What is Collaboration and how to use it.

1
What isCollaborationand how to use it.

• Plus Consultation
• and Collateral Contact,
• and how all three fit together.
• For DDAs and partner providers. Specific to
  Idaho
• (Please speak directly with Medicaid about
  billing questions.)

2
The Sense of the Goose
In the fall when you see geese heading south for
the winter flying along in the "V" formation, you
might be interested in knowing what science has
discovered about why they fly that way. It has
been learned that as each bird flaps its wings,
it creates an uplift for the bird immediately
following. By flying in a "V" formation, the
whole flock adds at least 71 greater flying
range than if each bird flew on its own. People
who are part of a team and share a common
direction get where they are going quicker and
easier, because they are traveling on the thrust
and trust of one another.
3
Whenever a goose falls out of formation, it
suddenly feels the drag and resistance of trying
to go through it alone and quickly gets back into
formation to take advantage of the power of the
flock. If we have as much sense as a goose, we
will share information and adjust or make
necessary changes with those who have the same or
similar goals. When the lead goose gets tired,
s/he rotates back in the wing and another goose
takes over. It pays to share leadership and
take turns doing hard jobs.
4
The geese honk from behind to encourage those up
front to keep their speed. Words of support,
encouragement, and inspiration help energize
everyone, helping them to keep pace in spite of
the day-to-day pressures and fatigue. Finally,
when a goose gets sick or is wounded by a gunshot
and falls out, two geese fall out of the
formation and follow the injured one down to help
and protect. If we have the sense of a goose,
we will stand by each other when things get
rough, and even when they are not.Author Unknown
(some alterations from the original.)
5

• Collaboration is required by rule.
• People often talk about collaboration.
• Research tells us that it is important and often
  essential for significant, lasting progress.
• But what is it?
• Is it Communication???

6

• Communication usually falls within one of four
  basic levels.  
• Damage Control
• Education
• Input/Feedback
• Collaboration
• Problems usually arise when
• More communication was needed than used, and
• When some of those involved say they are doing
  one level and in reality are doing another.

7

• 1 Damage Control  
• This often happens when
• Someone assumes that less communication and/or
  collaboration was needed than really was
• or just thought they could get away with less.
• There are critical errors, accidents, unnecessary
  barriers, or wasted time/money.  
• This also occurs when the individual/organization
  says/thinks it is doing one level and is actually
  doing another.  This is not collaboration and is
  usually a bad thing

8

• 2 Education
• This level of communication is often used by
  organizations and agencies.
• Information is shared
• With a release when confidential
• As public awareness or marketing, through
  outreach and advertising, and
• whatever motivation through whatever means anyone
  can come up with  This isnt collaboration
  either

9

• 3 Input/Feedback
• This is not only helpful but often required by
  rule.
• This may take place through
• surveys,
• assessments,
• discussion groups.
• etc
• This isnt collaboration

10

•  4 Collaboration
• Sometimes it is important to not only share and
  collect information, but also to share goals,
  decisions, ownership, plans, responsibility, and
  accountability.
• Collaboration allows for and encourages all of
  this.  
• It assures that everyone working with the child
  is on the same page.
• It allows for one plan to support another for
  the greater benefit of the child and family.
• In some situations it even allows for one
  umbrella plan with additional supporting plans.
  It discovers solutions and expands capacity for
  the child and family.  This could be it

11
Levels of Authority

• When there are assignments, it is imperative that
  everyone understand their level of authority and
  responsibility, to include who is responsible for
  what, when?
• This is part of good, honest, effective
  communication and collaboration.
• So what in the world does this have to do with
  our topic????
• http//www.collaboration.me.uk/LEVELS_OF_AUTHORITY
  .php

12
One size does not fit all.

• Collaboration comes in many shapes, sizes, and of
  varying duration.  It may not make sense to
  develop a broad in-depth collaboration when a
  short term coordinated effort is all that is
  needed and more efficacious.  
• For example, networking/communication may be all
  the is required to receive important information
  from a hospital about a past stay.
• Collaboration sometimes develops in developmental
  stages which may include
• and will be discussed with an activity.

13
1. Competition

• Channeled and in the right situation, can help
  groups or individuals stretch themselves and
  excel.
• can support and encourage creativity.  For
  example, competition is an important aspect of
  Special Olympics and through honest dialogue, a
  conflict of opinion resulting in consensus can
  create remarkable solutions.
• in order to achieve true success, there must be a
  balance between competition and cooperation and
  at times even collaboration.
• Competition does not need to mean that you want
  the worst for someone else, just the best from
  yourself. This is not
  collaboration

14
2. Networking/Communication

• As information begins to be shared and
  communication increases, it benefits everyone.  
• There may be more of an interest in gaining
  information than sharing at this stage.  
• Trust will develop as more information and
  resources are shared for the benefit of all.  
• This isnt collaboration, it could be collateral
  contact

15
3. Cooperation/Coordination

• Information sharing becomes more formalized with
  structure and agreements (though individual
  interests are maintained).  
• More resources are shared and duplication is
  limited.
• Coordination Formalized sharing of resources,
  information, and some common goals.
• This isnt collaboration, it could be collateral
  contact, it could be consultation

16
4. Coordination/Partnership

• Resources are gathered to create, discover, or
  access, new resources.  
• The management of resources is progressively
  shared, becoming mutually beneficial, increasing
  resource capacity for everyone.  
• This is a more formal and structured relationship
  with signed agreements, to include resource
  management.  
• In many good partnerships a partner is as
  concerned about their partner's success as their
  own.
• This still isnt collaboration however were
  starting to get warmer, this could be a part of
  both consultation and collateral contact

17
5. Coalition  

• Leadership decision making is shared by all
  through a direct democratic or an indirect
  representative process.  
• Decision making and communication are formalized
  and clear.  
• More resources are developed, created, and
  discovered for the benefit of everyone in the
  coalition. 
• (This stage may not be as applicable in the some
  settings. May be similar to a co-op.) This
  still isnt collaboration. We are still getting
  warmer

18
6. Collaboration

• Written goals are shared by all involved.  
• All interventions are integrated synergistic
  (The whole is greater than the sum of the
  individual parts).
• Communication relationships are strong clear.
   
• The team shares a strong sense of purpose,
  accomplishment, responsibility, accountability.
   
• Strengths resources, are shared created
  significantly amplified through the collaborative
  process.  
• Collaboration Shared vision, mission, power,
  resources, goals. This could be it

19
To build collaboration

• Take responsibility and give credit.
• (This is only one of many concepts that help to
  build collaboration).

20

• For treatment collaboration
• Everyone providing treatment and/or care for the
  child would be on the same page.
• Plans and interventions would be mutually
  supportive. (This requires close and ongoing
  communication and dialogue.)
• Plans would be supportive for the child and
  family.
• In some situations there may be an umbrella plan,
  such as the IFSP.

21

• For example A child who receives speech therapy
  from an SLP and communication and behavioral
  therapy from a developmental therapist
• The parent, speech therapist and developmental
  therapist would dialogue and plan the
  interventions. The intervention provided by the
  SLP would support the needs, interests and
  resources of the parent and child as well as the
  behavioral plan from the developmental therapist.
  etc.

22
To Build Collaboration

• Communicate "Real listening shows respect. It
  creates trust. As we listen, we not only gain
  understanding, we also create the environment to
  be understood. And when both people understand
  both perspectives, instead of being on opposite
  sides of the table looking across at each other,
  we find ourselves on the same side looking at
  solutions together". Stephen R. Covey

23

• Consultation
• Families are a lot like a hanging mobile, when
  one piece is pulled to a new position as soon as
  the pull stops, family dynamics and equilibrium
  return the individual back into balance with the
  family.
• Overwhelming research demonstrates that the
  best intervention and often the only lasting
  intervention must involve the family and
  sometimes can not occur effectively without the
  family learning new ways to interact and at times
  even act as co-therapists .

24

• Comparison of Collateral Contact and IBI
  Consultation

25

• 724. COLLATERAL CONTACT.
• Collateral contact is consultation with or
  treatment direction given to a person with a
  primary relationship to a participant for the
  purpose of assisting the participant to live in
  the community. Collateral contact must ( )
• 01. Conducted by Agency Professionals. Be
  conducted by agency professionals qualified to
  deliver services and be necessary to gather and
  exchange information with individuals having a
  primary relationship to the participant. ()

26

• 724. COLLATERAL CONTACT.
• 02. Face to Face or by Telephone. Be conducted
  either face-to-face or by telephone when
  telephone contact is the most expeditious and
  effective way to exchange information. Collateral
  contact does not include general staff training,
  general staffings, regularly scheduled
  parent-teacher conferences, general parent
  education, or treatment team meetings, even when
  the parent is present. ( )

27
724. COLLATERAL CONTACT.

• 03. On the Plan of Service. Have a goal and
  objective stated on the plan of service that
  identifies the purpose and outcome of the service
  and is conducted only with individuals
  specifically identified on the plan of service.
  Program Implementation Plans are not required for
  collateral contact objectives. ( )

28
804. IBI CONSULTATION.

• Professionals may provide IBI consultation to
  parents and other family members, professionals,
  paraprofessionals, school personnel, child care
  providers, or other caregivers who provide
  therapy or care for an IBI eligible child in
  other disciplines to assure successful
  integration and transition from IBI to other
  therapies, services, or types of care. IBI
  consultation objectives and methods of
  measurement must be developed in collaboration
  with the person receiving IBI consultation.

29
804. IBI CONSULTATION.

• 01. Service Delivery Qualification. IBI
  consultation must be delivered by an IBI
  professional who meets the requirements in
  Section 420 of these rules. ( )
• 02. Measurable Progress. IBI consultation must
  result in measurable improvement in the child's
  behavior. It is not intended to be used for
  educational purposes only. ( )

30
804. IBI CONSULTATION.

• 03. Evidence of Progress. Persons who receive
  IBI consultation must meet with the IBI
  professional, agree to follow an IBI
  Implementation Plan, and provide evidence of
  progress. ( )
• 04. Individualized. IBI consultation may not be
  reimbursed when it is delivered to a group of
  parents. IBI consultation is specific to the
  unique circumstances of each child.

31

• Collateral Contact is delivered by a variety of
  professionals to people who have primary
  relationships with a child eligible for DDA
  services.
• IBI Consultation is delivered only by IBI
  Professionals to children eligible for Intensive
  Behavioral Intervention (IBI).
• Some of the similarities and differences between
  the two services are described as follows

32

• Similarities
• Collateral Contact and IBI Consultation
• Promote generalization and coordination within
  the childs natural environments.
• Are delivered to persons with a primary
  relationship to the child.
• Require a goal and objective authorized in an
  Individualized Program Plan.
• Are specific to each child and may not be
  reimbursed for group training.
• Are not included in the 22 hour/week limitation
  under the Medicaid state plan that includes
  Developmental Therapy, IBI, and other therapies
  provided by the DDA.

33
Differences
IBI Consultation must result in measurable
improvement in a childs skills and positive
behaviors for continued authorization.

• Measurable improvement is not required for
  Collateral Contact.

34
Differences

• Collateral Contact may be provided by any DDA
  professional.

IBI Consultation may only be provided by an IBI
Professional.
35
Differences
The IBI Professional is responsible to develop
an IBI Implementation Plan that the person
receiving IBI Consultation can carry out, develop
a data collection method for that person, and
assure that the person receiving IBI
Consultation knows how to carry out the
Implementation Plan and collect data.

• The professional delivering Collateral Contact is
  not responsible to assure that the person
  receiving collateral information will carry out
  an Implementation Plan and collect data.

36
Differences
The person receiving IBI Consultation must
collect data and report back to the IBI
Professional on a regular basis about the childs
progress.

• The person receiving collateral contact doesnt
  have to collect data for the professional.

37
Differences

• Collateral Contact doesnt require an
  Implementation Plan.

IBI Consultation requires an Implementation Plan.
38
?

• Collateral contact under developmental therapy
  can serve a similar function and provide a
  similar benefit as consultation under IBI.

39
So what does this mean?

• How can we use collateral to improve outcomes for
  children and families?
• How can we use consultation to improve outcomes
  for children and families?
• How can we use collaboration to improve outcomes
  for children and families?
• What are you going to do differently?

40
RECAP
41

• The 2 Cs of Success

42

• Consultation Family members are the most
  important members of the therapy team.
• Intensive Behavioral Intervention (IBI) is a
  short-term program (36 months) designed to
  develop positive behaviors through direct,
  individualized intervention and through teaching
  parents (and other caregivers) hands-on skills to
  successfully manage the childs problem
  behaviors. IBI Consultation is provided by an
  IBI Professional to teach caregivers (e.g.,
  parents, daycare/school personnel) how to
  implement IBI techniques.

43

• By learning and utilizing therapeutic techniques,
  parents gain critical hands-on skills in managing
  difficult behaviors that may not respond to
  typical parenting methods. These skills will
  carry forward, empowering families to manage
  behaviors long after the child is finished with
  any particular services.
• When all caregivers use the same techniques, the
  consistency developed will ensure that problem
  behaviors will be reacted to in a similar manner
  across all settings - results will be much more
  successful.

44

• Permanent changes in a childs behavior requires
  repetition and positive reinforcement - isolated
  treatment by a therapist is much less likely to
  make a significant, long lasting difference.

45

• Collaboration Getting everyone on the same
  page, with individual input, and in full support
  of the plan.
• Through collaboration, we ensure the same
  methods are being used across settings. For
  example, if a certain communication method (e.g.,
  PECS, signs) is being taught and used in one
  setting, by collaborating we make sure all
  settings use this same system.

46

• Collaboration refers to therapists working with
  parents and other therapists, teachers or
  caregivers to ensure consistent therapy goals and
  methods. The consistency gained through
  collaboration will reduce confusion and
  frustration for the child.

47

• Consultation and Collaboration can make a
  tremendous difference in your life and the life
  of your child. Consistency between people,
  environments and methods will help to
  successfully generalize and maintain improvement
  in behavior, promote integration, and transition
  from one intervention to other therapies,
  services, or types of care.
• Ensure the 2 Cs are in place.
• Remember to use collateral in lieu of
  consultation when needed.

48
Now that we understand Collaboration better

• How do you collaborate with parents?

49

• Who should be involved in the collaboration
  regarding a childs treatment and/or intervention?

50

• Given the group of people just mentioned
• What would this collaboration look like?
• How could you help assure it happens?
• What difference might it make?

51
How do we document accurately?
52

• Any more questions?