New Roles for
Clinical Sociologists & Community Psychologists
A paper presented
at the April 2006 Trans-Tasman Community Psychology Conference in Sydney
Last updated Feb 2007.
Abstract
This paper
identifies new roles and work opportunities that may emerge for community
psychologists as Workcover Care Providers of self-help and mutual help amongst claimants.
The implications of the Victoria Workcover using a bio-psychosocial model is
discussed and a recent doctoral thesis on research on the bio-psychosocial
model in the 1960’s is introduced as a resource for Community Psychologists
interested in exploring working in, or researching this emerging field.
Wellnet, a Community Based Organisation that may form a Biopsychosocial Support
Network is introduced.
Changes in Victorian Workcover guidelines open up the
potential for new roles and work opportunities for community psychologists as
Workcover Care Providers for claimants. The new framework may also be an
impetus for community psychologists to explore the ‘enabler of self-help and
mutual-help role’ in contrast to the ‘expert service delivery role’.
Since 2004, Workcover has been using the ‘Clinical
Framework’ (Victorian WorkCover
Authority 2005). This is based
upon a bio-psychosocial approach rather than the
medical and psychiatric bio-pharmacological model. The Clinical Framework has
been worded for the various suppliers of professional services. The Clinical
Framework website sets out a set of guiding principles for the treatment of
injured workers. The five core principles reflect contemporary practice in injury
management and focus on:
1.
a demonstration of measurable treatment effectiveness
2.
a bio-psychosocial approach for the management of pain
3.
empowering workers to manage their injury
4.
treatment goals that focus on function and return to work and
5.
the delivery of treatment based on the best available evidence.
In focussing on the ‘psychosocial’ component of bio-psychosocial, the terms
‘functional overlay’, ‘somatoform reactions’ or ‘psychosomatic reactions’ are
used when people have a psychological overlay suppressing or inhibiting
physiological function. Workcover claimants with functional overlay may be
referred to a psychiatrist or psychologist.
Rather than the previous norm of expert-based
assessment, the clinical framework uses standardised outcomes measures of:
‘Life
participation restrictions’ asks for considerations on a wellness continuum
rather than nosological diagnoses of discrete or dichotomous conditions.
For
psychiatrists, psychologists and other caregivers to continue to receive
funding for their Workcover claimants, they need to demonstrate measurable treatment effectiveness
resulting in the enhancement of at least two of the above three
domains. Independent standardised outcome measures have to be used. There is
also a provision that the treatment must focus on empowering the claimants to
manage their own injury. Another provision is that treatment goals must be functional and focused on a return to work.
Workcover has field officers ensuring compliance with the clinical framework.
It is understood that the Transport Accident Commission is likely to introduce
a similar Clinical Framework. Workcover authorities in other states may introduce
similar legislation.
The
framework changes the patients’ role from being a passive and dependent upon a
professional expert to having an active self-help role with a functional return
to work focus.
Within a bio-psychosocial model, sociological factors
are viewed not only as secondary and tertiary outcomes of impairment, but
importantly, also a possible primary component of physical impairment. Hence, with those
cases where the sociological is primary, ongoing provision of services that
target the physical and psychological may well be promoting chronicity. Also,
one may view any injury in three dimensions; hence, the worker simultaneously
receives a physical, psychological and sociological injury or insult. The
recovery is therefore dependent on the resilience of all three domains.
The bio-psychosocial approach recognises that the
psychosocial is an integral aspect of any loss of function, and also an
integral aspect of return to function.
Engel (1977) makes this point well in a paper entitled "The Need for a New Medical Model: A Challenge for
Biomedicine”. Engel was advocating a bio-psychosocial model for medicine and
makes a very strong case for it.
Having a ‘return to work’ focus is isomorphic with a
concern to have people returning to functional living in society rather than
being warehoused in asylum back-wards like soldiers with war neuroses – a
concern that led to the evolving of Therapeutic Communities in the UK and USA
during the Second World War (Spencer,
2006, Chap 3).
The Clinical Framework does hold a space for a
psychopharmacological approach; drugs may be an aspect of treatment.
During 1959 to 1968 there was sustained
action research in evolving a bio-psychosocial model of practice in North Ryde Psychiatric Hospital’s Fraser House Unit.
Fraser House was a psychiatric therapeutic community. Over 140 psychological
and social scientists were involved in Fraser House research and other related
research through the Psychiatric Research Study Group in Sydney. This Unit and
the Study Group played a very large part in evolving community psychology,
community psychiatry and clinical sociology in Australia.
Fraser House and the Study Group was the
theme of my doctoral research called ‘Cultural Keyline’ (Spencer 2006). Dr
Neville Yeomans, the founding director of Fraser House called the Unit’s
bio-psychosocial model, ‘Cultural Keyline’. Neville drew on his father’s work
called ‘Keyline’ relating to working well with living systems in agriculture
(Spencer, 2006, Chap 5). Neville adapted his father’s work to the social and
cultural sphere.
Fraser House staff and patients
evolved a very extensive body of praxis that works. This praxis is very
applicable as treatment and support modes in the Workcover context. In Fraser
House, patients and outpatients were actively involved in their self-help and
mutual-help. Fraser
House was also a primary influence in setting up peer-run psychosocial
mutual-help groups in Australia.
Mutual-help
in Fraser House became so effective, that after the
Unit was running for a year the patients going through the Unit were recognised
as being extremely skilled in community psychiatry - so much so that after two
and a half years, patients were co-opted to act as trainers in the new subject
of community psychiatry for the Australian and New Zealand College of
Psychiatry. New psychiatrists were required to stay in the unit for three
months to gain credits towards this new subject.
WELLNET a community-based
organization is being evolved as a framework for offering psychosocial
treatment and support to Workcover claimants and the wider community within
self-help and mutual help frameworks. WELLNET is resonant with Fraser
House.
The aim of WELLNET is to stimulate
community action and concern about psychosocial constraints on wellness.
Evolving in Victoria Australia and spreading to the Australia Top End, WELLNET
is also spreading throughout East Asia, Oceania and Australasia.
WELLNET is made up of professional
and other people experienced in supporting others to be able to engage in
psychosocial mutual help.
WELLNET is also a group of people
experiencing psychosocial crisis supporting each other in mutual help, These
are people who may be:
a)
Victorian WorkCover/Transport
Accident Commission claimants with ongoing and unmet psychosocial needs,
b)
Consumers of health, allied health,
and welfare services,
c)
Survivors of man-made and natural
disasters,
d)
Grassroots natural nurturers in the
region others in psychosocial crisis
Seeing WELLNET as a mutual-help organization, we have formed
ourselves into a collective to:
a) come to
know ourselves and each other
b) form support
and friendship networks
c) increase
our understanding of psychosocial crisis and human relationships
d) explore
how we can transform to wellness
e) support
each other in living with and reducing pain in all of its forms.
The Trans-Tasman Community Psychology Conference
April 2006 may provide a forum for discussing the implications of Victorian
Workcover’s legislation and new roles and work opportunities for community
psychologists. It may also provide scope for interested attendees to
familiarise themselves with ‘Cultural Keyline’ a new model for the social
sciences and WELLNET a community-based movement and network.
Engel, G. (1977). "The Need for a New Medical
Model: A Challenge for Biomedicine." Science. 196: 129-136.
Spencer, L. (2006) “Cultural Keyline – The Life Work
of Dr Neville Yeomans” Internet Source www.laceweb.org.au/ck/ck.htm
Victorian WorkCover Authority (2005). "Clinical
Framework - For the Delivery of Physiotherapy Services to Injured Workers -
Internet Source - http://www.workcover.vic.gov.au/dir090/vwa/home.nsf/pages/Physiotherapy/$file/clinical_framework.pdf
(Accessed 1 Aug 2005)."
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