How do you do relationship-based practice?

This month sees two years since the introduction of the Team Around the Relationship in Brighton & Hove Children’s Services and the move to Social Work “Pods”. The new structure was a crucial part of whole system change to support relationship-based practice, providing containment and collaboration for social workers to enable confident practice with families. Principal Social Worker, Tom Stibbs, reflects upon the service transformation that took place and thinks about how you do relationship based practice:

After ‘why are they called pods?’, one of the most common questions about our model of social work is ‘how do you do relationship-based practice anyway?’ 

One important thing to say about relationship-based practice at the outset is that it is not just a skill you teach.  It is about a whole approach, or way of being, whether this is for an individual worker or an entire organisation.

That is why our model of practice is built on cultural change to support social work practice.  We could have simply told our social workers to go off and do relationship-based practice, and sent them on a training course to teach them to do this, but this would not have embedded sustained change. There is a danger in using Donald Forrester’s phrase, ‘culture eats training for breakfast’ too glibly, but it really encapsulates a powerful message for those wanting to implement systemic change – culture counts most (Glisson and Williams 2015).

Instead of just saying to workers to go and do relationship-based practice, what we are trying to do is to become a relationship-based organisation.  By doing this we believe we will create cultural change that will support relationship-based practice.

So what does becoming a relationship-based organisation mean?  For us it means embedding the 6 mechanisms, or principles, of relationship-based practice as we conceive of it – our theory of change at an organisational level:

• continuity of social work relationships with families – so families do not have to change social workers or re-tell their stories because of our processes;

• consistency of social work relationships with families – so families have support from a team that knows them;

• collaboration between practitioners – so workers share skills and specialisms to promote change for children and families;

• social workers as change agents – so that support is purposeful, outcome-focused, and builds on families’ own strengths;

• creating a learning culture, and;

• developing an organisational culture which is open and just.

Crucially the model of practice is not about imposing these principles in a hierarchical top-down way, but trying to implement them by modelling this way of working at all levels of the organisation.

The initial question might be reframed as ‘how does being employed by a relationship-based organisation impact on your practice?’  Feeling supported and contained by your managers might mean that you can hold and contain the anxiety of the families you work with supporting families to affect change in their lives (Luckock et al, 2015).  Collaborating and sharing skills with colleagues and being part of an organisation that learns from things that go wrong might help you to work with families to affect change.  Being supported to take responsibility for your own practice and development might help you to work with families, not do things for, or to, families. Being part of an organisation that provides you with ‘high expectations, high support and high challenge’ (Ofsted, 2012) and helps you to be the best practitioner you can be might mean that you can help families to be the best that they can be (after Donald Forrester’s blog, MI and social work).

So what does this kind of practice look like?  Gillian Ruch emphasises that relationship-based practice recognises that human behaviour is complex and multi-faceted and each social work encounter is unique. Thus, while many authorities have implemented practice frameworks based on a single skills set, such as Motivational Interviewing, we believe that it is the common elements across well-indicated ‘interventions’ or methods that constitute ‘relationship-based practice’. Relationship-based practice is, in effect, based on the best of MI, Signs of Safety, systemic thinking, mentalisation, See Me Hear Me, the Secure Base Model and so on.  Within the Team Around the Relationship, relationship-based practice can best be articulated as the ‘containment of anxiety’ supported by specific knowledge and skill contingent on the child or family’s particular situation. Complex situations require complex responses.  This is the theory of change at the practice level.

The evaluation of the impact of the model so far (Empathy, tenacity and compassion: an evaluation of relationship-based practice in Brighton & Hove) suggests that we are getting the cultural mechanisms in place and that these are beginning to support change at a practice level and change for families.  This does not mean that skills, and the teaching of them, aren’t important.  In fact, the evaluation emphasises that the next stage of implementing our model needs to focus on change at a practice level supported by practice tools, training, and reflective discussion.  How social workers talk to families, understand families and help them to change are crucial skills (as demonstrated memorably by Donald Forrester at our first Relationships in Practice conference in 2015).  What relational practice should look like, focusing on what social workers do on visits, was also the subject of Harry Ferguson’s presentation at our conference last year (Why Relationships Matter?). How this might translate into assessments, and the ‘difficult conversations’ that are fundamental to relationship-based practice, is emphasised by Andrew Cooper in his blog, based on his visit to our Clermont Family Assessment Centre (Relationship-based practice works – the evidence).

Relationships are important, but it is how you use them which is crucial.  As Forrester, states: ‘relationship-based practice – provides a discipline of helping that challenges us to do more than simply building relationships. It challenges us, as Bateson memorably said, to “be the difference that makes a difference”.’

If you have any comments on Tom’s blog, please contact him at tom.stibbs@brighton-hove.gcsx.gov.uk or follow him on twitter @TStibbs