Social workers responding to a recent Community Care survey revealed the devastating consequences faced by some people who have had their care package cut, or whose eligible needs for support to maintain relationships and access their local community are not being met.
In identifying how reductions were being made, practitioners reported an increasing need for people to be diverted away from council-funded support and instead to access universal services, call on family and friends for informal help, or be signposted to voluntary and community organisations, to meet these needs.
I was told to provide this gentleman with information on local lunch clubs and social clubs [and] had to make him aware that there would be a cost for this service and that transport is also not covered.” Social worker
While some respondents cited budget pressures and shrinking provision as drivers for this trend, these approaches are also hallmarks of strengths-based practice, an approach that focuses on building on people’s strengths, rather than focusing on their deficits, to achieve better outcomes.
This approach has gained traction in recent years, so do these findings point to a positive shift in the way social care support is being delivered, or is the model simply being used to justify cuts?
Tensions over strengths-based aims
Recent publications from government and council leaders highlight this tension clearly.
Last year’s Association of Directors of Adults’ Social Services (ADASS) annual budget survey found that 82% of directors saw developing asset-based and self-help approaches to reduce the numbers of people needing long-term care as “very important”, with 33% of planned savings for the 2018-19 financial year expected to come from this route.
Conversely, the Department of Health and Social Care’s (DHSC) framework and handbook on strengths-based practice, published in February 2019, said the reduction of care packages was “generally a collateral benefit” of this approach, but it should not be the intended outcome.
More on strengths-based practice
Martin Routledge, convenor of the Social Care Future movement and a former social worker and civil servant, says he hears “all the time” of areas using strengths-based approaches as way of making savings. He says the value of the approach is in how and why you use it.
“Where councils are under massive resource pressure and the culture or leadership is such that they are not focused sufficiently on the right things, then they won’t use this for the right reasons.
“But in places where there are staff who are absolutely driven to help people who need some kind of support from social care to get that in a different, better way, then it will be used well.”
Routledge adds that the costs pressures faced by councils cannot be ignored and will have “concentrated people’s minds”. But he believes the increasing emphasis on strengths-based practice is also due to the ideas and values that underpin it now gaining more traction.
“These traditions have been around for a long time, but in the last few years there has been more focus, more research and more experiments that people have been trying out locally,” he says.
“Both in health and social care, there is now an increasing emphasis on the ways in which people can take charge of their own lives and on how service resources can be used differently.”
As the DHSC handbook describes, strengths-based practice does represent a clear shift away from the care management model, where people are assessed to identify deficits and offered a traditional service like home care to address these, an approach considered by many to create a dependency on social care services.
People were seriously over provided for by a NHS driven medical model of dependency. Unintentionally, the cuts have led to greater focus on strengths, less on deficits and better outcomes for individuals.” Social worker
Instead, a strengths-based approach is holistic and based on the “fundamental premise that the social work relationship is one of collaboration”, the DHSC handbook says, and while it acknowledges a person’s disability or illness, it shifts the focus to the positive attributes of their lives and recognises “the capacity, skills, knowledge and potential that individuals and communities possess”.
“This is important because we really need and have done for a long time to move away from a system that places people into service options that we have determined for them,” Routledge says.
“What you’re looking for is the win-win of people being able to get supported in ways that work for them and not get drawn into elements of a service system that actually aren’t what they need.”
Building social capital
There are a number of different models that sit under the umbrella of strengths or asset-based practice, including local area co-ordination and three conversations, but they all have similar trends, and focus on drawing on the strengths, skills and knowledge of a person, their social network and the community resources around them, which are sometimes referred to as ‘social capital’.
Beverley Latania, co-chair of the Adult Principal Social Worker Network, says most councils have now opted to use a particular model, but she adds that, as the work is taken forward, it is imperative that it is not done “over and above” the consent of the service user and their carer.
“Getting the service user and the carer right at the heart, as the driver, and having them fully involved in that co-production, multi-disciplinary way is how we’ve got to proceed,” she says.
When asked what an example of strengths-based practice disguised as a cost-savings exercise might look like, Latania says: “If someone is coming out of hospital, it would be something like the social worker going in and saying this has happened, this is what you need, but your carer is there so they can do the shopping, the cleaning and therefore we’re not going to facilitate any support.
“That’s a very simple story – but it’s that lack of recognition as to what the carers needs are, not asking the right questions, not facilitating a discussion and just making assumptions.”
‘Giving social workers freedom’
Strengths-based practice, Latania says, should be a method, a conversation and a communication style – not “a decision-making tool for eligibility”. It should be about making connections with individuals, trying to identify the person’s story, and “allowing social workers to get away from the template”.
“A lot of councils implement long, wordy assessment documents that are a kind of script that social workers or social care staff have to follow and it’s very difficult to deviate from that,” she says.
“If you want to implement strengths-based practice really well, then you need to do away with those and give social workers the freedom and the time to go out and just have the conversation.”
A strengths-based approach also requires a culture shift within the whole local authority, with social workers, middle managers and resource managers who fully believe in this way of working, says Rob Mitchell, principal social worker at Bradford council.
“I think the evidence is there as to why these approaches work, but I think you have to be really careful that you don’t impose strengths-based working,” he says.
“This is not a top-down cascade where people fall into line and support it – it’s a philosophy that you either believe in or you don’t.”
In Bradford, Mitchell says another key thing they’ve done to make this approach work is to “genuinely get to know” the local community and what is available for people who need support.
“You need to spend a lot of time doing mapping of the community and finding out what’s out there – and there are so many thing out there that we never knew about because we didn’t find out before.
“But now we’ve got social workers back in the communities far more, getting to know them.”
Mitchell firmly believes social workers would be practising in this way “regardless of austerity” because it has the potential to be life-changing for service users. He adds that if you get the intervention right and the support around people right then it can also “by default save money”.
But he also issues a warning to local authorities that the social work involved is not cheaper; it is relational social work – or “slower social work” – and there is a resource implication to that.
“It can literally be a day’s work to assess someone’s deficits, write up that assessment and then put in a support plan, commission a care home and place someone in that home,” he says.
“Whereas if we genuinely want to have therapeutic relationships with people, then it could be weeks or even months to build up a relationship that teases out someone’s strengths.”
Reliance on voluntary sector
Strengths-based approaches that involve signposting people to voluntary or community services also rely on those services being available – and in some areas they have been hit badly by cuts, as highlighted by successive ADASS budget surveys.
[When] supporting people to access the community we must consider use of ‘universal services’ which are already stretched. “Social worker
Routledge says this a key issue and the places taking strengths-based practice “really seriously” are finding ways of investing in the things that need to be in place for the approach to work. He gives the example of Wigan, who have changed the way they use resources in order to allocate significant sums of money through grants to voluntary organisations and community services.
“To be fair this is not all about requiring resources – because much of it is about people’s own strengths and the assets they have through family connections and so on,” he adds.
“But you do have to have a strategy that encompasses both a strengths-based approach and a serious attempt to support and the sustain the infrastructure that it requires.”
Strengths-based social work with adults is among the topics covered at this year’s Community Care Live. Register now for free access to over 30 essential learning sessions.