‘I have seen therapists being unwilling to share ideas with portage workers because of differences in levels of training. The portage workers characterised this as professional snobbery.’
In the September TAC Bulletin I made informal observations about a recent paper from England’s Council for Disabled Children, ‘It takes leaders to break down silos: CDC's new report on integrating services’. The paper had intended to identify the key factors enabling or hindering progress towards integration of services for children with SEND (special educational needs and disabilities). I argued that the paper had fallen short in this ambition by omitting disability prejudice as a hindering factor and omitting initial professional training in universities as a potential enabling factor. I also suggested that there should now be a serious effort to fully involve parents and family members in discussions to solve this long lasting problem of how to integrate health, education and social care.
In my informal observations, I said:
In my view, for a variety of conscious and subconscious, spoken and unspoken, logical and illogical reasons the generality of managers and practitioners are content to stay within the bounds of their discipline or training.
I now want to explore this particular hindering factor further using my experience of promoting integration in the UK and other countries. While the CDC’s paper seemed to exclude babies and pre-school children, I will try to be relevant to children of all ages who have disabilities and special needs ̶ the problems caused to children and families by fragmentation do not wait for the child to enter school.
Chief executives, senior managers, middle managers and practitioners all come with beliefs and attitudes. This is inevitable because they are people, not automatons. When it comes to joining their work with other people, these basic mind-sets come into play. Some people seem to be instinctively for integration; some are against. Some take strength from a collaborative effort; some would rather do their own thing in their own way. Some are confident in sharing their approach; others are not. Some are ready to embrace and consider all aspects of the whole child and of the family’s situation; some need to maintain a narrower focus to avoid being overwhelmed. Some feel integration is the fullest expression of their professionalism; some fear their professional standards will be compromised.
I have met all of these attitudes in my workshops, seminars and conferences. There are no angels or devils here, no good people and bad people. The only judgement I feel qualified to make is that a child and family who are suffering from fragmented systems will be left with unmet needs if the managers and practitioners around them persist in working separately from each other. The child and family’s situation can be made significantly worse when health, education and social care are not integrated into a seamless whole.
Having characterised some joint-working mind-sets in the way that I have, practitioners and managers at all levels in their service hierarchies can reflect if they wish on their present attitudes and actions in hindering or enabling integration. I have seen practitioners who collectively long for integrated systems and pathways but whose managers resist creating them. I have met managers who are frustrated by practitioners’ unwillingness to work together in multiagency and multidisciplinary teams. I feel there are some very basic attitudes and assumptions at play here, both conscious and subconscious.
While managers certainly have a key role in breaking down silos to promote integration, any new systems they create will surely fail if they have not acknowledged and addressed the valid fears, apprehensions and anxieties in some members of the of their workforce.
I will continue this discussion under three interconnected headings: