Liberate social work from its procedural constraints

Social work in the UK needs to be freed from its organisational constraints in order to be more effective. Across child and family social work, adult social work and mental health social work, practitioners are locked in to procedural activities which prevent them from utilising professional skills and achieving better outcomes for children or adults.

The findings of two recent studies in different settings suggest that the organisational context and culture in which social workers are employed prevents them from implementing practice which has been found to improve outcomes for people. A trial of motivational interviewing in children and families’ social work, and a pilot of Connecting People in adult and mental health services, both found that outcomes were determined more by organisational culture than individual practice.

Motivational interviewing

There is good evidence that motivational interviewing helps people overcome ambivalence about making changes in their lives. It has helped people to resolve problems with addictions, or a lack of exercise, for example, and has even been used in involuntary settings such as prisons.

Social workers trained in motivational interviewing can use it to support people to make changes in their lives. In a recently published paper in Children and Youth Services Review, Donald Forrester and colleagues explored if it could be used by social workers to better engage parents in child protection proceedings and support them to achieve their goals. He used a randomised controlled trial in a London local authority to test this out.

Randomised controlled trials in social work in the UK are rare. However, when conducted well, they are arguably the most reliable way of testing if a particular way of working with someone improves outcomes for them. In this case, Forrester evaluated if motivational interviewing could improve parental engagement with social workers and their attainment of goals.

Social workers from Child in Need teams in a London local authority were randomised to receive either motivational interviewing training and supervision or not. 165 families were allocated to workers at random and interviewed by researchers at two time points to evaluate if motivational interviewing made a difference.

The study found that training and supervision improved the motivational interviewing skills of social workers, particularly their empathy. However, it also found that there were no differences in outcomes for families. Families allocated to workers trained in motivational interviewing were no more engaged with their social worker than those in the control group. Other outcomes such as goal attainment and mental health were also the same in both groups.

The authors suggest a number of reasons why no difference was found. For instance, as most social workers only saw the families three or fewer times during the 20-week follow-up period, it is possible that their skills had limited opportunity to impact on the families. However, when they did meet with families, the meetings were not obviously about change. Their primary focus were on previous or forthcoming meetings or otherwise meeting the needs of the system.

“Put bluntly, MI [motivational interviewing] was introduced as a way of helping parents and families, and often it did not really feel that was what the ‘child protection system’ was trying to do” – Forrester et al, 2018, p.23

They found that supervision for practitioners largely focused on procedural tasks, and this was mirrored in meetings with families. The focus was on risk assessment and management rather than change in families. Forrester and his colleagues concluded that organisations produce social work practice as much as, if not more than, individual practitioners. Therefore, shaping the practice of individual practitioners will only have limited impact on the effectiveness of social work practice.

These findings struck a chord with me as they chided with my own conclusions drawn from research in adult social care and mental health services.

Connecting People

When we developed Connecting People, a model of practice which supports people to develop contacts with others through engagement with their communities, we included a role for the organisation within it. We had found in our exploratory work that led to the development of the model that individuals’ practice was shaped by the organisation they worked for. If we are to improve outcomes for people using services, change is required at the organisational level as well as the individual level.

Our paper reporting the findings of the pilot of the Connecting People model has recently been published online by Research on Social Work Practice. This study of the outcomes of Connecting People for 155 people with a mental health problem or a learning disability found that organisations able to implement the model in full saw increases in service users’ access to social capital and perceived social inclusion.

Adopting the Connecting People model of practice was more readily achieved in the voluntary, rather than the statutory, sector. However, one community mental health team for older adults in the study was able to fully implement the model. This team was embedded in their local community with good connections with local networks, resources and assets. Practitioners were able to implement a social model of practice which supported people to engage with new activities in their local community, which facilitated new social connections.

Our finding that only one of the community mental health teams in the study – in which individualised health models of practice predominated – was able to fully implement Connecting People led us to question whether the culture and context of teams can change to accommodate social models of practice.

As in children and families services, social work in many integrated community mental health teams has become proceduralised. Engaged in Care Programme Approach procedures and bureaucracy associated with Payment by Results care clusters, mental health social workers have limited capacity for therapeutic work in general, and community engagement work in particular. This appears to be even more the case in local authorities who have withdrawn mental health social workers from community mental health teams. Here, their work is focused on statutory Approved Mental Health Professional roles or Care Act assessments.

We realised that without wider organisational change and adoption of the model, training for mental health social workers in Connecting People will only have a partial impact. Therefore, we developed an implementation toolkit for community mental health teams to use when implementing Connecting People. This emphasises a team’s collective responsibility for implementing the model rather than just individual practitioners. For the model to be effective it requires teams to engage more fully with the communities in which they are based, and develop and share these connections within the team and with people who use the community mental health team.

The implementation toolkit is currently being evaluated in a study funded by the NIHR School for Social Care Research. I will write a separate post on this in due course, but in the meantime I’m interested to hear about how teams in which social workers practice have taken on board new models of practice which focus on improving outcomes for children or adults.

In your experience, is it possible to change an organisation’s or team’s culture? How can social workers employed by local authorities or the NHS undertake statutory responsibilities and use social interventions to improve outcomes for children or adults? How can we tackle the predominance of procedural activities in social work practice.

Please share your thoughts or examples of good practice below. Thanks!