A Guide for Interprofessional Collaboration [1 ed.] 9780872931817, 9780872931787

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A GUIDE FOR I N T E R P R O F E S S I O N A L C O L L A B O R AT I O N

Copyright © 2018, Council on Social Work Education, Inc. Published in the United States by the Council on Social Work Education, Inc. All rights reserved. No part of this book may be reproduced or transmitted in any manner whatsoever without the prior written permission of the publisher. ISBN 978-0-87293-178-7 Printed in the United States of America on acid-free paper that meets the American National Standards Institute Z39-48 standard. CSWE Press 1701 Duke Street, Suite 200 Alexandria, VA 22314-3457 www.cswe.org

A Guide for INTERPROFESSIONAL

COL L ABOR AT ION

Edited by A I DY N L . I A C H I N I , L A U R A R . B R O N S T E I N , AND ELIZ ABETH MELLIN

A L E X A N D R I A , VA

ACKNOWLEDGMENTS

This book is dedicated to all our professional collaborators both within and outside of social work, along with those clients and consumers with whom we work. We also dedicate this book to our personal collaborators: For Aidyn: to Joe; For Laura: to Aria, Alexander, Evan, and Chuck; For Liz: to Allison and Marshall.

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CONTENTS

PART I: Foundations CHAPTER 1: Relevant Contexts for Interprofessional Collaboration in the 21st Century: Social Issues, Settings, and Policies . . . . . . . . . . . . . 3 Aidyn L. Iachini, Laura Bronstein, and Elizabeth Mellin

CHAPTER 2: Exploring Definitions and Models of Interprofessional Collaboration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Naorah Lockhart, Elizabeth Mellin, Laura Bronstein, and Aidyn Iachini

CHAPTER 3: A Model for Interprofessional Collaboration . . . . . . . . . . . . . 23 Laura Bronstein, Elizabeth Mellin, and Aidyn Iachini

PART II: Putting the Model Into Action: Interprofessional Collaboration Across Setting and Populations CHAPTER 4: Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Annahita Ball

CHAPTER 5: Criminal Justice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Alana J. Gunn, Kelli E. Canada, and Joan M. Blakey

CHAPTER 6: Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Teri Browne, Elizabeth Blake, and Heather McCabe

CHAPTER 7: Mental Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Cassandra L. Bransford

CHAPTER 8: Aging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Paul Gould and Youjung Lee

CHAPTER 9: Child Welfare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Leticia Galyean, Jennifer Lawson, Jennifer Jones, Susan Dreyfus, and Ken Berrick

CHAPTER 10: Crime Victims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 Carrie A. Moylan

PART III: Maximizing Interprofessional Collaboration CHAPTER 11: Personal Characteristics: Relationship Building . . . . . . 221 Samantha Bates, Dawn Anderson-Butcher, and Tasha Henderson

CHAPTER 12: Professional Roles: Knowledge and Understanding of Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249 Terry Mizrahi and Yossi Korazim-Kőrösy

CHAPTER 13: The Importance of a History of Collaboration: Promoting Interprofessional Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279 Cheryl Springer and Carol Gawrys

CHAPTER 14: Structural Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 Aidyn Iachini, Laura Bronstein, and Elizabeth Mellin

Epilogue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 319

Part I

Foundations

Chapter 1

Relevant Contexts for Interprofessional Collaboration in the 21st Century: Social Issues, Settings, and Policies Aidyn L. Iachini, Laura Bronstein, and Elizabeth Mellin

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ocial workers are addressing some of our nation’s most pressing and complex social issues. From poverty and discrimination to school dropout and substance abuse, social workers collaborate with individuals, families, groups, organizations, and communities to help address a wide array of societal challenges. Recently, the American Academy of Social Work and Social Welfare (AASWSW, n.d.) mobilized the social work profession around 12 of these complex social issues, collectively referred to as Grand Challenges. These Grand Challenges are ensuring healthy development for all youths, closing the health gap, stopping family violence, advancing long and productive lives, eradicating social isolation, ending homelessness, creating social responses to a changing environment, harnessing technology for social good, promoting smart decarceration, building financial capability for all, reducing extreme economic inequality, and achieving equal opportunity and justice (AASWSW, n.d.). 3

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Addressing these complex challenges facing our society cannot be achieved by social workers alone. There is wide recognition that no single profession can effectively address any of these issues in isolation. Therefore, the social work profession is increasingly emphasizing interprofessional collaboration as a best practice strategy for addressing these societal challenges (AASWSW, n.d.; Bronstein, 2003; Nurius, Coffey, Fong, Korr, & McRoy, 2017). Throughout this book interprofessional collaboration is defined as “an effective interpersonal process that facilitates the achievement of goals that cannot be reached when individual professionals act on their own” (Bronstein, 2003, p. 299). This type of collaboration requires social workers to collaborate with professionals from other disciplines (e.g., psychologists, counselors, doctors, educators, nurses, pharmacists, child welfare workers, and law enforcement personnel) to achieve positive outcomes on behalf of any client system. In fact, the National Association of Social Workers (NASW) Code of Ethics articulates social workers’ ethical responsibility to colleagues in relationship to working as part of a collaborative interdisciplinary team (Jones & Phillips, 2016; NASW, n.d.). Priorities related to interprofessional collaboration are increasingly promoted through a plethora of organizational bodies and policy/practice initiatives. In 2010, for example, the World Health Organization published their Framework for Action on Interprofessional Education and Collaborative Practice to help advance interprofessional collaboration efforts. The Institute of Medicine (2015) recently published the report Measuring the Impact of Interprofessional Education on Collaborative Practice and Patient Outcomes to provide guidance on critical issues related to evaluating collaborative practice. National and international bodies, such as the American Interprofessional Health Collaborative, the National Center for Interprofessional Practice and Education, the Interprofessional Education Collaborative, and the Centre for the Advancement of Interprofessional Education, all exist to support and promote interprofessional education and collaboration. Of special relevance to social work, the Council on Social Work Education’s (CSWE) Annual Program Meeting’s (APM) theme in 2016 was Advancing Collaborative Practice through Social Work Education,

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and the 2018 APM conference theme was Expanding Interprofessional Education to Achieve Social Justice. Universities also are engaged in unique and innovative efforts to support interprofessional education and advance interprofessional collaborative practice (Jones & Phillips, 2016), where social workers are often key facilitators. At the University of South Carolina, for example, there are specific interprofessional courses offered that are co-taught by faculty members from different health science professions to promote interprofessional collaboration and preparedness to engage in this type of practice in the workforce. One course is designed with a service-learning component to provide students real-world opportunities to engage and reflect on working in an interprofessional team (Iachini, Dunn, Blake, & Blake, 2016). At the University of New England, the director of the School of Social Work also serves as the director of the university’s Interprofessional Education Collaborative. At Binghamton University a program of interprofessional education, research, and practice has been developed as a collaboration among social work, pharmacy, and nursing. Binghamton University, along with other universities, has been supporting trans/interdisciplinary research clusters that cut across the entire university. Most recently, social work faculty members led the development of a new transdisciplinary working group focusing on poverty and inequality. In addition, Binghamton University has an innovative interdisciplinary doctoral program in Community Research and Action and an interdisciplinary organized research center, the Institute for Justice and Well-Being, with strong involvement from the Department of Social Work. These are just a few examples of how universities are embedding interprofessional education into their institutional research, service, and curricular designs, with social workers as key players. Moreover, scholars at these institutions are contributing to the evidence base in this area through dissemination of findings of such interprofessional education efforts in critical interprofessional education outlets, such as the Journal of Interprofessional Care and the Journal of Interprofessional Education and Practice. However, despite the promise of interprofessional collaboration and the organizational and policy/practice mechanisms that are in

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place to promote this type of collaborative practice, interprofessional collaboration is challenging (Mellin, Hunt, & Nichols, 2011). According to Mellin et al. (2011), some of these challenges relate to the method of training in various professions; the differences in terminology used among professions; and the limited understanding of other professions’ roles, responsibilities, and scopes of practice. Moreover, power dynamics and a focus on competition related to service delivery can also hinder interprofessional collaboration (Mellin et al., 2011). These factors that can serve to limit interprofessional collaboration often begin during the professional socialization process (Mellin et al., 2011), which makes professional education the critical place to begin professional socialization for interprofessional collaborative practice. This edited workbook is designed to help prepare social work students and other practitioners interested in gaining additional knowledge, skills, and expertise in interprofessional collaborative practice. This workbook uses Bronstein’s (2003) Model for Interprofessional Collaboration (MIC) as a framework to help conceptualize interprofessional collaboration and promote skills critical to engaging in interprofessional collaborative practice. It is important to note that some scholars and practitioners refer to this type of collaboration as interdisciplinary collaboration (Newhouse & Spring, 2010). Indeed, this is the term Bronstein initially used. There is still discrepancy within and beyond the social work profession as to the use of different terms to refer to this type of collaboration (e.g., inter-, multi-, trans- disciplinary and professional). Over the past decade the term interprofessional has emerged as the most accurate description of successful collaboration among professionals; therefore, that is the term used to frame this workbook. There are three parts to this workbook. Part I includes foundational information for conceptualizing interprofessional collaboration and its relevance for addressing complex social problems. After the introduction to the book, Chapter 2 explores models of interprofessional collaboration and discusses related collaboration concepts (e.g., multidisciplinary collaboration, transdisciplinary collaboration). Chapter 3 outlines the MIC in detail, including the core components of

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and key influences on interprofessional collaboration for social workers and other professionals. Part II of the workbook illustrates the application of the MIC in real-world settings and fields of practice. Leading social work educators, who collaborate with professionals in a variety of settings, apply the components of the MIC as they discuss their interprofessional collaborators and contemporary issues in their subfields. Each chapter begins with a list of the CSWE’s (2015) competencies most saliently addressed in that chapter and ends with a few reflective questions that promote critical thinking and discussion relative to those competency domains. Chapter 4 focuses on an interprofessional technology-based effort, Closing the Broadband Gap (CBBG), in an educational setting. Specifically, Ball offers an example of a university–school partnership designed to support parental engagement in an elementary school that includes teachers, social workers, and school/district administrators, along with technology and business professionals. She describes the innovative CBBG program that resulted from the collaboration among professionals from different disciplines, along with critical influences and challenges that affect this interprofessional effort. Chapter 5 explores interprofessional collaboration in the context of problem-solving courts designed to support individuals and divert them from becoming involved in the criminal justice system. Problem-solving courts are led by a judge but require a collaborative team of social workers, court officials, probation officers, and other treatment providers to develop a treatment plan and to connect individuals with services. In this chapter Gunn, Canada, and Blakely provide a case example of how these problem-solving courts function in relationship to one unique case and then discuss the strengths and challenges of interprofessional collaboration in this type of approach and practice setting. Chapter 6 examines interprofessional collaboration in the context of the health-care system. Browne, Blake, and McCabe discuss care coordination for diabetes management in acute care hospitals. Specifically, they address the collaborative efforts of social workers, nurses, pharmacists, doctors, and nurse practitioners to support patients with

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diabetes and their related needs and then outline one specific patient example to further highlight and exemplify how interprofessional collaboration works in this type of clinical service delivery model. Chapter 7 focuses on interprofessional collaboration in the context of mental health. Bransford provides a case example of interprofessional collaboration in a treatment team supporting a patient in an inpatient psychiatric unit. She describes the components and influences on collaboration that occurred as social workers, nurses, occupational therapists, psychiatrists, and others worked together to meet the client’s needs. Chapter 8 examines interprofessional collaboration in a geriatric consultation clinic designed to support the needs of aging adults. Gould and Lee describe a university–community partnership that resulted in an interprofessional clinic to support training of social work and medical students for practice with older adults. The authors discuss the influences on and challenges of conducting collaborative, interprofessional, geriatric assessments and developing comprehensive intervention plans to support aging adults living in the community. Chapter 9 explores interprofessional collaboration in the child welfare system. Galyean, Lawson, Jones, Dreyfus, and Berrick present a case example of a youth living in foster care and how both interagency (i.e., collaboration among people from different agencies) and interprofessional collaboration were essential to meeting the needs of this client. This chapter uniquely describes different interagency partnership models in the child welfare system and then focuses on how a specific partnership model—the Full Partnership model—encompasses and maximizes interprofessional collaboration to support and address the needs of the system’s clients. Chapter 10 focuses on interprofessional practice with crime victims. Moylan describes how interprofessional collaboration occurs in the context of sexual assault response teams (SARTs) and identifies how the key components of the MIC are evident in this approach to service delivery. She also discusses the key influences on interprofessional collaboration in SARTs. Across all these chapters in Part II, you will notice many similarities,

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as well as differences, in terms of how interprofessional collaboration is actualized. Across chapters, for example, you will notice how the expertise and ideas offered from each professional and client is essential to best meeting the needs of the client system. In almost all cases the direct recipient of the program or service is involved in the collective decision-making process. You will also note how many of these efforts require flexibility among professionals and shared time in the form of team meetings and informal conversations to keep the interprofessional collaborative effort progressing and sustainable. However, each example also provides insight into how power and influence, personal characteristics, and policy structures all affect collaboration among professionals in varying ways in different practice contexts. Each chapter also exemplifies how these interprofessional collaboration efforts began. In some cases, interprofessional collaboration was embedded into the design and delivery of the program or service from the outset. In other cases, program and services began with a few individuals who later realized they needed the expertise of others from different disciplines to best meet the needs of the client system. Together these chapters highlight the complexity and nuances of interprofessional collaboration in the realities of social work practice. Part III of the workbook offers case examples, practice tips, and exercises to help build skills for interprofessional collaborative practice relevant for any practice setting or context. Each chapter focuses on one of the key influences on interprofessional collaboration as identified in the MIC. Bates and Anderson-Butcher focus on personal characteristics and offer ideas to help social workers use their personal strengths to build relationships with professionals from other disciplines. Mizrahi and Korazim-Kőrösy focus on professional roles and specifically provide examples, tips, and activities that help social workers consider how conditions and context, commitment, competencies and contributions, and challenges all influence social workers’ roles in interprofessional collaborative efforts. Springer and Gawrys focus on how history influences interprofessional collaboration and offer activities and exercises designed to help social workers develop or reflect on their history in interprofessional collaborations. In the last chapter of

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this section we describe how structural characteristics—specifically, time, space, and administrative support—can influence interprofessional collaboration and offer tips and activities to help social workers reflect on how these conditions influence their collaborative practice. In summary, this book is designed to support social work students and other practitioners interested in advancing their interprofessional collaborative practice. As societal issues grow increasingly complex, interprofessional collaboration is a necessity for effective practice. Our hope is that this book provides a variety of examples of how interprofessional collaboration occurs in a variety of contexts and practice settings. In addition, we hope this book provides a foundation of knowledge and skills, so that social work students and others feel confident they can engage and navigate in these critical, yet complex, interprofessional collaborative efforts. References American Academy of Social Work and Social Welfare. (n.d.). Grand challenges for social work [Website]. Retrieved from http://aaswsw.org/grandchallenges-initiative/ Bronstein, L. R. (2003). A model for interdisciplinary collaboration. Social Work, 48(3), 298–306. doi:10.1093/sw/48.3.297 Council on Social Work Education. (2015). Educational policy and accreditation standards. Retrieved from http://www.cswe.org/Accreditation/Standards-and​ -Policies/2015-EPAS Iachini, A. L., Dunn, B., Blake, B., & Blake, C. (2016). Evaluating the perceived impact of an interprofessional childhood obesity course on competencies for collaborative practice. Journal of Interprofessional Care, 30(3), 394–396. doi:10.3109/13561820. 2016.1141753 Institute of Medicine. (2015). Measuring the impact of interprofessional education on collaborative practice and patient outcomes. Washington, DC: National Academies Press. Jones, B., & Phillips, F. (2016). Social work and interprofessional education in health care: A call for continued leadership. Journal of Social Work Education, 52(1), 18–29. doi:10.1080/10437797.2016.1112629 Mellin, E. A., Hunt, B., & Nichols, L. M. (2011). Counselor professional identity: Findings and implications for counseling and interprofessional collaboration. Journal of Counseling & Development, 89(2), 140–147. doi:10.1002/j.1556-6678.2011. tb00071.x National Association of Social Workers. (n.d.). Code of ethics. Retrieved from https:// www.socialworkers.org/About/Ethics/Code-of-Ethics/Code-of-Ethics-English

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Newhouse, R. P., & Spring, B. (2010). Interdisciplinary evidence-based practice: Moving from silos to synergy. Nursing Outlook, 58, 309–317. Nurius, P. S., Coffey, D. S., Fong, R., Korr, W. S., & McRoy, R. (2017). Preparing professional degree students to tackle the grand challenges: A framework for aligning social work curricula. Journal of the Society for Social Work and Research, 8(1), 99–118. doi:10.1086/690562 World Health Organization. (2010). Framework for action on interprofessional education and collaborative practice. Retrieved from http://www.who.int/hrh/resources/ framework_action/en/

Chapter 2

Exploring Definitions and Models of Interprofessional Collaboration Naorah Lockhart, Elizabeth Mellin, Laura Bronstein, and Aidyn Iachini

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n increasing number of professions, including social work, rely on interprofessional collaboration to serve clients. Whether it is a hospice social worker collaborating with a physician to help a client make end-of-life decisions or a school social worker collaborating with teachers to support students with mental health needs in their classrooms, social workers routinely collaborate with other professionals on behalf of their clients. However, what it means to collaborate (versus cooperate or coordinate) with other professions, and whether it improves outcomes (or just gets in the way), is often unclear despite common practice wisdom that suggests its effectiveness. Indeed, interprofessional collaboration is increasingly included as a key practice competency in accreditation standards for social workers and related professions (Ball, Anderson-Butcher, Mellin, & Green, 2010), but there have historically been few models and little research to support graduate training and social work practice in this area. In response, professionals and scholars alike are increasingly sharpening their definitions of collaboration and developing models to guide training and practice. 13

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This chapter clarifies the term interprofessional collaboration and presents major models that have been developed across professions.

What Is Interprofessional Collaboration? Finding a common definition for interprofessional collaboration is complicated by widespread confusion with related terms (Keast, Brown, & Mandell, 2007). Collaboration has been used to describe widely different types of associations, including interorganizational and interpersonal relationships (Lawson, 2016). Terms such as alliance, coalition, collective action, partnership, and team or teamwork have been used interchangeably with collaboration (D’Amour, Goulet, Labadie, Martin-Rodriguez, & Pineault, 2008; Gajda, 2004; Kvarnström, 2008; Marek, Brock, & Salva, 2015; Steen & Noguera, 2010). What may be called collaboration in one social work program or area of social work practice may be referred to as service integration or partnership in another (Claiborne & Lawson, 2005). Adding to the confusion, interprofessional and interdisciplinary collaboration are also often conflated (D’Amour, Ferrada-Videla, Rodriguez, & Beaulieu, 2005). Given the emphasis on interprofessional collaboration and questions about whether and how it relates to outcomes for clients, distinguishing the terms is increasingly important.

Collaboration, Cooperation, and Coordination Conceptualizing collaboration, as part of a continuum with its related terms, has contributed to developing a sharper definition of collaboration. In 1992, Kagan differentiated these three terms as part of a pyramid, with cooperation at the base, coordination in the middle, and collaboration at the top. Keast et al. (2007) also differentiated collaboration from cooperation and coordination in terms of increasing levels of interdependence, organizational structure, commitment, and risk, where collaboration involves the most commitment and cooperation the least commitment. Individuals who work cooperatively are more independent from one another, less organized, less committed to each

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other, and take fewer risks as a group (Lockhart, 2017). Cooperation often happens when professionals link services through referrals. To help some of their clients access health care in rural communities, for example, clinical social workers may cooperate with physicians by taking clients to appointments or arranging home visits. Individuals working in coordination, however, are more interconnected, organized, committed, and take more risks together. Coordination among clinical social workers and physicians might occur as part of a local taskforce to increase access to transportation to medical appointments for people living in rural communities who lack access to public transportation. Likewise, individuals engaged in collaboration are interdependent, more organized, highly committed to one another, and take more risks as a group—even more so than in teams characterized by coordination. Collaboration among clinical social workers and physicians to increase access to health and mental health care might take place as services are co-located, with both professions contributing to treatment planning and intervention.

Interprofessional or Interdisciplinary Collaboration Researchers have also drawn on a continuum model to further unpack interdisciplinarity. D’Amour et al. (2005) described collaboration between and among professionals from different disciplines on a continuum that reaches from multidisciplinary collaboration on one end to transdiciplinary collaboration on the other, with interdisciplinary collaboration located in between. Multidisciplinary collaboration occurs when professionals from similar backgrounds are engaged in mutual work, when multiple disciplines are additive to the project rather than integrative (Choi & Pak, 2006). Mental health assessments for children are often multidisciplinary, with teachers, special educators, psychologists, and social workers offering assessments based on discipline-specific expertise that are presented as individual perspectives, side-by-side, in a single report. Interdisciplinary collaboration happens when boundaries between knowledge and expertise are blurred yet remain distinct, resulting in novel ways of working

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together to achieve common goals (Choi & Pak, 2006; D’Amour et al., 2005). Treatment teams for children with mental health needs may be interdisciplinary, developing intervention plans that consider multiple perspectives. The result is an integrated and comprehensive treatment plan that demonstrates understanding of the client, the client’s needs, and resources. Finally, transdisciplinary collaboration is a newer concept often described as occurring when boundaries are crossed between and among disciplines and knowledge is exchanged and transformed into something new (Choi & Pak, 2006). This type of collaboration may be observed in children’s mental health when professionals deliver interventions together and outside their typical practice boundaries. For example, a teacher and a clinical social worker may collaboratively run a counseling group for children who are grieving the loss of a loved one. The definition we use in this book for interprofessional collaboration includes the characteristics noted here by Choi and Pak (2006) and some others as qualities of transdisciplinarity. The terms interprofessional and interdisciplinary are also commonly confused and often used interchangeably. Some of the authors in this book use the terms interchangeably. To distinguish the terms, it is helpful to think of interdisciplinarity as concerned with knowledge and interprofessionality with practice (D’Amour & Oandasan, 2005). The term interprofessional stems from the professionalization of disciplines in which an area of study has shaped service delivery. Interprofessional collaboration can be thought of as the practice of interdisciplinarity (Lockhart, 2017). Because the work of collaboration often takes place in professional settings, the term interprofessional collaboration, rather than interdisciplinary collaboration, is a more accurate way to describe the professional-to-professional, frontline engagement (Mu & Royeen, 2004) where social workers are typically involved.

Related, but Distinct, Types of Collaboration Numerous other types of collaboration involving professionals can occur, and interprofessional collaboration, although a distinct type, can also be part of these related practices. Interagency and interorganizational

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collaboration, for example, occur at organizational levels (Hodges, Hernandez, & Nesman, 2003). Multiparty collaboration describes engagement between/among stakeholders (individuals and/or organizations) from various perspectives and disciplines (Gray, 1989). Intergovernmental collaboration and intersectoral collaboration typically occur at the policy level and can operate at local, state, and federal ranks (Milward & Provan, 2006). Collective impact is an intensive collaboration strategy in which stakeholders in multiple sectors commit to a common agenda, shared measurement systems, mutual activities designed to reinforce collaboration, strong communication, and an independent organizational structure (Kania & Kramer, 2011). This book deliberately focuses on interprofessional collaboration, or professional-to-professional relationships, which is a common responsibility of practicing social workers.

Major Models of Interprofessional Collaboration Several models have been developed to describe the process of collaboration. The models provide guidance to practitioners about the major components or processes for collaborative practice. The next section describes major models of collaboration that are used in a variety of professions.

Gray’s Three-Phase Model Gray’s (1989) seminal model describes three phases of collaboration. Collaborators first come together in the problem-setting phase to identify common concerns. They then organize their agenda and strategy to solve a problem in the direction-setting phase, and finally enact and monitor their strategy in the implementation phase. Social workers might come together with judges, attorneys, police officers, emergency room physicians, and community members, for example, to address opioid addiction in their communities. According to this model, the first phase of such a collaboration focuses on defining the problem. The collaborators then move on to developing ideas to address the problem, relying on the perspectives and experiences of their

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training and practice backgrounds. Finally, the group works together to implement and monitor the impact of their strategies, ultimately aiming to reduce opioid addiction in their community. This model can be applied to multiple types and levels of collaboration, including interprofessional and interorganizational collaboration.

Forbes’ Model of Interprofessional Social Capital Forbes (2009) draws on social capital theory to describe interprofessional collaboration. Presented as a matrix, the model describes components (networks, norms, and trust) and types of social capital (bonding, bridging, and linking) that can be applied to collaboration at the policy-making and governance, agency, and practitioner levels (Forbes, 2009). At the practitioner level, bonding social capital takes place among individuals from the same professional background, for example, social worker to social worker. Bridging social capital, comparatively, takes place among individuals from different professional backgrounds, such as social workers and police officers. Linking social capital also refers to relationships among people from different professional backgrounds but focuses on relationships in which there are explicit power differentials and associated variations in access to resources—relationships with social workers and physicians (who often are situated higher in professional hierarchies) is one example of linking social capital. This model can be useful for thinking about different types of collaborative relationships and how they might have similar or different effects on outcomes. The model was originally developed for use in children’s services and can be used to help stakeholders reflect on and identify their own engagement in collaboration.

Model of Team Effectiveness West, Borrill, and Unsworth (1998) conceptualized collaboration as an input-process-output structure that influences collaboration. Inputs are the group goals and objectives; the personal characteristics of the collaborators (gender identity, race, ethnicity, knowledge, and skills);

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the professional setting where the collaboration occurs, such as an agency or school; and the broader cultural values and beliefs that shape how the group functions. Processes are how the group works together to handle the inputs, such as leadership style and systems of communication and decision making; how integrated the group is with one another; and the dynamics of the relationships between collaborators. Processes also include how minority voices in the group are integrated into the collaboration and how unconscious beliefs may shape group processes. Outputs are the performance, innovations, and overall well-being and viability of the collaboration. These are wide-ranging and can encompass team productivity, such as the number of weekly client referrals or client-level outcomes or changes in client-level outcomes. Outputs can also be indicated by the sustainability of the group, such as acquiring new funding. Together, the inputs, processes, and outputs describe the relationship between group goals, context, interpersonal relationships, and achievements of the collaboration.

The Integrated (Health Care) Team Effectiveness Model Designed for use in health care, the Integrated Team Effectiveness Model (ITEM) describes task design, team processes and traits, and team effectiveness as the main components of collaboration (Lemieux-Charles & McGuire, 2006). Like the Model of Team Effectiveness, discussed previously, major components of collaboration include group goals, service delivery strategies, team member knowledge and training, demographics, group norms, ability to problem solve, and the objective outcomes (client-level, team-level, organizational-level) and subjective outcomes (perception of team effectiveness). These components are situated in organizational and social/political contexts, which include the leadership structure, terms of a grant or external funding, care delivery setting, opportunity for continuing education, mandated services, and statutes or laws.

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Four-Dimensional Model of Interprofessional Collaboration The Four-Dimensional Model of Interprofessional Collaboration assumes that although professionals want to collaborate to provide better care, they do so while also trying to preserve a degree of autonomy and independence through power negotiations (D’Amour et al., 2008). In real-world settings it is common to have multiple professional commitments, conflicting personal and professional goals, and challenging work schedules, all of which contribute to a tension between commitment to the collaboration and other responsibilities. To incorporate these realities into a collaboration model, D’Amour and colleagues (2008) present four components of collaboration: shared goals and vision (goals, motives, and expectations); internalization (sense of belonging to the collaboration, interdependence, and management of differences); formalization (procedures, protocols, and group structure); and governance (leadership—both group-level and organizational, financial constraints, policies); and three types of collaboration: active collaboration (highest and most stable level), developing collaboration (not firmly rooted; still negotiating goals, relationships, and mechanisms), and potential collaboration (nonexistent or blocked collaboration; system cannot move forward). The three types of collaboration can be thought of as developmental and are similar to Keast et al.’s (2007) cooperation-coordination-collaboration continuum.

Conclusion This chapter clarifies the meaning of interprofessional collaboration and highlights models that could be used in social work education and practice. Each of the models presented describes the processes that often occur in interprofessional collaboration; however, they are mainly descriptive and take a broad look at what shapes collaboration. Aspects of interprofessional collaboration, such as how reliant collaborators need to be on another to accomplish goals or how adaptable collaborators are when roles may overlap, can have an important impact on

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collaboration. In Chapter 3 we introduce you to the MIC (Bronstein, 2003), which focuses on specific components that can contribute to successful collaboration. References Ball, A., Anderson-Butcher, D., Mellin, E. A., & Green, J. H. (2010). A cross-walk of professional competencies involved in expanded school mental health: An exploratory study. School Mental Health, 2(3), 114–124. doi:10.1007/s12310-010-9039-0 Bronstein, L. R. (2003). A model for interdisciplinary collaboration. Social Work, 48(3), 297–306. doi:10.1093/sw/48.3.297 Choi, B. C. K., & Pak, A. W. P. (2006). Multidisciplinarity, interdisciplinarity and transdisciplinarity in health research, services, education and policy: 1. Definitions, objectives, and evidence of effectiveness. Clinical and Investigative Medicine, 29(6), 351–364. doi:10.1016/j.jaac.2010.08.010 Claiborne, N., & Lawson, H. A. (2005). An intervention framework for collaboration. Families in Society, 86(1), 93–103. doi:10.1606/1044-3894.1881 D’Amour, D., Ferrada-Videla, M., Rodriguez, L. S. M., & Beaulieu, M-D. (2005). The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. Journal of Interprofessional Care, (Suppl. 1), 116–131. doi:10.1080/13561820500082529 D’Amour, D., Goulet, L., Labadie, J-F., Martin-Rodriguez, L., & Pineault, R. (2008). A model and typology of collaboration between professionals in healthcare organizations. BMC Health Services Research, 8(1), 1–14. doi:10.1186/1472-6963-8-188 D’Amour, D., & Oandasan, I. (2005). Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept. Journal of Interprofessional Care, 19(Suppl. 1), 8–20. doi:10.1080/13561820500081604 Forbes, J. (2009). Redesigning children’s services: Mapping interprofessional social capital. Journal of Research in Special Educational Needs, 9(2), 122–132. doi:10.1111/j.1471-3802.2009.01125.x Gajda, R. (2004). Utilizing collaboration theory to evaluate strategic alliances. American Journal of Evaluation, 25(1), 65–77. doi:10.1016/j.ameval.2003.11.002 Gray, B. (1989). Collaborating: Finding common ground for multiparty problems. San Francisco, CA: Jossey-Bass, Inc. Hodges, S., Hernandez, M., & Nesman, T. (2003). A developmental framework for collaboration in child-serving agencies. Journal of Child and Family Studies, 12(3), 291–305. doi:10.1023/A:1023987710611 Kagan, S. L. (1992). Collaborating to meet the readiness agenda: Dimensions and dilemmas. In Ensuring student success through collaboration (pp. 57–66). Washington DC: Council of Chief State School Officers. Kania, J., & Kramer, M. (2011). Collective impact. Stanford Social Innovation Review. Retrieved from https://ssir.org/articles/entry/collective_impact Keast, R., Brown, K., & Mandell, M. (2007). Getting the right mix: Unpacking integration meanings and strategies. International Public Management Journal, 10(1), 9–33. doi:10.1080/10967490601185716

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Kvarnström, S. (2008). Difficulties in collaboration: A critical incident study of interprofessional healthcare teamwork. Journal of Interprofessional Care, 22(2), 191–203. doi:10.1080/13561820701760600 Lawson, H. (2016). Categories, boundaries, and bridges: The social geography of schooling and the need for new institutional designs. Education Sciences, 6(4), 32. doi:10.3390/educsci6030032 Lemieux-Charles, L., & McGuire, W. L. (2006). What do we know about health care team effectiveness? A review of the literature. Medical Care Research and Review, 63(3), 263–300. doi:10.1177/1077558706287003 Lockhart, N. C. (2017). Applying social capital theory to research on interprofessional collaboration in expanded school mental health (Doctoral dissertation). Available from ProQuest Dissertations and Theses database. (UMI No. 10618294) Marek, L. I., Brock, D-J. P., & Savla, J. (2015). Evaluating collaboration for effectiveness: Conceptualization and measurement. American Journal of Evaluation, 36(1), 67–85. doi:10.1177/1098214014531068 Milward, H. B., & Provan, K. G. (2006). A manager’s guide to choosing and using collaborative networks. Retrieved from http://www.businessofgovernment.org/sites/ default/files/CollaborativeNetworks.pdf Mu, K., & Royeen, C. B. (2004). Interprofessional vs. interdisciplinary services in school-based occupational therapy practice. Occupational Therapy International, 11(4), 244–247. doi:10.1002/oti.214 Steen, S., & Noguera, P. A. (2010). A broader and bolder approach to school reform: Expanded partnership roles for school counselors. Professional School Counseling, 14(1), 42–51. doi:10.5330/prsc.14.1.puq62087h7q70801 West, M. A., Borrill, C. S. A., & Unsworth, K. L. (1998). Team effectiveness in organizations. In C. I. Cooper, & I. T. Robertson (Eds.), International review of industrial and organizational psychology (Vol. 13, pp. 1–48). Chichester, England: John Wiley.

Chapter 3

A Model for Interprofessional Collaboration Laura Bronstein, Elizabeth Mellin, and Aidyn Iachini

C

hapter 2 highlighted several models of collaboration that articulate important components of this practice strategy. In this chapter, we introduce Bronstein’s (2003) MIC, which serves as the framework used throughout the rest of this book. The MIC is the most extensively cited and studied model for interprofessional collaboration in social work and beyond (Petri, 2010). Here we discuss the foundational concepts that make up the MIC; the remaining chapters focus on application of the model in different social work practice contexts. By understanding what constitutes and influences collaboration, social workers can maximize their abilities as collaborative partners. Because social workers practice most often in settings where they are not the primary professional group (e.g., in health care where physicians and nurses are the primary professionals or in education where teachers are the primary professionals), social workers are often required to practice collaboration to serve their clients. This chapter begins by laying out the theoretical model that underlies the skills and knowledge necessary for effective collaboration. We describe the components that 23

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constitute effective collaboration between social workers and other professionals and then discuss what supports and hinders collaboration in practice.

MIC: Components of Interprofessional Collaboration The five constructs that constitute interprofessional collaboration are interdependence, newly created professional activities, flexibility, collective ownership of goals, and reflection on process (see Figure 3.1). In following sections we operationalize each of these and include examples from social work practice.

I Interdependence

Newly Created Professional Activities

Flexibility

Collective Ownership of Goals

Reflection on Process

N T

C

E

O

R

L

P

L

R

A

O

B

F

O

E

R

S

A

S

T

I

I

O

O

N

N

A L

Figure 3.1 A Model for Interprofessional Collaboration

CHAPTER 3: MODEL FOR INTERPROFESSIONAL COLLABORATION 

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Interdependence Interdependence is a frequently cited component of interprofessional collaboration (D’Amour, Ferrada-Videla, Rodriguez, & Beaulieu, 2005). Social workers and other professionals with whom they collaborate practice interdependence when they rely on each other to accomplish their goals and tasks. A prerequisite to being able to practice interdependently is to understand one’s own professional role and one’s collaborators’ roles to use each other’s expertise appropriately. In high-quality collaboration, professionals and other team members value and maximize each other’s specific expertise and make referrals that are appropriate. When practicing in a school where effective collaboration is occurring, for example, teachers rely on a social worker’s expertise to help them assess when and how contextual variables may be negatively affecting a student’s classroom performance. In such a scenario, a teacher acting interdependently might ask a social worker to make a home visit and share with the teacher ways to maximize a student’s academic success given variables external to the classroom that may be affecting achievement. In a nursing home, social workers may practice interdependence when they request information from a nurse or physician on hearing family members’ concerns about medication changes.

Newly Created Professional Activities This second component of collaboration is made up of organizational developments that occur unexpectedly when high-quality interprofessional collaboration is practiced. Other collaboration scholars describe this element as partnership synergy, or new approaches or strategies that result from interprofessional practice (Weiss, Anderson, & Lasker, 2002). Examples include new protocols or structures that interprofessional colleagues create as part of their work together. An example is regular team meetings or recurring agenda items at team meetings. Interprofessional colleagues can also collaboratively apply for external funding that can expand interactions and agency missions in new ways that further the goals of the organization and its clients.

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Flexibility Although each profession has its own expertise and role, a small amount of role-blurring, when it is strategically and thoughtfully employed, signifies a high level of collaboration. Several scholars have similarly noted the importance of professional flexibility (Anderson-Butcher, Stetler, & Midle, 2006; Rappaport, Osher, Greenberg Garrison, Anderson-Ketchmark, & Dwyer, 2003; Weist, Proescher, Prodente, Ambrose, & Waxman, 2001). An example is when a hospice social worker who works collaboratively with nursing staff members over a period of time can preliminarily answer a patient’s basic question about a physical health matter that arises often in hospice care but refers the patient to a nurse or physician for a more informed response. In the same way, a hospice nurse who collaborates frequently with a social worker may become more able to respond to psychosocial issues that emerge in a family when someone is dying. Again, the nurse should ultimately refer the patient to the social worker for a more informed response, but it can be comforting for a patient or family member to get some information without waiting for when a professional can provide it, even if it is outside the typical area of expertise of the person giving the initial response.

Collective Ownership of Goals When high-quality collaboration occurs, all professionals involved participate in goal setting, goal implementation, and goal evaluation. In addition to the involvement of professionals, clients and family members actively participate in team efforts related to defining, executing, and assessing goals (Opie, 2000). To do this work most successfully, team members need to be able to disagree in efforts to develop the highest quality services and outcomes. Sharing ideas when agreeing with others is usually much easier than voicing opposing views, but both are required for a high level of collaboration.

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Reflection on Process This fifth component of collaboration often emerges in research as the most significant (Mellin et al., 2010), although it is often the most overlooked and undervalued (Hilton, Sohani, Fellow-Smith, & McNeil, 2006). Through a broad array of research studies, collaborators’ ability to discuss their own behaviors and interactions with each other correlates with strong collaborative relationships. Sometimes such conversations and reflections occur as regular parts of team meetings, and sometimes they occur spontaneously in team meetings or informal discussions. To make it more likely that collaboration occurs, reflecting on interprofessional processes should occur thoughtfully and regularly. Structural Characteristics

Professional Role

Interprofessional Collaboration Interdependence Newly Created Professional Activities Flexibility Collective Ownership of Goals Reflection on Process

Personal Characteristics Figure 3.2 Influences on interprofessional collaboration

History of Collaboration

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In addition to understanding what constitutes interprofessional collaboration, it is useful to know what influences interprofessional collaboration in practice. As illustrated in Figure 3.2, these variables, which can strengthen or undermine interprofessional collaboration, include professional roles, structural characteristics, personal characteristics, and a history of collaboration.

Professional Roles Debates often occur about the importance of having a thorough grounding in one’s own profession—does it further interprofessional collaboration or keep collaboration from occurring? Those arguing the latter believe that allegiance and identity need to be more aligned with an organization than a profession for high-quality collaboration to occur. Scholars across fields (Bronstein, 2002; Myers, Sweeney, & White, 2002) have argued that identification with an individual’s profession as well as an organization are required for effective collaboration. Because professional identification provides grounding in professional expertise that is necessary to improve outcomes for individuals, families, groups, organizations, and/or communities, it is critical. Professionals also need to be able to articulate their expertise and contributions, so that interprofessional colleagues know how and when to use them. However, this is not sufficient for collaborative efforts because identification with an organization and the organization’s goals are also necessary to avoid professional turf wars. Therefore, professional role positively influences collaboration when you can articulate and implement the values, knowledge, and skills of your own profession while also knowing when and where other professionals’ expertise needs to come to bear.

Structural Characteristics It is easy to assume that structural characteristics are nonessential in supporting collaboration, but they can be the difference between the success or failure of collaboration. How often do you hear that there

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is no time to collaborate? Almost as frequently, we hear there is no physical space for team meetings to occur. Administrative support for collaboration also is a vital structural support. If a supervisor values collaboration, it makes a big difference in whether collaboration will occur. Scholars beyond social work also describe these characteristics as affecting interprofessional collaboration (Lever et al., 2003; Osher, 2002; Weist et al., 2001).

Personal Characteristics Scholars frequently have found that personal characteristics have the strongest influence on collaboration (Mellin & Weist, 2011; Weist, Ambrose, & Lewis, 2006). Do we like the people with whom we need to collaborate? Do we trust them? Do they like and trust us? It is easy to get frustrated and think these are static attributes we cannot change; but if we know they are critical influences on collaboration, we need to find ways to affect them. In drastic situations and when it is possible, it may mean changing the team; but more often it requires teambuilding as a critical component of relationship building.

History of Collaboration Research has shown that when professionals have positive prior experiences with collaboration, they are more likely to have current positive collaborative experiences (Mellin & Weist, 2011). Therefore, university faculty members in all professional education programs should teach their students about collaboration and its requisite skills (hence, this workbook you are reading). This should occur both in the classroom and in professional internships where students have opportunities to try out and practice these skills.

Conclusion This chapter introduced the reader to the components that constitute effective interprofessional collaboration and to the influences on it

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Part I: FOUNDATIONS

as articulated in the MIC. In Part II of this book social work experts from an array of practice fields bring this model for interprofessional collaboration to life by offering examples of how it has been applied in different settings and with varying populations. Each chapter in Part II follows the same structure, so readers can easily compare similarities and differences across practice fields. We hope that as more social workers and other professionals thoughtfully and strategically engage in practices that support collaboration, our clients and constituents will be better served with the resources and expertise of the array of professionals who can improve practice, programs, and service delivery. References Anderson-Butcher, D., Stetler, E. G., & Midle, T. (2006). A case for expanded school-community partnerships in support of positive youth development. Children & Schools, 28(3), 155–163. doi:10.1093/cs/28.3.155 Bronstein, L. (2002). Index of interdisciplinary collaboration. Social Work Research, 26(2), 113–126. doi:10.1093/swr/26.2.113 Bronstein, L. (2003). A model for interdisciplinary collaboration. Social Work, 48(3), 297–306. doi:10.1093/sw/48.3.297 D’Amour, D., Ferrada-Videla, M., Rodriguez, L., & Beaulieu, M. D. (2005). The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. Journal of Interprofessional Care, 19(Suppl. 1), 116–131. doi:10.1080/13561820500082529 Forbes, J. (2009). Redesigning children’s services: Mapping interprofessional social capital. Journal of Research in Special Educational Needs, 9(2), 122–132. doi:10.1111/j.147- 3802.2009.01125x. Gray, B. (1989). Collaborating: Finding common ground for multiparty problems. San Francisco, CA: Jossey-Bass, Inc. Hilton, A., Sohani, M., Fellow-Smith, E., & McNeil, T. (2006). Working for inclusion: A CAMHS/education interagency project. Progress in Neurology & Psychiatry, 10, 41–43. Lemieux-Charles, L., & McGuire, W. L. (2006). What do we know about health care team effectiveness? A review of the literature. Medical Care Research and Review, 63(3), 263–300. doi:10.1177/1077558706287003 Lever, N. A., Adelsheim, S., Prodente, C., Christodulu, K. V., Ambrose, M., Schlitt, J., & Weist, M. D. (2003). System, agency, and stakeholder collaboration to advance mental health programs in schools. In M. D. Weist, S. Evans, & N. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 107–118). New York, NY: Kluwer Academic/Plenum Publishers.

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Mellin, E. A., Bronstein, L. R., Anderson-Butcher, D., Amorose, A., Ball, A., & Green, J. H. (2010). Measuring interprofessional collaboration in expanded school mental health: Model refinement and scale development. Journal of Interprofessional Care, 24(5), 514–523. doi:10.3109/13561821003624622 Mellin, E. A., & Weist, M. D. (2011). Exploring school mental health collaboration in an urban community: A social capital perspective. School Mental Health, 3(2), 81–92. doi:10.1007/s12310-011-9049-6 Myers, J. E., Sweeney, T. J., & White, V. E. (2002). Advocacy for counseling and counselors: A professional imperative. Journal of Counseling & Development, 80(4), 394–402. doi:10.1002/j.1556-6678.2002.tb00205.x Osher, D. M. (2002). Creating comprehensive and collaborative systems. Journal of Child and Family Studies, 11(1), 91–99. doi:10.1023/A:1014771612802 Opie, A. (2000). Thinking teams/thinking clients: Knowledge-based teamwork. New York, NY: Columbia University Press. Petri, L. (2010). Concept analysis of interdisciplinary collaboration. Nursing Forum, 45(2), 73–82. doi:10.1111/j.1744-6198.2010.00167.x Rappaport, N., Osher, D., Greenberg Garrison, E., Anderson-Ketchmark, C., & Dwyer, K. (2003). Enhancing collaboration in and across disciplines to advance mental health programs in schools. In M. D. Weist, S. Evans, & N. Lever (Eds.), Handbook of school mental health: Advancing practice and research (pp. 107–118). New York, NY: Kluwer Academic/Plenum Publishers. Weiss, E. S., Anderson, R. M., & Lasker, R. D. (2002). Making the most of collaboration: Exploring the relationship between partnership synergy and partnership functioning. Health Education & Behavior, 29(6), 683–698. doi:10.1177/109019802237938 Weist, M. D., Ambrose, M. G., & Lewis, C. P. (2006). Expanded school mental health: A collaborative community-school example. Children & Schools, 28(1), 45–50. doi:10.1093/cs/28.1.45 Weist, M. D., Proescher, E., Prodente, C., Ambrose, M. G., & Waxman, R. P. (2001). Mental health, health, and education staff working together in schools. Child and Adolescent Psychiatric Clinics of North America, 10(1), 33–43. doi:10.1016/s10564993(18)30070-1 West, M. A., Borrill, C. S. A., & Unsworth, K. L. (1998). Team effectiveness in organizations. In C. I. Cooper & I. T. Robertson (Eds.), International review of industrial and organizational psychology (Vol. 13, pp. 1–48). Chichester, England: John Wiley.

Part II

Putting the Model Into Action: Interprofessional Collaboration Across Settings and Populations

Chapter 4

Education Annahita Ball

T

his chapter addresses the following 2015 Educational Policy and Accreditation Standards competencies (CSWE, 2015):

• • •

Competency 2: Engage Diversity and Difference in Practice Competency 3: Advance Human Rights and Social, Economic, and Environmental Justice Competency 8: Intervene with Individuals, Families, Groups, Organizations, and Communities

A recent Google search of interdisciplinary collaboration in education yielded 6,840 hits, and a recent search of the same phrase in academic journal databases yielded 6,848 citations of scholarly articles. A scan of the results indicated that just a few of the hits were truly about interdisciplinary collaboration in K-12 education settings, yet school systems are inherently interdisciplinary (Ball, Anderson-Butcher, Mellin, & Green, 2010; Leonard, 2011). On any given day, one will probably find teachers, educational administrators, social workers, school counselors, speech pathologists, nurses, school psychologists, and many other professionals working in one school to collectively meet the needs of diverse students. 35

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Part II: PUTTING THE MODEL INTO ACTION

Importance of Interprofessional Collaboration in Education Schools and districts are under substantial pressure to demonstrate academic gains for their students, placing the primary emphasis on academic instruction and learning. Most recently, the 2015 Every Student Succeeds Act expanded on requirements in the 2001 No Child Left Behind Act to create state and national systems of accountability requiring standards-based instruction tied to ongoing assessment for all students. To strengthen curriculum, instruction, and school improvement, schools are required to report on the academic progress of all children, in aggregate and among vulnerable subgroups (e.g., racial/ ethnic minorities, low-income students, students with disabilities). These requirements come with strict accountability that connects school performance with available financial, staffing, and physical resources, creating an emphasis on academic outcomes that was previously unprecedented in the United States. Considerable evidence, however, points to the importance of other components of children’s school success that are not within the realm of instruction and learning but are closely related and critical for academic outcomes. Children and youths throughout the United States are struggling with unmet social, emotional, and mental health needs (Katoaka, Zhang, & Wells, 2002) and experience trauma to an alarming degree, such as witnessing community violence, sexual abuse, neglect, and disaster (APA Presidential Task Force, 2008). Poverty, homelessness, and other forms of family instability also are on the rise, particularly in urban areas with concentrated poverty and in rural areas with inadequate and inaccessible resources (Miller & Bourgeois, 2013). Further, students who identify as racial/ethnic minorities or LGBTQ+ experience bullying, disproportionately harsh discipline, microaggressions, and systemic oppression in schools (Allen, 2013; Losen, 2013; Robinson & Espelage, 2011). Because these nonacademic concerns are strongly related to students’ academic outcomes, schools are now forced to address these varying needs while also focusing on traditional academic expectations (Adelman & Taylor, 2012).

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However, schools cannot address all the needs of all their students on their own. Rather, schools may operate as community hubs that are positioned to address students’ and families’ needs through myriad services and supports that involve several professionals from multiple disciplines. Together, systems of support that include school and community resources (e.g., after-school programs, summer enrichment, youth leadership programs, religious activities) are essential for fostering resilience and healthy social-emotional development among children and youths (Anderson-Butcher, Lawson, Iachini, Flaspohler, & Bean, 2010; Durlak et al., 2007). Effective interdisciplinary collaboration is necessary for these systems of support to have a meaningful impact on students and families and to positively affect students’ academic outcomes. Examples of interdisciplinary collaboration in education include those rooted in positive youth development, parent/family engagement, expanded school mental health, school-linked services, community schools, and public–private partnerships. For example, expanded school mental health and school-linked services require multiple professionals (including teachers, school psychologists, social workers, and occupational therapists) to collaborate and coordinate services for children in need of additional school-based supports, such as more individualized instruction, mental health counseling, or speech and occupational therapy. In this case, teams of professionals meet regularly to share information, develop new strategies of service delivery, and monitor progress (Iachini, Anderson-Butcher, & Mellin, 2013). Additionally, researchers have found that collaboration across professionals is a key component of school mental health services for students with disabilities (Kohler & Field, 2003), school-based universal mental health screening (Dowdy et al., 2015), and comprehensive school mental health programs in rural settings (Michael, Renkert, Wandler, & Stamey, 2009). Further, more traditional after-school programming, school-family-​ community partnerships, and school partnerships with private entities (e.g., corporations, local businesses) require ongoing collaboration across professions in which individuals must collectively design,

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administer, and implement programs that support children’s development and academic success. For example, research on whole-school physical activity programs emphasizes that interprofessional collaboration is critical to program success and that it often comes in multiple forms, including within-school professional collaborations and public–private partnerships (Lee & Solmon, 2007). Moreover, a recent study of an interprofessional collaboration in an after-school setting found that these opportunities hold the potential for professionals to enhance their own professional practice and their collaborative skills across professions (Shor, 2008). In sum, research in these areas highlights the differences and similarities across professions and how these collaborations maximize resources to meet students’ needs (e.g., Anderson-Butcher, Iachini, Ball, Barker, & Martin, 2016; Ball, 2011; Mellin, 2009). In this chapter I present a case example to illuminate how the MIC (Bronstein, 2003) was exemplified in one education setting, with special attention to the important structural considerations pertaining to this context.

Interprofessional Collaboration Example The possibilities for interprofessional collaboration in education settings are endless. The example here, Closing the Broadband Gap (CBBG), was a university–school partnership developed to address three distinct district-wide priorities: (a) using technology in classrooms to engage students and enhance learning, (b) engaging parents/caregivers in student learning, and (c) addressing an extant gap in broadband access for the district’s students. As a pilot initiative, we rolled out CBBG during one semester in one K-8 school (PS 2701) in a large urban Northeastern city. The CBBG is a technology-based initiative to enhance parent engagement in school and students’ engagement in learning. Rooted in theories of parent engagement in schools (e.g., Ward, Drew, Lasseigne, & Anderson-Butcher, 2012; Warren, Hong, Rubin, & Uy, 2009), 1. Pseudonym

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the CBBG focused on engaging parents and families in their children’s learning by creating a reciprocal, mutually beneficial relationship between parents and the school. Research highlights several factors that influence parent engagement, such as parents’ previous educational experiences, employment obligations, access to transportation and child care, unmet basic needs, and limited English proficiency (Ward et al., 2012). Additionally, low-income and marginalized parents may have myriad needs that preclude their typical involvement in schools. Thus, schools must broaden their perspectives of parent involvement to include two-way exchanges between parents and schools that include consideration of the cultural, social-emotional, and societal issues that affect families (Anderson-Butcher, 2006). As parents’ needs are increasingly met, they may be more involved in their children’s education. The CBBG addressed the broadband gap as a specific need experienced by families of fourth and fifth grade students at PS 270. A gap in access to consistent and reliable home Internet has emerged in recent years between those who have Internet at home and those who do not. In 2014 one in three low-income children did not have high-speed Internet at home, compared to one in 1,250 higher-income children (Horrigan, 2015). The gap in broadband access has several implications for families, such as limited access to job, career, and educational opportunities and reduced access to materials for daily life. Prior to the CBBG, more than one-quarter of fourth and fifth grade students at PS 270 did not have reliable access to the Internet at home. Children suffer along with individuals and families from the broadband gap. Teachers increasingly rely on students’ connectivity for at-home research, homework completion, and out-of-school time communication (Olmstead, 2013). In addition, blogs, teacher websites, and e-mail provide opportunities for schools and parents to communicate about student learning. When these modes of communication reach only some parents, the dialogue becomes skewed and exclusive, leaving the most vulnerable parents out of the conversation (Hagel & Brown, 2008). Scholars agree that the broadband gap is an emerging social justice issue in the United States (e.g., Bernasconi & Maxlow, 2010;

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Prieger, 2015), and it is particularly troubling in relation to schooling. In response, I worked with the instructional technology coach at PS 270 to develop and pilot the CBBG. As a social work faculty member, I designed the program with several social work values in mind, including self-determination, social justice, and strengths-based perspectives. As an instructional technology coach, my colleague focused on effective use of technology in classrooms, digital literacy, and student motivation. After the two of us engaged in this initial development work, we relied on the collaboration of professionals from multiple disciplines for program refinement and implementation. The goals of CBBG were to (a) increase parent and child access to WiFi and learning tools at home and in school, (b) enhance parent perceptions of school, (c) increase student motivation for learning, (d) increase positive academic behaviors, and (e) increase parent engagement in student learning. These goals were to be achieved by providing WiFi hotspots and workshops for parents and their children to better equip them with the resources and skills they need to enhance learning. We provided 94 students in fourth and fifth grade with tablets for use in their classrooms; 36 of those students also received tablets and WiFi hotspots for use in their homes. We also held four parent events serving 62 parents, one professional development session for teachers, and eight lessons for students during one academic semester.

Interprofessional Nature of the CBBG The primary collaborators included teachers, social workers, educational leadership, district administrators, one instructional technology coach, one university researcher (myself), parent coordinators, and business professionals. After we co-developed the program, we collaborated with the school principal, district technology executive director, university researchers, and other district administrators to create a plan for program rollout, recruitment, management, and operations. The principal and the district leaders chose to limit the program to two grades based on upcoming district initiatives and learning needs at

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the school. Decisions about classroom instruction, mobile apps on the tablets, and the timing of the program were driven by the educational technology coach and educational leadership, because this was their primary area of expertise. Based on their expertise in family involvement, the social workers (university faculty members and students) primarily guided the parent engagement component of the project. For instance, it was a priority for the tablets and take-home WiFi to be free of charge with unlimited data access, so families could use them for a wide scope of activities. Additionally, unlimited data access and take-home devices were consistent with the focus of parent engagement theory in helping parents to meet their basic needs and in demonstrating a sense of trust and commitment from the school to families. Next, the team expanded to include the school’s parent coordinator, who was a parent/caregiver employed by the district to involve and represent parents in the school’s operations. We included business professionals from Internet and cellular service providers to inform the logistical operations of the program. Teachers also ensured that the program’s structure and implementation were aligned with their own teaching priorities and informed by their own expertise. The roles and responsibilities of each member of the collaboration are listed in Table 4.1. In addition, each member’s discipline is highlighted in the table to indicate which roles and responsibilities pertained to each. All members of the collaborative team were involved in development and implementation, but each member had a different role during implementation to maximize the team’s knowledge, skills, and interdisciplinary nature. To kick off the program, we held a series of parent events to distribute the devices and involve families in the new program. District administrators in the department of technology designed the device rollout, including tracking the devices, helping parents complete appropriate paperwork, and answering technical questions about the program. The social work students and I designed the program and agenda for the event to include a social activity to build relationships, time to gather information and feedback from parents, and time for parents to ask questions about any other needs they may have. In addition, the parent coordinator assisted with planning an event that would

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Table 4.1 Members, Roles, and Responsibilities of the CBBG Collaborative Team Social Workers

Educational Technology Coach

Educational Leadership

Support development of the CBBG

X

X

X

Support CBBG implementation

X

X

X

Provide technical assistance to parents and staff

X

X

Design program implementation to maximize impact and efficiency

X

Facilitate parent events

X

X

Design and implement an evaluation plan

X

Market the program

X

X

X

Build relationships with families

X

X

X

Facilitate student lessons

X

Create assignments and assess student progress

X

Facilitate teacher professional development

X

Align the CBBG with district and school priorities and initiatives

X

X

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Teachers

District Administrators

Business Professionals

Parent Engagement Coordinator

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

X

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appeal to parents and families, including input on the time and date of the events, available food, child care, and transportation for attending parents. The instructional technology coach and I facilitated the events together, providing information on parent/family involvement and the importance of digital literacy for today’s students. Following the initial kick-off events, we hosted three parent workshops, one teacher professional development session, and eight student lessons. All events were held at the school. The parent workshops occurred at 3-week intervals throughout the semester. They provided information, question–answer sessions, and informal conversation about using technology to monitor and track their children’s progress and assist with homework, digital literacy and safety, and communication between teachers and parents. The content of the workshops was developed and facilitated by myself, the instructional technology coach, parent coordinator, and teachers. Social work students assisted with the facilitation of the events and conducted evaluation research throughout the program. The 60-minute professional development session for teachers occurred at the beginning of the program and focused on using the new technology in the classroom for instruction and assessment. The eight student lessons were held throughout the semester and focused on digital citizenship, online safety, screencasts, movie-making, and other mobile learning applications. The instructional technology coach designed and facilitated these sessions, given his expertise in educational technology and coaching. Additionally, the district administrators collaborated with him to inform the content of the sessions. The school’s fourth and fifth grade teachers were responsible for providing classroom instruction, creating assessments, and monitoring students’ progress.

Application of the Model for Interdisciplinary Collaboration In this case, an interprofessional team (comprised of teachers, social workers, educational leadership, district administrators, one instruc-

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tional technology coach, one university researcher [myself], parent coordinators, and business professionals) implemented this school-based program. Thus, the CBBG is a rich case example to explore the MIC (Bronstein, 2003) in a K-12 education setting. Each of the components of interprofessional collaboration will be described next as they relate to the CBBG.

Interdependence Interprofessional collaboration relies on the interdependence of its members, which includes each member’s dependency on the others to accomplish goals and tasks (Bronstein, 2003). Interdependence requires that the expertise and perspectives of all members are needed for the collaboration’s success. The CBBG is an interprofessional program that requires the expertise, skills, and perspectives of a variety of professionals. At its core, the CBBG incorporated educational technology and parent involvement to improve student outcomes. Social work faculty members and students are not typically equipped to provide instruction on technology use in student learning, and the social work members of this collaboration had no previous knowledge of the logistical implications for such a program, such as tracking 94 devices that are district property in the possession of families. Likewise, district administrators and the educational technology coach were not experts in parent engagement and frequently referred to the social workers for guidance on recruiting and engaging parents in the project. This is one example of how the CBBG team was an integrative team, defined as a team in which the members believe that their ability to carry out their responsibilities depends on each other (Bronstein, 2003). The CBBG developed this interdependence through formal and informal time together and through oral and written communication. For instance, three meetings occurred before implementation, in which all members of the team joined to discuss the program, allowing members from multiple professions to spend formal time sharing their knowledge and perspectives. Throughout implementation, team subgroups continued these formal meetings to discuss workshop content,

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problems with the devices (e.g., lost tablets, hard to reach families), and unexpected problems with implementation (e.g., substitute teachers, low event attendance). Each of these subgroup meetings furthered the interdependence of team members, as all these issues required the knowledge and experience of members from different disciplines. Informal time spent together also was essential for developing interdependence. The events were co-facilitated, requiring a significant amount of planning and preparation, most of which was done during informal meetings, e-mails, and phone calls across the professions. Throughout these interactions, it was important for members to demonstrate a respect for professional opinions and input. Team members frequently noted who the expert was in certain areas, such as leaving the content development of student lessons to teachers and the instructional technology coach or seeking parent input on the design of program events.

Newly Created Professional Activities Interprofessional collaboration is more than the sum of its professional parts. Thus, newly created professional activities that result from these types of collaborations are more than the professionals that make up the collaboration would have been able to do independently (Bronstein, 2003). The CBBG program was a newly created activity; the initial idea developed from informal conversations between the social work faculty member and the technology coach. The CBBG was an unexpected program that arose from the needs of students and the relationships among the professionals involved. It would have been an impossible endeavor for any one professional to accomplish given the interdependence of the group. Further, the premise of the program (i.e., offering technology services to parents in their homes as a mechanism for student and parent engagement) is a novel form of parent engagement in schools that represents a fundamental shift in service delivery. The CBBG program, however, was relatively short-term in nature and its implementation did not result in any new structures or policies. As discussed later in the section on influences on collaboration,

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the structural constraints of the educational system create a setting in which professional activities may evolve to enhance the collaboration and the program, but collaboration does not immediately result in formalized policy or professional expectations. Instead, interprofessional collaborations in education often involve small and incremental shifts that vary based on the needs of the program or initiative.

Flexibility Bronstein (2003) describes flexibility as “the deliberate occurrence of role-blurring” (p. 300), in which members of an interprofessional team expand and contract their role perceptions to facilitate collaboration and meet the goals of the group. This level of flexibility is difficult in highly structured settings with highly socialized professionals, such as in education systems. Role theory provides insight into how professionals in educational settings may develop and negotiate their professional roles. Professionals develop clear definitions of their roles and responsibilities, particularly through professional socialization that occurs in their training. The flexibility required in interprofessional collaboration represents a degree of role expansion, in which professionals can extend their existing perceptions of their roles to include new and novel roles and responsibilities. Given the many external influences on collaboration in this case (as discussed later), little flexibility was exhibited in the CBBG, yet salient examples are evident. Generally, the members of the team remained somewhat siloed according to their traditional roles and responsibilities for their professions. For instance, the instructional technology coach and teachers were the only providers of lessons for the students. Further, during parent events, the instructional technology coach delivered content on technology and the social worker delivered content on family involvement in schools and community resources. These are clear examples of the ways in which each member of the team remained within the traditional realm of his or her professional role. The social workers in this case served as the link across all the disciplines, arranging meetings, translating disciplinary language for

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members, and synthesizing feedback from all parties to inform program implementation. As school social workers are routinely referred to as the link among schools, families, and communities, these roles and responsibilities are not surprising. In fact, the social workers in this case example exhibited the most flexibility when compared to the other team members. Still, there are select examples of other professionals’ flexibility that enhanced the CBBG and, in fact, were critical to the project. Although the teachers on the team provided lessons and assessments using the new technology, they also called parents at home and conducted home visits to boost families’ recruitment and initial engagement in the CBBG. Additionally, the parent coordinator worked closely with educational leadership to ensure that the program was operated with parents’ preferences and needs in mind. This is also contrary to the traditional hierarchical structure of education systems and to more rigidly defined traditional social work roles. This flexibility was necessary for the CBBG’s success, because these examples represent creative, flexible tactics to involve families in the program that go beyond the members’ traditional professional roles and responsibilities.

Collective Ownership of Goals Admittedly, the CBBG is rooted in strengths-based, capacity-building parent involvement that emphasizes mutual relationships between schools and parents. This contrasts with more traditional conceptualizations of parent involvement that emphasize parents’ activities that support the school. Although this school district was advanced in many ways (e.g., district-wide parent leadership council, a parent engagement office at the central office, and parent coordinators located at each school), the full potential of more strengths-based approaches had not been realized throughout the district. The CBBG’s goals (i.e., increase family access to WiFi and learning tools, enhance parent perceptions of school, increase student motivation and positive academic behaviors, and increase parent engagement in student learning) were identified collaboratively across educational leadership, district administrators, and social workers. This, indeed, reflected shared

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responsibility in program goal development. However, the project was initiated by the university social work faculty member; thus, it was heavily rooted in newer models of parent involvement. Starting with this underlying focus, the team developed the specific goals and objectives of the program, while still rooted in the conceptual model of the faculty member’s choice. In this way, the CBBG differs from MIC (Bronstein, 2003), because the goals were not developed using collective decision making in its fullest capacity. Further, Bronstein (2003) notes that “each professional must take responsibility for his or her part in success and failure” (p. 301), which is easier said than done in most contexts—education is not alone in this. The stakes are high for educators and school districts. In some ways, it is unreasonable to expect large encumbered systems to take full responsibility for any failures associated with the program. For instance, low parent attendance at events is a common problem for parent engagement efforts in urban schools (e.g., Brower & Griffin, 2011). It is difficult to identify individual professional’s responsibilities in this situation, but those who were most closely related to the situation identified methods to improve turnout and acted accordingly. We also solicited feedback from teachers, the parent coordinator, students, and parents throughout the program, beginning with feedback about the program priorities in the opening kick-off event. The parent coordinator was critical in identifying programming that met parents’ needs (e.g., holding one event in the morning and one in the evening) and modifying implementation to address unexpected concerns (e.g., parents asked for a workshop to include information about summer camps). This is essential, as racial/ethnic minority and low-income parents may feel marginalized in education systems. In the future, we plan to modify the CBBG to include families earlier in the process to ensure that they are more involved in defining the goals and guiding the implementation. Additionally, the CBBG team did not evaluate the goals collectively, which is included in collective ownership. Although I shared the results on the effectiveness of CBBG with some members of the team, it was impossible to have true collective evaluation, because many team members were assigned to different schools shortly after

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the conclusion of the program. The principal, instructional technology coach, parent coordinator, and some teachers were no longer at the school when I shared the results, and in fact, the collaboration did not last long enough to complete the program from conceptualization to evaluation. Turnover among educational leadership and staff members is common in urban schools and is a critical barrier for ongoing effective interprofessional collaboration in education.

Reflection on Process Special attention to the processes that occur during interdisciplinary collaborations is essential for effective intervention and continuous improvement (Bronstein, 2003). Reflection on process occurred in the CBBG, but it was largely within professions. For instance, those in educational leadership regularly discussed and reflected on their own process of implementing the CBBG and engaging in the collaboration. The social workers also reflected on the difficulties of maintaining their own professional identities in a host setting and interprofessional collaborative team. Additionally, the social workers and educational leadership made specific efforts to solicit feedback on the collaborative process from educators and the parent coordinator via focus groups, e-mails, phone calls, and brief surveys. This is the only example of reflection on process that crossed professions, demonstrating that this component of interprofessional collaboration was largely absent from the CBBG initiative. It is likely that the structural characteristics of education settings played a role in the limited reflection on process that occurred in this case example. The CBBG program was funded by a university grant and the school district to pilot the new parent involvement program. It was developed and implemented over the course of 1 academic year, with development occurring largely in the fall semester and implementation occurring in the spring semester. Public schools in the United States administer state-required standardized assessments to all students at least twice per year, often in the spring and the fall. Additionally, schools typically close completely during the summer, and

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teachers are not required to visit the building at all during this time. These timing constraints made it difficult to implement the program and reflect on the process as a team. The program concluded in June on the last day of school, but at that time, nearly half the devices had not been returned by parents and more than three-quarters of parents had not completed the final feedback survey for the program. Moreover, teachers and educational administrators were occupied with end-of-year events, such as field days, graduation ceremonies, and committee meetings, making it difficult to schedule meetings. These complexities are not uncommon in schools, and they pose considerable constraints to interprofessional collaboration. It is possible that more discussion of our own collaborative process would have enhanced the CBBG’s implementation and outcomes. For example, reflection on process would have highlighted a need for team members to meet shortly after each parent event to debrief and identify necessary changes for future events.

Application of the Influences on Interprofessional Collaboration Professional Role Bronstein (2003) and others emphasize professional allegiance and allegiance to the interprofessional team as prerequisites for interprofessional collaboration. In the case of the CBBG, professional role was a strong influence on the collaboration. During professional training, team members underwent a socialization process that was specific to their profession (e.g., educational leadership, teaching, social work). The results of the varying socialization processes played out in the day-to-day operations of the collaboration. An example of the influence of professional role was especially apparent when considering each member’s views on parent involvement in school. Social workers are strongly aligned with the profession’s Code of Ethics (National Association of Social Workers, 2008), which emphasizes self-determination as a primary value. Additionally, social workers are

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trained to adopt a person-in-environment perspective that is central to the profession. In this vein, social workers’ professional identity stresses parents’ freedom to make their own choices in the contexts of their own experiences, regardless of whether those choices are aligned with our own programmatic goals. In the other professions involved in the collaboration, self-determination was not as heavily emphasized as other values, such as personal responsibility or student centrality. Thus, in the CBBG, when parents chose to attend an event for just 10 minutes, had dinner but did not take part in the activities, or did not attend events at all, they may have been perceived as uninvolved with their children’s learning. All members of the collaborative team had to be cognizant of our differing professional perspectives and values to navigate the interprofessional nature of the project. At the same time, individual professionals had to remain consistent with their own professional values and perspectives to the extent they were comfortable. Nevertheless, the interprofessional team united around the common goals of the CBBG beyond each member’s individual role. This is most evident in the processes we used to involve parents in the program. The primary goals of the CBBG were to increase access to WiFi at home and in schools, enhance parents’ perceptions of school, increase student motivation for learning and positive academic behaviors, and increase parent involvement in student learning. Teachers and the educational technology coach expanded their roles to call parents, deliver devices to homes, and to conduct home visits. The social work faculty members expanded their roles to assist in the development of curriculum for student and teacher workshops focused on connecting technology, learning, and assessment. Going beyond our individual roles allowed us to use the full professional potential of the team and build trust among team members. Still, it is likely that even more role expansion would have aided in program implementation and potentially would have improved outcomes.

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Structural Characteristics Structural characteristics in educational settings cannot be ignored. These may include features of the organizational culture, policies and procedures, or programmatic constraints (e.g., physical space, equipment availability). Schools serve as host settings for social workers, and thus, practitioners are frequently faced with structural characteristics that may seem limiting or inflexible (Dane & Simon, 1991). The CBBG program operated in this system, where several structural characteristics influenced interprofessional collaboration, positively and negatively. District policies, priorities, and staff availability were structural characteristics that supported and inhibited the collaboration. The district had policies and staff members in place to support parent involvement, as well as technology integration in the classroom. In this way, educational leadership was able to advocate to district leadership and bring the project to fruition. Likewise, parent involvement was identified as a top priority for the district, so infusing student learning, technology, and parent engagement was nicely aligned with the district’s other initiatives. However, other structural issues posed challenges for the CBBG. Teachers across the country are faced with increasing demands on their time and energy. Although the CBBG was integrated into the teachers’ existing curriculum, and the planning team was careful to ensure that excess work would be minimized, the CBBG was still largely an add-on program at the school. Teachers had to learn a new mode of instruction and assessment, as did students. It is likely that additional efforts to minimize workload for teachers and educational leadership would have improved the collaboration and ultimately benefitted the CBBG’s implementation. In fact, it may have been necessary for some members of the team to take on a greater workload given the fewer responsibilities required for their specific professions. Similarly, district policies, staff availability, and space influenced the day-to-day operations of the collaboration. The school district required that an administrator be in the building at all times of its use, and that building doors were locked after school hours. The social workers and

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parent coordinator felt that it was important to hold parent events after typical business hours to make it more convenient for parents. They also provided staffing resources to provide childcare during the events, but this still required the use of an additional room in the school. These posed problems with implementation as members of the collaboration attempted to operate creatively within the constraints of district policy. In the end, educational leadership agreed to stay in the building late for the events, the parent coordinator recruited another parent to help open the locked doors for attendees, and childcare stations were set up in the same room as the parent event to save space in the school.

Personal Characteristics Trust, respect, and the perceived value of other professionals are all personal characteristics that influence interprofessional collaboration (Bronstein, 2003). The CBBG case is somewhat uncharacteristic of other interprofessional collaborations in education because the team leaders had more control over the team membership than is typical. The CBBG was not a required program that the district leadership forced on the school or the team. Instead, the program came about after several informal conversations between the instructional technology coach and myself, and we had known each other for some time. We chose to pursue this project out of mutual interest and enthusiasm. Additionally, because a portion of the project funds were under my control, I chose the other social workers and educational leaders with whom I wanted to work. Further, all members of the team expressed a strong commitment to family engagement, innovation, and social justice, which were shared professional values and goals. Even though team members had many similar personal characteristics, few of the members had ever collaborated in the past; therefore, the team members had to build trust and respect. The process of building the personal relationships behind the collaboration was informal. Informal meetings and phone calls were held outside the school, which facilitated trust and respect. Often these discussions were task-focused but still included more personal

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discussion, such as discussion about weekend activities and hobbies. These forms of relationship-building are critical to collaboration because members can identify common ground despite professional differences. Further, the nature of the CBBG also generated trust among the collaborators. Many of the parent events were informal, including food, games, music, and small talk. In some ways, educational settings facilitate these relationships because team members engage frequently and in multiple ways. The teachers worked closely with the instructional technology coach during the day, the social workers engaged with the school principal at other city-wide events, and the families engaged with all the collaborators in ways that were not typical in this school (e.g., e-mail, phone calls, informal gatherings). Finally, it was critical that the collaborators held each other accountable (and that accountability was delivered in return). As a school-driven initiative, the social workers, educational leadership, and district administration had to follow through on commitments, both large (e.g., delivering WiFi to families) and small (e.g., providing food at events when the flyer said food would be provided).

History of Collaboration The team members’ individual histories with collaboration were varied. Many members had experience collaborating within their own professions, and a few had experience collaborating across professions. For example, the district leadership routinely worked with business professionals to obtain equipment for information technology. Likewise, the social workers had considerable experience working on interprofessional teams. Working together, though, is not the same as collaborating. It is likely that the members of the team had more experience with cross-professional collaboration, in which professionals work with each other but do not demonstrate common characteristics of collaboration. In the beginning most team members approached the CBBG with the expectation that they would simply communicate across disciplines rather than collaborate, because that was their previous experience.

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In addition, the history of collaboration in education systems was of critical importance for the CBBG. Education systems in the United States are characterized by a peaked hierarchical organizational structure that has persisted for nearly a century (Barr & Dreeben, 1983; Lee, Dedrick, & Smith, 1991). In the case of the CBBG, district administrators would be at the top of this hierarchy, followed by educational leadership, teachers, the parent coordinator, and then parents. Outside of education, as a social work faculty member, I was higher in the organizational structure than the social work students, and business professionals were located in the private sector, which has a complex history with public institutions such as education. Even though the CBBG did not explicitly adhere to this structure, it was necessary for team leaders to be acutely aware of the history of power structures in education. Given the existing organizational structure, members of this project had to navigate their own histories, expectations, and current experiences to collaborate effectively. Occasionally this hierarchy was exemplified explicitly, and it was apparent that traditional educational organizations were in the minds of those in the collaboration. Further, the long-standing histories of family–school partnerships must be noted in this case example. Racial and ethnic minority and low-income families have a collective history of marginalization, discrimination, and exploitation in the U.S. public education system (Anyon, 2014; Noguera, 2009). This history may increase feelings of mistrust between families and school professionals that must be considered in any parent involvement strategy. Each member of the collaboration was responsible for maintaining the collaborative nature of the group; yet, as one of the team leaders and as a social worker, I actively sought to undo these longstanding power dynamics in education. Specifically, all members of the team, regardless of profession or role, were included on e-mail communication pertaining to the program. Additionally, a variety of methods was used to elicit feedback from members, including direct informal communication, surveys, focus groups, and team brainstorming sessions. This was done to help members contribute however they were most comfortable doing so. My own history of interprofessional collaboration,

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when coupled with my role as a team leader, was instrumental in the success of the team’s work. As a social work faculty member with experience in school social work and school mental health services, I have experience with sustained interprofessional collaborations and am especially aware of the importance of collaboration, as well as the strengths and difficulties associated with it. In the end, it is likely that individuals’ histories with collaboration in the education system and their own personal histories of collaboration presented more obstacles for the CBBG than benefits.

Conclusion The education system is a ripe setting for interprofessional collaboration, yet it is not without obstacles. In the CBBG case example, it is evident that the collaboration included interdependence, newly created professional activities, flexibility, collective ownership of goals, and reflection on process to varying degrees. Likewise, issues of members’ professional roles, personal characteristics, structural characteristics, and the history of collaboration in education collectively operated to facilitate as well as impede the interprofessional collaboration. Social workers in education settings must be especially attuned to the structure and culture of the host system, as well as their own professional identities and roles. The educational system primarily focuses on teaching and learning, with heavy pressure from external stakeholders. At the same time, schools present an opportunity to address children’s social, emotional, and behavioral health needs, while also promoting positive youth development and overall well-being. Social workers need to be flexible in these settings to balance their own priorities, values, and practice expectations with those of the other professionals in the system. This was highlighted in the CBBG case example, because all the professionals had to be flexible and expand their roles beyond what was traditionally expected of them. Further, it is important for social workers to maintain their own professional identities in education settings, particularly because schools do not always have the same priorities as social workers do. Often, interprofessional

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practice in education settings requires social workers to advocate on behalf of vulnerable, often marginalized, children and their families. This must also be done with great flexibility due to the highly structured nature of educational systems. There is no doubt that social workers’ professional identities and roles may shift or adapt at times according to the needs of the collaboration. Further, social workers must pay careful attention to the personal characteristics of the team members, including themselves. Trust, respect, and the perceived value of the collaboration should not be assumed among members of a collaborative team. Social workers, especially those in leadership positions, should actively foster development of these characteristics among team members. This may include formal and informal strategies, such as problem-solving activities, open communication, and substantial opportunity for teamwork. Social workers also need to navigate conflict within the collaboration to maintain trust and respect, while staying focused on the collaboration’s shared goals. An intentional reflection on process may prove especially useful in thwarting conflicts that have a negative impact on the collaboration. The MIC (Bronstein, 2003) highlights areas of focus for improving interprofessional collaboration in schools. Case examples such as the CBBG illuminate these possibilities and draw attention to the potential opportunities for future interprofessional collaborations serving children, youths, and families in schools. Social workers are often positioned to provide leadership for interprofessional collaborations in education settings. It is critical that they are prepared for these roles and for both the challenges and opportunities that these collaborative teams hold.

Reflection Questions 1. How did the professionals on the CBBG leadership team engage diversity and difference in their interprofessional approach to CBBG? 2. What were the contributions of each profession to addressing the broadband gap as a social justice issue?

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Miller, P. M., & Bourgeois, A. K. (2013). Considering the geographic dispersion of homeless and highly mobile students and families. Educational Researcher, 42(4), 242–249. doi:10.3102/0013189x12474064 National Association of Social Workers. (2008). Code of ethics of the National Association of Social Workers. Washington, DC: NASW Press. No Child Left Behind Act, 107–110, 20 U.S.C. § 6319 (2001). Noguera, P. (2009). The trouble with Black boys . . . and other reflections on race, equity, and the future of public education. New York, NY: Jossey-Bass. Olmstead, C. (2013). Using technology to increase parent involvement in schools. TechTrends, 57(6), 28–37. doi:10.1007/s11528-013-0699-0 Prieger, J. E. (2015). The broadband digital divide and the benefits of mobile broadband for minorities. Journal of Economic Inequality, 13(3), 373–400. doi:10.1007/ s10888-015-9296-0 Robinson, J. P., & Espelage, D. L. (2011). Inequities in educational and psychological outcomes between LGBTQ and straight students in middle and high school. Educational Researcher, 40(7), 315–330. doi:10.3102/0013189x11422112 Shor, R. (2010). Interdisciplinary collaboration between social workers and dieticians in nutrition education programs for children-at-risk. Social Work in Health Care, 49(4), 345–361. doi:10.1080/00981380903364775 Ward, H., Drew, H., Lasseigne, A., & Anderson-Butcher, D. (2012). Effective strategies for involving parents in schools. In C. Franklin, M. B., Harris, & P. Allen-Meares (Eds.), The school services sourcebook: A guide for school-based professionals (2nd ed., pp. 633–644). New York, NY: Oxford University Press. Warren, M. R., Hong, S., Rubin, C. L., & Uy, P. S. (2009). Beyond the bake sale: A community-based relational approach to parent engagement in schools. Teachers College Record, 111(9), 2209–2254. Retrieved from http://www.lsna.net/ content/2/documents/beyond_the_bake_sale.pdf

Chapter 5

Criminal Justice Alana J. Gunn, Kelli E. Canada, and Joan M. Blakey

T

his chapter addresses the following 2015 Educational Policy and Accreditation Standards competencies (Council on Social Work Education [CSWE], 2015):

• • •

Competency 2: Engage Diversity and Difference in Practice Competency 3: Advance Human Rights and Social, Economic, and Environmental Justice Competency 8: Intervene with Individuals, Families, Groups, Organizations, and Communities

Importance of Interprofessional Collaboration in Criminal Justice Settings Currently, there are approximately 2 million persons incarcerated in U.S. prisons and jails (Travis, Crayton, & Mukamal, 2009). This marks a 300% increase from the approximately 500,000 individuals imprisoned in the late 1970s (Lamb & Wienberger, 2005). When considering specific types of detainment, there are clear differences between 63

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jails and prisons. Jails are locally operated institutions for individuals who are awaiting sentencing and those serving sentences of less than 1 year, typically for a misdemeanor (Carson, 2015). Prisons, on the other hand, predominantly are for individuals who have been charged with felonies requiring longer term imprisonment (Carson, 2015). Even though prisons and jails detain individuals with varying sentences and offenses, incarcerated individuals often interface with both systems and experience common barriers to successful reintegration (Freudenberg, 2001). These similar challenges include individual-level factors, such as drug use, mental health disorders, chronic medical health conditions, and lack of educational and vocational skills (Vigne, Mamalian, Travis, & Visher, 2003; Visher & Travis, 2011), as well as more structural impediments of inequities in access to health care (Olphen, Eliason, Freudenberg, & Barnes, 2009), stigma, and discriminatory policies (Binswanger, Krueger, & Steiner, 2009; Olphen et al., 2009).

High Prevalence of Co-Occurring Disorders Among the Incarcerated Population Men and women who interface with criminal justice systems experience myriad health challenges. Estimates suggest that between 16% and 24% of the 2 million individuals who are incarcerated have been diagnosed with major depression, schizophrenia, bipolar disorder, or other psychotic disorders (Lamb & Weinberger, 2005). The rates of drug use are even more alarming, with estimates of 50% of incarcerated individuals meeting the criteria for a substance use disorder (Chandler, Fletcher, & Volkow, 2009; Mumola & Karberg, 2006). In fact, jails and prisons hold more individuals with substance abuse and mental health problems than mental health facilities do (Harner & Riley, 2013). Unfortunately, many of these individuals are also economically disadvantaged, with the majority of those incarcerated coming from communities with high levels of concentrated poverty, with little to no education (Western, Lopoo & McLanahan, 2004; Western & Muller, 2013). Men who are not college educated are about six times more likely to be in prison than men who

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have gone beyond a high school education (Western & Pettit, 2002), with rates as high as 80% (Sampson & Loeffler, 2010).

Women Are the Fastest Growing Population Although the number of incarcerated individuals has risen in general, the greatest increase has occurred among women (Lawston, 2008; Women’s Prison Association, 2009). The number of incarcerated women in state and federal jurisdictions in the United States increased at an average rate of 3.3% between 2000 and 2006; the corresponding figure for males was 2.0% (Moloney, van den Bergh, & Moller, 2009). This rise in female imprisonment can be attributed to the pervasive effect of stringent drug policies and the disproportionate impact of substance use, illness, and trauma on women’s pathways into carceral systems (Moloney et al., 2009; Olphen et al., 2009). Incarcerated women are 10 times more likely to abuse drugs, including 27 times more likely to use cocaine, than women in the general population (Charles, Abram, McClelland, & Teplin, 2003; Covington, 1998). In terms of trauma, approximately 70% to 90% of women in prisons report a history of sexual and physical abuse (Jordan et al., 2002; Messina, Burdon & Pendergast, 2006), which is a much higher rate than in the general population (Bartlett & Hollins, 2018; Pimlott-Kubiak & Cortina, 2003). Additionally, women in prisons and jails have a much higher rate of diagnosed mental health problems than their male counterparts, with rates of 73% and 55%, respectively (Abram, Teplin & McClelland, 2003; Charles et al., 2003). Nevertheless, men and women enter prisons and jails with a plethora of needs that must be met (Duwe, 2013; Visher, LaVigne, & Travis, 2004). These needs include access to medication, mental health evaluations (Theriot & Segal, 2005), and drug use assessments and treatment (Freudenberg, Daniels, Crum, Perkins, & Richie, 2005), as well as health-care needs, such as screening for communicable diseases and medication to manage diabetes, asthma, and high blood pressure (Lee, Fordyce, & Rich, 2007). This is why scholars suggest that prisons are

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the primary health-care providers for poor and ill individuals (Harner & Riley, 2013; Reingle Gonzalez & Connell, 2014). Unfortunately, the tough on crime policies started in the 1970s (Andrews & Bonta, 2010) have led to a current climate that continues to criminalize illicit drug use and distribution, as well as institute mandatory minimum sentencing, removing judicial discretion for certain offenses (Olphen et al., 2009). As such, this policy context can shape an individual’s pathway into incarceration and continue to affect their lives after incarceration. Federal bans on social services and laws, such as “One Strike, You’re Out” for example, disbar formerly incarcerated individuals with felonies from accessing critical resources of employment, housing, and education on release (Allard, 2002; Olphen et al., 2009). With this shift from rehabilitation to criminalization, individuals often face significant barriers to addressing the factors that promote criminal involvement, social disadvantage, and illness after incarceration (Burke, 2002; Travis, 2005).

Interprofessional Collaboration and Other Decarceration Initiatives In recent decades, there has been a growing response to addressing the complex circumstances of incarcerated men and women amidst the stringent policy climate. Practitioners, policy makers, and researchers have begun to work collaboratively across professional disciplines to develop therapeutic interventions at the court level and to promote healthy reentry back into families and communities (Hora, Schma, & Rosenthal, 1999; Winick, 2002). Interprofessional collaboration speaks to this process in which a group of people work together across professions to figure out how best to meet the needs of clients who become involved with the criminal justice system (Freeth, Reeves, Koppel, Hammick, & Barr, 2005; Krvanstrom, 2008). Together, these individuals bring their unique strengths and orientations to create a dynamic that enhances overall treatment for clients. In addition, this approach values the voices of clients and their needs (Bronstein, 2003; Easen, Atkins, & Dyson, 2000), which is a critical component

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considering the level of marginalization faced by incarcerated populations. Given the needs of justice-involved populations and the limited ability of the criminal justice system to adequately address them (Lamb & Weinberger, 2005), an interprofessional approach offers a critical opportunity to intervene regarding problems of illness, substance use, and disadvantage. Jails and prisons are implementing a variety of interprofessional collaborations to meet the needs of incarcerated individuals. Some initiatives include social workers partnering with the prison hospice system to provide services to dying prisoners and to promote common missions of safety and stability (Bronstein & Wright, 2007). Prisons are also working with medical and social service professionals to address the pre- and postrelease sexual health needs of incarcerated individuals managing risks of HIV (Wohl et al., 2011) and to decrease homelessness, increase educational opportunities, and improve employment outcomes on reentry (CASES, 2016; Duwe, 2013).

Problem-Solving Courts: An Emerging Innovation Problem-solving courts are another innovative example of initiatives designed to reduce the incarcerated population by providing specialized services to address the ills that may have caused or contributed to their illegal involvement (Epperson, Thompson, & Canada, 2013; Hora, 2011). A core component across these courts is the use of an interprofessional team approach to first divert individuals from entering the criminal justice system and then target each individual’s underlying problems (Canada & Gunn, 2013; Hora, 2011; Huddleston & Marlowe, 2011; Huddleston, Marlowe, & Casebolt, 2008). Prior to problem-solving courts, the criminal justice system was a revolving door for lower-level issues such as drug abuse, mental health, and prostitution (Schweig, Malangone, & Goodman, 2012). Currently, more than 3,000 problem-solving courts nationwide address a spectrum of social issues (e.g., gambling, homelessness, vandalism, mental health, gun control, reentry, truancy, child support, and prostitution) and populations (e.g., veterans, domestic violence batterers, homeless; Epperson et al., 2011; Wolff, 2002).

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Problem-solving courts are led by one judge, a team of court officials, probation officers, social workers, and treatment professionals who work collaboratively to link participants with community-based services and treatments to support behavioral change (Hora, 2011; Huddleston & Marlowe, 2011). The team collectively develops a plan that often includes intensive supervision, regular court appearances, and ongoing substance abuse and mental health treatment intended to help participants address unmet service needs that can lead to future offending (Huddleston & Marlowe, 2011). Finally, sanctions and incentives are used to promote behavior change and compliance with the courts. Although research has shown great promise in the problem-solving court model, additional exploration is needed to understand its collaborative culture and intervention implications (Goldkamp, White, & Robinson, 2001). The remainder of this chapter uses the MIC (Bronstein, 2003) as a lens to examine contemporary issues faced by criminal justice-involved populations who interface with problem-solving courts. As the United States begins to move toward efforts to deincarcerate (Pettus-Davis & Epperson, 2014), it is vital that we examine these alternative models and their implications for promoting interprofessional collaborative practice.

Interprofessional Collaboration Example Rhonda1 is a 23-year-old African American mother of two children living in Chicago. She was referred to a problem-solving court by her social worker, Ms. Leah Wilson,2 who thought her needs would best be served through diversion programming. Three months prior, Rhonda was arrested for shoplifting from a retail store. She also was in possession of drugs. During the past 4 years Rhonda had been charged with several misdemeanors for solicitation of prostitution and possession of a controlled substance. 1. “Rhonda” is a pseudonym and is based on the compilation of multiple clients with whom authors worked during their practice. All potentially identifying information has been modified for purpose of confidentiality. 2. “Ms. Leah Wilson” is a pseudonym.

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Rhonda’s Background At the age of 15, Rhonda ran away from home and began staying with friends and her favorite aunt after experiencing sexual abuse by her mother’s romantic partner. As a result of experiencing a great deal of instability, Rhonda did not graduate from high school. Rhonda was introduced to marijuana by a boyfriend, which quickly led to experimentation with drugs, such as heroin, at various house parties. Around her 20th birthday, she began exchanging sex for money to pay her bills. Although Rhonda wanted to work a traditional job, she was unable to maintain a position because of her extreme moods, which fluctuated between periods of elation and depression. Rhonda never sought help for her mood changes because she was uninsured until she became pregnant at age 20. At that time, she received public aid and medical insurance, which allowed her to see a psychiatrist for the first time in her life and led to a diagnosis of bipolar I disorder. When Rhonda was 24, her 7-month-old son and 3-year-old daughter began living with her mother, who has temporary custody of them. Rhonda and her mother have a strained relationship stemming from the sexual abuse, but they communicate for the children’s sake. Before her arrest, Rhonda shared an apartment with a high school friend and stayed with her mother sometimes to spend time with the children. Rhonda does not feel supported by her mother, because her mother often tells her, “You will always be an addict; you will never change.”

Mental Health Court Rhonda will be working with a mental health court team. Mental health courts are voluntary, court-based, rehabilitation programs involving an interprofessional team of criminal justice and mental health professionals. The mental health court team consists of a judge, a probation officer, the mental health court administrator, a defense attorney, and social workers and/or case managers from community-based agencies. The mental health court team, headed by the judge, meets weekly to discuss participants on the court docket. Each team member provides updates

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on the participant’s treatment engagement and compliance with court orders. Although mental health courts vary, most facilitate client engagement in case management services, mental health and substance use treatment, vocational training, and social skills training. These services are often provided by contracted community service agencies. On entry into the mental health court, the team works together to identify an individualized treatment plan for court participants.

Rhonda’s Individual Treatment Plan Ms. Wilson hopes that through wraparound services, the diversion programming will help Rhonda address the reasons she keeps getting arrested and may be helpful to turn her life around. The prosecutor and mental health team reviewed Rhonda’s case and accepted her into the mental health court program. The judge informed Rhonda of the conditions of participation, which included treatment adherence, attending weekly court hearings, abstaining from substances, and attending meetings with Rhonda’s probation officer. Rhonda agreed to these court conditions and accepted admittance into the mental health court program. As such, the mental health court team referred Rhonda to a residential drug and mental health treatment provider located on the south side of Chicago. Following an initial assessment, Rhonda’s residential treatment providers, which included a team of social workers and professional counselors, worked with Rhonda to develop a treatment plan unique to her needs. Rhonda’s treatment plan included attendance at weekly women’s empowerment meetings, weekly drug counseling, and biweekly meetings with a psychiatrist. She was also required to participate in case management, submit to random urine analyses, and attend weekly court hearings before the mental health court judge. Rhonda visits with family and friends; however, she is prohibited from fraternizing with people on probation (i.e., many people in her family and primary support network) and is encouraged to refrain from romantic relationships. Rhonda is expected to work with her mental health court case manager on locating employment

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opportunities and safe housing. Rhonda’s residential treatment team provides the mental health court case manager with regular updates on Rhonda’s progress, treatment adherence, and sobriety. These updates are shared with the entire mental health court team in meetings prior to the weekly court docket.

Challenges and Barriers Although Rhonda feels the drug treatment program is providing needed support, she believes the program administrators treat her like a child, promoting norms that reinforce a culture of patronization, because the women are often told what to wear and the kind of language that “a proper lady should use.” A few times, Rhonda heard her peers at the treatment center make remarks in group like, “I wasn’t that kind of druggie. I never sold myself,” which made Rhonda very uncomfortable. Rhonda is struggling to find employment opportunities, because she is having difficultly explaining her gaps in employment. She believes potential employers and housing authorities judge her because of her past drug use and solicitation charges. In addition, Rhonda wants to eventually get her children back, but she is having challenges with her mother, who is making it hard for her to see her children. Although Rhonda has been sober, she told Ms. Wilson that the issues with her mother are weighing on her and making her want to use again. She voiced her concerns to the mental health court caseworker. The judge has praised Rhonda for her resilience and sobriety. Rhonda has successfully completed 2 months of the mental health court and is expected to graduate in 10 months, if she continues to do well in the program.

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Application of the Model for Interdisciplinary Collaboration Interdependence Interdependence, a key component of interprofessional collaboration, occurs when professionals rely on one another and merge their expertise to achieve better client outcomes and provide more responsive services (Bronstein, 2003). Problem-solving courts only work if people from different professions (judge, probation officer, nurse, social workers/caseworker, psychiatrists/psychologists/therapist, other social service providers) work together and rely on one another’s expertise to create a shared vision (i.e., develop a system that meets the needs of participants). The growing complexity of health problems that often result from legacies of underuse of services makes this kind of interdependence key (D’Amour, Ferrada-Videla, San Martin Rodriguez, & Beaulieu, 2005). Addressing such a diversity of needs through an interdependent practice model advances the human rights of clients to have access to services attuned to their complex lives. This interdependence was particularly important in Rhonda’s case to address her complex circumstances. Rhonda has a history of trauma and unresolved pain. She also is embedded in a family system where her mother may be experiencing her own unresolved trauma and feelings of mistrust, as she has witnessed Rhonda’s past struggles with addiction and criminal activities. She also has a drug use problem that can further impede her ability to secure employment, regain custody of her children, and desist from crime. Thus, it was important for Rhonda’s team to establish a culture of interdependency to best use their diversity of expertise to address her complexity of needs. In her case, professional identities were well-defined and team members were comfortable asserting their roles as part of a collective. Moreover, they were all secure with sharing and merging knowledge with other mental health team members to maximize creativity to meet their client’s needs. Rhonda’s social worker relied on her team members’ expertise to make sure she received the support to adhere to her

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treatment plan. For example, the social workers collaborated with the drug treatment agency, criminal justice, and mental health professionals to understand her co-occurring illness and trauma history and how each system could be responsive to this. Through this partnership, the team intervened to address Rhonda’s intersectional issues in a specialized way, which incorporated an understanding of trauma, deepened their cultural awareness of varying populations, and fundamentally diversified the team’s skills and orientation to practice. Moreover, Rhonda’s social worker served as her client advocate through sharing insights with the other treatment staff and mental health court team members regarding the drug treatment culture and its lack of sensitivity to Rhonda’s challenging past with trauma. There is a great deal of empirical support, for example, for an integrated approach to treating trauma and substance abuse. Many substance abuse treatment programs, however, have been slow to embrace integrated models of practice (Blakey & Bowers, 2014). Interdependency, which is embedded in the intervention strategy, nonetheless allowed Rhonda’s team to cultivate a culture that effectively refined the treatment plan to consider the potential role of trauma and to promote Rhonda’s sense of empowerment, while addressing her substance use problems. This interdependent approach promoted Rhonda’s need for trauma-informed care, which advances her rights to socially just and responsive services. Social workers must form an alliance with participants, while also maintaining an alliance with other team members. This is particularly challenging when both the court and the individual being served are your clients. You must figure out how to balance the needs of both, as well as to identify under what circumstances a client’s need takes precedence over the others. Moreover, you are a member of the team, as well as an individual. Thus, being on a problem-solving court team does not absolve social workers from responsibility to discern whether a certain course of action is in accordance with our core principles of social justice, empowerment, self-determination, dignity, and respect.

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Newly Created Professional Activities Newly created professional activities, the unplanned joint initiatives and structures that emerge through the collaborative process, is a second component of interprofessional collaboration. Rhonda is working to access and maintain employment. Financial insecurity, lack of employment, and detachment from the labor market are key reasons both men and women recidivate (Travis, 2005; Vigne et al., 2003). For Rhonda, the task of finding a job becomes incredibly complex, as she lacks previous work experience and specialized skills. Rhonda’s challenges to acquiring employment are common among populations in the criminal justice system, making the support of a collaborative team essential. In this instance, Rhonda needed to work with community organizations with specialized knowledge in helping the formerly incarcerated obtain employment. This was an unplanned activity that emerged through collaborative information sharing and a deeper understanding of Rhonda’s unique needs. An important component of these newly created activities involved the mental health court team attending training to help them understand the role that stigma plays in marginalizing populations with substance use, incarceration, and/or mental health disorders. Studies show that women, particularly of color, face additional burdens of stigma, because their involvement with crime may be looked on as a greater deviation from the normal expectations for women (Gunn & Canada, 2015; Gunn, Sacks, & Jemal, 2016; O’Brien, 2001; Olphen et al., 2009; Sanders, 2014). Like many women, Rhonda faced perceived stigmatization due to societal beliefs about her intersecting drug use, criminal involvement, and mental illness experiences. Rhonda also experienced internalized stigmatization, because she felt shame as a result of her illness and how it shaped her criminal involvement and affected her ability to maintain employment and take care of her family. This newly created professional activity of engaging in specialized trainings allowed the team to understand Rhonda’s barriers to community reentry and to assist her in managing potential stigmas in a culturally responsive way.

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Attending training that promotes Rhonda’s ability to navigate various oppressions also advances social justice. With a deepened understanding of the barriers to reentry, these stakeholders recraft their professional tasks to advance Rhonda’s human right to services, which can promote her ability to advocate for herself. This kind of staff training and awareness building is incredibly important for individuals such as Rhonda, who are situated at the intersection of many challenges to reentry due to their experiences with economic, racialized, and gendered oppressions. Trainings such as these cultivate greater awareness and cultural responsivity in professional contexts. Social workers must educate and propose creative solutions. In addition, social workers must advocate for clients and provide insights to complex problems, which often lead them and the team to pursue unplanned intervention strategies. These unplanned initiatives are critical to the process. Clients who interface with problem-solving courts face myriad complex problems of trauma, illness, discrimination, and poverty, requiring teams of professionals to gain knowledge outside of their realm of expertise. Moreover, they are often embedded in family systems that are also entrenched in poverty, illness, and trauma. Interprofessional practice requires professionals to create a shared program of unintended practices that respond to their unique multilayered circumstances.

Flexibility Flexibility is a third component of interprofessional collaboration; it consists of deliberate attempts to alter roles to fit the context. Flexibility is an essential part of the problem-solving court model. In this model, the judge, probation officer, and social service professionals use their skills and expertise to meet the needs of clients (Hora, 2011; Huddleston & Marlowe, 2011; Huddleston et al., 2008). Sometimes the role of the social worker looks very much like the role of the court officials. Social workers who work with problem-solving courts often have two clients: the problem-solving court team of which they are members and the client. Sometimes these roles conflict, which

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occurred in Rhonda’s case. Rhonda, for example, was sanctioned because she did not adhere to the stipulations of the treatment plan. Ms. Wilson had to act as an enforcer when Rhonda’s urine analysis was positive for substances, because the social worker was required to tell other members of the mental health court team that Rhonda had been noncompliant. Monitoring the client’s progress and ensuring that clients are adhering to court mandates can conflict with the therapeutic process. As in Rhonda’s case, social workers in the mental health court team model will have to manage how their role becomes ambiguous—feeling at one moment like an advocate helping to empower and build the client’s self-efficacy and at another moment feeling like a law enforcer. Managing the duality of these roles is critical for social workers on the mental health court team as they advocate for clients such as Rhonda, who may have significant histories of surveillance and disempowerment. Like the social worker, other professional staff will have to be flexible to meet the needs of the client and the cultural context of problem-solving courts. Judges, for example, do not traditionally develop relationships with defendants in their courts. However, the problem-solving court model relies on the flexibility of the judge to provide support and build rapport while also sanctioning people when they are noncompliant with court orders. Probation and court officials also do not traditionally view defendants’ cases through a therapeutic lens. The problem-solving model, however, required the judge and probation officer to understand the underlying motivations that may contribute to Rhonda’s behavior and mete out justice that is sensitive to her needs for healing from intersecting trauma, illness, and substance use. Only with this level of professional flexibility was the team able to responsively promote Rhonda’s well-being in ways that advance her rights to attuned services. Social workers must be good consumers of research, which requires flexibility because it means that our roles and practice may change as new information becomes available. For example, historically, confrontational methods routinely were used in substance abuse treatment settings. The goal of confrontational methods was to break

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down a client’s denial. As research regarding trauma became more available, it suggested that these methods were very harmful to clients and, in fact, could retraumatize clients. Studies have found that many social service professionals remain wedded to traditional treatment approaches, despite new information that other approaches, such as providing clients with integrated treatment, are best (Grella, 2003). As research continues to progress, problem-solving court best practices must continue to evolve to incorporate more trauma-informed practices that are responsive to clients’ complex illness experiences and histories. Moreover, integrating new professionals or service providers into existing teams requires flexibility. Problem-solving court teams can change over time as new members (e.g., service providers) join the team or team members take on new roles. The team should work together to determine a communication strategy that works best for all team members.

Collective Ownership of Goals The fourth component of interprofessional collaboration involves having collective ownership of the treatment goals and the process of reaching these aims. The most effective problem-solving teams possess a collective commitment and investment in the overall treatment goals established by professionals and participants alike. There are essentially two sets of goals for problem-solving court participants. One set of goals is defined by the court teams and involves compliance with court orders (e.g., no new arrests, abstinence from substances, attendance to court hearing). The other set of goals is established by the treatment providers and client and is based on the individual treatment needs of the client. Rhonda has no input into the development of the court goals. The court goals were defined for her and implemented when she agreed to participate in the mental health court process. Rhonda’s treatment goals, however, were developed collaboratively with Rhonda and her treatment team at the inpatient substance use facility. Rhonda’s social worker communicated the treatment goals to the mental health court team. Treatment providers evaluate Rhonda’s

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progress toward treatment goals through weekly assessments. Similarly, Rhonda’s mental health court team evaluates progress toward court goals during each staff meeting prior to the weekly court docket. Rhonda’s progress toward completion of the mental health court program depends on reaching established treatment and court goals. In Rhonda’s case, team members had slightly different visions of what Rhonda’s goals should be. It became clear, for example, that Rhonda’s substance use goals were coming into conflict with the goal for her to seek employment. When this tension emerged, the mental health court team worked closely to reclarify their mutual goals for helping Rhonda create stability and a life of desistance from crime. Although employment is critical, substance use poses an incredible barrier to not only accessing a job, but also to maintaining the resources to help sustain employment. Thus, the team sought to intervene in offering Rhonda responsive care that reemphasized the primacy of drug abstinence and merged their visions into the overarching mission of the team. Also important is an understanding that the collective ownership of goals must include buy-in and investment from the client. Thus, Rhonda also played a part in this process by communicating what she saw as her goals for her life and how those goals aligned with the team’s communicated goals. One goal Rhonda expressed was a desire to strengthen her relationship with her children. Thus, the team had to work together to strengthen their collective ownership of the goals and to address and validate Rhonda’s goals. This process of including Rhonda’s voice and family planning needs strengthened and promoted a unified investment in the goals and further advanced her human rights to responsive care. Buy-in is an essential part of interprofessional collaboration. It is important to understand that the collective ownership of goals must include not just the professionals’ investment, but that of the client as well. Clients must be a part of this process to strengthen and promote a unified investment of the goals. Moreover, promoting client buy-in advances their rights to be engaged in a collaborative network of responsive services. However, in the process of cultivating collective ownership, we must remember that conflict is inevitable. For instance,

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there may be times when social workers find that their duties as part of the team do not fully align with their overall commitment to the core values of the social work profession. Social workers are advocates who seek to empower clients and further an agenda of greater social change. Questions may arise as to whether there is even room for individual members to promote larger structural change while also promoting the goals of the collective. A social worker must grapple with this duality to embrace commitment of the larger goals of the problem-solving courts, which target public safety and participant’s desistance from crime.

Reflection on Process The fifth component of interprofessional collaboration involves the ability of the team to reflect and pay attention to the process of working together, thereby deeply evaluating their working relationship and incorporating member feedback. Reflection in interprofessional collaborations requires that professionals work together to understand what is and what is not working, assess areas of practice that are strong and those that need improvement, reflect on points in time where they have contrasting opinions, and examine the overall process to best serve participants. For problem-solving courts to promote interprofessional collaboration, there must be an understanding that reflection strengthens the process. Effective problem-solving courts focus on the process of working together as a team to foster trust and respect for the process and for each individual’s role. Having a specified time and space to reflect on the process of working with one another and the potential impacts of court processes on clients can strengthen the problem-solving court model. Moreover, feedback loops can help programs assess and evaluate practice. Problem-solving courts evaluate and reflect on their processes in several ways, which has been a critical component of their success. The first way the mental health court uses reflection is through regular (e.g., weekly, bimonthly) team meetings. These meetings allow reflection on process-oriented, as well as task-oriented, topics and help create a more cohesive team.

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Another mechanism that allowed mental health court team members to discuss their process of working together to strengthen collaboration was their work with the Council of State Governments (CSG) Justice Center. This nonprofit agency worked with the mental health court team to provide technical assistance and training for practitioners and court officials aimed at strengthening their personal and professional development and promoting deeper understanding of the larger criminal justice issues that affect the mental health court model overall. The mental health court team’s work with CSG also helped cultivate a deeper appreciation for the team’s diversity of skill sets, as well as their professional and personal backgrounds, because some of the social workers and counselors had personal experiences with the same problems facing Rhonda. The team understood that their personal skills and background experiences would significantly influence the process of reflection. The CSG-led training allowed the mental health court team to build a stronger collaborative link inclusive of the diverse talents and backgrounds of its members to promote their process of working together. For this reflection to be genuine and authentic, it is essential for all team members to feel safe and secure in providing their perspectives without fear of retribution. Rhonda took part in a well-established mental health court. Rhonda’s mental health court team had worked together since the court was originally established 6 years before. In the early years of Rhonda’s mental health court, team members did not have rapport and did not provide one another genuine reflection opportunities. As the team gained trust with one another and built rapport, however, reflection on their practices became a regular part of their work. In predocket staff meetings, team members feel free to remind each other of their roles if members overstep their roles. Rhonda saw collaboration and mutual respect between mental health court team members in the courtroom during hearings. Without reflection, this mental health court team may not have been able to provide Rhonda with the collaborative care she required. Fundamentally, this reflection is critical to holistically intervening in the lives

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of clients such as Rhonda who face complex illness and trauma needs that require an innovative approach to care.

Application of the Influences on Interprofessional Collaboration Four factors can facilitate or thwart collaboration: professional role, structural characteristics, personal characteristics, and history of collaboration. Each factor is discussed individually as it relates to the problem-solving court team in Rhonda’s case.

Professional Role Problem-solving court teams include a diverse group of professionals trained with unique and, at times, conflicting perspectives on reasons for criminal justice involvement, interpretation of behaviors, and effective responses to behaviors. Social workers, for example, view problems through a social justice lens, assessments using a strengths-based approach, and intervention through harm reduction. A probation officer or court administrator is trained through a criminology lens, through which trauma or victimization may not be as important to consider when thinking about sanctions to crime. Professionals with training in criminal justice are often required to use an abstinence approach with substance use. Each of the professionals on problem-solving court teams must remain true to their profession’s values and ethics. They must also respect their fellow team members and their unique roles. Successful interprofessional collaboration in problem-solving court teams requires a strong and equal commitment to their profession and to their team. When reflecting on practices, as discussed previously, it may be helpful for problem-solving court members to periodically remind members of the boundaries of their role and how they can work within those boundaries while being a strong team member.

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One pertinent example for social workers on problem-solving court teams is the bounds of confidentiality and how much client information social workers should share with the team. If Rhonda tells her mental health court caseworker that she is stressed out and thinks about using drugs to cope, should the caseworker share this information with the team? The answer depends on the policies of the court program. If the mental health court caseworker does share this kind of information with the team, Rhonda should know the limits of confidentiality at the onset of working with the caseworker and should be provided with reminders of those limits throughout. Mental health court caseworkers need to be mindful of the possible dual role they have with court participants. Social workers will have to balance their commitment to building rapport and maintaining confidentiality with sharing progress about the client’s recovery to the problem-solving court team. This balance, in part, can be achieved by clearly discussing and describing unique roles and professional values with the team.

Structural Characteristics Structural characteristics, such as the size of caseloads, agency culture, and professional autonomy in agencies, are challenging to navigate in problem-solving courts. Because mental health courts can interface with dozens of community providers, it is challenging to manage all structural barriers they may face. For example, the substance use counselors as well as the transitional employment caseworkers have high caseloads because of the turnover at their agencies. The quality of Rhonda’s care and the communication among community agency social workers, professional counselors, and other members of the mental health court team may suffer due to these constraints of high caseloads and not having sufficient time to complete all necessary tasks. This significant structural factor potentially posed challenges to Rhonda’s interprofessional team. When team members face external agency-specific challenges such as this, it impedes their ability to invest in a case uniquely and in the collaboration process overall. Nonetheless, Rhonda’s diverse team established clear expectations

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for communication and quality of care, as well as for a system of ongoing evaluation to account for changes in resources and staff capacity. Their system of accountability and evaluation allowed for open communication; moreover, it minimized the structural challenges that can affect problem-solving court collaborations and challenge their ability to advance clients’ multidimensional rights.

Personal Characteristics Personal characteristics of problem-solving court team members can greatly affect how well the team works together to properly intervene in their clients’ lives. Team members may bring different background experiences and values that shape how they see other team members or the team process. For example, some team members may be managing their own histories of incarceration and/or substance use that may shape their personal characteristics and orientation toward engaging in collaborative practice. Applying self-awareness in acknowledging and managing one’s varied personal experiences is a critical step in promoting interprofessional team collaboration. This is important not only for meeting the clients’ needs, but also for upholding the commitment to engaging diversity in practice in the social work profession. The team members must manage their personal characteristics in ways that allow them to develop and maintain trust. Developing trust among team members may take differing amounts of time and can mean different things for each team member. Developing and cultivating respect for each other’s views and profession takes time, as each team member brings a unique history of personal experiences to the collaboration. Nonetheless, this developmental process is integral to healthy collaborative work, which considers the ways in which personal characteristics can shape a team’s ability to intervene in the lives of clients and communities. Having a team of individuals with a shared vision or passion (i.e., helping participants address the underlying causes that often contribute to crime) for the topic can enhance successful collaboration. For example, Rhonda’s mental health court team was passionate about criminal

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justice reform and with finding alternatives to incarceration for people with co-occurring disorders like Rhonda. They also understood the cycles of drug use and acknowledged that recovery is not a one-way street. To this end, Rhonda’s mental health court team supported her rather than punished her for the one time she tested positive for alcohol. The judge encouraged her to get back on track and asked her social worker to help her create a plan to deal with stress to minimize the chance of relapsing. Rhonda learned that the mental health court team all chose to be a part of the program because they wanted to make a difference. Recognizing this made Rhonda exclaim that, “They’re not here just to get the paycheck.” Knowing their desire to help her made all the difference to Rhonda. It was clear that the personal characteristics of the members of Rhonda’s mental health court team and each member’s investment in social change promoted their ability to best meet Rhonda where she was at in her recovery and treatment.

History of Collaboration Having a shared history of collaboration can enhance the likelihood of success. Early social work traditions included deep engagement in courts and corrections (Young & LoMonaco, 2001). However, significant division developed in the mid-1900s because the systems viewed each other as challenging their diverging missions, which created reluctance to work with one another (Fox, 1997; Peters, 2011). Fortunately, in the past few decades problem-solving courts have flourished. Consequently, this has created a reemergence of joint efforts between social work and criminal justice systems. Rhonda’s mental health court team came from varied backgrounds: law, probation, psychology, counseling, and social work. All mental health court team members entered the mental health court with prior positions that required interprofessional collaboration. The judge and public defender worked on teams to serve clients in need of pro bono services. They often collaborated with social service agencies for support and for retrieving client information. The caseworkers and social workers also worked with professionals in prior employment in

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community mental health and hospital social work settings. Although they were accustomed to working across health and mental health professions, they were less experienced working with criminal justice professionals. The probation officer was a trained social worker. Although he had not worked in a traditional social work job, he used his social work education in his day-to-day work. Rhonda’s mental health court team members entered the court team with an understanding that interprofessional collaboration would enhance their work and was essential for providing clientele with comprehensive services.

Conclusion Problem-solving courts offer a promising model for interprofessional collaboration in the criminal justice system. One of the primary strengths of this model is that although professionals come from different professional traditions and training, they demonstrate how teams can function when stakeholders unite to accomplish a shared vision that engages diversity in practice and advances human rights. Problem-solving courts were founded on the ideals that a diverse group of professionals are needed to therapeutically intervene in the lives of people like Rhonda, who are likely to recidivate if they do not receive a coordinated, collaborative response. There are important implications for interprofessional collaboration as it relates to social workers who work with problem-solving courts. Problem-solving courts, in particular, must create a space for the discussion of ethical issues that arise. Organizations such as the National Association of Drug Court Professionals (1997) support professionals in the problem-solving courts to reflect on issues of ethics and how it relates to national recommendations for problem-solving courts. In addition, it is equally helpful to develop a strategy for evaluation of individual problem-solving courts. These evaluations may include feedback loops, through which interprofessional team members discuss which processes are working and which need refinement. There is great potential and strength in social workers working with criminal justice professionals to reduce the number of individuals

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entering the criminal justice system. This kind of collaborative process can promote larger structural and systematic changes in how services are delivered and how vulnerable populations are viewed. The social work field promotes a social justice lens for understanding how micro, mezzo, and macro systems intersect to shape inequalities for marginalized populations. Populations involved with criminal justice systems face myriad structural-, community-, and individual-level barriers that exacerbate their experiences with trauma, substance abuse, and mental health, all of which impede an individual’s healthy reintegration and desistance from crime. Applying this kind of social justice lens to interprofessional collaborative work in criminal justice settings can be critical to promoting transformation in how various systems and professionals in those settings address the needs of clients. Social work and criminal justice professionals have worked independently for decades. In an era of mass incarceration, professionals must come together to form innovative solutions that respect and uphold diversity in practice. Interprofessional collaboration, particularly for vulnerable populations in the criminal justice system with diverse and complex needs, holds great promise for providing intervention to address critical issues. Professionals working in these collaborations may come from different traditions, but with mutual respect, communication, and thoughtful planning, these interprofessional teams have the potential to create lasting and needed social change.

Reflective Questions 1. How do we provide interprofessional collaborative services that are responsive to clients’ histories of trauma and allow for a level of flexibility and diversity in practice that can best meet their complex needs? 2. How can professionals reflect on how their varying levels of privilege and marginalization may shape their personal viewpoints in efforts to promote the team’s commitment to their unified goals as they intervene in the lives of individuals, families, and communities?

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3. How do factors such as race, ethnicity, gender, socioeconomic status, and ability intersect to shape how clients involved in the criminal justice system experience multilevel challenges to their well-being? Moreover, how can interprofessional collaborative practice be culturally responsive to these intersecting statuses in ways that advance human rights and social justice? References Abram, K. M., Teplin, L. A., & McClelland, G. M. (2003). Comorbidity of severe psychiatric disorders and substance use disorders among women in jail. American Journal of Psychiatry, 160(5), 1007–1010. doi:10.1176/appi.ajp.160.5.1007 Allard, P. (2002). Life sentences: Denying welfare benefits to women convicted of drug offenses. Washington, DC: Sentencing Project. Andrews, D. A., & Bonta, J. (2010). Rehabilitating criminal justice policy and practice. Psychology, Public Policy, and Law, 16(1), 39–55. doi:10.1037/a0018362 Bartlett, A., & Hollins, S. (2018). Challenges and mental health needs of women in prison. British Journal of Psychiatry, 212(3), 134–136. doi:10.1192/bjp.2017.42 Binswanger, I. A., Krueger, P. M., & Steiner, J. F. (2009). Prevalence of chronic medical conditions among jail and prison inmates in the United States compared with the general population. Journal of Epidemiology & Community Health, 63(11), 912–919. doi:10.1136/jech.2009.090662 Blakey, J. M., & Bowers, P. H. (2014). Barriers to integrated treatment of substance abuse and trauma among women. Journal of Social Work Practice in the Addictions, 14(3), 250–272. doi:10.1080/1533256X.2014.933731 Bronstein, L. R. (2003). A model for interdisciplinary collaboration. Social Work, 48(3), 297–306. doi:10.1093/sw/48.3.297 Bronstein, L. R., & Wright, K. (2007). The impact of prison hospice: Collaboration among social workers and other professionals in a criminal justice setting that promotes care for the dying. Journal of Social Work in End-of-Life & Palliative Care, 2(4), 85–102. doi:10.1300/j457v02n04_05 Burke, A. C. (2002). Triple jeopardy: Women marginalized by substance abuse, poverty and incarceration. In J. Figueira-McDonough & R. C. Sarri (Eds.), Women at the margins: Neglect, punishment and resistance (pp. 253–269). Binghamton, NY: Hawthorn Press. Canada, K., & Gunn, A. (2013). What factors work in mental health court? A consumer perspective. Journal of Offender Rehabilitation, 52(5), 311–327. doi:10.1080 /10509674.2013.801387 Carson, E. A. (2015). Prisoners in 2014 (NCJ 248955). Washington, DC: U.S. Department of Justice. Retrieved from https://www.bjs.gov/content/pub/pdf/p14.pdf CASES. (2016, December 29). Reentry services. Retrieved from https://www.cases. org/reentry-services/

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Chandler, R. K., Fletcher, B. W., & Volkow, N. D. (2009). Treating drug abuse and addiction in the criminal justice system: Improving public health and safety. JAMA, 301(2), 183–190. doi:10.1001/jama.2008.976 Charles, D. R., Abram, K. M., McClelland, G. M., & Teplin, L. A. (2003). Suicidal ideation and behavior among women in jail. Journal of Contemporary Criminal Justice, 19(1), 65–81. doi:10.1177/1043986202239742 Council on Social Work Education. (2015). Educational policy and accreditation standards. Retrieved from http://www.cswe.org/Accreditation/Standards-and​ -Policies/2015-EPAS Covington, S. S. (1998). Women in prison: Approaches in the treatment of our most invisible population. Women & Therapy, 21(1), 141–155. doi:10.1300/ j015v21n01_03 D’Amour, D., Ferrada-Videla, M., San Martin Rodriguez, L., & Beaulieu, M. D. (2005). The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks. Journal of Interprofessional Care, 19(Suppl. 1), 116–131. doi:10.1080/13561820500082529 Duwe, G. (2013). An evaluation of the Minnesota comprehensive offender reentry plan (MCORP) pilot project: Final report. St. Paul, MN: Minnesota Department of Corrections. Easen, P., Atkins, M., & Dyson, A. (2000). Inter‐professional collaboration and conceptualisations of practice. Children & Society, 14(5), 355–367. doi:10.1111/j.1099-0860.2000.tb00190.x Epperson, M. W., Thompson, J., & Canada, K. E. (2013). Mental health courts. In C. Franklin (Ed.), Encyclopedia of social work online. New York, NY: Oxford University Press. Epperson, M. W., Wolff, N., Morgan, R., Fisher, W., Frueh, B. C., & Huening, J. (2011). The next generation of behavioral health and criminal justice interventions: Improving outcomes by improving interventions. New Brunswick, NJ: Center for Behavioral Health Services and Criminal Justice Research, Rutgers, State University of New Jersey. Fox, V. (1997). Foreword to first edition. In A. R. Roberts & D. W. Springer (Eds.), Social work in juvenile and criminal justice settings (2nd ed., p. xiii). Springfield, IL: Charles C. Thomas. Freeth, D., Reeves, S., Koppel, I., Hammick, M., & Barr, H. (2005). Evaluating interprofessional education: A self-help guide. London, UK: Higher Education Academy Learning and Teaching Support Network for Health Sciences and Practice, Freudenberg, N. (2001). Jails, prisons, and the health of urban populations: A review of the impact of the correctional system on community health. Journal of Urban Health, 78(2), 214–235. doi:10.1093/jurban/78.2.214 Freudenberg, N., Daniels, J., Crum, M., Perkins, T., & Richie, B. E. (2005). Coming home from jail: The social and health consequences of community reentry for women, male adolescents, and their families and communities. American Journal of Public Health, 95(10), 1725–1736. doi:10.2105/ajph.2004.056325 Goldkamp, J. S., White, M. D., & Robinson, J. B. (2001). Do drug courts work? Getting inside the drug court black box. Journal of Drug Issues, 31(1), 27–72. doi:10.1177/002204260103100104

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Grella, C. E. (2003). Contrasting the view of substance misuse and mental health treatment providers on treating the dually diagnosed. Substance Use & Misuse, 38(10), 1433–1466. doi:10.1081/ja-120023393 Gunn, A. J., & Canada, K. E. (2015). Intra-group stigma: Examining peer relationships among women in recovery for addictions. Drugs: Education, Prevention and Policy, 22(3), 281-–292. doi:10.3109/09687637.2015.1021241 Gunn, A. J., Sacks, T. K., & Jemal, A. (2016). “That’s not me anymore”: Resistance strategies for managing intersectional stigmas for women with substance use and incarceration histories. Qualitative Social Work, 17(4), 490–508. doi:10.1177/1473325016680282 Harner, H. M., & Riley, S. (2013). Factors contributing to poor physical health in incarcerated women. Journal of Health Care for the Poor and Underserved, 24(2), 788–801. doi:10.1353/hpu.2013.0059 Hora, P. F. (2011). Courting new solutions using problem-solving justice: Key components, guiding principles, strategies, responses, models, approaches, blueprints and tool kits. Chapman Journal of Criminal Justice, 2(1), 7–16. Retrieved from https://www.ndci.org/wp-content/uploads/CourtingNewSolutions.pdf Hora, P. F., Schma, W. G., & Rosenthal, J. T. (1999). Therapeutic jurisprudence and the drug treatment court movement: Revolutionizing the criminal justice system’s response to drug abuse and crime in America. Notre Dame Law Review, 74(2), 439–537. Retrieved from https://scholarship.law.nd.edu/ndlr/vol74/iss2/4/ Huddleston, C. W., & Marlowe, D. B. (2011). Painting the current picture: A national report card on drug courts and other problem-solving court programs in the United States. Alexandria, VA: National Drug Court Institute. Huddleston, C. W., Marlowe, D. B., & Casebolt, R. (2008). Painting the current picture: A national report card on drug courts and other problem-solving court programs in the United States. Alexandria, VA: National Drug Court Institute. Jordan, B. K., Federman, E. B., Burns, B. J., Schlenger, W. E., Fairbank, J. A., & Caddell, J. M. (2002). Lifetime use of mental health and substance abuse treatment services by incarcerated women felons. Psychiatric Services. 53(3), 317–325. doi:10.1176/appi.ps.53.3.317 Kvarnström, S. (2008). Difficulties in collaboration: A critical incident study of interprofessional healthcare teamwork. Journal of Interprofessional Care, 22(2), 191–203. doi:10.1080/13561820701760600 Lamb, H. R., & Weinberger, L. E. (2005). The shift of psychiatric inpatient care from hospitals to jails and prisons. Journal of the American Academy of Psychiatry and the Law Online, 33(4), 529–534. Retrieved from http://jaapl.org/content/33/4/529 Lawston, J. M. (2008). Women, the criminal justice system, and incarceration: Processes of power, silence, and resistance. NWSA Journal, 20(2), 1–18. Retrieved from https://www.jstor.org/stable/i40002994 Lee, J. D., Fordyce, M. W., & Rich, J. D. (2007). Screening for public purpose: Promoting an evidence-based approach to screening of inmates to improve public health. In R. B. Greifinger (Ed.), Public health behind bars: From prisons to communities (pp. 249–264). New York, NY: Springer. Messina, N., Burdon, W., & Prendergast, M. (2006). Prison-based treatment for drug-dependent women offenders: Treatment versus no treatment. Journal of Psychoactive Drugs, 38(Suppl. 3), 333–343. doi:10.1080/02791072.2006.10400597

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Moloney, K. P., van den Bergh, B. J., & Moller, L. F. (2009). Women in prison: The central issues of gender characteristics and trauma history. Public Health, 123(6), 426–430. doi:10.1016/j.puhe.2009.04.002 Mumola, C. J., & Karberg, J. C. (2006). Drug use and dependence, state and federal prisoners, 2004 (pp. 1–12). Washington, DC: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. National Association of Drug Court Professionals. (1997). Defining drug courts: The key components (NCJ 205621). Washington, DC: U.S. Department of Justice. O’Brien, P. (2001). Making it in the “free world”: Women in transition from prison. Albany, NY: State University of New York Press. Olphen, J. V., Eliason, M. J., Freudenberg, N., & Barnes, M. (2009). Nowhere to go. How stigma limits the options of female drug users after release from jail. Substance Abuse Treatment, Prevention, and Policy, 4(10), 1–10. doi:10.1186/1747-597X-4-10 Peters, C. M. (2011). Social work and juvenile probation: Historical tensions and contemporary convergences. Social Work, 56(4), 355–365. doi:10.1093/sw/56.4.355 Pettus-Davis, C., & Epperson, M. W. (2014). From mass incarceration to smart decarceration (CSD Working papers No. 14-31). St. Louis, MO: Center for Social Development. Pimlott-Kubiak, S., & Cortina, L. M. (2003). Gender, victimization, and outcomes: Reconceptualizing risk. Journal of Consulting and Clinical Psychology, 71(3), 528–539. doi:10.1037/0022-006x.71.3.528 Reingle Gonzalez, J. M., & Connell, N. M. (2014). Mental health of prisoners: Identifying barriers to mental health treatment and medication continuity. American Journal of Public Health, 104(12), 2328–2333. doi:10.2105/ajph.2014.302043 Sampson, R. J., & Loeffler, C. (2010). Punishment’s place: The local concentration of mass incarceration. Daedalus, 139(3), 20–31. doi:10.1162/daed_a_00020 Sanders, J. (2014). Women in narcotics anonymous: Overcoming stigma and shame. New York, NY: Palgrave MacMillian. Schweig, S., Malangone, D., & Goodman. M. (2012). Prostitution diversion programs. New York, NY: Center for Court Innovation. Theriot, M., & Segal, S. (2005). Involvement with the criminal justice system among new clients at outpatient mental health agencies. Psychiatric Services, 56(2), 179–185. doi:10.1176/appi.ps.56.2.179 Travis, J. (2005). But they all come back: Facing the challenges of prisoner reentry. Washington, DC: Urban Institute Press. Travis, J., Crayton, A., & Mukamal, D. A. (2009). A new era in inmate reentry. Corrections Today, 71, 6. Vigne, N. G., Mamalian, C. A., Travis, J., & Visher, C. (2003) A portrait of prisoner reentry in Illinois. Washington, DC: Urban Institute, Justice Policy Center. Visher, C., LaVigne, N., & Travis, J. (2004) Returning home: Understanding the challenges of prisoner reentry. Maryland pilot study: Findings from Baltimore. Washington, DC: Urban Institute Justice Policy Center. Visher, C. A., & Travis, J. (2011). Life on the outside: Returning home after incarceration. Prison Journal, 91(Suppl. 3), 102-119. doi:10.1177/0032885511415228 Western, B., Lopoo, L., & McLanahan, S. (2004). Incarceration and the bonds among parents in fragile families. In M. Pattillo, D. Weiman, & B. Western (Eds.), Imprisoning America: The social effects of mass incarceration (pp. 21–45). New York, NY: Russell Sage Foundation.

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Western, B., & Muller, C. (2013). Mass incarceration, macrosociology, and the poor. ANNALS of the American Academy of Political and Social Science, 647(1), 166–189. doi:10.1177/0002716213475421 Western, B., & Pettit, B. (2002). Beyond crime and punishment: Prisons and inequality. Contexts, 1(3), 37–43. doi:10.1525/ctx.2002.1.3.37 Winick, B. J. (2002). Therapeutic jurisprudence and problem-solving courts. Fordham Urban Law Journal, 30, 1055–1090. Retrieved from https://ir.lawnet.fordham.edu/ ulj/vol30/iss3/4 Wohl, D. A., Scheyett, A., Golin, C. E., White, B., Matuszewski, J., Bowling, M., . . . Earp, J. (2011). Intensive case management before and after prison release is no more effective than comprehensive pre-release discharge planning in linking HIV-infected prisoners to care: A randomized trial. AIDS and Behavior, 15(2), 356–364. doi:10.1007/s10461-010-9843-4 Wolff, N. (2002). Courts as therapeutic agents: Thinking past the novelty of mental health courts. Journal of the American Academy of Psychiatry & the Law, 30(2), 431–437. Retrieved from http://jaapl.org/content/jaapl/30/3/431.full.pdf Women’s Prison Association. (2009). Quick facts: Women & criminal justice 2009. Retrieved from http://www.wpaonline.org/wpaassets/Quick_Facts_Women_and_ CJ_2009_rebrand.pdf Young, D. S., & LoMonaco, S. W. (2001). Incorporating content on offenders and corrections into social work curricula. Journal of Social Work Education, 37(3), 475–489. doi:10.1080/10437797.2001.10779069

Chapter 6

Health Teri Browne, Elizabeth Blake, and Heather McCabe

T

his chapter addresses the following 2015 Educational Policy and Accreditation Standards competencies (CSWE, 2015):

• • •

Competency 1: Demonstrate Ethical and Professional Behavior Competency 4: Engage in Practice-informed Research and Research-informed Practice Competency 8: Intervene with Individuals, Families, Groups, Organizations, and Communities

Importance of Interprofessional Collaboration in Health There is a long history of interdisciplinary collaboration in health settings. Social workers have officially been part of medical teams in the United States since 1905 (Gehlert, 2011). They play important roles on these teams in a variety of micro and macro settings, such as hospitals, outpatient centers, hospice organizations, and free health clinics, as well as private, county, state and federal health services and 93

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policy organizations. In these roles, social workers work with individuals, families, and communities across the life span to deliver a variety of interventions (e.g., patient navigation, supportive counseling, discharge planning, care coordination, care transitions, and community health assessments) to ameliorate psychosocial barriers to health (Browne, 2011b). Health social workers collaborate with a wide variety of professions, such as pharmacists, nurses, physicians, physician assistants, physical therapists, occupational therapists, dietitians, speech language pathologists, genetic counselors, chaplains, psychologists, lawyers, and policymakers. For example, all dialysis clinics in the United States mandate that master’s level social workers be part of the team providing outpatient care to individuals who have kidney failure (Conditions for Coverage for End-Stage Renal Disease, 2011). These teams also include patients, their family members, physicians, nurses, dietitians, and patient care technicians. Together, the interdisciplinary team creates an assessment and care plan for the patients. Nephrology social workers help patients and their families cope with their chronic illness and treatment regimens and deliver interventions, such as health education, emotional support, assistance with vocational rehabilitation, and helping patients obtain kidney transplants (Browne, 2011a). These social workers closely collaborate with their team and with other providers to help patients. For example, when a patient has a high phosphorus level, social workers can coordinate with medical and nursing colleagues to help the patient understand the importance of taking phosphorus binder medications, work with the team and the patient’s community pharmacist to reduce the patient’s pill burden and reduce the total number of pills the patient takes each day, and partner with the dietitian to help the patient address barriers to purchasing low-phosphorus food (Browne & Merighi, 2010). Social workers in many settings perform similar clinical tasks coordinating care and improving patient outcomes. Social workers in any health setting probably help patients self-manage their medications, diet, and other care regimens. This can be done in outpatient settings, such as a primary care office or a diabetes clinic, and in hospitals.

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Collaboration is critically important in all medical settings. Health-care delivery in the United States was significantly transformed by the Patient Protection and Affordable Care Act (2010) and other reform efforts. This paradigm for health delivery (Anand & Parekh, 2014) necessitates collaborative team interventions (Iglehart, 2013; Leppin et al., 2014; Medicare Payment Advisory Commission, 2007) as services transition to patient-centered care with significant attention to the social determinants of health. Even if there are changes in the Affordable Care Act, it is likely that interprofessional collaboration will remain a needed component of quality health care. As part of the service shift under the Affordable Care Act, there is now an emphasis on patient-centered medical homes, care coordination (American Hospital Association, 2010; Robert Wood Johnson Foundation, 2013; Trudnak et al., 2014), and transitions of care (Fabbre, Buffington, Altfeld, Shier, & Golden, 2011). These models necessitate interprofessional collaboration. According to the Agency for Healthcare Research and Quality (AHRQ, n.d.), Care coordination involves deliberately organizing patient care activities and sharing information among all the participants concerned with a patient’s care to achieve safer and more effective care. This means that the patient’s needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient. (para. 1)

Social work skills and expertise in working with patients and the systems that influence their health status are an excellent fit for this new emphasis in health-care delivery (McCabe & Sullivan, 2015). Care coordination requires that different professions work together to facilitate the necessary services that patients need from a variety of disciplines and providers. In addition, there is oversight across professions to make sure that services are coordinated and that social determinants of health are addressed so that patients can effectively self-manage their care plans. This oversight may be done by

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social workers, nurses, or other team members. Interdisciplinary services are provided to patients and their families during a hospitalization and after discharge. The Bridge Model (http://www.transitionalcare.org/) is one example of care coordination that includes social workers and other professionals helping patients and families with transitions from hospitals to their homes. In the Bridge Model, social workers lead interventions with their interdisciplinary colleagues that address psychosocial facilitators to hospital readmissions. This model is evidence-based and demonstrates promise for significantly reducing hospital readmissions and reducing medical costs (Altfeld et al., 2013; Alvarez, Ginsburg, Grabowski, Post, & Rosenberg, 2016; Boutwell, Johnson, & Watkins, 2016). Currently, reducing hospital readmissions is a significant practice trend resulting from health-care reform efforts. The Centers for Medicare and Medicaid Services has declared that hospital readmissions are “one of the leading problems facing the U.S. health system” (Robert Wood Johnson Foundation, 2013, p. 3), and hospital readmissions within 30 days of discharge account for $12 billion in annual Medicare spending alone (Medicare Payment Advisory Commission, 2007). Hospitals now face financial penalties for patient readmissions (AHRQ, 2014), which requires a new paradigm for health-care delivery and workforce training and development (Anand & Parekh, 2014) that emphasizes proactive interprofessional team interventions (AHRQ, 2014; Iglehart, 2013; Leppin et al., 2014; Medicare Payment Advisory Commission, 2007) that reduce the risks for such readmissions. The current solutions to reducing hospital readmissions, however, may be impeded by a lack of attention to behavioral and social determinants of health (American Hospital Association, 2011; Shier, Ginsburg, Howell, Volland, & Golden, 2013; Sommers & Cunningham, 2011; Williams, 2013) and require an interprofessional team approach to best succeed. Indeed, the number one reason for Medicaid patient readmissions is mental and behavioral disorders (Trudnak et al., 2014), with mental illness as one of the top three diagnoses associated with the highest hospital readmission rates (Elixhauser & Steiner, 2013). Accordingly, social workers need to collaborate with their colleagues

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to help reduce hospital readmissions. Bronstein, Gould, Berkowitz, James, and Marks (2015) have created a promising interdisciplinary model that uses social work student interventions to significantly reduce hospital readmissions. In the last decade a growing emphasis has been placed on the triple aim of health—improving health-care delivery, enhancing population health, and reducing medical costs (Berwick, Nolan, & Whittington, 2008). Achieving this triple aim requires an interprofessional team approach that includes social workers. As part of the team, social workers can address social determinants of health that are increasingly recognized as key facilitators or barriers to individual and community health outcomes (Office of Disease Prevention and Health Promotion, 2011;World Health Organization, 2008). One example of such evidence-based approaches is using social workers as patient navigators and to deliver depression management interventions in collaborative settings. Ell and colleagues have successfully demonstrated that this model can result in greater patient adherence to recommended medical treatments and follow-up appointments, higher patient satisfaction, lower health-care costs, increased emotional well-being, greater use of depression treatment, and better quality of life and physical functioning (Ell et al., 2009; Ell et al., 2012; Hay, Katon, Ell, Lee, & Guterman, 2012). Social workers in the medical system have a broad view of the issues affecting patients and their access to the health-care system. This includes recognition and addressing issues of health disparities related to ethnicity, race, gender, age, geography, socioeconomic status, gender identification, and sexual orientation. Social work practice is grounded in a code of ethics that requires treatment parity for all vulnerable populations, and this perspective can help inform teams to address health disparities. However, it is important to recognize that in health settings there may be a power differential; patients may be treated as passive recipients of professional directions (i.e., patients do not “comply” with professionals’ instructions). Increasingly, though, patients are viewed as active and even equal partners of care teams and an interprofessional approach that fosters patients’ ability

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to self-manage their own care (see Browne & Merighi, 2010). Social workers can promote this paradigm to ameliorate the power differential between patients and providers. Recently, we have seen movements to bring increased interprofessional approaches to bedside care that include social work. In 2009, representatives from six professional organizations worked together to form the Interprofessional Education Collaborative (IPEC), which went on to create the 2011 Core Competencies for Interprofessional Practice (IPEC Expert Panel, 2012). The competencies primarily focused on clinical care, although there was some discussion of the health-care system in general. In 2016, IPEC expanded its membership to include nine additional professional organizations, one of which is the CSWE. It released updated competencies (IPEC, 2016) that include additional emphasis on population health. Inherent in attempts to affect population health is the need to affect the systems in which people are born, grow, work, and age (World Health Organization, n.d.). Social work expertise in systems theory and ecological perspective is critical to support needed changes in health systems, legislation, and regulations.

Interprofessional Collaboration Example Most accrediting bodies for health profession education require integration of interprofessional education into the curriculum, with documentation of achievement of interprofessional competencies at the student level (IPEC, 2016). The 2015 CSWE Educational Policy and Accreditation Standards require interprofessional competencies throughout the document, which guides social work education curricula. Although many academic institutions have begun the process of integrating interprofessional education into curricula, health delivery systems have been inconsistent with implementation of interprofessional collaboration in practice, despite the recognition of the benefits of collaborative care (Cox, Cuff, Brandt, Reeves, & Zierler, 2016; Morgan, Pullon, & McKinlay, 2015; Reeves, Perrier, Goldman, Freeth, & Zwarenstein, 2013). Financial limitations, hierarchal perceptions, and uncertainty regarding the roles of various health professions have

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been cited as barriers to implementation of interprofessional practice (Supper et al., 2015). Published studies regarding interprofessional collaborative practice have documented improvements in patient safety and satisfaction, as well as better health-care quality (Morgan et al., 2015; Reeves et al., 2013). Parker-Oliver, Bronstein, and Kurzejeski (2005) found that in hospice settings in one Midwestern state, there are high levels of interprofessional collaboration, and that such collaboration may positively relate to patient care quality. More research linking interprofessional care and improved health-related outcomes is needed (Lutfiyya, Brandt, & Cerra, 2016). Lutfiyya and colleagues (2016) identified research questions, along with possible outcomes measures, to analyze regarding interprofessional education and collaborative practice that should be part of future research efforts. Additionally, research on collaboration in the hospice settings by Parker-Oliver, Bronstein, and Kurzejeski (2005) identified an overall positive regard for collaboration, but the authors suggest additional research is needed to examine links with health-care outcomes. The following case example provides context to one of these concepts regarding improvement in diabetes control in adult patients. A local tertiary health system encompasses seven acute care hospitals spread over one main campus and four regional locations. In addition, patients may be seen in a variety of physician practices providing primary and specialty care services. Fourteen of the primary care practices have received accreditation as patient-centered medical homes. In 2013, an interprofessional team consisting of registered nurses, pharmacists, and social workers began implementation of care coordination for diabetes management in collaboration with physicians and nurse practitioners in these practices. Since then the team has expanded to include seven registered nurses, one licensed practical nurse, two full-time social workers, and two full-time and two part-time pharmacists. Each registered nurse provides services to two practices; the social workers and full-time pharmacists split the coverage of the practices between them. The two part-time pharmacists each spend 15 to 20 hours per week embedded in a single primary

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care clinic. The licensed practical nurse assists with recruitment and contact of patients for diabetes group classes offered monthly in a four-session cycle at each practice. Identification of patients for care coordination occurs through a variety of methods. Initially, care coordinators approached patient selection through a population health approach and reviewed diabetes control for all patients enrolled in each practice. Those patients with uncontrolled diabetes (hemoglobin A1c [HgA1c] >8%) were then contacted to offer additional education and management services to improve control. Providers also referred patients on an individual basis. At first, providers were reluctant to refer patients due to uncertainty of the care coordination process and role delineation of the health professionals involved compared to traditional patient care management by medical assistants in the practice. Over time, the success of this program alleviated such reluctance. In one practice site in this health system, three internal medicine physicians provide comprehensive medical care for more than 5,300 patients, of which 850 have a diagnosis of diabetes. A registered nurse care coordinator and a clinical pharmacist collaborate to provide clinical services in the practice for a combined total of 4 to 5 days per week in the practice site. More than 475 patients with diabetes have been referred during the first 2 years of care coordination at this site. In addition, about 30 patients have been referred for preventive care for prediabetes and weight management. Care coordination services include a variety of educational opportunities, from individual sessions discussing an overview of diabetes, medication management, and lifestyle modifications, to group sessions regarding diabetes, nutrition, stress management and physical activity, and prevention of complications. The pharmacist involved works with the patients and their physicians to modify drug therapy when needed between primary care appointments. A few times a week, the pharmacist or the nurse see patients together with the physician, medical assistant, and social worker during scheduled follow-up appointments. This allows for the health professionals to conduct patient assessments and to collaborate to determine the best care plan.

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The patient becomes an integral part of the decision-making process, which tends to improve patient satisfaction as well as health outcomes. This approach can help decrease the power differences that may exist between the patients and their providers. Most patients are contacted via telephone at least once between primary care follow-up visits for additional coaching or medication management. When needed, patients are referred to a social worker to improve access to resources that would allow the patient a better chance to meet therapeutic goals. During the first 6 months of this interdisciplinary care coordination, diabetes care measures for the clinic improved, with an average decrease in HgA1c by 1.1% and an additional 10% of patients achieving a goal HgA1c of