I remember the day very well. It was 21 June 2005. The CEOs of the two voluntary agencies, Kare and Muiriosa Foundation, and I had met previously to discuss how we would approach the meeting. It had been arranged to bring together the early services staff from both voluntary agencies and the HSE to discuss the possibility of all moving forward together to develop early services for clients with an intellectual disability in South Kildare.
The meeting was held in the Stand House Hotel (the days when we could use hotels as venues for meetings). The people present included the early intervention team from Moore Abbey (now known as the Muiriosa Foundation), who at that time provided services to children from 0-3 years with an intellectual disability. The Early Intervention Team from Kare, who at that time provided services to children from 3-6 years with a intellectual disability, and staff from the HSE—myself, a Medical Officer and a Public Health Nurse.
The teams were comprised of psychologists, physiotherapists, occupational therapists, social workers and speech & language therapists—who had had, up to then, very little contact with each other. The seating at the table told a story in itself, in that one side was the staff from Kare, with the staff from Moore Abbey at the other side, and the CEOs and myself, and the staff from the HSE were at either end.
The tension in the room was high. Everyone was vaguely aware of the proposal to join them together in partnership to form one team. This would, of course, change their ways of working, their ethos, their work location, the age group of the children with whom they were currently working etc. etc. I chaired the meeting, supported all the way by the two CEOs. We referred to the review that had been carried out by Dermot Rush in 2003, which looked at early intervention services in Kildare. It had highlighted the need for a more coordinated approach to early intervention services which it described as being fragmented at that time.
From a clients’ perspective, the proposed partnership would ultimately lead to a more seamless, child and family-centred service. It would mean that instead of having to move from one agency to another when a child turned three years of age, that he/she could stay with the same team of clinicians who would continue to support them and their family until they reached school age. This would lead to less disruption and anxiety for families who were already dealing with the issues involved of having a child with a disability.
Following on from that day in June 2005 there were many more meetings. Sub-groups were established to look at specific issues and the importance of developing relationships with other colleagues, gaining trust, and learning new ways of working began. In addition to developing a new partnership, a new model of service delivery was also being established. The team chose to run with the ‘Team around the Child’ approach, while using the Transdisciplinary Play-Based Assessment Tool developed by Professor Toni Linder. As this was completely new, and required the team to take a more open approach to how they worked, while sharing and learning from each other, it was agreed that training in how to use the model would be needed. The training was twofold. It brought the team together, providing the opportunity for team building while learning new skills and, even more importantly, they learned to work together and trust each other.
The first training module was carried out in 2006. Professor Linder came to Ireland from Denver, Colorado, and provided training on the Transdisciplinary Play-Based Assessment method, and Mr Peter Limbrick, came from the UK to provide training on the Team around the Child Approach. Both training sessions gave the team members an opportunity to agree, disagree, argue and find common ground. They were invaluable in many ways and really moved the partnership to a new level. The Team now had a better understanding of what they were trying to achieve and what their goals would be for the future in terms of their client group.
In 2007, having been established for almost a year, the partnership team felt it would be appropriate to carry out a review/evaluation of where they were and, in particular, to examine the model of service which had been adopted. It had thrown up some anomalies from time to time, especially its inflexibility.
The services of Dermot Rush were once again engaged to carry out the evaluation on our behalf. Many would say that after just one year of operating the new model, there had not been enough time yet to carry out an evaluation. However, the team felt themselves that it could be quite restrictive in some areas and maybe wasn’t serving our client group well. For example, the play-based assessment tool was excellent for children from 18 months to 36 months, but prior to that it wasn’t really appropriate, and after that children were in need of standardised assessments for moving on to school. The purpose of the review was to establish the following:
- The effectiveness, or otherwive, of the Early Intervention Service and, within this, of the TAC (Team around the Child) model of service
- What factors or elements were having the most positive impact
- What were the main areas for further development or improvement
- A review of the policies and procedures for the service
- What were the operational delivery issues and problems and how they could be positively addressed?
- A review of the efficacy of the interagency partnership.
Four main frames of reference were used to focus our attention throughout the process: Service Effectiveness: That the service delivers on its mission and achieves its key objectives. Organisation and development: That service builds capability and looks to develop better methods on an ongoing basis.
Service Organisation and Effectiveness: That the delivery of the service is planned and organised in a manner that ensures consistency of quality and best value. Customer and Stakeholder feedback: That the service is informed by regular feedback from its primary customer and other stakeholders.
The review took approx six months to complete and involved a lot of time and work on behalf of the team. Interestingly, this six months brought them closer together in terms of reaching outcomes for each of the above objectives.
When the review was completed, a number of recommendations outlined the way forward for the team. A number of sub-groups were established to address the various recommendations and, in turn, each group reported to the full team for discussion and sign-off. The sub-groups addressed the above issues and work continues on a number of them even today.
One of the main recommendations coming from the report was the need for a Manager for the Early Services Team. We had previously toyed with the idea of appointing a Coordinator for the Team, but the recommendations in the report were very clear that a Manager was needed. We recruited a Manager in July 2008. This appointment has made a huge difference to the team and how they do their work. The manager is responsible for the day-to-day management, which supports the team, and allows them, as clinicians, the time they need to work with children and families. As the members of the team are employed by a number of agencies, each member reverts to their own agency for issues relating to HR, professional development etc. This process works very well and to everyone’s satisfaction. This is the key to the success of the partnership and indicates the level of trust which has built up between the agencies, the team and the manager.
The partnership is managed by a steering group which is made up of representatives from the three agencies, CEO of Kare, CEO of Muiriosa Foundation, a parent representative and me (Chair), the Manager of Disability Services Kildare West Wicklow, HSE. The Steering Group meets four times a year and deals with matters such as national or cross-agency issues, priority areas for development in line with national policy, decisions in relation to resources, signing off on changes in policy and procedures and agreeing an annual service plan for the service.
We are now almost midway through 2009, in a process which first began in in 2005. It works well now,but it took time, effort and energy and a lot of anxiety along the way before we reached what I could call true partnership. Partnership takes time and energy on everybody’s part to make it a success. Trust is a huge part of it and this also takes time to build. However, when you achieve it and all the elements are in place it can be truly rewarding both for the team, but more importantly for our children and families.