Podcast Episode: Influencing practice: relationships matter
Category: Social work (general)
What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.
Shaping our future: relationships matters 31 May 2019.
JI - Jackie Irvine
JI I suppose quickly just to introduce myself, I am actually the past President of SWS as of two weeks ago, so, however, the diary hasn't freed up much. The role in SWS - just to say a wee bit about that - SWS is a membership organisation that is there to encourage the leadership of sw as a profession, and therefore we do work very closely with Iona and her team and we also host the Chief SW Officers meeting which happens every two months where the 32 Chief Social Work Officers across Scotland come together to discuss, clearly the policy issues that Iona has covered, but also to discuss issues that are happening for us in practice, where the challenges are and where some of the pressures are, the implications of a tightening financial climate. So we commit - we've got various standing committees within the children's service and Social Work Scotland arena and we have got a fairly good, revitalised website, so I would encourage you to have a look at that, and you can get the papers from standing committees for children's services, adult services, and criminal justice and the likes, and any other event that we are running or research that we are taking part in. We also work very much in conjunction with Scottish Government and Iona's team. So we have staff who are based part-time with SWS and working part-time with the government, and that is on certain specific policy initiatives- so social care in prisons, we've just agreed self-directed support - that there will be a piece of work there and a team employed that will work across the two organisations. An important part of their role is coming out to you when you are practitioners and hearing from you about the examples of work in your area, so good examples but also looking at where the gaps are and where we need to develop legislation and practice.
So today, a wee bit of a cover of what Iona has covered but I'll try and make it a bit more based on your role. So we are looking today at influencing practice and that's through building relationships with a variety of people - partnership managers, service users. I also want to look a little bit about the role of yourself in relationships, so what do you bring to relationships personally and professionally, and finally looking at self-care strategies, so acknowledging what Iona has said - this is a busy, busy area of work. I always say when people say to me, why did you come into SW or why do you stay, why do you still love it - because it's never boring. So Iona is saying "you don't know what's happening next week, you don't know what's happening tomorrow." So from my point of view I've enjoyed it all the way up from being a professional practitioner to a senior SW team leader, service manager and now Head of Service and Chief Social Worker Officer in Edinburgh City. And in fact just a wee story about that. Yesterday I went to visit Craigmillar in Edinburgh where I did my first practice placement 32 years ago - that made me feel very very old - and I probably shouldn't say this, it's a bit unprofessional of me, but it is what a taxi driver said to me, so. I was talking to the taxi driver on the way there and he was saying, oh have you been to Craigmillar, and I was explaining that I was there as a student. He was saying, "aye hen the houses have changed, but the folk are still radge." (laughs) So, I was saying, I suppose it tells us a wee bit about our communities, that what we see on the outside and how they appear, we know that across any community, not just deprived communities, there are complex families, individuals and people for us to try and work with and support into a more independent state.
So, in looking at relationships, Iona has covered the fact that we have got Health and Social Care Partnerships -that was brought about by the Joint Working Act 2014. We have obviously got council departments, because they are really important, and we've got key partners - national partners, and most importantly, we've got the third sector that we need to engage with. And what I'd say about that is, is that social work has changed significantly in that you will have been in practice placements where they will have had a certain structure. You'll either have been involved in the Health and Social Care Partnership, or you will have been sitting outside the Health and Social Care Partnership. So they all have a slight variation in what they include in- whether they have children's services included or whether they've got criminal justice. And what that means for you, I think, is an extra challenge, because where you might have been as a student on placement and where you go next and your subsequent jobs, there's likely to be a huge variety as reflected across Scotland. So therefore it will be important for you, I suppose, to orientate yourself fairly quickly. You've learnt all about social work, but you'll need to orientate yourself locally in the area you go to work in: who are the key players at a local level? You'll know that from your training in terms of education, health professionals, but you know, how does the local structure reflect up and what does the strategic structure look like - because there are tensions that come from that that and it is also important to understand where you sit, but most importantly, what you bring to that table. And I think Iona has talked about the fact that we do have a bigger role, I think, in promoting the role of social workers now because there is so much going on, and it's so busy, and there are so many partners.
So, I was at the Ministerial Strategic Ministerial Group the other day for health and care integration, which is chaired by Cabinet Secretary Jeanne Freaman, and there was a discussion. It was started off with the New Chief Executive of the Care Inspectorate talking about the role of SWs, and that it is not helpfully expressed or described, and what was then interesting was we then had nurses saying, but we are not, you are losing site of the nursing role because it's mostly about GPs and acute hospitals. We then had allied health professionals saying the same thing - so it was quite interesting. What it meant to me was, it wasn't a competition, but it does mean that there are more roles out there and professions that we now need to be absolutely clear about what we all do - and how do you get that clarity? I think one of the things - if you can do this when you first start practicing - is to actually shadow some of your colleagues and your partners for a period of time. Not an extensive period of time, but take that time early on to get to know their role and how your role fits with them - because if you don't do it early, you will get too busy and it doesn't happen. So as part of your induction, that might be one of the things you want to think about and ask of your managers.
That's really all I'm really going to say about that, but I think the important message from that is what you bring to that partnership at a local level and how you engage with your partners, particularly the third sector which is very varied across the areas as well. What supports can they provide, and much more on a preventative level as well, and less stigmatised, so there are some HUGE opportunities there.
I'm going to come to the service users and users of our services in a wee while, but the next thing I just want to quickly focus on was that in 2011 we had the Christie Commission Report which came about really as a recognition that money was getting very tight, demand was going up, we had an increasing elderly population, and really (it was) commissioned therefore to look at what we need to do differently.
And the Christie commission said:
"Peoples' needs are better met when they are involved in an equal and reciprocal relationship with professionals and others working together to get things done."
So really that talks to that collaborative, co-productive approach to services, the seamless service, the one door entry and whilst we are doing well to get there, we are not there, and it is now 2019 so there is much more work to be done, but it does recognise the need for us to deliver services that are designed with service users actively. And when we are scrutinised, we are actually asked about that and we are judged on the basis of how much we are engaging our service users in what it is they need as opposed to making them fit into the systems and the processes and the practice and the service that we have. So we've got further to go, and I think that's something you will see, and hopefully you will bring some innovative ideas as well to your practice when you are out there.
In terms of constructive relationships, I think there's some key components here. We've talked about partnerships today, and I'm trying to emphasise that need for that coproduction, that collaboration, but quite often, and I think we've experienced in the move towards greater integration, we can become defensive, and that's not just ourselves, it can be health colleagues or elsewhere and I think actually we need to be more open minded and say, well what can we bring to the table. Is sn't a battle, or a competition. But it's also what we do collaboratively and in partnerships to actually understand what peoples' needs are, and that's the bit about being more innovative, being more solutions-focused. As a manager and a more senior manager, and a counsellor, as I've gone up, I know that the people with the right ideas - or the bright ideas I should say - are usually the people at the ground level, in the forefront of working with people and knowing what they need. So, there is a need to become more innovative, and actually to hand over some of that influence to yourselves and allow you to influence what happens in your local area. And also those innovative solutions can build personal and community capacity and also resilience within your community and within yourselves as teams. So, rightly so in some respects, in terms of partnerships, we are judged on our success. Success is judged by how we collaborate together, not in silos, but what we deliver, how we improve outcomes together, and the focus of the Care Inspectorate, Health Improvement Scotland, is very much on that partnership level - and that has been a shift for people, it still is a shift for people, even people you think should know better. So, we tend to retreat into our single silos, but actually if we are going to make things better and there is less money, we need to do it together to be effective, but to be efficient. We can't have duplication of task or role, but we can have collaboration. And technically we can't actually afford to do the same as what we used to do so we have to be a bit more innovative.
In respect to managers, and I think I'm very clear, to say that there's a duty of care to provide supervision, development, and learning from your managers, and I would hope that you as social workers when you go out there can expect that, see that as your right, and to some extents demand it. In Edinburgh, and I know that a lot of Local authorities will do supervision survey, to basically do some quality assurance, around what's the quality of supervision that people are getting. Are they getting regular supervision? Is it of a the nature that's assisting you in your day to day work and challenges? And we hear back from social workers - and that allows me as a Chief Social Work Officer in Edinburgh anyway - to then influence my conversation with managers and staff as well.
When I was in Craigmillar yesterday, we were talking about supervision, and actually staff were saying was that what they have developed are supervision teams. So as well as having your supervision with your manager, you have a supervision team - and I was saying, how does that work? And they were saying, "well it's not my manager that's in my team, but there's my colleagues, and team leaders, senior social workers, but not within" ... and what they were saying was that it was almost like a mini practitioner's network, so it allowed them to talk about research, focus on what the challenges were for their area, for their larger team, to look at pairing up when doing pieces of work and taking forward some developments, but also to talk about support. And I'll come to support at the end, but just hold that in your mind.
I think, before I move on, managers have got a key role in trying to develop you and develop the confidence you have as social workers out there in a very busy area of work, and I can remember, I can remember probably on one hand, the managers I've worked with who I still remember who had a direct influence on my practice, my confidence, my ideas, my understanding. And they were managers who let me go out and do the job - obviously gave me support - but allowed me to work on my own and as part of my team. But they were also managers who challenged me to take myself a bit further, to say 'you can do more than that.' But importantly, they were also managers who had my back, so even when things didn't go to plan - which is, well we are working with people, it's not a science - there is always a bit of risk in what we do. They were there to support me and understand that it can't always go to plan. And I think, I remember a manager saying to me, and you've heard it repeatedly said, folk come to their work to do a good job. They don't come to do a bad job that day, but sometimes things are out of your control, and sometimes - you know- with the benefit of hindsight, everything looks simpler but when you are in it and you've got a varied caseload and you've got a lot of pressure, things can develop. So that role of your manager is really important, and I think it's a two-way thing. So, they have got a professional duty to provide you with support and supervision, but you as a professional have also got that self-determination, you need to say "this is my right." So, you might have cancelled supervision, but I still need supervision because actually the risk that they, the role that they have, the responsibility they have is to make sure their team is well supported, know what they are doing, aren't having too many dilemmas, have got an opportunity to talk through options and decisions and make those decisions collaboratively.
And with respect to your colleagues, they are really an essential part of supporting you in that. You can't underestimate what you learn from the people you sit next to or you have a chat with at a coffee break. And I remember as a NQSW in London sharing a room - and obviously we have all gone to very big open plan spaces now - but sharing a room with 5, 6 other social workers. Now I am dreadful at remembering people's names, always have been, but I remember every person in that team, 30 odd years ago, and I remember their particular professional experience. So, I sat opposite someone called Julie, who was the equivalent of out Mental Health Officer, she was an approved social worker, and she was doing a lot of research in South London at that time, and what I learnt from her I would never have learnt anywhere else. So, it was, you know, ground breaking and it widened my understanding of why some people were having particular difficulties. And at that point she was doing some research into the prevalence of young black males smoking dope, who were getting picked up and taken to mental health institutions because their behaviour was erratic, and obviously, there was some racism in there as well. But that was fascinating for me, and also, you know, there was the opportunity to take part in an evening group with disabled clients, which our team had just set up. They were a children and families team, but they recognised that there were lots of adults out there who had had their children removed, who were in positions of pain, who were coming back into the community and who needed that support. So they were, I remember more about that team than I probably remember about anywhere else that I've worked, which is maybe is a bit telling.
The other thing I think, in terms of your colleagues, is about having that practitioner kind of network approach so... Some areas they have got a specifically set up a practitioner network, in other areas, it's quite difficult to maintain them, but the best practitioner networks that I've seen are ones where the staff, and you know the front-line managers as well, they sustain them, they plan them, they organise them. In Edinburgh we've got a very long standing one, and I get invited in for 10 minutes at the beginning, and then I'm quite rightly told, well you can stay for this item, but we need time on our own. And for the staff.., I went to the last one recently, and I was saying to them, you know, what's your advice for sws today, NQSWs? - and they talked about the things that we would all expect: coaching, shadowing people, having a practitioner's network - even if you haven't got one established, having one in your team that's maybe one day a week or one day a fortnight - you say, let's have coffee at that time and look at what the issues are for us. But the practitioner networks, if they are self-sustaining, and self-determined, and they invite speakers in and they decide what the topics are they want to talk about, then I think people are much more likely to engage. So, I would encourage you to seek out - is there a practitioner's network? Probably what you'll hear is, "yes, we used to have one but we got too busy and things kind of overcame us." That time out, that time to self-reflect is really important, the time away, getting your head out of the busy day job is really helpful, and it influences your practice when you go back in.
And in respect of service users, which takes me onto my next slide. We do know that we need to be open, honest and respectful, but we also ..., we hear from service users a lot about what it is they need, but we need to be listening. So, from studies with families and their experience, we know that from their perspective, what approaches and behaviours contribute. If they are good, they can achieve, they can contribute towards improved outcomes, so it is important to take account of what they tell us. And for some people that we will work with, or you'll work with, they can have a real sense of shame and that can prevent their participation, and we need to kind of understand that. So, they will have a fear of being judged because we are in a statutory role, and we will quite often be in there in terms of a protective role, in terms of child protection, adult protection etc. And what service users tell us is that they fear, their fear of an unsympathetic and punitive approach - Iona touched on this - can inhibit them from asking for help. It will inhibit them from saying, "Actually I'm struggling here", because what they are worried about is a decision that we make. And we know that there is a power imbalance there. And, I think, if you are consciously aware of that and think about that person and how they perceive you. You are the person who can remove their children; you are the person that can make decisions that will impact on their life significantly.
There is a recent book out called "Protecting Children: a social model" by Brid Featherstone and colleagues, and within there, the bits that I found really helpful, was about hearing a family's experiences, where they experienced positive relationships with practitioners- and that wasn't just social workers, just keep that in mind, that is the mixed group of professions, out there working with them. And they were clear there that where they felt involved, where they felt that people were being absolutely explicit with them about why they were involved in their lives, what their concerns were, they were then able to understand that more and were able to seek, well they were able to work more actively with the plan around their case or their family, and they were able to be more reflective as a family with that person, and the keyword there is trust -and that doesn't come immediately. So as practitioners we do need the time to get to know people, to understand where they are coming from, to understand where they've been and why they have arrived at where they are today - as opposed to just being seen to judge them. So, we do need to invest more actively in that working relationship, and I know that you all will have heard that and I think, you know, when you pick up your first cases, it's good when you've got to the end of that case, reflect back and say: "What do you think? What worked well there, what didn't, what could I have done differently? Could I have done anything differently?".
So, some families will attribute positive and accepting relationships as a key factor in improving outcomes for them, in improving their circumstances, obviously it's not always, not always the case, and Iona has already touched on a sort of asset-based and restorative approach to working with families, so "working with them, you know, not doing to them". And people who have experienced working with social workers in that way and other professionals emphasise the importance of listening, listening to their views, being respectful and honest, recognising their strengths and displaying acts of kindness, of taking the time. We know that that gets harder the bigger your caseload and the busier you are, but we always try and strive to do that. So the nature of that relationship can influence, can influence the effectiveness of your intervention, in part, not completely, because obviously as we say, there's a lot of risk in here and there's a lot of human nature.
This final slide is really about self-care, and I've touched on some of this already - supervision, team supervision, having a buddy or coaching system, shadowing your colleagues, doing joint visits, building in time for reflection and recognising the personal impact on you of doing the job that you are doing, and being accepting and open to support. I spoke to our practitioner's network a few, about a month ago, and I said I was doing this, and what would they say to you - and they said all of these things, but they also said some things that I hadn't really anticipated. So they were talking about dialogue and support to learn, and that should be about supporting you and encouraging you and not instructing you to do things. And it made me think of a case I had in London years ago, and everything unfortunately was done through the court system in London, so it was a family court, and I was a baby social worker and I was told to go in with a certain expectation of what I was to achieve in that court. I didn't actually believe in it, but I didn't have the experience or the self-reflection thing. I knew consciously I didn't agree with the plan, and we went into court, and we didn't get that plan, and I thought, that's because I didn't believe in it, and I thought what I should have done was be much more explicit about that before I went into court. And I suppose the other things I remember as well - and it comes back to yourself in practice- how do you, is understanding that stigma that people feel. So, I was a senior social worker, and I took two years out to go out and explore the world, and that seemed fine, and I came back to be a basic grade social worker for a short period of time. A lot of colleagues said to me, that must be difficult because you've been a manger, and I said, but I came into social work to work with people, but obviously it was a bit difficult because I had been a manger and I remember having this case where a young woman had just recently had her children, very young children returned to her, having been in care for a period of about a year, and she was doing really well, and one morning I got a call from the senior social worker saying 'Oh, my God, wait until you hear what she's done.' She's wired up the electricity to the close, she's got someone in to jimmy the electricity to the close and you need to go out there and you need to consider whether we take those kids into care.' And I was saying, maybe we just need to think about why she would do that. She did that because she wanted to keep her children and she didn't want to tell us she had no money for the electricity and that she got it cut off. So, if you understand why she did that and her intentions were good, they were to keep her children, whom she loved dearly, then your approach in that situation is, so I suppose I'm just trying to say, for your self-care, be true to yourself as well and that's what the social workers in our practitioner network were saying.
They also said that organisations and your employer need to listen and provide appropriate support, they saw that as really essential, so allowing them time to have their practitioner's network, providing the funding for them to do that. The time out of work was really important to them, and so therefore there's also a role in your managers in meeting your needs, making sure that you are keeping well and that your health and wellbeing is surviving in a very busy profession, a very busy profession, as well as yourself doing something about that.
So, just that's. I think that's probably my last slide. It is. So thank you very much, thanks for taking the time.
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