An Empirically Determined Taxonomy of Interdisciplinary Social Work

Background and Purpose: Despite tremendous reductions in morbidity and mortality during the last century, cost dimensions limit the distribution and delivery of health care in the United States. To enhance quality while containing cost, the Institute of Medicine (IOM) posits that psychosocial factors such as patient and family's perceptions of health and illness, cultural beliefs, environmental and social factors should be part of assessment, intervention and follow-up health care, which are all within the professional competencies of social work. The profession has—paradoxically—not fared well in health care resource allocation for a variety of reasons. One problem addressed by this study is social work's inadequate demonstration of its contributions to health care. The purpose of our study was to empirically demonstrate disciplinary competencies of clinical social work within medical teams. The study aimed to 1. identify universal professional competencies that social work may contribute to interdisciplinary teams, and 2. develop an evidence-based taxonomy of interdisciplinary clinical practice to frame social work with the precision and rigor required in medical settings. The research question asked, what are the universal functions of social work on interdisciplinary teams in acute care?

Methods: Using interdisciplinary collaboration as the conceptual model (Satin, 2008), our study adapted a participatory action research (PAR) approach used in nursing research to improve clinical practice (Glasson, Chang, & Bidewell, 2008). A core research panel consisting of three clinical social workers assigned to interdisciplinary teams, a senior clinical director, and a research scientist collaborated in every phase of the year long study from the development of research questions through the analysis and dissemination of findings. We used deductive approaches in reviewing archival and current literature, and inductive approaches to analyze current practice by using a retrospective qualitative case review methodology (Anthony & Jack, 2009; Yin, 2008). We explored the work performed by 37 hospital-based clinical social workers assigned to interdisciplinary teams in a large New England teaching hospital. The final analysis included 43 cases selected for universal rather than case-specific elements.

Results: Deductively, along with a paucity of empirical evidence supporting social work's interdisciplinary function, we found the historical roots of medical social work (around 1915) to be directly aligned with current IOM recommendations. Our findings empirically identified a universal taxonomy that classifies social work functions on interdisciplinary teams across five elements: 1. rapid collection of case information from multiple sources, 2. interdisciplinary assessment, 3. psychosocial intervention, 4. referral, and 5. identified outcomes. We added two additional factors for their utility; 6. identified benefits to interdisciplinary team, and 7. clinician competencies needed.

Conclusions and Implications: The empirically determined taxonomy may be used to articulate, explain, and justify the profession's potential contributions to interdisciplinary teams. It will assist clinicians to communicate in operational terms recognized by other disciplines and clearly defined for measurement and evaluation. The taxonomy may help demonstrate the value added by social work's ecological perspective, giving teams a better perspective of the patient's home environment. Furthermore, the study provides formative evidence for future investigations evaluating interdisciplinary practice.