At the conclusion of this session, the participants will be able to: 1. Describe a team-based approach to addressing complex patients’ needs. 2. Develop engaged and experiential methods for teaching interprofessional learners about team-care for complex patients. 3. Demonstrate familiarity with an evaluation strategy and preliminary outcomes data for a team approach for complex patients.

Permission has been gained from Children’s Rehabilitation Centre, Minsk and from the relevant authorities in Belarus to use the name of the Centre in this thesis. This research explores the principal meeting points and tensions, for practitioners at Children’s Rehabilitation Centre Minsk, between Winnicott’s theories of the holding environment (1960) and play (1971), and current classroom practice with children with complex needs based on Vygotsky’s theory of defectology. It considers whether and in what ways those practitioners are able to assimilate Winnicott’s theories, and their usefulness in supporting classroom-based work with children with complex needs. Finally, the research explores perceived changes in relationships between staff and children arising from this experience, in accordance with CRC’s self-identified need for support in this area. A mixed-methods design was adopted, employing qualitative and quantitative research methods. Winnicott’s theories provide the framework for the development of a new evaluation instrument. This gives the theoretical structure for a specifically designed staff development programme, integrating teaching, experiential work and practice-based sessions, which was central to the fieldwork at CRC. Eight staff participants evaluated their usual musical interaction with a child with complex needs (pre-intervention). Following engagement with the staff development programme (intervention), participants undertook ten individual music sessions with the same child (post-intervention). Sessions were filmed, and two self-chosen extracts pre- and post-intervention were self-rated against the descriptors of the evaluation instrument. Participants then reflected on the experience with the child in interviews. To provide triangulation, the same 16 video extracts were randomised, and then rated in the same way by 16 UK music therapists in an online study. Thematic analysis of data shows that the experience of Winnicott’s ‘holding’ in the learning process enabled participants to attune to, and empathise with the child. Quantitative analysis shows consequent adaptation to the child. It is concluded that Winnicott’s theories are accessible, relevant and applicable within classroom practice at CRC, to support the establishment and development of positive relationships between staff and children.

Denna studie undersöker hur socialarbetare på Socialtjänsten upplever att samverkan mellan enheterna; Barn- och ungdomsenheten samt Enheten för funktionshinder fungerar i praktiken samt hur de ser på eventuella utmaningar med att utreda barn med komplexa behov. Studien byggde på kvalitativa semistrukturerade intervjuer och resultatet har analyserats utifrån organisationsteori och systemteori. Studien visar att enheterna kan betraktas som separata subsystem med olika institutionella logiker. Socialarbetarna beskriver att barn med komplex problematik behöver att de skilda subsystemen kan verka över de organisatoriska fälten och att samverkan är ett värdesatt verktyg. Det uttrycks en klar vilja till att samarbeta men det saknas tydliga direktiv för hur det ska säkerställas i praktiken. I syfte att förbättra samverkansarbetet beskriver socialarbetarna att det behövs fler och regelbundna utbildningstillfällen samt väldefinierade riktlinjer. Denna studie är visserligen inte generaliserbar till hela samhället men indikerar ändå att svårigheterna i samverkansarbetet är möjliga att motverka.

Homelessness and rough sleeping has dramatically increased in the UK over the past six years. Links between welfare changes, inequality and social exclusion are pronounced. This study looked into the experiences of a particular group of people experiencing homelessness; those with complex needs who had had multiple moves round homeless projects. Qualitative research of the lived experiences of those experiencing homelessness is limited, particularly for this group of individuals in the UK. An Interpretative Phenomenological Analysis was applied to interviews undertaken with six men with these experiences. The four main themes from this analysis were Moving forward vs no way forward, Being here has really helped but it's only temporary, Being treated as different and Desperately longing for yet deeply fearing relationships. These themes were supported with extensive participant quotes and were contextualised in the current literature. The themes reflect and demonstrate: Challenges with hope and future plans and the role of substance use; Relationships to help in the context of conditionality and the temporary nature of projects; Issues regarding coherent identity development and stigmatisation; and Complexity around forming relationships. These findings develop our understanding of this population and support improvements in practice. A clear role for Clinical Psychologists in this area was identified and recommendations across domains of individual, service level and community practice were presented.

This study employed qualitative research methodology informed by the grounded theory tradition to explore good practice and optimal services for young people presenting with complex care needs associated with challenging or high risk behaviour. In-depth interviews were conducted in three waves of data collection and analysis with fourteen experienced practitioners whose careers have included sustained periods of work with this group in a number of selected Victorian service systems. The principal vantage point was the interface between the supported accommodation and assistance programs for homeless young people, statutory child protection and care, placement and support programs for young people at risk and juvenile justice programs for young offenders. The nature of the problem necessarily included some consideration of mental health and services dealing with substance abuse. The findings propose a view of good practice giving emphasis to the accessible and assertive presence of a responsible adult to �be there� fostering relationships and skilled purposive intervention. Intervention should be planned, holistic, sensitive and responsive to particular needs. It provides active unconditional care. It attends to attachment and trauma concerns and works with short run goals and a long term perspective. Intervention is sustained until constructive disengagement can occur. The complexity and challenge in the task of helping hurt youth warrants the support, strength and guidance of a multi-skilled team. Ideally the team will be described using normative terms. Optimal services are timely, congruent, seamless and robust in capacity to nurture, establish boundaries and meet developmental and therapeutic requirements. They should be connected to a community and there for as long as it takes, with ready access to suitable accommodation, purchasing power and flexibility of operation. To the greatest extent possible solutions are generated in the place where help is sought. Voluntary service commitment lasts till personal capacity and natural networks take over.

This study employed qualitative research methodology informed by the grounded theory tradition to explore good practice and optimal services for young people presenting with complex care needs associated with challenging or high risk behaviour. In-depth interviews were conducted in three waves of data collection and analysis with fourteen experienced practitioners whose careers have included sustained periods of work with this group in a number of selected Victorian service systems. The principal vantage point was the interface between the supported accommodation and assistance programs for homeless young people, statutory child protection and care, placement and support programs for young people at risk and juvenile justice programs for young offenders. The nature of the problem necessarily included some consideration of mental health and services dealing with substance abuse. The findings propose a view of good practice giving emphasis to the accessible and assertive presence of a responsible adult to �be there� fostering relationships and skilled purposive intervention. Intervention should be planned, holistic, sensitive and responsive to particular needs. It provides active unconditional care. It attends to attachment and trauma concerns and works with short run goals and a long term perspective. Intervention is sustained until constructive disengagement can occur. The complexity and challenge in the task of helping hurt youth warrants the support, strength and guidance of a multi-skilled team. Ideally the team will be described using normative terms. Optimal services are timely, congruent, seamless and robust in capacity to nurture, establish boundaries and meet developmental and therapeutic requirements. They should be connected to a community and there for as long as it takes, with ready access to suitable accommodation, purchasing power and flexibility of operation. To the greatest extent possible solutions are generated in the place where help is sought. Voluntary service commitment lasts till personal capacity and natural networks take over.

Socialtjänsten i Sverige har blivit alltmer specialiserad, vilket har lett till att klienter med komplexa behov är aktuella på olika organisatoriska enheter och har kontakt med flera socialsekreterare samtidigt. Syftet med denna studie var att undersöka förekomsten av parallella kontakter inom socialtjänsten och hur det hade förändrats över tid. Undersökningen antog en kvantitativ ansats och utgick från statistiskt material hämtat från en IFO-organisation i en större svensk stad. Materialet visade att andelen klienter med parallella kontakter hade ökat med en tredjedel på de fyra undersökta enheterna mellan 2014 och 2018 och att vissa klientgrupper uppvisade parallella kontakter i större utsträckning än andra grupper. Diskussionen behandlade klienters komplexa behov, fragmentisering och socialarbetares överlappande arbete för klienter med parallella kontakter. / Swedish social services have become increasingly specialized, with the result that clients with complex needs are in contact with several organizational units and social workers simultaneously. The purpose of the present study was to examine the degree to which such parallel contacts occur within social services and how their incidence has changed over time. We have employed a quantitative method and drawn on statistical material collected from a personal social services organization in a large Swedish town. The material revealed that the extent to which parallel contacts occurred had increased by a third between 2014 and 2018 among clients at the four units that were chosen for the study, while certain client groups had a greater incidence of parallel contacts than other groups. In a concluding section of the study we discussed clients’ complex needs, fragmentation and the overlapping responsibilities of social workers with regard to clients with parallel contacts.

This study explores the experiences of the Swedish front-line social workers (socialsekreterare) in the municipal income support unit, Young Adults, monthly assessing the income support applications as well as daily processing the activation programs for young adult clients with mental ill-health combined with social-medicinal vulnerabilities, also referred to as young adults with complex needs. Furthermore, this study aims to illuminate the ever changing conditions of the Swedish welfare state and its underlying driving forces through the lens of the social workers. 9 Semi-structured distance interviews with 11 social workers from 6 municipalities belonging to 5 regions in Sweden, were conducted for the collection of qualitative data. It has been analyzed by the inductive-deductive coding as well as a theoretical frame consisting of concepts such as discretiona and advocacy of M. Lipsky, and reciprocal interaction (Wechselwirkung), form and contents, and call of G.Simmel. The result and analysis show that the rehabilitative approach based on the interactions and relations with the clients, is prevalent through the social workers’ processing of the activation program. It seems to be effective in a dyad, between the social workers and the client while the social workers’ discretion is maximized for the utilization of the agency (unit) activation resources. However, it proved not to be as effective in a triad or more when an extern agent outside of the unit, Young Adults begins to be involved. The tension is a fact and the social workers’ discretion is minimized when they have to process the activation program for the clients who are neither “active enough” to have a job in the ordinary labor market, nor “sick enough” to be eligible for the stately activity compensation (aktivitetsersättning) from the Social Insurance Agency (Försäkringskassan) which heavily relies on the medicinal expertise for its decision making. The social workers’ experience to fail to deliver the best possible results out of the activation programs, and the client relationship built on the rehabilitative approach turns out to be unsustainable, which can indicate the discrepancy between the rehabilitative approach as well as the activation programs, as content, and the unit, Young Adults, as form. Even though the social workers daily carry the ideological as well as the social-political tensions between the medicalization and the activation through the ever changing reality of the Swedish welfare state, their mandate to make an impact on the decision making of the activity compensation program, is rather limited, reflecting the Swedish welfare state’s expectation for the professionalism of the social workers. Rather striking that the social workers, however, confess that they in spite of the pressure of organizational efficiency as well as socio-economic discourse of digitalization undermining the concept of the unit, Young Adults, are not willing to give up the rehabilitative approach for the client’s sake but also to protect their unit, Young Adults, which postulate that they are not the gatekeepers in the agency but the advocate for the clients. In this moment, they also seem to know, and even have the call, the essential, if not mandatory, element needed to be landed in the perfect society of G. Simmel.