Inter-Agency Working in Europe and the Uk to Support Vulnerable Young Children and Families

Introduction 

Disadvantaged families living in poverty, especially in culturally diverse and deprived neighbourhoods where risks may accumulate, may have multiple needs. “Silo working” is endemic in bureaucracies, including governments, and the resulting lack of communication and integration between services fails families. For example, families may be involved in multiple assessments, with replicated explanations to many different professionals in different locations.

Relevance

An international review¹ found that, of 54 countries, more than half had made moves towards more coordinated provision for children and families. In the context of early intervention, integrated inter-agency working has been tried in many European contexts including the UK as a way to improve support for children and families and to potentially reduce inequalities.^2-9 It has been promoted as a way to provide joined-up solutions for the most marginalised and disadvantaged groups such as cultural minorities, families on low income or recent immigrants, who are likely to experience multifaceted problems that are inadequately addressed by traditional separated services.^10,11 

Examples of inter-agency working are the UK’s Sure Start Children’s Centres program, the Greek and Portuguese strategies to enhance educational outcomes for groups such as Roma families, and the Centres for Youth and Families in the Netherlands.¹² Also it is reflected in local policies such as Canada’s Toronto First Duty program,¹³ the Action Base of Integrated Activity (Baza Akcji Zintegrowanej Animacji; BAZA) in Warsaw, or the inter-agency coordination of services for children and families in the Municipality of Reggio Emilia in Italy.¹²

One underlying assumption is that families with multiple needs are best supported by services working together, sharing information and possibly working from one common location.  Joint-working is expected to avoid duplication of effort and fragmentation; pooling of budgets can lead to economy; shared assessment of needs and coordinated plans will lead to more appropriate services; and the quality and take-up will be greater if front-line delivery of services is co-ordinated, with a shared governance structure.¹⁴ The importance of information sharing is explained well in Scotland’s recent Getting it Right for Every Child policy.¹⁵ The European Union and the Council for Europe have prioritized integration of family support for the most marginalized and disadvantaged groups.¹⁰ However, recent work in nine European countries, investigating policies to support disadvantaged and linguistically or culturally diverse populations, found that national legislation to support this approach was limited, generally focussing on child protection issues, with decisions about integration of other services made locally, where strategies depend on the local political context.¹⁶

Problems

Firstly, inter-agency collaboration has different forms. There is a lack of clarity about its meaning; rather than being a single strategy it represents a continuum or ladder.¹⁷ The number of ‘steps’ in this ladder in programs in the UK, for example, has ranged from three to five.^18-20 Case studies in the UK and Norway of successful centres providing co-located integrated services also reveal that several levels of integration may exist within one site.¹² 

Secondly, to promote this approach, commissioners and policy makers increasingly want evidence to support their decisions. While closer integration has been extolled as a policy designed to enable disadvantaged young children to be better prepared for formal education,¹⁴ a review⁸ concluded there was limited evidence for such an approach, locally or nationally,  leads to better outcomes for children or families, although there are some exceptions such as the positive impacts identified for well-evaluated area-specific programs in Canada.¹³  This lack of evidence partly reflects the limited resources committed to collecting the evidence.

Recent Research Results

Research on inter-agency working in Europe has focussed predominantly on process, developing frameworks or terminology to conceptualise the policy in practice, and then identifying what contributes to, or hinders, successful implementation.^18-21

Reviews^22-24 have examined factors related to success or failure of inter-agency initiatives. The most significant facilitator in a series of successful case studies in Europe¹² and in local areas that were home to culturally and linguistically diverse families and those of low-income¹⁶ was ‘top down’ national policy with the accompanying financial provision.  However local ‘bottom up’ support was also important, in addition to clear management and governance.^12,16,25,26 Also, establishing effective partnerships depends on commitment at all levels of hierarchies; clarifying roles and responsibilities; engendering trust and mutual respect through effective communication; and developing a shared purpose with joint goals with shared protocols, which can be challenging and is dependent upon the professionals involved.²⁷

There is substantial consensus about the barriers to successful inter-agency working, often more numerous than facilitators. They can be categorised as contextual, organisational, and those relating to different professional cultures or to commitment.²⁴ Contextual barriers such as political climate are common; organisational barriers include differences in geographical boundaries of agency catchment areas or problems with data sharing. Interviews have revealed that new European regulations about personal data have heightened this issue.^12,16 But the most commonly mentioned cultural barriers are status inequalities and professional differences or mistrust.^{3,16,26,28-30}  

European studies of perceptions of impact have described benefits as including the ability to react more flexibly, more effective referrals, and avoiding duplication. Most informants also suggested that families experienced less stress.  However, practitioners less often specified improved child outcomes in relation to inter-agency collaboration.¹²

Research Gaps 

The extent of new evidence concerning inter-agency working ebbs and flows as governments change their political leadership and their focus on policy for disadvantaged children and families.³¹ This lack of continuity has hindered long-term research on outcomes for children and families.³² Even respondents in case studies selected to represent best practice across Europe were generally reluctant to suggest that improved academic attainment for children living in disadvantage may be associated with high quality integrated provision.¹² Their work is based mainly on principles and values, but well-designed larger-scale studies of impact are needed in order than policy makers and providers can be confident that inter-agency collaboration can be linked with better child outcomes.

Conclusions 

Children and parents experiencing disadvantage are likely to require support and services from many different providers. Without coordination between agencies, families need to explain their circumstances numerous times, visiting multiple professionals. Moving to closer inter-agency work will involve devoting substantial time and effort to identify common understanding of factors that enhance or detract from inter-agency collaboration.³³ Policy makers in many countries have promoted closer connections between agencies such as education, health, youth welfare, employment and criminal justice.  However, this is often limited to child protection issues that children most at-risk may ‘slip through the net’ when agencies are not sufficiently joined-up.³⁴ Consequently, it is common in the European context to have strong legislation regarding collaborative working with regard to child protection.¹⁶ However, such support is important not just for ‘fire-fighting’ but also for ‘fire prevention’. There is good understanding of what helps inter-agency working become a reality. However, barriers will persist if professionals are not allowed time to manage organizational change to enable them to integrate expertise and roles. Also, increasing data protection legislation often hampers sharing of information between services. These issues can be overcome with good planning and political support. Indeed, in many countries, using different models, pioneering policies have allowed agencies to work together successfully. In Warsaw, Poland for instance, two years was spent in planning the BAZA project, with secure local funding. In Reggio Emilia, Italy, there is also local funding and legislation to establish an integrated system for 0-6 year olds.¹²

Implications for Parents, Services and Policy 

Agencies working in collaboration, with a common agenda, a shared vision, a common location, and (ideally) a common governance structure, can be responsive and efficient in supporting disadvantaged children and parents. However, it has proved challenging to develop and maintain integrated services for young children and families in the face of fluctuating ‘top-down’ policies and financial support. Overall, the close collaboration and possibly co-location of agencies providing education, childcare, family support, public health and mental health can be an effective way to develop services for young disadvantaged children and their parents. It is challenging to sustain this style of working as governments and policies change, unless there is also strong ‘bottom up’ support and proof that this way of working can reduce inequalities. Research on children’s outcomes is essential to persuade agencies to develop integrated working.

References

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