Consultation, Interprofessional Collaboration, and Systems
Rehabilitation psychologists work within teams-physiatry, PT/OT, nursing, speech, social work, vocational-and consult to systems. Understand consultation models: client-centered (case consultation), consultee-centered (building the team's capacity), and program/administrative consultation. In team settings, know role clarity, shared goal-setting, communication structures (rounds, huddles, documentation), and conflict resolution. Interprofessional collaboration requires respecting scope of practice, contributing psychological expertise (behavior, cognition, motivation, family dynamics), and translating findings into actionable recommendations. Systems issues include insurance and reimbursement constraints, length-of-stay pressures, accessibility, and discharge planning. Traps in questions: assuming the psychologist's role is to make unilateral decisions (collaboration is shared), confusing advocacy with insubordination, and overlooking that recommendations must be feasible within the setting's resources. Understand team functioning concepts-psychological safety, shared mental models-and how to handle disagreement (e.g., a therapist pushing a patient beyond tolerance).
Worked example: PT wants to discharge a patient who is anxious and avoidant of mobility. The best consultation response is to share behavioral formulation, propose graded exposure within PT sessions, and co-set goals-not to override the therapist or simply recommend more therapy. Rule of thumb: effective consultation changes the consultee's behavior and the system's process, not just the patient.