Academic journal article Social Work

An In-Law Comes to Stay: Examination of Interdisciplinary Conflict in a School-Based Health Center

Academic journal article Social Work

An In-Law Comes to Stay: Examination of Interdisciplinary Conflict in a School-Based Health Center

Article excerpt

It is one of the peculiar curses of the social work profession that we often find ourselves guests in another's domain. Social workers are often destined to toil in settings, such as hospitals, schools, prisons, nursing homes, and mental health facilities, where other professions exert a higher level of control because of their number, their historical precedence, or their professional status (Cowles & Lefcowitz, 1992; Dane & Simon, 1991). Privatization, decentralization, specialization of services, as well as the emergence of complex social and economic problems, have contributed to increased interdisciplinary collaboration over the past four decades, a trend that appears to be ongoing (Abramson & Rosenthal, 1995).

Increase in Collaborative Services

School-based health centers (SBHG) are a recent, effective example of an attempt by social services, medical services, and urban high schools to form an interdisciplinary collaboration to provide health care to medically and psychiatrically underserved children (U.S. General Accounting Office, 1994). Only half of all school-age children receive any health care. Although 7.5 million children under 18 years of age require mental health services, fewer than one in eight receive them (U.S. Department of Health and Human Services, Public Health Service, 1990).

The call for "services integration" and the school reform movement of the late 1960s and early 1970s provided a conducive climate for school-linked and school-based social and medical services (Hare, 1995). The first three SBHCs were located in Texas, Connecticut, and Massachusetts and were funded by grants from the Robert Wood Johnson Foundation, which continues to lobby and support SBHCs to this day. The success of SBHCs is apparent in their rapid growth, from 40 sites in 1985 to more than a thousand in 1997 (Lear & Schlitt, 1997). Minimum staffing for SBHCs includes a nurse practitioner, a social worker, an office manager, and a medical director who is a physician. Although SBHCs are internally interdisciplinary and collaborative, the majority of conflicts occur between the SBHC and the school host. This article focuses on these conflicts.

Interdisciplinary and Interdepartmental Conflict

Whereas writings on interdisciplinary conflict per se are limited in number, the organizational literature yields a wealth of speculation about interdepartmental conflict, which appears to be similar to interdisciplinary conflict in many regards. Organizational theory contends that conflict between departments is the norm rather than the exception (Pondy, 1967) and that the boundary between departments is often a locus for this conflict (Follett, 1940). Likewise, interdisciplinary conflict often emerges in the areas of gatekeeping, domain, and disposition (Scott, 1997).

Conflicts arise because departments develop individual objectives, goals, and norms (Katz, 1964; Thompson, 1961). Professions also have their own cultures, goals, and ideologies, which sometimes differ radically from one another. Schools are run by teachers whose ideologies may be strikingly different from those of social workers. Although social workers cherish values such as empowerment, self-actualization, and confidentiality (Levy, 1973), teachers often emphasize self-discipline, obedience, hard work, attentiveness, and other values that are conventionally thought to contribute to a successful education. Likewise, the hospital-based social worker must adapt to the "medical model"; those in employee assistance programs must live in the culture of capitalist business; and social workers in prisons must deal with what may sometimes seem like draconian perspectives on punishment and rehabilitation.

It is easy to imagine how disparate ideologies lead to divergent goals. Departments with similar goals are more likely to seek solutions to conflicts than those with differing goals (Pondy, 1967; Tjosvold, Dann, & Wong, 1992). …

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