Understanding Boundaries in Interprofessional Work

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Understanding Boundaries in Inter-professional
Work

• anne.edwards_at_education.ox.ac.uk

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Boundaries

• Social practices are open to negotiation there
• There are opportunities for creativity
• They are socially constructed
• They can be uncomfortable

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Overview

• Why boundaries are important for working on the
  prevention of social exclusion
• Concepts for examining the prevention of social
  exclusion and boundaries
• The negotiation of values and motives at the
  boundaries
• The analytic usefulness of the concepts weve
  developed in a study of preventative practices in
  and around secondary schools

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Social Exclusion OECD 1990s

• Is the process of becoming detached from the
  organisations and communities of which society is
  composed and from the rights and responsibilities
  they embody
• (Room 1995 243)

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Implications

• A dynamic process of accumulated vulnerability
• Early intervention (PAT 12) (Home Office 2000)
• Inter-professional collaboration essential
• Important role for universal services such as
  schools in recognising vulnerability and alerting
  other services (Treasury/DfES 2007)
• Tier 2 and 3 level work (where tier 1 is
  universal services and tier 4 is child
  protection)

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Democratic engagement and the tailoring of
services

• We want to hear the voices of young people
  influencing and shaping local services
  contributing to their communities feeling heard
  feeling valued being treated as responsible
  citizens
• (Childrens Fund
  2000)

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Major long-term policy change

• Collaborating practitioners racing ahead of their
  employing organisations
• New affinity or solution spaces opening up
  between organisations (Hartley 2007)
• Practitioners potentially vulnerable as they push
  against the grain of established practices
• Can organisations (e.g. schools) accommodate the
  new practices that are informed by collaborations?

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Analytic resources developed in our CHAT-based
studies

• A trajectory of social exclusion
• Distributed expertise
• Relational agency
• Boundaries

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A trajectory of social exclusion

• Can be disrupted by timely early interventions
• A problem space being worked on by practitioners
  (and families)
• An object of activity in CHAT terms

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Distributed expertise

• CHAT view expertise a collective attribute
  spread across systems
• Discursive construction of tasks, solutions,
  visions, breakdowns and innovations within and
  across systems (Engestrom and Middleton 1996)
• Expertise negotiated task accomplishment

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Relational agency

• Working with others to expand the object of
  activity by recognising the motives and
  resources they bring to bear
• Aligning ones own responses to the newly
  enhanced interpretations with those of others to
  act on the expanded object of activity
• Recognising the motives of others is key

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Boundaries

• Boundaries are social constructions
• Values give shape to boundaries
• The sacred and the profane (Midgley et al
  1998)
• The are not neutral spaces but are sites of
  struggle

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Revealing values and motives in discussions at
the boundaries

• Values are a glue which give direction to
  immediate actions
• Not enough to know who can help
• Need to know what their values and object
  motives are i.e. what do they see in a childs
  trajectory that leads them to take action
• Discovering values and motives for different
  professions is a prerequisite for fluid,
  flexible, responsive work with vulnerable children

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Narrative accounts at the boundaries of
organisations (Edwards and Kinti forthcoming)

• Clive Its interesting it makes me think of
  boundaries again. There is a sense in which
  although the child is the same child outside and
  inside we sort of feel we can almost draw a
  boundary around the school and say when you are
  in here you can leave it at the gates or we can
  minimize the effects yeah.I think we set
  ourselves a target which is almost unachievable,
  unattainable in the sense. Um and perhaps the way
  in which schools with others need to be bridging
  that boundary differently. It resonated with
  (name of nearby city) where the teachers feeling
  was although a lot of the cause of
  underachievement and so on lieare outside the
  school, its their responsibility to do something
  about it. And theres the terrible bind. I think
  teachers put themselves into feeling responsible
  for doing something. Of course with one hand tied
  behind your back.

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Contd

• Cathy (one of the teachers) But isnt this where
  we feel we are working in isolation, that the
  school is really quite apart from those, its
  quite apart from the rest of what is going on. We
  are .. this is different, therefore we can move
  up this way because its not going to come in. And
  thats what we are trying to say.
• Clive .if you keep bringing people into the
  school, if you keep doing that the school will
  burstPerhaps there is a model that works

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One hour later Cathys second story

• I mean something that just sorry, something that
  just came into my head is many years ago I worked
  in (name of city) for the child guidance service.
  And the way they worked it there was that the
  child guidance service there were offices in
  each area. And each office then had its own
  schools and the schools referred to child
  guidance. I was a teacher in the team, we had
  weekly meetings where all the children that were
  referred by those schools were discussed with the
  paperwork obviously. That team consisted of
  psychiatrist, Ed Psych, social worker, teacher
  and I can see a couple of others but Im not sure
  what agencies they were. So then the child is
  discussed, the presenting problem is discussed
  and it was decided at that weekly meeting which
  agency was actually going to be dealing with
  them, at that timeI actually look back that on
  that systemas being a very good one at the time.

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Boundary work

• Clive (the EP) revealed his meaning systems-
  values and motives effects, targets, models,
  systems
• Cathy (the teacher) picked them up - balancing
  at the boundaries and starting to align with the
  educational psychologist
• A vertical ranking of discourses in meetings
  about children (Mehan 1993)

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The secondary school study

• What can the analytic resources outlined so far
  tell you about what is going on at the boundaries
  of schools and other services?
• What questions are raised about how English
  schools are dealing with the prevention of social
  exclusion and childrens wellbeing?

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The research questions

• What were
• the challenges facing schools and teachers as
  they contributed to preventing social exclusion
• features of schools which gave rise to
  preventative practices which included working
  responsively with other professionals
• the shifts in teachers professional practices
  which enabled them to work in preventative ways
  with other professionals and vulnerable children

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The design

• Five secondary schools as case studies shaped by
  CHAT (purposes, tools, rules, division of labour
  etc.)
• Oral questionnaire based on case study findings
  with one teacher in 46 secondary schools

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Attainment and wellbeing the sacred and profane?

• Academic systems separating from pastoral/welfare
  systems
• Workforce remodelling (welfare managers) and
  revised professional standards for teachers
• Welfare managers picking up and expanding the
  work that could not be accommodated by schools as
  academic systems

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Boundaries as social constructions?

• The academic and welfare systems operated with
  different purposes and methods of communication
  and ran in parallel within schools
• Boundaries were being negotiated during the study
• I think it is a source of frustration for
  them (WM) as the boundaries arent as clear as
  they would like them to be (deputy head)

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Stretching the boundaries?

• Welfare managers were also looking outwards
  towards other services
• Creating a new problem space for
  inter-professional tier 2 and 3 interventions on
  children identified as vulnerable by the school
  welfare system
• Carers often seen as part of the problem (at a
  time when the academic system recruiting carers
  as partners in monitoring achievement)

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Distributed expertise outside schools?

• What expertise did the welfare managers offer?
• Short courses gained know-who knowledge
• Drawing other services into preventative work to
  help them
• Ive got the sort of rapport with social
  services that I can ring them up for advicenow I
  would automatically ring themcan you give me
  some advice. And it if it is not you who should I
  go to?
• 
  (welfare manager)

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Revealing values and motives?

• No meetings set up to reveal the values and
  motives in play in inter-professional work
• A focus on immediate problem solving and know-who
  knowledge in multi-agency meetings
• And sometimes I sit there and think actually,
  you know, that might be useful. And you jot it
  down. And then maybe a few months later it is
  something you can tap back into. I find that part
  very useful.
• 
  (welfare manager)

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Relational agency?

• working flexibly with other services to support
  a child involves developing new insights into the
  priorities and practices of other services
  most highly ranked statement about what needs to
  be learnt
• Welfare managers learning as they worked with
  other services building up an intelligence
  around a child
• No evidence that the learning was reciprocal

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Who was shaping the new preventative landscape?

• Schools - as they moved expanded welfare concerns
  outside the dominant academic systems
• Welfare managers plugging a gap between universal
  services and the tier 4 work of social services
• New practices were being driven forward by
  welfare managers as they followed childrens
  trajectories helped by senior teachers who
  could bend rules where necessary to take things
  forward i.e. the schools were shaping the new
  landscape

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Key features of this snapshot

• Trajectories were followed and worked on by
  welfare managers
• Distributed expertise what expertise was
  offered by welfare managers?
• Relational agency other services were recruited
  to work on problems identified by welfare
  managers but some evidence of welfare managers
  learning from other professions
• No work on values and motives as a prior to
  relational agency
• Boundaries separating the sacred (academic
  systems and tier 4 work) and the profane
  (preventative systems and carers)
• Academic systems and social service systems
  separated by an emergent system seen as profane
  by both

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Implications for work on and at boundaries

• Preventative work needs to be removed from its
  profane status of carrying out work that cant be
  absorbed by schools
• Welfare managers need a professional education to
  avoid their knowledge being low status in
  boundary conversations
• Time needs to be spent on identifying what
  wellbeing means for different services so that
  values and motives can be revealed

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Concluding points

• Boundaries are fascinating places
• How and why they are drawn is revealing
• But not just an esoteric exercise
• Strong practical implications