Showing papers in "Journal of Interprofessional Care in 2005"

Interprofessional teamwork: Professional cultures as barriers

Abstract: Each health care profession has a different culture which includes values, beliefs, attitudes, customs and behaviours. Professional cultures evolved as the different professions developed, reflecting historic factors, as well as social class and gender issues. Educational experiences and the socialization process that occur during the training of each health professional reinforce the common values, problem-solving approaches and language/jargon of each profession. Increasing specialization has lead to even further immersion of the learners into the knowledge and culture of their own professional group. These professional cultures contribute to the challenges of effective interprofessional teamwork. Insight into the educational, systemic and personal factors which contribute to the culture of the professions can help guide the development of innovative educational methodologies to improve interprofessional collaborative practice.

The conceptual basis for interprofessional collaboration: Core concepts and theoretical frameworks

Abstract: Interprofessional collaboration is a key factor in initiatives designed to increase the effectiveness of health services currently offered to the public. It is important that the concept of collaboration be well understood, because although the increasingly complex health problems faced by health professionals are creating more interdependencies among them, we still have limited knowledge of the complexity of interprofessional relationships. The goal of this literature review was to identify conceptual frameworks that could improve our understanding of this important aspect of health organizations. To this end, we have identified and taken into consideration: (A) the various definitions proposed in the literature and the various concepts associated with collaboration, and (B) the various theoretical frameworks of collaboration. Our results demonstrate that: (1) the concept of collaboration is commonly defined through five underlying concepts: sharing, partnership, power, interdependency and process; (2) the most complete models of collaboration seem to be those based on a strong theoretical background, either in organizational theory or in organizational sociology and on empirical data; (3) there is a significant amount of diversity in the way the various authors conceptualized collaboration and in the factors influencing collaboration; (4) these frameworks do not establish clear links between the elements in the models and the outputs; and (5) the literature does not provide a serious attempt to determine how patients could be integrated into the health care team, despite the fact that patients are recognized as the ultimate justification for providing collaborative care.

Interprofessionality as the field of interprofessional practice and interprofessional education: An emerging concept

Abstract: This paper proposes a new concept and a frame of reference that should permit the development of a better understanding of a phenomenon that is the development of a cohesive and integrated health care practice among professionals in response to clients' needs. The concept is named "interprofessionality" and aims to draw a clear distinction with another concept, that of interdisciplinarity. The utilization of the concept of interdisciplinarity, which originally concerns the development of integrated knowledge in response to fragmented disciplinary knowledge, has caused some confusion. We need a concept that will specifically concern the development of a cohesive practice among different professionals from the same organization or from different organizations and the factors influencing it. There is no concept that focuses clearly on this field. Interprofessionality concerns the processes and determinants that influence interprofessional education initiatives as well as determinants and processes inherent to interprofessional collaboration. Interprofessionality also involves analysis of the linkages between these two spheres of activity. An attempt to bridge the gap between interprofessional education and interprofessional practice is long overdue; the two fields of inquiry need a common basis for analysis. To this end, we propose a frame of reference, an interprofessional education for collaborative patient-centred practice framework. The framework establishes linkages between the determinants and processes of collaboration at several levels, including links among learners, teachers and professionals (micro level), links at the organizational level between teaching and health organizations (meso level) and links among systems such as political, socio-economic and cultural systems (macro level). Research must play a key role in the development of interprofessionality in order to document these linkages and the results of initiatives as they are proposed and implemented. We also believe that interprofessionality will not be pursued without the requisite political will.

The determinants of successful collaboration: a review of theoretical and empirical studies.

Abstract: Successful collaboration in health care teams can be attributed to numerous elements, including processes at work in interpersonal relationships within the team (the interactional determinants), conditions within the organization (the organizational determinants), and the organization's environment (the systemic determinants). Through a review of the literature, this article presents a tabulated compilation of each of these determinant types as identified by empirical research and identifies the main characteristics of these determinants according to the conceptual work. We then present a "showcase" of recent Canadian policy initiatives--The Canadian Health Transition Fund (HTF)--to illustrate how the various categories of determinants can be mobilized. The literature review reveals that very little of the empirical work has dealt with determinants of interprofessional collaboration in health, particularly its organizational and systemic determinants. Furthermore, our overview of experience at the Canadian HTF suggests that a systemic approach should be adopted in evaluative research on the determinants of effective collaborative practice.

Key elements for interprofessional education. Part 1: The learner, the educator and the learning context

Abstract: This paper is the first of two that highlights key elements needed for consideration in the planning and implementation of interprofessional educational (IPE) interventions at both the pre and postlicensure qualification education levels. There is still much to be learned about the pedagogical constructs related to IPE. Part 1 of this series discusses the learning context for IPE and considers questions related to the ‘‘who, what, where, when and how’’ related to IPE. Through a systematic literature review that was conducted for Health Canada in its move to advance Interprofessional Education for Patient Centred Practice (IECPCP), this paper provides background information that can be helpful for those involved in an interprofessional initiative. A historical review of IPE sets the international context for this area and reflects the work that has been done and is currently being initiated and implemented to advance IPE for health professional students. Much can be learned from the literature related to the pedagogical approaches that have been tried and the issues that need to be addressed related to the learner, the educator and the learning context which this paper examines.

The Readiness for interprofessional learning scale: A possible more stable sub-scale model for the original version of RIPLS

Abstract: The original version of the Readiness for Interprofessional Learning Scale (RIPLS) was published by Parsell and Bligh (1999). Three sub-scales with acceptable or high internal consistencies were suggested, however two publications suggested different sub-scales. An investigation into how to improve the reliability for use of the RIPLS instrument with undergraduate health-care students commenced. Content analysis on the original 19 items involving experienced health-care staff resulted in four sub-scales. These sub-scales were then used to formulate a possible model within a structural equation model. The goodness of fit was assessed using a sample (n = 308) of new first year undergraduate students from 8 different health and social care programmes. The same data was fitted to each of the two original sub-scale models suggested by Parsell and Bligh (1999) and the results compared. The fit of the new four sub-scale model appears superior to either of the original models. The new four factor model was then tested on subsequent data (n = 247) obtained from the same students at the end of their first year. The fit was seen to be even better at the end of the academic year.

Key elements of interprofessional education. Part 2: Factors, processes and outcomes

Abstract: In the second paper of this two part series on Key Elements of Interprofessional Education (IPE), we highlight factors for success in IPE based on a systematic literature review conducted for Healt...

Interprofessional learning and higher education structural barriers

Abstract: Structural changes need to be made within universities such that interprofessional education for patient-centred collaborative practice becomes a responsibility that crosses faculty jurisdictions and is accepted as the responsibility of all associated health and human service programs. In communities, the patient or client is the centre of professional attention requiring care that goes beyond the skill and scope of any one profession. Notions about collaboration inform and drive interprofessional education and should lead to sustainable system changes within centres of advanced education that ensure a permanent place for interprofessional education in all health and human service programs. This chapter explores the many barriers to achieving this goal, and offers insights into their removal from one university's experience.

Learning together to teach together: interprofessional education and faculty development.

Abstract: Interprofessional education for collaborative patient-centered practice has been identified as a key mechanism to address health care needs and priorities. Faculty development can play a unique role in promoting interprofessional education (IPE) by addressing some of the barriers to teaching and learning that exist at both the individual and the organizational level, and by providing individuals with the knowledge and skills needed to design and facilitate IPE. This article highlights a number of approaches and strategies that can facilitate IPE. In particular, it is recommended that faculty development initiatives aim to bring about change at the individual and the organizational level; target diverse stakeholders; address three main content areas, notably interprofessional education and collaborative patient-centred practice, teaching and learning, and leadership and organizational change; take place in a variety of settings, using diverse formats and educational strategies; model the principles and premises of interprofessional education and collaborative practice; incorporate principles of effective educational design; and consider the adoption of a dissemination model to implementation. Clearly, faculty members play a critical role in the teaching and learning of IPE and they must be prepared to meet this challenge.

Effective health care teams: a model of six characteristics developed from shared perceptions

Abstract: This study into understanding health care teams began with listening to participants' teamwork experiences. It unfolded through a dialectic of iterations, analyses and critique towards a simplified model comprising six key characteristics of effective teams. Using the complementary theoretical perspectives of personal construct theory and inductive theory building, three research methods were used to collect a range of participant perspectives. A purposive sample of 39 strategic informants participated in repertory grid interviews and clarification questionnaires. A further 202 health care practitioners completed a purpose designed Teamwork in Healthcare Inventory. All responses were transformed through three iterations of interactive data collection, analysis, reflection and interpretation. Unstructured participant perspectives were qualitatively categorised and analysed into hierarchies to determine comparative contributions to effective teamwork. Complex inter-relationships between conceptual categories were investigated to identify four interdependent emerging themes. Finally, a dynamic model of teamwork in health care organisations emerged that has functional utility for health care practitioners. This Healthy Teams Model can be utilised in conjunction with a Reflective Analysis and Team Building Guide to facilitate team members to critically evaluate and enhance their team functioning.

Team types, perceived efficiency and team climate in Swedish cross-professional teamwork.

Abstract: This paper aims to identify the dominant types of team organization in cross-professional Swedish human service organizations and the relationship between team type and perceived efficiency as well as team climate as an aspect of work satisfaction. A questionnaire was responded to by 337 individual professionals from 59 teams, mainly from psychiatric care (50.7%) but also from social, neuropaediatric and vocational (re)habilitation, school health care and the occupational health service. The interprofessional model of team organization was the most frequent (62%), followed by the transprofessional (33%), and the multiprofessional team, (5%). A moderate positive correlation was found between team type and perceived efficiency as well as team climate. The greater the interdependence and the closer the co-operation, the higher the efficiency and the better the climate. No differences were found between professions or organizational domiciles with respect to team type. This paper suggests (1) a more consisten...

Effectiveness of pre-licensure interprofessional education and post-licensure collaborative interventions.

Abstract: In this paper we scanned and summarized the empirical research evidence and found that the effects of pre-licensure interprofessional education on patient/client care are unknown. In contrast, for post-licensure collaboration interventions, there is a growing body of evidence suggesting positive effects on the delivery of care. The coverage of this latter evidence, however, is patchy, being especially weak in primary care. In interprofessional education, where policy level interventions have been value driven for the last half century, we have identified a base of evidence for the effectiveness of certain post-licensure collaboration interventions; this evidence is lacking for pre-licensure interprofessional education. If interventions and policies for both pre-licensure interprofessional education and post-licensure collaboration are implemented without accompanying rigorous evaluation research, we will remain mired in this same uncertainty into the future.

A blueprint for interprofessional learning

Abstract: Interprofessional education (IPE) has been promoted as a method to enhance the ability of health professionals to learn to work together. This article examines several approaches to learning that can help IPE fulfill its expectations. The first is aimed at the transfer of learning novel situations and involves two ideas. Students need to be challenged with progressively more complex tasks and those tasks need to reflect the reality in which they will be working. Second, the learning situation needs to be structured using the five elements of best-practice cooperative learning: positive interdependence, face-to-face promotive interaction, individual accountability, interpersonal and small-group skills, and group processing. Finally, the learning process itself needs to be approached from an experiential learning framework cycling through the four-stage model of planning, doing, observing and reflecting. By using increasingly complex and relevant cases in cooperative groups with an experiential learning pro...

Changing the culture: Interprofessional education for collaborative patient-centred practice in Canada

Abstract: (2005). Changing the culture: Interprofessional education for collaborative patient-centred practice in Canada. Journal of Interprofessional Care: Vol. 19, No. sup1, pp. 1-4.

Health professionals in multi-disciplinary and multi-agency teams: Changing professional practice

Abstract: The article draws on an Economic and Social Research Council (ESRC)-funded research project that aimed to investigate the reality behind the rhetoric of ‘‘joined up thinking’’. The research project was a qualitative, multi-method study involving three phases, including observation and documentary analysis; interviews; and focus groups around decision making and knowledge sharing. The article reflects on the perspectives and experiences of health professionals and their colleagues in multi-agency teams about the impact of multi-agency teamwork on their professional knowledge and learning, and on their ways of working. Actual and potential conflicts between professionals are explored about models of understanding, about roles, identities, status and power, about information sharing, and around links with other agencies. Dilemmas of team building and of conflicting values and knowledge are exemplified from health professionals’ accounts, using theoretical models of ‘‘communities of practice’’ and ‘‘activity theory’’. The article presents groups of strategies that health professionals and their colleagues in multi-agency, multi-professional teams use to overcome barriers and to strengthen team cohesion. The conclusion reflects on some implications of our findings in theory and practice for professionalism within integrated, multi-professional teams that are building new ways of working.

Australian evidence for interprofessional education contributing to effective teamwork preparation and interest in rural practice

Abstract: A pilot interprofessional education (IPE) placement for undergraduate health care professional students was undertaken in rural Victoria, Australia from 2001 to 2003. Medical, nursing, physiotherapy and pharmacy students were involved, and the project is ongoing. This paper briefly outlines the educational model, then focuses on the evaluation methods and results obtained from student evaluations. The placement experience improved self-reported teamwork skills and knowledge, and supported participating students' belief in the value of interprofessional practice. Placements strengthened nursing and allied health students' intention to work in rural health settings after graduation. The rural interprofessional educational experience improved interprofessional abilities in a group of students who have the potential to influence change towards collaborative practices in their future workplaces. The results obtained provide sufficiently strong evidence to justify the continuation and expansion of this educational model in the Australian setting. Pedagogical and evaluation modifications are discussed that may benefit future IPE programs.

Second year scepticism: pre-qualifying health and social care students' midpoint self-assessment, attitudes and perceptions concerning interprofessional learning and working.

Abstract: A study in an English Faculty of Health and Social Care explores the effects of a pre-qualifying interprofessional curriculum incorporating interprofessional modules in each year of study. The study design involves collecting data on entry to the Faculty, after completion of the second interprofessional module, on qualification and after 9 months qualified practice. At each point, students complete questionnaires concerning communication and teamwork skills and interprofessional learning and working. This paper presents results from 723 students at the second data collection point. Although most students were positive about their communication and teamwork skills, they were less positive than on entry to the Faculty. Similarly there was a negative shift in students' attitudes to interprofessional learning and interprofessional interaction. Nevertheless, most students were positive about their own interprofessional relationships. Mature students' responses were more positive than those of younger students. The emergence of differences in responses based on a professional programme suggests that interprofessional education may not necessarily influence professional socialization. Demographic and professional variables affecting students' responses in their second year of study demonstrate the complexity of student learning. The planned follow-up of the students will show whether variables affecting interim data have a long-term effect on attitudes.

Factors in implementing interprofessional education and collaborative practice initiatives: findings from key informant interviews.

Abstract: Health Canada (the federal government department in Canada responsible for health issues) commissioned a research team to conduct an environmental scan and research report in order to understand interprofessional education and collaborative patient-centred practice (IECPCP). This paper presents the findings from semi-structured telephone interviews with key informants conducted as part of the environmental scan. Grounded theory analysis was employed in order to identify factors associated with interprofessional education and collaborative practice initiatives. These factors were grouped according the following themes: lack of consensus regarding terminology; the need for both champions and external support; sensitization to the effects of professional culture, and logistics of implementation. Findings are discussed related to the literature and to the other papers included in this supplement to the Journal of Interprofessional Care.

Beginning the process of teamwork: design, implementation and evaluation of an inter-professional education intervention for first year undergraduate students.

Abstract: An evidence-based interprofessional educational (IPE) intervention involving first year undergraduate students studying medicine, nursing, physiotherapy and occupational therapy was piloted at the University of Liverpool. Campbell's phased approach and Complexity Theory guided development of the intervention and its evaluation. The intervention included a staff-training programme, e-learning materials and interprofessional team working skills workshops. A multi method study design was used to evaluate outcomes and the processes by which the outcomes had transpired. The first year cohort of students (n=442) was invited to attend the pilots. Fifty-four per cent (n=237) opted to attend. Findings showed that the intervention promoted theoretical learning about team working. It enabled the students to learn with and from each other (p<0.001), it significantly raised awareness about collaborative practice (p<0.05), and its link to improving the effectiveness of care delivery (p<0.01). The qualitative data showed that it served to increase students' confidence in their own professional identity and helped them to value difference making them better prepared for clinical placement. The findings support the need to start IPE early in students' training before professional doctrines have been built into their learning. As a result of the findings, the intervention has become compulsory for students to attend and the project has evolved to include trained service users/carers as co-facilitators of the workshops. It is also working on strengthening e-learning by integrating the generic materials into the curricula of all courses. Alongside this, strategies are being explored for interprofessional learning in practice.

New approaches to interprofessional education and collaborative practice: lessons from the organizational change literature.

Abstract: This paper highlights a variety of issues from the organizational change literature that are especially relevant to the implementation of initiatives in interprofessional education (IPE) for collaborative practice (CP). At the level of the individual, these include the existence of strong professional cultures and the need to motivate change. At the level of the organization, context and leadership for IPE and CP are relevant. At the system level, a discussion of incremental versus radical forces for change is particularly germane. Drawing on relevant theoretical and empirical literature, we address each of these three domains and highlight lessons learned from the study of organizational change to the implementation and adoption of IPE and CP. The paper concludes with a set of key recommendations suggested for reducing the incidence of implementation failure.

The Contact Hypothesis: An exploration of its further potential in interprofessional education

Abstract: This paper highlights the research challenges that face researchers wishing to build the evidence base around interprofessional education (IPE). It concentrates specifically on the short-term impact of IPE on a student population. The Contact Hypothesis is a particularly useful theoretical framework to address these challenges as well as guide the development of IPE interventions. A brief description of this theory and the closely-related theories of social identity and categorization is made in order to support and clarify this theoretical position. The application of the Contact Hypothesis as it has already been made in the IPE field is also described. The paper then addresses how the Contact Hypothesis can be further utilized to address IPE research needs. Through consideration of critique of this theory outside of this field, the development of this framework beyond its early applications to the IPE field are addressed in terms of future direction, the caveats and models of IPE that now require empirical testing.

Do primary care professionals work as a team: a qualitative study.

Abstract: Teamworking is a vital element in the delivery of primary healthcare. There is evidence that well organised multidisciplinary teams are more effective in developing quality of care. Personal Medical Services (PMS) is a health reform that allows general practices more autonomy and flexibility in delivering quality based primary care. Practices in the locality where this study was conducted were offered resources to employ additional staff. Such arrangements provided the opportunity to expand and develop Primary Care Teams. In this qualitative study, semi-structured interviews were conducted with primary care professionals in 21 second wave PMS practices. Some participants felt they had used PMS to build their teams and develop quality based patient care. For other practices teamworking was limited by the absence of a common goal, recruitment difficulties, inadequate communication and hierarchical structures, and prevented practices from moving forward with clear direction. The study indicates that changing the contractual arrangements does not necessarily improve teamworking. It highlights the need for more sustained educational and quality improvement initiatives to encourage greater collaboration and understanding between healthcare professionals.

Academic administrators' attitudes towards interprofessional education in Canadian schools of health professional education

Abstract: Interprofessional education is an approach to educating and training students and practitioners from different health professions to work in a collaborative manner in providing client and/or patient-centred care. The introduction and successful implementation of this educational approach is dependent on a variety of factors, including the attitudes of students, faculty, senior academic administrators (e.g., deans and directors) and practitioners. The purpose of this study was to examine attitudes towards interprofessional teamwork and interprofessional education amongst academic administrators of post-secondary health professional education programs in Canada. A web-based questionnaire in English and French was distributed via e-mail messaging during January 2004 to academic administrators in Canada representing medicine, nursing, pharmacy, social work, occupational therapy and physiotherapy post-secondary educational programs. Responses were sought on attitudes towards interprofessional teamwork and interprofessional education, as well as opinions regarding barriers to interprofessional education and subject areas that lend themselves to interprofessional education. In general, academic administrators responding to the survey hold overall positive attitudes towards interprofessional teamwork and interprofessional education practices, and the results indicate there were no significant differences between professions in relation to these attitudinal perspectives. The main barriers to interprofessional education were problems with scheduling/calendar, rigid curriculum, turf battles and lack of perceived value. The main pre-clinical subject areas which respondents believed would lend themselves to interprofessional education included community health/prevention, ethics, communications, critical appraisal, and epidemiology. The results of this study suggest that a favourable perception of both interprofessional teamwork and interprofessional education exists amongst academic administrators of Canadian health professional education programs. If this is the case, the post-secondary system in Canada is primed for the introduction of interprofessional education initiatives which support the development of client and patient-centred collaborative practice competencies.

Models of interprofessional learning in Canada.

Abstract: This article provides an overview of interprofessional education in Canada, with a view to defining programs at all levels in terms of what models have been employed. The available information implies that the lack of convincing evidence of the effectiveness of existing programs is probably the most serious problem for the expansion of interprofessional education. The objectives of the programs are both to increase the knowledge about the other professions and their scope of practice, and to improve team function, and there are a number of well-established interprofessional programs in Canada that are designed to achieve these objectives, and many other examples of programs that are partial or planned. Despite this, the present interprofessional education initiatives tend to involve only a small proportion of the total health work trainees. There is a need for programs that are more widespread. The most frequent model involves a mandatory experience, which is case-based, involves all the students registered in Health Faculties, and where the students form interprofessional student teams. In addition to examining believable cases, the students also learn some specific information about interacting with the other professions and gain knowledge about the roles, knowledge and contributions that can be made by professions other than their own.

Case-based learning in cross-professional groups – the development of a pre-registration interprofessional learning programme

Abstract: This paper describes the development and evaluation of an interprofessional learning (IPL) programme at the pre-registration level. The principal aim of the study was to investigate whether case-based learning in cross-professional groups is a feasible and an effective way to conduct interprofessional education (IPE). Student volunteers from five different health professional training programmes were allocated to two groups: an intervention group and a control group. Interprofessional attitudes of all students were measured at the beginning and at the end of the study. Group members fed back their views about their learning experience after the 9-week long intervention. The study reports significant effects of the intervention on students' attitudes to different health professions. For example, students in the intervention group tended to view each profession as more 'caring' when compared to the control group. Student feedback was positive, with the main message to integrate the programme in the timetable and to introduce an opportunity for IPE in future years. The initial findings reported in this paper show that this is a feasible and an effective way to deliver IPE across the wide range of professions in the study and that the learning programme was viewed positively by the students who took part.

Development of the 'Attitudes to Health Professionals Questionnaire' (AHPQ): a measure to assess interprofessional attitudes.

Abstract: This paper describes the development and preliminary validation of a measure to investigate interprofessional attitudes and how these attitudes change over time. Items for the questionnaire were elicited from 'construct exercises' with staff from different Health Schools resulting in a 20-item 'Attitudes to Health Professionals Questionnaire' (AHPQ). The questionnaire was completed by first year students from five different health professions. Its structure was evaluated using principal components analysis, the internal consistency was determined and the test-retest reliability assessed. Analysis of these data led to rephrasing/ removal of certain items and a revised form of the AHPQ. The revised AHPQ was completed by a different cohort of students and a preliminary validation was carried out. A solution with two main components labelled 'caring' and 'subservient' emerged from analysis of the structure of the initial AHPQ, the overall internal consistency was good although the test-retest reliability varied. Preliminary validation of the revised questionnaire suggested significant differences, on both scales, in students' attitudes towards different health professions at the outset of their training. The AHPQ appears to be a useful instrument for the assessment of interprofessional attitudes in the health professions.

Cultural considerations in interprofessional education and practice.

Abstract: Promoting cultural competency in health care was examined from the Canadian perspective, and explored practice environments and educational programs for future health professionals that foster cult...

Professionals' perceptions of interprofessional working in community mental health teams.

Abstract: This paper seeks to establish whether the presence of core structures influences professionals' perceptions of interprofessional working within their teams by means of a cross-sectional questionnaire survey of all professionals working in integrated community mental health teams in an identified NHS Trust. The findings confirm that the interprofessional teams were integrated, but that the presence of meetings, Care Programme Approach policy or operational policy had little influence on perceptions of interprofessional working. Joint policies on documentation, risk and supervision were related to perceptions of interprofessional working. The majority of professionals were clear about their roles, but perceived that other members of the team did not recognise or understand these roles. Questions arise about how identified structures are operationalised in interprofessional teams. Practice areas may need to examine the effectiveness of the identified meetings and the involvement of the different professionals.

Regulatory and medico-legal barriers to interprofessional practice.

Abstract: Unlike the other contributions to this issue, this paper is concerned with the prospects and potential ramifications of implementing interprofessional practice from the legal standpoint. The author...

Integrating health and social care: implications for joint working and community care outcomes for older people

Abstract: In England, the theme of promoting collaborative working between social and primary health care remains high on the policy agenda. The underlying assumption, largely untested, is that a greater degree of structural integration benefits service users. This paper reports the findings from a feasibility study comparing two models of joint working and examining the relative impact of personal characteristics, service use and co-location on the likelihood of older people remaining in the community. Baseline standardised interviews with 79 older people aged 75 + with complex needs in two social services departments were carried out following referral, covering social circumstances, physical and mental health and services received, with follow-up interviews after six months. Contacts between social workers and primary care were tracked. The findings suggest that co-location does not necessarily lead to substantially closer interprofessional working in terms of greater contact between social workers and GPs or social workers and community nurses. Factors affecting outcome were degree of cognitive impairment, intensity of home care received and whether the older person lived alone. Whatever the model of collaborative working, its effects on remaining in the community must be assessed in the wider context of the characteristics and services received by older people.