ARE INTERDISCIPLINARY TREATMENT TEAMS GRADUALLY DISAPPEARING?
By Mickey Skidmore, ACSW, LCSW
In many agencies, the interdisciplinary treatment team process has formally or informally fallen to the domain of social work. This is perhaps a bit of a fluke, especially in psychiatric hospital settings where they continue to operate out of a medical model hierarchy. The concept of the interdisciplinary treatment is a sound clinical tool which affords the ideas of several professional disciplines (i.e. psychiatry, nursing, social work, psychology, occupational therapy, activity therapy, etc.) to contribute recommendations and interventions in an individualized treatment plan for each client/patient. Although many agencies continue to utilize this process, this article acknowledges a growing concern that many agencies may be faced with the gradual vanishing of the interdisciplinary treatment team process.
Despite various regulations requiring hospitals to adhere to the principals of the interdisciplinary treatment team process, it is perhaps most threatened in the acute inpatient psychiatric level of care. Concerns have already been raised that the fast-paced evolution of today’s health delivery systems have placed various programs and levels of care under siege (Partial Hospitalization Programs and Home Health just to name a few). These same dynamics are now adversely affecting inpatient psychiatric settings, and may be encroaching on other levels of care as well. Consider the following:
As it relates to inpatient psychiatric care, regulations require that the interdisciplinary treatment team convene within 7 – 10 days of the patient’s admission. Now that managed care has forced hospitals to focus solely on crisis stabilization, the average length of stay for adults has dwindled to 7 – 10 days, with many patients stabilized and discharge anywhere from 23 to 72 hours. For these patients, one has to wonder if they have actually been afforded the interdisciplinary treatment process. In short, the regulations have not kept pace with or acknowledge the reality of present day health care delivery systems. With growing demands and pressures to the admitting psychiatrists, many succumb to a thought process similar to this: “if they’re discharged within a week then we have not violated the regulation by not holding the formal interdisciplinary treatment team.”
Not withstanding the above pressures, many social workers have endured the challenges of overseeing the interdisciplinary treatment process in the face of various organizational dynamics, including the nuances of agency or programmatic cultures and the interpersonal characteristics of the clinical treatment team. For example, two minute hallway conversations between the psychiatrist and nurse or social worker does not constitute an interdisciplinary treatment team meeting – by the letter or spirit of the law. Neither does the psychiatrist getting a quick report from the nurse before they begin daily rounds on their patients. So, what about when psychiatrists simply do not participate or refuse to participate in treatment team meetings as part of their regular practice? If other treatment team members meet without the psychiatrist routinely because of these factors, does that meet the requirements of an interdisciplinary treatment team meeting?
Needless to say, these issues should raise certain questions and concerns for social workers. If the treatment team is documenting something that is in fact not actually occurring, is this illegal? … fraud? … deception? … ethical? Furthermore, if this scenario rings true, how does the patient participate in such a process? How are they educated about their treatment goals? How is their personal information, preferences, and ideas honored and incorporated in such a process? What is the accountability and liability of the professionals who participate in such a process?
For social workers in particular, such circumstances speak to mounting concerns on more profound levels. Based on this type of scenario, one could conclude at best, that the interdisciplinary treatment team process is being reduced to an exercise in creative writing (avoiding for the moment the potential issues of fraud). A more severe interpretation however, might be that the so-called interdisciplinary treatment model has only led to professional isolation and subservience to the medical model in psychiatric hospital service delivery. Nurses are assuming all aspects of patient care and skilled social workers are facing elimination, as the professional social worker has become nothing more that a resource manipulator and discharge planner. Furthermore, advocacy regarding interdisciplinary treatment team issues such as this in the present political climate often results in further professional isolation and antagonism within the bureaucracy.
While these observations may be largely anecdotal, the likelihood that such scenarios may in fact be more commonplace is worthy of significant exploration. Perhaps this article can be a small voice to this contemporary potential in health care. Professional training is an essential ingredient, and advocacy from our professional organizations and regulating bodies are clearly needed. Without this, little will change and it may not be long before the interdisciplinary treatment team process is a thing of the past.