Team cooperation in addressing ESL – lessons learnt from health and social care and education

Establishing multi-disciplinary [1] or multi-professional teamwork is one way of addressing complex cross-cutting social issues as members of a range of professional and occupational groups, including education, work towards achieving social inclusion targets (Willson & Pirrie, 2000). Multi-professional teams ensure the coordination of assessment and treatment activities to best meet the complex mental, physical and social needs of service users (Deane & Gournay, 2009), and for this they require the cooperation of the team. The importance of multi-professional collaboration in health and social services as well as educational settings is shown in several publications (e.g. Cheminais, 2009; Leathard, 1994) and has grown in significance in all areas of work, including the issue of addressing ESL (European Commission, 2013).

This article aims to review the literature on multi-professional teams in health, social and education settings – what are the conditions for them to successfully function and whether there are any caveats. The role of educational alliances is highlighted. Finally, we examine the current situation of multi-professional teams dealing with ESL and provide recommendations to facilitate their functioning based on lessons so far learnt about multi-professional team cooperation in various contexts.

The publications included in this literature review were found using computerised searches in the Arizona State University Library search engine (which includes several databases, e.g. PsycINFO, Academic Search Premier (EBSCOhost), ERIC (Proquest), JSTOR Arts and Sciences, ProQuest, SAGE Premier, Science Direct) and in other online resources (e.g. ResearchGate, institution webpages). We used the following keywords in the searches: multi-professional, multi-disciplinary, inter-professional, cooperation, collaboration, health services, social services, education, early school leaving etc. In the next step, we examined references cited in the articles (i.e. “backward search” procedures). Original scientific articles and monographs as well as reports for or by the European Commission are mostly considered.

About two decades ago, the issue of inter-professional collaboration, its development and challenges was on the rise in the health, welfare and caring domains (see, for example, Leathard, 1994; 2003; Molyneux, 2001). Over this time, there has been a large expansion of multidisciplinary settings that involve several social and health care and related professionals (e.g. in hospitals, children’s centres, child/adolescence mental health services; Frost, 2011; nursing and residential homes, day care services; Leathard, 2003). Teamwork in the healthcare environment is recognised as being beneficial not only for patients, but also for healthcare professionals. While working together, a healthcare team can find solutions and create strategies that will improve a client’s function, activity and participation (Borrill et al., 1999; Huss et al., 2013).

Despite the acknowledged potential of multi-professional team cooperation, various authors see several challenges to its successful functioning. Hardy et al. (1992) identified barriers in joint working and planning across the health and social services, including problems associated with competitive ideologies and values; professional self-interest; competition for domains; conflicting views about users; as well as differences between specialisms, expertise and skills. Several ethical dilemmas (e.g. boundary issues, confidentiality, consent, safety, involuntary treatment and restraint; Leathard, 2003; Thistlethwaite & Hawksworth, 2015) may occur where there is diversity amongst team members in terms of personal, professional, and/or organisational values (Thistlethwaite & Hawksworth, 2015). Approaches used within health and social care settings were identified to create and conduct interventions (e.g. team training, quality improvement initiatives) to improve inter-professional teamwork (Reeves et al., 2010).

On a similar note, lessons arising from introducing multi-professional teams in health care (primary, emergency mental) teach us that attention to team development (e.g. extensive consultations with relevant staff groups), team management (e.g. a team coordinator in charge of leadership, managing the budget, communication), training for the team coordinator and team members as well as ongoing support is needed. This brings a series of benefits for the functioning of the team (e.g. a climate of cooperation, more integrated care for patients, improved quality of life of team members; Borrill & West, 2001; behaviour change, Mazzocato et al., 2011; Morgan, 2001). Collaboration on health care shows that communication between groups of professionals is the linchpin of successful collaboration, along with patient-centred care (as opposed to power struggles), inter-professional learning and the localisation of budgets (Daly, 2004). Parallel to this, workload, increased bureaucracy, inter-professional and interpersonal conflicts were the biggest problems identified in community mental health teams (Carpenter et al., 2003). The point was reiterated by Felkner et al. (2004) who observe the importance of addressing communication issues, client expectations of care, and understanding of the roles in the multidisciplinary team. Similar issues were discussed in a model of interdisciplinary collaboration in social work, e.g. interdisciplinary collaboration depends on one’s professional role, structural characteristics, personal characteristics and history of collaboration (Bronstein, 2003). The identified issues and approaches that need to be overcome may be very informative while discussing multi-professional ESL teams.

Another very important lesson emerges from the health sector – inter-professional education in healthcare has been developed (Bridges et al., 2011; WHO, 2010). Inter-professional education is a collaborative approach to developing healthcare students as future inter-professional team members. Complex medical issues can best be addressed by inter-professional teams. Training future healthcare providers to work in such teams will help facilitate this model, resulting in improved healthcare outcomes for patients. The didactic programme emphasises inter-professional team-building skills, knowledge of professions, patient-centred care, service learning, the impact of culture on healthcare delivery and an inter-professional clinical component (Bridges et al., 2011).

The body of research on multi-professional teams in the USA shows this has become the norm (taking a variety of names and functions) rather than the exception in schools (Markle et al., 2014). The authors review some of the scarce evidence suggesting school multi-professional teams can have a positive impact on individual students, teachers, school psychologists, schools and school districts, but identify the following barriers to effective functioning of the teams: limited funding and resources, the marginalisation of school teams (compared to support for academic instruction directly targeting better achievement), misunderstanding of the roles and responsibilities (e.g. duplication of services, sense of undermining one’s role), turnover rates, lack of time (e.g. for regular meetings), the need for problem-solving tools (best practices or evidence-based procedures (ibid.). Not so much evidence is available on the efficacy of multidisciplinary teamwork in educational settings as there is for health and social services (Wilson & Pirrie, 2000).

Multidisciplinary teams in schools (e.g. learning and behaviour support teams) are important for improving the support structure provided for children and teachers (Downes, 2011). Schools as universal services are well placed to identify early signs of vulnerability in a student and work with other professions to explore the extent of that vulnerability and to develop a joint response. Schools have long referred students with specific individual needs to discrete external services which give specialist support. These services, for example, include school psychology, mental health services, speech therapy and counselling (Edwards & Downes, 2013). Schools can help to build local capacity and parents’ social capital through paying attention to how they help foster local networks and engage with parents (Edwards & Downes, 2013). Such services usually target general issues of child welfare (e.g. Every Child Matters – ECM, United Kingdom, Cheminais, 2009; Behaviour and education support teams – BEST, the Netherlands, Downes, 2011).

The use of multi-professional teams has also been proposed for the ESL context. The potential of multi-professional teams and team cooperation for ESL is recognised by the European Commission which has identified multi-professional teams operating at the local level (school or community) as a form of cross-sectorial cooperation; namely, one of the key conditions for successful policies against ESL (European Commission, 2013). Putting ESL in the context of multi-professional teams indicates that ESL is not seen as only a teacher-related problem. Placing ESL in the setting of cross-sector team cooperation (i.e. professionals working under jurisdictions of different sectors like education, health, justice, social welfare and business; from the private and public sector) shows that ESL is not only seen as an education-related problem.

There is an impression that such multi-professional team cooperation in European countries is a recent phenomenon. For example, Edwards and Downes (2013) state that a great deal of inter-professional collaboration in and around schools is "work in progress" without any robust evidence of outcomes for children and young people. However, the study shows that many European countries have a well-established multi-agency partnership practice for tackling ESL at the school or community level (European Commission/EACEA/Eurydice/Cedefop, 2014). Where it is well established, it may: (1) take the form of a legal obligation to form the partnership (e.g. Spain) – even though the legal framework does not guarantee effective partnerships; or (2) be an institutionalised partnership practice (where teams work together in a structured and institutionalised way, e.g. France, Luxembourg, Slovenia). In other countries, (3) these partnerships may be developed within projects (e.g. Latvia) or (4) the partnerships are just beginning (e.g. Hungary, Norway) (ibid.). Generally, these partnerships are not necessarily established specifically to address ESL but within a wider action framework (in any case, the partnerships are reported as contributing to ESL prevention and/or intervention). The professionals involved vary between countries, but school heads and teachers are the key professionals in all European countries. Psychologists and education and career counsellors are present in most countries (either based in schools or as part of external organisations), social workers (usually external to the school) and youth workers are also important partners. The team works together locally to identify the most suitable support on a case-by-case basis – both the composition and scope of the teams vary according to each student’s needs (Thibert, 2013).

There is a lack of research on the evaluation of such teams and how they function. The TITA project aims to fill this gap. As an exception, ongoing research work in France on ESL multi-professional teams has identified four types of collaborative work within ESL prevention groups in secondary schools: Narrowly based collaboration; Structured, collaborative preventive effort; Broader approach to prevention; Whole of the school community (Maillard, Merlin, Rouaud, & Olaria, 2016). These types differ in how they approach the prevention of ESL (e.g. a focus on absenteeism only or a wider focus on any difficulties in education, health and social domains as well as a lack of academic success and perseverance) and their understanding of ESL (e.g. does it result from the student’s lack of investment, inappropriate choice of school or inadequate teaching and learning, or the lack of parental involvement).

Another exception is research work on educational alliances and ESL. In Switzerland, Allenbach (2014) conducted interviews with professionals already involved in collaborative practices (specialist teachers, psychologists, nurses, meditators, speech therapists and psycho-moto therapists). The professionals identified the following practices as being crucial for building an educational alliance with teachers: (1) the quality of the listening (to be interested in the emotions and needs of the teacher); (2) distancing oneself from the figure of expert, because positioning oneself as an expert is an obstacle to the development of collaborative practices (instead of sharing, reflecting, and planning actions together); (3) negotiating all the multiple alliances (with the child, other actors, and hierarchical instances that appointed him/her, as well as alliances between other actors). Studies (e.g. Desmarais, Merri, Salvà, Cauvier, Moriau, & Dionne, 2014; Poirier, 2015; Blaya, Gilles, Plunus, & Tièche Christinat, 2011) show the effectiveness of educational alliances between schools and community organisations that share the mission of educating young people. Youngsters in the situation of ESL are referred by school professionals to special centres providing pedagogical, psychological, social, legal, health support, including their own educational programmes. They accompany youngsters on their entry to school after having stayed at their organisations. There is a lively debate in these alliances – several members (stakeholders) are convinced the student should be prevented from creating a distance from school, while others believe entering the labour market will allow them to mature and return to school later. These alliances allow for new opportunities in the educational career of the youngsters and provide for the (re)construction of identity. Another study (Liechti et al., 2014) showed that teachers within educational alliances are turning to different stakeholders and consider different actions depending on the profile of the students at risk of ESL; for ‘disruptive’ students, teachers are more likely to turn to external actors from a different professional sphere, while for a ‘quiet’ student teachers turn to both actors working in their sphere as well as external actors. Moignard (2015) studied educational alliances and observed the strengthening of the traditional school forms beyond school boundaries and a logic of outsourcing, that illustrate the injunctive character of the new partnership forms. Studies also show that teachers assign little weight to some internal organisational and structural factors in the school system (strongly associated with ESL and mendable by schools), suggesting that efforts should be made to inform and educate school personnel about the importance of these variables in the ESL process (Angelucci et al., 2014).

‘Better multi-professional working’ is a very popular recommendation made for improving services that support vulnerable children and young people. Yet it seems to be very difficult to achieve the long-term benefits for children and young people that are expected of it, particularly in teams covering a wider range of fields (Glenny & Roaf, 2008). Ongoing commitment to the effectiveness of such collaboration should be provided, so that the time taken in developing and maintaining the partnerships does not lead to disappointment and frustration (ibid.). The findings from health and social care (e.g. Daly, 2004; Frost, 2011) as well as education (Downes, 2011) show that a lot of time and effort must go into developing the knowledge and understanding of other partners (institutional culture, language, practices etc.), agreeing on process, structure, governance and desired outcomes as well as into building trust to overcome barriers to cooperation.

It seems there is a consensus across settings on what the barriers to successful teamwork are, and many authors propose recommendations to improve this (e.g. Cheminais, 2009; Downes, 2011; European Commission, 2013). Inter-professional working is largely considered worthwhile, although studies reveal that much awaits to be addressed so as to enable effective outcomes. The concern and effort regarding inter-professional cooperation should not only focus on those who are actively involved and their educators, but also those who lead the professions, manage services and determine policy. As Edwards and Downes (2013) put it, it is not enough just to designate a desk for these different services in schools. Moreover, there is a need to minimise the fragmentation that sees various services ‘passing on bits of the child’ and family (Edwards & Downes 2013).

To conclude, the recommendations for ESL multi-professional teams that are presented here draw together lessons from diverse settings and are also very closely aligned with the findings of other authors or our own findings arising from the large body of theoretical and empirical literature on small groups and teams. To ensure successful implementation, simply putting people together in a team is not enough – at least some of these recommendations should be considered; they may seem demanding and challenging, but only in this way will ESL teams be able exploit their potential to prevent ESL.