Achieving Collaborative Competence through Interprofessional Education

1. Achieving Collaborative Competence through Interprofessional Education Lessons learned from Joint Training in Learning Disability Nursing and Social Work

2. Why Interprofessional Education? • Complex practice making different professions mutually dependent • Holistic approaches • Failures in communication • Policies requiring integrated working • Singular disciplines, training and identities • Knowledge for collaborative practice

3. Jointly trained practitioners – a different professional perspective • Expected to integrate two discourses into their practice • Experienced the tensions and conflicts of a new ‘hybrid’ worker • Occupying ‘thirdspace’ (Beattie, 2003) • Experienced dual socialisation

4. Dual Socialisation in a Joint Training Programme • practice placements in both health and social services • practice supervision from both nurses and social workers • lecturers from both disciplines • learning the ‘language’ of nursing and social work • shared learning with other nurses and/or social workers • two different codes of practice • assessed against integrated learning outcomes

5. Collaboration and Collaborative Competence Collaboration: • Involves different degrees of proximity in time or space and different levels of complexity eg. • May be concurrent and co-located –people working physically together on the same task at the same time in the same place • May be sequential – a series of steps to provide seamless care (eg. acute trust works with Social Services to discharge an older patient) • May be virtual (eg researchers working with practitioners/organisations to improve services) (Meads and Ashcroft, 2005)

6. Professional Competence Barr (1998) distinguishes between: Common Competencies – those held in common between all professions – part of the rationale for joint training Complementary Competencies – those that distinguish one profession from another – also part of the rationale for joint training Collaborative Competencies – those necessary to work effectively with others – the evidence suggests that joint training develops them

7. Collaborative Competencies • Communication • Understanding roles • Respecting /valuing other professions /networking • Managing change and conflict • Working together • Acceptance • Developing and supporting each other • Facilitating Teamwork (Barr, 1998)

8. Boundary Talk – Research with jointly trained practitioners • Postal survey of ex students (n =47) from 5 universities in England • Semi-structured interviews with 25 self selecting respondents • Information from Course Leaders • Ethical Approval through the Institute of Education • Grounded Theory methodology

9. Prepared for Interprofessional Practice?

10. How was Collaborative Competence expressed by respondents? ‘we were looking at two cultures weren’t we? We were trying to assimilate two cultures into one person and we were being taught by two cultures and there were significant differences between mornings and afternoons in terms of the culture of the lesson and the content of the lesson’. (Int 04) respecting, valuing other professions managing competing discourses (Barnet, 1997)

11. Transcultural Understanding ‘I think the placements also helped. I mean I did two placements in hospitals, one in a mental health residential home, one in a learning disability day centre, and again, you experience different cultures’. (Int 04) Understanding roles, networking Breadth of Knowledge (Sims, 2008)

12. Cultural Competence ‘When they do a multi-agency assessment of a family of a child (in health) and they feed back to the family they call it a case conference, but obviously within social services a case conference is a child protection matter, so they have different language and different things mean different things within their role – so working across the two you can put people’s minds at ease because you understand the language that they are on about and talk in terms that they are comfortable with’ (Int 20) Communication Cultural competence – openness, respect and willingness to learn (O’Hagan, 2001)

13. Constructing practice differently Valuing other professions Learning how other professions construct understandings of problems (Barrett and Keeping, 2005) ‘being able to recognise and see that different people might look at (practice) slightly differently and you need to take that into account and work with that, not try to resist it or defend against it or kick against it really’. (Int 23)

14. Confidence and Conflict ‘I think I feel relatively confident in getting a consensus on a care plan. I feel more able to identify and challenge members of the support network who may be trying to bluster their way into having their own say, when it does not appear to be what the consensus had identified as in the clients’ best interests’. (Int 12) Managing Conflict Confidence – in own role and skills (Barrett and Keeping 2005)

15. Challenging Boundaries ‘I have actually sometimes been told off for acting too much like a social worker – that’s a social worker’s role! Why did you make that referral? The social worker should have made it. And I say –well, it is a piece of paper half a page long, it takes two and a half minutes and I have the link!’. (Int 08) Acceptance – tolerating differences Street Level Bureaucracy (Means & Smith,1994) Elegant challenging (Thompson, 2006)

16. Negotiating Boundaries ‘I was told by the social worker that I always have to have nurse present… and I thought – I can do this! It’s no big deal. I can ask these questions and I can make a referral to the psychiatrist. No you can’t do it, said the social worker’. (Int 06) Managing conflict Role/boundary negotiation (Barrett and Keeping 2005)

17. Facilitating Interprofessional Working ‘I got social services to come and sit in the meetings and that worked really well, so we were already joint working and integrated before we were told to integrate. I initiated that, and that was because of the joint training I think’. (Int 25) Developing/supporting one another

18. Managing Collaboration ‘All the time you are in your comfort zone you are less likely to learn, whereas if you are faced with those difficulties, you know, and quite often they are operational logistical difficulties, you have to try and manage……once you become qualified it is a real mistake to retreat into the comfy arms of those professional bodies’. (Int 23) Working Together Professional Adulthood (Barrett and Keeping 2005)

19. Lessons which can be learned • Broadening the socialisation of social work students • Ensuring contrasting / diverse placements • Involving other professionals in the assessment of students • Drawing on different discourses and knowledge (eg. nursing, health) • Establishing contact opportunities with students from other disciplines – joint tasks? • Placement contracts - IP learning opportunities • Key Role 5:17 Scrutinising the evidence of multidisciplinary working (in teams, networks, systems)

20. Final Thoughts • Workers are needed in the crucial space between disciplines (Bernstein, 2000) • They need a professional habitus which goes beyond a single discipline (Bourdieu,1998) • Collaboration involves celebrating definitional uncertainty (Beattie, 2003) rather than being overwhelmed by it • Social workers need the ability to tread lightly on shifting professional sands!

21. The Challenge Do you think that interprofessional experiences can help social work students to develop collaborative practice? If so, how can singular social work programmes best achieve this? Dave Sims University of Greenwich

22. Sources • Barnett R. (1997). Higher Education: A Critical Business. Buckingham: Open University Press. • Barr H. (1998). ‘Competent to Collaborate: towards a competency-based model for inter-professional education’. Journal ofInterprofessional Care, 12 (2), 181-187. • Barrett G. and Keeping C. (2005). ‘The Process Required for Effective Interprofessional Working’, in Barrett G., Sellman D. and Thomas J. (eds.) Interprofessional Working in Health and Social Care. Basingstoke: Palgrave Macmillan. • Beattie A. (2003). ‘Journeys into thirdspace? Health Alliances and the challenges of border crossing’, in Leathard A. (ed.) Interprofessional Collaboration. From Policy to Practice in Health and Social Care, Hove: Brunner-Routledge

23. Bernstein B. (2000). Pedagogy, Symbolic Control and Identity. Theory, Research, Critique. Revised Edition. Lanham: Rowman and Littlefield (USA). Bourdieu P. (1998). Practical Reason. On the Theory of Action. Cambridge: Polity Press. • Department of Health. (2002). Requirements for Social Work Training. London, DH. • Means, R and Smith, R. (1994). Community Care Policy and Practice. Basingstoke. Macmillan. • O’Hagan, K. (2001). Cultural Competence in the Caring Professions. London: Jessica Kingsley

24. Quality Assurance Agency for Higher Education. 2008. Social Work Subject Benchmark Statement. Gloucester, QAA. • Sims, D (2008) The Role of Joint Training in Practitioner Development for Learning Disability Services in the International Journal of the Interdisciplinary Social Sciences. Vol 2, Issue 5. pp 207-214. • Thompson, N. 2006. People Problems. Basingstoke. Palgrave Macmillan.

25. Collaborative Competencies (Barr, 1998 – for information) • Describe one’s roles and responsibilities clearly to other professions and discharge them to the satisfaction of those others • Recognise and observe the constraints of one’s role, responsibilities and competence yet perceive needs in a wider context • Recognise and respect the roles, responsibilities and competence of other professions in relation to one’s own, knowing when, where and how to involve those others through agreed channels • Work with other professions to review services, effect change, improve standards, solve problems, and resolve conflict in the provision of care and treatment

26. Work with other professions to assess, plan, provide and review care for individual patients and support carers • Tolerate differences, misunderstandings, ambiguities, shortcomings and unilateral change in another profession • Enter into interdependent relationships, teaching and sustaining other professions and learning from and being sustained by those other professions • Facilitate interprofessional case conferences, meetings, team working and networking Barr (1998)