Mutli-agency working and its implications and practice, Study notes of Literature

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July 2007

Mary Atkinson

Megan Jones

Emily Lamont

A review of the literature

Multi-agency working and its

implications for practice:

Contents

Introduction 1

Executive summary

In recent years, multi-agency working has received much attention and has been the focus of some political agendas. For example, the Government’s Every Child Matters white paper sets out a Children’s Trust model of practice, involving a range of professionals working together in an integrated way in order to promote positive outcomes for children and young people (DfES, 2005). Recent reviews of literature on multi-agency working are typically limited to one specific sector or issue and do not consider multi-agency working in the wider sense, across all sectors and different types of activity. The NFER was therefore asked by the CfBT Education Trust to conduct a multi-agency literature review, which, it is hoped will contribute to current knowledge about multi-agency activities and best practice. The literature review builds on previous NFER work highlighting the variety of multi-agency working which exists, the associated challenges and the key factors for its success, as well as its ‘potential’ impact (e.g. Atkinson et al. 2001 and 2002; Tomlinson, 2003).

Different types/models of multi-agency working

• While there is much discussion and refinement of models of multi-agency activity within the literature this does not appear to have extended to linking models with outcomes , particularly for service users. A number of authors implicitly or explicitly draw a picture in which ‘integrated’, ‘transdisciplinary’, or ‘holistic’ working practices will bring about the most benefit (to all, and to service users in particular). However, studies tend not to provide evidence that this is the case. Thus, one fruitful area for further research would be to investigate which models of multi-agency activity bring about which types of outcomes for professionals, agencies and, importantly, for service users.
• Multi-agency activity takes many forms and the terminology used to describe it varies , making classification and comparison between different types difficult. Even so, there have been several attempts in the literature to characterise or categorise different types of multi-agency activity.
• Models of different types of multi-agency activity tend to focus on one of two aspects – either the extent of multi-agency activity or the organisation of multi-agency structures or teams. Those classifying the extent of activity approach it by producing a hierarchical typology of forms, based on the extent, ‘stage’ or depth of the multi-agency activity.

Introduction 2

• Examination of both types of model led to a distillation of them into three principal dimensions. These were organisation , joint investment and integration. The types of questions that might be asked in order to assess the type or extent of multi-agency activity are therefore: Are there organisational structures set up to support multi-agency working? To what extent are agencies and/or professionals working towards a shared vision or common goal? To what degree are services synthesised and coordinated? To what extent is the focus of services on the service user?

The impact of multi-agency working

• Some studies focused on the perceived benefits of multi-agency working, the most commonly identified being improved/more effective services and joint problem solving, although the ability to take a holistic approach and increased understanding and trust between agencies were also cited.
• Whilst the impacts on professionals involved in multi-agency working appeared to be often cited and well evidenced, empirical evidence for impacts on service users was sparse. Given the current climate, which places much emphasis on multi-agency working and the attention given to the client’s voice, this would seem an important area for further research.
• Positive impacts on professionals centred mainly around multi-agency activity being rewarding and stimulating, increased knowledge and understanding of other agencies, and improved relationships and communication between agencies. Negative impacts on professionals involved in multi-agency activity focused in particular on uncertainty regarding their professional identities. There were some conflicting messages about whether multi-agency working resulted in an increase or reduced workload for the professional involved, although the evidence seemed to be weighted towards an increased workload.
• The main impacts on service users, where they were reported, was their improved access to services, through speedier and more appropriate referral, and a greater focus on prevention and early intervention. Impacts cited also included improvements to the lives of service users through more focused support, enabling disabled children, for example, to remain at home and attend their local school.
• There were mixed reports with regard to whether multi-agency working increased or reduced the demand on services/agencies as a whole, although, as with the demand on professionals, the evidence seemed to be weighted more towards an increased demand. These conflicting findings, together with the previous conflicting reports with regard to the impact on professionals’ workload, suggest that the demand placed on both individuals and agencies might warrant further investigation.

Introduction 4

having transparent lines of communication, creating opportunities for discussion), developing a shared purpose (e.g. by agreeing joint aims, conducting a needs analysis) and effective planning and organisation (e.g. by developing shared protocols, having a clearly defined structure).

• It was considered important to secure the necessary resources for multi- agency work and this involved securing adequate and sustained funding (e.g. through pooled budgets, written agreements around funding), ensuring continuity of staffing (e.g. by ensuring staff capacity, providing support for staff) and an adequate time allocation (e.g. by having realistic timescales, built in time for planning).
• Effective management and governance was particularly dependent on ensuring effective leadership (e.g. by identifying a key staff member, appointing leaders with specials attributes), although also dependent on effective governance and management arrangements (e.g. by developing appropriate accountability systems and having a transparent decision-making process) and an effective performance management system (e.g. through joint review and evaluation protocols and joint performance indicators).
• Overall, three aspects of good practice emerged throughout the literature as particularly important in that they were each identified as key to addressing a number of critical issues to the success of interagency practice. These areas of good practice related to providing sufficient time for the development of multi-agency working, the provision of joint training and agreement of joint aims and objectives.

Concluding comments

Review of the literature sample within this study again testified to the complexity of multi-agency working. Whilst there has been some discussion about models of multi-agency working within the literature over the last five years, this does not seem to have extended to the linking of models with facilitators, barriers and, more importantly, outcomes. This is an area that may fruitfully be explored in further research.

There is substantial empirical evidence for the impact of multi-agency working on the professionals involved. Multi-agency activity is rewarding and stimulating for staff and provides them with a greater understanding of other agencies and services, although it can also lead to uncertainty over professional identities. In contrast, there seems to be very little empirical evidence for the impact on service users. The evidence available suggests

Introduction 5

that the main benefit to service users is likely to centre around improved access to services, but more research needs to be conducted in this area.

There is also little evidence to draw on to determine the impact of multi- agency working on the agencies and services involved. There appears to be conflicting evidence with regard to the demands that multi-agency working makes on both the agencies, and the professionals involved (although it seems to be weighted towards an increased demand on both). This would indicate the need for further exploration in this area and a pressing need to confirm (if evident) the impact on service users.

In contrast, facilitators, barriers and good practice with regard to multi-agency working have been widely explored in the literature and, as such, there appears to be much conclusive evidence with regard to elements of good practice. These findings are not new and appear to have been well refined and documented over the last few years. There is therefore a wealth of information for practitioners to draw on. It may be that practitioners need to be directed to accessible sources of information and there needs to be more acknowledgement that effective multi-agency working is not easily achieved and takes time. However, by considering the information that is currently available, it would appear to be a process that can be worked through.

Introduction 7

Findings from this scoping exercise indicated that reviews of literature on multi-agency activity are typically limited to one specific sector or issue and do not consider multi-agency working in the wider sense, across all sectors and different types of activity. The findings from this initial scoping exercise therefore suggested that it is both timely and pertinent to carry out a review of multi-agency work across different sectors and to assess the relevant literature to further current knowledge about multi-agency activities and best practice.

The review aims to build on previous NFER research, which focused on different types of multi-agency practice, impacts and the challenges and facilitators associated with multi-agency working (Atkinson et al. , 2001; 2002). In that study, the first phase involved an audit of multi-agency approaches between health, social services and education. Following on from this, a range of different initiatives were selected and key personnel interviewed, with a small number being revisited for the purposes of more detailed case- study analysis. The findings derived from the research suggested that different types of multi-agency activity existed and that there was ‘complexity’ and also ‘potential’ in integrating services. The current review of literature therefore builds on the findings of this initial research by providing an up-to- date analysis of what the literature is currently saying about multi-agency practice.

1.2 Aims/focus of the study

The overall purpose of this study was to review existing research and evaluation to explore different models of multi-agency work, the impacts and possible facilitators and challenges to multi-agency working, as well as the implications this has for good practice. The review aimed to address the following research questions.

• What research on multi-agency working has been carried out since 2000?

Introduction 8

• In what ways can the research be categorised so as to gain an overview of different models of multi-agency working, methodology and substantive area (e.g. education, health, community etc)?
• What is the evidence for different models of multi-agency working?
• Has any work explored the impact of multi-agency work and the facilitators/challenges?
• What are the most compelling findings on outcomes of multi-agency working based on the best evidence available?
• What are the implications for good practice?
• What research is planned or currently underway in this area but not yet published?
• What gaps are there in the research or evidence-base?

1.3 Methodology

This section outlines the methodology and includes:

• The search strategy
• Identification of the most relevant pieces of literature
• Analysis of the evidence.

The search strategy

Sources were identified from a range of educational databases. Details of the range of databases searched and the key words used are provided in the search strategy which is detailed in Appendix 1. The initial criteria for inclusion were:

• Evidence from empirically-based research and evaluation
• Evidence about different types of multi-agency working
• The impact of multi-agency working
• The facilitators and challenges to multi-agency working
• Implications for good practice
• Evidence from a variety of sectors, such as education, health, social care, police and so on

Introduction 10

• Thirdly, the most relevant sources were identified using the main criteria (leading to 29 sources being included). These were summarised more fully into an agreed template (see Appendix 2).
• The main criteria for inclusion in the review were that sources contained information pertinent to the research questions: types or models of multi- agency working; the impact of multi-agency working; factors which facilitate multi-agency working and the associated challenges. In addition, whether sources conformed to search parameters, their relevance and research quality were taken into account.

Analysis of the evidence

Initial searches identified 1385 sources as relevant to the literature review. As a result of the selection process (based on initial abstract information and using the criteria identified above) 89 sources were identified for closer examination and application of the key review criteria.

Detailed examination of these sources led to the final selection of 33 sources fitting the required criteria. These sources referred to 29 actual research studies, as some sources related to the same piece of research and were therefore counted as one work overall. These sources were then summarised more fully into an agreed template, thereby capturing information relevant to the review (see Appendix 2). The summary template utilised allowed researchers to review the evidence in terms of the quality of the research. This was assessed by considering:

• The appropriateness of the analysis that was reported
• Any author interpretations
• Any biases/caveats to be aware of
• Any corroboration or triangulation of sources.

Once the templates had been completed for each source, a coding system was developed and applied to each of the summaries. This process enabled the research team to account for the range of evidence, to locate the evidence in context and to draw out key themes across the different sources. A detailed summary of the literature in terms of the area/target groups, the

Introduction 11

dates of sources, the research methods covered and their location is provided in Appendix 3.

From the 79 organisations which were emailed regarding current research details, only 12 responses were received, despite reminders being sent. These responses included seven completed pro formas and five email responses containing relevant links. A list of the organisations responding to the email is provided in Appendix 4. Links, in the main, identified pieces of research which had already been included or eliminated from the review. However, a few current projects of interest were:

• Youth justice Board : The national evaluation of children’s trust by the National Children’s Bureau (NCB) which is examining six YOTs nationwide using focus groups with parents and young people, surveys with practitioners in YOTs and partner agencies, as well as interviews with other stakeholders. This data is currently undergoing analysis.
• Leicester Children’s Trust : Evaluation of a local programme in order to develop a model for integrated children’s services.
• NSPCC : A three-year project involving a survey of schools in three counties within the multi-agency context of safeguarding. Initial findings highlight difficulties in making referrals from schools and finding out what happened next.
• Institute of Education : A research project for the Australian Research Alliance for Children and Youth entitled ‘What Works in Collaboration’. This is an international literature review on effective collaboration between agencies and is due to report summer 2007, but not available at the time of publication.
• Universities of Birmingham, Oxford and Bath : A project entitled ‘Learning in and for Interagency Working’, which produced a literature review in the early stages and this has been included within the review. The project also includes detailed examination of multi-agency practices via small-scale intensive studies in five local authorities, focused on for example, a YOT; a ‘virtual’ multi-agency team; extended school; multi-professional team; and LAC team. The project also plans to hold workshops with local authorities to discuss data. The key findings from the project are soon to be published, but were not available at the time of this review.
• DfES : Research into the role of the budget holding lead professional to report in March 2008; evaluation of early learning partnerships to be completed March 2008; early intervention and intervention with children at risk starting September 2007.

2 Different types/models of multi-agency

working

This section addresses two of the aims of this review: to explore in what ways the research can be categorised so as to gain an overview of different models of multi-agency working; and to examine the evidence for different models of multi-agency working. As such, section 2.1 begins by presenting some exemplification of the range of terminology relating to multi-agency activity to be found in the literature. section 2.2 addresses the feasibility of classifying the different types of multi-agency activity within the sources that informed this review. The chapter then moves on in section 2.3 to examine the models of multi-agency activity presented in the literature, before drawing out three common dimensions to models of multi-agency activity in section 2.4. It should be noted, however, that this review sought to address a number of aims, of which models of multi-agency working was just one part. As a consequence, the models presented in this chapter represent a flavour of the extensive work that has been undertaken in this area.

2.1 Terminology of multi-agency working

Activity that could be characterised as ‘multi-agency’ is referred to by a large number of different terms. Some of these are listed in Table 2.1. This has implications for researching multi-agency activity. The confusing and/or conflicting nature of some of these terms can make research more complex and lead to difficulties in making comparisons between studies.

Table 2.1 Terms of reference for multi-agency activity Multi-agency working Atkinson^ et al. (2002) Multi-agency activity Kennedy et al. (2001) Partnerships Dickson et al. (2004) Partnership working Fox and Butler (2004) Interprofessional collaboration Interprofessional work Interprofessional consultation

Harker et al. (2004); Leathard (2003)

Co-operative practice Harker^ et al. (2004) Joint-working Kennedy et al. (2001) Multi-disciplinary working Gregson, (1992) cited in

Different types/models of multi-agency working 14

Leathard (2003) Integration Leathard (2003) Interagency working Warmington et al. (2004) Interdisciplinary working Watson et al. (2000; 2002 cited in Sloper (2004)) Transdisciplinary working Watson et al. (2000; 2002 cited in Sloper (2004))

Percy-Smith (2006) attempted to define these terms and these definitions can be found in Appendix 5 of this report.

2.2 Classification of different types of multi-agency activity

The literature examined testified to the complex nature of multi-agency working and this can make classification of different types problematic. For the purposes of this study, researchers attempted to classify the literature sample according to a number of variables. This included the target group or area within which the multi-agency activity was focused, the agencies or sectors involved and the models of multi-agency activity examined. The findings from this exercise are now presented to both exemplify the ways in which multi-agency activity can be classified and to provide an overview of the literature sample (further detail regarding numbers within each category are provided in Appendix 3).

The reviewed literature covered a wide range of areas and target groups, suggesting that multi-agency practice is relevant across a wide range of areas. Of the sources that explored multi-agency activity on a particular area or target group, those most commonly encountered focused on early intervention or family support. In addition, more than one initiative was described within each of the following areas: disabled children; crime prevention; behaviour problems; child welfare/protection; drugs education/substance abuse (see Appendix 3). Others included looked after children; homelessness; mental health; domestic violence and strategic

Different types/models of multi-agency working 16

Models that describe the extent of multi-agency working

One approach to modelling or classifying different types of multi-agency working has been to produce a hierarchical typology, often presented as a progression or journey towards multi-agency working. Using this approach, Gaster et al. (1999), cited in Percy-Smith (2005:p. 9) identify a ladder of partnership as follows.

• Information exchange: Involving mutual learning, knowledge of what each partner does and could do, openness about decision-making processes, new methods of access to information
• Planning action: Involving identifying local and service needs where cross boundary working is needed and could be effective. Debate of local needs and priorities, agree different partners’ contributions, decide actions and processes. Identify (the need for) new partners.
• Implementing projects and service plans: Joint or separately taken action on agreed plan, identify monitoring methods and review processes, mutual feedback on success/failure.
• Coordination and co-operation in practice: Involving active coordination process; coordinator knows what’s going on, draws on each (autonomous) partner as appropriate, helps to nurture developmental and co-operative culture and involve and support new partners.
• Collaboration and full partnership: Involving separate and distinct roles but shared values and agenda. Pooled resources, blurred boundaries, continuously developing to meet changing needs. Less powerful partners supported to play a full role. Percy-Smith (2005: pp. 28–29)

Similarly, Townsley et al. (2004a: p 27) describe a three-level typology that they observed in the literature they reviewed for their study. These are paraphrased below.

• Autonomous working: Services are still separate but individual professionals from different disciplines will work together to achieve specific goals. Professionals may offer training and support to staff from other agencies, but the focus and funding of service delivery remain single agency and services are separate with little obvious coordination.
• Coordinated working: Professionals from different agencies assess separately the needs of children and families but meet together to discuss their findings and set goals. The focus of service delivery will be multi-

Different types/models of multi-agency working 17

agency and coordination of services across agencies is achieved by a multi-agency panel or task group. Funding may be single- or multi-agency.

• Integrated working: Services are synthesised (and coordinated). The approach is more holistic with the focus of service delivery on the user. Funding is multi-agency and professionals operate as a team, with the expectation that roles will be blurred or expanded. A key person, or link worker, coordinates services for families and liaises with other professionals and agencies on their behalf.

In a related approach, Fox and Butler (2004) refer to earlier research describing a four-level typology of different stages of engagement with multi- agency working (Griffith, 2002, cited in Fox and Butler, 2004: p. 39). This was originally produced with an initial stage describing networking that the authors felt should precede any partnership. The three stages, or levels of engagement, are paraphrased below.

• Cooperation: At this stage relationships may be more formal. Members agree to co-operate with each other. Their goals remain individual rather than collective, but they see their future as linked. Some planning and division of roles may be required.
• Coordination: In this second (originally third) stage group members agree to carry out pieces of work together, which represent collective goals. Each member is now allowing their activities to be influenced by the contributions of other members. The aim is usually to deliver pre-set, common objectives.
• Integration: In this final stage the activities undertaken are developed, implemented and ‘owned’ by the group. The partners are committed to co- designing something for a shared purpose. The organisations involved are brought into a new structure with commitment to a common mission.

The authors combine these with three functions that partnerships might perform as follows.

• Strategic: The immediate product of partnership will be strategic priorities that shape the strategies of individual partners.
• Commissioning: The product of partnership will be commissioning priorities and the performance management of services and projects that are commissioned.