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In institutional settings such as health and social care services, multi-agency meetings are the forum for implementing policies and procedures of interagency operations and service user participation. In Chapter 1, multi-agency meetings are conceptualised as boundary spaces that bring together professionals from different professions and welfare agencies, service users and (sometimes) their next of kin or lay representatives. This makes the communicative and interactional processes important, as it is through face-to-face meetings that the everyday practices of professionals and service users are examined, directed and reviewed in a formal setting.

The multi-agency meetings examined in this book are from a number of countries, contrasting welfare regimes and different sectors of health and social care, and they are formulated through different legal jurisdictions. However, as will become clear, there are a number of important similarities. The book does not propose to provide a comparative analysis, but together the analyses suggest that there is something particular about the frame, structure and function of multi-agency meetings that promotes certain interactional practices and addresses interactional dilemmas. This reflects the function of the multi-agency meeting as an organisational procedure for processing people and entities, as occurs in a team meeting or home visit, which requires participants to conform to certain conventions and constraints of turn allocation, topic progression, role performance, politeness, delicacy and so on.

This chapter first questions the notion that meetings should be treated as formal events for making plans and decisions. Instead, it argues that they should be approached as complex social and interactional encounters that draw on everyday notions of what constitutes appropriate organisational interaction.

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In social welfare, holding multi-agency meetings in which professionals from similar or different welfare perspectives meet with service users is increasingly seen as a promising way to make decisions about how to solve complex problems. The hope is that this collaboration will increase the effectiveness of interventions and that the service user will be included in the process through their participation in the meeting (see Chapter 2 for a more thorough exploration of these tendencies). Although appealing, however, this ideal is challenged by numerous studies that show a more complex reality in practice. For instance, Hitzler and Messmer (2010) find that a service user’s participation in a multi-agency meeting does not necessarily mean that they are included in decision making, while Dall (2020) shows that, even among professionals, decision-making responsibilities may not be equally distributed among participants, even when this is the stated ideal for the meeting.

Similar trends and challenges exist in Danish social welfare, and the interprofessional and multi-agency rehabilitation teams that were introduced as part of the active labour market policy in 2013 are one example of these tendencies. Rehabilitation team meetings are based in the employment services and meant to ensure interprofessional assessment and service user participation in cases where the service user’s attachment to the labour market is at risk due to complex health issues, social problems or other challenges. This has proven a challenging task, as several of the professionals present in meetings are unfamiliar with the legislative and organisational context of the employment services (Dall, 2020).

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This chapter analyses how the public authorities involve employers in the work of hiring unemployed individuals who have social, mental and physical challenges and, in doing so, interact with employers and their organizations. To do this, it elaborates on existing conceptualizations of employer engagement and links employer engagement to the aims of strengthening the ability of the disadvantaged unemployed to work. The analysis shows how employer engagement is not set and stable but continually created, developed and maintained at the street level – local employment services. Empirically, the analysis in this chapter is based on a study of the day-to-day work of the staff in Danish public employment services collaborating with employers on workplace-based employment policies for disadvantaged groups of unemployed. The qualitative dataset consists of interviews with job consultants, ethnographic observations of municipal employer engagement staff, interviews with unemployed individuals and, to some extent, observations within actual workplaces.

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Analysing Meetings in Social Welfare

This book brings together contributions from a range of social welfare settings, including child welfare, unemployment, mental health and substance abuse treatment, to examine how interprofessional collaboration and service user participation are realised or challenged in multi-agency meetings.

It provides empirically grounded analyses of specific aspects of multi-agency work and offers a distinctive conceptual framework for understanding and analysing interaction during meetings in various social welfare settings.

Based on audio and video recordings, the authors provide clear examples of actual practices of social welfare professionals and demonstrate how the realisation of collaborative and integrated welfare policy is contingent on effective interactional practices between professionals and service users.

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I walked into the room, and I was nervous as it was, because obviously you’re going into something that is like judge and jury on you. And you walk in and you look at the people and I thought to myself, I’ve got to sit here in front of all these people being judged and … Well, everyone introduced themselves, like they do, they all go round the table. You don’t take it all in, because there’s so many people, all going, ‘Hello my name is so and so’. You have to acknowledge them, but you don’t take it in … (Packman and Hall, 1998, p 222)

These words, from a parent talking about participating in an initial child protection conference, encapsulate the tension at play when service users participate in multi-agency meetings in social welfare. The number of participants alone can make the meetings hard to ‘take in’, and differences in status confer predetermined roles of judging and being judged before the meetings even begin. At the same time, however, multi-agency meetings constitute an opportunity for shared discussions that may increase both cooperation and understanding between different professionals and service users. It is this opportunity that has made meetings where professionals from different disciplines and service users are co-present become commonplace in health and social welfare in Western welfare states. This has happened as part of a larger development, where collaborative and integrated welfare is promoted as a solution to the perceived ineffectiveness of health and social services that are professional-led and dispersed (Kitto et al, 2011).

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This book has examined how policy trends that promote interprofessional collaboration and service user participation are implemented (or not) through frontline practices in multi-agency meetings. The challenges faced by service users are seen as complex and interconnected, demanding many kinds of expertise for them to be understood, assessed and resolved. As a result, collaboration and participation together have become the prevailing approach in health and social care policy in Western welfare states. Bringing together diverse viewpoints of professionals and service users is also thought to create boundary spaces that, at their best, produce joined-up thinking and constructive debate, resulting in novel ideas. Chapter 1 has provided a more thorough introduction to the trend and its ‘selling points’. In the literature, concepts such as ‘relational turn’, ‘relational agency’ and ‘responsive process’ have emerged in an effort to understand collaborative and integrated welfare and its potential for generating new common knowledge (Edwards, 2011). In this literature too, collaboration and participation are perceived as positive and desirable ideals. However, a number of concerns about the policy approach have also arisen and been presented in the literature. As outlined in Chapter 1, instead of equal collaboration, the policy may lead to:

  • loss of specialised expertise by professionals and service users;

  • a blurring of professional responsibilities;

  • increased responsibility being placed on service users to participate;

  • asymmetrical power relations between participants;

  • comprehensive surveillance of service users’ lives.

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At the time of completing this book (June 2020), most of the world is gripped by the coronavirus pandemic, with various regimes of lockdown, quarantine, social distancing, isolation and closure. The multi-agency meetings we have studied in this book are likely to have taken on new forms as the world – and health and social care – come to terms with this new reality. We quoted Hughes et al (2011, p 136) in Chapter 2, that the practice of meetings that are ‘face-to-face … in close proximity’ would not comply with current social distancing requirements. Yet most of these meetings are essential for the everyday work of social welfare professionals and are consequential for the lives of service users.

We do not know what multi-agency meetings look like at the moment. There seems to be a variety of responses between different countries and settings. It is likely that most of the meetings we observed have been postponed, scaled back or are taking place virtually, although there are some reports of plans to organise meetings with social distancing restrictions (Turner, 2020b). For example, we understand that the rehabilitation meetings described in Chapter 3 were postponed but are restarting with social distancing. Child welfare meetings (examined in Chapters 4 and 8) are taking place using virtual meeting or teleconference applications, according to official local authority websites in the UK. These websites provide little detail of how virtual meetings currently are being organised.

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During recent decades, Western welfare states have gone through a number of substantial transformations. One such transformation was the turn to active welfare states, based on the neoliberalist ideas of limiting the role of the state in welfare provision and emphasising citizens’ responsibilities instead of rights. Along with this, there has been a transition to a managerialist mode of governance, calling for more effective and efficient welfare services, and an increasing demand to understand service-using citizens as active participants in service provision. Common to these kinds of transformations is that they travel across countries and are often defined as indispensable steps to maintaining welfare states and to securing effective, fair and flexible responses to citizens’ wishes and needs. In other words, these are globally promoted and shared policies of welfare states, which are then realised in national legislation and guidelines.

New managerialist modes of governing have, among a range of other features, facilitated an increasingly specialised organisation of work in health and social care services. The idea is that specialised units of professionals will be able to develop more effective and productive service delivery due to both a specialisation of professional skills and an optimisation of procedures guiding work. However, this specialisation has produced fragmented services, which lack coherence and coordination in individual cases and between services more broadly. This has led to a call for collaborative and integrated welfare services across service sectors and national contexts. The resulting collaborative and integrated welfare policy and its accomplishments and implications in frontline social welfare service practices are at the core of this book.

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