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Community Teams

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Community Teams and Brain Injury 

It is not uncommon for a person who has experienced traumatic brain injury to be referred to three, four, or even five programs after injury: mental health, vocational rehabilitation, substance abuse, and others. Each has its own operating system, jargon, philosophy, and treatment approach. 

Just like a computer that needs consistent instructions for operation, clients and families need clear, consistent directions. "System incompatibilities" pose a special hardship for persons with TBI because their injuries may have interfered with the ability to process new, complex, or inconsistent information.

Teamwork is perhaps the most common-sense and most difficult of all the tools available to community professionals. Teams are widely used in business, manufacturing and the military to solve complex problems, to increase productivity, and to engineer creative solutions.

Teams are also widely used in inpatient medical and rehabilitation settings where many professionals must coordinate goals for recovery. But for persons who have experienced brain injury and have left the medical setting, there is usually no single person to take responsibility for coordination and planning.

Typically, collaboration among community professionals involves busy direct-service professionals who play phone tag in order to exchange information and formulate plans. Written referrals and recommendations often do not arrive until weeks after the community professional has begun work with a client. Seldom do all professionals sit down together with the client and family to plan a coordinated strategy. The team process is one of the most effective tools to make this happen. 

Challenge of Teams

Professionals also report that they sometimes meet resistance to the idea of teams, especially in the early stages of work. Among the early challenges are:

  • Lack of knowledge about teamwork
  • Unwillingness to commit time
  • System or agency restrictions
  • Lack of respect and/or familiarity with other disciplines
  • Geographic distance

Purpose of Teams

Professionals who have worked on ad hoc teams are enthusiastic about the benefits of teamwork. They report:

  • Consistent communications for people recovering from brain injury and their families
  • More creative problem-solving as the result of team synergy
  • Better interprofessional support for working on complex issues
  • Less fragmentation and duplication of services
  • Less opportunity for manipulation

Making Teams Work

 A group of professionals at The Ohio State University's TBI Network are using ad hoc community teams as a way to plan and coordinate services for persons with traumatic brain injury.

Professionals who have worked on these teams say it is worth the effort because they have seen improvements for clients and families. The following practical guidelines are offered to help get started and keep community teams operating smoothly.

  1. Take responsibility for forming the initial team. Thereafter, the responsibility should be equally shared.
  2. Meet face-to-face initially and periodically afterward.
  3. EVERY meeting should allow time to:
    • address willingness to collaborate (expect some "storming").
    • address turf issues--seek to understand each member's goals, perspective, and needs.
    • address roles and responsibilities--who will facilitate and take notes? Who will keep the team on task and on time?
    • facilitate the client's and family's involvement in the process--encourage participation and shape appropriate interaction.
    • identify individual and shared goals--have everyone provide updates.
  4. Decide how communication between meetings will occur (by phone, fax, mail or email), and when and where the next meeting will occur. Use the means of communication decided upon so that everyone is kept up-to-date.
  5. Convene another meeting to respond to crisis (even better, to avert crisis) or if the involvement of team members seems to be waning.

Team Development

 The formation and operation of teams has been widely studied as they have become a predominant organizing strategy in business. Though there are many theories of how teams develop, experts agree that teams go through developmental stages, just like people.

One of the more well-known theories of team development describes four stages: forming, storming, norming, and performing.

Forming: The team recruits core members and decides its purpose.

Storming: As team members begin to work together, tensions arise over appropriate methodologies.

Norming: The team begins to formulate rules of conduct and further defines the roles of team members. This activity results in greater team cohesion.

Performing: The team works more smoothly together to achieve common goals.

Most other models of team development are similar, emphasizing periods of:

  • recruitment and role definition,
  • conflict and power struggles,
  • goal and boundary establishment, and
  • effective performance.

It is important to note that work is accomplished even before the final stage of development, and that the stages may recur as goals change and as people join or leave the team. Also, some experts believe that teams cycle through these stages throughout the life of a team.

People with experience in teamwork learn how to set ground rules and goals early in the team development and are willing to address conflict issues so they can get on to the next phase of work. Knowing developmental stages also allows team members to understand their own feelings and the behavior of others.

With this understanding, team members anticipate aspects of group development and work more productively. This knowledge is especially useful for ad hoc teams that must come together quickly and then disband. 

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This website has been funded with financial assistance from Grant #H133A120086 awarded by the U.S. Department of Education, National Institute on Disability Rehabilitation Research (NIDRR) to the Ohio Valley Center for Brain Injury Prevention and Rehabilitation for the current funding period of 10/01/2012 - 09/30/2017.