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we. not me.. Decision Making
Co-ordination in a Multidisciplinary Team
Monica McTurk Clinical Co-ordinator Community
Child Health / Head SLT for Special Needs,
Dumfries Galloway
February 2010
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The Multidisciplinary Feeding Team

• Paediatric Gastroenterologist
• Paediatric Surgeon
• Community Paediatrician
• Family GP
• Paediatric Radiologist
• Clinical Nurse Specialist
• Dietician

• Speech Language Therapist
• Physiotherapist
• Occupational Therapist
• Psychologist
• Social Worker
• Community Nurse
• Health Visitor
• Educational Staff

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Vital Features of Intervention in Enteral Feeding
must be to

• Ensure feeding is safe
• Maximise nutrition
• Support the family whatever the feeding
  difficulties
• Consistency of advice
• Timely communication
• Co-ordination

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• Support during diagnosis
• Communication
• Respect for parents
• Respect for expert knowledge
• Attitudes and values
• Organisational issues

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A Key Worker is both a source of support for
disabled children and young people and their
families and a link by which other services are
accessed and used effectively. Key workers have
responsibility for working together with the
family and with professionals from services and
for ensuring delivery of an inter-agency care
plan for the child and family.
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Practice Standards

• The role of the key worker should include
• Providing information
• Identifying and addressing the needs of all
  family members.
• Providing emotional and practical support as
  required.
• Assisting families in their dealings with
  agencies and acting as an advocate if required.

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This role will be achieved by

• Pro-active, regular contact.
• A supportive, open relationship based on respect
  for the view of parents, children and young.
• A family centred (not only a child centred)
  approach.
• Working with the families strengths, acting as
  an advocate or enabling parents, children and
  young people to access advocacy support as
  required.

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What should Co-ordinators Aim to Accomplish?

• They should
• Enable families to see their group professionals
  working in unison with similar goals for the good
  of their child.
• Increase level of information available to
  parent.
• Increase the level of family participation.
• Reduce to running around element for parents.
• Reduce the parental and professional confusion
  and frustration.
• Reduce duplication and gaps in services.

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What should Co-ordinators do to Achieve that?

• They should
• Listen, hear and understand the concerns and the
  priorities for families.
• Address the present, medium and long term
  implications for the childs disability for the
  family families do not want specific answers or
  predictions, they want opportunity to discuss
  and to feel they are being heard.
• Mediate, if needed (i.e. between the
  professionals and between the family and the
  professionals).
• Facilitate, if needed (e.g. appointments for the
  family).

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• Ensure that the agreed service plan is
  implemented, through regular contact with other
  workers.
• Ensure that the agreed service plan is
  implemented, through regular contact with other
  workers.
• Contact the family regularly and pro-actively
  (on an I am interested in you lives basis
  rather than on a ring me, if you have a problem
  basis).
• Be a signpost for other services.
• Ensure that the family has access to any
  professional whose information the family is
  unclear about.
• Provide support to other client team members.

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What Skills do Co-ordinators Need to Have?

• The ability to be unbiased. They must bit be
  seen to take sides and wave their own
  disciplines flag. They should be able to
  accurately reflect what is being said by others,
  including the family.
• The ability to take a broad overview of a
  situation, without becoming immersed with
  particular details.
• Skills to work in the multiagency team. They
  need to have an equally high regard and respect
  for families, other professionals and their
  disciplines.
• Honesty, so that promises are not made that
  cannot be fulfilled by other disciplines.

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• The ability to talk to anyone at their level
  without jargon.
• Skills to negotiate with other disciplines
  concerning their contributions to the family,
  without dictating to others.
• They should be human, informal and appear to
  have time for the whole family.
• The ability to plan well ahead and anticipate.
• The ability to chair meetings (some
  professionals feel they need training).

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The Role of Care Co-ordinator is NOT about?

• Being a family befriender or counsellor other
  than in the usual professional role.
• Being responsible for solving all actual and
  potential problems for a family.
• Being responsible and / or accountable for the
  actions or omissions of other professionals and /
  or agencies and their support staff.
• Being a voice for other agencies, other than
  within the sphere of an agreed family care plan.

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Potential Outcomes .

• Proactive management of needs through
  multidisciplinary care co-ordination
• Reduced family stress
• Reduced duplication in assessment / reporting to
  families
• Holistic view of whole family
• Equity of approach
• Single access point for families and
  professionals
• Reduction in response time to parents