Multiagency working in the early years: confidence,competence and context

Research and development with regard to interprofessional practice have extended over recent decades to early years services in children’s centres (CCs). However, most children in England attend private and voluntary settings, rather than CCs. where early years practitioners have varying amounts of opportunity, training and experience to work interprofessionally. Developing our Social Practice analysis of case studies, we propose a theoretical framework for interpreting early years interprofessional practice that takes account of specific contexts, noting conditions which promote boundary-crossing competence. This paper presents selected findings from a survey of 52 early years practitioners from England about their experiences of interprofessional working, woven together with case study exemplars. Their extensive responses to open-ended survey questions showed great variation in work with other professions and in reported levels of confidence and competence. However, there were also differences depending on the setting type. Findings suggest the need to tailor training to individual contexts, and argue for securing space for practitioners to gain experience of interprofessional working through mentored opportunities.     

Teachers’ Attitudes Toward Inclusion: Factors Influencing Classroom Practice

Effective collaboration between early childhood teachers and social workers is now considered critical to providing children with adequate psycho-social supports and services in early childhood settings. In order for this interdisciplinary collaboration to be more effective, opportunities for each discipline to learn about each other's knowledge, skills, roles, and responsibilities need to occur well before these professionals enter early childhood settings. This pilot study engaged 2nd-year, preservice, graduate early childhood education and social work students in an interprofessional training and collaborative activity as part of their graduate coursework. Following this training and activity, the early childhood education graduate students and the social work graduate students were invited to participate in uni-professional focus groups as a way to explore their experiences. Findings suggest that although there is general agreement among graduate students that interdisciplinary training and learning activities during coursework provide an important foundation for collaboration, there are several challenges. These challenges include a lack of clarity around professional roles and responsibilities, differences in understandings of children's behavior, and a perception that there will be little opportunity for interdisciplinary collaboration in early childhood settings. Implications are discussed for strengthening relationships between professional preparation programs as a way to improve collaborative teaming and increase early childhood teacher retention.     

Personal action potency: early years practitioners participating in interprofessional practice in early years settings

This paper reports on case study research in the UK analysing the participation of early years staff in interprofessional practice to provide effective care and education for children, primarily those with special educational needs. Even though case study staff in different ‘outstanding’ settings had equivalent qualifications and similar years of experience, the ease with which they were able to marshal and deliver effective provision for children requiring input from other services varied depending on a complex set of factors. Social Practice Theory (Holland and Lave 2009) and the concepts of personal action potency in trajectories of participation (Dreier 2002, 2008) shed light on how and why this was the case. The findings indicate that structural arrangements, interpersonal relationships, history and contentions influenced the practitioners' participation in interprofessional practice, but were not entirely deterministic. Contributing to theoretical development, the paper argues that the potential for interprofessional practice is a shared rather than individual capacity in settings. There is scope for enhancing this capacity through attention to the features identified in the analysis.     

Interprofessional work in early childhood education and care services to support children with additional needs: two approaches

Abstract

In Australia, over 900,000 children attend some type of early childhood education and care service. Many of these children have learning difficulties and early childhood teachers play a significant role in identifying children’s needs and working with other professionals to instigate and/or implement appropriate interventions. When educators and allied health professionals work collaboratively in interprofessional ways, they are in a better position to support children and their families. Drawing on findings from a sustained body of research, this short paper shares our reflections on some of the benefits and challenges of two different approaches to working in interprofessionally in Australian early childhood education settings, and provides some suggestions for supporting this work.     

Dissecting through Barriers: A Follow-up Study on the Long-Term Effects of Interprofessional Education in a Dissection Course with Healthcare Professional Students

Several studies have shown significant improvements in the attitudes and perceptions of healthcare professional students toward interprofessional education (IPE) immediately following intervention with IPE courses. However, there remains little evidence on the lasting effects of IPE courses and the long-term influences of these IPE experiences are poorly documented. The purpose of this study is to assess the long-term effects of an intensive, ten-week interprofessional gross anatomy dissection course at McMaster University. Attitudes and perceptions of past participants towards interprofessional learning were evaluated, now that they have started working with other healthcare professionals outside of the IPE course setting. Thirty-four past participants who have clinical experience working in interprofessional settings or are currently working in the healthcare field completed a follow-up questionnaire consisting of a modified Readiness for Interprofessional Learning Scale (RIPLS) and open-ended questions. Quantitative analysis revealed a significant decrease in their attitude towards teamwork and collaboration and respect for other health professions, but a significant improvement in their understanding of roles and responsibilities compared to their results immediately after the IPE intervention. Qualitative analysis of open-ended questions revealed several themes such as developing interprofessional competencies, developing relationships, and remembering the strengths of the IPE dissection course. The results of this study indicate that the IPE experience in anatomy was highly valued by the students and that past participants maintain a clear understanding of their scope of practice, but the reality of clinical practice may have eroded gains made in the program. Anat Sci Educ. © 2018 American Association of Anatomists.     

Evaluating the Implications of Complex Interprofessional Education for Improvements in Collaborative Practice: A multidimensional model

This article questions the notion that interprofessional education necessarily leads to interprofessional learning and improved collaborative practice, and argues in favour of evaluation that sets out to examine these issues. It outlines some of the key theoretical and methodological debates that currently inform potential evaluation models, and seeks to illustrate their relevance by outlining their incorporation into the development of an existing evaluation of a programme of interprofessional education. To demonstrate how this design ‘works’, the article also offers some selected findings, relating these specifically to the methodological issues previously presented.     

EVALUATING AN INTERDISCIPLINARY GERIATRIC EDUCATION AND TRAINING INSTITUTE: WHAT CAN BE LEARNED BY STUDYING PROCESSES AND OUTCOMES?

As recognition of the need for interdisciplinary geriatric teams grows, new and varied training methods will be necessary to reach health and human service professionals in different contexts and settings. This article reports on the development and evaluation of one such model: an interprofessional educational institute sponsored by the Queen's University Gerontology Project in 1993. Data analyzed include information on participants’ backgrounds and teamwork experience and their assessment of session content and group work processes that made up the knowledge acquisition and skills attainment objectives of the program. Major implications of the institute that became evident include the need to develop a strong institutional foundation, the importance of targeted recruitment, the connection between theory and practice, and the need to present practical techniques, strategies, and modeling opportunities.     

Professional Attitudes in Health Professions' Education: The Effects of an Anatomy Near-Peer Learning Activity

Interprofessional attitudes existing between healthcare disciplines can negatively impact communication and collaboration in the clinical setting. While human anatomy is a topic central to healthcare trainees, the potential of the anatomy laboratory to minimize negative interprofessional attitudes has yet to be characterized. This study aimed to assess the effects of an anatomy interprofessional near-peer learning activity (AIP-NPLA) on medical and nursing students' interprofessional attitudes at McGill University. The authors employed a convergent parallel mixed methods study to explore participants' AIP-NPLA experiences. The Attitudes to Health Professionals Questionnaire (AHPQ) was used pre- and post-AIP-NPLA to assess participants' attitudes toward their own and their counterpart profession. In addition, a focus group was held immediately following the AIP-NPLA to explore participants' experiences and interprofessional perceptions. Quantitative results using a principal components analysis demonstrated significant changes in nursing students' responses between pre- and post-AIP-NPLA scoring, rating the medical profession as being more caring overall. Medical students' responses pre- and post-AIP-NPLA demonstrated no significant differences. Qualitative results also suggested a breakdown of negative attitudes, an increased understanding of inter- and intra-professional roles, and the importance of interprofessional collaboration and mutual learning for their careers. These findings revealed that attitudes among healthcare trainees may be positively restructured in the anatomy laboratory, allowing for collaborative care to predominate in current and future clinical practices.     

Psychiatry in the sorting of schoolchildren in Scandinavia 1920–1950: IQ testing,child guidance clinics,and hospitalisation

ABSTRACT

This article explores the role of psychiatry in the sorting of schoolchildren in Denmark, Norway, and Sweden from 1920 to 1950. Whereas the role and rise of educational psychology and IQ-testing in the differentiation processes in schooling have been examined through earlier research, the role of psychiatry in the interprofessional collaboration has so far been largely unexplored when it comes to the Scandinavian case. In line with Michel Foucault, the article regards these professional efforts as part of the biopolitics, where psychiatry amongst other disciplines engaged in the development of means to involve strategically in the life of schoolchildren and their families, as part of shaping the future of the population. We argue that psychiatric sorting activities related to schoolchildren did not solely take place through IQ-testing in schools, but involved classification of children through a range of measures in various settings. We further argue that these processes took place due to local agents and initiatives in a broader context of interprofessional collaborations between psychiatrists, psychologists, and teachers, rather than top–down processes initiated by the state. The analysis in the article draws on different sources of the period: journals, articles, and monographs from the key-agents of the period.     

The impact of wireless keypads in an interprofessional education context with health science students

The aim of this study was to identify if wireless keypads could facilitate interprofessional interaction among undergraduate paramedic, nursing, occupational therapy, physiotherapy, health science, social work and midwifery students. Secondary research aims included the examination of students' perceptions of interprofessional education and how students perceived using wireless keypads in large lecture classes and smaller tutorials. The study used a mixed methodology approach via self‐reporting questionnaires and focus groups that included (n = 210) students in week 1 and (n = 151) students in week 13 of an undergraduate unit. Overall, students were satisfied with the use of wireless keypads in their interprofessional undergraduate unit of study. While modest findings supported the use of wireless keypads in improving student interaction, other findings were statistically significant in understanding the roles of other health professions and why collaboration in health‐care environments was important for professional growth. The following themes emerged from the qualitative data: engagement, satisfaction, use of educational technology, interprofessional education and learning environment. Integration of wireless keypads has assisted undergraduate students to better appreciate and understand other health‐care disciplines within an interprofessional education setting. Students reported that they appreciated the alternative teaching and learning approach that wireless keypads offered, thus improving engagement and interactivity, and providing a broader understanding of other allied health‐care professions.     

Preschool Teachers’ Perceptions About and Experience with Child Abuse and Neglect

This study reflects Estonian preschool teachers’ perceptions about and experience related to children in need in the context of neglect and abuse. Using quantitative and qualitative data, it was determined that, in general, teachers understand the meaning of “child in need” and abuse, and they have had experience with such children in their classes. However, emotional neglect and abuse are more difficult to identify than, for example, physical abuse. The study indicates the need to find ways to support teachers’ competence and confidence in identifying and reporting cases of children in need. Practice implications are discussed and recommendations for future research are outlined.     

Tools for talking: the purposeful and inventive use of languages by bilingual children in primary classrooms

This article is based on a number of observations of bilingual children in an East London primary school, and some work carried out for a doctoral study. The article explores children’s views and perspectives on their use of first and second languages at home and at school. The kernel of the investigation is that language use is dependent on purpose. Bilingual children’s use of their first and second language depends on which language best serves a particular function. Often children who speak two or more languages on a regular basis combine these to create a new language. Schools therefore need to review their language policies and practices in relation to their pupil intake, taking into account the contribution of bilingual experience to children’s overall linguistic development. Teachers also need to understand parents’ views on their children’s language and literacy education. These issues are of vital importance if schools are to provide an inclusive curriculum.     

Creating change agents for interprofessional education and practice: a leadership programme for academic staff and health practitioners

Universities face increasing pressure not only to embed interprofessional education within health education curricula but also to prepare graduates as catalysts of change for interprofessional, team-based approaches to health care delivery. Currently, few leadership programmes exist that support the expansion of interprofessional education. This paper describes the development, implementation and evaluation of a leadership programme aimed to build faculty and health practitioners’ capacity to become change agents for interprofessional education and practice. The programme was delivered by two Australian universities, each in partnership with a local health care provider. A mixed method approach was adopted to measure participants’ pre- and post- knowledge, reactions to the programme, planned and reported behavioural changes, and organizational outcomes. The programme was positively evaluated and reported to increase participants’ understanding of interprofessional education and practice. Follow up with participants suggested the programme had facilitated the implementation of interprofessional education and practice in both academic and practice contexts.     

教育孩子谨防“缺点轰炸”

现今社会竞争异常激烈,很多家长为使自己的孩子在学习成绩方面最具竞争优势,"恨铁不成钢",采取了指责、抱怨、训斥、嘲讽、拳脚棍棒教育等"缺点轰炸"的方法,严重影响了孩子心理的健康发展.家长需要通过文化理论知识的学习,运用科学的教育方法预防"缺点轰炸".     

Internalizing or externalizing: Screening for both problem youth

This study is an initial report of work to develop simple procedures to screen out children and adolescents who internalize or externalize their psychological problems. Such screening procedures can easily be used in classrooms by teachers, peers, children themselves or other observers who know the students in class. Most children are referred to counseling services because they are disturbing to others or externalizing their problems. However, other children who internalize their problems get much less attention of teachers and referral to counseling services. Instead of working mainly with referred children, counselors need to make sure that both children are screened out so that their services could be equally disturbed. The screening procedures in this study are intended to help in identifying particularly the "internalizer" who may get neglected in distribution of counseling services.     

Mock Interdisciplinary Staffing: Educating for Interprofessional Collaboration

Training for interprofessional collaboration is important because professionals are increasingly required to work together in a coordinated and collaborative manner to meet the complex needs of clients. However, few published reports exist on interprofessional training for community counselors and marriage and family therapists. The authors discuss the use of a mock interdisciplinary staffing with students who are training to be counselors and marriage and family therapists. This method of instruction holds promise as an effective means of introducing students to a range of issues, including the knowledge, skills, and attitudes needed for interprofessional practice.     

Using Q-methodology to determine students' perceptions of interprofessional anatomy education

Interprofessional education (IPE) prepares healthcare students for collaboration in their future careers. The purpose of this study was to determine which aspects of the IPE Program in Anatomy at McMaster University contributed to the development of healthcare student's interprofessional skills. Q-methodology was used to identify the students' common viewpoints of the IPE experience. A total of 26/28 (93%) of students in the course from the medical, nursing, midwifery, physician assistant, occupational therapy, and physiotherapy programs participated in this study. Students were asked to sort a Q-sample of 43 statements about the IPE dissection course derived from previous qualitative studies of the program. Using the centroid factor extraction and varimax rotation, three salient factors (groups) emerged, namely: (1) Anatomy IPE Enthusiasts, (2) Practical IPE Advocates, and (3) Skeptical IPE Anatomists. The Anatomy IPE Enthusiasts believed that students from different disciplines brought unique anatomical knowledge and each group member guided others through difficult material. The Practical IPE Advocates expressed that they would be stronger advocates for interprofessional teams in the future because of the course. The Skeptical IPE Anatomists strongly disagreed that learning with students from different disciplines helped them gain an understanding of their roles in the context of other healthcare professionals and felt that there was little benefit from the IPE program compared to other non-interprofessional programs. These findings about student attitudes are critical to drive an evidence-based evolution of the IPE dissection course, since students' perceptions can have a profound influence on interprofessional collaboration in the workplace.     

THE RESIDUAL PARENT TO COME: ON THE NEED FOR PARENTAL EXPERTISE AND ADVICE

In this essay, Nancy Vansieleghem starts from the observation that parents nowadays are addressed as individuals in need of parental expertise and advice. She maintains that the notion that we are living in a permanently changing society has created a context in which parents feel that they no longer “know” what is good or bad for their children. On this view, parents need to learn how to manage their parenthood. Vansieleghem questions the need for expertise and advice that is characteristic of our new mode of understanding parenting. In developing her argument, she borrows from Michel Foucault the notion “figure”—in this case, the type of parents who understand themselves as in need of expertise in order to respond to their children—and she draws further on Giorgio Agamben's analysis of the state of exception. Vansieleghem concludes by detailing the figure of the residual self as one that understands parental care as something that can and should be managed beyond concepts such as “disciplinary power” and “normalization.”     

Between psychopathology and inclusion: the challenging collaboration between educational psychologists and child psychiatrists

This article reports on a Danish study on interprofessional collaboration between child psychiatrists and educational psychologists concerning children who are categorised as being at risk. Methodologically, the analysis is grounded in qualitative interviews with psychologists. A Foucauldian approach is applied to narratives and experiences that occur within these interviews concerning external collaboration with child psychiatrists. The article is informed by the research tradition that has problematised the significance of psychiatry and diagnoses in the field of special needs education and social pedagogy. We thus enquire into how the rise of diagnostics and medicalisation affects our understanding of children's difficulties. We discuss a paradox that is present in Denmark and other countries. As educational policies emphasise inclusion, the field of schooling experiences a huge rise in children with medical diagnoses. We argue that diagnostic knowledge is itself an insufficient basis for action and must be considered in relation to teachers’ overall training and teachers’ situated professionalism.