understanding interprofessional practice; drivers and theory
TRANSCRIPT
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Understanding interprofessional
practice in social work
The Drivers for Changeand
Theoretical Frameworks
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Aims of this presentation:-
Part 1 the drivers for change
To explore some of the historical perspectives of thechanging context of practice;
To consider the some of the political and policy
imperatives that have led to these changes;
To consider economic and social influences that
have influenced developments in contemporary
professional practice.
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Aims of this session:-
Part 2 theoretical frameworks
To outline, as examples, two different theories - systemstheory and social exchange theory - to support analysis
and understanding of the context of practice;
To reflect on the implications of these theories for
personal and professional practice; To outline a model of collaboration that assists both the
practice and analysis of collaborative practice.
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Sir William Beveridge (report 1942) start of welfare state; identified fiveareas of social need: idleness, want, ignorance, squalor and
disease.
National Health Service Act 1946
Tripartite structure:
1. Hospital and specialist servicesemployed own almoners;
2. General practitioners service;
3. Local authority health services Medical Officer of Health was
responsible for public health and community services.
Services were fragmented or even duplicated.
1948 new Childrens Departments
The background.
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Hospital Plan (1959) - rigid distinctions inhibiting to
the development of services;
1960s growing concern about the costs of
duplication and the failure of fragmented services;
Seebohm Report (1968)- reduce differences
between children and adult services through umbrella
of a unified local authority social services department;
NHS followed in 1974.
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Rundown of institutions - disjunction between therealities of institutional closure and the abilities ofcommunity health and personal social services towork together was exposed in the 1980s by thepace of hospital closures;
Making a Reality of Community Care (AuditCommission, 1986) existing arrangements forcommunity care were seen to be chaotic. Thisreport led to policy, statute and early mandatoryapproaches to driving collaborative working.
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The approach, thus far, was deemed a failure (DHSS
1981a; Audit Commission 1986; DoH 1989) chronic
lack of coordination, failure of joint planning and
effective collaboration were major factors that werehighlighted;
Conservative government growth in care provision
from across the wider sector of providers;
Increasingly more reliance on informal carers,
voluntary groups and private providers.
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- Griffiths Report led to Caring for People (DoH, 1989) a
white paper;
- National Health Service and Community Care Act 1990 -
quasi-market; community care plans; a plurality of
providers;
Positive: A greater degree of accountability; greater flexibility and
responsiveness; greater focus on service users; increased knowledge
by them of services available;
Negative: Inadequate co-ordination in joint working arrangements;
difficulties in managing quasi markets; lack of resources; rationing and
charging poor assessment procedures. (Johnson 1999)
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Moves from co-ordination tocompetition
From altruism and reciprocity as fundingprinciples
to
emphasising the individual consumer,providers of services, entrepreneurs and
the market as governing principles
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Throughout the 1990s until the election of NewLabour in 1997 continued advice and
guidance to encourage more collaborative
working, sometimes linked to monies; e.g.
Mental Illness Specific Grant.
The history of partnership work slow with little
effective joint working or planning developedon a consistent or national basis (Bridgen 2003).
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Election of the Labour government (1997) partnership
one of the key strategies for developing public
services;
The New Labour modernisation agenda led by a whitepaper The New NHS: Modern, Dependable(DoH 1997)
a new duty of partnership requiring local services to
pull together rather than pull apart;
Bringing down the Berlin Wall between health and
social care (Glasby 2003);
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Then followed.a raft of initiatives to implement the
modernisation agenda, for example.
Modern Local Government (1998); Health Act 1999; Multiagency drug action teams; Crime and Disorder Act 1998
multi agency YOTs; Quality Protects; Modernising Social
Services (DoH, 1998); NHS Plan (2000); Community Care
(Delayed Discharges) Act 2003; Every Child Matters
Children Act 2004; Independence, Well being and Choice
(2005); Our Health, Our Care, Your Say (2006).
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Tony Blair (1997)Barriers between GPs, socialservices and hospitals must be broken down.
Jack Straw (referring to criminal justice agencies) arocket up the backside and financial penalties for
failing to collaborate. (BBC,1997a)
Frank Dobsonto break down the Berlin Wall betweenhealth and social services (BBC 1997b)
Education, education, education for those toiling incare services collaboration, collaboration,collaboration!
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Old Labour democratic socialism (left)
Conservatives capitalism - rational goal model (right)
New labour hybrid rational goal/ hierarchical model-
entrepreneurial governance - Modernisation and partnership -
The Third Way - (somewhere in-between?)
Conservative-Liberal Democrat coalition government - More
marketisation; driving forward the personalisation agenda;
decentralising - What does the future hold?
Changing political ideologies
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Since the mid 1970s the organisation, financing,managing and provision of health and social care has
been subject to significant, fast and multifarious
change;
At the highest level of generality the goal of healthy
members of a healthy society is likely to be agreed;
The questions are ones of definition, ideology,
strategies and methods.
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Demand has risen;
Expectation has risen;
Changing philosophies;
These take place as a result of struggles for
power over what is to be pursued as
desirable and over how the pursuit is to beorganised and resourced.
(Loxley, 1997:7)
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A series of public inquiries highlighting
professional misconduct as a significant
factor in the resulting tragedies, commonly
with failure of communication between
agencies and different professionals asthe heart of this misconduct.
Additionally .
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Study examined all available child abuse
inquiry reports published in Britain between
1973 and 1994 45 reports (Reder et al
1993);
Forty percent of the inquiries reported an
error in communication that had serious
repercussions on the case because it was not
detected (ibid).
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1974 the report into the death of 7 year-
old Maria Colwell stated that there was
ineffectiveness in communication and
liaison between the agencies involved -
information was not being passed on
and there was no proper co-ordination -
at risk children were not being identified
(DHSS 1974)
Maria Colwell
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The Laming Inquiry (2003)
The inquiry uncovered that child protection staff
missed at least 12 chances to save Victoria.
It also exposed a complete breakdown in the
multi-agency child protection system
established in the wake of the murder of
Maria Colwell. Health, police, housingcharities and social services failed to work
together effectively to protect Victoria.
Victoria Climbi
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Baby Peter Connelly
Extensive contact with different agencies;
Multi-agency meetings; core group meetings;
case conferences; family support service; child
protection meetings; child protection register;child protection plan; police
investigationsetc..
The summary of the case review addresses a
need to improve inter-agency communication
(Haringey Safeguarding Children Board 2009)
Laming (2009)progress report
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it is evident that the challenges ofworking across organisational boundaries
continue to pose barriers in practice and
that co-operative efforts are often the firstto suffer when services and individuals
are under pressure
(Laming 2009: para 4.3)
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Vulnerable adults too
Safeguarding adults board - serious case review
where a mother took her own life and that of
her learning disabled daughter;
The review noted significant deficiencies in
partnership working, insufficient sharing of
information and a need for a more rounded
assessment of the complex range of pressureson this family(Leicester, Leicestershire and
Rutland 2008: para 3.13)
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Report into the murder of Jonathan Zito (Ritchie et al 1994)
A catalogue of errors and missed opportunities in
Christophers care, stretching back over many years;
A long history of violence and non-compliance with treatmentprogrammes;
43 different psychiatrists in the past five years;
Crossed from one side of the City to the other on four
occasions, passing through three out of the four former
regional health authorities.
Christopher Clunis
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Inquiry into the death of Denis Finnegan (Chaired by RobertRobinson 2006)
John Barratt five hospital admissions between 1997 and 2001
psychotic symptoms
Found guilty of three serious assaults in 2002
Murdered Denis Finnegan on 2nd Sept 2004 as he was cycling
through Richmond Park
Inquiry findings included;
ways of working did not facilitate effective discussion
the team did not communicate effectively with John Barratts
partner
John Barratt
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Economic Drivers
The drive for efficiency and effectiveness;
Incentive strategies (with parallel penalties);
Financial powercontracting out etc.
Legislation to remove financial barriers to
joint working Section 75 NHS Act 2006
flexibilities (Lead commissioning; integratedservice provision and pooled budgets).
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Growth of professionalisation challenging the
pervasiveness of a medical model of care;
Shift to the whole person as a basis for action with an
emphasis on the management and co-ordination ofmany different elements of health and social well-
being;
The idea of the collaborative team responding to
complex situations where the needs of individuals andfamilies cannot satisfactorily be meet by one
occupation or agency working in isolation.
Changing patterns of
professional practice and welfare
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In summary the last decade has provided a powerful case for
collaboration and partnership:
A history of inquiries where failures of inter-agency cooperation,
co-ordination and communication were publicly blamed for deaths
or harm to individuals;
A desire to overcome fragmentation caused by recurrent
reorganisations and to manage change in the wider system;
The drive for effective, efficient and economic services;
The movement for consumer rights and empowerment of service
users;
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Growing empirical research and evidence - gains of working
together and the harmful effects of not working together;
The support and protection of children cannot be achieved by a single
agency Every service has to play its part. All staff must have placed
upon them the clear expectation that their primary responsibility is to the
child and his or her family.Lord Laming in the Victoria Climbie Report, paragraph 17.92 and 17.93.
The influence of management theories which view a whole system
in which services should be planned and co-ordinated;
Growing recognition by practitioners themselves that providing
services involves working with other professionals and agencies.
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Part 2
Theoretical Frameworks
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Evolved from mechanical and biologicaltheory.
All organisms are systems, composed of
subsystems and are in turn part of supersystems, e.g. cars and ants!
something that maintains its existenceand functions as a whole through theinteraction of its parts
(OConner and McDermott, 1997: 24)
Systems Theory
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Concepts about the structures of systems:
Systems are entities with boundaries within which
physical and mental energy are exchanged internally
more than they are across boundaries;
Closed systems have no interchange cross the
boundaries;
Open systems occur where energy crosses the
boundaries which are permeable.
Systems Theory
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Input energy being fed into the system general and
specific elements;
Transformation - how the energy is used within the
system;
Outputs effect on the environment of energy passed
out through the boundaries of a system;
Feedback information and energy passed to thesystem system across the boundaries. (See Payne, 2005)
Systems Theory
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Emphasis is on a social focus rather than on an
individual perspective;
Think about the social and personal elements in
any social situations;
Elements interact with each other to integrate
into a whole;
Important principles and ideas that can be
applied to collaborative practice and to
organisations.
Systems Theory
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How is Systems Theory relevant to collaboration?
1. Interaction and interdependence;
2. Energy, e.g. in the form of information and working
together;
3. Resources and services, with the emphasis on
management of processes;
4. Understanding of boundary issues;
5. Interdependence of wholes.
Systems Theory
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A relationship maintenance theory, whichlooks at how people arrive at their
decisions in relationships.
Strong element of reciprocity, a
calculation of return; there is some
element of self interest in all instances
of social exchange and the incurring of
obligation or indebtedness.
Social Exchange Theory
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Social Exchange theory explains how we feel about arelationship with another person as depending on our
perceptions of:
Cost-benefit analysis
Power differences
The negotiation of expectations
Understanding of the roles and responsibilities
The kind of relationship we deserve The chances of having a better relationship with
someone else
Social Exchange Theory
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Comparison level against which we comparethe give/take ratio;
A comparison level for the alternativerelationships;
Social Exchange - concerned with factors that
mediate the formation, maintenance and
breakdown of exchange relationships and the
dynamics within them.
Social Exchange Theory
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Social exchanges are characterised by
interdependence;
Social exchanges are regulated by
norms;
Trust and commitment result from the
emergent experiences;
Social Exchange Theory
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Social Exchange Theory
Therefore there is some element of
self-interest in all instances of social
exchange (Loxley 1997: 36)
But a caution
Power within professional relationships,
professional superiority can damage the
collaborative process (Barrett andKeeping 2005)
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A Model of Collaboration (Whittington, 2003)
Five interconnected spheres - Two stages
First stage = identifies key participants.
1. Service users and carers;
2. Personal;
3. Professional;
4. Team;
5. Organisational.
SUPPORT
A model of collaboration
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Identity constructed through the relationships developed inpartnerships;
Second stage = identifies interaction and collaborative
processes.
1. Collaboration with service users and carers;
2. Inter-personal;
3. Interprofessional;
4. Inter-disciplinary team;
5. Inter-organisational.(Whittington 2003, p.45)
A model of collaboration
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According to Whittington (2003: 57) this
model shows participatory collaboration
across the shifting boundaries of
professions and organisations, and inthe spaces in between
The model is replicated in the whole
systems approaches you may have
come across in practice.
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(collaboration) depends on a sufficient
perception of what is necessary, and
what is to be gainedthe crucial
perception for interagency andinterprofessional collaboration is the
recognition of interdependence (Loxley, 1997:41)
P 1 R f
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Audit Commission (1986) Making a reality of community care, London: HMSO
BBC Radio 4 (1997a) The World at One, 15 October
BBC Radio 4 (1997b) Todayprogramme, 29 December
Blair, T. (1997) Speech to the Labour Party conference 30 th September, Guardian, 1, October, 8.
Bridgen, P. (2003) Joint planning across the Health and Social Services boundary since 1946,
Local Government Studies,Autumn 29 (3): 17- 31.
Department of Health and Social Security (1981a) Care in Action, London: HMSO
Department of Health and Social Security (1981b) Growing Older, Cmnd. 8173, London: HMSO.
Department of Health (1989) Caring for People: Community Care in the Next Decade andBeyond, Cm 849, London: HMSO.
Department of Health (1997) The New NHS: Modern Dependable London: HMSO
Department of Health and Home Office (2003) The Victoria Climbi inquiry: report of an inquiry by
Lord LamingLondon: The Stationery Office
Department for Health (2005), Independence, Well-being and Choice, London: Stationary Office
Department of Health (2006) Our health, Our Care, Our Say, London: Stationery Office
DHSS (1974) The report of the committee of inquiry into the care and supervision provided in
relation to Maria ColwellLondon HMSO
Glasby, J. (2003) Bringing down the Berlin Wall: The health and social care divide. British
Journal of Social Work V.33 (7) pp.969-975
Glendinning, C. (2002) Partnership between health and social services: developing a framework
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Part 1 - References
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Haringey Safeguarding Children Board (2009) Serious case review: Baby Peter Executive summary
http://www.haringeylscb.org/executive_summary_peter_final.pdfHuxman, C. (2003) Theorising
Collaborative Practice, Public Management Review, 5 (3): 401 23.Johnson, N. (1999) The personal social services and community care,
In M. Powell (ed.) New Labour New Welfare State? Bristol:Policy Press.
Laming, H (2009) The Protection of Children in England: A Progress ReportHC330 London The
Stationery Office
Leicester, Leicestershire and Rutland Safeguarding Adults Board (2008) Executive Summary of Serious
Case Review in relation to A and B available from http://www.leics.police.uk
Loxley, A. (1997) Collaboration in Health and Welfare, London: Jessica Kingsley.
Newman, J. (2001) Modernising Governance: New Labour Policy and SocietyLondon: Sage.
Osborne, D. and Gaebler, T. (1992) Reinventing Government, Reading, MA: Addison-Wesley.
Parrott, L. (2005) The Political Drivers of Working in Partnership. In R. Carnwell and J. Buchanan (eds.)
Effective Practice in Health and Social Care, Maidenhead: Open University.
Reder, P, Duncan,S. and Spencer. M. (1993) Beyond Blame, London: Routledge
Ritchie, J.H., Dick, D. and Lingham, R. (1994) The report of the inquiry into the care and treatment of
Christopher Clunis London: HMSO
Robinson, R. (2006) Report of the Independent Inquiry into the care and treatment of John Barratt NHS
London: South West London Strategic Health Authority available from www.zitotrust.co.uk
Seebohm Report (1968) Report of the Committee on Local Authority and Allied Personal Social Services,
Cmnd. 3703, London: HMSO
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Abrams, P and Bulmer, M. (1986) "Neighbours, the work of Philip Abrams", Cambridge:
Cambridge University Press
Beresford, P. (2002) Making User Involvement RealProfessional Social Work, June, 16
17.
Department of Health (2001) National Service Framework for Older People, London:
Stationery Office.
Loxley, A. (1997) Collaboration in Health and Welfare, London: Jessica Kingsley.
OConner, J. and McDermott, I. (1997) The Art of Systems ThinkingLondon: Thorsen
Payne, M. (2005) Modern Social Work Theory(3rd Ed) Basingstoke; Macmillan
Scott J (1992) "Social Network Analysis", London: Sage
Travers, J. and Milgram, S. (1969) An experimental study of the small world problem.
Sociometry, 32, 425443.
Whittington, C. (2003) A Model of Collaboration, In J. Weinstein, C. Whittington, and T.
Leiba (eds.) (2003) Collaboration in Social Work Practice, London: Jessica Kingsley.
Part 2 - References