Guilt, Work and Switching Off

Over the weekend, I was reading Dorlee, from the ‘Social Work Career Development’’s guest post ‘The ABCs of Self-Care for Psychotherapists’ on ‘Private Practice From the  Inside Out’.

It is a useful and interesting list that can be extrapolated for many in the social work and social care sector – and probably many other sectors and areas where we work in stressful environments to be honest.
Libby's Guide to Total Relaxation

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It made me reflect on some of the ways in which our organisations work and are structured here in the UK and how unhealthy some of the ways we are forced to work are.

It is easy to blame poor management in the public sector (and that’s what I’m concentrating on, because honestly, that’s what I know) and in many cases it would be a fair place to apportion blame.

I have seen so many friends and colleagues ‘burn out’ by being almost criminally unsupported in the work place – ‘learning by doing’ through the false assumption that employers make that somehow social work graduates are immediately ‘ready for practice’ due to having one statutory placement.

Placements during the course are good arenas for training but they aren’t any more than a stepping stone to practice which is one of the reasons I am so strongly in favour of an assessed year of practice prior to registration as a social worker in the UK.

The real area for exploration though is the assumptions that are made at higher management levels about what work can and is safely carried out ‘on the front line’. I wonder sometimes what happens in the higher echelons of the Adult Services (and Childrens Services) directorates in the local authorities when they set some of the strangest and oddest targets and keep feeding the pressure on to the front line managers. It seems so very very distant.

So back to ‘self-care’ and ‘switching off’ from work.  It is something that, I think, for me anyway, takes practice.

I sometimes draw on my A level economics recollections of ‘Cost Benefit Analysis’ but instead of ‘costs’ and ‘benefits’ – I have the two ‘mental columns’ of ‘Things I can change’ and ‘Things I can’t change’ (without the financial implications!)

I can’t change whether Mrs M is going to have a fall this weekend. I felt that although she lacks capacity to make a decision as to her care and placement needs, it was in her best interests to stay at home in potentially risky environment as she had, prior to her dementia taking hold, indicated she never wanted to ‘go into a home’. She knows her way around her own home and while some ‘trip hazards’ may have been removed through an Occupational Therapy assessment and actions resulting from that, she remains a bit wobbly on her feet. Do I think about her when I go home on a Friday – sure, maybe a little – but I know I’ve done everything I could and I can’t stop her falling on a Friday evening or even on a Monday morning.

Am I worried about Mr Y who I assessed last week and made a decision not to admit to hospital under the Mental Health Act? Well, a little – after all, he wasn’t well and was disturbed – but I have to follow the criteria of the Act and I genuinely didn’t feel that he met them. Yet. I can’t ‘save the world’ or prevent all the accidents and incidents that might have adverse effects happening – so I try not to over-worry about them.

I am bound by the law of course and if someone doesn’t meet the criteria for compulsory admission to hospital under the Mental Health Act and they retain capacity – there’s nothing I can do. Quite rightly. Although sometimes, that instinct that drove me into this job – the ‘wanting to help’, the ‘wanting to make things ‘right’’ – it tries to pull me in another direction and those seeds of worry can be planted to blossom through the evenings and early mornings or over the weekend.

Sometimes I have to do this consciously and logically tell myself to evaluate situations.

Sometimes the worry comes because there are things that I haven’t done at work – telephone calls I haven’t made – reports I haven’t sent – visits I haven’t made.

Time is limited. As long as I can justify the time I do spend at work, I try to detach myself from these thoughts. I could always do more but the job is one of constant re-prioritising. Sometimes I forget to do things I’ve said I’d do or follow up on things I said I would. It happens. While it is my ‘fault’, I don’t necessarily see it as my ‘failing’. I know I can account for every single minute that I’m paid to be at work – even those minutes that I’m sitting chatting to colleagues about the weekends’ television or having a cup of coffee – because if we don’t have those minutes, we run the risk of further rushed, unreflected, unthoughtful pieces of work.

Colleagues have told me since my first social work job how important it is to look after ourselves in this profession.  The spur that often drives people into social care is a wish to make a difference and perhaps a desire for self-validation – the odd pat on the head of feeling that you made a positive difference to someone’s life. Unfortunately that same trait which is usually a force for good can be used and manipulated by managers to force people to work overlong hours, not take breaks throughout the day, push people to take work home because, you know, Mr K will suffer if you aren’t able to finish the paperwork this week. They know well how to pull on our ‘conscience’ because the same happened to them when they were mere practitioners.

It’s hard to say ‘no’ when you know the people involved. I’m drawn into some of the guilt because I promised to visit Mrs P last week. Well, I won’t say promise, because I don’t put things in those terms, but I said I would – then things happen and other things seem to take over and the telephone call about this or that suddenly has to take priority – and before I know it the week is over and I haven’t seen Mrs P or written up the report that I should have or telephoned a family member to confirm dates for respite.  It’s hard not to feel that I haven’t done my job.

But by weighing up what I did and how I prioritised, I can, at least switch off and learn to ease some of the personal responsibility by redrafting and reframing it as organisational guilt and responsibility.  That isn’t to say that I slack off or try and push the blame on others – to be clear, I never do that with a service user – and always take personal responsibility there as the last thing anyone ever wants to here if they are upset, disappointed or distressed is a social worker trying to fob them off on someone else – but mentally I try and differentiate between ‘things I can change’ and ‘things I can’t’.

For me, it works. But sometimes it’s something that has to be learnt each for themselves.

Social Work Education and the Munro Report

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I won’t apologise for not having read the entire Munro review on Child Protection which was published yesterday (and can be read here)   by this morning – partly because there is so much coverage of the contents in the press –  which I know isn’t the same as reading the document in its entirety myself, but also because I don’t work directly in child protection services so my knowledge of the systems as they are currently and how they are proposed is not based on experience and knowledge so I don’t think I can necessarily add anything to the discussion which isn’t already ‘out there’.

The Guardian has a good general summary of the proposals  and there is, unsurprisingly, extensive coverage in Community Care through a number of articles.

In some ways, it has been confusing for me, as a social worker who does not work in childrens’ services to understand how the Munro report links in with the Taskforce which was, I thought, carrying out a more general assessment of social work and how the specific proposals regarding social work in the Munro report will feed back to the Social Work Reform Board.

I want to focus on one of the recommendations particularly though because it is an area that I think may have significant implications for the profession as a whole.

Recommendation 12 reads that:-

Employers and higher education institutions (HEIs)
should work together so that social work students are prepared for the challenges of child protection work.   In particular, the review considers that HEIs and employing agencies should work together so that:
•     practice placements are of the highest quality and – in time – only in designated Approved Practice Settings;
•     employers are able to apply for special ‘teaching organisation’ status, awarded by the College of Social Work;
•     the merits of ‘student units’, which are headed up by a senior social worker are considered; and
•     placements are of sufficiently high quality, and both employers and HEIs consider if their relationship is working well.

It is incredible to m e that there are not already more guidelines about what constitutes a ‘practice setting’ in social work training. Ready-to-practice Social Workers rarely emerge perfectly formed, on graduation. Yes, there is a need for more stringent guidelines in the universities regarding placements and the quality of students that pass the course but, and this is a big but, local authorities, and in fact, all employing services , really need to take responsibility for training the social work graduate to become a professional. I know there are some steps being taken in this way but it is not fair to demand statutory placements prepare a student for statutory practice and that employers discriminate in favour of those who have been fortunate enough to get the ‘right’ placements. Why don’t local authorities invest a few months to ‘create’ their own internal placements across all areas of social work, adults, children and mental health to ensure that social work graduates get broader experience rather than expecting graduates to perform immediately.

I know there is discussion about having an assessed year in practice before being registered as a ‘social worker’ but this will only happen if it is forced on the local authorities as in a climate of cuts they can’t afford to take on and train anyone who isn’t immediately capable but this weakens the profession as a whole.

I have never understood, not really, why it is the jobs in child protection social work that are taken by the newly qualified social workers. Surely it makes sense to have some kind of post-qualifying training similar to the AMHP role before taking on what is one of the more complex and risky areas of social work. I couldn’t arrange a compulsory admission to hospital for someone until I had substantial experience as a social worker and a further extensive qualification and a great deal of observed practice and had to pass an additional legal exam before I could do so. Why is it not the same in child protection work?

Cost, I suspect – but since I qualified 10 years ago, and probably for a long time previously, it was a known fact among my cohort that there would always be jobs for newly qualifieds in child protection – and then, often, comes the burnout and the move into management – not by people who have any particular management skill but the people with the ‘right’ faces or those who just want to apply in order to escape from frontline practice themselves. Being bitter or having had poor models, they perpetuate the toxic and oppressive management styles that are embedded in systems which are dependent on targets and so others come into the system with poor supervision and poorly modelled management roles and the profession deskills as no critical appraisal is required – just form filling ad infinitum.

Student units existed before my time but I’ve heard only positive things about them at Practice Assessor’s forums when other Practice Assessor’s hark back to the ‘old days’. The utter frustration of working in this profession is the cyclical learning or non-learning processes which seem to lead us back to where we started from over and over again.

The report also says

Degree courses are not consistent in content, quality and outcomes – for child protection, there are crucial things missing in some courses such as detailed learning on child development, how to communicate with children and young people, and using evidence-based methods of working with children and families. Theory and research are not always well integrated with practice and there is a failure to align what is taught with the realities of contemporary social work practice.

I’m in a lucky position in that students have come into teams I have been working in from just about every London university – because of this, and in discussion with them, I do pick up an idea of the differences between universities and yes, differences in content and quality (I can’t really judge outcomes) is massive in my own experience.

I am concerned about the focus on detailed learning related to child protection as I am sure it would probably push out learning which is already significantly limited in adult and mental health work.  I hope that universities reading this don’t forget that the training is generic. One of the differences I’ve noticed between universities is that some ask their students to specialise after one year (in the Masters) or two years (undergraduate). I’m not sure how helpful this in a generic degree where there is little enough time to cover everything anyway. I would hope that the year post-qualification when the newly qualified social worker has a position would be the time to specialise and train in a more focused way in a particular area.

I don’t think it’s fair to expect universities to pump out ‘ready to practice’ social workers. There is not time enough to do that. There needs to be more training and development in practice.

This all costs though, and there’s the rub with almost all of the proposals. Changes cost. Although of course, the cost of not changing could potentially be much higher.

So many people with and without voices have a stake in creating a good, strong and cohesive social work profession – I just worry that between a College of Social Work, the British Association of Social Workers which has decided to also call itself a College of Social Work, a Social Work Reform Board and a possible Chief Social Worker – we don’t end up with too much confusion at the top of the profession and lots of talk in the absence of any change.

I’ll try to be hopeful though because if I weren’t I’d despair.

Things can only get better.

World Social Work Day

Tomorrow is World Social Work Day. As I am taking a break from updating the blog this week (apart from today!), I am writing my post for the day now.

I wanted to consider a few things in relation to the ‘celebratory day’ such as it is although celebration seems a bit raw in the face of the  humanitarian disaster taking place in Japan. I don’t want for there to have to be these disasters to provide context. People do not need to suffer in order for me to learn. But my human reaction to those pictures is to look inside myself for ways that I can console my own thoughts. Part of human nature is to look for answers. We have enquiring minds. I am not religious although I toy with agnosticism. I thought the Independent’s piece was thoughtful though.

Back to World Social Work Day. I’m not doing anything special to ‘celebrate’ apart from going to work. Which I think, in this economic climate and amid the vagaries of chance and an angry earth, more to celebrate on this Monday morning than I might credit.

I am going to spend World Social Work Day not celebrating as such. I think for me, the day will be more about inward reflection and consideration of what it means to me to be a social worker. What the job has provided me with and the areas which I am still lacking in.

How can I learn to be better at my job? How do I reconcile the tough days when I arrive home exhausted with the good days when things fit together? How do we become more confident as a profession to the extent that we don’t need external bodies to ‘speak for us’ and we don’t rely on the morsels that the media throw at us but we can stand among ourselves and have enough confidence to be proud of being social workers without having to claim a need to be like doctors, or nurses, or occupational therapists or teachers.

I see an issue of a lack of professional self-confidence. We are, in the UK, generally, servants of the state and often despised. But we also buy into it and just as I would tell an adolescent that she needs to learn to love and respect herself before anyone else will – so I feel a need to tell our still, in some ways, adolescent profession, that we need to learn to love and respect ourselves – as social workers – before anyone else will.

Regardless of media interviews, regardless of social media campaigns. If we are not advising our children to become social workers, we should work on creating a profession that everyone, including our children, will strive to join.

This is no time to be bashful but before looking outwards for approval, we need to seek it internally – amongst ourselves.

So for those social workers, on World Social Work Day, it’s worth looking on what it is you want to achieve and how being a social worker will help you. And if it won’t, consider what needs to change in the profession for you – for us – to be able to realise our goals.

I love my job. I’m proud to be a social worker. I heartily recommend the profession and anything else I have done has not been as stimulating and challenging. I  have found qualities that I never knew I had and have been able to develop them  but now I see a flailing and unconfident profession.

Not helped in the UK by the bickering over the identity of social work by the professional organisation and the nascent College. My message to BASW would be to listen to your members rather than the Council and treat democracy seriously – while remembering you only represent 13,000 social workers – some of whom are not English (so wouldn’t be part of the College) and some of whom are members for the insurance benefits. You can’t take a unilateral decision and palm it off as ‘democracy’. My message to the SCIE ‘college’ would be to take listening seriously if you want to gain credibility.

As Social Workers we shrive for social justice and providing a voice for those without one. So a College for Social Work needs to consult and provide channels for the voices within the profession that don’t always shout the loudest.

Finally, I’d recommend this post by JaeRan Kim. Watch the videos. And reflect on why we do this and what we need to do to make our profession stronger. It isn’t about colleges and unions and professional organisations (although they all have a place) – it is about self-confidence, a strong moral and ethical compass and strong reflective practice.

Happy World Social Work – I’ll be back at the weekend!

 

NB Tomorrow, The Guardian Local Government Network are having a Q and A session between 12pm – 3pm about achieving a work/life balance in social care. Very topical for World Social Work Day!

Balls and Hypocrisy

Just a quick post today. I was minding my own business reading the Evening Standard on my tube journey home yesterday when I came across the following headline

GORDON BROWN ‘FUDGED AND TRIMMED’ TO PLEASE DAILY MAIL, SAYS ED BALLS.

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I had to double-take and hold down a rue snigger. This is ED BALLS! The man who put an agony aunt from The Sun on the Social Work Taskforce! He is criticising Brown for pandering to the popular press?

Seriously.

I know social workers aren’t his target audience but Ed Balls really thinks he can gain favour by criticising Brown over this when he displayed the worst examples of actively pursuing the ‘hang ‘em’ brigade of the right-wing press in the aftermath of the inquiry into the death of Peter Connolly. He was the first to appear in the popular press telling them exactly what they wanted to hear and handing Sharon Shoesmith and the socialworkers involved, in Haringey,  to the howling press and public. All for the sake of some popularity.

Seriously.

I don’t know what planet Ed Balls is on but he is certainly in no place to criticise Brown for pandering to the press when he engaged in far worse during his unfortunate tenure as a minister.

Safeguarding

I have a few safeguarding investigations underway at various stages at the moment. There are a lot running concurrently and while wanting to patter off the usual gripes and groans about workloads increasing at different rates, at different times of the year – I can safely blame my current predicament on a shortage of staff and of people who have trained up to complete safeguarding investigations within our team.

Historically, it would have been one of those situations which would have been lead by the social workers in a multi-disciplinary team – because the local authority provides additional training for us in this respect and it is seen to fit into the ‘social work’ role and domain  but over the last year, this training and this role has been extended to other disciplines.

For my part, while I don’t want to discuss any of the details of any of the cases, there are some interesting comparisons to make in some of the factors involved.

In two of them, the people with whom I work are the alleged ‘perpetrators’ – both ‘incidents’ took place with residential care settings. This is not as uncommon a situation as might be assumed. We are often, with the resources we have, placing people where the beds are – sometimes there is little choice in the process because there is such a limited resource of the right type of beds in the right type of areas. It may be pot luck where a bed turns up and who might be placed in the room next door. This isn’t meant to scare anyone in this position but it is an interesting recognition of the status of the older adult in our society and perhaps a remnant of the ‘work house’ model.

There are some and actually a lot of excellent residential and nursing care homes and a lot I personally know that have thoroughly devoted and hard-working staff but the care homes that we work with exclusively are privately operated. Times are hard and everyone has to pay attention to base line costs. Placements can be ‘worth’ thousands and homes may feel either pressured (by social services departments, by social workers, by their own wish to ‘help’) to take placements that might not be ideal for all the residents already in situ.

While there is a lot of excellent work done in smaller group homes for younger adults with learning disabilities, the cost of smaller homes is much higher and the funding for older adults is much lower in general so there is less attention, less choice and arguably poorer quality of service. Often the quality depends as much though on the individual members of staff who may be working on particular days as the physical layout of the home but it figures that paying at minimum wage level is barely going to promote extensive loyalty to a particular care home or team. Some companies capitalise on these matters by feeding off the better nature of caring members of staff and it’s hard to argue for raising costs at the moment when money is so short but it comes as no surprise when quality is poor.

Abuse within residential homes between one resident and another can be dealt with in different ways and I have seen very different approaches used – from the ‘trying to brush things under the carpet’ type approach where the care home were terrified of local newspapers and family members of other residents finding out what had happened and trying to cover up a serious criminal offence committed by one resident on another – to an over compensation and a crack down on what might be assumed to be a relatively minor incident with very little risk to either party, that would happen in any situation when you put together a group of people.

In all these situations, there is a balance of risk assessment that needs to be considered particularly where capacity and understanding is a factor.

One of the interesting points for me is that I am party of the investigation process of other social workers in other teams. This led me into one particularly tricky situation as one of them I felt was, to be frank, making a complete hash up of the process and was adding little coherence or clarity. I tried not to be over-critical to a point that I felt her practice was pretty poor and I did raise this. I know, it isn’t very comradely but I felt no great affinity due to the way that things had been done.

I tried to highlight it as a very clear training need rather than as poor practice and I do genuinely believe it was because she either hadn’t been guided particularly well by her manager or hadn’t a clear handle on the process herself.

Then I found out she was actually an unqualified worker. She shouldn’t have been carrying out safeguarding investigations at all. Cue the slightly guilty feeling along with more than a little frustration geared towards her manager who has both badly advised her in the processes of the investigation and has placed her in a position to do work that she really shouldn’t have been doing. It is a completely different team and service area from the one in which I work so I have to be measured and I’ll probably wait for the conclusion to input more about this particular matter as I’ve made my feelings and thoughts known but I can guess why it has been done.

Staffing levels and funding. The cuts are not going to be brushed off easily.

Of the others I have in progress, one is a very straightforward (because there is a stack of substantial evidence that is irrefutable) but unpleasant, another seems to be a little more difficult to extract as it may have depended on a few misunderstandings but it may not have.

I know it has been recorded and researched that adult abuse is rife. I know there are reams of policies written about it but it does still seem to be misunderstood in a lot of settings – particularly the policies where a service user – usually either residential or day services – is an alleged perpetrator. Sometimes the policies which try to compartmentalise don’t allow for much give or if someone is both an alleged victim and an alleged perpetrator.

Perhaps it is due to societal predispositions and assumptions about the status of who a ‘victim’ is and who a ‘perpetrator’ might be.

One of the best lessons I’ve learnt and one of the most useful as I try to follow through all these pieces of work simultaneously is to try and cast aside as many assumptions as possible. The longer you work with people the more you realise how wholly misconceived  some of these assumptions can be.