New challenges in social work and health care: - PowerPoint Presentation

Slide1

New challenges in social work and health care:

Interdisciplinary collaboration between social workers and health care professionals in a workfare discourse

International week 2018 Seinäjoki University of Applied Sciences Finland

1

Paper by Karin Nissen and Kim Jønsson

University College South Denmark

Slide2

Interdisciplinary collaboration in a workfare discourse

 How do we perform interdisciplinary collaboration between social workers and health care professionals in a workfare discourse where (re-)joining the workforce seems a universal cure to most ailments and problems be they physical, mental or social?

Slide3

Programme

Introduction of speakersLecture A short historical and theoretical overview

Challenges in interdisciplinary collaboration What is rehabilitation? An example of

how to organize rehabilitation – rehabilitation teams in a Danish jobcentre context

Interdisciplinarity in the rehabilitation process

Workshop

including

cases from a Danish jobcentre

Slide4

Introduction – Mrs. Karin Nissen

Trained and worked in shipping and international marketing i Denmark, Egypt and The Netherlands for app. 10 years.Trained as a counselor

and master practitioner of neuro-linguistic-programming at the South African College of Applied Psychology for 2 years.

Trained and worked as a social worker in Denmark for app. 13

years before doing a 2

year

programme

in master of science in social

sciences

at Aalborg University.

Since

2017

employed

as

lecturer

at University College of Southern Denmark. Has

joined

the

assistant

professor

training

programme

.

Slide5

In my

sparetime I like to hike with my family…

Slide6

Introduction – Mr. Kim Jønsson

Trained and worked as a leisuretime teacher for app. 10 years.Trained and worked as a social

worker for app. 10 years.Worked in social sciences at management level for another app. 10

years before doing a 2

year programme in master of science in social sciences.

Since

2015

employed

with University College of Southern Denmark as a

lecturer

. Has

joined

the

assistant

professor

training

programme

.

Slide7

In

my sparetime I try to keep up with these guys…

Slide8

A short historical and theoretical overview

Slide9

Welfare vs. Workfare

Traditional welfare benefits systems are usually awarded based on certain conditions, such as searching for work, or based on meeting criteria that would position the recipient as unavailable to seek employment or be employed. Under workfare, recipients have to meet certain participation requirements to continue to receive their welfare benefits. These requirements are often a combination of activities that are intended to improve the recipient's job prospects (such as training, rehabilitation and work experience) and those designated as contributing to society (such as unpaid or low-paid work).

Slide10

Workfare schemes

There are two main types of workfare scheme: those that encourage direct employment to get individuals off the welfare roll and directly into the workforce, and those that are intended to increase human capital by providing training and education to those currently in the welfare system

Slide11

Historical development

From a dependents concept with rights-based benefits anchored in a collective citizenship where unemployment, illness and

disability were mutual problems and where everyone was to be

ensured a reasonable standard of living

.To a concept of activity

where

the

unemployed

are

expected

to

work

on

their

employability

thru

social

efforts

or interventions. The human

being

is

seen

as an

individual

project

of

development

who

has to

adapt

to the

demands

of the

labormarked

.

From

passively

being

provided

for

thru

policies

of social

benefits

and a

highly

regulated

labormarked

to an

active

laborpolicy

.

Slide12

The Keynesian

Welfare National State 1940’s-1970’s (Marshall, Truman, Kennedy)The goal of Keynesianism was to ensure 100% employment and to

stabilize the economy thru an overall regulation of the state economy.

Unemployment benefits were high and the public

welfare sector grew big.

The

Schumpeterian

Workfare Postnational Regime 1980’s –

now

(Thatcher,

Regan

, Kohl)

The

goal

of

neoliberalism

is to re-

establish

the marked as a

governing

factor in

economy

and

politics

.

Hence

the public

welfare

sector

was

reduced

and the

unemployed

were

expected

to

work

on

their

employability

.

Slide13

Foucaults term: ”Governmentality”

In this period the citizens have been subjected to the following forms of management and power:Disciplining of body and structuring of work

time and space Normalising of soul/behaviour thru creation of healthy and

unhealthy behaviourA narrative of an entrepreneural

citizen in charge of his or her own life

who

in his or her

quest

for

success

on the

labormarked

accepts the public offer of

therapy

,

counseling

,

education

and

worktraining

.

A

combination

of

two

powertechnologies

:

”Technologies of

agency

” (

creates

free

independently

acting

players) and

”Technologies of performance” (

ensures

confirmist

actions

thru

checking

and

assessment

systems and

thru

clear

objectives

).

Slide14

Welfare professionals under New Public Management (NPM)

We are ourselves exposed to governmentality and powerbased technologies based on self-regulation

:As public employees our work is governed by fixed

goals, detailed regulations and

we are required to

use

certain

standardized

methods

.

We

are

exposed

to

opposing

demands

to

adjust

our

professionalism

to the

environment

of social

work

.

Our

role

and

identity

is

also

changing

:

We

are

required

to

act

as

therapists

and to

counsel

the

citizens

as to

how

they

can

become

more

employable

.

We

are

required

to

sanction

ressource

weak

citizens

who

cannot

take

on the

role

of

entrepreneur

in

their

own

lives.

But

during

recession

we

might

loose

faith

in the

avail

of

our

efforts

Slide15

Interdisciplinary collaboration

Slide16

Interdisciplinary

collaboration – integration of professions in order to create new knowledge and a new way of working

Problem

Assessment

criteria

:

Are

we

cooperating

on a

previously

defined

and

mutual

problem?

Do

several

professions

discuss

the problem?

Are the

boarders

between

the

involved

professions

transcended

when

the problem is

explored

?

In

coorporating

do

we

create

new

knowledge

about

the problem?

Slide17

A Danish research shows what we

think of interdisciplinary collaborationSocial workers, teachers and health care professionals agree

that the person closest to the citizen should give the initial reactionWe do not agree

on how and on whether or not we

should partake in interdisciplinary

collaboration

We

do not

agree

on

how

a case

should

be

discussed

within

the

various

professional

groups

When

it

comes

to

choosing

between

interventions the differences

between

social

workers

,

teachers

and

health

care

professionals

are

minor

and have no

significant

influence

on the

interdisciplinary

collaboration

But

within

the

three

professional

groups

themselves the differences

between

the

employees

are

major and

can

thus

have a large

impact

on

both

the mono-professional

collaboration

and on the

interdisciplinary

collaboration

Slide18

Can we agree

to disagree?The fact that a group of employees

share the same educational background and have trained for the same profession does in no

way guarantee uniformity

in analysis or adjudication of

which

step

should

be

taken

regarding

a

certain

social problem

Across

professional

boarders

the research

finds

significant

differences in attitude

towards

social problems

We

lack

knowledge

of differences

between

our

own

oppinion

and the opinion of

other

social

workers

,

teachers

or

health

care

professionals

towards

problems central to

our

professions

We

lack

consciousness

about

our

own

deviant

attitudes

Our

personal

biography

plays

a major part

when

we

as professionals

choose

between

interventions

Our

choice

of intervention is

influenced

by emotions and attitudes

towards

certain

interventions (

especially

when

it

comes

to

children

)

Differences in

knowledge

and

experience

Differences due to

lack

of

knowledge

about

rules

and

regulations

Slide19

Rehabilitation

Slide20

What is rehabilitation?

Habilitas (latin) = an advanced skill, ability or competence.Rehabilitating = to restore someones credit,

honor and position.There are several forms of rehabilitation: Besides

physical rehabilitation we operate

with medical, mental, social, educational and occupational

rehabilitation.

Slide21

Definition: Rehabilitation I

"Rehabilitation can be defined as a series of efforts or interventions that support the individual human being, who is at risk of a decreased

functionality or already has experienced at decreased functionality in achieving and

maintaining the best possible

functionality in his or her interaction with the

surrounding

society

”.

Kilde: World Report on

Disability

, 2011 – World Health Organization & The World Bank, ©WHO, 2011.

 

This definition is

used

by the Danish Health and Social

Agencies

.

Slide22

Definition: Rehabilitation II

An occopational definition is rather narrow with a starting point in a coordinating and interdisciplinary collaboration which serves as a

tool in promoting the citizens participation in the vocational community. The aim is the

citizens financial self-support

rather than a passive financial support by

focusing

on the

development

of his or her

ability

to

work

.

”

Vocational

or

occupational

rehabilitation

concerns

the

development

of the

action

oriented

competences

of the

citizen

in

order

to

increase

the chances of (re-)

entry

into

the

work

force”

Slide23

Rehabilitating teams in Danish jobcenters

2013 occupational reformFewer citizens on incapacity benefitNo citizens under the age of 40 on incapacity

benefitOverall increase in the workforce

Slide24

The intention behind the rehabilitating

team isTo ensure that a parallel clarification of the citizens health, occupational and social ressources and challenges takes

place. Focus is primarily on education, employment and on being

able to support oneself. The aim

is an effective use of the joint ressources.

Slide25

The rehabilitating team works

with ICF: International Classification of Functioning, Disability and HealthIt is WHO’s framework for measuring health and dissability in a specific

context. The fraction:

Individual

ressources

Environmental

demands

Health/

participation

Slide26

ICF – International Classification of Functioning

, Health and DisabilityHealth condition or disease

Activities

Participation

Personal factors

Environmental

factors

Bodily

functions

Slide27

Occupational rehabilitation - ICF

ICF is not ment to classify people with disabilities, but instead to point out areas where disabilities can occur. Therefore

the model can be used on anybody.The component ”activities” covers individual task

solving or actions. Impairment in activities

occurs when a person has problems solving tasks and

taking

actions on

their

own

.

The component ”participation” covers tasks in

daily

life

.

Both

in the

household

and in society in general.

The

labor

marked is a major arena for

individual

activity

and participation.

Please note

that

benefits

can

be

withheld

from a

citizen

who

does

not show

enough

enthusiasm

in

regards

to ”participation and

activity

”

during

ressource management.

Slide28

Who partakes in a rehabilitation team?

According to Danish law the rehabilitation team must consist of representatives fromEmployment departmentHealth

departmentSocial services

Slide29

Rehabilitation team in a Danish municipality

Employment consultant

State employed medical doctor

Moderator/social

worker

from the Jobcentre

Social

worker

from Social Services

Health

care

department

The

citizens

employment

case

worker

The

citizen

Assessor for the

citizen

Ad hoc

Slide30

Employment department:

Contributes with knowledge regarding:Educational factorsRessource managementOccupational factorsEarly retirement

Representatives may be trained social workers but

are not necessarily so.

Slide31

Health department:

Counseling regarding: Help supplies, practical help in the household Physical rehabilitation, dietitians, sleep,

excersice, incontinence, treatment of addictions Cancer-rehabiliteringObesity, diabetes, COPD (

Chronic Obstructive Pulmonary Disease

)Pain, anxiety, depression, occupation

and

disease

 

Representatives

are

trained

nurses,

physiotherapists

,

occupational

therapists

etc.

Slide32

Social services:

Social services contributes with knowledge regarding:Support systems where a person helps with structuring everyday life, plans

grocery shopping, teaches how to shop for groceries and how to cook, teaches

how to clean and personal

hygiene, teaches how to

manage

ones

finances

Building

groups

for

networking

with

other

people

who

are

unemployed

Networking

posibilities

with

other

people

who

suffer

from

disabilities

and

diseases

Brain

injury

Representatives

are

trained

social

workers

.

Slide33

Medical doctor

A state-employed medical doctor also partakes in the rehabilitation team. They are called ”health coordinators” and their job is to

counsel the team in regards to which extend the citizen is capable of partaking

in educational og occupational efforts

or interventions.Has the citizen at some

point

been

deemed

incapable

of

working

the

health

coordinator

counsels

as to

which

extend

this

is still the case.

The

health

coordinator

partakes

in the

interdisciplinary

discussions

on

equal

terms with the

other

members

of the rehabilitation team.

Slide34

Ad hoc participants

A representative from the educational system partakes in meetings with cases with people under the age of 30 who have not trained for a profession. These representatives are employed by the jobcentre.

Internal og eksternal experts and employees with particular experience

(for example socialworkers from the family

department) are invited

to

join

the team in

order

to

qualify

the teams

work

and

orientations

.

Slide35

Coordinating case worker

When a citizen has a meeting with the rehabilitation team he/she is joined by a coordinating case worker.The coordinating case worker is employed by the jobcentre.Prior to the meeting the

citizen and the coordinating case worker meet up and prepare the paperwork for the rehabilitation team.

The paperwork consists of educational

and/or occupational goals along

with the

citizens

ressources and a

description

of his/her

entire

situation.

Slide36

The citizen meets with the rehabilitation team

During the meeting the citizen receives support in order to partake in a dialogue where he/she is

expected to present his/her…Educational or occupational wishesJobs he/she would

like to tryOwn ressourcesNeeds

Slide37

Interdisciplinarity in the rehabilitation process

Slide38

Interdisciplinarity

in the rehabilitation process

Slide39

Interdisciplinarity in the rehabilitation process –

why is it effective?Compared to a traditional effort with no emphasis on interdisciplinary collaboration the effectiveness

of rehabilitation is furthered by focusing on interdisciplinary collaboration. Good results have

been shown in the following areas

:FunctionalityNeed for

fewer

and

shorter

admittances

to hospital

Improved

survival

rate

Fewer

post-operative

complications

Less

dependent on

help

from

others

Faster re-

employment

Less

need

for

sick

leave

Studies show

that

pointing

out

exactly

which

types of

interdisciplinary

team-

collaboration

has the

best

effect

is

difficult

.

Slide40

Interdisciplinarity in the rehabilitation process –

why is it so difficult?Niklas Luhmanns theory of communication between social systems point to a possible explanation. His theory

explains how social systems reduce the complexity of the knowledge the system recieves and

dispatches. This means that a system

translates a professional perspective communicated

from

another

system to

something

understandable

within

its

own

system.

This

entails

:

A large

risk

of misinterpretations of

communication

from

other

systems

Battles for tasks and

finances

for

efforts

between

professional

fields

Domainal

battles

between

professions and

sectors

form a

barrier

for

interdisciplinary

collaboration

if

they

are

not

transformed

into

arenas of professional

exchange

and

development

Slide41

Interdisciplinarity

in the rehabilitation process – what needs to be in place for it to succeed?Prerequisites for a good

interdisciplinary collaboration:Concurrence of which criteria a team is formed

, its members, coordinator, and of

wether the citizen partakes or not

A common

goal

must

be

agreed

upon

A

mutual

ICF-plan must

be

established

–

who

does

what

,

when

and in

which

order

Indikators and

endpoints

for the

rehabilitating

efforts

must

be

agreed

upon

Concurrence

of

wether

the

goal

has

been

reached

or not must

be

established

.

Along

with

whether

a new rehabilitation

process

is to

be

initiated

and/or the

current

process

is to

be

terminated

Slide42

Interdisciplinarity in the rehabilitation process-

personal and professional skills neededTrained specialists who partake in rehabilitation processes must pocess knowledge

about rehabilitating methods i.e. be trained inCommunication

skillsDialogue skills

Citizen cooperation skillsEntirity

orientation

skills

Coordinating

skills

Interdisciplinary

and

intersectorial

collaboration

Quality

development

skills

Documentation

skills

Follow

up

skills

on

initatives

Slide43

Cases/workshop

Slide44

Form groups

of 4-5 personsDefine the social problem(s) in the caseContribute with knowledge about the problem(s)Discuss the possible challenges in interdisciplinary collaboration in your caseBefore we meet again reflect on your process: What surprised you? What did you learn? Share your thoughts with us in plenum. See you in 30 minutes



Slide45

References:

Ejrnæs, Morten: Faglighed og tværfaglighed – vilkårene for tværfagligt samarbejde mellem sundhedsplejersker, pædagoger, lærere og sagsbehandlere. Publisher: Akademisk Forlag, 2006 ISBN13: 9788750040446Foucault, Michel, Power/Knowledge: Selected Interviews & Other Writings 1972 – 1977, Publisher: Pantheon Books, 1980 ISBN 039473954x, 9780394739540Højholdt, Andy,

Tværprofessionelt samarbejde i teori og praksis, Publisher: Hans Reitzels Forlag

, 2016, ISBN13: 9788741262185Keynes, John Maynard, The General Theory of Employment, Interest, and Money (Great Minds Series), Publisher: Prometheus Books, 1997 ISBN10:1573921394Lipsky

, Michael, Street level bureaucracy. Dilemma of the individual in public services, Publisher: Russell Sage, 2010, ISBN13: 978-0871545442Luhmann

, Nicklas, Social Systems, Publisher: Stanford University Press, 1996,

ISBN 0804726256, ISBN13: 9780804726252

Schumpeter, Joseph Alois, The Theory of Economic Development, Publisher: Taylor & Francis Inc, 1984, ISBN 10: 0878556982