Social Structures
Authors: Kate Rochford, 3rd Year Undergraduate Intern, Department of Psychology, Maynooth University & Mac MacLachlan, Co-Director of the Assisting Living and Learning (ALL) Institute, Maynooth University and Clinical Lead for Disability Services, Irish Health Service (HSE).
Introduction
An interdisciplinary approach to research has become increasingly popular when dealing with different topics (Aboelela et al., 2007). Such an approach can offer a more comprehensive or holistic perspective and is most suited to addressing real-world complex issues (Repko et al., 2017). However, while interdisciplinary collaboration may be appealing in theory, it is often difficult in practice (Cummings and Kiesler, 2007). In that regard, we believe that the concept of ‘disciplinary capture’ can supplement an enhanced interdisciplinary approach. It can also help to transpose academic thinking into practice. Particularly, in relation to disability, and services for persons with disabilities, this concept can translate into more effective integration of services.
Disciplinary capture involves thinking about problems from only one perspective (Brister, 2016). Disciplinary capture can determine what sort of ideas, facts, interventions or causal explanations, are depicted as permissible. For instance, a disease-model approach to mental health may only accept pharmaceutical interventions as being legitimate for a range of mental health problems, while a more psychological, social or human rights approach may not accept this (MacLachlan et al, 2021). In this scenario, if proponents of the disease model are positioned in such a way that other professions are expected to be deferential towards them, then this is likely to inhibit truly interdisciplinary practice. Moreover, this can impede the empirical merit of such a position through the preclusion of an open discussion which would allow for full exploration of all the possible alternatives. The result may manifest in poorer decision-making processes and sub-optimal interventions.
By contrast, if a service is integrated it means that different parts of it work together to achieve a good quality of service for the service user, and furthermore, that the service is designed around the service user, rather than the service user having to fit into a rigid structure of service delivery. The graphs below illustrate the number of publications in the areas of disability, mental health, aging and rehabilitation, that incorporate a interdisciplinarity, or integrated services. This data was accessed through the dimensions platform which collates publications and allows searching by using key words. Upon viewing the trends of the past decade, it is clear that prior to the onset of Covid-19, there was an apparent, and concurrent increase in interest in both interdisciplinary working and integrated services.
However, it is useful to distinguish between multidisciplinary and interdisciplinary services. In multidisciplinary services multiple disciplines are involved in providing services; and they work in a parallel fashion, each providing a distinctive and separate contribution (Taberna et al., 2020). Within interdisciplinary services, it is recognised that there is an overlap, not only in the skill sets of different professions, but also in the services they can provide. Therefore, there is an explicit attempt to synthesize the work of different professions; to share tasks among them and thus allow for a more integrated intervention for the service user or patient (Jessup, 2007). The benefits of interdisciplinary working and integrated services, when realised, are well established (Maslin-Prothero & Bennion, 2010). However, in the Irish context of health and social care services, effective interdisciplinary working often requires new and different approaches to participation and decision making (Nancarrow et al., 2013). One of the challenges to such an approach is where a single discipline expects, or is positioned within the existing system, to have a dominating or domineering role.
Disciplinary Capture and its Utility
Brister, 2016 argues that disciplinary differences, such as differences in causal explanations, ideas of rigour, or what is taken as fact, often reinforce each other and may suggest that some methods or interventions are more legitimate than others. If early decisions are dictated by a single discipline, further resolutions from the same discipline are likely to emerge as a result of, and in support of, the initial opinion. Thus, this snowballing effect produces results which are likely to be less integrative than initially intended.
Change What?
Disciplinary capture is promoted in systems that encourage more dictatorial behaviour by members of individual disciplines who are given a dominant position in groups comprised of multiple disciplines. However, it is crucial to stress that disciplinary capture does not imply that those whose disciplinary perspectives take precedence, are necessarily acting in poor faith, nor with malevolent purpose. It is the structures that support dominance – rather than the individuals operating within these structures – that should comprise the targets for change.
Those placed in dominant positions may be quite aware of, or indeed unhappy with, the role they occupy. Therefore, it is not only the responsibility of individual researchers, practitioners and disciplines to avoid disciplinary capture; it is also, perhaps especially so, the responsibility of those who design the structures in which such activities take place.
Designing Fairness for Effectiveness
When it comes to service areas widely acknowledged to be interdisciplinary such as disability, mental health, rehabilitation, aging and child development, the function of service design must be to avoid structures that promote dominance and deference. It is an imperative to promote structures that put different disciplines on a level playing-field; where resolutions arise not from dominance, but from an open, fearless and effective interaction between team members who wish to share ideas and decisions.
One important step in achieving this transition within the Irish health and social care system is the establishment of leadership positions, not on the basis of disciplinary membership, but on the basis of competence – including the competence to promote effective interdisciplinary working. The filling of leadership roles on the basis of membership of a particular profession may position one discipline as being more dominant and encourage disciplinary capture; whilst undermining interdisciplinary accord and the integration of service delivery. With countless changes currently taking place in Irish health and social care services, this ‘unfreezing’ (Lewin, 1948) of structures presents real opportunities to release ourselves from disciplinary capture; and to design services that stand a better chance of producing more integrated and effective interventions.