Essay on setting and work

Describe the Setting and the Work it does

This report is commissioned by the Local Authority and is the result of a review a Phase One Children’s Centre who currently adopt and integrated model of working. The scope of the review was to identify benefits and limitations of an integrated approach. Furthermore, a brief exploration of the economic implications is provided and recommendations regarding future strategic structure and planning are detailed.

Terminology

A primary issue with multi-agency working is the inter-changeability and misuse of associated terminology (Morris, 2008; Walker, 2008). This report offers two distinct definitions of multi-agency working and clarifies the use of terms. The first definition describes multi-agency work as ‘a range of different services which have some overlapping or shared interests and objectives, brought together to work collaboratively towards some common purpose’ (Wigfield & Moss, 2001). The second definition contends that multi-agency work is about ‘Bringing various professionals together to understand a particular problem or experience…In this sense they afford different perspectives on issues at hand, just as one sees different facets of a crystal by turning it’ (Clark, 1993). These definitions share the ideology of different professionals from separate agencies working with a common goal and attempting to resolve an issue.

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It is essential to note the differences between multi-agency and multi-disciplinary work. Multi-agency work refers to two or more professionals from different agencies working together, whereas multi-disciplinary refers to the collaboration between different professionals from one agency. For example, (Walker, 2008) suggests that the professional working relationship between a teacher, nursery nurse and teaching assistant within a school is multidisciplinary because although their roles are different, they work within the education agency. However, the relationship between a Teacher, Social Worker and General Practitioner would be multi-agency because it encompasses different agencies (Education, Social Services and Health).

(Wilson & Pirrie, 2000) make further distinctions between multi-agency and inter-agency and argue the choice of terminology is determined by three factors- numerical, territorial and epistemological. This relates to the quantity of professionals involved, locations, and the amount of innovation in developing new ways of working which considers the philosophical foundations of each professional identity(Wilson & Pirrie, 2000). Inter-agency may involve two professionals from different agencies whereas multi-agency involves a minimum of three (Wilson & Pirrie, 2000). Furthermore, true multi-agency working requires professionals to enter each other’s professional environment, both physically and culturally, and establishing or re-establishing a novel and universal awareness and understanding (Coad, 2008; Walker, 2008; Wilson & Pirrie, 2000).

For the purpose of this report, the term multi-agency shall be adopted throughout and shall refer to two or more professionals from different agencies working collaboratively to address the needs of children and young people.

Rationale

The emphasis for multi-agency teamwork initiated following the death of Maria Colwell in 1973 (Walker, 2008) which resulted in significant changes to the structure of child services. However, the deaths of children with whom various agencies were involved continued. Such deaths include Jasmine Beckford (1984), Tyra Henry (1984), Heidi Koseda (1984) Kimberley Carlile (1986), Doreen Mason (1987), Leanne White (1992), Rikki Neave (1994), Chelsea Brown (1999), Victoria Climbié (2000), Lauren Wright (2000) and Ainlee Labonte (2002). Despite enquiries into these deaths only a minority led to negligible changes in policy or guidance and only one led to a radical change in children services (Walker,2008). (Laming) (2003) highlighted significant failings on the part of agencies to work collaboratively to ensure the well-being of children and young people. Laming’s (2003) recommendations were broadly adopted into the Every Child Matters agenda (DfES, 2003) which (Walker, 2008) suggests the government were already considering implementing which suggests the it was implemented because it mirrored the ideological perspective of the government. However, van Eyk and Baum (2002) suggest that inquests have provided h3 evidence that agencies should be working together in a collaborative manner to safeguard children and therefore it is unsurprising that the government have adopted this ideological stance.

Laming (2003) supports this by indicating the inseparability of the protection of children and wider support to families which has been widely accepted (Morris, 2008) and therefore the need for Local Authorities to have agencies working collaboratively is essential (Coad, 2008; Walker, 2008). Despite the development of legislation and policies, the death of Baby Peter in August 2007 was attributed to the failure of Social Workers and other professionals who had seen him approximately sixty times. 

In November 2008 Lord Laming was commission by the government to conduct independent report on the progress being made by Local Authorities to work collaboratively to protect children. Key findings from Laming (2009) included:

• Social Workers are under-pressure deliver but inadequate training.
• The Day-to-day running of protection cases has significant problems.
• Managers are failing to lead by example with an over-emphasis on targets and process.
• The lack of a centralised Information Technology system is hampering progress.
• Administration is too complex and lengthy with a tick-box recording system.
• There is a lack of communication and joined-up working.
• Data protection laws are not clear nor understood resulting in information not being shared.
• There is a lack of funding in Social and Child Protection work.
• There has been a reduction in Child Protection Police Officers.

Laming (2009) made the following recommendations:

• Directors of Children’s Services with no experience with child protection issues should appoint an experienced social work manger.
• All Local Authority Leads and Senior Managers should have child protection training.
• Social Work students should get more child protection training.
• Employers should face prosecution for failing to protect.
• Court fees for Care Proceedings should be reviewed (currently £4000 per case)
• OFSTED inspectors must have experience of child protection
• Explicit targets should be developed for all frontline services
• A national agency should be developed to ensure the implementation of these recommendations.

Legislation

Under Section 17 of the Children Act 1989 the Local Authority has a duty to safeguard and promoted the welfare of children within their area and are in need.  Section 22(3) extends this to include children within care. As the local authority is constructed of many agencies there is an implicit requirement for agencies to work collaboratively. This is stipulated within Section 10 of the (Children Act, 2004) Children which is a development of Section 27 of the Children Act 1989. This places a duty on agencies to pro-actively work with each other to support children and their families. 

However, there also conflicting social policies and legislation which may act to limit the effectiveness of multi-agency working. An example may be a single-mother under the care of Social Services because she is over-crowded in her house.  The assessment indicates this is the primary factor from concern and recommends better accommodation from the Housing Department.  The Governments Every Child Matters vision demands that all children be placed at the centre of social action. However, other laws conflict this.  Housing law does not need to consider the Children Act 1989 or 2004, nor does it force Local Authorities to consider the allocation of accommodation on a child-centred basis, but on the basis of ‘reasonable preference’ (Shelter, 2005, p.www). This leaves the potential for one law to stigmatise with the other to maintain stigmatisation and conflict between agencies arising.

Current Model of Inter-Agency Working

Integrated Service Model

The Integrated Service Model unites various agencies into one hub who deliver a range of services and integrated support children and families within a community. The team share a location, vision, agreed principles and philosophies in developing localised plans to improve outcomes for service-users. This is usually delivered from an early years setting such as a Children’s Centre. The facilities and services of the integrated team are funded by all agencies and out-sourcing funding from voluntary, community and government agencies is also available. Such services may include access to childcare, education, and counselling as well as advice on health, employment and benefits. Furthermore, practitioners actively and collaboratively engage in outreaching activities to identify and target ‘in need’ families.

Parents and children are given the opportunity to learn new skills, discuss their issues (formally and informally), and engage in communal activities. As services are localised it recognises each community is different and has unique needs. Therefore, activities will differ from hub to hub. Furthermore, there is a greater emphasis on co-working and co-training with skills between agencies being shared at a deeper level resulting in better practice and information sharing.

However, the benefits of this model can be limited by local factors such as poor management or failing to identify local needs. Furthermore, getting all agencies involved requires an initial financial and personnel investment along with a clear and agreed strategy on how to merge services. Managing the differences in pay between practitioners and the power each agency holds needs to be considered at a macro-level to ensure fairness and consistency. A failure in this may result in practitioners feeling devalued or threatened. Atkinson et al’s (2001) study found this model is most effective when there is a case lead/manager responsible for co-ordinating services for families which ensures services are aimed at the service-user rather than the organisation or professional. 

A review into outcomes for families with disabled children indicates that a key worker integrated model promotes better outcomes (Liabo et al,2001). Although Liabo et al (2001) acknowledge a lack of large scale and robust studies, an integration of the current evidence indicates families enjoy a better quality of life, lower levels of stress and quicker access to services. However, from a critical perspective a systematic review is required to minimise any bias. Although Watson et al (2000,2002) concur, they argue these are opinions rather than fact and call for localised research aimed at measuring outcomes to enable a synthesis of results.

Alternative Models of Multi-agency Working

Multi-agency Team

The multi-agency team model is considerably more formal than the Multi-agency panel model currently employed. Practitioners are recruited as part of a singular team who share a common goal and a sense of team identity and are line managed by a team leader. However, links are maintained with home agencies through supervision and training.

This team would share a base, although some practitioners would be required to work in two settings. Such an example might include a School Attendance Officer who would be based within the Local Service Team and at the school which can lead to confusion between job roles. As collaborative working is at the foundation of the approach there is inevitably a sharing of skills and knowledge with communication being uncomplicated.

However, recruitment of staff is time-consuming and identification of people not only with the appropriate skills, but also to work collaboratively may be problematic. Also, as this will be new to the Local Authority, time and funding would need to be allocated for team building and development.  There is also a reliance on agencies sharing a good relationship and be willing to partake in meetings, conferences and strategy meetings in addition to service-user discussions.

Measuring the Impact of Integrated Working

The above has highlighted the implications for failing to work in an integrated manner and there is an assumption that effective integrated working actively contributes to the positive outcomes of Every Child Matters. Therefore this section focuses on studies and literature aimed at measuring the efficacy of integrated working.

Cameron and Lart’s (2003) systematic review reaffirms the findings of Cameron et al (2000) that there is little evidence to confirm the benefits for service users of integrated working. Cameron and Lart (2003) are critical of the lack of evaluations aimed at measuring the effectiveness of multi-agency working and highlight the few that have are methodologically poor. Similarly, few studies have provided information regarding the effectiveness of different models. For example, Atkinson et al (2002) interviewed professionals to assess benefits of multi-agency working to service users. They identified quicker access to services leading to quicker diagnosis and treatment. Furthermore, they identified that professionals from different agencies communicated more effectively. However, this study collected the subjective views of professionals and failed to obtain the representative view of the service user. 

Webb and Vuillamy’s (2001) study indicated a reduction in the exclusion of high risk pupils through the introduction of specialist support workers responsible for avoiding inter-agency disputes regarding responsibilities and resources. Webb and Vuillamy (2001) claim the support workers differentiated between school-focused agencies (such as educational social workers, educational psychologists and teachers) and external-agencies (such as Social Workers, Police and General Practitioners). This study reported a 25% reduction in exclusions. Webb and Vuillamy (2001) claim this has far-reaching consequences such as a reduction in crime, better educational and vocational attainment, however, this is broad assumptions based on the statistical link between exclusion and crime and is not proven within the study.

Challis et al (2004) conducted a Randomised Control Trial (RCT) of 256 older people at risk of care home entry. The objective of the RCT was to redesign the decision-making process by assessing the value of obtaining a specialist clinician assessment prior to placing individuals into care homes. Participants were randomly allocated into two groups, the first received the standardised assessment process and second (experimental group) received a clinical assessment from a geriatrician or psychiatrist. The collaboration between the clinician and social worker was at the heart of this RCT. The experimental group continued to experience reduced deterioration mental and physical, had minimal contact with emergency services and carers reported lower levels of stress. Furthermore, NHS costs were lower and social services and the NHS benefited from merging skills, developing communication; and improved outcomes for users and carers.

Despite the findings from these studies, the majority of studies focus on process rather than outcome, for example a Systematic Review by Cameron and Lart (2003) indicate factors which promote and hinder integrated working. This is supported by the Integrated Care Network (ICN) (2004) who contends that even when outcomes are considered this is narrowly focused and are difficult to measure in the short-term without evidence from a cohort study. The ICN (2004) believes emphasis needs to shift from structure and input to outcomes.

Benefits of Multi-agency Working

Inter-agency working is reported to improved the knowledge, skills and expertise of professionals (Sammons et al,2003) due to the increased opportunity for professionals development through working with other agencies (Atkinson et al, 2001,2002). This is supported by Townsley et al (2004) who indicate that the process of multi-agency working is having an effect on positive outcomes for families with disabled children. However, this incorporates the views of professionals rather than service users suggesting a subjective and biased view. The study by Atkinson et al (2002) also considers the views of professionals who suggested service users benefited from quicker access to services leading to quicker diagnosis and treatment. Furthermore, they identified that professionals from different agencies communicated more effectively.

Challis et al (2004) conducted a Randomised Control Trial (RCT) of 256 older people at risk of care home entry. The objective of the RCT was to redesign the decision-making process by assessing the value of obtaining a specialist clinician assessment prior to placing individuals into care homes. Participants were randomly allocated into two groups, the first received the standardised assessment process and second (experimental group) received a clinical assessment from a geriatrician or psychiatrist. The collaboration between the clinician and social worker was at the heart of this RCT. The experimental group continued to experience reduced deterioration mental and physical, had minimal contact with emergency services and carers reported lower levels of stress. Furthermore, NHS costs were lower and social services and the NHS benefited from merging skills, developing communication; and improved outcomes for users and carers.

Webb and Vuillamy’s (2001) study indicated a reduction in the exclusion of high risk pupils through the introduction of specialist support workers responsible for avoiding inter-agency disputes regarding responsibilities and resources. Webb and Vuillamy (2001) claim the support workers differentiated between school-focused agencies (such as educational social workers, educational psychologists and teachers) and external-agencies (such as Social Workers, Police and General Practitioners). This study reported a 25% reduction in exclusions. Webb and Vuillamy (2001) claim this has far-reaching consequences such as a reduction in crime, better educational and vocational attainment, however, this is broad assumptions based on the statistical link between exclusion and crime and is not proven within the study.

Counter-Evidence

Despite the findings from these studies, the majority of studies focus on process rather than outcome, for example a Systematic Review by Cameron and Lart (2003) indicate factors which promote and hinder integrated working. This is supported by the Integrated Care Network (ICN) (2004) who contends that even when outcomes are considered this is narrowly focused and are difficult to measure in the short-term without evidence from a cohort study. The ICN (2004) believes emphasis needs to shift from structure and input to outcomes.

Cameron and Lart’s (2003) systematic review reaffirms the findings of Cameron et al (2000) that there is little evidence to confirm the benefits for service users of integrated working. Cameron and Lart (2003) are critical of the lack of evaluations aimed at measuring the effectiveness of multi-agency working and highlight the few that have are methodologically poor. Similarly, few studies have provided information regarding the effectiveness of different models.

Facilitators to Multi-agency Working

Evidence on Removing Barriers

Barriers to Effective Multi-agency Work

There are apparent dangers to encouraging inter-agency and multi-agency working. As (Walker, 2008) stipulates, different professions are likely to have unique values at their foundation which they may want to protect. To provide an example of different values, cultures and practices consider a social worker partaking in an interview with a police officer. The child who they are interviewing breaks down. The role of the social worker is to consider the well-being of the child (from a child-centred perspective), however, for the police officer it is to provide evidence to consider prosecution. Obvious barriers, conflicts and confusion can arise. (Coad, 2008) offers support to (Walker, 2008) and suggests the primary trigger for such issues is the lack of clarity of roles and authority in decision making. The lack of clarity regarding roles may lead to work duplication or providing advice which conflicts with that of another professional. However, this can be overcome through effective communication between agencies and practitioners (Walker, 2008) and transparency regarding decision making processes (Coad, 2008).

In addition, each agency will have its own language, terminology, budgets, targets, assessments and measurement criteria to which other professions may not fully understand.

Overcoming the barriers presented is dynamic and complex. As expectations of politicians, academics and service users change so do the barriers which are presented. Therefore, in order to overcome such barriers a model of integrated thinking should be adopted with the development and deployment of a Children’s and Young Persons Strategy. This should be developed through the conduction of research to include all agencies, academic institutions training professionals, and the views of service users. This should be reviewed on a bi-annual basis to ensure it remains contemporary.

Recommendations

Conclusion

Seeking funding utilises large amounts of managerial time and resources.