Working Partnerships? A Critique of the Process of Multi‐Agency Working in Services to Disabled Children with Complex Health Care Needs

Abstract

Recent government policies in relation to children stress the importance of service integration and partnership working, with particular emphasis on combating social exclusion. With reference to findings from a three‐year empirical study, this article examines some key elements of the process of multi‐agency working in services for disabled children with complex health care needs. It highlights some of the barriers to effective partnerships and lists some pointers for policy and practice.

Service integration and co‐ordination: a framework of approaches for the delivery of co‐ordinated care to children with disabilities and their families

“…Although there is wide variability in real‐life implementation models (Halfon et al . 1993; Townsley et al . 2004), our review of the literature indicates that there are three general approaches to the delivery of co‐ordinated care: (i) a system/sector‐based service integration approach reflecting functions and activities focused on integrating services provided by a number of agencies in a geographical area for a particular client group; (ii) an agency‐based service integration approach reflecting functions and activities focused on co‐ordinating the delivery of services across programmes offered by an agency for families in a particular catchment area; and (iii) a client/family‐based service co‐ordination approach reflecting functions and activities focused on assisting specific families to obtain appropriate and needed services from agencies in a geographical area.…”

“…Service co‐ordinators with systemic roles decide which clients and families will gain access to which services, and make decisions about discharge from services (Austin 1990; Lash & Wertlieb 1993). They may determine the magnitude of the client’s needs, in order to assign clients to different levels of co‐ordination services (Townsley et al . 2004).…”

“…The client‐specific planning, linking, and liaison function is designed collaboratively and provided as part of an overall scheme for a circumscribed population and community or region. When service delivery is provided on a multi‐agency or system‐level basis, there tends to be an emphasis on client‐level planning of services, linking and liaison; there is less emphasis on providing co‐ordination‐related support functions to families (Townsley et al . 2004).…”

Nurses’, midwives’ and health visitors’ involvement in cross‐boundary working within child health services

“…Townsley and colleagues’ (2004) detailed examination of six different multi‐agency services for disabled children across the UK revealed distinct characteristics relating to multi‐agency working. They built upon Mukherjee and colleagues’ (2000) resource pack which identified three different approaches; autonomous working (separate services with inter‐professional working to achieve specific goals); co‐ordinated working (characterized by joint planning to deliver a co‐ordinated service); and integrated working (holistic, integrated team planning, delivering and funded service) called transdisciplinary working.…”

Taking advantage of dissonance: a CPD framework

“…It has been suggested that when thinking about collaborative or integrated services it is useful to consider a continuum of integration from organisations working totally independently and coming together for specific tasks to complete merging of services (Percy-Smith, 2005;Townsley et al 2004). There is a considerable literature exploring the factors that help or hinder collaborative working, although it needs to be noted that the evidence in relation to outcomes of integrated work on the lives of children and families is limited (Marsh, 2006 andSloper, 2004).…”