We are humans, not robots - we have to cater for human emotions as we move forward
In my early reading about the education of young children who have cerebral palsy, I learned that the ideal approach as used in some parts of USA was transdisciplinary teamwork. I could easily tune into this because, as a teacher, I had always collaborated with other practitioners around each child in order to integrate their approaches with mine into a whole-child approach. This was usually a one-way exchange. While I was with children five days a week, the other practitioners saw children on a sessional basis and did not need, as they saw it, to integrate my educational approaches into their work.
In 2009, Gillian King and others reviewed the literature on the transdisciplinary approach in an article entitled ‘The Application of a Transdisciplinary Model for Early Intervention Services’. She wrote:
Transdisciplinary service [TA] is defined as the sharing of roles across disciplinary boundaries so that communication, interaction, and cooperation are maximized among team members. The transdisciplinary team is characterized by the commitment of its members to teach, learn, and work together to implement coordinated services . A key outcome of TA is the development of a mutual vision or “shared meaning” among the team, with the family considered to be a key member of the team.
This last sentenced about families was music to my ears! She went on to say:
One exception to the lack of published practice models is a family-centered, transdisciplinary model of early intervention service delivery called “Team Around the Child” (Davies 2007), based on work by Limbrick in the United Kingdom. Davies outlines 10 model components, including philosophy, family role, key worker role, team interaction, lines of communication, staff development, and the assessment process. Descriptions of practice models such as this translate the rhetoric of TA into reality. The present article contributes to the literature by providing information about how to implement a transdisciplinary model of service for infants with special needs and their families, developed in Ontario, Canada. It is hoped that the article will inform managers and early childhood intervention practitioners about how to design a transdisciplinary service program and ensure its key aspects are sustained over time.
So we have known for decades how to support babies and young children but the overwhelming majority of service providers have not caught up. Services have remained stuck in the old systems in which separate fragmented approaches around each child and family is the professional default. Gillian King looked at challenges to the transdisciplinary approach:
To practice in a transdisciplinary manner, service providers must grasp the concepts of role release and collaborative interprofessional teamwork and display the skills required to deal with the practicalities each entails. Role release and teamwork reflect 2 of the 3 essential elements of TA we have outlined. The required professional competencies go beyond discipline-specific knowledge and skills and include personal qualities such as empathy, self-awareness, self-reflection, emotional self-control, sensitivity, interacting with authenticity, listening effectively, facilitation skills, and interpersonal communication skills. Service providers require self-confidence and a positive professional identity, allowing them to share without feeling threat to professional identity and accept feedback with humility.
Is this where the fear of transdisciplinary teamwork comes from, that we have to be prepared to get 'up close and personal', or 'up close and interpersonal'? I suspect it is a large prohibiting factor in many countries. The Team Around the Child approach (TAC) invites the three or four most regular people around each child to collaborate closely with each other and with parents. I have always suggested this needs familiarity, empathy, honesty, trust and respect. It is a horizontal team without vertical hierarchies in which people treat each other as equals. Not everyone is prepared to work in this way. Are you?
The medical world, perhaps more than the educational world, is characterised by degrees of status and superiority, with different levels of professional training and great variations in lifestyles. Getting beyond this, to start acknowledging that others have equal contributions to make in discussions around a child can be difficult or almost impossible for some. There can also be real fear that a team discussion will expose a practitioner’s uncertainty and lack of confidence in working with a particular child. Of course, some children will challenge all of us, but TAC is then an empathetic support system rather than a threat.
When TAC moves further towards full transdisciplinary teamwork with a primary worker or primary provider, one practitioner maintains direct contact with child and family while others move into the background to work indirectly through the primary person. In this way, we achieve the magical transdisciplinary triangle of parent, practitioner and child working and playing closely together with collective competence.
Believe me, this will only succeed if the practitioners in the TAC can be up close and personal with each other. If they cannot, then the approach will be full of resentment and threat. And when the child acquires new understanding and skills, the practitioners working indirectly might feel unacknowledged, pushed out of the limelight, unappreciated. We are all human. Gillian King describes how teams can be built to avoid these dangers as far as possible.
Another major reason why transdisciplinary teamwork is still in the starting blocks in my country is the failure of colleges and universities (UK and Ireland) to prepare practitioners for this way of working and to carry out cross-disciplinary research into the subject. (See Integration research effort interrupted by the pandemic). Is training better than this in your country? When practitioners are taught by lecturers deep in their departmental silos, it is not surprising that a fragmented approached to each child is the safe default approach after qualifying.
Peter Limbrick, April 2023.