Bridging Disciplinary Boundaries (January 11 - 14, 2007)

New York City's Administration for Children's Services (ACS) recognizes that mental health (MH) issues, domestic violence (DV), and substance abuse (SA) are widespread psychosocial problems that are closely linked to child protection but have complex service delivery ramifications. This study describes and analyzes experiences of multidisciplinary consultations and collaboration at ACS. The study describes the dynamics of multidisciplinary consultations; the impact of team practice on staff; effective strategies employed by consultation teams as seen by team members; the conditions under which they flourish; challenges; and guidelines for “successful consultations.”

This study is a case study of a single clinical consultation program. It is multi-method, combining both quantitative and qualitative data sources, drawn from multiple stakeholders, and making use of available (data-mining) as well as original, prospectively-generated data. Qualitative interviews were conducted with child protective caseworkers and supervisors from various ACS settings as well as clinical consultants from MH, DV, and SA disciplines. Quantitative data came from Consultation Evaluation Forms, Office-Based Training Evaluation Forms, and Consultation Request/Response Forms reviewed from several teams over the course of a year.

The quantitative data informed about the levels of satisfaction of workers with consultations and office-based trainings and patterns of clinical consultation usage. Completed forms reflected the four types of consultations provided to caseworkers and their supervisors—DV (33.6%), SA (33%), MH (16.5%), and cross-consultations (14.5%). The prevailing problems that led to requesting cross-consultations, which is a consultation that involves two or more consultants, were intimate partner violence (53%), parental alcohol and substance abuse (48%), and parental mental illness (36%). Overall, the satisfaction of caseworkers and supervisors with the consultations (on a scale of “1” to “5” with “5” being the highest) was extremely high (M=4.53; SD=.77). The satisfaction with the office-based trainings was also high (M=4.17; SD=.85). The results of a qualitative analysis of collaborative multidisciplinary experiences revealed three major themes related to positive experiences: learnings; information and resources sharing; and on-site availability of support and accessibility of consultants. The most frequently identified challenges were: workers resistance; occasionally conflicting practices; and scheduling problems. According to the respondents, “successful teamwork” related to the process of consultation (the ability to discuss the case thoroughly; coming to a consensus; being able to prioritize problems; receiving concrete/easy-to-apply advice; and coming up with a workable plan) and the qualities of consultants (teamwork skills, accessible, respectful of each other, knowledgeable). To others, success meant insights—learning things they did not know before.

These findings are useful in facilitating andvances in staff supervision, training, and consultation as well as program design and implementation. The positive experiences as well as difficulties in the collaborative process may be highly transferable, which in turn, indicates that solutions may be shared across systems with the real possibility that these solutions will be effective in a variety of settings. The author believes that the findings can contribute to a specific understanding of the program itself and a general understanding of contextual issues facing all efforts to improve multidisciplinary clinical practice in child protection.