This essay relates to an observation of professional social work practice in a Crisis Centre for people with mental health issues who are in crisis, who need support and short-term accommodation with the goal of returning home or to a new environment. This essay will mainly focus upon the role of multidisciplinary collaboration regarding the Crisis Centre staff and Crisis Resolution Home Treatment Team (CRHTT) and discuss why collaboration appears to play an important and fundamental role within social work practice. The essay will also aim to demonstrate good practice and possible strengths and weaknesses of multidisciplinary working.
Within the field of social work practice it does seem 'Multidisciplinary working is work undertaken jointly by workers and professionals from different disciplines or occupations' (Pearson & Thomas, 2010:342) and has evolved at varying speeds over the past 30 years in response to imperatives of central government. Mental health was among the first professions to adopt teams of workers from different professions. TheÂ Community Mental Health Team is widely regarded as the model for multidisciplinary working (Community Care, 2010). Relating this to social work the distinctive quality is demonstrating a holistic and anti discriminatory approach, by working with a range of situations, people and having an attribute for developing multidisciplinary and partnerships (Higham,2006:).
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The Crisis Centre is run by a Local Council and National Health Service Trust based in the local community. The centre seems to follow the guidelines set down by the 1975 White Paper 'Better Services for Mentally Ill'. Which highlight's the importance of professions working together to provide a community based service (Social Care Institute for Excellence (SCIE), 2010) demostrating that collaboration is fundamental to social work. The Crisis Centre provides beds for adults suffering a mental health crisis who have been referred to them from the CRHTT, for instance by referral from their Doctor or health department. The next step is to complete an assessment in line with local authority guidelines and procedures, then produce a care plan and risk assessment. If they decided the service user is in crisis and cannot return home, contact will be made to the Crisis Centre.
CRHTT use numerous ways and methods of contact to inform social workers, such as, E-mail, telephone calls and home visits, This demonstrates collaboration through good practice and communication, which is essential to social work. Effective collaboration between staff at the 'front-line' is also a crucial ingredient in delivering the Government's broader goals of partnership between services' (Whittington 2003). Also, in the audit commission 2002 found that 'service users want social workers who can collaborate effectively with others to obtain and provide services.'
During this observation multidisciplinary working was witnessed between the Crisis Centre staff, and the CRHTT regarding a service user already in the centre through a telephone call. The CRHTT seemed to be following the National Occupational Standards key roles section three, by 'supporting the individual, representing their needs, views and circumstances by acting as an advocate' (Higham 2006: 98) and had been informing the Crisis Centre of what was happening. The Crisis Centre staff asked questions in a way that was treating the service user as an individual, by listening to their individual case, respecting and maintaining dignity by only asking questions relevant to the Crisis Centres needs and criteria. Staff spoke clearly and discussed the dynamics of other service users (respecting confidentiality) already in the centre, declaring any conflict or positive interactions that had arisen since their last visit (General Social Care Centre (GSCC), 2010).These skills seem fundamental to social work practice as they are valuing the individual having a holistic, anti discriminatory approach and also ensures no inappropriate misuse of power from the social worker.
Furthermore, in the 1990's New Labour recognised that problems cannot be addressed by people and organisations working in isolation. The Department of Health (1998) introduced the White Paper 'Modernising Social Services', which had multidisciplinary working as a key objective. (Wilson, et, al, 2008:388). In 2000 No Secrets actively promoted that multidisciplinary teams will empower, and promote, well-being of vulnerable adults, through the services they provide and the' need to act in a way which supports the rights of the individual which lead independence'(Department of Health 2000) .
No Secrets (2000) guidance was carried out, by the service user, Crisis Centre and CRHTT via staff communicating throughout the day, and providing an environment where service users can come and go freely, yet still have support during their crisis. An example of encouraging independence was allowing the service user to cook and clean for themselves. Ryan's (2010) evaluation of Crisis Centre and CRHTT asked service users what they valued best about their stay? Their responses included "I was on the lowest rung of the ladder in terms of depression and self esteem. Now I can cook and iron." "It has restored my get up and go" and "It is given me a sense of life back and helped me to find myself. I couldn't have gone on any longer." "Staff have taught me to cope better and manage my panic attacks.'" This demonstrates partnership working with the service user. The 2006 White Paper Our Health, Our Care, Our Say emphasises the importance of people having more control over their lives and access to responsive, preventative services by working together in multidisciplinary teams (Department of Health 2006). The Crisis Centre fulfils this by empowering the individual and following the guidelines.
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Throughout the day, through discussions and observations, it appeared that the Crisis Centre staff and CRHTT encouraged emancipatory practice by involving the service user in their support. This shows good practice also staff were not routinized as each day was different; they for example, they discussed how each individual was unique with unique situations. If social workers become oppressed by working in routines this does not always benefit the service user or themselves, it is not good practice and is not fundamental to social work values (Thompson, 2008). An example of this was observed when a member of the CRHTT came to the Crisis Centre and completed a visit with a service user. During her visit she was contacted from her office through a telephone call, one of which was a new service user needing assessment urgently. She had to re -evaluate her cases, as the new referral seemed to be more of a priority. She did this by speaking to her manager on the telephone and re -arranging for another colleague to see her service user, then asked the office to let the service user know about this change showing collaboration, good practice.
This commitment demonstrates multidisciplinary working and partnership working with the service users are fundamental and collaboration is needed for social work and the interpretation from the staff involved, demonstrates good practice, 'Collaborative working is required by government. To illustrate the importance of partnership working with service users Ryan (2010) asked service users how they felt about staff? Service user's responses included "Any questions or anything you are upset over, you can go and ask the staff" and "Staff are very supportive and help sort problems out." Illustrating how social work is about working with people to help themselves.
This essay has demonstrated positive multidisciplinary working through observation at the Crisis Centre. However, it appears multidisciplinary working can be negative and can be totally dysfunctional. When a group of diverse people with varied skills come together into a team, things don't always go smoothly (Community Care, 2010). Cree, (2003) cites 'multidisciplinary working can be positive, but also frustrating, isolating' (Dalrymple &Burke 2006:139). Wilson et al (2008) agrees multidisciplinary working does not always work effectively and such failures have been documented in finding of Victoria Climbie enquiry and Baby Peter. It was also made clear that social workers must reflect on each case and not make assumptions that someone else is doing it. In addition Thompson (2005) believes that multidisciplinary can do more harm than good and can make situations worse.
During the day it was bought to attention through a staff handover, refection that one of the service users in the Crisis Centre had experienced a negative experience. Conquesenlty, this seemed due to the breakdown of communication between, his social worker, CRHTT, Crisis Centre staff and medical staff. According to Thompson (2009) without effective communication the notion of multidisciplinary becomes unobtainable. Staff at the Crisis Centre believed it was due to lack of budgets and lack of communication. During this handover reflective practice was witnessed because as a team they spoke about what, why and how things had gone wrong for the service user and how they could approach the situation to get the best outcome. The staff at the Crisis Centre spoke about how they valued supervision meetings as it gave them the chance to voice any concerns they had and also gave the manger chance to deal with any systematic practice that was leading the staff to become unfocused (Thompson and Thompson 2008). Supervision meetings demonstrate good practice and are part of social work codes of practice to develop through opportunities to strengthen skills and knowledge.
This essay has demonstrated through observation the important of working with other professionals as one person cannot solve another person's problems alone (Thompson and Thompson, 2008). Also that multidisciplinary working is integral for social workers and many other professionals. This essay has aimed to provide a balanced outlook on multidisciplinary working as it demonstrated positive points, as working with other professional's by pooling skills together is essential. Correct use of legislation and commitment to social work practice can all enrich a service user's life. Problems do occur though when multidisciplinary teams do not always communicate effectively and this can be frustrating. Through observation it became apparent that lots of people contributed to multidisciplinary teams and showed that collaboration, good practice and communication were not always ideally used within practice.
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