Relationship-based social work: Starting & scaling the practice
This paper was developed with the input of people* with insight and experience into different parts of the wider social care and health system.
Meilys Heulfryn Smith - Gwynedd and Anglesey Community Health and Social Care — Programme Lead — Community Transformation
Phil Veasey — West Northamptonshire Council (former London Borough of Newham) — Public Health
Dennis Vergne & Max Goodall, Basis — social impact organisational change
And others.
*Input was provided in a personal capacity and does not necessarily reflect the policy or thinking of the organisation individuals are working for.
Introduction — relationships and trust
Why, when we have a personal problem, are we more likely to ring a family member or a friend than head out into the street and ask around for an expert?
A friend or family member is unlikely to be some kind of expert life coach or world-renowned problem solver for hire, but you to go them anyway.
Say, you phone your mum. Why? It’s because:
● You know she’ll answer your call and listen
● You know she’ll do her best and use what she knows about the problem to help you
● She knows you and your situation, so is in a good position to help
In short, you have a relationship. You trust her.
Some people are lucky enough to have someone they can rely on like this to help them when they have a problem, but not everyone.
This is part of why we need public services, but they’re rarely quite like the relationship described above.
Many of the people we work with have been thinking this through. And many have the same idea: why can’t public services be more like this?
In these papers (you are currently reading paper one of five), we will offer something practical, in order to build a system that can better help people who have complex social needs. We will outline a framework and a set of practices to develop and scale relationship-based social care organisations.
Avoiding Daniel Blakes — the problems we see
In many cases, as things stand in the UK public services, although services are populated by many talented, empathetic, and skilled people, interacting with support isn’t much like the relationship described above.
In the worst cases, with residents presenting with multiple complex needs, services are overwhelmed by demand and lack the space and time to really understand the problems. Services can miss the connections between multiple needs, lack methods of effectively and ‘warmly’ handing residents over and residents fall between the gaps.
If you want a good understanding of the way this can exacerbate and deepen problems for residents, a great place to start is the film I, Daniel Blake.
However, we don’t think this state of affairs is inevitable or permanent. We think public service can and must be just like giving your mum a ring when you need some help. And in fact — they can be even better.
Relationships are primary; all else is derivative
A Newham social welfare alliance worker (if you’re not too sure what a “social welfare alliance worker” is, don’t worry, read on and find out), for example, can do all of the things mentioned above:
● They can make sure they answer your call when you need it
● They can do their best and use everything they know to help you
● They can build a longer-term relationship and get to know you, understanding the (evolving) most pressing needs to work on
But even better, they can also pull in lots of other people. They can use the resources of their organisation. And they can use their learning from solving other people’s problems like yours every day.
Now, this might sound simple, but this is actually a pretty radical approach. I’m sure you would agree, for most people their relationship with public services isn’t that much like their relationship with their mum. We want to change that.
Radical though it is, this is not a new idea.
Relationship-based social care has the potential to be significantly more effective than current approaches. It has therefore been a hot topic in both research and practice for a good few years. Hillary Cottam has written about these ideas and tested some of them with her organisation Participle. Inspired by the Dutch organisation “Buurtzorg”, some UK organisations dealing with adult social care (often home care) such as Wellbeing Teams and Cornerstone have had big successes applying this approach.
In children’s services too this has been the direction of travel for a while. The recently published Independent Review of Children’s Social Care (2022) acknowledges this. E.g. one of the Review’s recommendations was:
“To reduce the number of handovers between services, we recommend introducing one category of “Family Help” to replace “targeted early help” and “child in need” work, providing families with much higher levels of meaningful support. This new service would be delivered by multi-disciplinary teams made up of professionals such as family support workers, domestic abuse workers and mental health practitioners — who, alongside social workers, would provide support and cut down on referring families onto other services. These Family Help Teams would be based in community settings, like schools and family hubs, that children and families know and trust…”
Despite the many recommendations and great examples, these ideas have not scaled yet in practice.
Relationship-based social care isn’t the norm yet. These papers aim to aid the movement with practical help to start or scale relationship-based social care.
Starting/scaling points — working on three pillars
We see three pillars that organisations can use as starting or scaling point for this way of working. The key is to start small and grow, gradually adding and growing each of the three until you have a full relationship-based approach in place.
A “big bang” attempt to implement all three of these pillars entirely all at once won’t work — every locality has slightly different needs, culture, practices and relationships. It takes iterations to build and change this (but these can be very fast).
The three pillars to iteratively redesign and develop are:
- Space to build relationships
Role and Team design: develop a team that gives people space to build relationships with clients and with each other
This is about roles and teams. It involves giving workers the space, flexibility and authority to invest time in getting to know individual clients and their problems in a holistic way.
Allow workers to avoid a focus on the small part of the problem they specialise in, the process they follow or the targets they need to hit. Instead, a real relationship can lead to a broader and deeper understanding of the client and solutions beyond the worker’s professional scope. Through connections, collaborations and relationships within the system, many — acting as a team — can provide an answer to the client’s complex needs, and even consider how to prevent problems from occurring in the first place. The team should consist of different “T-people” (see next pillar).
2. Multi-skilled “T-people”
Competency development: Workers develop their skills so that less handovers are needed (less fragmented care and stronger relationship) and when pulling in another professional it is done through a “warm” handover.
This is about the individual skills and the “practice” of working in a relationship-based service. It means two things:
(1) supporting workers to develop personal skills in building relationships and
(2) helping workers — rather than knowing only their area of speciality — to become multi-skilled “T People”.
Being a T-person means that a worker, rather than being generalists or specialists, has both a deep knowledge of one particular area (the vertical line) but also a breadth of knowledge/ skills that enable them to support a client with other key skills (no or fewer handovers needed). Also, in case another specialisation needs to be brought in, the worker knows enough to identify the additional expertise needed and do a ‘warm handover’. A ‘warm handover’ means an introduction to another individual with accompanying information, so that no resident has to tell their story twice.
3. A community approach
Partner/system development: Build a networked community of community and government organisations
This is about how the public sector works together and with the local community — i.e. how does everything fit together.
It involves moving away from a single centralised offer that waits for residents to “come to us” towards a “network organisation”. People with complex needs should be able, when they need support, to go to who they trust and feel they can have a relationship with. It might be a local authority service, but it could also be a community organisation. These organisations then need to pull in each other to allow support by many, providing coherent but customised help to people with complex needs.
Services become something closer to a network of small hubs embedded in hyper localities within the community. Think “15 minute neighbourhood” services.
An aside, you might be thinking…
“How is this different to social prescribing & link workers?”
Typical social prescribing models involve assigning a resident with complex needs a “link worker” who sign-posts them to non-medical support available within their local community.
A relational social care model takes this a step further with two key differences:
(1) Relational social care workers are not “link workers”. They are professionals with specific expertise or skill(s), who can practically support residents. They don’t only assess and refer or signpost to others. This has the important benefit of building and deepening their relationship with the resident. It also means that this is not a separate job (like sometimes social prescribers), but a role as part of many professions.
(2) Relational social care workers try to avoid signposting people. Instead, they connect the resident with other professionals they already know and provide a “warm handover”. In practice this means, being part of conversations introducing them to other professionals and avoiding residents needing to provide the same information again. Often, they might be the key worker and continue to “hold” the resident’s case.
An example — the Newham Social Welfare Alliance
Newham Council, in the midst of the corona lockdowns realised many of their residents were falling quickly into deprivation. Many were struggling to afford food and others were at risk of becoming homeless. Many in gig jobs and casual employment such as cleaners and restaurant workers went in instant from a reliable income to being out of a job without a chance of getting furlough.
As a result, queues at food banks were doubling each week. But what people needed was often much more than food. They needed help applying for benefits, finding new work, support with their mental health, clothing, accommodation, help with their visa status, the list goes on.
For many people, moreover, the council wasn’t the logical and sometimes trusted organisation to ask for help. When residents were in need, instead, many contacted one the borough’s local community organisations. The council recognised that these community organisations were pivotal. They had the opportunity to initiate and strengthen a relationship with residents and to use this to discover and support their other needs.
Although providing food was often the starting point, the question was, when someone presented at a community organisation, how did the helpers start a conversation and begin to understand what the person needed a bit better? Some of the principles were “Food and More”, “Then and There Help”.
To build a relationship with the member, community organisation volunteers would take their time. First they would help them then and there (e.g. provide clothing, or together fill in a benefit form).
They also might refer them to someone else, like an expert on finding employment, if they needed.
However, when doing this referral, instead of just giving them a phone number or sending an email, as much as possible this would be a “warm referral”. During the pandemic, they turned on a laptop and connected with another professional on Zoom. Helpers introduced the colleague from the other service/organisation to the resident and supported the resident to explain the problem. The helper in the community organisation would continue to hold the main relationship and endeavour to get the resident to come back and have a follow-up conversation.
The helpers (later given the name ‘social welfare advisers’), keen to provide more valuable support wanted to learn what other services could offer and how to contact them. They also wanted to increase their own skills to help people without always needing to refer; becoming multi-skilled.
The council and community organisations therefore organised training sessions on the most critical topics, housing, benefits, immigration status, and work. However, the first training, a prerequisite, was to do “core conversations”, how to have a chat with someone you don’t know, establish rapport and a relationship to understand and help them.
In Newham, this has now evolved into something called the “Social Welfare Alliance” where workers aim to support residents with multiple complex needs across the borough come together to share learning and work together.
Newham developed in stages all three of the pillars:
1. Finding community organisation workers who have the space and time to build relationships with residents as well as allowing council employees to take more time.
2. Supporting helpers to develop more skills and knowledge to be able to build relationships and deal with multiple needs.
3. Centering their approach on small organisations based in hyper-localities throughout the borough
They are now continuing to grow each of these pillars and scaling the approach across the Council.
You can watch Phil Veasey, who led this work in Newham, talking about the work and how it developed below. Also Newham’s website has more info here.
What’s next?
We are developing four additional papers. We will be sharing a paper on each of three pillars and one on the iterative approach to change every fortnight from now onwards.
These will get into the weeds, giving more detail, ideas and some possible places to start for each.
If you want to make sure you gain these papers, please sign-up here.
You can also download a PDF copy of this paper here.
Or if you have any questions, drop us an email at max.goodall@basis.co.uk or me dennis@basis.co.uk
