Tuesday, January 10, 2012

Continuity vs. Cohesiveness

I work at an agencies that provides a continuum of care including inpatient, residential, partial, and intensive outpatient levels of care. In these programs, and in similar programs where I've worked in the past, there has been significant emphasis on the multitdisciplinary treatment team.

The idea of the treatment team is that the various professionals (psychopharmacologists, social workers and other clinicians, nurses, dieticians, program directors...) staffing a given program at any level of care will meet regularly to discuss each client's treatment and develop a coordinated plan of care moving forward. For individual clients, the benefit of this team approach is that everyone is on the same page, supporting the same treatment goals with complementary interventions, rather than duplicating efforts or accidentally getting in the way of each other's interventions. It also gives staff the opportunity to share insights, and any new information gathered. Clients appreciate not having to tell their story repeatedly, and I, for one, appreciate having a little background on clients I don't work with individually but do have in groups. Finally, from a program perspective, all of the treatment (groups, family meetings, individual sessions and case management) is being done by members of the team, so a cohesive treatment program can be developed with contributions from each team member.

Sounds logical and beneficial, right? The only down-side relates to the concept of a continuum. By virtue of their cohesion, treatment teams may contribute to each program feeling separate and distinct from other programs on the continuum. Whether that is problematic depends on the program and agency goals. If programs aren't meant to be connected, and are even run by different agencies, they will obviously be separate. However, when the continuum of care exists within one agency, with the goal of smooth and seamless transitions between levels of care...separateness can be seen as a barrier.

Thus, my agency is shifting the way treatment teams function on its main campus. Specifically, a plan is being implemented such that each client will keep the same social worker/clinician as they move between levels of care. It is supposed to allow for deeper and more effective individual work, less repetition in the form of new assessments at each level of care, and a sense of continuity during transitions.

These goals also sound logical and beneficial. The problem I see is that the move toward continuity comes at a cost to cohesion. When the clinician is part of the treatment team, running groups etc. at one level of care, but managing cases at multiple levels of care, it becomes challenging to know what's really happening with clients in treatment in the programs where the clinician spends less time. There may be miscommunications over program policies and expectations, a delay in communicating concerns that arise, and misunderstandings over interventions and treatment goals. Communication is just less effective, because the number of people involved has increased and the face-time has decreased.

So, what matters more to effective treatment: cohesion or continuity? I don't have the answer, but I do think it's important to ask the question! What do you think?

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