Abstract
This AOTA Position Statement describes how occupational therapy practitioners work as part of an interprofessional collaborative practice in various settings, including, but not limited to, hospitals, skilled nursing facilities, school systems, and community agencies.
This AOTA Position Statement describes how occupational therapy practitioners work as part of an interprofessional collaborative practice in various settings, including, but not limited to, hospitals, skilled nursing facilities, school systems, and community agencies.
Occupational therapy practitioners (i.e., occupational therapists and occupational therapy assistants) work as part of interprofessional teams in various settings, including, but not limited to, hospitals, skilled nursing facilities, school systems, and community agencies. Interprofessional teams are composed of multiple professionals who vary by practice setting (e.g., physicians and other therapy providers in rehabilitation settings, educators and paraprofessionals in school settings). Interprofessional collaborative practice (IPCP) is defined as multiple professionals “working together with patients, families, carers, and communities to deliver the highest quality of care” (World Health Organization [WHO], 2010, p. 7).
Occupational therapy practitioners are prepared to engage in IPCP through their initial preparation programs. The Accreditation Council for Occupational Therapy Education (ACOTE®) Standards state that a graduate from an ACOTE-accredited program must “be prepared to effectively communicate and work interprofessionally with all who provide services and programs for persons, groups, and populations” (ACOTE, 2018, p. 4). The American Occupational Therapy Association (AOTA) further demonstrated support of interprofessional education by adopting the official document “Importance of Interprofessional Education for Occupational Therapy” (AOTA, 2022b).
Definitions
IPCP is guided by four core competencies established by the Interprofessional Education Collaborative (IPEC; 2023): Values/Ethics: Work with team members to maintain a climate of shared values, ethical conduct, and mutual respect. Roles/Responsibilities: Use the knowledge of one’s own role and team members’ expertise to address individual and population health outcomes. Communication: Communicate in a responsive, responsible, respectful, and compassionate manner with team members. Teams and Teamwork: Apply values and principles of the science of teamwork to adapt one’s own role in a variety of team settings.
In addition to these competencies, the following definitions are commonly used when discussing IPCP:
Interprofessional collaborative practice: When multiple professionals “from different professional backgrounds work together with patients, families, carers, and communities to deliver the highest quality care” (WHO, 2010, p. 7).
Interprofessional education: “When students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes” (WHO, 2010, p. 7).
Interprofessional team-based care: “Care delivered by intentionally created[,] usually relatively small[,] work groups . . . who are recognized by others as well as by themselves as having a collective identity and shared responsibility” for client outcomes (IPEC, 2016, p. 2).
Interprofessional teamwork: “The levels of cooperation, coordination and collaboration characterizing the relationships between professions” (IPEC, 2016, p. 2).
Intraprofessional practice: Collaboration between occupational therapists and occupational therapy assistants regarding the delivery of occupational therapy services (AOTA, 2018).
Significance of the Topic
When considering the importance of IPCP, an understanding of the relationship between teamwork and client outcomes is critical. IPCP moves away from traditional hierarchies and silos of service delivery (Cahn, 2020). The viewpoints and expertise of each team member are valued to ensure a comprehensive approach to care is delivered (Cahn, 2020), and all team members are encouraged to practice at the highest level of their license to provide optimal services (Arenson & Brandt, 2021; Pearl & Greenberg, 2020). Quality teamwork and collaboration can improve care and safety (Rydenfält et al., 2017) and clinical performance (Schmutz et al., 2019). Poor communication and strong hierarchies can lead to errors (Green et al., 2017; Rosen et al., 2018). IPCP not only improves the client experience but also improves practitioners’ work satisfaction by promoting well-being and reducing burnout (Deneckere et al., 2013; Guck et al., 2019; LeNoble et al., 2020).
The Occupational Therapy Practice Framework: Domain and Process (OTPF–4; AOTA, 2020c) recognizes service delivery as a collaborative effort for occupational therapy practitioners to embrace and engage in IPCP (AOTA, 2020b). The OTPF–4 offers a broad view of occupational therapy service delivery that includes groups and populations within traditional and nontraditional contexts of practice. In high-functioning care teams, each member of the team, including occupational therapy practitioners, should be practicing at their full scope to provide optimal care to clients (Arenson & Brandt, 2021; Pearl & Greenberg, 2020). However, as noted previously, interprofessional teamwork is not only a clinical venture. In community and population health efforts, the occupational therapy practitioner’s role on the team is critical to consider multiple perspectives and address complex challenges with comprehensive solutions. Occupational therapy practitioner entrepreneurs and those involved in health information technology need to be able to work with diverse communities of interest in effective team models. To illustrate this, specific case studies of IPCP care are outlined in the Appendix.
Role of the Occupational Therapist and Occupational Therapy Assistant
The roles of occupational therapists and occupational therapy assistants are detailed in AOTA’s (2020b) Guidelines for Supervision, Roles, and Responsibilities During the Delivery of Occupational Therapy Services. Occupational therapists and occupational therapy assistants work intraprofessionally in many settings (e.g., hospitals, clinics, schools, communities) to provide occupational therapy services to clients using a collaborative approach.
Both occupational therapists and occupational therapy assistants can work with interprofessional teams and engage in IPCP. During IPCP, the role of the occupational therapy practitioner is to articulate the value of occupational therapy services to team members, communicate effectively and honestly, provide accurate feedback, manage conflict, and establish a shared decision-making process with other team members (Grossman-Kahn & Schmuckal, 2019).
Occupational therapy practitioners should also be prepared to act as advocates and take the lead on change to improve the team’s functioning. They can be instrumental in helping teams develop processes, habits, and routines that promote communication and productivity. In addition, they may use group facilitation skills to support team cohesiveness. The Appendix provides case examples.
Ethical Considerations for IPCP
Occupational therapy practitioners have a professional and ethical responsibility to provide services within their own competence and scope of practice as well as their state’s practice act. AOTA’s (2020a) Occupational Therapy Code of Ethics establishes principles that guide inclusive, cooperative, and safe practice to promote well-being and occupational justice for all clients. During IPCP, occupational therapy practitioners must strive to act in accordance with all ethical core values but particularly use prudence and altruism to guide their actions. The Core Value of Prudence should guide practitioners to make sound judgments about what is best for their client and then seek assistance from colleagues to enhance that client’s care; this is especially true when optimal interventions extend beyond the occupational therapy practitioner’s scope of practice. The Core Value of Altruism invites occupational therapy practitioners to demonstrate unselfish concern for client welfare and dictates that they will work cooperatively with other practitioners (inside and outside the profession) to elevate their care to the highest level possible.
Overall, practitioners should refer to relevant principles in the Code of Ethics and comply with state licensure and federal regulatory requirements. In IPEC’s (2023) Core Competencies for Interprofessional Collaborative Practice, one of the main competencies is Values/Ethics for Interprofessional Practice. As occupational therapy practitioners, IPCP is a moral imperative calling forward the need to integrate the Code of Ethics with the Core Competencies to enact optimal IPCP (IPEC, 2023).
Education and Training
Occupational therapy practitioners are lifelong learners who demonstrate flexibility to adapt to the ongoing transformations across different practice settings. For current practitioners, most learning related to teamwork has been iterative and has come with practice experience. Current occupational therapy and occupational therapy assistant students are learning and engaging in intraprofessional (i.e., collaboration within a profession, including among occupational therapy assistants and occupational therapists) and interprofessional education as preparation for practice (ACOTE, 2018; IPEC, 2023). Most clinicians are usually less familiar with teaming strategies that can enhance IPCP than they are with intraprofessional practice.
The National Center for Interprofessional Practice and Education, along with the American Interprofessional Health Collaborative (AIHC), offers opportunities for mentoring and ongoing education to grow as an interprofessional team member and leader (e.g., AIHC Mentoring Program, https://aihc-us.org/index.php/activities/aihc-mentoring-program). Other important interprofessional organizations that offer conferences and education include the National Academies of Practice, the Interprofessional Education Collaborative, Collaborating Across Borders, and Interprofessional Global.
Funding and Reimbursement
Occupational therapy practitioners engage in IPCP across practice settings, including, but not limited to, acute care, early intervention, schools, outpatient clinics, hospitals, rehabilitation facilities, home health and community agencies, and mental health settings. Funding and reimbursement for services are contingent on eligibility, diagnosis, setting, and geographic location. Practitioners must become familiar with relevant third-party payer policies in their state and may need to educate payers about the need for consultative services and cotreatment sessions with other providers and their expected outcomes.
Conclusion
IPCP is one of the methods of service delivery that occupational therapy practitioners use. Occupational therapy practitioners are a critical part of every interprofessional team.
Authors
Lesly Wilson James, PhD, MPA, PMP, OTR/L, FAOTA, FNAP
Joy Doll, OTD, OTR/L
Dana H. Washburn, MS, OTR/L
Audrey Wilson-Alston, BS, MBA, COTA/L, ROH
Meredith Gronski, OTD, OTR/L, CLA, FAOTA, Chairperson
Adopted by the Representative Assembly Coordinating Council for the Representative Assembly, April 2024.
Copyright © 2024 by the American Occupational Therapy Association, Inc.
Citation. American Occupational Therapy Association. (2024). Interprofessional collaborative practice: Importance across populations and settings. American Journal of Occupational Therapy, 78(Suppl. 1), 7810410140. https://doi.org/10.5014/ajot.2024.78S107
Footnotes
Appendix. Case Studies
Case Study 3. Skilled Nursing Setting
| Occupational Therapy Process | Clinician’s Findings |
|---|---|
| Client description |
|
| Occupational therapy evaluation and goal setting | José’s postsurgery goals include the following: return to work without limitations or pain, return to fly fishing, return to baseball and volleyball, improve shoulder ROM, and reduce pain when completing ADLs. After José’s surgery, Dr. Smith recommends a 3-day hospital stay followed by 20 days in a SNF with orders for OT, PT, and speech therapy, which José adheres to. He is instructed to wear a sling for 3–4 wk, per the TSA protocol. An assessment is conducted during a coevaluation with OT and PT, and the therapists learn that José has mild edema to the right anterior shoulder. He reports pain to be 5/10. No drainage from the incision is noted, though a scar is forming, and stiffening in the underlying tissue is noted. Nursing is monitoring the surgical wound because there are concerns about possible infection. In addition, the wound on his right LE (residual limb) will not close, so nursing is starting a wound vacuum treatment protocol to enhance healing. During the coevaluation, José appears confused regarding which UE was impacted, and he has difficulty following directions; he is awake and oriented to person and place. José’s mobility is impaired because his right UE is non-weight bearing and he is unable to use his right LE prosthesis with functional transfers, resulting in the need for maximum assistance ×2; bed mobility is considered dependent. The OT and PT report José’s status to the nurse and physician. |
| Occupational therapy interventions | The OT reports concerns about cognition to Dr. Smith, and they agree that José could be experiencing cognitive deficits because of high pain medication levels and negative drug interactions; José’s confusion clears after medication levels are adjusted, and he is relieved to feel like himself again. OT interventions include the following: • Improve strength and AROM in José’s left UE. • For José’s right UE, the OT interventions follow the surgical protocol: use of a sling, passive ROM in specified planes, isometrics, and AROM of his distal extremity. • ADL retraining is completed. • The OT works with PT and nursing to teach José how to independently transfer using a slide board. • The OT works with PT to arrange the rental of a one-arm–drive wheelchair for José to use while he progresses through rehabilitation of his right arm (which could take 4–6 mo) and tries to achieve wound closure of his right residual LE so he can begin wearing his prosthesis again. José voices to his OT that he really misses working with his hands and would love to make some fly-fishing lures as his surgical protocol allows. At 7 wk, José begins constructing fly fishing lures, which involves weaving fishing line and bait together and then tying them onto the hooks. This bilateral activity is very rewarding and helps him feel centered once again and able to work toward his goal of returning home. While José is recovering in the SNF, he and the OT collaborate with PT regarding modifications to his house during a home visit. The OT recommends a commode for José’s bedroom and notes that he already has a bath bench in place, along with a raised toilet seat. Fortunately for José, his ranch-style home is one level, with just one step to enter. The OT and PT are able to secure a small grant from a local organization that funds home modifications for people with disabilities to have an accessible ramp built to facilitate entry into José’s home. Modifications to his vehicle are considered; however, because of the estimated costs and lack of insurance coverage, José elects to wait on modifications to see how he heals to determine the true need for them. Because of José’s ongoing health issues, he and the OT are beginning to question whether he can ever return to work at his construction and auto repair jobs. The OT reaches out to a vocational rehabilitation counselor, who begins working with José to consider alterations in his job duties or another career that fits his skill set. |
| Occupational therapy outcomes | After 2 mo, José reports that he is feeling much more optimistic about the future. His cognition has stabilized, and his right LE is showing signs of healing but is not yet closed. He continues to work through his right shoulder postsurgical rehabilitation process with his OT. With durable medical equipment and home modifications in place, he is ready to be discharged to home and will continue OT and PT on an outpatient basis. He reports that the strategies provided by the OT have helped him immensely, and he feels excited to resume living with his wife and children. He will continue consulting with vocational rehabilitation to assess the need for a career change after he has completed rehabilitation. José’s care is affected by the team collaboration in the SNF setting where the OT, PT, nurse, and physician work as a team with him to address his concerns using shared decision-making. As José transitions out of the SNF, his OT works collaboratively with the vocational rehabilitation counselor to help José focus on new work roles. Overall, the OT works interprofessionally to facilitate an integrated health care model that can achieve optimal outcomes for the patient. Using effective team values, such as open communication, and using knowledge of roles and responsibilities of all team members helps all of the professionals collaborate to meet the patient’s needs while working at the highest level of their expertise. |
| Research evidence and related resources guiding practice |
AOTA (2024), Marik & Roll (2017), Stark et al. (2017) |
| Team IPCP Challenge | Ensure an understanding of roles and shared goals between medical professionals and families to reach the best health outcomes for client. |
| Key IPEC Tenets That Apply to This Case |
Roles/Responsibilities: Use the knowledge of one’s own role and team members’ expertise to address individual and population health outcomes. Communication: Communicate in a responsive, responsible, respectful, and compassionate manner with team members. |
Note. ADLs = activities of daily living; AROM = active range of motion; LE = lower extremity; OT = occupational therapist/occupational therapy; PT = physical therapist/physical therapy; ROM = range of motion; SNF = skilled nursing facility; TSA = total shoulder arthroplasty; UE = upper extremity.