Training for future Social Workers

Positive Partnerships towards a Trauma-Informed Workforce


In autumn 2020, the Fulfilling Lives South East (FLSE) Area Lead, together with the Systems Change Officer reached out to Lucy Basterra, Senior Lecturer in Social Work at the University of Brighton, to offer training sessions around working with people experiencing multiple and complex needs (MCN) and experiences of repeat child protection processes. The idea was to influence social workers’ attitudes and behaviours before they start practising social work as their profession.

Issues faced

FLSE understands that Social Workers play a key role in providing support to people experiencing multiple disadvantages and MCN. Following our research and front line experience, we developed a Manifesto for Change, with emerging themes and commitments. One of which is about supporting women through repeat removals of children. Our commitment states: For women with MCN to not suffer stigmatising practice (e.g. from antenatal and post-natal healthcare providers, courts, police, GP and Social Services).

In our previous blogs on this theme, we have explored the gaps women with multiple and complex needs often fall through and the issues that arise when the working practices of social services don’t respond flexibly and creatively to these needs.

Women often feel disempowered throughout the process of working with social services, not understanding their rights or having a firm grasp of what is happening at each stage. Many women have also had negative experiences of social services in the past, often as children themselves, leading to a distrust and disengagement from services. Our clients have reported that they felt like passive recipients of a process that is making permanent decisions about their own lives and those of their children. 

Quote from our client

“I feel like everything is going to come crashing down around me.  I feel I haven’t been given enough time to turn my life around it’s just not fair. How can I be expected to just stop using and attend all these appointments without any period of lapse?  I’m not perfect.” 

What we did

Our partnership with the University of Brighton, has provided us with a platform to reach future social workers and provide an enhanced understanding of multiple disadvantage, encouraging the students to consider the intersecting issues faced by their future clients and to respond in ways that are adaptive to the complex needs and informed by experiences of trauma.

FLSE delivered two guest lectures on the subject of ‘Trauma Informed Practice (TIP) and working with people experiencing multiple and complex needs (MCN)’ in November 2020 and January 2021. These sessions were co-produced with front line staff, project consultants, volunteers, experts by experience, the learning and impact team as well as the systems change team. Following their success, FLSE were invited to deliver the lectures again to the next year’s cohort of students. In January and February 2022, two guest lectures were held, one online and one in-person, which again received overwhelmingly positive feedback, highlighting the importance of teaching students about trauma informed practices, and working with people experiencing MCN.

Student feedback on the training sessions

I found this session really useful and was really comfortable to engage with the facilitators. I found this session to be a safe place to ask questions, be curious and think outside my box”.

I found the information provided about MCN and trauma very useful and will definitely look more into this and take it into the future. Also information around women and repeated pregnancies interesting, as it was topic I was debating recently”.

I really enjoyed the session, especially the way that each breakout group had an assigned practitioner as it allowed for a detailed group discussion. I was also really impressed with the passion each of the workers showed”.

The practice examples were really interesting, and I learnt some important skills for building relationships with service users who have experienced trauma”.

The need for trauma informed practice and unconditional positive regard for the client. Be strength and person focused. Work as part of a team around the person and celebrate small wins for the client. The need for long term approach”.

“I have learnt about the importance of considering language used (terms such as label) and how this can impact on the clients we work with.  Thus, learnt to challenge the use of such terms”.

“Thank you for the training. I am working with a mum who has had 2 children removed and has a learning disability, ADHD and poor mental health. I have often had tense, difficult conversations with her, and I think I may have been dismissive at times. Your presentation has opened my eyes and made me realise what she has gone through.  I feel better able to support her and her children. Thank you”!

“In social work we focus on the children and keep them at the centre of our practice.  This has helped me consider the wider impact on the parents”.

Feedback from Lucy Basterra, Senior Lecturer in Social Work at the University of Brighton

“It has been a pleasure collaborating with the Fulfilling Lives team, and it is clear from the feedback that the team’s expertise and passion has made a positive impact on students’ learning.  From my perspective, as a lecturer in social work with a practice background in working with people experiencing multiple disadvantages, it is vital that we bring the voices of an often-marginalised group of people into the teaching and training of social workers.  Fulfilling Lives were able to do this by putting together a session which kept service users at the heart of the content, while also offering expert knowledge from a practitioner perspective.  Linking the themes that were covered with broader concepts of trauma-informed care means that the learning is applicable to any setting our students go on to practice in. The resources and case studies that Fulfilling Lives have shared will continue to be put to good use across our programmes where applicable and will add depth and insight into the experiences of people with complex needs as well as the practice tools and approaches best-placed to support practitioners in their work”.

Reflections from the facilitators

Participating as a facilitator in the training as a volunteer with FL has been an invaluable experience that I am proud I was part of. An important part of healing and growing is the ability to use past experiences, good and bad ones, in order to help and support others, but that’s not always easy. I thought taking part in this training would help me gain some confidence and trust in myself.  I’m really grateful I got to do that in a very professional and human environment, working alongside staff members while being supported step by step.

I think the training was a highlight for everybody involved, and it was great to read the feedback left by students, it made me realise what a great achievement to have been part of shaping, through our efforts, a next generation of a trauma-informed social workers”. – Linda, FL Volunteer

As a member of the Service User Involvement team with lived experience of MCN it has been extremely rewarding to play a role in the development and delivery of training for social work students. In addition, mentoring volunteers to develop new skills they are interested in, and working together on them achieving each step to get to where they want to be, is a part of my role I feel really privileged to be doing.

Linda has worked with Fulfilling Lives as a dedicated volunteer for a year and a half and seeing her get to the stage of presenting slides in training to a room of people is testament to how hard she has worked. People with lived experience can bring a unique and valuable insight to our work, but beyond that learn and bring skills that have really supported our project in achieving its own goals. I would like to thank the volunteer involved for being part of our team and congratulate her on her achievements.

This training has been a great example of co-production in action. Bringing together the expertise of frontline staff, diverse lived experience voices, and knowledge from our systems change work. It’s great to hear the feedback that the training was valuable to the students.” – Vikki, FL Engagement and Coproduction Worker

Legacy

One of the main objectives of Fulfilling Lives nationally and locally is to work in partnership with organisations and institutions to nurture system change to help with the development of accessible, responsive, flexible and coordinated approaches for those with the most complex needs.

We are conscious that social workers and social work students are key to how social services are being delivered and perceived from a service user point of view. We are keen to help develop skills and approaches for future professionals.

The positive impact of the collaboration between FLSE and the University of Brighton has resulted in a commitment to continued use of Fulfilling Lives resources on MCN, Trauma and the repeat removal of children into care. Having these key resources being integrated into educating our future workforce is a legacy we are proud of and shows the importance of collaboration. 


Authors:

Eve McCallam, Systems Change Officer

For further information about Fulfilling Lives work in this area, please contact:

Systems Change Officer

eve.mccallam@sefulfillinglives.org.uk

Rebecca Rieley, Systems Change Lead:

rebecca.rieley@sefulfillinglives.org.uk  

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How women and children are falling through the gaps and what to do about it  

Throughout 2021 Fulfilling Lives South East has worked with volunteers, experts by experience and partners to understand the impact of child care proceedings on women with multiple and complex needs. Our work culminated in publishing a Guide to Child Protection and Care proceedings as well as a leaflet for women and workers with the aim to help navigate a complex system. In this blog piece, we have decided to focus on Clare’s story to bring to light the missed opportunities the current support system perpetuates.


Clare’s story

Clare is an amalgamation of the stories we have heard and witnessed from our clients who have experienced the repeated removal of children into care. Through sharing this story, we hope to highlight four key missed opportunities. While the system continues to miss opportunities to support women like Clare, this cycle will continue.  

Missed opportunity 1 – Access to Mental Health Support 

Clares Story: Clare grew up in an unstable home with parents who used drugs and she experienced sexual abuse from a young age. After being removed from her parents and entering the care system age 11, she began using drugs as a teenager and left care to live with a man she was in a relationship with, where she was a victim of domestic abuse. While living in temporary accommodation with her abusive partner, Clare fell pregnant and concerns for the safety of herself and unborn baby meant she was moved out of area, to another temporary accommodation away from her support network. During her pregnancy, Clare’s drug use continued and despite having suspected depression and a possible personality disorder she wasn’t able to get a formal mental health diagnosis due to her substance misuse. Mental health services ask that referrals be 6 months sober before being added to their waiting lists. In addition, her new temporary accommodation was far away from support services. A care order was placed on her unborn child and after going into hospital to give birth, Clare’s baby was removed 3 days after birth. An emergency c-section meant that Clare wasn’t able to physically hold her baby during the three days they were both at the hospital. Clare didn’t meet the referral criteria of the Perinatal Mental Health Team as there was no plan in place for her child to return to her care, so she was ultimately discharged from hospital without support.   

Recommendation  

The gaps and barriers in mental health support are felt most at the intersection of overlapping disadvantage. We can see this in Clare’s case when she is unable to receive an assessment for support before she gives birth due to her drug use, and after birth when she does not meet the threshold for support from the Perinatal Mental Health team. The void in mental health support for women whose children are placed into care at or soon after birth has devastating effects.   

Linking women experiencing multiple and complex needs in with mental health support at this difficult time is essential. Referrals to other sources of mental health support should be made when women don’t meet the referral criteria for crisis care in primary care settings and at the very least the woman should be signposted to sources of support before she is discharged from hospital. Such a formative time for both mother and child should also not be overlooked and every effort should be made to allow mothers to bond with their new-born. Fulfilling Lives is not seeking to challenge decisions to remove children, but to identify and highlight opportunities for more supportive interventions to be considered. Tools like hope boxes can be used alongside other mental health support to help women to process and feel a sense of attachment to their child despite the circumstances. Many services offer mental health support, however siloed working and a lack of capacity mean that healthcare professionals are sometimes not aware of the support available to women. By developing channels of communications and a multi-agency approach across children and family services as well adult social care, services can work together to prevent women falling through the cracks and referrals can be made before the point of mental health crises.   

Missed opportunity 2 – Advocacy support for Court Proceedings

Clares Story: Care proceedings began, but the process of going through care proceedings wasn’t explained to Clare. This additional stress led to a decline in her mental health and drug use which meant that she missed meetings with social workers. Professionals interpreted her absence as a lack of engagement instead of seeing it as an opportunity to provide information about advocacy services in the area that could talk her through the care proceedings and represent her voice during multi-agency meetings. The child protection case went to court, in a different town to where Clare was now living in temporary accommodation, so she was unable to attend, and her child was placed into foster care.   Quotes gathered from FL research: “I felt very alone through the whole process.”  “I lost trust in the system.”    

Recommendation

In our experience, women often feel disempowered throughout the process of working with social services, not understanding their rights or having a firm grasp of what is happening at each stage. Many women have also had negative experiences of social services in the past, often as children themselves, leading to a distrust and disengagement from services. Many women don’t have an Adult Social Care key worker and are only interacting with Children’s Services, whose main priority justifiably is the safety of the child. This leads to a lack of support for the women experiencing repeat childcare proceedings. Our clients have reported that they felt like passive recipients of a process that is making permanent decisions about their own lives and those of their children. 

We would advocate that accessible information be made available to women, including an information pack with leaflets for support services and a simple guide to their rights and care proceedings. All women experiencing multiple and complex needs should be offered independent advocacy services to help to represent their voice, explain the process and support them with the practicalities, for example financial support to cover the cost of transport to meetings and hearings. This time is often one of crisis for women and having continuity of care and a clear source they can go to for information and support is pivotal in maintaining their well-being. The assertive outreach model means that this support would also reach women who are isolated and perhaps not on the radar of other services.

Missed opportunity 3 – Collaboration between Children’s and Family Services and Adult Social Care

Clares Story: In order to have contact with her child, Clare was expected to be abstinent from all substances. Without therapeutic aftercare for the loss of her child, Clare used these drugs as a coping mechanism for her trauma and grief and continued to have relapses during this period. Clare felt like the requirements services put on her in order to be able to have any contact with her baby are designed to set her up to fail. Getting help for her mental health isn’t possible while she is still using drugs so her Emotionally Unstable Personality Disorder remains undiagnosed.  Quote from FL client: “I feel like everything is going to come crashing down around me. <…> I feel I haven’t been given enough time to turn my life around it’s just not fair. How can I be expected to just stop using and attend all these appointments without any period of lapse?  I’m not perfect.” 

Recommendation

The exclusive focus on the child seems to often come at the cost of supporting the mothers. Our partnerships with services that support women through this process highlight that a whole family approach is beneficial for both the women and children and their wider support networks. However, this needs to be the product of a coordinated effort by social services to collaborative and open working. The differing requirements put on women by services can be very overwhelming, and when they aren’t able to meet these, they feel judged, punished and like the opacity of the system is being used against them. We understand the pressure that social workers are under but by building an understanding that people with complex needs require a creative, flexible and joined-up approach from the professionals supporting them, women are given an active role in the decisions that affect them, empowering them rather than punishing them for seeking out support.  This trauma informed approach can lead to better outcomes for mothers and children.  

Missed opportunity 4 – Long-term Therapeutic Aftercare

Clares Story: After 6 months of waiting for the final court case and a ruling on the contact Clare will be able to have with her child it is decided that an adoption order will be applied, before which there will be a final contact opportunity for Clare. Clare didn’t have a support network or professionals that she engaged with who could help her emotionally prepare for the final contact, which was extremely difficult for her. Without continued therapeutic aftercare, Clare expressed that she doesn’t feel life is worth living without being able to see her child.   

Recommendation

Many of the women working with Fulfilling Lives have histories of Adverse Childhood Experiences (ACEs) and abuse, many are care leavers themselves and so the loss of their child in this way compounds their trauma, doing immeasurable damage to their well-being and sense of self-worth. The complex and lasting impact of these experiences can manifest as ‘challenging’ or difficult’ behaviours and the coping mechanisms that women develop such as drug use are seen as further justification for the removal of their children.    

Better access to open-ended therapeutic aftercare for women in this position allows time and space for the symptoms of trauma to be addressed and for these experiences to be reflected on in a meaningful way. Specialised support can help to develop women’s understanding of their relationship to motherhood and their bodies and look at what healthy relationships and attachment means to them. These trauma-informed and relationship-based therapeutic interventions are not quick fixes but instead offer ways of breaking the cycle of trauma and the repeat removal of children and build tools for resilience that women can access in themselves for a lifetime.    

Quote from FL client: “I still want to fight for my baby and maybe in a few years when I feel better after having the anger management and by entering the steps programme we could look at appealing.” 

From these recommendations, we have six system-wide calls to action –    

  • We would like Adult Social Care and Children & Family Services to collaborate and communicate with each other throughout the child care proceedings.  
  • We would like resource put in place which allows the Perinatal Mental Health team to support mothers who have their children removed after birth, independent of whether the child returns within 12 months.  
  • Reduce siloed working practices and create multi agency wrap around support for women experiencing MCN and care proceedings, including creative, flexible and assertive outreach. 
  • For staff to be trained in trauma informed approaches.  
  • An investment into advocacy services which leads to improved understanding of care proceedings. 
  • Long term, open ended specialist therapeutic aftercare for women who have experienced having a child removed from their care.  

Our active participation locally

We have published a Guide to Child Protection and Care proceedings as well as a leaflet for women and workers with the aim to help navigate a complex system. These resources are available for free here and received some positive feedback already: ‘Thank you so much for sharing these, what great resources, especially the video which I’m going to share with someone this morning! I’m so glad you reached out to us, I think your work is amazing and so needed for the women in our community.’ Nicola Johnson, Advocate, SpeakOut.  

We also published a blog about FLSE’s front line workers witnessing a direct child removal and how difficult this can be for workers, let alone mothers and discussed the importance of joined working when supporting women who experience recurrent child care proceedings.     

Link to Looking Forward report   Looking_Forward_Report_08_Final-09.12.21.pdf (bht.org.uk) 

Links to resources    Launch of Guide for Child Protection and Care proceedings, and Women’s Rights Leaflet – Fulfilling Lives South East Partnership (fulfilling-lives-se.org) 


Authors: Michaela Rossmann, Eve McCallam

For more information on this work please email: rebecca.rieley@bht.org.uk or eve.mccallam@bht.org.uk

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Joint Working: The Power of Collaboration

Throughout the COVID-19 pandemic and lockdown, many services (statutory and third sector alike) stopped all face-to-face contact with service users and started working remotely. This shift in support was especially difficult for clients experiencing multiple and complex needs (MCN), including learning disabilities (LD), where the right type of communication is vital for understanding.

This article is about the importance of collaboration between services and an example of good practice when supporting women with MCN and LD through care proceedings.

We, at Fulfilling Lives South East (FLSE), together with Brighton & Hove Speak Out (BHSO) are currently working with the same mother, who has MCN and a LD. This mother’s child is subject to care proceedings and is currently living in foster care. This collaboration has highlighted some obstacles in the system for the mother from a front-line perspective, as well as advocacy point of view.

The FLSE Women’s Specialist Worker and BHSO Advocate agreed that it was much harder to build a trusting relationship remotely, and that effective communication was impaired

Whilst FLSE continued face-to-face support throughout the pandemic; the BHSO Advocate and Specialist Adult Social Worker were only able to offer remote support. When reflecting together, the FLSE Women’s Specialist Worker and BHSO Advocate agreed that it was much harder to build a trusting relationship remotely, and that effective communication was impaired. In some instances, the client’s mistrust of professionals and their misunderstanding of her and her partners’ behaviour, led to them making assumptions, which the FL Women’s Specialist Worker needed to challenge.

During the client’s pregnancy and post-birth, all Children’s Services meetings were held using video-conference facilities. Court hearings, parenting assessments and support, were also remote during this period. Children’s Services enabled digital access for some of the meetings at their premises; at other times the FL Women’s Specialist Worker had to provide equipment in alternative locations. Where the physical equipment was available, the FLSE Women’s Specialist Worker supported the client to use the technology, and to understand, communicate, and regulate their emotions. The BHSO Advocate was able to support the understanding of information before and after each meeting and feed the client’s voice back into the process. Without FLSE’s support, the client risked complete exclusion from the care proceedings.

Unfortunately, digital inclusion does not always reach the most marginalised people, including people experiencing MCN. The push for digital inclusion when providing essential services, for example health care appointments, adult social care support and court proceedings, has demonstrated just how many vulnerable adults do not have easy access to laptops and the internet. Even when digital access is available, communication via this method offers challenges to all participants. Non-verbal communication is much harder to recognise, multiple voices can be hard to follow, and a large number of participants can be intimidating. This type of communication is additionally difficult for those with a LD who have additional communication and processing needs and requirements.  With the parenting assessment and support also being conducted on-line, this again creates a further barrier for those with MCN.

FLSE would like to call for a person-centred approach for key meetings, to enable professionals to meet clients in a safe way to reduce the impact of exclusion and reduce the infliction of further trauma

FLSE would like to call for a person-centred approach for key meetings, to enable professionals to meet clients in a safe way to reduce the impact of exclusion and reduce the infliction of further trauma. In this case, the Local Authority applied for the child to be removed from the mother’s care at birth. The FLSE Women’s Specialist Worker supported the mother at hospital just after her birth, to make sure her voice was heard in meetings, medical exams and at the virtual court hearing. As the mother had a diagnosis of LD, she had access to a Specialist Adult Social Worker who was able to arrange this support and other reasonable adjustments whilst she was on the ward. Without this collaboration between the Local Authority, NHS and FLSE, the event of having a child removed at birth would have been even more traumatic for the mother.

When reflecting with BHSO, we agreed that the child protection process is very child focused – and rightly so. However, we would like to see an improved understanding and implementation of the communication and support needs of parents with LD, at the start of Local Authority interventions. Easy read documentation of the processes, key reports and assessments are rarely made available by children’s professionals, yet they are essential for the vast majority of MCN and LD mothers, as is, allowing additional time for processing and understanding information. Advocacy at the earliest opportunity is also essential within the tight child timescales, along with referral to adult services and other 3rd party support as needed.

FLSE and BHSO, would also like to see specialist support for parents with LD going through child protection and care proceedings. This includes conducting parenting assessments in a more LD friendly way, focussing on what parents can achieve, rather than just their struggles. Where support needs are identified, commissioners should ensure that services are available and accessible. This includes longer-term parenting support options, (such as Shared Lives- a scheme that matches someone with care needs to an approved carer), relationship safety support and awareness, and a holistic approach as provided by FLSE.

The right support and a trauma informed approach with the time and care put in at early stages can have a lasting positive effect on their recovery and reduce the likelihood of another pregnancy

We know that women who are going through child protection processes and care proceedings are likely to be experiencing MCN and LD. These parents often face increased stigma, and without advocacy to challenge professional behaviours, this will continue to exacerbate harm. However, the right support and a trauma informed approach with the time and care put in at early stages can have a lasting positive effect on their recovery and reduce the likelihood of another pregnancy.

Throughout our client’s journey and together with BHSO, peer support between the FL Women’s Specialist Worker and BHSO Advocate was appreciated and this collaboration has shown that a flexible and trauma informed approach can lead to positive relationships, not only for organisations but most importantly for the wellbeing of the mother.

Authors: Michaela Rossman, Gemma Harfleet & Nicola Johnson