Integrated Children′s Services

John M Davis

• Publisher: SAGE Publications Ltd
• Year: 2011
• Print ISBN: 9781849207317, 9781849207300
• eBook ISBN: 9781446243152
• Edition: 1
• Topic: Education
• Subtopic: Education General

Working together with fellow professionals across different sectors of children?s services is central to good practice for all those who work with children and young people. This book looks at how children?s services can work together more effectively; by taking an approach that is grounded in research, the book engages critically with both the benefits and the pitfalls of integrated working.

The importance of relationships, roles, responsibilities and strategic planning is discussed, and chapters cover:

- what integrated working looks like in practice

- how early years services work

- ethnicity

- Child and Adolescent Mental Health Services (CAMHS)

- disability and integrated working.

The book encourages readers to reflect on their own background and how this influences their view of specific children, families and fellow professionals, as well as their own practice. Suitable for all those working with children and young people from birth to 19 years in any aspect of children?s services, this book will ensure professionals work together successfully to the benefit of all.

1

Introduction

Chapter Overview

This chapter outlines the key aims and rationale of this book. Before summarising the key arguments, you are encouraged to see the book as an academic and practical text that employs case studies and activities to enable you to get to grips with structures, concepts and relationships in integrated services.

An Integrated Text

Very few books take a truly integrated approach to writing about integrated children’s services. In the main they are dominated by a specific subject bias e.g. either family work, community care, child protection, disability, early years, social work, etc. I have tried to overcome this problem by drawing from research and evaluation that I have undertaken in a range of services (health, education, early years, disability, family support and youth/community education). There are five case study chapters (Chapters 3 to 7), a chapter that defines integrated working (Chapter 2) and a chapter that draws together the different conceptual issues in the book (Chapter 8). You are encouraged to start with Chapter 2 as it sets out a straightforward literature review of writing that defines integrated working and should aid you to quickly get to grips with the different meanings of specific words (e.g. co-location, strengths-based, participatory, etc).

A Text that Draws from Practical Experience

Some of the books in this field tend to draw heavily from academic material/literature reviews, in contrast the chapters involving case studies in this book discuss the practical experience of staff, parents, children and young people before linking these experiences to academic ideas in a ‘discussion’ section. The book aspires to act as a sign-post to quality practice and to enable the reader to self-evaluate how they and their services measure up to a range of theoretical and practical ideas concerning integrated service delivery. The book is innovative in that it can be used in both teaching and practical contexts. For example, to enable students/practitioners and their managers/colleagues to jointly consider the key issues confronting integrated children’s services. The book draws from my experience of teaching students on the BA in Childhood Practice and the MSc in Childhood Studies at the University of Edinburgh. The Childhood Practice students take their degree part-time in the evening and work during the daytime. This means that the degree programme does not separate out academic from practical work. The two concepts are always in play. This differentiates the degree programme from dated approaches that separate out placement from academic work.

The activities in each chapter encourage the reader to pose questions, gather information and develop their practice in the places in which they work/train. The book does not supply the answers to the questions posed in each chapter. You are expected to work those out with your colleagues, team members and/or managers. Though the case studies are drawn from Scotland and England, the book connects its ideas to issues in a range of countries (including Sweden, New Zealand, Ireland and Canada).

Content and Argument

Defining Integration: What are the Different Approaches? (Chapter 2) employs a range of authors to describe a variety of definitions of integrated working and suggests that there are a number of different starting points from which to attempt integrated working. It concludes that at its heart integrated working strives for some kind of jointness (Christie and Menmuir, 2005; Lloyd et al., 2001; Scott, 2006; Wilson and Pirrie, 2000). The chapter indicates that there is a continuum of integrated working including co-operation (at its simplest, information sharing), collaboration (processes of joint planning), co-ordination (more systematic than co-operation and involving shared goals), merger (the full integration/unification of services) (Cohen et al., 2004; Leathard, 2003b). The chapter stresses the need for integrated working to be based on clear professional practices, relationships, roles and responsibilities. It also makes a connection between the requirement for clarity and the need to develop ‘harmonious relationships’ (Bertram et al., 2002; Harker et al., 2004; Stone and Rixon, 2008). Interestingly the chapter does not connect harmony to political neutrality. It argues that discussions concerning conflict should be a central part of team meetings, forums and networks.

Some writers highlight the need for structural merger – others for conceptual unity built on strong relationships. This chapter tentatively begins the processes of analysing the meaning of these different perspectives and argues that the way integrated teams are set up effects their ability to overcome professional differences and build strong relationships (Anning et al., 2006; Glenny and Roaf, 2008; Tomlinson, 2003). The chapter critiques approaches that stereotype professionals and that lead to professional snobbery. The chapter highlights a tension between structure, concepts and relationships, indicating that some writers see relationship building as more important than structures (Anning et al., 2006; Gilbert and Bainbridge, 2003; Leathard, 2003b; Scott, 2006). Yet others argue that structures vary in their effectiveness over time and that good outcomes can be achieved from a range of models (Glenny and Roaf, 2008).

Chapter 2 introduces the concept of holistic ‘strengths based’ approaches that enable flexible services, consider the strengths of families/communities, mobilise support where people live, attend to issues of rights/equity and utilise informal support networks (Dolan, 2006, 2008; Gilligan, 1999, 2000).

‘Strengths based’ approaches are also connected to ‘child centred’ and ‘client focused’ perspectives that view children/families as the experts on their own lives (Foley, 2008; Leathard, 2003b; Rixon, 2008a). The chapter argues that we should move beyond approaches that work with children in isolation of their family and peer group and traditional deficit model approaches to children and families (Davis, 2007; Dolan and McGrath, 2006; Mayall, 2000; Tisdall et al., 2008). It calls for strong relationships to be built with both parents and children (Glenny and Roaf, 2008). In the main, the chapter considers the positive aspects of integrated working (subsequent chapters look deeper into the problems of integrated working). The chapter concludes by stating that there is no perfect way to do integrated working, that integrated working is fluid and that it requires critical engagement with parents/children concerning the pros and cons of specific approaches.

Chapter 3 – Integrated Early Years Services: Co-location, Roles and Development – considers issues concerning co-location, professional roles and qualifications/training in early years children’s services. It employs a case study (Davis and Hughes, 2005) from a Scottish local authority to discuss innovative structural, conceptual and workforce change. It questions the notion of a holistic pedagogical approach in early years because the concept comes from countries that do not have a tradition of integrated children’s services and may overlook political issues. This chapter concludes that different professionals have varied experience of working face-to-face with children and parents in integrated child-care, education, health and social care services. Quality integrated early years provision is connected to the qualification levels of staff, however the chapter critiques the assumption that teachers should be managers and concludes that all staff (whatever their profession) need to make an equal contribution in integrated centres (Billingham and Barnes, 2009; Hawker, 2010). Structural and conceptual integration is linked to discussions concerning the development of a hybrid workforce. This chapter considers the idea that processes of integration require different professions to merge into a hybrid worker (pedagogue). It indicates that individuals in certain professional groupings (e.g. teaching and health visiting) are resistant to ideas of professional merger. Yet it also notes that many early years workers hold similar values and concepts and therefore that a professional merger in children’s services may arise from a step-by-step process of relationship building during merged training routes, joint classes within qualifications, multi-professional CPD and the eventual development of a specific degree programme/qualification (e.g. similar to the BA Childhood Practice degree that has been developed in Scotland for managers/lead practitioners in early years, social work children/family centres, play and out-of-school provision).

The chapter concludes that there is conceptual resistance in Scotland to the structural merger of schooling with play, daycare, out of school and early years but that the new degree-level Childhood Practitioner (e.g. early years centre manager) may be a person who can strive to enable conceptual integration between different professionals. The standards for childhood practice are characterised as encompassing the best traditions of pedagogy that aspire to link theory, policy and practice (e.g. holistic approaches to the child’s mind, emotions, creativity, history and social identity – Bruce, 2004; Cohen et al., 2004). It is suggested that the Childhood Practice standards may enable conceptual integration around more politically nuanced strengths based approaches (incorporating concepts of pedagogy, childhood theory, anti-discrimination and social justice). It is concluded that most professionals who work with children already have aspects of pedagogy in their practice, that the Childhood Practice degree could become a core aspect of the initial training of professionals who work with children in Scotland, that these processes could involve multi-disciplinary classes (or joint academic years) and that existing professionals should be required to carry out multi-disciplinary continuing professional development on key aspects of Childhood Practice. These conclusions lead to the suggestion that for such change to be effective it will need to be bottom up; prevent one professional grouping (e.g. teaching/social work) from dominating others; involve clear roles/targets; and involve a balance of staff providing daily, regular and targeted work.

Chapter 4 – Integrated Children’s Services and Ethnicity – discusses the changing nature of early years services, it considers the strengths and weaknesses of early years services for black and minority ethnic families in a Scottish local authority area. It explains that an evaluation of early years services found that: only a small number of childcare providers employed staff specifically to work with black and minority ethnic children; black and minority ethnic parents and staff felt there was a need for more immediate and accessible interpreters for daily communication; a number of parents had no experience of participation in services; a large number of service providers made no overt effort to value and recognise diversity; and some black and minority ethnic parents were not happy with their provision (Davis and Hancock, 2007). The chapter concludes that greater sharing of resources (e.g. knowledge) should occur between those centres identified as high-quality service providers and those that have difficulties including children from linguistically and culturally diverse families. The activities in this chapter encourage you to consider the diverse nature of racism by adopting a community/strengths based approach to service provisions.

The chapter defines different types of racism: cultural (group behaviour); structural (resources, rewards, roles, status and power); individual (stereotypical views); interpersonal (harassment); and institutional (procedures, e.g. a culturally exclusive curriculum [Figueroa, 1993]). The chapter draws a distinction between writing that gives helpful advice on how to deal with issues of racism and writing that connects issues of anti-discrimination, equity and social justice to the ability of children’s services to develop collaborative, capacity building, integrative and systematic approaches to working with communities. It also raises issues concerning the cultural appropriateness of European concepts of pedagogy, arguing that the westernised play ethos approach of pedagogy may not work for children who have culturally different starting points to those providing the services (Brooker, 2002, 2005; Clark and Waller, 2007; Smith et al., 2000) and that we should never assume that one country’s approach, (e.g. that of Sweden) works in another (David et al., 2010).

The case study is compared to approaches in Canada that cross the boundaries between service provider and user (Ball and Sones, 2004; Moore et al., 2005) and contrasted with approaches in England that concentrate on academic ‘school ready’ criteria, westernised notions of ‘skills development’, and ‘age appropriate’ behaviour (e.g. Sylva et al., 2004). The chapter argues that we need to find ways to integrate community members into services through volunteering, training and employment and that we should engage with models of community governance. Professionals are asked to demonstrate multi-cultural competence; for example, the ability to speak about your feelings, respond to cultural variations concerning verbal/non-verbal queues, and display personal characteristics such as warmth, respect, genuineness, the ability to be honourable and the capacity to be practical, etc. (Moore et al., 2005). Family-centred approaches are defined as those that avoid imposing Eurocentric notions of assessment, involve families from the start of the development, promote local choice/decision-making, and strengthen family/community self help (Ball and Sones, 2004; Moore et al., 2005). You are encouraged to recognise the resources that immigrants bring with them and to consider how to utilise their values, skills and knowledge within processes of community development (Dolan, 2008). It is concluded that whatever your conceptual position, you need to develop approaches that put the participation of children, parents and community members at the centre of service development.

Chapter 5 – Strategic Planning of Integrated Child and Adolescent Mental Health Services – examines attempts by a local authority to develop a more strategic approach to children’s and parents’ involvement in integrated child and adolescent mental health services. The project involved qualitative work with children, young people and professionals. It also involved a review of previous reports – from local children’s rights organisations, psychologists, universities and health services. The case study enables practitioners to consider the key issues of integrated child and adolescent mental health services. It discusses the development of a local mental health strategy, issues of prevalence, different professional approaches to assessment, participatory approaches and conceptual integration. It is argued that we need to question the way we assess children in relation to mental health because some adults fail to take account of children’s own views. Practitioners need to question their personal assumptions and recognise the difference between their medical model presumptions and strengths based approaches (Davis, 2006; Davis and Watson, 2000; Davis et al., 2000). The chapter makes connections with Chapter 4, indicating that children and young people critique professionals who claim to take neutral approaches to ‘treatment’ and judge professionals on the basis of whether they care, are trustworthy, enable choice and take time to explain processes. The chapter indicates that a number of professionals identify with holistic approaches, promote the notion that services should be inclusive, and believe that children and young people should produce solutions for their own life issues. It concludes that different professionals need to be clearer about the different ways that they assess, characterise and treat children and young people, we need to consider the power relations within processes of consultation, participation, evaluation and review, and the development of holistic approaches must take account of local politics.

The chapter defines different assessment/treatment approaches to children and young people in child and adolescent mental health services. Individualised approaches highlight the individual child’s pathology and judge children against normative criteria related to developmental age and stage. Ecological models (based on the work of Bronfenbrenner, 1989) consider the social context outside of the individual child (friends, school, neighbours, local services, national culture, government and the media). Multi-agency approaches aim to ensure that no one professional defines children’s ‘problems’ or the solutions to their life issues, and politically nuanced holistic models (e.g. from the field of family therapy) challenge hierarchical approaches that assume that the medical professional knows best (assuming instead that service users are the expert on their own lives).

The chapter demonstrates the interconnectedness of the body to social places and the importance of understanding the role of social relations in different social locations (Dyck, 1999; Stables and Smith, 1999; Valentine, 1999). It highlights the importance of social as well as organisational aspects of mental health services. It concludes that integrated services have to confront conceptual differences and professional vested interests if parents, teachers, counsellors, psychologists and medical professionals are to move away from processes of labelling children and young people.

Chapter 6 – Participation, Disabled Young People and Integrated Children’s Services – discusses the involvement of disabled young people in service development. It considers a case study of a ‘Communications 2004’ participation project that employed four disabled young people to ask children and young people what they wanted to change about local services and how they would like to engage with their local council (Davis and Hogan, 2004). The project found that children and young people wanted: disability awareness events; improved public transport; better transition to work; and greater inclusion in education, leisure, play and sport (Davis et al., 2006). It is argued that such projects are only worthwhile if they lead to real changes in the life conditions of disabled people (Davis, 2000; Davis and Hogan, 2004). The chapter demonstrates that the impact of the communications project was in the main positive but that it did not enable disabled children and young people to develop the t...

Table of contents

• Cover Page
• Title Page
• Copyright
• Contents
• About the Author
• Acknowledgements
• 1 Introduction
• 2 Defining Integration: What are the Different Approaches?
• 3 Integrated Early Years Services: Co-location, Roles and Development
• 4 Integrated Children’s Services and Ethnicity
• 5 Strategic Planning of Integrated Child and Adolescent Mental Health Services
• 6 Participation, Disabled Young People and Integrated Children’s Services
• 7 Analysing Participation in Local Authorities: A Politically Nuanced Holistic Approach
• 8 Conceptual Integration in Children’s Services
• References
• Index