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What is integrated and collaborative working and why is it so important in childhood practice? The numerous well-publicised child protection cases such as Baby P and Daniel Pelka have emphasized just what can happen when services fail to work collaboratively and this shows why integrated working and collaborative practice is vital and imperative. The outcomes of fatal accident enquiries, like the cases of the children mentioned, continually conclude that a lack of communication between agencies with regards to sharing of relevant information and concerns regarding vulnerable children are one factor which requires to be addressed. The idea behind multi-agency working is that children and families who may require additional assistance are supported effectively and efficiently, therefore minimising or even preventing any difficulties from arising. Children develop in different ways and achieve developmental stages at different rates therefore a diversity of skills and support from a range of different professionals is required in order to successfully meet these needs.
On 10th December 2008, the Scottish Government launched The Early Years Framework to highlight the importance of working in professional partnership to give children the best possible start in life. The Scottish Executive’s concern for social inclusion and desire to promote ‘joined up’ policies, an increased demand on services from service users and not to mention the focus on child-centeredness are just a few justifications for such a focus on and drive towards collaborative practice. The benefits of integrated working are enormous as all professionals implement a holistic approach, and working in partnership creates better quality services. Integrated working ensures early identification of any difficulties by efficient sharing of relevant information, thus ensuring that appropriate intervention can be delivered timely.
Families also develop closer relationships with a variety of agencies throughout the stages of assessment/intervention resulting in better support and engagement of families, and subsequently the needs of the child are more likely to be met. Another benefit is that the more collaborative working that is carried out between agencies, the more knowledge is transferred between professionals allowing for a more well-informed and proficient team around the child. This could also potentially reduce the need for more specialised services. By working in a collaborative way it also allows for critical reflection allowing all agencies to participate in decision-making while refining their knowledge. With that being said, we are faced with a number of barriers that can often make integrated working less than simple. These can include poor communication both within and between agencies, and to some degree a lack of uncertainties in roles and responsibilities, inconsistencies regarding legislation, confidentiality and the sharing of information.
Funding streams are often a barrier to collaborative working. One which I can relate to in my workplace is little to no access to IT equipment and/or compatible systems which would facilitate sharing of information. Some research has been carried out in relation to personality traits within teams and Belbin’s team roles theory shows the importance of recognising the strengths and weaknesses of individuals utilizing the strengths of each person in order to create a productive and efficient team, a clearly beneficial factor in collaborative working. While utilizing the strengths, it is important to manage the weaknesses suggesting that an unbalanced team could just as likely become a barrier. The importance of collaborative working can be seen in the example of a Speech and Language Therapist (SLT). This professional works in close partnership with children and their families, not to mention other professionals. Their job is to assess children with speech, language and communication difficulties or those with difficulties eating, drinking or swallowing.
Communication is an important part of child development which affects every other area of progression. SLT are an invaluable link between education and health as they are skilled at identifying potential underlying difficulties/disorders. There are many factors an SLT has to consider including the impact these difficulties have on the child’s life and the urgency of such a referral. Integrated working is crucial as professionals gain a full family history, thorough assessment of every aspect of the child’s life, and pull this together into a formulation about the child’s difficulties and how they are being maintained. If such a comprehensive assessment was not available then an SLT could potentially arrive at an inaccurate formulation of a child’s difficulties due to incomplete information which other agencies may hold.
The significance of effective integrated working is clear in this case, as the barriers previously discussed can make the job of Speech and Language Therapists very difficult as an inaccurate formulation may result in serious implications for a child’s intervention. An Educational Psychologist is another professional that heavily relies on effective integrated working. The purpose of these professionals is to work with children and young people who are having difficulties with achieving their learning potential. Gone are the days where the only rationale for such issues was innate condition of the child which required treating. Instead psychologists are considering the need for adjustments in certain external influences such as environment, curriculum and peers as well as internal factors like child resilience as possible solutions to such difficulties. This does not undermine the possibility of organic causes such as autism etc.
Their role is vital in supporting children, families, and educators whereby children are not achieving their maximum level of educational attainment for whatever reason (be it social, emotional, familial, or academically) and educational psychologists must work with many different agencies in order to gain a full and clear assessment of all potential factors and causes. Urie Bronfenbrenner’s ecological theory explains how lives are affected by people and events around us, further evidence that psychologists have good reason to believe that certain difficulties children face are in fact to do with these external influences. Bronfenbrenner’s theory is based on five levels of social interaction and its effects. The first level, Microsystem is based on the most direct interactions. Family, peers, school, work or the area in which an individual lives. Mesosystem follows and includes the relationships between microsystems. Next is Exosystem which involves the connections with a social environment in which the individual doesn’t have direct interaction. Macrosystem is the influence of culture, religion, traditions and media. These differ and conflict in different countries.
The fifth level Chronosystem consists of the significant events that occur in an individual’s life, such as getting married or divorced etc. Bronfenbrenner believed that the influence of environmental factors was paramount in shaping the development of children from childhood to adulthood. The Scottish Executive published ‘It’s everyone’s job to make sure I’m alright’ (2002). The focus of this child protection review was an audit of the practice of police, medical, nursing, social work, children’s reporter, and education staff concluding that everyone has a duty and role in safeguarding and ensuring the welfare of children. The audit was based on a sample of 188 cases which covered the range of possible concerns about children from early identification of vulnerability to substantiated abuse or neglect (both of which are significantly detrimental to childhood development).
Neglect and abuse can be deemed as the environmental influences suggested by Bronfenbrenner that manipulate a child’s progression. In many cases the audit found that children were not receiving the services they required and many could not access services such as health care if their parents/carers did not cooperate. This highlights the importance of integrated and collaborative practice and the need for sharing of information across agencies regarding concerns with vulnerable children. Good practice included the provision of help to parents and children as and when was needed, timely responses, early thought and preparation, and accurately assessing the source of the risk. In order to properly assess a childs risk, a multiagency approach is required in order to gain a comprehensive assessment of the child’s needs. Every professional involved in providing a service to children has a duty to ensure their safety and promote psychological wellbeing. In order to do so professionals must share information when there are concerns about a child’s presentation in order to gain a comprehensive assessment of a child’s needs.
Every Child Matters is a UK Government initiative for England and Wales launched in 2003, partly in response to the death of Victoria Climbie. It is one of the most important policy initiatives and development programmes in relation to children and children’s services. It has been the title of 3 Government papers, which lead to the Children Act 2004. The main aims of Every Child Matters are for every child, whatever their background or circumstances, to have the support they need to: stay safe, healthy, enjoy and achieve, economic wellbeing, and positive contribution. Each of these themes have a detailed framework attached whose outcomes require multiagency partnerships working together to achieve. Every Child Matters advocates that it is essential that all professionals working with children are aware of the contribution that could be made by their own and each other’s service and plan and deliver their work accordingly (Baker R 2009). Every Child Matters has been influential throughout the UK-Getting it Right for Every Child is the equivalent approach in Scotland.
The Scottish Government recently published Getting It Right for Every Child (GIRFEC), which was designed to create a consistent, child-centred approach within and across the agencies who are involved with children and young people. Getting it right for every child is being threaded through all existing policy, practice, strategy and legislation affecting children, young people and their families. GIRFEC uses the Wellbeing Wheel (Appendix 1) or the SHANARRI indicators as they’re often referred to, in order to create a consistent way for professionals in multi-agencies to assess a child’s development and general wellbeing. SHANARRI is an acronym for the eight indicators (Safe, Healthy, Achieving, Nurtured, Active, Respected, Responsible, Included) used to make the evaluation of a child’s welfare in order to help them develop their full potential.
It is important that everyone is assessing the same aspects of a child’s wellbeing using their own unique professional training and skills by using these indicators as guidance. This allows all agencies involved to have the same shared understanding of a child’s needs and the support they require. The Scottish Government values the purpose of collaborative working and in order to do so effectively, there must be certain legislation inaugurated. The Children (Scotland) Act 1995 is a child-centred piece of legislation that outlines the provisions offered to children and families and the duties of the local authorities to children’s wellbeing regarding support, safeguarding and intervention. The act emphasizes the importance of the child’s welfare and gives the child the right to have their views considered, when key decisions are being made about their life, incorporating UN Convention on the Rights of the Child. It is law that all agencies must adhere to this act when working with children and families requiring additional needs, ensuing successful multi-agency working.
The Regulation of Care (Scotland) Act 2001 was established to create regulations to which all social care services must adhere to in order to improve and maintain a high quality of care, otherwise they are no longer permitted to provide a service. With Care Inspectorate, the regulatory body ensuring that all care services are following the National Care Standards set by the Scottish Government, it’s easy to see how encouraging everyone to offer the same high quality of care can support collaborative working by sharing knowledge, skills and practice. “A well-qualified, professional workforce is the most important factor in delivering the quality of services that will give children the best possible start in life.” (QAA Scotland) The Benchmark Statements for Childhood Practice outlines the expectations from SSSC and ensures that lead practitioners in childcare settings are qualified to high standard and competent in working collaboratively with parents, families and other agencies.
As previously discussed, when agencies do not work collaboratively there can be devasting impacts which in extreme cases can contribute to fatality which is highlighted by the Victoria Climbie Inquiry Report, 2002-3. Victoria Climbie died in the intensive care unit of St Mary’s Hospital Paddington in February 2000, aged 8 years old. Her death was caused by multiple injuries arising from months of ill-treatment and abuse by her great-aunt and her partner. Victoria’s death led to a public enquiry and produced major changes in child protection policies. One of the recommendations from the fatal accident enquiry was that society should be aiming to ensure that there are systems in place which detect what is happening at an early stage so as to be able to intervene successfully to protect the child. This tragically did not happen for Victoria. She was failed comprehensively by all the services she was known to and who should have ultimately protected her.
Despite repeated contacts with different services, no proper assessment was ever undertaken, and no more was known about Victoria when she died than was known about her the day after she arrived in the country. The very fact that her case was closed by Haringey Social Services the day she died points to the scale of failure. So too does the fact that the authorities charged with her care almost without exception failed to talk to Victoria directly, instead addressing their concerns to those responsible ultimately for her death. Peter Connelly (also known as the case of baby P) was a 17month old baby who died in London after suffering over 50 injuries in an 8month time period, during which time he was repeatedly seen by Haringey Children’s Services and NHS health professionals. The case caused shock and concern partly because of the magnitude of Peter’s injuries, and partly because Peter had lived in the borough of Haringey, under the same child care authorities that had already failed 10 years earlier in the case of Victoria Climbe which had, as previously stated, led to a public enquiry resulting in measures being put in place in an effort to prevent similar cases happening.
The child protection services of Haringey and other agencies were widely criticised. Following the conviction, 3 enquiries and a nationwide review of social service care were launched. Over the course of months, Peter was admitted to hospital with a range of injuries including bruising, scratches and swelling to the head. The serious case review concluded that there were instances of mishandling by officials, missed and delayed meetings, miscommunication among officials, and a failure to follow through with decisions related to the child’s safety. Parental involvement is high on the Scottish Government’s expectations and working within a community nursery run by a committee of parents requires a great deal of collaborative working in order for the nursery to run efficiently and effectively. Finding a balance of what parents want, what children need, while embracing the Curriculum for Excellence requires a great deal of expedient communication.
It requires successful sharing of knowledge and skills between experienced parents and qualified practitioners. The most productive committee would ideally be influenced by Belbin’s team role theory, however finding volunteers to be on such a committee can be difficult. Working collaboratively with agencies such a Visual Screening and Oral Health can have tremendous benefits to children’s wellbeing, is essential in promoting a healthy lifestyle and can offer preventative interventions. Working with other agencies such as Speech and Language Therapists and Educational Psychologists requires a great deal of integrated and collaborative working also and with the introduction of standardised referral forms has helped to establish consistency in information gathering which is a step towards more collaborative working, however working in such a small nursery, communications with these agencies can be infrequent and having such little experience dealing with these agencies, staff can sometimes lack confidence and knowledge how to fill out paperwork and follow procedures.
A suggestion would be to offer more in-house training regarding these procedures to ensure that when issues do arise staff feel competent in dealing with these situations. The importance of transitions for children going to school seems to be high on the local authorities’ agenda. There are many initiatives that would be highly beneficial to children but trying to obtain the involvement of other nurseries can sometimes be difficult. Poor communication and incapability to participate can be an obstacle often hard to overcome due to other establishments’ finances, staffing issues and in some cases the unwillingness to take part. Attending liaison meetings with other nurseries to share knowledge, ideas and information is a great source of collaborative practice, but again this requires the willingness to be involved. One of the biggest barriers in collaborative working is poor communication. It is everyone’s role to ensure that as much information is shared with all agencies involved, the importance of this cannot be stressed enough. How little knowledge some professionals have regarding the roles of others can also be a hindrance. In order to improve collaborative working an increased awareness of the roles and responsibilities of other agencies is imperative.
A Guide to GIRFEC, Scottish Government, 2013
Baker R, 2009, Making Sense of Every Child Matters – Multi-professional Practice Guidance, Policy Press
Early Years Framework, Scottish government, Edinburgh, 2008
Every Child Matters, Sept 2003. www.everychildmatters.gov.uk
House of Commons Health Committee: The Victoria Climbie Inquiry Report, 2002-3
It’s everyone’s job to make sure I’m alright, Report of the child protection audit and review. Scottish Government, 2002
The Case of Child A. Haringey council, 2008, 11-12
The Quality Assurance Agency for Higher Education, The Standard for Childhood Practice, 2007, Linney Direct, Mansfield
The Structure of Belbin’s Team Roles. Fisher et al, 1998, Journal of Occupational and Organisational psychology, 71, 283-288