Education of children in need

A study suggesting ways to iron out failures in communication between schools and children’s services is evaluated by researcher Claire Cameron

The research

Title: Multiprofessional communication: making systems work for children

Authors: Georgina Glenny and Caroline Roaf

Publisher: Open University

Background

Teamwork is the cornerstone of practice in integrated children’s services. This is underpinned by the Children Act 2004, which stated that agencies must actively make arrangements to work together in preventive and pre-planned ways.

The Children’s Plan in 2007 reinforced the vision of integrated working in interprofessional teams to cut across professional boundaries to fit services around the needs of children.

Research evidence shows, however, that teamwork is difficult to achieve and sustain. This article examines some critical issues arising from Glenny and Roaf’s study and draws on relevant research.

Objectives and methods

This study aimed to identify the ingredients of effective communication systems in professional practice with children. Taking place over seven years, it re-examines a series of case studies that describe and discuss the services around six school clusters in areas with varying levels of social disadvantage. Two of the six studies were reviewed three times over the seven years, allowing changes to be evaluated.

In each cluster, interviews were held with members of staff in schools and support services, and case studies of individual children and collaborative projects were reviewed. In the analysis, Glenny and Roaf aimed to identify how individuals “made sense of” their experiences of working together, which they saw as strongly influenced by the specific context in which interactions took place.

Findings

The starting point was a perceived failure of the system of communication between schools and children’s services about help for children. There were those whose level of need fell below the threshold for help from children’s services departments, but were still living with levels of neglect that affected their educational success, and others whose needs met the threshold but schools could not engage the attention of overstretched social workers.

There was no sense of a team effort built on consensus on behalf of children and their families.

Negative outcomes

Early findings from the first study were negative. Examination of pathways for individual children with multiple needs showed a lack of strategic direction and ownership about who was involved and on what basis, with frequent delays, lack of co-ordination and assessment taking up a disproportionate amount of time compared with actual help.

Moreover, respondents reported that, although they could recognise difficulties with the system, they were individually powerless to overcome them.

The second phase of the study examined the introduction of multi-professional school consultation teams in the same locality as phase one. These met twice a term to consider issues, plan action and review progress.

Input came from the head, the special educational needs co-ordinator, pupil support services, health teams such as school nurses and speech therapists, and Sure Start staff. These teams were considered successful forums for problem-solving, planning, avoiding duplication and identifying gaps in provision.

Teams based in schools reported up to a core group which had a locality-wide role in reviewing needs and planning action to improve service delivery. The partnership of cluster schools as a whole participated in projects to address perceived needs such as developing a home school community link worker, collaborative approaches to providing speech therapy in schools, sharing specialist resources and developing a crisis response initiative to complex and urgent cases.

School level expertise

Gaps in expertise at the school level – safeguarding teams and mental health – were later addressed through more direct communication between SEN co-ordinators and social workers, which improved the quality and decreased the flow of referrals.

A third phase of study examined responses to similar issues in rural areas. This was done using a network, which was a looser grouping of agencies and community groups. Discussions resulted in a review of mental health provision for young people but the less continuous and focused membership of the network did not always ensure that identified needs translated into action.

School consultation teams, or their equivalent, are nothing new. A study of multi-professional teamwork by Anning and colleagues examined teams working in youth crime, young people’s psychological services, nurseries, head injury and child development, all of which were complex entities with varying methods of professional management and accountability and all seeking to integrate working methods and plan to avoid duplication of effort.

Similarly, a study of working together in extended schools and children’s centres by Cameron and colleagues found that schools used multi-professional teams to discuss and plan for individual children causing concern either on case-by-case basis or on a regular, institutionalised basis.

Swedish schools

The latter study used comparisons with Swedish schools where a “pupil health and care group” reflected on and analysed children’s progress and more institutional level matters, from the viewpoints of teachers, school nurses and “free-time workers” whose roles were weighted towards the pastoral care of children.

In all these cases, teamwork was seen as complex and requiring active construction and re-construction as team members arrive and leave. For Glenny and Roaf, the first step in creating an effective communication is building reflective capacity among team members and into organisational structures.

This could be a core group or a network, but is needed to facilitate “quality information” about the dynamics of the local area.

A shared purpose is also required, which can be a function of shared activity rather than its prerequisite. In Glenny and Roaf’s examples, the working together took the form of small-scale collaboration on ­resolvable pieces of work directly relevant to all concerned.

Question of scale

Added to this can be the question of scale. Glenny and Roaf found that a concept of locality or “patch” which was large enough for collective resources and action to be pooled created a sense of belonging.

Cameron and colleagues found that the size of groups or schools was an important factor in teamwork: a large school had created a “school within a school” through halls with which students and staff identified throughout their time there.

Swedish schools were organised into groups of staff and about 100 students, often drawn from more than one year group. In both cases the size was small enough to create a sense of relevance and meaningful participation.

There is also the question of coherence of any geographically defined patch in terms of neighbourhoods and congruence with service delivery from a number of agencies.

If there is a lack of congruence, the costs of collaboration can outweigh the perceived benefits.

A fourth characteristic of successful team working was the presence of what Glenny and Roaf referred to as a “system minder”, someone who maintained and nurtured the network of relationships.

This person had a facilitative rather than a traditional leader role; he or she held “the collective memory” of the group, and offered a point of continuity when membership of the group changed or ways of working were re-discussed.

Finally, Glenny and Roaf point to the importance of local relevance and ownership in creating effective multi-professional teamworking. They argue that replicating multi-professional teams on the basis of policy or organisational instruction is likely to fail if it does not engage with the local practitioners’ perceptions of relationships that require nurture and protection.

In their study this was particularly the case when large-scale restructuring took place, and established ways of working were threatened.

Glenny and Roaf conclude that developing effective multi-professional teams requires attention to the whole “appreciative system” of communication and includes the aforementioned ingredients. In their study, the appreciative system offered continuity to children and their families and specialist help was offered much earlier than before.

Schools are seen, under the Children Act 2004, as the first and often the main point of access for support services for children and families. Unpicking the complexity of multi-professional relationships and contexts for practice in and around schools and support services shows that successful implementation of working together policies cannot be guaranteed.

Integration of children’s services into effective teams, further encouraged through the policy injunction to co-locate services within schools, is likely to be dogged by what Glenny and Roaf call “collaborative inertia” unless attention is paid to the essence of collaborative activity: purposeful communication about particular pieces of work “ensuring the patchwork of individual effort in relation to a particular family makes sense”.

Claire Cameron is a senior research officer at the Thomas Coram Research Unit

Resources and links

● Anning A, Cottrell D, Frost N, Green J, Robinson M (2006), Developing Multiprofessional Teamwork for Integrated Children’s Services, Open University Press

● Cameron C, Moss P, Owen C, Petrie P, Potts P, Simon A and Wigfall V (2009), Working Together in Extended Schools and Children’s Centres: a study of inter-professional activity in England and Sweden, Executive Summary, Thomas Coram Research Unit Institute of Education University of London

● DCSF (2007), The Children’s Plan: building brighter futures 

● Glenny G and Roaf C (2008), Multiprofessional Communication: making systems work for children, Open University Press

● HM Parliament, The Children Act 2004, www.opsi.gov.uk/Acts/acts2004/ukpga_20040031_en_1

PRACTICE IMPLICATIONS

Collaborative activity:

Consider why, for what purpose, and to whose benefit, collaborative activity needs to take place.

Local solutions

Locally driven solutions to pressing and resolvable issues of direct relevance to team members are likely to be more successful than top-down approaches.

Resources

Multi-professional teams require resources and effort to build and sustain, including a system minder.

Is co-location essential?

Multi-professional teams operating around schools and local support services do not have to be co-located to be effective; they can be based on agencies working in an appropriately and sensitively sized “patch”.

Importance of reflection

Effective multiprofessional working requires an organisational structure for reflection on activity and dynamics of the group, at a local, and at an overarching, supra-level.

This article is published in the 16 July issue of Community Care magazine under the heading Teamwork in integrated children’s services