Joint working

Mental Health Nursing,  Oct 2000  by Barlow, Ken

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Joint working is patently not a new concept for most CPNs. There has been a gradual move toward collaborative involvement in care over many years, arguably driven by cost saving efficiencies initially but also by altruistic influences surrounding the nature of client needs and the development of multidiscplinary provision.

For 30 years or so, successive governments have sought ways of encouraging collaboration between the many agencies involved in mental health care in the community including clients and carers. For purposes of this guidance paper, however, joint working can be defined as: `the acting together of two or more people from the same or different agencies and/or involving client/carer, with the same aim of delivering a service that could not be offered to the same degree by one person alone.' Multi-disciplinary approaches have massive implications for service structures, procedures and operational processes. which cannot be explored here in any detail. This paper will concentrate on the basic essentials of joint working with a clinical emphasis, from a CPN practice perspective.

Role clarification

Joint working presents a number of problems and opportunities. CPNs need to know how to convert the former into the latter. One of the keys to this is to recognise the need to adapt roles to different situations and as expressed needs demand. It is just as important to clarify what the CPN role is not, in given circumstances, as much as what it is.

If a CPN and a team colleague undertake a joint visit it is important to establish in advance why the visit is joint, what the purpose of the visit is, who will adopt which role and when this might be changed. Good communication skills are vital to the smooth transition of roles during a joint visit.

An appropriate venue for the session needs to be established. Not all visits will be at the client's home. For instance, seating arrangements, a mutually agreeable time, and who is the nominated key worker are all issues which need consideration in establishing the mechanics of the joint session. There are also factors to be taken into account regarding the blurring of traditional professional boundaries. For example would you, as a CPN, be happy to help fill in a housing application form, while your social work colleague is busy taking down details of the client's medication if this is how the session works out?

A precise, heavily prepared script or plan is not recommended. It may well appear contrived, rigid and, to some people, suspicious in nature. Too rigid a preparation can court disaster in the event of spontaneous unexpected occurrences.

It is usual, and common courtesy, to inform clients and/or carers that a joint visit is being planned and unless there are specific reasons for withholding such information, who will be undertaking what aspects of the visit. The involvement of clients in care planning is now far more common. Their informed consent to joint working should be sought with the reasons behind the decision to joint work being clearly explained. Beresford and Trevillion (1995) emphasise the essentiality of trust and sharing in the collaborative relationship with the client.

Justification

Joint working can be seen as an expensive option in terms of using scarce resources. It is suggested that CPNs refer back to the original definition at the top of this paper before opting for joint working. The key component of the definition which should help guide decision making in this respect is that part which says, `delivering a service which cannot be offered by one person alone.' The following are suggested as criteria against which to gauge the need for joint working or not.

* Therapeutic activity is raised.

*Safety aspects indicate a strong recommendation.

* Specific skills are brought to bear.

*Introduction or transfer activities are required.

*Legislative or structured care needs are indicated.

*Casework supervision is indicated.

*Supervised training needs are indicated.

*Local, specific or unique conditions exist. Values

Joint working is based upon three basic values, namely trust, sharing and good faith. CPNs working with colleagues from other disciplines need to be sure that there is a commonality of value systems which forms the basis for a working philosophy upon which to base practice.

The following issues are felt to be essential to good joint working

* Trust.

* Respect.

* Autonomy

* Risk Taking.

* Self-awareness. - Tolerance.

The opportunity to openly discuss these issues in a non-threatening and nurturing atmosphere should always be encouraged. When Peck & Norman linked these to practice based issues in a multi-disciplinary setting, the results made for fascinating reading.

Team working

CPNs working in structured or semi-structured community mental health teams (CMHTs) are arguably in a more advantageous position, because they are more familiar with their colleagues and their unique working methods. While this familiarity can bring its own problems, it does alleviate some of the more common obstacles faced when considering joint working with a colleague who may be a virtual stranger in a `hands on' clinical situation. Multi-disciplinary teams are growing in numbers around the UK. Many CPNA members will no doubt be members themselves. For them, the opportunity for joint working could not be more available. One of the keys to success in establishing and then maintaining CMHTs lies in the commonality of agreed values, philosophy, aims, priorities and working structures whilst at the same time encompassing a broad approach to the balancing of local needs against available service provision. (Onyett et al and Ovretviet.)