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This essay will outline and explain why inter professional collaborative practice in social work is important. It will also examine key factors that help or hinder effective inter professional collaborative practice. It will explain why it is important that professionals work together and effectively as a team and the consequences that can occur when professionals fail to collaborate successfully.
There has been a great deal of political and professional pressures for the development of inter professional collaborative practice. From the late 1990’s onwards there were vast amounts of official documents to promote the importance of collaborative working within the health and social care sector. The 1998 social services White Paper Modernising Social Services (DoH, 1998) and The NHS Plan (2000) devoted entire chapters to the subject. It has been argued that inter professional working has advanced further in relation to services for older people than it has in relation to children and families. The Green Paper Every Child Matters (DfES 2003) recognised this and one of the main elements of this paper focused that improved collaboration was required so as not to repeat the tragic events of the Victoria Climbie case (this case will be discussed in further detail later in the essay). 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. Inter professional collaborative practice involves complex interactions between a range of different professionals and is when professionals work together as a team to reach mutually negotiated goals through agreed plans. It is a partnership that can be defined as a formal agreement between the different professions who agree to work together in pursuit of common goals. Collaborative is defined as putting that partnership into operation or into practice. It involves the different professions working together and using their own individual skills instead of working in opposite directions to meet the needs of particular service users. It is suggested that when social workers and other 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 inter professional collaboration.
Social workers have certain ethical obligations to society that they must follow and this comes in the form of The British Association of Social Work (BASW) Code of Ethics and the National Occupational Standards for social workers. The Code of Ethics follow five basic values, Human Dignity and Worth, Social Justice, Service to Humanity, Integrity and Competence whilst the National Occupational Standards outline the standards of conduct and practice to which all social workers should adhere to. Whilst working in collaboration with other professionals, social workers should follow these Codes and Standards to ensure that the best possible outcome is achieved for the service user.
In the past inter professional collaborative practice has been difficult with many disadvantages and that this has caused problems between the different professions involved. This has in the past led to catastrophic tragedies as in the case of Victoria Climbie. Shared accountability is important for effective collaboration and all professionals should be accountable. Each profession should support one another, not be seen as self interested and that no one profession is higher than another. Some of the problems that can occur are when 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 group members. Struggles for power are rooted in professional tradition and social difference. It is believed by some critics of social work that ‘social workers have often been located in settings where they were considered as subordinate to other more established professional groups’ (Brewer and Lait, 1980, cited in Wilson et al, 2008, p.401). Traditionally there have been difficulties within the medical profession and Cooke et al, (2001, cited in Barrett et al, 2005, p.23) suggests that ‘general practitioners felt threatened by a redistribution of power and had problems letting go of their traditionally held power base’. Social work in the past has been described as a semi profession and similar to nursing and teaching and not comparable to the ‘learned profession of medicine or law as it does not have the required features of those professions’ (Freidson 1994). Payne (2000 cited in Barrett et al, 2005, p.23) identifies this as ‘people’s capacity to get what they want’. Power in inter professional collaborative practice 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. Being territorial and not sharing information and knowledge has long been a problem in inter professional collaborative practice. 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 Barratt 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 inter professional collaborative practice. 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’.
Open and honest communication is a vital and probably one of the most important aspects of inter professional collaborative practice. 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 criticism needs to be undertaken alongside constructive suggestions and encouragement and should take place at a time when other professionals are receptive. Active listening is an important skill. To be able to recognise and respond to what is being communicated is a fundamental skill. Professionals working collaboratively should 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 the speaker is saying. Keeping good eye contact and having good body language is just as important. ‘It is estimated that approximately two-thirds of communication is non-verbal, i.e. something is communicated through ‘body language’ – by a body movement, a posture, an inflection in the voice’ (Birdwhistell, 1970, cited in Wilson, 2008, p.297). A breakdown in communication and the lack of sharing of information between the professions in the past have been major failings in inter professional collaborative practice for example in high profile child protection inquiries and this has led to tragic consequences. Effective systems of communication and knowing what information should be shared are essential not just between the professions but also between the service users.
Trust, mutual respect and support are key features to inter professional collaborative practice. Trust was highlighted by many professionals as one of the most important factors in successful collaboration. When trust is absent professionals may feel uncomfortable and insecure in their role and this in turn can lead to defensive behaviour to counteract their insecurities. Stapleton (1998, cited in Barratt et al, 2005, p.22) suggests that ‘trust develops through repeated positive inter professional experience and develops gradually over a period of time’. Trust cannot be gained overnight so it is important for professionals working collaboratively to give one another time for trust to develop. When professionals feel valued, they feel respected. This can be achieved by actively listening to each other and having an insight into one another’s professions.
Conflict between the professions can have a huge impact on the different professionals and service users. Loxley (1997, cited in Barrett et al, 2005, p.24) suggests that conflict is ‘interwoven with collaborative practice’. To counteract some of the problems associated with conflict it may be beneficial to all concerned to form ground rules. These ground rules could go some way to prevent and help the management of conflict and could include; open discussion and the obligation to be able to give each other honest feedback. Most importantly these ground rules need to benefit all parties involved.
A great deal of emphasis is placed on social workers to critically reflect their practice. It literally means that social workers reflect on their practice before, during and after, thinking through tasks carefully. Other professionals may not do this in line with social workers beliefs of critical reflection or in the same way or see that reflection on their own practice is an important aspect of successful inter professional collaborative practice.
To illustrate the above points a practice example will now be explained. The inquiry into the death of ten year old Victoria Climbie highlights the disastrous consequences when communication in inter professional collaborative practice fails. This child death case was fraught with communication breakdowns across the range of professionals associated with the case. In Lord Laming’s report (2003) he draws attention to and illustrates lack of communication as one of the key issues. Victoria Climbie was failed by a system that was put into place to protect her. Professionals failed in this protection by not communicating with each other or with Victoria herself. One of the criticisms in the Laming Report (2003) was that none of the professionals involved in the case spoke to Victoria about her life or how she was feeling and suggests that even basic service user involvement was absent. There was an opportunity which is highlighted in his report that a social worker missed an opportunity to communicate with Victoria by deciding not to see or speak to her while she was in hospital. It could be argued that if basic levels of communication with Victoria herself had been implemented, then more could have been achieved to protect her. It was not only a lack of communication with Victoria herself but a lack of communication between the professions that were investigated in the Laming Report (2003). Communication is equally important between the service user and the different professional bodies. Professionals are less effective on their clients’ behalf if they cannot communicate precisely and persuasively’. (Clark, 2000, cited in Trevithick, 2009, p.117). For successful inter professional collaborative practice to work a combination of personal and professional skills are required, together with competent communications skills to enable the different professions to challenge the views of others. Recommendation 37 of the Laming Report (2003) states ‘The training of social workers must equip them with the confidence to question the opinion of professionals in other agencies when conducting their own assessment of the needs of the child’. On at least one occasion, this did not happen when a social worker did not challenge a medical statement which turned out to be professionally incorrect which in turn led to the tragic eventual death of Victoria. Had the social worker challenged the medical opinion in this instance then it could be argued that more efficient communication and less confusion in the case may have saved Victoria. Alan Milburn (Hansard 28 January 2003, column 740, cited in Wilson et al, 2008, p.474), the then Secretary of State commented when introducing the Children Bill in the Commons that ‘Victoria needs services that worked together’ and that ‘down the years inquiry after inquiry has called for better communication and better co-ordination’. Communication lies at the heart of high quality and successful inter professional practice and Victoria is just one case of when there is a lack of communication between the professionals and the devastating consequences that can arise.
In conclusion, successful inter professional collaborative practice has many elements and all these different elements require that the different professions adopt them. Although inter professional working practice 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 health and social care professionals from different disciplines truly understand each other’s roles, responsibilities and challenges, the potential of inter professional collaborative practice could be fully realised and many of the barriers alleviated, giving a more successful outcome to the service user.
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