Interprofessional And Interagency Working
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This assignment will critically analyse two examples of interprofessional and interagency practice using examples from my current practice placement. Relevant literature will be used to identify what factors support or constrain interprofessional and interagency collaboration (IPIAC). IPIAC is often described as a holistic approach to an individual's needs. When used effectively, a holistic approach allows for better service delivery to the service user. Hammick et al (2009, p.10) states that being interprofessional is "learning and working or working and learning with others as appropriate, when necessary and sometimes both". Interagency working concentrates "more on the organisational roles and responsibilities of those involved in collaboration" (http://www.scie.org.uk). Interprofessional is relationships between individuals and interagency is relationships between organisations.
IPIAC was a modernisation agenda introduced in public policy by the New Labour Government. Government recognition suggests that many social problems cannot be effectively addressed by any given organisation acting in isolation from others. That is, when professionals work together effectively they provide a better service to the complex needs of the most vulnerable people in society. New Labour also specified that there was a 'Berlin Wall' type division between agencies and professionals and that there was a barrier to co-operation and this barrier should be confronted so that services worked in partnership with service users. However according to research conducted by Hiscock and Pearson (2002, p.11) "several government reports have criticised the lack of coordination between health and social services in the community". So, in essence when professions work collaboratively the service user gets a better deal. "Willing participation" (Henneman et al, 1995, cited in Barrett et al, 2005, p.19) and a "high level of motivation" (Molyneux, 2001, cited in Barrett et al, p.19) have been stated as vital aspects of effective IPIAC.
My current practice placement is within a voluntary organisation in a domestic abuse service. I am a project worker at a Refuge for women and children who are escaping domestic abuse. My role is to co-link work with permanent Refuge staff and co-ordinate each service users support needs whilst maintaining links with appropriate statutory and voluntary sectors.
INTERPROFESSIONAL PRACTICE ONE
The first example of IPIAC to be discussed and analysed within my practice placement will be a weekly meeting held between Refuge staff, health visitors and the play-worker from Women's Aid. The aim and purpose of these meetings is to share information so that identified needs of the families in the Refuge can be addressed and where possible be signposted to other services as required. The meetings are designed for professionals to share information and knowledge about the family's lives but not make decisions on their behalf (except where there are child protection issues). The meetings also aim to provide support to families according to assessment of need using professional judgement. Within these meetings everyone discusses and communicates the personal development and progress of the women and children in the Refuge so that all professions involved are kept up to date with the family's circumstances and situation. This supports IPIAC and is effective in that it is a chance for everyone involved to gain further advice and guidance from other professionals in relation to their current level of involvement with the families. This in turn supports the families and assists them with their future goals and plans. However these meetings could be interpreted to some as 'secretive' as they are held behind closed doors and it is a meeting in which the families are not involved in. This could be construed as an 'expert power relationship' to some (Maclean and Harrison, 2011, p.31).
For IPIAC and these meetings to be effective it is vital that all professionals involved support one another and are not be seen as self-interested or see themselves as higher than another profession. This is when problems occur as there is not a logical distribution of power. "Unequal power distribution can be oppressive" (Payne, 2000, cited in Barrett et al, 2005, p.23) and can limit participation for some professionals. Power in IPIAC should be shared and distributed and no hierarchy of power should exist. If some professionals see themselves as more powerful than another they are not meeting the needs of the service user. Sharing of information and knowledge about the families in the Refuge is the purpose of these weekly meetings so as to achieve the best possible outcome for the service user.
A constraint of IPIAC is that some professionals are territorial and do not like to share information and knowledge. Molyneux (2001, cited in Barrett et al, 2005, p20) "found that professionals who were confident in their own role were able to work flexibly across professional boundaries without feeling jealous or threatened". "Professional adulthood" was an expression used by Laidler (1991, cited in Barrett et al, 2005, p.20) to describe professionals who were confident in their own role to share information and communicate effectively with other professionals. These professionals do not feel territorial about relinquishing their knowledge and understanding to further enhance good IPIAC. Stapleton (1998, cited in Barrett et al, 2005, p.20) suggests that "a combination of personal and professional confidence enables individuals to assert their own perspectives and challenge the viewpoints of others".
Active listening is an important skill to maintain in order to achieve effective IPIAC. To be able to recognise and respond to what is being communicated is fundamental. Professionals working collaboratively should be able to demonstrate this verbally and non-verbally to each other. This is greatly helped if all concerned put aside the typical stereotyping of each other's professions in order to hear and listen to what is being said. Effective open and honest communication is vital and probably one of the most important aspects of IPIAC. It requires professionals to take into account each other's views, be respectful, dignified and to listen to each other without being highly critical of one another. Constructive feedback about the family needs to be undertaken alongside constructive suggestions and encouragement and should take place at a time when other professionals are receptive. However, being receptive to what is being said does not always occur during these meetings. At times, one professional does not like what another is conveying and this can create conflict within the professions. However the need here is to remember that it is the service user that is central to the process and that the goal is to achieve the best outcome for them and their family.
There are elements within this example that both support and constrain IPIAC. To achieve the goal and not result in a poor outcome for the service user it is important for all professionals involved to communicate honestly and openly and for there to not be a significant power imbalance between the professions.
INTERPROFESSIONAL PRACTICE TWO
The second example of IPIAC to be discussed and analysed within my practice placement will be a Multi-Agency Risk Assessment Conference (MARAC). A member of the Refuge staff attends these meetings on a fortnightly basis. A MARAC meeting is a community response to domestic abuse. Cases are referred to a MARAC by the Refuge as a result of completing a CAADA-DASH risk identification checklist (RIC) (see appendix one) with the victim of the domestic abuse. This checklist determines the victim's level of risk/need. If the risk identification score is 14 or more on the RIC, the MARAC threshold for high-risk has been meet and a referral to a MARAC meeting is made. Cases can also be referred to the MARAC either as a result of a high risk domestic crime/incident recorded by the police or by a direct referral from a participating agency. Participating agencies attending the meetings can include representatives of statutory services such as the police, criminal justice, health, child protection, housing practitioners and Independent Domestic Violence Advocates (IDVA's). The purpose of the meetings is for professionals to implement a risk management plan that provides professional support to all those at risk and which reduces the risk of harm. The aim is then to produce a safety plan for each victim of domestic abuse.
The MARAC's aim is to share information to increase the safety, health and well-being of victims/survivors of domestic abuse. They can determine whether the alleged perpetrator poses a significant risk to any particular individual or to the general community. According to Bowen (2011, chapter 5.) "MARAC functions through meetings designed to facilitate multi-agency information sharing, with a view to implementing an agreed-upon risk management and victim safety plan". Effective communication and information sharing supports IPIAC as it can assist to build relationships between agencies across a much broader range. A MARAC with effective communication and information sharing between agencies can also promote IPIAC in developing much stronger relationships between the voluntary and statutory sector. Barrett et el (2008, p.21) states that "communication competence contributes to effective interprofessional working and enables those involved to articulate their own perspectives, listen to the views of others and negotiate outcomes". An effective MARAC meeting which supports IPIAC is when professionals work collaboratively to ensure that victims/survivors and/or their children are safeguarded from further abuse. The government's action plan "Call to End All Violence Against Women and Girls" states that "we all have to work together to achieve our goal of ending violence against women and girls. It is not a task for central government alone". It suggests that agencies need to work together to meet the needs of their local communities and that agencies are held accountable.
However, a constraint of a MARAC meeting that I witnessed was that not all professionals brought the appropriate information to the meetings which lead to an inefficiency and delay of the case which frustrated others professionals attending. Poor timekeeping was another avenue that at times would frustrate other professionals attending the meetings. This seemed to alienate them as I would hear comments such as "we are all professionals here and should act as such" and "as professionals attending important meetings like this, we should always strive to be on time". I also found at the MARAC that some agencies only had snippets of information that on their own did not raise any particular concern. It was only when the jigsaw of information was pieced together that the risk factors could begin to be understood.
This example shows that when MARAC meetings support and strengthen interagency working and is effective, it is IPIAC at its best. This approach to working more collaboratively is beneficial as all organisations are coming together for the purpose of a common goal, with that goal being the best possible outcome for the service user. However some of the MARAC meetings that I had attended were not always that effective due to the fact that not all key agencies or organisations attended the meetings when required to do so or did not have the appropriate information to hand. It is beneficial that all agencies have as much information to hand as possible to facilitate IPIAC and have a profound positive impact on the outcome for the service user.
In conclusion, IPIAC has many elements and all these different elements require that the different professions adopt them so that effective outcomes are achieved for the service user. Although IPIAC has been around for many years and is not new, it still needs to be continued, developed and incorporated into the daily work of all professions. When organisations and professions from different disciplines truly understand each other's roles, responsibilities and challenges, the potential of IPIAC could be fully realised and many of the barriers alleviated. This in turn will contribute to a more successful outcome to the service user which of course is central to effective IPIAC. If IPIAC is ineffective it can limit choice for the service user and also increase risk.
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