A constructivist grounded theory study of the decision-making processes of professionals in a Children’s Service, mixed multi-disciplinary assessment team

Since 2003, Children’s Services have sought to promote more consolidated work by professionals of different disciplinary backgrounds who might otherwise follow independent forms of practice. This is believed to enhance efficacy and reduce inequality in providing for vulnerable children (Boddy, Potts, & Statham, 2006; DCSF, 2003). Evidence that this improves child outcomes is mixed, however. Professionals may have difficulties working together effectively, for example Anning, Cottrell, Frost, Green, & Robinson (2006) and Sloper (2004). This research presents a qualitative study into the decision-making processes of a Children’s Services multi-disciplinary team (MDT) of educational, health and social care professionals. The study explores which aspects of the MDT strengthen and undermine collaborative work, and how this influences child assessment outcomes. The study was exploratory, using Constructivist Grounded Theory (CGT) analysis of the recorded discussions of professionals concerning six preschool child cases. All six children were referred with neurodevelopment difficulties. The transcripts revealed a fragmentary MDT with a singular, medical model approach to practice, which in this particular situation, averted collaborative working. The established context for the operation of decision-making was in the professionals’ referral system, whereby a Child Assessment ‘pathway’ functioned. Decision-making comprised System routines, Weighing-up significance, Expediency including Centralisation and Convenience, Continuation of Function, and Avoidance of Difficulty/Unpleasantness. Use of the Autism Diagnostic Observation Schedule (ADOS) cut-off score to diagnose autism spectrum disorders (ASD) was an outcome of the decision-making process. Discussions revealed that once such decisions were made, they remained unchanged. Psychoanalytically informed concepts (Hollway, 2011) were used in analyses. This enabled a framework of understanding for professionals’ work, as well as for promoting organisational development and change.