Ten thousand whispering and nobody listening

cat 1

I received my social work qualification in the post just two days before I started my first ever social work post. New social workers, in the days before we defined Newly Qualified Social Workers, were just called a new social worker. The fact that you were newly qualified was never  discussed. I was a social worker. I bought a new shirt for the occasion of my first ever day in the profession. It would have been ironed had one of the children not delayed me by being sick in one of my wedding (now work) shoes.

I met my first line manager in the first hour of the first day. She talked a lot and I was to listen. In fact she even passed me a notepad and pen as she commented that she was surprised I was not noting some of the things she was telling me. In truth I wont have been listening. I can’t listen when people give me instructions. If I get lost and ask people for directions I never listen to a word they helpfully try and give me. As much as I need their assistance I instead find myself concentrating on the kindly direction givers accent or slight whistle when they pronounce anything with an ‘s’ in it or I notice the expression of their passengers face. Whilst nodding and saying ‘yes, turn right’ after they’ve said it to give the impression I am listening I am wondering where they going themselves or where they have been. Now that I would listen to. But directions and instructions far less so. I expect my new superior was telling me about fire alarms that probably wouldn’t go off and the ritual of car parking or maybe even how to pay the tea club. I smiled and nodded and I remember noting something down in the pad she had given me. It will have likely to have been the last one I heard her say in order that it looked like I was listening. My guess is that it said something like ‘ok’. It may as well as said ‘turn right, yes’.

I remember my first ever social work client from that day. She was called Jean. She talked and I listened because she was talking about herself, her life, her ambitions, her present situation and her desires. Jean spent a lot of time talking about her cat. There were no instructions attached to Jean talking, and so I just listened. I asked questions from time to  time, but crucially I listened and Jean just spoke. On my lap I had a Community Care Assessment. This, my boss explained, was where we wrote down relevant points about peoples lives to do ‘The Assessment’. I had heard a lot about assessments in my first morning as a social worker. They were described as the cornerstone, the purpose and the focus of our role. In truth I hadn’t had much in the way of training on assessments at university. There was some mention of Care Assessments and Care Plans but in three years of training, 24 separate 3000 word assignments, two 8000 word portfolios based on two practice placements I rarely mentioned assessments. My training was about our approach, our understanding of people, relationships, the dynamics of relationships, empowerment, advocacy and rights. Maybe I was on the sick on the day they did ‘assessments’? Either way, assessments were a form and forms came with instructions. I wouldn’t have listened.

Half way through week one the boss was clear that my work with Jean needed reviewing. I was invited in to the meeting room and asked to explain where the discharge planning was up to. With my paperwork in hand I began talking about Jean. I had completed the assessment through recording what I had heard Jean say. So half reading from the assessment document and half through memory I talked about my conversations with Jean. I talked about her background and her family, I talked about her husband Bob and his job and how when he retired he died shortly after robbing Jean of the retirement that they planned. I talked about how Bob had helped choose the new carpet that she had tripped on, causing the fracture that led to her fall and how she laughed at the thought that he was getting his own back. I talked about the grandchildren in Australia and how the letters and photographs kept Jean going as well as the 3am phone calls from her granddaughter Laura due to the time difference and how excited Jean felt when she was due a 3am call. I talked about Jeans cat and how when Bob had died and her daughter had gone to Australia it was the main focus on Jeans life. I listened to Jean talking about the life that Jean once had, the life she was planning to have and the life she had now. After I had talked about Jean I waited for the boss to speak. There was a long pause and then she spoke. ‘You may have well as assessed the bloody cat’. She went on to explain that what I needed to assess was the support Jean needed, not Jean herself and certainly not her long lost husband, far flung daughter and bloody cat. I needed to listen to how many times she needed the toilet during the night. I needed to hear if she now thought she needed to be in a residential home. I needed to hear how the care package was going to get her back home. I needed to listen out for who manages her finances and how much money she has. I was genuinely perplexed. I wasn’t trained to do that sort of listening. I didn’t like that sort of listening. That wasn’t the social work I was educated in and in truth I didn’t even recognise that it was social work. But this was my job.

I didn’t speak to Jean again or get the chance to listen to her. Our conversation was converted into an assessment by an experienced social worker. Apparently with a half decent nursing report and a functional assessment from the OT we could just about throw together an assessment that would help Jean be discharged as quickly as possible. The assessment documented that  Jean needed four calls of home care a day. The calls would start anytime between 7am and 11am. Lunch was between 12 and 3. Tea from 3.30 to 7 and bed every night by 10pm. No mention of Bob or little Laura in Sydney or even Audrey next door. On the box that documented whether or not Jean had got any pets it said in bold capital letters NONE.

 

 

The elephant in the room in adult social work is often a cat

elephant in the room

Firstly, thanks to @Harr_Ferguson for the title which was inspired by this tweet:

I remembered this tweet today whilst driving home and reflecting on having heard several stories this week from amazing social work colleagues where pets featured in a critical role.  The colleague who, having tried to engage with someone through their letter box had the dog set on them.  The parents who were walking the dog every night past their son with a learning disability who was living independently in his new home to reassure them that he was OK.  The mum and son with very complex communication needs whose face lights up when he sees the family dog come into the room.  And finally, the amazing colleague who was planning to finish for the weekend only after they had sorted out 11 cats and 3 dogs so that the person they were supporting could feel safe enough that their pets were cared for to accept a period of convalescence and recovery from a period of acute ill health.

Social care is full of evidence to suggest that pets are associated with psychological and emotional well being.  Something that we could perhaps pay more attention to in adult social work.  Dr Sara Ryan (yes Connor’s mum) has written a really thoughtful paper on how pets are important members of the families they belong to and yet how often they are unseen by the “professional” in the room – it’s here if you want a read:

http://onlinelibrary.wiley.com/doi/10.1111/1467-9566.12176/abstract

Sara’s paper reminds us that as social work practitioners, it is far too easy for important family member to become invisible when they are sat right in front of us – an observation which Harry Ferguson has written about in his brilliant piece about the unbearable complexity of social work decision making in the British Journal of Social Work.  See here:

http://bjsw.oxfordjournals.org/content/early/2016/06/29/bjsw.bcw065.abstract

In our induction for Newly Qualified Social Workers, we often talk about a real case which we got very wrong.  The lady had 20 cats.  We thought we knew best.  We thought we could see something as professionals that she couldn’t about her life and experience.  We took her away from everything she knew, everything that was important to her in her life.  The result was that she deteriorated very quickly.  It is telling, that when we talk about the lady with the cats, we only talk about her cats as a passing, almost jokey remark at the start of the story.

And if you want to know just how wrong we can get it in social care – see the case of Fluffy the Cat https://ukhumanrightsblog.com/2015/01/29/what-price-liberty-damages-dols-and-a-cat-named-fluffy/ whose 91 year old owner was removed from his home and unlawfully deprived of his liberty in a care home leaving his beloved cat behind.

Today, pets have featured heavily as we have reflected on this week, appearing in several of the stories which I have heard being told as part of the end of week come down.  All social workers will recognise the end of week come down.  It is the really important bit of the week when social workers take care of each other and the complexity of the decisions they have supported people to take.  It is the moment where social workers use story telling to reflect about the week which has past and as the social work office winds down, it is the process which enables practitioners to go home without carrying the weight of every potential risk with them into the weekend.  Without that moment of story telling, social workers, the best social workers, the ones who will be back fighting for people’s human rights once they have rested and recovered, will often spot the small things they have missed during the heat of the busy week.  That is the time when the pets emerge.

Today, as we told our end of week stories, we heard of that we had seen 11 cats and 5 dogs.  We spotted something we didn’t know before, something we didn’t previously notice about what is important to the people we are supporting.  And when we next speak to them, because of that moment of insight, we will be able to include in our conversations with them that they have another member of their family that we are interested in.

And crucially, we had a moment of laughter and mutual support which came out of that recognition – because we are pet owners too and we know what our pets mean to us. In that moment you become less professional and more human and you are closer to the person you are there to support.  Which is a really good thing.

This week, however, I am left with unanswered questions which I leave me unsettled – what happened to the lady’s cats?  What if we got it wrong?  What if it was being removed from her beloved cats that was the tipping Point?

Honestly, I will never know what happened to the cats.  But we do know what happened to the lady with the cats, we moved her, leaving her cats behind, she became very distressed and after a long and lonely 6 months on various hospital wards she died.  It was traumatic for all concerned.  Including the social worker who has never forgotten her.   To quote Professor Ferguson “The powerful impact of unbearable levels of complexity and anxiety on social workers requires much greater recognition.”

Have a safe weekend to all our EDT and hospital weekend colleagues working this weekend.