Practitioner Qualities

In this section:

  • Qualities of effective practitioners;
  • Recruiting practitioners, including volunteers.

First steps:

Work with colleagues and, if possible, a group of clients to identify the characteristics of practitioners, including volunteers, who can support families where parental alcohol misuse is a problem.

Ask yourself whether all the needs of the families you support can be met by one kind of practitioner, and whether the characteristics of those supporting adult substance misusers and children and young people are different. The characteristics could include training and qualifications but also personal qualities such as empathy, patience and tenacity. If you are working with a group of children you could ask them to draw around a person on a large sheet of lining paper and then use craft materials to create their ideal worker, recording words and phrases which clarify their views.

Qualified

In the five Comic Relief funded projects, practitioners had a range of qualifications including social work, youth work, community development and nursing. In addition, practitioners were often qualified in specific approaches such as psychotherapy, play therapy, motivational interviewing or parenting support. While volunteers did not necessarily have formal qualifications they often had valuable insights as former clients or family members. Many were looking for experience to help them decide whether to pursue a career e.g. in social work. Some also brought experience from another profession e.g. teaching or catering which were valuable. However well qualified your staff and volunteers may be, you will still need to provide training for those who have not previously specialised in working with children whose parents misuse alcohol.

Social Care: Institute for Excellence (SCIE) has published e-learning resources for practitioners in a range of social care settings. One of these resources is entitled ’Parental substance misuse’ and consists of three modules:

  • Understanding substance misuse;
  • Understanding the impact on children;
  • Implications for children’s social work practice.

There are also National Occupational Standards for those who work with drug and alcohol users, known as DANOS. The qualifications are divided into units which cover a wide range of competences including recognising problematic drug and alcohol use and supervising methadone consumption, not all of which are relevant to an alcohol hidden harm service. You will also find the national occupational Standards for Health and Social Care valuable as these focus on the needs of families, safeguarding and reflective practice. [See tools at end.]

See also the Skills Consortium for examples of e-learning in drug and alcohol misuse (http://www.skillsconsortium.org.uk/).

You can use the results of your discussions about the characteristics of an effective practitioner to compare with the national occupational standards to draw up a ‘role profile’ of the volunteer or worker you are seeking to employ. In most organisations several practitioners will share some of the same competences, while others will be unique to a particular role.

Trusted

Well qualified and/or competent practitioners and volunteers are vital to the smooth running of a service. However, as far as clients are concerned, it is the personal qualities of the staff and volunteers which are most often commented upon. Here are some words and phrases clients used to describe team members in the Comic Relief funded projects:

Non-judgemental, Caring, Accepting, Welcoming, Helpful, Told me straight, Pulled no punches, Approachable, Warm, Fun, Friendly, Kind, Just listened, Take(s) the time to just sit and talk, Listens to me, She didn’t give up on me

It is interesting to note that many of these comments related to the first encounter the client (whether adult or child) had with the service, either face to face or on the phone. In some cases it related to a receptionist role and not the key worker. First impressions count! (Service qualities: quality standards).

It is clear that practitioners need to be able to engage positively with a wide range of clients, some of whom have been referred by the courts or social services, and some who may have been through several cycles of support and treatment with other agencies previously and so lack confidence that they will be able to change their lives for the better.

Case study: Adapting 'Strengthening Families’

A hidden harm service planned to deliver an intervention based on the ‘'Strengthening Families’ model, where parents and children attended group sessions. However, they found that the groups for both adults and children were difficult to sustain over a long enough period due to the chaotic and turbulent lifestyles of their clients. Over time the practitioners developed a unique approach to engaging the parents of some of the most vulnerable children. This included inviting parents and children on family outings. For some families it was the first time they had spent time together doing a fun or educational activity. Once families were engaged the youth worker visited children regularly at school to provide help and support, while adult clients used drop-in coffee mornings to gain the confidence they needed to begin to attend parenting and other groups.

Thresholds

In any work where children are involved, safeguarding or protecting children from immediate risk of harm has to be a priority.
Children in need are defined in law as children who are aged under 18 and:

  • need local authority services to achieve or maintain a reasonable standard of health or development;
  • need local authority services to prevent significant or further harm to health or development;
  • are disabled.

Practitioners working with children whose parents misuse alcohol will be prepared to alert social services if they feel a parent is intoxicated or otherwise not able to care safely for their child. Clearly not all children whose parents misuse alcohol meet these criteria, but the aim of alcohol hidden harm services may be to prevent children’s needs from reaching this threshold.

In the past, and in some drug and alcohol services today, there has been a reluctance to ask adults about dependent children in case this creates a barrier to their engagement. However, since the publication of Hidden Harm in 2004 and the introduction of the Common Assessment Framework (CAF) services are more likely to be aware of children whose parents misuse alcohol and also more able to identify and meet their needs.

Where several members of a team are involved with a family it is important to keep good records and for all practitioners to know what should be recorded.

Case study: Key worker system

A service offered group sessions run by sessional youth workers and volunteers. All staff and volunteers had received training in child protection. They developed a system where a specific adult would be the key worker for each child. The children were not aware of this mechanism and were able to talk to any adult about worries or concerns. However, any concerns about a particular child were reported to the key worker at the end of each session and these were immediately recorded. Clear procedures were in place for identifying and acting on the seriousness of any concern. Low level concerns would be discussed in supervision, but if a child was felt to be at immediate risk of harm, children’s services would be contacted immediately.

It can be challenging when different services appear to have different thresholds for referral. Ask yourself if the thresholds are really different, or if the information you hold about a child and their family is different to another agency? Good communication among partners can help ensure thresholds are similar and that relevant information is shared.

Case study: Appropriate thresholds

A service was commended by its partners in children’s services and the NHS for having ‘appropriate thresholds’ which enabled other agencies to act promptly when approached with a referral for a child whose parent or carer misused alcohol. Prior to the establishment of the alcohol hidden harm service, partner agencies felt that the needs of children whose parents misused alcohol were more likely to be overlooked than children whose parents misused illegal drugs.

Practitioners are obliged to respect clients’ rights to confidentiality except where he/she believes a child is at immediate risk of harm. The British Association of Counselling and Psychotherapy have published a useful ethical framework for practitioners. See tools.

Reflective practitioner

Practitioners in day to day contact with families where alcohol misuse is a problem are well placed to be able to identify clients’ needs and consider whether their service is meeting those needs either individually or more generally as a group of clients. Effective practitioners are reflective, that is they review what they are doing and why and though their managers and in supervision, suggest ways to help clients. Independent clinical supervision and responsive management are key to enabling practitioners to reflect on their work with families where parental alcohol use is causing harm to children. The development of reflective practice enables both practitioners and organisations to grow and develop. In some examples the reflections of one individual practitioner can change the way a whole organisation works with their clients.

Case study: Flexible approach

A drugs charity had developed a successful structured programme for supporting families where parents misused illegal drugs. Aware that alcohol misuse was also a cause of hidden harm to children, they sought to roll out the same programme in another geographical location, specifically focussed on families where alcohol was the primary substance misused by parents. The lead practitioner quickly recognised that unlike the clients who misused drugs, the structured programme did not suit the needs of the new clients. Many of the new clients were in work and not available to attend a structured programme during working hours. Also the lack of public transport meant parents and children were travelling long distances in the evening to attend sessions. There was also less demand for parenting work than expected. The manager had regular routine contact with the practitioner and responded quickly to her suggestions for adapting the service. Alternative premises were sought so that children could be seen nearer to their home or at school, and adults were increasingly offered more flexible approaches to suit their needs and lifestyles. The service employed specialist therapists on a sessional basis and the practitioner trained in play therapy for which there was a much greater demand than expected.

As a result of the experience gained from the alcohol hidden harm service, the host organisation began to adopt a more flexible approach to their other clients, reviewing their structured programme for those who misused illegal drugs.

Reflective practice

Reflective practice is a term commonly used in health, social care and education and so it is not surprising that it is crucial to the professional development of practitioners in alcohol hidden harm. Reflective practice has its roots in experiential learning but was formalised by the American Professor of Urban Studies and Education, Donald Schön. His book ‘The Reflective Practitioner’ (1983) described ways that professionals think and solve problems which made it easier for those more recently qualified to understand. His model of reflection included two interlinked processes: reflection on-action, which is retrospective and reflection in-action, which is ‘thinking on your feet’. Both require the skills of critical evaluation of a situation with the idea that you might do things differently/better. Schön’s work described the process for individual practitioners but it can also be a shared process (for example as part of clinical supervision, during case conferences, or within action learning sets). An example of reflection on-action in the context of alcohol hidden harm might be a practitioner reflecting on the poor referral rates to a new service. Why after all the efforts to publicise the service do partners not make referrals, or make inappropriate referrals? What could be done to rectify the situation – and what can be done next time a new service is introduced, based on this experience? Inevitably, reflection on-action cannot change what has already happened. Reflection in-action occurs typically during an encounter with a client. The client may be ‘stuck’, repeating again and again the barriers to progress. Through reflection in-action the practitioner might find a way to ask the question differently – and change the way the client responds. A third form of reflection is sometimes described as ‘reflexivity’. This is when the critical reflection takes into account the personal and political values of the practitioner. A form of treatment or approach may conflict with the practitioner’s view of themselves, for example, as a client centred practitioner. Inevitably something has to give and the result may be a rejection of the approach or a shift in values held by the practitioner. It is clear that reflective practice at its best should be a challenging and at times uncomfortable process for the practitioner. At worst, individuals can use the term reflective practice to defend their reliance on their ‘instincts and good practice’ habits to justify sticking rigorously to current ways of working. An example of this could be a therapist whose work with clients relies on open ended techniques. This can become an obstacle to evaluation which relies on some more structured forms of questioning. Resisting evaluation on this basis could damage the service in the long run if there is no reliable evidence for the achievement of outcomes. Something has to give – and in this example evaluation data could be collected by another member of the team, so that the therapist-client relationship would not be disturbed by the change in approach.

There are other models of reflective practice which you might find useful including Rolfe’s ‘What? So what? Now what?’ which was developed for health professionals . See Linda Finlay’s article for the Open University (2008) : Reflecting on ‘Reflective practice’ which includes some useful appendices which also encourage critical reflection on practice. http://www.open.ac.uk/cetl-workspace/cetlcontent/documents/4bf2b48887459.pdf

Flexible

Practitioners who adopt a rigid approach to the delivery of a service can often find that it does not meet the expected needs of their clients. The five projects funded by Comic Relief all found that they needed to adapt what they offered to clients as they developed experience of working with families. Practitioners often remarked on differences they perceived between clients who misuse illegal drugs and those who misuse alcohol. One difference noted by several projects was the way those who misused alcohol used the services. Where illegal drug users maintained contact with services because of their ongoing need for methadone, adults who misused alcohol often viewed their treatment as time limited and complete after a short period. As a result of the lapsing nature of the condition, they often returned to the service later – or sought help from another service in the same area.

Families with young children also found that they needed new strategies to support their children as they matured. These features led to services re-opening closed cases or extending the original time period and encouraging clients to keep in contact so that they could offer other approaches in the future. This required patience and tenacity on the part of several different practitioners.

Overview

The practitioners and volunteers you employ are the shop window of the service. The qualities of an individual practitioner can be generalised to the whole service or agency. All those who interact with clients from receptionist to specialist therapist contribute to how the service is valued by the clients. Clients value practitioners they can trust, who have clear boundaries but who are reflective in their practice and able to respond flexibly to the needs of the client and their family.

Tools