The House Model of Care Teams
A Practice Guide for Effective Interprofessional Work
Overview of the House Model
In the complex landscape of human services, no single professional can address the multifaceted challenges that clients face in isolation. The interconnected nature of human needs – spanning physical health, emotional wellbeing, social connection, and material security – demands an equally interconnected response from service providers. This practice guide introduces the House Model of Care Teams, a framework designed to transform fragmented service delivery into cohesive, client-centred support systems. Whether you’re a seasoned professional or new to inter-professional work, this guide offers both conceptual understanding and actionable strategies to navigate the complexities of functioning effectively in a care team.
Inspired by Assoc Prof Michael Gordon’s ‘rules of good shared care’ and the Core Principles & Values of Effective Team-Based Health Care (2012), this model is being developed as a teaching tool for use across sectors. These ideas have been workshopped at a series of talks to interdisciplinary groups working in mental health, education, child safeguarding, out of home care, and community services.
What is a Care Team?
A Care Team represents a purposeful alliance of professionals from diverse sectors who come together to support the wellbeing of their client – be it a child, adult, or entire family. Unlike formally established units within a single organization, these teams form organically yet deliberately, emerging as localized service intersections generated around an individual’s unique circumstances. They arise precisely because complex challenges rarely respect the boundaries of service silos; they spill across domains, requiring integrated responses.
When a client’s needs intersect with trauma, instability, or systemic barriers, professionals from relevant fields form a system around the client that mirrors the distinctive pattern of that client’s strengths and challenges. Each professional contributes their specialized expertise to this collaborative ecosystem – whether through risk assessment, therapeutic intervention, housing support, or educational advocacy. Through their intentional collaboration, professionals achieve greater impact than they could manage in isolation.
The foundation of an effective care team lies in collective responsibility. Rather than working in parallel tracks, professionals pool their insights, resources, and authority to craft a cohesive plan tailored to the client’s specific situation. They maintain regular communication through structured meetings, shared documentation systems, or virtual check-ins, creating multiple opportunities to align their efforts, exchange critical updates, and collectively reflect on progress and setbacks.
A genuine care team transcends being merely a collection of experts; it functions as a dynamic, living system that generates possibilities greater than the sum of its individual components. This system thrives on authentic dialogue, professional humility, and an unwavering commitment to centring the client’s voice and experience. By collectively holding the client’s needs in mind, the team transforms what might otherwise be fragmented interventions into a unified force for healing and positive change.
These teams do not form in a vacuum—they emerge within systems that may inadvertently erect barriers to collaboration. Nonetheless, when practitioners commit to working together despite these challenges, they create microsystems of support that can buffer clients from the fragmentation that often characterizes larger service systems. In this way, care teams not only serve individual clients but also demonstrate how systems might evolve toward more integrated models of care.
How Care Teams get Derailed
The vision of seamless collaboration often collides with a much harsher reality on the ground. Instead of coordinated care, practitioners find themselves navigating a maze of missed connections, conflicting priorities, and meetings that deteriorate into either accusatory finger-pointing or uncomfortable silence. Families bear the heaviest burden of this dysfunction, forced to navigate a bewildering patchwork of services while repeatedly recounting their stories to disconnected professionals who may never speak to one another.
Meanwhile, practitioners themselves battle mounting frustration, professional burnout, and the persistent sense that the system is working against them – and by extension, against the families they aim to serve. These challenges aren’t incidental to the work; they emerge from deep structural issues that compromise our best intentions for collaborative practice.
Communication fractures under the weight of professional jargon, hierarchical dynamics, and the simple logistics of connecting busy professionals across different organizations. Role boundaries blur, creating confusion that leaves critical tasks either duplicated or, worse, entirely overlooked. Power struggles simmer beneath the surface of ostensibly collegial interactions, fuelled by competing mandates, differing theoretical frameworks, and unacknowledged biases about which perspectives should take precedence.
All these challenges unfold against a backdrop of chronically depleted resources – not just financial constraints, but shortages of time, training opportunities, and the emotional bandwidth necessary to engage in thoughtful, creative work with complex cases. Let’s examine each of these barriers in greater depth.
Fragmented communication stands as perhaps the most visible obstacle to effective care team functioning. In systems theoretically tasked with collectively “holding families in mind,” critical details too easily slip through widening cracks in communication. The paradox is striking: teams simultaneously drown in procedural emails and documentation while starving for meaningful dialogue about the human beings at the centre of their work. Professional exchanges often devolve into speaking at rather than with one another, with interactions reduced to hurried status updates rather than collaborative sense-making. Different sectors speak essentially different professional languages, with terminology, priorities, and risk thresholds that may not translate cleanly across disciplinary boundaries. Most critically, amid this professional cacophony, the voices of clients themselves – which should anchor all discussion – frequently go unheard or unheeded.
Role confusion compounds these communication challenges, creating both practical inefficiencies and deeper relational tensions within teams. Organizations typically design professional roles around bureaucratic convenience and regulatory compliance rather than the integrated needs of clients, creating artificial silos that prioritize procedural adherence over collaborative problem-solving. This structural issue is often exacerbated by professionals who unconsciously guard their domain boundaries, driven by underlying fears that collaboration might dilute their authority or expose the limitations of their expertise. The consequences ripple outward: for families, role confusion translates to missed opportunities and contradictory guidance; for professionals, it breeds frustration, territorial disputes, and accelerated burnout as energy diverts from client work to professional posturing.
As complexity increases in cases, teams frequently succumb to power struggles that corrode collaborative potential. What begins as professional disagreement can escalate into entrenched positions where competing agendas collide, and families become collateral damage in interdisciplinary conflicts. Teams ostensibly tasked with modelling stability and healthy relationships instead inadvertently replicate the very dynamics they aim to resolve – becoming hierarchical, distrustful, and rigid in their thinking. Behind closed doors, professionals trade accusations: “They don’t understand risk,” “They’ve lost sight of the child’s best interests,” or “They’re enabling destructive patterns.” These conflicts rarely stem from malice; more often, they emerge from genuinely competing lenses regarding urgency, expertise, and institutional culture. Yet from the family’s perspective, these power struggles manifest as a professional tug-of-war where they become the rope—pulled between contradictory expectations and approaches.
Underlying all these challenges, especially in complex care teams, is the reality of depleted resources, both structural and cyclical. Many professionals work within systems stretched so thin that even the most dedicated practitioners find themselves operating on reserves of goodwill that gradually deplete without replenishment. Resource limitations extend beyond tight budgets and staffing shortages – though these certainly matter – to include the slow erosion of intangible assets essential to meaningful work: time to build genuine trust, energy to think creatively, and emotional bandwidth to hold a family’s pain without collapsing under its weight. When teams lack these fundamental resources, they default almost inevitably to survival mode, prioritizing urgent fires over sustainable solutions. Throughout this cycle, the emotional toll of bearing witness to suffering compounds over time, further depleting the very resources needed for thoughtful collaboration. The result is a downward spiral where practitioners have decreasing capacity precisely when complex cases demand more from them.
The House Model of Care Teams
The House Model offers a compelling metaphor and practical framework for building collaborative care teams that can withstand the storms of complex casework while providing genuine support to clients. Like constructing any sound dwelling, we begin with the understanding that each element serves both distinct and interconnected purposes in creating a structure that offers safety, stability, and the possibility of growth.
Starting from the ground up, we recognize that even the most skilled professionals cannot create a stable collaborative environment without first establishing a Shared Purpose as the foundation of their work together. This foundation represents more than vague aspirations about client wellbeing; it manifests as an actionable, living commitment to the client’s best interests as understood through authentic engagement with their voice and unique context. Developing this shared purpose requires practitioners to move beyond professional platitudes to articulate specific, mutual understandings: What does success look like for this particular client? Which needs take priority at this moment? How will we balance immediate safety concerns with longer-term healing goals? A well-constructed foundation of shared purpose doesn’t eliminate professional differences but creates a common platform from which to navigate them productively.
Once this foundation is secure, we turn to constructing sturdy walls in the form of Defined Roles for all team members. Clear role boundaries serve dual purposes – preventing wasteful duplication of efforts while simultaneously creating the security necessary for genuine collaboration. When practitioners understand which actions fall within their domain of authority and accountability, they can work with greater confidence and less defensiveness. Well-defined roles don’t create rigid silos; rather, they establish the necessary structure within which flexible collaboration becomes possible. Like walls that divide interior space while supporting the shared roof, clearly delineated professional responsibilities help teams respect the unique perspective and expertise each member brings while working toward common goals. This clarity becomes especially crucial when navigating the ethical complexities that arise when professional obligations appear to conflict.
The framework’s third essential element is Clear Communication, which serves as the connective tissue binding the entire structure together. Effective communication in care teams extends far beyond information exchange; it involves integrating fragmented narratives into a coherent whole that informs collective action. This requires both formal mechanisms – structured meetings, shared documentation, clear handover protocols – and informal channels that allow for timely adjustments as circumstances change. Communication in effective care teams operates bidirectionally across all relationships, including with the client themselves. Information flows not just from practitioners to clients but meaningfully incorporates client feedback and insights into the team’s evolving understanding. When communication channels function properly, they create transparency that builds trust while ensuring that critical information reaches those positioned to act upon it.
These three elements – Shared Purpose, Defined Roles, and Clear Communication – provide sufficient structure for most routine collaborative work. However, when cases involve heightened complexity, whether from severe trauma histories or particularly challenging service intersections, additional reinforcement becomes necessary. In these instances, the metaphorical “roof” of the house – representing the weight of complexity – exerts greater pressure downward on the entire structure. Complex cases often generate powerful relational forces that can easily dislodge practitioners from their roles, shared purpose, and communication pathways. These disruptions might manifest through double binds (contradictory demands imposed simultaneously), recurring crises that divert attention from core goals, or emotional intensity that overwhelms professional boundaries. In such cases, two additional reinforcing elements become essential.
The first reinforcement comes through processes that actively promote Mutual Respect among team members. This respect represents more than professional courtesy; it embodies the recognition that every member, regardless of training background or disciplinary focus, brings irreplaceable value to the collaborative table. When teams establish genuine respect across professional boundaries, they create the trust and equity they hope to foster in their engagement with family members. Mutual respect enables practitioners to disagree productively without undermining collaboration or escalating into power struggles. It allows for the vulnerable acknowledgment of uncertainty – “I don’t know” becomes a strength rather than a liability when expressed within a context of mutual respect. Most importantly, respect creates space for the integration of diverse knowledge systems, including the lived expertise of clients themselves alongside professional perspectives.
The second reinforcement essential for highly complex cases involves establishing agreed-upon Change Markers that help teams resist case drift and maintain focus amid the pushes and pulls of intensive work. These markers transform abstract goals into measurable, collectively endorsed indicators of progress. When thoughtfully designed, they serve multiple functions: inviting appropriate accountability, counteracting tendencies toward case drift, and highlighting small wins that sustain energy for change even when broader transformation moves slowly. Effective change markers balance professional assessment with client-defined outcomes, recognizing that meaningful change must register in both domains to be sustainable. They create natural pauses for reflection – opportunities for teams to assess not just client progress but also the effectiveness of their collaborative processes. By anchoring discussions in observable changes rather than interpretations alone, these markers help depersonalize disagreements and refocus attention on shared goals.
Together, these five structures – Shared Purpose, Defined Roles, Clear Communication, Mutual Respect, and Change Markers – uphold the ultimate aim of the House Model: creating a trauma-informed system of care that serves as a platform for meaningful recovery. Within this structure, clients are not passive recipients but active participants, invited to co-design plans, voice concerns, and celebrate progress alongside professionals. The metaphorical “roof” represents not a fixed endpoint but an evolving space where safety, connection, and growth become possible through collaborative effort.
When all five elements function in harmony, care teams can manage effective collaboration even while working with the most complex cases. The House Model offers both conceptual clarity about what matters in collaborative care and practical guidance on how to build these elements into daily practice. By attending to each component with intention, practitioners create not just more effective service delivery but transformative spaces where healing can flourish for both clients and the professionals who serve them.