Having the right conditions in place
Social workers need supervision, training, reasonable caseloads, integrated systems and good local commissioning to best support people as they prepare for adulthood.
Challenges we face
No social worker, however skilled and knowledgeable, and with whatever passion for person-centred practice, can effectively support a young person and their family to prepare for adulthood in isolation, and without the right support themselves. To practise effectively, social workers need to be operating in systems that bolster good practice. Some things in this section will be beyond the power of individual practitioners to put in place. However, it is important that practitioners can call on frameworks such as this, to make a case for working conditions and systems that allow them to work to their best ability, in support of young people and families.
In the current operating model, time and resources are often focused on servicing processes and minimising risks, leaving less time to focus on enabling people to live the life they want to live. Social workers, who came into the profession to deploy the best of their humanity, empathy and resourcefulness to help people flourish, can find themselves managing large caseloads and focusing on tasks and protocols to meet service throughput targets.Putting people at the heart of social work: lessons from the named social worker Programme (Innovation Unit & SCIE, 2018)
Social workers frequently wrestle with large caseloads. Alongside this, pressures on services mean that allocations often only take place either when a young person is nearly or already 18, and planning then needs to happen too quickly, or when the young person is experiencing a crisis. Either way, it becomes hard for social workers to plan and practise as they should, for example by taking the time to consider more bespoke, community-based options for people.
Caseload pressure has other effects. It can become custom and practice to operate a model in which cases are closed as soon as any immediate tasks are completed, which leads to a repeated switching of practitioners, and militates against the development of a lasting, trusting relationship, which many of the people we have spoken to say is key to good transition support. Or, even more disruptively, cases are not allocated to a practitioner at all, and young people’s future services are managed by duty social workers.
Lack of supportOpen
To help address the challenges of work, and to discuss options for young people – especially where these are to be innovative or creative – good quality, regular supervision is vital for social workers, but too often we have heard from practitioners who do not benefit from this.
Lack of servicesOpen
For a social worker to be able to support a young person into adulthood effectively, there also has to be a range of good quality things available for young people to do, once their education comes to an end, so that tailored, creative support can be put in place. SCIE heard from young people in college that there are few options for them once their course is finished. The number of people with learning disabilities in paid employment, for example, remains stubbornly low – at roughly 6 per cent – despite years of initiatives to promote work as an option.
In some areas, quality community-based alternatives to employment simply do not exist, or not on a sufficient scale to provide support to substantial numbers of young people with disabilities. In part, this can be because commissioning budgets, stretched as they are, become disproportionately spent on a small number of extremely high-cost care packages.
Bureaucracy has long been a bugbear for social workers, sometimes perhaps excessively so; accountability to one’s clients and one’s employer does require a measure of paperwork. But, the balance needs to be right, and some management systems feel overly burdensome. Furthermore, some such systems are based on the premise that social work consists solely of assessments, care planning and reviews, and do not support the recording of all the additional meetings, phone calls and communication through which a social worker assists and reassures people at a time of significant change.
We look in more detail elsewhere at the role of the social worker within a wider network of education, health and social care provision for young people. But it is worth noting here that, where those systems do not work well together, social workers can be hamstrung in their efforts to navigate an effective path to adulthood with and for the young person they support.
Making it better
How best to put in place the structures and systems to support good transition work has been a matter of consideration for many years. In 2008, for example, the then Department of Health produced its ‘Transition – moving on well’ guidance, which called for joint strategic planning and good links between children’s and adults’ services; joint funding arrangements; a clear transition pathway; and transition teams with a skilled mix of core professionals delivering a comprehensive service to young people. It also recommended specialist commissioning for young people preparing for adulthood, alongside quality standards to enable performance management, and measurable outcomes to ensure a value-for-money service.
To take those last points first: quality standards and measures will always be controversial among social workers, with a recurrent strand of thought that as soon as one measures something, then it is the measurable that becomes important, rather than actual, hard-to-quantify changes in a young person’s life, such as more confidence, more independence and so forth. SCIE has some sympathy with this, but outcome measures are important for accountability, and the challenge thus becomes to develop measures that are meaningful for people preparing for adulthood (rather than, as can happen in adult social care, the target focus being predominantly on older people), and which capture genuinely important outcomes, for example work and independent living.
Some desirable outcomes for young people, such as being a part of one’s community, with a strong friendship group, will always be hard to measure, but social workers need to be part of the discussion as to what can be monitored that would focus individual and organisational efforts in directions that actually benefit young people.
More broadly, organisational settings which promote joint working between professionals will benefit a cohesive effort to support young people to adulthood. There is a wealth of material, much of it from SCIE, on how best to integrate services – the debate has raged even longer than the one on how best to manage transitions – but social workers we spoke to cited joint management arrangements and pooled budgets as the basic necessities for organisational arrangements which do not get in the way of good life outcomes for young people. If these outcomes are hampered because of fragmented service provision, social workers need to use their collective voice to push for local change. This could involve citing organisational Care Act duties to cooperate to promote wellbeing, or raising the issue in consultation and team forums.
The responsibility for addressing integration ultimately rests with senior, strategic leaders, but they need to hear from frontline staff if young people with learning disabilities are being adversely affected by organisational arrangements. Similarly, if disjointed IT systems hamper good transition planning, it may not be for any one social worker to address, but every social worker should raise the concerns they have about the impact on young people.
Good commissioning is another key part of the structure that will enable social workers to support young people well. There needs to be a marketplace of appropriate support, with a focus on community engagement, and on services that are suitable for adolescents and young people. One issue that seems to beset many aspects of transition planning is that there is a binary distinction between children and adults, and a lack of provision for adolescents/young adults. We have heard from young people who don’t want environments covered in cartoon animals, but also do not want, at 18, to be in settings designed for middle-aged people or older.
Regulation regimes are an issue here, because children’s services are overseen by the Office for Standards in Education (Ofsted), and adults’ services by the Care Quality Commission (CQC), and it can be problematic for organisations to get registration from both, if they want to cater for an adolescent cohort. Therefore, part of the ‘ecosystem’ in which a social worker needs to operate is the provision of good quality support options specifically for young adults.
Support from managers is pivotal. Supervision, and opportunities to learn and to reflect – individually and in teams – all enable better practice, and managers cannot reasonably expect a good performance from social workers without making these opportunities available. But this needs to go beyond the simple provision of supervision and reflective sessions. These forums need to be places in which social workers are given permission to think creatively, to take risks and sometimes to make mistakes.
Evidently, this does not mean that social workers should be encouraged to take extravagant risks with the futures of young people, but it does mean that social workers, alongside the young people and families they are supporting, need to be allowed to work outside the often very risk-averse climates of local authorities.
Talking to professionals from the NSW pilot sites for this guidance, our Innovation Unit partners heard, among many similar messages, that ‘having a supportive manager willing to fight for what’s right …’ and having managers ‘willing to get behind an ambitious vision’ were two of the main determinants in whether a piece of work succeeded in helping a young person embark on a future they wanted. The message that social workers need to be supported throughout the hierarchy by people who believe in young people in the same way as frontline staff is clear, and needs to be heard.
A social worker, to work well, needs to be part of a team. Peer learning, mentoring and informal mutual support are all important elements in developing a social work culture in a team that consistently supports young people well. Looking beyond the team, access to the PSW in each local authority is useful too; they provide an expert source of knowledge and experience, without – as can be the case with managers – a parallel focus on target and budgetary considerations. Working in transitions, links with PSWs in both children’s and adults’ departments will be useful.
A supportive team network feeds into an important issue, raised consistently with young people and their families as perhaps the most determinative factor behind a good transition: consistency in staff support. As we see in our final section, a strong, trusting relationship between a young person and their social worker is at the heart of good transition planning.
But, given that any social worker may leave their job, or take extended time off, part of good transition team management is to have a focus on staff retention, and where possible some contingency/succession planning for when people do leave. Using a departing social worker’s notice period to introduce a new staff member to a family can help, as can joint case working, where newer staff learn alongside more experienced practitioners, and can then step in should the primary social worker leave.
The work the Innovation Unit did with SCIE looking at the role of the NSW approach in transition teams also stressed the importance of small teams that are familiar with each other’s cases, so that if a non-allocated worker does need to get involved, they at least know the young person’s story to some extent.
If a social worker is to truly focus on each person they support, their caseload has to be of a size that enables this. It is a challenge: budget pressures on local authorities make large caseloads more likely. But, allowing staff the time to work creatively reaps benefits in terms of outcomes and, as we explore in Focus on the person, potential cost savings too. A framework that enables sufficient attention to be paid to everyone on a social worker’s caseload is an important building block to a good transition service. Local authorities cannot burden practitioners with more work that they can do well, and still expect creative, community-based social work to take place.
It is worth noting that transition social workers can sit at different points within a local authority structure. This can be:
- within disabilities teams for children aged 0–18
- within disabilities teams for children aged 0–25 – this is becoming more common since the Children and Families Act 2014 expanded special educational needs provision to 25 years of age
- within standalone transition teams in adult social care
- within other adult social care teams, be they based on client need – e.g. learning disabilities – or geography
- within an all-age disability service.
There is no clear evidence as to which model works best for young people. We believe that the structural conditions necessary for good practice to flourish can exist in any of them; similarly, those conditions could be lacking, whatever the location of the social workers concerned. So what becomes important is not where within the structure social workers are located, but how they are supported, to best be enabled in turn to support young people. The National Institute for Health and Care Excellence (NICE) reviewed the available evidence in Learning disabilities and behaviour that challenges: service design and delivery(NICE, 2018) about which models of service delivery work best, and identified some important components for success:
- person-centred services
- a ‘whole life’ approach to planning and commissioning
- community learning disability teams to ensure access to specialist support
- a named worker to coordinate care and support
- behavioural support
- support during a crisis.
The call for people with learning disabilities to have access to a specialist service chimes with the messages we heard from social workers themselves, who pointed to the importance of learning disability expertise within teams. We look further at what social workers need to know in the next section, but there is perhaps at least some indication that generic teams without a learning disability focus may not be the best model to help young people with learning disabilities prepare for adulthood.
Knowing your populationOpen
This framework looks at how social workers can best support people with learning disabilities. A well-functioning system needs to include the ability to track, and make provision for, young people who do not straightforwardly progress from children with disabilities teams to adult social care, however that may be configured. These groups would include:
- Children with disabilities who are not known to children with disabilities teams, perhaps because they have been in out-of-area residential schooling from an early age.
- People who are not likely to be eligible for adults’ services. The Care Act is clear that people must be offered an assessment for adult social care if they appear to have social care needs, even where it is unlikely they will prove to have eligible needs. But even where assessments are being offered, there is a cohort of people for whom support can drop away dramatically if and when they are found to be ineligible for adult social care.
- Children and young people entering adulthood with life-limiting conditions, who need palliative care alongside sensitive planning for the future.
- Young offenders. Often people in this group go from being seen as child victims to adult perpetrators overnight, a change with which they, and services, can struggle to cope.
- Siblings. The Care Act and the Children and Families Act (see Underpinning knowledge) have combined to give greater flexibility to how young carers can be supported, but siblings of young people with learning disabilities have specific needs and challenges that a local area will need to be able to address.
Each of these groups merit the close attention of policymakers, local leaders and frontline practitioners, but are outside the scope of this particular framework. We hope, however, that some of the main messages and themes here have an applicability to these groups.
- Create protected time to build trusting relationships with young people and their families.
- Allow time and opportunity to learn and develop, with an emphasis on reflective practice.
- Social workers should have permission and opportunities to work in creative, person-centred and risk-aware ways.
- Staffing should be consistent wherever possible, bolstered by contingency planning should staff leave, and by team awareness of other workers’ cases.
- Links should be in place with PSWs locally, for both adults and children.
- Decent commissioning is vital: a range of services, shaped by an understanding of adolescents.
- Collaboration with other services is also important, including co-location and shared management and budgets.
- Practitioners should work towards measurable outcomes that promote accountability, and measure things of real worth to young people.
Resources: guidance and tools
- Developing and sustaining an effective local SEND system: a practical guide for councils and partners (Isos Partnership, 2018)
- Jointly commissioning palliative care for children and young people aged 0–25 including short breaks (Together for Short Lives, 2015)
- Learning disabilities and behaviour that challenges: service design and delivery (NG93) (NICE, 2018)
- Transition: moving on well – a good practice guide for professionals and their partners on transition planning for young people with complex health needs or a disability (Department of Health & Department for Children, Schools, and Families 2008)
- Transitional safeguarding: Adolescence to adulthood, strategic briefing (RiPfA, 2018)
- Quick guide: commissioning for transition to adult services for young people with special educational needs and disability (SEND) (NHS England, 2018)
- Quick guide: guidance for health services for children and young people with special educational needs and disability (SEND) (NHS England, 2018)
- 10 Steps Transition (Alder Hey Children’s NHS Foundation Trust)
- In it together: achieving quality outcomes for young people with complex needs (Children's Services Development Group 2009)
- Named Social Worker site profiles and resources (Innovation Unit, SCIE, 2018)
- PfA Self-evaluation tool: local authority – adults’ social care (Preparing for Adulthood, 2015)
- PfA Self-evaluation tool: local authority – children’s social care (Preparing for Adulthood, 2015)
- Preparation for and transition to adulthood audit tool (Preparing for Adulthood, 2018)
- Stepping up: A guide to enabling a good transition to adulthood for young people with life-limiting and life-threatening conditions (Chambers and Kelly, 2015)
- The preparing for adulthood review: a good practice toolkit (Preparing for Adulthood, 2015)