Guest Post - What it Means to be a Social Work and Public Health Dual Professional by Mark Flanagan (Dec ’15)

What is a dual professional?

Mark Flanagan (Dec '15)

A dual professional is anyone who uses two or more sets of professional competencies in a work setting.  Dual professionals address complex problems from multiple perspectives and modalities. The dual perspective of clinical social work and health promotion in public health provide complimentary frameworks to address health issues.  Clinical social work focuses on working with individuals, families or groups to solve psychosocial issues.  Health promotion in public health emphasizes facilitating programs or initiatives to enhance wellness of groups or communities.

 Social work and public health dual professionals creatively combine social work and public health approaches to address multifaceted health problems. For example, by understanding human behavior in the social environment (clinical social work framework) a professional can better design, implement, and evaluate a health program (health promotion public health framework).  As healthcare in the United States becomes increasingly integrated as a result of the Affordable Care Act, additional broad practice professionals are needed to ensure coverage continuity and client-centered care.  Dual social work and public health professionals are specially equipped to provide these linkages based on their training in community, program, and family system practice. 

What is a dual professional’s identity?    

Dual professionals’ identities are expansive and responsive.  More so than professionals with one discipline focus, dual professionals need to construct much of their identity based on self-reflection, work-experience and solution-focused thinking (Trede, Macklin, & Bridges, 2012).  Dual professionals need to be particularly aware of their emotional world and how it shifts across a career landscape. 

For dual professionals, identity development means identity authorship and emotional growth. Identity is a way of being. Identity for dual professionals is continually remade through dynamic interactions between clients, co-workers, and the public.   Identity is also a way to evaluate and make sense of practice. Therefore as roles shift, so likely will evaluative and practice frameworks (Trede, Macklin, & Bridges, 2012). A look at where dual professionals work will reveal why. 

What is the practice setting of dual professionals?

 Dual professionals work in diverse interdisciplinary settings.  Interdisciplinary teams come from varied personal backgrounds to deliver and coordinate client care to achieve unique service needs.   For example, professionals including doctors, nurses, physical therapists, nutritionists, pharmacists, social workers, public health workers, and administrative personnel commonly work together in treatment of cancer, mental health, obesity, domestic violence, chronic illness, and addiction.  Alternatively, counselors, nurses, lawyers, social workers, occupational therapists, and business people work to provide HIV, housing, legal, food, and psychosocial services.  Interdisciplinary teams vary in their makeup and group dynamics. 

The very heart of collaborative teamwork involves sharing.  An interdisciplinary team should be first and foremost united in achieving the needs of the client system, whether that is an individual, family, or community group (Reeves, et al., 2010).  This centers practice on the client and forms common ground to guide decisions for otherwise distinct professional practices.  Secondly, team members should share accountability for client outcomes (Reeves, et al., 2010).  Accountability sharing ensures that team members will fulfill the roles necessary to improve client health.  While it is not uncommon for hierarchical organizations to assign leaders to solve problems, interdisciplinary teams generally thrive off shared problem solving (Reeves, et al., 2010).  By sharing problem solving, teams can work through difficult situations with limited stress on any one part of the team, allowing for overall enhanced efficiency and effectiveness.  Next, teams share the value of working with and learning from other disciplinary perspectives (Reeves, et al., 2010).  Adopting an attitude of inquiry towards co-workers of other disciplines allows interdisciplinary teams to continually grow instead of becoming isolated.  Finally, interdisciplinary teams set goals collaboratively to deliver treatment.  In doing so, the team enhances shared expertise and reduces barriers of professional autonomy (Hammick, et al., 2009). 

The Interprofessional Education Collaborative Panel (IPEC, 2011) emphasizes that professionals should be keenly aware of practice roles and boundaries.  This has as much to do with legal parameters as it does with client-centered care.  It is important that all team members know their roles in treatment and their scope of practice to not provide treatment or advice that is not legally authorized.  In addition, team members should know the roles of other group members to provide continuity of service and to facilitate useful collaboration. 

At the same time, IPEC (2011) emphasizes team members should understand that role boundaries are somewhat flexible and should be able to accommodate changing responsibilities as client needs shift.  Practice environment may change, say from a hospital to home care, which would necessitate the renegotiation of roles within a professional team.  Through this kind of responsive collaboration, the team can develop a body of best practice knowledge that transcends disciplines and promotes effective treatment (Hammick, et al., 2009).  

It should not be a surprise, then, that interdisciplinary settings can promote an unbalanced sense of identity, particularly for dual professionals.  Robin Kirkpatrick, LCSW, MPH explains that it can often feel challenging to balance both social work and public health approaches.  She explains that social work can be very intuitive while public health tends to be much more logical and prescribed.  Robin describes the tendency for many dual social work public health professionals to end up specializing in one discipline because combining the disciplines into one role is not always feasible.

Dual professionals also frequently balance competing values and ethics.  In an interprofessional setting, these conflicting values are intensified by agency goals and objectives.  For example, in vaccination programs, the social work value of autonomy and self-determination is in conflict with public health values of evidence-based practice.  Social work champions the client’s ability to choose, but what if evidence suggests choosing not to vaccinate is extremely harmful, particularly in the long term?  And while public health advocates providing interventions that have proven efficacy, what about a client group that has been systematically oppressed by the medical establishment, creating lasting distrust of mainstream medical recommendations?  These conflicts are not easily resolved and perhaps should not be.  Often, the “right answer” comes from an equal combination of knowledge, experience, continual learning, and adaptation.  

Combining social work and public health in an interdisciplinary setting

Interdisciplinary settings thus serve as a double-edged sword for dual professionals.  As described, such settings can make establishing a professional identity difficult.  However, interdisciplinary environments promote creative solutions to complex problems. My internship experience at Bread for Life, a Watkinsville-based employment readiness agency, is an example of the positive effects of an interdisciplinary setting. 

At Bread for Life we recruited low-income, at-risk individuals to train in a multi-week employment simulation and job readiness program.  Clients received individual case management, brief counseling, as well as skills training through health promotion programs.  We worked in an interdisciplinary team of social workers, board members, lawyers, executives, and clergy to promote job readiness and security.    

From the clinical social work side, I provided contextualized care.  I call this “client-in-community” care.  I conducted assessments of individual clients with the knowledge that community structures influenced their behavior and success in the program.  For example, one client was unable to fully participate in the program because he was constantly concerned about his housing security and safety within the community.  I immediately thought of environmental health risks of sleeping outside or in the negative social context of a homeless shelter.  I then collaborated with program staff to connect with the client’s personal social supports and resources within the community.  We also provided an environment at Bread for Life that allowed for enhanced nutrition and focus to allow the client to feel empowered to learn new skills.

On the public health promotion side, I used insight into client’s lives to create programs that were responsive to client needs.  I call this “client-centered health promotion”.  I learned from clients that it was very easy to get caught up in past wrong-doings and the stress of real world challenges.  It was easy to focus on problems.  From my clinical social work training, I recognized the value of solution-focused therapy to create immediate and powerful changes in client lives.  Because Bread for Life did not conduct psychosocial therapy, I created a “solution-focused thinking” program that would provide clients tools to solve problems at their job and in their broader life.  This health promotion program incorporated the “lived life” experience of clients while providing evidenced-based techniques to create positive change.  The program accounted for the psychosocial histories of clients and sought culturally sensitive change. 

During this time, my identity shifted between social worker and public health worker depending on my project and role.  As not all competencies or frameworks fit for a particular problem, it was unnecessary to carry one “complete framework” with me at all times.  Reflecting on my experience, I gained valuable insight into the overlapping practice of social work and public health, as well as the limits to both. 

Dual professional identity as becoming

Complex problems and competing guides for practice present a daunting challenge to any professional in an interdisciplinary team, especially dual professionals.   As each practice context will have new problems and responsibilities, dual professionals must endeavor to think creatively and flexibly about real world problems (Repko, 2014).  Ultimately, while discussing theory in a classroom is useful, dual professionals must learn how to successfully integrate complementary frameworks “on the job” (Repko, 2014).  Such integration includes critically analyzing diverse approaches, seeking to create common ground and creating a more complete picture of layers of cause. 

As a dual professional, I see the value in embracing ambiguity and assuming an active role in lifelong, ongoing identity construction.  Because of my experience at Bread for Life and my ongoing training in dual professional education, I now understand dual professional identity as a “way of becoming” (Scanlon, 2011).  The ongoing creation of an identity is literally linked with participating in the social membership of the group.  Thus, as interdisciplinary practice continues to evolve and expand, the construction of identity for any dual degree professional will similarly grow. 

Learn more about Mark Flanagan (Dec ’15).

References

Trede, F., Macklin, R., Bridges, D. (2012). Professional Identity Development: A review of the higher education literature.  Studies in Higher Education, 37(3), 365-384.

Hammick, M., Olckers, L., & Champion-Smith, C. (2009). Learning in interprofessional teams: AMEE Guide no 38. Medical Teacher, 31, 1-12.

Interprofessional Education Collaborative Panel (IPEC). (2011). Core competencies for Interprofessional collaborative practice: Report of an expert pane. Washington, D.c.: Interprofessional Education Collaborative.  Retrieved from:  www.aacn.nche.edu/education-resources/icpreport.pdf.

Reeves, S., Lewin, S., Espin, S., & Zwarenstein, M. (2010).  A Conceptual Framework for Interprofessional Teamwork.  In Interprofessional Teamwork for Health and Social Care (pp.57-76).  United Kingdom: Blackwell Publishing.

Scanlon, L. (2011). Becoming a Professional: An Interdisciplinary Analysis of Professional Learning. New York, NY: Springer. 

Repko, A.F., Szostak, R., Buchberger, M.P. (2014). Chapter 3: The Interdisciplinary Studies “Cognitive Toolkit.” In Introduction to Interdisciplinary Studies (pp.46-61).  Los Angeles, CA: SAGE