Integration Made Possible: A practical manual for joint working – multiagency, multidisciplinary, transdisciplinary. For people of all ages. SECTION 2
The whole manual is offered in 7 parts – Introduction first and then 6 Sections
Integration Made Possible: A practical manual for joint working – multiagency, multidisciplinary, transdisciplinary.
By Peter Limbrick. Published by Interconnections in 2020. ISBN 978-0-9576601-7-5
SECTION 2: Benefits of Integration
When there is a well-organised and sustained effort to integrate support services, there are real benefits to service users, to their families, friends and carers and to practitioners and their agencies. When we extend our thinking to include a child or adult’s play, social and leisure activities, then the benefits that come from people working together contribute to a richer and more inclusive community. Potential benefits of integration are discussed in the following topics:
- Benefits to service users
- Benefits to the people around them as family, carers or friends
- Benefits to practitioners and their agencies
- Benefits to the local community
The last of these, benefits to the local community, is discussed in Topic 19, Integration as a cultural phenomenon.
Topic 5: Benefits to service users
The effort to integrate various elements of support around a child or adult only has validity if it results in tangible improvement in the support being offered. There cannot be an exhaustive list of the benefits to service users that can come from integrating health, education, social care and other local agencies. This is because perceived benefits depend on the nature of the person’s condition, their particular situation at the time and their personal preferences and aspirations. Integration is part of a person-centred approach in which there are no rigid formulas for either approaches or outcomes.
In general terms, when health, education, social care and other agencies integrate their support around a person in need, there are three major interconnected benefits:
- A whole and comprehensive picture of the person needing support
- A well-organised pattern of interventions
- A harmonising of intervention programmes.
A whole and comprehensive picture of the person needing support
This is achieved when considerations have included all relevant issues including physical, psychological, social and emotional needs (and including a child’s attachment needs). Just as integration can never be achieved fully, so a whole picture is impossible for two reasons: Firstly, no person can ever be described in full and any picture drawn of them will inevitably change. Secondly, the whole picture that can be drawn is dependent on who is contributing to it. For example, if psychologists are not yet part of the local integrated effort, their perspective on individual children and adults will be missing.
Working towards a whole and comprehensive picture is a first step to counter fragmentation. It must include what is known of the person’s strengths and abilities, their needs (either already being met or so far unmet) and a full picture of the various support services the person is receiving. The sincere attempt to create a whole picture of the person being supported reassures them, as far as they can be aware of it, that the people supporting them are well acquainted with them as a person and have a good understanding of their condition, situation, needs and aspirations. This is part of the respect one person can show another and it can have immediate therapeutic benefit.
In a fragmented approach, the people receiving interventions and/or those most closely involved with them, keyworkers for instance, are the only ones who see the totality of support being offered. When a whole picture is created it will make this information more generally available. This will facilitate judgements about the appropriateness of the current pattern of interventions and whether there are too few or too many practitioners and services involved.
A well-organised pattern of interventions
In this, all sessions to explore needs and provide short or long term treatment and other interventions are organised with proper consideration of the person’s comfort, general wellbeing and quality of life. It is a shared effort to co-ordinate and rationalise appointments with respect to venues, dates, times and people to see. Factors to be aware of include travel costs, energy levels, time availability and, for a baby or young child, feeding and sleeping routines. For some children who have particular emotional and social needs, very serious consideration should be given to the number of non-family people they have to encounter either at home or in centres and clinics.
This is a multiagency exercise done in discussion with the person being supported and/or the people around them. This avoids ill-informed assumptions being made, for instance about whether a particular person would or would not prefer to have two appointments in the same place on the same day. A perfect plan will probably not be achieved because practitioners and their agencies do not have total flexibility. Compromises are inevitable but the starting point must always be the preferences and needs of the person being supported.
A harmonising of intervention programmes
When two or more practitioners are providing programmes of intervention to support a child or adult’s wellbeing, health and development, there should be no assumption that they are best delivered separately from each other – as happens in a fragmented approach. Some integration or harmonising of these interventions might be appropriate in the interests of the child or adult. For a school child with autism, this can mean their teacher, speech and language therapist and psychologist meet to share and compare their programmes. This can include the child. For a baby or pre-school child who has a multifaceted condition, it can mean therapists, teachers and parents meet together. The aim is to agree a single unified approach with shared goals. Consideration is given to whether there should be a shared programme instead of separate programmes and whether the number of people providing programmes can be reduced – perhaps to a single primary interventionist.
This level of integration works towards a whole approach to the person’s development and learning and can rationalise the number of people involved in providing the programmes. Stresses and strains can be reduced and quality of life enhanced.6
6 For an account of the impact of multi-agency working on disabled children with complex health care needs see Townsley, R. et al. (2004) Making a difference?
For Discussion
- What benefits has integration already brought to the people you are focused on?
- What additional benefits do you wish to see now? Can you list them in priority order?
- What types of integration are necessary to achieve these aims? Refer to Topic 2 and Section 3.
- Which of these require enhanced integration?
- Which of these require new patterns of integration?
- Which of these aims require practitioners within an organisation (agency, service, or unit) to work together?
- Which of these aims require practitioners in different organisations to work together?
- Which of these aims require practitioners and other people (family members, carers, friends and neighbours) to work together?
- Which of these aims require directors to be involved?
- Which of these aims require managers to be involved?
- Have existing benefits and those still needed been established with co-production?
- Other discussion points?
Topic 6: Benefits to family, carers and friends
Family members, carers, friends and neighbours, to a greater or lesser extent will be part of the support around a child or adult and, depending on the situation, might be major players. The benefits to the service users described above will also benefit these people – remembering that some children are carers.
All will benefit from a shared whole picture of the person and of their condition and situation and from an agreed list of which of their needs are being met and so far not being met. Logically, family, carers and concerned friends will have contributed to this whole picture and will be able to see now how the support they are offering fits into it. The whole and comprehensive picture will bring to light the needs of some people around the person being supported. For instance, the practical and emotional needs of carers of any age will be brought into clearer focus.
When appointments, in the home or other places, are well-co-ordinated, the time, energy and money of family, carers and friends can be saved with, perhaps, some reduction in their stress levels. As an example, there can be a direct benefit to young siblings whom a parent of a disabled child has to bring to all appointments.
The people around a person in need will benefit directly when there is clarity about how interventions they are involved in fit together and about how they reinforce each other. It might be that family and carers have already noticed that there are some obvious contradictions in the elements of support and will be reassured to know that these have been resolved.
For Discussion
- With respect to children, are parents, siblings, grandparents and other significant family members:
- respected for their supporting role?
- involved in building the whole picture of the child?
- asked what support they need to help them support the child?
- asked what support they need for themselves?
- With respect to adults, are those family members, carers, friends and neighbours in a significant caring role:
- respected for their supporting role
- involved in building the whole picture of the adult
- asked what support they need to help them support the person
- asked what support they need for themselves?
- Are children acknowledged and supported when they are young carers of children or adults?
- Are there established rules and agreements about confidentiality for these conversations?
- Are family members, carers and friends involved in establishing the best possible pattern of interventions?
- Are family members, carers and friends involved in harmonising interventions?
- What good practice in this do you have for the evidence base?
- Other points?
Topic 7: Benefits to service providers
Integration brings benefits to local public, voluntary and private agencies and to the people who work in them. These should be seen, though, as a secondary outcome. If they are allowed to be the primary motivation, then there will surely be some reduction in the support being offered to people in need.
Practitioners will benefit from seeing the whole and comprehensive picture of the person’s condition, situation, needs and total pattern of support. This will put their contribution into context and will bring to light any duplication of effort and any intervention overload of the service user. When appointments are organised into a coherent pattern of who is seeing the person and where and when, there can be a saving of practitioner time and agency resources.
When there is an attempt to harmonise interventions it might arise that two or more practitioners are offering very similar programmes or that two or more programmes can easily be combined into one multifaceted programme. Adjusting the programmes appropriately can mean that practitioners can rationalise which of them needs to be mostly involved. The result can be a better use of an organisation’s resources.
Private agencies that offer programmes of intervention will benefit similarly from being part of the integrated effort by seeing the whole picture of the person they are supporting and understanding how their work fits with other people’s. Also, they will know who to consult when a problem arises that is beyond their brief or competence. Inviting private services and practitioners into the local integrated effort is discussed in Topic 18.
For Discussion
- Is there a process to construct a picture of the total pattern of support around each adult or child?
- Is this whole picture analysed to explore:
- if one or more practitioners are overloaded?
- if there is some duplication of effort?
- if there are gaps in provision?
- if some interventions could be rationalised in terms of dates and venues?
- if some programmes could be harmonised so they do not need to be offered separately?
- Could the writing of reports and other paperwork be made more relevant and efficient in a shared effort?
- With regard to how busy practitioners and managers are and how stressed they might be, is there oversight of their mental health?
- Other points?
