The MDT is an integrative system that enables the therapist to perform integrative therapy for children with special needs. The system works through few levels of integration starts with evaluation, analysis, integrative goals and exercises, team work, methods a nd disciplines, therapy settings and more. The MDT strives to integrate as much knowledge as possible with as little boundaries as possible in order to create the ultimate therapy plan.
The MDT strives to be trans-disciplinary in nature in which the boundaries between the disciplines are almost not exist whilst every therapist can play any role in the team. In the multi-disciplinary approach the disciplines work together and collaborate while each discipline is responsible for its own field and won’t take responsibility over other areas nor practice them.
MDT is not replacing the disciplines but rather enhancing the broader view of the single case in different ways and levels. The MDT is expertise in integration of rehabilitation knowledge. It brings this added value to the treatment system. A disciplinary therapist can become an MDT therapist. It like having a major in disciplinary studies and a minor in integrative therapy.
The case manager or the MDT therapist cannot be an expert in all areas but can acquire a lot of knowledge in all areas that will be sufficient for most of the cases for treatment or analysis. The integrative view is needed mostly in the complex cases were a narrow rehabilitative angle in not sufficient. The MDT case manager or therapist are experts in integration in different levels.
The basis studies for OT, PT and SLP are similar in the first year or two of studying. The rest of the topics vary depends on the profession. There are also common topics regarding treatment guidelines, ethics, planning treatments, treatment principles, research etc that are similar. Blending the three disciplinary courses is doable over 5-6 years for a master or doctorate degree. Another way of studying is having a primary studying course for a master or doctorate in one of the profession with complimentary studies towards the other two professions including integrative studies.
The process of becoming a good therapist is long in the traditional course and longer to be an integrative therapist. The MDT training in Yaelcenter takes 3 years but is optional only after3- 5 years of field work, depends on previous studies. After studying, the therapist needs to practice for few good years in order to become good at it. Don’t look for shortcuts, it is not professional, ethic or effective. Invest in studying and learning to become a good professional and then you can practice with full stim ahead.
The MDT serves the cause of the treatment. It tries to answer the complex problem. The patients’ needs will determine the course of treatment rather the constraints of the profession. The profession is researching and acquiring knowledge in a specific area. The constraints of the profession sometimes will not answer all the requirements of the complex problem.
It is very hard to collaborate 6-10 professionals around one complex case on a weekly basis. Usually, the meeting will take place once every three months for an hour in which it is almost impossible to have a productive discussion, collaboration, bridging gaps of perception, teaching inter-disciplinary knowledge etc. If the core group of therapists is much smaller (2-3 therapists) it is much easier to collaborate, having more frequent meetings, less bridging and perceptions and more effective work can be done in one major direction.
The MDT uses non-professional therapists, tutors or family members as part of the therapeutic team. It is common in other broad system such as ABA for example. The therapeutic system requires a lot of practicing hours which is very costly. The disciplinary work can’t cover all the hours due to cost and time. Using the para-professional or assistant therapists can be beneficial.
Over the years we have found that in some cases we get even better results using the para-professional therapist since they are bringing more hours and not necessarily potentially not as good as the professional therapist. In some cases the para-professional had better results then the professional therapist since he had better connection with the child or in other cases parents who could get better results than the therapists.
If the para-professional therapist gets a detailed treatment program, support and guidance, has good reasoning, passion to help the child and can establish good relationship with the child – success is promised.
The specialty of the professional is one hand the delivery of the treatment but that can be learnt quickly. The more important part is accurate diagnosis and good planning of treatment. This is the important role of the professional therapist.
The MDT uses techniques from all disciplines which are evidence based equally to every discipline or method. The MDT strives to practice reliable and valid techniques and be the most accurate it can be.
Evidence based practice is not a clear cut term. The trend now in therapeutic world is to practice only EBP techniques. Some people claim that not practicing EBP is mal practice. In the field of early age rehabilitation it is very hard if not impossible to research every technique used in order to ensure EBP. The amount of variables is huge while in research we isolate only one variable for testing. In real treatment the variables are not isolated but rather combined. The call for pure EBP practice reduces dramatically the amount of techniques the clinicians are “permitted” to practice. It is an absurd situation where people with minimal field experience try to dictate the course of treatment based on limited research.
Many of the techniques being used in the field are successful but yet to be researched for many reasons. That is not making them less effective. It is true that we should choose our techniques and methods carefully and not to work based on feeling but rather investigating our work.
The idea of the MDT started in 1997 and was practiced till 2005 in an experimental way. Since 2005 the MDT is being developed rapidly with increasing field work. In 2015 there are two day care facilities in Israel working with 50 children on a regular basis, one clinic in Melbourne, Australia, that practice the MDT as the basis platform for all the treatments, and over a hundred of new evaluations per year.
On one hand the MDT is a very structured system with attention to the smallest detail. It is being developed as a mathematical algorithm for having eventually a computerized system to help in organizing the treatment. Accuracy is fundamental in the MDT.
On the other hand, the MDT is flexible like water. It can take any form or shape. There are no boundaries in thinking and forming a treatment plan. No boundaries of place, time, duration, therapist, discipline, method, technique or any other variable as long as it serve the goal of the treatment.
Being able to be highly flexible and highly structured at the same time is very difficult. By learning how to do it we create a new form of therapy.
The ABA is a well-structured method, based on behavioral principles. The ABA is very popular around the world for ASD treatment. The MDT was established from the ABA at the beginning, by embracing the cross-disciplinary structure and intensive intervention. However, the ABA is a behavioral treatment which disregard much disciplinary knowledge. The MDT on the other hand, will use behavioral approach when needed and will strive to use as much disciplinary knowledge or other sources of knowledge, techniques or methods as needed, if answering the goals of treatment.
The ABA uses master programs that forms the treatment. The MDT set goals and only then defines the way of treatment. The ABA will use behavioral strategies for every problem since a behavior is “ everything that a dead man can’t do”. The MDT on the other hand will choose any strategy that would best fit the situation.
One of the main differences is the “reinforcements system”. In the ABA reinforcement is a way to enhance desired behavior or extinct non-desired one. In the MDT the reinforcement is just one tool to create motivation out of many. The ABA will use the reinforcement as part of conditioning whilst in the MDT there is almost non conditioned interaction unless it is behavioral (under MDT definitions).