A Virtual Mock Developmental Assessment: Interdisciplinary Collaboration and Leadership During COVID-19

January 11, 2021

The Alaska LEND Without Walls is a program that has embraced video teleconferencing as a method to reach faculty and fellows across the geographically vast state. During the current pandemic, the Alaska LEND program utilized a virtual environment for all activities. As part of the annual fall semester "face to face" seminar, interdisciplinary faculty and fellows participate in a mock developmental assessment. This experience showcases the disciplines of occupational therapy (OT), physical therapy (PT), speech therapy (ST), and developmental pediatrics. Traditionally, a young child and parent volunteer attend the "face to face" LEND seminar where faculty and fellows from various disciplines complete assessments and a parent interview as LEND fellows observe the process. With the constraints of COVID-19, a team of interdisciplinary providers designed a virtual experience of the mock developmental assessment. The experience proved highly rewarding, engaging, and successfully showcased the dynamics of an interdisciplinary assessment team.

The interdisciplinary team was composed of LEND faculty and fellows, including clinical doctorate students. A parent and child volunteer were identified and agreed to a total of 3 virtual encounters: one meeting with the neurodevelopmental physician, one meeting with the OT, PT, ST therapy team, and participation in the LEND virtual face to face seminar. A HIPAA compliant telehealth platform, Zoom, was used to meet and record encounters. The interdisciplinary team members communicated via email with the parent volunteer prior to the scheduled Zoom sessions. This communication established the objectives of each encounter, allowed the team members to preview findings and ensured that ample developmental observations were obtained. For example, the therapists pre-arranged the encounter to capture an eating activity, a motor activity, and a comprehensive language sample. The neurodevelopmental physician administered the Capute Scales to assess cognitive abilities while the child and parent were in their living room environment. These encounters were captured as Zoom recordings and uploaded to the course website to allow fellows to view the recordings prior to the Fall 2020 "face to face" seminar.

The "face to face" seminar occurred one month after the recorded developmental assessment session. In the seminar session, the interdisciplinary team and the child and parent volunteer were present. The session used video clips, a screen shared PowerPoint presentation, and conversations with the child and parent volunteer to demonstrate the developmental assessment process and diagnostic considerations from interdisciplinary perspectives. The therapists showcased specific video clips and screen shots from the recorded encounter to illustrate specific developmental skills. The neurodevelopmental physician presented a short didactic on developmental surveillance and screening and evaluation for a child with developmental concerns. The therapists presented on interventions in the home, such as Infant Learning or Early Intervention and clinic and school based services. The parent was interviewed in real time by the neurodevelopmental physician and guided through a physical exam as part of the telehealth visit. The therapists and medical provider highlighted developmental changes from the recorded sessions (one month prior) and the telehealth visit during the seminar, allowing fellows to see the rapid acquisition of development skills in a young child. To further support the experience, the interdisciplinary team contributed to a comprehensive developmental report that was available for review on the course website.

As part of the experience, LEND fellows were provided with a developmental chart to guide observations across multiple developmental domains, including gross and fine motor, self-help, problem-solving, social emotional, and receptive and expressive language. Fellows were then assigned to small groups on Zoom to further discuss specific developmental domains and estimate the chronological age of the child based on developmental observations. These small groups were led by LEND faculty and fellows who participated in the interdisciplinary assessment. There was rich discussion during the small breakout sessions regarding developmental milestones and the interrelatedness of developmental skills.

Overall, the fellows enjoyed the demonstration of the mock developmental assessment and provided positive feedback on the experience. The asynchronous format allowed LEND fellows to access the assessment recordings and interdisciplinary developmental report in advance. This allowed non-clinical fellows, including those in the family and self-advocate disciplines, to review the developmental assessment prior to the mock real-time session. The interdisciplinary team greatly appreciated the collaboration and expertise of the various disciplines represented. Participation in the assessment and presentation provided leadership opportunities for clinical fellows. It also allowed a self-advocate fellow and their family to share their developmental assessment story. The experience provided an example of clinical problem solving through the barriers experienced by many families and providers during the COVID-19 pandemic and the opportunity for interdisciplinary team members to observe and interact with a child and family in their home environment. Sincere appreciation is extended to our wonderful child and parent volunteers who provided an engaging and positive example of developmental skills.