How do you do relationship-based practice?

This month sees two years since the introduction of the Team Around the Relationship in Brighton & Hove Children’s Services and the move to Social Work “Pods”. The new structure was a crucial part of whole system change to support relationship-based practice, providing containment and collaboration for social workers to enable confident practice with families. Principal Social Worker, Tom Stibbs, reflects upon the service transformation that took place and thinks about how you do relationship based practice:

After ‘why are they called pods?’, one of the most common questions about our model of social work is ‘how do you do relationship-based practice anyway?’ 

One important thing to say about relationship-based practice at the outset is that it is not just a skill you teach.  It is about a whole approach, or way of being, whether this is for an individual worker or an entire organisation.

That is why our model of practice is built on cultural change to support social work practice.  We could have simply told our social workers to go off and do relationship-based practice, and sent them on a training course to teach them to do this, but this would not have embedded sustained change. There is a danger in using Donald Forrester’s phrase, ‘culture eats training for breakfast’ too glibly, but it really encapsulates a powerful message for those wanting to implement systemic change – culture counts most (Glisson and Williams 2015).

Instead of just saying to workers to go and do relationship-based practice, what we are trying to do is to become a relationship-based organisation.  By doing this we believe we will create cultural change that will support relationship-based practice.

So what does becoming a relationship-based organisation mean?  For us it means embedding the 6 mechanisms, or principles, of relationship-based practice as we conceive of it – our theory of change at an organisational level:

• continuity of social work relationships with families – so families do not have to change social workers or re-tell their stories because of our processes;

• consistency of social work relationships with families – so families have support from a team that knows them;

• collaboration between practitioners – so workers share skills and specialisms to promote change for children and families;

• social workers as change agents – so that support is purposeful, outcome-focused, and builds on families’ own strengths;

• creating a learning culture, and;

• developing an organisational culture which is open and just.

Crucially the model of practice is not about imposing these principles in a hierarchical top-down way, but trying to implement them by modelling this way of working at all levels of the organisation.

The initial question might be reframed as ‘how does being employed by a relationship-based organisation impact on your practice?’  Feeling supported and contained by your managers might mean that you can hold and contain the anxiety of the families you work with supporting families to affect change in their lives (Luckock et al, 2015).  Collaborating and sharing skills with colleagues and being part of an organisation that learns from things that go wrong might help you to work with families to affect change.  Being supported to take responsibility for your own practice and development might help you to work with families, not do things for, or to, families. Being part of an organisation that provides you with ‘high expectations, high support and high challenge’ (Ofsted, 2012) and helps you to be the best practitioner you can be might mean that you can help families to be the best that they can be (after Donald Forrester’s blog, MI and social work).

So what does this kind of practice look like?  Gillian Ruch emphasises that relationship-based practice recognises that human behaviour is complex and multi-faceted and each social work encounter is unique. Thus, while many authorities have implemented practice frameworks based on a single skills set, such as Motivational Interviewing, we believe that it is the common elements across well-indicated ‘interventions’ or methods that constitute ‘relationship-based practice’. Relationship-based practice is, in effect, based on the best of MI, Signs of Safety, systemic thinking, mentalisation, See Me Hear Me, the Secure Base Model and so on.  Within the Team Around the Relationship, relationship-based practice can best be articulated as the ‘containment of anxiety’ supported by specific knowledge and skill contingent on the child or family’s particular situation. Complex situations require complex responses.  This is the theory of change at the practice level.

The evaluation of the impact of the model so far (Empathy, tenacity and compassion: an evaluation of relationship-based practice in Brighton & Hove) suggests that we are getting the cultural mechanisms in place and that these are beginning to support change at a practice level and change for families.  This does not mean that skills, and the teaching of them, aren’t important.  In fact, the evaluation emphasises that the next stage of implementing our model needs to focus on change at a practice level supported by practice tools, training, and reflective discussion.  How social workers talk to families, understand families and help them to change are crucial skills (as demonstrated memorably by Donald Forrester at our first Relationships in Practice conference in 2015).  What relational practice should look like, focusing on what social workers do on visits, was also the subject of Harry Ferguson’s presentation at our conference last year (Why Relationships Matter?). How this might translate into assessments, and the ‘difficult conversations’ that are fundamental to relationship-based practice, is emphasised by Andrew Cooper in his blog, based on his visit to our Clermont Family Assessment Centre (Relationship-based practice works – the evidence).

Relationships are important, but it is how you use them which is crucial.  As Forrester, states: ‘relationship-based practice – provides a discipline of helping that challenges us to do more than simply building relationships. It challenges us, as Bateson memorably said, to “be the difference that makes a difference”.’

If you have any comments on Tom’s blog, please contact him at tom.stibbs@brighton-hove.gcsx.gov.uk or follow him on twitter @TStibbs

  • 1. Universal

    Has needs met within universal provision. May need limited intervention within the setting to avoid needs arising.

  • 2. Early Help

    Has additional needs identified within the setting that can be met within identified resources through a single agency response and partnership working.

  • 3. Early Help Partnership Plus

    Has multiple needs requiring a multi-agency coordinated response.

  • 4. Specialist Services to address Acute & Chronic need

    Has a high level of unmet & complex needs, or is in need of protection.

  • Child developmental needs
    • Good attendance (above 90%)
    • ×

      Good attendance (above 90%)

      ×

      Good attendance (above 90%)

    • Meeting developmental & learning milestones
    • ×

      Meeting developmental & learning milestones

      ×

      Meeting developmental & learning milestones

    • Has emotional well-being
    • ×

      Has emotional well-being

      ×

      Has emotional well-being

    • Ability to protect self and be protected
    • ×

      Ability to protect self and be protected

      ×

      Ability to protect self and be protected

    • Resilient and able to adapt to change
    • ×

      Resilient and able to adapt to change

      ×

      Resilient and able to adapt to change

    • Physically healthy
    • ×

      Physically healthy

      ×

      Physically healthy

    • Age-appropriate self care & independence skills
    • ×

      Age-appropriate self care & independence skills

      ×

      Age-appropriate self care & independence skills

    • Ability to express needs
    • ×

      Ability to express needs

      ×

      Ability to express needs

  • Child developmental needs
    • Absence/truancy from school    
    • ×

      Absence/truancy from school

      ×

      Absence/truancy from school

    • Incidence of absence/missing from home    
    • ×

      Incidence of absence/missing from home

    • Persistent poor behaviour in school  
    • ×

      Persistent poor behaviour in school

      ×

      Persistent poor behaviour in school

    • Risk of social exclusion    
    • ×

      Risk of social exclusion

      ×

      Risk of social exclusion

    • Poor relationships  
    • ×

      Poor relationships

      ×

      Poor relationships

    • Language and communication difficulties  
    • ×

      Language and communication difficulties

      ×

      Language and communication difficulties

    • Disability or additional special educational needs    
    • ×

      Disability or additional special educational needs

      ×

      Disability or additional special educational needs

    • Difficulty in achieving in education  
    • ×

      Difficulty in achieving in education

      ×

      Difficulty in achieving in education

    • Potential for becoming Not in Education, Employment or Training (NEET)    
    • ×

      Potential for becoming Not in Education, Employment or Training (NEET)

      ×

      Potential for becoming Not in Education, Employment or Training (NEET)

    • Slow in meeting developmental milestones    
    • ×

      Slow in meeting developmental milestones

      ×

      Slow in meeting developmental milestones

    • Missing health checks/immunisations    
    • ×

      Missing health checks/immunisations

    • Minor health problems  
    • ×

      Minor health problems

      ×

      Minor health problems

    • Early signs of offending/anti-social behaviour  
    • ×

      Early signs of offending/anti-social behaviour

      ×

      Early signs of offending/anti-social behaviour

    • Underage sexual activity    
    • ×

      Underage sexual activity

    • Early signs of drug/alcohol misuse    
    • ×

      Early signs of drug/alcohol misuse

    • Poor self-esteem    
    • ×

      Poor self-esteem

    • Low level emotional & behavioural issues that may be linked to attachment and/or emotional development delay    
    • ×

      Low level emotional & behavioural issues that may be linked to attachment and/or emotional development delay

    • Young carers    
    • ×

      Young carers

    • Bullying    
    • ×

      Bullying

      ×

      Bullying

    • Children who have previously been in Care, and children living away from their birth parents e.g adopted children, Special Guardianship Orders, Kinship Care.  
    • ×

      Children who have previously been in Care, and children living away from their birth parents e.g adopted children, Special Guardianship Orders, Kinship Care.

      ×

      Children who have previously been in Care, and children living away from their birth parents e.g adopted children, Special Guardianship Orders, Kinship Care.

  • Child developmental needs
    Despite intervention at 2, there is evidence of continuing and escalating need:
    • Persistent absence from school    
    • ×

      Persistent absence from school

      ×

      Persistent absence from school

    • Missing from school/ home regularly with no explanation    
    • ×

      Missing from school/ home regularly with no explanation

    • Fixed Term exclusions/no school place  
    • ×

      Fixed Term exclusions/no school place

      ×

      Fixed Term exclusions/no school place

    • Social exclusion    
    • ×

      Social exclusion

      ×

      Social exclusion

    • Poor relationships  
    • ×

      Poor relationships

      ×

      Poor relationships

    • No access to universal services / “Hidden Children”    
    • ×

      No access to universal services / “Hidden Children”

      ×

      No access to universal services / “Hidden Children”

    • Significant disabilities    
    • ×

      Significant disabilities

    • NEET (Not in Education, Employment or Training)    
    • ×

      NEET (Not in Education, Employment or Training)

      ×

      NEET (Not in Education, Employment or Training)

    • Developmental milestones not being met due to persistent parental failure/inability    
    • ×

      Developmental milestones not being met due to persistent parental failure/inability

      ×

      Developmental milestones not being met due to persistent parental failure/inability

    • Chronic/recurring health problems    
    • ×

      Chronic/recurring health problems

      ×

      Chronic/recurring health problems

    • Regular missed appointments affecting developmental progress    
    • ×

      Regular missed appointments affecting developmental progress

      ×

      Regular missed appointments affecting developmental progress

    • Teenage pregnancy    
    • ×

      Teenage pregnancy

    • Drug/alcohol misuse impacting negatively    
    • ×

      Drug/alcohol misuse impacting negatively

    • Risky sexual behaviour (e.g. unprotected sex)    
    • ×

      Risky sexual behaviour (e.g. unprotected sex)

    • Offending / anti-social behaviour resulting in risk of entering Youth Justice System  
    • ×

      Offending / anti-social behaviour resulting in risk of entering Youth Justice System

      ×

      Offending / anti-social behaviour resulting in risk of entering Youth Justice System

    • Emotional / mental health issues    
    • ×

      Emotional / mental health issues

      ×

      Emotional / mental health issues

  • Child developmental needs
    Persistent/continued/severe:
    • Chronic persistent absence, permanent exclusions or no school place that risks entry to the care system  
    • ×

      Chronic persistent absence, permanent exclusions or no school place that risks entry to the care system

      ×

      Chronic persistent absence, permanent exclusions or no school place that risks entry to the care system

    • Persistent social exclusion    
    • ×

      Persistent social exclusion

      ×

      Persistent social exclusion

    • Poor relationships  
    • ×

      Poor relationships

      ×

      Poor relationships

    • Complex / multiple disabilities    
    • ×

      Complex / multiple disabilities

    • Complex mental health issues affecting development needs, including self harm    
    • ×

      Complex mental health issues affecting development needs, including self harm

      ×

      Complex mental health issues affecting development needs, including self harm

    • High level emotional health issues and very low self-esteem    
    • ×

      High level emotional health issues and very low self-esteem

    • Non-organic failure to thrive  
    • ×

      Non-organic failure to thrive

      ×

      Non-organic failure to thrive

    • Inappropriate sexual knowledge / sexualised behaviour for age.    
    • ×

      Inappropriate sexual knowledge / sexualised behaviour for age.

      ×

      Inappropriate sexual knowledge / sexualised behaviour for age.

    • Harmful Sexual Behaviour / Peer on Peer Abuse    
    • ×

      Harmful Sexual Behaviour / Peer on Peer Abuse

    • Teenage parent/pregnancy under the age of 13    
    • ×

      Teenage parent/pregnancy under the age of 13

    • Concerns about exploitation (including sexual exploitation/ abuse, radicalisation; criminal exploitation; gang affiliation)    
    • ×

      Concerns about exploitation (including sexual exploitation/ abuse, radicalisation; criminal exploitation; gang affiliation)

    • Child victims of modern slavery or human trafficking    
    • ×

      Child victims of modern slavery or human trafficking

      ×

      Child victims of modern slavery or human trafficking

    • Unaccompanied minors    
    • ×

      Unaccompanied minors

    • Drug/alcohol use severely impairing development    
    • ×

      Drug/alcohol use severely impairing development

    • Frequently missing from home resulting in self-neglect    
    • ×

      Frequently missing from home resulting in self-neglect

    • Relationship breakdown between child & parent    
    • ×

      Relationship breakdown between child & parent

    • Offending and in the criminal justice system    
    • ×

      Offending and in the criminal justice system

      ×

      Offending and in the criminal justice system

    • Unexplained / suspicious injury    
    • ×

      Unexplained / suspicious injury

  • Family & Environment
    • Positive relationship between parents
    • ×

      Positive relationship between parents

      ×

      Positive relationship between parents

    • Stable & affectionate relationships with caregivers
    • ×

      Stable & affectionate relationships with caregivers

      ×

      Stable & affectionate relationships with caregivers

    • Housed, good diet and kept healthy
    • ×

      Housed, good diet and kept healthy

      ×

      Housed, good diet and kept healthy

    • Supportive networks
    • ×

      Supportive networks

      ×

      Supportive networks

    • Access to positive activities
    • ×

      Access to positive activities

      ×

      Access to positive activities

    • Positive sense of self and abilities
    • ×

      Positive sense of self and abilities

      ×

      Positive sense of self and abilities

  • Family & Environment
    • Children of prisoners/ parents subject to community orders    
    • ×

      Children of prisoners/ parents subject to community orders

    • Low income affects achievement    
    • ×

      Low income affects achievement

    • Parental conflict and risk of relationship breakdown    
    • ×

      Parental conflict and risk of relationship breakdown

    • Concerns about possible domestic abuse    
    • ×

      Concerns about possible domestic abuse

  • Family & Environment
    • Housing tenancy at risk    
    • ×

      Housing tenancy at risk

      ×

      Housing tenancy at risk

    • Harmful parental conflict and/or relationship breakdown    
    • ×

      Harmful parental conflict and/or relationship breakdown

      ×

      Harmful parental conflict and/or relationship breakdown

    • Transient families  
    • ×

      Transient families

      ×

      Transient families

    • Domestic abuse & coercive control    
    • ×

      Domestic abuse & coercive control

    • No recourse to public funds    
    • ×

      No recourse to public funds

  • Family & Environment
    • Significantly harmful parental conflict and/or relationship breakdown    
    • ×

      Significantly harmful parental conflict and/or relationship breakdown

      ×

      Significantly harmful parental conflict and/or relationship breakdown

    • Suspicion of physical, emotional or sexual abuse or neglect    
    • ×

      Suspicion of physical, emotional or sexual abuse or neglect

      ×

      Suspicion of physical, emotional or sexual abuse or neglect

    • Domestic abuse resulting in child being at risk of significant harm    
    • ×

      Domestic abuse resulting in child being at risk of significant harm

    • Homeless Child/Young Person    
    • ×

      Homeless Child/Young Person

    • Family intentionally homeless    
    • ×

      Family intentionally homeless

    • Extreme poverty affecting child well-being    
    • ×

      Extreme poverty affecting child well-being

      ×

      Extreme poverty affecting child well-being

    • Forced Marriage, Honour Based Violence, Female Genital Mutilation    
    • ×

      Forced Marriage, Honour Based Violence, Female Genital Mutilation

  • Parents & Carers
    • Protected by carers
    • ×

      Protected by carers

      ×

      Protected by carers

    • Secure and caring home
    • ×

      Secure and caring home

      ×

      Secure and caring home

    • Receive and act on information, advice and guidance
    • ×

      Receive and act on information, advice and guidance

      ×

      Receive and act on information, advice and guidance

    • Appropriate boundaries maintained
    • ×

      Appropriate boundaries maintained

      ×

      Appropriate boundaries maintained

  • Parents & Carers
    • Inconsistent care arrangements  
    • ×

      Inconsistent care arrangements

      ×

      Inconsistent care arrangements

    • Poor supervision by parent/carer    
    • ×

      Poor supervision by parent/carer

      ×

      Poor supervision by parent/carer

    • Poor response to child’s physical, emotional or health needs    
    • ×

      Poor response to child’s physical, emotional or health needs

      ×

      Poor response to child’s physical, emotional or health needs

    • Historic context of parents/carers own childhood, i.e Adverse Childhood Experiences (ACEs)  
    • ×

      Historic context of parents/carers own childhood, i.e Adverse Childhood Experiences (ACEs)

      ×

      Historic context of parents/carers own childhood, i.e Adverse Childhood Experiences (ACEs)

  • Parents & Carers
    • Parental learning or physical disability, substance misuse, or mental health impacts on parenting    
    • ×

      Parental learning or physical disability, substance misuse, or mental health impacts on parenting

    • Inconsistent care arrangements  
    • ×

      Inconsistent care arrangements

      ×

      Inconsistent care arrangements

    • Poor supervision by parent/carer  
    • ×

      Poor supervision by parent/carer

      ×

      Poor supervision by parent/carer

    • Poor response to identified needs    
    • ×

      Poor response to identified needs

      ×

      Poor response to identified needs

    • Historic context of parents/carers own childhood, i.e Adverse Childhood Experiences  
    • ×

      Historic context of parents/carers own childhood, i.e Adverse Childhood Experiences

      ×

      Historic context of parents/carers own childhood, i.e Adverse Childhood Experiences

  • Parents & Carers
    • Edge of care  
    • ×

      Edge of care

      ×

      Edge of care

    • Parental encouragement of abusive/offending behaviour
    • ×

      Parental encouragement of abusive/offending behaviour

      ×

      Parental encouragement of abusive/offending behaviour

    • Continuing poor supervision in the home    
    • ×

      Continuing poor supervision in the home

    • Parental non-compliance / superficial co-operation    
    • ×

      Parental non-compliance / superficial co-operation

    • Inconsistent parenting affects child’s developmental progress  
    • ×

      Inconsistent parenting affects child’s developmental progress

      ×

      Inconsistent parenting affects child’s developmental progress

    • Private fostering    
    • ×

      Private fostering

  • Level of assessment
    No formal assessment
  • Level of assessment
    Consider commencement of Early Help Assessment / Pastoral Support Plan
  • Level of assessment
    Strengthening Families Early Help Assessment and Plan
  • Level of assessment
    Strengthening Families > Child in Need Plan or Child Protection Conference
  • Go direct to Service or search the Family Service Directory for the Local Offer, or call the Family Information Service on 01273 293545
  • Early Help Strengthening Families Assessment & Plan. If you require advice or guidance in respect of the child needs contact the Front Door For Families on 01273 290400
  • Contact Front Door For Families on 01273 290400 or if the child is at immediate risk call the Police on 999