Multi-Agency Working: Part One - Crossing barriers

The idea that agencies shouldn’t work in isolation but collaborate has been a formally recognised approach since the 1980s, yet one serious case review (SCR) after another cites poor information-sharing between agencies as a factor. It was a prominent feature of the Baby P case. A less-well-publicised case from 2013 into the death of a two-year-old girl at the hands of her 19-year-old stepfather found that while the agencies alone couldn’t have prevented it, there were misunderstandings between professionals, a need to clarify conversations, and duplications of recording procedures.

In less extreme situations, poor information-sharing can also have unwanted consequences. In one case, a disabled child had multiple appointments with different professionals at one centre because staff wrongly believed they were unable to share information about his condition.

We now live in the age of the integrated review, a focus on disadvantaged two-year-olds, and education, health and care plans for children with special needs. Along with the more familiar issues of safeguarding, inter-agency working is firmly the direction of travel for everyone working with children.

The challenges

Jenny French, in a chapter of The Team Around the Child (TAC), defines these working relationships as a ‘commonsense ideal’ that practitioners have sometimes managed to achieve. ‘However, many have been thwarted because of the impossibility of agencies agreeing targets and being unable to transfer finance across agency boundaries,’ she adds.

A major issue is also culture: there is a different set of norms, standards and language to contend with. At a basic level, problems can arise simply because of different understanding of simple terms such as ‘assessment’, says Bernadette Duffy, head of the Thomas Coram Centre. ‘For early years, observation is of children over time to see typical behaviour, e.g. are they able to express views and ideas?, in a typical context. With health visitors, the assessment takes place in a clinic using short tests designed to find out if a child can do a particular task.

‘When it comes to the integrated review or TAC, it can be quite challenging – early years will say a child does something all the time, while health will say, “Well, they didn’t do this in the assessment.”’

Jean Gross, co-author of Information Sharing in the Foundation Years and who headed up a taskforce on the issue, adds that when it comes to the thorny issue of information-sharing between health and early years professionals, one commonly misunderstood issue is over consent. ‘The problem is not early years services not passing on information to health colleagues – they do; it is early years not knowing they have to ask the consent of parents before they pass information on.’

This is compounded by attitudes of early years practitioners about their roles, according to consultant and trainer Sue Overton. ‘Nursery staff are best placed to know their key children and offer a very valuable perspective to the TAC. But this can be undermined sometimes by a lack of confidence in their own professionalism.

This might be because of the perspective that they are a “justa”; e.g. “Hi, I’m Linda and I’m just a nursery nurse/childminder/room leader”,’ she says.

The CAF, a pre-assessment checklist used by all agencies, has led to improved outcomes

When it works

That is not to say that it is impossible or not worth trying. Recent research from Oxford University shows that organised activities for parents and children in children’s centres reduced parental stress and improved mothers’ health and home learning. Use of the Common Assessment Framework (CAF) – a pre-assessment checklist to identify unmet needs at an early stage, designed to be used by all agencies – has also shown better outcomes. According to a Thomas Coram review of literature on multi-agency working, an evaluation of the CAF in south Gloucestershire found that professionals had been able to successfully deliver two-thirds of interagency plans made for children, and that children and families were reported to have improved access to support, better family relationships and improved school attendance and behaviour as a result. But it found confusion about whether the CAF is a mechanism for referring onto social services or for shared working and responsibility.

The Thomas Coram Centre approach

This flagship Sure Start children’s centre is comprised of a nursery, a separate parents’ centre providing a range of support services, e.g. for special needs and fathers, and health services through the locality team for the area. More than 80 staff work there.

According to Ms Duffy, ‘The key thing is the personal relationship. If you know a professional at a personal level, you feel more comfortable about picking up a phone.

‘At a very simple level, it is, “Do you know who we are and what we do?” We have also worked together on devising aims and objectives. That is very powerful.’ The centre as a whole, including contributions from children, parents, staff and governors, audits its work against this statement.

Ms Duffy adds, ‘All the agencies are committed to working in the best interests of children and families, but we come to it from different perspectives. This means that when we do assessments as part of TAC, other practitioners are clear about how we reach our judgements and vice versa: speech and language therapists can offer real insights for early years practitioners about what it is we are observing, while health assessments tell you how a child compares with children of a similar age, for example.

‘Leaders need to be committed to the multi-agency model. Instead of saying, “We refer on where necessary”, we say, “We are working together on it.” It can be very easy if everyone wants to do it. The difficulty comes when people feel it is outside their brief and don’t want to extend it. That is when it can be useful to have more formal policies in place.’

Information-sharing will be fully explored in part 2 of this series in the 22 February-6 March issue of Nursery World

THE KEY AGENCIES

Health visitors – These are qualified registered nurses who work in the community to promote good health and prevent illness. They spend most of their day visiting people in their homes, especially new mothers and children. They also lead on the 0-5 elements of the Healthy Child Programme (now part of the Integrated Review).

Speech and language therapists – SLTs work with parents and others to assess if a child has speech and/or language difficulties, communication or eating and drinking difficulties. ‘It is incredibly beneficial in our experience having them come in and do a training session for staff, but not usual for this to happen,’ says Ms Duffy. ‘We’ve had staff video themselves working with children and SLTs supporting them by sensitively going though it using their knowledge. When you video yourself, you realise we don’t leave enough time for the children to process, time to think. Generally they say that early years practitioners talk too much and ask too many closed questions.’

Occupational therapists – OTs help those with mental, physical or social disabilities to independently carry out everyday tasks or occupations. They work with adults and children whose difficulties may have been present since birth, or the result of an accident, illness, ageing or lifestyle.

Social workers – Professionals who work with individuals and families to help improve outcomes in their lives. This may be helping to protect vulnerable people and children from harm or abuse or supporting people to live independently. ‘Social workers are under so much pressure and have such heavy caseloads that the chance to get out and do development work with our staff is very small,’ says Ms Duffy. She suggests observing them in action when they visit instead to get a sense of how they view the child. ‘Their perspective might be, “Is this family meeting this child’s needs?”,’ she adds.

GP – community-based non-specialist doctor. GPs also find it difficult to get away, says Ms Duffy. But building up a relationship with the practice manager can be beneficial in many ways, such as informing parents about services.

Other: school nurses/SENCOs, physiotherapists, psychologists, psychiatrists, psychotherapists, specialist services such as experts in autism.