Running head: INTERPROFESSIONAL COLLABORATION: INTERVIEW OF A SOCIAL WORKER IN INJURY

PREVENTION 1

Interprofessional collaboration: The role of a social worker in injury prevention

Caitlin Kilts
SUNY Delhi
NURS604
Dr. Digger
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Abstract

This paper examines the four competencies of interprofessional collaboration (IPC) as defined by

IPEC (2011) through the analysis of an interview with a social work student who works in an

interprofessional injury prevention program. The four competencies are: values/ethics for

interprofessional practice; interprofessional teamwork and team-based practice; interprofessional

communication practices; and roles and responsibilities for collaborative practices. Each

competency is discussed utilizing examples from the interview, particularly about the role of IPC

in the organization of Gun Buy Back events in West Hartford. Based on the themes of the

interview, IPC is effectively demonstrated by the interviewee and the organization with which

she works, allowing for efficient, effective and creative care of patients and the community in

which they live.

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Introduction

Interprofessional collaborative practice (ICP) is an evidence-based current trend in

healthcare which is based upon the philosophy that patient/client outcomes are significantly

improved when providers respect one another and work synergistically to achieve common

patient goals (Vega & Bernard, 2017). The goal of ICP is for healthcare professionals to

deliberatively work “deliberatively working together with the common goal of building a safer

and better patient-centered and community/population oriented U.S. health care system (IPEC,

2011, p. 3).” While IPC can take diverse forms, the common thread is that healthcare

professionals from different fields come together to provide care for patients, families and

communities in the most effective and efficient way (Ambrose-Miller & Ashcroft, 2016). The

common goal is simply the improvement of the health and wellbeing of those who use the

healthcare system. The four core competencies for IPC, as defined by IPEC (2011), are:

values/ethics for interprofessional practice; interprofessional teamwork and team-based practice;

interprofessional communication practices; and roles and responsibilities for collaborative

practices.

Social workers are an integral part of many interprofessional teams, because of the

unique perspective on patients and communities that they can bring to the table (Ambrose-Miller

& Ashcroft, 2016). Additionally, social workers have a history of providing team-based care,

making them both valuable team members and role models for IPC. Yet, social workers often

experience medical dominance (Goldman, et.al, 2016). Medical dominance theory posits that

physicians hold a dominant position within the medical field, allowing them autonomy over their

own practice, as well as the practice of other professionals. Because social workers are often one

of the only “non-medical” professionals on a healthcare team and are generally the sole social
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worker (Ambrose-Miller & Ashcroft, 2016), they have to struggle significantly to throw off the

weight of medical dominance. With the increasing popularity of IPC and the adoption of IPEC’s

core competencies, social workers will become increasingly valued members of health-care

teams.

Introduction to Interview Subject

For this paper, I interviewed Johanna Strauss Schubert (johanna.schubert@gmail.com)

who is a Master’s Candidate in Social Work at the University of Connecticut at Hartford. Her

concentration is in Community Organizing and she currently works at St. Francis Hospital in

their Department of Trauma, specifically in the Violence and Injury Prevention Program. Prior

to her work at St. Francis Hospital, she served as a community liaison with The Jewish

Federation of Hartford, which allowed her to develop strong ties to the community, especially

the different faith communities. Choosing a Master’s Candidate as my subject may be a bit

unusual, but I am impressed with the programs she works in and have had the opportunity to

volunteer with her at one of her Gun Buy Back Programs in Hartford. Personally, attending that

event opened my eyes to some of the potential ways to impact public health and helped me learn

to think outside the box. I am also intrigued by the structure of her organization, which is based

out of the Department of Trauma in a major metropolitan area, but does not actually work within

clinical settings. Rather, it focuses on preventing people from needing their trauma services and

does so by working outside the facility in the community. The four main projects that Ms.

Schubert works on are:

 Let’s Not Meet By Accident, a hands on program that teaches adolescents to make

educated choices in dangerous situations, such as texting while driving (Trinity Health of

New England, 2018).

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 Elder Fall Prevention and Safety, a workshop for elderly people living in

towns/cities/neighborhoods that have shown a spike in falls among the elderly

population, as evidenced by data from the hospital registry (Trinity Health of New

England, 2018).

 Kids in Safety Seats, a community based clinic program that educates parents how to

correctly install and use car seats (Trinity Health of New England, 2018).

 Gun Buy Backs in conjunction with the Hartford Police, a program where community

members can trade in guns for grocery gift cards without fear of legal repercussions

All of these programs are intended to promote the well-being of the community, by preventing

injury before it happens. Injury is being treated as a disease, using epidemiological theory,

which makes injury prevention essentially preventative care.

Values/Ethics for Interprofessional Practice

The competency of values/ethics is based upon the idea that there are a set of common

core values and ethics shared by healthcare providers, which allow interprofessional groups to

maintain a climate of respect, while providing ethical care to their clients (IPEC, 2011). There

are really two components to this competency, the ethical treatment of clients and the ethical

treatment of members of the interprofessional group, both of which are integral to effective IPC.

Ms. Schubert spoke about both aspects of ethics during our interview, focusing on the Gun Buy

Backs as an example of ethically collaboration between professionals. The Gun Buy Back

program is a collaboration between The Connecticut Children's Medical Center, Hartford

Hospital and Saint Francis Hospital and Medical Center, the City of Hartford, Hartford Police

Department, the Hartford State's Attorney's Office and Community Renewal Team (Wenzel &

Cashman, 2017). Within this collaboration, there is a wide variety of professionals involved in
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the prevention of the public health crisis of gun violence, including physicians, social workers,

nurses, police officers, politicians, lawyers, and community members. Some of the members of

this group historically do not get along or respect one another, especially police officers and the

community members of West Hartford. Yet, within the boundaries of this group, they treat each

other with respect, because they share an important and community-altering goal, namely, to get

guns off the streets and decreased gun violence and gun-related deaths. This goal is not possible

without the collaboration of a wide range of people, which makes it an excellent example of IPC.

Based on data collected by the Hartford Police Department and the Office of the Chief Medical

Examiner, a study by Baumann, et.al (2017) supports the efficacy of Gun Buy Back programs in

decreasing community gun violence, both murder and suicide. The efficacy of these programs

provides the “buy-in” needed for all of the different professionals to come together in a setting of

mutual respect to run this program. While the individual values of the group members may

differ, their values regarding the safety and health of their community are aligned, allowing for

effective IPC.

The ethical treatment of clients, either individuals or a community, is also key to good

IPC and this can be demonstrated by providing care that is respectful of the diversity of the

patient, the community and the healthcare team (IPEC, 2011). The specific competency

addressing this states: “Embrace the cultural diversity and individual differences that

characterize patients, populations, and the health care team (IPEC, 2011, p. 19).” Ms. Schubert

discussed a case where one of the research groups at St. Francis Hospital reached out to her for

assistance in finding research subjects for their study on palliative care within the Puerto Rican

community in Hartford. The researchers were having difficulty gaining access to this population,

but because of familiarity with the faith leaders of Hartford as well as her personal connections
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to the Puerto Rican community, Ms. Schubert was able to link together the research team to

subjects. She worked with Spanish-speaking faith leaders to recruit patients and care-givers

involved in palliative care. The research team, comprised of physicians, nurses and researchers,

was able to continue their research by reaching out across professional lines to someone with the

appropriate knowledge and experience to recruit from the desired population. Ms. Schubert was

able to help because she had worked with and was respected within a diverse group of faith

leaders and community members. The research project had the goal of creating more sensitive

tools regarding palliative care to use with different ethnicities.

Interprofessional Teamwork and Team-based Care

The competency of interprofessional teamwork and team-based care has much in

common with the competency of ethics/values, because without respect for each team member’s

values/ethics it is impossible to form a working team. IPEC (2011) states that the competency of

interprofessional teamwork and team-based care requires the application of “relationship-

building values and the principles of team dynamics to perform effectively in different team roles

to plan and deliver patient-/population-centered care that is safe, timely, efficient, effective, and

equitable (p. 25).” Ambrose-Miller & Ashcroft (2016), in their study on the challenges faced by

social workers in IPC, found that having a culture of collaboration, which fosters respect,

supports members and values diversity, is perceived by social workers as integral to team-

building. In our interview, Ms. Schubert discussed the nurturing environment of her department,

which was based upon her supervisor who had been with the organization for twelve years. Her

supervisor is a transformational leader, who is able to create lasting and valuable change in her

followers and fosters the development of her followers into leaders (Grossman & Valiga, 2009).

The presence of a transformational leader can allow for superior team building, because of their
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ability to create the needed climate of respect and ethical behavior, as well as motivate positive

and lasting change. While Ms. Schubert felt that overall her team was strong, she felt that the

supervising physician was distant and maintained supremacy over the team, without actually

being a team player. Her description of his interactions with the team is consistent with the

model of medical dominance and demonstrate that it is still alive and well, even in a strong

working team. Yet, her team shows that you can continue to be an effective IPC, even if one

member does not play along. It is not ideal, but it is functional, as evidenced by the good work

that the department has carried out over the years.

Roles/Responsibilities for Collaborative Practice

Successful IPC requires a solid understanding of the roles and responsibilities of every

member of the team, including one’s self. To achieve this competency, the IPEC (2011) states

that one must “use the knowledge of one’s own role and those of other professions to

appropriately assess and address the healthcare needs of the patients and populations served (p.

21).” A lack of role clarification has been a consistent barrier to the effective participation of

social workers in IPC (Ambrose-Miller & Ashcroft, 2016). Social workers serve such a wide

variety of roles that it can be hard to define what they do, or perhaps more precisely, what they

do not do (Ashcroft, Kourgiantakis, & Brown, 2017). Social workers work with diverse

populations, ranging from geriatrics to pediatrics to the mentally ill to the community, and play a

variety of roles, including mental health worker, educator, counselor, case manager, and

palliative care giver, which makes it difficult to pin down their actual scope of practice. Being

unable to clearly define scope of practice can be a serious barrier to effective participation in

IPC.
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When asked to describe her scope of practice within IPC, Ms. Schubert was surprisingly

directed in her response. She felt that, as a social worker, she provided context for the group.

For her, social work starts from the premise that a person does not function within vacuum and

environment, context and landscape are required to provide the best and most accessible

treatment. This premise, she believes, allows for social workers to make a unique contribution to

any interprofessional group. When discussing the strengths of social work, Ms. Schubert told the

following story:

I have a white older gentleman who is so committed. He sees that West Hartford is a

food vacuum. Wouldn’t it be great if we could work with Peapod to deliver to that area?

He thought he could use his influence to make this change. But social workers know that

people in those areas may not have credit cards, internet access, the ability to use

foodstamps online, a permanent address. He didn’t consider it. Maybe we use shelters,

churches or libraries as distribution centers. There aren’t enough stable homes there to

make home food delivery a reality.

While there is work to be done in defining the professional scope of social workers in IPC, I am

hopeful, based upon my interview with Ms. Schubert, that the next generation of social workers

will be confident and defined within their roles and be unaffected by medical dominance.

Interprofessional Communication

The last of the four IPEC core competencies for IPC relates to interprofessional

communication and requires that team members “communicate with patients, families,

communities, and other health professionals in a responsive and responsible manner that

supports a team approach to the maintenance of health and the treatment of disease (p. 23).”

Communication is key to the effective functioning of any team and it is particularly important
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when dealing with anything health related, since miscommunication is a primary cause of

medical errors (Vega & Bernard, 2017). The use of technology in communication can be a huge

benefit, especially when it is something that the team is able to use as second nature. Ms.

Schubert discussed how she communicated with her team using a wide variety of technology,

ranging from text messages to email to skype, as well as the more traditional phone calls and

face-to-face meetings. She quipped that she used just about every type of communication to stay

in touch with her supervisor. The modes of communication varies depending on the team

members involved, but flexibility and variety were a common thread. The frequent and

comfortable exchange of communication allows for a sense of group to form. Ms. Schubert sees

herself as an integral part of the team, in part because she is included in so much of the

communication. Communication is also important in working with patients and the community.

With the focus of the program being the community, it is necessary to get their message out to a

variety of different groups, ranging from parents of small children to elders at risk for falls to

teenagers to gun-owners. Therefore, they use media sources such as newspapers, flyers,

television, facebook and websites, as well as word of mouth. In fact, the majority of the gun-

owners who bring firearms to the buy backs hear about the event through word of mouth, rather

than media sources. In order to have effective community communication, the organization must

have a tight connection with the community and maintain a high level of trust with them,

otherwise, the messages will not be received.

Reflection

Having had the opportunity to participate in a West Hartford Gun Buy Back, I felt

confident that I had a good grasp of what Ms. Schubert did in her job and how our conversation

would go. But, I was pleasantly surprised by the depth with which she answered the questions
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and the insight into IPC I gained through our interview. As a nurse, I have always worked

nights, with the result that most of my healthcare team members are other nurses and aides, with

perhaps a doctor or respiratory therapist occasionally. We interact with the phlebotomists and

perhaps an x-ray technician, but otherwise, we work with other nurses. Though I felt a strong

sense of comradery with all of the night shift workers, we did not work as an interdisciplinary

team. We each had our job to do and we did it. There was even a part of me that relished not

having to cooperate with other disciplines, since nurses essentially run the hospital at night. But,

after speaking with Ms. Schubert and participating in an event where I watched police officers

work with community members, as well as nurses and ED physicians, I have a deep

understanding of how valuable IPC can be. Each member of the team brought something unique

and valuable to the team; each team member valued each other; and everyone knew what every

one’s roles were. As Ms. Schubert passionately talked about the programs she helps run, I was

struck by how she felt on equal footing with every other team member, though she

acknowledged how different they all are.

As a final reflection, I would like to retell a parable that Ms. Schubert shared with me

about the two main types of social work. Two social workers are standing on the bank of a river

and as they look out onto the river, they see a body float past them. They both jump in, pull the

person out of the water and begin resuscitation. They see a second body float by and they jump

in after that body, trying to say them. They see a third body float by and one social worker

jumps in. The second social worker begins to walk upstream. In shock, the first social worker

yells to the second one “how can you desert these people? We need to save them!” The second

social worker responds “I’m going upstream to stop whoever is throwing these people in the

river.” While this story is about social work specifically, I feel that the lesson can be applied to
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all types of IPC. Both social workers brought different skills to the table, both of which were

necessary skills to save these people. But, because of poor communication, and lack of role

clarity, respect for each other and teamwork, they were unable to be as effective as they could be.

The parable is a reminder of how valuable different viewpoints and skill sets are when trying to

care for people and communities.

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Interview Questions

1. What is your job description? Can you describe a “typical” day at your job?

2. What is your scope of practice?

3. What are some of the limits of your practice?

4. What are the strengths of your practice?

5. Who is on your “team” at work? What are each of your roles?

6. Within your team, are you able to maintain clear roles?

7. How does your team work together to maintain the dignity of all of your clients?

8. Do you include your clients in your healthcare team?

9. What does ethical care look like to you?

10. How does your team communicate with each other? How do you communicate with the

community and/or clients?

11. How does your team evaluate each other’s performance?

12. How does your team maintain effectiveness?

13. How do you maintain respect for your team, community and client’s diversity?
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Ashcroft, R., Kourgiantakis, T., & Brown, J. B. (2017). Social work’s scope of practice in the

provision of primary mental health care: protocol for a scoping review. BMJ open, 7(11),

e019384. doi: http://dx.doi.org/10.1136/bmjopen-2017-019384

Baumann, L., Clinton, H., Berntsson, R., Williams, S., Rovella, J.C., Shapiro, D., Thaker, S.,

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