Abstract
This article explores 100 years of interprofessional practice and education (IPE) through the archives of Families and Society: The Journal of Contemporary Social Services. A journal-specific archival and systematic review employing quantitative and qualitative methods identifies early references to, and frequency of, terms and meanings associated with IPE; examines meanings associated with terms describing interprofessional interactions; and explores related contexts, settings, and populations served. Articles were searched using key terms from two scoping IPE reviews and narrowed based on inclusion and exclusion criteria. An Excel© spreadsheet was prepared using descriptive, qualitative, and coded items. Findings revealed early references to IPE-related concepts, an expanded list of classifications and descriptions of interprofessional interactions, and an extensive list of practice settings and populations served through IPE-related activities. Implications for social work education, practice, policy, and research are addressed.
This article celebrates 100 years of Families in Society: The Journal of Contemporary Social Services (FIS) by exploring the topic of interprofessional practice and education (IPE) through the historic lens of this journal, which was established in 1920 by the founder of social casework, Mary Richmond (SAGE Publishing, 2019b). Before embarking upon this review of FIS, it is important to understand some historical milestones related to IPE.
The concept of “interprofessional” teamwork emerged from a 1909 collaboration between “medicine and the evolving ‘human-focused’ field of social work” (Cabot, as cited in Schmitt et al., 2013, p. 284). Interprofessional teamwork and collaboration, like social casework, is central to the practice of social work.
The phrase interprofessional education, known by the abbreviation IPE, had its roots in the United Kingdom and the United States during the 1960s and 1970s. A 1969 paper, Interprofessional Education in the Health Sciences, recommended establishment of “a committee on IPE in the health sciences . . . to promote interprofessional education and to experiment with educational programs to arrive at recommendations concerning what students should learn together and how they should learn it” (Gilbert, 2010, as cited in Fransworth et al., 2015, p. 1).
An emerging concept, interprofessional education began gaining traction with a 1972 Institute of Medicine report Educating for The Health Team. Alternating between the phrases “interdisciplinary education” and “interprofessional education,” a common occurrence to this day, the report recommended that academic health centers and “regional consortia of health professions schools . . . foster educational teamwork” (“Highlights of Recommendations”) and prepare health professions students through “interdisciplinary education” (p. 19). A prescient observation that “examples of professional interdependence and of various kinds of health care teams are most readily demonstrated in the clinical setting” (p. 25) foreshadows a 2019 report on the importance of the interprofessional clinical learning environment (IP-CLE) to the process of interprofessional education (National Collaborative for Improving the Clinical Learning Environment).
The first known use of the phrase interprofessional team was credited to Rosalie Kane, a prominent social work educator, while in pursuit of a doctor of philosphy degree. The phrase was first known to have appeared in the literature in Kane’s 1975 doctoral dissertation titled The Interprofessional Team.
Interprofessional education, the original IPE, was defined in 2010 by the World Health Organization (WHO) as “when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” (p. 13). Its corollary, collaborative practice (CP), was defined as, “when multiple health workers from different professional backgrounds provide comprehensive services by working with patients, their families, carers and communities to deliver the highest quality of care across settings” (p. 13). Reflective of the report’s title, the phrase interprofessional education and collaborative practice became known alternatively as IPECP or IPE/CP in the literature.
In 2015, Brandt described IPECP as “the ‘new’ forty-year old field” (p. 9). Coming full circle, interprofessional practice and education, the new IPE (National Center for Interprofessional Practice and Education, 2015) now focuses on preparing the current and future health care workforce at the intersection of interprofessional education and collaborative practice. This article seeks to look back on social work’s historical contributions to IPE through the pages of 100 years of FIS and look forward by identifying implications for social work education, practice, policy, and research.
Method
This study examined the English-language journal, FIS, including the content of all issues published between 1920 and 2019. As of this writing, the most current published issue was Volume 100, Issue 3 (2019, July–September). In preparation for the 100th anniversary of FIS, the author was provided with full access to the complete online journal archives by the journal’s editorial team and publisher.
The method undertaken represents a journal-specific archival and systematic review utilizing quantitative and qualitative methods. An archival review uses an historical research method entailing “extracting evidence from archival records” (Wikipedia, 2019, para. 1), whereas a systematic review “provide[s] as complete a list as possible of all the published . . . studies relating to a particular subject area” (Cronin et al., 2008, p. 39). Systematic reviews are “widely accepted as providing a reliable source of information about the effectiveness of health care” (Hek & Langton, 2000, p. 40), “central to the drive for evidence-based health care” (Parahoo, 1997, as cited in Hek & Langton, 2000, p. 40), and are “most likely to generate a review . . . beneficial in informing practice” (Hek & Langton, as cited in Cronin et al., 2008, p. 39).
Utilizing the guidelines for systematic reviews as outlined by Cronin et al. (2008), this study will address the research questions, inclusion and exclusion criteria, selection of the literature, assessment of the literature selected for inclusion, and analysis of the findings. Quantitative methods were used to determine search term frequency and percentages by article type associated with IPE, and frequencies related to IPE-related meaning, context, and population served. Qualitative methods were employed to code meanings associated with words and phrases that describe interprofessional interactions, and then compared with an existing classification of IPE-related meanings (Brandt et al., 2014, p. 395).
Step 1: The Research Questions
The research questions that informed this review were as follows. First, in the 100 years of FIS, how early and how often have social work researchers used words and phrases associated with IPE? Second, what meanings have been associated with words and phrases used to describe interprofessional interactions around learning and/or practice? Finally, what populations have been served by IPE and within what practice and education contexts?
Step 2: Inclusion and Exclusion Criteria
Inclusion criteria were informed by the questions guiding this review. Inclusion and exclusion criteria were identified, considered, evaluated, and finalized in an iterative process based upon findings at each stage of the systematic review process, as discussed in this section (see Figure 1).
Article selection flow chart.
First, a search was conducted that included all article types (research articles, book reviews, editorials, books received, letters, and notes) and content (anywhere, title, author, keywords, abstract, and affiliation). These categories were based on article types and content available through the advanced search engine on the publisher’s website (SAGE Publishing, 2019a). This initial search yielded a total unduplicated count of 329,571 articles of all types, including research articles (n = 233,309).
Next, a list of search terms was developed based upon words and phrases drawn from two recent scoping reviews specific to IPE (Brandt et al., 2014; Brewer et al., 2016). Given the historic nature of this review and relatively recent adoption of common definitions related to IPE (WHO, 2010), additional search terms were included based on words and phrases commonly used interchangeably with IPE by practitioners and authors (i.e., interdisciplinary, multidisciplinary). Finally, an additional search term often associated with interprofessional practice by the social work profession (collaborate) was included in recognition of the historic contributions of FIS to social work research and scholarship.
The search strategy was developed from the list of search terms using individual words (interprofessional, interdisciplinary, and multidisciplinary) and Boolean logic techniques, including operators (e.g., interprofessional AND team) to search for articles containing two or more terms, wildcards to construct queries with partial search terms (e.g., team* to locate teams, teaming, teamwork), and quotation marks to identify literal phrases (e.g., “interprofessional education”) (Ecker & Skelly, 2010).
A search of all dates, article types, and content was conducted using selected search terms related to IPE. This initial search yielded a total count of 3,979 articles of all types prior to identifying and removing duplicate results. Research articles yielded the highest frequency and percentage of total articles by type before removal of duplicates (n = 2,895, 72.8%), followed by book reviews (n = 621, 15.6%), other (214, 5.4%), editorials (105, 2.6%), news (50, 1.3%), index (41, 1.0%), letters (18, 0.5%), review articles (8, 0.2%), case reports (8, 0.2%), notes (7, 0.2%), and books received (5, 0.1%), in descending order of frequency (see Table 1). Book reviews, editorials, news, index, letters, review articles, notes, and books received were excluded for lack of relevance or rigor. Other was excluded as it contained a collection of inconsistent article types over time and therefore lacked comparability. Case reports and notes were excluded as they represented only 2% each (3.7% combined) of the total search term results by all article types.
Search Term Frequency by Article Type.
Note. Search terms sorted from most to least frequent by article type. Totals noted are prior to removal of duplicate results. IPE = interprofessional education or interprofessional practice and education.
Based upon this initial review, article type was narrowed to include only peer-reviewed research articles, as they represented by far the largest frequency and percentage (n = 2,895; 72.75%) of the total articles by type, and represented a comparable article type “grounded in the rigorous and systematic collection and analysis of data, with investigators paying attention to reliability and validity as well as generalizable findings and conclusions” (Brandt et al., 2014, p. 394). The term IPE was excluded as it produced only one article from the database search, which upon close inspection was a false positive. Also, the term “multidisciplinary” was excluded as it describes the composition of a team, rather than the way in which the team interacts (Brandt et al., 2014, p. 395).
Research articles were then searched by content based upon categories available through the publisher’s search engine (i.e., anywhere, abstract, and keywords; see Figure 1). A search of keywords using all selected search terms yielded only one article, associated with the term interdisciplinary. The same article appeared in the abstract search. Inclusion criteria were therefore further narrowed to abstracts of research articles only.
Step 3: Selection of the Literature
The final selection of literature for review was narrowed to 69 abstracts from research articles (see Table 2). This decision was based on the rationale that an abstract provides a “comprehensive summary of the contents of the article” and generally includes “embed[ed] key words” (American Psychological Association, 2010, pp. 25–26). A search of this literature based on inclusion of abstracts of research articles by selected search terms resulted in the following frequency of articles by search term, listed in order of frequency from most to least: team* (40), interdisciplinary (15), interdisciplinary AND team* (4), interprofessional (3), interprofessional AND practice (2); interprofessional AND team*, “interprofessional team*,” interprofessional AND collaborat*, interdisciplinary AND collaborat*, and “interprofessional practice” (1). The following search terms yielded no results from the search of research article abstracts: interprofessional AND education, “IPE,” interprofessional AND education AND practice, “interprofessional education and practice,” “interprofessional practice and education,” and “interprofessional education” (0) (see Table 2).
Frequency of Research Article Abstracts by Search Term.
Note. Search terms sorted from most to least frequent by article type. Totals noted are prior to removal of duplicate results. IPE = interprofessional education or interprofessional practice and education.
Finally, duplicate articles (19) and articles incorrectly included in the publisher’s advanced search engine (7) (e.g., article types other than research articles, articles in which the search term appeared only in the author’s note or reference list, and articles that mentioned a concept only in passing) were excluded. As a result, 43 articles remained for inclusion in the final review.
Step 4. Assessment of the Literature Selected for Inclusion
Descriptive details of each of the 43 research articles selected for inclusion in this systematic review were entered in an Excel© spreadsheet. Headings included search terms; year, to facilitate identification of early uses of language or concepts associated with IPE in the FIS research literature; and author, volume, number, pages, and article title to facilitate ease of retrieval and review of relevant articles during the coding process.
To facilitate identification of meanings associated with words and phrases that describe interprofessional interactions within each of the 43 articles, brief notes related to, and relevant quotations derived from, each article were added to a comment column for ease of reference during coding. Articles were examined and coded using a classification system based on a 2014 scoping review of the IPECP literature by Brandt et al. (2014) to ascertain “the type of interprofessional interaction around learning and/or practice” (p. 395). This classification system included codes and related classifications and descriptions of terms associated with IPE (i.e., interprofessional, multiprofessional, not interprofessional/uniprofessional, and unknown/other) resulting from a review of 496 articles identified through selected inclusion criteria (Brandt et al., 2014, Table 2, Level of interprofessionalism code). The original classification system will be compared with codes, classifications, and descriptions of terms resulting from this systematic review in the analysis of findings. Additional column headings were developed to facilitate the identification of words and phrases used to describe IPE contexts and populations served through IPE, as identified in the selected FIS literature.
Analysis of Findings
Earliest Use of Terms Associated With IPE
This systematic review of 100 years of FIS’s archives reveals three notable early references to concepts associated with what is now referred to as IPE. The earliest identified use of the phrase “interprofessional education” in FIS was found in a 1949 article described as a “beginning experiment in interprofessional education” (Dickson, Levinson, Leader, & Stamm, p. 324), considerably predating the 1969 paper currently credited with introducing this phrase (Gilbert, 2010, as cited in Fransworth et al., 2015): As part of the interprofessional educational process, a brief course evolved which was planned by the Psychology Department to interpret to the Social Service staff the purpose, meaning, and use of the various psychological tests and concepts. Other structural arrangements were worked out to encourage closer contact between psychologist and social worker. Appreciative of the interviewing skills of the social worker, the Psychology Department requested the Social Service Section to teach a required summer session course in “Case History Method” to the psychology interns . . . [T]he main purpose of the course was to help psychology interns with problems, feelings, and questions involved in interviewing so that they would be better equipped to help the patient participate in the testing situation. A secondary purpose was to evaluate . . . through testing . . . [and] interviewing, significant areas of the patient’s functioning and capacity with emphasis on the views and attitudes of the patient himself. Throughout the course, emphasis would be placed upon making each contact between patient and psychologist a constructive experience for the patient. (pp. 318–319)
Significantly, this finding reveals discovery of the earliest known use of the phrase “interprofessional education” to date as having appeared in FIS. This article is also notable for portraying an early patient-centered approach to professional education, with a strong focus on the importance of developing interviewing skills to maximize communication between the patient and the professional.
A 1951 article by Tanenbaum introduced the concept of a “team relationship” (p. 202), recommending that the “family casework and psychiatric professions . . . ally themselves in a collaborative process to contribute their specials skills toward a more complete social-psychiatric diagnosis and treatment” (p. 196). This represents the first appearance in FIS of what is now referred to as interprofessional practice. In addition, the article refers to competencies now associated with interprofessional practice, values/ethics, and roles/responsibilities, related to the proposed “integrated consultation service” (p. 196), including “differentiated roles . . . [or roles/responsibilities] derived from the same stem (concern for the individual’s total adaptive function) [or values/ethics] . . . [and u]nderstanding of their respective roles . . . [as] complementary activities” (pp. 201–202). This reflects two of the four core competencies later established by the Interprofessional Education Collaborative (IPEC), the other two being interprofessional communication and teams/teamwork (IPEC, 2011, 2016).
Finally, an article by Haselkorn appearing in a 1958 issue of FIS prophetically discussed opportunities to advance interprofessional practice through education: We need to know considerably more about our participation in teams . . . Interdisciplinary workshops focused on communication problems and mutual examination of operational patterns will promote understanding . . . Opportunities offered in student training experience for development of skills in interprofessional practice should not be overlooked. In the classroom the trend toward cross-discipline teaching is opening new horizons . . . some experimentation in sharing parts of common curriculum content among allied professions should extend our perceptions and initiate mutual understanding early in professional development. (pp. 400–401)
Haselkorn also foreshadowed the tremendous potential of field education to advance interprofessional practice, now referred to as the IP-CLE (Weiss et al., 2019), noting that “[u]ntapped sources exist in agency placements which can be drawn upon for more purposeful and conscious learning and which would also make us less reliant on intellectualized learning about ‘the other professions’” (1958, p. 401).
Frequency of Use of Terms Associated With IPE
An initial search using selected search terms of all years and all article types contained within the 100 years of FIS revealed a high volume of articles containing words and phrases associated with what is now referred to as IPE, with the search terms team* and interprofessional yielding 1,900 and 105 matching articles respectively (see Table 1). It is important to note that this initial search did not account for duplicate articles, articles incorrectly included in the publisher’s advanced search engine, false positives in which the search term appeared only in the author’s note or reference list, or articles that mentioned a concept only in passing. Of the 105 total articles by all types that included the word interprofessional, 66 were in research articles, 27 in book reviews, six in editorials, five in other, and one in index. As a result, the research articles provided the most relevant article type for inclusion.
After narrowing the search to scholarly research articles, and further narrowing to abstracts of research articles, then removing duplicates and false positives, 43 research articles remained that referenced words and phrases related to IPE. The presence of selected search terms within these abstracts reflects the relevance of words and phrases associated with IPE, as abstracts contain among the “four or five most important concepts, findings, or implications” within these articles (APA, 2010, p. 26).
Meanings Associated With Words and Phrases That Describe Interprofessional Interactions
As is common in reviewing literature relating to interprofessional interactions, particularly prior to the 2010 WHO definitions related to IPE, the terms interprofessional and interdisciplinary were used interchangeably and imprecisely in this review of FIS. Rather than focusing on actual word usage, this review sought to analyze the meanings associated with words and phrases describing types of interprofessional interactions. These meanings were then compared with an existing classification system developed for a scoping review of interprofessional literature (Brandt et al., 2014).
Analysis of the use of words and phrases describing types of interprofessional interactions reinforced the use of the codes, classifications, and descriptions for interprofessional as presented by Brandt et al. (2014). The classification interprofessional represented the most frequent meaning found to be associated with words and phrases describing interprofessional interactions. Found in 14 of the 43 selected research articles, it describes “Two or more professions learning or practicing interprofessional competencies: teamwork, communication, ethics and/or professional roles” (p. 395).
The next most frequent classification found in nine of the 43 articles describes what Brandt et al. (2014) classified as “[m]ultiprofessional” involving “Two or more professions working side by side for any purpose” (p. 395). This classification tied with uniprofessional/intraprofessional, also found in nine of the 42 articles. These classifications were followed in decreasing frequency by emerging (4), other (4), and interdisciplinary (3) (see Table 4).
As “themes and categories” emerged from a review of qualitative data (i.e., brief notes and quotations from the review each of 43 selected articles) (Cronin et al., 2008, p. 42), existing codes, classifications, and descriptions were modified or added to better represent concepts that arose from this review. Modifications informed by this review included renaming the existing classification multiprofessional to a more commonly used and understood term, multidisciplinary, while retaining the original description. In addition, the existing classification not interprofessional (uniprofessional) was renamed uniprofessional/intraprofessional with a new description in more common and contemporary usage: “Two or more people from within one profession learning or practicing together.”
Finally, new codes, classifications, and descriptions were added, specifically emerging, described as “A new or emerging role as part of a team for any purpose. Includes professionals, paraprofessionals, or volunteers”; interdisciplinary, described as “Two or more disciplines integrating knowledge and/or synthesizing approaches”; and other, de-scribed as “Not reflected in other categories (e.g., task force, task group, or work group).” For a complete listing of original, modified, and new codes, classifications, and descriptions, see Table 3.
Level of Interprofessionalism Code.
Note. Original codes, classifications, and descriptions derived from Brandt et at. (2014). Modified and new codes, classifications, and descriptions derived from this systematic review (Kennedy).
New description; bModified classification; cNew coding, classification, and description.
Contexts and Populations Served Interprofessionally
A close examination of 43 selected research articles yielded education and practice as the two contextual domains related to IPE, as expected based upon existing IPE literature. A review of education and practice-related settings resulted in two settings related to the context of education, social work education and research, as well as an impressive 23 distinct settings related to the context of practice. In the same review, 19 unique populations were served by contexts and settings in research articles using language associated with IPE (see Table 4).
Frequencies of IPE-Related Meaning, Context, and Population Served.
Note. Associated meanings appear in order of frequency from greatest to least. Context/setting and population served appear in descending alphabetical order. IPE = interprofessional practice and education.
Implications for Education, Practice, Policy, and Research
The unique opportunity to plumb the depths of rich archival literature in celebration of 100 years of FIS has yielded noteworthy results, including historical milestones related to the early use of language associated with IPE, expanded classifications and descriptions for terms commonly used in the literature, and a broad spectrum of identified settings and populations found within the literature with language related to IPE.
Education
A common misconception among social work educators is that IPE only or primarily relates to social work in health care settings. Importantly, the findings of this systematic review support IPE’s relevance and portability across social work practice settings and populations, reinforcing the importance of preparing the current and future social work workforce for interprofessional collaborative practice through IPE. In addition, social work educators can play a central role in developing the nascent concept of interprofessional, as differentiated from professional, identity formation.
Practice
Given the frequent interchangeable use of the terms interprofessional and interdisciplinary found in established IPE literature (Brewer et al., 2016) and reinforced through this review of FIS research articles, it is strongly recommended that differentiated descriptions between these terms be adopted and consistently used. An expanded list of classifications and descriptions derived from this review can contribute to adopting a more precise use of terminology to describe the range of professional interactions related to IPE (see Table 3).
Policy
The wide range of practice contexts and populations associated with interprofessional practice identified through this systematic review of 100 years of FIS points to the need for payment reform to support interprofessional team-based care and integrated health/behavioral health and social services. Although policies related to reimbursement formulas in the health care sector are currently undergoing a shift from volume to value, reimbursement is often still tied to the presence of specific professions (e.g., physician or advanced practice nurse). Although there is a growing emphasis and recognition of the importance of social determinants of health and shift toward the provision of integrated care, policies guiding reimbursement are still focused on health care rather than on social care. Payment reform would go a long way to support the breadth of contexts and populations served by the social work profession as part of an interprofessional team.
Research
Future research suggested by this historical and systematic review includes (a) identifying and analyzing historical references to current interprofessional competencies (IPEC, 2011, 2016), (b) exploring the role of the patient, family, and community as part of the interprofessional team over time, and (c) demonstrating Triple and Quadruple Aim outcomes of interprofessional practice on patients’ experience of care, the health of populations, the cost and quality of care (Berwick et al., 2008), and the practitioner’s experience of care (Bodenheimer & Sinsky, 2014), including increased resilience, retention, and joy in work.
“The historical context of interprofessional education and collaboration is largely absent from the published literature and may provide an important contribution to our understanding of forces for and against change” (MacMillan & Reeves, 2012, p. 353). Further research using the FIS archives presents an opportunity to fill this gap by interrogating the social work research and practice literature.
Conclusion
This article traced the evolution of words and meanings related to IPE, and their influence on the developing “art, science, and practice of social work as we know it today” (SAGE Publishing, 2019b, para. 1). This historical, systematic review of social work research literature over 100 years of FIS provided a unique opportunity to identify further references demonstrating social work’s early and significant contributions to IPE over time.
Upon the 100th anniversary of social work research’s seminal journal, FIS, the year 2019 presents a unique opportunity for social workers and social work educators to reflect on the rich history of the profession. Serendipitously, the Council on Social Work Education’s 2019 Annual Program Meeting theme was Social Work Education: Looking Back, Looking Forward, “focus[ed] on honoring and celebrating the history of social work education” (Baffour, 2019, p. 3). May this opportunity to reflect upon social work’s rich history enlighten our understanding of “how the past has informed the present and where social work’s future lies” (Fogel, 2019, p. 5).
Footnotes
Disposition editor: Sondra J. Fogel
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
