Cooperation – Who benefits the
most?- Camilla Blomqvist
• PhD thesis in social work
• Qualitative and quantitative study
• Finished by 2009
Aim
• How co-operate child psychiatry, social
services and school when all organizations
are involved with the child?
• How does the process look like to be a cooperating case?
• Is the child perspective similar or different
in the different organizations?
Method
• Observations in consultations
• Observations and interviews in cases
• Survey
Categories cases
Categories survey
Categories consultations
Partial results –
cases, survey,
consultations
Themes
Organisational level
- Internal organization complicates
- Tasks and boundaries
- Time
Concrete – pratical level
- Cooperation for whom?
- Interprofessional cooperation
- Power
- What did the cooperation lead to?
Distribution of survey answers
0,7
58%
0,6
0,5
0,4
0,3
24%
19%
0,2
0,1
0
Child psychiatry
Social Services
School
Who answered the survey?
 1 in 5 were men
 Most men were from School services and Child
Psychiatry
 It was more common that women had worked at least 6
years than men (38% vs 25%).
 The average for job experience was a little more than 8
years.
 The majority of personnel with more than 15 years of
experience worked in Child Psychiatry and at school.
Who is cooperating?
 Joint cooperation: Child Psychiatry/School/Social services
-
41% participate 1-4 times/month (frequent cooperation),
-
40% less than once quarterly.
-
The remainder every other or every third month.
 Half of those who frequently cooperate have at least 10 cooperative cases
per year. (many cases few meetings or few cases many meetings)
Child Psychiatry
cooperates more
often than school
and social services:
Organisation/
Frekvens
1-4 ggr/mån
Mer sällan än
en gång/mån
BUP
89,3 %
10,7 %
Socialtjänst
56,7 %
43,3 %
Skola
24,3 %
71,4 %
Who cooperates?
 Frequent
cooperation is most
common among
personnel with 6-15
years of job
experience.
1-4 times/month
93%
100%
60%
50%
43%
0%
0-5 Years
6-15 Years
16- Years
How does cooperation take place?
Telephone and mail is more common than
meetings.
Meetings often include the parents. This is
more common for Child Psychiatry.
Meetings that include the parents and
children are most common for Social
services.
Thoughts on cooperation
 Every other person from Child Psychiatry/Social
services feels that he/she has good or very good
cooperation with school services.
 A little more than 1 in 3 from Child
Psychiatry/School services feel that he/she has
good or very good cooperation with social
services.
 1 in 4 from Social/School services feels that
he/she has good or very good cooperation with
Child Psychiatry services.
Differences in cooperation – all
 Perception/Experience of cooperation with
Social services and Child Psychiatry changes
positively once one has experience of it.
 The perception of cooperation with School
services is not dependant upon experience.
 Differences are amplified: those who cooperate
within School and Social services (70%) are
more familiar with the UN’s Children’s rights than
those within Child Psychiatry are (24%).
What influences the development of
cooperation between organizations
67%
63%
54%
45%
33%
33%
34%
16%
0
Mgmt
Work load
Teams
Enjoy
work
Work time
Pers
Chem
Edu
Like
workplace
The best for the child
 All organizations are familiar with the UN’s Children’s
rights act. Social and school services are more familiar
than Child Psychiatry.
 Assessments regarding what is best for a child is done
for each individual case – Social services more than the
others
 Organizations reach consensus together regarding what
is best for a child.
 Social services most often decides what is best for a
child when their is disagreement.
 1 in 6 do not discuss what is best for a child in their
organizations. This is equally common in all
organizations.
Consultations at Child Psychiatry
 Participated in 42 treatment/diagnosis
consultations.
 Listened to 269 patient histories
Partial results from consultations
 The majority of cases were brought up by
the parents.
 Cooperation was initiated by referral or
invitation.
 In 4 of 10 cases cooperation was started.
 The idea with cooperation was benefits
for Child Psychiatry or for Child Psychiatry
and the family.
 Focus shifts between children, parents, and
which contributions Child Psychiatry can
make.
 The case officer’s preconceptions
characterize the child’s history and
influences efforts.
 Ambiguous between assessment/treatment.
Eight cases
 From treatment consultation/treatment at Child
Psychiatry
 All the children had problems in school as well as
previous contact with Child Psychiatry and social
services.
 7 out of 8 children had had long-term contact.
 7 out of 8 were boys.
 Children between 10 and 17 years old.
 2 of the children lived with their original families.
 Many resources have been given to the families.
Partial results of cases
 Families were moved around between
organizations
Personnel change
Ambiguity
 Little room for the child’s best
Disagreement
 Exposure
For both the family and personnel
 Time
Long time to gather oneself
What was the final result of
cooperation in the cases?
Better cooperation between organizations
Treatment process begins together
Slow change – no change?
Disagreement among organizations
Conclusions – organizational level
 Internal organization complicates things
 Assignments and boundaries
-
Skepticism for the assessments of other organizations
Discussions about costs
Confidentiality
The efforts of the organizations and the children's needs
 Time
- Problems in 1st grade are not solved in 9th grade
- Seasonally controlled organization
- Simultaneous work
Conclusions – concrete practical
level
 For whom are we cooperating?
- Personnel?
- Child?
- Parents?
 Inter-professional cooperation internally and externally
-
Different professions – different explanation theories?
Fun to work together.
Difficulties describing the causes of problems.
Teachers are important for children.
Lack of clarity in their work efforts.
 Power
- Parents and children feel they are overrun
- Personnel also feel they are overrun
The cooperation of organizations
and the UN’s child rights act – how
does it work?
• The child becomes an object.
• It takes time for the child’s story to be
heard.
• The child’s exposure
– In individual meetings
– In the agreements of organizations
– In difficulties obtaining help
Things to think about …
… How would cooperation be affected with one authority
instead of three?
… How would the personnel’s efforts be affected if they
talked with and not about the family?
… Would there be a difference if the child’s story was
heard earlier?
… What would happen if cooperation started earlier?
… Would it make a difference if the child’s needs controlled
organizational efforts instead of the resources of the
organization?