JOURNAL ISSUE 2
1999/2000

table of contents | abstracts

 

Social Work in a Multi-Professional Environment

Juha Hämäläinen
Erja Widgren

 


ABSTRACT

Social work is part of a multi-professional network of social services in the Nordic countries. The special know-how and attitudes required for cooperation are an essential part of social workers' professional skills. Cooperation between different occupational groups vary in content, form, and intensity, and concerns both client-related and administrative matters. Cooperation can be divided into cooperation inside and among organizations.

The need for the developing of cooperation has been justified by economic arguments and the interests of the client. Problems hindering cooperation are varying organizational cultures and professional principles, professional specialization, professional power, administrative hindrances, and personal characteristics of workers. Strict confidentiality regulations can obstruct the intended cooperation.

The aim of the cooperation between social and health services is that services are easily available and clients get better and more humane help.

In the Nordic model, social work is regarded as part of a comprehensive multi-professional system of welfare services. Social work is done in cooperation with representatives of many professions; the cooperation varies in form and content with different sectors of the welfare service system.

One of the goals in the Nordic system of welfare services has been to increase interprofessional cooperation. This has been persued by cooperation groups inside each sector. Joint administrative coordination of different organizations, regionalization of welfare services, and legislative obligations have been the central administrative measures for increasing interprofessional cooperation, lowering the threshold of cooperation, and removing obstacles which hinder cooperation.

Professional cooperation of social workers with the representatives of other professions can be administrative or client related. It can be more or less nominal and occasional or regular, systematic, intensive, and programmatic (Bruce, 1980; Hallet & Stevenson, 1980; Westrin, 1986). The cooperation can be the exchange of information through telephone, consulting, work in multi-professional groups, or developing joint projects.

Traditionally, social and health services have been sectorized; separated administratively in the Nordic countries. As a result, legislation does not usually oblige the administrations of different social and health service sectors to cooperate, although it often creates premises for it. Cooperation between the social workers and the representatives of other occupational groups is seldom required by law. However, social workers work increasingly in a variety of multi-professional, network-styled cooperation projects and teams.

 

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COOPERATION BETWEEN SOCIAL AND HEALTH SERVICES

Cooperation between social and health services has been numbers of special interest in Finland. In addition, attention has been drawn to intensifying cooperation between municipal social services and those offered by other state and municipal institutions including schools, municipal leisure time and culture administrations, police, employment offices, and housing administrations. The main focus, however, has been on the development of cooperation between the social and health services.

The Municipal social and health service organizations were separated until the 1980s, although they had historically developed in close interaction historically. At present, service organizations are combined in many municipalities, which has created conditions to improve interprofessional cooperation. For social work this means both administrative and client-related cooperation between doctors, public health nurses, public health psychologists, and others working in the health service sector.

Traditionally, the social point of view has played an important role in the Finnish health service system. At the beginning of the century, social factors were known to be connected with many illnesses, and the knowledge of these connections has continuedtogrow. The position of social nurse was established in the Finnish social service sector in the 1920s. About one fourth of Finnish social workers work within health care, and a great many of the others work in close cooperation with health care workers.

Cooperation between social and health services has been justified by both economic and humane arguments. Improving cooperation to decreases double treatment, clears the division of labor between the different occupational groups, decreases the moving clients from one sector to another, and diversifies professional know-how in producing welfare services.

There are numerous principles and practical reasons for the improvement of cooperation between social and health services. But the development has not occurred without difficulties. The central problems and obstacles were the differing organizational cultures and traditions within social and health services, professional specialization and professional power, insufficient financial resources, lack of time and planning, management methods which hinder cooperation, and workers' unawareness of tasks done by others (Nikkla, 1986; Kaasalainen, 1991; Marjamaki, 1992). The factors hindering cooperation between social and health services refer both to workers and the administration systems. Strict confidentiality rules have also complicated cooperation by workers in social and health care services. Even so, with the client's permission, all kinds of cooperation is possible in client-related matters.

In the long run, at least part of the problems concerning cooperation can be solved by improving the education of different occupational groups within social and health services. In addition to improving knowledge required for cooperation, the attitudes of different occupational groups toward cooperation could be molded during education. It is essential that people are aware of the necessity and the possibilities of cooperation and that they also know how to work together in practice. The possibilities of education are indispensable for reforming operations methods which hinder cooperation and for discussing occupational status conflicts.

An inquiry made of Finnish social workers (Hämäläinen, 1993) found that readiness for cooperation requires that social work education include a general idea of the health care organization, knowledge of regulations concerning the legal protection of clients and, strengthening the identity of social workers, and what is needed for multi-professional cooperation.

To increase cooperation between social workers and doctors requires that social workers' diplomas have an academic status in the educational system. This would create a prerequisite for cooperation based on equality and enable genuine social exchange without an asymmetric power-dependence. It is also essential that social workers' expert knowledge correspond to the requirements of social exchange. Each party should see benefits from the change of information.

 

REGIONALIZATION OF THE WELFARE SERVICES

People need social networks to preserve their mental well-being. It is important to create an organization method based on cooperation and social networks. Such a method enables high quality, efficiency, and productive work. In networks, people exchange ideas, solutions and experiences; new solutions and new techniques can quickly be developed and absorbed. The objective and the result of

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the work are developed by the entire staff. In network organizations, strict division of labor has been abandoned and replaced with various, substitutive jobs. The work is done in teamwork, overlapping the traditional borders set for every profession.

The present social service system is characterized by general dissatisfaction and the desire for reorganization. Lack of money changed ideas of the function and the tasks of a social state, self-help movements, desires to decentralize and reorganize the administration of social services, to divide the work among workers in the social sector, and the need for professional development of social work (Greca, 1995) are all typical. Regionalization is regarded as one method of reforming the administration of the system of social services.

The organization model for health care in Finland is based on networks and can be realized in health care centers operating with the principle of "responsibility for the citizens." Doctors, public health nurses, and other staff provide clients of their region with all health care services,whereas in more specialized models services according to special fields have been preserved. In the sector of social services "regionalization" corresponds to the concept of "responsibility for the citizens" (Makela et al., 1992). The concept of "regional responsibility for the citizens" is used in the mutual projects of social and health services. It means "the responsibility of a multi-professional work group for the organization of social and health services for the citizens of a specific geographical area" (Pilkama, 1991; Engerstrom et al., 1991).

Along with the combining of social and health services, attempts have also been made to build and create efficient multi-professional work groups. The network of authorities in the field of social and health services consists of very different helpers and different working cultures. Helping is always a question of selecting and interpreting, which means that various frames of reference guide workers. The multi-professional way of working is fruitful in situations in which many people representing different viewpoints are to work with each other.

 

MULTI-PROFESSIONAL COOPERATION

The basis of multi-professional cooperation is that the other party is seen in a positive light, the parties have a similar concept of human nature, and the parties believe that people can change. The aim of the work is uniform; the parties do not compete for right solutions, or for what is best for the client (Kuusela, 1996). The needs of the client form the basis of multi-professional teamwork. The client is seen as a whole in relation to his abilities, the course of his life, and the changes in his immediate surroundings. Willingness to be of service, increasing personal contribution to the work, and increasing clients' possibilities to participate in matters concerning themselves are the aims of multi-professional cooperation (Makela et al., 1992; Partanen,1992).

The experts, representing various sectors on a team work together as equals, according to their own professions, and strive for what's best for the client. Different viewpoints are allowed in the team; resolving problems through discussing and debating is a sign of the maturity of the team. The team has great freedom to improve its own work to respond to the needs of the region.

To work with each other, experts from different occupational groups must be aware of cultural values and underlying assumptions. If various occupational groups of workers observe and understand certain facts in differing ways, they belong to different cultural units. This can cause problems in interaction and communication between the workers. Each team must struggle with questions. How many conflicts can be tolerated? How can the differences be fixed? Whose assumptions are put before the assumptions of the others? (Ojuri, 1996; Schein, 1991).

A problem of the service system is that it is organized and sectorized according to the symptoms and problems. The alcohol-clinic, the mental health clinic, and the child and family guidance clinic are examples of this. Multi-professionality is as a new professional skill. But can not be achieved only by the workers are moving under the same roof. Mutual development and learning process in which professional skill is given to mutual use is needed. An expert-dominated and sectorized system cannot prevent isolation of children and the young (Linnosuo, 1996).

Identifying of the client as the mutual object of the work and a reform of cooperation methods are the fundamental criteria for efficiency and the integration of cooperation between experts.

The personal relation of each person to the aims set to the work is significant to cooperation. Workers in social and health services are experts and the institutions they work in are professional organizations, in which the work is done relatively independently. In expert organizations of social

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and health services, people can take at least three different attitudes towards cooperation (Ojuri, 1996; Schein, 1991):

  • cooperation is selective and regarded as important with a representative of the own occupational group,
  • cooperation is regarded as positive, but its importance is primarily the benefit which can be obtained in the work done, or
  • cooperation-orientation with unreserved support of teamwork

SUMMARY

Social work in the Nordic countries is seen as part of a multi-professional network of social services. The special know-how and attitudes required for cooperation are an essential part of social worker's professional skill. Doctors, public health nurses, psychologists, teachers, youth workers, nursery school teachers, police officers, and social workers of the church are the main cooperational partners.

Cooperation between different occupational groups varies in content, form, and intensity, and concerns mainly client-related or administrative matters. Cooperation involves transforming and obtaining information among workers. Cooperation can be divided into cooperation inside and between the organization.

The need for cooperation has been justified by economic arguments and by the interest of the client. The essential problems hindering cooperation are varying organizational cultures and professional principles, professional specialization, and professional power, administrative hindrances, and personal characteristics of workers.

Education and administrative reforms are the basic instruments in developing cooperation. Nordic system of welfare services have traditionally been sectorized in relatively independent administrative districts. Legislation obliging different occupational groups to cooperation is limited to some special fields of social and health services. Strict confidentiality regulations can obstruct the intended cooperation.

In large population centers the organizations which produce services are often distinct from citizens. In the Finnish social and health care system the principle of "regional responsibility for the citizens" is the basis of the production of services. The aim of the cooperation between social and health services is that the services are easily available and that the clients get better and more humane help. From the workers' point of view, the aim cooperation helps develop professional skills. Furthermore, workers will be able to evaluate the situation of the client more holistically and be better able to help the client. Multi-professionality can be regarded as a new professional skill.


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Engerstöm, Y. & Saarelma, O. & Launis, K. & Simoils, R. & Punamäki, R. (1991) Terveyskeskusten uuden työtavan kehitäminen. Sosiaali- ja terveyshallitus: Helsinki.

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