Health Education Research, Vol. 18, No. 6, 717-728,
December 2003
© 2003 Oxford University Press
Multi-agency, multi-professional work: experiences from a drug prevention project
Department of Sociology, Queen Margaret University College, Clerwood Terrace, Edinburgh EH12 8TS, 1 Faculty of Social Work and Education, Northumbria University, Newcastle-Upon-Tyne NE7 7XA and 2 School of Community Health, Napier University, Edinburgh EH10 5DT, UK
e-mail: stephen.pavis{at}isd.csa.scot.nhs.uk
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Abstract |
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Policy documents at local, national and international level continue to call for greater multi-agency and multi-professional working. These calls are based on three arguments: (1) health and illness are created and influenced by multiple factors outside of health service policy, (2) health improvement requires collaboration between statutory, voluntary and private sector organizations, and (3) efficiency and effectiveness are aided when duplication of effect is avoided and service transition is as seamless as possible. However, there remains limited process-orientated research that has explored the difficulties and challenges faced during multi-agency and multi-professional work. This study employed qualitative methods (interviews, participant observation and documentary analysis) to understand the social construction of a multi-agency and multi-professional health promotion project orientated toward the prevention of drug-related harm. The findings illustrate the ways in which the processes involved in securing funding led to multiple and competing project aims, how changes in personnel and the internal (re)organization of agencies created disjunctions in project membership and shared understandings of key priorities, and how the social need to keep group members ‘onside’ and committed, competed with the imperatives of prioritization and addressing issues surrounding differentials in power between members and between agencies.
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Introduction |
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Behind the endless calls at international, national and local levels, for ‘intersectoral’, ‘integrated’, ‘partnership’, ‘alliance’ or ‘multi-agency’ approaches to the promotion of health lie a compelling set of arguments. First, health and illness are noted as being created and influenced by many factors which lie outside health service policy.
In government, diverse authorities take decisions that affect health including, for example, those in the sectors of agriculture, housing, energy, water and sanitation, labor, transport, trade, finance, education, environment, justice and foreign affairs. The policies of all sectors that affect health directly or indirectly need to be analyzed and aligned to maximize opportunities for health promotion and protection. [(WHO, 1998), p. 34]
Second, interventions to secure improvements in health commonly take place at multiple levels involving individuals, communities, and statutory and voluntary sector service providers.
... Our new approach, based on our three-way partnership between people, local communities and the Government, adopts a new way of tackling poor health which is both inclusive and integrated, comprehensive and coherent. It ensures that all involved in improving health play their part. Individuals have the responsibility to improve their health, and the health of their families. Local agencies, led by health and local authorities, have the responsibility for delivering local services and local programmes which will enable people to claim the right of better health. And the Government has the responsibility of giving everyone throughout our country the opportunity for better education, better housing, and better prospects of securing work. [(Department of Health, 1998), paras 1.30 and 1.40]
Third, there are concerns around efficiency and effectiveness, and the ways in which various agencies, statutory and voluntary, often duplicate effort or service provision and fail to provide seamless transitions between services.
At the same time, within published research there is a lack of consensus regarding what is the best measure of ‘success’ in multi-agency and/or multi-professional health promotion work. As Gillies (Gillies, 1998) shows, a variety of ‘outcome’ measures have been used, including individual-level health gain or behavior change; community-level change in terms of social capital, political activity or need determination; and changes in organizational structures and ways of working. These ‘outcome’ studies using:
The RCT and comparison designs combined with quantitative and rather limited qualitative methods of data collection, simply cannot capture the richness of the process nor give a detailed enough understanding of the meanings of activities and actions, nor of the process of change. [(Gillies, 1998
Process-orientated evaluations are less prevalent and where such research evidence exists it has tended to be produced by participants within projects. As Douglas (Douglas, 1998) notes, this has often led to a strong emphasis on positive experiences. The attempt has been to inform colleagues about aspects of practice which have been successful and/or to point to the potential benefits of multi-agency, multi-sectoral work. However, the unintended effect of this approach has been to create a situation whereby there is limited work that charts, explores and seeks to understand factors which inhibit or mitigate against effective mult-agency, multi-sectorial practice.
This paper reports on the experiences of a recent multi-agency, multi-professional project which sought to reduce drug-related harm in a deprived community. We have chosen to address some of the difficult and less positive processes which occurred within the project so as to add to the pool of knowledge regarding how multi-agency partnerships can work effectively. This focus should not be taken as evidence of an unsuccessful project. Despite the difficulties encountered, a great deal was achieved. In the Discussion we relate our findings to Douglas’s theoretical insights and suggest areas where her model may be developed further. In conclusion, we offer more practical recommendations related to effective multi-agency, multi-professional working.
Overview of the project
EVERGREEN was a 39-month project funded between April 1996 to June 1999 by a national agency. (To preserve anonymity all names, locations and job titles have been changed.) The agency funds projects that deliberately set out to develop new ways of working, generate knowledge and improve existing health promotion practice. Such projects are not always intended to be examples of ‘best’ practice, but rather seek to generate learning opportunities which can improve future service provision. From the outset, EVERGREEN was both multi-sectoral and multi-agency, involving collaboration between the national agency and local health authority/board. At the same time, the day-to-day work involved collaboration between various statutory and voluntary sector agencies and community representatives within a particular local area. These agencies were united by the desire to work more effectively to reduce drug-related harm.
Evaluation is a key aspect of all projects funded by the national agency and was an integral part of EVERGREEN. Initially the evaluation was conducted internally by staff members employing a broadly action research perspective. However, the first project evaluator resigned after 12 months; a second was appointed, but again resigned after a further 2 months. Subsequently, the authors were commissioned to undertake an external evaluation of the project from March 1998 to June 1999; this generated the data on which this paper is based.
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Method |
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The research was ethnographic and employed a social constructionist perspective (Berger and Luckmann, 1966
). It sought to understand the ways in which respondents actively created the project on a daily basis. This perspective recognizes that social actors often hold differential levels of power (both material and personal), and that they make sense of events and take decisions within organizational contexts. In turn, organizational contexts are seen to provide both opportunities for, and constraints upon, participants’ actions. The research sought to generate an evolutionary understanding of the project which took account of dynamic processes over time. For these reasons we were concerned to understand the origins of the project and the negotiation processes prior to formal funding, as well as post-funding project developments. Three types of data were collected. Qualitative interviews were conducted with respondents from the national funding agency, the health authority/board, EVERGREEN project staff, and the various agencies and community members who made up the project steering group (the composition, role and function of the steering group are discussed in detail below). These interviews included previously employed EVERGREEN staff, and managers from both the national funding agency and the health authority/board. Key personnel who had had major involvement during the life of the project, whether at the national funding agency, the health authority/board or EVERGREEN were interviewed twice. In total, 19 interviews were conducted, and all were audiotape recorded and transcribed verbatim.
The interviews which related to the inception and early stages of EVERGREEN were necessarily retrospective. Our evaluation did not start until the project had been underway for some 21 months. Later interviews focused on the day-to-day workings of the project, and sought respondents’ understandings and interpretations of the project’s key aims and objectives. Data were collected on current activities and perceptions of the bridges and barriers to achieving the goals of the project.
Documentary analysis was undertaken with materials produced by the national funding agency, the health authority/board and internal materials produced within EVERGREEN (including early evaluation documents). For example, minutes from steering group meetings were reviewed in order to identify patterns of agency representation and the personnel attending the group at various stages. This exercise proved valuable in identifying key participants who were subsequently invited to take part in qualitative interviews. Other documents were used to gain an understanding of the development of ideas within the project and to generate issues for discussion with respondents in interviews. Comparisons were also made between respondents’ contributions and understandings as expressed in interviews and the project’s written records.
Finally, participant observation was conducted at steering group meetings and other EVERGREEN organized events. Fieldwork notes were made during and following such activities. Understandings developed through this research technique were again triangulated with other data and fed back to respondents during interviews.
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Results |
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The development of ideas and the securing of funding
The origins of EVERGREEN lay in a set of needs identified by health promotion officers (HPOs) working at the health authority/board. During their practice these HPOs came to realize that within the local area there were several statutory and local voluntary sector agencies working in the broad area of drug prevention, without necessarily having an overview of each other’s work or coordination of effort. A ‘drug prevention group’ was convened in an attempt to redress this situation. Membership of this early group was somewhat ad hoc and not all members attended all meetings. However, representation was broad, and included personnel from primary and secondary schools, community education, social work, the police, health promotion, and general practice. The membership of the group represented an attempt to operationalize policy initiatives which highlight the benefits of addressing drug-related problems through partnership between stakeholder organizations.
Simultaneously, the HPOs were interested in developing understandings of multi-agency and multi-professional work through research. The area of drug work, with its range of different agencies (statutory and voluntary) and various practice ideologies, ranging from abstinence through to harm reduction, was seen as providing an opportunity to explore issues which aid or hinder multi-agency working and coordination of effort. These interests and concerns led to the submission of an application for project funding from the national funding agency. This initial proposal suggested that the agency fund a project to promote multi-agency drug prevention work, and that this be evaluated through a quasi-experimental design involving an intervention and control area. The ‘drug prevention group’ were involved in discussions about the direction and content of the submission. However, the application was written by the HPOs, and our data from the later evaluation point to various members of the ‘drug prevention group’ holding subtly different understandings of the aims and objectives of the initial application. From the outset some members of the ‘drug prevention group’ viewed the application as potentially generating more workers to undertake direct drugs-related health promotion in the community, whilst other members saw the project as primarily leading to greater coordination of the group’s own efforts.
The national agency did not fund the initial application. However, a year later the political and policy contexts had changed. Drugs were receiving extensive media coverage in the wake of several high-profile, middle-class drugs-related deaths and a ‘moral panic’ was building (Cohen, 1987). Multi-agency, partnership working was also gaining increasing support within health promotion. At this point the national agency felt it was appropriate to fund a project along the lines suggested in the original application. Following negotiation, funding was subsequently agreed from the Community Programme budget of the national agency. In the following interview extract a manager from the national agency explains his/her understanding of the funded project.
I was very keen, a lot of the work we do in the community programme is community development work. I was very keen on this project because it was an opportunity to look at community development in that slightly broader context—it is not just a community development project. It is very firmly rooted with the local agencies as well... [and later on]... It wasn’t about agencies in the community getting together and creating something else, other than what they were doing. It was about bringing together that effort in a more coordinated way and it was also about the community as partners, which I think is quite important [emphasis added].
As these data indicate, during negotiations between the national agency, the health authority/board and the drug prevention group there were shifts in both the scale and emphasis of the project. These shifts were to have important implications throughout the life of the project. The formally agreed goal, aims and objectives of EVERGREEN are presented in Figure 1.
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In addition to the shifts in the project’s aims between the initial application and funded project, the research design also changed from quasi-experiment to action research. Budgetary constraints meant that the evaluator/action researcher post was reduced from a full-time to a half-time position. The finally agreed staffing complement was a full-time HPO, a half-time evaluator and a half-time administrator/secretary.
Multiple and competing aims and objectives
Examination of the written project goal, aims and objectives reveals tensions and a degree of ambiguity regarding the relationships between various elements. From the very early stages of the project the key stakeholders (funding agency, HPOs and the ‘drug prevention group’) sometimes held different and often multiple views about the project’s primary purpose. Stakeholders also gave different weightings to the various aims at different points in time.
Within the proposal, multi-agency working and collaboration are stressed (e.g. aim 1 objective 7 and part of objective 3), but so too is the development of community involvement and ownership (e.g. objectives 1, 2 and 6), and the idea that the project should undertake its own drug prevention work over and above coordinating the efforts of participating agencies (e.g. objectives 4, 5, 8 and 9).
These inherent tensions within the aims and objectives were also reflected in the project’s intended evaluation/action research. Figure 2 lays out the early evaluation aims, and the intended outcome and process measures: (1) the evaluation was intended to monitor and aid the process of multi-agency working (e.g. indicators 1, 2 and 4), (2) it was to monitor and aid community involvement and project ownership (e.g. indicators 1, 3 and 4), and (3) it was hoped to be able to demonstrate the impact of the project on drug-related harm in the community (e.g. indicators 5–11). Here it should be borne in mind that all of these competing tasks were seen as achievable by a single half-time action researcher.
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The steering group
The start of formal funding saw the ‘drug prevention group’ change its name to the ‘EVERGREEN steering group’. At that time the group reviewed their composition, and the decision was taken to try and make the group more representative of both professional agencies and the community. Within the funded application it was envisaged that the group would move toward a balance of 50% professionals and 50% community representative members. Here we consider the role and functioning of the steering group in order to provide insight into the day-to-day workings of the project, and the ongoing impact of multiple aims and objectives.
Attendance at the bimonthly steering group meetings was variable, ranging from six to 25 people. In total, 13 different agencies (nine statutory, four voluntary) sent representatives during the life of the project. In addition, members of the youth group (up to six, 13- and 14-year-olds) and community group (up to four women) attended certain meetings. Some individuals attended throughout the duration of the project, giving continuity to the group and representation from their agencies; for other agencies the individual representatives changed (often several times); and for others the agency was represented for only part of the duration of the project. There were also variations in the seniority of representatives from different agencies (statutory and voluntary).
Our analyses suggest that the change in the group’s name at the time of project funding was significant and related to some group members seeing themselves as ‘steering’ or managing project workers. On the one hand, this view was consistent with the theme of project workers undertaking direct health promotion activities within the community. On the other hand, it was inconsistent with the idea that the project was primarily about the coordination and management of multi-agency service provision. From the project workers’ perspectives the name change served to confuse the management structure and to further complicate the processes of trying to negotiate what were (and what were not) priorities. Here one of the early project workers explains her difficulties in relation to the role of the steering group:
[the health authority/board manager] and I talked a little bit about it, this idea of ‘do I sit back and wait to be told what to do, you know, from the group, do they really manage me?’ and she was ‘well, no, I’m your manager and they’re...they’re the Project’. But the question would come up ‘what is the Project?’ in a sense, ‘is the Project the things I do, the things I initiate, or is the Project the things they initiate?’. [Project worker]
These comments should not, however, be taken as a suggestion that the ‘steering group’ did not fulfil certain very useful functions. First, steering group membership aided the development of interpersonal relationships between professionals. The EVERGREEN project was somewhere agency representatives could meet regularly, and get to know each other and, to a lesser extent, members of the community. News about promotions, new appointments, changes in role, absences through sickness as well as more personal information about family and domestic events were exchanged. The group also served as a forum for exchanging information about agency remits, policies and current priorities. This extended to the exchange of information about other agencies and groups who were not represented at the steering group meetings.
Our data suggest that at points project workers actually saw these functions as sufficient to justify the group’s existence and appeared to believe that these constituted the limits of what could realistically be attained. However, other participants hoped for and expected more. For some, as already indicated, this ‘more’ involved managing the EVERGREEN project workers and encouraging them to undertake direct health promotion work with community members. For others, the ‘more’ related to the development of a ‘strategy’ (see Figure 1, objective 4). However, as the following interview quotations illustrate, there were again differences of opinion as to what a ‘strategy’ involved in this context.
I think there is pressure in all directions for agencies to have drugs policies...it would be highly relevant for a project like this to look at those, discuss them within the multi-agency steering group, such that recommendations go back to individual agencies, or even come up with common themes for a locality, that all the various agencies are comfortable with. [Steering group member]
There would be some kind of self-help line or some kind of group was also going to be formed. That was what we were trying to get to. And the community, as a whole, would come together and it would be addressed in one way. [Steering group member]
In the event whether the ‘strategy’ should be concerned with: changes within agencies (to working practices or priorities), changes to agencies’ relationships with one another or decisions about what additional initiatives should be supported, who should fund and be involved in these, and whether the initiatives should involve temporary or permanent commitments, was not resolved. An agreed, written formal strategy was never produced. Our data suggest that the key reason was that its creation would necessarily have led group members to discuss and confront very difficult issues, including differences in service ideology and orientation, e.g. abstention versus harm reduction and primary prevention verses secondary treatment; the centrality of drug issues to the respective agencies; the resources available to agencies and their prioritization of use; and power and hierarchical differences between agencies and individual group members. To take one illustrative example, members in managerial positions (e.g. in social work or health promotion) were in a more favourable position to be able to commit resources or to change their agencies’ formal policies than the organizationally more junior members (e.g. nurses located in general practices or frontline community education workers).
The steering group ‘managed’ the differences between agency priorities and members’ organizational positions and power by avoiding controversial decisions. In turn, the scope available to EVERGREEN project workers to address this situation was severely hampered by the fact that some steering group members believed that they were actually the managers of the project workers. The situation existed whereby no one appeared to have the authority or responsibility to challenge the status quo. Simultaneously, however, avoiding difficult discussions and decisions served to keep the group together and to maintain general goodwill for the project.
Staff turnover within the project and management structures
High staff turnover both at project and managerial levels (see Figure 3) also contributed to the failure to set clear project priorities and address difficult issues. No project staff member stayed throughout the project. The first project coordinator resigned after 16 months; a second was appointed, but resigned after a further 12 months. The project coordinator was not replaced a third time, and the decision was taken to amalgamate the posts of administrator and coordinator. There was thus discontinuity between the first team of project coordinator and evaluator, and the appointment of a subsequent project coordinator. The second project coordinator was also appointed without the support of an internal evaluator.
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Three people at the health authority/board had responsibility for EVERGREEN’s management at different points in the life of the project. As a result of an internal reorganization within the health promotion department (1 year into the project), from ‘issues-based’ to ‘patch-based’ work, the HPO who initiated the project handed over managerial responsibility. Eighteen months later this second manager was promoted and, although she retained overall responsibility, a third manager became involved.
The reasons for the high staff turnover within the project were found to be several and multifaceted. First, project staff were employed on short-term contracts. This type of employment tenure creates feelings of insecurity within employees and carries the associated risk that staff will move on before the project is completed. Second, the high turnover of project staff related to certain characteristics of the project itself.
It was a very destructive process, desperately disappointing because of the expectations that I had of learning new skills and new knowledge. I was hoping to gain a lot of new knowledge around drugs and drugs research. I had actually learned nothing very much at all. I found it difficult even to achieve the things that I was already very skilled at because of the set up. [Project worker]
The high staff turnover disrupted the project in a number of ways: (1) there was a disruption to the normal pattern of work and meetings, (2) local knowledge and project-specific knowledge were lost each time someone left, and had to be reacquired by each new incumbent, and (3) the vision of the project, negotiated, created and internalized by staff, is necessarily freshly created by each newly appointed person—this was particularly important to this complex project.
I think I found, I mean obviously I started off reading the paperwork before April 1st and I actually found the aims and what the project was about quite difficult to get to grips with. [Health authority/board manager]
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Discussion |
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The last decade has seen the proliferation of multi-agency joint working within health care and health promotion. Theoretical insights into how multi-agency or multi-professional projects work (or do not work) have been slower in coming. This said, there have been several recent texts which highlight the dimensions along which ‘partnerships’ or ‘alliances’ vary and the areas which affect the efficacy of partnership working ( Douglas, 1998; Gillies, 1998
; Whitelaw and Wimbush, 1998). Whitelaw and Wimbush point out that projects involving ‘partnerships for health’ are far from homogeneous, and involve a diverse range of initiatives which can differ along such key dimensions as activities and outputs, rationale, scope and degree of formality. They conclude by arguing that:
...what is important is that the nature and scope of the structures and processes chosen are appropriate to the circumstances within which a partnership exists and associated expectations. [(Whitelaw and Wimbush, 1998), p. 7]
Douglas provides a useful theoretical model which attempts to identify key elements in the creation of ‘healthy alliances’ (Figure 4). The first six elements in her model relate to project potential, with the final three being concerned with different types of achievement.
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Where the literature remains limited is in relation to the provision of empirical examples which provide insight into ways that theoretical understandings can be further developed. There remains a need to draw together, on the one hand, theoretical insights, and, on the other, the realities of securing funding, creating projects and operationalizing intentions.
Our data are largely supportive of Douglas’s model. However, our findings also draw attention to the ways in which pre-funding relationships and the negotiation processes which often surround the securing of funding can exert strong influences throughout the life of a project. Within EVERGREEN, from the very outset, there were three discernible stakeholding groups: managers at the funding agency, HPOs located in a health authority/board and a diverse group of workers who shared a professional interest in the reduction of drug-related harm. These three groups had different priorities, and types and levels of power. The national funding agency managers held the budget and their priorities influenced the shape of the final funded application. The community development element of the project came, in large part, from the national funding agency managers and the election of the new Labour administration in 1997, with its stress on addressing the ‘up-stream’ determinants of health, further reinforced the national agency’s emphasis upon community development. As Gillies (Gillies, 1998) note, community involvement is a positive force in most health partnerships.
...however one defines the outcome and whoever the partners in the process are, the stronger the representation of the community the greater the community involvement in the practical activities of health promotion, the greater the impact and the more sustainable the gains. [(Gillies, 1998
Within the EVERGREEN, however, key stakeholders where unclear as to why community involvement had been incorporated into the final funded project nor did they share a view as to its importance vis-à-vis other priorities.
The HPOs initiated and wrote the application, and stood between the national funding agency and the frontline professional workers (i.e. steering group). Their role became one of negotiating with the national funding agency to secure funding, whilst also keeping the frontline workers enthusiastic and involved. The HPOs’ priorities were to encourage better multi-agency, multi-professional working and to learn more about the factors which aid or hindered such practice. The frontline workers themselves recognized the need for better coordination between services, but were also keen to secure funding for new or additional areas of work. These workers saw EVERGREEN as an opportunity to secure staff to undertake drugs-related health promotion activities within a deprived community. At the same time, many members were attracted to the community development model, with its emphasis upon community involvement and empowerment. Each of the three stakeholder groups acted with integrity, professionalism and respect for each other throughout the project. However, they also pursued their own priorities and agendas. The result was that throughout the life of the project the three competing strands of multi-agency working and collaboration, development of community involvement and ownership, and undertaking direct drug prevention work remained in play. These strands were often found to be in tension with one another and to compete for resources.
The setting of clear priorities was something that proved extremely difficult. Our data highlight the ways that tensions can exist between the three constituent elements which Douglas includes under Assessing Potential (see Figure 4). Within the EVERGREEN project, relationships between the three stakeholder groups (national funding agency, health authority/board and steering group) and between members of the steering group remained congenial. However, the maintenance of these relationships was achieved, at least to some extent, through the avoidance of difficult issues, these including reaching agreement on ‘core purposes and priorities’ and explicit discussion of the ‘nature and extent of planned collaboration’.
A further issue closely related to the tension between maintaining congenial relationships and addressing difficult issues was what Douglas termed the ‘nature of leadership and coordinated activity’. Within the project there were unresolved issues concerning who had responsibility for what and who managed whom? Formally the national funding agency commissioned a project to be run by the health authority/board, who in turn employed project workers. These workers were charged with the coordination of multi-agency work to address drug-related harm. Simultaneously, however, some influential frontline workers within the steering group saw themselves as managing the project staff. To complicate matters further, members of the steering group were ‘volunteers’ in the sense that they themselves or their agency choose to attend the steering group meetings. They were under no formal obligation to attend or to contribute resources.
Phrases such as ‘partnership’ and ‘alliance’ invoke images of equality, communication and shared priorities. However, in reality ‘partnerships’ or ‘alliances’ often involve unequal relationships in terms of professional standing, material resources or personal confidence and skills. Managing these relationships, in order to achieve productive activity, is difficult. Yet the people charged with such responsibilities are often quite junior within a ‘partnership’ or ‘alliance’. In the case of EVERGREEN, the project workers who attempted to coordinate multiple agencies and professionals were also employed on insecure short-term contacts.
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Conclusion |
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We highlight several key issues from which lessons can be learnt. Applications for the funding of multi-agency, multi-professional projects normally involve various stakeholders with complex priorities. The process of securing funding often exacerbates these complexities (e.g. through competitive tender). In such situations there is a danger that applications can become over-optimistic with many, possibly unfocused, aims and objectives. Funding agencies can usefully counter the pressures to please all stakeholders by explicitly looking for focused achievable projects. Once funding is agreed there remains a responsibility upon funders to keep aims and objectives focused and achievable.
Within complex projects it is crucial that there is clarity in the management structure. Multiple aims and objectives require reflexive practice involving open discussion between stakeholders (key players) so as to keep priorities to the fore and subject to review. Experiencing difficulty during these processes should not be taken as a sign of failure, but rather as an indication of an effort to move the project forward. The sooner any difficulty is brought to the surface, the sooner it can be tackled. What is not acceptable is for frontline project staff to experience competing demands from different tiers of management. Supervision and time for reflection seem key to the success of complex projects.
When good communication between partner agencies and professionals has been achieved it should be possible to openly discuss aims and priorities. Often it will be necessary to address the issue that some members’ aims are not current priorities and accordingly need to receive less attention in the short term. Within such discussions and negotiations it seems advisable to keep in mind the relative power of members, both in terms of the size of the agency they represent, its statutory or voluntary nature and the group members hierarchical position within their agency. It is unrealistic to expect all project members to be able to make the same contributions, either in terms of material resources or personal skills/knowledge. Indeed, if this were possible multi-agency, multi-professional working would not be of such importance.
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References |
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Berger, P. and Luckmann, T. (1966) The Social Construction of Reality: A Treatise in the Sociology of Knowledge. Penguin, London.
Cohen, S. (1987) Folk Devils and Moral Panics: The Creation of Mods and Rockers. Basil Blackwell, Oxford.
Department of Health(1998) Our Healthier Nation. The Stationery Office, London.
Douglas, R. (1998) A framework for healthy alliances. In Scriven, A. (ed.), Alliances in Health Promotion: Theory and Practice. Macmillan, Basingstoke, pp. 3–17.
Gillies, P. (1998) Effectiveness of alliances and partnerships for health promotion. Health Promotion International, 13, 99–121.
Scriven, A. (1998) Alliances in Health Promotion: Theory and Practice. Macmillan, Basingstoke.
Whitelaw, S. and Wimbush, E. (1998) Partnerships for Health: A Review. Health Education Board for Scotland, Edinburgh.
WHO (1998) Health for All by the Twenty-First Century. WHO, Geneva.
Received on September 8, 2002; accepted on November 22, 2002
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