How attachment theory can transform adult social work and save councils money

How can social work adapt to increasing consumer expectations and demographic demand against a backdrop of diminishing resources? Since the 1988 Griffiths report into community care, the emphasis in statutory social work with adults has been the allocation of resources to meet assessed need, firstly through care management and latterly through the introduction of resource allocation systems.

However professional social workers are only too aware that throwing money at people’s problems doesn’t necessarily solve them. For some citizens and their families, a narrative of deficit and dependency, rooted in unresolved loss, means that services are at best a sticking plaster. For others, an unexpected crisis brings out a host of strong emotions, especially fear, which drives the family’s urge to protect, often regardless of individual human rights and freedoms.

Councils have typically responded to the austerity measures through bureaucratic means. By increasing eligibility thresholds, cutting services and retendering contracts they reduce supply-side costs but do nothing to act on demand. Integration and total place approaches reduce duplication between public services and improve efficiency. Investment in prevention, reablement, and community capacity-building aim to deliver demand-side efficiencies, but do not address the rising demand that inevitably crosses the eligibility threshold.

Narrative of dependence and deficit

There’s a deterministic ethos underlying the policy agendas, which says that eligibility is avoidable for some, but not all, and once a person is eligible, there is nothing more that can be done; they just need adequate resources to meet their needs. And the nature of the beast means that greater dependency brings greater budgets, so rather than underpinning the rhetoric of hope and self-determination, resource allocation may well contribute to the narrative of dependence and deficit.

Can social workers reduce demand from eligible citizens, and if so, how? Since 2012 all adults social workers in Sutton have been trained in ‘attachment-based practice with adults’ in a series of short courses comprising seven days in total. If you haven’t revisited attachment theory since Bowlby and Ainsworth the fact that it is entirely relevant to work with adults may come as a surprise.

Professor Patricia Crittenden’s work identifies three adult survival strategies that, at their extreme expression, will undermine trust and well-being and even lead to harmful behaviour. These manifestations relate to the experiences of predictability, safety and responsiveness from early attachment figures. Predictable but frightening parenting on the one hand, or that which is inconsistent or unreliable, can result in adult strategies that are, respectively, very guarded and undemonstrative or, conversely, excessively expressive and focused on a sense of personal hurt, abandonment and betrayal.

Careful, respectful listening

The way we tell our personal history offers a rich insight into how self-image and world view are constructed and rooted in early experiences of safety. But this view carries the optimism of a strengths perspective rather than determinism and pathology. The important message is that behaviour that causes concern has meaning which, with help, people can unlock. The careful and respectful listening and enquiry of an empathetic social worker may be enough to empower the person to reframe their narrative. This is social work, not psychotherapy.

Clark Baim offers a methodology for structured conversations around attachment experiences, in the book he co-authored with the late Tony Morrison, Attachment-based practice with adults. He has been delivering training in Sutton based on this since 2012. The familiar Morrison trademarks, of self-reflection and good supervision, are central features. Baim says of the model:

“It helps to explain and understand a great deal about human behaviour and how we as humans cope when experiencing stress, threat, danger or loss…[It] can help us enormously when we are trying to make sense of our clients’ behaviour and to formulate plans that are more likely to help them to make needed changes and access support.”

Significantly improved assessments

Can busy social workers make time for this approach? Baim believes a greater accuracy is achieved in assessment when a worker is attuned and attentive, leading to collaboration and connection with informal support.  It is notoriously difficult to prove direct impact of training on service user outcomes (Carpenter, 2005). However this training has consistently received excellent ratings, and anecdotal practitioner evidence points to entrenched family situations becoming eased. Objectively, managers report significant improvements in the quality of assessments. Attachment-informed working has played a part in less risk-averse and more person centred practice while expenditure on traditional service models and placements has considerably decreased in Sutton. The council’s strategic director of adult social services and housing, Adi Cooper, explains:

“I believe it supports social work skills development and improves the quality of relationships and outcomes for vulnerable adults. As leaders, we have increased our demands on frontline staff in terms of understanding and supporting people in increasingly complex and risky situations. This training has been really critical to support a cultural change – to make personalisation, choice and control a reality in Sutton and to reclaim adult social work.”

Sutton’s experience of developing new models of working suggest that we may be able to square the circle of reclaiming social work with the reality of austerity.

Angela McAndrew is training and development manager, adult social services and housing, at Sutton Council.

Sources

Baim C/Morrison T (2011), Attachment-based practice with adults, Pavilion Publishing

Carpenter J (2005), Evaluating outcomes in social work education, Social Care Institute for Excellence/Scottish Institute for Excellence in Social Work Education

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