Rehabilitation team

The rehabilitation team is the core of the diagnosis, treatment, and follow-up care for the patient who is disabled or handicapped. The elusive quality of team interaction must be blended with the individual professional expertise of the clinical social worker to work out the best possible outcomes for the patient and for family members, especially the spouse and parents. The social worker must be able to approach the team with a sense of competence while contributing toward the combined competence of all team members involved. This is not an easy task for a variety of reasons.

The team notion is not new in medical treatment or health .care. There has always been a commitment to team process, but it does not always work smoothly. Mental health models in psychiatry are perhaps the most notable in their clinical combination of psychiatrist, psychologist, psychiatric nurse, and social worker. It is, incidentally, this model that led to the development of the early child guidance movement for the treatment of childhood schizophrenia and behavior disorders. This resulted in the formation of the American Orthopsychiatric Association in 1923, which was the first to give equal status to each of the disciplines involved. Decision making and the allocation of tasks were shared or divided among the various disciplines. For legal and credentialing reasons, the psychiatrists assumed the major decision making and discharge planning responsibility concerning matters such as the readiness of the psychiatric patient to move back into the community without harm to himself or the community. With the development of the community mental health movement in the 1960s (stimulated by the Kennedy family's interest in mental health and mental retardation) there were a variety of innovative approaches such as rotating various team members as team leaders. Of all team members, social workers were the most knowledgeable about the family-parental-community role and the availability of community resources for follow-up. This was further enhanced by their work with self-help and other groups.

The rehabilitation team is larger and more complex than the psychiatric model because the rehabilitation process, which follows acute care intervention, of necessity must use all the various skills of care. The emphasis shifts according to the nature of the problem and what aspects of treatment are indicated on an individual basis, The development of the "therapeutic milieu" for treating psychiatric patients, as expounded by Maxwell Jones in his classic development of the therapeutic community as a treatment . model, was a significant innovation that pointed out that the roles of team members varied; for example, primary therapists were designated according to which person on the team had the most effective relationship with the patient, not according to professional status. The responsibility for the family has always been the major assignment of the clinical social worker, since this responsibility requires knowledge of community resources that assist families. Public and private agencies are available and needed for after-hospital assistance.

As is evident from the earlier discussion, the smooth working of the rehabilitation team is critical if treatment goals are to be attained. Issues of competition, status, and seniority are inevitable at local patient evaluation conferences, as well as at senior department heads meetings. Departments must vie for space, personnel, equipment, and budget flexibility; competition automatically ensues. Administration has a responsibility to help resolve these issues in an equitable fashion, and to develop an objective approach to its policy and decision making because it affects the growth or limitations of the disciplines comprising the rehabilitation team. Many of the roles overlap, and the relationships must permit an opportunity to discuss mutual roles and the appropriate allocation of tasks to various patients. This overlapping is strikingly apparent in the psychosocial issues, specifically between social work and psychology.

Palmer discussed role confusion, overlap, and duplication of effort in rehabilitation medicine. She presents a team is a method for identifying service goals, differentiating roles, coordinating goals, and educating staff on the expertise and use of various disciplines. Falck similarly discussed interdisciplinary collaboration with regard to social work activity. He proposed the team process as "a form of behavior that must be learned and involves people who make mutual adaptations to each other's differences such as profession, method, use of knowledge, skill and professional goal. The effective collaborative behavior he suggested includes the following qualities:

1. Thorough commitment to the profession's values and ethics and belief in the usefulness of one's profession

2. Belief in a holistic approach to the client's problems

3. Recognition of the interdependency of practice

4. Recognition of the expertise of colleagues and others "learn success as well as team failure must be equally shared. Mature professionals are aware of their own knowledge, values, and skills yet are able to recognize, appreciate, and accept those of their colleagues on the team.