Supporting the person through the system

Social workers need to understand local systems and services, and support young people and families to find what they need from those systems.

Challenges we face

We have put the interests of a system that is no longer fit for purpose above the interests of the people it is supposed to serve. The system is fragmented, confusing, sometimes frightening and desperately difficult to navigate.
Professor Steve Field, ‘From the pond into the sea: children’s transition to adult health services’, CQC 2014

Complex systemsOpen

Underpinning many of the problems that have beset transitions-working over the years is the sheer number of different agencies involved. In an age in which we are working to education, health and care plans (EHCPs), and young people are moving from children’s to adults’ services in each of those three areas, then six different systems are in play, and need to align if the transition process is to work smoothly.

Each of these systems may transfer a young person with learning disabilities to adult services at different times. Some may contain a number of different strands: ‘health’ may be a catch-all term for half a dozen or more separate medical disciplines; and social care departments can incorporate both long-term teams and safeguarding services, for example.

Further complications can occur when different bodies cover slightly different geographical areas; when some services are contracted out; and where different organisations use different eligibility criteria. Very quickly, a young person and their family can find themselves in the midst of a baffling array of different professionals, each with their own set of priorities, organisational cultures and values; each with their own legal duties and limits; and each answerable to some extent to the demands of a different bureaucracy.

Even recent changes, designed to improve the transition process, can complicate things. The move towards 0–25 social work teams, to fit with the EHCP agenda, can unbalance partnership with health colleagues, where transition often remains at 18 (although proposals in the NHS Long Term Plan to move to a 0–25 model for healthcare provision ought to address this). And more bespoke, personalised care and support can bring in a number of new organisations into a young person’s life, creating packages of support which need a lot of active managing.
Culture clashesOpen

There remains the risk of a culture clash between services: for example, when health services push for options that social workers consider over-medicalised and restrictive, or when the children’s social care duty to ‘maintain stability’ is at odds with adult social care efforts to build independence. To ice the cake, young people and their families may be learning for the first time that some of these new services will have to be paid for.

We have thus created in many places a system that is complicated, and at times simply dysfunctional. At its heart are young people and their families, struggling to work out what needs to happen when, and who can support them. And alongside them, there are social workers who, in some circumstances, are also confused about where to turn.

Making it better

The role of social workers as aspirational and committed champions for young people going through transition is vital in engaging all of those multi-agency professionals involved in an individual’s care and support in order to develop joined-up, effective and person-centred plans that lead to positive outcomes.
Caroline Bennett, ‘21st century social work with children and young people with disabilities (Research in Practice, 2018)

Knowing the systemOpen

It is the professional duty of every social worker to use what forums they have within their organisations to push for improvements to how things are done. Nonetheless, remedying the complexities of the health, social care and education systems through the transition period is beyond the scope of any individual practitioner. Each worker will need to develop ways of navigating the system, so that they understand it well enough to be of service to the young people they are supporting. And having understood it, the social worker will need to act as a champion, supporter and advocate to young people, in whatever ways best suit each different individual.

In order to do this well, a social worker needs to get to know three things: the systems and resources of the area in which they work; their colleagues within those systems; and the young people and families they support.
Knowing your areaOpen

Knowing one’s local area inevitably takes time. Under both the Children and Families Act requirement to produce a local offer and information and advice duties of the Care Act, a local area will – led by its council – have to provide good quality, accessible information about what services and support may be out there, and these will provide social workers with a starting point from which to map the assets that will benefit the young people they serve. Taking the time to get out and about in communities, to learn what groups are running at the nearest church, to discover when the village hall hosts a dance class, when the local cricket club needs volunteers or when a neighbourhood park is having a clean-up can help develop bespoke, community-based support for people.

We learned of different models of doing this. In some social work teams, each team member looks out for local activities within specified geographical areas. Others have appointed community connectors/navigators with whom social workers can share ideas. Often, such community navigators are located within the voluntary sector, which feels like a natural fit, but which means it is vital that they maintain good links with statutory partners. However it is done, a good social worker – if they are to meet their duties under the Care Act to promote strengths-based approaches – should be able to understand the assets of the communities in which they work.
Colleagues and specialist servicesOpen

As well as what is available in the community, it will be necessary to understand the more formal parts of the education, health and social care systems: what specialist provision there is for young people with learning disabilities; what colleges and schools exist; where one’s health colleagues are based, and so on.

As well as getting to grips with the system, it helps to get to know one’s colleagues within it. Much of the work on integrated care stresses the benefits of developing strong relationships with fellow professionals, and the NSW pilots reinforced the message that nurturing those relationships is important. Putting faces to email addresses, understanding the motivations and pressures of partners in multi-agency teams, attending shared learning events – there are many ways in which social workers can build relationships with colleagues.

Behind these efforts, we again have the duties, under Sections 3, 6 and 7 of the Care Act, to work together with partners for the general wellbeing of people with care and support needs, and in each individual piece of case work. It can be useful to reflect on the fact that working cooperatively is a legal duty, and in extremis, citing the legislation may help in bringing people together in support of a young person when diaries and priorities perhaps clash.
Advocating for the young person Open

At the heart of the practice framework – in Focus on the person – is the requirement for social workers to get to know the young people with whom they are working. But doing so is relevant here too, in discussions about advocating for young people, and supporting them to navigate complex systems. One of the key strengths that a social worker can bring to a multi-disciplinary discussion is their value base and training in working holistically with, and alongside, the young person, in a way that empowers them.

For this to be credible and effective, however, the social worker needs to demonstrate that they do indeed know and understand the person well. Why would a doctor listen to a duty social worker who is calling for a person-centred approach with someone, but who has met that person only once? Getting to know the young people one serves is vital to representing them professionally and effectively in multi-agency settings.

Given the holistic approach that characterises the discipline, the role of coordinator and navigator will frequently fall to social workers, and we heard often from young people and their families that this aspect of social work support – of managing handovers and joining up services – is vital.
Working with familiesOpen

The system with which the young person preparing for adulthood is likely to be most familiar is their own family, and a social worker will often need to support both the young person and the family to navigate the wider landscape. Sometimes, the social worker will need to support the young person to negotiate with their own family, who will, as we have seen, often be anxious about the move to adulthood. Anxious because most parents of teenagers have a measure of trepidation about their children becoming adults, but anxious too because of the many service and systems changes that involves for young people with learning disabilities.

Working with families to address their concerns, and to mediate between the family and the young person, requires a strong set of skills, which are core to being a good social worker: listening, empathising, negotiating and planning. But social workers can also get involved in forums for families, information days and other projects designed to enable families to seek mutual support and ideas. The workshops that Innovation Unit ran as part of this project stressed repeatedly the importance of working alongside families if any creative work was to be done with young people, highlighting that this is not an area of practice that can or should be short-changed.
Supporting other lead professionalsOpen

The NSW pilots demonstrated more generally some of the advantages of allocating a dedicated professional to support a family, and there are specific elements of the social work role that can particularly benefit young people and their families at this time. But that dedicated professional need not be a social worker. The best person for the role will be dictated by the needs and wishes of the young person themselves, supported by their family where appropriate. So in many instances, the role of the social worker will be to liaise with, and support, whoever is the lead professional supporting a particular person as they prepare for adulthood.

Top tips

Learn about the community resources that can benefit the people you support.
Develop an understanding of local social care, health and education systems, and get to know the organisations providing support in these areas.
Work alongside, understand and support colleagues in other disciplines.
Recognise that you cannot advocate for and support someone you do not know well. Get to know the people with whom you are working.
Get to know the families with whom you are working, addressing their concerns and supporting their aspirations for the young person.
Develop the skills to coordinate and lead multi-agency groups, working together to support young people.
Develop the skills to be a part of such teams, when other professionals are taking the lead.