Working alongside and with carers has always been one of the most satisfying areas of social work for Medway Council's Principal Social Worker for Adults, Justine Collom. In the week that seven major charities joined with Alistair Burt, Minister of State for Social Care and Community to announce their support for Carers Week (6-12 June), she reflects that her experience of caring , coupled with her work with the care and support system, has been essential in understanding how to intervene with individuals within their own social environments.
"Last week, I participated in a workshop run by Research in Practice for Adults (RIPFA) with carers from across the UK. The workshop is part of an ongoing piece of work which RIPFA has been commissioned to undertake by the Department of Health, to develop a practice tool for social workers working with carers. I felt really privileged to be a participant in this important work and found the contributions by carers humbling whilst also incredibly motivating.
During my career, I have heard many carers speak of the difficulties they experience when social care or health services are needed to support the person they care for. Comments often relate to feeling that they are invisible in the assessment process, or that their view is not valued or respected.
Those who care for adult children with mental health, learning or physical difficulties have told me they are often perceived as overprotective parents who need to let go and let their loved ones make their own decisions, even on occasions when these might be unwise decisions. Statements such as this are often made with the best intentions to make sure the rights of the cared for are met. However, these need to be made within a broader context, which takes account of how the carer might be supported to understand and manage the anxiety this often generates for them and the inevitable impacts on the cared for. Sensitive and thoughtful practice reduces the possibility of tension on issues such as this. A further issue which raises its head again and again is that of confidentiality, which I shall return to later.
Now of course, as with all human interactions there are varying degrees of how people interact with each other, carers and cared for are no different. Naturally carers who are parents are going to be anxious and a little overprotective; after all they have the lived experience to draw upon. Their lives in many cases revolve around the caring role; they have often given up work, followed by increasing social isolation, their own physical health neglected and their own mental health compromised.
When a social worker crosses the threshold into their private space to do an assessment (whether that be a carers' assessment or an assessment of the cared for, or even for a regular visit), carers are likely to be exhausted and unclear as to what this will mean for them and the cared for. They may wish to speak with the social worker about some important information, and often their view is the social worker hasn’t got time and needs to rush off or they can’t because of confidentiality. Sometimes it can be a huge relief that someone has come to do an assessment of their needs and at last something will change for them, this is often followed by a dash of hopes as they realise that everything is already being done.
The challenge for us as social workers is to use our skills to ensure that we build trust and engage with carers in a way which will enable them to feel their voice is valued and contributes to the overall evaluative assessment or intervention process. When a carers' assessment is offered, what has been suggested as standard is a letter explaining the purpose and possible outcomes of the assessment. Carers want this to be jargon free and would welcome a follow up letter stating the outcome of the assessment. Every contact we have is an opportunity, sometimes we might need to create that opportunity by picking up the phone and just asking “how are you, how have things been for you?” Making time for the carer as part of any intervention is not only respectful, it is also cost effective and proactive, it enables us to better assess and manage potential risks, evaluate the carers health and well-being and respond to ensure this is maintained.
Whilst there is a critical need and a duty to respect confidentiality, this should never be a barrier to having a conversation with a carer. What I heard form carers this week was that they welcome openness and honesty so a gentle explanation around what you may or may not share would go a long way, this links to the need to avoid defensive responses. I also heard that carers understand the pressures on social care and really value the input of social workers, especially when they are knowledgeable about community services.
One common theme which the carers cited is having to repeat their story over and over again. This is not unique to carers; we know the same frustration is shared by individuals with care and support needs. One idea shared was for the carers (or a social worker) to create a synopsis (or chronology) about the cared for’s situation. Which brings me to the matter of preparation - we know that professionalism is related to being organised and prepared. Carers want to tell their story in their words, but they also want to feel assured that we have read the notes and have a sound understanding of their circumstances, a simple action which demonstrates professionalism and respect. I’ve also heard a strong message that a single point of contact would really help provide continuity. Staff who allocate cases might therefore want to think about who worked on this before and knows the individual and the carer, whilst strategic staff might want to consider how this might be addressed across the wider service.
The messages I heard from carers at this workshop were simple things that I believe are achievable and don’t use too many resources, other than our time, energy and thoughtfulness. Carers are one of society’s richest resources and I know that social workers recognise the added value when they are able to work in partnership with them. I am looking forward to viewing the resources and case examples that were generated from this workshop, especially in the knowledge that this work has been undertaken and informed by the people who are really in the know: the carers themselves."