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Social Work in Health Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wshc20
INTERPROFESSIONAL EDUCATION AND SOCIAL WORK Rosalie A. Kane DSW
a
a
Associate Professor, University of Utah Graduate School of Social Work, Salt Lake City, Utah 84112 Published online: 26 Oct 2008.
To cite this article: Rosalie A. Kane DSW (1977) INTERPROFESSIONAL EDUCATION AND SOCIAL WORK, Social Work in Health Care, 2:2, 229-238, DOI: 10.1300/J010v02n02_09 To link to this article: http://dx.doi.org/10.1300/J010v02n02_09
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
INTERPROFESSIONAL EDUCATION
AND SOCIAL WORK: A SURVEY
Downloaded by [Johns Hopkins University] at 19:15 30 December 2014
Rosalie A. Kane, DSW
ABSTRACT. In 1974, the author surveyed all graduate schools of social work to determine how team concepts were being introduced t o master's degree level students. A 76% response mte was achieved; 31% of the schools offered joint courses with other professional schools, 17% offered courses o n teamwork itself within the school o f social work, 10% had virtually no content o n interprofessional collaboration, and the majority attempted t o introduce this content through the pmcticum and the overall curriculum, especially health courses. These modalities are further described along with advantages and disadvantages of various approaches.
The interprofessional team has become a standard feature in the delivery of professional services. Social workers have been involved in the interprofessional health team since the turn of the century,' and now advanced teamwork skills are considered mandatory for practice in hospitah2 Social workers have also been regularly included on the large interprofessional rehabilitation team,3 where facility in team relationships has become necessary for effective functi~ning.~ Teams are flourishing in mental health, ranging from the old child guidance team, of which social work is a charter member, to the modem community of mental health teams with their four basic professions of psychiatry, psychology, social work, and n u r ~ i n g .Spe~ cialized health fields, an admixture of health and mental health, such as geriatrics6 or mental retardation,' are fast developing the interprofessional team modality as an essential tool of practice. Continuing the catalogue, interprofessional teams are manifest in the juvenile court,' in c o r r e c t i ~ n s , ~and ~ ' ~in schools, especially in learning disability programs."*'2 They are now coming into prominence as vehicles for urban planning, health planning, and a variety of indirect servi~es.'~J~ Dr. Kane is Associate Professor, University o f Utah Graduate School o f Social Work, Salt Lake City, Utah 84112. Social Work in Health Care, Vol. 2(2), Winter 1976-77
229
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SOCIAL WORK IN HEALTH CARE
The challenge to the social work profession in forging a role on the team is magnified because so many professions have boundaries that overlap their own. The psychologist, the psychiatrist, and, more recently, the psychiatric nurse perform therapeutic and community sewices similar to social work. The occupational and recreational therapists may work closely with both the group worker and the caseworker. The public health nurse, the health educator, and even the home economist may utilize much of the social worker's expertise. Clergymen, rehabilitation counselors, guidance counselors, schoolteachers and school psychologists, planners, and administrators have at various times interfaced with social work function. As various groups have expanded the boundaries of their roles, many professionals have added a psychological dimension t o their self-definitions; one now reads of "psychodie t e t i c ~ " ' ~or "psychoreligious counseling."16 At the same time, other ~ occupational therapy l 8 have begun professions such as n u r ~ i n g ' and emphasizing knowledge of community agencies as part of the expertise their groups bring t o the team. Perhaps no profession as much as social work enjoys so large a cast of collaborators with similarities of interest and role. EDUCATION FOR INTERPROFESSIONAL PRACTICE Translating a conviction about the necessity for tearnwork skills into a social work curriculum raises a host of ideological and practical problems. It is debated whether such content is best conveyed through courses offered in separate professional schools, through interdisciplinary ventures with students and faculty from a number of professional disciplines, or through a continuing education approach involving more seasoned professional practitioners. Some authorities advocate all of these modalities. Before learning experiences can be designed, educational objectives are required. Again the social work educator is faced with a dilemma. Does social work practice in interprofessional contexts lend itself t o a generic course with a single set of objectives? Or is social work practice so related Lo particlala settings that it must be taught in specific contexts such as health, education, corrections, or a myriad of others? Several volumes of the 1959 curtdcuhm study on social work education, particularly those on group work, rehabilitation, and corrections, highlighted the need for interprofessional skills in their particular f i e l d ~ . ~ *Other ' ~ s ~ commentators ~ have suggested a generic base in t e a skills, taught within one's own professional school before the student mingles with students of other di~ciplines.~'
Rosalie A. Kane
Downloaded by [Johns Hopkins University] at 19:15 30 December 2014
Lately it has been suggested t h a t t h e MSW level of practice should b e characterized b y teamwork in emerging fields.22 In forecasting f u t u r e practice to lay a rational groundwork f o r curriculum building, moreover, ~ n d r e wreports ~ ~ t h a t "participation in interprofessional treatm e n t teams" a n d "participation i n interdisciplinary planning" b o t h figured highly in t h e experts' projections of master's degree level social work i n 1985. T h e present paper reports o n a survey of MSW programs to determine w h a t schools of social work are n o w doing t o m e e t t h e present a n d future need f o r teamwork skills.
METHOD The population surveyed consisted of 84 MSW programs in the United States and Canada listed by the Council on Social Work Education as accredited schools or schools in the process of becoming accredited. The questionnaire was designed to be brief (a single page) and for the most part contained objective questions. By use of a checklist, respondents indicated the existence of content for interprofessional teamwork in the classroom and in the practicum, and the degree of emphasis placed on such content. They also indicated which courses in the cumculum, if any, incorporated teamwork concepts, and the timing of such content over the 2-year program. The questionnaire differentiated G o approaches to interprofessional education: (a) courses for social workers within a school of social work that deal with the nature of collaboration; and (b) collaborative courses offered with another discipline on a mutually significant subject or field, or on teamwork processes themselves. While these latter courses would not always focus on teamwork per se, they would permit students from different disciplines to mingle and communicate with each other. The questionnaire was circulated in the late spring of 1974;about 3 weeks after the initial mailing, a reminder was sent along with a time-saving card for the use of schools with no content at all related to the topic. As a result of the first two mailings, 63% of the programs surveyed responded. A third solicitation was made in the fall of 1974 to those schools that had not replied in the spring, bringing the total of respondents to 76%.
FINDINGS 'Pables 1 a n d 2 illustrate t h e presence of teamwork concepts i n t h e p r a d i c u m a n d in t h e general classroom curriculum. As Table 1 indicates, 50% of t h e respondents declared a strong emphasis o n teamwork in t h e p r a d i c u m component of their programs, 34% declared a slight emphasis in t h e p r a d i c u m , a n d 13%stated t h a t n o content o n teamwork had been deliberately introduced in t h e p r a d i cum. Three percent stated t h a t t h e degree of emphasis o n teams in fieldwork depended o n t h e particular setting involved.
SOCIAL WORK IN HEALTH CARE
TABLE 1 lnterpro fessional Teamwork Emphasis in Practicum
Amount of Emphasis
Number of Schools
Percentage
Strong emphasis Slight emphasis Other
Downloaded by [Johns Hopkins University] at 19:15 30 December 2014
None Total
Since the fieldwork sequence is traditionally the place where it has been assumed that students would develop a competence in teamwork, the fact that half the respondents reported a strong emphasis here was not surprising. However, the fact that almost half reported a slight emphasis or none at all was rather unexpected. Table 2 reports the presence of teamwork concepts in the classroom curriculum. Fifty-two percent of the group stated that the subject was emphasized slightly throughout the curriculum as a whole, 19% reported strong emphasis, and 30% indicated that no theme regarding teamwork appeared in the curriculum. Additionally, respondents checked cumculum areas in which they tended t o introduce teamwork concepts. Thuty-eight schools designated practice electives in special fields, 39 practice courses, 23 ad-
TABLE 2 lnterpro fessional Teamwork Concepts in Overall Curriculum Amount of Emphasis
Number of Schools
Percentage
Strong emphasis
12
18.8
Slight emphasis
33
51.6
19 -
29.6 100.0
None Total
64
Downloaded by [Johns Hopkins University] at 19:15 30 December 2014
Rosalie A. Kane
ministration courses, and 1 5 policy courses; schools could, and did, check off more than one area for this question. Seven schools replied that they had no content around teamwork either in field or class, and nine additional schools had no content other than a slight emphasis in the curriculum. The majority of schools indicating teamwork content permitted it t o fall equally in the 1st or 2nd year. Eleven percent placed the content primarily in the 1st year, 6% in the 2nd, 69% in both years, 9% in neither year, and 4.7% could not address the questions because their pattems differed from the traditional 2-year program. As Figure 1 illustrates, 31% of the schools offered joint courses with other professional schools, and 17% offered courses on teamwork per se in the school of social work. Six schools, or 9% of the respondents, offered both of these modalities, while 60% offered neither pattern. The nine schools offering courses on teamwork processes placed them in the following cumculum areas: three schools, as general electives; three as practice electives; two, as an elective on the health team; and one, as a behavior elective. Several schools illustrated the variety of organizational thrusts possible by providing additional information about their intraschool electives on teamwork processes. Since all schools did not d o so, this information cannot be quantified, but some of the pattems in use can be enumerated. One course focused on manpower arrangements, asking students t o develop a viable model for collaboration in their particular field of practice. Several courses were structured around the different professions with whom social workers collaborate, with the reading list
BOTH INTERSCHOOL AND l NTRASCHOOL COURSES N = 6 19.1:/.,) INTERSCHOOL COURSES OFFERED N = 2 0 131.2%)
INTRASCHOOL COURSES ON TEAMWORK per se N.9 (17%)
-
\OR
NO I NTRASCHOOL INTERSCHOOL N = 3 9 (60.9%)
FIGURE 1. Intraschool and interschool courses.
Downloaded by [Johns Hopkins University] at 19:15 30 December 2014
SOCIAL WORK IN HEALTH CARE
divided according t o collaborating professions such as law, medicine, nursing, divinity, and so on. One course emphasized the sociology of the various professions, examining the socialization processes and the various status concerns of the different disciplines. Another offering was subdivided into four topical areas, namely, the organization, the work group, the participants, and the skills. The several courses devoted to teamwork in health tended t o highlight descriptive accounts of role conflict in health and mental health settings. The 20 schools reporting electives offered jointly with other professional disciplines accounted for at least 39 collaborative courses. Table 3 shows the frequencies of the various collaborative alliances. Health schools were involved in the largest number of joint courses, and law schools were second. These courses shown on the table under the heading "Barge-scale interprofessional effort" refer t o courses planned with a large number of disciplines; in this category one school mentioned five cooperating schools, one mentioned six, and one mentioned nine. As an example, the most ambitious effort involved physical therapy, occupational therapy, rehabilitation counseling, speech pathology, psychiatric nursing, nursing education, leisure education, and gerontology, as well as social work. Beginning as a course on "Interdisciplinary Collaboration in Social Work," it evolved into an experimental offering with an emphasis on the common skills needed by all professionals t o engage in the collaborative process. According t o the report, content was drawn from activity directed at patient care, program development, policy change, and relevant research. The right-hand column of Table 3 lists the subject areas mentioned for the interprofessionally sponsored courses. Not all respondents provided this detail so the list is suggestive rather than exhaustive. Some respondents supplied additional detail about the organization of the courses from which it was leaned that some courses attempted to equalize the numbers of students from the participating disciplines and to form student teams. One such example was a course on urban and social planning that sent student teams into local communities t o study needs from the physical and social perspective. The outlines volunteered listed a number of objectives for interprofessional courses. These objectives have been culled and, with duplications eliminated, are listed below: 1. To identify trends and dilemmas in social work manpower. 2. To explicate team models that have developed in the field and examine them critically. 3. To develop for personal professional use a viable model of teamwork. 4. To expose graduate students from several disciplines t o interdisciplinary team approaches.
Rosalie A. Kane
TABLE 3 Joint Courses with Social Work and Other Professional Schools Name of Cooperating Disciplines
Number of Schools
Downloaded by [Johns Hopkins University] at 19:15 30 December 2014
Health Schools Medicine (4) Nursing (2) Public Health (2) Combinations (8) Law schools Large-scale interprofessional effort Urban planning Education Engineering Psychology Business Public communication, Public administration Architecture and design Law, psychiatry Medicine, theology NOTE: Subject matter of the interprofessional courses: Teamwork processes Health planning Issues in health care Medical social work Death and dying Mental retardation Alcoholism Family planning Gerontology
Mental development Mental health in children Family law Correctional law Juveniles and the law Use of media Organizational analysis Interviewing skills
5. To identify what is common and unique to various professions. 6. To expand students' knowledge of and capacity t o use collaboration as a technique of intervention. DISCUSSION No patterns distinguished the nonresponding from the responding schools. All parts of the corntry were represented: Urban and rural schools.were present in the same proportion as they are in the population. The early returns tended t o include most of the respondents who reported vigorous programming in interprofessional teamwork. Only a few replying t o the second mailing reported any
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SOCIAL WORK IN HEALTH CARE
substantial emphasis on teamwork, and the positive returns dwindled further with the third mailing. It seems plausible that the nonrespondents resemble the late respondents and that the findings more likely overstate than understate the proportion of schools of social work engaged in some form of interprofessional education. About a third of the responding schools were offering courses on teamwork principles or collaborating with other professional schools on joint courses. A small group of schools (9%)were doing both. Despite this activity, the survey also indicated that the majority of schools were giving little attention to the subject matter. When the questionnaire was devised, it seemed likely that all schools would claim at least a slight emphasis on teamwork in the practicurn and a slight emphasis throughout the curriculum. A "slight emphasis" seemed t o be a minimal expectation, yet some schools did not even claim this much involvement. Seven schools had no emphasis at all, and 9 additional schools claimed only a slight emphasis in the curriculum and no emphasis in the practicum. Thus 16 schools had virtually no content in the area. The great majority of respondents felt that the teamwork content was equally appropriate for 1st- or 2nd-year students; there no longer seems to be a philosophy of sequencing that exposes the student to a social work setting in the 1st year and an interprofessional or "secondary" setting in the 2nd year. Teamwork content appeared in a wide variety of niches in MSW curricula. A number of respondents utilized courses on consultation that were part of administration offerings t o discuss collaboration with other professionals; since collaboration and consultation are quite distinct processes with different assumptions this combination is interesting. The administration sequence in general seemed a hospitable home for content on teamwork. Perhaps, as one respondent commented, this affinity occurs because administration students are expected t o analyze the systems in which social workers are employed. It was interesting to note that one course on teamwork even occurred in the human behavior sequence. If such a course emphasized the role behavior of professional groups, this placement seems justifiable. Most schools introduced content in teamwork in practice courses, focusing on the practic skills needed to collaborate effectively. The breakdown of offerings shows an association between teamwork and health-related courses. Thirty-eight schools introduced some teamwork concepts in electives on social work in health settings. A number of the c o m e s on teamwork per se were centered around the health team, and the majority of the joint courses involved collaboration with one or more health schools. This result is not surprising in view of the long history of collaboration in the health field, the close interdepen-
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Rosalie A. Kane
dence of the health professions, and the current impetus toward interprofessional education in health schools across the country. More striking than the predominance of health-related courses on the team was the variety of other directions that have been taken in interprofessional education involving social work. These include the use of media with a school of communications, attitudes toward death with a theology school and a medical school, and program analysis in cooperation with a school of public administration. Social work educators have forged a great variety of collaborative alliances. Responsiveness to demands of practice does indeed suggest the current need for an emphasis on interprofessional teamwork in social work education. The question remains as to whether the social work response should be separate for all the fields in which social workers are employed or be cast in a generic kamework, or whether both these approaches are needed. The form such content takes must grow out of a conviction about the behaviors that constitute competent teamwork. A conference on interprofessional education for medicine and social work debated whether the objectives should be to develop shared abilities or rather a mutual a p p r e ~ i a t i o n . The ~ ~ preference of the group was toward "combined understanding, but separate talents" as an objective of interprofessional educational efforts. The final form, too, must be compatible with the philosophy of social work education and permit identification with the social work profession. A social work educator who has strongly advocated interdisciplinary education puts the dilemma well: "All professional schools have the same curriculum problems; namely to limit the content so that the student has sufficient opportunity to learn what is distinct and essential t o the practice for which he is preparing and, at the same time, to broaden his base of learning so that he perceives what is related significantly to his pra~tice."~' The survey reported here shows that MSW programs are beginning to approach that task.
REFERENCES 1. Cabot, Richard. Social Work: Essays on the Meeting Ground of Doctor and Social Work. Boston: Houghton Mifflin, 1919. 2. 'Phillips, Beatrice; McCulloch, J. Wallace; Brown, Malcolm; and Harnbro, Naomi. "Social Work and Medical Practice." Hospitals 4 5 (1971):76-79. 3. Horwitz, John. Education for Social Work in the Rehabilitation of the Handicapped. New York: Council o n Education for Social Work, 1959. 4. Ellwoo.d, Paul. "Can We Afford S o Manv Rehabilitation Professions?" Journal of Rehabilitation 34 (1968):47-52. 5. Smith, Neilson. "Interprofessional Training for Community hfental Health." Journal o f Education for Social Work 10 f 1974l:lO6-13. 6. Brody, ~ i a i n e ;Cole, charlotte; and ~ o s s ; ~ i r i a"Individualizing k Therapy for the Mentally Impaired Aged." Social Casework 54 (1973):453-61.
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SOCIAL WORK IN HEALTH CARE
7. Stone, Nellie. "Effecting Interdisciplinary Coordination in Clinical Services t o the Mentally Retarded." American Journal of Orthopsychiatry 40 (1970): 835-40. 8. Brennan, William, and Khinduka, Shanti. "Role Expectations of Social Workers and Lawyers in the Juvenile Court." Crime and Delinquency 17 (1971): 191-201. 9. Conrad, J. P. "The Interdisciplinarian at Home and Abroad." Prison Journal 44 (1964):7-13. 10. Hogan, Charles, and Campbell, Charles. "Team Classification in Federal Institutions." Federal Probation 32 (1968);30-35. 11. Anderson, Robert. "School Social Work: The Promise of a Team Model." Child Welfare 53 (1974):524-30. 12. Chrisopholos, Florence. "Multid~Sciplinary Paradigm." Journol of Learning Disabilities 3 (1970):167-68. 13. Ardell, Donald. "Urban PlanningIHealth Planning Interrelationships." American Journol of Public Health 59 (1969):2051-55. 14. Smith, James. "Study Seeks t o Help Form Future of Rural Towns." Lutheran Social Welfare Quarterly 11 (1971):54-57. 15. Manning. Marv Louise. "The Psvchodvnamics of Dietetics." Nursing Outlook 1 3 (196;;):57:59. 16. Peterson, Dennis. "The Broadening Role of the Hospital Chaplain." Hospitals 4 2 i1968\:58-60. 17. De 'YO"&, C ~ O I . "Nursing's Contribution in Family Crisis Treatment." Nursing Outlook 1 6 (1968):60-62. 18. Wanatabe, Sandra. "The Developing Role of Occupational Therapy in Psychiatric Home Service." American Journal o f Occupational Therapy 2 1 (1967): 353-56. 19. Murphy, Marjory. The Social Group Work Method in Social Work Education. New York: Council o n Education for Social Work, 1959. 20. Studt, Eliot. Education for Social Workers in the Correctional Field. New York: Council o n Education for Social Work, 1959. 21. Dana, Bess, and Sheps, Cecil. "Trends and Issues in Interprofessional Education." Journal of Education for Social Work 4 (1968):35-41. 22. Vigilante, Joseph. "Social Work Education Matures t o the Undergraduate Level." Social Work 19 (1974):638-46. 23. Andrew, Gwen. "Forecasting Social Work Practice as a Base for Curriculum Development." Journal of Education for Social Work 1 0 (1974):3-8. 24. Rehr, Helen, ed. Medicine and Social Work. New York: Prodist, 1974. 25. White, Grace. "Preparation of Social Workers for Interprofessional and Inter-
-
agency Collaboration." Education for Social Work, 1960 Proceedings. New York: Council on Education for Social Work, 1960.
Social Work in Health Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wshc20
INTERPROFESSIONAL EDUCATION AND SOCIAL WORK Rosalie A. Kane DSW
a
a
Associate Professor, University of Utah Graduate School of Social Work, Salt Lake City, Utah 84112 Published online: 26 Oct 2008.
To cite this article: Rosalie A. Kane DSW (1977) INTERPROFESSIONAL EDUCATION AND SOCIAL WORK, Social Work in Health Care, 2:2, 229-238, DOI: 10.1300/J010v02n02_09 To link to this article: http://dx.doi.org/10.1300/J010v02n02_09
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
INTERPROFESSIONAL EDUCATION
AND SOCIAL WORK: A SURVEY
Downloaded by [Johns Hopkins University] at 19:15 30 December 2014
Rosalie A. Kane, DSW
ABSTRACT. In 1974, the author surveyed all graduate schools of social work to determine how team concepts were being introduced t o master's degree level students. A 76% response mte was achieved; 31% of the schools offered joint courses with other professional schools, 17% offered courses o n teamwork itself within the school o f social work, 10% had virtually no content o n interprofessional collaboration, and the majority attempted t o introduce this content through the pmcticum and the overall curriculum, especially health courses. These modalities are further described along with advantages and disadvantages of various approaches.
The interprofessional team has become a standard feature in the delivery of professional services. Social workers have been involved in the interprofessional health team since the turn of the century,' and now advanced teamwork skills are considered mandatory for practice in hospitah2 Social workers have also been regularly included on the large interprofessional rehabilitation team,3 where facility in team relationships has become necessary for effective functi~ning.~ Teams are flourishing in mental health, ranging from the old child guidance team, of which social work is a charter member, to the modem community of mental health teams with their four basic professions of psychiatry, psychology, social work, and n u r ~ i n g .Spe~ cialized health fields, an admixture of health and mental health, such as geriatrics6 or mental retardation,' are fast developing the interprofessional team modality as an essential tool of practice. Continuing the catalogue, interprofessional teams are manifest in the juvenile court,' in c o r r e c t i ~ n s , ~and ~ ' ~in schools, especially in learning disability programs."*'2 They are now coming into prominence as vehicles for urban planning, health planning, and a variety of indirect servi~es.'~J~ Dr. Kane is Associate Professor, University o f Utah Graduate School o f Social Work, Salt Lake City, Utah 84112. Social Work in Health Care, Vol. 2(2), Winter 1976-77
229
Downloaded by [Johns Hopkins University] at 19:15 30 December 2014
SOCIAL WORK IN HEALTH CARE
The challenge to the social work profession in forging a role on the team is magnified because so many professions have boundaries that overlap their own. The psychologist, the psychiatrist, and, more recently, the psychiatric nurse perform therapeutic and community sewices similar to social work. The occupational and recreational therapists may work closely with both the group worker and the caseworker. The public health nurse, the health educator, and even the home economist may utilize much of the social worker's expertise. Clergymen, rehabilitation counselors, guidance counselors, schoolteachers and school psychologists, planners, and administrators have at various times interfaced with social work function. As various groups have expanded the boundaries of their roles, many professionals have added a psychological dimension t o their self-definitions; one now reads of "psychodie t e t i c ~ " ' ~or "psychoreligious counseling."16 At the same time, other ~ occupational therapy l 8 have begun professions such as n u r ~ i n g ' and emphasizing knowledge of community agencies as part of the expertise their groups bring t o the team. Perhaps no profession as much as social work enjoys so large a cast of collaborators with similarities of interest and role. EDUCATION FOR INTERPROFESSIONAL PRACTICE Translating a conviction about the necessity for tearnwork skills into a social work curriculum raises a host of ideological and practical problems. It is debated whether such content is best conveyed through courses offered in separate professional schools, through interdisciplinary ventures with students and faculty from a number of professional disciplines, or through a continuing education approach involving more seasoned professional practitioners. Some authorities advocate all of these modalities. Before learning experiences can be designed, educational objectives are required. Again the social work educator is faced with a dilemma. Does social work practice in interprofessional contexts lend itself t o a generic course with a single set of objectives? Or is social work practice so related Lo particlala settings that it must be taught in specific contexts such as health, education, corrections, or a myriad of others? Several volumes of the 1959 curtdcuhm study on social work education, particularly those on group work, rehabilitation, and corrections, highlighted the need for interprofessional skills in their particular f i e l d ~ . ~ *Other ' ~ s ~ commentators ~ have suggested a generic base in t e a skills, taught within one's own professional school before the student mingles with students of other di~ciplines.~'
Rosalie A. Kane
Downloaded by [Johns Hopkins University] at 19:15 30 December 2014
Lately it has been suggested t h a t t h e MSW level of practice should b e characterized b y teamwork in emerging fields.22 In forecasting f u t u r e practice to lay a rational groundwork f o r curriculum building, moreover, ~ n d r e wreports ~ ~ t h a t "participation in interprofessional treatm e n t teams" a n d "participation i n interdisciplinary planning" b o t h figured highly in t h e experts' projections of master's degree level social work i n 1985. T h e present paper reports o n a survey of MSW programs to determine w h a t schools of social work are n o w doing t o m e e t t h e present a n d future need f o r teamwork skills.
METHOD The population surveyed consisted of 84 MSW programs in the United States and Canada listed by the Council on Social Work Education as accredited schools or schools in the process of becoming accredited. The questionnaire was designed to be brief (a single page) and for the most part contained objective questions. By use of a checklist, respondents indicated the existence of content for interprofessional teamwork in the classroom and in the practicum, and the degree of emphasis placed on such content. They also indicated which courses in the cumculum, if any, incorporated teamwork concepts, and the timing of such content over the 2-year program. The questionnaire differentiated G o approaches to interprofessional education: (a) courses for social workers within a school of social work that deal with the nature of collaboration; and (b) collaborative courses offered with another discipline on a mutually significant subject or field, or on teamwork processes themselves. While these latter courses would not always focus on teamwork per se, they would permit students from different disciplines to mingle and communicate with each other. The questionnaire was circulated in the late spring of 1974;about 3 weeks after the initial mailing, a reminder was sent along with a time-saving card for the use of schools with no content at all related to the topic. As a result of the first two mailings, 63% of the programs surveyed responded. A third solicitation was made in the fall of 1974 to those schools that had not replied in the spring, bringing the total of respondents to 76%.
FINDINGS 'Pables 1 a n d 2 illustrate t h e presence of teamwork concepts i n t h e p r a d i c u m a n d in t h e general classroom curriculum. As Table 1 indicates, 50% of t h e respondents declared a strong emphasis o n teamwork in t h e p r a d i c u m component of their programs, 34% declared a slight emphasis in t h e p r a d i c u m , a n d 13%stated t h a t n o content o n teamwork had been deliberately introduced in t h e p r a d i cum. Three percent stated t h a t t h e degree of emphasis o n teams in fieldwork depended o n t h e particular setting involved.
SOCIAL WORK IN HEALTH CARE
TABLE 1 lnterpro fessional Teamwork Emphasis in Practicum
Amount of Emphasis
Number of Schools
Percentage
Strong emphasis Slight emphasis Other
Downloaded by [Johns Hopkins University] at 19:15 30 December 2014
None Total
Since the fieldwork sequence is traditionally the place where it has been assumed that students would develop a competence in teamwork, the fact that half the respondents reported a strong emphasis here was not surprising. However, the fact that almost half reported a slight emphasis or none at all was rather unexpected. Table 2 reports the presence of teamwork concepts in the classroom curriculum. Fifty-two percent of the group stated that the subject was emphasized slightly throughout the curriculum as a whole, 19% reported strong emphasis, and 30% indicated that no theme regarding teamwork appeared in the curriculum. Additionally, respondents checked cumculum areas in which they tended t o introduce teamwork concepts. Thuty-eight schools designated practice electives in special fields, 39 practice courses, 23 ad-
TABLE 2 lnterpro fessional Teamwork Concepts in Overall Curriculum Amount of Emphasis
Number of Schools
Percentage
Strong emphasis
12
18.8
Slight emphasis
33
51.6
19 -
29.6 100.0
None Total
64
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Rosalie A. Kane
ministration courses, and 1 5 policy courses; schools could, and did, check off more than one area for this question. Seven schools replied that they had no content around teamwork either in field or class, and nine additional schools had no content other than a slight emphasis in the curriculum. The majority of schools indicating teamwork content permitted it t o fall equally in the 1st or 2nd year. Eleven percent placed the content primarily in the 1st year, 6% in the 2nd, 69% in both years, 9% in neither year, and 4.7% could not address the questions because their pattems differed from the traditional 2-year program. As Figure 1 illustrates, 31% of the schools offered joint courses with other professional schools, and 17% offered courses on teamwork per se in the school of social work. Six schools, or 9% of the respondents, offered both of these modalities, while 60% offered neither pattern. The nine schools offering courses on teamwork processes placed them in the following cumculum areas: three schools, as general electives; three as practice electives; two, as an elective on the health team; and one, as a behavior elective. Several schools illustrated the variety of organizational thrusts possible by providing additional information about their intraschool electives on teamwork processes. Since all schools did not d o so, this information cannot be quantified, but some of the pattems in use can be enumerated. One course focused on manpower arrangements, asking students t o develop a viable model for collaboration in their particular field of practice. Several courses were structured around the different professions with whom social workers collaborate, with the reading list
BOTH INTERSCHOOL AND l NTRASCHOOL COURSES N = 6 19.1:/.,) INTERSCHOOL COURSES OFFERED N = 2 0 131.2%)
INTRASCHOOL COURSES ON TEAMWORK per se N.9 (17%)
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\OR
NO I NTRASCHOOL INTERSCHOOL N = 3 9 (60.9%)
FIGURE 1. Intraschool and interschool courses.
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divided according t o collaborating professions such as law, medicine, nursing, divinity, and so on. One course emphasized the sociology of the various professions, examining the socialization processes and the various status concerns of the different disciplines. Another offering was subdivided into four topical areas, namely, the organization, the work group, the participants, and the skills. The several courses devoted to teamwork in health tended t o highlight descriptive accounts of role conflict in health and mental health settings. The 20 schools reporting electives offered jointly with other professional disciplines accounted for at least 39 collaborative courses. Table 3 shows the frequencies of the various collaborative alliances. Health schools were involved in the largest number of joint courses, and law schools were second. These courses shown on the table under the heading "Barge-scale interprofessional effort" refer t o courses planned with a large number of disciplines; in this category one school mentioned five cooperating schools, one mentioned six, and one mentioned nine. As an example, the most ambitious effort involved physical therapy, occupational therapy, rehabilitation counseling, speech pathology, psychiatric nursing, nursing education, leisure education, and gerontology, as well as social work. Beginning as a course on "Interdisciplinary Collaboration in Social Work," it evolved into an experimental offering with an emphasis on the common skills needed by all professionals t o engage in the collaborative process. According t o the report, content was drawn from activity directed at patient care, program development, policy change, and relevant research. The right-hand column of Table 3 lists the subject areas mentioned for the interprofessionally sponsored courses. Not all respondents provided this detail so the list is suggestive rather than exhaustive. Some respondents supplied additional detail about the organization of the courses from which it was leaned that some courses attempted to equalize the numbers of students from the participating disciplines and to form student teams. One such example was a course on urban and social planning that sent student teams into local communities t o study needs from the physical and social perspective. The outlines volunteered listed a number of objectives for interprofessional courses. These objectives have been culled and, with duplications eliminated, are listed below: 1. To identify trends and dilemmas in social work manpower. 2. To explicate team models that have developed in the field and examine them critically. 3. To develop for personal professional use a viable model of teamwork. 4. To expose graduate students from several disciplines t o interdisciplinary team approaches.
Rosalie A. Kane
TABLE 3 Joint Courses with Social Work and Other Professional Schools Name of Cooperating Disciplines
Number of Schools
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Health Schools Medicine (4) Nursing (2) Public Health (2) Combinations (8) Law schools Large-scale interprofessional effort Urban planning Education Engineering Psychology Business Public communication, Public administration Architecture and design Law, psychiatry Medicine, theology NOTE: Subject matter of the interprofessional courses: Teamwork processes Health planning Issues in health care Medical social work Death and dying Mental retardation Alcoholism Family planning Gerontology
Mental development Mental health in children Family law Correctional law Juveniles and the law Use of media Organizational analysis Interviewing skills
5. To identify what is common and unique to various professions. 6. To expand students' knowledge of and capacity t o use collaboration as a technique of intervention. DISCUSSION No patterns distinguished the nonresponding from the responding schools. All parts of the corntry were represented: Urban and rural schools.were present in the same proportion as they are in the population. The early returns tended t o include most of the respondents who reported vigorous programming in interprofessional teamwork. Only a few replying t o the second mailing reported any
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substantial emphasis on teamwork, and the positive returns dwindled further with the third mailing. It seems plausible that the nonrespondents resemble the late respondents and that the findings more likely overstate than understate the proportion of schools of social work engaged in some form of interprofessional education. About a third of the responding schools were offering courses on teamwork principles or collaborating with other professional schools on joint courses. A small group of schools (9%)were doing both. Despite this activity, the survey also indicated that the majority of schools were giving little attention to the subject matter. When the questionnaire was devised, it seemed likely that all schools would claim at least a slight emphasis on teamwork in the practicurn and a slight emphasis throughout the curriculum. A "slight emphasis" seemed t o be a minimal expectation, yet some schools did not even claim this much involvement. Seven schools had no emphasis at all, and 9 additional schools claimed only a slight emphasis in the curriculum and no emphasis in the practicum. Thus 16 schools had virtually no content in the area. The great majority of respondents felt that the teamwork content was equally appropriate for 1st- or 2nd-year students; there no longer seems to be a philosophy of sequencing that exposes the student to a social work setting in the 1st year and an interprofessional or "secondary" setting in the 2nd year. Teamwork content appeared in a wide variety of niches in MSW curricula. A number of respondents utilized courses on consultation that were part of administration offerings t o discuss collaboration with other professionals; since collaboration and consultation are quite distinct processes with different assumptions this combination is interesting. The administration sequence in general seemed a hospitable home for content on teamwork. Perhaps, as one respondent commented, this affinity occurs because administration students are expected t o analyze the systems in which social workers are employed. It was interesting to note that one course on teamwork even occurred in the human behavior sequence. If such a course emphasized the role behavior of professional groups, this placement seems justifiable. Most schools introduced content in teamwork in practice courses, focusing on the practic skills needed to collaborate effectively. The breakdown of offerings shows an association between teamwork and health-related courses. Thirty-eight schools introduced some teamwork concepts in electives on social work in health settings. A number of the c o m e s on teamwork per se were centered around the health team, and the majority of the joint courses involved collaboration with one or more health schools. This result is not surprising in view of the long history of collaboration in the health field, the close interdepen-
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Rosalie A. Kane
dence of the health professions, and the current impetus toward interprofessional education in health schools across the country. More striking than the predominance of health-related courses on the team was the variety of other directions that have been taken in interprofessional education involving social work. These include the use of media with a school of communications, attitudes toward death with a theology school and a medical school, and program analysis in cooperation with a school of public administration. Social work educators have forged a great variety of collaborative alliances. Responsiveness to demands of practice does indeed suggest the current need for an emphasis on interprofessional teamwork in social work education. The question remains as to whether the social work response should be separate for all the fields in which social workers are employed or be cast in a generic kamework, or whether both these approaches are needed. The form such content takes must grow out of a conviction about the behaviors that constitute competent teamwork. A conference on interprofessional education for medicine and social work debated whether the objectives should be to develop shared abilities or rather a mutual a p p r e ~ i a t i o n . The ~ ~ preference of the group was toward "combined understanding, but separate talents" as an objective of interprofessional educational efforts. The final form, too, must be compatible with the philosophy of social work education and permit identification with the social work profession. A social work educator who has strongly advocated interdisciplinary education puts the dilemma well: "All professional schools have the same curriculum problems; namely to limit the content so that the student has sufficient opportunity to learn what is distinct and essential t o the practice for which he is preparing and, at the same time, to broaden his base of learning so that he perceives what is related significantly to his pra~tice."~' The survey reported here shows that MSW programs are beginning to approach that task.
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7. Stone, Nellie. "Effecting Interdisciplinary Coordination in Clinical Services t o the Mentally Retarded." American Journal of Orthopsychiatry 40 (1970): 835-40. 8. Brennan, William, and Khinduka, Shanti. "Role Expectations of Social Workers and Lawyers in the Juvenile Court." Crime and Delinquency 17 (1971): 191-201. 9. Conrad, J. P. "The Interdisciplinarian at Home and Abroad." Prison Journal 44 (1964):7-13. 10. Hogan, Charles, and Campbell, Charles. "Team Classification in Federal Institutions." Federal Probation 32 (1968);30-35. 11. Anderson, Robert. "School Social Work: The Promise of a Team Model." Child Welfare 53 (1974):524-30. 12. Chrisopholos, Florence. "Multid~Sciplinary Paradigm." Journol of Learning Disabilities 3 (1970):167-68. 13. Ardell, Donald. "Urban PlanningIHealth Planning Interrelationships." American Journol of Public Health 59 (1969):2051-55. 14. Smith, James. "Study Seeks t o Help Form Future of Rural Towns." Lutheran Social Welfare Quarterly 11 (1971):54-57. 15. Manning. Marv Louise. "The Psvchodvnamics of Dietetics." Nursing Outlook 1 3 (196;;):57:59. 16. Peterson, Dennis. "The Broadening Role of the Hospital Chaplain." Hospitals 4 2 i1968\:58-60. 17. De 'YO"&, C ~ O I . "Nursing's Contribution in Family Crisis Treatment." Nursing Outlook 1 6 (1968):60-62. 18. Wanatabe, Sandra. "The Developing Role of Occupational Therapy in Psychiatric Home Service." American Journal o f Occupational Therapy 2 1 (1967): 353-56. 19. Murphy, Marjory. The Social Group Work Method in Social Work Education. New York: Council o n Education for Social Work, 1959. 20. Studt, Eliot. Education for Social Workers in the Correctional Field. New York: Council o n Education for Social Work, 1959. 21. Dana, Bess, and Sheps, Cecil. "Trends and Issues in Interprofessional Education." Journal of Education for Social Work 4 (1968):35-41. 22. Vigilante, Joseph. "Social Work Education Matures t o the Undergraduate Level." Social Work 19 (1974):638-46. 23. Andrew, Gwen. "Forecasting Social Work Practice as a Base for Curriculum Development." Journal of Education for Social Work 1 0 (1974):3-8. 24. Rehr, Helen, ed. Medicine and Social Work. New York: Prodist, 1974. 25. White, Grace. "Preparation of Social Workers for Interprofessional and Inter-
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