Which approach is based on a vision of society as a community whose members work together to achieve a common set of values and goals?

An interdisciplinary approach involves team members from different disciplines working collaboratively, with a common purpose, to set goals, make decisions and share resources and responsibilities.1

A team of clinicians from different disciplines, together with the patient, undertakes assessment, diagnosis, intervention, goal-setting and the creation of a care plan. The patient, their family and carers are involved in any discussions about their condition, prognosis and care plan.2

In contrast, a multidisciplinary approach involves team members working independently to create discipline-specific care plans that are implemented simultaneously, but without explicit regard to their interaction.3

Depending on the resources of the individual health service, a combination of the two approaches may be used when caring for older people.

Why is it important?

  • Older people in hospitals often have a number of different diagnoses and consequently have multiple and complex needs. Compared to younger age groups, a greater proportion of older people require an interdisciplinary approach to their care in order to deal with complex multimorbidity, social and psychological issues.3
  • The best possible outcomes for older people are achieved through a consultative, collaborative approach to care that actively involves the patient, their family/carers and an interdisciplinary team.1
  • An interdisciplinary approach can help avoid risk averse thinking by weighing up the risk against benefits for the patient.
  • An interdisciplinary approach can improve patient outcomes, healthcare processes and levels of satisfaction.4,5 It can also reduce length of stay 6,7 and avoid duplication of assessments, leading to more comprehensive and holistic records of care.8
  • The opportunity for discussion created by interdisciplinary care planning can be used for the patient, their family and carers to develop their ongoing plan.3

How can you adopt an interdisciplinary approach to caring for older people?

The care team need to work together, utilising an interdisciplinary approach, to provide and implement a care plan that meets the patient’s goals and needs.

All health care professionals have a shared role in providing person-centred care for older people.

Elements integral to a successful interdisciplinary approach

Leadership

Positive leadership and management give clear direction and vision for the team through:

  • Promoting an atmosphere of trust where contributions are valued and consensus is fostered.
  • Ensuring that the necessary resources, infrastructure and training are available, as well as a mix of skills, competencies and personalities amongst team members.9

Person-centred practice

Well-integrated and coordinated care that is based on the needs of the patient can contribute to reducing delays to provision of care and duplicating assessment.1

  • Involving the patient in all aspects of their care empowers them to speak up and contribute to decision-making.
  • Formulating shared standardised interdisciplinary care plans and records of care to contribute to holistic and comprehensive person-centred care.

Teamwork

An interdisciplinary approach relies on health professionals from different disciplines, along with the patient, working collaboratively as a team. The most effective teams share responsibilities and promote role interdependence while respecting individual members’ experience and autonomy.9

  • Ensure team members have clear goals, and an understanding of their shared roles and responsibilities within the team structure.5
  • Participate in joint assessment, diagnosis and goal setting.
  • Recognise the overlap in knowledge and expertise of staff from different disciplines.8
  • Encourage team cohesiveness and creativity through team commitment and the identification of mutual goals.5
  • Encourage less experienced team members to ask questions which may give rise to creative ideas and alternative perspectives.5
  • Establish teams with members from diverse disciplines to foster higher overall effectiveness, and hold regular team meetings which are associated with higher levels of innovation.10

Communication

Communication across disciplines, care providers and with the patient and their family/carers, is essential to setting the goals that most accurately reflect the person’s desires and needs.

  • Involve the patient’s GP or pharmacist to increase the success of the intervention.11
  • Communicate openly to encourage genuine collaboration. A breakdown of communications between health professionals is a common factor in hospital errors and adverse events.4,12
  • Document assessments and ensure clinical handover documents are completed thoroughly and stored in a central place.

1. Department of Human Services 2008, Health independence programs guidelines, State Government, Melbourne.

2. Jessup RL 2007, ‘Interdisciplinary versus multidisciplinary care teams: do we understand the difference?’, Australian Health Review, 31(3):330-331.

3. Continuing Care Section, Programs Branch, Metropolitan Health and Aged Care Services Division, Department of Human Services 2003, Improving care for older people: a policy for health services, State Government of Victoria, Melbourne. .

4. Fewster-Thuente L & Velsor-Friedrich B 2008, ‘Interdisciplinary collaboration for healthcare professionals’, Nursing Administration Quarterly, 32(1):40-48.

5. Youngwerth J & Twaddle M 2011, ‘Cultures of Interdisciplinary Teams: How to Foster Good Dynamics’, Journal of Palliative Medicine, 14(5):650-654.

6. Curley C, McEachern JE & Speroff T 1998, ‘A firm trial of interdisciplinary rounds on the inpatient medical wards – An intervention designed using continuous quality improvement’, Medical Care, 36(8):AS4-AS12.

7. Curley C, McEachern JE & Speroff T 1998, ‘A firm trial of interdisciplinary rounds on the inpatient medical wards – An intervention designed using continuous quality improvement’, Medical Care, 36(8):AS4-AS12.

8. Jacob A, Roe D, Merrigan R & Brown T 2013, ‘The Casey Allied Health Model of Interdisciplinary Care (CAHMIC): Development and implementation’, International Journal of Therapy & Rehabilitation, 20(8):387-395.

9. Nancarrow SA, Booth A, Ariss S, Smith T, Enderby P & Roots A 2013, ‘Ten principles of good interdisciplinary team work. Human Resources for Health’, 11(1):1-11. doi:10.1186/1478-4491-11-19.

10. Xyrichis A & Lowton K 2008, ‘What fosters or prevents interprofessional teamworking in primary and community care? A literature review’, International Journal of Nursing Studies, 45:140-153.

11. Nazir A, Unroe K, Tegeler M, Khan B, Azar J & Boustani M, 2013, ‘Systematic Review of Interdisciplinary Interventions in Nursing Homes’, Journal of the American Medical Directors Association, 14(7):471-478.

12. Mansah M, Griffiths R, Fernandez R, Chang E & Thuy Tran D 2014, ‘Older folks in hospitals: the contributing factors and recommendations for incident prevention’, Journal of Patient Safety, 10(3):146-153.

Community development is a process where community members are supported by agencies to identify and take collective action on issues which are important to them. Community development empowers community members and creates stronger and more connected communities.

Community development is a holistic approach grounded in principles of empowerment, human rights, inclusion, social justice, self-determination and collective action (Kenny, 2007). Community development considers community members to be experts in their lives and communities, and values community knowledge and wisdom. Community development programs are led by community members at every stage - from deciding on issues to selecting and implementing actions, and evaluation. Community development has an explicit focus on the redistribution of power to address the causes of inequality and disadvantage.

Outcomes of community development

There are potential outcomes at both individual and community level. Children and families directly involved in community development initiatives may benefit from increases in skills, knowledge, empowerment and self-efficacy, and experience enhanced social inclusion and community connectedness (Kenny, 2007). Through community development initiatives, community members can become more empowered, such that they can increasingly recognise and challenge conditions and structures which are leading to their disempowerment or negatively impacting their wellbeing (Ife, 2016). At a community level, community development and empowerment initiatives can achieve long-term outcomes such as stronger and more cohesive communities, evidenced by changes in social capital, civic engagement, social cohesion and improved health (Campbell, Pyett, & McCarthy, 2007; Ife, 2016; Kenny, 2007; Wallerstein, 2006).

What is not community development?

Community development is not one-off events, consultation to inform goals or strategies, community advisory groups or committees, or leadership training. All these things could be part of a community development strategy but, by themselves, they are not community development.

Community-based work and community development work

Table 1 outlines the difference between community-based work, which involves the community, and community development work, which is led by the community.

Community-based workCommunity development work

Source: Adapted from Labonte (1999)

An issue or problem is defined by agencies and professionals who develop strategies to solve the problem and then involve community members in these strategies. Ongoing responsibility for the program may be handed over to community members and community groups

Characteristics:

  • Decision-making power rests with the agency.
  • The problem or issue is defined by the agency.
  • There are defined timelines.
  • Outcomes are pre-specified, often changes in specific behaviours or knowledge levels.

Community groups are supported to identify important concerns and issues, and to plan and implement strategies to mitigate their concerns and solve their issues.

Characteristics:

  • Power relations between agency and community members are constantly negotiated.
  • The problem or issue is first named by the community, then defined in a way that advances the shared interests of the community and the agency.
  • Work is longer term in duration.
  • The desired outcome is an increase in the community members’ capacities.
  • The desired long-term outcomes usually include change at the neighbourhood or community level.

When to use community development

Community development is not always a suitable approach to use. Community development may be particularly appropriate:

  • to address social and community issues: Community development is a good approach when you are trying to create change at a community or neighbourhood level. For example, if your goal is to improve community safety, increase community cohesion, reduce social isolation or create communities that are better for children.
  • for Aboriginal and Torres Strait Islander communities: Community development is a good approach to use with Aboriginal or Torres Strait Islander communities because it can enable self-determination and build the capacity of local Indigenous organisations and grassroots community groups (Higgins, 2010).
  •  for disadvantaged communities: Community development initiatives are likely to work well in disadvantaged communities where they can alleviate some of the impacts of disadvantage on children and families by building social capital and social inclusion (Ife, 2016; McDonald, 2011; Price-Robertson, 2011; Wallerstein, 2006).

Community development may not be the best approach if:

  • You already know what you want to do. If the outcomes you want to achieve, and the activities that you will use, are already decided then there is no space for the community to determine outcomes and activities. Similarly, if you don’t have the authority or resources to implement the community’s decisions, community development is not a suitable strategy.
  • You have limited time or short-term funding. Community development is a long-term process. Engagement and planning can take a year or more, and it can take several years to build the capacity of community members to lead a project and ensure sustainable results.
  • Your focus is improving specific individual skills. If you are seeking to build individual skills in a specific area (e.g., parenting skills or literacy), a program that targets these directly may be more appropriate.

Who can do community development?

It is important to recognise that community development is a practice with a well-developed theoretical framework. Community development practitioners should be familiar, through training or experience, with the theory, practice and principles of community development work. In saying this, it is important that community development practitioners have effective and respectful relationships with the communities they are working with, and sometimes the ability to be able to build these relationships with the community is a more important quality in a worker than having a community development qualification. In these instances, it is important that the worker is supported by someone who has a good understanding of community development theory and practice.

What is the role of a community development practitioner?

The key role of community development practitioner is to resource and empower the community (Kenny, 2007). This is done through a broad range of actions and activities that change depending on the context. Community development practitioners support community members through the provision of information needed to identify issues and plan actions. This could include sharing information on local data, good practice around particular identified issues, and relevant programs and resources that are available. Community development practitioners also connect with and build local networks and local leaders, undertake community engagement and plan, deliver and evaluate projects and programs. Community development practice has a focus on facilitation, education and representational and resourcing skills.

Difference between community development and other approaches:

Asset-Based Community Development (ABCD): ABCD is a version of community development that begins the development process by identifying and building on a community’s “assets” rather than needs. Assets include physical spaces, skills, local knowledge, local groups and associations and networks as well as financial resources (Kretzman & McKnight, 2005).

Strengths-based approach: A strengths-based approach seeks to build on an individual’s strengths rather than deficits. This can be a good practice for a community development practitioner to use, but by itself is not community development.

Collective impact: Collective impact is an approach to addressing complex social problems. The collective impact framework consists of  five “conditions” that provide a framework for collaboration between stakeholders (Kania & Kramer, 2011). There are many similarities between community development and collective impact, and much of the difference or similarity derives from how the project is delivered. Collective impact is an emerging practice and there is ongoing discussion around the role of community engagement and community leadership (Cabaj & Weaver, 2016; Christens & Inzeo, 2015). Community development is always driven by the community. The CFCA paper Collective impact: Evidence and implications for practice discusses this and other practice challenges.

Key terms

Community: A community is often a geographical area; for example, a local government region or a particular town. Community can also be defined based on shared interests, identity or characteristics (e.g., a particular cultural and linguistically diverse community or the LGBTIQ community). Community in a community development sense refers to the citizens of the area, and does not usually refer to service providers or organisations.

Consultation: Consultation is the process of asking community members via surveys, interviews or focus groups for their opinion or preference on an issue. This is not participation in the community development sense.

Participation: In community development, participation refers to the full involvement and leadership of community members in planning, developing, delivering and evaluating community actions or initiatives. Participation must not be tokenistic; community members must be participating in a way that is meaningful to them and to the community development project itself. It takes time to build full and meaningful participation. Figure 1 shows the different aspects of consultation, participation and empowerment.

Figure 1:  The wheel of participation

Which approach is based on a vision of society as a community whose members work together to achieve a common set of values and goals?

Source: Dooris & Heritage, (2013), adapted from Davidson (1998)

Further reading and resources

  • Asset-Based Community Development (ABCD) Institute – based at the Northwestern University in Illinois, the ABCD Institute has a range of resources and shares news updates about ABCD initiatives
  • Borderlands Institute of Community Development – located in the suburbs of Melbourne, Borderlands aim to revitalise community development through education, publications and consultations
  • Collaboration for Impact – an Australian website and forum with information and resources on collective impact
  • Collective Impact Forum – a US website and forum with information and resources on collective impact
  • Ife, J. (2016). Community development in an uncertain world: Vision, analysis and practice (2nd ed.). Port Melbourne: Cambridge University Press.
  • Kenny, S. (2010). Developing Communities for the Future (4th ed.). South Melbourne: Thompson.
  • New Community Journal – an Australian quarterly journal for social justice, sustainability, community development and human rights

References

  • Cabaj, M., & Weaver, L. (2016). Collective impact 3.0: An evolving framework for community change. Canada: Tamarack Institute.
  • Campbell, D., Pyett, P., & McCarthy, L. (2007). Community development interventions to improve Aboriginal health: Building an evidence base. Health Sociology Review, 16, 304-314.
  • Christens, B. D., & Inzeo, P. T. (2015). Widening the view: Situating collective impact among frameworks for community-led change. Community Development, 46(4), 420-435.
  • Dooris, M., & Heritage, Z. (2013). Healthy cities: Facilitating the active participation and empowerment of local people. Journal of Urban Health, 90(1), 74-91.
  • Higgins, D. J. (2010). Community development approaches to safety and wellbeing of Indigenous children. Closing the Gap Clearinghouse. Canberra & Melbourne: Australian Institute of Health and Welfare & Australian Institute of Family Studies.
  • Ife, J. (2016). Community development in an uncertain world: Vision, analysis and practice (2nd ed.). Port Melbourne: Cambridge University Press.
  • Kania, J., & Kramer, M. (2011). Collective Impact. Stanford Social Innovation Review, Winter, 36-41.
  • Kenny, S. (2007). Developing Communities for the Future (3rd ed.). South Melbourne: Thompson
  • Kretzman, J. P., & McKnight, J. L. (2005) Discovering community power: A guide to mobilizing local assets and your organization's capacity. Illinois: ABCD Institute.
  • Labonte, R. (1999). Community, community development and the forming of authentic partnerships: Some critical reflections. In M. Minkler (Ed.), Community Organising and Community Building for Health. New Brunswick: Rutgers University Press.
  • McDonald, M. (2011). What role can child and family services play in enhancing opportunities for parents and families: Exploring the concepts of social exclusion and social inclusion. Melbourne: Australian Institute of Family Studies.
  • Price-Robertson, R. (2011). What is community disadvantage? Understanding the issues, overcoming the problem. Melbourne: Australian Institute of Family Studies.
  • Wallerstein, N. (2006). What is the evidence on effectiveness of empowerment to improve health? Copenhagen: World Health Organization.

Authors and Acknowledgements

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