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A STUDY OF SCHOOL-AGENCY COLLABORATION IN SOCIAL WORK IN HEALTH CURRICULUM BUILDING Phyllis Caroff DSW
a
a
Professor of Social Work, Hunter College School of Social Work, City University of New York, New York, NY 10021 Published online: 26 Oct 2008.
To cite this article: Phyllis Caroff DSW (1977) A STUDY OF SCHOOL-AGENCY COLLABORATION IN SOCIAL WORK IN HEALTH CURRICULUM BUILDING, Social Work in Health Care, 2:3, 329-339, DOI: 10.1300/J010v02n03_09 To link to this article: http://dx.doi.org/10.1300/J010v02n03_09
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
A STUDY OF SCHOOL-AGENCY COLLABORATION IN SOCIAL WORK IN HEALTH CURRICULUM BUILDING
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Phyllis Caroff, DSW
ABSTRACT. Viewing agencies offering a fieldwork practicum as underutilized educational planning reserues, Hunter College School o f Social Work undertook t o upgrade its relationship with its health settings from cooperative t o collabomtiue status. The process, achievements, and goals o f the joint e f f o r t o f campus and agency educators are described.
Social work education is currently debating how to achieve maximum utilization of the expert knowledge and experience of the class and the field in educating for the profession, and there is ferment. This ferment stems from pressures for change from the larger social order which has mandated social work's existence, and the profession itself, the colleges and universities offering classroom curricula and the agencies providing the practicum for students and dependent on the educational product for delivering social work services. Pressure can provide opportunity, a climate conducive t o effective enrichment of the professional cumculum. In this climate, one graduate school of social work and a selected group of agencies in health services embarked on the joint development of a curriculum for social work in health. The objective of this paper is to share the experience to date. Understanding the process, progress, and obstacles of the curriculum-development effort requires recognition of the historical relationships between schools of social work and agencies providing the practicum. These relationships reflect the town-gown conflict. Social work educators have presumed that they are better prepared than practitioners to formulate practice models for helping and to define the Dr. Caroff is Professor o f Social Work, Hunter College School o f Social W o r k , City University o f New Y o r k , 129 East 7 9 t h Street, New Y o r k , N Y 10021. T h e author acknowledges the particular contribution o f Elinor Stevens in the beginning organization and implementation o f the educational project described in this article. Social Work i n Health Care, V o l . 2(3), Spring 1977 329
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professional body of knowledge. In the development of theory for practice, the school-based faculty has been perceived by agency practitioners as relatively free of the pressure to respond to the immediacy of client need and the constraints of inadequate resource. The schoolbased faculty is seen as existing in an academic "ivory tower," unrealistic, being limited in its ability to relate t o the "real" needs of people and demands of 'practice. The school, by virtue of its authority and responsibility to award the degree and to accredit competence for admission to the profession, has held the initiative to invite the agencies t o participate in the educational endeavor. Consequently, there has been conflict in the differential valuing of the respective contributions of school and agency in educating for our profession. It is the author's view that the tension created by this historical reality has reverberated as a theme in the attempts of schools and agencies to move toward collaboration in social work education. Those who agreed t o participate in the project to be presented agreed that the dichotomy was unproductive. They assumed that the debate on the respective roles of school and agency could be transcended by confronting the educational tasks.
HUMAN NEEDS: A RATIONALE FOR REORGANIZATION
In an attempt to respond to unmet human needs, changing patterns of service delivery, and the school's rapid growth in resources and size, Hunter College School of Social Work sought a more viable and qualitatively relevant structure for educating its students. The curriculum framework adopted by the faculty in 1972 departed from the traditional rubrics of process, problem, and program in developing practice concentrations. Reorganizing the curriculum into a structure based on human needs, and identifying concentrations accordingly, the school sought t o shift its focus from skill to competence. Competence was seen as including but not restricted to skill. Competence is concerned also with the context in which skill is exercised. It assures the integration of information and orienting theoretical knowledge on which differential and timely use of skill is contingent. A core of social work content for all students was to be identified. In addition, the specialized knowledge of a particular need area was to be pursued in depth.
Phyllis Caroff
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BEGINNING EXPLORATIONS WITH HEALTH FIELD REPRESENTATIVES The Collaborative Process At the time of the formal decision for the reformulation under the human needs rubric, 40% of the student body at the Hunter College School of Social Work were placed in health settings, i.e., medical, psychiatric, rehabilitative, etc., for their field practicum. Our prior cooperative curriculum efforts in the field had sensitized us to the need for systematic collaborative and concurrent work in the agencies and in the school t o achieve mutually held objectives. In the spring of 1972, three preliminary meetings were held with a group of social work administrators in health agencies to present the concept of the curriculum reorganization and a projected skeleton curriculum for their reactions, modifications, and additions. There was consensus about the mutual responsibility for assuring the conceptual, orienting, and integrative learning that professional education required. That opportunities for such learning existed in both class and field was clear. Therefore, the knowledge, style, and value components of skill, and the conceptualization of role, task, and function in practice were t o be taught in both places. Implementation of such agreement required mutual willingness t o review existing structural arrangements for learning and teaching as well as current patterns for utilization of resources, including personnel. In this initial phase, some major content gaps in the traditional curriculum were identified: health service delivery systems; interprofessional and interdisciplinary collaboration; and the urban community, including ethnic variability in the perception and use of health care. Also, content related to the impact of physical illness, chronic and acute, and an approach t o obtaining necessary medical background information were seen as insufficiently emphasized. Agency participants felt strongly that social workers in health must be prepared t o deliver services in more than one modality, that collaborative skills were central to their competence as health professionals; and, equipped with appropriate knowledge, they must see themselves as potential change agents in the improvement of health services t o the community. Accountability as well as the professional responsibility t o make the social work contribution t o comprehensive health care more visible were also stressed. There was agreement that a mechanism was required for ongoing collaborative work between school and hospital educators. Time would be required t o modify existing content and t o develop new content. To factor out how best t o use the combined resources of agency and school t o enhance the educational product would necessitate joint
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effort. A formal structure was recommended as the logical next step t o the collaborative effort. Design for Collaboration A School-Agency Social Health Module Curriculum Committee was convened in the fall of 1973. Its membership consisted of Hunter College faculty assigned to the Social Health Module and representatives of health settings reflecting a range of services in which students were placed. ("Module" is the term adopted by the Hunter College School of Social Work for the cohort of faculty, students, and agencies in a human need concentration.) All agency participants were committed to a practicum that would go beyond the traditional tutorial relationship between student and field supervisor and legitimitize the multiplicity of teaching and learning resources to which students in complex health systems are exposed. The faculty members on the committee represented the range of expertise in the traditional sequences of the cumculum: human behavior and the social environment, social policy and social welfare, research, and practice methods. Both school and agency participants brought a deep understanding of existing and projected programs and resources. The majority of agency participants were administrators and educational coordinators, primarily from multifunctional health care settings. Most important, they also held the authority to innovate in both class and field cumculum should new directions evolve in the process of work together. A beginning consensus around objectives for master's level social work practice in the health field was quickly achieved. This committment was a source of support and stimulation to the work of learning the real meaning of collaboration. To summarize succinctly a three-year process in developing a collaborative climate presents a formidable task. The author, who has served as chairperson of the committee, takes responsibility for the perception of the process as here presented. Learning t o Work with our Conflicts Initially, the heavy demand was for work related to revisions of and additions to content. Agency participants accurately perceived the school content as more adequately related to practice in family agencies and child-guidance clinics than in health care settings. A common criticism about the school cumculum was that students had little awareness of the dynamics of functioning in a larger system as part of an interprofessional endeavor. For some of the agencies, student class assignments did not reflect awareness of the nature of their practice in which short-term, crisis-oriented work comprised a large
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measure of the interventions in individual, family, and group modalities. There were particular complaints about the school calendar, the scheduling of vacations, particularly among those institutions where educational programming was linked to the calendars of medical and nursing students. What surfaced among the agencies was the recognition that some of what was spoken was from their individual agency perspective, and that our task in resocializing ourselves was to think in terms of the education of more than one-third of the total student body in a range of health settings. The school-based faculty expressed their concern that the agency teachers in large measure did not perceive themselves as educating for the profession as well as for their particular institutional practice; they did not seem to move from the case and the service to the principles of the practice. There were differences among school-based faculty as to whether or not education for the profession would be best served by the agencies' teaching their own practice well and leaving the conceptualization of principles of the practice, with their knowledge and value components, to the school. Our struggle reflected mutual awareness of the unevenness of practice in the field. We were using a wide range of agencies, all interested in contributing to education, but at different levels of commitment and capability. The group finally reaffirmed the principle that conceptual orienting and integrative learning were responsibilities of both class and field. There was agreement that the school was primarily responsible for teaching concepts and principles of a range of orienting theories, and would draw upon health practice issues and problems as illustrative in both program implementation and orienting knowledge stems of the curriculum. The agency was primarily responsible for the experiential learning, including the development of professional use of self. Each in turn has responsibility for reinforcement and adding to knowledge as gaps are observed. The primary challenge was to improve communication and develop an attitude of mind which accepted the benefits to the profession of a more truly collaborative effort. The greatest felt need on the part of the school-based faculty was to familiarize our colleagues from the agencies with the processes and challenges involved in selecting relevant content from a rapidly expanding body of knowledge, to be presented in a two-year progression, in a large school and university operating under such constraints as available resources, professional and university regulatory requirements, and contractual arrangements with students. In this initial phase, the committee was well served by the presence of a colleague working on a special health project. By virtue of being neither a member of the school nor the agency subgroup, she was in the unique position of being able to assume the role of "observing ego," facilitating our work together in our learning from each other.
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A turning point toward cohesion in our relationship occurred in the second year of the committee's operation. It was precipitated by a confrontational question from an agency colleague posed t o the chairperson following a scheduled work session: "How come you always say, 'Let me bring you on board'? How come we never say, 'Let us bring you on board'?" Following some discussion about our process together in the next general meeting, there was a noticeable shift among the committee members from the use of "you should" t o "how can we?"
Emerging of Common Goals An analogy can be drawn from the literature on interprofessional education which highlights the demands made upon the involved actors in achieving mutual objectives. Asking that the professional person pool his ideas with others in the assessment o f the problem to be solved means that he is required to have not only a secure hold on his own professional knowledge, but an ability to communicate it to others and to acknowledge the limitations as well as the possibilities within his own professional armamentarium. It necessitates that he respect both himself and others as having knowledge, understanding, skills, and most importantly, equal right to participate in the problem-soluingprocess.'
Clearly, the demands upon us as intraprofessional collaborators were very much the same. Our early adulthood might well have been marked by the statement from the same agency colleague that "In this crowd we've learned that if we get shot down it's for our ideas, not because of where we come from." A major curriculum challenge was t o develop skills to respond t o the needs of people in changing, time-limited pattems of care and at the same time provide the opportunities t o develop skills in depth. While not every social worker's knowledge and skill could cover the gamut of the profession's responsibility, it was deemed necessary t o encompass the whole in the development of the curriculum t o assure the student's comprehension of and identification with the scope and depth of the profession's responsibility in health and medical care. Consultation and/or supervision of allied health manpower as well as beginning skill in administration were perceived as among the repertoire of skills for master's level social work practitioners, and, consequently, projected areas for curriculum development in class and field. The school-based administration's decision t o allow for a five-to seven-year span t o achieve sound curriculum reorganization was comforting in light of the amount of work t o be done. Content modification and changes in pattems of learning and teaching were t o be assessed through feedback from the general practice arena, the classroom teachers, and the students in the Social Health Module.
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THE PROCESS OF CURRICULUM MODIFICATION Having decided t o build on the existing curriculum, the committee's first step was t o identify the core social work knowledge, skills, and attitudes required for all social work students. We perceived these as being embodied in those required courses in practice, human behavior and the social environment, social welfare policy, administration, and research. We then moved t o specify needed modification and enrichment t o educate toward the objectives of the committee's " C r e d ~ . " ~Revised first-year course outlines and bibliographies were presented by individual campus faculty t o the committee for their information, reactions, and suggestions. Through this process, all campus faculty as well as agency participants became familiar with what was t o be taught to the health students. Even though ultimate responsibility for classroom content resided with the individual teacher, the process sensitized all participants t o their respective competencies. Further, the gaps and areas needing reciprocal school-agency reinforcement t o achieve better integration were sharply delineated. An important outcome was the recognition of the need for better integration among courses offered within the health curriculum at the school. As a result, in the following year the instructors in human behavior and social policy attended each other's classes with the objective of identifying and presenting to students the links in the respective content. This was tested through a collaboratively designed question on the final examination in each course. Through the planning and implementation of the orientation of more than sixty first-year students t o the newly formed Social Health Module, we experienced our first collaborative contact with the students in the fall of 1974. Having jointly identified the health care system and collaborative work as priority content, it was decided t o schedule agency visits for small groups of two or three students t o observe social work in action through such experience as case presentation, rounds, team meetings, and direct observation of programs involving multiple professionals. We hoped t o expose them t o these valued dimensions of learning as a core t o their ability effectively t o deliver direct services in health settings. Those agencies participating were provided with guidelines for orienting students t o the setting and for selecting the observation. Students too were presented with observation guides. Visits were followed by small-group discussions co-led by school and agency personnel. The aim was to help students generalize from their varied experiences and deal with reactions, questions, and criticism. In addition, an important intent was to provide a model for new students which would reflect the working relationship between class and field teaching.
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The planning together and the readiness of both school and agency to provide the considerable resources necessary t o test out the value of this approach affirmed the validity of such collaborative work, at least for a circumscribed project. Student feedback reflected an unevenness in the learning experience. We had to rethink how best t o implement our objectives for orientation. Our ability t o evaluate and assume the shared responsibility to replan was a new and promising experience for us as partners. Modifications in Curriculum Content In explicating the "new" content, the committee reaffirmed the importance of teaching a dynamic orientation t o growth and development, utilizing a life-cycle model. However, increased emphasis on physical health and the impact of illness was needed. Examination questions would be a key variable in assessment of individual/farnily needs and required resources. The social welfare policy sequence for the health module was reformulated t o emphasize current programs in health care, operative legislation, government regulations and entitlements, with their respective imports for social work tasks and roles. The history and development of health system institutions and their philosophical underpinnings were perceived as illuminating the current climate of health and medical service. Understanding the demographic profile of a community and how social health needs are defined were seen as necessary to understand programmatic emphases in social welfare policy. In the area of intervention it was observed that in practice the primary modalities among the participating health agencies were in work with individuals and families. It was the judgment of the agency representatives and faculty that changing patterns of service required learning skill in working with small groups. More aggressive leadership was needed t o maximize the potential use of small-group intervention. Understanding of group dynamics was seen as essential t o collaborative practice. There was considerable debate about whether we were ready t o require group work as a second method, given the unevenness of related learning opportunities in the practicum. The committee had previously affirmed the existing policy regarding method so that students begin a concentration in one method and add a second method as appropriate t o their interests and to the related learning demands in the agency. The decision was t o recommend that students in the Social Health Module take group work as a second method. There was a concommitant agency commitment t o further develop their own group service programs. Furthermore, it was determined that the agencies needed t o create opportunities for student exposure t o and direct work with community groups.
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The committee continues t o confront an important educational challenge. Exposure to long-term process has been deemed essential learning for the development of quick assessment skills. How, then, can we teach first-year students the skilled dynamic assessment required in short-term and crisis-oriented work which composes so much of health practice, without sufficient opportunity for longer term treatment? Currently, we have agreed that all first-year students in health will be taught short-term and crisis-treatment models in class. Efforts will be made to select some case situations in the field which lend themselves t o learning such skill through longer term process. The need for specificity of health content in the individual methods was identified. The practice faculty also addressed itself t o the refinement of an integrated methods course for work with individuals, families, and small groups t o be offered in the second year. The educational content of collaborative practice t o be systematically addressed in all case study with its attendant systems work included: (1) knowledge of the particular expertise of the multidisciplines and professions involved in meeting patients' needs; (2) sensitization of the student t o his own behaviors and those of other professionals; (3) communication skills, including group interaction. A serious gap noted was the absence of the requirement t o record collabo: rative practice in both class and field. The pressing demand t o meet the needs of urban population more effectively has resulted in the inclusion of an additional first-year requirement for health students t o assure systematic coverage of economic, political, and cultural variables as these affect social health needs, programs, access to and acceptability of service. Changes in Educational Format Planned and implemented collaboratively between the Hunter College School of Social Work and the Mount Sinai Hospital of New York, a course in the social components of health and illness presents specific content about major health problems with emphasis on chronic illness. Agency-based practitioners representing the expertise of multiple professions have composed part of the teaching cadre. The coordination and integration functions have been carried by a Hunter faculty member. Classes have been taught on both school and medical center campuses. In this curriculum offering, academic and practice centers have combined resources t o the development of social work knowledge and practice, and important benefits have accrued t o the two institutions, for both short- and long-term objectives. Most important, this endeavor has provided evidence that a school agency intraprofessional collaborative process need not challenge the authority of either institution.
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Another offering was a final semester integrative seminar. It is designed t o enable students t o expand what they know through becoming more conversant with the issues, problems, and challenges they may expect t o confront as they enter professional practice. Cast against a backdrop of an adequately functioning health system, the topics included collaboration, consumerism, health manpower, the economics of health care, new trends in service delivery, accountability, and research. The presentations by experts in their respective fields provided excellent role models. The open exchange among the students and the six class and field health-module faculty who participated in the entire course resulted in an interesting and productive educative experiment for all involved. A subgroup of agency participants, meeting as a task force t o develop guidelines for strengthening the field curriculum, have identified two priority areas of work for the coming year. These are: (1)the teaching curriculum for induction of new field instructors for students in the social health module; and (2) recording for social work practice in health mandated by new accountability systems, such as PSRO. The recommendation t o experiment with a homogeneously sectioned seminar for new field instructors in health t o be co-led by a campus and a field faculty member is being implemented. A school-agency task force is t o work on recording guides, in consultation with a wide range of agency personnel. Ultimately, these will be distributed t o all health agencies in which Hunter students are placed. SUMMARY As a committee, we believe that preparation for health practice, broadly conceived, can provide the learning of concepts and principles of practice which are readily transferable to other fields. We are continuing our collaborative work a second year to address a second-year curriculum beyond elective offerings, and will focus on ways better to infuse the field with what we have learned together t o date. In sum, those of us who have been actively involved in this effort are committed t o its workability. As a result of our operating as a cohort of campus-based faculty, field agencies, and students, we have already experienced the capability of quicker response than would otherwise be possible in the face of changing demands in professional practice, as well as policy and procedural matters. The committee's experience t o date attests t o the reality of productive and effective collaboration for curriculum change. Continued success will be based on our ability t o risk open exchange of ideas and attitudes, however conflictual or threatening t o prior presumed prerogatives of autonomy, and t o maintain a focus on mutually held objectives for education. In the face of
Phyllis Caroff
the budget crisis experienced by both schools and agencies, our commitment to the shared responsibility for graduate-level professional education and the utilization of our common resources is imperative. How better can we demonstrate our ability to prepare social work students for effective participation in meeting the human need for adequate health care?
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REFERENCES 1. Bess Dana and Cecil G. Sheps, "Trends and Issues in Interprofessional Education: Pride, Prejudice, and Progress," Journal of Social Work Education 4, no. 2 (Fall 1968):37-8. 2. "Credo for the Social Health Module" (New York: Hunter College School of Social Work, July-August, 1973). "1. The availability of and access t o health care services essential to individual physical and emotional well-being is a right. "2. Health and medical care exist on a continuum from social provision for the maintenance of health through primary and secondary prevention of disease and disability, rehabilitation and restorative treatment and life enhancing care of the chronically and terminally ill. "3. Health care is comprehensive, best provided by integrated action of multidisciplines and professions accomplished through collaborative effort; concerned with enabling people t o achieve and maintain positive well-being through maximizing their potential for enhanced social functioning and quality of life. "4. The consumer is an active participant in the identification of health problems; in the planning for and evaluation of health care."
Social Work in Health Care Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/wshc20
A STUDY OF SCHOOL-AGENCY COLLABORATION IN SOCIAL WORK IN HEALTH CURRICULUM BUILDING Phyllis Caroff DSW
a
a
Professor of Social Work, Hunter College School of Social Work, City University of New York, New York, NY 10021 Published online: 26 Oct 2008.
To cite this article: Phyllis Caroff DSW (1977) A STUDY OF SCHOOL-AGENCY COLLABORATION IN SOCIAL WORK IN HEALTH CURRICULUM BUILDING, Social Work in Health Care, 2:3, 329-339, DOI: 10.1300/J010v02n03_09 To link to this article: http://dx.doi.org/10.1300/J010v02n03_09
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/terms-and-conditions
A STUDY OF SCHOOL-AGENCY COLLABORATION IN SOCIAL WORK IN HEALTH CURRICULUM BUILDING
Downloaded by [University of Sussex Library] at 17:45 10 February 2015
Phyllis Caroff, DSW
ABSTRACT. Viewing agencies offering a fieldwork practicum as underutilized educational planning reserues, Hunter College School o f Social Work undertook t o upgrade its relationship with its health settings from cooperative t o collabomtiue status. The process, achievements, and goals o f the joint e f f o r t o f campus and agency educators are described.
Social work education is currently debating how to achieve maximum utilization of the expert knowledge and experience of the class and the field in educating for the profession, and there is ferment. This ferment stems from pressures for change from the larger social order which has mandated social work's existence, and the profession itself, the colleges and universities offering classroom curricula and the agencies providing the practicum for students and dependent on the educational product for delivering social work services. Pressure can provide opportunity, a climate conducive t o effective enrichment of the professional cumculum. In this climate, one graduate school of social work and a selected group of agencies in health services embarked on the joint development of a curriculum for social work in health. The objective of this paper is to share the experience to date. Understanding the process, progress, and obstacles of the curriculum-development effort requires recognition of the historical relationships between schools of social work and agencies providing the practicum. These relationships reflect the town-gown conflict. Social work educators have presumed that they are better prepared than practitioners to formulate practice models for helping and to define the Dr. Caroff is Professor o f Social Work, Hunter College School o f Social W o r k , City University o f New Y o r k , 129 East 7 9 t h Street, New Y o r k , N Y 10021. T h e author acknowledges the particular contribution o f Elinor Stevens in the beginning organization and implementation o f the educational project described in this article. Social Work i n Health Care, V o l . 2(3), Spring 1977 329
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professional body of knowledge. In the development of theory for practice, the school-based faculty has been perceived by agency practitioners as relatively free of the pressure to respond to the immediacy of client need and the constraints of inadequate resource. The schoolbased faculty is seen as existing in an academic "ivory tower," unrealistic, being limited in its ability to relate t o the "real" needs of people and demands of 'practice. The school, by virtue of its authority and responsibility to award the degree and to accredit competence for admission to the profession, has held the initiative to invite the agencies t o participate in the educational endeavor. Consequently, there has been conflict in the differential valuing of the respective contributions of school and agency in educating for our profession. It is the author's view that the tension created by this historical reality has reverberated as a theme in the attempts of schools and agencies to move toward collaboration in social work education. Those who agreed t o participate in the project to be presented agreed that the dichotomy was unproductive. They assumed that the debate on the respective roles of school and agency could be transcended by confronting the educational tasks.
HUMAN NEEDS: A RATIONALE FOR REORGANIZATION
In an attempt to respond to unmet human needs, changing patterns of service delivery, and the school's rapid growth in resources and size, Hunter College School of Social Work sought a more viable and qualitatively relevant structure for educating its students. The curriculum framework adopted by the faculty in 1972 departed from the traditional rubrics of process, problem, and program in developing practice concentrations. Reorganizing the curriculum into a structure based on human needs, and identifying concentrations accordingly, the school sought t o shift its focus from skill to competence. Competence was seen as including but not restricted to skill. Competence is concerned also with the context in which skill is exercised. It assures the integration of information and orienting theoretical knowledge on which differential and timely use of skill is contingent. A core of social work content for all students was to be identified. In addition, the specialized knowledge of a particular need area was to be pursued in depth.
Phyllis Caroff
Downloaded by [University of Sussex Library] at 17:45 10 February 2015
BEGINNING EXPLORATIONS WITH HEALTH FIELD REPRESENTATIVES The Collaborative Process At the time of the formal decision for the reformulation under the human needs rubric, 40% of the student body at the Hunter College School of Social Work were placed in health settings, i.e., medical, psychiatric, rehabilitative, etc., for their field practicum. Our prior cooperative curriculum efforts in the field had sensitized us to the need for systematic collaborative and concurrent work in the agencies and in the school t o achieve mutually held objectives. In the spring of 1972, three preliminary meetings were held with a group of social work administrators in health agencies to present the concept of the curriculum reorganization and a projected skeleton curriculum for their reactions, modifications, and additions. There was consensus about the mutual responsibility for assuring the conceptual, orienting, and integrative learning that professional education required. That opportunities for such learning existed in both class and field was clear. Therefore, the knowledge, style, and value components of skill, and the conceptualization of role, task, and function in practice were t o be taught in both places. Implementation of such agreement required mutual willingness t o review existing structural arrangements for learning and teaching as well as current patterns for utilization of resources, including personnel. In this initial phase, some major content gaps in the traditional curriculum were identified: health service delivery systems; interprofessional and interdisciplinary collaboration; and the urban community, including ethnic variability in the perception and use of health care. Also, content related to the impact of physical illness, chronic and acute, and an approach t o obtaining necessary medical background information were seen as insufficiently emphasized. Agency participants felt strongly that social workers in health must be prepared t o deliver services in more than one modality, that collaborative skills were central to their competence as health professionals; and, equipped with appropriate knowledge, they must see themselves as potential change agents in the improvement of health services t o the community. Accountability as well as the professional responsibility t o make the social work contribution t o comprehensive health care more visible were also stressed. There was agreement that a mechanism was required for ongoing collaborative work between school and hospital educators. Time would be required t o modify existing content and t o develop new content. To factor out how best t o use the combined resources of agency and school t o enhance the educational product would necessitate joint
SOCIAL WORK IN HEALTH CARE
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effort. A formal structure was recommended as the logical next step t o the collaborative effort. Design for Collaboration A School-Agency Social Health Module Curriculum Committee was convened in the fall of 1973. Its membership consisted of Hunter College faculty assigned to the Social Health Module and representatives of health settings reflecting a range of services in which students were placed. ("Module" is the term adopted by the Hunter College School of Social Work for the cohort of faculty, students, and agencies in a human need concentration.) All agency participants were committed to a practicum that would go beyond the traditional tutorial relationship between student and field supervisor and legitimitize the multiplicity of teaching and learning resources to which students in complex health systems are exposed. The faculty members on the committee represented the range of expertise in the traditional sequences of the cumculum: human behavior and the social environment, social policy and social welfare, research, and practice methods. Both school and agency participants brought a deep understanding of existing and projected programs and resources. The majority of agency participants were administrators and educational coordinators, primarily from multifunctional health care settings. Most important, they also held the authority to innovate in both class and field cumculum should new directions evolve in the process of work together. A beginning consensus around objectives for master's level social work practice in the health field was quickly achieved. This committment was a source of support and stimulation to the work of learning the real meaning of collaboration. To summarize succinctly a three-year process in developing a collaborative climate presents a formidable task. The author, who has served as chairperson of the committee, takes responsibility for the perception of the process as here presented. Learning t o Work with our Conflicts Initially, the heavy demand was for work related to revisions of and additions to content. Agency participants accurately perceived the school content as more adequately related to practice in family agencies and child-guidance clinics than in health care settings. A common criticism about the school cumculum was that students had little awareness of the dynamics of functioning in a larger system as part of an interprofessional endeavor. For some of the agencies, student class assignments did not reflect awareness of the nature of their practice in which short-term, crisis-oriented work comprised a large
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Phyllis Caroff
measure of the interventions in individual, family, and group modalities. There were particular complaints about the school calendar, the scheduling of vacations, particularly among those institutions where educational programming was linked to the calendars of medical and nursing students. What surfaced among the agencies was the recognition that some of what was spoken was from their individual agency perspective, and that our task in resocializing ourselves was to think in terms of the education of more than one-third of the total student body in a range of health settings. The school-based faculty expressed their concern that the agency teachers in large measure did not perceive themselves as educating for the profession as well as for their particular institutional practice; they did not seem to move from the case and the service to the principles of the practice. There were differences among school-based faculty as to whether or not education for the profession would be best served by the agencies' teaching their own practice well and leaving the conceptualization of principles of the practice, with their knowledge and value components, to the school. Our struggle reflected mutual awareness of the unevenness of practice in the field. We were using a wide range of agencies, all interested in contributing to education, but at different levels of commitment and capability. The group finally reaffirmed the principle that conceptual orienting and integrative learning were responsibilities of both class and field. There was agreement that the school was primarily responsible for teaching concepts and principles of a range of orienting theories, and would draw upon health practice issues and problems as illustrative in both program implementation and orienting knowledge stems of the curriculum. The agency was primarily responsible for the experiential learning, including the development of professional use of self. Each in turn has responsibility for reinforcement and adding to knowledge as gaps are observed. The primary challenge was to improve communication and develop an attitude of mind which accepted the benefits to the profession of a more truly collaborative effort. The greatest felt need on the part of the school-based faculty was to familiarize our colleagues from the agencies with the processes and challenges involved in selecting relevant content from a rapidly expanding body of knowledge, to be presented in a two-year progression, in a large school and university operating under such constraints as available resources, professional and university regulatory requirements, and contractual arrangements with students. In this initial phase, the committee was well served by the presence of a colleague working on a special health project. By virtue of being neither a member of the school nor the agency subgroup, she was in the unique position of being able to assume the role of "observing ego," facilitating our work together in our learning from each other.
SOCIAL WORK IN HEALTH CARE
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A turning point toward cohesion in our relationship occurred in the second year of the committee's operation. It was precipitated by a confrontational question from an agency colleague posed t o the chairperson following a scheduled work session: "How come you always say, 'Let me bring you on board'? How come we never say, 'Let us bring you on board'?" Following some discussion about our process together in the next general meeting, there was a noticeable shift among the committee members from the use of "you should" t o "how can we?"
Emerging of Common Goals An analogy can be drawn from the literature on interprofessional education which highlights the demands made upon the involved actors in achieving mutual objectives. Asking that the professional person pool his ideas with others in the assessment o f the problem to be solved means that he is required to have not only a secure hold on his own professional knowledge, but an ability to communicate it to others and to acknowledge the limitations as well as the possibilities within his own professional armamentarium. It necessitates that he respect both himself and others as having knowledge, understanding, skills, and most importantly, equal right to participate in the problem-soluingprocess.'
Clearly, the demands upon us as intraprofessional collaborators were very much the same. Our early adulthood might well have been marked by the statement from the same agency colleague that "In this crowd we've learned that if we get shot down it's for our ideas, not because of where we come from." A major curriculum challenge was t o develop skills to respond t o the needs of people in changing, time-limited pattems of care and at the same time provide the opportunities t o develop skills in depth. While not every social worker's knowledge and skill could cover the gamut of the profession's responsibility, it was deemed necessary t o encompass the whole in the development of the curriculum t o assure the student's comprehension of and identification with the scope and depth of the profession's responsibility in health and medical care. Consultation and/or supervision of allied health manpower as well as beginning skill in administration were perceived as among the repertoire of skills for master's level social work practitioners, and, consequently, projected areas for curriculum development in class and field. The school-based administration's decision t o allow for a five-to seven-year span t o achieve sound curriculum reorganization was comforting in light of the amount of work t o be done. Content modification and changes in pattems of learning and teaching were t o be assessed through feedback from the general practice arena, the classroom teachers, and the students in the Social Health Module.
Phyllis Caroff
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THE PROCESS OF CURRICULUM MODIFICATION Having decided t o build on the existing curriculum, the committee's first step was t o identify the core social work knowledge, skills, and attitudes required for all social work students. We perceived these as being embodied in those required courses in practice, human behavior and the social environment, social welfare policy, administration, and research. We then moved t o specify needed modification and enrichment t o educate toward the objectives of the committee's " C r e d ~ . " ~Revised first-year course outlines and bibliographies were presented by individual campus faculty t o the committee for their information, reactions, and suggestions. Through this process, all campus faculty as well as agency participants became familiar with what was t o be taught to the health students. Even though ultimate responsibility for classroom content resided with the individual teacher, the process sensitized all participants t o their respective competencies. Further, the gaps and areas needing reciprocal school-agency reinforcement t o achieve better integration were sharply delineated. An important outcome was the recognition of the need for better integration among courses offered within the health curriculum at the school. As a result, in the following year the instructors in human behavior and social policy attended each other's classes with the objective of identifying and presenting to students the links in the respective content. This was tested through a collaboratively designed question on the final examination in each course. Through the planning and implementation of the orientation of more than sixty first-year students t o the newly formed Social Health Module, we experienced our first collaborative contact with the students in the fall of 1974. Having jointly identified the health care system and collaborative work as priority content, it was decided t o schedule agency visits for small groups of two or three students t o observe social work in action through such experience as case presentation, rounds, team meetings, and direct observation of programs involving multiple professionals. We hoped t o expose them t o these valued dimensions of learning as a core t o their ability effectively t o deliver direct services in health settings. Those agencies participating were provided with guidelines for orienting students t o the setting and for selecting the observation. Students too were presented with observation guides. Visits were followed by small-group discussions co-led by school and agency personnel. The aim was to help students generalize from their varied experiences and deal with reactions, questions, and criticism. In addition, an important intent was to provide a model for new students which would reflect the working relationship between class and field teaching.
SOCIAL WORK IN HEALTH CARE
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The planning together and the readiness of both school and agency to provide the considerable resources necessary t o test out the value of this approach affirmed the validity of such collaborative work, at least for a circumscribed project. Student feedback reflected an unevenness in the learning experience. We had to rethink how best t o implement our objectives for orientation. Our ability t o evaluate and assume the shared responsibility to replan was a new and promising experience for us as partners. Modifications in Curriculum Content In explicating the "new" content, the committee reaffirmed the importance of teaching a dynamic orientation t o growth and development, utilizing a life-cycle model. However, increased emphasis on physical health and the impact of illness was needed. Examination questions would be a key variable in assessment of individual/farnily needs and required resources. The social welfare policy sequence for the health module was reformulated t o emphasize current programs in health care, operative legislation, government regulations and entitlements, with their respective imports for social work tasks and roles. The history and development of health system institutions and their philosophical underpinnings were perceived as illuminating the current climate of health and medical service. Understanding the demographic profile of a community and how social health needs are defined were seen as necessary to understand programmatic emphases in social welfare policy. In the area of intervention it was observed that in practice the primary modalities among the participating health agencies were in work with individuals and families. It was the judgment of the agency representatives and faculty that changing patterns of service required learning skill in working with small groups. More aggressive leadership was needed t o maximize the potential use of small-group intervention. Understanding of group dynamics was seen as essential t o collaborative practice. There was considerable debate about whether we were ready t o require group work as a second method, given the unevenness of related learning opportunities in the practicum. The committee had previously affirmed the existing policy regarding method so that students begin a concentration in one method and add a second method as appropriate t o their interests and to the related learning demands in the agency. The decision was t o recommend that students in the Social Health Module take group work as a second method. There was a concommitant agency commitment t o further develop their own group service programs. Furthermore, it was determined that the agencies needed t o create opportunities for student exposure t o and direct work with community groups.
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Phyllis Caroff
The committee continues t o confront an important educational challenge. Exposure to long-term process has been deemed essential learning for the development of quick assessment skills. How, then, can we teach first-year students the skilled dynamic assessment required in short-term and crisis-oriented work which composes so much of health practice, without sufficient opportunity for longer term treatment? Currently, we have agreed that all first-year students in health will be taught short-term and crisis-treatment models in class. Efforts will be made to select some case situations in the field which lend themselves t o learning such skill through longer term process. The need for specificity of health content in the individual methods was identified. The practice faculty also addressed itself t o the refinement of an integrated methods course for work with individuals, families, and small groups t o be offered in the second year. The educational content of collaborative practice t o be systematically addressed in all case study with its attendant systems work included: (1) knowledge of the particular expertise of the multidisciplines and professions involved in meeting patients' needs; (2) sensitization of the student t o his own behaviors and those of other professionals; (3) communication skills, including group interaction. A serious gap noted was the absence of the requirement t o record collabo: rative practice in both class and field. The pressing demand t o meet the needs of urban population more effectively has resulted in the inclusion of an additional first-year requirement for health students t o assure systematic coverage of economic, political, and cultural variables as these affect social health needs, programs, access to and acceptability of service. Changes in Educational Format Planned and implemented collaboratively between the Hunter College School of Social Work and the Mount Sinai Hospital of New York, a course in the social components of health and illness presents specific content about major health problems with emphasis on chronic illness. Agency-based practitioners representing the expertise of multiple professions have composed part of the teaching cadre. The coordination and integration functions have been carried by a Hunter faculty member. Classes have been taught on both school and medical center campuses. In this curriculum offering, academic and practice centers have combined resources t o the development of social work knowledge and practice, and important benefits have accrued t o the two institutions, for both short- and long-term objectives. Most important, this endeavor has provided evidence that a school agency intraprofessional collaborative process need not challenge the authority of either institution.
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SOCIAL WORK IN HEALTH CARE
Another offering was a final semester integrative seminar. It is designed t o enable students t o expand what they know through becoming more conversant with the issues, problems, and challenges they may expect t o confront as they enter professional practice. Cast against a backdrop of an adequately functioning health system, the topics included collaboration, consumerism, health manpower, the economics of health care, new trends in service delivery, accountability, and research. The presentations by experts in their respective fields provided excellent role models. The open exchange among the students and the six class and field health-module faculty who participated in the entire course resulted in an interesting and productive educative experiment for all involved. A subgroup of agency participants, meeting as a task force t o develop guidelines for strengthening the field curriculum, have identified two priority areas of work for the coming year. These are: (1)the teaching curriculum for induction of new field instructors for students in the social health module; and (2) recording for social work practice in health mandated by new accountability systems, such as PSRO. The recommendation t o experiment with a homogeneously sectioned seminar for new field instructors in health t o be co-led by a campus and a field faculty member is being implemented. A school-agency task force is t o work on recording guides, in consultation with a wide range of agency personnel. Ultimately, these will be distributed t o all health agencies in which Hunter students are placed. SUMMARY As a committee, we believe that preparation for health practice, broadly conceived, can provide the learning of concepts and principles of practice which are readily transferable to other fields. We are continuing our collaborative work a second year to address a second-year curriculum beyond elective offerings, and will focus on ways better to infuse the field with what we have learned together t o date. In sum, those of us who have been actively involved in this effort are committed t o its workability. As a result of our operating as a cohort of campus-based faculty, field agencies, and students, we have already experienced the capability of quicker response than would otherwise be possible in the face of changing demands in professional practice, as well as policy and procedural matters. The committee's experience t o date attests t o the reality of productive and effective collaboration for curriculum change. Continued success will be based on our ability t o risk open exchange of ideas and attitudes, however conflictual or threatening t o prior presumed prerogatives of autonomy, and t o maintain a focus on mutually held objectives for education. In the face of
Phyllis Caroff
the budget crisis experienced by both schools and agencies, our commitment to the shared responsibility for graduate-level professional education and the utilization of our common resources is imperative. How better can we demonstrate our ability to prepare social work students for effective participation in meeting the human need for adequate health care?
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REFERENCES 1. Bess Dana and Cecil G. Sheps, "Trends and Issues in Interprofessional Education: Pride, Prejudice, and Progress," Journal of Social Work Education 4, no. 2 (Fall 1968):37-8. 2. "Credo for the Social Health Module" (New York: Hunter College School of Social Work, July-August, 1973). "1. The availability of and access t o health care services essential to individual physical and emotional well-being is a right. "2. Health and medical care exist on a continuum from social provision for the maintenance of health through primary and secondary prevention of disease and disability, rehabilitation and restorative treatment and life enhancing care of the chronically and terminally ill. "3. Health care is comprehensive, best provided by integrated action of multidisciplines and professions accomplished through collaborative effort; concerned with enabling people t o achieve and maintain positive well-being through maximizing their potential for enhanced social functioning and quality of life. "4. The consumer is an active participant in the identification of health problems; in the planning for and evaluation of health care."
