Order 1029111: Family-centred practices

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Inter-professional Practice to Support Inclusion

Sandie Wong

CHAPTER OVERVIEW

This chapter will focus on the development of collaborative relationships between professionals1.

Learning goals for this chapter include:

› Increasing understanding that working with children and families with complex needs often requires the skills, knowledge and expertise of professionals from diverse disciplinary backgrounds;

› Gaining a greater awareness of the potential benefits for child and family outcomes when professionals work in collaborative inter-professional ways;

› Increasing knowledge of key factors (at policy, service and individual/professional levels) that may assist in the development of collaborative inter-professional ways of working that will support inclusion of all children.

KEY TERMS AND CONCEPTS

multi-disciplinary

inter-disciplinary

trans-disciplinary

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Cologon, Kathy. Inclusive Education in Early Years : Right from the Start, Oxford University Press, 2014. ProQuest Ebook Central, http://ebookcentral.proquest.com/lib/csuau/detail.action?docID=4191369. Created from csuau on 2018-05-07 18:58:35.

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Introduction: Inclusive settings require diverse professional expertise All children have skills, knowledge and capacities. Likewise, all children have

needs. Most will require access to a range of childcare, health, social and/or

intervention services. Some children, however, especially those with a disability,

and/or those with a parent with a mental or other health issues, and/or from

families that are fi nancially, socially and/or culturally marginalised, often have

multiple and complex needs that require the skills, knowledge and expertise of

professionals from diverse disciplinary backgrounds. These children, such as

Sam, the fi ctional child in the case study below, will likely require the skills of

a number of professionals.

CASE STUDY 10.1

Sam’s story Sam is four and a half years old. He was recently enrolled in Lonepine Childcare Centre—a long day care centre in one of Sydney’s most disadvantaged suburbs. Sam was temporarily placed in the care of his elderly maternal grandparents (who live in private rental accommodation in the local area) by social services three months ago. His mother, who he lived with up till then, has mental health issues and drug- and alcohol-related problems. She lives in rural New South Wales and is currently on bail awaiting trial for burglary and prostitution—she will likely receive a custodial sentence. His father is unknown.

Sam attends the centre five days a week. His grandparents, who usually drop him off together at about 9.30am, often stay with Sam for an hour or so as he settles into the centre. They usually sit with Sam and other children doing jigsaw puzzles or at the craft table. Sam’s grandmother has been teaching origami to the children and often has five or six children, including Sam, sitting with her, deeply engaged in the intricate and complex task of folding paper and making animals and other objects. Sam’s grandfather, who has been doing minor maintenance around the centre on a voluntary basis, has promised to work with some of the older children on a woodwork project and has been discussing with the educators how they can do this in a safe and accessible way. Sam’s grandparents usually pick him up well before the centre closes and always chat to the educators about Sam’s day, asking what he ate, what and who he played with, and if there were any significant events during the day.

The centre’s Director, Stacey, a teacher with a four-year university degree, reports that Sam appears to have a very strong, loving relationship with his grandparents—and always smiles and cuddles them when they arrive to pick him up. He is well-nourished and always attends the service in clean, appropriate clothing. In his grandparents’ presence Sam engages with craft materials for sustained periods. When his grandparents leave the centre he does not appear

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Sandie Wong

If you were Sam’s teacher how would you go about ensuring that he received the necessary professional expertise? 1. Who would you involve? Think about Sam, his family and community, staff

in the service, as well as professionals and services outside the childcare setting.

2. How would you involve them? Think about strategies you could use to ensure multiple voices are heard.

3. What resources might you need and how could you procure them? Think about the resources and expertise that already exists in the service as well as availability of external support (see Wong, Sumsion & Press, 2012a).

CRITICAL REFLECTION

QUESTIONS

overly distressed. He is a mostly quiet child, who often plays alone and seems nervous around unfamiliar adults. While he appears to have settled into the centre quite well, and is frequently able to communicate his needs through gesture (e.g. pointing and facial expression), Stacey is concerned that Sam seldom speaks and when he does it is often in one word utterances. Further, although he complies with instructions this is often only after watching other children and following their lead. In one-to-one interactions he often seems confused or looks away. Given the choice, Sam prefers to play outside in the sandpit where he spends prolonged periods creating elaborate tunnels to drive toy cars through. If other children destroy his tunnels— whether accidently or deliberately—he screams in a high pitched way: on one occasion he hit with a spade and bit a child who stomped on his tunnels. When the carer shouted at him to stop Sam stood still, eyes wide, and wet his pants. During indoor play times Sam builds roadways and tunnels with the blocks. When encouraged he will engage with craft materials but recoils at the touch of paint and paste. At group reading times he sits on the edge of the group and listens attentively but never speaks. Stacey cannot remember a time when she has seen him independently reading a book or using writing implements.

From this description of Sam’s family history, and Stacey’s observations of

his behaviour, it is apparent that his family has strengths, but that they and

he are also facing a number of challenges. Among the family’s strengths is the

apparent close, nurturing and supportive relationship between Sam and his

grandparents. Sam’s grandparents appear comfortable attending the centre and

are actively contributing to the centre activities. They are keenly interested in,

and are proactive in fi nding out about, Sam’s experiences. In their presence,

Sam appears better able to engage in development-enhancing activities than

when they are absent. Sam’s strengths include his abilities to develop close

relationships, to manage others’ expectations of his behaviour, and make known

and meet his own needs. He also demonstrates capacity to engage in complex

tasks and, by and large, to manage well in group social situations. Some of the

challenges Sam’s family faces are unstable care arrangements; insecure tenancy;

and a high likelihood of psychological and fi nancial distress, and mental and

physical ill-health. Concerns with Sam’s wellbeing include possible speech,

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cognitive and fi ne motor developmental delay, and troubling and challenging

social behaviours that may indicate abuse.

It will require the expertise and support of a range of professionals to

appropriately investigate, identify and build on Sam and his family’s strengths,

to address the many challenges he and his family face, and to increase the

centre’s capacity to include Sam and support his development. Some of the

professionals that might be called upon to support Sam and his family, for

instance, are: educators to facilitate Sam’s engagement in development-enhancing

learning experiences; family workers to provide advice and support the family

in accessing fi nancial and social resources; psychologists to investigate and

address behavioural concerns; speech therapists to investigate his language

development; and occupational therapists to investigate his tactile sensitivity

and fi ne motor skills and (where necessary) provide appropriate support. Some

of these professionals might be employed by the childcare centre. It is more

common, however, that they will be employed across multiple external services,

requiring families to negotiate a complex and sometimes confusing service

delivery system and to tell their stories multiple times, which often results in

families receiving diverse and even confl icting advice (Moore, 2008).

Thinking holistically, from an ecological perspective, it is highly likely

that many of the challenges and concerns that Sam and his family face are

interrelated. For instance, Sam’s reluctance to engage with some materials

and his poor socialisation skills may be due to his inexperience in group care,

FIGURE 10.1 PAPER CRAFT

Photo: Dinah Cocksedge

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Sandie Wong

or a result of the quality of the care (note, for instance, that the staff member

inappropriately shouted at Sam). Or, perhaps they stem from inattentive or

chaotic parenting as a result of his mother’s mental health and drug-related

diffi culties, which in turn may have been exacerbated by social isolation from

living in a rural area. Likewise, Sam’s nervousness around adults and his

reluctance to speak may be due to him feeling insecure because of the recent

upheavals in his life and ongoing tensions in the family due to his mother’s

court case, or to his being abused.

The most effective way diverse professionals can support Sam and his

family is to work together to develop a holistic care plan. Working together

and with his family, these professionals can each draw on their disciplinary

expertise to observe and interpret Sam’s circumstances and behaviours in a

range of domains, carefully identifying areas of strengths, and paying attention

to environmental factors (such as the quality of relationships, availability of

materials, and engagement strategies used in the centre), to develop mutually

agreed goals. In collaborative partnership with Sam and his family they can then

jointly plan and implement appropriate, family-centred, cohesive and well-

coordinated interventions to reach those goals, evaluating their effectiveness

as they go, as well as identifying and addressing issues as they arise. In this

way, Sam and his family will experience seamless and consistent care and

intervention, tailored to their individual goals and responsive to their emerging

needs.

Just as for Sam and his family, many children and families with complex

needs and facing multiple challenges require the support and expertise of diverse

professionals. The best experiences for these children and families, which are

most conducive to positive outcomes, occur when children and families receive

intervention that is cohesive, coordinated and integrated (Anning, 2005; Nichols

& Jurvansuu, 2008; Siraj-Blatchford & Siraj-Blatchford, 2009; Warmington et al.,

2004; Wigfall, 2002; Winkworth & White, 2011). This can only happen when

professionals from diverse disciplines work collaboratively.

Defining collaborative inter- professional work The Macquarie dictionary defi nes ‘collaborate’ as ‘to work, one with another’

(2013, n.p.). Minnis, John-Steiner and Weber (cited in Barnett & Frede, 2001

p.5) state that:

The principals in a true collaboration represent complementary domains of

expertise. As collaborators, they not only plan, decide, and act jointly, they

also think together, combining independent conceptual schemes to create

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original frameworks. Also, in a true collaboration, there is a commitment to

shared resources, power and talent: no individual’s point of view dominates,

authority for decisions and actions resides in the group, and work products

refl ect a blending of all participants’ contributions.

Collaborative work between professionals in early years settings is referred

to in the literature variously and interchangeably as multi-professional (Anning,

Cotteral, Frost, Green & Robinson, 2010; Davis & Smith, 2012); inter-professional

(Edwards, Daniels, Gallagher, Leadbetter & Warmington, 2009; Trodd & Chivers,

2011); multi-disciplinary (Collin, 2009), and interdisciplinary (Hains et al.,

2005). For consistency, the term inter-professional is used in this chapter.

However, these terms are also used to refer to the degree of collaboration.

FIGURE 10.2 COLLABORATION

Artwork by Emma

Collaborative inter-professional work is often placed on a continuum

from multi-disciplinary to trans-disciplinary, depending on the degree of

collaboration, with trans-disciplinary indicating the most collaborative working

relationships (Briggs, 1997, cited in Moore & Skinner, 2010). Table 10.1 defi nes

and outlines the different characteristics of professionals working at each of

three levels of collaborative inter-professional work in early years’ settings:

multi-disciplinary, inter-disciplinary, and trans-disciplinary (McGonigel,

Woodruff, Roszmann-Millican, 1994; Moore, 2005; Moore, 2008; Moore &

Skinner, 2010) boundaries.

Moore (2005) explains that in the fi eld of early intervention, a shift occurred

in the early 1980s from the multi-disciplinary mode to an inter-disciplinary

one, motivated by both practice and theoretical considerations. Practitioners

recognised the diffi culty, stress and alienation that uncoordinated services

were causing for families; and research evidence identifi ed that disjointed

interventions were not resulting in sustained change. At the same time, the

fi eld was infl uenced by ecological and transactional perspectives relating to

inter-disciplinary: In inter-disciplinary work, professionals work together (for example, to develop service plans), but maintain professional boundaries.

trans-disciplinary: In trans-disciplinary work, the most recent iteration of inter- professional work in early intervention and also the most collaborative, professionals work across professional boundaries.

multi-disciplinary: In multi-disciplinary work, professionals from different disciplines work individually, alongside one another, rather than with one another.

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Sandie Wong

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Some of the professionals at The Infants Home work in trans-disciplinary ways. For instance, a speech therapist works within the setting several days a week. Working closely with the educators, the speech therapist uses her expertise to observe children and identify those who might need intensive support. Together, drawing on the teacher’s early childhood pedagogical knowledge (e.g. play-based and child’s rights perspectives), and her understandings about individual children’s temperament, routines, interests and skills, they plan the curriculum. This might include, for example, planning a small language group at an appropriate time and place, and on a topic of interest to the children, targeted at a particular child in the group. The speech therapist also suggests strategies to support the educators’ communication with children (e.g. waiting 30 seconds before expecting a reply/repeating back the child’s words/using signs and visuals)—strategies that become part of the educators’ everyday practice. The speech therapist also models effective communication strategies, carefully explaining their rationale to the educators to ensure fidelity. For instance, the speech therapist might pick up a book with strong alliteration (e.g. Peter the Parrot) and explain to the educators that the aim here is to support children’s phonological development. Likewise, the teacher might suggest to the speech therapist materials and strategies that the speech therapist can use to respectfully and effectively engage children in both individual and group work (e.g. waiting for an appropriate ‘moment’ when the child is attentive and not otherwise engaged, using materials that the child/ ren have previously expressed interest in, working in a variety of indoor and outdoor spaces and at different times of the day). Through this trans-disciplinary approach the skills, knowledge and expertise of the speech therapist and teacher are combined to provide a setting that supports the inclusion of all children.

CASE STUDY 10.2

The Infants’ Home: An integrated early years service At The Infants’ Home Ashfield in Sydney’s Inner West, professionals from diverse disciplinary backgrounds work collaboratively to provide a range of education and care and early intervention services. Medical and allied health, social welfare and early years professionals share their specialist knowledge, expertise and understandings about health, nutrition, family support, early intervention and education. They each contribute to the overall program as well as the development of individualised programs and interventions that will best meet the needs of particular children and families. Many work directly with individuals and groups of children in the mainstream setting.

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Sandie Wong

early intervention (McGonigel et al., 1994). These perspectives recognised

the interrelated nature of human development—that is, children could not

be separated out into discrete units requiring individual treatment, but must

be treated as integrated individuals with interrelated developmental needs

(McGonigel et al., 1994). Further, it was recognised that children’s development

was connected to other signifi cant relationships in their lives, and by extension,

to their family’s broader social and community connectedness (as was the

case with Sam in Case study 10.1). These new understandings created an

imperative for greater coordination and collaboration between diverse early

intervention professionals. Two models of work that emerged from this more

coordinated approach to practice were the ‘team around the child’ (Limbrick,

2001 see http://www.teamaroundthechild.com) approach and the ‘key worker

model’ (Drennan, Wagner & Rosenbaum, 2005). In these approaches a multi-

disciplinary team of practitioners work together on a ‘case’ coordinated by one

key worker who liaises with the family (see for instance Rural Beginnings, n.d.).

Today, the trans-disciplinary mode of collaborative inter-professional work

is often aspired to in early intervention as the ‘best practice’ (King et al., 2009).

As an example of trans-disciplinary work in practice, Case study 10.2 (adapted

from Wong & Press, 2012, p.20, and reprinted with permission of The Infants’

Home) describes how a speech therapist and educators work together in an

early childhood setting. Combining the knowledge and skills from both their

disciplines, together they plan and implement the curriculum. The early

childhood educators use strategies that support children’s language acquisition

suggested by the speech therapist in their everyday interactions with children;

while the speech therapist works as an integral member of the education team,

providing learning experiences for groups and individual children.

A truly trans-disciplinary approach is challenging to achieve, however.

It not only requires professional commitment to new ways of working that

disrupt traditional disciplinary boundaries, but it also demands supportive

organisational and systemic structures. Trans-disciplinary work is made

especially diffi cult when professionals are employed across organisations

and service systems—as is most often the case in early years’ settings—where

structural barriers tend to operate against working in trans-disciplinary ways

(Press, Sumsion & Wong, 2010). Rather than see multi-disciplinary, inter-

disciplinary and trans-disciplinary ways of working as a strict hierarchy,

therefore, it may be more effective for professionals to consider the purpose

of working in an inter-professional way for a particular setting, at a particular

time. Some of the benefi ts of working in inter-professional ways in early years’

settings are explored below.

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Benefits of inter-professional work in early years settings The major tenet of collaborative inter-professional relationships in early years’

settings is that they allow knowledge and expertise to be shared and distributed

across all those working with children to create inclusive environments. In

collaborative inter-professional relationships each member is valued for the

knowledge and expertise they bring. Diverse ideas and opinions are actively

sought and shared openly through mutually respectful exchange: knowledge

fl ows freely among the group, distributing expertise and broadening the

understanding and skills repertoire of all team members (Drennan, Wagner &

Rosenbaum, 2005; Edwards, 2009). For example, in Case study 10.2 the speech

therapist shares her skills and expertise with educators who subsequently

integrate this newly acquired knowledge into their everyday professional

practice. Likewise, from the teacher, the speech therapist learns about resources,

materials and strategies for effectively and respectfully engaging children in

individual and group work. The distribution of expertise therefore enhances

their respective professional practice in ways that benefi t all children they

work with.

That is not to say that through collaborative inter-professional relationships

everybody becomes an ‘expert’ in all disciplines. As Edwards (2009, p.38) notes,

inter-professional work is not about moving towards ‘hybrid practice’. Rather,

it is about ‘developing the capacity to work with the expertise that others

offer’ (p.38). Disciplinary specialism and expertise continues to be valued and

acknowledged.

Collaborative inter-professional relationships enable professionals to

respond effectively to the diverse needs of children. Edwards (2009) contends

for instance that when professionals see themselves as a part of a collaborative

network, where expertise is distributed, they are better able to ‘look across

the lives of vulnerable children, identify the complex components of risk …

and work together to disrupt trajectories of exclusion’ (p.38). For example,

collaborative inter-professional relationships heighten awareness of the holistic

nature of children’s growth and development and its interconnectedness

with a range of familial, community, social, cultural, political and historical

factors, enabling a more nuanced response. In Sam’s case (Case study 10.1),

for instance, if educators, family workers, psychologists and speech therapists

each bring their professional expertise to bear on his story, multiple and diverse

challenges facing him and his family can be made visible and their origins and

potential trajectory understood. Once they are bought into the line of sight it

then becomes possible to intervene to address those challenges and lessen the

severity of any negative outcomes.

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Importantly, more than merely distributing existing expertise, collaborative

inter-professional work also generates new ways of working. Through

respectful and collegial processes of sharing and combining professional

expertise, challenging one another’s thinking, and engaging in joint problem-

solving, alternative ways of practising emerge, and are discussed, implemented

and evaluated. Inter-professional collaborations generate new solutions and

develop innovative practices (Darlington, Feeney, & Rixon, 2005). In this way,

collaborative inter-professional teams have an enhanced ability to respond

fl exibly to changing circumstances, requirements and emerging needs. In short,

in collaborative inter-professional teams the whole is far greater than the sum

of its parts.

Research, including numerous evaluations and case studies conducted in

Australia (see for instance Brettig & Sims, 2011; Colmer, 2008; Cumming & Wong,

2012; Moore & Skinner, 2010; Press et al., 2010; Wong, Press, Sumsion & Hard,

2012; Wong & Press, 2012), provide compelling evidence of the positive impact

of effective and sustained inter-professional and organisational collaborations.

Table 10.2 (adapted from Wong et al., 2012a) summarises a number of these

potential benefi ts for children and their families, communities, professionals,

the service and service system.

For children and families:

~ Increased awareness of, and understanding about, different disciplines and services;

~ Easier referral and access to a range of services through ‘soft-entry points’; ~ Ability to transition simply between services and/or use a range of services

simultaneously at the level of intensity required;

~ Smoother, more informed transition from early years services to school; ~ Families only have to tell their story once; ~ More effective identification and response to families’ emerging/ongoing needs; ~ More timely intervention; ~ More holistic service delivery—i.e. families are able to get a range of needs met in

one place;

~ Families experience increased consistency and continuity across programs/ services;

~ Reduced family stress due to professionals knowing the whole child within the context of their family and needs;

~ Reduced feelings of isolation; ~ Children having greater scope for social inclusion; ~ Increased parenting confidence and capacity.

TABLE 10.2 POTENTIAL BENEFITS OF COLLABORATIVE INTER-PROFESSIONAL PRACTICE

(Continued )

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For communities:

~ Access to services that meet local needs more effectively; ~ A larger pool of skilled and connected professionals.

For professionals:

~ Increased knowledge and skills; ~ Development of collegial and supportive relationships with a range of

professionals;

~ Career advancement opportunities; ~ Advancement of professional standing leading to greater job satisfaction; ~ Increased capacity to lead and articulate their practice to families and other

professionals;

~ Increased satisfaction of contributing to effective service delivery.

For services:

~ Greater sharing of professional expertise and resources across programs/ services;

~ More cost-effective service delivery through reduction of duplication within services;

~ Greater ability to use funds and resources in innovative ways; ~ Increased capacity to respond to families’ needs in innovative and

creative ways;

~ Improved profile and status of services in the community; ~ Improved staff retention and an enhanced capacity to attract staff due the service’s

positive standing and ‘marketability’.

For the service system:

~ Effective referrals resulting in fewer cases of children ‘falling through the cracks’;

~ Greater coherence across services/programs; ~ A more comprehensive service system; ~ Services are able to reach a broader population; ~ Reduced public expenditure through reduced service duplication; ~ Prevention of ‘problems’ becoming entrenched or worsening.

TABLE 10.2 POTENTIAL BENEFITS OF COLLABORATIVE INTER-PROFESSIONAL PRACTICE (CONTINUED )

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Sandie Wong

Supporting the development of inter-professional collaborative relationships The process of forming collaborative inter-professional relationships can be

challenging. It requires thoughtful, targeted and ongoing action at multiple

levels—from legislation and policy, through service delivery, to personal and

professional action (Edwards et al., 2009; Horwath & Morrison, 2007; Press

et al., 2010; Whalley, 2006). This fi nal section of the chapter outlines some of the

key factors for supporting the development of collaborative inter-professional

relationships at each of these levels. The discussion is necessarily condensed,

so readers are directed to referenced sources that provide expansive discussions

(e.g. Mattessich, Murray-Close & Monsey, 2001; Special Edition of Early Years,

2013) and to documents that support inter-professional practice (e.g. Prichard,

Purdon & Chaplyn, 2010; Wong, Sumsion & Press, 2012b).

SUPPORTIVE POLICY Inter-professional collaboration is supported through facilitative policies and

practice frameworks. Internationally, inter-professional collaboration has

emerged in policy documents as an important way of working in the early years,

especially for those working with children and families facing challenging

circumstances (Nolan & Nuttal, 2013). In the United Kingdom, for example,

greater recognition of the complexity of children’s and families’ lives have led

to shifts, over the last two decades, towards integration between health, welfare

and education services. In early years service delivery, in particular, Sure Start

Children’s Centres were established from the late 1990s to deliver ‘joined-up’

solutions for ‘joined-up problems’ (Nichols & Juvansuu, 2008). In these new

types of services, diverse professionals work together with the aim of reducing

social exclusion and enhancing the life trajectory of disadvantaged children

(Lewis, 2010).

Shifts towards inter-professional work are also evident in Australia. In

particular, there is increasing interest in the role that integrated early years

services, which incorporate a range of professionals from education, care,

intervention and family services, can play in ameliorating disadvantage (Press

et al., 2010). For example, the Indigenous Early Childhood Development National

Partnership Agreement has as one of its three elements, ‘integration of early

childhood services through the development of children and family centres’.

Under this agreement, 35 centres with integrated early learning, childcare and

family support services will be established in communities regarded as highly

disadvantaged that also have a high proportion of Indigenous children under

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fi ve years old (DEEWR, 2011). Similar commitments to ‘one-stop shops’ and

collaborative service provision as a way of addressing inequality can be found

in state/territory government policies (e.g. Victoria, Western Australia and

Queensland) and within local government (e.g. Moonee Valley City Council in

Victoria; and the Stronger Families Alliance in New South Wales) (Press et al.,

2010; Wong et al, 2012b).

Policies for integrated service delivery require complementary practice

frameworks. One such document that acknowledges the importance of

collaborative relationships in early years setting is the early years national

curriculum The Early Years Learning Framework (EYLF) (DEEWR, 2009). In

this document, reference is made to the critical role of refl ective partnerships

between early years educators, educators in the early years of school and

other professionals, as well as with children, their families and communities.

In particular, such partnerships are recognised as making an important

contribution to equitable practice and to inclusion. The EYLF states, for

instance, ‘by developing their professional knowledge and skills, and working in

partnership with children, families, communities, other services and agencies,

they [educators] continually strive to fi nd equitable and effective ways to ensure

that all children have opportunities to achieve learning outcomes (DEEWR,

2009, p.13; emphasis added). Likewise, ‘partnerships also involve educators,

families and support professionals working together to explore the learning

potential in every day events, routines and play so that children with additional

needs are provided with daily opportunities to learn from active participation

and engagement in these experiences in the home and in early childhood or

specialist settings’ (DEEWR, 2009, p.13; emphasis added).

Yet, despite current Australian policy being supportive of inter-professional

relationship development, a number of structural barriers remain. Among

factors that have been identifi ed as operating against collaborative relationships

are divergent compliance and legislative requirements across and between

government departments and service systems (Press et al., 2010). For instance,

when professionals operate under multiple jurisdictions they often have

to comply with different reporting and acquittal mechanisms requiring the

collection of different types of data over different periods. Such procedures can

be complex and burdensome for professionals and management alike. Further,

competition for government funds can operate against cooperation between

organisations. Similarly, while policies are increasingly relying on inter-

professional collaboration, there is limited acknowledgement of the additional

resources (e.g. time, space, and professional development) required to facilitate

this way of working. Moreover, inequitable pay and working conditions between

disciplines can compromise collaborative working relationships. Organisations

and professionals seeking to work in inter-professional collaborative ways

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Sandie Wong

have to negotiate these, and myriad other, challenges—but more than this they

have a responsibility to advocate for systemic changes that support new inter-

professional ways of working.

SUPPORTIVE SERVICES Collaborative inter-professional working relationships are supported in services

where there is a clear vision enacted through sound governance and management,

an open and trustful organisational climate, and strong, facilitative leadership.

Vision, governance and management

Organisations that support inter-professional ways of working often have a

strong vision, grounded in concerns with social justice and human rights

that extend well beyond the confi nes of the organisation (Press et al., 2010).

For example, the organisation Vision at The Infants’ Home, from where Case

study 10.2 is drawn, is for a socially inclusive ‘society in which each child is

given the opportunity in early childhood to develop the abilities to meet life’s

challenges and opportunities’ (The Infants’ Home Annual Report, 2011, cited

in Wong & Press, 2012, p.15). Further, work at The Infants’ Home is based on a

core principle: ‘to provide each child with every opportunity’ (p.20). Embedded

within this larger framework of social justice and equity, The Infants’ Home’s

work is directed to the best interest of their clients. This approach has facilitated

inter-agency collaboration and a movement towards inter-professional work.

For instance, greater recognition of the holistic needs of children has resulted

in information exchange and collaboration with other organisations (such as

family support and medical services) to ensure that children get the range of

services they require. In addition, the organisation has employed professionals

from diverse disciplines to work with early years professionals, to ensure

children and families receive the most effective and timely intervention.

Organisational visions can also act as a type of ‘social glue’ that holds

diverse professionals together. They articulate a common goal to which each

professional aspires and commits and which orients their practice—fostering

what Robinson, Atkinson and Downing (2008) refer to as ‘collective ownership’.

Having an effective vision is not enough however; the vision needs to be enacted.

It has to permeate the practices and procedures of the organisation. Good

governance and management, therefore, is critical for supporting collaborative

inter-professional work.

Collaborative inter-professional relationships are supported when

organisations have sound governance and facilitative management structures

that are oriented to this way of working. In particular, organisations must

strategically plan the shift towards, or development of, collaborative

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inter-professional work, recognising the time it can take for such shifts to occur

and managing the changes sensitively and effectively. For instance, in regard

to personnel, organisations wanting to support inter-professional work need to

actively recruit professionals who express a willingness to work in collaborative

ways. They need to provide ongoing incentives for those who exemplify this

way of working, as well as sensitively support the transition out of those who

do not wish to work in that way (Wong & Press, 2013).

Organisational systems, procedures and processes also need to be oriented

to supporting collaborative inter-professional ways of working. For instance,

Memoranda of Understanding, joint referral processes and staff exchange

can expedite inter-professional collaboration across different organisations.

Likewise, the provision of adequate resources (e.g. time, space, materials and

professional supervision), effective communication strategies (e.g. meetings,

documentation and records), and equitable employment conditions, can

support inter-professional relationships within organisations (Press et al.,

2010). While these structures and procedures are facilitative, collaboration is

essentially about relationships, and so workplace culture also plays a critical

role in the success or otherwise of inter-professional work.

Culture

Inter-professional relationships are supported where there is an organisational

culture and ethos that values and cultivates inter-professional expertise

(Edwards, 2009; Horwath & Morrison, 2007; Whalley 2006). For instance,

organisations that have been successful in working in inter-professional ways

actively operate to build trusting relationships, founded on mutual respect for

diverse ability, knowledge and skills (Edwards, 2009). They are often grounded

in a commitment to equitable infl uence where all people’s voices are heard.

Such relationships are necessary for creating conditions for robust debate in

which commonly held ‘truths’ (such as the centrality of play in early childhood)

can be explored; the meaning of language (e.g. child-centred) interrogated; and

practices (such as individualised intervention) scrutinised in collegial ways.

Organisations that support inter-professional collaboration are also often

dynamic and open to change: They encourage risk taking and creativity and take

time to celebrate success (Press et al., 2010). Such cultures are often supported

by philosophies such as strengths-based approaches and other change-oriented

philosophies that assist professionals to reorient interpersonal confl ict towards

resolution (Press et al., 2010). They also tend to have strong leadership.

Leadership

Strong leadership is a critical factor in the development of collaborative inter-

professional teams. Leaders of successful inter-professional teams tend to be

committed to this way of working. They are typically described as inspirational,

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knowledgeable, informed and dynamic (Wong et al., 2012b). They engender

the respect of their teams by their openness and willingness to listen to and

respond to staff. They are fl exible and able to manage change effectively and to

negotiate new professional practices (Press et al., 2010). Without such effective

leadership, the development of collaborative inter-professional relationships in

early years settings will be severely compromised. But even with supportive

service conditions, the development of inter-professional relationships

depends largely on the willingness, capacities and commitment of individual

professionals.

Personal and professional action FIGURE 10.3 WORKING TOGETHER

Artwork by Joshua

Working towards collaborative inter-professional relationships is a deliberate

activity undertaken by professionals with the purpose of improving outcomes

for the children in their charge, their families and their communities. To work

in inter-professional ways requires personal, philosophical and professional

commitment to developing strong relationships and working with others

for the purpose of developing shared goals, for which each member of the

relationship is responsible. Successful inter-professional relationships also

require professionals to have a certain degree of confi dence both in their

disciplinary knowledge and their competency in their roles. It also requires an

ability to articulate that knowledge to others. Those who have been successful

in developing inter-professional relationships tend to be highly self-refl exive:

They are open and keen to receive new knowledge and experiment with new

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ways of working, but they are also willing to share their expertise with others

and assist and support others’ learning (Cumming & Wong, 2012).

While each member of an inter-professional collaboration brings their own

disciplinary knowledge, culture and philosophies, inter-professional work, and

trans-disciplinary work in particular, requires professionals to not only cross

disciplinary boundaries, but also to cede disciplinary control (McGonigel et al.,

1994). For some, working in this way can be experienced as a threat to their

professional identity (Cumming & Wong, 2012). One way for professionals to

develop the skills necessary to engage effectively in inter-professional work

with an intact professional identity is to engage in professional development

that deepens their disciplinary knowledge as well as that which fosters inter-

professional ways of working. Indeed, as collaborative inter-professionalism is

increasingly viewed as a key professional competency across many disciplinary

domains, a new fi eld of professional development, known as ‘inter-professional

learning’, has emerged. In inter-professional learning, which is common in the

United Kingdom but less so in Australia, professionals from a range of disciplines

come together to learn around a topic of common interest (Payler, Meyer &

Humphris, 2007). Inter-professional learning has the potential to further support

inter-disciplinary understandings and foster collaborative relationships. In

Australia, several resources have been created to support the development of

inter-professional relationships, such as Moving Forward Together (Prichard,

Purdon & Chaplyn, 2010); Developing and Sustaining Pedagogical Leadership

(Macfarlane, Cartmel & Nolan, www.ecceleadership.org.au); and Supporting

professional learning in an integrated context: a resource for early childhood

leaders (Wong et al., 2012b).

Conclusion This chapter has argued that collaborative inter-professional relationships can

support the inclusion of all children, but especially those with complex needs.

It has outlined what inter-professional collaboration looks like in practice and

its benefi ts. While acknowledging that working in collaborative ways can be

challenging, the chapter has provided information about the conditions at policy

and service levels that may assist professionals’ work in collaborative inter-

professional ways. Ultimately, however, inter-professional work is a personal

professional choice. When professionals choose to work in collaborative

inter-professional ways, they enable their skills, knowledge and expertise to

be pooled with others, through processes of mutual exchange, to create new

and innovative ways of working that benefi t children, families, the community,

services and themselves.

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Anning, A. (2005). Investigating the impact of working in multi-agency service delivery settings in the UK on early years practitioners’ beliefs and practices. Journal of Early Childhood Research, 3(1), 19–50. doi:10.1177/1476718x05051345

Anning, A., Cotteral, D., Frost, N., Green, J. & Robinson, M. (2010). Developing multi-professional teamwork for

integrated children’s services (2nd edn). Maidenhead: Open University Press.

Barnett, W.S. & Frede, E.C. (2001). And so we plough along: The nature and nurture of partnerships for inquiry. Early Childhood Research Quarterly, 16(1), 3–17. doi:10.1016/ s0885-2006(01)00082-5

1. Think about your early years work setting or another place that you are familiar with. a. What types of inter-professional work have

you seen in action? Think about who was involved; what it looked like in practice; how collaborative it was; and the degree to which multiple voices were heard.

b. What do you consider some of the benefits and challenges of working in collaborative ways? Think about the children and their families, the local and professional community, the service and the professionals.

2. Minnis, John-Steiner and Weber (cited in Barnett & Frede, 2001, p.5) argue that in a ‘true collaboration, there is a commitment to shared

resources, power and talent: no individual’s point of view dominates, authority for decisions and actions resides in the group, and work products reflect a blending of all participants’ contributions’. a. What might a collaboration based on these

ideals look like in your early years or higher education setting? Think about who would be involved and the ways they would be involved.

b. What strategies might need to be adopted to ensure a ‘true’ collaboration? Think about: resources available, processes and practices, the skills, knowledge and expertise of staff, and ways of working.

FOR FURTHER REFLECTION

WEBSITES

www.tandfonline.com/toc/ceye20/33/4#.U3CgYMbtWIw For further reading on current and international research and commentary on the provision of integrated early years services and inter-professional work see a Special Edition of Early Years: An International Research Journal exploring Integrated Children’s Services: Re-thinking Research, Policy and Practice (Volume 33, Issue 4, 2013).

www.ecceleadership.org.au This website is on ‘Developing and sustaining pedagogical leadership’. Authored by Macfarlane, Cartmel, & Nolan, this website provides a number of online learning modules to support leadership capacity, including in integrated services, in the early years sector.

NOTES

1 This chapter is based on work conducted with my colleagues Jennifer Sumsion, Frances Press, Louise Hard and Tamara Cumming (Cumming & Wong, 2012; Press, Sumsion & Wong, 2010; Wong & Press, 2012; Wong, Sumsion & Press, 2012b; Wong, Press, Sumsion & Hard, 2012).

REFERENCES

Sandie Wong

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Brettig, K. & Sims, M. (Eds). (2011). Building integrated connections for children, their families and communities. Cambridge Scholars Publishing: Newcastle upon Tyne.

Collaborate. (2013). The Macquarie dictionary online (5th ed.). Retrieved from www.macquarieonline.com.au

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