The traditional therapeutic professional concept is built upon disciplines such as Physical Therapy, Occupational Therapy, Speech Therapy, Social Work, Psychology and some include Special Education. In addition to these disciplines there are different broad methods that were developed in order to give therapeutic answers that weren’t being provided within the traditional disciplines. Such methods are: ABA (Applied Behavior Analysis), Son-Rise, Bobath, DIR etc.
Every therapeutic method or discipline interprets the child’s condition from its own point of view and in a statistical metaphor “explain” only a certain part of the phenomena. All of them tell the truth, but how much of the truth? The MDT method acts on a different level – it tries to use all the known methods and techniques and subsequently explain the child’s condition. It thus builds a more accurate treatment program while using techniques and ideas from all methods.
It is not easy to implement the MDT since it requires a broad knowledge of as many methods as possible, the ability to integrate all the knowledge and come to the final decision, as well as the flexibility of thinking and the courage to face this challenge.
MDT method is a tool designed to implement the multi-disciplinary therapy idea. Many therapists and educators believe in the idea but in order to work with it they need a tool that will guide them through the process. The MDT method pretends to give the answer. It is a dynamic, developing tool that includes:
1. Evaluation forms for all domains.
2. Analysis forms that help the therapists and guide them in the analysis process.
3. Treatment plan forms
4. Treatment programs for every domain
5. Accessories and tools for every therapeutic subject
The MDT method is a broad concept of integrative analysis and treatment of the whole developmental path. MDT acts and offers intervention on different levels – consultant, case management, one on one treatment, MDT Para-professionals and family guidance and inter-professional collaboration.
The tool is a work in progress, continually being improved while being used successfully in therapeutic practice.
THE MDT METHOD
A New Integrative Framework for Inter-disciplinary Collaboration in Treatment of Children with complex developmental disorders
WHAT IS THE MDT?
The MDT is a system that implements the integrative therapy perception. The MDT strives for optimal integration of all developmental areas, disciplines, methods, goals, schools, activities etc. So the child is seen as a whole and all developmental areas are considered in unison (not separately).
The integration takes place at different aspects of therapy: evaluation, analysis process, case management, team work, disciplines and methods, therapist, goals and exercises.
The MDT uses an integrative evaluation and analysis process, case management, integrative system (disciplines and methods), primary therapist, integrative goals and exercises, and high flexibility in implementation of the program.
The MDT system brings:
Multi-level integration across all developmental areas
A structured method to ensure therapy is effective and efficient
A variety of treatment systems and services
Flexibility by using a variety of techniques from different methods and disciplines.
Tailoring of the optimal system for the child and his/her family.
Interdisciplinarity involves the combining of two or more academic disciplines into one activity (e.g. a research project). It is about creating something new by crossing traditional boundaries between academic disciplines or schools of thought, as new needs and professions emerge, and thinking across them.
The roots of interdisciplinarity can be found hundreds of years ago however, In the twentieth century it became a more academic movement.
Interdisciplinarity also involves integrated thinking, borrowing ideas and metaphors, collaboration, flexibility in thinking, innovation and complex problem solving.
The traditional professional model is usually disciplinary. Complex problems sometimes demand interdisciplinary solution. There is a constant dispute between the disciplinary and interdisciplinary approaches.
MDT is part of the transdisciplinary approach. This is the next step after interdisciplinarity in which there are no boundaries between disciplines and the role of a primary therapist is established.
TRADITIONAL THERAPY MODELS
In traditional therapy children generally have separate assessments and treatments from each discipline. In complex cases the Multi-disciplinary approach is common today where few disciplines work together. However, the overlapping between disciplines might leave “holes” of untreated areas and often collaboration and integration of the knowledge is difficult. In most cases there isn’t a case manager that will integrate the knowledge and oversea the whole picture.
Along the disciplines we can find today cross sectional therapy systems that go across the developmental fields however don’t have the depth of the traditional disciplines.
Over the last decades the understanding that collaboration between multiple methods or disciplines and integration of all the knowledge is essential for complex cases, grew and developed.
The MDT is a tool for implementing that professional perception of integrative intervention.
The MDT was started in Israel in 1996 by Dr. Elad Vashdi. Dr.Vashdi has a doctorate in Physcial Therapy and is a specialist is child development.
Dr Vashdi has experience working in special education schools, hospitals and in his private practice, and has been a part of ABA programs, the Miller system, D.I.R. therapy and the Sun-rise approach as well as other systems. Having seen the special contribution of each program and discipline but the lack of integration of knowledge , Dr. Vashdi leads a team of therapists from varying allied health disciplines (i.e. physiotherapy, speech therapy, occupational therapy, special education and psychology), who collaborate to form a new more integrated and streamlined method of developmental therapy: Multi-Dimensional Therapy (MDT).
Since 1996, they have worked on creating evidence-based evaluations for all developmental areas, creating an analysis procedure which will enable the integration between fields and developing treatment tools based on their experience and professional knowledge. Some of these MDT tools are still being developed, tested and validated internationally, to ensure the highest standard of evidence based assessment and therapy.
The MDT program is now practiced in Israel in two day-care facilities, in Melbourne , Australia, through the “voicewithin” clinic and also in several other places around the world.
THE MDT MODEL & PROCEDURE
The MDT targets for evaluation and treatment are the “developmental prime numbers”: fine & gross motor, sensory preferences/conditions, communication skills, receptive & expressive language, speech, cognition, social skills, emotional conditions, ADL’s and behavior. Evaluating the developmental condition of a child through these primary areas ensures reduced overlapping, no therapist bias, and reduces the likelihood for “holes” in the program.
Within the MDT the child and his/her family are in the center, and the therapy program is built around them. The therapy team (seen in blue), work in an integrated way across the therapy program (seen in green), to ensure the child’s overall development and well-being.
The analysis process is the heart of the system. The process considers thousands of variables using zooming in and out steps of analysis. It enables the case manager to perform series of analytic procedures – inter and intra fields, zoom in and out of different layers while considering the time dimension. The end product of this procedure is identifying targets for intervention at primary, secondary and tertiary levels.
Once the primary targets are identified, the case manager starts developing the treatment structure on a weekly basis cycle, and sets multi-level goals: The vision, functional long term, short term measurable goals. The set of goals is the heart of the intervention system. It will guide the team in choosing activities and in the decision making process.
The tip of the spear is the intervention exercises. The MDT system adapted and developed thousands of exercises in all developmental fields. Any method, discipline or other intervention tool will be potentially integrated into the program, as long as it follows the goals and has been proven effective.
The last stage in the MDT procedure is the report and feedback. It involves reporting after each session, frequent team meetings, re-visiting the program frequently, training the team and collaboration of all factors taking part in the program. This stage regenerates the whole MDT process and creates a new cycle of analysis and intervention.
ASPECTS OF INTEGRATION
Family – The center of the procedure. Navigates the procedure alongside the case manager.
Case manager – The professional center of the program. The CM integrates all the information and constructs the final program. The CM will train the therapists, manage the team and lead the whole system forward.
Integrated therapist/tutor – Primary therapist that practices in all fields under supervision and direction of the specialists.
Professional therapists – Specialists collaboration.
Schools – Collaboration between all educational frames.
Inter disciplinary – Uses knowledge from all disciplines when the goals of the program lead the way of thinking across disciplines.
Trans methods – The program will optionally include every method as long as it serves the main goals effectively. .
Analysis – The system has a unique method of integrating thousands of variables through zooming in and out and sorting procedure on each level. The process will integrate all developmental areas considering the time dimension as well.
Goals – Are integrated and measurable. Are divided into levels: vision, long term, short term, specific steps.
Exercises – Are organized in a massive structure of master programs, divided by developmental categories and vary in: type, place, duration, dosage. There are more than 15000 exercises in the exercises structure. The use of each exercise is determined according to specific needs.
UNIQUENESS OF THE MDT
1. Integrative structured model that enables collaboration of any method or discipline.
2. Trans-disciplinary approach that creates an integrative thinker therapist.
3. The use of a case manager to lead the system.
4. Structured methodology of analysis of thousands of variables.
5. More than 15000 exercises ready to use.
6. Structured set of guidelines for treatment