Collaboration with counterchecks: On collaboration between child psychiatry,social services, school and the family

This thesis concerns the collaboration between child and youth psychiatry, the individual and family unit of social services, schools and families. Collaboration around children with both complex social and psychiatric problems and problems in school is an area of great importance. Significant resources are channeled into supporting this group not only in the form of child and youth psychiatry and social services interventions, but also in terms of input from schools in the form of pedagogical and student health initiatives. The demand for collaboration is matched by the requirements of legislation, the reports of official investigations and policy guidelines, all of which emphasize the importance of collaboration around children with complex problems. The purpose of this thesis is to investigate collaborative processes between child and youth psychiatry, social services and schools and, additionally, to investigate what takes place between the professionals from these organizations, the children and their parents. Further investigation of which cases become cases for collaboration is also made, as well as the factors that impact on collaborative processes and what collaboration actually results in for the organizations and for the families. The empirical data comprises 42 observations of treatment and evaluation conferences at a particular a child and youth psychiatry service, as well as observations and interviews in eight cases of collaboration. The theoretical lenses used in this thesis concern the ways in which organizations function and the interaction between organizations, between professionals and between professionals and patients/clients. Concepts such as institutional environments, organizational fields, logics, boundary-setting, boundary-expansions, domains, human service organizations, discretion and jurisdiction are used to analyze the data. The results reveal that it is not possible to identify in which cases child and youth psychiatry chose to collaborate. Collaboration is however least likely to occur in cases judged from a child psychiatry perspective to be problematic. Cases in which collaboration takes place can be divided into three phases; an initiating phase, a negotiation phase and a changing phase. In these phases there are both ideal patterns that reflect the professionals’ ambitions in collaboration, as well as patterns that reveal how things are in practice. The factors that impact on collaborative processes are the different logics of different institutional environments as manifested in different goals/working-tasks, different hierarchical positions, as well as a lack of clarity surrounding internal organization which makes it difficult to know who has responsibility for the case. Organizations, the professionals and families all have different pictures of the problems at stake, which also impacts on the process of collaboration. The professionals’ capacity to collaborate and the ways in which they exercise discretion can also be seen as impacting on collaboration, both internally and externally. Collaborative processes mean that new identities are created – a collaboration-client/patient – and parents’ subordination in the face of the power of organizations is also clearly evidenced. Another result is that it takes a long time before professionals decide to collaborate and initiate collaborative processes. Collaboration occurs in both evaluation and treatment work. Collaboration is clear for the professionals who work in collaborative processes but not to those who are not privy to such decisions. To a large extent parents and children remain outside of collaborative processes and do understand the help that is offered. Their hope is for rapid changes to the child’s situation, a change that does not in fact take place