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SSWWeek Day Two Blog: It Takes a Team - An example of integrating systems of care for abused children in the Philippines
By Dr. Bernadette Madrid, Executive Director, Child Protection Unit Network, Philippine General Hospital, University of the Philippines
Often, the biggest challenge for multidisciplinary teams is how to put together members of the team who belong to different agencies and encourage them to work together as one team under one roof. It would be so much easier if all the members of the team belonged to just one entity such as a hospital or law enforcement agencies. However, the needs of abused children and their families go beyond what one agency can provide. There are many different ways to put together these complementary services. The relationships of the different “pieces” can range from simply constructing a referral system where the different services operate independently from one another to an integrated system where all the “pieces” are under one managing unit. The latter is the most difficult to achieve and to scale up.
Government agencies and hospitals are generally rigid structures that operate independently from one another. Asking them to share financial and human resources to form an independent team is attempting the “impossible.” However, one can never underestimate political will. A partnership between the Advisory Board Foundation, University of the Philippines, the Department of Health and the Philippine National Police was forged with a memorandum of agreement to form a Child Protection Unit (CPU) at the Philippine General Hospital. Each one provided the pieces: physician, social worker, police, mental health professional and budget.
The challenge was not only found in creating the partnership structure, but also in putting it into practice. Key questions had to be addressed. How can the members work together as a team? How does one build trust among team members? What are the boundaries between the professions so that each remains distinct even as they function as part of a team? What kind of training is needed? When is the case closed? What are the measures of success? What is the relationship with other social service workers in the communities? What is the relationship with shelters? Who is the case manager? How long is the follow-up? Each of these questions took some time to be answered and the answers needed to be revisited several times. The first five years of the team’s development was about getting it right or as near as it could get. As the saying goes “the proof of the pudding is in the eating.” Outcomes that were monitored included, among others: re-abuse rates, physical and mental health and keeping the child in school.
To learn more about the role of workers engaged in this process, read the following social worker profiles that we are featuring during Social Service Workforce Week:
- Annaliza Macababbad, Social Worker, Child Protection Unit, Philippine General Hospital
- Rosemarie Abadingo, Social Welfare Assistant, Women and Child Protection Unit in Tacloban City, Philippines
- Majida Bashir, Case Care Worker, Protection and Help of Children Against Abuse and Neglect (PAHCHAAN), Pakistan
The next challenge is how to scale up. Can the whole program be replicated? What kind of delivery structure can be institutionalized? Should it be in health? Social welfare? Law enforcement? The health care delivery system was chosen as the main vehicle since the CPU was started in a hospital. This needed a change in paradigm, an acceptance that child maltreatment is a public health problem. The Adverse Childhood Experiences Study done in the Philippines (Ramiro, Madrid, Brown, 2010) was pivotal in showing the link between child maltreatment and health.
In scaling up the CPU, a laddered approach was taken, as described in the CPN annual report 2012. The pieces can be put together in steps: Level 1 is the physician and social worker together; Level 2 is physician, social worker and police or mental health worker and Level 3 is a training center with all the necessary personnel. There are now 62 CPUs in 35 provinces and 7 cities in the Philippines. The Department of Health came out with the Administrative order on the establishment of Women and Child Protection Units in government hospitals with the description of the training, the budget source, process for setting up the standards and accreditation.
With the functions of health and social welfare devolved to local governments, advocating for establishment of CPUs by local governments is an attractive option that can immediately yield a level 2 CPU. Legislative action at the local level can ensure sustainability independent of the national government. This is by no means a finished product but this has gone a long way from when the first CPU was a pilot project!
If you’re interested in learning more, take a look at Webinar 12 in the Alliance’s webinar series, entitled: Strengthening Social Service Systems through Cross-Sectoral Collaboration: Multidisciplinary teams in communities and local health facilities.
Excellent description of multi-disciplinary teams at work
Thanks for this very important blog. In order to provide effective services for vulnerable familes and children, there is a compelling need for effective cooperation and teamwork between people who have different disciplines and who come from different organizations at different levels. This description by Bernadette Madrid includes some very helpful hints about physicians, social workers, policy and mental health professionals come together in a partnership to form a Child Protection Unit. I think the thing that is impressive about this is that it didn't involve just ways to refer -- which are important -- but actually resulted in a team working together in an integrated manner. Obviously, this doesn't happen automatically, and I found her questions in the third paragraph above to be very helpful to others who are thinking about forming multidiscipinary teams.Thinking through these questions together will provide a good headstart for eithe forming a team, or improving the team that already exists. In addition to the other links in the blog, we invite any of you to share your experiences or thoughts about multidiscipinary teams here.
Reply to James McCaffery
Thanks for your comments Jim! Actually I could add more questions: Who supervises? As the model is adopted and scaled up how does one deal with human resource development? The Global Social Service Workforce Alliance will be of great help here. I urge those of who are not yet members to sign up. It's free!