Why have a model of practice – quality assurance and feedback in 2014

From social workers:

  • admin demands prevent social workers building relationships
  • not enough support and guidance from managers
  • lack of opportunity to develop expertise
  • supervision not reflective
  • blame culture

Why have a model of practice – quality assurance and feedback in 2014

From children and families:

  • we want social workers who understand us
  • we want social workers who see us regularly and build a relationship with us
  • we want honesty, reliability and consistency from social workers
  • we don’t want to change social workers

Developing a vision of excellent social work with families and practitioners - 2015

Not just training but a whole system change

Theory of change

If social workers feel supported and contained they can build relationships with families and use these relationships to facilitate change with families based on their practice expertise.

Supported by six principles:

  1. Continuity of relationships between social workers and families
  2. Consistency of relationships between social work teams and families
  3. Collaboration between practitioners
  4. Social workers being purposeful partners in change for families
  5. The organisation supporting a learning culture
  6. A transformation of the organisational culture from a blame culture to a relationship-based one that inspires trust and confidence

 

How did we implement these principles - October 2015

Social work relationship is at the heart of a network of relationships - the Team Around the Relationship.

This requires small teams of social workers who support families across the service and know each others cases and can work collaboratively.

The pod includes:

  • 1 Full Time Equivalant (FTE) Pod Manager
  • up to 2 FTE senior social Workers
  • up to 5 FTE social workers 
  • at least 1 social worker in training
  • Business Support Officer 

Implementing these principles was about more than just service redesign

Whole system change, a coherent model with clear principles and a way to enact them, required structural change - the pods.

Supported by new processes, including:

  • a new supervision model based on 1 to 1 and group supervision as well as Reflective Practice Groups
  • a new quality assurance processes, practitioner-led audits
  • the One Story model of recording and assessment

Based on a new culture (‘creating the conditions that allow good relationships to grow’ Care Crisis Review):

  • relationship-based management and leadership
  • trust and openness
  • prioritising relationships, containment and direct work

Feedback to a pod manager from an ‘academic in practice’ who shadowed the pod – the culture we are aspiring to

First of all, I was blown away by the quality of practice I was observing. Next, your sense of team-ness. It was lovely to watch your team interacting and supporting each other. When one struggled with a task there was always another there to listen and provide support.

What I think it all speaks to, though, in particular is your style of management. You have created an environment where your team clearly look to you and trust you. They told me that they go home on time and don’t come in early, and that you model that for them, so they have a good work/life balance.

They seem very in touch with the emotional and relational side of their practice, forming real relationships with family members and managing to balance their authority and task-centredness with warmth and compassion.

But best of all it absolutely inspired me and reminded me of why I came into social work. As a social work educator, I worry at times about sending our newly qualified Social Workers out into a career where stress and burnout is so high. Your team showed how the job can be structured to meet the needs of children and families in a way that is safe and manageable for staff.
 

What relationship-based practice is

Recognise that relationship-based practice is an ambiguous and contested term. 

Our definition of relationship-based practice, a meta position:

  • human behaviour is complex and multi-faceted
  • not a practice framework based on a single skills set
  • common elements across well-indicated interventions
  • containment of anxiety supported by specific knowledge and skill contingent on the child or family’s particular situation
  • this is the theory of change at the practice level
  • complex situations require complex responses

Relationship-based practice and direct work

Relationship-based practice

Containment of practitioners, in terms of professional and organizational anxiety, allows purposeful thinking about and work with families.

Relationships and purpose

A quote by Donald Forrester: 'Relationship-based practice provides a discipline of helping that challenges us to do more than simply building relationships.'

It is how we use relationships that makes the difference, feedback from a parent: 'Louise (social worker) has established a great relationship with me and my children so that the more difficult things can be addressed. Louise remembers the children’s birthdays etc, I could write pages. I know Louise deals with 100’s of family’s but you would not know that. She makes us feel like we are the only family that matter - always.'
 

Relationship-based practice and direct work

Relationships and time

Continuity and consistency are important but relationships are not just long-term or continuous. Relationship-based practice can be part of initial visits and assessments

A social worker siad: 'At the beginning when I was doing assessment, I was talking to the parents and whenever I met the children, I am interviewing them rather than doing stuff with them. Now I’ve realised that I can actually play or do things with the children and actually still get information out of them. So yes over the last 6 to 7 months there has been a noticeable change for me.'

http://www.talkingandlisteningtochildren.co.uk/project-impact/

Organisational commitment to direct work as part of relationship-based practice, for example commitment to Talking and Listening to Children for ASYEs
 

Model of practice based on relationships and the importance of direct work but challenges

Your Voice

Social work survey (our version of the social work health check), shows respondents spending more time on direct work but still not as high as we would like.

In an average month/the last month what percentage of your time do/did you spend on the following:

Activity

Percentage of time in 2019

Percentage of time in 2018

Percentage of time in 2017

With children/young people

15%

12%

10%

With adults in families

15%

14%

15%

Reports and admin including carefirst, court reports etc

30%

38%

33%

Meetings

22%

21%

23%

Supervision

11%

11%

12%

CPD and contributing to learning and research

5%

4%

6%

Model of practice based on relationships and the importance of direct work – green shoots

Breakdown of respondents by role more positive, social workers are spending more time on direct work in 2019.

In an average month/the last month what percentage of your time do/did you spend on the following:

Activity

Percentage of time

With children/young people

25%

With adults in families

23%

Reports and admin (inc. carefirst, court reports etc.)

29%

Meetings

19%

Supervision

9%

CPD and contributing to learning and research

4%

Is the model leading to improved outcomes?

Has the experience of families improved?

Direct comparison is difficult, as evaluation since model of practice more robust, but the number of compliments and complaints provides a proxy indicator:

Compliments from all sources

2015 to 2016

2016 to 2017

2017 to 2018

14

54

103

Complaints

Stage

2015 to 2016

2016 to 2017

2017 to 2018

2018 to 2019 - projected

1

101

58

66

40

2

11

6

9

4

Is the model leading to improved outcomes?

Has the experience of staff improved?

In 2018, Ofsted siad: 'Social workers’ morale is high and they enjoy working for Brighton & Hove.'

Containment - do staff feel safe and supported?

From Your Voice: social work survey our version of the social work health check: Supported by improved social worker stability, for example no agency social workers since September 2017. In 2016, 64 per cent of people agreed compared to in 2019 when 89 percent agreed.

Is the model leading to improved outcomes?

Are we supporting families to be safe and stable?

Difficult to measure causal links between changes to social work systems and outcomes for families but proxy indicators suggest improvement.

For example:

  • in October 2015, there were 403 children subject to a Child Protection Care Plan compared to in January 2019 when there were 333 children subject to a Child Protection Care Plan
  • in October 2015 there were 473 children in care, compared to in January 2019 when there were 375 children in care
  • in 2016 to 2017 there was an average of 26 care applications per quarter, compared to in 2018 to 2019 there was an average of 15 care applications per quarter

 

 

Empathy, tenacity and compassion

An evaluation of relationship based practice in Brighton and Hove

The Team Around the Relationship provides the potential to make a difference for children and families.

The key messages from the first 3 and a half years are, in general, that: 

  • families have a better experience of social work
  • social workers feel more supported and more able to make a difference for families
  • relationship based practice appears to be supporting safe and stable family lives for children
  • the model of practice seems to have decreased demand for high level social work interventions