I. r. 1 III N I | 1 II I I i .l‘. ‘. z | W I l I w I! E ’ ‘ II I 'l A I I I I l c>-e l -ACD 01—; ,5 Wendell G. Asplin and Albert ~ I . ’ V ,ii . - f.-. \'~ 3' A CONSIDERATION OF ATTITUDES CONCEINING SOCIAL WORK SERVICE AS A MEMBER OF THL CLINICAL TEAM IN A NEUROPQYCHIATRIC HOSPITAL by '3‘" -"'r-‘: ‘r'~:7r - m-r as ”rt-W? ..::~ "'31";qu t"; (.3"u"‘"“ -" 'M‘nt’ A C:.’?-.. I.“ UTI - LIMJCIWQ L. J. 4 I?» "(Lu-1A1; 42}; ¢" Q. - f“ '7: 3:7." ' fir“ TM: ”?'V‘\7 Pa" to. n.1,...» At; A? ll“! .1' l. 3" A Uu TkhJ‘u It; A ’1'V‘n*'133:.&.fif .13 H “\I’ITfi-L by Albert 0. Lilly and we ndall G. £35331an A E13 3‘. :LCT BLTJ K‘. '17: Submitted to the School of Socio 1 ’uinrk kick gran “ etate University in Partial Fulfi‘ lment of the Requirements for the Dogma of June 195 2 Approved: 0414-9 E! iWfl-k T Cbaiman, Rasearch unmittea ;HE§?-‘d .‘i‘ “T T 75'3“"! 1-! C.Lf‘!u..l S". “.2311. ”The genius of social work lies not so much in what it knows, as in what it does with what it knows, net so much in what it does as how it daea it, mat alone in how it does it but in the confluence of knee flags, method, purpose, 8nd philasonhy it reflects in its unique relation to other professions, and princigally 1n.its unaerstanéing View of the whole person.“ Leonard Faye ii - ."H’Wn. pm -K 'o grep A ’3?»1‘31?Izi....;l.1.i-.: I119: I .3 Ea wish to express cur appreciation ta‘firs. Rachel Sm'th, our faculty adviser, and fir. lrnald Gurin, aur research adv-sar far'thair guidance in the preparation of this study. We are especially grateful to Hrs. Filurad Lilly for‘har assistance in the prenaratlon and typing of the original dreft of this paper. Also, our thanks go to all manlers of the social work staff at the $etarans Hospital for their Cooyaratlon and undsrfitanding through at this study. .n’ '0‘. {Y a 1. ~ 1 AU: a." run—3 TAEEE OP C13‘TEET3 na~~gp Uus9\(u. o o o o o o a o o o t o c o o LISTwIk'173T‘3.TI?:~33outoo000.000. Chapter: T ‘0 IV. V. “T ~74 DJ- J .' r, ‘ L who \ .4.--'\" ‘d‘ tr)" & won-had.- J.i.‘. My; yvr'n't‘! ‘Pf‘ Itva..xLuooooooooobooo Setting Of the St"dy. O o The Team if! EFL-.13 LENA.“ O :r'125=W'rflI MT. “‘a 'Yfl: " mm. o o o o o a o gm r“? "T W 1: 3} i: n;& L:.:1v JJL~)1'Jx o a o o O Q o o o o FGLHOéS Of Sacaring Data. 0 6 o o o o \°"1;.1‘fifW\:‘Azx23 !.tn.v «'11! 5"??? 3‘2“. .. 3‘. .‘ inf—3' flocial Lark's Relationahip vita thfl patifinta. o o o o o o o o o o 0 Team Astitudas TaLarn Sccia Service. Con..ent of Social ‘~ork ” ole . . . o . Eiffuram ~33 in Functicna. a . . . o . Social «orkers' {pinions Co."cer.:1ng IF... 2.1;!311‘3013. oo- o o o co 9 no a Huff“: ”WT‘A‘i-‘Q‘ 7*";71-:firq-.5:1----j.-71;‘ PfiTr-Hfi r‘.~"'§. ' ' fl .v"“.3 P" ,‘ 5. 3 1., .,.. ' LLAJD 43.23.; .LJL-LLAJJPL‘J o o a . ‘Lanv-aaj «undoocooooooooooou.b v-u‘rr‘rv [tiara-Lace...coo-00000000. it Q... CO0. .00. OKC'MH 16 16 20 a 25 27 31 3h 37 39 Figura 1. Questionnaires Listributed.and Returned. . 2. Ea Fationts hava Confiéenca in the Ability of Smcial Workers ta Help Them7. . . o n o 3. Are Social Karkers Cooperative?. . . . . . 11. Do Social workers Go Out from the Hospital to interview tie patient in his hams on trialvisit7......oo..o.... 5'. Am $905.31 Ee‘écrkars Qualifiad to da Psychotherapy? . . . o . o o . o o o , o o 26 31 .-~:; 3, tar-q ‘3': i‘. t '.N ‘ $_ .s-n ux’v .0a -- ‘5'...”‘1‘ I_‘-._.‘i ‘b’uik/‘L.’ {J As students we are concarned with tha task of learning the role of the social worker. This invalves fihat a £131 workers ex- pact of themselves and what othfira expect of them. Our observations indicate there are varying degrees of acceptance and understanding of the social worker, not only by other disciplines, but by encial wvrkers themselves. Th3 mars presence of sevaral disciplines in can setting in— éicatea diffarences in paints of viaw. In c1339 ccoperation dif- ferencea become a threat. Cultural differences have the notential of becnning culture conflict and the solution is compromise. when we compromise we must knew what Ra claim and what we can affcrd to give up. It, further, invalvea a need to understand the role or 'he claim of other disciplin 3. Khan negativa attitudes exist among team memhera, the free exchange of data within the team hécomes difficult and stiflea the warking-through of ayabolic and actual ralatiansfiipa. Thus, there is a lack of understanding of the treatment role of resaectivo team mefiberfi and their'perscnal resctions. fiithout this unflat— standing there is always tbs likelihond that negative feelings of rivalry ana self-depreciation may stand in the way of providing the patient and his problem with the team's undivided attention. The intratsam relatiozvhips involva the quality 0; pro- fessicnal preparation and ccnpetency of each of the disciplines, the mutuality of respect for Each other's prbfesgirmss, the quality and degrea of integrstion in handling cages within the philssophy or the team and the intaigibles of paracnalitg of Various team madhers imnlicitly underatcod and accepted. Eratlams of status, rivalry, and structurad hierarchy amcng the clinical team members undermine healthy interaction, black he at adg flaw of communi- catian, and impede the rate of patient recaverg. Thia stuflr involvms an inquiry into the level of un$arb standing of the rule of the Sacial' ark Service in a particular setting and attitufiea of clinical team manbers toward that service. For purposes of the study we ccncarn ourselvwa with the attitu§es ané opinions of the mefihers of the clinical tean in a nguropsychi- atria hospital, the veterans Administration hosyital, Eattle Creak, Satting_cf the Studg The Veterans Administraticn'fiospital, Battle Creek, Hichiran, is locatefi on a 731 acre tract appraximately six miles wast of the city. The hasrltal, Opened in 192k nd operated by the ?ederal Cavernmmnt, 15 one anon; sevaral such h-stitala thrauxhaut the country which have to d9 with caring for tha physical and mantal illnasaes of veterans of our armed sarvices. A 2,053 had neurcpsycfiiatric hospital, it is devotsi pri- marily ta tha Cara of thase vetarans with mentwl and auctional dieturhances. The 1,251 full-time and L3 partotififi erployeus, plus a compliment of volunteers, provide the pationts with fa- cilitioa for many typos of treatment: psycfiothoraoy, activity therapy, and casework therapy. The treatment program 13 divided into two sections: he Acute-Intensive Treatment Service and the Continuous Treatment Service. On the acute-intensive section are found those patients whose period of hospitalization is axpectcd to be of short duration. The continuous treatment section‘houaes pationts whose degree of impairment is more cfironic and who bone- fit from a longer period of hoaoitalization. The hospital organization is headed by a director who is a psychiatrist. Eircctly'undcr the Director are too Assistant 21- rector who is concerned with non-clinical administrativc motocrc and the Liroctor of Professional Services who is in charge of clini- cal or treatment adolnistrotive mattars. There are a number of non-treatment operational functions which are performod‘by units known as diV1siona. Examples of those are the Registrar Livision which takes care of administration, discharge and absence admin- istrative proccdurca in accordance with Veterans Administration regulations. And tho Engineering Elvicion takos care or the maintenance of the hospital's chycical plant. Thor. are six of theoc divisions. Professional Services includes all units which are directly involved in the care and trootmcnt of the patient. Social work Service is one of the aevcrol professional cor- vicoa coordinated by the Liroctor of Professional Servicos. Tho Chief of Social'oork fiervicc hoods a comolomont of eleven clinical ' social workers, each of whom holos the Roster of Social work degree. the clinical team, for purooooo of trio otufiy, lnC1odoo chigl york Service, Vayoholoqy, Frye .iatry, Thoreo', Occuootional Thoraoy, and Physical Therapy. aeao c.1zarts -9 ls). begin to function as soon as too pat cot is admittod to to o ongoi- tol. Tho tcao in a unitod ooproach is involve d in a moltiofacctod stucy 9211c1 is brought togetho r in the diaozooo ic staff mootinfi for pornooos of diagnosis am tmntnc rat planning. ”rm-:3 e s.ct~.1r."’.1-t om concorrod with to _hyo : cal, pogohooogical, and social fume ci~-1.g of the patient and trootmznt plooniog includes a projection of the finiings in terms of the anticipation of involvement by tho pationt in the various trootmont aspects of the progroo. At tho timo of aomisoion the patient is examinod by a psychiu atrist and if family moo t2ors ECCQ ; oy the patient they are soon by a social worker. I! a need or roycho logical eralooti.o on is infil- cnted, arrangements for testing are made at this timo. Following the diagnostic staff, the pationt_ goes to a.1 as 3i szomo nt board meeting for ocncduling of activities oh ch iocl1xdo tho sorricoa offered by educational, occuoatiooal, nod physical therapy. Edu— cational toorogsv maintai:s$ as soortmont of cloooo such as music, photography, soda '1 5 range of academic courses. ficcooational therapy prosoots a comyloto program of handicrafts inclnoing loathorwork, :oovio g, pointzlng, metal wo k, and many othoro. Physical therapy of.for5 a vorioty of treatment a soar as ro iia tion therapy, hgorotuoro “y, on-d moorlo 5tfiq4{ Ac1in dovioos. VI A ra-evaluation of the patient may be reqaaated by any of the team members during the tregtment process which wanld involve a repetitian of the diagnostic protein . Jaint consiiaration is called for again at the time the patient leaves the haspital for a trial visit or family care placement. Collaboration exists throughout the treatment precess. The physician asanmea raspon- aibility for the dacision cancerning the final digcfiarge of tha patiant from the hasFital. Q :1 . 3 .5) 5' “I 9...; :— ff'r’ur:¢ an an“; 7'“;- {‘3 .9936 :44 ‘1! .3 .-~;~~' 31‘ . ow .535.“ch » :de Seeial workars and psychologists were used as resources in the apyroaah to peycaiatric disnrdera during Karla War II. The 33613 wnrkers Nara uaually employed by the Red Cross and suyplied ea voluntear workers ta army'hoewitals but did not halo 033 to the mil itany services. The 33 W' nclojists were menbers of he armed forces and warn arbitrarily 3335 333d to army hospitals without much of & precanceived plan. The huge 103d 3! psychiatric casuo 815135 crest -d an extrfima ahcrtaga of psychiatrists in military unifcrm. $313 shortage 13d t3 a "makeshift“ use of social wmrkers and psychclagista in a ”team" approach. T33 prinary function 3f eacial 33r33rs was to cantact families of the patierts, 32: wrviso p3t13nt recrafitinnal and ac 333313331 programs, and t3 help thase r333335n to civilian lifat to adjust t3 whet sometimas 393333 to be a ”new warld." 533 pSychologists ware used for testing patiants as an aid to the p3ychiatrists in evaluatikv .the patients for dia- pmsitinn. VH3. World'fiar II ended, the Veteraus Administration strer; fit 3333 the idea of th3 "team apprcach” by using psyc5.olng ista and 33313 warr:ars tegether on a broader 33313, ard later elab- or3+3d on the idea by in¢luri5ing 0333: 3t55 anal, educational, and recreatienal t? 3er32313t3, and 03 2er pro.“ 333:3 2313 t-e the “team apprnach." Th,3 3333131533310n cr33teé a diViS¢Ofl c: labar in the treatment of the mental patient with each profession assuming re- atonaibility for a different aspact of the patient's life. With the vsterans Aiminiatraticn aatting the precedent of the "multi- disciplinary appraach," necerfiing to Coshen, state heapitals, general hospitals, and outpatient clinics have seen the value a! combining the skilla of many diaciplinas in the treatmant of the psychiatric gatient.1 However, where the multi-disciplino approach is used, ri- valry, dissension, lack of communication, and misunderstanding art all potential problems. As stated earlier, whenever two or more prafasaiona are brought tcgether in a clinical team, they each bring a diffsrert crientation and training which constitutes the pctantial for these problems. Our highly complex society of industrial automation and nu- claar power requires a great degraa of specialization in all as- pacts of life. Thla Specialization has carried ovar to the social sciences and haa extended to the operatien and staffing of our hastitals. apecialization has brcught about the existence 0? the clinical team in many heapitals headed by the physician and usually including the psycholnaiat, social worker, and more recently an- cillary disciplines such as educational therapy, occupational therapy, nureing, and other disciplines which may be activs in the hospital. 18. E. Gashen, "Currant Status of Mental Health Fanficwer,” Archives of Gene, 1 Psychiatry, (September, l?61), pp. 265-275. webster defines a team as a number of persons associated together in any work; as a group of persons pulling together. This coincides with the mental health definition of the clinical team in a mental hospital - "a group of professionally and scien- tifically trained people brought together.for a common goal, namely, understanding and treatment of a patient with each individual of the team contributing uniquely from his own background of training and experience toward that common goal."2 The use of social workers in the hospital setting and on the clinical team is a relatively recent development. Their roles are based partly on.the expanding idea of therapy related to the phil- osophy that problems of physical illness are often inextricably tangled with social and psychological difficulties beyond the scope of technological.medicine. It is also related to the func- tion of counselor and general family advisor. The social worker's central task ”is to assist in relating the patient'e environment and personality to his medical treatment in such a way that the treatment may have maximum.effect. In some important respects, the worker'tries to supplement the communication between doctor and patient, interpreting the details of the patient's situation to the specialist and helping the patient understand fully what his illness and its treatment mean."3 The social worker, as a 2Jules D. Holsberg, "Problems in the Team Treatment of Adults in State Mental Hospitals," American Journal of Orthoa psychiatrx, VXXX; No. 13 (1960). 3Burling Temple, Edith Lents, and Robert Wilson, The Give and Take in Hospitals, (New York: G. P. Putnam's Sons, I9§5,. 4 | anetos be a weaoiseoto'xq ‘lc rmo'zg a” - Iaihao' .Z‘~.:rrsem 3 n1 use? (Liam .1803 mo s so} deride-god Manned signeq sadism agile-511.1: lo Lee‘bl‘vtbnl dose dflw finalise s is nominees has animate-Laban 3111:1131: :o bruro'taxoso' mm '51.“: I'D‘I'l vieupiou antiodl‘fiaaz me: mi: "51503 norm:- 3 sold 3mm: sonoheqxe bus exit so has 331333- .[sflqsod ed: :31 memos 131908 '10 can ed? on 1010'! 11oz?! .3mmqolevqlb ineoe't ‘LIS'TI‘Trjf'TL 0. a1 mess [mimic ofldq ed: a: beveled when? '30 eebi gnibnaqxo an: no urns booed without!!! none on casein 13013151111 ‘10 smelo’mq earn Wee 0113 belated soldlkron‘ilb .[solgoloriowso has 13100:: .131": missed .om ed: to hassles eels ei .11 .eMolhew Isahgoiozube: 'zo eqooe 3'10)!” [£10003th .703.th $116151 indexing-bu: ideanmo to not: Memotbne o'taeldsq ed: gnlisim 111 $9186.;- of :5“ fies: Levine!) 8113 #8113 m 3 done :11 3119153221.? Ieoiben 1191' of Yunnan-reg has . .esoeqees 3n8310QMI emos n1 .foello mumtxsm sure gem :ue&33013 «use!» muted nole‘so1nmmoo end 3:13:11anqu 0:: 89113 192110»: on: not!” o'Jnoflaq and: lo alkeieb erfi gmiferxq'xedol ,sneiisq has 336' wr‘! bande'xebnu Jaelui =3 and soldier. 1321-; deiisut'asg-e s: t o: s as neiuow £31903 9fo 5".nsem ineo...‘ 58.813 31 one aseczfl}. C111 _. A_. f iv .. . i‘ 10 Mamet-£315.“ and mi emeicozl” e379d3£0fi . -eIe'L‘ gage? ‘f-: I:-- who: usages“ sis: 31.qa E-I 53313595 a- off: 111 action). Q. .(05 Q1) 11 .315: 5.1.“- “minim W18 8 {T mealtime-1c}? has timed {13:53 siqme’l‘ 3:215'wfl’5 '1" l a . . t ' .7oz'fk3i 8:303 e'mmxdrfl ,q .3 who‘. we!) ‘aisgofics’ ”Egan? has part of the clinical team, uses the same techniques and skills that characterize social work in general in his effort to solve the problems created by the stress and strain of illness and hes- pitalization. ”In essence, the social worker's contribution is based upon an understanding of the dynamics of human behavior, upon an ability to translate this unaerstanding as it applies to the individual patient, and toward maximal adjustment to his ill- ness in he light of the limitations it imposes."h The first step in the helping process of the social worker is individualizing the patient in terms of understanding his inner and outer environment. Also important is t.e manner in which help is given. “. . . the social worker's approach is governed by an attempt to see the problem as the patient sees it, to allow the patient to move at his own pace, and to make his own decisions to- ward a goal that he is helped to set for’himself."5 It is impor- tant for the social worker to View the patient as a total human being to better understand his problems and to effectively assess his strengths and those among members of his immediate social circles that can be brought to bear on the solution of the prob- lem. It is also the responsibility of the social worker to help members of the patient‘s family to accept and cone with the un- certainties, deprivatiens, and anxieties connected with prolonged LFinna Field, "Role of the Social worker in a Modern hos- pital," Social Casework, (hovemoer, 1953), p. 399. Wm 09 313'!!! gtn' a1 {awn at has (doc: .szi‘xwmado no: «MMW to We two can“ out; w! human; idem: w ‘3 WW Mm“ {8190: W moon :4) .miiuilaétq 0171“!“ 3Q mob at” '1: mflumnw: n a: new bond 03’ ”m ’1 ’u ”WWW a!!!) ”use“: 0: {mm m: mm: M m 8;: much: mum mo: bus :8 .snar: .zmtvmc: sax " . w 4" .mx :: macaw m. to .v .u mu at am Milt-hm W 1' alum anfiqim 06¢ a! one .1211“: ad? Wm whatnot“ to we: £2 now: am 3m Haabtvlkui u m aim and! ot 3W out. .n maxi?” woo has ,. -- .:?'1f~Vor .. .. it dam ‘a'smv “loco an: . . ." .90”; a: “MON ‘31 an moi": ed: M lei-om:- as??? 9:: r oi mm“: ~11" W m C!!! tabs: 03 has .9059 mm a: :9 sec: :- mum M3t ”*QUMM 10‘} it}: o: bmim' a}. on foot? 4:50,: a can “Wk“ i305” 0:3 mm of! "rear-w {stuck on: 1:? :w m film 00 has. miqu of: mort‘rz at. A: “mamm- of mud W um Old to moomo mom oxen-H ms adamant: no N is Emuloe 59:49 no 1996 oi '61!qu en“ n59 3-563 taint: M§Mw Islam «:1? "at; tit-“Minna“?! no 1' out o: .‘."-':' um; d“ “t 6’}! am: in! ”9:13: o! (I. t; ;'L a’$:91L..-LL oda‘ lo modem: 4“... .4 ‘ ' \ ' u . «an mutcfi o at who“ iatoor‘. on: to aim." . .Mol? aflfit’.’~ ‘05! .1 -H‘fiO' Harman“! 4fif4ftmnf'z hum-3. Kinda 10 illness, as well as ‘elping he patient to adjust upon his return to the connunit' {clinging dischnrge. ?har3 seems to be considerable ambiguity and disagrenment hy professional persons practicing in tha field of menial health ra- gnrding the concept of the clinical team. ‘Eolzberg, in the articla refnrred to above, indicated that the problem of thm team in tha state mental hnspital results from "authoritarianism,” 19., an arbitrary mathod of decision-making. He believes it plays a sig- nificant rola in inhibiting the complete integration of team prac- tice by fostering the attitude that the lnadar’doea the thinking on which others act and allows no Opportunity far training in the assumption of the role of democratic leader. “The profesaions themselvea have status positions derived from the larger world in which they participate. In a hosyitnl setting the physician has the highest status, and the other professions are ordinnted be. low that. It is not clear just how they are ordered, but on: might suggest the follcwing order: physician, psychologist, aficial worker, nurse, occupational therapist, businass manager, diatician, patient."5 "Leadership and ultimate reaponsibility in the treatment of mental illness rest with the pay:hiatriat.”7 It is sometimes said that the psychiatric social worker is really tha poor man's psychiatrist. It is bacause of tnis rather tenuous W 6Greenblatt, Levinson and Williams, The Patient and the Vantal'fiospitel, (filnncoa, Illinois: The Free Press, 1957}. 7Ruth I. Knee, _§ntter Snciel Services for‘Fentallg Ill Patienta, (Hem York: Anerican Assneiatinn of kayakintric Eacial W garners, 1955). 11 and insecure position on he clinical team that Ruth Knee said, "Hers often, perhaps, the parsntal role is thrust u:on the pay- chiatrist by the social worker . . ."8 As a maahar of the clini- cal team the social worker serves as a facilitating agent whose Jab it is to assist in medical earn. Social work is not the pri- mary discipline within the hospital structure so it must gear it- aelf to tha laadership of tho medical profession. The greater professionalization afid wider use of psycho- therapy by mambera or the non-medical prefessions, primarily social work and psychology, have posed problems in tha relationn chips betwasn psychiatry and its ancillary profaaaiona. In most mental health settings the psychologist and social worker practice under the direction.of the psychiatrist and their use of psycho- therapy is the center of much conflict among them. “Attempts to raselva this 135a. have usually involved effectiva subordination of the psychologist and social worker even where he is permitted to practice payChotherapy. This wound to the prestige of a pro- fession which ardently dasires to change its status and to maxi- mize its professional cantribution often ranklea in departnfints of paychiatr .“9 Professions includad on the clinical team oftsn View each other toe narrowly from the atandpaint cf focus of function. 5mm. 9flilton Greanblatt, Sanial Lavinacn, 1d Richard Williams, T59 Fatient and tfie Mental finsfitql, (Siamese, Illinois: The Fmée :Tt‘iSfig 1337) o 12 This is the basis for a great deal of tension and strife between them. It is very difzic 1t if not impoosi bio to dW ino exclusively tho function of the doctor, tho social worker, or any other member of the helning profo53ions. Ie;m no 515 boundaries of the focus of their respectiva functions 116 an aroa of ovarlapping servicos uhero every ho‘i ping pro £553 i-on has a staka. "Those pr J?essions established to so rvo t‘xo com .on good t;roufh tho proviaion and ad~ ministration of services to promoie indivL i551 honor wo lfare ha.vo cortain decisively impor,ant elements in common. Thay all servo poople, individual by individual, in the interest of their'wal- taro g phyaical, mental, intalloctual, Spiritual, or social."19 Seward Hiltner has roferrodt a tzis 5: ea of overlarping responu nibilities as "The 'village green' that aspect of t“o In «c‘l n and reap onsibility of 655 a profoss on that transcends what is unions and distinctive about it.“11 Eo states that function is viewed a bit dif fer‘.rt1y‘bye 52h profession and is often plastared over with "no troopassing" *L firs. it is in this area of ovarlapping resaonsibility, "th village green,” where close cocyerotion is essential. Eembers of a professional team possess a high dogzge of toehnical ability nzd are capo.b a of functioning inflefiao.o tly. However, total patient care demands and depends on their ability to cooperate so L _-—. A louharlotto Toule, The Learner in Edvcrtion for tho Pro, fossions, (Chicago: Unitt.5it, o? “:zicago 2r55' 5, 135;), p. 3: 113% 3rd iiltnor, "fansion Wd Mutual Support Among the Holming Er fassiona,":ooi51 iorvice Feviow, Vol. 31 (Earch to L000mbel“,195?)ppo 3‘.“in ' . ' lo. ' - . . . :' ' .E . .v o x . P v I . O a. o u ‘ J ‘ ’ u . . ‘ I ." '.' J. '. I H ' ‘ ' .0. ' . a ‘ 1‘ j _', 3.1-; . . 5cm:- ag-‘.ta;‘rc.'£q -‘ ' - . '~ - :.: .. -2' " "' '. W212 earth}: {minim . ' - ‘ .5: -- . . - ' - '- -. -- mailu., . .‘. . 5. ‘ -. .--.,~_-. «19.15 “963%; d'avzwnx Mr} , ‘. ' -- .21 “Risks“: in .1258?!“th ,. ' . . i:._ - . vo' «300,001 :zntqanI-wvo ‘lo :‘ - - ‘ - :- " 1-. Sir-Ewan}. $153 ,.'- '.._ i . -: _. .- ‘ . a]: 31min umemt' ‘“ " . 1 .- '.... 5' '1‘! r .- a! mum..:m . .- _- :-.~ . - . -. £95932an £16310 at . I'- ' . - g ‘ " .f: s L'-'-...' “a“ a . H. . u .- ' A .'-. w ' ' ' . . I. I. 'Mfi 5‘2. '..'. ' . ‘ " . ' " . ' _ : --_ ..;:\.‘ ”will/d: Inmdnm ' ' ' ' . ' ' ' .'- . '. . ; '. ' :. 1.: IL‘Q’ ‘TSVQHBV . . .." . .1 I. I “ 3: ” t -'z ; q Blflmmusot 3 .‘7' "- 'z ‘ 1 fl 5‘ \ “#1 Eff I‘: waif-.1925): mi 7&1'1323‘ 91W (My, .- - t .—-— ‘h‘ rY-v.:( 'V,_ . - f“ 3, ,J' 77.97:”? 1".”h-7"9-(37 - \ ,, .- , f 03‘ 3C7 . ,1: (.5 Vivi." (2333.:fi-J 1v and». J~~""‘.'~- .‘ . . ' .' _. I. .. ‘l ‘ Pr.“ u C \ . c: awn-2H1" , . c ‘- ° 1 13 in an organized team. "For any team to function wall, its individ- ual members must rslinquish some of their autonamy and modify their personal and prbfassional needs to meet the needs of the group. In the case of thc medical social work team the aim of the group is to achiev. bettar’and more complete benefits for their patient. This can only be achievad 1f the members of the team pOSSBSS‘Ihat Eaano has called 'clinical maturity,‘ that is, insight, n sense of proportion and practical wisdom. without these characteristics the teaa membera will‘ba unable to adapt themselvua to the organ- izhd group.“12 Individual membera of the clinical team aunt be willing to makn their specific role subservient to the goal of tha team. This means keeping each other informed of any progress or setbacks encountered in carrying out their tasks. The aocial worker must have a close identity with his own profession in ordar-to wark effectivaly'with the other*disciplines. This meana.feeling secure in his own position, being awaru of his own acceptance of the other disciplines, a: well as knowing tho degree of their'acceptance of him. "Successful result: in the tumor}: approach depend in lama measure on tho attitudm of one member of tha taam tcward.another."l3 Positive attitudes encourago a graater'axchange of information and data and an atmosphere in which prculena and,differences in ralationships can be marked 12Arthur L. Drew J15, "Teamwork and Total Patient Cara,“ fiburnal of Psychiatric flociel gsrk, Vol. 23 (0ctober-Juna, 1953- 13fiorothy Robinson, "Some Aspects of the Integrative Process in 3 Psychiatric Setting," Jnurnzl of Paychiatric 599191 dork, Vol. 23 (fictoberbdune, 19534IEJLT} p. 32. Q o - ' . D . o O '0 .- D . I O I. ' .- I O 1 i I O a r I l U' o I a ' ‘ ’ ‘ ‘ g . a Q “I I. ‘ . max-0e is ‘flfgtzmt .. .’ '..'. .' r. ' ' . .1. ' aakJst1039zvsac weed: .. ' .- ‘ * :n-::- u. '5 «13310 23:17 -:" -~:w."aar ' ' ‘ ‘ .‘ ' . - - - : to ad tlsm mas: Isalflg ‘ 1' -. , ~2‘ , ,.n ‘i‘n In.» 311.903 firm“ ‘ ' ° .. . ' '. I...'...'o nanfiaaiq $55 Kc bSflK'" - u --« ' " ..'- . ’ ~ 3 C .' g C O .0 ‘ . . 3 O - u . . v v - u I J . u. ‘1 u g f I ' .. , ‘ . a a ' I 1 . . . o . . . o"-.-' O—II‘ I ' — ' r- l U I C. I . o t J . I '. O . ' ‘ u q a, \ fl. 0 J O . u so ‘ ~ g ’ ' I. . .L ‘ ’ ‘ 4- u" A II - I ‘ O ‘ d l ' '. . u g . ' ‘. o '- u g a . -. I I o - fl 0 «a ' . I ' l' ' '0 u. I I n D ..- 5.. o n u g . D hi... .- n." --.-~o-;o- n“ unap- IonunOODIa‘ ' ' a o n w . . I ‘ u I ' . I. l I o ‘ : c o o -g Q. on o no. uc. . a—v-QQoa. II 0- 0 CI- u r O .n a d '4 I - - o c I , . o . . . O I - no a . - Q I Q .o g Q Q . 1h mmxsgh. This creates a greatar untiemtanding of the treatment role of thn respective taam mambmrfi. The absence of this mutual understanding incrmassa tha tendmncy at rivalry and self- depreoiation which stand in the way of uffaring the patiant tam full benefit of the services offered by the team. A system of cmurxicmtlon is the lifeline of my organizatinn. ‘eéithout it coopsration and mutual nnderstarriing within tho clinical team cannot operate to their fullest extent. Groanblatt found in the Veterans Attainiatmtion Hospital in Bedford, Massachuaatts that increasing twodway communicatian uni interaction among groups of personnel tended to damn. the fcmrly extreme Iocial dis- tanca between them, and tha more flexible extension of roles raised the pmstige and morale of each gr'tl'cmrulh "Regardless of the atmcturo or mechanic. of team mum, the degree 91' conscious application of team tumor. to this prablema of interrelationships in the antltmding element in team func- timing. The extent to which trantment may bemfit I patient, ones 3831 gmment of role is mach, depends to a large oxtant on the facility of us: of tho componzmts of the team by ita members, and their awareness of the subjective thrnmmic forces operating within the team."15 M ‘_ 1lirilton Cfreenblatt, Richard York, and lather Fm, Fm Custodial to T‘7 ‘rwmfl’m Pa+ient Care in have]. anfiifala, (fiat! Y—Sfl‘ u-USuen 0353 EOulhutuLon, 11,41), 9. 9&0. 15'. alter Lesser, "the Team Concept—4; 133mm: 6 Factor in Tmmtmnt,"?mrm1 cf: ”we “’71“: Social 7.5m k, (January, 1‘? 55), P0 126. W at: in Winona 1333067: :3 wanna no“ «lam minim. mus. our mama“ "ham «4 a. an All“ in with to mean: on: Imam-31 gum-um d? malt! $3 With ‘20 V. N»: a} man hid! nuuumcb and out a ”in new «no to am“ an .muamwzo mm at: 2:5: no- ammo-coo to mm :1 3M mm mum Mm bm noun-cm. u sauna W W at wwa’ ackéwbtr m mun! w mm “W h! nab-alarms 2mm: Mum In" 4* ..I thou»: on: W 03 mm» tau-sq 1- our: in mm damn m on has won: mm m *‘ '7 “emishmholuuhnnnwmqwmm mm M 30 ”W ‘10 ”was!” or“ to andbmafl" tum m not! 'w Maxims amxoaum to mad w J” “it man“. Mum an": 0.: mxdmrtoxmdar ‘h JMJ “wa- w mums» damn-n: mom on? .W 003‘ man: a 93 chums}, .uu u aim is mural-vac um um hair! that o: saw. “an no! b; m '31 u no: on: an ax.'manan: to us: in yum: .Mném mot omw «fiestas. on: 10 eons-am 1m inflame! It” Wiffiif “iv “7 -—__;_~—- - - w __.= u...— m ma ”rim!- but (53101 Mb! Mme ”9:112“ .. ‘ *tv- .3 W“ j”: -‘.' .1“; 9 I» ‘ff'. 3’ r " N «t ('3. (1' ’“ " '88 " 7- 1 u and “a!!! 0M Heisman W out!“ new»: tailed“ (3‘1 W) M‘ Imam”. own. 'to ”mud. " .mnnz .91?! .‘1 15 ?ne tcmn approach has bccn 55 an as the b “inginfi tagjet} er of professional specialisations, each of which camp” mats the total functioning of the group in ace mfcrtcfiircctcd tome rd 3 CG”1?fi gcal WilCh is t.,e urdcrstm .niing &id treat o3cnt 01 the gaticni. The bringing tcgcther of thesc smeaialiced disciplines often creates an overlapping of snrvicec and‘wit31 it m cm fusion of tM1 ir infii~ vidual roles. This leads to the need for same clarificrt :ton of the position of ‘Hc social worm pro csaion as a maiber cf t.ia team. We have seen that viflz‘tha team concept still in the nrcccss of re- fincmcnt, problcns still exist concerning such questions as status nd rivalry of team.membcrs and difficulties in communication. with this in mind our study of social'work functioning on the clinical team 1. c nour spay hictric hosyitcl becomes concerned with attitufies of other team msfibcrs, and cf social workmrs them- selves, concerning the functioning of social mcrkcrs on the team. Also, it seems reasonabla to qmcstion whathcr lack of familiarit with the role of team members is conducive to efficicnt team functioning. This need for clarification leads us to the docign for this particular study. mm; W on! I» am and w . . _ {hm 3° that .l M 5: mm wwb mm as WWII! ”4%.W ban w: ”\I 8 in. Mm» mum. «Map? “rm; 3,: gnaw mm mad Inland gnaw: W W m 10‘ hm .Mem z ““pnfifim £11003 “-0 gain“. ‘ " ado-t mum mum ,3 '93 ”button a: (r m “3 d II! M wouw‘uulo Some rgsearch has been directed, in this study, taward da~ termination of the team mefibera' cancept cf the Sec a1 Hark Ser- vice in terms of its professional functioning within the hospital setting. An attempt has been mada to look at the mutual unéerb standing 05 roles, dissension, cacyeration, and cammunication be- tween team mefibers as these factors relatsfi to sacial service. The discirlinas studied, in addition t0 social work, were nursing, educational therapy, ocaupational therapy, psycholagy, physical Q therapy, and medicine (includi g pay niatry). fiethofia of Securing Batu The writers spent same time in observation of the pro- fessional activities of the variaua team mafibers. we interviewed sevaral staff mefihers of disciplines other than aocial wurk to get informaticn ta use as a basis for di- rection in questicnnaira construction. These interviews each lasted for ayproximately thirty minutes and three beginning ques- tions ware asked of each participant. (1) what 19 the purpose of social aervica? (2) What strangths or good points do you sea in sscial service in this heapital? (3) what weaknesses or problems do ycu sea in social service in this hoayital? 17 Thu preliminary invnotigatlon ccomcd to indicate that thoro is need for greater communication and cooperation between social workers and other professions. Ono of the team monbera poln-od out that sometimaa his department and social service may both be working with the same patient but with two different individually conceived treatment plans. Ho acknowledgod the responsibility of his own department as uoll.as that of social purview in to- cllitatlng‘tuosway communication. Two nurses stated thot coma social worker: do not know tho extent to which the1r*disc1plino rolls: upon social work or how they can'maka greataat use of tho knowledge of tho patient which thoir profession possesses. Cue said thct often questions will come up and situation: will arise regarding the patient that her group is not qualified to handlo. A nurse pointed out that she is with the patients eight hours a day and feels that the nurse in a otorohouoc of considerchla knowlodgo about the patient which social workers often do not top. These intarvicuoca felt that the lack of communication and collaboration was the greatest problem that existed between clinical team meubcra. Two questionnaires woro constructed to gather the main body of information (See.Appondix). The questions were booed on areas of concern which came to the attention of the writers during pro- liminary investigation and review of the literature available on the subject. Two broad areas warn selected for questioning. I. Econ the team member understand the role of the social worker as it is preocribad by the social work profaosion and by hurrah» Maw-rim» avg) 31:: ”3:: a . '- 33' (£301! '13::- 6333’161.’ 7,5193): his)! ' ' . ' '. ’1 ’ ‘ I. wmam ans-warm am} my. ~ . - ' -- '- . - : ~ -.r vflldisccqm ado} M'wfiww - . ,' . ' , .3 - . ' .' .'. «31:21: ”Iv-ma 153002 1-3! m?“ - ' ' - -. ; 9:73 ”53' icon ab mafia: P3309. wad 19-21-103 Luau: ma: 32:13" 3. -' ' 19MB anal-tine, 9:33 '10 fifgi‘fii’vmal' , - ‘ . . - . , - ' - LCh! MOMW 239370 3:23.? am . . . ' ' -. ' ‘ ‘ '.. 3‘ '10:: “1!? 85913.02 3313' 33:15“ {-23:91 ‘ ' - . . ' .‘ ~ - s :1 aria. than? 3m bemmc, mum ’5 . ' -‘ ' . . -- -, - ~- 15 d m 31“? m: air-ha? 53m: 7, ;. , -. ' -. . . ' ' ' " r £190.19? 356338“: "UL, Cuflfis 9,; ’ .. . -.- '. ‘ '- ' ; 38.33 3L"). EimN9.{‘»”t':-*L‘fl 82:17.7 . .T " 'e ‘ - ' 3:. -: d'cej‘gsr; \ mt} 2m: r.-tat.“::'z'.1.‘.: " r .. ' . - '. n‘ 1 «names? "33:7 ..-.-.:;;5 . , .‘ . ‘ - . f. ‘Cbmfi 319:9 at” eta-“3‘s" :2? .--9.:":;--tfr ' ' ' . - ”an :3: fave art!" .,:,'-3:::=v-:;: . ' A ' . ' . ' '2 ”‘3 “arm W1} mza‘ 3 ‘ c: m): ’ . - .. -- . a H n .‘ ‘ ._ , n .. _ Div fudP~".‘;o'a ='.',s,’.?!.~"’,:)‘7~: if: . . ‘ 13 Ha Veterans Administ aticn far the warAer in tfiia satting? II. Ahat arA the attituées of tea. mefiberfi cancerning ascial wark functioning in t‘is settingfl Axe first quartionuAArA was adArAAAAA to team M Aberg ot‘:s*r than social workgra. Th3 secaad was AAAras 3 Ad t0 606131 woerrA. The tun QL saAionsalres wera construcL A 20 thain tha gang typa of information. Idem ACAI queationa were used far tA 19 moat ;nart An both ques AionnaAJea AA th thae Ame pt ion of cum qaea tA.on Afiich HAS changed in construction to adarass it to the sacial'wowkar akout himself. In the second questionnaire two qpaations were not aged because they wars inapyropriate for social workers and thraa qneationa warm aAAed that Hauli nut have been aggropriabe far disciplinas other than awcial work. Questionnaires Hera sent to all membera of the diseiplihes being at fled and ware accAMpanied by an em Fa.13naA or? lettar (Aee Appenéix). Prior to distribution, personal con atacAs Aura ma A6 with the chi Afs of the Vatican disciplinas to encourage coocara tion. Follawdua contacts were made in the same way ta enccuraga cam. platicn and rein, of the questionnaires. A camplata dascripticn of the reaponae ta the queatiannaire may b3 Bean in Figura 1. 19 F1 GUAE 1 QUE’E-TL’T‘AEA HES BIS T311 BZfl‘ED A321} RETIFIUED Discipline Distributed Returned Educational Tharapy 7 7 Aadical 1L 8 Social Service 11 8 flaming 32 19' Occupational Therayy' 6 5 Psychology 5 3 Physical Therapy 3 3 Student h h Totals 82 $7 ("J 5‘: u '1} Ii :21 #4 <1 "pa. r-z'mm-Avfi'z n a. 2:2 A: ”gin? 3"“ “”55; t'\-J!)¢‘cio"JA 5;. ilk: l". 4L. J; .133.- rJJ-h’ ‘6 ”ii-l... H ‘ I p' a 2 .n . W becial markerc' Asiaticnecip with the ratinflgg Several questions were desifned to givc us some idea of the type of relationship that team maubcrs feel sacial.werkars hava with paticnts. ficarly twoathirda of tbs reaccndcnts falt that patients had confidence in the ability of social wnrkera to help them. The majority of comments on fihis subject indicated that patients are hslped most by socicl workers in serving as a contact with the “outside warld" and assisting families with prcblema arising from hcspitalimation. A twpical comment was that the social uorkara aidad the patient "in helping work out patient- family-community relationships and in helping thc patient mc1n~ tain contact with his family." A psychiatrist qualified his a!- firmativa answcr. fie wrote, ”Actually there are saws pQOpla who feel that they have not basn benefitted, but this may result from their own problama, (e.g., extreme dependency which cannot be satisfied) or from those of an individual social worker, (e.a., naed to dcminmta and direct). I vauld cupncsa that mast peepla would feel more direct benefit whcn something tangible has been done - financial relief, etco" A paycheloaist wrote thst mast of the patients are starved for understanding ccntact and when thay get the understanding they crave, from sacial work or any other 20 21 department, they benefit. A very frequent cmnt UM that the social worker has a more personal and informal relationship with the patient than my other member of the team and takes a mater personal interest in him. Social workers View tha patient as a "fibula person" and in so doing evaluate the im’zividual patient along with the many fac- tors in his environment that have influenced his paracnality and, thus, his illness. This points up an important aspect of the ‘ ction cf the social wart-car in this setting; .. to war}: with relatives and friends of as many patients as time pcmits. ficaching into tbs patient's anvircnmcnt often includes contacting local community agencies and Veterans Administration Regional Offices for 1 .fomzation regarding previous lilac-33cc which tho patient may have encountered. In order to be most helpful to the patient, the social worker relates his knowledge of environment and family background to the current dysfunction of the patient. Ha functlcna tc met the patient 'a unmet social and relationship needs. Sana lies of the attitude of the team marchers may be seen tiu‘cugh the responses shown in Figure 2. It may be wadily seen that a comparatively large number of physicians and ps3 *chologicta answered that they dc not know whether patients have ccni’idcnca in the ability of social workers to help them. This may reflect smething of the kinds and amunt of per- sonal contacts that these disciplines have with patients. rinly one of nineteen nurses gave a "don't. know" answer to this question. 22 This would lead us to believe that the more frequent contact'with the patients that the nurses experience places than in a better position to know whother'pationtc have confidenco in social‘workors. "write in" commonts indicate that psychologists and physician. scold ratncr*answar this question on the basis of some research rather than by their personal opinions. “Romy of the rocpondcntc in other disciplines feel patients hava confidence in 50mm workers and not in others. 73““: F181,:m 2 ‘.‘Y'.".. (25"? AM '3!“ “3 «1*;- bff‘r-‘i‘ 1f: '71- w‘u'fll "gt-yd" t 3’- . mummy: .i .-.-‘~- I 1.)" 3 Lb; .. In. :: 2;) audit. C. 117-?!" ILLu-‘JL‘. I 7‘; Tug ABILITY «‘3? REL-1L ‘ziili-ZE‘ZEJLS TO ELL? T335??? W W . 7 Don't ,‘ Discipline Yes to Know Ctaar Total Nursing 13 1 19 PhysiCal Therapy 1 2 3 Educational Thorapy 3 3 1 7 Occupational The racy 2 1 1 1 5' Psychology 1 2 3 Medical h 1 3 3 Totals 29 S 9 2 1:5 5':- OC‘ 181 work 7 1 3 Eocial Work Studants h h Totals 11 l 12 T333 Ettf Lt flw Tsward Snaial Sarvica (me of time primary cc cerna of this study waa the attituée: toward social service that exist among :70.firer3 cf the clinical team. It is felt that an awareness of same cf tbasa attitudes is asaential to the anhancement of ti 8 camm 3 ca. tiea and coordinatian among team mefihera in their saint? effcrts to rehabilitata the patient. There is a.ganerally tam are bla att it :de towtra t a cooperu etion social wgrkara eWuihit within the hospital. Seventy-fiva percent of tb a TQSVHG gents fa 01 sac 131 warkers coepsrata well with them. However, there seems he be a noticeable lack of contact of social workarS'with occupatinnal therapy and ph331ca1 therapy. One of thefl wrot e of social worxa .rs, "As other mEmbars of the patient treatment at this hospital the" seam to w:3rk ipuepezdantly with out cnmnnuicatinn. Another stated he had us var had contnct witfi than at this hospital. This is similar to the one who felt social workers cooperated well wit E1 members 9f his pro.ession but he did not 5&3 enough of than. ?he cospar.a ti on tzat axiat.a be- tween social'work and the other fear disciplines on the team ap- pears ta meat t? e expectations of hetE1 most Cancer ed. The greatest difference of att tudes reaul ed conCurning the adavuacv of tr31n113 acc1a1.vo rkers p035 sass in this settinr ?ifty-fiva percent of the ras;' on«ients cons idsred sccial wcrkars to b8 adequately trained but thirtynone percent dién’t know. One of tha team members urnte that social warkers are adequately trainsd provid ed tney Ezava a psychiatrically oriefitsd backgrauad 2h or a medical social wcrk background with adequate supervision. Another quite accurgtaly wrote that continuous study on the part of all team me barn is imperative. The results aeemed to indicate that lack of sufficient contact with social workers was the primary reason why nearly one-third of the team msnbora didn't know if social workara warn adequately trained for this setting. Sons indication of the fealinga concerning team cooperation may be teen in Figur. 3. FIGUHE 3 Q'JI'LSTIWHI ARL. 53131132, 23-13333 CM311IQTI~E WITH PEE'Ei‘iLhS 35' $32112 PR 117?; “(an)” -- a=================================== Bi 2 7 u Don't acipline Ia: no Know Other Skip Totals Margins 15 2 1 19 Physical Therapy 2 1 3 Educational Tfierapy 7 7 Occupational Tnerapy 2 l 2 S Psycholagy 2 1 3 Eadical 8 8 Totals 37 2 L 1 1 L5 f“ “3.337131 1.... 7’8 AIS-{.72. 3" 11H: 32’ it? (1')“? 3; 31? "1‘53 f'fir-O {-"T-[TT '1, 11,-: ‘F‘ W’Y‘ ~-, ; -‘-_q \4- 1w ‘ Wild”; .E.-~..'."..v4..-"-Uu .‘.‘ .l.:_..J-.‘ :J'x '1'“; I 1.; '51:)? . i 3 Eiscipline Yea um Egg“? Other Skip Totals Social fork 8 8 Social mark Students 3 I h Tctala 11 1 12 25 M Content 0? nqcizl fir! R915 As atsted in Chaptsr r111, the quastiana Hare dasignad to ubtain information in two gansrsl areas. .136 f13ut area was atti- tudes of team manners tou:rd the fuxctirn ?.ing of 5301 al w~“k say» vice in the team. The secarxd firsa “at the e:330wn by overv wa :nber of the team. fineuhalf o! the toaml reaponsaa ware correct, while twmntyothree pg rcant were incorrect. For twentyuseven percent of the items, the “don't knaw” response was uaed. ?ue team members ganerally a; pear to hava a good nndarstand ing 03' the social worker's role in the family care program but most thought that tag fa wily care home is c1oaen for tha patient. Actually, the patient is allawed to viait aha or mare homas that are aw milabln ta him and the final choice 13 his. I est of t? a team mezbsrs have th e i.correct 09‘“ ”10 that the social workera go out of the hosyital to 1: iterviaw patients. All ham visit 3 ot‘ xer Man fmi 1:: ca: re viaits are made by social unrkars frnm the Veterans ALwinistrat on fiosyital in Laarborn, 51¢ Hi; an for the geographic arsa served by this hospi tal. 50mg 11a this c hapter, use of tag word team will include all d1 sci :_11nea stchie except social wart which will be specified in eacu case w?era it is included vi th the rast of the team. 26 comments were written in which indicata knowbadgs cf the aacial werker's utilisation of local resources. A breakdnwn of tr 39 re- sponses t0 ans 3f the questions 13 g3ven in Figure Lo 73‘: "W?“ L A’ .3’ ‘3.".. Adi) ’ v “fl'l. ' '3‘ I'." -' ,r~ "‘7 ‘1 at} ”8"] "”3"!” :‘Q' 3 1"' ‘3 21'3"...“ ‘r;"‘ 3* C'dk‘Euu-lz - “-1" I: " 2.) fiir 5" [LIL LE‘ (3} 1.1!; 1 : UNIT}; T 3:; E32,! .‘3 33:14.: v7? III-r: M "‘ m 9 v m?! H v 3:; t. m " ‘F A ‘f I"? W IZZI‘E’E’ .321 :313‘143'1'3’.‘ 133313: 22'}. 3.. 3.3 3 343333 VI 3... 33,333,...“ 3,: .3”: y... Cl) LwLiJU‘ ,'_"‘CJH-.421‘.z {'33 m 2‘ ‘ F'— ‘ “— ' “‘4 W ”‘1 ' ._ you t ,1 __ a. - . uizcialina Yes 39 3‘ Totals Eursing 12 2 5’ 19 ?hysical herapy 1 2 3 Eduegtional Therapy 2 2 3 7 Occupational Tharapy 2 l 2 5 Fayeholsgy 1 2 3 Radical S 1 2 8 Totals 23 8 lb LS Questiona used in the contant area a! the atu;!y'wera derivad frcm.material recaivefi in discussiana with supervisors of the 3933213 izad areas afid also {ram the VA manual of Sacial‘uark Fro- cadur9.2 Social warkera and 803 3al.wnrk atuients reapwnding to the Zflrcgram Cuide, Social 3crk Service, Va ersns Ad;n* mistratian, W833’1ifigtfin 2),;310 Co. «ax-€33 3t 169 19.)?! 27 quash Jana ca mrfierniag accial xsrk functioning wwra cnrrwet in aeventy-‘ciraa percent 0:. 131 air a gm: 8. Hang; $635.31 war-3mm era irzvolvea in a pm'tiwlar- part. of the Emmi ama cesvarzred by the total group. Gm the baaia of thair rasycaz 123 in this atua v it'uould team that pass ibly saw :9 cf the workers are not tanr1w11gy ac- quainted with the duties of those nymcializzing in other 1:11:13 of the pragram. 50mg cf tf1e snecialized 3: age are fa1i‘y Gaza, rer- iat1fics, cantinuaus treatment, asd acute and intensive tremtme nt. A133, atudant training does nab include a thornugh acquaintanca with the mlaa of all the workers. ¥ifffl «gums in mth-fl A great deal Hf nterest was shcgn in tha qn astions -n this area. There is rather*complata agraemant on tF a fact that there an: differ-1111963 in the type of service mat social mrk offers and that which paycholsfiy or psychiatry offers; however, one phy- sician and can nurse do nah beliavu that thara 19 & éiffercneo in the service offered by psychology and that or aocial work. All ware asked to 61211.3 what they thought was £1113 ma; or ciifi'fertance. Most rfiglies descrim sacial'uork udt‘n an er phs is on family and camfiunity cantacts. Fsycholegy is described as being involvud chiefly in testing and rssaarc11.F33icaia rv is aaen in its use of medicatiCJns Dr’samati c aids ar1d.in the @911 at tharapy offsrad. baa pgychologist felt th1t psycholagy and socia1.work com- plament each other in fihat their contributions combine to make a taller garganality study. The p33 c-olashsta indie a that they 28 believe that their level of invclvcment in the treatment rulnticn- ship is dacpar than that of the social worker’s. A psychiatrist made the follcuingg cements in ccntrasting his disciplinc with social work. "First, frcm a madical visa, the sceial.uorkar is certainly not campetent to administer to the physical needs of a patient (diagnosis and treatment). Seocndlg, the psychiatrist is snpgcsedly'bcttcr cquipyed to underatand tbs emotional problems of a patient. Hhcn the service offered is primarily supportivc and/or manipulative, than is pmbably littla differancc.“ One social worker, in comparing his discipline to paychology feels that thcra are differences in orientation but that the treatment goals are the 3111129. This, of come, cculd be said in regard to ot‘s-wr team watchers. The cam worker feels that than is not a differcnce hatuccn the type of service accial work offers and that. H‘hiCh psychiatry offars except as a matter of dogma, ”dcpendicg on the working rclctionahip, compctcnes cud arc: of skill, and sphere of orientaticn. Diagnostic assessments, tract- mcnt {1:09.13 6111:“: outcome may be the same although in arriving at thcse the approach may represent variaticna." Ancthcr social wcrkcr, 1n diseaseing difference: say! that paychiatrisfia are involvcfi, in afldition to medical activities, in caministrativc rcaponaibilitics such as granting laavaa and.d13- charges, 11:11.10 tbs social worker only makes reccmrdations in re- gard to these matters. No further points out that social workara are not active on an casca while there is same involvomant cf the psychiatrist with all cases. 29 A question which 933333 likely to given team members a real c: 3.3mm ta indicate whether they attach importance to the social worker as a member of the team is the question which asked if the ”817.30333383'31. feels that the functions of social workers could be 33:33 no well by ati'zers on the staff. There was a fouxato-ona negative response to this question which 333.333 ta indicate a definite: acceptance of social warmers on tw tam. 310m physicians than any other disciplines r331 mat the functians might be dorm as 33311 by 5931330333 9133, 50 we reviewed the quaationnairac of th phymi 1333a wavering "yes” on this question and foum‘ that two 01’ the tin-533 3123*ch 3133331 men in the questionnaire mat they do not 132-103: the pal-pass of social work. A psyc‘mlogist £311: that they could be done as: well by tho Registrar staff, 1.331332733310333, or the ward staff. A pychiatriat {1.12.33 social work £332 ctions could be done as well by the pay- chiatriazt if he had. time. 113333 0313310333, however, mm in the Mari-.123". me social workers feel that than is a need for tho cgecific train-133;; trey have received which eliminatas the like- 11303.": that at 333m could pct form the social work r013 adaquataly. Kim-33331333 there is mcoyition of the 3:... that mb—pmfasaional 1:351:33 63’ 51. within t 39 r0133 ‘1. 3st coul .1 be handled adequatchr by others. The 8.3.331: was rati 3r fragment 111* set sum 01' 3‘13ch 13333333313133.2331 tacks be 3331523331 to others in crder to free the axial warmer to use his cm :32: bili ties more profitably. 1’33 g.-3t amoun- t of litaratum- curmntly 33331132213 can» cam. 33., p6". 10t““‘2‘..“f 333.3333 c3. net 1333?. £3.33 kings. .ner-c are 30 widely varying opiniona as to definition of fine term and tiara is much disagreemant as to who is qualified to practice it. Our 'qnestion asked whether thg respond$at.feels tint aacial workers are quali ied to do nechot era; ama thing at tha level of thaling on this aubjecfi may b3 indicetad in -ha f1 ct that mere voluntary "write in" reapensas Nara given on this quaatian than on any other. East of the aocial wnrkars feel that they are qualifiafi to do ysychofiherapy. ?here was a divided Opinion on the part of at ?;er team ma-mbera but t11o to one feel that social warkera art not qualified t9 do PGQCuOt m1py. A larga number of tha re- agmndents indicated a desire to givm a qualifiad response acnorfiing to the wr;finition of p3"ezathe“muy bain13 159d anfi=many felt that the question was nst really applicable to social.workers an a grnup but rather to than as indivifi uua a, th-e idea being that psycno- tharapy demands certain paraonality characteristics in addition to specific training. “any neg at1va res1enses to trm question were follcwed by'Opinions that amvaral individual social vorkc rs are qualified psychotherapists. Ecuaver, the H113 range of opinioas on the psychotharapy question goes in several directicna. fine phygician feels that anyone be13 £r191 qdly 13 capabla of ps"c c‘nerafiv. A physical tnarapist feels taut 119 alga nae: it to a cartain extent. 1 auras writes t3: at ”:11 of us, evan nursing assistants, do a farm of psychotherapy." See Fi5are S far'a breakuawn of tb 15 reapansea to this queatinn. 31 FILL... ngg‘rlér;: fir .13. S ‘C. 1&1. E'U(‘E IU‘A‘F‘)‘; kuALl’AJ—ud TC) 3.20 F’ZEJ’ ”‘77-‘52; ' .LAi‘i' z; z *—L=====L __ r ;Ez:~ A gaaifi *; -. I . Disciplina 265 330 Egg: Cthe r Skip Tot-2.1: Filming h 8' 7 ' 19 Physical Then my 1 2 3 Educational Therapy 2 5 7 Occupational Therapy 2 2 1 5 Psychology 1 2 3 ’6dical 2 b 1 1 8 Totals 11 22 9 3 LS Social Wark 6 1 1 8 Social work Etude: nu h h Totala 13 1 1 12 Social Vfrkers' Crinigns Cagggrnina ?Eeir Rama As a tated 1n C‘?wtar I, tExe role of Una social wc rkar in. volvua'what other: expact of them and also what they expoct 0f thomsalves. finch a! tie matarial on this has alrssdg been prb’ seated as the variqus questions hava bean discussed. All of the social workers feel that they and athers in their profession are primarily interested in helging paeplo. TheyHVQru asked to tell what thay feel the majar puracse of aocial work 32 service to be. Two workers failed to answer the question. Three belicva that it is to help the client make a.mora aéoonate adjust- moot. .Anothor feels that the major purpose is ”to help the patient with '13 planning to facilitate his release froa.the hospital." A rather inclusive statement was given by one: "Accessing the otrcngths and problems of patient and family, attempting to rcoolvc the problem: both internal and external to enable the patient to fuaction, projecting and planning for the patient'a return to family, community, and employment." Another workor feels that the mjor purpose is ”dc-fining, modifying, and/or eliminating those parsonclity, social, and environmental factors causing, contri- buting, and perpetuating pationts' illness." The social workars coca gonerally satiafiod with the level of cooperation within their discipline and with tho cooperation oxtendcd to other disciplines but most feel that their‘profosaional capabilities arc not adequately utilized by othor'mombcrs of the team and half of than fool that their profcsaional recommendations are not given adequcta consideration by otbcr'team mothers. Goa 'workcr'fools that some team mothers conoider his recomnondationa Voila others do not. The entire group of social workers feel that thoy are ade- quatoly trained to work in this setting and they feel that the patients hcvc confidence in the ability of social workers to help them. All but one are of the opinion that pationta fool that they are bonefittcd by social work service; one workcr does not know. All‘worc asked in whst way patients feel that they are benefitted 33 by social service. Two social workers did not res-pond to tho question. Somml mentioned the; benefit that patients fool in being helped to loo-w the hospital and the value of having: some- ono who will listen sod show concom. "hey am aooooted many timos, for tho first time in their lives, as they are. They learn to fez-21 'humon' again.” Social workoro do not fool that their functions could be dam as roll by others on the staff. "Really, the troimd social worker has skills of inter-”rioting and knowloozm of human growth god behavior which reofior*hlm more secure and loso throatoning to the poroon be some" than other tom members. There in couple-ate agmomnt that a larger number of social workers are needed than are pmaently on the staff because of the hood to extend more oonploto oer-vices to all parts of the hospital hon om prooontly available. The group was equally dlvldod on the question as to what-her social workers arc too cont-amoral about thoir status, howevor, the students feel that than is executive! concern about status. {h s g -}~I~w; an uh»: Limit V ""‘-K'~.u.&TA‘S mn1wtv‘ "T A‘sv-r‘: C K). '4‘ a); ..'-.&J ‘11:; 3‘. LI '3 ' .- L'i‘l .\.A. Nun.) Th9 conclusinns ara prefiestad canciaely in order to render them ..ara readily acceg able to the reader than if thcy gave ac- comaaniad by the explanatory informatian which 1a tha case of can conclusion.has been presented and illus tratad in '”~.a ter IV. 1. Social wcrkars ara canfidaat of their ability to help patients. 2. Secial workers hava a pcaitiva relatianshi; with patients. 3. Eacial Markers are not fully acquainted with tha role of their own service. b. T33 role of the social warker is not wall known among taam m3 “.1391‘3 . So There is a great final of agaperation f social workers with t . 5. Thare is confusion amnng team members regarding tbs bound. aries of 8mm of the: services (p33, 'Ecxolmjj , sncial work, psychiatry). 7. Social wsrkers feel t2 3y can.be utilized mere 3? fectivaly as members of tna taan. Tiara i3: is iuswf‘lcl t am mcunt of contact batwacn social wark3rs a.nd educati.onal, 0Cyfl3§2&ti anal, and physical the“ - plats. C15 0 The writera feel that the ca -yin; through of the following ream neg lei? titans will en? zance the effectivmxesa of the: clinical tssn.by pramating coorfiination, csmfiunica ion and understanding of team functian. 3h 35 First, no real there should be regular discusalrm by clini~ cal team mambera with all professiana regarding the nature of the overlapping area of services offered by each profession and haw these services should be approached. we helluva that such d15- euasion will illuminate heretorare unracognised areas of cammon- ality 1n'uhich mutual support and assistance will be nut only nought after'but freely givan. Second, membara of tha taam should encourage each other to work in thn area of overlapping services which 13 conduciva to an atmnspharo of nonparation 1n collaborating toward tho rehabili- tation of the patient. Third, we believa there should be a formal educational pro- gram developed within social work aorvice to teach its workers all of the functions of their awn servica a: well as the functions of tha other disciplines on the taam. The function of social sat» ‘vico should likewise b0 transmitted to all other nexbers of the clinical team. For example, representativestmlght coma from each of tha services to explain their respectivn functions in accial service staff meetings. This should be followed up hy reciprocal visits of social workers to ataff mnetinga of the other services for-tho same purpose. cruster’knawledga of team function will lead ts an in» creasing number of referrals and more efficient use of team ra- aoureee to the over-all benefit of the patient. Fourth, we feel that the ancillary disciplines should be an» couraged to attend more interdisciplinary ataff meeting: such as diagnootlo staff meetings, ward.otaff meetings, etc., to gain a broader knowledge of the rotioot and view the aurportlng sorvicss in notloo. Finally, no fool that the implementation of theoo recom- mmndations will increaso that all-important aopoct of any team function, comwunicatlon, by Opening up new channels and motivating team mamhors toward ouch comounication. The immodlate benefactor will be the patient but the ultimata winner will be society. “.1... -\_~,-~ I .3 .3" ”oz; -¢J¢A. Ec rnnrd, f... y 3., and 13.1vana, Toaru. rut.3ri., Can..1 ci331n 33 the L'tructn re of }3yc1i3Lric Teams," Excial ~nrv, (:30 3 .w. J1: 123;, "hub. 50 Burlinc, Te331e, Lentz, Ldif 353., 3n€ Zilson, Robert L TLe Civa gnd Wake in EOE?!“ 913g 3": H YQTKS ”2‘. W I . VT .3)". Carstairs, G. K., and.ver9n, Llaatair. “The Lacial :nxfl ranmant of Rental Hospital Patient: A Eeasura of Staff Attitufie,“ The Eatiant and the Fental.finsyitalo Caudill, ..1Lia Tfin-Euka‘v+949 Fmsu4+9.l 33 3 “W911 Erriéfyo Cambridge, ”Pgoacqubvttaa harvara Uni ve;“'