CPT 7 Social Justice

Social Justice

System Inquiry and Community Healthcare Involvement

How would you proceed in developing a plan for building community involvement in health care in your community? How would you assess the situation? Who would you involve? Why?

The first step in developing a plan for community involvement in local healthcare is to create a forum for interaction of different representative members of the community. By employing the 'dialectical process' identified in the text by Finn & Jacobson (2003), it is possible to gather the far-ranging perspectives of a wide spectrum of possible participants before initiating any formal steps. According to Finn & Jacobson, the dialectical process "consists of members engaging the debate of ideas with members variably putting forth a thesis and antithesis and finally arriving at some form of synthesis. The process can help members explore contradictory forces and discourses that shape everyday life. And it can help members grapple with the pushes and pulls of ambivalent feelings." (p. 274) The hope, in the case of a community healthcare collaboration, would be to promote confrontation on those issues most in need of our collective attention. Participants would be invited from the leadership of community outreach groups, area health institutions, neighborhood associations and local business leaders. This diversity of participants would be invited to collaborate on the opening round of dialogue and debate in order to gain a full scope perspective on the most pressing community needs.

2. Choose one of the methods of systematic inquiry discussed in the chapter and explain how you would apply this method to practice?

The text by Finn & Jacobson indicates that in order to engage in an activity as complex as healthcare driven community outreach, it is necessary to understand the scope of the challenges ahead and to foster an actual organizational cohesion amongst the disparate participants represented in the discussion immediately here above. Though there is a value to involving a diversity of community representatives in the dialectical process, there is also challenge in producing a sense of unity amongst these same parties. However, the chapter here does offer a mode of 'systemization' that can simultaneously produce a streamlined process of information gathering and an atmosphere given over to collegial cooperation.

It is thus that the concept of 'mutual aid' is an appealing mode of systematic inquiry. This mode is described in the text as "a basis for collective support and action. . . By conceptualizing the group as a mutual aid system, we locate all participants, including the social worker, as learners, teachers, and facilitators, or 'animators.' We also recognize the dialectical relationship between the individual members and the group as a whole in the process. AS participants learn and practice the skills of mutual aid they contribute to a climate of trust and intimacy in the group that supports individuals in assuming the risks and opportunities of teaching-learning." (p. 273) This denotes the need in systematic inquiry to create an environment in which all group members feel a sense of collaborative inclusion and a sense of the importance of internal relationships in fueling group dynamism.

3. Use one of the family assessment tools presented in this chapter. What do you see as its strengths? What do you see as its weaknesses?

One family assessment tool that emerges as particularly useful is that of the Household Ecomap. Even as individual families are directly impacted by broad, far-reaching and highly entangled macrolevel effects of social systems, their daily lives are far more directly impacted by micolevel forces and experiences. The relationship between these macro and microlevel forces is extrapolated in the Ecomap. As Finn & Jacobson indicate, this "theoretical framework rests on understanding the effects of the larger political, social, and economic environment on families and 'the link between symptoms and chronic stress from lack of basic economic resources.'" (p. 293) The primary strength of this approach is that it helps to break down the array of challenges facing a family in the simplest terms, underlining ways that a family can begin to systematically and routinely face these challenges. Unfortunately, this instrument is only weakened by the fact that the vast majority of its solutions will rest significantly on helping client families access government sponsored support programs. This denotes that such family assessment tools are less aimed at helping create long-term and sustainable solutions for the problems outlined by the Ecomap and more designed to help classify client families according to their public assistance needs. While this is a valuable objective, it suggests something of a one-dimensional support strategy.

4. In what ways have your beliefs about health and illness been informed by a Western biomedical view? In what ways have your beliefs been informed by differing perspectives on health and illness? Think for a moment about some of the "folk" practices of medicine in your experience, such as your cure for hiccups. What beliefs inform these practices?

Few subjects provoke more kneejerk reactions than health. Indeed, we are each of us armed with a host of suggestions and theories on how to treat sicknesses and resolve ailments in spite of the fact that so few of us are medically trained. We owe this tendency to the preeminence of 'native theories' in our beliefs and behaviors. These theories are constructed by oral tradition, personal anecdotal experience and other forces that are unreliable from a scientific standpoint but personally and/or culturally resonant. Ironically, many of our native theories may connect to our faith in the tradition of Western Medicine. While this is, more than many historically traditions, controlled by a high level of scientific scrutiny, other values such as profitability play a role in medical practice. Therefore, that we generally invest our faith in such western practices as a high dependency on pharmaceutical treatment, is in some ways constructed on a native trust of our physicians. Moreover, this promotes a sense of skepticism of holistic practices that eschew the biomedical treatment strategies inherent to our experiences. This is to suggest that the notion of western medicine has achieved something of a 'folk' status, especially as resources like WebMD allow each of us to play doctor with little to no formal knowledge.