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Joining Up The Dots of Practice and Services

The current catch cry is for the service system to be joined up or integrated to better support families and children.  If services are joined up what difference does this make to the work of the individuals working within that system?

When we begin work with an organisation in community services  we are told about client confidentiality, and the need to maintain client information in a safe place, of the strictures of the Child Protection Act and Privacy law, of the issues we confront when writing case notes or client records, of the trauma associated of being called before a court to defend our professional assessment and records.  All this sounds as if we cannot talk to anyone about anything unless it is the police or staff of the Regional Intake Services about our concerns that children may be at risk of harm.

At the same time we are asked to work collaboratively with each other, to make referrals to other community agencies to help clients receive services that they need and to talk with clients about what services are in their neighbourhood that can help them, but some clients are hostile to this and we do not want to jeopardize our relationship with them. I remember talking to some of my supervisees who were most reluctant to bring up uncomfortable topics with clients in case the clients did not come back or got angry with them or it ruined their relationship.  My response was that if the relationship is strong it will build on it if it is weak it may strengthen it if you approach the issues with genuine concern and respect.  A professional relationship needs to have objectives, goals and tasks associated with it otherwise it is a friendship and should be stopped!

Joined up services means that more workers need to get involved in a real way with helping families connect to the early intervention services that they need earlier in their progression to vulnerability.  Workers will need to embrace those teachable moments when they can use their relationship with clients to help them acknowledge difficult areas in their life. So how do you approach a parent that you are working with about your concerns that some of their parenting habits may not be providing the nurturing that their children need?  Firstly look to your belief system- do you genuinely believe that all parents are doing the best that they can for the children that they love? In 99% of circumstances this is true and you will know those examples where it is not.

Secondly, look to your own parenting standards. There are loads of ways that people can parent their children successfully.  Just because it was not like this in your family does not make it wrong or dangerous!  Children are resilient and we know that good enough parenting brings forth happy  and healthy children and adults.

Thirdly, look to your motives.  Do you genuinely respect the client that you work with, do you really listen  to their concerns or are you  more concentrated on getting your point of view across whenever you engage with them?

These are tough but fair questions for you to answer about your work and yourself.  When you have done that about each client ( and you may need your supervisor’s help) then you can begin to contemplate your approach to the parents with whom you want to share your concerns and you know ,they will probably have the same concerns! So first build your relationship then have the talk.

Let me share some thoughts from a relationship guru of mine, John Gottman that good relationships are built by:

  • Mutual respect- treat the other person how you would like to be treated
  • Banking good will- always make a point of building positive credit in your relationship bank account, you can draw down on this later
  • Be authentic – only promise what you can deliver, tell the truth as you see ( see later about how)get back to people if deadlines have to extend
  • Be clear in your expectations of the other, people cannot mind read and may have quite different experiences of your relationship and reason for contacting them so careful checking that you have understood them and they you is imperative to building clear honest communication patterns.

So having built the best relationship you can in the time available how do you begin the rally hard stuff?  (Actually building the relationship is harder that the next bit but we always think the opposite!)

Practice these skills and you will have the best opportunity to engage in the tough conversations!

  • Soft start up– men especially close down very quickly if they feel criticised- so use a gentle approach – firm but soft voice, short clear sentences, relaxed body language

build up cooperation by asking permission to talk about the topic, try to arrange a quiet un-interrupted space to hold the conversation which is suitable to all concerned.

  • Using ‘I’ language and neutrality – here you are simply and clearly stating how you see the situation and leaving plenty of space for the point of view of the others who are part of the conversation. So you say something like.. “ I have been thinking about the times that you say you drink too much and I wonder about how this might be affecting your ability to look after Jimmy,  can we talk about this?  What do you think?
  • Five to one rule –this means that for every negative thing  you put into the conversation you need to try to find five positive things to add!  This is a really tough one but no less important! So taking the mythical conversation forward… I know that when you are sober you are able to  shop, cook, clean and play with Jimmy and I can tell that you really love him.  My worries are that your drinking can stop you doing all this well and I am interested in hearing if you sometime worry about this as well?’
  • Deep listening –  you need to show that you are really understanding and getting the meaning of what the other person is trying to tell you, this does not mean that you have to agree with it, unless of course you do! Your client may become defensive, hostile or angry sometime around now, so you need to stay calm and focussed. Acknowledge their feelings and seek to understand them, acknowledge that this is a very difficult conversation for all involved and   keep repeating what you understand them to say an ask if that is right, keep paraphrasing and asking for their response until you  and they are sure that you both understand each other.  This takes time and often sound an unreal conversation because we do not do it and we need to because words are received and understood in quite different ways by people than we mean them to be. To continue snippets of my conversation.. “ so let me say back to you what I think you are saying.  You believe that Jimmy can look after himself, in fact he is good at helping you when you pass out. Is that right?  Have I understood you?  Get response and if it is ‘yes’ then you can continue with the conversation.
  • Seeking a joint solution– when you have both agreed on the problem, there may be varying degrees of the problem here you may have a deep concern and your clients may have a slight concern but work on what you can agree on first and hold your deeper worries for later when you have both experienced success in problem solving jointly. Your conversation ( and remember this should always remain a deeply respectful conversation) can continue ’When I hear that I wonder what it is like for Jimmy, he is four years old. At four years old when did you feel scared?  … What would have helped you to conquer that fear?… Can you think of things that you can do differently that would have that happen now when you are too drink to care for him like you want to?’
  • Reaching agreed outcomes– really seek for solutions that your client can live up to, there is nothing more defeating of relationship building attempts than to set someone unachievable goals.   There may be extra resources that you can offer to your client, you may know of services that you can help your client to receive or you may be able to ask questions that can prompt your client to offer different solutions to the problem than they have been using to date e.g. seeking baby- sitting help for when they know they will go out drinking etc.

If all this sounds too difficult practice with those you love about things that you want to change in your relationship.  Practice makes perfect. When you feel confident begin on small things with your clients and watch the difference. Then move on to those more challenging themes!

Gail Slocombe – PeakCare Executive Director

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