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Great Britain (London Borough of Hackney): Basic Thoughts on Systemic Social Work in England Print E-mail

 

Olof Hedtjarn, Nasima Khanom, Karen Schiltroth, Sarah Wright

London Borough of Hackney

 

Part 1: Context

 

Systemic social work education and practice in England


Qualifying degrees in social work in the UK (BA or MA level) do not require the teaching of systemic ideas. Individual institutions and publication may include some systemic teaching but it is not routinely referenced or taught to social workers.

Genograms, eco-systems, the family life cycle, understanding the child within their family and community context, and relationship building are well established in social work programmes but the theoretical framework and skills to support intervention vary widely from programme to programme. Family therapy/systemic practice may appear in social work texts alongside other intervention approaches including cognitive behavioural techniques, structural social work and task-centred or person-centred approaches as a chapter or topic within a chapter (Lishman, 2007; Walker and Beckett, 2011) at most. There is a framework for post-qualifying professional development of social workers and it is at this level that systemic ideas are formally recognised for their relevance and contribution to social work practice.

Systemic psychotherapy training in the UK is a four-year endeavour. Social workers are often part of the learner cohort in these programmes which are offered by Universities, the Institute of Family Therapy or the Tavistock and Portman NHS Trust. Each year of the training is a recognised route to advanced training for social workers and is mapped to the SW post-qualifying framework.

Foundation year (specialist award in social work with children and families)

  • Intermediate year (higher specialist award in social work)
  • MSc in Systemic Psychotherapy, 2 years (advanced award in social work)

In practice, the joining up of systemic psychotherapy and social work varies depending on the type of organisation and subject of intervention. Adult mental health services and child and adolescent mental health services in the UK are routinely delivered by multidisciplinary teams which include systemic psychotherapy and social work alongside psychiatry, psychology and nursing. In this way, approach and expertise are shared and multidisciplinary consultation is routine, while joint working is less frequent but available. Dual qualified social worker/systemic psychotherapists are most likely to be found in such environments.

There has been an increased use of psychology and systemic psychotherapy in support offered to Looked After Children, by child and adolescent mental health teams in recent years.

There is substantial literature outlining the application of systemic practice to specific social work contexts and this knowledge base is overwhelmingly located in family therapy publications (e.g. Journal of Family Therapy) rather than social work publications.

In the UK, statutory services to families to prevent child abuse and neglect are provided by local government (Local Authority safeguarding services) and have been the exclusive realm of social work, until recently.

The rise of evidence based interventions for children (Multi-systemic therapy, mutli-dimensional treatment foster care, functional family therapy, signs of safety/solution focussed therapy) has prompted the development of multi-disciplinary teams and the introduction of systemic ideas to Local Authority safeguarding settings.

 

The Hackney Model

 

In 2008, Hackney Children’s Social Care refocused local social work services with the aim of introducing high standards of professional practice, supporting reflective thinking and improving outcomes for children and their families. As part of this development they identified systemic practice and social learning theory as their methodologies of choice in working with families in a safeguarding context (Carr, 2000; Hackney, 2008) and became the first setting in the UK to undertake wholesale organisational change to support systemic approaches to social work.  A significant number of family therapists and clinical practitioners with systemic qualifications were recruited to work alongside social workers to both provide clinical interventions with families and to support social workers in applying systemic thinking within their practice.  The organisation also invested in wide scale systemic training for practitioners. In the past three years, Hackney has trained more than 75 practitioners and managers in systemic practice or systemic leadership.

In order to support this approach practitioners were organised into ‘Social Work Units’ which comprised a consultant social worker, a social worker, a child practitioner, a clinical therapist and a unit administrator.  Rather than social workers being allocated their own individual caseload, cases are shared collectively by the unit.  There is an expectation that each unit will meet weekly to discuss and reflect on their work with each family, with the clinical practitioner ensuring that systemic ideas inform these discussions.

In the absence of established programmes for the teaching of systemic social work, this paper focuses on key ideas from the field of systemic psychotherapy that are transforming social work with children and families in Hackney.

 

Part 2: Literature Highlights

 

Systemic influences in Social Work with Children and Families


Domains of Action – the exercise of statutory duties

The context of social work practice within the child protection arena inevitably raises dilemmas for practitioners in managing the tensions of authoritative intervention and engagement in collaborative therapeutic work with families.  The concept of ‘Domains of Action’ set out by Lang, Little & Cronen, V. (1990) has proved extremely useful in reflecting on this tension.

Practitioners must make judgements about when it is appropriate for them to practice within the domain of 'explanations', in which the focus of their work is to explore a range of realities, explanations and perspectives with families, and when to work within the domain of 'production', in which they must apply their professional expertise, knowledge and theory-base in order to make decisions about levels of intervention.  Lang et al (ib id) suggest that decisions regarding which domain is appropriate at any given time take place within the 'aesthetic' domain in which professionals are, "conscious of the ethical dimension of their activities".  These ethical dimensions are described as being defined by the context of agency, social, cultural and political forces.

Practitioners need to be aware that definitions of what constitutes child abuse, what is considered to be good child-rearing practice, what is considered to be good social work practice, what is viewed as good management and the degree to which the 'State' has the right to intrude on the lives of its citizens are historically and contextually fluid and changeable and are in a constant process of being redefined.   Lang et al (ib id) suggest that "Theory, practice, ethics and a form of consciousness are in a recursive relationship with each other" (p44).  Whilst agency and social beliefs, values and definitions of the professional role of workers may be seen as constraints on practice, recognition that these are changeable can open up opportunities to influence redefinitions of the 'aesthetic' domain.

The exercise of professional authority within the Child Protection arena can be seen as formally defined by legislation, government policy and guidance and locally agreed procedures.  Less formal influences may also be perceived to operate through organisational values, public attitudes, media reporting of child abuse enquiries, levels of professional expertise, knowledge of new research and the availability of resources (such as treatment and support facilities) which might offer different opportunities for facilitating change within families.  Changes on any of these levels, and many more besides, are likely to produce changes at the 'aesthetic' level and consequently effect change in decisions about when it is appropriate to operate within the 'explanations' domain and when it is appropriate to operate within the 'productions' domain.    An example of the way in which local policy can impact on the ‘aesthetic domain’ would be the emphasis that the Local Authority in Hackney has placed on maintaining children within their own families leading to less children in the Borough being made subject to Legal action to remove them from their families.  Practitioners are encouraged to spend more time in the ‘domain of explanation’, working with families to reduce risk, and less time in the domain of ‘production’, taking action to remove children.

 

 

 

Assessing Risk – Moving from Safe Certainty to Safe Uncertainty

One of the defining features of social work practice in the field of child abuse and neglect is the pressure to continuously assess risk, make decisions and take action to protection children to minimise harm (DfE, 2011). Social workers, pressured by legally imposed timescales for decision making, have traditionally been quick to make judgements about children’s lives and alongside this have carried the emotional and professional burden of ‘knowing’ what is in a child’s best interest – safe certainty (Mason, 1993). The introduction of systemic concepts such as curiosity, neutrality and safe uncertainty have given permission to social workers to explore risk from multiple perspectives, explore expertise held by family members and other professionals and accept the limits of their own knowledge.  The result is a richer understanding of the complexity of children’s lives and an organisational wide acceptance that there are multiple explanations for and multiple solutions to problems facing children and families. There remains a tension in the organisation however, as language about families becomes less problem saturated and stories become richer with multiple perspectives that the child’s story and experience of harm may get lost. Social workers are learning that they can still take a position about parent or child behaviour, while being curious about another perspective.

 

Systemic Work with(in) Cultural Diversity in Hackney

An important part of working systemically within the domain of social work is to think about how social difference and power organise our work with clients. One of the key ideas is to treat cultural diversity as a ‘difference’ that is relational and contextual. The acronym GRACES (Divac and Heaphy, 1997) highlights aspects of our human experience that shape our identity (Ayo 2010). It is a useful concept when thinking about contextual variables such as race, gender, class, sexuality and religion etc, areas in which people may feel marginalised or silenced by virtue of feeling different or ”othered”.

The practice side of this has been to take on an appreciative inquiry approach (Cooperrider et. al., 2005) in valuing diversity; respecting differences but also showing appreciation and curiosity. To manage or “do” difference isn’t merely about seeking knowledge about the “other” or understanding about a particular “difference”, it is also about thinking relationally and self reflexively about our own differences, our own contributions to any given social interaction. For example, as “professionals” we may have researched and read about the issue which is brought alive by adopting a stance of respectful curiosity, neutrality and reflexivity, or practically implemented by the use of cultural genogram, sculpts or live observation of families’ interaction at home. We might be sensitive to local practices by joining in with the family activities, the family language for example, how we might greet the families and take part in the different seating arrangements that might not be euro-centric.

However difference is always in the process of ‘becoming’ therefore there is a constant ebb and flow of evolving. So the question is how we “do” and understand difference. In this, as people, we have shared common experiences that are universal in our diversity to one another. Another way of looking at this is as a world view or what Karl Tomm might call a meta view; with(in) our differences we seek that space where we come together, where we are equal thus each have voice entitlement to the other.  The idea of ”voice entitlement” means that our sense of having a ”voice” develops over time and across different contexts and is deeply embedded in for example ”cultural, gendered and educational experiences” (Boyd 2010).

Hackney is uniquely one of the boroughs in London where significant numbers of the population are from BME (Black Minority Ethnic) backgrounds including newly migrated and blended families. This challenges how we work, thus we have to always be looking to move out of our comfort zone and be ready to be on the learning edge.  At the same time, we want to hold on to our sense of self as a professional, holding our own cultural identities and prejudices, owning our differences and be comfortable in our “skin” as it were, whilst being mindful of how the very biases of our own cultural positions may impact on our work. In Hackney, anecdotal evidence suggests that majority of our clients are from BME backgrounds whilst the staff group in children’s and young people service is less diverse which will have its own challenges of working cross culturally.

Hence as representatives of a local authority we need to be mindful of the inherent power we hold as we are embedded in a statutory organisation whose work mainly revolves around management of risk and safeguarding. And as such we need to consider the discourses of power in play when we relate to clients. As part of marginalised groups people can often feel de-legitimised, silenced and thus “othered” as difference is often seen as opposites that divide rather than unify. ”The process of othering considers dualities of power and powerlessness, inclusion and exclusion, and representation” (Ayo, 2010). The process of ‘othering’ is always based on a value judgement. When mutual acknowledgements of the differences are made visible by being named and owned together it can be a fruitful process. However the responsibility to ‘bring forth’ the naming and acknowledgment of difference lies with the professional who usually holds a lot of power in the professional-client relationship. However, in social work it is not uncommon that professionals experience clients as “resistant”, which is often experienced as widening the gap in difference. But in the spirit of naming power and difference it is also useful to think about resistance, not merely as resistance but as a way of holding one’s position of power, as one end of a power continuum (Guilfoyle, 2003).

In summary, the wider socio-political and economical landscape, whether it’s globally or on a European level play a real impact in the local level of our work and the challenge remains how to continue to keep systemic ideas alive in social work practice to assist us in working with diversity.

 

References

Akister, J. (1998) Attachment theory and systemic practice: research update. Journal of Family Therapy, 20: 353–366. doi: 10.1111/1467-6427.0009

Ayo, Y. (2010) Addressing issues of race and culture in supervision. Chapter 11 in C. Burck & G, Daniel (Eds.) Mirrors and Reflections: Processes of Systemic Supervision. Karnac.

Boyd, E. (2010) ”Voice entitlement” narratives in supervision: Cultural and gendered influences on speaking and dilemmas in practice.  Chapter 10 in C. Burck & G. Daniel. (Eds.) Mirrors and Reflections: Processes of Systemic Supervision. Karnac

Burnham J. (2004) Relational Reflexivity: A Tool for Socially Constructing Therapeutic Relationships. Draft paper

Burnham, J. (1993) Systemic supervision: the evolution of reflexivity in the context of the supervisory relationship. Human Systems: Journal of Systemic Consultation and Management, 4: 349–381.

Carr, A. (2000), Evidence-based practice in family therapy and systemic consultation. Journal of Family Therapy, 22: 29–60. doi: 10.1111/1467-6427.00137

Cooperrider DL. Whitney D. Stavros JM. (2005) Appreciative Inquiry Handbook; The First in a Series of AI Workbooks for Leaders of Change. Crown Custom Publishing, Inc. Brunswick, USA.

Di Nicola, V. (1997) A stranger in the family. Culture, families and therapy. New York, London, W.W. Norton.

Divac, A. & Heaphy, G. (2005) Space for GRRAACCEES: Training for Cultural Competence in Supervision. Journal of Family Therapy, 27: 280-284

Hackney, LB (2008) A difference that makes a difference. Clinical Manual: The role of clinicians in the social work unit.

Hardy, K. V. & Laszloffy, T. A. (1995). “The cultural genogram: Key to training culturally competent family therapist,” Journal of Marital and Family Therapy 21:227-237

Gulifoyle, M. (2003) Dialogue and power: a critical analysis of power in dialogical therapy. Family Process, 42 (3), 331-343.

Lang, W.P., Little,M. & Cronen, V. (1990) The systemic professional: domains of action and the question of neutrality

Lishman, J. (2007) Handbook for practice learning in social work and social care: knowledge and theory JKP (London)

Mason, B (1993) Towards Positions of Safe Uncertainty. Human Systems: The Journal of Systemic Consultation and Management. Vol. 4. 189-200.

Education, Department of. (2011) The Munro Review of Child Protection: A child centred system.

Tomm, K. (1988) Interventive Interviewing: Part III. Intending to Ask Lineal, Circular, Strategic, or Reflexive Questions? Family Process, Vol: 27, Issue 1, page 1-15

Walker, S and Beckett, C (2011) Social  Work Assessment and Intervention Second Edition, Russell House Publishing Ltd. Dorset, UK


 
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