Interprofile practices: ensuring safety in the long-term care system (on the example of the Volgograd region)

Skobelina Natalia Anatolyevna Doctor of Sociology Professor, Department of Pedagogy, Psychology and Social Work, Volgograd State University 400062, Russia, Volgograd region, Volgograd, Universitetskiy ave., 100, office 2-20 V volnatmax@mail.ru Other publications by this author

Introduction

The long-term care system (SDU) has been gradually introduced in all regions of Russia since 2018 and is based on a multidimensional nature, which is manifested in the integration of healthcare and social services, in the interaction of specialists from various fields of activity, in the organization of interprofile practices in order to ensure safety in the process of caring for citizens in need of service. In practical terms, the process of creating a SDU involves a multi-level interaction of institutions, public structures and various specialists.

Our focus is on interprofile practices that are created in the SDU in order to provide high-quality and safe services to the population. Focusing on ensuring safety, scientists pay special attention to the integration of the competencies of various specialists in interprofile interactions ^[1]. Long-term care includes diverse specialists who share their competencies with each other in the process of providing social services to citizens in need of care ^[2],[3]. American researchers Zerden L., Lombardi B., Fras M., Jones A., Rico Y. It is noted that new models of integrated care have expanded access to preventive and curative services, and interprofessional medical teams, which include social workers, participate in mental health activities, manage medical care and refer clients to specialists ^[4]. Each profession has its own knowledge base. Interdisciplinary colleagues share their experience in collective teams ^[5],[6],[7]. In their research, scientists predict high-quality and effective results for patients of interprofile teams from the point of view of safe care and show the dependence of service results on the coordination of the activities of doctors, nurses, physiotherapists, and social workers. In most studies, the role of coordinator is assigned to a social worker. The competencies that social workers develop in the learning process are integrated and practice-oriented, since their professional activities are aimed at providing various services to the population ^[8]. An interdisciplinary approach to the study of interprofile interactions is used by many modern researchers ^{[9],[10],[11]}. The provisions of the interdisciplinary approach make it possible to justify the need for multidisciplinary cooperation in the long-term care of the elderly and the disabled ^{[12],[13],[14]}.

The fundamental theory for the study of interprofile interactions of specialists as organized practices is the theory of structuration by E. Giddens, in which social practices are understood as practices that are "reproduced in time and space" and include subjects, actions committed by them, and rules governing the behavior of subjects ^[15]. The provisions of the theory of E. Giddens made it possible to identify the features of interprofile practices and determine their components of ensuring safety in long-term care. Within the framework of E. Giddens' theory, the activity of SDU subjects manifests itself on several levels. At the macro level, cooperation practices between institutions are of great importance, including various service providers who participate in the implementation of measures to introduce hospital-substituting technologies in order to provide safe services to the population. At the macro level, an appropriate regulatory, methodological and technological base is being formed, as well as an infrastructure accessible to people with limited mobility. At the micro level, the brigade method is used in social service centers. Interprofile teams as social practitioners are created to meet the complex needs of clients in order to integrate the competencies of specialists in the field of health and social care.

The purpose of the article is to identify the features of interprofile practices in the aspect of ensuring safety in long-term care. In the SDU, safety is understood, on the one hand, as a way to protect the health and well-being of the elderly and disabled, creating conditions to improve the quality of life of citizens in need of care. On the other hand, it is relevant to create safe work for care professionals in order to prevent their professional burnout.

The article uses an analysis of scientific literature and the results of an expert interview of managers and employees of social service centers of the Volgograd region included in the register of social service providers and carrying out long-term care activities since 2018. Representatives of social service centers in Mikhaylovka, Frolovo, Kamyshin, Surovikino, Pallasovka, Uryupinsk, Ilovlya were interviewed, Volzhsky, S.P. Olkhovka, P.G.T. Svetly Yar, R.P. Novonikolaevsky, districts of Volgograd (Dzerzhinsky, Kirovsky, Sovetsky, Traktorozavodsky, Krasnooktyabrsky).

From the list of organizations included in the register of social service providers of the Volgograd region, organizations were selected that, since 2018, have been included in the process of implementing measures to introduce SDU in the region (N=27, Volgograd Region, January – February 2022). The study was conducted with the support of the Committee for Social Protection of the Population of the Volgograd Region. Among the experts: women – 89%, men – 11%, the age groups were under 45 years old – 19 people, over 45 years old – 8 people. The experts' personal data is not used in the analysis.

Features of interprofile practices in SDU

In the process of activity of the interprofile team, many functional components are manifested: identification of the patient, determination of his diagnosis, building communication, establishing interaction with the family. Multifunctionality requires the inclusion of specialists of various profiles in the SDU: psychologists, doctors, social workers, social educators. Russian researchers determine the technology of working in interdisciplinary psychotherapeutic teams, the specifics of building a system of professional development for psychotherapists and clinical psychologists in the process of their joint activities ^[17],[18].

Interprofile practice is based on the principle of cooperation and partnership. In the process of interaction between the participants of the practices, the experience of long-term care of family members, NGOs, and volunteerism is transferred ^[19]. The results of the analysis of scientific literature indicate that partnership practices are being introduced in Russian society, which consist in training family members, in developing a mechanism for interaction between various specialists, in cooperation between social service institutions and authorities. A feature of interprofile practices is the integration of medical care and social services ^[20],[21], the reproduction of practices in the process of applying technologies for organizing the activities of long-term care specialists, as well as the use of partner practices in long-term care for the elderly using organizational, personnel, insurance and other components ^[22].

The SDU identifies four stages of organizing the activities of specialists: identification of citizens, routing, typing, and direct care for those in need of help. At these stages, specialists from various fields of professional activity who participate in interprofessional interactions are involved in the work. Technologies for the identification of elderly citizens and people with disabilities, the organization of nursing services, the introduction of inpatient replacement technologies, the preparation of individual programs for recipients of social services taking into account their needs in various forms of social services, training for long-term caregivers, the organization of geriatric teams - these and other technologies require the integration of the efforts of specialists of various professions.

The activities of SDU subjects are regulated by formal and informal rules and regulations. Federal and regional documents define the forms of cooperation between specialists, which are organized in the process of implementing technologies aimed at improving the quality of service and ensuring the safety of the elderly. These include "personal assistants", a nursing school, "care assistants", "day care units for elderly and disabled citizens". Long-term care technologies represent the organization of activities of multidirectional specialists in providing services to citizens in need of care. Within the framework of technology, in accordance with formal rules, social services are provided, both included and not included in the social package of long-term services. The social package is provided to recipients free of charge in stationary, semi-stationary and home-based forms and is formed in accordance with the degree of need of a citizen and his individual need for care. Interprofile practices are created by service providers, subjects of the state and non-state sectors: employees of social service centers and social protection of the population, specialists of socially oriented non-profit organizations, neuropsychiatric boarding schools, foundations.

Thus, in modern Russian society, the SDU has developed a mechanism of interprofile interaction at the micro and macro levels. In the process of long-term care, service providers organize practices that are characterized by versatility, integration of social and medical care, and the technological basis for specialist interactions. Interprofile practices are created to ensure the safe work of specialists providing services and to protect the health of citizens in need of care. Long-term care involves a combination of technologies that include many different social care services. In addition to the block of services included in the social package, which are provided by nurses, additional services are provided in the process of interaction between social workers, psychologists, teachers and other specialists. These interactions are interprofile in nature.

Regional interprofile practices (on the example of the Volgograd region)

The regional specificity of the creation of SDU in modern Russia is explained by the different time involvement of regions in this process. In addition, each region has long-term care practices that have historically developed in this area. In 2018, the pilot project began to be implemented in six regions, and the Volgograd region became one of them. Within the framework of the SDU, practices in the field of healthcare, social services for the population and relatives of citizens in need of care are being integrated in the region. New approaches to the provision of integrated services in the system of safe care and the creation of a personnel center have appeared in the SDU, which is engaged not only in training relatives in need of care of citizens and long-term care specialists, but also carries out organizational, methodological, informational and analytical activities in the social service system of the population. The training program includes the prevention of complications (falls, bedsores), care for diseases that cause disability, solving problems related to communication, catering and feeding, and maintaining documentation by specialists.

The results of an empirical study have shown that educational technologies for long-term care are being created in the region, which have an interprofile character. The training of citizens in need of care is carried out by doctors, nurses, social workers and other specialists directly involved in the rehabilitation process. To the question: "Are there educational centers in the Volgograd region where training is conducted by diverse specialists? - an affirmative answer was received: "There are resource educational centers in the Volgograd region. These are interprofile centers. Funds have been allocated from the regional budget for the organization of points for the issuance of technical rehabilitation funds, schools of care" (Expert 1, head of the department).

In their answers to the question: "How is the work of various specialists organized in the process of long-term care in order to ensure their safety?" the experts confirmed the existence of interprofile practices of interaction between specialists in the Volgograd region: "For security purposes, the joint work of various specialists is aimed at applying an individual approach to the recipient of social services, specialists collect information about the state of health, on the course of the disease" (Expert 4, Director).

The emergence of new technologies in social service centers is associated with both the introduction of SDU and the period of self-isolation. Since 2019, specialists of institutions have been organizing interactions with recipients of social services in a remote format, issuing free technical rehabilitation equipment, nursing schools are operating, mobile teams are traveling to agricultural settlements in the Volgograd region, messengers are used to conduct group classes, virtual excursions are conducted.

During the empirical research, attention was focused on the organization of new practices and the application of innovative technologies. Answering the question: "What cross-industry practices and innovative technologies do you use in your work?" - Experts noted that in the pandemic and post-pandemic period, many new practices have emerged that integrate the efforts of various specialists in order to ensure safe care: "Mobile teams in Pallasovka deliver various goods and food, medicines, and social assistance to elderly citizens. In order to ensure the safety of our service recipients, we deliver doctors to their homes, take citizens to the hospital and back" (Expert 2, head of the department). In their responses, experts noted the technology of social families, the caregiver service, and the technology of a personal assistant. The technology "multidisciplinary practice of providing comprehensive assistance to those in need" is functioning in the region: "We use the brigade method. A team of social workers provides social services in accordance with the needs of the elderly. This technology allows you to reach a large number of people in need of help and provide high-quality additional services. Social service centers use innovations that improve physical and emotional well-being and help prevent cognitive disorders. Such technologies include trainings, psychological consultations, master classes on making "miracle from paper" and amulet dolls; "plasticinography"; "Iris folding" or rainbow folding from paper", "ornithotherapy" (Expert 11, director).

During the study, experts identified two problematic aspects. Firstly, one of the most effective and, at the same time, not yet universally used technologies is the "brigade method". The respondents were asked: "What function do social workers perform in a multidisciplinary team?" The experts focused on the role of a social worker: "Social workers identify people in need of long-term care, and interact with medical professionals to conduct a medical examination. This is the brigade method" (Expert 21, Director).

However, as the study shows, the brigade method is not yet used in all social service centers. Only 16 experts indicated its use. Despite this, all respondents noted the effectiveness of this technology in terms of safety and quality of service, because it provides safe care, supports and improves the health of the elderly and disabled. The implementation of the "Standard model of a long-term care system for elderly citizens and people with disabilities in need of care" makes it possible to expand the possibility of using the brigade method technology at the micro level and more effectively build a mechanism for multidisciplinary interaction to ensure safety in the care process. According to experts, constructive coordination of activities in teams contributes to improving the quality of social services, as well as positively affects the professional development of specialists from different fields working together. Psychologists, social work specialists, doctors, nurses take part in the teams, therefore, the integration of social, medical, psychological and other services provided to the population is at the heart of the activities of the interprofile team.

Secondly, despite the fact that almost all experts spoke in favor of integrating the healthcare and social services sectors, but in most organizations in the Volgograd region, interactions between social workers and doctors, social psychologists and doctors are not yet familiar and everyday. To the question: "For the sake of safety in long-term care, is the joint work of social workers and psychologists with doctors organized?" - 17 respondents identified such practices: "Social rehabilitation specialists with psychological education communicate with doctors in order to effectively develop individual work plans with recipients of services" (Expert 2, head of the department). "A geriatrician and a psychologist constantly hold meetings. The problems of service recipients are discussed, the geriatrician gives his recommendations on working with the elderly" (Expert 10, specialist in social work).

Thus, as the results of the study show, interprofile practices are being created in social service centers in the process of developing and applying long-term care technologies by various specialists. Currently, in accordance with the Standard Model of the long-term care system, practices of regional and territorial coordination centers, practices for organizing day care for the elderly and disabled, for training specialists in long-term care, schools of care for relatives and acquaintances caring for and training citizens in need of self-care in the rehabilitation process are organized. In the multilevel mechanism of interprofile long-term care practices, the technological basis of interaction between specialists is of primary importance. At the micro level, communication practices are created between care assistants, social workers, social psychologists and other specialists performing various functions in long-term care. At the macro level, the centers for social protection of the population accumulate all information about the recipients of services and coordinate activities between specialists of institutions in the field of health and social services of the population. Currently, the Volgograd region is developing a safety mechanism in the SDU, which includes a technological component (the use of hospital-substituting technologies, technical means of rehabilitation), a communicative component (multi-level interactions of subjects of SDU), an educational component (improvement of service skills).

Conclusion

Interprofile interactions as social practices are reproduced by SDU subjects within the framework of formal and informal norms and rules governing their activities. Institutional norms, various forms of cooperation, means and methods of activity of subjects of long-term care ensure safety in the social service system of the population.

In this article, interprofile interactions are considered as social practices using the tools of sociological science and the theory of social work in the context of the organization and functioning of SDU in Russian society. The application of the provisions of the theory of E. Giddens to the analysis of new forms of interactions in the SDU provided an opportunity to identify the features of interprofile practices, which include multifunctionality, partnership, integrated medical and social services, technological practices of interaction between specialists, focus on improving safety in the process of long-term care.

The analysis of scientific literature and the results of empirical research indicate that micro- and macro-level transformations of the social system contribute to the organization of interprofile practices. Changes in the sphere of social services in the region are aimed at promoting innovative technologies in the system of social services, at developing effective interprofile interaction in the aspect of ensuring security in the process of providing long-term services.

The results of the study show that in order to improve the quality of home care, create comfortable conditions for the elderly and disabled, SDU participants organize interprofile practices, implement a mechanism to ensure the safety of care professionals and citizens in need of care. However, not all social service centers in the Volgograd Region use the brigade method and establish cooperation practices between medical professionals and social service specialists, whose integration ensures the safety of both providers and recipients of services.