Keyworkers are an essential part of a quality service for families.So why do most families not have one? Is Team Around the Child part of the solution?

The design of the TAC team leader’s role overcomes the common obstacles and negative perceptions around keyworking

Introduction

It is generally acknowledged now that a multi-agency keyworker (or key worker) should be offered to each family who has a baby or young child with complex needs. This has been documented over three decades in research, surveys, reports and guidance and yet still the majority of families do not have one. It is interesting to speculate why keyworking has not been widely adopted by service providers in spite of the obvious need. In my view the reasons include:

Overloading practitioners who agree to add keyworking to their main professional role.
Inappropriate expectations of what keyworkers can achieve.
A general failure to treat keyworking seriously within organisational systems.

The Team Around the Child (TAC) approach is offered as a remedy to some of the problems.

1. Overloading shared-role keyworkers

The great majority of keyworking services have relied on existing practitioners agreeing to become keyworkers for a number of families and then dividing their time between the main professional role and keyworking tasks. This is because funds have not been available to provide new teams of single-role keyworkers. The typical situation is that these practitioners are already busy enough with their present case-loads but are willing to ‘go the extra mile’ because of their acute awareness of the needs of the families they support.

Logically, when new work is added to a busy practitioner’s workload, other work should be taken off them so that their job remains doable. In my experience shared-role keyworkers are not always given this consideration. If the practitioner has one manager for the keyworking role and another for the main role, tensions and disagreements can arise about how much time is allocated to each role. If the practitioner is relieved of some duties to make room for keyworking, it can leave the line manager with no option but to share that work out amongst other members of the team. Assuming that these people were already busy, they will become overloaded with this additional work. This in turn will reduce their capacity to take on shared-role keyworking.

It seems inescapable that additional resources are needed if families are to be offered either single-role keyworkers or shared-role keyworkers. A test of this need for additional resources is for service providers to project ahead three, five and ten years to anticipate the probable demands as keyworking is offered to an increasing number of families in their locality who require it. Services which expand their shared-role keyworking service to the point where they have no more practitioners to call on for the shared role will have a choice of rejecting new families or seeking funding for more practitioners.

2. Inappropriate expectations

There can be pressure on keyworkers to undertake tasks which go beyond their training, their status and their available time. The pressure might come from the family or from the keyworker’s employer or it might come from the keyworker’s own commitment to doing as much as possible for the family. Four examples are:

Keyworkers trying to be advocates. This role can require keyworkers to attempt to exert an influence over service provision which goes well beyond their status and the power invested in them. Advocacy can compromise a shared-role keyworker’s relationship with his or her employer. A distinction must be made between the appropriate keyworking role of helping families get what they need (so they don’t have to shout and battle for everything) and the inappropriate role of supporting the family in complaints or other formal approaches to service providers. When families require formal advocacy they should be linked to an appropriate advocacy service.

Keyworkers trying to co-ordinate services. Keyworkers cannot create strategic multi-agency collaboration, single-door referral systems, joint assessments or integrated pathways. This is the task of senior management from health, education, social services and the independent sector. When an effective co-ordinated system is in place, then keyworkers have a favourable environment in which to keep everyone linked together for the family. When services are fragmented and piecemeal the keyworker is very limited in what he or she can achieve. Keyworking should be viewed as an important element of service co-ordination but not as service co-ordination itself.

Keyworkers giving advice. Parents of children with complex needs will have to make many decisions which will impact on the wellbeing and survival of the whole family and on the wellbeing and perhaps the survival of the child. Keyworkers are not competent to give advice. Their role is to ensure the parents have good information about the issue and perhaps to support them as they think it all through.

Keyworkers giving significant emotional support. Many parents need emotional support from time to time. This might be a priority for new parents. Provision of emotional support by keyworkers varies between just being an occasional listening ear to being the one person to whom family members offload their experiences, feelings and emotions on a regular basis. Having someone to talk to is a therapeutic activity which can help parents adapt to the most challenging situations and help resolve any negative emotions which stop them moving on. This can make unrealistic demands on a keyworker’s time. Most shared-role keyworkers, like most practitioners anyway, do have time to be an occasional listening ear but should only offer more than this if they are sure they have the time and skills required. Families who require more emotional support should be referred to a relevant agency.

3. Lack of proper systems

Keyworking has mostly slipped informally into service provision without job descriptions, training, protocols, standards, career structure, management, support systems, monitoring, clerical support or proper funding. Keyworking projects, like the families they are trying to help, are very vulnerable. They can collapse when a particular enthusiastic practitioner or manager moves on, when practitioners opt not to assume the shared-role or when temporary funding dries up.

The Team Around the Child (TAC) approach

This provides each family with an individualised and evolving team (of just three or four or five) multi-agency practitioners who meet every half-term or so to review the child’s progress, to discuss pertinent issues and to update the Family Support Plan including the child’s development and learning goals. Each TAC includes parent or parents and has its own team leader (with a shared-role). The team leader functions as the family’s multi-agency keyworker. In a real sense, the TAC approach provides an effective response to the need for keyworkers. It keeps the role within manageable parameters until such a time as funds become available to develop keyworking further. The basic role consists of:

developing a helping relationship with the family and being a listening ear
keeping a list of all agencies, services and practitioners involved
ensuring the family has all the information they require
ensuring the family has access to all relevant services, resources and benefits
leading TAC meetings
ensuring each meeting results in a multi-agency support plan
ensuring the plan is distributed to other agencies, services and practitioners
supporting the family as necessary through all parts of this process

This can be seen as minimal approach to multi-agency keyworking. But we have to acknowledge that children and families are all unique in their needs and that TAC team leaders come from a variety of professional backgrounds and working conditions. In response to these varying conditions there might be pressure from the family, from the keyworking service or from the TAC team leader him or herself to expand the role. This should only happen if the TAC team leader is competent to perform the new role, has sufficient time for the additional tasks and has all necessary resources and support.

The design of the TAC team leader’s role overcomes the common obstacles and negative perceptions around keyworking. The role is very clearly defined and delimited, it falls to existing practitioners (from local statutory or voluntary services) and the TAC team leader is part of the supportive team rather than being an additional person grafted on to it. Formal advocacy is excluded from the role as is extensive emotional support. TAC team leaders operate within a supportive and co-ordinated matrix and are trained, resourced, supported, monitored and evaluated.

TAC team leaders must carry some authority, as must other keyworkers, if they are to be effective intermediaries between families and their local services.

The TAC approach empowers TAC team leaders in the following ways:

In dealings with the agencies and services around a family, the TAC team leader is a spokesperson for the TAC and does not just speak for himself or herself. As the TAC by definition comprises the handful of practitioners who are most closely involved with the child and family and who collectively hold the most rounded and detailed information about them, the Team collectively carries authority and status which equals or surpasses that held by anyone else involved with the family. This authority is invested in the TAC team leader.

Each TAC team leader operates within a system which is established by multi-agency agreement with principles and protocols about how TAC team leaders and local services will collaborate with each other in pursuit of effective support for children and families.

Within this system there is training and support for TAC team leaders to enable them to be effective communicators and negotiators.

The TAC system and the TAC team leaders within it are monitored so that lessons can be learned when TAC team leaders find themselves unsuccessful in representing the needs of children and families to other services and agencies.

Within the TAC system there will be a senior manager or a management group overseeing the system and providing support to TAC team leaders. This person or group can support any TAC team leader who encounters difficult situations or seemingly unmoveable obstacles.

Services for children with disabilities and their families have never been adequately funded. I expect that this will not always be so and that funds will be made available to local councils, health services and voluntary agencies to enable them to provide families with a choice of single-role keyworkers or shared-role keyworkers. In the meantime, the TAC approach can represent the best attempt we can make to give families multi-agency keyworkers who are empowered to support families within a system which is well organised, co-ordinated and accountable.