We invite you to join us as we talk about practical, actionable steps towards improving collaborative care through the lens of case study examinations. See you at the sessions!

Let's talk about ideas, challenges, and collaborative solutions in the world of rehabilitation medicine.

What are Case Study Sessions?

One-hour live discussions between people of different disciplines that examine and discuss a case study from a collaborative, interdisciplinary perspective.

What's the goal?

To promote critical thinking and discussion. We believe that there are no "right" answers when it comes to patient care. Rather, there are a million shades of grey and we must be open to being comfortable with uncertainty and curiosity. These sessions promote thoughtful, complex dialogue about the many ethical, moral, societal, spiritual, and cultural dimensions that are a fundamental part of the care and recovery of human lives.

Who is in on the discussion?

Each session hosts two guests, each from different disciplinary backgrounds who come together to dissect a case study.

Where can I watch?
How can I participate?

Sessions are hosted live via Zoom with the opportunity to participate in the discussion as our guest. The recorded versions are made available on YouTube.

Register now

Upcoming Case Study Session:

Alejandro: Social services in the context of rehab therapy- who gets to decide what is safe?

Date: Thursday, October 28, 2021
Time: 4:00 pm pacific | 5:00 pm mountain | 6:00 pm central | 7:00 pm eastern
See what time this is in your time zone around the world
Platform: Zoom

Free registration required.
Registrants will receive link to join us for the live event as well as link to recorded version.

Case Study: Sarah
Note that all case studies are 100% fictional.

Alejandro is a 55 yo male who was first diagnosed with Parkinson’s at the age of 48. He was taken to the emergency room due to a fall in his home that resulted in mild head trauma as well as a broken wrist. A friend hadn’t heard from him in a couple of days and found him on the floor. After his acute stay in the hospital, he was taken to a post-acute care facility. While working with a team of speech, occupational, and physical therapists, the therapy team learns that he has no running water at home and that he uses a bucket for a toilet. He has a dog that he has been unable to get outside recently and so urine and feces has been collecting in the house. Alejandro is also worried about his dog and is wondering if anyone is taking care of him. When asked what he eats at home, it’s unclear if he has consistent access to food. He is quite private and is wary of others entering his home and is not willing to do a home eval. He wants to go home as soon as possible.

In this case study we will discuss:

  • How SLP/OT/PT can be an advocate for social services.
  • The revolutionary Community HUB model.
  • How to build relationships with social workers.
  • Privacy/patient-choice and community assistance. At what point do we need to respect people’s wishes, even if that puts them in a high risk situation?
  • How our social service system works and what we can do to make it better.

Featured Interdisciplinary Guests

Emily LoPiccolo, Licensed Independent Clinical Social Worker (LICSW)

Megan Berg, SLP

Emily LoPiccolo received her Masters in Social Work from Boston College in 2015, and has been a Licensed Independent Clinical Social Worker (LICSW) since 2018. She is currently employed as a Clinical Manager within the Addictions Division at North Suffolk Mental Health Association in Boston, Massachusetts. Emily supports a dual diagnosis co-occurring enhanced residential treatment program and outpatient addiction services. She is also embedded in the communities of Chelsea and East Boston, where she provides community oversight and outreach to high risk individuals as part of an interdisciplinary treatment team. Additional special interests of hers include trauma and racial justice.

Megan Berg is the founder of Therapy Insights.

Live session details:

  • Platform: Zoom meeting.
  • You must be signed in to Zoom to enter the discussion room.
  • We welcome participation! Your video and microphone must be turned on to ask a question or participate in the discussion. You are welcome to join and leave your camera off. The video will be recorded and Therapy Insights retains all rights of use.
  • The discussion will last about an hour.
  • A recorded version will be made available.
  • This is a safe space and we take that seriously. Any hate speech, bullying, or aggressive behavior will not be tolerated and anyone in violation will be removed from the Zoom meeting.

Past Case Study Sessions

Case Study: Emily
Note that all case studies are 100% fictional.

Emily (name changed from Sarah) is a new clinician and just started her first job at a skilled nursing facility with an attached post-acute care wing. She is thrilled to have this job and excited to begin her new career in rehabilitation therapy. The first few months went really well as she got trained and acclimated to her job, but now she is facing increasing pressure to meet a productivity requirement of 90%. As each week passes, she feels less and less capable of her job because her manager is writing down her productivity percentage on a sticky note and leaving it on her desk each morning. Throughout the day, she struggles to find ways to increase her productivity. She finds that the only feasible way to do this is to fudge the number of minutes that she is spending with patients by billing for time she spends looking for them. This makes her feel slimy, but she doesn’t know how else to achieve 90% without clocking out for bathroom breaks and paperwork sessions. All of the other clinicians seem to be able to achieve it, so why can’t she? After a few months, she starts to dread going into work. Seeing the sticky note at her desk each morning makes her feel frustrated, resentful, and unappreciated. Fudging her billable minutes makes her feel like a fraud, and she starts to notice other slides in ethical decision making, such as ignoring an urgent call light or telling a family she doesn’t have time to talk with them because she knows she can’t bill for that time. She is starting to wonder if she made a mistake with this career choice. After work, she is turning to more and more coping strategies, including drinking more than she ever has each night, binge-watching TV, and venting about her job to whoever will listen. She does not feel that it’s safe to bring up the topic of productivity with her boss because anyone else who has tried to do so only has stories of how badly the conversation went. She feels stuck, ashamed, and burned out.

Results of the survey referenced

75% of participants reported that their productivity is measured.

17% required to get less than 50%

17% required to get 71-80%

50% required to get 81-90%

25% non-profit

75% for-profit

50% locally owned

50% non-locally owned

Featured Interdisciplinary Guests

Shelby Midboe, Union Representative

Ashleigh Kearney, RN, union member

Megan Berg, SLP

In this case study we discuss:

  • Productivity and where it came from.
  • The landmark switch to PDPM.
  • The residual crisis: Why productivity still exists in PDPM.
  • Point of care documentation- the pros and the cons and why this isn’t a solution.
  • Collective hands in the air: SNF brain drain, lack of cohesive solution, and... are unions the answer?
  • 5 things therapists can do to push back and turn the conversation in a different direction.
  • 5 ways leaders can communicate how they value employees beyond a productivity number.
  • The future of rehab medicine and how we measure efficacy of clinicians: What we want to see if we could wave a magical wand.

Case Study: Anju
Note that all case studies are 100% fictional.

Anju is a 62 year old female s/p anterior spinal surgery. Per MBSS report, she is aspirating on thin liquids. Various strategies were trialed. The only successful strategy was small sips, which reduced the risk, though did not completely resolve it. The evaluating SLP did try nectar thick liquids, which did resolve the risk of aspiration. The report concluded that the patient should be on a softer diet with nectar thick liquids. Anju is unhappy with this and does not want to drink thickened liquids. She is dehydrated and at risk for UTI.

Featured Interdisciplinary Guests

Emily McKey, RD

Megan Berg, SLP

In this case study we discuss:

  • Clinical recommendations and patient choice
  • How SLP documentation impacts dieticians
  • Therapeutic variance forms
  • The state surveyor dilemma
  • Patient-centered documentation
  • Women's bodies in the healthcare system
  • SLPs, dietitians, and diet upgrades/downgrades
  • How to build SLP+dietician relationships

Case Study: Brian
Note that all case studies are 100% fictional.

Brian is a 38 yo male who survived a traumatic car accident resulting in damage to right frontal lobe and a broken leg. He has spent the past three weeks in rehab therapy working on left neglect, insight, impulsivity, safety awareness, and mobility. He is emotionally ready to go home and return to work, but physically and cognitively, there are concerns that this isn’t a good option right now. He is married with two children and works as a programmer. Due to the nature of his injury, he does not exhibit the ability to have accurate insight into his limitations and prognosis. His short-term memory is impaired and there is concern of safety limitations in a home environment when he is alone or sole caregiver of the kids. The therapy team believes he would benefit from an additional 9 weeks of therapy before going home.

Featured Interdisciplinary Guests

Nathan Guza, PTA

Megan Berg, SLP

In this case study we discuss:

  • The word compliant and where it came from
  • The traditional medical model
  • The social/empowerment medical model
  • Who decides length of stay?
  • Brain injury, insight, and patient choice
  • Insurance companies and patient goals
  • Incorporating quality of life measures in addition to deficit-based tests

Why interdisciplinary care matters

We believe interdisciplinary collaboration is one of the most important conversations of our time. We know that a high level of collaboration and communication across all three therapy disciplines can accomplish two goals:

  1. Better patient care + outcomes
  2. Stronger advocacy of ethical workplace expectations

Interdisciplinary collaboration in health care has been shown to improve patient outcomes such as reducing preventable adverse drug reactions, decreasing morbidity and mortality rates, and optimizing medication dosages. Teamwork has also been shown to provide benefits to health care providers, including reducing extra work and increasing job satisfaction. (Bosch and Mansell, 2015)

As the research base that supports interdisciplinary collaboration grows, our systems of formal education, clinical training, and popularized models of patient care have yet to catch up. SLPs, OTs, COTAs, PTs, and PTAs continue to be trained in separate facilities with limited to no interaction during formal education. Additionally, new clinicians are placed in settings that demand excellent communication and collaboration between disciplines with little to no training on how to effectively achieve this.

Our current models of education/training and siloed (separate) tracks of care within facilities do not adequately create fertile ground for collaborative efforts to thrive. We want to help change that, one conversation at a time.

Why are we having these discussions? Because insurance companies, reimbursement rates, and lobbyists should not dictate patient care. It is our responsibility as front-line providers to advocate for our patients and uphold the integrity of our profession. We are stronger when we stand together with a collective voice and collaborative spirit.

How we see ourselves within the healthcare system:

How patients experience the healthcare system:

While rehabilitation clinicians are frequently trained in a linear model of healthcare, the reality is that as patients, we experience the healthcare system as intersecting groups with lots of overlap. Improved communication within these areas of intersection ultimately improves patient care by providing holistic, connected care rather than parcels of disconnected care. A few great example of the power of this care include:

  • A surgeon communicating with a physical therapists before and after surgery.
  • An oncologist reaching out to an SLP to discuss proactive dysphagia treatment before starting head/neck cancer radiation treatment.
  • A dietician collaborating with an OT when meeting the nutritional needs of a person with dementia who cannot sequence the motor movements required to use a fork.
  • An SLP and PT co-treating to address how a patient can access an important aphasia communication alert card when out in public.
  • An SLP or OT and dietician co-treating to address carbohydrate counting for people with brain injuries and a new diagnosis of diabetes.