English
中文Introduction
During my final year postings as a student social worker, I happened to witness and be part of collaborative working in an inter-professional environment. I am going to analyse collaborative working in relation to the scenario that I witnessed. My focus in this discussion of collaborative working will be on the social services. Dictionary definition of ‘to collaborate’ is to work together. Health professionals have been debating the merits of collaborative practice over the past decade, a period during which NHS reforms have been implemented (DoH 1990, 1992, 1993, 1999) addressing the issue (Whitehead 2001). An area of particular interest has been the varying levels of teamworking that currently exist, from interdisciplinary to multi-agency collaboration. In my context of work, multi-agency collaboration is vital for delivering a holistic, client centred care. Collaboration between health care professionals like doctors, nurses, health visitors and social services along with other agencies like school authorities and care home managers is quite crucial for addressing the needs of special group like the ‘looked after children’. First part of this paper briefly describes about a scenario involving a looked after child, in which collaborative working was needed to meet the complex needs of the child. Second part is an attempt to critically analyse the collaborative working, different perspectives and theories, advantages and disadvantages of collaborative working
As a final year student of the social services, I was posted in a community mental health team specialised in dealing with child and adolescent mental health problems. A 14 year old boy was referred to the child and adolescent mental health service (CAMHS) by the school authorities. He was living in a rented council house with the foster parents. He was dyslexic, was diagnosed to have Cystic Fibrosis and suffered from regular episodes of depression and agitation in the past and was attending special school. He was referred to CAMHS for his increasingly difficult behaviour, aggressiveness and episodes of depression
An approved social worker was integral part of CAMHS and I was posted to learn under the supervision of social worker. Co-ordinating the care for this child was assigned to the social worker. The foster parents were unable to cope with managing the child. The school was reluctant to have him back until the reasons for his presentation are identified and addressed. I accompanied social worker for the house visit and for the meeting with the reviewing officer. We discussed the case with the community psychiatric nurse (CPN) and with the consultant from CAMHS team. An appointment was booked for the CPN to go and visit the child in his house. CPN honoured my request and took me with her for the assessment. We arranged to meet school head teacher to discuss the issues surrounding this child. The management plan was conveyed to the school head teacher. Head teacher was relived to learn that the support is available from the mental health team and social services and was willing to take the chid back in the school once his acute problems are addressed.
A ‘local pooled budget’ was agreed upon between the professionals in health and social care and the social worker was given access to the pooled budget to meet the ongoing needs of the child. Comprehensive care package included providing emergency respite care, when needed, Providing nursery care for the younger sister of the child, arranging transport for the family including ‘social care taxis’ and carers from social service to attend to the needs of the parents. Care package was flexible to meet the changing needs of the family. Child’s medical needs were addressed by the G.P, District nurse, health visitor and the Consultant Physician from the local district hospital. Mental health assessment was completed by CPN, Consultant and the team. Child was referred to psychologist, who was part of the integrated team as well. Child got good benefit from the psychology services. He was started on antidepressant medication by the consultant. Child eventually got better and started attending school again
In the following sections of the paper, I would like to analyse collaborative working with reference to the scenario discussed above. What do we understand by collaboration? The literal translation of collaboration from Latin is ‘together in labour’. Wikipedia (Online Encyclopaedia) describes Collaboration as the process wherein units work together to achieve outcomes for shared stakeholders, quicker and more cost effectively than if they had worked on their own, without having to change the “how” codes of any of the participating Units. Collaboration in the context of health and social care would mean partnership working between multiple professions, agencies and sectors towards a common management plan or care pathway. There are various theories underpinning the group collaboration and interaction like sense making, inter subjectivity, distributed cognition, social facilitation, social impact theory and others (ICS Syllabus)
Collaborative working can be viewed from different perspectives. A critical perspective tries to compare and contrast between traditional professional practise and inteprofessional collaborative practise. The values underlying collaboration may seem to be contrasting with those that are the basis of traditional professional practise including autonomy, knowledge and responsibility (Forbes 2001). Collaborative practise requires a limitation on autonomy and sharing of knowledge. Knowledge is also problematic. While it is possible for two professionals to collaborate from different knowledge bases, some shared knowledge and understanding is required for effective communication to be possible (Lindsay et al 2002)
It is worth considering Government’s perspective on collaborative practise. Collaborative working between professions, agencies and sectors came to the forefront in health promotion, and throughout health and community care services in Britain during the 1990s (Leathard-Audrey 2002). NHS and Community Care Act 1990 brought about fundamental changes in the way health and social care is delivered in the communities (Department of Health. Caring for people 1989) Partnership working in health and social care at strategic, operational and individual levels has been encouraged by various legislations and guidance and funds have been allocated for the special initiatives towards partnership working, especially after 1997. One of the key policies is the NHS plan (Department of health. NHS Plan), which offers incentives to the local councils and health authorities to exercise their powers for joint working under the health act 1999. The Labour governments’ approach in its 1997 White Paper ‘The New NHS: Modern, Dependable’ included a system of integrated care, and the establishment of Primary Care Groups to bring community nurses and GP’s together to improve health. Leathard-Audrey study in 2002 concluded that a new ‘mood of endeavour’ has managed to secure more collaborative approaches, and that collaboration is well on the way to becoming a central part of health and welfare policy. Health and social care teams are now more focussed on the collaborative working and more often than not, a common care pathway and a flexible care package is put in place by integrated commissioning arrangements and integrated provision of services.
Collaborative working is achieved through several models depending on individual cases. Numerous constructs and psychological concepts have been used as a basis for designing and delivering collaborative work through different models. But I always wondered what is essential for successful collaborative working? Cunning et al study in 2003 identifies eight key components towards ensuring successful collaborative work for health improvement. The first is to identify the purpose of collaborative working, followed by the process of setting up the partnership and identifying leadership. Driving the work, effective communication, resource management, involvement of communities and evaluation and review were identified as further components (Cunning et al 2003). Successful collaborative working requires skills like negotiation, problem solving, communication and reflection on how they can be used. Relocating the professionals under the same roof had been propagated by some as a tool to successful collaborative working, but resources and professional skills seem to be more important than organisational arrangements in collaborative working between disciplines (Karicha et al 2005). Communication between the professionals plays a crucial role in collaborative working. Sheehan et al in 2006 compared patterns of communication between inter-professional team engaged in collaborative working and multidisciplinary team. They observed that inter-professional team was characterized by its use of inclusive language, continual sharing of information between team members and a collaborative working approach where as in the multidisciplinary team, the members worked in parallel, drawing information from one another but did not have a common understanding of issues that could influence intervention.
Achieving successful collaborative working requires necessary training for the members across the different disciplines. Inter-professional practise is based on collaboration. But it can not be assumed that the health professionals have either the skills or attributes required for inter-professional practise. They may need to learn how to collaborate (McCallin-Antoinette 2005). McCallin-Antoinette in 2005 concluded that developing inter-professional practice requires a commitment to engage in shared learning and dialogue. Dialogue has the potential to encourage collegial learning, change thinking, support new working relationships, and improve client care. Both formal and informal learning is a must for all the professionals to work effectively in a collaboration environment
In the following section, I am going to analyse my role as a collaborative worker and what I learnt from the experience. My communication skills and negotiation skills were handy when dealing with professionals like school head teacher and the reviewing officer. Collaborative working in this particular case made me realize my own skills and abilities. I received positive feedback from various professionals regarding my communication skills, negotiation abilities and good problem solving skills. In a collaborative working environment, it is important that all the members appreciate their own professional role as well as the role of other professionals involved. I witnessed the various approaches that the different professionals adopt to deal with a particular situation and I learned a lot while shadowing the professionals like CPN, health visitor and social worker. Looked after children and young people represent one of the most vulnerable groups within our society and experience significant health inequalities compared with their counterparts who are not looked after by the local authorities (Simpson-Amanda 2006). Tackling these health disparities and improving their health is a multi-agency responsibility involving local authorities, health professionals, education and many other agencies. Incorporating collaborative working into day to day practise, sharing the skills and expertise between professions is pivotal to the maintenance of an equitable and holistic service for looked after children (Simpson-Amanda 2006) Dealing successfully with this particular child was really an amazing personal experience for me and it further strengthened my aspirations of becoming a social worker.
I identified my own training needs while engaging in the collaborative working. With the advent of specialised education centres like the Centre for the Advancement of Inter-professional Education (CAIPE), formal education has become much more accessible. But the importance of informal learning by work experience can not be neglected. I gained enormous practical knowledge in this attachment as a student social worker. Effective inter-professional collaboration is considered essential for optimum healthcare delivery. Studies have investigated inter-professional education (IPE) as a means for improving collaborative practice, and evidence suggests that the clinical setting offers opportunities for inter-professional learning (IPL) (Moira et al 2007). Moira et al observe that clinical placements provide potentially valuable IPL opportunities and they recommend that facilitating the development of informal (ad hoc) collaborative teamwork skills is proposed as an important consideration when planning and implementing inter-professional education. The National Institute of Social Care, in its various training courses, has incorporated Collaborative Working Practices workshop which aims to promote generic skills for dealing with inter-role and inter-group conflicts (Morgan et al 1998). I honed my practical work based skills while working as a collaborative worker and identified the need for formal inter-professional education to help me work effectively as a collaborative worker.
I would like to highlight the advantages and disadvantages of collaborative working. The advantages of Collaborative working as listed by Whitehead in 2001 are as follow: it creates an environment where the team ‘exceeds the sum of the parts’. Shared aims are established and everyone works towards identified goals. It highlights, through the sharing of experiences and knowledge, the strengths and weaknesses of the collaborative team, it helps to break down barriers of mistrust and reduces rivalry. Hierarchies become more flattened and open. A variety of professional perspectives offers the prospect of innovative and creative practices. Differing perspectives and approaches help to highlight gaps in practice Partnerships and alliances lead to a more effective means of distributing and effectively using resources. The likelihood of more encompassing and holistic care being provided rather than curative biomedically related services is increased. There is greater retention of staff and less stress-related absence. Clients are able to see and have more confidence in a more proactive, concerted and combined approach to their health needs (Whitehead 2001). But collaboration has its own disadvantages and has received both praise and criticism over the years. Karicha et al argue that, at the present time there is insufficient evidence to demonstrate that formal arrangements for collaborative working (CW) are better than those forged informally between committed individuals or teams. Karicha et al further observe that the underlying assumption behind much of collaborative working activity is that a greater degree of integration provides benefits to both users and their carers, a perspective that at times obscures the issue of resource availability, especially in the form of practical community services such as district nursing and home help. They argue that the collaborative working is not evaluated in systematic reviews and they advice caution and discretion while moving towards collaborative care.
Lymberry-Mark in 2006 observe that effective collaborative working within health and social care is hard to achieve, particularly in the light of the vast differences in power and culture between various occupational groupings, and the inherently competitive nature of professions jostling for territory in the same areas of activity. Lymberry-Mark suggest that these issues cannot be resolved unless they are properly understood and they argue that an appropriate role for social work in the context of partnership working has yet to be defined. But most people would definitely agree that social service is one of the strong pillars supporting collaborative inter-professional working in health and social care scenarios
