Rick Hood

A critical realist model of complexity for interprofessional working.

This paper presents a theoretical model of complexity for considering issues relevant to interprofessional working. The need for such a model is introduced with reference to the literature on collaboration and integration in health and social care, particularly in childrens services. It is argued that interprofessional working is often seen as a response to complexity, but that current models fail to build an appreciation of complex causality into their approach to addressing needs through targeted interventions. The alternative offered here is a critical realist model based on Bhaskars domains of reality, focusing on the implications of open systems, complex causality and contingency. These ideas are used to examine some of the issues and dilemmas typically encountered by interprofessional networks in coming together to work on complex cases.

Exploring Demand and Provision in English Child Protection Services

This paper presents the results of an exploratory study linking the national data-sets for all children in need and child protection services in England. The study was informed by an emerging literature on systems thinking in public services, and aimed to examine variations and patterns of response in local authorities to demand for child welfare services in their area. One hundred and fifty-two local authority census returns and other statistical indicators covering up to a thirteen-year period were combined into a single data-set. Statistical analysis was undertaken to explore the characteristics of demand, workload and workforce, trends over time and variations between local authorities. The results showed that the overall system has become increasingly geared towards protective interventions, especially since the Baby P scandal of 2008. Deprivation levels continue to be the key driver of referrals and other categories of demand, and are strongly associated with variations in service response, particularly in the initial stages of referral and assessment. Implications are considered for the current organisation of child welfare services in light of recent reviews and reforms.

A socio-technical critique of tiered services: implications for interprofessional care

Abstract In the health and social care sector, tiered services have become an increasingly influential way of organising professional expertise to address the needs of vulnerable people. Drawing on its application to UK child welfare services, this paper discusses the merits of the tiered model from a socio-technical perspective – an approach that has emerged from the fields of accident analysis and systems design. The main elements of a socio-technical critique are outlined and used to explore how tiered services provide support to families and prevent harm to children. Attention is drawn to the distribution of expertise and resources in a tiered system, and to the role of referral and gate-keeping procedures in dispersing accountability for outcomes. An argument is made for designing systems “against demand”, and the paper concludes by discussing some alternative models of multi-agency provision.

Combining phenomenological and critical methodologies in qualitative research

Interest in qualitative methodologies has grown over recent decades, encouraged by alternative research paradigms in the critical and postmodernist tradition. The array of interpretative frameworks now available to qualitative researchers suggests a potential for pluralist study designs that are not widely employed at present. Drawing on doctoral research in the field of child protection, this paper explores the scope for combining two such frameworks: interpretative phenomenological analysis (IPA) and critical discourse analysis (CDA). It is argued from a critical realist perspective that these methodologies pose different but complementary questions about a given research topic. Within an integrated study design, they can provide a dual lens with which to explore qualitative information, which is interpreted both as lived experience and discursive practice. Textual examples are used in order to show how separate sets of findings are generated using IPA and CDA, and how these may usefully inform each other. The paper proceeds to discuss some broader issues about how researchers produce and interpret qualitative information.

A conceptual review of interprofessional expertise in child safeguarding

ABSTRACT It is increasingly accepted that practitioners across a range of professional fields must work together in order to promote children’s welfare and protect them from harm. However, it has also become apparent that interprofessional working is a challenging area of practice that cannot simply be prescribed through protocols and procedures, nor acquired as a set of technical competences. This article develops the concept of interprofessional expertise in order to explain how practitioners become more proficient at working with others to manage complex child welfare issues. Key principles are outlined with reference to relevant theoretical frameworks, including models of skill acquisition. The article concludes by discussing some potential implications for future research and contemporary developments in child safeguarding practice.

Complex systems, explanation and policy: implications of the crisis of replication for public health research

Abstract Much public health research considers interventions that influence and are influenced by both individuals’ health and the society around them; this can be described as a complex system. We consider the role of explanation alongside statistical inference as crucial to obtaining credible and useful insights, particularly in light of concerns about a ‘crisis of replication’, and reflect on the difficulty in researching complex systems. In this paper, we make a connection with Lipton’s philosophy of inference to the best explanation, and offer some tentative practical recommendations, extending suggestions from different fields. An extended hypothetical example is given on introducing ‘sugar tax’ in England.

Early experiences in extending personal budgets in one local authority

Purpose – The purpose of this paper is to report on the introduction of individual personal budgets for older people and people with mental health problems in one local authority (LA) in 2011. Design/methodology/approach – Jenny Weinstein is a Hon Senior Lecturer at Kingston University, Professor Ray Jones and Rick Hood are based at the Joint Faculty of Health and Social Care, St Georges, University of London and Kingston University, London, UK.A qualitative study is described in which structured interviews were carried out with participants belonging to each service user group. The study aimed to explore the following issues: first, service users’ experiences of the assessment process, second, whether service users wanted full control of their budgets and third, if personal budgets make a difference to quality of life. Findings – xService users (n=7 older people and carers; n=7 people with mental health problems) found the personal budgets system and assessment process difficult to understand and its ad...

An analysis of Ofsted inspection reports for children's social care services in England

Faculty of Health, Social Care and Education, Kingston University, Kingston upon Thames, UK Department of Social Work and Social Care, Kingston University and St Georges, University of London, London, UK Correspondence Rick Hood, Faculty of Health, Social Care and Education, Kingston University and St Georges, University of London, Kingston Hill, Kingston upon Thames KT2 7LB, UK. Email: rick.hood@sgul.kingston.ac.uk

Collaborating across the threshold: The development of interprofessional expertise in child safeguarding

ABSTRACT This article reports on an empirical study of the expertise that different professionals develop in working together to safeguard children. The research involved three key professional groups who work with children: nursing, teaching, and social work. The methodology used a clinical scenario and critical incident to explore professional perspectives and experiences of collaboration. Data collection was via semi-structured interviews with a sample of 18 practitioners, composed of pre- and post-qualifying practitioners from each professional group. Data analysis was undertaken through an inductive process, with open coding of transcripts followed by the synthesis of themes into a qualitative framework. The findings identified different elements of interprofessional expertise including assessment and decision-making, responsibility, risk and uncertainty, managing relationships, and dealing with conflict and difficulty. Collaborative activity was found to be shaped by the threshold between statutory and non-statutory services and mediated by the relationship between practitioners and parents. The article concludes by exploring constraints and opportunities for addressing potential gaps in interprofessional expertise in this area.