Developing Relationships in the Context of Poverty and Austerity: Thresholding or Rationing of Services?

1. Developing Relationships in the Context of Poverty and Austerity: thresholding or rationing of services? John Devaney Centenary Chair of Social Work J.Devaney@ed.ac.uk @jdev65

2. Devaney, J. (2018) The trouble with thresholds: Rationing as a rational choice in child and family social work. Child & Family Social Work https://doi.org/10.1111/cfs.12625

3. What is Social Work? • Often seen as the coming together of someone in need of support and assistance, and someone who has the values, knowledge, skills and mandate to provide this help • The outcomes sought, and the means to achieve these are arrived at through mutual discussion, and are led by the service user • While much social work practice is transacted on this consensual basis, a significant proportion is not • Always a strong sense of the ‘social worker as expert’ alongside the ‘social worker as agent of the State’

4. “A social worker was the only person who suspected I was being abused, and she persuaded me to tell the police.”

5. “Indeed, numerous studies find that client variables (e.g. motivation, expectation, self-efficacy, chance factors) and the ‘therapeutic relationship’ or ‘working alliance’ contribute more to positive outcomes than do specific interventions. One meta-analytical review found that the percentage of success that is attributable to the various factors was as follows: 40% client and extra-therapeutic factors (e.g. motivation, social support); 30% therapeutic relationship; 15% expectancy and placebo effects; 15% specific methods (Asay and Lambert, 1999). It is clear from such breakdowns that relationship factors loom large in the assessment of outcomes.” Burnett, R and McNeill, F. (2005) The place of the officer–offender relationship in assisting offenders to desist from crime, Probation Journal 52(3): 221-242

6. King et al. (2019) Association of the Youth-Nominated Support Team Intervention for Suicidal Adolescents With 11- to 14-Year Mortality Outcomes. Secondary Analysis of a Randomized Clinical Trial. JAMA Psychiatry, doi:10.1001/jamapsychiatry.2018.4358 The Youth-nominated Support Team is a psychoeducational, social support intervention. Adolescents nominated “caring adults” (mean, 3.4 per adolescent from family, school, and community) to serve as support persons for them after hospitalization. These adults attended a psychoeducational session to learn about the young person’s difficulties and treatment plan, suicide warning signs, communicating with adolescents, and how to be helpful in supporting treatment adherence and positive behavioural choices. The adults received weekly supportive telephone calls from YST staff for 3 months. The study found a significant reduction in deaths over an 11-14 year period.

7. “There was a relatively strong relationship between ‘relationship-building’ skills and the self-reported engagement of parents.” "Caring skills did not have much relationship with... outcomes. Good authority... was a much better predictor of positive family change: engaging parents is not enough. In child and family social work, purposeful and authoritative practice is crucial.” Forrester et al. (2019) What Is the Relationship between Worker Skills and Outcomes for Families in Child and Family Social Work? British Journal of Social Work (advance access)

8. “The professional encounter provides an opportunity to work both in and with the relationship to promote change: it is not just the foundation on which the working alliance is built but also the medium in which psychological change takes place” Howe, D. (2010) The safety of children and the parent‐worker relationship in cases of child abuse and neglect. Child Abuse Review, 19(5), 330-341.

9. Why context is so important • The contexts in which social work is operating are becoming increasingly complex, fluid and uncertain, and many of the issues and problems, which it is expected to address, can be seen as having no easy or unambiguous solutions • The last decade has seen significant increases in the demand for children's social care services at a time of public service retrenchment

10. 7% increase in referrals to children’s social care 26% increase in children subject to protection plans 15% increase in numbers of children in local authority care 9% decrease in funding

12. Public agencies are expected to achieve the maximum benefit for the greatest number of people with the most efficient use of public funds • Increasing holistic view of children’s needs • Public disquiet about social inequalities • Public expectations of consistency in how public services meet the needs of citizens

15. Eligibility v Thresholds v Rationing • Many of the threshold documents used by local authorities have a statement of principles that seek to provide both an explanation and a justification for the intent and operation of their approach • Striking that so few documents make any reference to the availability of resources as being one factor that will influence how decisions are made • Such an omission is both misleading of the general public and unfair on the staff within services who must make such decisions

16. “The adoption of a cheese‐slicing approach has pushed decisions about how best to meet competing needs (of both policy directives and between individual users of services) down the levels of decision‐making, in effect insulating those with the ultimate decision‐making power, politicians and senior civil servants, from the opprobrium and stress that those on the front line must deal with.” Devaney (2018, pp.7-8)

17. Klein and Maybin (2012) Thinking About Rationing. The Kings Fund, London.

18. The Accountability for Reasonableness Framework

19. In Conclusion • Relationships matter between workers and service users, and workers and other workers • Current period of austerity is resulting in increasing numbers of families being drawn into the child welfare system • The child welfare system is straining to meet needs of individuals and families, and the direction of policy • A more transparent terminology is required to ‘free up’ discussion about what can be achieved and how • Shift the rhetoric and the discourse

20. Devaney, J. (2018) The trouble with thresholds: Rationing as a rational choice in child and family social work. Child & Family Social Work https://doi.org/10.1111/cfs.12625