New Roles for Clinical Sociologists & Community Psychologists
A paper presented at the April 2006 Trans-Tasman Community Psychology Conference in Sydney
Written March 2006. Last update April 2014.
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, Clinical Sociologists and bio-psycho-emotionally experienced Social Workers 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’. Refer Interfacing and Government and Facilitating Grassroots Wellbeing Action.
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:
1. Physical impairment
2. Activity limitations
3. Life participation restrictions
‘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:
o Victorian WorkCover/Transport Accident Commission claimants with ongoing and unmet psychosocial needs,
o Consumers of health, allied health, and welfare services,
o Survivors of man-made and natural disasters,
o 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:
o come to know ourselves and each other
o form support and friendship networks
o increase our understanding of psychosocial crisis and human relationships
o explore how we can transform to wellness
o 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.vwa.vic.gov.au/__data/assets/pdf_file/0006/3885/clinical-framework.pdf (Accessed 21 Aug 2014)."
The workshop at the Trans-Tasman Community Psychology Conference spawned new networking that continues through the Oceania Australasia Region.
The above paper was published in the International Clinical Sociology Journal.