Magic of Teamwork – Key note

Hi All,

The below post is related to a topic which was part of the Conference / Workshop organized by Vasantham. Below are the details of the session:

Conference – Workshop cum conference on Best Practices in the rehabilitation of individuals with special needs
Topic – Magic of Teamwork
Date – 17th March 2023   11:30 am
Mode of Presentation – Offline Venue – Sengai Meenakshi Mahal, Mogappair, Chennai – 37
Speaker – Prof. Roopa Nagarajan, Audiologist & Speech – Language Pathologist.

Below are the points shared in the presentation:

At present the concept of Teamwork doest exist in the field of rehabilitation. Majority of the time all the rehabilitation professionals work in silos.

We have a concept of team that represents teachers, parents, OTs, SLPs, physiotherapists etc, but there is no Teamwork among them.

There is no “Magic” in team work, there is only “Hard Work” behind every team work.

It is extremely difficult to form a team that shares the same thought process, ideology , philosophy, ideas etc.. But even more difficult is making the team interact with each other.

Everybody in the team has a specific role which they have to play and at the same time they have to play the role together. She gave an analogy of a cricket team, where each player has a role. A batsman cannot perform a role of bowler or a spinner cannot perform a role of fast bowler, it will only lead to failure. Like how every player in a sports team has a specialized skill for them, but on top of it they all work together to achieve the common goal, which is to win the game. Similarly, a team of SLPs, OTs, Sp.Eds, etc each have a specialization and work on the child according to their specialization, but at the same time they have to work together in order achieve the goal i.e. progress on the child.

Every member of the team is different, have a specific goal, responsibility, specific skill, Capacity, defined role etc.. 

Within the team the role will be changing constantly, which needs to be embraced by everyone in the team. For example, if a child is very young, say less than 3 years, then the team leader for that child would be different, similarly if the child is around 5 years old, the team leader will be different and so on. Every one should obey the leadership change within the team. As a member of the team, we should know when we will play the role of a team leader and when we should work under another team leader. This is an issue by itself.

Most parents say that they are not a trained professional like an SLP, OT or PT or Sp.Ed, hence they cannot provide therapy to their child. Also they complain that their child does not even sit if they try to perform any activity with the child. They are more than happy to bring the child for 3-4 sessions for a week to a therapist than working with the child at home. A child spends 90% of the time with the parents; only less than 10% of the time in a day is being spent in therapy. Even in those therapy sessions parents stay outside and do not get involved in the therapy sessions. As a result they will never learn how the therapists are handling/managing the child, what strategies are used by them when things are not going as planned, how they are motivating the child, how they are ignoring behavior,  etc… This is a crucial skill which every parent needs which cannot be read from books, these are learnt only through observation as it is very specific for their child.

There is a school in Bangalore called “Institute of Mother and Deaf Child” which is for children with hearing impairment, where the mother has to accompany the child to school every day. The school had a very handful of special educators with them, it is the mother who does the training for the children. But the catch here is, every mother will not cater to their own child, they have to train another child. As the mothers began doing this, they realized the strengths and weaknesses they had in training the children, each mother took the responsibility in which they are good at. 

When a mother takes part in the therapy services, they will realize that they have the capacity to learn and change for their child. If motherhood is a gift given by god to a women, the mother becoming a teacher  is a best gift they can give for her child

The four characteristics of any team are GRIP:

1) Goal

2) Role and Responsibility

3) Interpersonal Relationship

4) Process

Goal

We must have a Goal. Childs need becomes the Goal. There can be a mix of short term and long term goals as well. Everybody in the team should know what that Goal is. Everybody in the team should understand and work towards achieving the goal. We should also specify the Criteria as to when the goal will be considered as achieved.

She gave an example:

A child who came for speech therapy sessions does not have sitting tolerance as he is extremely hyper, so he never sits down. The SLP did not provide any therapy to such child, she asked the parent to take the child to an Occupational therapist first, work on the hyper activity and behavior. This is an extremely wrong approach.

The speech therapist has to work with occupational therapists to achieve the goal, as the issue they are addressing is more on the physical movement, the occupational therapist will take the role of the Team leader until the goal of sitting tolerance is achieved. The speech therapist should be aware of what strategies occupational therapists are doing to resolve this and try to implement the same during her sessions with the child as well. In a childs development, nothing happens in phases, everything happens simultaneously. 

Role and Responsibility

Each member of the team must know what is their role and responsibility towards the goal and set specific goals in their area of expertise to achieve the common Goal. Also the specific goals that are set by therapists in their specialized areas have to be explained and justified to other members of the team. There may be occasions where the team leader will refuse to listen to the voice/opinions/ideas of other team members. By not listening to them, we may lose critical information that could have helped the child.

She gave an example,

she had a child who always sat under a chair during the therapy sessions for the entire duration. She saw this happening consistently for 4-5 sessions, later advised the parents that she cannot take therapy for the child as she cannot reach the child.  Upon investigating further, they came to know the child is also going to Special education classes elsewhere where this issue is not presented. So with the permission of parents, she spoke with the special educator to understand more about the child. The special educator mentioned that the behavior child is exhibiting happens whenever the child feels constipated. She has advised the parents to adjust the diet and routine, her system will be cleared, once that happens she will cooperate without any issue.

This is an amazing knowledge and critical piece of information which the special educator observed and advised the parents on. Later we also insisted on taking help from a nutritionist , set her system with a proper diet and routine to have a natural bowel movement. Child showed tremendous improvement post this on speech and other areas as well.

As a speech therapist, if i had not set aside my Ego and called the special educator, nothing would have been possible. It is important that teams communicate with each other.

Interpersonal Relationship

Teams often don’t work together as a result they fail. The primary reason why they don’t work together is due to Interpersonal relationships. Some of the reasons are:

1) Every professional is of the opinion they are more knowledgeable than the other

2) They also find faults or blame the other professional when the desired outcome/goal is not achieved.

3) They feel the other professional in the team does not listen to them

4) Push/Delegate the difficult tasks to the other professional.

5) They feel the other professional is ordering them to perform tasks i.e. For instance, you are just a special educator who are you to advise me (SLP) to do certain things or follow a particular approach for handling the child. I know how to do my work. 

Building interpersonal relationships are very difficult everywhere. For example, if you would have taken your schooling, out of 30+ children in your classroom you would have only had 2 or 3 best friends, remaining are just friends/classmates. With best friends the level of communication you have is different, because you need NOT put or express everything in words for them to understand, they will be able to tell you what you are thinking without any verbal cues, that is the level of Interpersonal relationship you have with them.

Process

For the goals and teams to work there has to be a process. There has to be a system in place so that every one can follow a sequence of events and act accordingly. No professional in the team should deviate from the fixed set of processes without consulting with others and providing a valid justification as to why they are deviating from the earlier agreed process. 

She shared her personal experience on this. When she was a student intern, she worked for a school in Hawaii called special education center. She was assigned a child who was 14 years old and non verbal. The school had 60-70 such children in the school, for each child they have done a detailed assessment on various aspects including the different behaviors the child has and the response that works for that particular child. So each child has a file which runs up to 20-30 pages containing every detail required to handle that particular child. For example, what words and Phrases you need to use while addressing the child (some children does not like to hear NO, they get triggered) , for some children you should use only childs right hand to handle or support them, etc.

As a student she felt the approach followed by the school was totally crazy, as every child had a rule book and she needed to learn each rule book when handling that child. There is a supervisor who is assigned to her, who observes her sessions and gives a report at the end. The report contains the mistakes happen during the session. She never thought that she would be able to read and do this for each and every child out there, as it is challenging for her memory. But after the course of one week, she was able to do what the others were doing, which helped the child a lot. When you work in a team, at times you have to do what is in the best interests of the child.

The system followed by the school worked because the teacher, special educator, therapists, caretakers, bus drivers etc, use the appropriate language and behavior when handling such children.

All of us have a collective responsibility in helping the child. When we achieve something all of us celebrate, when we do not achieve something we take collective responsibility, instead of finger pointing/blaming others, We work towards how to fix the issue.

If all this (GRIP) happens, the Magic of teamwork will happen. Even though it has its practical difficulties, it is my wish that when this happens, everyone will be brimming with Joy. Each one’s success is everybody’s success.

My Personal Feedback

This is the welcome note or key note address by the chief guest of the conference. I was happy that there was no power point presentation, at times instead of being informative they tend to be a distraction. She was very direct to the point, did not mince words. Openly spoke about the challenges happening in the world of rehabilitation professionals which is preventing them in providing better care to the children in need. What she said happens in every field, it will continue to happen, as these professionals are people first, they will have the drawbacks of every human. There has to be a strong leadership to ensure that what happens in a professional work place are as per the guidelines. process, policies laid down and nothing happens as per wishes and directions of any specific individual. Irrespective of age, every one does their work well, when there is some one to enforce the rule, administer and supervise. Also mistakes when made are to be punished and not tolerated, similarly hard work and positive results are to be rewarded to motivate the professional.

Every Intervention plan and Home program needs to be reviewed by the entire team (SLP, OT, Sp.Ed, Physio etc.), before it reaches the parent. Months wasted by an incorrect intervention plan is the time lost that will never be gained.

Regards,

Saranya and Karthikeyan