Integration Made Possible: A practical manual for joint working – multiagency, multidisciplinary, transdisciplinary. For people of all ages. SECTION 5

SECTION 5: Wider Integration

This Manual has so far discussed integration at the level of public health, education and social care agencies and including the voluntary sector. In this section I want to extend joint working around people who have special needs to include: private services and private practitioners; community services and facilities and the people who work in them; academics in universities and colleges. There are three topics for discussion:

• Inviting private services into the integration effort
• Integration as a cultural phenomenon
• The responsibility of academics

 

TOPIC 18: Integration with the private sector

Within every locality there are private services and practitioners offering support to adults and children who have special needs. It is clear, with a person-centred focus, that private elements of support should not be excluded from the integration effort. Problems caused by fragmentation are not exclusive to public and voluntary organisations.

            It might be generally assumed private enterprises cannot be part of integrated support. One reason is a mistrustful attitude towards them held by some people in the public and voluntary sectors. In this thinking, people in profit-making services cannot have high professional standards. This is not true in my experience. I would argue that each private service and practitioner has to be evaluated separately without assumptions.

            A second reason might be harder to combat. This is that the fees paid by clients do not usually allow for extra time spent in joint work with other people. A solution to this can be to invite particular private services and practitioners into the integration effort with a requirement that they sign up to a set of locally agreed standards. They can then be listed in local directories as ‘integration-approved’. Also, when practitioners in public and voluntary agencies are asked by service users for information about relevant private services, they can refer to the same list.²¹

            In my view, a proactive welcoming of private services and practitioners into locally integrated support services is an essential part of the process of creating a culture of joint working and must, sooner or later, become part of a sincere integration effort. This does not mean success will come easily or quickly.

²¹ The issue of practitioners in public agencies giving information to service users about private services is    discussed in Limbrick, P. et al (2011) What do the terms ‘therapy’ and ‘therapist’ really mean in early childhood intervention for children who need on-going multiple interventions? in PMLD Link 

For Discussion

• What are the main local private services and practitioners involved with the people you are concerned for? 
• Which of these would you like to involve in joint working?
• Can you put these in priority order?
• Should the agreement you ask them to sign up to include:
  • seeking client’s consent before embarking on joint working
  • respecting confidentiality
  • asking the client about other interventions they are having
  • asking the client if there is any existing teamwork
  • trying to ascertain the whole picture of the condition and situation
  • trying to avoid fragmentations, duplications, inconsistencies and overload 
  • considering the impact of a fragmented approach on the emotional and   psychological status of the person
  • other considerations?
• Who will take responsibility for invitations to private services and practitioners?
• What good practice do you have for your evidence base of private enterprises joint-working with local practitioners and organisations?
• Other points?

 

TOPIC 19: Integration as a cultural phenomenon

We can go further into the integration effort by involving all other local services and facilities that adults and children who have special needs will need or want to use or, in some cases, be required to use.

            This is where integration and inclusion overlap in the aspiration for rich and diverse communities in which people are treated fairly. Some shared effort and joint working might be necessary for each child and adult to participate in and benefit fully from all facilities and resources locally available. This can involve practitioners from public and voluntary agencies coming together with people in community services and facilities to remove obstacles that would otherwise exclude some people. Integration at this level promotes equality of opportunity and diversity within local communities.

            Without this level of integration, some facilities and services will remain out of reach, disjointed and unsatisfactory. Joint working fosters inclusion making many things possible for people with special needs simply because people are working together with a ‘can-do’ attitude and positive relationships. A culture of integration of this sort requires a network for potential joint working.

A network for potential joint working

I am using the word ‘potential’ to suggest the groundwork for joint working must be pre-established in each community service or facility so it can be quickly and easily activated when necessary without the need for lengthy discussion and delay.

            There are no limits to who should be invited into this local network. A short initial list might include institutes for evening classes and adult learning, leisure centres, sports and social clubs, gyms, swimming pools, libraries, adventure playgrounds, food banks, benefit agencies, hairdressers, dentists, opticians, magistrate courts, probation services, shelters and refuges. Joint working involving people in these facilities, people with special needs and, when necessary, the people around those adults and children can mean the person is not excluded, is enabled to get the best value from the service or facility and is treated with more respect, consideration and fairness than might otherwise be the case. 

            In many cases, people in community services and facilities will appreciate having a person’s needs explained to them and then be happy to contribute their skills to make inclusion possible. In this way, a child’s physiotherapist and swimming pool staff can work together to enable the child to use the pool safely and enjoyably. A dentist can confer with the people around a person with autism to make dental treatment possible. Court staff and a keyworker for a person with learning difficulties can work with each other and with the person concerned to help ensure fair treatment.

            This sort of joint working might fall into place automatically for some people in need but not for others. I am suggesting a sincere effort to integrate support and reduce fragmentation for all adults and children will include establishing a local network of potential joint working. Inclusion in the network will be by invitation with an accompanying list of expected standards as it was for private services and practitioners in Topic 18. Community services and facilities that are approved to join the network will have an ‘integration-approved’ badge to display just as do those facilities that offer a hearing loop or changing place²².

Perhaps generating this community culture of joint working seems a long way from encouraging health, education and social care agencies to work together. But, if we define integration as a process of joining things together with the purpose of achieving something better than was there when the things were separate, it becomes clear that joint working at community or neighbourhood level is all part of the same challenge. Otherwise, a person might receive seamless support from local support agencies but at the same time be unable to take a full part in community life.

²² The Changing Places Consortium campaigns on behalf of people who cannot use standard accessible toilets.

 

For Discussion

Note: The task here is to begin developing a network of potential joint working.

• What examples do you have of people in local community services and facilities working with people in need and/or the people around them to enhance the experience of the people in need?
• What are the successes in this?
• What are the elements of good practice you can add to your evidence base and build on?
• What local information do you have of people being excluded or having a spoiled experience for want of some joint working?
• What are the factors in these failures?
• Which services and facilities will you approach first to invite them into the network?
• Should the agreement you ask them to sign up to include:
  • listening to what the person in need wants
  • following their wishes about confidentiality and privacy
  • a willingness to learn about any special approach required
  • a willingness to be pro-active in seeking discussion when necessary
  • agreement to seek advice from the person overseeing the network
  • other items?
• Who can oversee this growing network?
• How can you feed ‘integration-approved’ services and facilities into local directories?
• Can co-production help grow this network?
• Other points?

 

TOPIC 20: Academic responsibilities in integration

This Topic comes quite late in the Manual but it could have been placed at the beginning. Students studying to be health, education or social care practitioners who are taught to work with others across discipline boundaries will take integration in their stride when they begin their professional work. It has never seemed logical or fair to expect practitioners to settle easily into joint working arrangements when they have had no experience of it or preparation for it in their university or college courses.

            This lack in education and training has been a long-term obstacle to integration. Relevant professional training would: encourage practitioners to see the whole picture of a person’s condition and situation in addition to the more focused concern their discipline requires; offer a Systems Theory perspective emphasising interconnections and interdependence; provide opportunities in lectures and projects to mix with people on other courses to learn about their studies, concerns, practice, ethics, etc.

            Universities and colleges could practise joint working as well as teaching it. Health, education and social care academics could work with each other in research, projects and writing course programmes. This would facilitate lecturers and students mixing with each other across disciplines and, importantly, generate research programmes in the subject of integration around people who have special needs.

 

Discussion Points

• Which people in your local academic institutions have an interest in integration between health, education and social care, or between just two of these three?
• Which people in your local academic institutions have a general interest in the people you are concerned for?
• Can you recruit local academic support for your integration effort:
  • locating relevant research papers and publications
  • providing meeting rooms
  • helping you run seminars and small conferences
  • supporting you at meetings
  • other support?
• Could you talk to students about integration?
• Could you suggest projects and research topics to local academics?
• Other points?