Improving Inter-professional Collaborations

Multi-Agency Working for Children's Wellbeing

Anne Edwards, Harry Daniels, Tony Gallagher, Jane Leadbetter, Paul Warmington

• Publisher: Routledge
• Year: 2009
• ISBN:
  9781134032372
• Edition: 1
• Topic: Didattica
• Subtopic: Didattica generale

** Shortlisted for the NASEN Special Educational Needs Academic Book Award 2009 **

Inter-professional collaborations are invaluable relationships which can prevent the social exclusion of children and young people and are now a common feature of welfare policies worldwide.

Drawing on a four year study of the skills and understanding required of practitioners in order to establish the most effective interagency collaborations, this comprehensive text

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• Gives examples from practitioners developing inter-professional practices allow readers to reflect on their relevance for their own work

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• Emphasises what needs to be learnt for responsive inter-professional work and how that learning can be promoted

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• Examines how professional and organisational learning are intertwined

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• Suggests how organisations can provide conditions to support the enhanced forms of professional practices revealed in the study

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• Reveals the professional motives driving the practices as well as how they are founded and sustained

Full of ideas to help shape collaborative inter-professional practice this book shows that specialist expertise is distributed across local networks. The reader is encouraged to develop the capacity to recognise the expertise of others and to negotiate theor work with others.

This book is essential reading for practitioners in education and educational psychology or social work, and offers crucial insights for local strategists and those involved in professional development work.

The book also has a great deal to offer researchers working in the area of cultural historical activity theory (CHAT). The four year study was framed by CHAT and offers a well-worked example of how CHAT can be used to reveal sense-making in new practices and the organizational implications of enhanced professional decision-making.

As well as being important contributors to the developing CHAT field, the five authors have worked in the area of social exclusion and professional learning for several years and have brought inter-disciplinary strengths to this account of inter-professional work.

Part I
What is the issue?

Chapter 1
Social inclusion and inter-professional collaboration

Introduction

The research project on which this book is based was funded by the Teaching and Learning Research Programme (TLRP) and ran from January 2004 to December 2007 at a time of major shifts in the organisation of services for children and young people. Over the four years of the study we worked with practitioners such as educational psychologists, children and families workers, teachers, education welfare officers, health professionals, speech and language therapists and colleagues from the voluntary sector who were all learning to work together in ways they had not done before in order to support the social inclusion of children and young people. They were learning to do this work while relationships between their organisations reconfigured around them. They remained focused on what they saw as the needs of children and adjusted their practices. In many ways, their practices raced ahead of both local and national strategies as they worked creatively for children in shifting systems. LIW was set up to capture the learning that occurred in these developing practices and the conditions that made learning possible. Two years into the study a research team based in Northern Ireland received TLRP funding to extend the LIW work in a different context. The Northern Irish LIW study did not entirely replicate the main study, but was an important sounding board for the ideas developed in the English analyses. In this chapter we outline the development of UK policy on the prevention of social exclusion through inter-agency collaborations and introduce the LIW study.

What is social inclusion?

The idea of social inclusion of children is not an easy idea to pin down. It raises all sorts of questions about how social practices can become more inclusive and the contribution of disadvantaged children and young people to them. Social inclusion is, nonetheless, seen as desirable because of concerns with equity and with the disruption that socially excluded youngsters can cause. Social exclusion is perhaps easier to describe. It was discussed with intensity in Europe during the 1990s because of serious concerns about the fragility of society. In 1993, for example, an early definition of the social exclusion of children and adults was provided in a European Commission Green Paper on European Social Policy Options for the Union.

Social exclusion does not only mean insufficient income. It even goes beyond participation in working life; it is manifest in fields such as housing, education, health and access to services. It affects not only individuals who have suffered serious set backs, but social groups, particularly in urban and rural areas, who are subject to discrimination, segregation or the weakening of traditional forms of social relations. More generally by highlighting the flaws in the social fabric, it suggests something more than social inequality and, concomitantly, carries with it the risk of a dual or fragmented society.

(Commission of the European Communities 1993:20–1)

Here we can see that social exclusion is being presented as a complex phenomenon that threatens the wellbeing of both individuals and their communities.

Finding ways of including disadvantaged children in the opportunities available for them became even more of a priority as a result of other strands being woven into the argument for it. One of these strands is economic. The1990s saw a growing fear that there were soon to be too few skilled workers to support the rapidly increasing number of elderly. During that period the idea of a child ‘at risk’ of not being able to contribute to society began to replace the notion of disadvantage. From the Organisation for Economic Cooperation and Development (OECD) perspective, children and young people who were ‘at risk’ were likely to fail in the school system and unlikely to enter work (OECD 1998). As Levitas (1998) has observed, inclusion had become an individual obligation that needed to be actively performed.

Social inclusion was therefore becoming recast, with the idea of entitlement to integration into society as both an individual right and a societal necessity. As Room explained at the time:

Social exclusion is the process of becoming detached from the organisations and communities of which the society is composed and from the rights and responsibilities that they embody.

(Room 1995:243)

The shift, from seeing problems in terms of being disadvantaged to being ‘at risk’ of being excluded from what society both offers and requires, was regarded as helpful by policy-makers. It was future-oriented and allowed the State to think about how it might prevent the exclusion of children from what binds society together and their responsibilities to society. The ‘prevention of social exclusion’ therefore emerged as a new core concept in welfare services in England in the late 1990s (Bynner 2001; France and Utting 2005).

The ‘prevention of social exclusion’ is as slippery a term as ‘social inclusion’. It is usually linked with the idea of early intervention at the initial signs of vulnerability. Most work on early intervention has focused on the early years of life in initiatives such as Head Start in the US and Sure Start in England (Glass 1999, 2005). This rather limited understanding of early intervention was particularly expanded in the report of Policy Action Team 12 in the UK, which argued that children and young people can become vulnerable at different stages of their lives through changes in their life circumstances and that early intervention needs to include acting at the early signs of vulnerability, regardless of age, to prevent ultimate social exclusion (Home Office, 2000).

Of course vulnerability is often complex and may not be evident unless one looks across all aspects of a child’s life: parenting, schooling, housing and so on. There are two important ideas for professional practice embedded in these developing understandings. First, social exclusion should be seen as a dynamic process and not a static condition (Walker 1995). The dynamic is the outcome of interactions of effects across different domains of a child’s life and therefore can be disrupted if the responses to it are also multi-dimensional. That means that practitioners, working together, can make a difference. Second, because vulnerability may not be evident until a picture of accumulated difficultly is picked up by looking across a child’s life, all services that work with children need to be brought into the process of prevention. Practitioners working in universal services, that is, services open to all children and young people, have a role to play in spotting vulnerability, if not in responding to it with specific support. As we shall see, these expectations have called for new forms of inter-professional work: new ways of looking at children with other professionals and new ways of responding to the picture of the child that emerges.

Box 1.1 Social inclusion

Social inclusion is therefore a much broader idea than, for example, being included in the school curriculum by receiving extra support. It ranges across the whole of a child’s life and is evident in their ability to experience what society has made possible. Being socially included involves having accessible resources as well as direct help, and most certainly includes the right to make some contribution to developing the social conditions one experiences. It is the beginnings of responsible citizenship and resonates strongly with Northern European ideas of Bildung and the general wellbeing of the developing child in relation to the moral order of general society. Socially included children or young people are able to navigate the opportunities available and the difficulties they meet in their lives so that they avoid becoming disconnected from those opportunities. For most children the navigation involves making choices between opportunities. For some, at times, the difficulties threaten to throw them off track. It is at this point that they become vulnerable and require extra responsive help.

Policy responses

It was quickly apparent that the welfare services that work with children should find ways of enabling collaboration between practitioners (Home Office 2000; OECD 1998) to enable responsive interventions to give support to children who appear vulnerable. This belief lay behind a raft of measures in England that aimed at producing joined up responses to the multi-dimensional problem of social exclusion in England. These included establishing the government’s Social Exclusion Unit, the Green Paper Every Child Matters (DfES 2003), and the subsequent Children Act (DfES 2004), which together set out an agenda for more responsive inter-professional work that recognised the complexity of the problem. Actual government initiatives have included Sure Start, which worked with children and their families from birth (Glass 1999; Melhuish et al. 2005); the Children’s Fund, which set up local partnerships to encourage interagency collaborations across services working with children aged five to thirteen (Edwards et al. 2006); On-Track, which focused on children and crime prevention in targeted areas (France et al. 2004); Local Network Funding (DfES 2005); and extended schools (Cummings et al. 2004), which offered support for families, activities for children, community access and quick access to other services.

The need for practitioners to be able to understand the totality of a child’s life circumstances has led to major reconfigurations of children’s services in local authorities in England. We have seen, for example, the merging of education and social care services under single directorates in English local authorities and a reorganisation in central government to produce, in 2007, the Department for Children, Schools and Families (DCSF). This merging has the potential to produce the infrastructural conditions for inter-professional work, but it represents a massive shift. The Policy Action Team 12, when looking at services for young people, reported that collaboration between services was not being achieved because local authority budgets for intervening in a crisis were different from those that funded preventative activities; priorities for services set out in policy guidance did not encourage collaboration; and professional cultures worked against the kinds of collaborations that were needed (Home Office 2000). The LIW study found many of these difficulties still in place when it completed its report in 2008.

Another element of the policy response to the problem of social exclusion reflected the link between exclusion and lack of engagement with the democratic processes of society, which marked European discussions during the 1990s. Alongside increased attention to collaboration between professionals was an expectation that citizens identified as vulnerable would participate in the development of the services that were to be provided for them. Sinclair and Franklin (2000:2) summarised the reasons for involving children as: upholding children’s rights; fulfilling legal responsibilities; improving services; improving decision-making; enhancing democratic processes; promoting children’s protection; enhancing children’s skills; empowering; and enhancing self-esteem. The Children’s Fund, for example, reflected the view in government that children should play a greater role in developing policy and practice. In 2000 its strategy document stated:

we want to hear the voices of young people influencing and shaping local services; contributing to their local communities; feeling heard; feeling valued; being treated as responsible citizens.

(Children and Young People’s Unit 2000:27)

This strategy required service providers to become more responsive to the needs and strengths of the groups with whom they were working. However, it was not always easy for them to adjust from being the expert who inhabited a culture of specific expertise to learn to recognise the expertise that parents and carers brought to discussions of their children and neighbourhoods (Anning et al. 2006; Edwards et al. 2006).

In this book we are focusing on the professionals and the cultures that shape them, and that they also shape, as they undertake new work. The policy and infrastructural changes during 2004–07 formed crucial background elements, and the ways in which they occurred impacted on the possibilities for action for the professionals. A theme that runs through this book is the interaction between local authority systems, the more local work systems of the professionals with whom we worked, and the professional learning that arose in new inter-professional practices.

Professionals in changing systems

The 2007 discussion paper produced by the UK Treasury, as a result of its detailed policy review of services for children, outlined the need for a broad interpretation of social inclusion and a systemic response:

the system needs to be capable of providing a continuum of support across services throughout childhood and to be able to intervene when poor outcomes do arise … new interventions would still be needed to deal with those who will begin to signal a higher likelihood of poor outcomes at a later age but who had not done so before.

(Treasury-DfES 2007:19)

The paper continued:

The need to identify children experiencing poor outcomes, and to monitor children to identify who might be showing signs of developing poor outcomes, implies a key role for universal services. These services, such as health visitors, GPs, children’s centres and especially schools – which have constant contact with children throughout their childhood – could play the primary role in identifying which children might be vulnerable.

(ibid: 19)

Box 1.2 The need for a whole system approach

The way forward for professionals, it argued, is to recognise that targeted and specialist services are vital for prevention and early intervention, but prevention also depends on the work of these universal services. Prevention needs ‘a whole system approach’ and the ‘full engagement of universal services, especially schools’.

A whole system approach marks a considerable change for services that are used to working to their own professional standards on their own professional goals. In the LIW study we focused on the changes in practice identified by the practitioners as they began to work across organisational boundaries with other professionals. Through examining their developing practices and their frustrations with them, we identified the organisational shifts that were necessary. These frustrations were usually related to the old rules that still governed new practices and the barriers that existed at the organisational boundaries that were tested by new practices. For example, systems of referral that meant that organisations passed on ‘bits of the child’, as one practitioner put it, from one to the other, were opened up for scrutiny and criticism of how slow the respective organisations were in enabling parallel inter-professional collaboration that was more responsive to the needs of children.

Our main focus, however, was the learning that occurred in doing interagency work. Here again practitioner frustrations were important because, as they were discussed, the ways in which they were understood were revealed to the research team. We will look in detail at what practitioners were learning in Chapter 4. At this point we will simply point to two major changes demanded of professionals. Discussion of these, and others, is developed in later chapters. First, practitioners learnt that they needed to look beyond the boundaries of their organisations at what else was going on in children’s lives and, at the very least, to develop some understanding of how other professionals interpreted specific children, their needs and strengths. Second, this outward-looking stance was accompanied by a revived focus on individual children as people with complex lives who were interconnected with their families and communities. The complexity of children’s worlds was no longer hidden from practitioners by their looking at them using the narrow lenses of a tightly focused profession. Instead, areas of children’s lives that were beyond the influence of practitioners as individual specialists were revealed.

Initially these revelations were met by worries about professionals being expected to become the all-purpose generalist practitioner, the complete problem-solver. Edwards outlined these practitioner concerns in a paper drawing on her study of the Children’s Fund and, arguing against generalist practice, produced a list of elements of the new multi-agency working – see Box 1.3.

Box 1.3 Features of inter-professional practice

• • A focus on children and young people as whole people, that is, not as specific ‘needs’.
• • Following the child’s trajectory.
• • An ability to talk across pr...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• List of illustrations
• Series editor’s preface
• Introduction
• Acknowledgements
• PART I What is the issue?
• PART II What does the research tell us?
• PART III What are the implications?
• Appendix A: Activity theory in the Learning in and for Interagency Working Project
• References