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 Show
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?
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 approachLeadershipPositive leadership and management give clear direction and vision for the team through:
Person-centred practiceWell-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
TeamworkAn 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
CommunicationCommunication 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.
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 developmentThere 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 workTable 1 outlines the difference between community-based work, which involves the community, and community development work, which is led by the community.
When to use community developmentCommunity development is not always a suitable approach to use. Community development may be particularly appropriate:
Community development may not be the best approach if:
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 termsCommunity: 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
Source: Dooris & Heritage, (2013), adapted from Davidson (1998) Further reading and resources
References
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