▸ Interdisciplinary Benefits and Approach
In a world where social service organizations have seen their budgets shrink, staff diminished, and the ability to provide services cut due to difficult economic times, the interdisciplinary approach to providing services has become even more essential. Working to provide services in an era char- acterized by limited resources has resulted in clients working with multiple agencies and multiple professions. In this challenging environment, an interdisciplinary team approach to service provi- sion is the best approach.
Social work and the nursing profession are well suited to be in the forefront of the interdisci- plinary service provision movement. Clients’ compartmentalized problem focus is often a result of having to seek services from multiple organizations. The interdisciplinary team approach to ser- vice lessens compartmentalization of problems by clients and can be found in many mental health and medical settings (Johnson, 1995). “Medical settings also make use of the interdisciplinary team approach in providing for both the psychosocial and the physical needs of the patients; diagnostic centers also make considerable use of this type of team approach” (p. 119). When agencies work together and take an interdisciplinary team approach to helping, the client recognizes, respects, and benefits from this approach. Most importantly, the professions and social service community ensure the most effective and efficient use of public resources.
▸ Case Studies
CASE STUDY 2-2: MRS. SMITH
Laura Smith is a 24-year-old mother of three who lives in a one-room motel unit and works at a low-paying waitress job at a local café. Although the restaurant chain where she works offers health insurance, she cannot qualify because she is scheduled to work 29 hours per week.
Recently, one of Laura’s children developed a cough and fever. Laura was able to have her child seen at the local emergency room, but the treatment was limited such that it covered only enough medication for 3 days of treatment. Laura was told she should follow up with the child’s primary care physician and have some testing done to confirm that the cough was not something more serious.
The emergency room doctor also recommended that her child receive a vaccine that might prevent future problems. Laura explained to the doctor that she did not have a regular physician or insurance, and she could not afford to pay for a vaccine or any future doctor visits. The emergency room doctor made a referral to the social work department in the hospital and asked if someone could assist Laura with accessing resources to get her medical needs met. The emergency room nurse, who had been working with Laura and her son, completed the referral to the social work department and asked the social worker to come and meet with Laura as soon as possible given Laura’s limited flexibility with her employer.
The social worker came to the emergency room and met with Laura and her child. The emergency room nurse remained in the room because Laura was becoming agitated and nervous about the numerous individuals asking her for personal and medical information during this hospital visit. The nurse thought her presence might provide Laura with a sense of consistency and assist with calming her fears about the presence of the social worker.
The social worker met with Laura and collected background information about her current home environment, employment, and potential social support network. After determining that Laura would need some community resources beyond what the hospital could provide, the social worker and the nurse met to discuss community agencies that might be able to assist Laura and her family. The nurse recalled the opening of a community health clinic about 1 mile from the motel where Laura resided. Given the proximity to Laura’s current home, this was an ideal option for her child’s follow-up appointment. The social worker agreed to make a call to the clinic to determine if Laura might qualify for services.
The social worker was told by the clinic staff that the clinic provided services to families
underinsured or uninsured. The clinic also had a sliding-scale policy that it used if families could afford to pay only a small amount. Laura was referred to the clinic and received the following services:
1. Laura was scheduled to come to the clinic and complete her intake and income assessment paperwork. A social work intern student was assigned to assist her with completing her paperwork.
2. Laura’s son was seen by the nurse practitioner to evaluate his cough and other symptoms.
3. It was recommended to Laura that she should have a brief physical examination because she had not seen a doctor for several years. Her primary focus had been work and her children, and it was suggested that a physical might provide Laura with some knowledge about her own health status. A nurse practitioner completed her physical examination.
4. The social worker at the clinic asked Laura if there were any other areas in which she might need assistance. Laura stated that she could use some assistance with housing, employment, and food. The social worker and the social work intern provided Laura with a contact name and direct number for the local housing authority to determine if she would qualify for assistance with Section 8 housing (housing assistance provided to families meeting federal guidelines).
(continues) Case Studies 25
CASE STUDY 2-3: MR. JACKSON
Marty Jackson is a 35-year-old homeless man who has had repeated incarcerations for alcohol abuse, public drunkenness, and simple assaults when drunk. Marty’s most recent arrest occurred while he was loitering in a local park in a downtown urban area. Individuals at the park called the police and reported that a man was “harassing” individuals in the park. The police arrived at the park to find Marty incoherent and disoriented. The police officer observed that Marty had an alcoholic odor and had difficulty walking. The officer also observed that Marty had an open wound on his hand that had been hastily wrapped in a soiled bandage.
The police officer transported Marty to the local hospital for observation. During the ride in the police car, Marty complained that “Marvin” was taking up too much of the backseat and was threatening him with a knife. The only occupants in the vehicle were the police officer and Marty. Upon arrival at the hospital, the police officer noted to the intake nurse that Marty might be hallucinating and recounted his comments on the ride to the hospital. The intake nurse placed Marty in an area of the hospital where he could be observed and asked the police officer if he could remain with Marty until a psychiatric evaluation could be completed.
The nurse then requested a psychiatric consult from the Mental Health Unit in the hospital. The Mental Health Unit used an interdisciplinary approach to service provision, in which a team consisting of a psychiatrist, a psychiatric nurse specialist, a clinical social worker, and a psychologist would see patients.
A licensed clinical social worker (LCSW) was sent to the emergency room and interviewed Marty.
The clinical social worker conducted a biopsychosocial assessment of Marty that included an evaluation of whether he posed any harm to himself (suicide) or to others (homicide). The clinical social worker’s assessment found that Marty was not homicidal or suicidal but noted that there was a possibility of some mental instability. Marty did meet all the risk markers for alcoholism. He adamantly stated he wanted to stop drinking, but he claimed the alcohol subdued his “moments of confusion and voices.”
The clinical social worker called for a consult from another member of the mental health team, the psychiatric nurse. The psychiatric nurse reviewed the initial assessment and assessed Marty for any mental health risk. The nurse and clinical social worker met and conferred about their assessment findings and determined that Marty had bipolar disorder and needed medication to be able to function without continued intervention by law enforcement. The psychiatric nurse and social worker worked together to create the following treatment plan for Marty:
1. Marty was given a 3-day regimen of medication for bipolar disorder and scheduled for a follow-up consult with the psychiatric team at the county services board. The clinical social worker contacted the mental health worker on the crisis intervention team at the county Laura was also provided with a referral for a food bank (in the same building as the clinic) so that she would be able to get food after her time at the clinic. Finally, she was referred to an employment support program (provided with an actual contact name and direct number) to assist her with locating full-time employment.
5. The nurse practitioner at the clinic provided Laura with a prescription for the medications she needed for her child. The social worker assisted Laura with completing prescription assistance paperwork to qualify for prescription assistance from the pharmaceutical company.
CASE STUDY 2-2: MRS. SMITH
(continued) 26 Chapter 2 Advocacy Role of Providers▸ Implications for Practice
These cases suggest how social work and nursing professionals can work effectively as an interdisci- plinary team. The role of the social worker and nurse, in each of the cases, was that of advocate: In each instance, the social worker and nurse sought out resources that would be useful to the client and enhance the client’s ability to function in his or her everyday life. The role of advocate played by the professionals in each case scenario was critical to the client’s health. The interdisciplinary team worked together to avoid compartmentalizing each client’s issues, which ensured the deliv- ery of more effective and efficient services for the client.
Acknowledgment: The authors acknowledge Marshall Smith, who conducted an early litera- ture search for this chapter.
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CASE STUDY 2-3: MR. JACKSON
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28 Chapter 2 Advocacy Role of Providers
▸ Introduction
There are significant ethnic and racial disparities that exist in women’s health. This chapter will explore birth outcomes, racism, and privilege. This chapter explores theories that help try to explain the continued gap in outcomes between racial and ethnic minorities and White women. The chapter also describes and offers strategies for combating racial inequities in wom- en’s health and provides case studies to aid you in applying concepts from this chapter. The purpose of this chapter is to identify racial disparities in women’s health and discuss the inter- sectionality of privilege.
OBJECTIVES
At the end of this chapter, you will be able to:
1. Discuss the health disparities that exist among childbirth and family planning outcomes for racial and ethnic minorities.
2. Understand privilege and identify ways an individual with privilege can influence others in need.
3. Apply strategies to reduce disparities in women’s health through a series of case studies.