understanding interprofessional practice; drivers and theory

7/30/2019 Understanding Interprofessional Practice; Drivers and Theory

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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



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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.



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Social exchanges are characterised by

interdependence;

Social exchanges are regulated by

norms;

Trust and commitment result from the

emergent experiences;



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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

for evaluation, Policy and Politics, 30 (1): 11527.

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

understanding interprofessional practice; drivers and theory

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