Understanding integrated working- challenges for policy, practice and research Professor Nick Frost

Sources for the presentation Research in Practice (2005) – ‘Professionalism, partnership and joined- up thinking’ ‘Social workers in multi-disciplinary teams’ – CFSW 2005, vol10, pp ‘Joining-up children’s services’ – CAR, vol16, 2007, pp ‘Being a social worker in an integrated world’ Care Knowledge – Special report Anning et al ‘Developing multi-disciplinary teamwork for integrated children’s services’ (Open University, 2006) With Nigel Parton ‘Understanding Children’s Social Care’, Sage, forthcoming

Recent literature reviews ‘Supporting theory building in integrated services research, Mark Robinson, Mary Atkinson Dick Downing’, NFER2008 ‘Multi-agency working and its implications for practice: A review of the Literature’, CfBT, Education Trust Mary Atkinson, Megan Jones, Emily Lamont July 2007

Integrated working  Integrated working has been a key theme of British child welfare in recent years.  Social work has a key role to play – arguably as the profession best placed to promote integrated working.

A theory? COMMUNITIES OF PRACTICE Etienne Wenger, 1998 MEANING PRACTICE COMMUNITY IDENTITY (Wenger,1998, p5)

Elements of a communities of practice Joint enterprise – negotiated, mutual accountability, interpretations, rhythms, local response Mutual engagement- diversity, doing things, complex, related, maintenance Shared repertoire – stories, actions, discourses, events, tools

The challenges ‘Ambiguity makes processes like co- ordination, communication, or design on the one hand difficult, in continual need of repair, and always unpredictable; and, on the other hand, dynamic, always open-ended, and generative of new meanings … agreement.. is not a precondition for mutual engagement in practice, nor is it an outcome’ (p.84)

The role of social work Arguably social work is the ‘joined-up’ profession – a profession that seeks to liaise, to mediate, and to negotiate between professions and between the professions and the children and their families. In some ways we can see social work as the cement that holds together the service for children and their families, and attempts to ensure that it is connected and forms a coherent whole.

The social worker and integrated working Models of professional practice Status and power Confidentiality and information sharing Relations with external agencies

Models of professional practice “And there was a great deal of tension amongst quite a few workers about why these young people should be treated to a trip to Disneyland in Paris for the Christmas period …how do you work and maintain a professional capacity to endorse something you don’t actually believe in?”

Status and power “I am not overawed by working with people just because they have got a tall hat on, but a lot of people are, and I think a lot of people with tall hats are overawed by their own status as well. And so I think one of the barriers is that sometimes people aren’t listening to each other in that meeting.”

Confidentiality and information sharing ‘There’s issues around confidentiality sometimes, health records having to be, I suppose all records are supposed to be locked up, but the Health Worker and the Drugs Worker have confidential files which don’t go on the system so if you want some information and they’re not there to be able to talk through about it, you can’t access that information.’

Relations with external agencies “that did actually become a team problem because myself and the Social Worker weren’t really having an impact on the problem and things were being promised by the Housing Office that weren’t coming to fruition”

Three major challenges The challenge of ‘models’ The challenge to ‘identity’ The challenge to ‘expertise’

The challenge of ‘models’ Ways of understanding the world Social and medical models Social structural and pathology models

The challenge to ‘identity’ Am I a social worker or a YOT worker? What are my core values? How am I willing to change?

The challenge to ‘expertise’ What am I good at? Why is everyone undertaking assessments?! Can I develop new skills?

Researching ‘the onion’

A conclusion? There is no single way to go about integrating services for children and their families. Local conditions and opportunities for change vary so much that no-one can say, ‘This is where you should start and this is where you'll end up’ (Miller and McNicholl, 2003, p.1)