Thursday, September 18, 2014

Interdisciplinary Collaboration

Interdisciplinary Collaboration



Interdisciplinary Collaboration is the convergence of multiple disciplines on a team to serve a client. Interdisciplinary teams are commonly found in nursing homes, substance abuse treatment centers, psychiatric hospitals, medical facilities, rehabilitation centers, the military and correctional programs. Depending on the setting, a social worker may join with a team member who is a psychiatrist, psychologist, nurse, physician, other medical provider, teacher, clergy, administrator, marriage and family therapist, drug counselor, probation officer or other relevant professional or provider.

Interdisciplinary collaboration within a team setting is a powerful modality than can serve a client or client system without the limits of any one treating profession. The expertise and divergent thought may create a clinical, educational or other environmental picture that would have otherwise been missed if addressed by any one discipline. When multiple disciplines discuss and debate a case, the values and perspectives of those professions weed out the limitations or confirm the merits of any particular intervention approach, maintaining a check-and-balance system unavailable to any one profession.

Those who have worked for any length of time in an interdisciplinary setting also become aware of turf battles and a natural deference that may be given to one profession over another. For example, it is not uncommon for a collaborative team in a psychiatric hospital setting to defer to the psychiatrist or in a medical hospital setting to deter to the physician. However, there is an inherent danger in this because these individuals are likely the ones least involved with the client or patient and who have the least amount of time spent interacting and observing. While their training may be the most extensive, the family counselor or recreational therapist may have information that may directly contradict the information presented to the medical doctor.
Social Workers have a unique role to play in the interdisciplinary team, and must assert professionalism and appropriate diplomacy at all times. While Social Work training may look similar to training in other fields, professional ethics and values are unique from other professions. For example, while working in a mental health clinic undergoing budgetary cuts, a director who is trained in another mental health field may not put the same emphasis into maintaining a counseling program for low-income people as a social worker that is directed by specific values and ethics, spelled out in the NASW Code of Ethics, to strongly advocate for a contingency plan to make a provision for low-income individuals in need of mental health services.

Example:
Mary, a 68 year old, lives in a nursing home for the past 21 years following a stroke that left her in a wheelchair. She is described by many on the staff as “bitter“ and “difficult,“ often making up allegations that one of the nursing staff has withheld a pain medication or treated her poorly in some way. She has often been caught lying, with other staff and patients observing a situation in which Mary says one thing happened when the opposite was true. This has caused an air of fear in the workers assigned to work with Mary, further exacerbating the situation.

The interdisciplinary team is made up of the Director of Nursing, the treating physician, recreational therapist, occupational therapist and social worker. The nursing staff has the most interaction with the patient, and has begun to see Mary as a “trouble maker“ who has an “agenda,“ and is seeking an intervention that will protect the nursing staff from legal complication and will hold Mary accountable for her lies. The physician believes the issue is conflicting personalities and an alteration in staffing patterns will improve the situation. The recreational and occupational therapist have observed the contrary manner in which Mary has treated staff and peers and are not certain how to proceed. The social worker decided to meet with Mary, believing there is more to the story. He discovers a long history of rejection by family members and friends after her stroke, including her spouse who left shortly after the stroke. The social worker discovered Mary has a pattern of “leaving“ others (i.e. making them leave before they choose to leave) out of emotional protection. He designs an intervention to target issues of abandonment with Mary, and educates the treatment team about Marys use of pushing others away to protect herself emotionally, rather than to personally attack staff.

In the example:
The social worker was able to discern underlying issues not otherwise detected using a medical model or discovered in daily interactions with Mary. Approaching Mary and assessing her biopsychosocial history more fully gave a different assessment than the one observed in her daily interactions.





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