CONNECTIONS AND COLLABORATIONS
By:
SOPHIA F.
DZIEGIELEWSKI
Serving as part of a team, social
workers and other mental health professionals have a unique role in the
assessment and diagnostic process. Most professionals agree that a
comprehensive diagnostic assessment starts with taking into account the complexity
of the human condition and situational factors that affect behavioral health
(Pearson, 2008). As part of a collaborative team, the mental health
professional gathers a wealth of information regarding the client’s
environment and family considerations. The practitioner also needs to remain
aware that whether taking a leadership or supportive role, all efforts must resonate
with the culture of the team (Conyne, 2014). Therefore, the practitioner can serve
as the professional bridge that links the client to the multidisciplinary,
interdisciplinary, and transdisciplinary teams and the environment (Dziegielewski,
2013).
The term multidisciplinary can best be explained by dividing it
into its two roots, multi and discipline. Multi means “many” or
“multiple”;
discipline means “the
field of study a professional engages in.” When
combined, professionals from multiple disciplines work together to address a common
problem. In health care settings, multidisciplinary teams were part of a
cost-effective practice response to the shifts from institutional care to
community and home care through the delivery of specialized services (Rosen
& Callaly, 2005). This type of team collaboration may also improve patient
care outcomes (Burns & Lloyd, 2004).
The multidisciplinary team is often
recognized as a preferred form of service delivery, especially in complex health and mental health service delivery systems
(Orovwuje, 2008).Multidisciplinary teams include health and social-welfare professionals
from various disciplines: psychiatrists, physicians, nurses, social workers,
physical therapists, occupational therapists, and so on.
When serving on a multidisciplinary
team, each member has a distinct professional role and refers to other professionals in the same or other agencies in a loose yet semi-structured
manner. Each professional generally works independently, sometimes in
isolation, to solve the problems and related needs of the individual. At the
same time, the professionals share what is learned about the client to improve
treatment progress and overall team concerns.
A key feature of multidisciplinary
teams is participants’
network-style group
interaction (Rosen & Callaly, 2005), in which the boundaries within professional
disciplines are maintained, with each providing a perspective of the client’s
problem to address key features in the delivery of care. This process of
patient care planning provides a comprehensive method of service delivery for
the client. In multidisciplinary teamwork, “a
team manages its resources collectively according to client needs or along
professional discipline boundaries”
(Whyte & Brooker,
2001, p. 27). Communication and goals are consistent across disciplines, with
each contributing to the overall welfare of the client.
Multidisciplinary Teams
A group of professionals working together for a common purpose, working
independently while sharing information through formal lines of communication
to better assist the patient/client/consumer.
In the current mental health care
system, which stresses evidence-based practices and outcomes to measure
quality, multidisciplinary approaches are limited in meeting the current standards of care secondary to their structural makeup and style of approach to
service delivery. Measurement is difficult when the interpretation of the
stated goals and how to best achieve them differs among varied professionals.
These professionals are all committed to working together to help the client,
but in this type of teamwork, there may be different approaches and
expectations for what is considered high-quality care and how to best achieve
it.
And while communication is evident,
cohesion in multidisciplinary teams is not always feasible in service delivery,
especially with normal differences in worldviews, professional identities,
salaries, status, attitudes, and educational backgrounds (Carpenter, Schneider,
Brandon, & Wooff, 2003; Lankshear, 2003). The multidisciplinary team is
still often used to provide services from a team perspective in mental health
care, yet a more collaborative and integrative approach, known as the interdisciplinary team approach, is
gaining in popularity (Dziegielewski, 2013; Molodynski & Burns, 2008; Rosen
& Callaly, 2005).
Similar to the multidisciplinary team,
the interdisciplinary team includes a variety of health care professionals. An interdisciplinary approach takes amuchmore holistic
approach to health care practice. “An interdisciplinary team in a modern mental
health service brings specialist assessments and individualized care together
in an integrated manner and is the underlying mechanism for case allocation,
clinical decision-making, teaching, training and supervision and the
application of the necessary skills mix for the best outcomes for service users” (Rosen
& Callaly, 2005, p. 235).
Interdisciplinary professionals work
together throughout the process of service provision. Generally, the entire
team develops a plan of action. This type of teamwork involves a collaborative coordination
of care; team-related activities, such as treatment planning; and shared
leadership and power (Zeiss & Gallagher-Thompson, 2003).
In service provision, the skills and
techniques that each professional provides often overlap. Interdependence is stressed throughout the referral, assessment, treatment, and
planning process rather than through networking. This is different from the
multidisciplinary team, where assessments and evaluations are often completed in
isolation and later shared with the team.
Boundaries in the formation of
interdisciplinary teams are often blurred. In the interdisciplinary team
process, each professional team member is encouraged to contribute, design, and
implement the group goals for the health care service to be provided
(Dziegielewski, 2013; Mezzich & Salloum, 2007).
Within the interdisciplinary team, each-member
may also supervise each other’s work— a
key difference from multidisciplinary teams, in which each member is measured and
supervised independent of each discipline and agency (Rosen & Callaly,
2005). Interdisciplinary teams can facilitate high-quality care by gathering
participatory information related to the analysis of the client’s
problem. A variety of multidisciplinary skills are available that work in a
mutual and reciprocal educational fashion and produce viable and demonstrable
results. This allows implementation and problem-solving capabilities that
encourage collaboration among providers to decrease and avoid isolation and to
generate new ideas.
Interdisciplinary Teams
A group of health care professionals who work together for a common purpose,
working interdependently where some degree of sharing roles, tasks, and duties
can overlap with both formal and informal lines of communication to better assist the patient/client/consumer.
The transdisciplinary team is similar
to the interdisciplinary team in that it also has a variety of health care professionals. The primary difference is the degree of openness
between the team members, with all openly sharing information and participating
in the client-helping strategy.
With this holistic approach to
practice, all of a client’s health and mental health needs are treated together, and case allocation and clinical decision making, teaching,
training, and supervision are done collaboratively as a team. This is more
common in health care but may continue to gain in importance as the need for
more collaborative teamwork grows.
Transdisciplinary Teams
A group of health care professionals and the patient/client/ consumer and
identified members of his/her
support system freely share ideas and work together as a synergistic whole where
ideas and sharing of responsibilities are commonplace in routine care.
Regardless of the type of team utilized, multidisciplinary, interdisciplinary, or transdisciplinary mental health professionals should always emphasize client skill building and strength enhancement. A team approach helps to build satisfaction among members and provides leadership enhancing satisfaction among all team members (Baran, Shanock, Rogelberg, & Scott, 2012). If client needs are addressed from this perspective, each team member will be well equipped to contribute accordingly to the diagnostic assessment, supporting the development of the treatment plan, which will guide and determine future service delivery.
Attending to the dynamics of the team
collaboration as well as the contributions each team member makes can only lead
to enhanced service delivery (Packard, Jones, & Nahrstedt, 2006). These
types of collaborative teams can be utilized in service delivery and provide
fertile ground for understanding how service delivery can be unsuccessful when fragmentation occurs (Bunger, 2010).
References
SOPHIA F.
DZIEGIELEWSK, 2015, DSM-5TM
in Action, by John Wiley & Sons, Inc.
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