Team teaching of the multidisciplinary approach

Team Teaching of the Multidisciplinary

Approach

S. Ludwig, M.D. Assistant Professor of Pediatrics, University of Pennsylvania School of Medicine, Educational Coordinator, S.C.A.N. Center, Philadelphia General Hospital, Philadelphia, Pennsylvania, U.S.A.

The multidisciplinary approach to management of cases of child The beneabuse/neglect has been widely advocated (1,2,3,4,5). fits of such an approach have been evident within the Supportive Three Child Adult Network (SCAN Center) in West Philadelphia. of the five hospitals affiliated with the Center have had functioning multidisciplinary teams, the first since 1971 (6). Recently, the Commonwealth of Pennsylvania has revised its child abuse law (7) to include that the local child protective agency include multidisciplinary teams 'I...for the purposes of developing and implementing treatment plans for abused children and their families." The teams currently functioning meet on a regular basis (two of the teams weekly), and their tasks can be enumerated as: 1) information sharing; 2) decision making; 3) planning; 4) education; and 5) providing mutual support. The teams consist primarily of hospital personnel, both "on-line" workers and consultants, and a representative of the Department of Public Welfare. Interested workers from other agencies may be invited for the discussion of a particular case. The multidisciplinary teams, as in the case of any group, go through the stages of an evoluThe tionary process until all the workers become comfortable. result is an efficiently functioning group whose members seem highly satisfied with this mode of operation. New members to the group may find it difficult to establish themselves in this setting because of their inexperience with the multidisciplinary team and its functioning. One of the objectives of the SCAN Center is to provide training programs about child abuse/neglect to hospital personnel, community workers, students within affiliated institutions and to other local agency personnel and community groups. Through our academic affiliation with the University of Pennsylvania, we were given the unique opportunity to attempt to teach information about child abuse/neglect and to convey the advantages we perceived in using a multidisciplinary approach. The teaching

381

Ludwig

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of a course to professional fied many of the innovative attitudes, and skills.

and pre-professional ways of communicating

students exempliinformation,

The Interdisciplinary Health Care Committee of the University of Pennsylvania* sponsored a fully accredited 13-week semester tours e . Students were recruited separately by the Schools of Social Work, Medicine, Nursing, Allied Medical Professions, and The class size was 20, with nearly equal representDentistry. Students varied in their level of training. ation by profession. For example, the social work students were in postgraduate training, while those in allied medical professions were undergraduate. The nurses enrolled were from pre-degree, advanced degree, and faculty levels. Ten students were in placements or were employed in settings where they might have some contact with the problem of child abuse/neglect. Each professional school established its own rules for credits, grading, and registration to be compatible with the standards of the more traditional curricula. The faculty started several months before the start of the Like the stusemester with the formation of a planning group. dents, the faculty represented several occupational categories, including nurse, psychologist, pediatrician, occupational therafamily workes (lay therapist concept), and social worker. pist, a mental health facility, This group represented two hospitals, the local Department of Public Welfare Protective Services DiviAll of the individuals in the plansion, and the SC&V Center. Most of ning group had worked together on an actual case basis. the planners were also members of functioning multidisciplinary The planning group met on several occasions and formuteams. lated the topics in the course curriculum, discussed effective enlisted additional faculty members, deterteaching techniques, mined course requirements, and established a list of suggested readings. 1) to conThe final curriculum established had four main goals: vey information about the phenomenon of child abuse/neglect; 2) to stimulate the students to examine and modify their feelings to teach some practical human interand attitudes ; 3) to begin action skills; and 4) to demonstrate and thereby promote the The topics listed advantages of the multidisciplinary approach. for weekly discussion were as follows: Student Session 1. starting point. What is Session 2. operational, sonal, Societal Session 3. societal legal view.

attitudes

and expectations

child abuse? and legal. view of child

Definitions abuse

* The author acknowledges his appreciation to mittee, Betty Bassoff, ACSW, School of Social Coordinator.

- the - per-

- evolving

the members of Work, Executive

com-

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Team Teaching of the Multidisciplinary Approach

Session 4. Family dynamics. Session 5. "The Abusive Parent." Session 6. The family and helping contacts. Session 7. Evaluation of the family - the parent. Session 8. Evaluation of the family - the child. Session 9. Decision making. Session 10. The legal court system. Session 11. Organizing a community response. Session 12. Community resources - what's available what's needed. Session 13. Review - evaluation.

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The faculty group was widened to include three lawyers and a Each class was taught by more than one proFamily Court Judge. fessional, and there were always several other faculty members on hand as resource persons. All the faculty used an informal style which encouraged maximum participation by colleagues and students. The teaching techniques varied from week to week. There was major emphasis on role-play in order to convey the feelings of the parent, the child, the interviewer, and the court room witness. At times, students were asked to role-play professionals in disciplines other than own. Invariably, this resulted in the projection of rather stereotyped characters. Such presentations provided a chance to examine attitudes and to gain appreciation for the subtle difficulties of another's position. Particularly effective was the assignment of being placed in the parent role and feeling the stress of "professional intervention." Other teaching techniques used included small group work sessions, group discussion, panel presentation, didactic lectures, and audio-visual presentations. The course First was an assignment required three important field visits. to observe a family. This was included to encourage students to critically view family interaction and to report on their observations. The field visit was integrated into the sessions on family evaluation. The second field visit involved attending a multidisciplinary team meeting at one of the hospitals. This was integrated with the class session on decision making. The final obligatory visit was to attend a session of the Family Court.* This too was integrated with a classroom presentation. Available also were optional field visits to get a more in-depth view of the hospital emergency department, occupational therapy, the protective service worker and others. The students were given a pre-and-post test** which sought information about both their attitudes and their knowledge about child

* To Hon. Nicholas A. Cipriani, Judge of the Family Court Division of the Court of Common Pleas, and Alice Tuohy O'Shea of the Child Advocacy Unit of the Defender Association of Philadelphia, sincere thanks for their roles in guiding the students through the court experience. ** Instrument for measurement developed by Harold Whitney, chologist with Get Set Dav Care Proiect, Philadelohia.

psy-

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S.

abuse. This was strongly disagree) tions were:

a simple paper

1) Parents from their 4) Child lenient

Ludwig

S-point scale (strongly agree to and pencil exercise. Some sample

have a right children.

abuse would be with adults who

27) A child subjected appear retarded.

to

to

expect

complete

eliminated if assault little

ques-

obedience

judges were children.

less

prolonged

undetected

29) Very few abusing parents are adequate care for their children help and treatment.

capable of even with

37) Wait until all a suspected case ties.

known before reporting to local welfare agen-

the facts are of child abuse

abuse

can

providing professional

There was a significant improvement in the scores at the conclusion of the course (p=.Ol using a pre-post test calculation). Of 18 students who completed both tests, 16 improved, one made and one declined in score. The greatest increment in no change, score was made by the medical students (x change 23.7) who started from the smallest base score (raw score x = 37.3). The least increment was made by the nursing students (x change 4.5) The students who had the highest base score (raw score x = 68). were given an open-ended course evaluation form in which they were asked about any value seen in having a course with students from other disciplines. For almost all students, this was the only course in their professional training where there were such The value students. All 20 students responded affirmatively. was stated in the following ways: 1)

heard

different

points

of

2) learned about unique as faced by other professionals; 3)

learned

different

4)

sharpened

one’s

5)

saw

professionals

6)

learned

other to

work

view

well

approaches own

role

and as and

attitudes;

shared

problems

techniques;

; as

resources;

together.

In 17 of The students stated their expectations of the course. these expectations were fully met and in two partially met. 20, Again in response to an open-ended summary question, ten of 20 students remarked that the course provided them an opportunity for broadening personal growth and views.

Team

Teaching

of the Multidisciplinary

Approach

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SUMMARY If the multidisciplinary approach is to be an important element in the care of abused/neglected children and their families, professionals and para-professionals will need to learn how to function within its context. This paper has described one innoThe technique described vative way of teaching this approach. seems to have been successful by several measurable standards. The elements which seem to have had a positive contribution to 1) the use of a multidisciplinary planning this success are: group and faculty which was a multidisciplinary task-oriented group itself; 2) a heterogeneous group of students; 3) the frequent presentation of multidisciplinary role models; 4) varied teaching techniques which stressed classroom interaction, roleThe course approval has been renewed play, and field visits. and will be offered again in the 1976-77 academic year. ACKNOWLEDGEMENT The findings reported in this paper reflect the work of many dedicated workers at the Children's Hospital of Philadelphia, Child Guidance Clinic of Philadelphia, Philadelphia General Hospital, Philadelphia Department of Public Welfare, Presbyterian-university of Pennsylvania Medical Center, Hospital of the University of Pennsylvania, and the SCAN Center. These individuals went beyond their respective roles to become excellent teachers.

REFERENCES (1) H. Delnero, J. Hopkins, and K. Drews, The medical center child abuse consultation team, Helping the Battered Child and His Family C. H. Kempe and R. E. Helfer, Eds., J. B. Lippincott, Phjladelphia, 1972. (2) D. S. Rowe, M. S. Leonard, et al., A hospital program for the detection and registration of abused and neglected children, New Eng. J. of Med. 282, No. 17, 950 (1970). (3) E. N. Joyner, Child abuse: the hospital, Pediatrics

The role of the physician and 51, 4 Part II, 799 (1973).

(4) F. C. Green, Child abuse and neglect, a priority problem for the private physician, Ped. Clin. North Amer. 22, 2 (1975). (5) E. H. Newberger, J. J. Hagenbuch, et al., Reducing the literal and human cost of child abuse: Impact of a new hospital management system, Presented at Annual Meeting of the American Pediatric Society in May, 1972.

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(6) E. P. Wilson and D. R. C. Hilbert, A hospital team approach to child abuse, Philadelphia Medicine 69, 419 (1973). (7) Pennsylvania "Child Protective November 26, 1975.

Services

Law" Act 124,