With our background in family therapy, it is not surprising that members of BRIEF have long been involved in work, often in partnership with local authority social workers, to help prevent the accommodation of young people away from their families. It is also hardly surprising that in nearly 25 years of running courses, solution focused training for this particular field of work has been a constant demand. Yet, it could be argued that this is an area where precisely a problem focused approach should be employed. After all, where there is potential family breakdown it makes sense to want to explore not just what has gone wrong but particularly why it has gone wrong. The family is damaged in some way and needs repair. The solution focused approach, with its focus on hopes for the future, successes, resources and strengths, could seem akin to whistling in the wind when faced with families being wrenched apart with arguing and fighting.
The evidence for the success of Solution Focused Brief Therapy is now well established – see, for example, the recent comprehensive overview by Gingerich and Peterson, Effectiveness of Solution-Focused Brief Therapy: a systematic qualitative review of controlled outcome studies (in Research on Social Work Practice, 2013) – but it is not always easy, when asked ‘does it work with X?’, to point to research in relation to specific problems, and the same applies with the prevention of young people coming into care. One can at least point to local projects that are getting excellent results. For example, there is a major initiative in Essex County Council that started in early 2012. There, the Intensive Family Support Service in the Divisional-Based Intervention Teams (D-BIT), under the inspired leadership of Sue Lancaster and basing its work on solution focused practice, is having a major impact on reducing the numbers of young people requiring reception into care. BRIEF is proud to be associated with the work of these teams – even if it is from the sidelines as trainers!
It is also a great pleasure to revisit the Ofsted (the Office for Standards in Education, Children’s Services and Skills in England) publication Edging Away From Care – how services successfully prevent young people entering care (published October 2011). This document should be essential reading for anyone who works with young people because, in my opinion, what is reported goes to the heart of good practice in any setting. It shows, to quote, “how services in 11 local authorities helped to change the lives of young people at risk of entering care for the better. It identifies the successful intervention services seen by inspectors during the survey and considers what young people, their families and the managers and professionals interviewed explained as the main factors that contributed to effective help” (p4). People with a solution focused outlook would immediately sit up straighter at this point. What, a government report that is about successful work and not about what has gone wrong?
To do the report justice would mean to simply copy it – or the reader can read it for themselves at http://www.ofsted.gov.uk/resources/edging-away-care-how-services-successfully-prevent-young-people-entering-care. Here I will endeavour to extract only the parts that most directly connect with solution focused practice, and I highlight particular phrases and sentences in italics for emphasis, and add a few comments.
From the young people and families interviewed the overriding message was that it was the quality of the professional involved, significantly the key professional, which was the crucial factor in helping to achieve success. These key professionals had a range of backgrounds and qualifications including social work, youth offending, nursing or psychology. They persevered with families who often did not want to engage with them. They were described as persistent, reliable, open and honest, which included being absolutely straight about what needed to change. They enabled the families to see that they had strengths and that change was possible. (p4)
So far, so predictable. This is something that research is coming to show in therapy and counselling as well, that who does the work may be as important as what is done. Workers bring particular qualities and skills to their work, and to the relationships they develop with clients, and what the portion highlighted shows is that an optimistic attitude – allied to a robust position (“being absolutely straight about what needed to change”) – can have far-reaching effects. Later we are told that
Evidence from those interviewed indicated that the most crucial factor in successfully preventing young people from entering care was the ability of the key workers to engage with the young person and their family to help them see that positive change was achievable. (p6)
Interestingly, the report is alert to the accusation that a purely positive approach is being fostered:
In families where confidence and self-esteem were low because of a range of difficulties, keeping a focus on their strengths and positive features was extremely important. This was a view shared by young people and their families as well as professionals. This was very different to the rule of optimism that Dingwall et al* described as a potentially dangerous factor in child protection work, in that progress against agreed targets was being continuously monitored; these were families who demonstrated that they could, with the right encouragement and support, make sustained changes which would impact positively on the lives of all family members. One manager explained, ‘We can become so focused on problems we forget there are positives. [Having the] ability to identify these gives us a more positive, common position to move forward from.’ For many families this was critical in enabling them to believe in themselves and sustain the changes after support services ceased involvement. (p25) *R Dingwall, J Eekalaar and T Murray (1995, 2nd ed), The Protection of Children: State Intervention and Family Life, Oxford: Blackwell.
The next section I’d like to quote is maybe a little surprising:
In addition to the qualities of the professionals involved, the most successful services were those which incorporated explicit and clearly stated models and methods of intervention, including a repertoire of tools for professionals to use. A clear intervention model supported professionals to be more confident and informed and led to better and clearer outcomes with young people and families. It was the clarity of the model, rather than the model itself, which seemed to support this success and this in turn enabled young people and families to understand more clearly the overall
direction, plan and timescales of the intervention. (p4)
The report goes further and states that “the survey did not find evidence that any one particular model was more effective than others” (p7). Much as one would like to stake a claim that one’s own model (solution focus, of course!) is superior, the survey’s finding fits with other research in the field of psychotherapy, that all approaches have roughly the same success rates. What I think the report does clarify is that having a model, a clear structure of intervention, is vital to the practitioner. A pick ‘n mix of things, an eclectic approach, as many advocate, is not the best thing after all.
In terms of the actual models used, we are told
Most professionals appeared to draw on a range of approaches or tools. They cited most commonly: the ‘Think family’ or whole family approach; solution-based or cognitive behavioural approaches; motivational interviewing; the key worker model; and particular parenting programmes such as ‘Triple P’. (p16)
The report discusses the features of successful engagement with young people and their families that were most valued by the families and these included
−approaches which built on the strengths of the family
−working alongside the family to achieve shared goals (p7)
and this is elaborated upon later:
For many of the young people and their families, these particular services had succeeded and made a difference where previous attempts at intervention by other services had failed. A number of common themes emerged from discussions both with the families and the professionals involved. These were:
-the worker’s ability to form positive relationships and engage with the young person and their family, based on:
−openness and honesty, including absolute clarity about the paramount needs of the young person, what needs to change and the consequences of not doing so
−persistence and reliability
−not judging or criticising the individual while providing clarity about what is and is not acceptable behaviour
−respect and empowerment
−encouraging people to have a voice
−responsiveness and flexibility
a positive, strengths-based approach which involves the young person and family in identifying solutions
-focusing on the needs of the child while recognising the wider role and needs of family members including fathers and male carers being there when needed and clarity about the arrangements for future support when the service ceases involvement with the family. (p16-17)
We are told that
It also meant being able to help the family see that change was possible, sometimes by identifying an important change where positive results could be seen fairly quickly, for example, in improving the physical environment of the home….As one professional put it: ‘Without engagement you can’t “do” therapy; engagement itself is often therapeutic but has to be purposeful.’ (p17)
and this of course chimes with one of the key messages in the Munro review of child protection which the report quotes: ‘Helping children and families involves working with them and therefore the quality of the relationship between the child and family and professionals directly impacts on the effectiveness of help given’ (p21).
Another section may give some solution focused practitioners pause for thought:
In these circumstances, nurturing the strengths and resilience of families rather than creating dependence is essential. In the view of families, this was done by not telling them what to do but offering options and suggestions. It meant working with them and supporting them but also, crucially, putting the responsibility on the families, agreeing a clear plan and goals and regularly
reviewing and acknowledging progress. One parent appreciated regular letters from the worker reinforcing the discussions and agreed actions and noting the achievements. This was found to be a useful reminder, when things became tough, about what strategies had previously helped. Mechanisms and plans for tapering down support were essential as family capacity increased. (p26)
The controversial bit for me here is the emphasis on plans. Obviously, if a family thinks that having a plan, and even one written down, would be useful (“how else will I remember what we talked about?”) then obviously that could work for them, but we would argue that it’s one thing to talk about possible actions that it might be useful to take, but setting things down leads to a process of checking up on clients – which seems exactly what the report is recommending.
Finally, the report contains a few case studies and in two, in Rochdale (p23-25) and Blackpool (p36), the work is specifically described as solution focused, and in another, North Yorkshire (p14), it is described as ‘based on a ‘family strengths’ approach’.
This piece is not intended to be an in-depth review of the report. There is so much valuable information to be found there, and overall the reader is left, I think, feeling in awe of the commitment of social workers. And it is heartening to see that solution focused practice and allied approaches are playing such a large part in the successful work that is going on. Work that has largely, until this report, gone unsung. But of course the real heroes are the clients. This whole report could be seen as evidence for the solution focused adage that the client is the expert.
Harvey Ratner March 2013