Transcript: Video enhanced reflective practice


Supporting improved communication and reflective practice amongst newly qualified child and family social workers.

Podcast Episode: Video enhanced reflective practice

Speaker(s):


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.

RS - Robin Sen

RS - What we did was Video Enhanced Reflective Practice and I just want to kind of locate that within the wider method of Video Interaction Guidance, which is a method used with parents to improve interaction with children, particularly young children. I want to focus on the process of what we did and how we set up the training and what we did in the training and give you a few examples of what we did, and then we are going to come onto the evaluation of the training and how effective it was, which is my shakiest point - still looking at the data at the moment. But I am going to talk about how we design the methodology and give you some of the data for the project, and then I am going to reflect on the learning from the project and future use around it.

So just acknowledgements before we start - the main funding came from the Higher Education Authority for running the project and evaluating it. Rotherham Metropolitan Borough Council ... Rotherham is just outside Sheffield, provided some match funding - they also allowed their workers time in order to attend the training, so we are very grateful for that. And the training was provided by (... unclear) particularly by Hilary Kennedy, who was for many years based in Dundee, which is why Video Interaction Guidance, or one of the reasons at least, why Video Interaction Guidance has a strong presence within Scotland. Hilary was also kind enough to lend me some of her slides around VIG for this presentation.

So just to start off with one of Hilary's slides, just around VIG projects in the UK, it is a growing intervention method. The NSPCC, for example, have recently bought into training a number of their project workers in Video Interaction Guidance - and it is spread across the country, albeit with some pockets where it is stronger than others. So Scotland has quite a strong presence, the south has quite a strong presence, not so strong in the Midlands. But it is a growing intervention method which has 80 supervisors, 750 trained practitioners and currently 500 people in training. It has actually been mentioned recently in the National Institute for Clinical Excellence's guidelines as an evidence based intervention method, so it is gathering momentum and gathering an evidence base to support it.

So just in terms of looking at VIG - so as I have said, Video Interaction Guidance is primarily an intervention method between looking at the interaction between a parent and a child - and influenced in many ways by attachment theory and the idea of the internal working model. So a child has a need and creates an initiative through that - through crying, through looking at the parent. And in the 'Yes' cycle, the positive cycle, the parent then responds, that need is then satisfied and the child is then associated through that and that process goes on in a positive cycle. And obviously where that does happen, where a child signifies a need, is hungry or signifies want for physical contact, for a smile, and that doesn't happen, it creates a negative dynamic. So Video Interaction Guidance is very much about looking through video footage at those micro initiatives and those micro responses between a child and a parent. So focused on its initial beginnings on parents and very young children, and looking at those ... creating those 'Yes' cycles. And one of the characteristics of the method is it's a strengths based method - and we talk about that in social work quite a lot. In terms of Video Interaction Guidance what that means is it is focusing what a parent is doing right, so some of those micro interactions where a parent has responded to their child and their child then responds positively and there is a positive reciprocal dynamic which builds up. So it's looking at those pieces of footage where there is positive interaction and seeking to replicate them and generalise out from those positive pieces of interaction.

One of the questions that sometimes comes up early on in VIG training is if you take video footage of someone or of a situation, don't people try and sometimes do behave better than they would in ordinary life? And the answer is "yes", and that is used by VIG very explicitly and consciously, because what you are trying to do is take the positives that people have in terms of their interaction and build those up through emphasising and through looking at them and through generalising them out into more general behaviour. So the kind of fact that people sometimes perform for the video and perform better than they would is used very explicitly in terms of the method.

So just looking at VIG and VERP. So Video Interaction Guidance - focused on parent/child interaction, although it has been used subsequently in a number of differing settings, so between parents and teenagers, but also in some criminal justice settings for example. Look at the interaction between primarily a carer and a child or a young person. It has its root in Netherland, and I have put in social work, exclamation mark - because of Hilary's influences, who is from a psychology background, it is often associated as a kind of psychological method of intervention. And I suppose I am keen to emphasise its social work roots in the Netherlands, partly because I don't want social work to be left out of being involved in the method here. So I do want to emphasise that. In terms of its evidence base in Holland, there have been randomised control trials, larger studies, where they looked at the effectiveness, and it has a fairly strong evidence base in the Netherlands. It was brought to the UK in the late 80's and 90's, primarily through Hilary and a colleague of hers efforts - they went over to Holland to get trained and they brought it back and it has been growing since then. The evidence base in the UK, because it is a newer technique in the UK, is emerging rather than established, but as I have said, it has a growing evidence base behind it.

So what is VERP as opposed to VIG? So Video Enhanced Reflective Practice - so it's developed from VIG, but the focus here is on the practitioner's interaction. So it can be used around inter-professional communication, so how professionals speak to each other - either within the same work setting or different work settings, but also about professionals' interactions with service users. So there is footage of practitioners with service users that focuses on what the practitioner did rather than what the service user did. And through that, and through looking at the micro footage and thinking what the practitioner is doing, it becomes a tool for reflective practice as well.

So some of the principles behind VIG that has been brought out through the various settings in which it has been used. So starting from the kind of the paradigm of the parent/child, around attentiveness, encouraging initiatives, receiving initiatives - the idea of attunement where a parent is attune with the emotions, with the initiative that their child gives and shows enjoyment through that, guiding and deepening discussion. And those are then broadened out for VERP in terms of looking at the principles for attuned conversations within professional interaction. So one of the things that sometimes happens in terms of receiving ... making and receiving initiatives - where there is a positive 'yes' cycle between, in an adult conversation, is where a person makes the initiative and they are received and they feel that initiative has been received. And quite often where that cycle breaks down is where someone feels that initiative hasn't been received. So I don't know if people are familiar with conversation analysis, which is if you take a transcript of a naturally occurring conversation in any circumstances and you look in detail at the turn-taking in that conversation. So who says what and what is said in response. And what is interesting about conversational analytic breakdown of interaction is quite often when conversations become difficult and there becomes a conflict situation, is the root of it is often that someone has made the initiative and felt they haven't been heard, and the other person isn't then receiving the initiative. So conversation analysis talks about, for example, latching - which is where someone says something and someone speaks over them - or two people speak at the same time. Now it's an ordinary thing that happens in conversation, and usually in a positive conversation, quite easily resolved by the person stopping and the other person taking their turn. But where conversations become more conflictual, you have either one person dominating the turn or two people trying to speak regularly at the same time. And that process of making and receiving initiatives can break down.

So just thinking about the foundations for attuned conversations - some of the basic things that you will be aware of in terms of friendly intonation, listening actively, waiting, looking for initiatives for the other person and then feeling them ... then receiving them. But also in terms of showing that you have heard, sometimes by paraphrasing, reflecting back, using the same language, by the appropriate use of body language. And I suppose one of the things that comes through when we look at breaking communication down - it's not enough to hear someone if they don't receive that hearing, so they need to be feeling that you are receiving that communication in terms of a positive cycle.

In terms of attuned interactions - also checking out understanding, waiting attentively, taking short-turns, and I will come onto that in some of my learning through the project - but just again when conversations tend to break down and there is less of a conversation, you quite often find that someone is taking a very long turn within that. So focusing on taking short turns as appropriate now in some contexts - I am obviously going to take a very long turn during this lecture, but it's not a conversation. So there could be situations in which someone takes a long turn appropriately, but it can be a sign of a conversation that is breaking down because someone is dominating the turn. And what tends to happen, as well as that person dominating, to receive that turn over a long period of time becomes difficult - we lose concentration, we find it hard to focus on what the person is saying, might become frustrated or bored. So looking at shorter turns in the attuned interaction.

And finally, in terms of deepening discussion, in terms of sharing viewpoints, collaborative discussion and problem solving - where there are differences, trying to name them - and I think this becomes relevant for social work communication in many ways. Naming of differences, naming contradictions and conflicts - and it is obviously not the expectation that you use this method or any others and you manage to resolve all conflictual situations, because that is obviously not possible - but what is the aim of VIG and VERP to do is for both sides of that conversation to leave feeling they have been heard, that their viewpoint has been heard and that they have had ... their viewpoint has been respected within that process. So it might be about naming the differences and naming that there has been disagreement, but for both sides to feel that they have been heard within that interaction - and that becomes a way of managing conflict and trying to get back into that 'yes' cycle of making and receiving initiatives.

So a bit about the project, but firstly I just wanted to say a bit about why I wanted to do the project. So I was working initially as a children and family social worker in Glasgow and I moved to a small project, a contact team, and I was basically sent on two days of VIG training by my manager - didn't know much about it, and was really taken by it in two ways. Firstly, I think in terms of intervention methods in social work, we have the standard ones that we teach, and not all of them have a clear evidence base. And it seemed to me that VIG was something that had a growing evidence base and that we should be doing more to teach evidence based interventions. And there are problems attached to only teaching evidence based interventions and how does an intervention get an evidence base, and it does sometimes depend on what is funded and who funds it. But I think there is a strong case for saying that we might teach qualifying and post-qualifying students an evidence based intervention rather than different methods which don't necessarily have an evidence base. So that was one thing, but it was also about the development of social work knowledge and social work expertise, and the idea that I think VIG is a method which enhances and develops practitioners. So I was interested in it for that reason.

After the two days training, and I moved into social work education, one of the things that also struck me is the kind of teaching we do on communication is often not of the interactions that you typically have in social work. So we teach around counselling methods and we teach around the core conditions coming from person centred counselling and (... unclear) counselling, which I think are really important in many ways, but quite often they are premised on a counselling interaction where someone is voluntarily going for help - they might not know exactly what, but they are volunteering to go and they want that intervention. In social work, particularly children and family social work, and particularly child protection within that, many of the situations you find yourself in, you have to negotiate your way over the threshold of the door, you have to negotiate at the very beginning as to why you are there, and try and build up rapport within that context.

One important paper that came out was a paper by Donald Forrester and colleagues, where he trained some qualified social workers in motivational interviewing at the beginning, and then he evaluated their learning through a scenario with an actor and saw how empathic their responses were. The paper was published in Child Abuse Review and he also wrote something in the British Journal of Social Work if people are interested in the paper. But what he found was that generally social workers used a very confrontational style of interaction, so the scenario was around a child protection scenario - typically a parent had ... there had been referral, the parent had arrived at a nursery or school under the influence, and the practitioner than had to respond to that situation. And he found that generally, despite the training in motivational interviewing, which you probably all know is a technique based around non-confrontational motivation. So it is based on person-centred, but it allows the practitioner to try and move the service user on to recognise issues which they hadn't started off recognising. But despite that training there was a very confrontational interaction that most social workers had - and what they conclude is that it wasn't the individual workers, but something around the training and the kind of social work education behind that. and I think, thinking back to my own days as a children and families practitioner - I often felt slightly disingenuous if I had a child protection referral, going in and building up rapport, because I knew I had this list of things that I had to ask by the end of that interaction. And so I can think back to situations where my own communication could have been characterised and probably was quite confrontational. But it also felt disingenuous going in there and building up rapport for the reasons that you had this list of concerns. So I think there is a need for a focus on communication within social work that recognises those things.

Now in terms of the project, Rotherham had a group of 17 newly qualified social workers and they had a first year of training for all the children and family NQSW's - and so all 17 got that. In addition, we then provided Video Enhanced Reflective Practice to 6 of them, so they got the Rotherham training and in addition they got this. So in some ways it was set up as a randomised control trial, with a control group getting the ordinary training and the intervention group getting the ordinary training plus VERP.

We also had 4 consultant social workers from Rotherham - they were in post, specifically in a mentoring role for newly qualified social workers, and they also went through the training. And then you also had 2 social work lecturers, of whom one was myself, who also did the training but used interactions with students.

So looking at the 5-day training briefly - so Day 1 and 5 were a full day - Day 1 was an introduction to VIG plus VERP and techniques of filming and reviewing. There were then 4 half days where people brought films along and made plans for changing ... looking at the positives in their interaction, but also looking at what they wanted to work on subsequently. On the third half day we introduced ... the idea was introduced by the trainers, rather, of difficult conversations and how to break back into the 'yes' cycle when using difficult conversations. And Day 4 looked particularly at deepening discussion.

So some of the key principles - the strength based approach I have already spoken about. So really the idea is of targeted sequences where you are looking at positive interaction, and it's a coaching or guiding approach. So the main person is the person whose video footage it is, identifying the positives in their own interaction. And quite often in both VIG and VERP, one of the things that I think helps it work is it is a parallel process. So quite often the trainers are also going through training themselves and may take the video footage of them giving the supervision session. So there is a parallel process in place.

In this project we arguably had a parallel process and the consultant social workers were also going through the training, so they would sometimes take video footage of their supervisions with the NQSW's, and at the beginning they ... the NQSW and the consultant, would sometimes use the same piece of footage but look at their own interactions within that. Later on we had some NQSW's who took footage with carers and with parents and used that, but it was again a parallel process for people in a supervisory capacity also using and looking at their interactions - so it didn't just become a focus on the one person, if you like.

The focus on difficult or just conversations - we had two key books - the Video Interaction Guidance one which is edited by Hillary and two other colleagues, and came out, I think last year - and also a book on Difficult Conversations - and that book is one of a number which are very much about this idea of 'how do you get back to the 'yes' cycle'? So difficult conversations and different settings, and you see from the front of the book, in work, in personal life, with service users. But just that idea that quite often when those interactions become difficult, is around long turns, is around people making initiatives which aren't received, and not hearing each other in those micro-interactions, and looking at how you get back into that positive 'yes' cycle within that and restore an attuned cycle, attuned process. As I say, it is not about saying that there is going to be agreement by the end of it, but by naming the disagreements, quite often one or both parties feels heard within that. So it might be about just recognising that there are disagreements, but hearing those at the same time.

We did move from the idea of difficult to just conversations, just I suppose in terms of labelling. Once you call something a 'difficult' conversations, I suppose there is certain expectations of it and certain emotions that you associate with it. So we did talk about just conversations, and very much the idea that by the end of it both parties could leave feeling that they had been heard.

Okay, so in the actual sessions we would have broken that down - so we would have stopped after every 5 or 10 seconds to break the communication down, which we don't have the time to do, but you would do that with a supervisor - the way we did it in the VERP project was within small groups, so you would get other people's feedback as well. Just watching the footage reminded me of one - firstly that you usually cringe when you see yourself on video. But also, in terms of the strengths-based approach, how ... I think all participants found this, you go for the negatives - that you pick up what you are not doing, and it becomes quite difficult to focus on what you do well. So in tune with the method there are several things that I can pick up that I didn't do, but I think what I tried to do was give the turn back - the student who has given her permission for the video use is called Libby. I have taken videos with another student who had himself taken very long turns when I looked at the video, and I had allowed him to take long turns because I was working on the basis of allowing him to explore his narrative was a good thing. What I found when I looked at the video was that my attention was waning, and that also he seemed to kind of lose focus in terms of his turn. So a lot of the focus in the work with the first student was around reflecting back but trying to break up his long turns. And what I found with Libby, who was an under-graduate student doing an extended essay - so it's a kind of long essay that students do in their final year - was in the first meeting it was very much she would ask the question and then wait for me to take the turn. It was very much difficult for her to take turns within that. So it was very much she asked and I said. And in this interaction she had contacted me because she had got feedback from another essay, which I hadn't marked, and said she wanted to meet me about it. So it wasn't clear why she wanted to meet me about that. And what I felt I did well was just get underneath what she wanted to speak to me about. And we managed to get to the fact that she was concerned about the bandings and she was on the cusp of a 2/1, 2/2 banding. And I think through asking the question about where she was and where she wanted to be, and trying to give her the turn back, we did actually, I think, get behind some of the anxieties that she had. Now still in that interaction you will find that I am taking the longer turns and still I am kind of very much in the position of the person giving advice and information - which may well be appropriate to the context, but I think in previous interactions I may well have taken longer turns and not asked the important question about where was she, why was she coming to me with this piece of work - and I think that helped address some of the issues and the anxiety that there was.

I want to move onto the evaluation. So just starting off with John Carpenter's Level of Outcomes. So he has talked about what we want to achieve through social work education, what are the end outcomes of social work education. And obviously learners' reactions and learners feeling positive about learning is important. But in many ways, in terms of what we do in social work, it's perhaps at the bottom of the scale. And because learners can have very positive reactions to learning, it doesn't mean that they change their attitudes or their knowledge has increased through that. And even if someone's knowledge and attitudes have changed, doesn't mean their behaviour has. You can argue that attitudinal change is a prerequisite for behavioural change - but just because you change your attitude on something, for example addiction issues are a classic case, in order to address an addiction you need to recognise that you have got a problem with that addiction - but just recognising the problem doesn't necessarily mean you will or that you can change that behaviour. So changes in behaviour. And at the highest end of the triangle, really what we are trying to do for social work education is to improve outcomes for service users and be a greater benefit to users and carers.

So Carpenter started, and there is another model that he has looked at. If those are the end outcomes of social work education, what do we need to do in terms of evaluating social work education to get data on whether or not we are affecting those higher level outcomes. And some of that is quite difficult - but what Carpenter has been, I think quite well known for, is saying that just the end of course smiley face evaluation isn't enough if you want to be looking at whether or not you have affected attitudes, perceptions and changes in behaviour.

So what we had was, in the end, in terms of evaluation data, slightly less than we started off with. We had 9 in the control group, 5 in the intervention group and 4 consultant social workers who I had some data from, but I am just going to focus on the NQSW's in terms of what I say today. And the methods that we had were, at the beginning of the training I put T1 and T2, and I think later I put T0 and T1, but anyhow, at the start, before the training we did a self-evaluation questionnaire with all the social workers and we also did a vignette scenario at the beginning and at the end. And we also asked all of them open questions about their training, and specifically we asked the VERP trainees about their feedback on that method. So in terms of what we were kind of seeking to do, in terms of Carpenter's levels, we got the feedback sheets on the training and that was learner's responses, which can be important - if people feel positive about the training, if they feel it has been beneficial, they are more likely to put that into interaction. In terms of looking at whether there was a change in attitudes and perceptions, we did self-evaluation questionnaires - and albeit they were self-evaluation, they did give a sense, I think, of how people were confident about their skills and abilities. And finally we used vignettes ... certainly Gillian McIntyre and colleagues had used them to evaluate the new degree in England, and as a result, speaking to Gillian, I had kind of put those in place. There were various flaws in the methodology that we used, and I am happy to speak to them in the questions. But it was probably the simplest ways that I could think of, of getting towards the higher level outcomes in Carpenter's methodology.

So firstly in terms of learners' responses, they were overwhelmingly positive, so just someone saying "it's built my confidence", someone saying "it is very helpful in developing communication skills and strength based approaches", "VIG clearly has great potential for use in many roles", "change of thought around my positive strengths", "despite our initial doubts, it has been beneficial and a real privilege to have had the opportunity to take part". I will maybe speak about this a bit later, but there was quite a few teething problems and I think quite a lot of resistance and cross misgivings as to whether this would work as an intervention method. So that is what that is referring to.

There were also some negatives identified - one which will be probably common to all of you in the room, is around the time to do the training and to put it into practice, to get time off work to attend the days, and also the technology did break down some of the time. Again, I can speak about that in more detail. We used what are called Flip camera's, but getting the software downloaded onto the local authority computers ended up being a big of a saga and didn't always work and limited the NQSW's ability to edit the videos.

So if we can turn to the hand-outs at the back of the slide in terms of the self-evaluation questionnaires - so it's on a scale of 0-100 - these were devised ... they had been used previously in social work education, particularly Jonathan Schofield has recently done a study of motivational interviewing and used these, so he kindly provided me with the ones that he had done and I adapted them for children and families NQSW's. So we had 15 areas where we asked them to evaluate themselves at the beginning and the end. So just in terms of some headline findings from that - I haven't included the consultant social workers in this, but just to say that they showed average increase in confidence levels of 15 points or more in all areas. The social workers were more mixed in terms of their findings, but the control group - that's to say those that didn't have the Video Enhanced Reflective Practice, increased confidence in 12 of the 15 areas and had one increase of 15 points or more. There were decreases in 3 areas, but those weren't primarily related to communication skills. So the one where both groups showed a decrease was in Category 11, which was around keeping accurate and helpful case records, which may well be around paperwork and the volume of paperwork which was there. The intervention group showed generally greater increases in confidence - so they increased in 14 of the 15 areas and they had 2 areas where there was increases of 15 points or more. In one area where they had an increase of 15 points of more was area 8, about challenging parent's constructively about safeguarding concerns , and the control group didn't. And we could clearly relate that to some of the course syllabus that we covered in VERP, so we could relate that to the stuff about difficult conversations and managing conflict. There were some others where the intervention group made progress, or more progress, and we might be able to attribute that to the VERP training or we might not be able to. So for example in area 13 - working effectively with other professionals within and outside your organisation' - the control group actually felt less confident, going from 73.3 to 68.9, and the intervention group showed an increase of 8 points on average. So we might relate that to VERP, but that wasn't specifically covered, but there was stuff about communication, inter-professional communication.

The last area was the vignettes, so I will try and describe briefly what we did. We have a vignette at the beginning and the end for all the people taking part, the intervention and the control group. We then, myself and a colleague sat down and graded them for each ... well we basically looked at the scenario and looked at 10 areas that we thought they could evidence through the scenario, through response to it, and then we gave them a score of 1, 2 or 3. So 1 was where there was little or no evidence in their response, 2 medium evidence and 3 there was strong evidence. And then in the hand-out that you have got, I have taken the average score for the control group and the intervention group at the beginning and the end. I have then looked at the difference between the beginning and the end score and the score at the bottom with a capital 'D' is the difference between the intervention group and the control group. So for example in 1 - demonstrates ways of building relationships with family members, engaging with family perspectives - D = 0.14 means that overall the average difference in score between the intervention and control group was greater by 0.14.

So the headlines, a slightly more muddled story - I suppose one of the positive things from the point of view of the training overall - there were positive differences in both groups between the beginning and the end of both sets of training. In the control group, in areas 4, 8 and 9, there weren't - and the intervention group, there were no areas where there were negatives for area 9, which was around knowledge of family and life (... unclear) where there was no change.

There was strong evidence of change in area 1 which is about building relationships and area 6 for both groups, which is around planning direct work with children. So an area which you think that the VERP training might influence because of its focus on communication, we might say that the increase change that we saw in the intervention group could be attributed to the VERP, albeit tentative. But there was also some areas where it was harder. So in area 4 - awareness of impact of poverty and social exclusion - the difference between the two groups is 0.52 - that was the greatest difference. And you might say that the VERP training, through focusing on what the other person was saying, through looking at parental perspectives, might have been behind that difference. But it's a harder case to make. So area 4, it wasn't entirely clear why the intervention group was significantly making more progress. And there was also one area of negative difference - that's to say where the people that didn't get the VERP training made more progress - and that was in knowledge of how to support families to engage with appropriate supports. And currently I have no explanation as to why that should be the case, other than perhaps the vignette didn't pick certain things up or people focused in the VERP training on interactional things rather than the care planning aspects in their written response. But I haven't really worked out why that might be and I am not sure I am going to have the ability or then very tentatively to suggest why that might be.

But the summary of the evaluation - first of all very positive learner's reactions, and I kind of regret, in hindsight, that we didn't map out what people said at the beginning of the training in more detail, because I think that could be one way of evidencing their positivity towards the training rather than just the feedback sheets - there was a real change in their attitude towards the training, but also I think their attitude towards themselves and their development. But there were positive learner's reactions, and they only get us to the bottom of Carpenter's scale, if you like.

Secondly, in terms of increased self-confidence, in most areas there was increased self-confidence for both groups, but the intervention group did clearly make more progress in two or three areas. And the last area around increased knowledge - again there were positives in most areas - both groups showed increased knowledge, and again with greater gains for the intervention group that were doing the VERP training in some areas related to VERP. But just to reiterate - one area where the control group made greater progress and gains for the ... that should say intervention group - in one or two areas that are harder to explain in terms of the VERP syllabus, we might make an argument and say people feel positive about themselves in their learning, they are more likely to learn in other ways. But again that is very tentative I think.

In terms of my own reflections on the process - there were substantial teething problems of which I was partly to blame. There were anxieties around the training and how effective it was - and because I wasn't maybe as knowledgeable about what VIG and VERP were at the beginning, I may have increased anxieties - and I did kind of arrive at a Newly Qualified Social Workers' meeting and think they would be really enthusiastic about it - not really figuring that there might be concerns about video recording, there might be anxieties about being recorded in that way and fears about being negatively judged through interactions. And I think it is one of the weird things about social work - is that the home visit and interactions with service users are often hidden - they are not scrutinised in social work education that much - you have your direct observations, but three during a long placement. And once you are a qualified practitioner, there is very little, other than perhaps colleagues' feedback that you get. So there is that whole kind of realm of social work interaction, the home visit, about which we know very little about how social workers host those meetings. So perhaps wasn't, in retrospect, very surprising that NQSW's, who were just new in the job, felt slightly concerned about it. And the other issue was time, and that remained a problem throughout, even with organisational support for NQSW's to attend.

In terms of methods, a real piece of learning ... I did speak to John Carpenter, whose model I showed you earlier on, just about having a randomised control trial - and he warned me - he said "you are going to have potential difficulties, because the people that don't get the VERP training are going to feel aggrieved that, you know, there is potentially a really good method and you are only giving it to some of them". In effect, it was the ones who actually were allocated to the VERP training that were less happy - they didn't feel that they had the time to do it - they felt it was an extra stress. And even though they ended up with very positive views on the training, it did add extra, I think stress to them at the beginning of what is a stressful period when you are starting in a new job as an NQSW.

Were the vignettes the best method to pick up the changes through VERP? Almost certainly no. and we used them for 2 reasons - partly because I wanted an overall overview of different areas other than the direct interaction, but also they were a cost effective way of doing an evaluation of knowledge. The best way probably would have been through using a video scenario or at least a scenario. I think that would have been difficult in terms of resources. I think it would have been difficult to get the NQSW's to buy into it as well, given that there was already anxieties. I think the idea of being assessed through a piece of video interaction would have caused more anxieties, and I am not sure we would have been able to get them on board for that. but I think ideally, if I was re-running it, I perhaps wouldn't have a random allocation and I would seek, as a result, to use video feedback.

And the final thought is around VERP learning and VIG learning, because one of the things that comes out around the focus of micro-interactions, and I think it is really positive - that micro-interactions is only part of the story. In any interaction, but particularly in social work, if you are very good in your interpersonal skills, but you are horribly unreliable, you don't do what you are say you are going to do, that you don't follow up on care plans - then obviously it only goes a certain way. So I think part of my reflection is around the micro-communications, but them leading to wider changes - and the micro-communication doesn't really amount of much unless you have those wider changes and those wider issues - that you are open, that you are honest, that you do what you say you do and so on. So yes, it is a very important part of the process, but only alongside those wider issues of professional reliability.


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