Multi-agency voices: A thematic analysis of multi-agency working practices within the setting of a Child and Adolescent Mental Health Service

Abstract

This qualitative study aims to explore the types and purpose of discourse emerging when professionals from a Child and Adolescent Mental Health Service meet with professionals from other agencies to discuss cases. The aim reflects current political and contextual agendas influencing agencies to work more closely together and obstacles to achieving this goal highlighted in the literature such as the need for agencies to develop a common language to discuss children of concern. Data were collected through eight audio-taped meetings involving CAMHS and members of other agencies such as social services and education. A thematic analysis identified nine themes, defined according to their discourse type, including: single agency discourse; case complexity discourse and multi-agency discourse. Results indicate that agencies are hindered from working more closely together and developing a common language for use in multi-agency meetings, because they tend to have different understandings of the terminology used and a common consensus about language and meaning is not usually negotiated within the meeting. There is a need for greater awareness amongst staff from different professional groups and agencies that meaning given by one group will often need to be clarified by others and assumptions about common understandings should not be made.

Teachers' responses to the emotional needs of children and young people. Results from the Scottish Needs Assessment Programme

“…There is also a need to understand better the obstacles to good communication as a precursor to more effective service delivery (Salmon and Rapport, 2005). …”

Barriers to collaboration on behalf of children with challenging behaviours: a large qualitative study of five constituent groups

“…Other relevant studies have examined workers' experiences of supporting children with challenging behaviour (Worrall‐Davies et al . 2004); barriers to inter‐agency case management in high‐risk youth (Okamoto 2001); and inter‐agency discourse between child‐focused agencies during collaborative case conferences (Salmon & Rapport 2005). Taken together, these empirical explorations of inter‐agency practice highlight the importance of resourcing issues, clear communication, clarity of terminology and of understanding the conceptual frameworks of others (Okamoto 2001; Worrall‐Davies et al .…”

Models of interprofessional working within a Sure Start “Trailblazer” Programme

“…The corollary of this is that some experience personal/professional discomfort, feel intimidated, undervalued hence leading to lower engagement and resultant ownership of the process. The discomfort may stem from failure to clarify terminology and professionals feeling inhibited to ask for clarification about meanings because of perceived hierarchies within the room or because they do not wish to be considered awkward or pedantic (Salmon & Rapport, 2005). Some considered the process time-consuming as they would have made a direct referral anyway -it had ''not added anything'' with regard to the family under discussion: ''it is a paper exercise the main thing is to involve the people who are going to be directly involved''.…”

“…The literature on interprofessional collaboration regarding health, education and social care shows that it is not readily achieved in practice owing to dilemmas associated with reconciling different professional beliefs and practices (Easen et al, 2000;Freeman, Miller & Ross, 2000) and further research is needed regarding outcomes and costs (Nicholas et al, 2003;Barr & Ross, 2006). Difficulties of joint working focus on differences in occupational culture, including professional identity, status and accountability (Johnson et al, 2003); the complexity of managing workers on different conditions of service and pay scales (Atkinson, Wilkin, Scott & Kinder, 2001); problems associated with combining funding streams from distinct service budgets (Roaf, 2002); difficulties in developing a common language for use in multi-agency meetings (Salmon & Rapport, 2005) and the need to invest in joint training and to generate continuing interprofessional learning opportunities that build on the basics (Barr & Ross, 2006). Differences and similarities in professional values for instance in relation to nursing and social work should perhaps be accepted as unavoidable and even desirable, and there may be good arguments for concentrating on optimising the quality of interprofessional dialogue around values, rather than for seeking to remove those differences (Wilmot, 1995).…”