Introduction: The Team Around the Child approach as a whole ‘system’ of intervention
In this approach to disabled children, a small individualised team or TAC (the Team Around the Child) is established around each child and family. Each child’s TAC is more effective, creative, wise and powerful than the individual people in it. Typically, the members of a TAC might include, in addition to parent, older child, therapist, teacher, nurse and perhaps grandparent or childminder. Membership is determined by parents and the number is kept low so that it is child and family-friendly and not an intimidating case conference.
The purpose of a TAC is to prevent the fragmentation and chaos that families often experience when the people working with the child keep their work separate from each other. Each individual TAC, as a system, can:
- See all aspects of the child (e.g. personality, strengths, weaknesses, preferences, genetic inheritance) interacting with each other to create a unique system
- See the child within the bigger systems of close and wider family and community
- See each child’s impairments and disabilities as interconnected parts of an emergent, unique and multifaceted condition
- Bring together the people closely involved into a whole intervention system around the child and family
- Integrate, as appropriate, separate treatments, therapies and educational programmes into a whole approach
How Team Around the Child evolved from the One Hundred Hours project
One Hundred Hours1 keyworking and then the Team Around the Child approach were developed in the UK in work with disabled infants and their families without reference to other published work. Both began and then evolved as a direct response to need and with careful observation about what worked and what did not work with parents and children.
One Hundred Hours, established in 1990, supported families with an infant who had complex disabilities and perhaps serious illness, usually from birth. Families were given a keyworker who developed a helping relationship and helped parents find their way forward.
One Hundred Hours was autonomous in that it was not part of any public service or government scheme and had no official funding or contractual arrangements. This charity pioneered effective early support or ‘early childhood intervention’ in the UK as follows:
- Offering emotional support to parents and other family members when public services generally did not acknowledge the need
- Supporting parents by helping them promote their baby’s wellbeing, health and development, making sure they had access to all information and helping them shout up for effective support from local agencies
- Joining interventions together into a whole approach, when practitioners in local health, education and social services mostly preferred to work separately from each other
The struggle to achieve a joined-up support system involved inviting key people around each child to meet face to face with each other and with parents and keyworker. The aim of these meetings was to get everyone working together on an agreed multidisciplinary plan. This close teamwork was an antidote to the customary fragmented and often chaotic approach in the UK.
The term ‘Team Around the Child’ or ‘TAC’ was first applied to this collaborative teamwork in the book Team Around the Child: Multi-agency service co-ordination for children with complex needs and their families2 published in 2001. After the One Hundred Hours project and Team Around the Child approach were published, many service managers in the UK and other countries developed their own versions of Team Around the Child to provide well-organised, multi-agency support for families of disabled children. This approach was the preferred option for them because it utilised existing practitioners with some modification of their roles, while the One Hundred Hours model required new teams of multi-agency keyworkers with keyworking as their only role.
The basic Team Around the Child approach is easily understood by families and paid workers. Key people, who already provide practical support to the child and family, are trusted by the parents and feel comfortable in their relationship, agree to join together regularly in the child’s TAC meetings. The purpose of these meetings is to tell each other about the approach they are using, agree what the needs of the child and family are and create a unified action plan that integrates all strands of support, no matter which agency or person is providing them. This plan is reviewed and modified as necessary at successive TAC meetings. The child’s TAC is kept small so that it does not become a case conference in which parents might be overwhelmed, disempowered and afraid to speak.
Parents are full TAC members and become powerful with other members in planning support for their child and family. Each TAC carries more authority in speaking for the child and family than does any other person or group in the networks around the child. TAC meetings are informal and have an atmosphere of warmth, positiveness, reassurance and helpfulness. Familiarity, empathy and honesty are key elements in the relationships between TAC members. This attitude of human decency paves the way for trust and genuine partnership.
The Team Around the Child approach represents collective action by people genuinely concerned and knowledgeable about the child and family. The child is viewed holistically and as part of a whole family. The action plan is then correspondingly all-embracing. The approach promotes horizontal rather than hierarchical relationships so that people treat each other on equal terms.
Local authorities that have established TACs for their disabled children have usually done so as a collective enterprise between health, education, social services and perhaps the voluntary sector. Rather than leave individual TACs to cope on their own, senior managers have created a new post of ‘TAC Co-ordinator’ or ‘TAC Manager’ to support TACs and secure for them the resources they need. TAC Managers probably hold authority within their own agency and must then adapt to the horizontal landscape of multi-agency collaboration. How they do this will depend on how their TAC work is designed. The options are fully explored in the 2012 book, Horizontal Teamwork in a Vertical World3.
In the TAC approach there are clear advantages for children and families when the people supporting them join together. It is also my experience that paid workers benefit too from mutual support in facing challenging situations, sharing difficult and complex decisions and being in a small familiar group for celebrating successes and sharing frustrations. In TACs, paid workers enhance their ability to perceive each child as a whole and as part of a family and have reassurance that their work with them is part of a plan agreed collectively by the people who know most about the child and family.
The position of Team Around the Child in the development of provision in the UK
In the foreword to Family-centred Support for Children with Disabilities and Special Needs4, Christine Lenehan, then Director of England’s Council for Disabled Children, says:
This powerful collection of essays is a welcome and timely contribution to the lives of families of disabled children. They illustrate the overwhelming importance of the quality of emotional relationships between parents and professionals… There have been some major steps forward in recent years particularly around key working and early support. Peter Limbrick’s early work on team around the child approaches transformed how we thought about services and enabled the move from services which met the needs of professionals to services which put parents and children at the centre. The government’s Early Support Programme has subsequently promoted and developed this.
1 Limbrick-Spencer, G. (2001) The Keyworker: A practical guide. Birmingham: WordWorks in association with Handsel Trust
2 Limbrick-Spencer, G. (2001) The Keyworker: A practical guide. Birmingham: WordWorks in association with Handsel Trust
3 Limbrick, P. (2012) Horizontal Teamwork in a Vertical World: Exploring interagency collaboration and people empowerment. Clifford: Interconnections
4 Limbrick, P. (2007) Family-centred Support for Children with Disabilities and Special Needs. Worcester, Interconnections
See also –
Limbrick, P. (2009) TAC for the 21st Century: Nine essays on Team Around the Child. Clifford: Interconnections
Limbrick, P. (2016) Caring Activism: A 21st century concept of care. Clifford: Interconnections. This book proposes that citizens join together to support vulnerable children, teenagers, adults and elderly people. It is edited by Professor Hilton Davis and has a Foreword by him. Read more here: http://www.teamaroundthechild.com/allnews/publications/2132-caring-activism-a-21st-century-concept-of-care-a-new-book-for-2016-written-by-peter-limbrick-and-edited-by-hilton-davis.html