The special-problem patient: victim or agent of splitting?
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The purpose of this paper is to describe the collaborative efforts of one successful research group. The Tube Feed Consortium Group was composed of seven investigators who lived in four different geographic locations. One of the members served as principal investigator and chairman of the group; the others as coinvestigators. A coinvestigator served as principal investigator in each location, managing subcontracted budgets and scientific concerns. This structure promoted efficiency in budget management, conflict management, and division of labor. Major advantages to this approach to the conduct of research included (a) a large number of subjects studied in a relatively short time period; (b) a data collection structure, which permitted wider generalization than data collected in one institution by one investigator; (c) a mechanism for direct replication and replication with expansion; (d) maximum usage and distribution of resources between investigators. Mechanisms established early in the history of the group helped to achieve maximum communication, resolve potential conflicts, ensure reliability of data, ensure publication and presentation rights of collaborators, and manage the overall budget and subcontracts. The group remained intact for eight years, completed all the proposed studies plus other related studies, presented numerous papers, and continues to publish findings of these endeavors.
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To disentangle clients from a social service network that has turned into a web, the author suggests a method: case conferences that include staff members of involved services, and a role: the systems-oriented case manager. As the coordinator of the client's social service network, the case manager would mediate the overt and convert conflicts that often exist among the professionals who are involved simultaneously with the client.
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