The Social Worker on the Medical Transdisciplinary Team

Providing services to the poor and underserved is a gift. The best kept secret is that it is work that most of us are unable to leave, work that allows the practitioner to live out his or her beliefs in a world that may seem increasingly hostile to them. Work with the underserved means being able to value every individual no matter how different she or he is from you and to fight for basic human rights, including health care for all. It also means meeting many fascinating people, each with his or her own touching, funny, and brave story to tell, and getting to work with providers and staff with similar views. Today, there is a new approach to teamwork known as transdisciplinary care. This new approach has been adapted from research and business team models and transformed to respond to the many challenges of providing the best health care to the underserved.

Fortunately, the clinic setting lends itself to this model, which is more efficient and cost effective than traditional staffing models and, more importantly, improves patient health and increases provider satisfaction (see Ruddy, this issue, and references therein). Transdisciplinary care involves a team of professionals who work together to share knowledge and skills across disciplines.¹ Transdisciplinary teamwork improves communication and cooperation, and provides integrated care to the clinic's patients. The aspect of transdisciplinary care that distinguishes it from all other team models is its emphasis on cross-training. The three goals of transdisciplinary staff development are "(1) sharing general information; (2) teaching others to make specific judgments; and (3) teaching others to perform specific actions."² The team is made up of medical providers and other professionals, including social workers, physical therapists, and patient educators. The patient, and sometimes his or her family, is also a member of the team.

On a transdisciplinary team, members of different disciplines are not only proficient in their own specialties but also, through cross-training and working on the team, become knowledgeable in other specialties as well, making team members' skills overlap. Transdisciplinary training and teamwork not only allow the provider to see a more complete picture of each patient, but also allow a single provider to assess and, in some cases, treat patients in an area other than his or her own. For example, the Association of Clinicians for the Underserved's (ACU's) Early Childhood Caries Prevention Project shows how a pediatrician can be trained to evaluate an infant's teeth for emerging dental problems and, if needed, administer a prophylactic sealing of the teeth.^*

Of all of the disciplines represented on the transdisciplinary team, social work is arguably the most oriented to teamwork. Social workers^† study families, group dynamics, and systems. They are trained to collaborate with others because so much of their work involves team interventions. On a transdisciplinary team, the social worker evaluates the patient's psychosocial status to determine the individual's strengths and weaknesses and the vitality of his or her social support, information that the social worker subsequently brings to the rest of the team as it develops the patient's care plan. The social worker also works with the patient's family and support network to maximize their ability to support the patient emotionally and to provide assistance at home. The social worker provides individual and family counseling to deal with immediate emotional issues and stresses that affect the patient; the social worker refers the patient, family, or both for long-term therapy, if needed. Of course, the social worker also links the patient with other services by making phone calls, filling out forms, and obtaining entitlements.

The Social Work Code of Ethics,⁴ which emphasizes patient rights and empowerment, guides professional social workers. It requires the social worker to identify a patient's strengths as well as his or her weaknesses before writing...