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Growing Support
12. Inter-agency issues
Many types of agency and professional group have a part to play in services for vulnerable families. The chief sectors are local government (notably education, social work and housing services), the NHS (health boards and trusts) and the voluntary sector, with the Benefits Agency, Employment Services and Inland Revenue having a major impact on family incomes. Research has identified that a number of issues need to be dealt with to achieve satisfactory partnerships. These include different expectations about child rearing and employment conditions (Penn 2000; Fawcett 2000).
Despite the fact that inter-agency co-ordination is widely advocated by policy makers it has been difficult to achieve, not only in the delivery of services to children and families, but across health and welfare services generally. With regard to inter-agency collaboration within child and family services, the majority of the literature has focused on child protection, therefore for the purposes of this review we shall be largely looking at inter-agency co-ordination in this area. In addition there is a paucity of experimental research to demonstrate clearly that inter-agency collaboration results in positive outcomes for children and families (Mulford and Rogers 1982) or to assess which kinds of collaboration work better for children's services. This reflects in part an oversimplified view of co-operation, with a failure to distinguish different types and levels of co-operation (Hallett and Birchall 1992; Tisdall et al 2000). Also studies have tended to focus more on 'performance against expectations' (Widner 1973), and on 'policy and administrative purposes' (Challis et al 1988). However, there is evidence from professionals to indicate improvements in certain aspects of the child protection process (Hallett and Birchall 1995).
Inter-agency collaboration, be it in child protection or community care is something which has been largely directed by central government, and although also advocated by those in the field, is not always easily achieved. Challis et al (1988:267) suggest that this is because in practice good co-ordination is extremely difficult to achieve, and others have made similar comments regarding co-ordination across the spectrum of health and social care (Wilson and Akana 1987). According to some (Hallett 1995, Weiss 1981, Scharpf 1978), the difficulties can be explained using organisational theory. This suggests that organisations tend to want to preserve their own autonomy, and the change to a more collaborative approach is costly, not only in terms of money but in terms of effort and morale. Therefore organisations are unlikely to change unless they can be persuaded that it is in their interests, or that it is their duty to do so (Scharpf 1978). Also a number of studies have pointed to the differences in professional values and outlooks which need to be reconciled or 'worked through' in order to reach shared understandings.
In a study by Hallett and Birchall (1995) a case study approach was used in two different areas of England to look at co-ordination policy and practice in child protection. This was carried out retrospectively in a purposive sample of cases of child abuse. Although this study did not use an experimental design, the findings provide an interesting description of the views of those working in this area. These views are particularly interesting, considering the literature suggests that barriers to co-ordination are located at an interpersonal level. Participants were asked about their experiences of inter-agency working and in particular were asked whether they agreed with the observation; 'given the opportunity, professionals would probably work better alone' (Blyth and Milner 1990:195). In addition they were asked scaled questions about:
- the ease of co-operation with particular professions;
- preferences as to collaborative partners;
- role clarity and role overlap;
- the extent of agreement about child abuse;
- the degree of urgency with which various professions approached the task;
- the importance of professions involved; and
- perceptions of competence in respect of child protection in various professions (Hallett 1995:295).
The study showed that the majority of participants were in favour of inter-agency working and positive about their experiences of it (Birchall and Hallett 1995). Reflecting the findings from a previous literature review (Hallett and Birchall 1992), the respondents indicated that inter-disciplinary work in child protection allowed an important aggregation of skills and resources.
A key issue in many of the discussions of inter-agency co-ordination has been the blurring of roles. In many areas of health and welfare the blurring of roles within teams has been advocated, but in the area of child protection, where the team approach is less often used this is not a practical approach. Hallett and Birchall found that most professionals were able to identify distinctive roles for themselves and others. They also welcomed role clarity. However, there was some degree of overlap particularly between social workers and health visitors, although this was not something that is particularly advocated by either profession. Health visitors were keen to specify and adhere to their role in child protection. Managers reported that the role of the health visitor was a preventative one and they should not be involved in the support of families, which was largely seen as the role of social work. However, in reality there was overlap. Health visitors did work supportively with families when the need arose, primarily as a result of limited resources in social work. Interestingly it was these two groups who appeared to collaborate most closely. Hallett and Birchall suggest that this possibly reflects the fact that they have most contact with each other in the child protection process and the familiarity of each other's role as well as frequent personal contact creates a preference for working with what is familiar. The other professions involved in the study did appear to have clearer roles where overlap was less likely.
In keeping with previous findings on inter-agency work (Challis et al 1988, Broussine et al 1988) the proximity of workers helped in developing good inter-agency working. Coterminous boundaries between health, education and social work proved to be an important factor in fostering good collaborative work, as well as small professional networks at a practice level. However, it was also found that personalities were a critical factor in the success or failure of inter-agency work. In particular those in senior positions had significant influence on the way in which professionals worked.
Overall the work carried out by Birchall and Hallett (1995) showed that professionals accepted the need for inter-agency co-operation and were mostly satisfied with it. They saw little need for more intense forms of joint work that blurred the roles of the different professions. Information exchange and joint planning were thought to work well.
Inter-agency co-ordination has been a key feature of early years planning and reviews. We have not come across systematic evaluations of the processes involved. There is evidence that some local authorities have sought to build their children's services plans on early years organisational networks (Wheelaghan et al 1999). Voluntary agencies have at times been marginalised as different parts of the statutory sector have sought to overcome some of the traditional barriers among themselves.
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