Collaborative Practice with Vulnerable Children and Their Families

Julie Taylor, June Thoburn

• Publisher: Routledge
• Year: 2017
• Print ISBN: 9781846198960
• eBook ISBN: 9781315346083
• Edition: 1
• Topic: Medizin
• Subtopic: Gesundheitsversorgung

Collaborative Practice with Vulnerable Children and Their Families focuses on the knowledge and skills needed by professionals who work across disciplines to meet the needs of parents and children experiencing complex difficulties. It establishes the importance of both interprofessional and interagency collaboration.

After detailing the characteristics of parents and children who may be in need of specialized services, the authors describe different approaches to service delivery in theory and practice, provide case examples and exercises, and address the developments in interprofessional education for those currently working in the field. They present evidence supporting collaborative practice as a means of achieving better outcomes for vulnerable children and their families, and explore the difficulties in working successfully across agencies and disciplines.

A provocative examination focused on the wellbeing of families in crisis and the care they receive, this book:

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• Introduces terms that are used in collaborative practice
• Details the legal mandate for working with families experiencing complex problems
• Provides legal definitions of 'children in need' and with a right to receive "targeted" services
• Outlines the circumstances that require court action (family law and criminal law) to protect children from "significant harm"

Collaborative Practice with Vulnerable Children and Their Families examines the values and ethical standards shared by all professionals who work together to help at-risk children and their families, and serves as a definitive guide to professionals in social work, nursing, general practice, pediatrics and related professions.

A volume in the series CAIPE Collaborative Practice Series
Series edited by Hugh Barr and Marion Helme

CHAPTER 1

Collaborative practice: an essential component of the service to vulnerable children and their families

SUMMARY

In this chapter we introduce the terms to be used and provide an overview of the reasons (both in law and from practice) why collaborative working is an essential part of the service needed by vulnerable children and their families. It describes the different approaches to service delivery. It ends with an overview of develop- ments in interprofessional education for those working in this field.

Section 1: Introduction: Why This Book And Why Now?

Interagency practice with vulnerable children and families is essential. It is essential across ‘levels of intervention, by which we mean between primary, secondary and tertiary service levels; between service delivery agencies; and between professionals working in multidisciplinary teams. The focus of this book is effective collaborative practice at the ‘tertiary’ level: that is, with children and their families and carers receiving a ‘targeted’ service because they are at risk of suffering significant harm, or needing out-of-home placement.

Child and adolescent development and child protection research make it clear that the wellbeing of parents and children across the age range who are experienc- ing complex difficulties will continue to deteriorate unless they receive high-quality single-disciplinary services but also well-coordinated services from a range of professionals. A ‘team around the family’ approach is now recognised as essential for the effective provision of support, educative, therapy and placement services.

In the UK when a child dies as a result of maltreatment (or there is a ‘near miss’) an independent review of the case is commissioned by the local board responsible for child protection. These reviews are not about apportioning blame, but rather about deriving the learning from that case. In England and Wales such reviews are known as Serious Case Reviews (SCRs); in Scotland Significant Case Reviews; and in Northern Ireland Independent Management Reviews. We will discuss the learning derived from SCRs more thoroughly in other chapters of the book. However, the evi- dence from serious case reviews is that, despite legislative provisions and policy and practice guidance, interprofessional and interagency practice often falls short of what is necessary.

On the other hand there are many examples of effective practice both in published research and in texts on effective practice aimed at the different professional groups. Most emphasise the importance of teamwork, but the number of texts focusing spe- cifically on interprofessional practice is still limited and some of these are specific to a particular subgroup of families, such as those for whom there are already formal child protection plans, where there are concerns about addictions, or where children are in out-of-home placement or placed for adoption.

It seems that wherever we turn at the moment, the emphasis on collaborative working, integrated care and multidisciplinary teams is at the forefront - mostly because we value it but don’t seem to be very good at it. At the same time, we are in an unprecedented era of knowledge explosion about vulnerable families: what makes them vulnerable, what that means for children and young people, and what we can do to reduce risk factors and increase protective factors.

If we combine these two things - collaborative practice and vulnerable families - we can begin to approach the ways we work with families differently. Whilst the evidence base isn’t as strong as it might be, our intuition, our respective practice wisdom and our moral sense suggest that it must surely be a good thing to work together more efficiently and effectively in engaging with families who are deemed vulnerable, either because of their situations in living with multiple adversities or because we have failed to reach them with our attention and services.

In addition to the many practice texts on working with children and families with complex needs available to each profession, much has been written about policies, procedures and systems that aim to improve collaborative working. However, very little has focused directly on how to work successfully together when parents and children are experiencing complex difficulties.

We aim not to duplicate but rather to build on the work of other scholars, educators and practitioners on the essential elements of effective interprofessional collaboration, and identify the pitfalls that make it less effective than it should be. The reader is strongly encouraged to read one of the key texts listed at the end of the chapter, alongside this book which aims to contribute more specifically to the available ‘tool- box’ for those who work with vulnerable children and families.

The handbook is written with qualifying and qualified professionals in mind, whose professional bodies require them to be competent in working across professional boundaries, but it is also of relevance to students with a more general interest in children’s services. The examples and practice and research literature will mainly be drawn from UK sources but the work will also be accessible to an international readership.

For students on qualifying programmes, it will provide knowledge and information on interprofessional perspectives and on practical approaches to working in integrated teams and networks: for experienced professionals undertaking post- qualifying courses it provides updates on the law, research and practice developments. The sources cited come mainly from health, social care and social work, but in the case vignettes and exercises the roles of other members of the teams around vulnerable families (teachers, solicitors, police, youth workers, housing and other advice workers are also referred to). Although it is accessible to ‘para-professionals’ (e.g. family support workers, teaching or healthcare assistants and at foundation degree level) and professionals working in primary care or community settings, the content aims to be of particular use to those who have decision-making and case-accountable roles in providing services to parents and children with more complex problems. The factual information on policy, procedures and legislation is drawn mainly from England, but reference is made as appropriate to the other UK nations and to the broader international context.

We have started from the assumption that the reader will have some familiarity, or will look elsewhere for, information about the causes and impact of family stress and vulnerability and child maltreatment and about best practice in texts for their specific discipline. We will reference some of the key ones at the end of each chapter.

So we focus in this book on those aspects of knowledge and practice that can make most difference to effective collaboration. The content will aim to develop reflective, knowledge-informed understanding and analytic skills.

Each chapter will include in the text exercises for the reader and reflection points. These are intended to help those using the book to gain the most from it, through making connections with their own experiences and practice and between different sections of the book, and will indicate opportunities for effective collaboration to improve services and care. Exercises will focus on cognitive learning (knowledge and thinking about); affective learning (feeling about); and (especially if the reader is able to learn in a group) behavioural skills. The aim of this book, along with others in the series, is to help readers to develop as collaborative and interagency practitioners working beyond traditional professional boundaries.

Exercises may relate to a paragraph topic, or to one of the case vignettes introduced in Chapter 2 and expanded in subsequent chapters to illustrate specific points. Some include further references, including material available on open websites. We have not, however, provided an appendix with answers to the questions posed. There are sometimes ‘correct answers’ to the questions we pose, as for example with respect to what the legislation permits or requires. But mostly the vignette-based questions we pose for you to explore are not the sort that have a ‘right answer’ and certainly not considering the limited information we have given you. So much depends in every case on the reactions of the different family members (as individuals and in their relationships), on the reasons you have become involved in their family; on whether they requested help or are grudging recipients of your attentions; on your particular role, professional knowledge and skills, and any statutory mandate you have; and on how family members react to you and the nature of the professional relationship you are able to establish with them.

And a word of advice if you are able to work through these exercises in an inter- agency or interprofessional group and which will serve you in good stead in your practice: always be willing to articulate clearly and ‘defend’ an action you are propos- ing, a professional stance you take or opinion you hold, but avoid being ‘defensive’ - of your profession or of your professional views and actions.

BOX 1.1 The terms we are using (see also Glossary)

We use ‘vulnerable families’ interchangeably with

• families living ‘with multiple adversities’
• families ‘with complex difficulties’
• families who are ‘hard to reach’ or ‘hard to change (although they may in reality be struggling to access services) (Daniel et al., 2011).

We avoid the term ‘at risk’ unless it is qualified by risk of what or from whom. We also avoid the term ‘safeguarding’ (from what?) and ‘child protection’ unless quot- ing from guidance or referring to a formal child protection service, e.g. ‘children in respect of whom there is a formal child protection plan’ or (in Scotland, Northern Ireland and Wales) a child is on a ‘child protection register’.

We will use the terms interdisciplinary or interprofessional when collaboration is between different professionals who may be employed in the same or a different agency. We use interagency when professionals work together with colleagues (from the same or a different discipline) employed by a different agency. We explore these terms, together with integratedand multidisciplinary teams, in more detail in Section 3. See Appendix for fuller discussion concerning interprofessional educa- tion and collaborative practice.

REFLECTIVE EXERCISE 1.1

Use the web or go to the library and find two reports or newspaper articles that refer to something that has gone badly wrong for a child or parent. Which professionals are referred to as trying to help the family or who should have been involved but weren’t? Is there any indication in the article that they were/were not working together? Can you think of any reasons why the different professionals managed to work together or failed to do so?

Section 2: The Mandate to Work Collaboratively

Much government-produced practice guidance, academie writing and research that analyses and aims to improve collaborative practice focuses specifically on responses to child abuse and neglect (referred to as ‘child protection’ or ‘safeguarding’ services). Our focus is broader, and we give detailed examples in the next chapter of what we mean by ‘vulnerable’ children and families. But whatever the reasons that have contributed to the family needing coordinated services, the four Working Together guidance documents issued since 1991 in England (and the similar documents from the other UK jurisdictions) give a message about the importance of effective working together which is repeated in the 2013 guidance.

Ultimately, effective safeguarding of children can only be achieved by putting children at the centre of the system, and by every individual and agency playing their full part, working together to meet the needs of our most vulnerable children...

Everyone who works with children - including teachers, GPs, nurses, midwives, health visitors, early years professionals, youth workers, police, Emergency Department staff, paediatricians, voluntary and community workers and social workers - has a responsibility for keeping them safe.

No single professional can have a full picture of a child’s needs and cir- cumstances and, if children and families are to receive the right help at the right time, everyone who comes into contact with them has a role to play in identifying concerns, sharing information and taking prompt action (Her Majesty’s Government, 2013).

Alongside this focus on services responding to child maltreatment, it has been rec- ognised in government guidance and regulations over the years that collaborative practice, between different professionals and for different age groups, is important for all children and their families to ensure that they make the most of the health, educational, leisure and community services available to them. Family support and the need for coordinated early help as soon as difficulties were recognised was a key part of the 1989 Children Act and has been highlighted in child protection guidance since the first version of Working Together: a guide to arrangements for interagency coopération for the protection of children from abuse was published in 1991(Department of Health, 1991). The 2013 version of Working Together to Safeguard Children (HMG, 2013) refers to the necessity of coordinated early help.

Children and families may need support from a wide range of local agencies. Where a child and family would benefit from coordinated support from more than one agency (e.g. education, health, housing, police) there should be an interagency assessment. These early help assessments, such as the use of the Common Assessment Framework (CAF), should identify what help the child and family require to prevent needs escalating to a point where intervention would be needed via a statutory assessment under the Children Act 1989 (HMG, 2013, p. 12).

In Scotland the term ‘protection’ has not been changed to ‘safeguarding’ as in England; area child protection committees and local authority social work departments hold the lead accountability for securing collaborative practice, but the guidance in essence is very similar (Scottish Government, 2014). The edited book by Malcolm Hill and colleagues (Children’s Services: working together, 2012) has very good cov- erage of child welfare policy and practice from across the UK and across service levels, including the range of professionals who work with vulnerable children and families.

The four nations of the UK all have proposals and policies relevant to the inte- gration of health and social care services - you should make it your business to familiarise yourself with those most relevant to your country and to your discipline. In 2004 the English government published a Green Paper entitled Every Child Matters that proposed a way forward to better integrate services for all children and drew together information, guidance and examples of best practice.

We want to put children at the heart of our policies and to organise services around their needs. Radical change is needed to break down organisational boundaries (Department for Education and Skills, 2004, p. 9)

Following on from this consultation, in 2005 the Department for Education and Skills published statutory guidance on interagency collaboration to improve the wellbeing of children:

A set of processes and actions by which partners ensure outcome-focused front-line delivery. It means a holistic approach within which needs can be identified and priorities - national and local - can be addressed (DfES, 2005, p. 11).

Like a range of other government documents around this time in the four UK nations, it concentrated on policies and management arrangements, and there is little in it to aid professionals in their day to day attempts to work together. Peter Marsh, in his critique of policy documents around this time, identified significant leadership challenges:

The Government aims to help services meet [the challenges] through devel- opments which address the problems at both practice and policy levels. The intention for practice is to provide for h...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Foreword
• About the authors
• Glossary of terms
• 1 Collaborative practice: an essential component of the service to vulnerable children and their families
• 2 Who are the children and families most likely to need additional supportive and protective services?
• 3 Working collaboratively within legal mandates and statutory guidance
• 4 The value base for working collaboratively with vulnerable children and families
• 5 The knowledge-base for collaborative practice
• 6 Towards effective collaborative practice
• References
• Index