Beauty & The Beast

1. Beauty & The Beast Of Inter-agency Working Sheena Bolland Dr John Henning Brodersen

2. Today’s Programme • Introduction • Service Development • Theory / Culture of multi-agency work • The Beast • The positives and negatives of multi-agency working • Interface with different cultures management • perspective supervision • The Beauty • Best of each culture

3. The C.A.S.T team

4. The 4-tier model for CAMHS Very specialist services, incl. children away from home Tier 4 Specialist Multi-disciplinary Teams Tier 3 Individual Professionals Trained in Children and Young People’s Mental Health eg Psychiatrists, Psychologists, Therapists etc Tier 2 Primary Mental Health Workers etc GPs, Paediatricians, Teachers, School Nurses, Youth Justice Workers, Health Visitors, Social Workers, Voluntary Agencies etc Tier 1

5. Objectives Of The Service • To establish a multi-agency service working across the Tiers • To reduce the waiting times & improve access to CAHMS • specialist services • To support children at risk of exclusion & reduce school exclusions • To ensure families of children using the Tier 2 service has • access to appropriate family support workers • To reduce the “risk” for children • To continually develop services for families in the Medway area • To provide a consultation service for professionals in Medway

6. Team Structure Service Development Manager SSA P/T Paediatrician Clinical Psychologist Senior Practioner PMHW Chatham Primary Mental Health Worker Gillingham Primary Mental Health Worker Rochester Primary Mental Health Worker Sexual Inappropriate Behaviour Behaviour Support Worker Strood & Chatham Behaviour Support Worker Gillingham & Chatham Connexions PA 13-19 years Medway Sessional Family Support Workers P/T Counsellor

7. PSA 2 Clinical Governance EDUCATION CAHMS MAPPING WKMHT National Service Framework

8. What can theory do to help us create more cohesive multi-agency teams? Helps us reflect on what goes on between team members and between agencies. Help inform us in how to improve working practice, in an evidence based manner with good accountability for decision making.

9. Social Construction of Reality and Culture Knowledge is not universally ‘true’ but depends on the culture. Traditions and what is viewed as common sense are culturally determined. e.g. nodding yes and no reversed in Bulgaria.

10. Coordinated Management of Meaning (CMM) Pearce & Chronin (1980) • Culture • Episode • Speech Act

13. Theories used in this presentation Attachment Theory (Bowlby, 1979). Family Scripts (Byng-hall, 1995). Narrative Approaches (White, 1995). Roles (Belbin, 1981). Structural Issues (Minuchin, 1974).

14. The Beasts of inter-agency working

15. Where is your team currently in terms of its development? e.g. Forming, Norming, Storming, Performing (Tuckman, 1973).

16. Beasts in interagency teams • Permeability • Coalitions • Capturing • Role reversal • Dysfunctional discipline

17. Group processes than inhibit team cohesion • Team Splitting and allocation of roles (Belbin, 1981). • Conformity seen as a higher priority than evidence based decision making (Harris, 1999). • Group think- under stress ,or dominant leader, consensus overrides looking at alternative courses of action. • Group polarization, more extreme decision making than in isolation.

18. Group processes than inhibit team cohesion Responsibility held by a manager means they cannot admit ignorance or dispensability resulting in poor decision making (Harris, 1999). Team cohesion has an influential role in the management process (Henning Brodersen, 2004). Colleagues seen as an important source of support versus making decisions very difficult (Henning Brodersen, 2004).

19. Beauty of Interagency working • Ability to access a diversity of perspectives. • Reduce the likelihood of clients falling into gaps in service provision. • Reduced conformity to professional/ organisational shackles. • Ability to form more informed beliefs about the strengths of other organisations. • Increased flexibility in matching internal resources to external demands.

20. Exercise Please draw a current map of your organisational, or professional cultures. You can circle any alliances or coalitions. Post exercise reflection How would the map created by other agency members differ? How would you like the map to look in the future? What would be the first step towards this aim?

21. What can we do to enhance the beauty of interagency working? Building clear structures. Communication. Groups and meetings. Lines of accountability. Feedback loops (Campbell, 2001). Whole Team Training (Henning Brodersen, 2004).