Social Work In A Multidisciplinary Context

Published Date: 02 Nov 2017

CANDIDATE NUMBER: 1208908

Name of Programme: MSc in Social Work

Name of Course: Critical Social Work

Course Code: HC5511

Question Answered: (Please type full question)

The role and contributions of social work in a multidisciplinary context.

Word Count:

3172

This essay aims to look at the role and contributions of social work in the health and social care setting, i.e. hospital setting. In the current economic climate health and social care services are facing increasing challenges, which more than ever seems to require a merging/liaison of or between services. For example, when it comes to older people, as the biggest service users of health and social care services, health and social care professions come together when planning discharge.

Multidisciplinary team working is becoming a model of working among children and adult services. The term multidisciplinary or MDT has been described widely across different settings, practices and professionals. In practice the degree to which a group of professionals is truly multidisciplinary tends to be driven by the level of influence and engagement of the interpersonal relationships of the different professionals involved (Continuing NHS Healthcare, 2011). But what does it mean to be multidisciplinary?

‘Multidisciplinary team' is a term used to describe a variety of different interprofessional working arrangements. A problem in designing and improving teams is that people use the same word to mean something different. This makes it difficult to discuss which type of team is best for a particular purpose and setting.

Multidisciplinary teams are recognised as playing a key role in ensuring that all aspects of service users’ needs are properly considered so that appropriate advice and/or interventions can be given. The aim is for these teams to provide a joined service that is beneficial to the service user and promote better quality of care. For example, when being discharged from hospital an adult person with mobility problems might require further assistance upon their return home. Health professionals might consider making a referral to social services for an assessment of needs and care plan. This client might need a district nurse to assist with medication and home care to assist with washing and dressing.

The process of multidisciplinary assessments of older people when being discharge from hospital can be seen as an example of health and social care services coming together. In this instance a degree of trust between the different professionals has been deemed as essential but at times there is conflict between nurses ‘service-led’ approach versus social workers ‘needs-led’ stance (Hudson, 2002).

The term multidisciplinary has been frequently used when reference is made to the delivery of health and social care services. The definitions of this term seem to vary from it referring to being a team or a group of people from different disciplines who work together and/or provide coordinated services. This term is also often used interchangeably and randomly with the term interdisciplinary. Pethybridge (2004) makes reference to multidisciplinary working being related to different professionals working with the same client towards the same objective. While interprofessional working as the interwoven working together of different professions. In contrast, McCallin (2001) refers to the term ‘multiprofessional’ as being a collaborative process in which members of different disciplines assess or treat a client independently and only share information with each other. While ‘interdisciplinary’ describes a deeper level of collaboration in which processes such as evaluation or development of a plan of care is done jointly, with professionals of different disciplines pooling their knowledge in an independent manner. Many further argue that the main difference between ‘inter’ and ‘multi’ is largely numerical, where the latter refers to more than two professionals being involved (Wilson and Pirrie, 2000). It makes one wonder whether these words do mean something or nothing to different professionals as from the literature available it is far from a clear concept.

However ambiguously it may have been defined, multidisciplinary concept is well established in the literature of health and social care. In the field of social work practice it does seem that multidisciplinary working is work undertaken jointly by workers and professionals from different occupations (Pierson and Thomas, 2010). While a full analysis of the complexities of this terminology is beyond the scope of this essay, it is important to acknowledge such intricacies when trying to understand the social work role in teams made up of different professionals.

Let us consider the role of social work in hospitals. For instance, the process of discharging patients from hospital could be seen as the indicator of the need for multidisciplinary involvement between health and social care services. As found by Hendwood (2006) for patients who have care needs which continue following their discharge from hospital, how well health and social care agencies are able to coordinate is critical. The contested point being where things go wrong which authority is responsible.

In a hospital setting, many of the difficulties between health and social care are set in the experiences of patients being discharge from hospital. The speed of discharge or its delay is frequently the result of disputed responsibilities (Hendwood, 2006). The issues (s) here seem to be that despite many restructurings within health and social care there remains tensions, such as: financial, power and authority in multidisciplinary teams as well as issues to do with lack of clarity of role. These challenges of multidisciplinary working may strain the role of social work in such settings as it struggles to maintain one professional identity in a setting of blurred professional boundaries.

For instance, Moran et al. (2007) study on multi-agency working from the perspective of social workers found that some of the more fundamental challenges were that of professional identity and status. Where social workers ‘feared that their unique professional contribution was in danger of being subsumed by other professionals’ (p.149). As further suggested in Hudson (2002) ‘doctors are widely seen as ‘full’ professionals whereas social work and nursing have been consigned to the category of ‘semi-profession’ (p.8). Moreover, according to Hudson’s (2002) notions about status, the extent to which professions share a similar status has implications for whether and how they may work together. The implications suggested here could be related to some of the conflicts in multidisciplinary hospital setting where there are perceived status differentials between professionals (i.e. health versus social care professionals).

The organisational complexities further create a gap in multidisciplinary working, for instance the multidisciplinary team in a hospital setting might be composed of only one social worker in a multitude of health service professionals. This consequently contributes to feelings of isolation and lack of support. As such one could argue that multi-disciplinary working can have great implications for the concept of professionalism and how we think about professional knowledge and practice. As put by Frost (2001) traditional claims to professional expertise are based on developing expertise in specific professional fields, the antithesis of joined-up thinking. Frost, et al. (2005) also states that in multi-agency teamwork, professional knowledge boundaries can become blurred and professional identity can be challenged as roles and responsibilities change. Such changes can generate discomfort, anxiety and anger in team members as they struggle to cope with the disintegration of one version of professional identity before a new version can be built. Moreover, Lymbery (2006) states that the essence of social work practice lies in broader processes and not technical which makes it easier for other professions, such as nursing, to claim the ability to undertake many social work related tasks, while on the other hand social workers cannot claim to have the technical knowledge and ability of a nurse. This reinforces the need for clarity of all roles in a multidisciplinary setting to ensure effective contribution to patient care by all involved.

Furthermore, practitioners from different disciplines are not usually expected to justify the conceptual base of their actions or interactions with clients in single-agency settings (Frost et al., 2005). In a multi-agency team differences potentially ‘collide’ as boundaries around specialisms are broken down. At this point, professionals have to find a common language to make knowledge accessible to their colleagues from other disciplines. This may involve discarding specialised vocabularies, which can be a challenging process as different disciplines may find that their language is a reflection/characteristic of their status and identity. As such, overcoming differences may promote the development a common language.

In a hospital based team, a main difference tends to be what is perceived to be the dominant medical model and the subordinate social model. Whilst among the professions that work with older adults there are a wide range of shared and diverse models of knowledge and practice, in a hospital setting there are bound to be tensions that arise between those differing explanatory models, i.e. ‘social’ and ‘medical’ models. The medical model focusses on issues of health and illness, with an emphasis on the individual. The social model takes a wider perspective and places more emphasis on the social context in which the individual lives. Thus, how can social work practice take place and professional capacity maintained if one has to endorse something they do not believe in?

With these complexities, there are challenges facing social workers in multidisciplinary settings. The most common challenge facing social workers in multidisciplinary settings seems to be to contain and embrace diversity while not sacrificing those beliefs which underpin their commitment (Frost et al., 2005). Research refers to a circle of exclusion, where belonging to a different agency precludes access to cycles of knowledge exchange and development. For example, accounts of consultants not being prepared to modify language, not speaking non-technical language, and lacking ‘patience’ to clarify meanings are impediments to collaboration. (Frost et al., 2005)

There are also issues and dilemmas around the distribution of power and status between different professions, which impact social work practice and service delivery. Different professions might set a different value on status differences, and in multidisciplinary teams this could be a factor in the different clashes between professionals.

In regards to the issue of power, one can argue that in a hospital setting the social work role is affected by the exercise of medical power. This might be accentuated by the suggestion that social workers are valued for being the gatekeepers of social care resources rather than for performance of other elements of their professional role (Lymbery, 2006). Huntington (1986) also made reference to social workers freedom to make contributions they deem proper as being dependent upon doctors and the importance they attach to psycho-social factors in illness.

There are other barriers to multidisciplinary working, such as professional rivalry (Lymbery, 2004) and mistrust (Hudson, 2002), lack of support for team working from key professionals, confidentiality issues, increased risk, lack of knowledge (Frost et al., 2005) of what other professionals do and what unique skills they have to offer.

Frost et al. (2005) research on the role of social workers in multi-agency teams concluded that the social work role in the different teams is complex and contested. Where there are actual and potential conflicts about models of understanding, about status and power, about information sharing, and around links with other agencies. For example, in a hospital setting nurses might be seen as the ones that really care about patients whilst social workers are perceived as rigid and bound by policy. Hence, collaboration between professionals has also been considered essential for the effective practice of service delivery (Bronstein, 2003). This is relevant in multidisciplinary working as professionals aim to work together to achieve a desired outcome, for instance in the case of hospital settings this could be a timely and safe discharge. As put by Lymbery (2006) ‘collaboration is the activity that gives practical expression to partnership’ (p.1121)

In the context of a multidisciplinary setting professionals must share information, clarify their respective roles and overcome the challenges and complexities cause by power imbalance values and work culture so as to deliver good quality services. The varied agencies’ culture and working policies might create rivalry between the different agencies (Thompson, 2005). This has also been found in literature relating to budgets and funding, as well as in terms of information sharing.

Despite the many challenges, social work makes many contributions to multidisciplinary teams. For instance as a discipline, it is underpinned by a broad range of social science theory which does not only think in terms of individual and family pathology but takes an ecological perspective to clients’ needs. Also, its wider political perspectives bring to multidisciplinary teams knowledge and understanding of oppression that may inform and influence a different and more appropriate type of intervention. Additionally, by health and social services working together upon discharge from hospital adults with complex needs have further means of support which could assist them to live independently in the community.

Herod and Lymbery (2002), comment on how social workers organisational and strategic role offers assessments more depth by their understanding of the wider social and family context that service users inhabit. Moreover social workers values and orientation challenge the dehumanising aspects of services, processes and procedures, with the aim to influence or redefine how health services should be define, with a focus on client centred-care. Such abilities have a major impact on multidisciplinary working. A further contribution to hospital-based social work, is the quality of the relationship a social worker is able to establish, which will have a major bearing on the success of the work (Lymbery, 2006). As put by Postle and Beresford (2007) another important feature of contemporary social work is the recognition of the importance of building fruitful alliances with people who use services. Additionally, benefits for social work in a multi-disciplinary context have been identified has opportunity to gain further understanding of other roles as well as improve inter-agency communication (Moran et. al, 2007)

Among the conflicts with multidisciplinary working Frost et, al (2005) also found that the teams commitment and ability to build new ways of working could potentially form the basis of effective joined-up practice. An important characteristic of social work practice is the ability to develop skills of critical reflection, clearly needed to provide a broader service to people in difficult situations. This could increase collaborative thinking in multidisciplinary settings.

Advantages of multidisciplinary working seems to be centred around offering a broader perspective, a better understanding of the issues affecting clients and improve interactions with other agencies. Nonetheless, it is acknowledged that multidisciplinary working increases demands and pressures on individual agencies.

From the body of literature, multidisciplinary working is considered to be key in order to promote best outcomes for services users and for a more cohesive delivery of services. Multidisciplinary working could also be considered as ideal, based on the argument that it is a holistic way of meeting clients’ needs. Nonetheless, challenges have been identified in literature and research which suggest that multidisciplinary working may blur professionals boundaries and threat professional identity for some social workers (Moran et al., 2007) There is also a concern that multidisciplinary working might be negative and flawed given that the wide range of skills brought in by different professionals may cause conflict. A lack of shared meaning and values may also result in alienation in multidisciplinary working. As put by Hudson (2002) where professionals have similar perceptions, values and experiences there will be more agreement, than between members of two different professions. Moreover, the combination of role perceptions and expectations may impact agencies priorities and views, both at agency and individual professional level. As noted by Frost (2005) professions are defined by what makes them distinctive rather than by what they have in common. With this in mind, it becomes a conflict for social workers to maintain their unique professional contribution while at the same time working within a multidisciplinary approach (a blur of professional boundaries).

In a hospital setting the professional relationship between social workers and medical professionals historically has been somewhat strained. As put by Thompson (2005) this relationship is often complex and sometimes fraught with difficulties. To move forward more effectively social workers must be aware of health care professionals’ values and be able to identify conflicts with social work values, the same could be applied vice-versa as useful lessons might be learned which could improve practice. Although different orientations may produce conflict such difference may also enhance multidisciplinary working to the benefits of services users and service delivery.

Moreover, the role of social work in the context of multidisciplinary working needs to be further defined in order to more clearly distinguish social work specific tasks from those of other related professionals. As put by Hudson (2002) an ill or weak definition of professional identity may hinder the ability to retain an independent approach.

In Pethybridge (2004) research into the factors in an interdisciplinary/multidisciplinary context that influence discharge planning, it was found that documentation, goal setting, training and team building were essential to develop multidisciplinary working. Also, that leadership and communication were vital to the success of good discharge planning. This seems to indicate that joint strategic planning and appropriate policy documentation is needed to overcome differences in aims and objectives in multidisciplinary settings. This will perhaps bridge the boundaries between different professionals and agencies. Cultural differences, policy and procedural differences have been linked with challenges for those working in a multidisciplinary setting. These seem to reflect fundamental differences in principles and philosophies and hence closely linked to cultural issues. Hence the importance of understanding the constraints under which other agencies operate so that expectations are realistic. It remains unclear the extent to which challenges are agency specific, felt by those working at a strategic or operational level.

To conclude, the promotion of multidisciplinary working in the delivery of health services and social care is regarded by policy makers as an approach to pursue towards delivering a quality of services. What research and literature seems to tell us is that such approach requires greater multidisciplinary contact which places practical and knowledge base demands on service providers to co-ordinate their practices. Practitioners are expected to integrate their services and develop MDTs, however the success of such teams seems to be elusive. As mentioned, perceived status differentials between different professional groups and lack of shared meaning and values could impede the creation of effective multidisciplinary teams.

On the other hand, there are benefits for multi-agency working from sharing skills to fostering shared decision-making. In terms of social workers role, as pointed out in Lymbery (2006) ‘Social workers have always had to develop the ability to work with organizational systems and networks; if this is combined with the social worker’s commitment to values, this facility can have a major impact on the multidisciplinary environment’ (p.1129). Likewise Thompson (2005) argues that all forms of social are at least indirectly multidisciplinary in terms of the need to liaise with one or more professionals, such as the social work process from assessment to review and evaluation. As such there is great scope for further research given the current emphasis on the need for joined-up thinking, perhaps by exploring the effectiveness of multidisciplinary working from a service user perspective and whether it contributes to better service deliver and outcomes. It might be also worth considering redefining the vocabulary associated with multidisciplinary working to promote a more consensual understanding and awareness of its processes and the expectations of each professional.