Naturalistic decision-making frameworks in multiprofessional assessment of early childhood disability
Young children with complex developmental difficulties are often referred for assessment by multiprofessional groups run by health or education services. The purpose of this research is to identify and describe the frameworks within which such groups make their judgements and decisions in real work settings. This study adopted an exploratory, multiple-case research design. It involved two tertiary multiprofessional groups in London. Each assessed two preschool children whose difficulties were suspected to lie within the autistic spectrum. One group consisted of a paediatric senior registrar, a clinical psychologist and a speech therapist working within a neurodisability centre attached to a hospital (Site M); the other group was multi-agency, managed by an Educational Psychology Service and included educational psychologists, a psychotherapist and the deputy head of a special school (Site E). Each child was assessed by all the professionals simultaneously in the presence of the parents over a morning session. All discussions were audio-recorded. Postassessment interviews were held with each participant. Data were subjected to verbal protocol analysis and discourse and conversation analysis. The major finding of the study was that professionals made use of four types of interlinked decision-making frameworks, activated either concurrently or in close alternation. Firstly, a common procedural framework included hypothesis testing and diagnosis carried out in three cycles of decision making, with varying characteristics related to the different institutional contexts of each Site. Secondly, knowledge frameworks were mainly within the 'disease' model at Site M, and the 'psychodynamic' and 'behavioural' models at Site E. Thirdly, goal structures were related to which client and purpose each assessment was intended to serve. Finally, negotiation frameworks consisted of inter-professional collaboration and power-game structures, and professional-parent interaction structures for negotiating the bad news. These findings have implications for research on decision making in assessment of children with disability, as well as for professional practice and training.