'Every professional has to be on top of their game': social work leaders on navigating multidisciplinary teams

From the Front Line is a new series where social workers share their experiences on various topics and running issues within the sector. To express an interest in taking part, email us at anastasia.koutsounia@markallengroup.com

Social workers frequently collaborate with professionals from other disciplines to safeguard or support children, families or adults. But fostering these working relationships can be tricky.

Inevitably, obstacles and clashes of expertise will occur when bringing together a diverse mix of professionals, whether in individual cases or multidisciplinary teams, such as in services using the family safeguarding model.

Yet when it works, a multidisciplinary approach can transform outcomes for the people social workers support. An evaluation of family safeguarding in five areas, published in 2020, found statistically significant reductions in the numbers of looked-after children and/or child protection plans in all areas two years after the model's introduction.

So how can professionals from different backgrounds work together effectively? How do you build collaboration and shared understanding when even the language and acronyms you use can mean different things?

Community Care spoke to three social work leaders, one from a local authority and two from NHS trusts, about the benefits of multidisciplinary teams and the ongoing challenge of helping other professionals understand the role and limits of social work.

Cheryl Grazette, service manager in a family safeguarding service

We’re a multidisciplinary team comprising domestic abuse practitioners and officers, drug and alcohol specialists, child psychologists, adult psychologists, non-social work family practitioners and mental health specialist, as well as social workers. Outside of that, we also work with the police and health professionals.

When the family safeguarding model was introduced in 2014, it was difficult. You're bringing different domains together who may understand risk differently. A drug and alcohol worker may say, 'Mum's doing well, she's cut down class A drugs significantly'. But the social worker says that amount still poses a risk to the child.

Ten years on, we've found a model that fits by ensuring all professionals have a child-centred approach, even if their remit is different. Even if your focus is parental drug use, you ask: 'What’s the impact on the child?'

Joint supervision also helps create a holistic, grounded view of what's happening in the family. But every professional has to be on top of their game. If you lose an element – for example, the alcohol practitioner isn’t seeing the mum regularly - the social worker might not even know there’s been a relapse.

Parents also often feel more comfortable talking to the domestic abuse practitioner because they see them differently. That person doesn't have the power to remove their children. So they will build different relationships and have open conversations that they might not have with their social worker. That’s why alignment is key.

It’s also about fostering relationships: inviting all the professionals to supervision and service meetings, including them, calling if you haven’t seen someone in the office in a while. Let them know they're part of this team, even if they’re not directly employed by us.

I have the benefit of knowing the time before the multi-agency approach. At one point, I had 44 children on my caseload. You can’t do the work. You’re just knocking on doors, asking if everything is ok.

Before, if Kelly had a drug issue, we’d refer her to the community drug and alcohol team and she would join the waiting list. Now I can ask the person across the desk, 'Can you come with me to see Kelly? We’re worried she’s using.'

That quicker access means we can prioritise. What do we need to focus on first? Is it low-level domestic abuse? Are the drugs and alcohol fuelling the domestic abuse? We can sit down together and work that out.

And social workers get to do more direct work. We’re doing in-depth, detailed, targeted work and we’ve got the time to support parents whose journeys take longer.

I just had a meeting with a mum who’s been using class A drugs for three years. I told her I wasn’t expecting her to say, 'I'm not using any more'. We can let them know it’s okay not to be okay. We can assess risk differently.

Before we were reactive. There was no time to assess the parents - if the child wasn’t safe, they needed to be removed. Now we can be proactive. We ask, 'What safety measures can we put in place while we do the work with the parent?'

My advice? Get to know the other professionals and understand their values, because they can have a different view of what safeguarding is.

Ensure you’ve all got the same value base and understanding of what is and isn’t good enough parenting. Build relationships and learn from each other. I've learned so much from domestic abuse practitioners and drug and alcohol practitioners.

We’re all experts in our fields. How can we share our knowledge and experiences? Make it a learning environment.

Yvonne Wright, safeguarding specialist, London Ambulance Service

My role involves working with 111 call handlers, paramedics and clinicians. Our team also gets involved in domestic homicide reviews, safeguarding adults reviews and joint agency reviews for unexpected child deaths.

Of the 9,000 staff in the trust, only around seven are social workers, three of whom are in my team. The rest are largely paramedics, which can sometimes feel isolating.

Our team brings a valuable mix of skills. With my knowledge of social care, I help assess what concerns are likely to warrant a referral. At times, I need to explain how social work operates. For example, someone might want to make a referral based on concern alone, but the concern doesn’t meet social work’s legal thresholds.

We all have that anxiety as humans. Mrs. Smith seems unkempt and not coping well. But from a social work perspective, especially with adult referrals, we have to ask: 'Do you have consent to refer? If not, does the person have capacity?'

When I first started, I sometimes saw safeguarding being used as a punishment. For example, if someone refused to go to A&E at 3am and there were concerns about a child or a vulnerable person’s health, some professionals would threaten to make a safeguarding referral. I’d have to ask, 'What do you expect from that?' If the concern is medical, the solution should be medical, not a social work referral.

So we deliver inter-collegiate training on safeguarding, including responding to patients who may have experienced trauma and how to engage them.

Working with non-social work professionals has been a huge learning opportunity. We try to foster a culture of learning - there is never a silly question.

Occasionally, there are misunderstandings about what we can do, but overall, there’s respect for different roles and expertise. There are times when people have unrealistic expectations of social care. That’s when we step in to explain that, like the NHS, social work faces pressures and practitioners have to work within certain thresholds.

Sometimes people, because they don't know your background, might assume you know all the terms.

We all love an acronym, don't we? When I started, people referred to IROs a lot. For us, an IRO is an independent reviewing officer. It took a while to realise that IRO also stands for incident response officer. Working in a highly medicalised environment, Google is my friend sometimes. I'm 10 years in and still finding acronyms I'm not sure about.

Being open to learning and recognising different perspectives is essential. We all have different starting points, so our priorities and how we interpret situations can vary.

That’s the beauty of a multidisciplinary team, you are surrounded by a range of expertise.

If you are concerned you are not being taken seriously, I would advise challenging that, but do so with an open mind. Sometimes people don't recognise the starting point of other people, and their perception of the same situation is different. Building mutual respect starts with acknowledging those differences.

Kareena Miller, deputy head of social work and vulnerable people, King's College Hospital NHS Foundation Trust

Kings is unique in its approach to multidisciplinary working, having a social work department of 33 practitioners working across specialist children and adults hospital clinical teams.

We work on safeguarding and then we've got all our periphery services, such as mental health, violence reduction, homelessness or learning disabilities, all under one roof. So we think about how we're addressing all of those vulnerabilities across acute hospitals and outpatient care.

It's a highly collaborative environment. Departments often appreciate our support and expertise, especially around things like the Deprivation of Liberty Safeguards, the Mental Capacity Act, best interest meetings and the Court of Protection. While our practitioners mostly hold non-statutory psychosocial roles, safeguarding is a core social work skill, and so we frequently provide support and guidance.

Overall, it’s been great. Naturally, there are occasional clashes due to differences in disciplines, models or understanding. With 33 practitioners embedded across 19 clinical multidisciplinary teams, many of which are very medically specialised, some friction is inevitable.

Many of our social workers work autonomously. Some roles sit under me but many report to clinical consultants. So social workers will sometimes report feeling isolated. Being the only social worker in a team can be particularly challenging when it comes to discussions around advocacy, mental capacity and best interests. These difficulties often stem from gaps in the team’s understanding of these processes.

So we do lots of training. For example, I run a two-hour workshop for medical students around ethics and mental capacity, and we have a compulsory adult safeguarding training programme. A lot of our work centres around communication and relationship-building.

What’s key in this setting is patience, respect, and confidence in using your legal knowledge, theory and models. When presenting a theory or challenging a perspective, you need to offer an articulate, evidence-based explanation. Be curious and open to dialogue.

I think there’s also real value to face-to-face working. It is hard to form relationships if you're not present. When joining or forming multidisciplinary teams, social workers need to prioritise in-person communication wherever possible. Those informal conversations - getting to know people’s mannerisms and building trust - are invaluable.

We don’t talk enough about what’s lost when we’re not regularly working and talking together. Flexible working is great for personal circumstances, but is it always great for social work practice? That’s something we need to reflect on.