THAT’S MY NAME, DON’T WEAR IT OUT—Activity One

The Asperkid’s Game Plan teaches how to use purposeful structured play to engage the bright minds of Asperkids, building on strengths that they already have and developing core skills that they often struggle with, such as fine motor and social skills.

Full of practical and fun learning games that can be used in the home or classroom, the following extracted activity is designed to find and concretely construct language, to help every Asperkid develop reading and “writing” long before their  motor skills would ever have allowed them to do the same:

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Jennifer Cook O’Toole has Asperger syndrome and is the mother to three young Aspie children. She graduated from Brown University, and attended Columbia University’s Graduate School of Social Work. She has previously worked as a social worker, and a teacher in both special needs and mainstream education. She has also served on the Family Advisory Board for Levine Children’s Hospital, North Carolina, and regularly gives presentations at hospitals and local universities on special needs parenting. In 2002 she was nominated for Disney’s Teacher of the Year Award. More recently, she has been honored with the GRASP (Global and Regional Asperger Syndrome Partnership) 2012 Distinguished Spectrumite Medal, as well as the 2012 Temple Grandin Award for outstanding accomplishment and contribution to [her] family and community. She lives near Charlotte, North Carolina.

 

No Shame for Extreme Night Owls

Author of An Occupational Therapist’s Guide to Sleep and Sleep Problems, Andrew Green is an occupational therapist specialising in sleep disorders. In a bid to clear the air about the myths that surround the early bird and nightowl stereotypes,  Andrew gently introduces the sleep disorders that are the root of the stereotypes that haunt those of us who just aren’t very good at sticking to ‘normal’ sleeping hours, if such a thing exists.

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In 1735, Benjamin Franklin made known the saying ‘Early to bed, early to rise makes man healthy, wealthy and wise’. Over two centuries later it turns out that the opposite may be nearer the truth. By comparing health and socioeconomic data relating to ‘owls’ and ‘larks’, Gale and Martyn (1998) found no evidence that early rising is actually more beneficial, and concluded that early bedtimes and rising times are not linked with ‘health, socioeconomic, or cognitive advantage [and] if anything, owls were wealthier than larks’ (p.1677). It is possible that Franklin learned in his long life that the earlier saying was inaccurate since the following is also attributed to him, presumably in his later years: ‘I wake up every morning at nine and grab for the morning paper. Then I look at the obituary page. If my name is not on it, I get up’.

In any case, the reality is that people are different and the tendency towards being an owl or a lark is inherited. For most people it is just a tendency – part of natural variation that can be accommodated in normal lifestyles, but at the extremes are circadian rhythm disorders. Circadian rhythms are the natural cycles that determine the timing of numerous body functions, including the sleep-wake cycle. When someone’s rhythm is advanced – when they are an ‘extreme lark’ – they tend to wake earlier and go to bed earlier than the norm; it is a very rare condition and Schrader et al. (1993) found no cases of advanced sleep phase disorder in a sample of 10,000 Norwegian adults. However, the same study found 17 individuals who met diagnostic criteria for delayed sleep phase syndrome (DSPS) – or who were ‘extreme owls’: it is therefore still an uncommon condition although the prevalence in adolescents and young adults may be as high as 10% (Wilson and Nutt 2013).

To have DSPS means that a person is unable to sleep until two hours, or longer, after a more conventional bedtime and naturally tends to wake correspondingly later. It might not seem much but is extremely disruptive to life. Someone with DSPS may not know they have it and think they have insomnia, perhaps going to bed at 11 p.m. in the hope of having eight hours of sleep and not sleeping until 2 or 3 a.m. However, they will still need to get up at 7 a.m. for work or school and have to get through the day. Whereas most people can manage after one short night, perhaps because of an early start for a journey, having DSPS is like having to get up at 4 a.m. every day, having gone to bed at 10 or 11 p.m., and then feeling sleepy every afternoon.

Individuals with DSPS complain that it is difficult to get to work reliably in the morning and that employers, and others, do not understand that they are not just being lazy. Some people are very embarrassed by staying in bed for half the morning. Others are able to adapt to some extent; for example, a research student might be able to work in the library during the night, arrange meetings in the afternoon and still have time to meet friends in the evening. The experience of DSPS has been investigated by Wilhelmsen-Langeland et al. (2012) in a qualitative study involving nine young people (age 16–23) in Norway. Participants talked about the difficulty of staying awake at school, and conflicts with others through being late when meeting, or unavailable to help with chores, for example, during the day, but the failure of others to understand was a key observation. Other people might suggest that they could just go to bed earlier – as if they could just try harder to sleep ahead of their biological preference.

Delayed sleep phase syndrome is a disruption of activity cycles and could be considered a disorder of occupation; it should be of interest to occupational therapists. Medical management could involve use of melatonin at night to encourage earlier sleep (supplementing naturally produced melatonin) and bright light (daylight or full spectrum artificial light that mimics natural light) on rising in the morning in order to help ‘reset the body clock’. In addition to these, chronotherapy involves going to bed successively later, a strategy that seems counter-intuitive, until the desired hours of sleep are reached; it is easier to adjust the timing of sleep by lengthening the day – in the same way that is easier to adjust to jet lag when flying east to west. It is then important to consider how the person keeps to more conventional hours.

In many respects maintaining more regular hours is like following advice for managing insomnia: keeping a consistent rising time (essential) – and seeing daylight on waking; avoiding daytime sleep that might delay night time sleep; doing regular exercise and having regular activity; having a clear winding down routine. In winding down it is preferable not only to avoid the mental or emotional stimulation that might accompany use of a computer late at night (and the temptation to play ‘just one more game’, for example) but also to avoid the blue light that is emitted by computer screens and televisions, which can suppress the production of melatonin.

Despite all such effort, however, it is likely that the individual is always going to be later than average and well-advised to avoid work that involves early starts. Finally, extreme owls might remember that there is no need for shame in rising late, which they cannot help. As Gale and Martyn put it, ‘there is no justification for early risers to affect moral superiority’ (p.1677).

References
 Gale, C. and Martyn, C. (1998) ‘Larks an owls and health, wealth, and wisdom.’ British Medical Journal 317, 1675–1677.
 Schrader, H., Bovim, G. and Sand, T. (1993) ‘The prevalence of delayed and advanced sleep phase syndromes.’ Journal of Sleep Research 2, 1, 51–55.
 Wilhelmsen-Langeland, A., Dundas, I., West Saxvig, I., Pallesen, S., Nordhus, I.-H. and Bjorvatn, B. (2012) ‘Psychosocial challenges related to delayed sleep phase disorder.’ The Open Sleep Journal 2012, 5, 51–58.
 Wilson, S. and Nutt, D. (2013) Sleep Disorders, 2nd edn. Oxford: Oxford University Press.

Andrew Green trained in occupational therapy in York and is now a specialist occupational therapist in North Bristol NHS Trust’s sleep disorders service at the Rosa Burden Centre. Learn more about his book An Occupational Therapist’s Guide to Sleep and Sleep Problems here.

Three Steps to Improving the Safeguarding of Children

Ofsted’s October 2014 report on the outcomes of the first 33 inspections under their new framework showed that over two thirds of children’s services where either “inadequate” or “require improvement”. Offering a pragmatic and achievable approach to assisting services to build their capacity to meet public, political and professional expectations in his book The Common-Sense Guide to the Safeguarding of Children, author Terry McCarthy outlines his three-step approach to improving the safeguarding of children.

Social workers are expected to enable fundamental and sustained change with parents and carers who often have long-term and entrenched issues relating to their capability, behaviour and life choices. These most commonly concern alcohol and drug use, violence, criminal activity, learning disability, mental health problems and serious emotional difficulties. Often more than one of these elements needs to be addressed to ensure the safety and welfare of children. The challenge is made even more difficult by families often being unwelcoming or fearful of agencies’ involvement, leading to them being evasive or hostile.

Whilst most social workers are highly committed, these complexities, demands and expectations take their toll with many being overwhelmed, stressed and anxious. This can lead to low morale, uncertainty and poor confidence. The impact on the continuity and long term stability of services is often felt through high staff turnover, sickness and shortened careers. For those who do remain in practice the complexities can cause misjudgements, tunnel vision, lack of focus and ineffective practice with practitioners feeling unable to challenge situations or creatively engage with families. This can also lead to process driven practice which meets procedure and policy requirements, committing considerable energy and resources without necessarily leading to significant benefit to children.

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The Three Step approach considers how safeguarding agencies, particularly children’s services, can work within available resources to make a real difference. This does not require a major ground shift but rather can be achieved through the accumulative effect of a series of small, easily implemented measures.

Step one: Establish a culture which enables and leads 

This culture should identify how organisational values, attitudes and behaviours are needed to model good parenting. This includes having healthy relationships, good communication, clarity of purpose, conflict resolution, constructive use of authority and creative approaches. It is argued that the “managerial” approach, which focuses on procedure, giving instruction and monitoring compliance, is limited and unlikely to adequately inspire, support and lead practitioners through the highly complex challenge of identifying and address the mistreatment to children.

Step two: Develop a stable, skilled and confident workforce

This presumes that most social workers are reasonably clear about what should be done and why this is required to safeguard children, however often struggle with how they can bring about the required outcomes. Effective practice requires practitioners to be supported to develop focus, understand the complexities and address anxiety which can overwhelm them. The practitioner skills outlined in the book are an expansion of the Performance Capability Framework and it is argued that a blend of supervision, coaching, consultation and case auditing can create a learning environment where best practice is likely to flourish.

Step three: Enable families to change.

This sets out thirteen aspects of effective work with families to ensure that risks to children and the fundamental reasons for these are clearly understood, leading to effective planning which focuses on addressing solutions and ensuring real progress within reasonable timescales. This requires honest, effective and direct relationships with families and partner agencies including clarity about how meetings and involvement with the family and professionals ensure that key aspects of the plan are progressed.

 Terry McCarthy  is a qualified social worker with over 30 years’ experience in children’s services. Read more about The Common-Sense Guide to Improving the Safeguarding of Children here.

Fostering Resilience in Children

scaryMelissa Moses, author of Alex and the Scary Things, offers some insight into why it is important for children to develop the right skills to cope with overwhelming emotions.

According to a study published in December, 2014 by the Johns Hopkins Bloomberg School of Public Health, nearly half of all children in the United States are exposed to at least one social or family experience that can lead to traumatic stress and impact their healthy development. These include such childhood experiences as extreme economic hardship, parental divorce/separation, living with someone with a drug or alcohol problem, witnessing or being the victim of neighborhood violence, living with someone who was mentally ill or suicidal, witnessing domestic violence, being treated or judged unfairly due to race/ethnicity, and the death of a parent.

The study found that more than 22 percent of children represented in the survey had two or more of these traumatic childhood experiences. Researchers found that children with two or more adverse experiences were more likely to struggle in school and have a wide range of chronic health problems, including asthma, ADHD, Autism Spectrum Disorders, and obesity. The study also suggests that training parents, providers, and communities to help children cope with traumatic experiences can help build resiliency, leading to later success despite the obstacles.

After spending two years working with children, adolescents, and families who had experiences trauma, I decided to write Alex and the Scary Things to help kids develop skills to cope with overwhelming emotions. Additionally, practicing the skills in Alex and the Scary Things will help children begin to feel a sense of agency in dealing with the effects of trauma. A strong sense of self-efficacy and self control, as well as encouraging individuals to recognize their accomplishments, helps foster resiliency in the face of trauma. My intention was to create a character with whom a child could identify without having the story feel overly therapeutic. In Alex and the Scary Things, children are taught strategies and skills such as breathing techniques, grounding skills, and emotional expression. My hope is that the story is fun and engaging so that children actually enjoy practicing the skills!

Melissa Moses is an Assistant Psychologist at McLean Hospital. She has a doctorate in Clinical Psychology from the Massachusetts School of Professional Psychology. Melissa has a private practice in Belmont, Massachusetts and specializes in treating survivors of trauma and the treatment of substance use disorders. She also has an MFA in Creative Writing from Lesley University. To learn more about  Alex and the Scary Things click here.

Alex and the Scary Things

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Autism Spectrum Disorder de-escalation strategies: Creating safe spaces

 Brown9781849055031In his third entry for the JKP blog Steve Brown offers another short practical insight into how professionals working with children that have an autism spectrum disorder can create the most comfortable learning environment possible and de-escalate situations that can lead to volatile meltdowns. Today Steve covers the importance of creating a safe space to learn and how one goes about doing just that. Steve Brown is the author of Autism Spectrum Disorder & De-Escalation Strategies: A Practical Guide to Positive Behavioural Interventions for Children and Young People – for more information on the book visit the JKP website

Creating safe spaces

Where do you prefer to go to when you feel anxious, angry or embarrassed?

Picture yourself in one of these states complete with an audience. As a means of protecting yourself I imagine you would ideally like to take yourself to a place that makes you feel comfortable and calm.

08-autism-afpgtThis is a major problem faced by a number of children with ASD – the acting out, the confrontation, the aggressive incidents are the result of them feeling great stress in the class environment and not being able to find that comfortable and calm space. One of the things that we as professionals should be doing is creating safe, calm places for children to feel good, learn and thrive in.

5 ways to create calmer spaces for children with an Autism Spectrum Disorder.

  • You can define any ‘safe’ area by giving it boarders. You can use a carpet tile, coloured spot or taped floor area to let the child know where to sit or stay provided this will help them feel safe.
  • You can introduce big bean-bags in classrooms or corridors for children to sit on when they need to calm down or have time to think. Bean-bags are flexible enough for the child to relax into, don’t pose a great deal of threat when thrown and are portable.
  • Set up a separate workstation (table and chair facing blank wall – low stimulation) inside or outside the classroom. This is a simple idea to allow the child to be slightly detached but still involved in lessons and work activities (not a punishment – just a safe space for them to be alone).
  • Comfortable chairs located in quieter areas for children to sit in or lean against help them to concentrate on what is bothering them or what they need to do next, rather than uncomfortable seats in busy areas which can provoke agitation and distract the rest of the class.
  • Designate a specific room that offers privacy and protection. In that room have slogans and pictures painted on the walls that offer positive thoughts such as ‘stay safe’ or ‘talk and listen’. You want a room that is a good size, is painted a calming colour and has soft furnishings or bean bags for children and staff to sit on.

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Children with ASD who abscond or hide under furniture often do this because they don’t realise there are other options and thus default to a pattern of behaviour that can cause a great deal of disruption. Offering an alternative space where the child can feel safe means as professionals we have a greater degree of control and can help diffuse a volatile situation much better.

The learning environment is often one of the last things we consider when trying to help manage emotions and behaviour. Have a good look at your work place and see if there is anything you can change to provide the children and educators with calmer, safer spaces.

Brown---ASD-and-Deescalation---CLICK-HERESteve Brown is the author of Autism Spectrum Disorder & De-Escalation Strategies which is available in paperback from Jessica Kingsley Publishers

Autism Spectrum Disorder de-escalation strategies: Non-verbal communication

Brown9781849055031In the second of his special blogs running this March Steve Brown is offering another short practical insight into how professionals working with children that have an autism spectrum disorder can create the most comfortable learning environment possible and de-escalate situations that can lead to volatile meltdowns. This week – the importance of non-verbal communication. Steve is the author of Autism Spectrum Disorder & De-Escalation Strategies: A Practical Guide to Positive Behavioural Interventions for Children and Young People – for more information on the book visit the JKP website

 

Non-verbal communication

Sixty per cent of communication is supposed to be conveyed through non-verbal communication according to Borg (2011.) Experts in this field disagree on the exact statistic (don’t all the academics disagree? it’s their job!) but it is generally agreed upon that body language makes up a large part of what we communicate.

How many times have you gazed across a sea of children’s faces and picked out the ones that are looking to cause trouble or show signs of needing help just through reading their body language? Now think back when you were a child and did something that was bad enough to warrant serious consequences, you could probably gauge how severe your punishment was going to be from the adult long before they opened their mouth.

An angry teacher holding a composition book and pointing a ruler.As professionals working with children on the autism spectrum it is essential to be aware of the power our body language has. There are things we should always try to avoid – negative messages that automatically send out a bad vibe such as, double tea pot stance (hands on hips), turbo boost eye brow lift eye contact (a really stern look) and finger wagging are all non-verbal wind up techniques that are confrontational and can raise anxieties in children with an ASD.

We all know it is difficult to manage body language, to keep control of eye contact and limit our negative gestures but it is important that we try and remain aware at all times of the power these signifiers can have.

The trick is to be relaxed with body language, appear confidant and assertive and send messages that convey clear statements without appearing aggressive or authoritarian.

eye contactYour gestures are going to give away a lot of your overall message to a child long before you have said a word – as professionals we should start thinking a lot more about using our words to back up our gestures rather than allowing our gestures to give away something we might be thinking but isn’t helpful in a potentially volatile situation.

With that in mind we should try to align our non-verbal messages with the words we use. If you are asking a child to sit down – point at the chair and not directly at them. Make your gestures in a confident and assertive manner remembering the whole time that rapport is often built on non-verbal communication.

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Steve Brown is the author of Autism Spectrum Disorder & De-Escalation Strategies which is available in paperback from Jessica Kingsley Publishers

Can children regain hope after suffering loss?

A social worker by profession, Camille Gibbs works closely with children who have experienced trauma and loss. Camille’s new book A Sky of Diamonds  presents a touching story of how a girl named Mia copes with the death of her mother. In an enlightening Q&A, Camille explains why and how Mia’s story came to be.

 Gibbs- a sky of diamonds - pg 46 - imageWhat was the inspiration behind writing A Sky of Diamonds?

I can recall, as a child clearly thinking that if I were to lose a loved one, I would find comfort in the idea that I could still talk to that person if I were to look up at the stars, as the stars are a constant. I think therefore that this book must have been in my head for many years!

During the writing of A Sky of Diamonds a close family member of mine was diagnosed with a serious illness. This news made me think about the possible impact that such a death would have on my own young daughter.  I thought about the types of questions she might, as a five year-old ask, and the reassurance and comfort she would require from those around her. My first book, One Marble a Day looks at the experience of a young child placed with an adoptive family.  Feedback from adoptive families has been that the book has helped children placed in their new family – as reading that others are experiencing similar feelings and emotions can be extremely comforting and reassuring. This led me to think further about the impact of the loss, through bereavement of a parent and how life changing this experience can be.

As you work with children who are being put into adoptive placements, you must see children going through a number of hardships. Are there many children in the adoptive system, who are there because of the death of a parent?

As a social worker in a family-finding team who specifically finds adoptive placements for older children, the children I work with on a daily basis have experienced trauma and considerable loss. Although, in my ten years as a social worker I have not experienced a child being placed for adoption due to the death of a parent, I regularly work with children who have been removed from their birth family as a result of abuse. On occasion, I have also worked with very young children who have been relinquished at birth. Although one might imagine that a baby or very young child has limited awareness, it is very clear that even very young children will grieve due to their separation from an adult with whom they have established a close relationship, whether this be the birth parent or a subsequent care-giver such as a foster carer.

A Sky of Diamonds is about loss, grief and hope – do you think children can have hope after loss due to death or separation?

Whilst the loss of a loved one changes a child’s life forever, it is important to nurture hope. It was my aim that A Sky of Diamonds will help children and their family members to see that grief is a process that has to be worked through before a child can move forward. Whether the loss is due to the death of a parent, separation via adoption, or due to another cause, what is key is the availablity of sensitive adults who are open and honest.  These adults can help the child to process their feelings, through validating the pain of losing someone, but also through helping the child to develop awareness that joy can still be derived from loving someone deeply.

In your experience, do children grieve differently when losing their parents/guardians, be it due to death or separation?Gibbs- a sky of diamonds - pg 28 - image

Grief is a process that a child needs to pass through before they can recover from the loss, whether this be as a result of death or separation from a parent, or someone with whom they have formed a significant meaningful relationship. Put simply, children need to grieve in order to move forward – there is no shortcut.

There is also the added complexity that the child may have had both positive and negative experiences when living with their birth family, and thus, some children will need extra support in managing overwhelming feelings as they develop an understanding of their earlier life experiences. Often children require support in expressing their anger and this can present at various stages in their development. Unlike the death of parent, a child who has been separated from their parent may know that the parent is still alive through some degree of contact.  This contact might be direct or indirect via letters if they are placed in a new adoptive family or in foster care.  Therefore the grief cycle may need to be repeated at different times.

What is the core message of the book and why do you think it would help children to get through their grief?

The core message of A Sky of Diamonds is that, although the death of a parent who is deeply loved, is the most painful experience one can suffer, with the right support there can be hope and a child can be helped to live a happy and fulfilling life.  A Sky of Diamonds is honest in its approach.  In writing from a child’s perspective it offers the message that it is okay to express emotions.  Children reading it will see that they are not alone in experiencing strong emotions and in the book, the main character’s father is also seen expressing his emotions at times.

A Sky of Diamonds addresses some of the questions children commonly ask about death. Helping a child with answers to these questions, enables them to better process what has happened and avoid fantastical thinking or becoming overwhelmed with anxious thoughts about surviving family members or their own mortality. The book highlights the importance of giving children the time and space to work through their feelings and provides ideas for therapeutic activities that a surviving parent or adult working with the child could put into place to support the grief process.

Camille Gibbs is a social worker in the field of adoption, specialising in direct work with school-aged children moving to adoptive placements. Learn more about A Sky of Diamonds here.

 

Autism Spectrum Disorder de-escalation strategies: Avoiding confrontation

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Throughout March author and de-escalation expert Steve Brown is offering short practical insights into how professionals working with children that have an autism spectrum disorder can create the most comfortable learning environment possible and de-escalate situations that can lead to volatile meltdowns.  Steve is the author of Autism Spectrum Disorder & De-Escalation Strategies: A Practical Guide to Positive Behavioural Interventions for Children and Young People – for more information on the book visit the JKP website

 

Avoiding confrontation
I often get asked how best to de-escalate in different situations – particularly when it comes to working with a child that a professional does not know well or has been able to establish some level of working relationship with.

In times of doubt or when a child of any age is displaying unpredictable behaviour, the space we have between us and the child is really important. Stand too close and we are physically vulnerable, stand square on and lean in and we put ourselves at further risk. This also looks confrontational. As an adult if someone gets too close what is our reaction? I often witness adults stepping back, instructing the person to back off.

armbentThe length of space between the elbow and the shoulder is deemed as intimate space, a space that we reserve to invite people into.

The next closest space is personal space which is defined from the elbow to the finger tips. This space is often entered unnecessarily or unintentionally. This is where problems occur. Eighty percent of injuries to staff are to the head and four to five year olds cause 3 times more injuries to staff than any other age group. Staff can fear older, taller children, yet it’s the younger, smaller children who cause the most damage to the most important resource: staff.

teacher_telling_off_sonEven though the staff who work with younger children get down to the children’s height, they tend to lean in and therefore bring faces closer into striking range.

If more staff stood sideways on and tried to keep in social space they would be safer and reduce the risk of injuries. The child would be less likely to be wound up or feel intimidated and have their emotions heightened.

An easy way to remember this is “sideways is safest”.

In times of trouble keep your distance and reduce and deflate your body language, by approaching sideways on you increase the chance of lowering the child’s anxieties which will help to reduce behaviours that challenge us as professionals. This doesn’t mean staff have to walk around placing their arm out pointing towards the children shouting “back off!” it has to be a controlled approach that is as calm as possible. The important thing is to not aggressively invade the child’s personal space. I once witnessed a staff member get so close to a child that when he was speaking little bits of saliva landed on the child’s face. The child kept on stepping back and then looked towards the member of staff, wiped his face and said “I asked for the news not the ******* weather!” It is important to remember that initially the professional must maintain that personal distance and approach side-on.

Emotions drive behaviours that get reactions and staff can wind up emotions or wind them down. De-escalation is subtle and can look like nothing is happening but done the right way it can make learning environments more comfortable for all involved. To avoid confrontation and winding up children staff can remain assertive, look confident, naturally smile, reduce body language by getting sideways on and stick to a positive script.

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Steve Brown is the author of Autism Spectrum Disorder & De-Escalation Strategies which is available in paperback from Jessica Kingsley Publishers

How care becomes corrupted and we lose heart

In a follow-up to his last blog post, John Burton looks at the factors which cause care, and our faith in it, to break down. Leading Good Care, his most recent publication, dives into the heart of the care world’s many problems, and resurfaces with compelling advice on how to take on a social care leadership role with integrity. John has worked in social care since 1965 as a practitioner at all levels, and is now an Independent Social Care Consultant.

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Strip away the irrelevant, brittle and showy exterior, all the quality and compliance waffle, the delivery and performance gobbledegook, and the key lines of regulatory assessment, to find the solid core task of caring human relationships. Focus on that and only that; put your heart and soul into the work; and use your imagination and creativity to make caring an art. That is the message of my new book, Leading Good Care.

For me, 2015 marks fifty years in social work. I started as an assistant in a run-down secondary school in a deprived area of London. I had a lot to learn there, but the real shock to my system was living as a resident in a probation hostel nearby. While I came with all the security and love of my upbringing in Devon, my fellow residents had nothing to fall back on, and the hostel provided no more than food and a small bed-space in multi-occupied rooms, in a cold and dirty little institution. My subsequent engagement with social care, and particularly with residential care, started there. I thought that surely there must be a better way of doing it.

I have worked with people of all ages, from children to the very aged, in a wide variety of places and teams, led several different services, and consulted to many others. While there have been landmark reviews and reports providing well researched support and stimulation for change and development, I find it hard to identify a single item of legislation, regulation or government guidance that has resulted in progress in social care. Nor can I think of “improvement agencies” or regulatory regimes that have substantially improved care.

No, the effect of central and top-down efforts to improve care is to corrupt it, and to undermine and weaken the role of those who lead care services on the ground, people like care home managers. With the best of intentions but lacking understanding of how good care is created, the current regulator and inspector of social care in England, the Care Quality Commission, has made its requirements for conformity the central objective of all but the most determined and confident social care managers. We pay many £millions to carry this millstone around our necks.

Look at Winterbourne View. The place was rotten to the core but it operated within the legislative and regulatory regime. It was inspected, people were sent to live there, and the owners charged the taxpayer £3,500 a week for “assessment”, “care” and “treatment”. It would still be open if there hadn’t been a brave and principled whistleblower and a Panorama programme. For nearly four years there have been unceasing panic, blame and denial. Parliament has gorged itself on the horrors of such places. Ministers decree that they will close. Nearly four years later very little has changed, yet politicians, civil servants, and the great and good of social care continue to put their faith in the same institutions and methods that have so abjectly failed to bring about change. Such scandals have punctuated the last fifty years, yet there are many wonderful, creative, joyful places that defy the corruption of this culture of compliance, the constipation of this rule-bound regime, this bullying bureaucracy of blame.

The most basic knowledge of the sociology and psychology of organisations tells us that the culture and relationships at the top determine the way the workforce behave with each other and perform their task. Social care works well when the team is well led (yes, CQC have got that one right) and the core task is the only task. It works well when all the external managers and organisations understand that their role is to resource, support and enable the core task to be carried out. Social care goes wrong when the core task is corrupted by the demands of those above and outside, when manager finds themselves distracted by compliance, form filling, attending to the needs of the managing organisation or the regulator or the local authority . . . by a hundred different jobs that take them away from meeting the needs of clients and the staff that care for them.

Managers lose heart when they collude with a corrupting system. To lead good care, the manager has to have that drive and belief, the professional authority, pride and principles to resist, to join with other like minded managers, and to say “no” when told to comply with demands that corrupt the core task.

John Burton has worked in social care since 1965 as a practitioner at all levels, and as a manager, writer, trainer, researcher, inspector and consultant. Learn more about Leading Good Care by John Burton here.

Leading Good Management in Care Homes

John Burton has long been fighting for a forward-thinking and conscientious care management system. Leading Good Care, his most recent publication, dives into the heart of the care world’s many problems, and resurfaces with compelling advice on how to take on a social care leadership role with integrity and pride. John has worked in social care since 1965 as a practitioner at all levels, and is now an Independent Social Care Consultant.

In Leading Good Care, I set out and recommend a positive and hopeful vision of social care. My subtitle – the task, heart and art of managing social care – is both realistic and idealistic. The task requires serious, disciplined, hands-on, and hard work. The heart signifies that this work is emotional and personal, and that care is a human relationship. And the art of managing care engages your skills, your imagination, your culture and creativity.

I write at a time when we should be learning the lessons of a command- and-control culture, but, as always, we are in danger of replacing yet one more set of instructions with another. It was a do-as-you’re-told, top-down, target driven culture that led to the atrocities of Stafford General Hospital and Winterbourne View. This ‘delivery’ culture was also characterised by the extraordinary selection and subsequent dominance of some of the most senior managers who recruited and protected each other and bullied their way to the top. Desperate to mend health and social care before the next election, politicians go on believing that it can be ‘fixed’, and the same old delivery culture believed that Jim could fix it for them. Then, they recruited Sir James Wilson Vincent Savile, OBE, KCSG to ‘manage’ a secure psychiatric hospital where he abused patients. They gave him free rein to prey on hundreds of victims in many other care settings, while being honoured, protected, sponsored and used by the Establishment that he so assiduously courted. Like Savile, celebrities and members of the Establishment have used their sheltered and safeguarded positions of authority to abuse the trust given to them by children and adults alike. They acted with impunity, while those who protested were ignored, silenced, threatened or punished and those who survive are only now being heard. The officials who colluded in concealing these crimes can still redeem themselves by exposing the truth about perpetrators in power. Abuse and exploitation are endemic in a top-down social care system that demeans, disempowers and damages the people who most need its help.

When you become a social care manager, you too may feel that in order to keep your job you will have to do as you’re told, put up with what you know to be wrong, get high marks in your inspections, and convince your employers and regulators that you are in every way a thoroughly compliant employee. Indeed, this has been the problem with developing leadership in social care. For several reasons (some shared with the health service) social care has become a top-down, rule-orientated, highly competitive and bureaucratised service. Compliance and delivery are the watchwords; if you don’t comply and you don’t deliver, you are likely to be regarded as a failure. The truth is that this top-down system has been a disaster and managers have been left dealing with the perpetual and tragic failures of such a regime. Hitherto, the response to these failures has been to do more of the same, thereby only making matters worse.

It doesn’t have to be this way. Leading Good Care encourages you, as a leader, to work out your own principles and set your own standards; you will take responsibility for your service and its task; you will encourage leadership in your team and assertiveness in the clients of your service. Ultimately, you must take the path that will help you embrace the leadership role you have been given and take the lead. Taking the lead means making decisions and sometimes being wrong, and then learning and moving on. It means taking the authority to lead and being given the authority to lead by your staff and your clients.

John Burton has worked in social care since 1965 as a practitioner at all levels, and as a manager, writer, trainer, researcher, inspector and consultant. Learn more about Leading Good Care by John Burton here.