The Integration of Theoretical Methods of Practice:
Within the Context of a Culturally Diverse Long Term Care Facility
Richard F Ramsay
SOWK 479 Final Assignment
Faculty of Social Work, University of Calgary
December 11, 2002
Note: Original copy. Minor editing/reformatting was carried out.
I completed my first degree in Sociology in 1989. At that time, I began my career in child/youth work, working in a residential group home. It was extremely challenging at the beginning, as I did not know how to integrate the theories and ideas I had learned into practice. In fact, initially much of my practice was instinctual. Sometimes I would be successful and other times well … this is where a common framework may have assisted me. As a youth worker, I might become frustrated with other colleagues and professionals, as their intentions were sometimes contradictory to mine and seemingly to those of the client! Although I was not a social worker, it seemed that I performed many of the same functions that a social worker would take on such as education, advocacy and so on. Perhaps if we had some type of common base and goal these frustrations would not have occurred? I believe Bartlett eloquently articulates this issue.
“Since the professional attributes of social workers were thus obscured, they were not well understood by other collaborating professions or society in general” (Bartlett, 1970 pp 53).
This paper will address the assessment and intervention processes that occurred during my practicum experience at Calgary Family Services. The writer will integrate two theoretical modes of practice approaches within the context of this practicum and critically evaluate the effectiveness of these theoretical ideas. Most of my practicum centered on the assessment phase of the social work process thus much of the intervention phase will be discussed in the context of proposals and possibilities for further intervention and how that relates to the theoretical constructs used. However, through my practicum and study of the common whole I have discovered that each phase in itself has a process of assessment and intervention. In the past, literature has addressed this point, however it had been hard to conceive and visualize that reality as it is usually presented in a linear fashion. The common whole framework and the multidimensional aspects of the tetrahedron have given me the model to see the interactive aspects of social work practice. It is in this context that I will present my paper.
My practicum was centered on a community development program, which concentrated on seniors in Long Term Care Facilities. (For the remainder of this paper, Long Term Care Facilities will be referred to as LTCF). Initially, the practice approach that guided my assessment and potential intervention was based upon a structuralist approach. However as the practicum evolved other modes of theoretical practice were incorporated such as aboriginal and other postmodernist theories based on social constructionism and post-structuralism. Along with these theories, I will discuss their efficacy as they relate to a common framework of Social Work.
common conceptual framework in this paper is the framework introduced by Ramsay
(2001, 1999). As my previous paper delved into the framework of a common whole
specifically, this essay will highlight the components and ideas of the
framework. It will however, integrate the assessment and intervention in
relation to the common whole of social work in detail.
The Common Whole of Social Work
As one can see, social work has had a varied history, and at times, diverging values and ideas, yet all along there has been a common goal to assist people in need. An early example of this is the charity organization movement, in many cases based on religious institutions, which were organized to help underprivileged people manage and adjust to their unfortunate environment. Another early example was the settlement house movement that was organized to develop social reform and action in opposition to the current political and economic milieu, which followers felt were debilitating and would create impoverished states (Heinonen & Spearman, 2001). These different ideas and values evolved into the different specializations and distinct elements of contemporary Social Work, for example, direct practice and community development. Although practitioners of both are considered social workers, how are they similar? Is there a common theme? Bartlett (1970) describes the common elements of social work to be values, knowledge, and repertoire of interventions and social functioning. These elements would be necessary to consider the work Social Work. Bartlett created a framework of social work using these elements. This framework has further evolved into a holistic model of social work that is based on the structure of a tetrahedron and allows for more diverse ways of thought (Ramsay, 2001).
The idea of synergetics works on the assumption that one must integrate all the components of a system to truly receive a true picture of how a system works. Synergetics thus flows into Buckminster Fuller’s conception of the tetrahedron. He states that a minimum whole system can be described by integrating four fundamental parts that relate in an interactive system based on six interrelationships, a tetrahedron (Ramsay, 2001). The tetrahedron structure can be used as a template to show the aspects of a common framework of social work. Ramsay describes four components, similar to Fuller’s four elements of a system, in his depiction of the common whole of social work. These are:
Domain of Practice - which is identification with the person (P) or client with his/her environment, identified as Otherness elements. These includes a person’s relationships better known as Personal Otherness (PO), the resources or supporting structures that support or create barriers to effective functioning, identified as Resource Otherness (RO). And finally, the values and norms that guide the other elements in society, known as Validator Otherness (VO).
Domain of Practitioner - The domain of the practitioner refers to the social worker’s personal self nd environment. It has the same elements as the domain of practice.
Paradigms of Profession - Social workers tend to have a variety of functions. These can best be described by the following four categories within this system. The Client System (CS) refers to direct interaction with a client group. This can vary from direct practice to community development. The Target System (TS) refers to working with a part of the person’s environment that might assist a client system in some capacity. The Action System (AS) refers to elements of a client’s environment that is supporting the person’s goal of social functioning. The Change Agent or (CAS) refers to the system that employs the social worker. It can be seen in the form of an organization or in many situations private practice.
Methods of Practice - This is commonly described as the system that encompasses the technological or problem solving components of social work (Ramsay, 2001; Karls & Ramsay, 1999).
My interests lie in the area of community development and work with seniors. I assumed that I would participate in a program that had already been developed and that I would be assisting one or more of the workers in the program. I indeed was given this opportunity but was also asked if there was an area of interest that I wanted to develop or look in to. Given this chance, I decided to pursue some of my interests. Along with my interest in gerontology, I’m also attracted to the area of cultural diversity. It is interesting to see that the domain of the practitioner had played a major role early in my practicum. As a person of Japanese heritage, I have experienced occasions of racism and isolation due to my ethnicity. I think this first hand knowledge has given me insight as to how some potential clients might feel and their need for some type of support. Along with special insight, this knowledge might create some biases that might affect the way I practice. Something I will need to be acutely aware. From personal and professional experience, I had noticed that many ethnically diverse seniors that reside in institutions such as LTCF or shelters were somewhat isolated and on many occasions did not have anybody to communicate or interact with. This initiated the idea of a volunteer based program that would assist seniors by engaging with these seniors socially and perhaps act as family liaisons and/or link back to their community if they chose to. Through interaction with my supervisor and agency or Change Agent System, we developed a plan to investigate the feasibility and initiate a needs assessment of this proposal.
my personal experiences it seemed clear to me that many of the organizations
and services developed to serve seniors did not take into account the cultural
diversity of this country. According to Statistics Canada, in 1996, 11.2% of Canada’s
population was identified as a visible minority. This is an increase from 9.4%
in 1991. With a growing amount of ethnically diverse seniors, were their needs
in organizations being met? I hypothesized that they were not and in many cases
it was due to institutional barriers that were created from a predominately
Eurocentric perspective. With these ideas, I initially incorporated a
Structuralist model in guiding my research into the development of this
assessment. Before delving into the specifics of the assessment, I will give a
short description of the structural approach. In the writer’s last essay, the
Aboriginal approach was integrated into the framework of the common whole. The
structuralist framework was not integrated as such thus the reason for the
outline of this theoretical approach.
This approach concentrates its efforts into creating collective change. In many cases, this follows some of the ideals discussed earlier regarding the settlement houses. As Mullaly states, “ … the progressive or critical view does not believe that our present social institutions are capable of adequately meeting human need” (Mullaly, 1993 pp 32). The implication of this quote is that these social structures at present (economic, social and political), cause oppression and thus must be changed or modified for people or society to work. The structuralist approach is based on a conflict philosophy that adheres to principles of eradicating injustice and focuses much of its effort towards collaboration and sharing rather than the competitive ideals typically seen in a competitive industrial economy based on capitalism (Heinonen & Spearman, 2001). In structural social work, the worker is judicious and in many cases is critical of how the characteristics of society are viewed (Mullaly, 1993). Mullaly refers to two different perspectives, one of order and the opposing view of conflict. The order perspective believes that society adheres to common values and culture that allows one the chance to flourish (Heinonen & Spearman, 2001). It is my contention that this perspective does not reflect reality, particularly in the areas of seniors and ethnically diverse people. It would seem as though many of the people in the aforementioned categories do not have the power or political influence to voice their needs and thus are in essence under oppressive forces. This led me to the assessment that was completed during my practicum.
During the beginning of this assessment, I set out to discover information that supported or disproved my original hypothesis that structural barriers have caused situations where ethnically diverse seniors in LTCFs were not empowered. The institutions that were created had a white Anglo-Saxon view, and thus supported, consciously or not, a western point of view that was alien to many immigrants that did not have a strong grasp of the English language. These institutional barriers would be seen as resource otherness (RO) within the domain of practice. It was surmised that some of these (RO)’s were LTCFs and governmental agencies or institutions that perpetuated this Eurocentric view of senior care. It is interesting that there is a separation or distinction between the statistics found at Statistics Canada (Statistics Canada, 2002). Why are the visible minorities differentiated from other ethnically diverse minorities? Are they somehow different from the western European based ethnicities that may not speak English either? To me this is an example of institutional racism and a method to further differentiate people that are already feeling isolated. Initially a large part of my practice was spent reviewing relevant literature in the area of ethnic diversity, particularly with seniors. It was interesting to see that although there were many theoretical discussions, the writer found a minimal amount of research studies looking into the effects of cultural diversity and seniors (Saldov & Chow, 1994; Ujimoto, 1987). Again, it appears as though the ethnic minority community has been overlooked. Ujimoto referred to how there was an increasing population of ethnic minorities moving into facilities that were oriented and structured toward the dominant culture. Within in these structures, social, cultural and physical activities overlooked the interests of ethnically diverse seniors because of their minor social status.
Due to the barriers of language and culture, it has been suggested that feelings of isolation, detachment and helplessness may occur (Lai, 1992; Saldov & Chow, 1994, Society for the Retired & Semi-Retired, dnk). This is interesting to see even though many of these seniors are in physical contact with others “they are isolated because not only are they unable to talk with anyone they cannot understand anyone either. They do not understand the dialogue on television, they can not read newspapers, and they cannot sing the same songs in senior groups” (Society for the Retired & Semit-Retired, pp 10). This information educates us in how we may view clients. Some individuals may seem to have personal resources (PO) such as nurses, next-door neighbors but are they really resources?
this was an investigation of the feasibility of developing a program, it was
necessary to access outside resources that would possibly assist in this
endeavor. We identified potential Target System (TS) organizations such as
other LTCF’s, Immigrant Aid organizations and other community resources. It was
important to work in a collaborative manner to gain valuable information,
obtain and share potential resources and skills, and find organizations that
would be willing to integrate a potential new program. We identified a LTCF
that had recently developed a Cultural Diversity Committee and was interested
in the idea of cultural competence and sensitivity. Through the meetings with
these (TS)’s we identified the complex nature of ethnicities and the various
factors such as gender that need to be addressed when developing an assessment
that is truly integrative. These ideas affected the approach I was taking
towards this assessment. Although I continued to believe that much of the
oppression and isolation ethnic seniors experienced were caused by
institutional factors, the writer began to discover that there were other
variables that might influence the difficulties these seniors faced. As the
assessment proceeded, I wanted to obtain the experiences and thoughts of the
seniors and their previous caregivers. They would provide fresh and most likely
unique insight to this issue of cultural diversity as they were living it! I
considered this the intervention phase of the assessment. As I read on, I
noticed some limitations to the structural approach. It had a tendency to view
things in an extremely homogenous perspective and at times simplify a complex
issue of cultural diversity. “Facilitators must be conscious of cultural
nuances when they deliver programs” (Society for the Retired). For example a
group that was developed by one of the agencies to attract members of a south
Asian community only attracted males. Traditionally this group format was not
an acceptable format for females. Intricate information such as this must be
integrated into a program for it to succeed in the community. At this point, I
changed my theoretical ideas to one that was more holistic and in my view more
accurately described the lives of these diverse communities. During this
portion of the assessment, I used a variety of postmodern theoretical concepts
based on social constructionism and poststructuralism (Freeman & Combs,
1996, Mo-Yee, Lee & Greene, 1999; Sands & Nuccio, 1992). What led me to
this view was the question of whether there was one reality or a multitude of
realities in society. It is the writer’s view that we have been living in a
Eurocentric reality and that we have determined that to be the one and only
reality. Theories incorporating postmodern ideas seem to reflect the diversity
within the world more successfully. For instance, a commonly used concept of
Narrative Therapy might be extrapolated to cultural diversity. Freedman and
Combs (1996) discuss how language can be used to determine our socially
constructed reality. When living in a society that is somewhat foreign to
ethnically diverse individuals, people of the dominant ethnic group might use
the western reality as a form of subjugation (Usha & Ka, 1999). Foucault (1978) goes on to discuss how there
are various realities or discourses in the world, however we, being the
dominant society, value and believe only one discourse and in doing so are
oppressive. Presently, the social work profession has based much of their
practice in a deterministic and compartmentalized manner. For example, we label
ourselves clinical workers or community developers, gerontologists or child
welfare workers and develop theories based on these groups. This generalization
might cause us to think and create interventions that are not applicable to our
clients and are repressive (Sands & Nuccio, 1992). This postmodern
philosophy may be too progressive for some social workers and the systems
within the domain of practice that relies on “fact” such as taxpayers and funders.
Along with my literature review, I had informal interviews with several LTCF professionals to get their perspective on the need for a possible volunteer program interacting with non-English speaking residents. These included volunteer coordinators and social workers. A majority expressed their keen interest in the project as it would add to their ability to interact with these residents and provide support that was greatly needed. Some volunteer coordinators stated that they did have some volunteers that spoke other languages and if they would require somebody that spoke a foreign tongue they would look at a variety of sources such as ethnic community centers churches and so on. This volunteer recruitment would be done on an ad hoc basis and they would receive the same orientation as other volunteers to the LTCF. Interesting to note, they looked for language skills only and did not really discuss the issue of cultural sensitivity or competence.
As individuals have different backgrounds and histories, people may behave in different manners even though they might come from similar heritages. For example, Chinese immigrants from Hong Kong or mainland China, Japanese Canadian immigrants who faced internment during WW2, and so on. These historical facts and realities may significantly add to one’s cultural identity and cannot be overlooked in the design of a culturally sensitive program such as the one being proposed (Ujimoto, 1987). This knowledge supported the next phase of the assessment. In terms of this paper, I also consider this the intervention phase. To get these details and perceptions it was necessary to obtain the ideas and feelings of ethnically diverse seniors in LTCFs. We developed a research design based on a phenomenological and qualitative approach, as we would not be able to interview a large sample of seniors due to time and logistical constraints. Again we were looking for their stories and were interested to know their views on cultural diversity and potential of the proposed program. Due to the age, physical and mental issues of LTCF residents, it was difficult for some to give lengthy explanations. Perhaps they were somewhat guarded due to perceived repercussions. Although I developed the research tool/interview, I needed the assistance of colleagues in my Change Agent System (CAS). They provided translators and cultural feedback on some of the questions involved. Consent forms were translated for legal aspects as well as giving the interviewees power and control. I wonder if many of the legal documents or simple informational documents from LTCF are translated? Something for further research perhaps. Along with my colleagues at the agency, I also collaborated with the (TS) as well. The LTCF that we had collaborated with was consulted and they were allowed input to develop questions that might be pertinent to them regarding cultural diversity. They were also the agents to organize and identify the people we were to interview.
I could not ask questions due to my lack of knowledge in different languages, I
was in the unique position to observe the interview. It was interesting to note
their affect during this process. Although
some of them gave very “pat“ answers, their emotions seem variant compared to
their flat affect they had upon initial contact. It was interesting to see this
during the process where they were able to engage in discussion using their
language of origin. This concluded the assessment phase.
We come to the Intervention phase of this practicum. A community development project typically takes patience as it deals with issues requiring many resources including various systems within the domain of practice. Patience is a skill that has to be honed when working with macro issues as many issues are systemically ingrained in our society and many people are not interested or do not have the opportunity to address the issue. In the case of this project, it was not the exception. Due to the time constraints, I was not able to move into the intervention phase. In some ways the assessment phase could go on further and be more comprehensive. It is in that vein that I hope to develop the intervention segment of this essay. Through the assessment, the writer noted various areas that need to be addressed from structural issues such as policies in governmental agencies (e.g. CHR) and policies of LTCF. Structural issues are not the sole dilemma; meeting the diverse individual needs of the various ethnic communities is also a challenge. Theoretically, how do I address this issue from a community perspective? Initially I thought that I would need to concentrate my efforts into Target Systems and Action Systems to provide change. I felt a necessary component might be the potential client him/herself! I proposed that the aboriginal approach based on harmony and balance of all aspects in nature was required to deal with this complex concept of cultural diversity (Heinonen & Spearman, 2001).
of limited time, I was not able to integrate many interviews of ethnic seniors
in LTCFs. As part of the healing
process, the social worker and client, in this case, the many ethnically
diverse communities of seniors, are in the role of learners (Heinonen & Spearman,
2001). Perhaps we could educate some of the clients regarding potential
programs such as the one being proposed and we could learn from their
experiences. I found the interview process to be very restricting at times. I
wonder if there are other forms of information gathering that would be more
successful? For example Tea and Talk focus groups or extended interviews with
seniors over time? This would also allow the community to develop a sense of
belonging and idea that they are not excluded but part of a system within the
medicine wheel or society as they are being asked to actively participate in
their healing (Regnier, 1994). It would also allow one to understand the issues
facing the community. It is interesting that the Understanding phase as
illustrated by the aboriginal pedagogy by Regnier (1994), describes the use of
a healing circle. Similar to these focus groups and teas?
The circle of life or medicine wheel discusses how all aspects of nature are interconnected and have value. When we discuss issues of cultural diversity, it is important to not exclude people that are not ethnically diverse as they can be of extreme benefit to finding the commonalities that link all society together. Perhaps people of the dominant (European decent) can be asked to engage in this information process. In today’s society, we have a tendency to dichotomize situations and thus look at things as bad and good. By excluding all the people in the information and intervention phases, we perpetuate this idea, thus my movement away from structuralist leanings within the context of this paper and practicum.
Again, I use the concept of the medicine wheel to various target systems and Actions systems that are related to my practicum. We are interrelated in that we have common goals of helping people but have different interpretations or methods of reaching that goal. For further intervention I would look into the development of the relationships I have and seek out other systems that would be helpful. An interesting note was that they come from different areas of the medicine wheel. For example, the areas ranged from spiritual, including different cultural and spiritual institutions such as churches and mosques, to practical involvement and access to other LTCFs.
of the proposed Senior Connection program might be looked at as a pilot project
with one or two different culture in a limited area. Perhaps, only a specific
LTCF? It might be the culmination of all
the interconnected systems of the domain of practice, paradigm of profession,
domain of practitioner and methods of practice. The pilot project is not an end
in itself but part of the circle of learning that proceeds until we find
pimatasiwan or the ultimate solution to this quandary of ethnic diversity among
seniors (Heinonen & Spearman, 2001).
The Common Whole
Throughout this essay, I have referred to the common whole to explain some of the decisions that were made within the context of the social work process. However, it is crucial that we discuss and summarize how this framework was used to guide the writer’s social work practice in his practicum.
I found the issue of seniors and cultural diversity to be extremely confusing at times with the different ideas and theories used to explain the existence of this phenomenon. It is a new area of study and is on the cusp of developing interesting and useful research. I found the concept of the common whole an excellent guideline and way to organize my thoughts. The framework described by Ramsay allows one to visualize and articulate the processes that are necessary in social work. Initially I found the post modern science foundation and the philosophical discussion for the framework to be too cerebral and did not understand how this was relevant to the practice. However a semester later, I have SEEN THE LIGHT!!! Especially as I have integrated some of these postmodern ideas into my own practice. The multidimensional aspect allows one to investigate many ideas of reality. If we stood by a two-dimensional framework, one would perceive the reality of our clients in one way.
The structure was also developed to enhance the profession’s ability to understand how as a unique profession there are common themes and goals no matter how diverse the practice (Ramsay, 2001). This is the aspect of the framework that was most integral to my practice. As I stated earlier, I found it difficult to organize my thoughts regarding the many different ideas brought forth in cultural diversity. It was interesting that I did my practicum, based in community development, with a Change Agent that traditionally concentrated their efforts toward a micro or direct practice aspect of social work. I borrowed from some of the ideas of narrative therapy, a traditionally micro concept and integrated these postmodern ideas of social construction into my practice. It allowed me to see that my methods as a community developer are extremely related on a concrete level to social work done in a clinical setting. A theoretical framework that was not open to these different realities may not come to those same conclusions.
common whole allows me to use new concepts of postmodernism into the practice
of social work, especially when I want to investigate the history and reality
according to many people who have not had a voice for years potentially! To
some social workers, postmodern thought might be considered unreliable and in
some ways unscientific according to modern science. The common whole framework
gives validity to the work I have done during my practicum. It has allowed me
as an individual the ability to add my personal experiences and knowledge into
the fold of social work.
I go back to the ideas and themes of Aikido that I discussed in my previous paper. Aikido is a martial art. There is a concrete base of knowledge but it is guided by values, ethics and philosophy. I very much see Social Work in the same light. Aikido talks about how Ki (energy) is all around us and is a part of nature itself. This is very much like the synergetic concepts discussed by Ramsay (2001). The techniques are like the structure and framework for the ideas and values an Aikidoist espouses. Without this structure, one cannot disseminate those aforementioned ideas. Without a common whole framework, we have a difficult time holding the principles and ethics of social work together.
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