MDPP Case Study Three. Completed by the Centre.

For this Case Study we spoke to an Integrated Family Services Practitioner, a Family Services Specialist in Disability, a Specialist in a Family Violence Service, a specialist in homelessness from a Child and Family Service and a Lawyer

The case study

Susan is a 40-year-old woman who is the mother to 6 children aged between 2 and 18 years. Susan identified as having undiagnosed Autism Spectrum Disorder (ASD), information processing issues, dyslexia and Attention-Deficit/Hyperactivity Disorder (ADHD). Susan’s children have complex health concerns including hearing impediments and seizures. Additionally, some of the children have been diagnosed with Autism Spectrum Disorder, mental health concerns, and display challenging behaviours.

The initial referral was for Susan’s 17/18-year-old young person, but overtime it became apparent that the other children were also experiencing health issues. Susan’s 3-year-old child had been observed to have developmental delays. During involvement with the family, it became apparent that the family were experiencing a range of social concerns including challenges with the children’s schooling, limited community and family support, difficulties with Centrelink benefits and the NDIS, and concerns regarding family violence perpetrated by Susan’s ex-partner.

The actions which were taken

• Susan was supported to complete an application for NDIS support for herself and for her children;
• Support with documentation regarding an affidavit and application for a family violence intervention order. Susan was also supported to access legal advice to increase her understanding of the order and navigating the legal system;
• Legal support in later court appearances because of criminal charges against Susan’s ex-partner for breaching the Intervention Order and recommendations to reduce the ex-partner’s access to the children.

Key outcomes of the multidisciplinary practice

• Support and advocacy to prevent Susan from losing access to Centrelink benefits;
• Numerous professionals were involved in support the family. Competing priorities regarding support needs for the family was a challenge which made the coordination of the care team essential.

‘We started to coordinate a CARE team meeting and it was amazing seeing all the different people there. There were OT, speechies, NDIS support coordinators, health care centre, primary school, paediatrician, lawyers. It was amazing to see all these people come together and they all understood the family’s needs and really were really open to working together.‘

• Susan and the children received ongoing support which addressed a variety of supports needs. Importance was placed on developing trust and confidence in the professionals involved with the family. Each professional was able to provide a different response to the family’s support needs and work towards positive outcomes with Susan and the children.

Key Features of Multidisciplinary Practice

There were a range of key features that were critical to the multidisciplinary practice and outcomes achieved in this case example.

Centering the Client  

Enablers: 

• Susan was supported by professionals in relation to a variety of support needs. Susan was offered options for supports to afford her agency in her engagement with services;
• Susan developed relationships with a variety of professionals which was facilitated by effective communication. Positive communication supported Susan to develop trust in service providers which in turn decreased her anxiety;
• Having a range of professionals actively working with the family meant the risk was being shared. Additionally, the care team had access to strategies to address concerns, greater availability, longer term support, and were able to centre Susan’s voice in all interventions. This was a significant shift from previous experiences which she reported to be ‘very poor and highly time limited’
• One practitioner reflected that regardless of what happens for the client now she will be in a different position, and more able to respond because of the support she has already received.

‘So I think time was really needed to actually make a difference and to empower this family, I think that it’s likely she’ll come back again through to Family Services, but maybe in a different way. The next time because there’s been so much support for her and that collaborative approach that’s been massive.’

Respectful relationships and ongoing communication  

Enablers: 

• Respectful relationships with strong rapport and trust between practitioners ensures they are responsive to requests from other team members, despite managing busy workloads.

‘Because we all respect each other’s expertise and recognise each other’s roles and responsibilities in terms of what part of the puzzle we play but you see the puzzle as a big picture.  And all of us have a clear vision of what that picture needs to look like going forward.’

• Adopting an MDP approach can support the delivery of improved outcomes as it supports practitioners’ understanding about each client and how to best support them. Sharing of information and case planning between professionals means new professionals are better equipped with knowledge regarding clients from the outset.

Challenge:

• It is crucial to be able to communicate effectively and understand what each practitioner is doing and what their role is. With large Multidisciplinary teams effective communication is essential to prevent the family from repeatedly telling their stories and to ensure they have an understanding of the support being provided to them.

Specialisation

Enablers:

• A critical enabler of the positive outcomes for Susan and her children was their access to a diverse range of specialist practitioners. This increased the understanding of the family’s support needs and ways in which to address them.
• Respect between practitioners regarding each other’s specialist expertise, roles and responsibilities were key contributors to a holistic approach while working towards a common goal.  

‘One of the critical things is that you all respect each other’s expertise that you recognise each other’s roles and responsibilities in terms of what part of the puzzle you play but you see the puzzle as a big picture. We all understand the family’s needs and are really open to working together but also looking at how they have their expertise and then they had a role to do it and then someone else had their expertise and they had a role to do so it was really good to see that connection between everybody. And we all have a clear vision of what that picture needs to look like going forward, its awesome.’

• While emphasising the importance of specialisation, this case also highlighted practitioners’ willingness to consider and support clients holistically, recognising additional specialist services, to help out collectively to meet clients needs and support warm referral for the clients to others.

‘A really good testament to practitioners not just coming in and doing what they need to do but actually stepping outside [their specific focus] and using their networks and knowledge to facilitate access to other services that are needed.’ 

Information and risk sharing

Enablers:

• The value of information sharing has been paramount to working successfully with Susan in addition to across a variety of organisations, professionals, and sectors. At times those involved included Occupational therapists, speech therapists, NDIS support coordinators, health care centre, primary school paediatricians and lawyers.
• MDP can encourage sharing of risk when working with families with multiple and complex support needs. This encourages continuous support with families and prevents practitioner burnout.

‘If I get stuck with something, I can go to someone else. I’m not trying to figure it out all by myself, which is just such a relief.’

Skills and Knowledge Sharing

Enablers:

• The ongoing development of understanding, knowledge and skills developed through working in a MDP process can be ‘carried forward’ to support other clients, other practitioners and be used in other roles.

‘We learn everyday, this is really important, transferring your skill across to someone else and vice versa. So the team will have certain skills that I don’t have and so I will rely on them to teach me basically what that skill is. And that also goes the other way so if I’m doing something that’s really specific to my discipline then I’ll try and explain it so that others can understand exactly what I’m doing and we can all learn from each other that way.’

• A flexible, persistent, and curious mindset across the team contributes to positive MDP outcomes. With this mindset, goals emerge and recede and are taken on and handed over to practitioners as needed. Interviewees described this as:

‘Warmth, mutual respect, trying to help each other, being really great communicators but also being open to learn from each other and share with each other as well… in our Care team meeting people were sharing phone number in the chats, and saying ‘go to this website…’ 

Governance and authorising environment

Enablers: 

• A key component of the positive and collaborative outcomes with Susan and her family was ensuring leadership was informed regularly of the family’s progress and any risk concerns. It was important to ensure management was informed and aware of the complexity and the professionals engaged with the family particularly while working with the family over a long period of time. 

Challenges:

• Family Violence service provision is often limited to a specified number of hours. This has increased pressure to respond within a specified timeframe to a family’s needs, which can be difficult and often insufficient for families with complex needs. Often when the hours of support are reached the case must be closed, regardless of whether the family has further needs. Families are then referred back to The Orange Door for a new episode of support.

‘But of course they don’t have the history and can’t appreciate how far she [the client] has come.’

• Interviewees commented that this was Susan’s previous experience with support services which had left her frustrated and distrustful.