Interdisciplinary collaboration in the Veterans health care sector - Final

Serving OIF/OEF/OND Veterans through Collaborative Practice: Implications for EducationMICHAEL CLARKSON-HENDRIX, PHD

JOHN CARROLL-BARBUTO, PHD

BackgroundThe skills necessary for proficient social work practice in the Veteran health care sector (VHCS) are in the midst of change (ACA/PACTs)

Interdisciplinary collaboration – A multidimensional construct – is the new norm

The needs of OIF/OEF/OND Veterans as a war cohort

What, if any, connection is there between the amount of time serving this war cohort and various features of interdisciplinary collaboration?

Purpose1. Look for potential associations between the percentage of time

social workers spend working with Veterans and their perceptions of interdisciplinary collaboration

2. Explore VHCS social worker perceptions of practice with this population

3. Explain significant associations using social worker perceptions of practice with this population

MethodsMixed methods design (Survey and Interviews)

Survey sample (N = 21; 31% completed survey)◦ Voluntary and snowball sampling

◦ 81% Female, 95% White, 86% Direct practitioners

Interview sample (N = 13)◦ Voluntary and snowball sampling

◦ 10 Female, White, most direct practitioners with a couple of supervisors

Qualitative data collection◦ Interview guide with specific probes as needed

◦ Tape recorded and transcribed

MeasuresInterdisciplinary collaboration - Index of Interdisciplinary Collaboration (Bronstein, 2002)◦ Five subscales representing components of interdisciplinary collaboration

◦ Responses: 1 = strongly disagree to 5 = strongly agree

Percentage of time working with OIF/OEF/OND Veterans and/or returning service members◦ “Which of the following choices best represents the percentage of time you work with

Operation Iraqi Freedom (OIF) Veterans and/or returning service members?” (Adapted from Beder, Postiglione, and Strolin-Goltzman, 2012)

◦ Responses: 0% to 100% in increments of 10%

Data analysisQuantitative analysis◦ Univariate analyses to assess normality and scale reliability◦ Bivariate analyses to test significance of associations between percentage of time

working with OIF/OEF/OND Veterans and Index of Interdisciplinary Collaboration subscales

Qualitative analysis◦ Thematic analysis

Mixed methods analysis◦ Explain associations using themes

Quantitative results – Descriptive statistics (N = 21)

Variables Mean (SD) Range

Interdisciplinary Collaboration (IIC)

Interdependence (thirteen items; α = 0.81) 4.08 (0.50) 2.54-4.62

Newly created professional activities (two items; α = 0.71) 3.88 (0.69) 2.50-5.00

Flexibility (two items; α = 0.71) 4.13 (0.86) 1.50-5.00

Collective ownership of goals (eight items; α = 0.74) 3.71 (0.49) 2.38-4.50

Reflection on process (ten items; α = 0.79) 3.65 (0.49) 2.60-4.40

Percentage of time working with OIF Veterans 27.14 (17.92) 0-70

Quantitative results- Bivariate associations

Interdisciplinary collaboration

Interdependence

Newly created professional

activitiesFlexibility

Collective ownership of

goals

Reflection on process

Variable r r r r r

% OIF Veterans

0.14 0.05 -0.06 0.41 0.46*

*p < .05

Qualitative results – Characteristics of work with OIF/OEF/OND Veterans and/or returning service members

Addressing frequent high acuity in behavioral health conditions

“Every time I’ve worked with a younger veteran it is much more intense; it’s more traumatic. I think it’s a couple things, so one thing I think it is based upon is

the fact that they are fresh out of war.”

Qualitative results – Characteristics of work with OIF/OEF/OND Veterans and/or returning service members

Containing and managing overwhelmed patients by targeting services based on Veteran need

“They are just overwhelmed. They're getting back. They think like in their head they have a plan maybe set up in their minds so they often brush off some of

the (transitional) services.”

Mixed methods resultsFrequent high acuity pushes attention to the process of working together in interprofessional health care teams

Containing and managing overwhelmed OIF/OEF/OND Veterans and/or returning service members inclines members of interprofessional health care teams to streamline their work together

LimitationsSmall non-stratified sample

Non-specific effects (PACTs)

Single coder for qualitative interviews

ConclusionsPercentage of time working with OIF/OEF/OND Veterans and/or returning service members was positively associated with the reflection on process subscale.

Frequent treatment of high acuity with overwhelmed Veterans and/or returning service members push interprofessional health care team members to discuss strategies to make more efficient their process of working together.

Implications for educationTeach skills in talking successfully with colleagues about interprofessional working relationships

◦ How to give and receive feedback to other professions to improve interprofessional efficiency and effectiveness

Teach skills in assessing and treating chronic high acuity in behavioral health conditions

Teach skills in managing overwhelmed clients◦ Social worker as broker in a complex service system

*This research was conducted at Stratton VA Medical Center, in Albany, NY. The opinions and findings expressed here are not those of SVAMC or the VHA. Michael Clarkson-Hendrix had a VA appointment at SVAMC at the time of this study. John Carroll-Barbuto is an employee of SVAMC at the time of this study. The study was approved by the SVAMC IRB.