Factors that can influence the level of Care Team Functionality

by David Brown

I have been reflecting on my behaviour during some recent events, meetings and interactions with both colleagues and friends. I noticed with significant disappointment how often I would hesitate to say something due to my own uncertainty regarding whether, by saying it, I might look foolish, uninformed or in some way not as competent as I wanted to present myself to be. It struck me that even at my age, I was still highly susceptible to using pretense, image or silence to portray myself as being something or someone I was not.

This is not a new realization. I have struggled with shame and anxiety regarding my competency and evaluation of performance my entire life. I have been susceptible to a need to impress people and have them see me as wise, smart, competent and generally, if not perfect, at least significantly above average. That has certainly been one of the motivators that led me to pursue more challenging work opportunities as well as similar pursuits and undertakings in my personal life. In some respects, this has led to worthwhile accomplishments and opportunities to overcome my inherent fear of failing by providing ample examples where, by any reasonable standard, I was successful and demonstrated competence. None the less, the fear and shame continues to haunt me and I recognize that one of the chronic outcomes of this well entrenched pattern is a tendency to remain somewhat distant and aloof with most (and some would say everyone) I have been or still am in relationship with.

It is an undeniable fact that our culture is monumentally hypocritical when it comes to values associated with self-identity and the perplexing dilemma of balancing the importance of self-acceptance with the effort to “fit-in” or at least behave in a manner that is not so outlandish or “socially inappropriate” that we end up alienated and shunned by our intended community or circle of family and valued others. On one hand, Facebook and other media tools are rife with themes that express the common element encouraging us all to “be ourselves”. The rhetoric expresses strong encouragement to give up our fear of being rejected or judged by our behaviour or personality attributes in favour of “being all we are” and living with full acceptance of ourselves. This is portrayed as one of the highest values of our culture. On the other hand, however, the overwhelming message that saturates us in a myriad of culturally based forms communicates that we must follow the dictates of acceptable dress, smell, values, presentation, and social correctness etc. to “win” the race of acceptability and the label of being normal and “good enough”. Winston Churchill once said: “When you’re 20 you care about what everybody thinks. When you’re 40 you stop caring about what everybody thinks. When you’re 60 you realize no one was ever thinking about you in the first place.” Unfortunately for many of us, being sixty doesn’t eliminate the vulnerability to remain influenced by this fear.

These reflections have been the foundation for reviewing, as I said previously, some of my recent interactions, not just from the perspective of my own behaviour but also as a lens for reviewing the effectiveness of Complex Care and Intervention (CCI) team functionality. For more on CCI see link: https://www.complextrauma.ca/about/the-complex-care-and-intervention-program-cci/ In fact, these principles can be applied over any team discussions and planning sessions. In one case in particular, there was evidence of a significant disconnect in our team. Though information was presented as ‘normal’, unspoken issues, thoughts, worries, anxieties, biases and conflicts remained hidden and thus not shared. The reality is, the exclusion of this will inevitably negatively influence the degree of a “functional team” that is formed and used to undertake the care plan for a child and his/her caregivers.

The question this situation raised for me is: How does one promote directness and “honest” dialogue between members of a care team in order to both increase the sharing of pertinent information and acknowledgment of conflicts which, by addressing them can increase the effectiveness of decision-making and collaborative problem solving? I think Dr. Ross Greene’s model has much to recommend it as one tool that can be used. This might involve the recognition of patterns of communication or impressions of inconsistencies in messages between team members that by overtly acknowledging could lead to more full disclosure and the establishing of a group ethic that such inconsistencies can be acknowledged. Clearly this is not necessarily a universally accepted value in all of our teams.

Another means to answering this question is to have team facilitators share the following in order to influence the effectiveness of Team Functionality:

1. Can we share our own efforts at overcoming these impediments?  By disclosing our fears, unspoken concerns/worries, or personal biases etc., we are being authentic in our own journey and helping overs gain the courage to also overcome.  It is also essential to offer stories where there has been some degree of success towards this end.  In implementing these factors, I think we can be a strong resource to one another if we did more of this.

2. Acknowledging the importance of ALL team members – by practising the elements of effective team functioning (clear role designation, honoring confidentiality, avoiding gossip, respecting one another, empowering each other, honest disclosure and authenticity as an example) you can improve team functioning outcomes especially, in regard to those teams where we have reason to believe they will likely form the basis for working on multiple cases.

3. Develop relationships with key team members – is perhaps one of the key elements in a team;  the commitment to taking the time to foster relationship and time together even when there may not be any assurance that those members will remain long term.

I hope that there will be opportunity to share some of our experiences with these issues in an ongoing manner to increase team functionality in order to provide the best care for those we serve.

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About the author

David has 40 years’ experience as a therapist working in a variety of settings including mental health, social services, corrections and non-profit societies. He provides clinical supervision at the inter-disciplinary clinic at at the School of Social Work UBCO for the past 3.5 years and is one of CTR's clinicians.

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