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Promoting systemic thinking, and therapeutic and relationship-based approaches in Social Work

Joining, Contracting and Intervening: three parts to embedding clinical practice in a child protection system 

Jamie Evans

Introduction

Professionals from a range of therapeutic disciplines join with social work colleagues in local authority children’s services departments to improve outcomes for vulnerable children and families. Many of these professionals are situated in contexts outside of the child protection (CP) system, for example, in local CAMHS services, or the voluntary and private sector. Increasingly local authorities have employed clinicians, such as family therapists, child psychotherapists and clinical psychologists to work internally alongside social workers on a day-to-day basis. Such clinicians can be referred to as ‘embedded’ in local authority structures. This article considers three recursive and interlinked processes – joining, contracting and intervening – that occupy the clinician in the process of becoming embedded. Embedding clinical practice at the level of senior management is not dealt with here, but ideas may be compatible, as they might be to other organisations that integrate professional disciplines, such as therapists or social workers working within schools (see Dowling and Osborne, 1985).

Joining

As the founder of structural family therapy, Salvador Minuchin, said: ‘Like the anthropologist, the family therapist joins the culture with which he is dealing’ (1974, pp.124). This idea can be seen as applicable to the joining of all human systems. For instance, in his celebrated ethnography of a Chicago boxing gym, Lois Wacquant (2006) realised that if he was to research the boxing gym culture, he was expected to learn how to box, to experience the pugilistic perspective. As an outsider to the gym, the position ascribed to him was largely pre-determined by the existing members of the club. In the case of the clinician, this is not radically different. At the start, he or she typically enriches their perspective on the child protection social worker’s reality and the wider organisational system by engaging in acts that the social work system conceives for them. This can often involve being positioned in ways that feel uncomfortable for clinicians, that may not chime with their expectations or preferred self-image of how to operate from their therapeutic discipline. Nonetheless, observing the rules of the system – its culture, policies, procedures, team dynamics – from the relative position of an outsider is, in many respects, a necessary initial vantage point for the clinician to become orientated to the system, which precedes their capacity to influence it (Tomm, 1988).

In contrast to being a social worker, the clinical role is not mandated by a statutory duty, but a set of operational beliefs and resources that support it. Outsider-ness is thus a position that bears direct relation to the insider-ness, or the private grammar and set of rules (within a public organisation) that determines what the child protection system does as a statutory service. The norms and values that underpin these rules are internalised by social workers over time as they perform the discourses and activities available to them in the CP context. Outsiders might not be trusted to uphold these norms or values. Unspoken and spoken rules may emerge that organise relationships with clinicians and their positions in the service, such as ‘clinicians do not go out on section 47 investigations’, ‘clinicians only work voluntary Early Help cases’, ‘clinicians work with wealthier families’, or ‘clinicians work mental health cases’. Rules transformed into patterns of practice give clues with respect to the boundaries that the CP system wishes to hold in relation to clinicians, and the beliefs they hold about them.

Joining the system is the first step towards the clinician developing a helpful and supportive relationship to the social work system and thereby potentially influencing it in myriad ways. Typically, joining is achieved through rapport-building, empathy, active-listening, developing trust, openness, curiosity and using simple relevant language. But these skills (common to good social work practice and therapeutic work) do not alone constitute joining. Joining is the process through which the clinician identifies and connects with the rules of the system, moving from the outside to the inside, so that the system may acknowledge the clinician – and their specific contribution – as a part of the system and not apart from the system. This can be a slow process of trial and error, and can be disrupted by events outside of the clinician’s control, such as changes to staffing, budgeting or revisions to preferred models of practice.

A ‘space-between’ (Flaskas, 2005) these different and collaborating systems is however to be nurtured to set a context for the co-creation of new perspectives, the tentative merging of beliefs and the step-by-step challenging of boundaries to create alternative patterns of behaviour in the system. This is not always straight-forward: boundaries in the CP system are sensitively monitored and its statutory duty to safeguard children from harm can be highly pressurised. The space-between the social work system and clinician can therefore mitigate against a potential perceived threat of outsiders in the organisation, to allow for the CP system to identify the clinician as an ally in their work with children and families. In turn (and over time), the ‘space between’ can evolve, allowing for the growth of a mutually enriching relationship.

There are however certain pitfalls that come with the narrowing or widening of the boundaries between social work and clinical systems. For the clinician to get too close to the social work system is to risk replicating the role of a social worker, without the statutory mandate to do so. On the other end of the continuum, if the space between is too wide, then the clinician can become potentially inaccessible and irrelevant to the social work system. In-between these two positions is a space where there is room for negotiation and flexibility, where ideas and differences can be shared and respected.

Figure 1.   Examples of different boundaries between social worker and clinician 

Too close (enmeshed)

Too far way (diffuse)

Healthy boundary

Telling the social work system what to doDisconnecting from core statutory processes and planningUniting in the common end to keep a child safe and improve their well-being
Taking on roles and responsibilities assigned to the social workerPursuing personal therapeutic missions away from social work systemSocial workers inviting clinicians to problem-solve  and be curious about their case-work
Assuming positions of expertise and superiority in relation to the case-work  Assuming positions of overwhelming passivity  and not sharing skills/knowledgeGenerating ideas together without pressure to use them, or privileging some over others
Unwilling to learn and develop from social work practice outside of their therapeutic disciplineAccepting the demands of the social work system without offering alternative suggestionsValidating the difference and similarity between respective models of practice
Seeking to take control over a safeguarding or threshold decision  Losing interest and curiosity in the threads and development of the case-work Negotiating roles and responsibilities to best serve the social work system in its work with the family 

Contracting

When the clinician has joined the social work system, then he or she is more likely to be invited into spaces where social worker and clinician can combine forces to agree a piece of work together. Subsequently, this acts as a further opportunity to enrich the clinician’s relationship to the CP system and therefore potentially contract further work. 

Figure 2. Joining and contracting between social worker and clinician

Fig.2

Contracting work with the social work system happens in many of the same spaces where joining occurs, which requires a consistent effort especially as cases and services evolve and members of staff come and go. Typically, a contract for a clinician to work alongside the social work system is an invitation into one of the following spaces: Team meetings, Case consultations; Reflective practice groups; Home visits; Joint sessions with children and families; Statutory meetings, such as ICPCs, Legal Planning Meetings, LAC Reviews; Supervision between social worker and manager.

The success or failure of this professional dance may depend on the ability of both systems to agree a clear focus for their work together in one or more of these contexts, for example: Generating hypotheses about a case in a consultation;  Using a reflective practice group (RPG) to focus on a case dilemma; Joining a social worker on a home visit to assess risk to the children; Working together to engage a parent in the child protection process; Stopping and preventing the use of physical chastisement towards the children.

The contract between social worker and clinician is thus an episode-specific agreement that consolidates them as colleagues working together towards a particular goal. This agreement may be required for a single meeting, or maybe ongoing for an extended period, depending on the piece of work. What is necessary, in addition to a clear focus for the work, is a clear definition of the roles that clinician and social worker will take when working together. For example, it would be a clinician’s role in a consultation to create a context for the co-construction of ideas related to a case. When conducting a joint home visit, the social worker will likely take the lead explaining core statutory safeguarding processes, however there may be times when the roles feel more blurred, with both social worker and clinician setting the context for intervention, posing questions, reflections and interacting with family members.

These matters need broadly to be agreed at the outset like a doubles-team in a tennis match, working out who will stay on the baseline, and who will go to the net, or whether they will stay more aligned (with allowance for flexibility and spontaneity). Neither social worker nor clinician wants to get into a muddle about who is leading the session, what is its purpose, who is taking notes, what are the safeguarding concerns etc. Likewise, children and families also ought to be helped to understand how the synthesis of social work and clinical roles effects their expectations of the intervention, particularly in terms of safeguarding responsibilities, and how the clinician will be contributing to the case-work (see Harvey & Van de Vijver, 2019).

Intervening

All forms of clinical intervention assist the social work system to perform its multiple complex tasks, in two primary ways:

  1. supporting the social work system to reflect upon its work with children and families, and
  2. supporting the social work system by engaging directly with children and families.

These two primary clinical work-streams are anchored in an effective joining process and clear contracting with the social work system. A clinician however needs to be mindful of which of the above contexts they are being invited into. Often, the social work system will have an expectation that the clinician see the children or family for therapy, when a more promising intervention may be to support the social work system to develop their conception of the case, and the intervention required to meet the children’s needs, prior to supporting them to undertake it. For example, a clinician may be asked to see parents ‘to help with their communication difficulties’, when it may be more advantageous to support the social work system to assess and plan an appropriate intervention to protect the children from the effects of being triangulated in their parents’ conflict. This could potentially reframe the risk profile of the case, which can create new forms of coherence around the related issues and reflects the systemic adage that change in one area of the system impacts other parts of the system. It may also be received as too challenging, or too different to the existing coherence of the social work plan and not be welcome. On the other hand, a clinician may be asked to help the social work team develop hypotheses and process complex feelings arising from a high-risk case, when it may be more useful for the clinician to be seeing the family alongside the social worker to mitigate against the risks to the children. Intervention is thus rooted in the quality of the joining and contracting processes to complete a triadic circular relationship in which the clinician becomes embedded.

Figure 3. Circuit of embedding clinical practice

Fig.3

Based upon the clearly defined goal that will enable the social work plan, the clinician sets forth on intervening to help achieve those ends. For example, a clinician may undertake a number of family therapy sessions, with the support of the social worker, or complete a Cognitive Assessment, or the Child Attachment Interview (CAI) as part of a court assessment, or be instructed to complete a parenting assessment as an expert witness. A clinician may co-ordinate NVR (Non-Violent Resistance) with a family, or VIG (Video Interactive Guidance), or deliver other evidence-base therapeutic interventions to children and families, or provide regular consultations on a case. Intervention can therefore occur in a variety of forms; however all interventions are anchored in the social work and clinical system (no matter the scale) engaging together with mutual respect for each other’s contribution to improving outcomes for vulnerable children. Many interventions, such as supporting a social worker to adapt their beliefs about the protectiveness of a father, or shifting narratives of ‘blame’ and ‘guilt’ for a young person open to a Youth Offending Team can often go un-noticed amidst the complex working of a CP system. Noticing and amplifying these small acts of change can create a ripple effect through the system that promotes greater possibilities for more joining and contracting between social work and clinical service. Witnessing and documenting (White, 1994) these moments can also attract the attention of other practitioners, and their managers, with whom the clinician may connect. This recursive process may lead to wider systems change that normalises clinicians as embedded members of the social work system. Some may become embedded to the extent that they are invited¬¬¬ to influence other areas of practice across the service.

Conclusion

This article considers three interlinked and recursive processes – joining, contracting and intervening – that help clinicians from a range of different therapeutic disciplines to become embedded practitioners in child protection social work settings. It suggests that the process of becoming embedded is an active and constantly evolving one, which requires the sensitive and effective application of clinical skills in a range of situations. By engaging carefully and thoughtfully in the processes of joining, contracting and intervening, then the clinician can move from the position of an ‘outsider’ to an ‘insider’, and become increasingly embedded – and therefore valued – in the CP system. From this position, as a part of the CP system, then the clinician is able to have a greater influence on the lives of vulnerable children and families, as well as on the social workers who support them.

About Jamie Evans

Jamie is a social worker and family therapist. He works as an ‘embedded’ clinician for Westminster Children’s Services and as a family therapist for the Family Trauma Team at the Anna Freud Centre.

References

Dowling, E., & Osborne, E., (1985) The Family & The School Routledge, London

Flaskas, C., Mason, D., & Perlesz, A., (eds) (2005) The Space Between: Experience, Context and Process in the Therapeutic Relationship, Karnac, London

Harvey, R., & Van de Vijver, K., (2019) ‘Child sexual exploitation (CSE): applying a systemic understanding of ‘grooming’ and the LUUUUTT model to aid second order change’ in Journal of Family Therapy (Vol 41, Issue 3) 

Minuchin, S., (1974) Families and Family Therapy, London: Tavistock Publications

Tomm, K., (1988) Interventive Interviewing: Part III. Intending to Ask Lineal, Circular, Strategic, or Reflexive Questions? in Family Process (Vol 27, Issue 1) 

Wacquant, L., (2006) Body and Soul: Notebooks of an Apprentice Boxer Oxford University Press, U.S.A 

White, M., & Epston, D., (1990) Narrative Means to Therapeutic Ends W.W Norton & Company, London

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