Creating Dialogic Contexts for Multidisciplinary Clinical Reviews: The Reflecting Team Process

When multidisciplinary teams review their work, it is common for clinicians to hypothesise about their clients from the perspective of their role or theoretical model. The outcome of this review process may depend on the team's views. Here the epistemological position taken by team members about reality and objectivity can lead to starkly different pathways. There can either be a dialogue about different hypotheses, with the team jointly constructing new meanings; or, conversely, there can be a monologic exchange based on competition between different hypotheses. This paper explores why teams may struggle with coordinating different theoretical approaches and models. It suggests the dialogic nature of a reflecting team process offers one approach for helping teams to find ways of ‘putting their differences to work’. Ideas for implementing this process within multidisciplinary teams are illustrated with comments provided by teams who have begun to experiment with this approach.     

Juvenile offender rehabilitation in Estonia: interprofessional collaboration in written assessments and specialists’ perceptions

Qualitative and quantitative research methods were used to study an interprofessional assessment model in rehabilitation services and its implementation in Estonia based on (1) a sample of rehabilitation plans for 160 juvenile offenders aged 7–18 and (2) expert interviews with 10 members of an interprofessional assessment team. Each specialist’s role was compared with the assessments. While each team member is assigned a discrete role based on discipline, in practice, the disciplines’ work overlapped considerably during the assessment process. The overlap seems to occur because team members conduct their assessments individually, rather than following the collaborative best practice model for interprofessional teams described in the literature. The expert interviews indicate that rehabilitation specialists perceive the individual-level elements of interprofessional teamwork to be consistent with the ideals articulated in the Perception of Interprofessional Collaboration Model, while the substantial overlap in assessments that occurred in practice could be related to lack of interprofessional collaboration at group and organizational levels. Recommendations to improve the functioning of teams serving juvenile offenders include establishing an interprofessional education system, increasing the flexibility of the legal framework for service provision, and improving the interprofessional assessment instrument.     

The use of multidisciplinary teams to support child welfare clients

Meeting the educational needs of young people in the child welfare system (CWS) requires effective collaboration between the CWS and the education system. In Norway and in other countries, there is an increased focus on interprofessional collaboration to support child welfare clients in and around schools. Multidisciplinary teams are employed to facilitate collaboration and coordinate supportive measures. The purpose of this article is to describe how teachers and social workers use such teams as part of a collaborative effort to support children living in difficult conditions. In an inductive thematic analysis of 13 interviews with 7 social workers and 6 teachers, the following five key themes were revealed: (i) solution-focused work; (ii) listening to the child; (iii) parental support; (iv) social/environmental opportunities for successful interactions and (v) ensuring school attendance through adapted education and support. In conclusion, we discuss the ways in which these themes reflect how teams support child welfare clients.     

Social Work and Interprofessional Education in Health Care: A Call for Continued Leadership

A report from the Interprofessional Education Collaborative and another from the Institute of Medicine cite working as part of interdisciplinary teams as a core proficiency area for improving health care. This article discusses the core competencies of interprofessional education and the essential role for social workers as leaders and facilitators of this practice. Educators will learn how to help students discover the knowledge, skills, and attitudes for successful interprofessional work. Specifically, this article has the following objectives:

1. Discuss essential elements of effective interprofessional practice;

2. Present exemplars of interprofessional education involving social work;

3. Identify the roles for social work in leadership, education, and practice in interprofessional education.

     

The Organizational Role of Clinical Practice Models in Interdisciplinary Collaborative Practice

This paper presents a method for using different practice models as the basis for organizing interdisciplinary clinical teams. The different dimensions of multidimensional practice models are used for selecting the various professionals involved in these teams. The Neuman Systems Model (Neuman & Young, 1972; Neuman, 1995) is used to illustrate how this process works by structuring interdisciplinary teams along its five overarching and interrelated dimensions of human experience—psychological, physiological, sociocultural, spiritual and developmental. By extrapolating these five areas to their respective disciplines, a protocol is developed for selecting the necessary professionals while establishing the parameters of each professional's involvement. By specifically addressing the relevant clinical dimensions of a particular model, interdisciplinary teams can formulate a more theoretical, holistic, and comprehensive assessment and treatment plan. This approach also allows multiple client problems to be addressed simultaneously in a more systemic and efficient manner than could be accomplished by any one profession alone. A case study demonstrating the approach is included.     

An interprofessional internship model for training master’s level social work and counseling students in higher education settings

ABSTRACT

The mental health needs of college students are steadily on the rise, which compels mental health service providers and educators to explore innovative ways to provide more collaborative, supportive, and interdisciplinary service models of practice and professional training. Graduate programs in social work and counseling are at the crux of producing internship training programs to help accommodate the influx of students with persistent mental health concerns across a variety of needs and cultures. This article describes an interprofessional internship program structured and designed to meet the clinical training needs of master’s level students matriculating in social work and counseling who aspire to provide mental health services in higher education settings. The interprofessional internship training model proposes an innovative interdisciplinary approach to field education which may result in positive training outcomes and learning experiences for social work and counseling students. This paper discusses the model’s emphasis on individual and interdisciplinary group supervision, objectives of the internship experience, internship site criteria, and professional and personal benefits to pre-service social workers and counselors. Recommendations for training and limitations of the model are provided.     

浅析博弈论在商务谈判中的应用

由于商务谈判活动中冲突与合作性并存的特点,导致博弈论在商务谈判中得到广泛应用。非合作博弈理论更多体现在谈判双方对各自获得的最大利益的争夺上,而合作博弈则在谈判双方合作共赢并对共同利益的分配问题上有广泛应用。     

A look behind the curtain at social work supervision in interprofessional practice settings: critical themes and pressing practical challenges

Supervision has been an integral aspect of social work practice since the early days of the profession. The literature suggests that ‘supervision is an essential and integral part of the training and continuing education required for the skillful development of professional social workers’ (p. 5). The literature does appear to support that all social workers ought to have some level of supervision; however, within interprofessional settings, where social work is one of many professions, that goal may not be easily attained. Although some interprofessional settings, like hospitals, have social work departments, other settings, like schools, may only have one social worker, resulting in a workplace environment devoid of social work supervision. This article presents findings from a national study of social workers employed in interprofessional organizations. It was hypothesized that this cohort could provide important insights about the nature of social work supervision in agencies characterized by an interdisciplinary workforce. Using both open-ended and specific categorical questions, respondents were asked to describe and convey information about the supervision process and experience in their agency. An Internet-based survey was used to reach a broad spectrum of social work practitioners and educators (975 deliverable and 426 completed) across the United States.     

Clinicians' fallacies in psychiatric practice

Eleven common clinicians' fallacies have been briefly described. Based on experience, the authors of this article believe these are the most common and pernicious ones in interdisciplinary psychiatric treatment. These patterns may lead to erroneous interdisciplinary treatment decisions for many patients. In order to protect the well-being of psychiatric patients, their families, and the integrity of interdisciplinary treatment teams, it behooves each and every team member to become knowledgeable about clinicians' fallacies. Those aware of clinician's fallacies will reason more soundly basing judgments on empirical evidence, careful observation, measurement, and a determination not to be influenced by emotional appeals.     

BEYOND LAW AND ETHICS: AN INTERDISCIPLINARY COURSE IN FAMILY LAW AND FAMILY THERAPY

The professions of family therapy and law share many clients and areas of overlap. Law-related coursework in family therapy programs in typically limited to legal, ethical, and professional issues. However, students can also benefit from understanding other areas of overlap, such as divorce, child custody, and mediation. This article discusses the curriculum for an interdisciplinary course that educates both family therapy and law students. The course provides: (1) a substantive education about similarities and differences between the profession, how they operate as systems, and specific areas of overlap, (2) opportunities to learn clinical skills, and (3) opportunities for personal insight about skills, personality tyes, and negotiations, styles, and how these may differ between the professions.     

Use of standardized client simulations in an interprofessional teaching concept for social work and medical students: first results of a pilot study

ABSTRACT

Teaching concepts with standardized clients/patients (SC) had been successfully implemented in the education of health professionals. Benefits were also demonstrated for social work education. Based on former experiences with simulated clients in medical education, we developed an innovative teaching concept for social work and medical students. We focused on the training of consultations with clients suffering from a serious illness like cancer—with different learning goals for medical students (e.g. breaking bad news) and social work students (e.g. psychosocial exploration and counseling). Both groups should gain knowledge about the other professions tasks and learn to handle clients’ emotional reactions. In addition to role-plays with simulated clients in small groups, the concept includes an interprofessional lecture by physicians, psychologists, social workers, and lawyers as well as a visit on the palliative care ward (for social work students only) and a research colloquium. A formative evaluation shows high satisfaction with the teaching concept. The students underline the realistic setting, interprofessional contact, authentic talks and direct feedback. The SC method and its interprofessional application proved to be a practicable and motivating way to enhance conversational skills.     

Inequality and Multiracial Gatekeeping

ABSTRACT

Theoretical propositions linking power and status relations are deeply rooted in classical sociological thought. Building on that tradition, this paper investigates the impact of racial status on a specific power relation, the relation between gatekeepers and their clients. Gatekeepers control access to “benefits” they do not own, benefits that are valued by “clients.” Seeking access to those benefits, clients assume obligations which may be discharged by a fee paid to the gatekeeper. The size of the fee paid is the amount of power exercised by the gatekeeper. Employment agents, car salesmen, real estate agents are gatekeepers because they control access to jobs, cars, and housing, respectively, as well as information about each. When clients are lower status, for example, African American, employment agents may steer them to lower-paid, less desirable jobs, car salesmen may ask for and receive higher prices, and real estate agents may show only segregated housing. Research reported here extends previous work on gatekeeping to multiracial (black-white) gatekeeping relations by jointly applying two theories. Network Exchange Theory (NET) models the gatekeeper–client relation, and Status Characteristics Theory (SCT) models the impact of racial status on that relation. The result is three theoretical predictions that are experimentally tested in the well-understood context of exchange networks. As a first replication of previous work on gatekeeping, a key finding is that gatekeeping does produce power differences, as theoretically predicted. Two new additional findings are that 1) whereas race does indeed undermine the effects of blacks’ gatekeeping of whites, 2) it does not amplify (significantly) the effect of whites’ gatekeeping of blacks. Theoretical and practical implications of these findings are discussed.     

The desire for control: Negotiating the arrangement of help for older people in Sweden

The interface between formal (public) and informal help for older people is unclear and subject to change in many welfare states. Our aim in this study was to contribute to increased understanding of the experiences of older people, their next of kin, and the care managers from the municipalities in the process of negotiating help in the everyday lives of older people who can no longer manage on their own. We took a qualitative approach, using qualitative interviews as the main data collection method. The results revealed that the different actors had contrary interests that made it difficult for all parties to be content with the outcome of the negotiations. The everyday lives of dependent older people and their next of kin are strongly affected by the conditions of formal eldercare.     

Interprofessional education for community mental health: Attitudes to community care and professional stereotypes

Social workers are considered key members of community mental health teams, yet difficulties in interprofessional collaboration between social workers and health care professionals, particularly psychiatrists and nurses, have been reported. This paper examines some sources of these difficulties in terms of perceived differences in models of mental illness, attitudes and values, including stereotyping, professional identification and role clarity. Interprofessional education (IPE) may diminish negative stereotypes and promote multidisciplinary teamwork. A theoretical framework is described and findings from the evaluation of a 1-year programme of interprofessional education for community mental health are presented. These findings suggest that attitudes and values concerning community care for people with mental health problems are largely shared by different professions, but they do confirm the existence of interprofessional stereotypes and of perceived status differences. In contrast to previous research, there was no evidence of changes in stereotypes. These findings are discussed in terms of the theoretical framework and the design of the programme.     

Enhancing Health-Conscious Behaviors Among Clients in Substance Abuse Treatment Programs

The physical health of substance abuse clients significantly deteriorates because of the client’s prolonged abuse of alcohol and other drugs and accompanying behaviors. The purposes of this study are (a) to understand how substance abuse clinicians think about the health needs of their clients, (b) to identify the mechanisms through which clinicians seek to enhance health-conscious behaviors among their clients, and (c) to identify how substance abuse clinicians view their role in enhancing health-conscious behaviors among their clients. A qualitative study was conducted using in-depth, semistructured interviews with substance abuse clinicians (N = 16) from 4 substance abuse treatment centers. Using the theory of planned behavior as a framework for understanding the promotion of health-conscious behaviors in substance abuse treatment, the findings suggest that substance abuse clinicians are capable of enhancing health-conscious behaviors among clients in substance abuse programs.     

Talking about Blame

In this analysis particular emphasis is given to the question of blame in meaningful relationships, such as those occurring within families and between practitioners and their clients. The authors suggest there is a potential in these contexts for the subjective experience of being blamed to challenge, perhaps even disturb, an individual's sense of personhood and for interpersonal boundaries to therefore become de-regulated. A general implication for practice is then raised: if blame can be so powerful in its effects, practitioners may benefit from talking explicitly to their clients about blame in order to access intrapsychic and interactional material, for its relevance to the immediacy of the client's lived experience, for its ability to contribute to engagement, and perhaps most importantly, because feeling blamed and being blaming reduces the self-agency available to clients and hence potential for change.     

Becoming aware of the grand social challenges: how an international and interdisciplinary educational context may broaden students’ perspectives on human rights and public health

ABSTRACT

The understanding of contemporary social problems and challenges in an international and national perspective is a significant issue for social work because of globalisation and social problems are too complex to handle by single actors themselves. The need for interdisciplinary and interprofessional collaboration is important. This paper focuses on experiences from an Erasmus Intensive Programme with the title Human Rights, Public Health and Social Service Challenges on Local Government in the Nordic-Baltic Sea Area. Social work students from different countries interacted with students from other disciplines such as political science, psychology and economy to discuss common challenges and solutions in this field. The analysis of the findings shows students reflect upon human rights issues as universal rights and how challenges presented by contextual differences in preconditions for everyday life between the countries, are reflected from different disciplines/professional perspectives. The paper argues that international and interdisciplinary programmes, where students get the opportunity to meet and to work with overarching and transnational issues, have a great potential for engaging students in global development in a rapidly changing world.     

What Do Social Workers Need to Know About Mental Health Courts?

Abstract

Mental health courts are an emerging strategy to engage mentally ill offenders in treatment and to avoid unnecessary incarceration. These courts began in 1997 based upon the drug court model; there are currently over 70 courts nationwide. These courts are heterogeneous in structure, work with interdisciplinary teams, and seek to engage the consumer in treatment rather than use judicial sanctions. Social workers are integral members of these teams; yet, no research has been published in social work journals on mental health courts. This article explains the background and context of the courts, describes their features, discusses what social workers need to know about mental health courts, and concludes with ideas for how social workers may work effectively with mental health courts.     

Child death review teams: a vital component of child protection

The alarming number of children killed and seriously injured as a result of child maltreatment and neglect has led to increased calls for action. In response, interdisciplinary and multiagency child death review teams have emerged as an important component of child protection. Paradoxically, child death review teams are among the least visible and understood elements in efforts to protect children. This article examines the role and functions of child death review teams and their contributions to child welfare in practice, prevention, and policy.     

Preparing Social Work Students for Interdisciplinary Practice

Summary

This article reports findings of an MSW interdisciplinary practice curriculum experiment. A diverse group of students at ten schools of social work were provided with specialized fieldwork and training. The agencies represented a broad array of services, fields of practice client populations and professional disciplines. Students encountered frequent interdisciplinary disputes and often found social workers coordinating interdisciplinary teams, a role upon which social work curricula rarely focus. This specialized experience seems to have not only enriched students' preparation for interdisciplinary work, but also deepened their understanding of social work as a unique discipline.