local and state medical provider meetings.
10 Tips for Maintaining Interprofessional Relationships Over Time
Maintaining relationships over time with colleagues from other disciplines and organizations – especially virtually – may be more challenging than establishing them in the first place. Here are ten tips for maintaining your interprofessional relationships and teams:
- Place the needs, preferences, and strengths of the child and family at the forefront of care
- Respect the communication preferences of virtual team members, taking into account their selected platforms (such as texting, phone, email, video conference) and desired timing for outreach
- Share responsibility for tasks that span different scopes of practice
- Promptly fulfill commitments to the team
- Engage in clear and open communication that is timely, concise (i.e., includes only essential information), and free of discipline-specific terminology or jargon
- Strive to ensure common understanding; reconciling discrepancies, differing viewpoints, and misunderstandings swiftly and considerately
- Recognize and capitalize on the unique expertise and strengths of each team member
- Express appreciation for the efforts of others
- Give and receive feedback with respect and share accountability as appropriate
- Work jointly to empower children, adolescents, and parents/caregivers to be active partners in all aspects of their care
When to Communicate Across Professional Sectors
The timing and frequency of asynchronous interprofessional team communication is guided by the needs of the child/adolescent and family. In general, the more acute and complex the child’s needs, the more frequent the communication.
Using Forms and Reminders to Facilitate Communication
Effective interprofessional communication can be facilitated by brief, easy-to-use forms/templates (scroll down to find some sample forms you can customize) that can be completed within an Electronic Health Record (EHR), sent as an attachment via encrypted email, and/or faxed and scanned, depending on the preferences and system capabilities of each team member.
It is helpful when cross-sector providers agree upon a mutually-defined baseline of information sharing at jointly identified intervals. User-friendly, streamlined templates and forms save time and increase the likelihood of prompt completion.
When available, automated reminders can also be helpful, and may include EHR notifications, automated email reminders, text message alerts, calendar invitations, and push notifications in a mobile app.
When to Send Periodic Updates to Other Providers
With proper consent, all team members are encouraged to initiate periodic updates. These updates can be facilitated through standardized communication forms and/or virtual team meetings, encompassing relevant information such as:
- Changes in diagnosis or treatment plan
- Acute concerns
- Severe symptoms
- Progress related to treatment/care plan goals
- Response to medication
Behavioral health providers should also send discharge notifications to their virtual team members, outlining any follow-up or supplementary services arranged.
Recommended Routine Procedures for Pediatric Providers & School Personnel Making Referrals to Behavioral Health Services
- Discuss the value of collaboration with the youth and family when initiating the referral
- Routinely obtain releases of information for the behavioral health provider and other essential collaborators
- With family consent, send a brief referral request, clearly stating the reason for referral, to the identified behavioral health provider (see sample templates in next section)
- Whenever possible, supplement asynchronous communication with a warm handoff (in-person or virtual)
Recommended Routine Procedures for Behavioral Health Providers Upon Completion of Initial Evaluation/Consultation
Whether referral was made by pediatric or school personnel or initiated independently by the family, the following process is recommended:
- Discuss the value of collaboration with the youth and family.
- Routinely obtain releases of information for the referral source and other essential collaborators.
- Upon securing necessary consents, promptly deliver feedback to other providers.
- When sending an update to the pediatric provider, include a brief summary of impressions and proposed treatment plan, and request information pertinent to care planning. When pediatric provider is the referral source, be sure to answer the referral question and specify the diagnosis.
- When sending an update to school district behavioral health or medical personnel initiating the referral, include a brief notification that the child/adolescent has begun treatment and request any information that will facilitate care planning.
Sample Communication Form Templates for Use by Pediatric, Behavioral Health, and School Providers
The form templates below include suggestions for both the timing and content of the most helpful forms of communication for pediatric and behavioral health providers to exchange. They are adaptable and can be used as-is or customized to suit the needs of a given practice or team.
These forms will download in Microsoft Word format (.docx) to enable customization:
The original versions of these form templates were developed and implemented by Carolyn Greene, Ph.D. and colleagues as part of an investigation summarized in the following article: Greene, C. A., et al. (2016). Strengthening the coordination of pediatric mental health and medical care: Piloting a collaborative model for freestanding practices. Child Youth Care Forum, 45(5), 729-744.
The Green Form
Another user-friendly tool for facilitating communication between pediatric and behavioral health practitioners at the commencement of behavioral health treatment is known as the Green Form. This form originated from a partnership between the Connecticut Children’s Medical Center and the Connecticut Chapter of the American Academy of Pediatrics and has been endorsed by various behavioral health organizations in the state.