Role strains of a health care team in a poverty community: The Columbia point experience

Abstract

An interview study of the professional functioning of health care teams in a low-income housing project was conducted by the authors. The setting was the Columbia Point Health Center, the first Office of Economic Opportunity-sponsored neighborhood health center, located in Boston, Massachusetts. The participants interviewed included physicians, nurses, and social workers. Columbia Point proved to be a more stressful milieu in which to work than most of the health professionals involved had anticipated. Various of the “cycle of poverty” aspects of the project created difficulties for them, as well as for the residents whom they were mobilized to serve. In addition, role relations between the different categories of health professionals who composed the teams constituted an important source of strain. A group of United States Public Health Service physicians who had been involuntarily drafted into the center had a disruptive influence on the teams' functioning. And relations between public health nurses and social workers were especially tense. The study points up the fact that high motivation to work as a member of an interdisciplinary health team in a poverty setting is a necessary, but not a sufficient condition for such a collaborative endeavor. Appropriate, clear, supple role-definitions worked out by participating health professionals prior to their entrance into the field, facilitated by a process of anticipatory de-socialization from certain role-patterns to which they are accustomed would seem to be prerequisite.