By Robin Miller and Sarah McLaughlin, IMPACT

There are many potential benefits of asset-based approaches, in which professionals start with what matters to the person and their family, take time to build a trusting relationship and complement informal and community resources.

These include better outcomes for individuals and their families, a strengthened voluntary and community sector, reduced demands on formal social care services and improved job satisfaction for professionals.

Barriers to asset-based approaches

Despite the benefits for people like Joanna, many local areas find it difficult to implement asset-based approaches within their social care systems.

Common problems include co-ordinating with health-led activities, such as social prescribing, enabling social workers to have the time to engage with people and developing the local voluntary and community sector to respond to identified needs.

Over the past twelve months, the first demonstrator project within the Improving Adult Care Together (IMPACT) centre has been exploring how best to embed asset-based approaches.

Translating adult social care evidence into practice

IMPACT, which has been set up to translate adult social care evidence into practice, worked alongside the charity Mid & East Antrim Agewell Partnership (MEAAP) in Northern Ireland. It had developed a model of care in 2017 to better connect older people with support available within their community and facilitate collaboration between local health and social care professionals and with community resources

The demonstrator gathered insights from research, older people and carers, and local health and social care professionals to identify what was working well and what could be improved.

The main components of the MEAPP approach, known locally as IMPACTAgewell, are that:

• Older people and their families can contact the service direct or be referred in by health and social care professionals.
• Project workers bring together local social workers, pharmacists and general practitioners in monthly locality hubs.
• Community organisations who provide support to older people receive a payment to help build their capacity.
• Older people are central to the overall running of the host organisation (MEAPP) and how it plans future initiatives.

Getting buy-in from social work teams

Whilst there had been strong engagement from general practice and pharmacy, there had been more reluctance from social work teams to collaborate with IMPACTAgewell and introduce older people to the support available. This had worsened since the Covid-19 pandemic due to redeployment of staff and the move to online meetings.

To address this gap, the demonstrator project liaised with the social work team manager in Larne, County Antrim, to build better connections. IMPACTAgewell officers were invited to present to social worker team meetings more often, social workers and IMPACTAgewell Officers went on joint visits to older people, and student social workers gained experience of working within a community-led service.

Social work teams said that they were not always being kept updated on the engagement between IMPACTAgewell and individual people once they had introduced an older person to the service, and therefore a feedback process was introduced to address this gap.

A view from a team manager

One social work team manager said:

“IMPACTAgewell workers truly demonstrate that person-centred practise is paramount to successful outcomes for service users. Quite often, our service users need a little nudge, a little direction and a little support for them to recognise they can live independently in their communities. Sadly, due to the competing priorities within statutory social work, we are not always in the positon to provide this little nudge or build a trusting rapport. Consequently, we rely heavily on the expertise of IMPACTAgewell to support our service users. They truly make a difference in our service users’ lives to promote independence and confidence at home.”

IMPACTAgewell was also introduced within the hospital discharge processes, through a pilot with the Inver Intermediate Care Unit.

The IMPACTAgewell project officer attended weekly meetings with community discharge facilitators to discuss older people who might benefit from support. Identified older people were then visited to discuss what would make a difference to their safe return home, alongside the arranged health and care support package.

Improving access for black and minority communities

Research evidence and local stakeholder perspectives raised the issue that few older people from black and minority ethnic communities were receiving support from IMPACTAgewell. This was in part due to access criteria that required an older person to live alone, or with another older person, and because details of the support available had not been shared in a culturally accessible format.

The demonstrator therefore collaborated with the Inter-Ethnic Forum, a local agency set up to provide a link between minority communities and service providers.

The forum provided training to the project officers on the composition and needs of the local populations and how they could ensure their support was culturally appropriate. The forum’s staff were in turn briefed on the role of IMPACTAgewell and what support was available. The access criteria for the service were then changed so that it would be open to older people living with their family.

The collaboration led to older people from minority ethnic communities accessing IMPACTAgewell for the first time.

Ingredients for embedding an asset-based approach

Embedding an asset-based approach in adult social care can be successfully led by the voluntary and community sector and be an opportunity to encourage better joint working across health and social services.

Evidence-based research, lived experience and local practice knowledge should be used to review impact and reach and identify opportunities to improve effectiveness and inclusion.

Social work practice is a relationship-based activity which pivots around interactions that occur between social workers, people who receive support, carers and other professionals. Social work supervision is itself a relationship-based activity that should reflect the kind of trusting, supportive and empathic relationship that practitioners are expected to build with the individuals they support.

This supervisory relationship should be strengths-based; the supervisor focusing on the strengths of the social worker just as the social worker uses strengths-based approaches with the people they support. Strengths-based supervision aims to draw on the knowledge and expertise of both parties. It supports a collaborative relationship between supervisor and supervisee, one built on shared responsibility and shared learning.

A strengths-based approach should be empowering while enabling the supervisee to grow and develop their professional practice.

Strengths-based approaches are indispensable in modern social work. By providing a forum to think critically about and model strengths-based relationships, supervision makes its own vital contribution.

References

Department of Health and Social Care (DHSC) (2018)
Post-qualifying Standards for Social Work Practice Supervisors in Adult Social Care

Department of Health and Social Care (DHSC) (2019)
Strengths-based approach: Practice Framework and Practice Handbook

Rankine, M (2019)
‘The “thinking aloud” process: a way forward in social work supervision’
Reflective Practice; International and Multidisciplinary Perspectives, Volume 20, Issue 1, p97-110

If you have a Community Care Inform Adults licence, log in to access the full guide. You can access more supervision guidance on the practice education knowledge and practice hub.

Since Lyn Romeo announced her retirement in October last year, the tributes to the now former chief social worker for adults from across the profession have been warm and fulsome.

Lyn Romeo is without a doubt a social worker for social workers! Will be hugely missed by many and certainly me. https://t.co/S4ck6Tsi7U

— Warren Belcher (@ermate) October 5, 2023

Behind anything that is good in social care over the last 15yrs at a national level, if you look you will find @LynRomeo_CSW was very likely behind it, working quietly & diligently to ensure rights for ppl & support for SWs. A real force for good. We will miss her. Thanks Chief. https://t.co/u5cRw8NXK3

— Rob Mitchell (@RobMitch92) February 2, 2024

‘A great role model for bringing people together’

The Adult Principal Social Worker Network said that Romeo, who stepped down at the end of January, “exemplifies kindness and compassionate leadership”, and was a “great role model for bringing people together”.

These comments capture three beliefs about Romeo’s tenure as chief social worker for adults: that she has achieved things, demonstrated strong social work values and worked collegiately.

Alongside her children and families counterpart, Isabelle Trowler, Romeo has also embedded the role of chief social worker within the civil service.

Though England has had a chief medical officer (CMO) since 1855, and a chief nursing officer (CNO) since 1941, it was not until 2013 that the country acquired its first – and second – chief social workers.

However, despite their short lifespan to date, the roles now appear to be fixtures. The Department of Health and Social Care (DHSC) is now recruiting for Romeo’s successor, while Trowler is at the heart of making the Department for Education’s (DfE) children’s social care reforms a reality.

The blueprint for the chief social worker role

The recommendation to appoint a chief social worker came from Professor Eileen Munro, in the final report of her landmark review of child protection from the government in 2011.

Munro saw the role as serving three overarching functions:

• Providing professional advice to government, including on the challenges in delivering social work services and the profession’s contribution to achieving local and national outcomes.
• Promoting improvements to social work, including the adoption of evidence-informed practice.
• Promoting social work’s role in society and raising public awareness of, and confidence in, the profession.

One chief or two

While Munro recommended the creation of a single role, spanning children’s and adults’ services, the government struggled to recruit an overarching chief social worker.

So, in 2012, ministers decided to appoint two chiefs – one for each service. The move was criticised at the time by the British Association of Social Workers (BASW) and the then College of Social Work as undermining social work’s integrity as a single profession.

However, Munro subsequently came round to the idea, warning that a single postholder would “drown” under the pressure of covering both services.

Twelve years on, Romeo is convinced this was the right decision.

“I think it would be quite challenging to have someone overseeing that across two departments and the complete social work sector,” she says. “I think in the end it’s worked well that there have been two of us.”

Isabelle Trowler, chief social worker children and families (left), with Lyn Romeo

Of her relationship with Trowler, she says: “We’ve worked really well together and had a real impact on those shared areas.”

Embedding social work values in practice

When asked about her key achievements as chief, Romeo says social work values and approaches are now much more central to adult social care than they were prior to 2013, as embodied in the Care Act 2014.

The legislation, which started its journey through parliament just as Romeo took up her post, made promoting wellbeing the first principle of adult social care.

As set out in section 1 of the act, this included promoting a person’s control over day-to-day life, including their care and support. Also, assessments became focused on identifying the person’s desired outcomes, with councils required to consider how these could be met other than through the provision of care and support (sections 9 and 10).

This should include considering the person’s own strengths and their support network, according to the statutory guidance under the act, which councils are required to follow other than in exceptional circumstances.

Championing strengths-based approaches

While Romeo was not involved in the drafting of the Care Act, she has since sought to embed its strengths-based principles in practice.

Photo: fotolia/daoduangnan

Notably, in 2019, the DHSC, at Romeo’s initiation, published a strengths-based practice framework and handbook. This defined a strengths-based approach, rooted it in the Care Act, set out what the key enablers were to make it happen and gave case studies.

Romeo says it has probably been the most influential of the many pieces of practice guidance produced during her tenure.

Not only has it been adopted in several areas but it is also referenced in the Care Quality Commission’s new framework for assessing the quality of local authorities’ delivery of their Care Act functions, she says.

‘Social work as we know it’

“It’s social work as we know it – deep listening, getting alongside people, choice and control, supporting people to have input into the lives they want to lead, protecting human rights, inclusion and taking a holistic systemic approach.

“It’s been a big move away from a commodified, assessment, care and support planning, reviewing approach. I think we’ve been able to shift that story.”

This view, and Romeo’s part in it, is endorsed by the Adult Principal Social Worker Network, who said she had “transformed social work with adults over the past ten years”, by championing “a return to relationship-based, strengths-based and rights-based social work”.

However, while Romeo’s commitment to strengths-based practice is in no doubt, achieving it against a backdrop of rising demand and constrained finances has been challenging.

Social workers ‘expected to be box-tickers’, peers told

Following an inquiry into adult social care in 2022, a House of Lords committee said it was told by many witnesses about the perceived disparities between the act’s ambitions and practice on the ground.

People were expected to adapt to “the narrow range of services that are on offer”, with disabled and older people not seen as experts in their lives.

Many witnesses praised some social workers for supporting a vision of adult social care as enabling equal lives, but they said practitioners were “met with a system that requires them to become ‘checklist completers and box-tickers’”.

Credit: Ralf Geithe / Adobe Stock

Romeo acknowledges the “demand, need, resources, the challenging context within which people are working across health, social care, local government”.

‘This is not about care management anymore’

“But I do think that when I’ve been out to visit teams, that shift to strengths-based conversations, looking to how people can be better connected to community resources, how people can be involved in conversations about who cares, what can be done [has been evident],” she adds.

“I think people who are there do feel better supported – that this is about social work and not about care management anymore.”

Lyn Romeo (second right), flanked by past, present and future chairs of the Adult PSW Network. Photo courtesy of the Adult PSW network.

Another way social work has become more central to social care is in the role of the adult PSW in local authorities.

Rise of the PSW

Romeo helped ensure an update to the Care Act statutory guidance in 2016 included expectations on councils to appoint an adult PSW with the “credibility, authority and capacity to provide effective leadership and challenge”.

The status of the role was underlined when the government introduced controversial legislation in 2020 enabling councils to stop applying some of their Care Act duties during the pandemic.

Guidance on the so-called Care Act easements stated that these should be implemented “with or on the recommendation of the principal social worker”.

Romeo herself was on extended leave at the time, caring for her mother in Australia.

She left the chief’s role in the hands of Fran Leddra – then a PSW – and Mark Harvey, who had previously been a principal social worker.

Fran Leddra, former interim chief social worker and now a consultant

“It was a really tough time during Covid and I want to acknowledge how well Fran and Mark did in covering through one of the most challenging times,” she says.

“They did a really great job.”

Promoting social work research

Also a source of pride for Romeo is the work she has done to raise the profile of research in adult social work. This started with a project with the James Lind Alliance (JLA) to identify the top 10 priorities for adult social work research, which were published in 2018.

These included the impact of available funding and the Care Act on practice, adult social workers’ influence on people’s wellbeing, how far the Mental Capacity Act 2005 had been embedded and effective interventions with people who self-neglect.

A 2022 evaluation by King’s College London identified research carried out since the publication had addressed each of the questions, though Romeo said subsequently that there was “a considerable way to go to address these questions fully”.

She says there’s now a “much more developed architecture around social work” through the programme of research financed by the National Institute for Health and Care Research (NIHR), which is itself funded by the DHSC.

Funding for research projects

In 2019, following the JLA report, the NIHR launched its research for social care (RfSC) programme, which has subsequently invested £13m in different studies. This was succeeded last year by the research programme for social care (RPSC), which has a budget of £10m.

Also in 2019, the NIHR announced £135m over five years for 15 partnerships of universities, councils and NHS bodies to conduct research into key health and social care issues in their respective regions. One of these applied research collaboratives (ARCs), in Kent, Surrey and Sussex, focuses on social care and social work.

Photo: Feng Yu/Adobe Stock

As well as more research funding, there are now increased opportunities for social workers to get involved with evidence gathering.

Opportunities for social workers

In 2021, the NIHR launched its local authority academic fellowships (LAAF) programme, providing social workers and other practitioners with protected time to do master’s level-research, PhDs or post-doctoral studies while retaining their existing employment contracts and salaries.

In the same year, it also started the local authority short placement award for research collaboration (LA SPARC), providing practitioners with the opportunity to gain research experience within NIHR or academia through short-term placements.

Last year, an advisory group set up by Romeo, along with BASW, produced a charter for social work research in adult social care, to encourage employers and universities to promote these opportunities, and research awareness more generally, in the sector.

It was launched with the backing of NIHR, the Association of Directors of Adult Social Services (ADASS) and five local authorities, with one other council signing up subsequently.

Apprenticeship funding

One of Romeo’s last achievements in post was helping secure agreement for the DHSC to provide £12m to fund up to 400 additional social work apprenticeships within local authority adults’ services over the next year.

With one in ten social worker posts in local authorities lying vacant, despite the workforce growing from 2022-23, increasing recruitment in this way is vital in meeting the demand for practitioners.

Photo: Momius/Adobe Stock

Apprenticeships are the fastest-growing source of recruitment into social work, with 43% growth in the number starting courses from 2021-22 to 2022-23.

Romeo and Trowler’s tenures have also coincided with the launch, and subsequent growth, of government-funded fast-track schemes Frontline and Think Ahead, which train people to work as children’s and mental health social workers, respectively, in just over a year.

The pre-existing 14-month Step up to Social Work course has also expanded during this time, through increased DfE funding.

Romeo’s regret over mainstream social work courses

The Cinderella of the social work education ball has been traditional university courses, for which direct government resources, through student bursaries and placement grants, have been static for a decade.

Community Care has reported on the severe financial challenges this has posed for students.

Romeo says her greatest regret is not overseeing additional investment into these routes.

“I would have liked to have more investment in mainstream routes into social work,” she says.

“What are the incentives to bring people into social work these days when there are lots of different choices who want to make a difference and a public contribution? How do we make social work an attractive option for them?”

Social work ‘still associated with children and families’

She would also like to have seen a greater profile for adult and mental health social work in attracting people into the profession.

“A lot of people who think about it are only aware of children and families social work. When people go on their courses, they tend to think of that as their future.

“However, one of the wonderful things about social work is all the different options there are to apply social work skills and knowledge, including direct work with people of all ages, community work, policymaking, research and academia.”

She says there should be more placement offers for students in adult social care settings – “in local authorities, mental health trusts, specialist services like acquired brain injury services or working in drug and alcohol services, domestic abuse services”.

‘There’s a point you have to pass the baton on’

Lyn Romeo (credit: DHSC)

So why is now the right time to be stepping down?

“It’s a bittersweet thing to give up this role as I’ve absolutely loved it, Romeo says. “But there’s a point at which you have to pass the baton on and bring in other ideas and ways of approaching things.”

And what’s next for the now former chief?

“I will want to make a contribution to social work and social care. I’m going to have a bit of a break for a few months – go to Australia, visit family, have a holiday.

“Hopefully [retirement] will be a mixture of doing some nice things I enjoy doing and making a contribution.”

Assessments under the Care Act 2014, in England, or Social Services and Well-being (Wales) Act 2014, aim to enable individuals to express their wishes and preferences regarding their care. Taking a strengths-based approach invites practitioners to put the assessment form away and engage the person in a conversation about more than just the problems they face.

Building a collaborative relationship is key in strengths-based practice. This requires practitioners to step away from holding themselves as the authority and to view the individual being assessed as the expert in their own life and experience.

To keep assessment and eligibility processes strengths-focused, try to:

1. Shift from discussing problems to exploring possibilities and solutions.
2. Reframe a negative experience in a positive light.
3. Encourage the person to take the lead in identifying their needs and desired outcomes.
4. Check and confirm whether the person wants the involvement of the local authority.
5. Prompt the person to ensure all their needs have been identified.
6. Ask about day-to-day outcomes like dressing, maintaining personal relationships, going out into the community and, where relevant, working.
7. Be clear about eligibility requirements. Emphasise the idea that people’s needs are often best met by combining complementary resources.
8. Write any notes or reports and record decisions you make in the knowledge that you are required to share these with the person. Consider what it would be like to read them.
9. Facilitate active involvement in decision making.
10. Use open-ended questions that allow the person to describe their situation without you making assumptions regarding deficits.

While a strengths-based approach is consistent with the outcome-based assessments required under the Care Act and Social Services and Well-being (Wales) Act, it does not provide all the answers. It must be used in tandem with critical theories and approaches to build a better understanding of situations, discover ways forward and help other possibilities emerge.

If you have a Community Care Inform Adults licence, log in to access the full guide and read more strengths-based ideas for moving beyond completion of an assessment form as well as suggested questions and strategies for engagement.

Taking a strengths-based approach to practice does not exclude the need to engage in difficult conversations. These may arise at any point when conducting needs assessments but are commonly found when:

• The final decision is not what the person, their family or carer were hoping for, and they respond in anger or distress.
• There is a personality clash between the social worker and the person being assessed, a family member or carer.
• The person being assessed, a family member or carer has a grievance or has made a complaint about the social worker or the decision made regarding their care.
• The person being assessed, a family member or carer engages in aggressive behaviour.
• The Care Act 2014 or Social Services and Well-being (Wales) Act 2014 (SSWBA) require the social worker to include the adult, their carer, someone else they nominate or an independent advocate in the assessment process. Having a number of people involved could increase the potential for differences of opinion and conflict, which leads to difficult conversations.
• The person being assessed experiences emerging impairments, such as short-term memory loss or a mental health concern. In these circumstances, it becomes particularly important to have appropriate assessments in place and to listen carefully to family or carers.

If you know there is a difficult conversation to facilitate on the horizon, prepare for it by:

• Considering the key points you want to communicate and be heard. Determine what you might say and how you might say it.
• Making a plan of the main points you need to convey. If you have time, jot these ideas down. This will help you remember critical information that needs to be conveyed, even in the heat of the moment should tensions flare.
• Keeping your ideas simple.
• Identifying the strengths the person holds that you might highlight in this conversation and having some ideas about how they might draw on these strengths to move through and beyond the difficult conversation.

Set a clear framework for the conversation:

• Be clear with the person about the purpose of the conversation and what you hope to achieve by the end of it.
• Enter the conversation with some ideas about possible solutions that draw on that individual’s strengths which were identified in the assessment.

Be prepared for disagreement:

• If you expect the person to disagree with you, be prepared with facts and alternative suggestions that might open up solutions to the problems the person perceives. Gather available evidence that supports what you are putting to the person that you can share with them (eg from independent assessments or observations in your case notes).
• Acknowledge differences of opinion openly and offer gestures of support.
• Be diplomatic.

Remember to use basic interpersonal skills:

• Listen, then listen some more.
• Acknowledge feelings as they arise. Allow their expression without judgment.
• Be empathic. Imagine what it’s like to be in this person’s shoes. Respond accordingly.
• Allow space for silence so emotions can be expressed and present.
• Avoid personalising any negative behaviours you perceive, and maintain your objectivity.
• Keep a broad perspective to help prevent misunderstandings.
• Clarify uncertainties within any communication to avoid misinterpretation.
• If the opportunity arises, and it feels appropriate, use humour to lighten the mood. Used well, this can help diffuse tense situations.
• Remain open to the other person’s view and interpretation of the situation.

Closing the conversation:

• Summarise the problem, issue or discussion and what has been agreed.
• Provide an explanation as to why these agreements are satisfactory for all parties.
• Agree on who should do what next and if there will be a follow-up.

Regardless of their beginning point, many difficult conversations reach the point of ‘what next’ or ‘what now’. It can be helpful to end a difficult conversation by focusing on the future and providing a clear picture of what happens next for the person or what other possibilities might be explored.

If you have a Community Care Inform Adults licence, log in to access the full guide and read more ideas for coping with difficult conversations using strengths-based practice as well as examples of difficult conversations that might emerge.