JOURNAL
ISSUE 2
1999/2000
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.
71.
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
72.
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
73.
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.
REFERENCES
Bruce,
N. (1980) Teamwork for preventive care. John Wiler & Sons:
Chilester.
Engerstöm,
Y. & Saarelma, O. & Launis, K. & Simoils, R. &
Punamäki, R. (1991) Terveyskeskusten uuden työtavan
kehitäminen. Sosiaali- ja terveyshallitus: Helsinki.
Greca, R. (1995)
Einfûhrung. In: Regionalisierung sozialer Dienste in
Deutschland. (pp. 1-2) Beiträge zur Fachtagung an der
Katholischen Universität Eichstätt am 19/20 Januar
1995: Eichstätt.
Hallett, C &
Stevenson, O. (1980) Child abuse: aspects of interprofessional
cooperation. Allen and Unwin.
Hämäläinen,
J. (1993) Sosiaalityöntekijöiden ja terveydenhuollon
työntekijöiden yhteistyö. Kuopion yliopistollinen
opetussosiallikeskus 1/1993: Kuopio.
Kaasalainen, M.
(1991) Yhteistyön monta todellisuutta. Kehittämisosaston
julkaisuja 5: Helsinki.
Kuusels, K. 1996.
Ohjauksen idea sosiaalityössä - kokemuksia moniammatillisesti
toteutetusta työhön ja koulutuseen valmentavista
kursseista. In: A. Metteri (toim.) Moniammatillisuus ja sosiaalityö.
(pp. 95-103) Sosiaalityöntekijäin liittro r.y. Helsinki:
Edita.
Linnosuo, O. (1996)
Tuottaako sosiaalityö pummeja vai oman elämänsä
sankareita, seikkailijoita? In: A. Metteri (toim.) Moniammatillisuus
ja sosiaalityö. (pp. 68-75) Sosiaalityönteki-jäin
Liitto r.y. Helsinki: Edita.
74.
Marjamäki,
P. (1992). Saman katon alla. Arviointitutkimus sosialli-ja
terveydenhuollon kokeilusta Helsingissä. Kehittämisosaston
julkaisuja 4: Helsinki.
Mäkelä,
M. & Winter-Heikkilä, M. & Åström,
M. & Rokka, S. (1992). Mihin alueellinen väestövastuu
vastaa sosiaali-ja terveydenhuollon kehittämisessä?
Dialogi 8/1992.
Nikkilä,
J. (1986). Ammatillinen vuorovaikutus ja valta sosiaali-ja
terveydenhuollossa. VALTAVAn seurantatutkimuksia 6. SVT XXII:123
Tutkimusosasto: Helsinki.
Ojuri, A. (1996).
Moniammatillinen yhteistyö ja organisaatiokulttuuri.
In: A. Metteri (toim.) Moniammatillisuus ja sosiaalityö.
(pp. 116-128) Sosiaalityönteki-jäin Liitto r.y.
Helsinki: Edita.
Partanen, T. (1992).
Alueellinen väestövastuu mahdollistaa toiminnan
sisällön muutoksen. Dialogi 8/1992.
Schein, E. H.
(1991). Organisaatiokultuuri ja johtaminen. Jyväskylä:
Gummerus.
Westrin, C.-G.
(1986). Primary health care: Co-operation between health and
welfare personnel. Eurosocial research papers: Vienna.
75.
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