Professional Development and Interprofessional Practice — Social Workers Share With (and Learn From) Colleagues in Other Disciplines
By Christiane Petrin Lambert, MA, MSW, LICSW
Social Work Today
Vol. 19 No. 5 P. 26

Social work has always intersected with other disciplines, but a new emphasis on the value and potential of this dynamic exchange fosters increased awareness and important dialogue.

Early social work practitioners worked interprofessionally in multiple contexts including family support, education, and health care. They cultivated collaborations, built resource networks, and served as conduits for improved social conditions. Over time, the roles of social workers have influenced the helping professions and have been shaped by emerging trends that show promise for improved service delivery. With the advent of interprofessional practice (IPP) in health care, ushered in by the Affordable Care Act (ACA) of 2010, there is increased realization of how the foundational skills and values of the field positions social workers to be key members on integrated care teams (Lombardi, de Saxe Zerden, & Richman, 2017; Horevitz & Manoleas, 2013). Social work field educators are at the forefront of the exchange in professional development, leaders in developing the skills to navigate collaborative work environments, and mentors in providing opportunities for future practitioners through interprofessional education (IPE).

IPP/IPE and Social Work
The Interprofessional Education Collaborative (IPEC) is a national assembly of health professions, including nursing, medicine, dentistry, pharmacy, public health, social work, and other related fields to “promote, encourage, and support efforts to prepare future health professionals so that they enter the workforce ready for interprofessional collaborative practice that helps to ensure the health of individuals and populations” (IPEC, 2019).

The World Health Organization declares, “IPE happens when students from two or more professions learn about, from, and with each other to enable effective collaboration, resulting in high-quality health care and outcomes” (2010, p. 10).

The Council on Social Work Education (CSWE) became an institutional member of IPEC in 2016, according to the organization’s website. Jo Ann R. Regan, PhD, MSW, FNAP, vice president of education for CSWE, represents social work education. Regan stresses the importance of preparing students for social work and IPP through collaborative supervision—a theme reinforced by colleagues and researchers in IPE. Regan promotes training for faculty about how to build courses in IPE. She notes that the accreditation standards mention IPE in one competency, with more likely to be added in the future. She would also like to see more training on how clinical supervisors can “think more interprofessionally and learn how to supervise in teams—to design supervision around competencies.”

IPEC developed core competencies for interprofessional collaborative practice to guide education and learning experiences across health professions (IPEC, 2016). They include values, ethics, and mutual respect; roles and responsibilities for population health; interprofessional communication with patients, families, communities, and professionals; and teams/teamwork “to plan, deliver, and evaluate patient/population-centered care and population health programs and policies that are safe, timely, efficient, effective, and equitable” (p. 10).

Interprofessional Approaches to Clinical Supervision

Teaching and Learning
Regan explains that clinical supervision in social work has always focused on interdisciplinary work. She also notes the importance and historical foundation of clinical supervision in social work education and practice. She stresses, “Learning to use the tool of supervision is an expectation of the social work curriculum.” Furthermore, research supports clinical supervision as essential to professional development for all mental health professions. Clinical supervision serves multiple purposes in both education and practice including the modeling of practice norms, imparting practice knowledge, and orienting the developing professional. “In addition to the efficient and effective administration of agency services, the education and support of the social worker fashioned the three-legged stool of modern social work supervision” (Kadushin & Harkness, 2014, p. 1).

Kimberly Gibson, MSW, LGSW, MSW field coordinator for the School of Social Work at the University of Alabama, explains, “Clinical supervision helps supervisees to home in on their strengths and where they could use more support to frame their developing IPP skills. Reflection is important to process what is going on, to be able to have a safe zone to support growth and learning.”

Mary C. Ruffolo, PhD, LMSW, associate dean for educational programs and Rosemary C. Sarri Collegiate Professor of Social Work at the University of Michigan (UM) School of Social Work, adds the importance of social workers understanding their unique contributions to the care team. In addition to important practice skills such as the use of assessment tools, evidence-based interventions protocols, case studies, and knowledge of the resources and services, clinical supervisors use reflection and critical thinking activities to bring about explicit awareness of social work practice principles.

Lisa de Saxe Zerden, MSW, PhD, senior associate dean for MSW education and John A. Tate Early Career Scholar for Children in Need at the University of North Carolina at Chapel Hill School of Social Work, notes that this awareness can happen in the interprofessional classroom by asking students from multiple disciplines to engage in conversation about how their professions contribute to patient care, such as understanding the impact of food insecurity on oral health. “We can trade expertise.”

Ruffolo notes the importance of “intercultural intelligence,” which may be one main contribution from the field of social work to IPP/IPE. She says, “Social work has a leadership role in working with the other allied health professional schools to develop training and educational opportunities across the different professions.” Ruffolo continues, “In practice, social workers often function as the team leader/facilitator; the behavioral health consultant; the care manager for individuals living with complex, chronic health and behavioral health issues; the problem-solver on the team that brings a greater understanding of the different domains that impact an individual or families’ access to services, and helps to bring the ‘voice’ of the individual/family to the development of culturally responsive interventions.”

Another of social work’s unique contributions to IPP/IPE may be the hallmark person-in-environment perspective that social workers bring to their work. Gibson says, “Social workers are good at looking at systems, at how an individual fits in the systems in their lives.”

de Saxe Zerden says, “Social workers already bring a lens to focus on the social determinants of health (SDOH) in patient care—and an ethos to help other professionals see like we do.” She offered an example in which a dental student worked hard to set up a root canal for a patient who could not pay for the service. On the day of the appointment, the patient was late and brought her children. The dental student was upset and disappointed. The social work student talked with her about what this patient had to do to get there—e.g., take the bus, attempt to find alternative child care, and otherwise cope with the complexity of her life. This created an “aha moment” for the dental student, who was more focused on the patient’s need for the procedure.

Bogo, Paterson, Tufford, and King (2011) conducted focus groups with clinicians from multiple professions in Canada’s largest teaching hospital to learn more about their perceptions of clinical supervision. Their study revealed a need for a hybrid approach to interprofessional clinical supervision that balances profession-specific support with cross-discipline opportunities for professional development. They suggested a stepped model that starts with a discipline-specific approach in the initial years of professional development, and then moves toward working with interprofessional supervisors and field groups in subsequent years.

There are several ways social work educators have incorporated IPE into their curricula. Ruffolo says UM has developed universitywide IPE in which all incoming students from allied health professions are encouraged to participate, including a team-based interprofessional day, and, this year, some will be part of the health team at a student-run free clinic. Students also complete a clinical decision-making course with students from the other allied health schools using a case-based model. “After the first few sessions, we often hear our social work students sharing that they were intimidated at first thinking that they did not have anything to offer, but soon found that their skill sets were needed to help the other students understand the patient, family, and the challenges around access to services and the resources needed to carry out plans,” Ruffolo says.

Similarly, Regan notes the Interprofessional Student Hotspotting Learning Collaborative through the Camden Coalition of Healthcare Providers in New Jersey, in which student teams from all different disciplines target support in “hot spotting hubs”—places in which utilization of health care is high. “What social work is bringing out is the importance of going directly to patients rather than meeting them in a hospital, even in the streets. Hot spotting brings out the realities of the SDOH,” Regan says.

In partnership with nursing faculty at the University of North Carolina, de Saxe Zerden created a collaborative hybrid class to talk about patient care and quality improvement metrics. The course has been a profound experience for the students and now includes seven to 10 specialties. “We built the course voluntarily, and then it grew into success and institutional support with social work seen as an anchor field in connection with the patient,” de Saxe Zerden says.

Gibson and a colleague from nursing coordinate an interprofessional medical mission trip for 10 days. Carla Durham, an MSW student from the University of Alabama School of Social Work, says, “I recently had the opportunity to work in an interprofessional health care team while serving refugees in Athens, Greece. This amazing opportunity allowed me to participate in taking care of people who were forced to flee from horrendous situations. People left their homes and everything familiar to them for fear of their safety and future. On their journey, some people were injured or became physically ill, but most everyone suffered harm to their souls and to their sense of security. The social work students worked with translators to unravel the tangled-up hurts the refugees described in their bodies and souls so that we could share them with the nursing students and doctor. Together, we made recommendations for care that sometimes included medication or symptom management but nearly always included self-care, reaching out for support from others, and spiritual care. Our common, shared goals for the refugees in the clinic included ease of physical and psychological pain.”

Professional Development Beyond Supervision
In order to prepare students for IPP, it is critically important to build the skills and experiences of field supervisors about IPP/IPE. de Saxe Zerden reinforced the need for “retooling and retraining the current workforce to be socialized in interprofessional approaches.” This will facilitate field supervisors to think about different approaches to help students learn to work in a team-based way.

Regan suggests another area for social work development would be incorporating IPEC competencies in clinical supervision and tools for evaluating teamwork and interprofessionalism.

Professional development can take the form of trainings, conferences/workshops, advanced degrees, peer consultation, and even informal networking. de Saxe Zerden shares, “It may be daunting to work within several different professionals, but start with one or two that make sense on your campus.” She continues, “Find a friend from another health-related field to bring in to speak to your students or go lecture to their students.” She stresses the importance of moving out of social work circles and speaking to interdisciplinary colleagues, “to move outside of social work venues and conferences to cross-pollinate.”

Horevitz and Manoleas (2013) note that two-thirds of respondents in their study of social workers on integrated health care teams reported learning the skills they need “on the job” (p. 764). Though participants believed that their MSW preparation provided a solid foundation, they felt the need for additional training such as in specialized treatment protocols, medications, and chronic health conditions. Related to IPP, respondents thought it would be helpful to have additional knowledge about “the culture of medical education” such as the curriculum taught in medical schools, and how the patient and physician relationship compares with the psychosocial approach (p. 765).

Regan suggests connecting with national, state, and local groups, associations, and conferences for networking and professional development in IPP/IPE. Specifically, she notes the National Collaborative for Improving the Clinical Learning Environment, the IPEC events webpage, and the Nexus Summit. There is also more information through CSWE.

Gibson stresses the value in connecting through the Association of Baccalaureate Social Work Program Directors. She also suggests attending integrated care conferences hosted by other disciplines. She shares an example of how IPE networks have grown through University of Alabama’s annual Policy and Advocacy Fly-In to Washington, DC.

Horevitz and Manoleas (2013) note a need to cultivate more IPE in social work programs and recommend specialties such as primary care practice to remain in step with current trends in health care delivery. Regan emphasizes the importance of regularly assessing gaps in IPP competencies among the current workforce to inform professional development priorities. de Saxe Zerden’s doctoral study involved an interdisciplinary PhD including social work and public health. She also notes expanded opportunities for grants and research though the ACA as well as interprofessional scholarship.

Interprofessional Lessons Learned and Future Implications
In order to integrate IPP/IPE into the range of health-related disciplines, practitioners and educators will have to engage in cross-profession teaching and learning as well as critical conversations. For social workers, this will mean a shift in some practice norms. In their study, Horevitz and Manoleas identified what they call a “primary care culture” including the length and number of treatment sessions, increased use of stepped-care evidence-based practices, a faster pace, a consultative role with medical personnel, and the use of large-scale outcome data—“a shift from an individual client-based model of care to a population-based model of care” (2013, p. 753 & 755). They stress the importance of gaining contextual knowledge related to health care policy and the ACA. For example, reimbursement systems do not recognize the full scope of social work practice and related contributions to positive health outcomes and cost savings, such as through decreased institutional readmission rates. It is key to teach IPP skills in the context of health care reform and shifts to value-based reimbursement, which is an ever-growing reality that influences all domains of health care (Lombardi et al., 2017).

Clinical supervisors and educators will need to facilitate cross-disciplinary dialogue regarding role responsibilities and overlapping and complementary functions of each profession (Lombardi et al., 2017; Bogo et al., 2011). Honest conversations need to be facilitated to find a common language in shared practice to avoid misunderstanding and miscommunication (Horevitz & Manoleas, 2013). It will be important to explore philosophical differences, distinct ethical standards, and practice norms among disciplines.

Growing research reinforces the value of IPP in delivering higher-quality care leading to improved health outcomes, with need for more rigorous research to better understand how (Reeves, Pelone, Harrison, Goldman, & Zwarenstein, 2017). Ruffolo stresses, “We need to engage in research to determine what the best practices are for social workers on these interprofessional teams, and we also need to evaluate how and when the interprofessional teams improve outcomes for individuals and families.”

de Saxe Zerden notes, “IPP/IPE is here to stay, and social work’s perspective of patients and their lives is so critical to optimizing care.” She believes that students will usher in systems change as their experiences and expectations involve IPP, which will require shifts in higher education such as incentivizing cross-listed courses, teaching with other disciplines, and IPP influencing future iterations of accreditation standards. When considering interprofessional collaboration, remember the math-oriented metaphor: “The whole is more than the sum of its parts.” IPP demonstrates this truth in improved patient/client outcomes and, one might argue, enriched practice beyond the professional development possible in only discipline-specific training. Social work has much to offer and much to learn.

— Christiane Petrin Lambert, MA, MSW, LICSW, works in community clinical practice; serves as a consultant for program planning, development, and evaluation; and is adjunct faculty at the Rhode Island College School of Social Work.

References
Bogo, M., Paterson, J., Tufford, L., & King, R. (2011). Interprofessional clinical supervision in mental health and addiction: Toward identifying common elements. The Clinical Supervisor, 30(1), 124-140.

Horevitz, E., & Manoleas, P. (2013). Professional competencies and training needs of professional social workers in integrated behavioral health in primary care. Social Work in Health Care, 52(8), 752-787.

Interprofessional Education Collaborative. (2016). Core competencies for interprofessional collaborative practice: 2016 update. Retrieved from https://hsc.unm.edu/ipe/resources/ipec-2016-core-competencies.pdf.

Interprofessional Education Collaborative. (n.d.). Vision & mission. Retrieved July 6, 2019, from https://www.ipecollaborative.org/vision---mission.html.

Kadushin, A., & Harkness, D. (2014). Supervision in social work. 5th ed. New York, NY: Columbia University Press.

Lombardi, B. M., de Saxe Zerden, L., & Richman, E. L. (2017). Toward a better understanding of social workers on integrated care teams. Retrieved from http://www.behavioralhealthworkforce.org/wp-content/uploads/2018/04/Y2FA2P2_UNC-Social-Work-Full-Report.pdf.

Reeves, S., Pelone, F., Harrison, R., Goldman, J., & Zwarenstein, M. (2017). Interprofessional collaboration to improve professional practice and healthcare outcomes. The Cochrane Database of Systematic Reviews, 6, CD000072.

World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/70185/
WHO_HRH_HPN_10.3_eng.pdf;jsessionid=8D545AAFC6453304FD38E9AE9F848D0C?sequence=1.