TAC, keyworkers and empowerment. A briefing paper by Peter Limbrick
'Why don't the people helping my child talk to each other?' 'Why can't I have just one special person who helps me join it all together?' 'Whose child is it anyway?'
This paper is writtern to answer some basic questions parents ask; 'Why don't the people helping my child talk to each other?', 'Why can't I have just one special person who helps me join it all together?' and 'Whose child is it anyway?' - important questions because they are often asked of service providers with a high degree of parental frustration and anger.
TAC (the Team Around the Child model) has been designed to meet the particular support needs of babies and young children who have an on-going multifaceted condition. Because these children have a range of needs in various developmental areas, e.g. motor, perception, communication, cognition and behaviour, the child and family can find themselves at the centre of confusing networks of service providers.
In this article I want to describe TAC as a successful response to the problematic complexity that can arise and as an example of horizontal teamwork. I will also show how TAC both depends on and supports keyworkers and outline the opportunities TAC brings to give more decision-making power to parents.
Putting it another way, the article and the TAC model answer some basic questions that parents often ask; 'Why don't the people helping my child talk to each other?', 'Why can't I have just one special person who helps me join it all together?' and 'Whose child is it anyway?'. These are important questions because they are often asked of service providers with a high degree of parental frustration and even anger.
Why don't the people helping my child talk to each other?
This is a fair question and it would seem both logical and common sense for teachers, therapists, psychologists, nurses, nursery staff, play workers and anyone else working directly with the same baby or young child with a disability to share observations and approaches with each other. In my experience in the UK and other countries many parents experience the opposite; practitioners do whatever it is they are supposed to do separate from each other. The consequence can be a failure to treat the child as whole, contradictory advice, treatment programmes that do not fit together, gaps of unmet need and sometimes too many people doing too many things.
TAC philosophy suggests that a few key practitioners around each child – those with the most practical and regular involvement – agree to meet together every so often for face-to-face discussions. Two major features help define TAC; the child's parent(s) has a full place in the team and the team membership is restricted to three, four or five people so that it is child- and family-friendly. TAC is not an old-type case conference for all comers.
TAC is a horizontal team because it is freed from vertical or hierarchical management. When a social worker, therapist and teacher, for example, agree to join their efforts together around a particular child none of them can assume the role of team manager. Nor can the culture and working practices of any of these three agencies (social work, therapy/health and education) predominate. This helps define the role of the child's keyworker (used synonymously here with the term 'lead professional') and makes space for the key people around the child to speak up and influence how support is provided.
Why can't I have just one special person who helps me join it all together?
Perhaps you have heard this question as frequently as I have. It often comes from exasperated parents who are bewildered and overwhelmed by the number appointments, assessments, planning meetings, reviews, etc. they have to keep abreast of. Often the dense scribbling on the calendar on the fridge tells the story. The plea is for one person who is known, liked and trusted by the family to sit with the parent at the centre of the web and help to make sense of it all – help fit it all together so there is maximum benefit to the child and minimum cost to the child and family's functioning, wellbeing and mental health.
At its worst, under traditional discipline-specific approaches, parents can find themselves lost and disempowered in chaos. This suggests no negative reflection on any practitioner's expertise, commitment, care or concern for the child and family. While each one of them is working with skill and compassion, the lack of any local co-ordinating system can reduce them, in the eyes of parents, to just one more piece of a jigsaw that is never put together.
In the TAC model, local senior managers work in their own cross-agency horizontal teams to create integrated pathways that will carry each child through the journey of referral, assessment, action planning and support. This strategic effort builds the horizontal landscape between the local 'vertical' agencies engendering effective communication and networking, co-ordination of all interventions as far as possible and close collaborative teamwork on each child's programmes.
The beneficiaries of this effort are child, family and keyworker. The keyworker, instead of being swamped by the same local chaos that disempowers parents, now has a well-organised environment with interagency systems and protocols. Work can now be more effective in supporting the child and family and helping them get the best from the services around them.
The keyworker is typically the facilitator of the child's TAC, being the one who knows the child and family best and supporting TAC meetings through their agendas. TAC is always a collective effort and each member will take on tasks to avoid the keyworker being overloaded.
Whose child it is anyway?
This is the plea of the parent who wants to be more involved in deciding what is going to happen to their child. They see plans are being made but do not feel they have been allowed to play a part – and do not necessarily agree with what has been decided. Frustration is made worse when they feel none of the practitioners have got to know the child or family very well or listened properly to their aspirations for the child.
The TAC model affords parents a full place in their child's TAC and, once there, acknowledges the role of the child's parent with very special knowledge and expertise. Opinions will be actively sought and their voices will be listened to with genuine rather than feigned interest. Parents are an equal member of the TAC and have a full part to play in its horizontal teamwork.
The spirit of TAC is the collective effort; the belief that, when facing very complex issues, two or three heads are better than one. While each person in the TAC brings their own particular skills and expertise, the TAC as a whole represents shared experience, shared concern, shared resourcefulness and shared wisdom. Decisions about a child's health, wellbeing and, sometimes, survival are likely to be better founded when they come from the child's TAC rather than from a single person. This authoritative voice of each child's TAC is built into the workings of the local integrated pathway in recognition that no other group or person has the same degree of knowledge or concern.
Empowerment of parents extends beyond the service to each individual child. Collectively, local parents hold a valuable store of experience, expertise and energy. In TAC thinking, parent empowerment means inviting representative parents into the planning of the local integrated pathway, into the discussions that agree a local vision for what support ought to look like, and into processes for gathering feedback for service development.
I have a repeated experience, in the United Kingdom, Ireland, Canada and Australia of speaking about TAC to groups of practitioners and managers without any parent in sight. These major stakeholders, for whatever reason, are absent from discussions which will surely impact on their lives and on the lives of families coming along. The result is that parents are denied a voice and service managers lose the grounding and dynamism that parents would have brought to the table. When we are planning new service models we should always ask ourselves, 'Whose children are they anyway?'.
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Please note: This essay was first published as a Members' Briefing Paper in March 2013 in the Equity and Childhood Program of the Youth Research Centre at Melbourne University, Australia.