Helen Gavaghan, Senior Engagement Worker at Inspiring Change Manchester (ICM), gives an inkling of some of the things workers do to support people to think about change. She says some ‘traditional’ approaches need challenging and staff freed up to be open about working with both their own and their client’s lived experience. She concludes by suggesting learning about what it is that staff are doing is collected and brought together as a tool-kit for other practitioners.

In the Fulfilling Lives (Multiple Needs) projects, when considering the learning that is being fed back overall, I feel there could be more detailed examination of what the frontline project workers do that makes a difference to people’s lives. I believe that there is some valuable learning that could be collected and shared and, if it isn’t, may be lost.  General explanations of the approach, such as “building trusting relationships” and “avoidance of judgement” are fine –  but I believe are in no way getting down to the specifics and nuances of the great work that is going on.

At Inspiring Change Manchester, those involved in research and evaluation have set up a learning group for various frontline staff to express their views and share learning. I believe this is really valuable. My experience is that there is typically some conflict around notions of appropriate working within projects.  Particularly between long-time supervisors/managers and traditionally experienced staff versus new and lived experience staff. In the latter consequent, perhaps of a practical understanding and insight into what works and what does not. For this reason, I was excited to become a lived experience manager (senior) at ICM whilst retaining a caseload. It is like this that I keep in touch with what the frontline job is about and what support and considerations the team need.

I’m most interested in identifying the specific details of what it is being done to help to engage those who have refused to engage, or been unable to engage elsewhere. I think this is important because it may call into question traditional notions of professionalism.  In my opinion this is very nuanced and varied case-by-case work, requiring flexibility.  For some people, shared laughter may be the basis for engaging them, for others finding a worker who understands their interests and doesn’t avoid genuine conversation, again for others it is being the closest thing they have had to a friend for a long time. Something resembling real healthy friendship may work, if only for a period whilst trying to manage individual’s expectations and to support them to embed in healthier support networks for the longer term.  But that word ‘friend’ can be considered taboo in this field. Its overt use, of course, can create issues but the types of relationships that work look a lot like friendship in terms of how workers and clients interact.

The strategic approaches required to engage and support those with, for example, a host of deflection and avoidant coping or defence mechanisms may be surprising to those who follow a ‘textbook’ person-centred ethos.  The ultimate person-centred approach is arguably to save lives (that want to be saved) and how one gets to that place with some of the most disadvantaged, complex and chaotic individuals may, on occasion, raise the eyebrows of those not immersed in this work. An example is included in the box below.

I used a call to the benefits agency as a kind of leverage to encourage a woman with learning difficulties to find out medical test results and access treatment.  It was presented in the context of” I want to see you helping yourself so that you are still here alive to collect your benefits”.  This woman seemed to push away and refuse support as a way of checking how hard people were willing to try to help her, so it was challenging to encourage her to help herself.

Making support somewhat conditional in this way, is typically considered ’bad form’ of course. And for this reason, some effective work can be overlooked because people keep quiet about what it takes at times, to move people forward. If you had been on the journey I had with that woman, I would argue that you would have done the same to potentially save her life.  She was very grateful that she was treated and got better thankfully but had struggled to permit help in a straightforward way to face her fears at the time.  She acknowledged this looking back.

I would like staff to be able to be open about what they are doing.  Such non-standard practices are likely what well-meaning staff have always done, but at risk of reprimand if they acknowledge it openly.  It is perhaps important to say in relation to this, that generalised, archetypal situations and individuals don’t exist, in my opinion and the complex truth of a person’s circumstances can be very difficult to articulate effectively to those not involved.  However, I have seen staff fall into the trap of rigid blanket ’dos and don’ts’ i.e.” we would never do that in any circumstance”. This pressurises frontline staff for doing something that doesn’t sound orthodox ‘on paper’ even though those not doing the work cannot always begin to have the same understanding of the service user’s circumstances.

I believe that frontline staff should, as much as possible, be trusted to assess the nuances of a situation, and that their judgements about appropriate action and its likely overall impact should be respectfully considered.  I think we are pretty good at this at Inspiring Change Manchester and believe that Fulfilling Lives gives permission for such a culture to grow across its projects. Like this we can develop together a far clearer idea of what work is really being done and what is required to achieve positive change so to inform ‘service-provision’ for the long term.

The nuances aren’t always controversial of course.  Good staff have more specific skills and approaches that could be summarised to form guidance for others (e.g. tool kits).

However, for me it is important to remember that any tool kit can never be exhaustive and should not be defaulted to over workers trusting their instincts in what approach is required for a particular individual.  I believe that to delineate some of the approaches that seem to work well for people as a reference, can only be helpful.

Rachel Moreton, Associate Director at CFE Research, reflects on Helen’s comments and suggests questions that Fulfilling Lives (Multiple Needs) projects may want to consider:

Helen, thank you for a thought provoking blog on a topic that we know is important to Fulfilling Lives (Multiple Needs) projects. Here at the national evaluation team we are keen to hear what research and analysis projects would find useful and we are thinking about how we can take your suggestions forward.

·         Have any other funded projects done something similar to explore the details of what effective frontline practice looks like? What did you find out?

·         How did you overcome the barriers Helen outlines of staff being reluctant to share ‘unorthodox’ practice?

Those with lived experience clearly have a lot to offer as frontline staff – and we highlighted this in our 2016 evaluation report. We would be interested to hear too from those ‘long-time supervisors / managers and traditionally experienced staff’ that Helen describes.

·         How do projects ensure that they are brought on the journey too and their knowledge and expertise is used, so they do not feel alienated or at sea within a different and more flexible way of working?

Please get in touch with your thoughts by e-mailing Rachel.moreton@cfe.org.uk