(CAMHS) and Schools - London Health Programmes

Joint work with parents was felt to facilitate an improved relationship between the
school and parents where this was necessary.
There was no single structure of services that was seen as crucial to joint working.
Factors within structures that were useful were having a tiered approach and being
located in small localised teams, and a tradition of joint working. Secondments of
staff were positive in two of the case studies. Smaller services allowed people to get
to know each other well. Shared offices with members of the team of different
disciplines were felt to be particularly useful as they facilitated learning and informal
communication. A strong commitment to the joint working by all levels of
management was also key. Chief Officer level was very important and middle
management who often had more difficulties in managing this approach, especially
dealing with budgets.
Joint working was helped by the skills of the individuals. As well as professional
skills, additional skills needed were confidence in their own abilities and profession,
being flexible and able to work in a different environment and having experience of
joint working. Knowing individuals was felt to be important which has implications
for staff continuity and funding.
A key issue in joint working is overcoming cultural differences between
organisations. These impacted on almost all levels of work from the approach to
children and families to management structures and information sharing. This
became particularly apparent when working in schools. Many of these approaches
and case studies had identified effective ways of overcoming these issues. Good
communication was a key feature of effective joint working.
Presence in schools by health workers was deemed to be very important to the work,
but so too was close working with the LEA. In three of the case studies, health staff
teams were based in or with the LEA services. This facilitated learning across the
disciplines. School staff tended to approach individuals whom they knew and had
working relationships, and those who spent time in schools. This was often the EWO,
Educational Psychologist or EBD Advisory teachers. When the health staff were
included in these teams they benefited from the education staff’s experience of
working in schools. In the other case study, the EAZ was key in facilitating these
links.
As with any methods of working, there were dilemmas that occur. These dilemmas
can be seen as:
• the role of specialist Tier 3 services;
• how to roll out this kind of service to other schools;
• potential duplication of work;
• complex management systems;
• increased identification of need with limited resources.
The majority of the case-studies had a structure of Tier 2 service based in small
locality teams. Some workers expressed anxiety that Tier 3 level problems were being
addressed by Tier 2 workers. This may have been due to Tier 3 services being less
accessible. This was being tackled in one area by further devolving the specialisms to
area based teams.