mommy back at college!: Whew! One entire semester's of work in one 83 page paper!

The following is a relection of my Fall 2011 semester as a student in a pilot section of an English Course at Wayne State University. The Appendix portion contains the final Synthesis Project, which outlines the findings of my study.

Part One: Reflection Letter

As an undergraduate student of Clinical Psychology and Social Work, I had the opportunity to participate in a pilot English course offered by the University this semester. The standard version of the course is Intermediate English, which emphasizes the conduction of research in order to prepare the student for intensive writing courses within their majors. The pilot section in which I participated was developed by the 2011 Composition Committee in order to research new teaching methods that will improve student connections between their required Intermediate English course and their future Writing Intensive course. The primary goal of the pilot course was to teach students such as myself a way to analyze discourse communities so that no matter what writing context encountered, we will be able to actively participate in that writing context. The theoretical framework for the course was an extensive body of research completed on discourse communities, which dissects how to completely analyze discourse communities so that a writer can achieve a heuristic of writing for not only for a particular discourse community, but for any and all discourse they may encounter. In essence, the course used the practice of writing about writing as a method to learn about writing across various discourse communities.

The objectives of the pilot course were clearly outlined into four well-defined learning outcomes:

I. To produce writing that shows an ability to effectively locate, comprehend, and analyze texts from the students chosen discipline or profession (or discourse community) and shows an understanding of their diverse rhetorical situation, purposes, audiences, and genre conventions.

II. To produce an extended, appropriate research project that applies rhetorical strategies to explore a research question applicable to the course. This project must draw substantively on concepts from the relevant literature; uses primary, and/or secondary research; and include a variety of research genres.

III. To produce writing that shows the use of a flexible writing process.

IV. To produce writing that shows an awareness of writing strategies and how these strategies function rhetorically and how they may be applied in other writing situations.

Through the successful completion of a Rhetorical Analysis, data collection and coding, a Data Collection Report, a Synthesis Project, and short written analyses of published works from discourse community theoretical framework, I have achieved the course objectives as outlined above. This reflection paper serves to cite examples of my mastery of these aforementioned learning objectives from these writing and research projects, collectively forming a portfolio of sorts of my work from this semester. All examples cited are located in the appendix of this document, and have been hyperlinked for ease of location within context.

The first learning objective of the course laid the foundation for successful completion of the remainder of the learning objectives. However, before rhetorical analysis could be competed on my chosen discourse community of study (Clinical Social Work), an understanding of what discourse communities are and what the key methods of analysis of a discourse community would be was necessary. This understanding was accomplished by extensive reading on the topic of discourse communities (as provided by the course instructor), and the writing of short responses to said readings. By completing these short analyses of the theoretical framework for the course, I was able to compare and contrast how different “experts” in the field of writing viewed and defined discourse communities; and more specifically, how a discourse community could be evaluated in order to gain assimilation into it. This reading and writing of analyses allowed me to develop my own ideas about what a discourse community is, including a methodology of analysis of any discourse communities, and finally, to analyze written works from within the discourse community of my chosen field.

In Writing Response 3, I spend some time summarizing the differing opinions of Gee and Swales, which illustrates my new basic knowledge base of the concepts introduced. This is noted in the following excerpt from Writing Response 3:

“Gee emphasizes the social practices of a discourse community, claiming it to be an “identity kit” that includes actions, language, literacy, and style, amongst other things. Gee states our identity kit also contains our primary Discourse, (our introduction to the world and our identity) and our secondary Discourse, (outside of the home based social institutions such as churches and schools.) Gee argues that the ease in which fluency is gained in any secondary Discourse is influenced greatly upon whether their primary Discourse community practiced similar “speaking, writing, doing, being, valuing, and believing” as the secondary Discourse. Gee goes on to say that you cannot embody a Discourse; the members of the community choose to either accept you as a member of the community or as an apprentice of the community. Swales, on the other hand, takes no note of the social behaviors of a Discourse, but instead defines a discourse community by six defining characteristics: “common goals, participatory mechanisms, information exchange, community specific genres, a highly specialized terminology and a high level of expertise.” In stark contrast to Gee, Swales argues that it is possible for participation in a Discourse to occur without assimilation, citing professional journalist who assume temporary membership in a wide array of discourse communities.” WAThree1

In Writing Response 2, an analysis of the reading The Idea of Community in the Study of Writing, I comment on Joseph Harris’ view that discourse communities are completely separate:

“I visualize this accumulation of knowledge about writing in the form of a wagon wheel. At the center, or hub of the wheel is the writer himself. The discourse communities to which the writer belongs to, or the extent of the writers involvement, exposure, conversation, and readings of a particular discourse community form the spokes of the wheel, connecting and serving as a conduit and support between the writer and the outside rim of the wheel. This rim, encircling both the discourse community and the writer himself, is the new ideas and opinions of the writer. The more discourse communities the writer is associated with, or the greater and deeper the relationship is between the discourse community and the writer, the more profound, original, and well supported the ideas the writer produces. As the wheel passes through space and time, it discards some ideas and develops new ones, as the writer and the discourse communities are in constant motion or processing.” WATwo1

My disagreement of Harris’ point of view reflects that I have, through assimilation of knowledge of other points of view, come to develop my own heuristic for exactly what a discourse community is. Most importantly, I am able over time to apply the knowledge I have gleaned from these professional writers and begin apply it to analysis of my own discourse community, that of Clinical Social Work. However, at this early stage of the knowledge gaining process, I was only able to apply it to circumstances of which I have experienced myself. I share this experience in my analysis of Gee and Swales in Writing Response 3:

“Gee makes a very compelling argument in his explanation of how our primary Discourse inflects the way we participate in our secondary Discourse. If our primary Discourse is vastly different (in language, practice or lifestyle) from the secondary Discourse we are trying to learn, our assimilation will be infinitely more challenging. I have witnessed this difficulty firsthand. As a foster parent, I have served children who have come to live in my home after many years of living within their primary Discourse, which was very different from mine. My family was to become one of their secondary Discourses (school being the other). Assimilation into the language, style, customs and behavior of my Discourse was very difficult for the children, even though they tried desperately to assimilate. In the fields of sociology and psychology, this assimilation is known as socialization.

What Gee fails to point out, and what I feel is of upmost relevance, is where cognitive ability comes into play when determining the speed of which one can assimilate into a new Discourse. Let us consider again my former foster children, who came to me as a sibling group of four. Two of the children had very low IQ’s, one had an average IQ, and one had a higher than average IQ. The one with the higher IQ was able to assimilate the language and dialect and even the social customs of my family much faster than the others, followed shortly thereafter by the one with the average IQ. This cognitive ability also placed them at or above grade level in school, thereby exposing them to a similar secondary Discourse that embraced higher thinking, literacy, and a similar cultural environment to that of my home. The two with lower IQ’s were in remedial school programs, which focused on basic skills. In this class, children with similar primary Discourses surrounded my foster children, thereby reinforcing the primary Discourse and making fluency in the secondary Discourse very difficult. While I by no means mean to suggest that this is concrete empirical evidence, I do think that it suggest exploration to determine if cognitive ability affects secondary Discourse assimilation is warranted.” WAThree2

Once I felt more confident of my ability to define discourse community, and the effective methods for analysis of one, I was able to complete a rhetorical analysis within the discourse community of my chosen field of study, Clinical Social Work. This rhetorical analysis defines social work practice, and uses the five knowledge domains outlined by Beaufort (15-19) as a framework for analysis of four primary sources consisting of both journal articles and case studies published in nationally known social work and public health journals. In dong so, I was able to define the key genres, rhetorical situations and the purposes of said tools within the Clinical Social Work discourse community.

A specific rhetorical situation mentioned in the rhetorical analysis was that of the usage of a specific lexicon. This is key, as:

“…words that can have multiple meanings or implications are clearly defined so that there is no room for interpretation. For example, in the public health piece, abuse is defined as “physical maltreatment” (628) and is further divided into the categories of child abuse, spouse abuse and elder abuse. “Care of the Adult Patient after Sexual Assault,” published in 2011 in The New England Journal of Medicine also clearly defines the main terms of the work: sexual assault and rape (835). This is done at the beginning of the piece, so there can be no confusion in the mind of the clinical practitioner. Defining terms comprehensively is of great importance in the social sciences, as there may be legal implications. Case in point, the piece on sexual assault clearly states the legal definitions of rape, body orifice, and incapacity. “Rape is a legal term and in the United States refers to any penetration of a body orifice (mouth, vagina, or anus) involving force or the threat of force or incapacity (i.e. associated with young or old age, cognitive or physical disability, or drug or alcohol intoxication) and nonconsent” (835). This very detailed definition of the terms provides the practitioner with information necessary to make a determination of whether to include law enforcement into the circle of patient care, and in what terms to explain to both the patient and the law enforcement what has happened. Second, all of the pieces examined use a lexicon that would be somewhat foreign to those outside of the social work discourse community. Words and phrases such as “supplemental security income”, “developmental disabilities”, “placement”, “environmental” and “coefficient” are just a few examples of words that take on a different meaning within social work practice. Examining both this lexicon as well as the APA method of formatting allows one to make a reasonable attempt at understanding the rhetorical knowledge domain of the social work discourse community.

As a novice in the social work discourse community, it is difficult to assess all of the knowledge that a rhetorical situation can provide. For example, it is unclear exactly who the anticipated audience is, specifically in the piece published in The New England Journal of Medicine. This piece could easily be read and put into practice by clinical social workers, physicians, nurses, emergency medical responders and police officers, all of which represent vastly different discourse communities. Further study in the field of social work is required in order to understand audience and context in a more concrete way.” RAFinal1

Clearly, an understanding of the very word choices the discourse community employs is critical to successful practice within the community.

The understanding of appropriate and functional genre within the discourse community was also illustrated within the rhetorical analysis, specifically in the instance of case studies. Note this example from the Rhetorical Analysis:

“Case studies are detailed analyses of an individual or family unit, which stresses developmental factors in relation to context. Social workers write and read case studies not as a method to determine causation or correlation, but as a method of providing a detailed and oftentimes ongoing record of events. In the case study of John, [1] the social worker interviewed John’s mother and summarizes all of what she had to say about John in the defined categories of Home, Life, School and Concerns. The social worker then uses the ecosystem perspective (another term in the social work lexicon) to look at how individual, family, and larger environmental structures affect John and his mother. Lastly, the social worker lists interventions that are needed at each level to improve family functioning. This mode of genre is extremely useful to social work discourse community for several reasons. , as social workers oftentimes do not see their clients more than on a monthly basis, the ongoing case study provides a summary of previous events, which can refresh the memory of the worker in regards to the case. Furthermore, the case study provides the worker with a list of all of the services that have been recommended for the client, and can be used in subsequent visits as a checklist to see what services have been utilized. Lastly, the case study provides those new to the case (other social workers, psychologist, medical professionals, adoptive parents, attorneys or judges) with a detailed recorded history of prior events in the life of the client. The case study genre is particularly interesting in that it employs a specialized style of writing that completely eliminates the writer of the document (the social worker) from the personalized case of the client. The studies are never written in the first person, but rather in the third person omniscient point of view, which takes a panoramic, bird’s eye view of the clients, and in describing the overall picture.

Published articles and journal studies have a very different purpose than the above- mentioned case studies. Articles are often used to inform social workers about new applications of methods of therapy. Articles also provide the discourse community with updates as to the political and governmental changes that effect case reporting, qualifications for funding, and acceptance into welfare programs and treatment facilities. In “Care of the Adult Patient After Sexual Assault,” the author provides both novices and experts with new information in regards to emergency department protocol. Journal studies usually report the findings of studies done either directly on clients, or by studying an accumulation of case studies. These studies usually report on how well or poorly a new law, change or governmental policy or program is doing. The media and the government (especially in times of political elections or social unrest), oftentimes quote these studies. Understanding case studies, and studies and articles published in journals is one way to grasp the genre knowledge of the social work discourse community.” RAFinal2

When combined with the abovementioned analyses of the course theoretical framework readings, the rhetorical analysis shows that I have gained mastery in locating, comprehending, and analyzing texts from within the Clinical Social Work discourse community, as I demonstrate an understanding of the communities rhetorical situations, purposes, and genre conventions.

The second learning objective of the course was by far the most challenging portion of the course for me. This objective required me to produce an extended, appropriate research project that applied rhetorical strategies to explore a research question applicable to the course. This project drew substantively on concepts from the relevant literature; used primary, and/or secondary research; and included a variety of research genres. Entitled Synthesis Project, this study uses:

“a large body of published works on discourse community analysis as it’s framework, this study uses rhetorical analysis, as well as data collected through interview and observation to examine the convergence of knowledge domains within the Clinical Social Work and Clinical Social Psychology discourse communities as practiced within an Emergency Department or Psychiatric Unit.” SYN1

This study was completed in order to answer my primary research question:

“ Must Clinical Social Workers practicing in the Emergency Department and Psychiatric Unit be completely adept in all of the knowledge domains of both the Clinical Social Work discourse community and Clinical Social Psychology discourse community in order to effectively achieve the overarching goal of the clinical social work community as previously described?” SYN2

The findings of this study draw substantively on concepts from relevant literatures, as examined in the rhetorical analysis, uses both primary and secondary research in the forms of interview, data collection and class readings, and makes an argument that is insightful, persuasive, and written in a style accepted by the Clinical Social Work discourse community.

First, the Synthesis Project uses both primary and secondary research to effectively argue its thesis. An interview was conducted with an expert in the field, and a day was spent in observation in the field. INT1, OBS1. Key to my understanding of these field notes was usage of the coding process as defined by Dr. Sharan B. Merriam of the University of Georgia. This framework of primary data collection aims to find answers to research questions by locating and labeling categories or themes and translating reoccurrence or regularities of these themes into findings:

“Coding of both the interview and observation data took place in two stages.

Open Coding: Memos of key words and my initial responses, reactions and queries were noted. Notation was made of application or practice of any of Beaufort’s five knowledge domains, each specifically labeled. Diagnosis was made of all patients (n=7) using the multi-axial system.

Axial Coding: Data was subsequently grouped and separated into the following categories based on the following recurring themes:

· Subject knowledge domain is very specific to the Clinical Social Psychology Discourse Community.

· Writing Process and Genre knowledge domains are very specific to the Clinical Social Psychology Discourse Community.

· Rhetorical knowledge domain blends both Clinical Social Work and Clinical Social Psychology Discourse Communities.

In agreement with Dr. Merriam, qualitative analysis of the data began with the use of inductive reasoning in the open coding process. Comparative analysis began in the axial coding process, as the three main pieces of data (rhetorical analysis, interview and observation) differentiated in relationship to recurring coding themes. Lastly, deductive reasoning was evident in the correlation and development of findings.” SYN3

Examples of this coding process can be seen in the Observation Field notes. OBS1 The field notes list actual observations in black ink, and then go on to code the observation in green ink. For example:

“Lisa explained to me that her job is to evaluate all patients that have a possible psych issue after the attending physician has medically cleared them. Note- medically cleared means that there is no reason medically for the patient to be admitted to the hospital other than for possible psychiatric treatment. Lisa uses the GAF Index (Global Assessment of Functioning) in addition to any prior records she has on the patient to determine course of treatment. Lexicon, Genre, Psych DC Knowledge.” OBS2

The green coding after this observation shows my labeling of categories within the observation, (lexicon and genre) and then the finally identification of the over-all theme of the observation (Psychology Discourse Community Knowledge). These themes were then compiled and synthesized into my three overall findings. Secondary research methods were also included in the final Synthesis Project, providing the overarching theoretical framework for the project. Presentation of this secondary research is located within the introduction of the project, note:

“Social workers are members of a discourse community. They share a common discourse, that is, a form of communication that leads to an informed way of thinking, reading and writing, and when combined, they form a community that uses and creates in an ongoing process the aforementioned discourse.

John Swales, a professor of linguistics and co-director of the Michigan Corpus of Academic Spoken English at the University of Michigan, and author of The Concept of Discourse Community, Genre Analysis: English in Academic and Research Settings proposes the following six defining characteristics sufficient for identifying a group of individuals as a discourse community:

A Discourse Community has:

i. A broadly agreed set of common public goals.

ii. Mechanisms of intercommunication among its members.

iii. Participatory mechanisms primarily to provide information and feedback.

iv. One or more genres in the communicative furtherance of its aims.

v. Acquired some specific lexis.

vi. A threshold level of members with a suitable degree of relevant content and discoursal expertise (471-73).

The discourse community of practicing clinical social workers is as diverse as the clients they aim to serve. However, the overarching goal of the community remains the enhancement of human well-being, and helping to meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed and living in poverty (National Social Workers Code of Ethics).” SYN4

This primary and secondary research allowed me to make a very persuasive argument both relevant to my area of interest discourse community (Clinical Social Work) and relevant to the overall study/analysis of discourse communities in general. My thesis supported the argument that Clinical Social Workers practicing in the Emergency Department and the Psychiatric Unit must be adept in the Clinical Psychology discourse community in order to effectively achieve the overarching goals of the Clinical Social Work community, which is obviously relevant to my field of study. The thesis is relevant in the area of general discourse study dialogue (within writing studies scholarship) in that it questions just exactly how easily one person can practice within two discourses simultaneously. This evidence is summarized in the Overall Findings portion of the Synthesis Project:

“Correlation between reoccurring themes within the rhetorical analysis, interview and observation showed a remarkable carry-over between the Clinical Social Work discourse community and the Clinical Psychology discourse community, specifically as practiced in the Emergency Department and Psychiatric Unit. This was evident within all five of Beaufort’s knowledge domains, but most pronounced in the domains of subject matter, writing process and genre, and rhetorical knowledge.” SYN5

The third learning objective of the course calls for me to produce writing that shows the use of a flexible writing process, specifically for the writing assignments that I found to be difficult. I have accomplished this objective in both the organization and coding of data in the Synthesis project, as well as in a revision process of the rhetorical analysis.

The writing and organization of the Synthesis Project was not without its challenges. At first glance, the organizational flow of the IMRAD seemed like it would be easily accomplished, especially since all of my primary and secondary research was accomplished. This did not prove to be the case. I struggled with the correct order to present my findings within each section of the IMRAD for days. This is in part because I struggled with the coding of both my interview and field notes in regards to writing process knowledge, and more specifically, how this knowledge became writing in action. The first time I coded my interview and observation field notes, I did not include The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) and Axial Coding in part of the categories of the coding. At that time, I did not consider the diagnostic framework an actual part of the writing process. After struggling with the Synthesis Project for days, I decided to scrap all of my previous coding and start over; looking for things I may have missed. This process led me to the discovery that I had not considered the hospital printed forms or the DSM IV and Axial Coding as an actual part of the writing process of my discourse community. Once I coded my field notes accordingly, I discovered what became a significant part of my findings: the Five Axis system and the DSM IV are a very important part of the framework of the Clinical Social Work discourse community and provide a much needed level of standardization and consistency. I was able to articulate this within the Synthesis Project in the following manner:

“Observation of the Clinical Social Worker in both the Emergency Department and the Psychiatric Unit revealed that the social worker wrote within the framework of the DSM IV and the Five Axis system in a methodical, standardized, almost robotic way. Given the rushed and often hectic pace of the ED, and given that the social workers primary responsibility was to diagnose and assign consumers and not to provide clinical therapy, her writing process must be drawn from a combination of concrete diagnostic knowledge and a very standardized method for communicating that knowledge.” SYN6

This discovery of this new finding led me to also revisit and rethink a previous project, my Rhetorical Analysis. Although coding of this part of my research was not required, I decided to do it as a part of the research for my Synthesis Project. In doing so, I discovered that much like the Observation and Interview field notes, the reoccurring theme of the importance of standardization of the writing process emerged. This finding is reflected in the Syntheses Project:

“Rhetorical Analysis of “Care of the Adult Patient after Sexual Assault” published in The New England Journal of Medicine revealed the importance of consistent standardized reporting standards. In the case of rape, evidence collection kits contain forms for documentation and to assist examiners and the Clinical Social Worker. “After medial clearance, the patient should be offered medical collection. The collection of forensic evidence is a multistep process that can take six or more hours to complete and is best performed by the Clinical Social Worker. The aim is to record the victim’s report of the assault, collect and record evidence to support this report, and collect DNA. Highly sensitive DNA techniques can assist in identifying a perpetrator by matching DNA to the Combined DNA Index System (CODIS) database of convicted felons, maintained by the Federal Bureau of Investigation” (2-3). In this case, the writing process and the genre used could be a key factor in a criminal case.” SYN7

Another very important part of developing a flexible writing process is embracing and accepting the process of revision. The revision process was crucial in the formation of my Rhetorical Analysis. My first draft of the Rhetorical Analysis did not define rhetorical knowledge within the theoretical framework of the course. I began the portion of the paper on rhetorical knowledge like this:

This start to the section was not an affective method of explaining to my audience the actual context from which I had gleaned the term “rhetorical knowledge.” The revision process resulted in a new introduction to that section, which states:

“Beaufort states that writers must address “the specific, immediate rhetorical situation of individual communicative acts…considering the specific audience and purpose for a particular text and how best to communicate rhetorically in that instance” (20). By examining details such as who the author is directing his work towards, the style and formatting of the work, and even the lexis the author has chosen, we can learn a great deal about what Beaufort calls the “social context, material conditions, timing and social relationships” (20) within a discourse community. This detailed examination will lead to obtaining greater rhetorical knowledge of a specific discourse community, which in this case, is social work. For example, “The Value of the Presence of Social Work in Emergency Departments” was published in 2010 in a journal entitled Social Work in Health Care and presents the findings of a study completed by the Wurzweiler School of Social Work at Yeshiva University using a scientific method of research to determine that the presence of social workers in an emergency department is very cost effective for a hospital as it reduces the occurrence of admittance. The study is presented in APA format, which outlines the piece into clearly defined sections including Abstract, Background, Method, Sample, Results, Limitations, Discussion, and Reference sections.” RAFinal3

The fourth and final learning objective of the pilot course requires me to produce writing that shows an awareness of the writing strategies that I have used, with an understanding of how these strategies function rhetorically, and how they may be applied to other writing situations. Upon completion of this course, I have found that the theoretical framework on discourse community analysis has been very helpful in developing my own heuristic of both the analysis process and writing processes of any future discourse community I may encounter.

The primary theoretical framework that I used to analyze the majority of my research was that of Anne Beaufort. A complete understanding of her proposed five knowledge domains was crucial in developing a method of analysis and an outline for my Rhetorical Analysis, Data Collection Report and Synthesis Project. Evidence of this is seen in the opening paragraph of the analysis portion of the Data Collection Report:

“Using Beaufort’s five knowledge domains of Writing Process Knowledge, Subject Matter Knowledge, Genre Knowledge, Rhetorical Knowledge and the all encompassing Discourse Community Knowledge as a framework, an analysis of both the interview and observation sessions can be made. In doing so, the key recurring themes of brief standardized writing and communication practice and a deep knowledge base of both Psychology and Social Work have emerged.” DCR1

Another example of my implementation of the course framework is seen in the theoretical framework portion of the Synthesis Project:

“My research emerges from a body of work on discourse communities. Central to this framework are five knowledge domains developed by Anne Beaufort in College Writing and Beyond: A New Framework for University Writing Instruction. This comprehensive model of the five knowledge domains applies to any discourse community. Awareness and assimilation of each of these domains aids a novice within a community to advance from general to context-specific expertise. These knowledge domains can also be expressed as the actual mental schemas writers need to invoke for analyzing new writing tasks either within their current discourse community, or as they enter or overlap into a new discourse community. According to Beaufort, within this model knowledge domains overlap, and yet still remain distinct, representing situated knowledge entailed in acts of writing. These five knowledge domains include:

Writing Process Knowledge: How the members of the community approach writing, including drafting, and revision; balanced by the community demands.

Subject Matter Knowledge: How informed and or educated the community members are on the subjects they are writing about. Knowledge of this domain defines what regards acceptable scholarship within the community.

Rhetorical Knowledge: How the community uses rhetorical techniques to successfully argue and defend positions.

Genre Knowledge: The types of writing the community employs in repeating situations.

Discourse Community Knowledge: The overarching goals and values of the discourse community make manifest in this domain, which encompasses the other four domains (15-19).

The five knowledge domains articulated here form the theoretical framework I will use for analyzing all data collected including the published works in the form of a rhetorical analysis, coded interview responses, and coded observation field notes.” SYN8

I feel very strongly that I will be able to apply the methodology of Beaufort’s five knowledge domains to any new discourse community I encounter, either in the academic or professional world.

Once I am able to make an analysis of a newly encountered discourse community, it is important then that I am able to write effectively and in a manner that is relevant and persuasive to the new discourse community. In order to do so, I must be aware of the writing strategies that I use, and make deliberate decisions about those strategies and how they function within my writing. In the writing of my Data Collection Report, I realized that I was not effectively speaking the “language” of the members of my chosen discourse community. While I had gained a great deal of content knowledge during the Observation, I was not effectively communicating that newly gained knowledge. Therefore, I added this section to the Data Collection Report:

“During the observation session, six patients were admitted to the ED, medically cleared by the medical doctor (meaning their only medial condition appeared to be psychiatric or substance abuse in nature), and turned over to the care of Lisa for an intake behavioral assessment. Lisa followed the BAI (Behavioral Assessment Intake Form) as a guide for questioning each patient. This form included questions ranging from prior hospitalizations and health history, to sharing thoughts of suicide. Upon completion of this form (which is computerized at some hospitals, but not at the Oakland location), Lisa would score (or code) the form. This score, combined with her with her own notes, would result in a final conclusion of Axis I, Axis II, Axis III, Axis IV and Axis V diagnosis, as well as a GAF (Global Assessment of Functioning Score). Axis I is the top-level diagnosis that usually represents the acute symptoms that need treatment; Axis 1 diagnoses are the most familiar and widely recognized (e.g., major depressive episode, schizophrenic episode, panic attack). Axis I terms are classified according to V-codes by the medical industry (primarily for billing and insurance purposes). This Axis was very important, and the most evident in my observation, as the insurance companies of the patients who required in-patient care demanded this Axis of information before the patient could be admitted. Axis II is for personality disorders and developmental disorders such as mental retardation. Axis II disorders, if present, are likely to influence Axis I problems. For example, a student with a learning disability may become extremely stressed by school and suffer a panic attack (an Axis I diagnosis). Axis III is for medical or neurological conditions that may influence a psychiatric problem. For example, diabetes might cause extreme fatigue, which may lead to a depressive episode. Axis IV identifies recent psychosocial stressors such as a death of a loved one, divorce, losing a job, etc. Axis V identifies the patient's level of function on a scale of 0-100, (100 is top-level functioning), which was abovementioned as the GAF score.” DCR2

This newly included portion helped my readers to understand and process the data I was presenting. It also showed to other members of the Clinical Social Work discourse community that I understood the writing process framework from which they function within. The inclusion of this section was an intentional rhetorical decision on my part, reflecting my ability to use writing strategies as a method of influence.

Overall, I am extremely pleased that I participated in this pilot English course. I feel that I have learned a great deal about methods of research, and more importantly how to effectively code that research to assess reoccurring themes and potential findings. I have also learned a theoretical framework from which I can analyze discourse communities, which will serve me well in both the academic and professional settings. Through the successful completion of a Rhetorical Analysis, data collection and coding, a Data Collection Report, a Synthesis Project, and short written analyses of published works from discourse community theoretical framework, I have achieved the course objectives as set forth by the Composition Committee.

Part Two: Appendix

Writing Response 2

In this weeks reading (The idea of Community in the Study of Writing, by Joseph Harris), community is defined by the author as an “empty and sentimental” word that does not have a positive opposing word. This, according to Harris, somehow devalues or makes defining one community in relation to another very difficult. This blurring of the very groups that are meant to be separated by definition when referring to discourse communities makes it possible for us as writers to keep one foot, so to speak, in several discourse communities simultaneously.

Harris’ thinking of each discourse community as separate things to step in and out of does not settle well with me. It brings to mind the image of a child moving from mud puddle to mud puddle on a rainy day, splashing and sloshing water along the way. The bits of mud from each puddle that splashed on his boots and pants are carried with him from puddle to puddle, much like the knowledge and styles of writing we have gleaned from one discourse community are carried, albeit not entirely, into our thoughts and writings of other discourse communities we become a part of. The knowledge gained from learning how to effectively communicate within one discourse community is like any other type of knowledge in that once gained, and continually practiced, it is not lost, and therefore a part of all future assimilation of new knowledge.

I visualize this accumulation of knowledge about writing in the form of a wagon wheel. At the center, or hub of the wheel is the writer himself. The discourse communities to which the writer belongs to, or the extent of the writers involvement, exposure, conversation, and readings of a particular discourse community form the spokes of the wheel, connecting and serving as a conduit and support between the writer and the outside rim of the wheel. This rim, encircling both the discourse community and the writer himself, is the new ideas and opinions of the writer. The more discourse communities the writer is associated with, or the greater and deeper the relationship is between the discourse community and the writer, the more profound, original, and well supported the ideas the writer produces. As the wheel passes through space and time, it discards some ideas and develops new ones, as the writer and the discourse communities are in constant motion or processing.

Writing, like knowledge and discourse communities themselves, can be complex, multi layered, and very diverse. The writer himself does not have to become one-dimensional by limiting himself to only one discourse community in order to effectively be a contributing member of that community.

Writing Response 3

As college professors and those who study linguistics attempt to improve writing curriculums to better prepare students for writing success both in the remainder of their academic pursuits, and in their future careers, they are attempting to define what a discourse community is, and if learning the discourse communities epistemology can enhance the student’s success. In Writing about Writing, a college reader prepared by Wardle and Downs, James Paul Gee and John Swales each present opposing view points as to what defines a discourse community. I agree with the approach of Gee, and am compelled by his understanding of primary and secondary Discourses, however, I feel that cognitive ability should be considered when gauging speed of assimilation into a secondary Discourse.

Gee emphasizes the social practices of a discourse community, claiming it to be an “identity kit” that includes actions, language, literacy, and style, amongst other things. Gee states our identity kit also contains our primary Discourse, (our introduction to the world and our identity) and our secondary Discourse, (outside of the home based social institutions such as churches and schools.) Gee argues that the ease in which fluency is gained in any secondary Discourse is influenced greatly upon whether their primary Discourse community practiced similar “speaking, writing, doing, being, valuing, and believing” as the secondary Discourse. Gee goes on to say that you cannot embody a Discourse; the members of the community choose to either accept you as a member of the community or as an apprentice of the community.

Swales, on the other hand, takes no note of the social behaviors of a Discourse, but instead defines a discourse community by six defining characteristics: “common goals, participatory mechanisms, information exchange, community specific genres, a highly specialized terminology and a high level of expertise.” In stark contrast to Gee, Swales argues that it is possible for participation in a Discourse to occur without assimilation, citing professional journalist who assume temporary membership in a wide array of discourse communities.

Gee makes a very compelling argument in his explanation of how our primary Discourse inflects the way we participate in our secondary Discourse. If our primary Discourse is vastly different (in language, practice or lifestyle) from the secondary Discourse we are trying to learn, our assimilation will be infinitely more challenging. I have witnessed this difficulty firsthand. As a foster parent, I have served children who have come to live in my home after many years of living within their primary Discourse, which was very different from mine. My family was to become one of their secondary Discourses (school being the other). Assimilation into the language, style, customs and behavior of my Discourse was very difficult for the children, even though they tried desperately to assimilate. In the fields of sociology and psychology, this assimilation is known as socialization.

Swales’ six defining characteristics of discourse communities are all warranted and valuable in distinguishing a discourse community from other seemingly similar communities such as a neighborhood or a speech community. However, Swales’ use of career journalist and spies infiltrating discourse communities as evidence to prove that membership in a discourse community can occur without assimilation is a bit far fetched and is of little relevance to assimilation by every day people.

As most students attend school (primary, secondary or college) to obtain an education that will allow them to be productive, independent members of society, it is the responsibility of educators they employ to do all they can to teach students the necessary social, speaking, writing, and thinking skills required to do so. Ignoring flaws in social behavior, speech, grammar or levels of thinking due to differences in primary Discourses is unconscionable. This teaching should occur both inside and outside of English departments, and in geographical areas of vast socio-economic or cultural differences, possible courses in adaptability could be added that promote the cultural aspects of the students’ primary Discourses while helping them to assimilate into a secondary Discourse, as one can exist in multiple Discourses simultaneously if they so choose.

Gee and Swales each present interesting definitions and arguments, and both are valid, and could each be applied in various circumstances. Gee’s definitions of primary and secondary Discourse provide an almost developmental stage approach to Discourses, and fits well with other theorists conclusions on socialization amongst new groups or communities. However, both authors do not take the cognitive ability of the student into consideration, and while at times controversial, I feel this needs to be considered, specifically when gauging the speed of assimilation.

Rhetorical Analysis Rough Draft

Rhetorical Analysis of Social Work Media as Defined by Knowledge Domains.

Social work practice assists individuals, groups, and communities by enhancing or restoring their capacity for social function and creating societal conditions favorable to reach their goals. Social workers are employed in a variety of settings, including health care facilities, public welfare agencies, child welfare agencies, public and private schools, colleges and universities, and community organizations. Within the more specialized area of clinical social work practice lies a systematic process and activity that is designed to assess client situations and help clients achieve agreed upon goals in order to promote optimal health and well bring. The discourse community of practicing social workers is as diverse as the clients they aim to serve, however, the overarching goal of the group remains the enhancement of human well-being and helping to meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty. (National Social Workers Code of Ethics.)

There are several categories of media a discourse community of social workers can examine to develop or evolve their own heuristic of practice. Examples of these media types include journals such as The Journal of Social Work and Child and Adolescent Social Work, which provide the community with scientific studies, articles, and information about upcoming conferences and presentations. Other medias include case studies, legal documents, court files and government memos, which provide the community with ongoing information and update knowledge bases and source information. According to Anne Beaufort, examining this media can provide an outsider with knowledge of the subject matter, genre, rhetorical methods and writing processes of a discourse community (18). Using a rhetorical method of analysis, one can extract Beaufort’s knowledge domains within the clinical social work discourse community by analyzing selected articles, studies, and case studies from Social Work in Health Care, The American Journal of Public Health, The Center on Human Development and Disability, and The New England Journal of Medicine. Analysis of these pieces points to a clearly defined rhetorical usage of American Psychological Association formatting (APA) and a specialized lexis, a varied number of genres, and a diverse subject matter knowledge base including developmental psychology, substance abuse treatment, and governmental social welfare policy and programming.

Rhetorical Knowledge

“The Value of the Presence of Social Work in Emergency Departments” was published in 2010 in a journal entitled Social Work in Health Care. The piece presents the findings of a study completed by the Wurzweiler School of Social Work at Yeshiva University and uses a scientific method of research to determine that the presence of social workers in an emergency department is very cost effective for a hospital as it reduces the occurrence of admittance. The study is presented in APA format, which outlines the piece into clearly defined sections including Abstract, Background, Method, Sample, Results, Limitations, Discussion, and Reference sections. The piece also includes tables to clearly illustrate findings. “Factors that Influence Clinicians’ Assessment and Management of Family Violence” published in 1994 by The American Journal of Public Health, also uses the APA format, but extends to include sections on Interventions and Mandated Reporting. This piece evaluates different professionals within the health services (dental hygienists, dentists, nurses, physicians, psychologists, and social workers) to assess which factors may contribute to their reporting (or lack of reporting) of suspected abuse. The APA format is frequently used in the social sciences, as it allows for precise details and leaves little room for conjecture. Also, further studies can build on works that use APA, as application of the same methodology creates a constant in what can appear to be an ever-changing field of practice.

In addition to utilizing the APA format, the social work discourse community also employs a very similar lexicon. First, words that can have multiple meanings or implications are clearly defined so that there is no room for interpretation. For example, in the public health piece, abuse is defined as “physical maltreatment” (628) and is further divided into the categories of child abuse, spouse abuse and elder abuse. “Care of the Adult Patient after Sexual Assault,” published in 2011 in The New England Journal of Medicine also clearly defines the main terms of the work: sexual assault and rape. (835) This is done at the beginning of the piece, so there can be no confusion in the mind of the clinical practitioner. Defining terms comprehensively is of great importance in the social sciences, as there may be legal implications. Case in point, the piece on sexual assault clearly states the legal definitions of rape, body orifice, and incapacity. “Rape is a legal term and in the United States refers to any penetration of a body orifice (mouth, vagina, or anus) involving force or the threat of force or incapacity (i.e. associated with young or old age, cognitive or physical disability, or drug or alcohol intoxication) and nonconsent.” (835) This very detailed definition of the terms provides the practitioner with information necessary to make a determination of whether to include law enforcement into the circle of patient care, and in what terms to explain to both the patient and the law enforcement what has happened. Second, all of the pieces examined use a lexicon that would be somewhat foreign to those outside of the social work discourse community. Words and phrases such as “supplemental security income”, “developmental disabilities”, “placement”, “environmental” and “coefficient” are just a few examples of words that take on a different meaning within the social sciences. Examining both this lexicon as well as the APA method of formatting allows one to make a reasonable attempt at understanding the rhetorical knowledge domain of the social work discourse community.

Genre Knowledge

In addition to studies and articles published in journals (as mentioned above) the social work community regularly utilizes case studies. Case studies are detailed analyses of an individual or family unit, which stresses developmental factors in relation to context. Social workers write and read case studies not as a method to determine causation or correlation, but as a method of providing a detailed and oftentimes ongoing record of events. In the case study of John, [2] the social worker interviewed John’s mother and summarizes all of what she had to say about John in the defined categories of Home, Life, School and Concerns. The social worker then uses the ecosystem perspective (another social work lexicon) to look at how individual, family, and larger environmental structures affect John and his mother. Lastly, the social worker lists interventions that are needed at each level to improve family functioning. This mode of genre is extremely useful to social work discourse community for several reasons. Firstly, as social workers oftentimes do not see their clients more than on a monthly basis, the ongoing case study provides a summary of previous events, which can refresh the memory of the worker in regards to the case. Secondly, the case study provides the worker with a list of all of the services that have been recommended for the client, and can be used in subsequent visits as a checklist to see what services have been utilized. Lastly, the case study provides those new to the case (other social workers, psychologist, medical professionals, adoptive parents, attorneys or judges) with a detailed recorded history of prior events in the life of the client. The case study genre is particularly interesting in that it employs a specialized style of writing that completely eliminates the writer of the document (the social worker) from the personalized case of the client. The studies are never written in the first person, but rather in the third person omniscient point of view, which takes a panoramic, bird’s eye view of the clients, and in describing the overall picture. Understanding case studies, and studies and articles published in journals is one way to grasp the genre knowledge of the social work discourse community.

Subject Matter Knowledge

The social work discourse community is very diverse. As mentioned above, social workers practice in a variety of settings, including health care facilities, public welfare agencies, child welfare agencies, public and private schools, colleges and universities, and community organizations. While each of these practices can be specialized, a broad base of general knowledge of a wide variety of subjects is necessary. These subjects include substance abuse diagnosis and treatment, mental health diagnosis and treatment, developmental health and psychology, and state and federal policies on welfare, foster care, adoption and elder care. Upon analyzing the four pieces used for this analysis, it is clear that a broad knowledge base is in action. In the case study of John, the social worker recommends application for Supplemental Security Income (SSI) by the client, as well as enrollment in the Division of Developmental Disabilities, Medicaid, and the Medicaid Personal Care Program. All of these are government programs that have very specific criteria for application and enrollment. In the “Care of the Adult Patient after Sexual Assault,” it is made clear that the social worker is expected to know emergency room protocol, the steps in a sample evidence-collection kit and established trauma protocol (836). “The Value of the Presence of Social Work in Emergency Departments” makes frequent mention of the social workers ability to assess whether a patient is in a serious psychological state of crisis and therefore in need of medical care, or if the patient is in need of at home or community based services and is interpreting that as a need for hospitalization (316). Each of these works illustrates a sample of the base of subject matter knowledge held within the social work discourse community.

Writing Process Knowledge

In addition to the three mentioned domains of knowledge Beaufort suggests for the understanding of a discourse community (rhetorical structure, genre, and content knowledge), the knowledge domain of writing process is also included. As this paper was conducted via research and not personal interview, it is impossible to deduce the writing process knowledge of each of the authors of the above-mentioned case study, journal article, and journal studies.

Using the analyzed texts, one can deduce the overall goals of the social work discourse community, which, as Beaufort states, is the primary objective. Analysis of these pieces shows a clearly defined rhetorical usage of American Psychological Association formatting and a specialized lexis, a varied number of genres, and a diverse subject matter knowledge base. All of these are surrounded by the overarching goals of enhancing human well-being and helping to meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty.

Rhetorical Analysis Final Draft

Rhetorical Analysis of Social Work Media as Defined by Knowledge Domains.

Social work practice assists individuals, groups, and communities by enhancing or restoring their capacity for social function and creating societal conditions favorable to reach their goals. Social workers are employed in a variety of settings, including health care facilities, public welfare agencies, child welfare agencies, public and private schools, colleges and universities, and community organizations. Within the more specialized area of clinical social work practice lies a systematic process and activity that is designed to assess client situations and help clients achieve agreed upon goals in order to promote optimal health and well bring. The discourse community of practicing social workers is as diverse as the clients they aim to serve, however, the overarching goal of the group is enhancing human well-being and helping to meet the basic human needs of all people, with particular attention to the needs and empowerment of people who are vulnerable, oppressed, and living in poverty (National Social Workers Code of Ethics).

There are genre categories that a discourse community of social workers can examine to develop or evolve their own heuristic for understanding writing practices. Examples of these media types include journals such as The Journal of Social Work and Child and Adolescent Social Work, which provide the community with scientific studies, articles, and information about upcoming conferences and presentations. Other media include case studies, legal documents, court files and government memos, which provide the community with ongoing information and update knowledge bases and source information. According to Anne Beaufort, examining these genres can provide an outsider with knowledge of the subject matter, genre, rhetorical methods and writing processes of a discourse community (18). Using a rhetorical method of analysis, one can extract Beaufort’s knowledge domains within the clinical social work discourse community by analyzing selected articles, studies, and case studies from Social Work in Health Care, The American Journal of Public Health, The Center on Human Development and Disability, and The New England Journal of Medicine. Analysis of these pieces points to a clearly defined rhetorical usage of American Psychological Association formatting (APA) and a specialized lexis, a varied number of genres, and a diverse subject matter knowledge base including developmental psychology, substance abuse treatment, and governmental social welfare policy and programming.

Rhetorical Knowledge

Beaufort states that writers must address “the specific, immediate rhetorical situation of individual communicative acts…considering the specific audience and purpose for a particular text and how best to communicate rhetorically in that instance” (20). By examining details such as who the author is directing his work towards, the style and formatting of the work, and even the lexis the author has chosen, we can learn a great deal about what Beaufort calls the “social context, material conditions, timing and social relationships” (20) within a discourse community. This detailed examination will lead to obtaining greater rhetorical knowledge of a specific discourse community, which in this case, is social work. For example, “The Value of the Presence of Social Work in Emergency Departments” was published in 2010 in a journal entitled Social Work in Health Care and presents the findings of a study completed by the Wurzweiler School of Social Work at Yeshiva University using a scientific method of research to determine that the presence of social workers in an emergency department is very cost effective for a hospital as it reduces the occurrence of admittance. The study is presented in APA format, which outlines the piece into clearly defined sections including Abstract, Background, Method, Sample, Results, Limitations, Discussion, and Reference sections. The piece also includes tables to clearly illustrate findings. “Factors that Influence Clinicians’ Assessment and Management of Family Violence” published in 1994 by The American Journal of Public Health, also uses the APA format, but extends to include sections on Interventions and Mandated Reporting. This piece evaluates different professionals within the health services (dental hygienists, dentists, nurses, physicians, psychologists, and social workers) to assess which factors may contribute to their reporting (or lack of reporting) of suspected abuse. The APA format is frequently used in the social sciences, as it allows for precise details and leaves little room for conjecture. Also, further studies can build on works that use APA, as application of the same methodology creates a constant in what can appear to be an ever-changing field of practice.

In addition to utilizing the APA format, the social work discourse community also employs a very similar lexicon. First, words that can have multiple meanings or implications are clearly defined so that there is no room for interpretation. For example, in the public health piece, abuse is defined as “physical maltreatment” (628) and is further divided into the categories of child abuse, spouse abuse and elder abuse. “Care of the Adult Patient after Sexual Assault,” published in 2011 in The New England Journal of Medicine also clearly defines the main terms of the work: sexual assault and rape (835). This is done at the beginning of the piece, so there can be no confusion in the mind of the clinical practitioner. Defining terms comprehensively is of great importance in the social sciences, as there may be legal implications. Case in point, the piece on sexual assault clearly states the legal definitions of rape, body orifice, and incapacity. “Rape is a legal term and in the United States refers to any penetration of a body orifice (mouth, vagina, or anus) involving force or the threat of force or incapacity (i.e. associated with young or old age, cognitive or physical disability, or drug or alcohol intoxication) and nonconsent” (835). This very detailed definition of the terms provides the practitioner with information necessary to make a determination of whether to include law enforcement into the circle of patient care, and in what terms to explain to both the patient and the law enforcement what has happened. Second, all of the pieces examined use a lexicon that would be somewhat foreign to those outside of the social work discourse community. Words and phrases such as “supplemental security income”, “developmental disabilities”, “placement”, “environmental” and “coefficient” are just a few examples of words that take on a different meaning within social work practice. Examining both this lexicon as well as the APA method of formatting allows one to make a reasonable attempt at understanding the rhetorical knowledge domain of the social work discourse community.

Genre Knowledge

In addition to studies and articles published in journals (as mentioned above) the social work community regularly utilizes case studies. Case studies are detailed analyses of an individual or family unit, which stresses developmental factors in relation to context. Social workers write and read case studies not as a method to determine causation or correlation, but as a method of providing a detailed and oftentimes ongoing record of events. In the case study of John, [3] the social worker interviewed John’s mother and summarizes all of what she had to say about John in the defined categories of Home, Life, School and Concerns. The social worker then uses the ecosystem perspective (another term in the social work lexicon) to look at how individual, family, and larger environmental structures affect John and his mother. Lastly, the social worker lists interventions that are needed at each level to improve family functioning. This mode of genre is extremely useful to social work discourse community for several reasons. , as social workers oftentimes do not see their clients more than on a monthly basis, the ongoing case study provides a summary of previous events, which can refresh the memory of the worker in regards to the case. Furthermore, the case study provides the worker with a list of all of the services that have been recommended for the client, and can be used in subsequent visits as a checklist to see what services have been utilized. Lastly, the case study provides those new to the case (other social workers, psychologist, medical professionals, adoptive parents, attorneys or judges) with a detailed recorded history of prior events in the life of the client. The case study genre is particularly interesting in that it employs a specialized style of writing that completely eliminates the writer of the document (the social worker) from the personalized case of the client. The studies are never written in the first person, but rather in the third person omniscient point of view, which takes a panoramic, bird’s eye view of the clients, and in describing the overall picture.

Subject Matter Knowledge

The social work discourse community is very diverse. As mentioned above, social workers practice in a variety of settings, including health care facilities, public welfare agencies, child welfare agencies, public and private schools, colleges and universities, and community organizations. While each of these practices can be specialized, a broad base of general knowledge of a wide variety of subjects is necessary. These subjects include substance abuse diagnosis and treatment, mental health diagnosis and treatment, developmental health and psychology, and state and federal policies on welfare, foster care, adoption and elder care. Upon analyzing the four pieces used for this analysis, it is clear that a broad knowledge base is in action. In the case study of John, the social worker recommends application for Supplemental Security Income (SSI) by the client, as well as enrollment in the Division of Developmental Disabilities, Medicaid, and the Medicaid Personal Care Program. All of these are government programs that have very specific criteria for application and enrollment. In the “Care of the Adult Patient after Sexual Assault,” it is made clear that the social worker is expected to know emergency room protocol, the steps in a sample evidence-collection kit and established trauma protocol (836). “The Value of the Presence of Social Work in Emergency Departments” makes frequent mention of the social workers ability to assess whether a patient is in a serious psychological state of crisis and therefore in need of medial care, or if the patient is in need of at home or community based services and is interpreting that as a need for hospitalization (316). Each of these works illustrates a sample of the base of subject matter knowledge held within the social work discourse community.

Writing Process Knowledge

Works Cited

Auerbac, PhD., Charles, and Susan E. Mason, PhD. "The Value of the Presence of Social Work in Emergency Departments." Social Work in Health Care. 49.4 (2010): 314-326. Print.

Beaufort, Anne. College Writing and Beyond. 1st ed. Logan, Utah: Utah State University Press, 2007. 18-21.

"Clinical Social Work." Center on Human Development and Disability. Clinical training Unit, University of Washington, 19 Jul 2007. Web. 9 Oct 2011. <http://depts.washington.edu/lend/seminars/modules/socialwork/clinical.htm>.

Clinicians' Assessment and Management of Family Violence." American Journal of Public Health. 84.4 (1994): 628-633. Print.

Linden, M.D., Judith A. "Care of the Adult Patient after Sexual Assault." New England Journal of Medicine. 365. (2011): 834-841. Print

"National Social Workers Code of Ethics." National Association of Social Workers. National Association of Social Workers, 5 Jul 2011. Web. 9 Oct 2011.

Interview with Lisa Kopacka

Interview on October 16, 2011

Questions are in BOLD

Answers are in Italics.

Coding is in Green.

What made you choose medical care social work over child welfare and adoption social work?

I always knew I was more interested in the medical side of social work. After I worked in a hospital for a few years, I realized that unless I had Psych and substance abuse training I would never do any more than Discharge planning, which is a minimum wage job.

SW DC Knowledge, Psych DC Knowledge, Substance Abuse. Discharge Planning.

Please describe some of the things you do during a typical day at work.

I assess all of the patients who come into the ED and decide if they are in need of psychiatric treatment or care. I speak to the insurance companies to obtain approval codes or inpatient services. I do rounds on the PW and help the staff there with some of their discharge planning. I also see patients in the medical units that are in need of psychiatric care but have not yet been medically cleared to the PW. I also work at the Moross location, but I only do Behavioral Psych intake there.

ED. Insurance Companies. Psych DC Knowledge. PW. Discharge planning. Medically Cleared. Behavioral Psych Intake.

How much of your day is spent in actual one on one care of clients?

70%. The rest is spent on the phone with the insurance companies, other mental health facilities, with the other Social Psychologist on the PW.

Insurance Companies. Mental Health Facilities. Social Psychologist. PW.

How much of your day is spent writing?

I fill out the charts and forms as I talk with each consumer, so I do not have a lot of writing to do after I see them. We are not on a computer system yet like other hospitals in the St. John network, (Like Moross) and I am actually glad. I think they spend a lot more time doing data entry there.

Charts. Forms. Data Entry

What types of writing do you participate in? (i.e. case reports, forms, etc.)

All of the writing that I do is on pre-printed forms that exactly outline the information I need to collect, and the information I need to chart and the information I need to obtain codes from the Insurance Companies.

Forms. Charts. Codes. Insurance Companies.

Is there a particular format or writing style that is used in your practice? When or where did you learn this writing style?

My writing style is directly from the DSM IV.

DSM IV

Do you read any journals or other publications that relate to your career, such as the New England Journal of Medicine or Other Social Work journals?

When I have time, I read the New England Journal and the APA Journal.

New England Journal of Med. APA Journal.

Are there other published materials that are helpful to your practice? If so, can you please name some of them?

I really do not have a lot of free time, so no, not very often.

Do you see the themes of these publications in action in the workplace?

Sometimes, mostly with Substance Abuse related articles.

Substance Abuse

At what point in your practice did you feel a true member of the social work community. (Which I will refer to as your discourse community.)

I am not familiar with the term discourse community. I felt like a social worker from day one. You will see when you complete your practicums, you are practicing from the minute you hit the ground. There are far too many people to serve and far too few of us to help.

SW DC Knowledge. Practicum.

Can you please tell me about your transition from novice to expert?

I guess when I completed my MSW I became and “expert” but I really felt more on board in the ED when I finished my Masters in Psych.

SW DC Knowledge, Psych DC Knowledge.

How does your Discourse Community of social Workers interrelate with the Discourse Community of Nurses and the Discourse Community of Doctors?

I am not going to lie. It is really hard sometimes. The physicians do not want to deal with my patients. They practically run from them the minute they are medically cleared. The nurses in the ED are the same. They despise the psych patients. They almost see it like the people who come into the ED with the common cold. I am oftentimes the lone advocate for them. At the same time, we all work so many hours together we are kind of like a family. When you work five straight Christmas’ with the same team of docs and nurses, you do start to care about each other. I guess its like any other office or job, you like some of them and you do not like some of them.

SW DC Knowledge. Medical Clearance. Team of Doc and Nurses.

How does your writing practice differ from that of the nurses or doctors that you work with?

The nurses also use many forms, but they do not make diagnosis. The physicians do not use as many forms, they just record directly on the charts.

Forms. Diagnosis. Charts. Docs & Nurses.

Do you think that WSU adequately prepared you for the writing that you have to do in your career?

Yes, absolutely

Do you have any advice for me that will help me transition from a student to a practicing medical social worker?

Pick a good place to do your internships/practicum’s. If you do not like your supervisor, put a request in for a change immediately, do not try to stick it out. You want to be with someone who will teach you the ropes, not expect you to do all of their work.

Internship. Practicum.

Observation Field Notes

Observation Date: October 19, 2011

Observation Time: 9:00 a.m.-5:00 p.m.

Observation Location: St. John Macomb-Oakland Hospital, Madison Heights, MI

The day was spent shadowing Ms. Lisa Kopacka, a Behavioral Intake Specialist.

All Notes of Observation are in BLACK.

All Coding is in Green.

· Arrival in ED- front security gave name and showed WSU ID card to security. Observed that there were no patients in the ED waiting room. However, outpatient surgery waiting room across the hall was jammed packed. Security guard went and got Lisa. Waiting Room

· Lisa showed me where to hang my coat, and gave me a quick tour of the ED- The triage area, the center nurses workstation, and the beds. ED Practices

· Lisa explained to me that her job is to evaluate all patients that have a possible psych issue after the attending physician has medically cleared them. Note- medically cleared means that there is no reason medically for the patient to be admitted to the hospital other than for possible psychiatric treatment. Lisa uses the GAF Index (Global Assessment of Functioning) in addition to any prior records she has on the patient to determine course of treatment. Lexicon, Genre, Psych DC Knowledge,

· Psychiatric Floor is referred to as PW. Lexicon

· We will do rounds on PW later in the day. Lexicon

· Sadly, course of treatment Lisa decides for a patient oftentimes correlates with the number of available beds on the PW, or what the consumers insurance will allow for. If insurance company denies inpatient care, Lisa can still admit, but the hospital may end up being responsible for the cost of the care, and they keep track of how many times that happens via Lisa. If she has too many, she could be fired. However, at the same time, it a patient kills or harms themselves or another person after Lisa denies them inpatient treatment, Lisa and the hospital could face a lawsuit, which is also costly, not to mention the ethical issues at hand. SW DC Knowledge, Psych DC Knowledge, ED practices

· Course of treatment options include (but are no limited to): Inpatient Psychiatric Unit, Partial Hospitalization with or without transportation, or treatment for dual diagnosis (Psychiatric-Substance abuse). Psych DC Knowledge, Lexicon,

· Patients are referred to by the Social Workers, Insurance companies and PW caregivers as “consumers.” SW DC Knowledge, Psych DC knowledge,

· Received explanation of charting system, and how to read the screens in the workstation. Ed practices

· Consumer 1ED arrived to the ED via police car from an adult foster care facility. Male. Age 46. Highly agitated and angry. Missing many teeth.

Unkempt. Pupils constricted. Waving his hands in the air at unseen objects. Physician unable to clear medically due to his violent behavior. Consumer sedated and placed in ED room that has a door to close (instead of just a curtain) and has one way glass so that consumer can be observed from workstation. Approx. 30 min later Consumer was medically cleared by attending physician. Agitated, hallucinations. Violent. Sedatives. ED Practices. Medical Clearance. Psych DC Knowledge.

· While waiting for medical clearance, Lisa printed out and went over in detail the five forms she uses on a daily basis. Copy of each form was given to me to take home. *Ask about Axis levels. Axis levels. Forms. Psych DC Knowledge.

· Was told to return to Consumer 1ED and use the psychiatric assessment form (PAF) as a guide to question and to evaluate the patient. (Lisa would observe) Returned to patient, who although sedated was still very agitated. Patient spit on me during questioning. The nurse and I worked together to restrain the patient, who was somewhat willing. Consumer described the demons that were living with him, and flying around his head. He was able to provide medical history, today’s date, the name of the president, and the name of the facility where he was living, which agreed with the report of the police officer. A sitter is ordered to keep watch on the patient. Lexicon. Sitter. PAF. Restrain. Sedated. Spit. Demons. Psych DC Knowledge, Police.

· Returned to work station and called adult foster home where Consumer 1ED had been transported from. Consumer had not been given his medications for three consecutive days, as there had been difficulty obtaining the meds form the pharmacy. Home had previously arranged transportation for the Consumer to a different residential facility, which was supposed to have occurred later in that day, however the a.m. shift had decided the consumer was a danger and had called the police to transport him to this ED. Adult Foster Care, transportation, Police, Residential facility. Medication withdrawal.

· Medication was ordered and given to Consumer1ED. Medication

· Returned to work station and called the residential facility that patient was supposed to transfer to later in that day. Left message, as supervisor was unavailable. SW DC Knowledge, Residential Facility

· Rec. Page from day program that Consumer 2ED was struggling with withdrawal symptoms and may need to admit thru ED. Lisa advised transport to ED triage. Day Program. ED Practices,

· Sat in on phone call between Lisa and Insurance Company of Consumer 1ED. Insurance Company denied inpatient or day patient treatment. Lisa decided to hold Consumer 1ED for a 4 hour observation. Insurance Companies. Consumer Observation

· Sat at workstation and reviewed Lisa’s PAF of Consumer 1ED, while looking up in the DSM IV the criteria of multi-level (Axis) Diagnosis. Axis 1: Schizophrenic. Cannabis Abuse. Axis II: unknown. Axis III: Diabetes. Axis IV: poverty, homeless, divorced. Axis V: GAF score on arrival: 13. PAF, DSM IV, Axis I, III, IV, V. Schizophrenic, Cannabis, Diabetes, Poverty, Homeless, Divorced.

· Note: 11:30a.m. and monitor shows 11 beds in ED filled. I have no idea how many are in the waiting room. ED Waiting Room

· Triage nurse calls Lisa and informs her that Consumer 2ED was in room. Lisa informs attending as to Consumer’s prior records, calling the consumer a “Frequent Flier”. Attending orders labs to be drawn on Consumer 2ED. Frequent Flier Lexicon. Lab Work.

· Lisa takes me to the PW, where I am given a tour. The Unit has 26 beds, for adult use only. The unit is served by 1 Psychiatrist, who completes rounds in the early a.m. (7 a.m. or earlier) Lisa reviews his notes from rounds, and notes on charts any comments she has from that day. I am introduced to the three Social Workers and One Behavioral Social-Psychologist who provides clinical individual and group therapy. The unit currently has two empty beds, neither of which is available, as both are in rooms with Consumers who are a danger to others. PW, Rounds, SW DC Knowledge, Behavioral Social Psychologist, Psych DC Knowledge, Therapy.

· I speak with one of the Social Workers for about 3o min. She informs me that she works all day trying to arrange discharge care for the consumers in the PW. This includes countless conversations with family members, primary care physicians, and insurance companies. She dislikes her job. SW DC Knowledge. Discharge Care.

· Lisa shows me how this unit consumer rooms have no mirrors, no needles, no televisions, no phones, etc. Visiting hours are limited to 2 hours, twice a week. The consumers wander the halls and sit in a community area, where a television is located. Psych DC Knowledge. PW Practices.

· I met Consumer 1PW in the hallway, after being introduced by Lisa. Female, age 29, white, wearing hospital gown (some consumers were dressed in street clothing.) Affect was very flat. Repeated same sentences several times. Asked me repeatedly when I could drive her home. Frequent Flier. Dual Diagnosis. Axis I: Major Depressive Disorder. Cocaine Abuse. Axis II: Learning Disability. Axis III: HIV Positive. Axis IV: Two children removed from home. Flat Affect. Repeating Speech. Dual Diagnosis. Axis I, II, III, IV. Depressive Disorder Cocaine Abuse, Learning Disability, Loss of Children, HIV Positive. Frequent Flier. Psych DC Knowledge.

· Met Consumer 2PW in community area. Female. Age 62. Wearing hospital gown with cardigan sweater. Would not speak with me or look in our direction at all. Axis I: Schizophrenic Axis II: Antisocial Axis IV: homeless. Schizophrenic. Antisocial. Axis I,II, IV. Psych DC Knowledge.

· Met consumer 3PW in community area. Female. Age 38. Wearing street clothing but hair clearly not washed in days maybe weeks. Seemed overly excited to see Lisa and I. Asked if I was the new therapist. Asked me to evaluate her so that maybe she could go home. Eyes darted from person to person. Overly anxious. Axis I: Bipolar Disorder. Axis III: Victim of incestuous rape. Axis I, III. Anxious. Unkempt. Therapy. Incest. Rape. Psych DC Knowledge.

· Met Consumer 4PW in his room. Lisa was checking on him. Flat affect. Restrained in bed. Sedated. Pupils completely dilated. Axis I: Major Depressive Disorder. Axis II: Schizotypal personality disorder. Axis V: GAF score of three on arrival. Threat to self and others. Axis I, II, V. Threat. Major Depressive disorder. Schizotypal Personality Disorder.

· Met several other consumers, only in passing and Lisa did not inform me of their axis diagnosis. Axis

· Ate lunch in cafeteria, which was rushed, as Lisa felt we had already been away from the ED for too long, and I met several nurses. Lisa explained to me the scrub system…. Different colors mean different positions. Lisa and the doctors wear street clothing and lab coats. All others wear scrubs. Residents are called greenies because they wear green scrubs. Lunch. Scrubs. Hospital Practices.

· While in the cafeteria, Lisa rec. a call on her portable phone from the Residential facility that Consumer 1ED was to be released to. Lisa approved of transportation and transfer. Portable Phone, Residential Facility, transportation, Transfer. SW DC knowledge.

· Returned to Ed and met the Chief of the ED who was polite, at best. He criticized Lisa immediately because Consumer 2ED had a red light blinking by his name, meaning he had been medically cleared for 25 minutes, but no orders and been given. Lisa checked with the nurses and labs were not yet back on Consumer 2ED. Red Light, ED Practices, Nurses, Labs, Medical Clearance.

· Lisa instructed me to check in on Consumer 1ED and to inform him of his transfer. Consumer 1ED was conscious and easy to talk with. His medication seemed to be working. I got him a sandwich and some juice from the service area. He apologized for spitting on me. I was surprised he could remember doing it. Transfer. Spit.

· Lisa received a phone call from ambulance driver. ETA with Consumer 3ED in 10 minutes. Consumer 3ED was nude and walking along Dequinder. Motorist reported via cell phone and police and EMT responded. Consumer 3ED was disorientated, confused. Blood pressure was slightly low but with acceptable range. Identity of Consumer 3ED was unknown, as no ID was located. Ambulance. Nude. Police. Disoriented. Confused. Identity unknown.

· Labs returned for Consumer 2ED showed recent cannabis usage. Observed Lisa as she questioned and filled out PAF for Consumer 2ED. Lisa was brief and brisk with this consumer. She knew him and had previously treated him. Lisa reminded him that any misuse of the day treatment program would result in termination of the program, and that possible re-admittance could not take place for at least 365 days. Lisa determined discharge back to the Day program was the course of treatment. Labs. Cannabis. PAF. Day Program. Psych DC Knowledge.

· Consumer 3ED arrived and was placed directly into trauma/crisis room. Vitals all look good, body temp low but within in range. Consumer 3ED gives us his name and age however cannot remember the morning, the date, his address, his birth date, or how he lost his clothing and arrived on Dequinder Rd. Patient is not violent, but clearly confused. Urine and blood samples are obtained and sent to the lab. Trauma/Crisis, Labs. Confusion. Psych DC Knowledge.

· 3:25 and I was supposed to be done at 2! Lisa informed me that I should wait for the transportation for Consumer 1ED to arrive, so that I could fill out and complete discharge planning paperwork. Transportation. Discharge Planning. SW DC Knowledge.

· 4:52 transportation arrives for Consumer 1ED to his new residential facility. Discharge forms are completed and the patient signs release forms. Release Forms. Discharge Forms. Residential Facility, SW DC Knowledge.

· Labs return normal for Consumer 3ED and he is medically cleared for Psych intake. Lisa evaluates Consumer 3ED using the PAF, however very little information is obtained, as Consumer 3ED cannot seem to remember much, and falls asleep during questioning. Lisa decides to hold him in the ED for a 12-hour observation period. Medical Clearance, PAF, 12 hour Observation.

· 5:15 I thank Lisa, and Leave.

Data Collection Report

Report of Proceedings

Interview: October 16, 2011

Observation: October 19, 2011

St. John Macomb- Oakland Hospital

27351 Dequindre

Madison Heights, Michigan 48071

248-967-7480

1.0 Executive Summary

This report contains data collected from an interview and seven hours of observing a practicing Behavioral Social-Psychologist working in both an emergency and in-patient hospital setting. The purpose of the interview and observation was to gain insight and further knowledge of the writing and literacy practices of the Medical Social Work Discourse Community.

The interview portion of this report was held in a small quiet coffee shop in Grosse Pointe with Ms. Lisa Kopacka, a licensed Clinical Psychologist who has Masters Degrees in both Social Work and Psychology. Ms. Kopaca (here-on referred to as Lisa) works for St. John Hospital, at both the Macomb-Oakland location and the Moross location. At the Oakland location, Lisa splits her time between three different jobs. Her primary responsibility is to see patients in the Emergency Department (ED) and determine if the patient (or consumer as they are called within the department) is in need of in-patient psychiatric treatment, partial-day treatment, or if they should be released from the ED with recommendation to seek treatment elsewhere. Lisa’s second and third responsibilities are to make rounds on the medical floors of the hospital to check on patients who are in need of psychiatric care but are not medically cleared to be in the psychiatric floor, and to remain in constant communication with the Social-Psychologist on the Psychiatric floor to see how many beds are available and the status of the patients admitted there. At the Moross location, Lisa only works in the ED setting, performing the same job as she does at the Oakland location. The interview consisted of 1.5 hours of Lisa answering questions asked about her education, her career path, and lastly about her writing and literacy practices on the job.

The observation portion of this report was conducted at St. John Macomb-Oakland Hospital in Madison Heights, Michigan, in the Emergency Department and on the Psychiatric Floor. The Emergency Department is a twenty- two- bed facility and offers emergency psychiatric assessment. The Psychiatric Ward (PW) is a twenty-six bed floor, and offers in-patient adult Psychiatric treatment as well as both in-patient and outpatient Electroconvulsive Therapy (ECT). I was able to both observe and practice in both the ED and the PW over a nine-hour consecutive period, seeing six consumers in the ED and walking rounds on the PW.

Clearly, a person working in Lisa’s position must have knowledge of both the Psychology and Social Worker’s Discourse Communities. Since Discourse Community knowledge encompasses the other four knowledge domains of Writing Processes, Subject Matter, Genre, and Rhetoric[4], does that imply that all Medical Social Workers must be completely adept in both communities, or is a broad knowledge base in both adequate?

2.0 Analysis

Using Beaufort’s five knowledge domains of Writing Process Knowledge, Subject Matter Knowledge, Genre Knowledge, Rhetorical Knowledge and the all encompassing Discourse Community Knowledge as a framework, an analysis of both the interview and observation sessions can be made. In doing so, the key recurring themes of brief standardized writing and communication practice and a deep knowledge base of both Psychology and Social Work have emerged.

Writing process knowledge, i.e. “knowledge of the ways in which one proceeds through the writing tasks in its various phases” (Beaufort page number) was very difficult to ascertain during the interview process. The interviewee, Lisa, has been practicing in an expert level role for so long, that she had a difficult time vocalizing and expressing her writing process phases. According to Lisa, “all of the writing that I do is within the context of pre-established forms.” There appears to be no editing or reviewing process for Lisa: she self-corrects and modifies her writing as she goes, or as more information becomes available from the consumer. “I would say that the writing style used in my practice is taken directly from the DSM IV (The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), although that doesn’t always line up with the ICD-10 (the International Statistical Classification of Diseases-10), which is what the Docs use.” At the time of the interview, this explanation was unclear, but the observation session shed much more light on the subject.

During the observation session, six patients were admitted to the ED, medically cleared by the medical doctor (meaning their only medial condition appeared to be psychiatric or substance abuse in nature), and turned over to the care of Lisa for an intake behavioral assessment. Lisa followed the BAI (Behavioral Assessment Intake Form) as a guide for questioning each patient. This form included questions ranging from prior hospitalizations and health history, to sharing thoughts of suicide. Upon completion of this form (which is computerized at some hospitals, but not at the Oakland location), Lisa would score (or code) the form. This score, combined with her with her own notes, would result in a final conclusion of Axis I, Axis II, Axis III, Axis IV and Axis V diagnosis, as well as a GAF (Global Assessment of Functioning Score). Axis I is the top-level diagnosis that usually represents the acute symptoms that need treatment; Axis 1 diagnoses are the most familiar and widely recognized (e.g., major depressive episode, schizophrenic episode, panic attack). Axis I terms are classified according to V-codes by the medical industry (primarily for billing and insurance purposes). This Axis was very important, and the most evident in my observation, as the insurance companies of the patients who required in-patient care demanded this Axis of information before the patient could be admitted. Axis II is for personality disorders and developmental disorders such as mental retardation. Axis II disorders, if present, are likely to influence Axis I problems. For example, a student with a learning disability may become extremely stressed by school and suffer a panic attack (an Axis I diagnosis). Axis III is for medical or neurological conditions that may influence a psychiatric problem. For example, diabetes might cause extreme fatigue, which may lead to a depressive episode. Axis IV identifies recent psychosocial stressors such as a death of a loved one, divorce, losing a job, etc. Axis V identifies the patient's level of function on a scale of 0-100, (100 is top-level functioning), which was abovementioned as the GAF score.

In her writing processes, Lisa worked within the framework of the DSM IV and the Five Axis system in a methodical, standardized, almost robotic way. Given the rushed and often hectic pace of the ED, and given that Lisa’s primary responsibility was to diagnose and assign consumers and not to provide clinical therapy, her writing process must be drawn from a combination of concrete diagnostic knowledge and a very standardized method for communicating that knowledge.

Similarly, Rhetorical Knowledge expressed in the interview format was very vague and difficult to process. When asked about establishing logos, pathos and ethos, Lisa once again referred to the DSM IV. It appears that all credibility on her part would be lost if she varied from this standardized heuristic of diagnosis. It became obvious throughout the interview that there was a specific lexicon used among the community. Terms that were unfamiliar included “consumer” in place of “patient”, “intake” in place of “admit”, and most surprising “Social-Psychologist” in place of “Medical Social Worker.”

This new lexicon continued in the observation session, both in the ED as well as on the PW. In some cases, this slang terms such as “frequent flier” for patients who returned on a very frequent basis, “greenie” for the Residents (because of the color of scrubs they wear), and “sitters” who are minimum wage hospital employees hired to sit or guard a patient that may be a danger or physical threat to other patients or personnel. Also noticeable were many unfamiliar terms that appeared to be not medically related, but rather slang for other everyday tasks or items, exchanged between the Doctors, Nurses, Lisa and the Residents. This private language may be used so that the patients, who are in curtained off areas surrounding the ED center station, do not fully understand what the staff is saying to one another. This would be in keeping with the practice of social awareness and of attempting to protect the patient and their dignity in all circumstances.

The afore mentioned forms and writing practice methods are also helpful in establishing the preferred writing genre of an ED. There is oftentimes little opportunity for extended lengths of time to be spent with each patient, especially if the situation if life-threatening or highly traumatic, and the clear cut, easy to read format of consistent preprinted forms makes for fast skimming of important to see facts and information. For example, one of the patients, Henry [5], a “frequent flier” arrived at the ED in a state of extreme agitation and confusion. Henry was hearing demons talking to him and seeing illusions of those demons in front of him. He was aggressive, spitting, and had to be restrained in his bed and a “sitter” had to be called in. A quick scan of the BAI forms from his visit the previous month indicated his Axis I Diagnosis of schizophrenia, complicated by Axis III Psycho-Social conditions of alcoholism, and homelessness. Because of this information, it took Lisa only a few seconds to determine Henry’s condition, rather than the minutes it would have taken to read another format, such as a case report.

This “quick and fast” genre of writing was also obvious in the speech patterns observed between Lisa, the insurance companies, and other facilities she spoke with during the course of the day. There were no social niceties exchanged during these conversations, but rather brief and hurried code numbers and names for diagnosis, and treatment suggestions such as in or outpatient services.

Lastly, the breadth of Lisa’s Subject Matter domain of knowledge was easily processed in both the interview and observation settings. The beginning of the interview was spent answering my questions that were primarily centered around the interviewers understanding of medical social work, which included many questions about education, the differences between the ED and in-patient floors, and the amount of time spent on discharge planning. It became very clear within thirty minutes of the interview process that Lisa’s subject matter knowledge domain reached far beyond that of Clinical Social Work. “While I obtained my Masters of Social Work, many of the skills I use on a daily basis draw mainly from my Masters of Clinical Psychology”, Lisa stated. She continued, “My social work skills help me understand where the patients are coming from and the life they are probably going to be discharged back to. My social work skills also help me a lot in understanding and quickly seeing signs of substance abuse and physical abuse. My Psych skills allow me to converse with the Doctors and see what the underlying physiological illness of the consumers are.”

A full understanding of both the Clinical Psychology and Social Work Discourse communities was also evident in observing Lisa in practice in the PW. In doing rounds on the PW, Lisa discussed with the consumers (and in some cases their families) their discharge plans. Who would help them to remember to take their daily medications? Where would outpatient treatment take place? How would transportation be arranged to this therapy? These concerns are all in the role of a social worker, however, knowledge of the underling causes for the treatment, such as Depression, bi-Polar disorder etc was also necessary.

It is important to note the similarities between Lisa’s communication style in the interview, and her professional communication style in the ED. Lisa spoke in the same manner in both settings, forgetting perhaps the novice level of the interviewer. It was much easier to decipher her lexicon using the heuristic approach of hands on learning in the observation setting, allowing all to be placed in proper context and situation.

3.0 Critical Reflection

The primary components for the interview portion of the data collection consisted of questions about the interviewee’s education, job experience and writing and reading practices. As mentioned before, it became clear very quickly in the interview process that perhaps the questions being asked were somehow in disconnect with the actual “on the job” practices of the interviewer, and that the Discourse Community of Social Work was too narrow to encompass the role that Lisa plays as a Behavioral Social-Psychologist ED Intake Specialist. At that point in the interview, Lisa “took over” for a period, informing as to the differences between the education level of an job description of a discharge social worker, and that of Lisa in her position.

The observation portion of the data collection had much more clearly defined components, which included observation and practice of ED consumer care, observation and communication with patients on the PW, and observation of dialog via telephone between Lisa and insurance companies, and Lisa and other Psychiatric care providing facilities.

Drafting and coding and rewriting my field notes was easily accomplished, as it was done immediately after the observation session, which in itself was only days after the interview. My recommendation for those completing this project in the future would be to conduct the observation session first, and then proceed to the interview, as more questions that are appropriate could be formatted, and a review and “decompression” of the observation process could then occur.

4.0 Conclusion

A great deal of information about the Medical Social Work Discourse Community has been obtained by analyzing within the framework of Beaufort’s five knowledge domains time spent in interview and observation of an expert in the field. Understanding the application of the rhetorical knowledge, writing process knowledge, genre, and subject matter within the actual situation of practice has provided invaluable insight as to what is necessary to be an expert within this discourse community. The focus of further research remains a deeper understanding of how the Psychology and Social Work communities interact and overlap, and the depth of knowledge required from each area of expertise in order to practice successfully.

Synthesis Project

The Writing and Literacy Practices of the Clinical Social Work Discourse Community: How Clinical Social Work and Clinical Social Psychology Discourse Communities Converge in the Emergency Department and Psychiatric Unit.

Abstract

Using a large body of published works on discourse community analysis as it’s framework, this study uses rhetorical analysis, as well as data collected through interview and observation to examine the convergence of knowledge domains within the Clinical Social Work and Clinical Social Psychology discourse communities as practiced within an Emergency Department or Psychiatric Unit.

1. Introduction

Social work practice assists individuals, groups and communities by enhancing or restoring their capacity for social function and creating societal conditions favorable to reach their goals. Social workers work in a variety of settings, including health care facilities, public welfare agencies, child welfare agencies, public and private schools, colleges and universities, and community organizations. Within the more specialized area of clinical social work practice lays a systematic process and activity that is designed to assess client situations and help clients achieve agreed upon goals in order to promote optimal health and well-being.

Social workers are members of a discourse community. They share a common discourse, that is, a form of communication that leads to an informed way of thinking, reading and writing, and when combined, they form a community that uses and creates in an ongoing process the aforementioned discourse.

A Discourse Community has:

vii. A broadly agreed set of common public goals.

viii. Mechanisms of intercommunication among its members.

ix. Participatory mechanisms primarily to provide information and feedback.

x. One or more genres in the communicative furtherance of its aims.

xi. Acquired some specific lexis.

xii. A threshold level of members with a suitable degree of relevant content and discoursal expertise (471-73).

In this article, the role of clinical social work as practiced in both the Emergency Department and Psychiatric Unit is examined. I argue that Clinical Social Workers practicing in the Emergency Department and Psychiatric Unit must be completely adept in all of the knowledge domains of both the Clinical Social Work discourse community and Clinical Social Psychology discourse community in order to effectively achieve the overarching goal of the clinical social work community as previously described. This argument constructs on the theoretical framework of discourse community analysis, rhetorical analysis of published works from social work discourse, interview data from a practicing Behavioral Social-Psychologist Intake Specialist, and observation data from a Clinical Social Worker in both the Emergency Department and Psychiatric Unit settings.

2. Theoretical Framework

My research emerges from a body of work on discourse communities. Central to this framework are five knowledge domains developed by Anne Beaufort in College Writing and Beyond: A New Framework for University Writing Instruction. This comprehensive model of the five knowledge domains applies to any discourse community. Awareness and assimilation of each of these domains aids a novice within a community to advance from general to context-specific expertise. These knowledge domains can also be expressed as the actual mental schemas writers need to invoke for analyzing new writing tasks either within their current discourse community, or as they enter or overlap into a new discourse community. According to Beaufort, within this model knowledge domains overlap, and yet still remain distinct, representing situated knowledge entailed in acts of writing. These five knowledge domains include:

Writing Process Knowledge: How the members of the community approach writing, including drafting, and revision; balanced by the community demands.

Rhetorical Knowledge: How the community uses rhetorical techniques to successfully argue and defend positions.

Genre Knowledge: The types of writing the community employs in repeating situations.

Discourse Community Knowledge: The overarching goals and values of the discourse community make manifest in this domain, which encompasses the other four domains (15-19).

3. Method

The present study analyzes coded data from one interview with a Behavioral Social Psychology Intake Specialist, rhetorical analysis of four pieces of published material culled from universally accepted social work, public health or psychology journals, and the coded field notes taken from observation of a Clinical Social Worker practicing in both an Emergency Department and Psychiatric Unit.

3.1 Collection Method

i. Rhetorical Analysis

Mastery of discourse within clinical social work practiced in an Emergency Department or Psychiatric Unit requires determination of primary sources for published articles, research and case studies within the community. Publications chosen to obtain pieces for rhetorical analysis include Social Work in Health Care, the New England Journal of Medicine, the American Journal of Public Health and the Center on Human Development and Disability. Chosen for analysis based on their relevance to Clinical Social Work, Social Psychology, Emergency Department Procedure or Psychiatric Unit Procedure were the following:

a. “Care of the Adult Patient after Sexual Assault”[6]

b. “Factors That Influence Clinician’s Assessment and Management of Family Violence.”[7]

c. “The Value of the Presence of Social Work in Emergency Departments”.[8]

d. “Interdisciplinary Team Evaluation of “John”: A Case Study.” [9]

Using a rhetorical method of analysis, I examined each piece for evidence of this study’s theoretical framework: Anne Beaufort’s five knowledge domains. Noting recurring themes and strengths or weaknesses of each domain confirmation, I was able to deduce the overall goals of the Clinical Social Work discourse community.

ii. Interview

Ms. Lisa Kopacka, a licensed Clinical Psychologist who obtained Masters Degrees in both Clinical Social Work and Clinical Psychology from Wayne State University willingly participated in dialogue and questioning. Ms. Kopaca currently works for St. John Hospital at two different locations. At location one, Ms. Kopacka splits her time between three different jobs. Her primary responsibility is to see patients in the Emergency Department and determine if the patient is in need of in-patient psychiatric treatment, partial-day treatment, or if they should be released from the Emergency Department with recommendation to seek treatment elsewhere. Ms. Kopacka’s second responsibility includes completion of rounds on the medical floors of the hospital to check on patients who are in need of psychiatric care but have not obtained medical clearance for admittance to the Psychiatric Unit. Lastly, Ms. Kopacka remains in constant communication with the Social Psychologist on the Psychiatric floor to see how many beds are available and the status of the patients admitted there. At location two, Ms. Kopacka works in the Emergency Department performing the same job as she does in the Emergency Department at location one. The interview consisted of 1.5 hours of Ms. Kopacka answering questions asked about her education, her career path, and about her writing and literacy practices on the job.

iii. Observation

Observation for this study took place at St. John Macomb-Oakland Hospital in Madison Heights, Michigan, in the Emergency Department and in the Psychiatric Unit. The Emergency Department is a twenty-two-bed unit and offers emergency psychiatric assessment in addition to other emergency related services. The Psychiatric Unit is a twenty-six-bed ward located on the seventh floor of the facility. The unit offers in-patient adult psychiatric treatment as well as both in-patient and outpatient Electroconvulsive Therapy (ECT). I was able to both observe and practice in both the Emergency Department and the Psychiatric Unit over a seven-hour consecutive period, seeing patients in both the Emergency Department (n=3) and in the Psychiatric Unit (n=4). Notation was made of the writing practices and procedures of the Clinical Social Worker present in both the Emergency Department and the Psychiatric Unit, and all intake, evaluation and discharge forms were collected as further data.

3.2 Coding Process

In her book Qualitative Research: a Guide to Design and Implementation, Dr. Sharan B. Merriam of the University of Georgia provides the framework of data analysis used in this study. This framework or methodology of data analysis aims to find answers to research questions by locating and labeling categories or themes and translating reoccurrence or regularities of these themes into findings i.e. answers to research questions.

Coding of both the interview and observation data took place in two stages.

Axial Coding: Data was subsequently grouped and separated into the following categories based on the following recurring themes:

· Subject knowledge domain is very specific to the Clinical Social Psychology Discourse Community.

· Writing Process and Genre knowledge domains are very specific to the Clinical Social Psychology Discourse Community.

· Rhetorical knowledge domain blends both Clinical Social Work and Clinical Social Psychology Discourse Communities.

4. Findings

My findings are presented in four subsections: overall findings, necessary specific social psychology subject matter domain knowledge, necessary specific writing process and genre domain knowledge, and finally a broad multi-community understanding of rhetorical knowledge.

4.1 Overall Findings

Correlation between reoccurring themes within the rhetorical analysis, interview and observation showed a remarkable carry-over between the Clinical Social Work discourse community and the Clinical Psychology discourse community, specifically as practiced in the Emergency Department and Psychiatric Unit. This was evident within all five of Beaufort’s knowledge domains, but most pronounced in the domains of subject matter, writing process and genre, and rhetorical knowledge.

4.2 Clinical Social Workers practicing in the Emergency Department or Psychiatric Unit must have subject knowledge specific to the Clinical Social Psychology Discourse Community.

Clinical Social Workers practicing in the Emergency Department or Psychiatric unit see patients with a variety of social, economic and mental health issues. These issues may include but are not limited to: substance abuse diagnosis and treatment, mental health diagnosis and treatment, developmental health analysis, rape, incest, and physical abuse including child abuse, spousal abuse and elder abuse. Rhetorical analysis of four published works from relevant Clinical Social Work publications, as well as data collected from the interview and observation indicate that Clinical Social Workers practicing in the Emergency Department or Psychiatric Unit must have subject knowledge specific to the Clinical Social Psychology Discourse Community.

Rhetorical analysis of “Care of the Adult Patient after Sexual Assault”, from The New England Journal of Medicine illustrates that a complete understanding of Clinical Psychology methods of analysis, diagnosis, and treatment are necessary. The piece provides a case vignette of a twenty- year old woman who presents in the Emergency Department with a report of having been sexually assaulted twenty-four hours earlier. She reports that a man she had met at a campus party walked her to her apartment, where he assaulted and raped her, including vaginal penetration. The article presents evidence supporting various strategies comprised of evidence collection and photography of injuries, formal legal guidelines that include an awareness of time limitations, and the author’s clinical recommendations. These recommendations involve a detailed section for the practicing Clinical Social Worker, who in this setting explains the process of evidence collection, offers support, describes options, and explains the hospital process to both the victim and any of the family or friends present. The social worker must be aware that “sexual assault survivors are at an increased risk for post-traumatic stress disorder (PSTD) (30%), major depression (30%), and contemplation of suicide (33%), or an actual attempt (13%)” (3). The worker must evaluate the patients immediate and future emotional and safety needs, showing complete competency of the treatment necessary for the psychological conditions aforementioned.

The breadth of Ms. Kolpacka’s subject matter domain of knowledge was evident in the interview setting. Ms. Kolpacka spent the beginning of the interview answering questions primarily centered around the interviewers understanding of medical social work, which included many questions about education, the differences between the Emergency Department and in-patient floors, and the amount of time spent on discharge planning. It became very clear to me within thirty minutes of the interview process that Ms. Kolpacka’s subject matter knowledge domain reached far beyond that of Clinical Social Work. “While I obtained my Masters of Social Work, many of the skills I use on a daily basis draw mainly from my Masters of Clinical Psychology”, she stated, continuing, “my social work skills help me understand where the patients are coming from and the life they are probably going to be discharged back to. My social work skills also help me a lot in understanding and quickly seeing signs of substance abuse and physical abuse. My Psychology skills allow me to converse with the Doctors and see what the underlying physiological illness of the consumers are.”

The consistent use of subject matter knowledge from the Clinical Psychology discourse community was also evident in the observation setting. During the session, three patients were admitted to the Emergency Department, medically cleared by the medical doctor (meaning their only medical condition appeared to be psychiatric or substance abuse in nature), and turned over to the care the Clinical Social Worker for intake behavioral assessment. The social worker followed the BAI (Behavioral Assessment Intake Form) as a guide for questioning each patient. This form included questions ranging from prior hospitalizations and health history, to sharing thoughts of suicide. Upon completion of this form (which is computerized at some hospitals, but not at the Oakland location), the social worker scored (or coded) the form. This score, combined with the workers own notes, would result in a final conclusion of Axis I, Axis II, Axis III, Axis IV and Axis V diagnosis, as well as a GAF (Global Assessment of Functioning Score. Axis I is the top-level diagnosis that usually represents the acute symptoms that need treatment; Axis 1 diagnoses are the most familiar and widely recognized (e.g., major depressive episode, schizophrenic episode, panic attack). Axis I terms are classified according to V-codes by the medical industry (primarily for billing and insurance purposes). This Axis was very important, and the most evident in my observation, as the insurance companies of the patients who required in-patient care demanded this Axis of information before the patient could be admitted. Axis II is for personality disorders and developmental disorders such as mental retardation. Axis II disorders, if present, are likely to influence Axis I problems. For example, a student with a learning disability may become extremely stressed by school and suffer a panic attack (an Axis I diagnosis). Axis III is for medical or neurological conditions that may influence a psychiatric problem. For example, diabetes might cause extreme fatigue, which may lead to a depressive episode. Axis IV identifies recent psychosocial stressors such as a death of a loved one, divorce, losing a job, etc. Axis V identifies the patient's level of function on a scale of 0-100, (100 is top-level functioning), which was abovementioned as the GAF score. This multiaxial diagnostic system is the standard for classifying all mental illnesses and disorders within the Clinical Psychology practice. When considered together, these five levels give the Clinical Social Worker a complete diagnosis that includes factors influencing psychiatric conditions, which is of great importance for effective treatment planning.

4.3 Standardization of the writing process and genres used by Clinical Social Workers practicing in the Emergency Department or Psychiatric Unit provides consistent reporting standards, and indicates the importance of complete assimilation by the Social Worker into the Clinical Social Psychology Discourse Community.

Rhetorical Analysis of “Care of the Adult Patient after Sexual Assault” published in The New England Journal of Medicine revealed the importance of consistent standardized reporting standards. In the case of rape, evidence collection kits contain forms for documentation and to assist examiners and the Clinical Social Worker. “After medial clearance, the patient should be offered medical collection. The collection of forensic evidence is a multistep process that can take six or more hours to complete and is best performed by the Clinical Social Worker. The aim is to record the victim’s report of the assault, collect and record evidence to support this report, and collect DNA. Highly sensitive DNA techniques can assist in identifying a perpetrator by matching DNA to the Combined DNA Index System (CODIS) database of convicted felons, maintained by the Federal Bureau of Investigation” (2-3). In this case, the writing process and the genre used could be a key factor in a criminal case.

Writing process knowledge was very difficult to ascertain during the interview process. The interviewee, Ms. Kolpacka, has been practicing in an expert level role for so long that she had a difficult time vocalizing and expressing her writing process phases. According to Ms. Kolpacka, “all of the writing that I do is within the context of pre-established forms.” There appears to be no editing or reviewing process for her: she self-corrects and modifies her writing as she goes, or as more information becomes available from the consumer. “I would say that the writing style used in my practice is taken directly from the DSM IV (The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition), although that doesn’t always line up with the ICD-10 (the International Statistical Classification of Diseases-10), which is what the Docs use.” At the time of the interview, this explanation was unclear, but the observation session shed much more light on the subject.

Observation of the Clinical Social Worker in both the Emergency Department and the Psychiatric Unit revealed that the social worker wrote within the framework of the DSM IV and the Five Axis system in a methodical, standardized, almost robotic way. Given the rushed and often hectic pace of the ED, and given that the social workers primary responsibility was to diagnose and assign consumers and not to provide clinical therapy, her writing process must be drawn from a combination of concrete diagnostic knowledge and a very standardized method for communicating that knowledge.

The bedrock in which all of the information gathered, and the multiaxial diagnosis are recorded onto are the standardized forms provided by the hospital. These forms are very helpful to the Clinical Social Worker, as there is little opportunity for extended lengths of time to be spent with each patient, especially if the situation if life-threatening or highly traumatic. The clear cut, easy to read format of consistent preprinted forms makes for fast skimming of important facts and information. For example, one of the patients, Henry[10], a “frequent flier” arrived in the Emergency Department in a state of extreme agitation and confusion. Henry was hearing demons talking to him and seeing illusions of those demons in front of him. He was aggressive, and spitting. For the Safety of the staff, Henry was restrained in his bed and a “sitter” was called in. A quick scan of the BAI forms from his visit the previous month indicated an Axis I Diagnosis of schizophrenia, complicated by Axis III Psycho-Social conditions of alcoholism, and homelessness. Because of this information, it took the Clinical Social Worker only a few seconds to determine Henry’s condition, rather than the minutes it would have taken to read another format, such as a case report.

This “quick and fast” genre of writing was also obvious in the speech patterns observed between the Clinical Social Worker, the insurance companies, and other facilities she spoke with during the course of the day. There were no social niceties exchanged during these conversations, but rather brief and hurried code numbers and names for diagnosis, and treatment suggestions such as in or outpatient services. Clearly, standardization of the writing process and genres used by Clinical Social Workers practicing in the Emergency Department or Psychiatric Unit provides consistent reporting standards, and indicates the importance of complete assimilation by the Social Worker into the Clinical Social Psychology Discourse Community.

4.4 Rhetorical knowledge, (specifically lexicon) blends both Clinical Social Work and Clinical Social Psychology Discourse Communities.

“Factors that Influence Clinicians’ Assessment and Management of Family Violence”, published in 1994 by The American Journal of Public Health, also uses the APA format. However, it extends to include sections on Interventions and Mandated Reporting. This piece evaluates different professionals within the health services (dental hygienists, dentists, nurses, physicians, psychologists, and social workers) to assess which factors may contribute to their reporting (or lack of reporting) of suspected abuse. The APA format is used frequently in the social sciences, as it allows for precise details and leaves little room for conjecture. In addition, further studies can build on works that use APA, as application of the same methodology creates a constant in what can appear to be an ever-changing field of practice.

In addition to utilizing the APA format, the Clinical Social Work discourse community employs a very similar lexicon as the Clinical Psychology discourse community. First, words that can have multiple meanings or implications are clearly defined so that there is no room for interpretation. For example, in the public health piece, abuse is defined as “physical maltreatment” and is further divided into the categories of child abuse, spouse abuse and elder abuse (628). “Care of the Adult Patient after Sexual Assault” also clearly defines the main terms of the work: sexual assault and rape. This is accomplished at the beginning of the piece, so there can be no confusion in the mind of the clinical practitioner. Defining terms comprehensively is of great importance in the social sciences, as there may be legal implications. Case in point, the piece on sexual assault clearly states the legal definitions of rape, body orifice, and incapacity. “Rape is a legal term and in the United States refers to any penetration of a body orifice (mouth, vagina, or anus) involving force or the threat of force or incapacity (i.e. associated with young or old age, cognitive or physical disability, or drug or alcohol intoxication) and nonconsent” (1). This very detailed definition of the terms provides the practitioner with information necessary to make a determination of whether to include law enforcement into the circle of patient care, and in what terms to explain to both the patient and the law enforcement what has happened. Second, all of the pieces examined use a lexicon that would be foreign to those outside of the social work discourse community. Words and phrases such as “supplemental security income”, “developmental disabilities”, “placement”, “environmental” and “coefficient” are just a few examples of words that take on a different meaning within social work practice. Examining both this lexicon as well as the APA method of formatting allows one to make a reasonable attempt at understanding the rhetorical knowledge domain of the Clinical Social Work discourse community.

Rhetorical knowledge expressed in the interview format was very vague and difficult to process. When asked about establishing logos, pathos and ethos, Ms. Kopacka once again referred to the DSM IV. It appears that all credibility on her part would be lost if she varied from this standardized heuristic of diagnosis. However, it became obvious throughout the interview that there was a specific lexicon used among the community. Terms that were unfamiliar included “consumer” in place of “patient”, “intake” in place of “admit”, and most surprising “Social-Psychologist” in place of “Medical Social Worker.”

This new lexicon continued in the observation session, both in the Emergency Department as well as in the Psychiatric Unit. Slang terms such as “frequent flier” for patients who returned on a very frequent basis, “greenie” for the Residents (because of the color of scrubs they wear), and “sitters” who are minimum wage hospital employees hired to sit or guard a patient that may be a danger or physical threat to other patients or personnel were used regularly. Also noticeable were many unfamiliar terms that appeared to be medically unrelated, but rather slang for other everyday tasks or items, exchanged between the Doctors, Nurses, the Clinical Social Worker, and the Residents. This private language may be used so that the patients, who are in curtained off areas surrounding the Emergency Department center station, do not fully understand what the staff is saying to one another. This would be in keeping with the practice of a Clinical Social Workers raised social awareness, as well as an attempt to protect the patient and their dignity in all circumstances.

5. Discussion

When combined with a comprehensive rhetorical analysis of selected published articles and a case study produced by the Clinical Social Work Discourse community; my data from interview and observation field notes clearly indicate that clinical social workers practicing in the Emergency Department and Psychiatric Unit must be completely adept in all of the knowledge domains of both the Clinical Social Work discourse community and Clinical Psychology discourse community. Most important for successful Clinical Social Worker practice in an Emergency Department or Psychiatric Unit setting is complete comprehension of the subject matter domain of the Clinical Psychology discourse community. Application of the subject matter occurs in theory in the evaluation and diagnosis of consumers. Application occurs in practice within the writing process and rhetorical domains, specifically in the successful completion of standardized forms. The Clinical Social Worker practicing in the Emergency Department or Psychiatric Unit must effectively embrace the knowledge domains of the Clinical Psychology community in order to achieve adeptness in patient care and to achieve the overarching goals of the Clinical Social Work community.

As a novice in the Clinical Social Work discourse community, it is difficult to assess all of the knowledge that a rhetorical situation can provide. For example, it is unclear exactly who the anticipated audience is, specifically in the piece published in The New England Journal of Medicine. This piece could easily be read and put into practice by Clinical Social Workers, Physicians, Nurses, Emergency Medical Responders and Police Officers, all of which represent vastly different discourse communities. However, the basic underlying principals of further study in the field of social work is required in order to understand rhetorical audience and context in a more concrete way.

A full understanding of both the Clinical Psychology and Social Work Discourse communities was evident in observing the Clinical Social Worker in practice in the Psychiatric Unit. In completing rounds on the Psychiatric Unit, the social worker discussed with the consumers (and in some cases their families) their discharge plans. Who would help them to remember to take their daily medications? Where would outpatient treatment take place? How would transportation be arranged to this therapy? These concerns are all encompassed in the role of a social worker, however, knowledge of the underling psychological causes for the treatment, such as Clinical Depression, Bi-Polar Disorder etc. was also necessary.

It is also important to note the similarities between Ms. Kopacka’s communication style with me in the interview and her professional communication style with me during my observation of the Emergency Department and Psychiatric Unit. Ms. Kopacka spoke in the same manner in both settings, forgetting perhaps the novice level of the interviewer. It was much easier to decipher her lexicon using the heuristic approach of hands on learning in the observation setting, allowing all to be placed in proper context and situation. This realization is in alignment with James Gee’s theory that Discourses are “not mastered by overt instruction (even less so by languages, and hardly anyone ever fluently acquired a second language sitting in a classroom), but by enculturation (“apprenticeship”) into social practices through scaffolded and supported interaction with people who have already mastered the Discourse”(484). Gee goes on to say: “You cannot overtly teach anyone a Discourse, in a classroom or anywhere else (484).” While the completion of the rhetorical analysis and interview processes for this article provided a great deal of data; it took full assimilation in practice in the observation setting for me to gain my own heuristic of how the Clinical Social Work and Clinical Psychology discourse communities intersect and overlap.

6. Conclusion

As with all bodies of exploratory research, this study has several limitations. First, the interviewee and the Clinical Social Worker observed were the same person, Ms. Kolpacka. Second, the data-base of consumers observed was very small (n=7).

My findings, however, do point to interesting questions for further research. First is the question of how many Clinical Social Workers are practicing in an Emergency Department or Psychiatric Unit setting with little or no subject matter knowledge of the Clinical Psychology discourse community, and how does this lack of expertise affect consumer care? Second, in terms of discourse community studies, should the Social Sciences be viewed in terms of one large discourse community, thereby revisiting college level writing instruction within these majors? Finally, this study points to the importance of looking at the practice of Clinical Social Workers and Clinical Social Psychologists through the lens of discourse community analysis in order to provide insightful perceptions of the literacy heuristics of each community.

References

Auerbac, PhD., Charles, and Susan E. Mason, PhD. "The Value of the Presence of Social Work in Emergency Departments." Social Work in Health Care. 49.4 (2010): 314-326. Print.

Beaufort, Anne. College Writing and Beyond:A New Framework for University Writing Instruction. Logan, Utah: Utah State University Press, 2007.

Clinicians' Assessment and Management of Family Violence." American Journal of Public Health. 84.4 (1994): 628-633. Print.

Gee, James P. “Literacy, Discourse, and Linguistics: introduction.” Journal of Education (1989): 5-17. Print.

Linden, M.D., Judith A. "Care of the Adult Patient after Sexual Assault." New England Journal of Medicine. (2011): 834-841. Print

Merriam, Sharan B. Qualitative Research: A guide to Design and Implementation. San Francisco, CA: Jossey-Bass, 2009.

"National Social Workers Code of Ethics." National Association of Social Workers. National Association of Social Workers, 5 Jul 2011. Web. 9 Oct 2011.

Swales, John. “The Concept of Discourse Community.” Genre Analysis: English in Academic and Research Settings. Boston: Cambridge UP, 1990. 21-32. Print

[1] Case studies are extremely private documents, so for the purpose of this analysis, a mock case study provided by the Clinical Training Unit at The University of Washington was used.

[2] Case studies are extremely private documents, so for the purpose of this analysis, a mock case study provided by the Clinical Training Unit at The University of Washington was used.

[3] Case studies are extremely private documents, so for the purpose of this analysis, a mock case study provided by the Clinical Training Unit at The University of Washington was used.

[4] Anne Beaufort College Writing and Beyond (Utah State University Press: 2007) 5-27.

[5] This, as well as all other patient names, has been changed for the protection of the patient’s privacy.

[6] The New England Journal of Medicine

[7] The American Journal of Public Health

[8] Social Work in Health Care

[9] Center on Human Development and Disability

[10] This, as well as all other patient names was changed for the protection of the patient’s privacy.

mommy back at college!

Sunday, December 18, 2011

Whew! One entire semester's of work in one 83 page paper!

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