- Co-locating professionals in Warrington – Naomi’s story
- Our Place – Rochdale’s No Wrong Door: Trauma-informed approaches to working in CSC
- New Roads Norfolk: Susan’s story “It’s not just on one person’s shoulders”
- Our Place – Rochdale’s No Wrong Door: Anne’s story “What good parents do”
- Challenging each other’s perspectives – multidisciplinary teams in the Warrington No Wrong Door hub: Amy and Neil’s story
Breaking down silos – co-locating professionals in Warrington
Naomi Mackett, Clinical Psychologist, No Wrong Door, Warrington
Naomi trained as a Clinical Associate in Applied Psychology (CAAP) at Edinburgh University, after which she worked in Fife as a CAAP across both CAMHS and looked after children services. She finished her doctorate in clinical psychology at Bath University, and then started in Warrington as part of the No Wrong Door service.
Reflecting on her journey to this point, Naomi picked out a role she had in Fife as the moment when her interest in working with children was sparked. She explained that it was a split post between CAMHS and looked after children services working with children in Fife therapeutic placements.
It has been this passion that has pushed her into more challenging roles where she feels she can make a big impact on the lives of children. Her current role in Warrington has been unlike anything she had experienced before.
“When I arrived there wasn’t much of a framework or structure to what was wanted from the role other than just come and do it and see what happens. I feel like I had never worked somewhere like this, everywhere else has always had quite clear structures of what they want from you. That has been very freeing and very scary at the same time, but it has been a really flexible way of working.”
Professionals need to understand each other
This flexible approach is very different to the ways of working Naomi experienced before starting at No Wrong Door. In her career journey to date, Naomi has seen how a lack of collaboration and understanding between organisations restricts their ability to work effectively to support children and young people. Too often organisations fall into working in silos as a direct result of their rigid boundaries and processes.
“One of the major issues I have seen everywhere I have worked is the lack of relationship between social services and CAMHS and I think that comes down to the different ways services are trained. What CAMHS think is a mental health problem and what social care think is a mental health problem are completely different things and I think half of the time of the people in those services is spent fighting over definitions of things and who should do what rather than actually doing things.”
Naomi gave the example of a particular young person she has worked with in the past. This young person had experienced extensive developmental trauma, he had diagnosed ADHD, high levels of communication needs, difficulties with learning, and had repeatedly been in trouble with the police. “When he became known to our service the conversation was very much CAMHS saying the issue was the environment and it’s his home, and social care saying they think its psychosis, and we were stuck in this situation where people on both sides were pulling in higher and higher people and the conversation never went anywhere.”
“There are huge cultures of what these different organisations expect from each other, but they don’t really understand each other’s work.”
Learning across organisations
This challenge of managing traditional organisational boundaries is something that No Wrong Door is actively trying to improve by co-locating professionals within residential hubs. Naomi works closely with the hub staff, social workers, the police, and a speech and language therapist.
Being co-located with other professionals has fostered a learning culture between them based upon trust and Naomi feels it has given her the space to bring her expertise to make a difference to children and young people. Importantly, this learning goes both ways and benefits all involved in the system.
“There is some really good stuff in terms of learning from both spaces and how I bring my knowledge into a social care context and then how I bring that knowledge from social care into child and adolescent mental health services. I think that learning from each setting has been really helpful in some ways.”
She feels that her insights as a clinical psychologist have supported her colleagues in their understanding of the challenges faced by the children and young people they work with, but her colleagues have also affected her own way of working. “I think psychologists can be quite cautious in what they say but this role has made me more direct in what I say and how I speak, which is much less an NHS way of speaking and is a more social care way of speaking.”
Relationships at the centre of collaboration
Naomi is convinced that greater collaboration between organisations is needed to improve how services are provided and outcomes for children and young people.
A greater understanding between those services is one of the most important things to achieve and a project like this is getting somewhere to improving that relationship as it is so entrenched everywhere as it is a resources issue.
For Naomi, Trusted relationships are the foundation of effective collaborative working where professionals develop ways of working together and they can approach challenges together with their collective expertise. This fuels the learning environment and supports the cross-pollination of ideas. It’s not as simple as attending more training but requires “professionals to actually work alongside each other and to be constantly having conversations.”
Naomi would like to see the No Wrong Door approach to co-locating professionals used more widely.
She feels that being co-located at the No Wrong Door Hub, “you get to know people so well and you can see their perspective when you trust their opinions and their intentions. I think a solution is for more co-locating of services and seeing how each other work.”
Our Place – Rochdale’s No Wrong Door: Trauma-informed approaches to working in CSC
Katie and Kristian’s story
‘Our Place’ is Rochdale’s service for adolescents in or on the edge of care, adapted from North Yorkshire County Council’s No Wrong Door (NWD) model. The service – now running for over two years – is based around a residential Hub providing beds for up to five young people, with outreach work supporting young people and their families to stay together.
The multi-professional and multi-agency team – working in and from the Hub – includes a registered manager and deputy managers, Portfolio Leads (who focus on key areas of work, such as education), key workers, residential and edge of care workers, plus a Clinical Psychologist (known as Life Coach), Speech and Language Therapist (known as Communication Support Worker) and Police Liaison Officer.
In Rochdale, effective multidisciplinary working has been central to the success of the NWD model. The Life Coach, Kristian, and Communication Support Worker, Katie have worked together for the last 18 months and have developed a strong working relationship based on shared values and understanding of the needs of traumatised children.
After working in Manchester and Oldham, Kristian took the job in Rochdale because he’d always wanted to work with Looked After Children (LAC), and because he was looking for a role where he could apply his interest and training in attachment theory, in particular, DDP, a therapeutic approach to working with children and their parents. Katie trained in Speech and Language as a mature student, having worked previously in schools and a Pupil Referral Unit.
Together, they have drawn on their separate professional training, and literature relating to developmental trauma (including Kim Golding’s work on Hierarchy of Needs), to develop a trauma-informed practice which sees children’s behaviour as communication that needs to be understood and responded to in a consistent and predictable way by everyone who works with them. Together, they have modelled ways of working with young people and their parents that uses clear, accessible language and focuses on developing understanding, building rapport and helping young people to feel safe. Katie often works directly with young people (using an ‘Emotional Coaching’ approach) and with schools, while Kristian uses a therapeutic approach (DDP) to work directly with parents and families. In the Hub, the pair’s office is just across the carpark from where the young people live; there, they create a ‘safe space’ for conversations with young residents, and with staff, on a regular and ad hoc basis.
In the Hub, Katie and Kristian play a vital role working with and supporting the wider Hub team in their interactions with young people and families – raising awareness of the impact of trauma on development, and helping to build empathy. Key workers are often pushed for time, so it helps them to know they can ask for advice and support in building relationships with a young person. Also, the Police Liaison Officer will ask for Katie’s support as a kind of translator, when talking to young people – to make sure that the technical jargon of ‘law and order’ does not get in the way of building a relationship.
In the wider Rochdale team, Social Workers ask for help with a letter to a family or ask advice on the best way to talk to parents, while Heads of Service in areas such as Fostering regularly consult on training and practice. At a recent meeting, Kristian was delighted to hear a wide range of colleagues, from different disciplines, talking about a family’s situation with a shared view of the parenting; instead of judging the parents for failing their child, they expressed empathy about the many challenges the parents were facing – meeting the family’s basic needs in the midst of the cost of living crisis – and agreed on the need to support the parents to find time, energy and headspace to work on building better relationships with their children.
Working in a NWD Hub is demanding for all staff, whatever their role or professional background, and can take its toll on mental health and well-being; Kristian and Katie see ‘caring for the carers’ as a key part of their work. Kristian runs debrief sessions for staff after incidents with young people, giving the staff space not only to talk about what happened, but also how they felt. He is, also, currently working with colleagues in other Authorities who have adopted NWD on translating the Golding’s Hierarchy of Need model into a framework for staff to help support them in being consistent, reliable presences for young people and their families, while staying resilient and looking after their own needs.
New Roads Norfolk: Susan’s story “It’s not just on one person’s shoulders”
Susan is the Hub Manager for New Roads in Norfolk. She is proud to support other professionals on their ‘learning journey’ and believes that through continuous reflection and working together New Roads are empowering young people and families to ‘move on with their lives’.
Before becoming the Deputy Support Manager at New Roads, Susan worked in frontline child protection. Later, she worked in youth offending, and it was here that Susan reflected on how young adults are not always listened to. She decided she wanted “to be that listening ear”.
“I first came to New Roads to be the Deputy Support Manager. I did that job for 18 months and I really, really enjoyed it. I really loved the fact that I had all these practitioners who I could share my experience of working in the community with. I was able to give them that additional confidence that they needed.”
Susan was able to continue working directly with families. She explained, “I did visits myself to support the team. I had the best of both worlds. I had the Deputy Managers world and the hands-on work with young people, which is so important”.
Susan is now the Hub Manager of New Roads, based in Norwich. She enthuses, “Well, I love this role! I love the fact that we’re working with so many families.”
For Susan, her team is her priority. “Empowering my team is what I love about this role. Because we have the benefit of having a psychologist and speech and language therapist at the Hub, we’re able to upskill our team. Our psychologist can give training and group supervision and clinical supervision. We talk about what’s going on for young people and families and share our experiences.”
Susan talks about the advantages of having specialist skills within the team. “Some of our team have never written reports, like child protection reports. Our speech and language therapist provides guidance on the language we use, how we write reports and what needs to be in them. We reflect a lot about the fact that young people ask to see everything that has been written about them. We ask our staff to really think about that – how would you feel reading back what people had written about you?”
Playing to our strengths
At the heart of the No Wrong Door model is the combination of specialist workers and how they work together . For Susan, “specialists are critical to the model and the way in which we think. It’s about the risk and holding the risk but sharing it with other professionals. We – the whole team – know that our main aim is to support young people and families to stay together. Young people in care do not generally do well. Whatever happens, even if young people are in foster care or residential care, they will gravitate to their families. Families are so important. We’re empowering families to work together.”
Discussing the benefits of multi-disciplinary working, Susan explains that at New Roads, the team are going into families with more information because of working so closely with the Police Liaison Officer. “It’s about using the structure and the specialists that we have. The more information you can go to a family with – the more tools in your box – the better work you can do.”
Another example is the impact of specialist assessment undertaken by the Speech and Language Therapist. Susan says, “It’s crazy how many young people have undiagnosed speech, language and communication needs. As a result, we are working with them in completely different ways.”
“Our Speech and Language Therapist uses pictures and breaks things down in a way that they understand. When I worked in youth offending teams, we would simply say to the young person ‘this is your order and this is what you need to do.’ But here, we put things in ways that they can understand and of course they respond better.”
Why would a young person sit down and want to have a conversation with you? It’s about thinking outside the box. We go walking, climbing, take them to the beach. They have time away from the home, and time to talk openly about how they feel.
The team is focused on working therapeutically and ‘thinking therapeutically’ as Susan says. She gives an example, “When we’re using formulations to understand what’s led a young person to where they are now, we talk and think about things from a young person’s perspective.”
We’re on a learning journey together
In her role, Susan is focused on appreciating everyone in the team. She talks about being on a journey. “Mistakes will be made. There are times when we might think ‘oh what did we do’ but it’s about being reflective. I’m personally a very reflective practitioner. I like the team to reflect as well because that’s how we learn.” Susan explains that perceptions about low status of residential work are challenged .
We’re working really hard to upskill everybody, to think differently, to work differently.
Susan is an experienced practitioner and manager, but she demonstrates how a culture of learning is supported at New Roads, as she reflects on her own learning. “It’s been a huge learning curve for me. Managing people and a team is difficult at times. We do have the other Hub so they can support us and we can support them…and it’s about all of us – the whole team around the young person holding that risk. That’s what we’re trying to promote in the social work team. It’s not just one person holding this – we’re doing it together. So, when something goes wrong with a family, let’s get us all together, let’s have that conversation, who can do what, who can support today, who can support tomorrow.”
It’s about making sure that we all work together and we share the risk. It’s not just on one person’s shoulders.
Susan speaks about having a stake in speaking up and how different this can feel for workers at New Roads compared with other settings. She explains, “The team know the young people really well. In other settings the team might not be involved in the conversations about what happens to young people. It would normally be managers but here everyone has an input.”
She adds, “Team wellbeing is really important. The team need to be able to come and talk to me. It’s challenging and daunting work sometimes, and they need to talk it through. We’re working with high-risk families and young people. We hear information and experiences that can be distressing.”
Susan puts it succinctly:
There’s a support chain. If one of us breaks, then the support breaks and the young people don’t get the support they need. We’re back to square one again.
Support when it’s needed
Speaking about how the team works, Susan underlines the importance of low caseloads. Working with fewer families enables the team to build relationships, and give young people and families “the support that they need, when they need it”.
“We have worked with so many young people in the community or would have been in that crisis, would have come into care, but we have kept them in the community, kept them staying at home. They have built up some amazing relationships with the team who can support them where the social worker can’t. I remember having caseloads of 30 and you’re trying to get round and do your statutory visits. Whereas our guys can go out, have a coffee with them, spend that time and get to know them.”
“It’s because we have managed to keep caseloads low and we can give people the attention and support that they need. We potentially won’t be with them for such long periods of time. We don’t want to be in their lives forever. That’s not what we’re here for. It’s about empowering young people and families to move on with their lives. They don’t want professionals in their lives forever – that’s not good for anyone”.
‘Look at me now’
Susan has a steadfast focus on developing and supporting the people in her team. Taking a moment to reflect on her personal impact, she shares one more story.
“We have a person here who was an edge of care worker when he started…he was then tempted to return to his previous role in education and handed in his notice. But now, this person is the Deputy Manager. He always says to me ‘I was ready to leave, but you saw something in me, you believed in me and encouraged me and look at me now’. It’s been a real success. We work well together, we think very similarly, he’s very reflective and therapeutic…and he’s taken my job!”
Our Place – Rochdale’s No Wrong Door: Anne’s story “What good parents do”
Drawing on a lifetime of experience, Anne makes connections between what it’s like to be a parent and what it means to care for young people using the No Wrong Door (NWD) model in Rochdale.
Spanning boundaries has characterised Anne’s experience “When the local authority I was working for decided to close their residential homes, I worked across traditional boundaries, working with young people and their families, assessing fostering families and delivering what we called the “Crashpad” service.” Anne also worked as a social worker and managed fostering, adoption and therapeutic services. “Oh, I’ve also worked with care leavers,” she adds.
In 2020 and about to retire, Anne joined Our Place (as NWD is called in Rochdale) to help set up the service.
Looking back at her career, Anne reflected that elements of the No Wrong Door model have been used for many years. “But, the No Wrong Door Model is unique in the way that the provocations challenge the quality and purpose of the service we deliver across partnerships. I was attracted to it because I know that bringing young people into care for the first time in adolescence does not provide the best outcomes. I am passionate about keeping young people safely in families, whether that is with kinship carers or birth family, fostering and adoption.”
Protect and care for the carers
Anne’s observations about No Wrong Door are compelling. Reflecting on how the Our Place has developed, Anne highlighted how psychologically informed practice influenced a residential setting.
We talk about therapeutic care but what does it mean?
Anne provides an example. “One of our young people is struggling with life and struggling to engage with staff in an appropriate way. It’s leaving staff unsure, asking ‘are they doing it right?’ Our Life Coach went through the young person’s formulation (which aims to explain how they have come to the present circumstance) to remind us what her life experiences have been… you could see the staff moving from being quite defensive and quite anxious to actually ‘oh yes this is what we can do’.”
Anne explains how the Life Coach supports the staff to work in the best possible way with the young person. “You’re a residential care worker and you’re on a shift where a young person is dysregulated, you become dysregulated, you’re on high alert and high arousal – it’s human. It’s the brief and support from the Life Coach that supports the staff to be calm and respond in the best possible way.”
Anne notes that this is highly skilled work but relates it to experiences of parents everywhere. “If you’re a parent and you’re solo parenting for a couple of days, you’re frazzled and tetchy…you need someone to come in and say you’re doing a good job and say ‘how about trying this’. I think this is what the Life Coach does for residential workers who do a 24-hour shift in an unpredictable environment.”
The support that workers at the Hub receive also “ripples out into edge of care work” Anne goes on, “it is about supporting the young people, but a lot of time is spent on supporting the carers. We’re helping our workers protect and care for the carers. We work out what parents are experiencing – is there child-parent violence, for example or risk taking behaviour – we work out what will help when their child is challenging for them, and robustly support families when we have a clear idea of what we’re trying to achieve.”
Anne makes the work happening at Our Place feel directly relevant to ways we all need to think about parenting when striving to do the best for our cared for children. She speaks passionately about the transformational impact of the No Wrong Door provocations in Rochdale.
“The provocations have been weaved through social work practice and partner practice. Our Assistant Director was in a high-level meeting with the police talking about Missing from Home. The police said that they have adopted the provocation ‘Is this good enough for my child?’ Our housing colleagues were in a difficult meeting with a family and said, ‘Is this good enough for my child?’ and ‘What’s this going to look like in 20 years’ time?’”
It’s like dropping a stone in a pond – it rippled out to partners and that is powerful, the No Wrong Door provocations are so powerful… It’s not just about how we work with young people on the edge of care… What I love is that it’s also about how we do business around here.
A shared approach to parenting
In Anne’s view, the provocations have helped to re-frame partners’ thinking when they’re involved in keeping teenagers and young adults safe. “The thing is, teenagers take up a lot of time and the response can be knee jerk, but when elected members or the police for instance reflect on whether the response taken today is improving the quality of the life for the young person, then we know it’s about managing the risk for the child , not managing the risk for the organisation.”
Anne goes on to explain that a shared approach to decision making for young people is supported by the way information is shared amongst partners. “We’re able to know what’s going on for them today, make connections and think long-term.”
“It’s about having shared information and reaching a shared approach. But having a shared approach to parenting is really difficult. We all have different levels of tolerance to risk for different reasons.” Anne uses an example of her own daughter climbing a tree to illustrate her point, “I said come down at once, and my partner said climb higher!” So, we must sit down with our partners and work out our shared approach…that’s what do here.”
What good parents do
It is apparent that constant communication and negotiation is required amongst the professionals, but when a ‘shared approach to parenting’ succeeds everyone benefits.
I think, having a shared approach to parenting and managing the risk for the child enables people to stop being so protective about their own professional role and work together in true partnership.
“We’ve had some brilliant success. We’ve had those edge of care young people who have stayed at home. But also cared for young people that no one else was prepared to care for. For some, Our Place has been the last place a young person can go…if we can’t look after them who’s going to? I feel passionately about that.”
Anne’s passion is palpable – by connecting the experiences of all parents and young people with those of the families she works with, she encourages us all to think more deeply about what caring must involve. As she says,
We need to be constantly talking about our children…in the home, in the hub and foster care… we need to be constantly having those conversations and being constantly curious. I wonder why they’re doing that? Isn’t that what good parents do?
Challenging each other’s perspectives – multidisciplinary teams in the Warrington No Wrong Door hub: Amy and Neil’s story
Amy Walsh, Police Intelligence Officer; Neil Macleod, Speech and Language Therapist, Warrington
Amy joined the police straight out of university working for the Cheshire Police service. It was here that she got her first role in intelligence. Amy laughs as she reflects on why she moved into this field within the police, “I really like digging into things and being nosey”.
Through this role Amy worked with other agencies including fire and ambulance but she had never worked alongside children’s services. She remembers when she saw the role in Warrington working as part of No Wrong Door advertised. “Something really drew me to it.”
There is just something different about this role, it feels really worthwhile like you’re doing something good.
Being in a multidisciplinary team
In her role as a Police Intelligence Officer within the No Wrong Door Service in Warrington, Amy works alongside colleagues from different backgrounds as part of a multi-disciplinary team. This includes social workers, psychologists, and speech and language therapists.
“Working within the police for so long, there are certain cultures and certain ways of working that you get used to, but then coming in and working with the other staff has been a breath of fresh air. It’s really nice to see everyone working together towards a single goal. And it is really interesting how the different roles play a part in it. It has been really eye opening.”
For Amy, it is the coming together of professionals with different perspectives from diverse working cultures that really sets apart the No Wrong Door model and strengthens the approach to working with young people and families. They can challenge each other’s assumptions and provide new insights and perspectives to each other’s work.
A key element of this is being collocated in the No Wrong Door hub.
“There are times when it has been easier being in the same space for those times when someone wouldn’t necessarily think about ringing the police but because we’re in the same place we can have a conversation with them. The staff come to me directly with information that they wouldn’t necessarily do if I wasn’t there, and this is information that would get quite easily missed.”
Being collocated helps to breakdown barriers between professionals. “The staff have that relationship with me where they can just approach me. The relationships result in better information that we wouldn’t know we were missing.”
Bringing different skills to the NWD hub
Amy reflects on the importance of speech and language in particular and the impact of her colleague Neil Macleod, a speech and language therapist, on her own work.
Before I came here I didn’t realise how important speech and language was. And since working with Neil, I’ve been able to share things with other colleagues.
Neil agrees, “there are those moments when other professionals see what we are doing and what we can achieve”, he says. “It’s really nice having that recognised.”
“We’re here because speech, language and communication needs are such an important part of the challenges that the young people we are working with are experiencing. We can ask ‘why is this young person reacting the way that they are’ and I think we always overestimate how much we are communicating and how well we are communicating.”
Collocation and collaboration
The importance of different professionals working together to challenge each other’s perspectives is emphasised again and again in conversation with Amy and Neil.
Neil gives an example of how speech and language skills can benefit the work of other professionals. “I can think of how easy it is to go away from a conversation with a young person and think it went well and that it’s been understood by the them, but the young person has built up the skills over years to look like they have understood what has been said but in fact they haven’t taken it in at all.”
At the No Wrong Door hub in Warrington they worked with a young person who had come to live in the residential hub. He had struggled all the way through school but had not had an assessment of his communication skills. Staff in the residential hub had noticed that he struggled to understand things. Neil worked with him and through a speech and language assessment found that “he has specific difficulties with understanding and producing spoken language. We have been able to incorporate this into our work with him. He ended up going home and we did more work with the college.”
For Neil, there is a clear lesson to learn from this. This young person “would never have had this kind of support and focus if he hadn’t been a part of this No Wrong Door model” and this was only possible because of the different skills and perspectives of the professionals within the multidisciplinary team.
Amy agrees and would like to see this way of working become more widespread. “Having us all working together has been very helpful to all of our work with young people and families.”