Collaborating To Serve The Poor: Perceptions of Poor Clients by Social Workers and Primary Care Physicians in Israel

Purpose: This study examines the way poor clients are perceived by social workers and primary-care physicians (PCP) working in the community. Community involvement and cooperation between SWs and PCPs is common in the US and elsewhere (Mizrahi & Berger, 2001; Kharicha, Iliffe, et al., 2005). Different models of cooperation have been researched (e.g., Abramson & Mizrahi, 2003; Ruddy & Rhee, 2005) in various settings but not in community services for the poor. Inter-professional relationships between PCPs and SWs and problem definition are affected by differences in their perception of the client and of client problems (Hudson, 2002), while both attest to the importance of similar perspectives as contributing to effective teamwork. Moreover, studies on service provision to poor clients show that SWs' and PCPs' service behavior is affected by their perceptions of poor patients' situational attributes (Dowling, 1999; Monnickendam, Monnickendam, et al., 2007). Although social work and medical literature stresses the need for providing better community health care to the poor through improved teamwork (Green, 2000; Russel, 2006), we are not aware of comparative research on perceptions of poor clients.

Methods: Two focus groups (9 PCPs and 11 SWs working in community clinics and municipal community services) were selected to represent the socioeconomic and multi-cultural diversity of Israeli society. In depth interviews with six SWs and seven PCPs were conducted. PCPs' age ranged between 35 and 66, nine were female and six male. SWs' age ranged between 41 and 66, 15 were female and two male. Transcripts were coded and classified within themes and sub-themes. Open coding was used to classify statements within new themes and sub themes (Denzin & Lincoln, 1994). Relationships were analyzed and conceptualized by axial coding, then collapsed into main and secondary constructs (Heath & Cowley, 2004). Repetitive patterns were indentified (Huberman & Miles, 1994). Coding and classification was carried out independently by two MSWs experienced in the social service and medical system. In the case of divergence, final classification was determined in consultation with the researchers. Axial coding was carried out by the researchers.

Results: For the participants, perceptions of clients' poverty comprise two components: the reason for poverty (individualistic, fate and structural/policy) and the desired behavior (work, education, and skills training) of the client. PCPs and SWs did not differ greatly on reasons for poverty. They varied however on desired behavior. SWs were more accepting of clients not working, displayed emotions, sympathized with clients' plight, and focused on their weaknesses. PCPs were more judgmental, removed, less accepting of able clients not working, and emphasized clients' strengths.

Conclusions and implications: This study indicates that the main differences between the professions are not about poverty and its causes, but about what to expect from poor clients. In practice this implies fleshing-out whether SWs and PCPs can agree on problem definition and common service goals, thus improving the effectiveness of their partnership. The study was conducted in one country with a limited number of participants. Further research should assess whether these findings apply to other settings.