Nigel Malin

Parents and professionals working together: turning the rhetoric into reality

Parental involvement and participation, partnership with parents, and community‐focused development are important features of government initiatives such as the Sure Start project for children under four years of age and their families. A common feature of the rhetoric is ‘empowerment’ as a means of achieving this. This article describes the activity and development of the Parents Committee in one Sure Start programme and uses this to tease out different dimensions of empowerment. In particular, it highlights issues regarding developing empowerment and the dynamic tension between the growth of personal power and the changing symmetry of power relationships. A tentative model of the trajectory of developing empowerment is presented. This may raise challenges for professionals seeking to fulfill their professional role in a complex context and questions as to whether, or how, it might be possible to better prepare professionals for this dimension of their work.

Interprofessional teamworking for child and family referral in a Sure Start local programme

Interprofessional and inter-agency working are important features of UK government initiatives, such as Sure Start local programmes for children under 4 years old and their families. Part of the vision for Sure Start was that providers of services and support would work together in new ways that cut across old professional and agency boundaries and focus more successfully on family and community needs. This paper describes the development and functioning of a Referral and Allocation Project in one trailblazer Sure Start local programme. The Programme employs staff with backgrounds that include health, social work, education and clinical psychology who work in a shared location. The Referral and Allocation Project sought to develop, through regular meetings, a whole-team inter-agency focus on discussing the needs of families who had been referred, or had referred themselves, to Sure Start and on suggesting ways in which support or advice could be offered and accessed in order to meet their needs. The paper examines issues that arose during the development of the Project, in particular psychodynamic dimensions such as emotional impact and professional anxiety. These may have implications for the format and culture of interprofessional team meetings and for training and professional development.

Models of interprofessional working within a Sure Start “Trailblazer” Programme

This paper evaluates interprofessional working within a Sure Start “trailblazer” programme based upon definitions of multi-, inter- and trans-disciplinary practice. Examples of practice from within the programme include professionals working towards family support and child protection objectives, providing a forum for child and family referral and a programme to promote mother-child bonding. Findings are discussed in the context of linking interprofessionality with government target-setting, professional identity and values and integrated working practice for Sure Start/Childrens Centres.

Evaluating the role of the Sure Start Plus Adviser in providing integrated support for pregnant teenagers and young parents.

This paper offers a descriptive evaluation of the role and performance of the Sure Start Plus Adviser in providing integrated support for pregnant teenagers and young parents, and focuses on their interprofessional working. The study, based upon interviews and questionnaires with advisers, pregnant and parenting teenagers and mainstream professionals, was conducted within five Local Authorities in the north-east of England. Findings show differences in how the role was undertaken and in terms of its impact within different authorities. The principal contribution was perceived as providing one-to-one advice, personal and emotional support and by networking within agencies to help change the attitudes and role of mainstream professionals, for example, in midwifery, housing and Connexions. The conclusion affirms the adviser as a role model to inform current developments towards creating lead professional status and integrated packages of support for teenage parents.

The impact of social policy on changes in professional practice within learning disability services: different standards for children and adults? A two-part examination: Part 1. The policy foundations: from welfare markets to Valuing People, personalization and Baby P

This is the first of two articles examining links between policy developments and changes in professional practice within learning disability services in England, focusing upon emergent differences between children’s and adult provision. The article focuses on the evolving tension around policy directions and managerialism/professionalism, with the latter as a set of practices driving services, particularly following the 1988 Griffiths Report but referring also to its antecedents. Implications of this development are examined to highlight a difference in emphasis between the credibility and professional status of the workforce in children’s, as opposed to adult, services for people with learning disabilities. A historical narrative demonstrates a continuum from the policies of Thatcherism to those of New Labour, underpinned by the assertion that normalization ideas have shaped both social policy and professional directions. The origins of current policy initiatives covering the last 20 years are explored, showing the consequences of a developing gap between professional inputs for children’s and adult services.

An Ethical Advisory Group in a Learning Disability Service What They Talk about

This is the second of three papers reporting on a study of the work of an ethical advisory group working within a learning disability service. The part of the study reported in this paper sets out to investigate the ethical content of the groups output by studying the content of its discussions, and its processes of decision-making and conflict management. Three consecutive meetings of the group were recorded and observed. Also, individual members were interviewed. Meeting transcripts were subjected to a qualitative analysis. This revealed that a wide range of ethics-related concepts were articulated in the meetings, and a productive balance seemed to be achieved between conflicting principles. The major tension was between the ethics of care and protection, and the ethics of autonomy. The concept of duty was only expressed in the context of the duty of care, and the ethics of character and virtue were absent, perhaps justifiably. Overt conflict was almost entirely absent, and probably for this reason opinions were sometimes expressed without supporting argument. However the conflict of principles supplied the element of controversy recommended in the literature. The group also showed a willingness to subject its parent organizations actions to ethical analysis.

The impact of social policy on changes in professional practice within learning disability services: different standards for children and adults? A two-part examination: part 2. Professional services under the coalition: the trends continue apace.

This is the second of two articles examining links between policy developments and changes in professional practice within learning disability services in England. The first article focused on policy foundations over the last 30 years, and concluded that there was a developing gap in professional inputs between children’s and adult services. This article, written one year into the Coalition government, argues that its policies – especially the large-scale reduction in public expenditure, but also the decline in support for inclusion of children in mainstream education, the rapid growth of academies, and proposals for the reorganization of the NHS – have exacerbated the trends identified earlier. In addition, local authorities, though outwardly compliant, have variously interpreted their responsibilities under the personalization agenda, in particular in relation to individual budgets, and this has resulted in assessments of need being based on ‘service hours’ rather than service quality and staff qualifications.

An Ethical Advisory Group in a Learning Disability Service Members’views on outcomes

This, the third paper on the work of an ethics group in learning disabilities uses the perspective of group members/participants to identify the nature and scope of the group’s work and its achievements. Fairly lengthy audiotaped interviews were undertaken with 15 individual members which were subsequently transcribed and content analysed to obtain information about the ethics group: its purpose, focus, perceived benefits to service users and staff from different professional disciplines, and manner of operation. The fact that the group had been in existence for a reasonable duration, but with slightly changed membership, meant that members would have a historical record of the diversity of individual cases presented for the group’s attention. The ethics group was perceived as benefiting service users, professional care staff and the Trust organization as a whole. Its style of approach was to seek out consensus for a specified course of action and to offer both pragmatic and trial/error solutions. Issues considered by the group, more frequently than not, involved allegations of exploitation of users (either sexual, psychological or financial) and the associated balance between risk, autonomy and promoting independence. Suggestions were put forward to enhance the effectiveness of the ethics group including raising its overall profile within the Community Trust – widening membership, monitoring outcome and increasing clerical/administrative support. The main generally perceived advantage concerned the process of giving reassurance to professional care staff and in helping problem-solving and decision-making centred around care provision for individual adults with learning disabilities.