A knowing silence

Frontline practitioners should be experts in how best to improve
services, but their voices are often not heard. Frances Rickford
reports on why their input is so important.

Once upon a time, not so long ago, social work academics sat in
universities writing fat books, social services managers sat in
their offices writing business plans and social care staff were too
busy to take much notice of either.

Fat books and business plans are still appearing of course, but
over the past five years there has been a growing expectation that
the way people work in social care agencies – both managers and
frontline staff – should be based on something firmer than
ideology, custom or fashion. “Evidence” is the new must-have in
social care, not least because professional social workers need to
know why they do what they do, and to be able to make their case
confidently to colleagues from other disciplines such as
health.

But where is this evidence? The most obvious source is those fat
books. Academic research evidence, at least for those of us outside
the research industry, has a special authority. They can tell us
what works, and why.

But as many academics are eager to point out, life is not that
simple. In the first place, there’s not enough academic research to
provide by itself a reliable basis for practice, largely because
social work itself is barely 50 years old.

Secondly, there is very little research evidence that is
incontrovertible in terms of its implications for social work
practice. Two people can interpret the results of the same study in
totally different ways, and draw opposing conclusions about what it
means. They may disagree about the weight of a piece of evidence.
Some studies may be too old or too small to be helpful, or they
were carried out in the context of a different country. Often a
study will show an association between two things – for example
family poverty and child protection registration – but that doesn’t
necessarily mean one caused the other. A high proportion of people
die in bed, but the Health Education Authority isn’t advising us to
sleep on the floor.

There is another interesting problem about using academic social
care research to determine practice, and that concerns what gets
researched. Who decides, and why do those decisions get taken?
Would we be learning different lessons from research if different
questions had been asked – questions determined perhaps by users,
or practitioners, instead of the Department of Health or social
work professors?

When the Alzheimer’s Disease Society started involving people
with dementia and carers in decisions about how the society spends
its research budget, it found they had very different priorities
from doctors and scientists.

In social care, user-led research is becoming more common,
especially perhaps in the voluntary sector. In the Mental Health
Foundation’s Strategies for Living project, for example, mental
health service users undertook a large study looking at what people
found helped them cope with mental distress.

But what about the evidence of managers and practitioners about
“what works”? Academics are themselves often at pains to point out
that research evidence is useful only in conjunction with the
experience and skill of an individual practitioner. Every situation
is social care is different because each involves human beings and
relationships between human beings, so off-the-shelf answers are
never going to work. But what about harvesting and disseminating
some of that expertise and skill that practitioners hold?

Imogen Taylor is professor of social work and social care at the
University of Sussex. She believes the top-down management culture
of the 1990s in social care not only failed to exploit the
knowledge held by practitioners, but also may have damaged their
confidence in their own expertise. “My concern is that we are at
risk of losing sight of the practitioner.

“Practitioners over the past few years have become so submerged
in new initiatives and pressures it has become very difficult for
them to step back and reflect on their practice. The managerialist
culture of recent years has not fostered a climate which has
encouraged them to do that.”

In some organisations, staff are now encouraged to use their
practice as a basis for research. The Children’s Society for
example uses all its projects as a means to gather information
about a social justice issue which is then used to campaign for
change. One example is the York-based project PACT. The project was
originally set up about 20 years ago to provide respite services
for disabled children, but has developed into a research and
consultancy organisation.

Bernard Flanagan, a project worker at PACT, explains: “It became
clear from when we were providing short-term care that disabled
children needed to be involved in their own reviews, and were not.
Eventually the local authority took over the short-term care
service and we took on the role of researchers on the views of
disabled children, supporting children to tell about the things
that affect them most day to day. We try to work with young people
themselves as researchers, and we’ve developed a pack, based on our
own experience and the skills we have developed, on consulting
children with severe communications difficulties.”

The idea of a “learning organisation” is beginning to gain
popularity in the statutory sector, too. In Essex, for example, the
social services directorate supports staff to undertake “action
research” which will benefit the organisation (see box). The
research is accredited by local colleges, and can contribute to a
masters degree.

In Brighton, too, staff are encouraged to carry out research
projects in conjunction with local universities. Social services
director Allan Bowman says: “You want people to feel professionally
responsible for their own practice, so you encourage them to
undertake their own research to assess its effectiveness.

“For example, there might be a concern about the number of
looked-after children in an area. Someone might carry out a piece
of research looking at what we need to change in our practice,
focusing on what it is about working in this particular community
that merits a specific response.”

In the London Borough of Hillingdon, staff are encouraged to use
their own expertise to propose ways to improve both services to
users and working practices. It started off with a series of
workshops in which every member of staff was asked to come up with
one idea. The ideas were then discussed in teams, and the teams
introduced agreed changes. Now there is a monthly competition for
the best good idea, with a £50 prize for the winner. Ideas
already implemented included adapting the disabled toilets in a
waiting room to provide baby changing facilities, introducing
evening appointments for young offenders who are working, and team
“quizzes” on departmental policies to make them more fun for staff
to learn.

The Social Care Institute for Excellence, due to begin work in
October, will be trying to set up a national “knowledge base” on
good practice which assesses and interprets evidence from users and
staff as well as from academic literature. So how will Scie set
about collecting practitioner and manager “knowledge”?

Imogen Taylor argues that it’s not going to be a simple process.
The experts on how to go about it are, she says, frontline staff
themselves and Scie will need to work closely with them rather than
impose another demand upon them.

“We certainly cannot just expect them to add this to their very
high workloads. We will need to do as we have done with users. We
should start by looking with practitioners at where they are now,
and consult with them about how to develop their voice.”

Focus groups create supportive framework to ensure
consistency

Coral Moore, service manager for older people in Essex, wanted
to know how she could support managers in day care and home care
services to introduce consistent induction training for staff.

She set up three focus groups for managers, which aimed to
establish why there wasn’t a consistent approach, even though they
all had the same guidelines.

“They were all saying the same thing, which was that they feel
overwhelmed about the constant stream of paperwork coming from the
directorate, and the large number of policies and procedures they
have to work to, and are expected to communicate to their staff.
They felt guilty about taking the time to read and understand these
documents, and they weren’t confident they were working to the
current policy because there was no updated list available of what
was current.”

They went on to discuss what they would see as a supportive
framework for introducing all the directorate’s policies and
procedures, and decided that each person would take a document and
pick out the key points. From this, they brought together the key
areas and after a small pilot study, used them as a basis for
induction training for their own staff. A few months later they
went back and checked how well the staff had understood the
programme.

Moore says: “It went from me saying, ‘How can I support unit
managers’ to them saying ‘this is how we can introduce consistent
induction training for staff’.”