Table of study survey and interview questions mapped to PARiHS elements and sub-elements.Â Survey and interview questions mapped to the PARiHS framework elements and sub-elements

Barry Goldstein (3574820)

Charlesnika Evans (3574826)

Jennifer Hill (710916)

Kenzie Cameron (3407657)

Marylou Guihan (3574817)

Salva Balbale (3574823)

Timothy Hogan (3416009)

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Additional file 2: Appendix A. of Evaluating implementation of methicillin-resistant Staphylococcus aureus (MRSA) prevention guidelines in spinal cord injury centers using the PARIHS framework: a mixed methods study

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Scottish Journal of Residential Child Care 2016 – Vol.15, No.3  Nicola (2016). Appropriate and inappropriate relationships: David’s story. [Joint Special Issue, Love in Professional Practice] Scottish Journal of Residential Child Care, 15(3) and International Journal of Social Pedagogy, 5(1), 139-144. doi: https://doi.org/10.14324/111.444.ijsp.2017.10  Available online www.celcis.org/journal and http://www.ingentaconnect.com/content/uclpress/ijsp. SJRCC is published by CELCIS, ISSN: 1478 – 1840. IJSP is published by UCL Press. ISSN: 2051-5804  Appropriate and inappropriate relationships: David’s story By Nicola: a residential care worker. Nicola is not the writer’s real name. Keywords Relationships, leaving care, SSSC  At just about every level, conceptually, politically and professionally, it is accepted that properly close relationships are the heart of social work practice. Bronfenbrenner, for instance, states that ‘every child needs at least one adult who’s crazy about them’ (1977, p.5). Gilligan advocates for the necessity for children and young people to experience an ‘emotional connection’ to another human being in order to influence ‘healthy human development’ (2008, p.46). Ricks (1992) states that ‘the presence of feelings provides the link which connects the worker and client. Very simply put, without this connection, without feelings in the relationship, the people do not matter to each other’ (1992, p.51). At a political level, Adam Ingram, the former MSP and Minister for Children and Early Years stated that ‘corporate parents’ attitudes should be these children are my responsibility, are in my care, and I need to do the best for them’ (Scottish Executive, 2008). This political statement merely reinforces the Extraordinary Lives document (SWIA, 2007), which states that ‘It is important that qualities of a supportive family are re-created in every setting in which children are cared for’. At a professional level, the Relationships Matter project, managed by the Institute for Research and Innovation in Social Services (IRISS) along with the Centre for Excellence for Looked After Children in Scotland (CELCIS), and WhoCares? Scotland explored how to best support young people who are leaving care.  An important finding, identified by both workers and young people, was that the ‘bureaucratic obstacles workers experience … do not preserve and promote positive relationships’ (IRISS, 2015).    Appropriate and inappropriate relationships: David’s story  140  Running alongside all of this this are the messages at the core of the public sector reform agenda that those who engage with public services, should be involved in a meaningful way in making decisions about what public services should look like and how they should be experienced. This requires a shift away from the paternalistic delivery of public services that we have become used to, and demands a shift in how we think about and practice in the public services (Whyte, 2016). Mari-Anne MacDonald (2016) from the SSSC reminds us that the public sector reform agenda applies to everyone, not just social workers; all public servants should be expected to work in person-centred ways, to listen to the people they work with, essentially shifting the balance of power between citizen and state. MacDonald’s position may reflect one side of the SSSC’s position, the side focussing on professional development. The SSSC’s other role, however, is a regulatory one, charged with ‘strengthening public protection’. It claims to do so through upholding professional Codes of Practice (SSSC, 2014). Section 5.4 of the part of the code around upholding public trust and confidence in social services states that social services workers must not ‘form inappropriate personal relationships with service users’ (SSSC, 2015). Against the backdrop above, which highlights the importance of suitably close relationships, which take into account the needs and wishes of those who use services, one might logically surmise that an appropriate relationship was one that foregrounded such relational characteristics and an inappropriate one, one which failed to do so. Indeed, in a recent article, Anna Fowlie, the SSSC Chief Executive shared her view that she would be concerned if any social service worker did not show comfort or warmth to the young people they work with. She went on to acknowledge that when in care ‘you have no one else to offer warmth, comfort and affection. You also need the people working with you to show you what a normal human relationship feels like so you can go onto form those relationships in your own life’ (Fowlie, 2015). Encouragingly Ms Fowlie urged readers to share their ideas on ‘how we can shift the perceptions and create a climate where appropriate human contact is accepted’. It is in this spirit that I offer my own story regarding the SSSC’s understanding of appropriate relationships. David and me With the support of my employer, I maintained a relationship with a young person when he moved from residential care into throughcare services. I will call this young person David. I had worked closely with David for a number of years and watched him grow, develop and flourish into a confident, lovely, yet incredibly vulnerable young person. During the time I was the allocated keyworker for David, my colleagues and I as a ‘corporate’ family, encouraged, Appropriate and inappropriate relationships: David’s story  141  supported and allowed him to create a secure base with us. David needed to feel lovable and worthy of our time without it being deemed ‘inappropriate’, and within the therapeutic environment promoted within my workplace this was able to happen. David had no protective family members; his father’s whereabouts was unknown, and his mother had passed away. When it came to the time for David to move on, myself and a colleague, Anne, David’s throughcare worker sought to fulfil our ‘corporate parent’ responsibility and maintain what was an important relationship for David.  Before doing so I accessed the Good Practice Guide to Keeping in Touch jointly produced by The Bryn Melyn Group Foundation, The Charterhouse Group, The National Centre for Excellence in Residential Child Care and Voice. This guide offers a framework for considering a range of professional and personal perspectives to enable staff and carers to feel confident about keeping in touch with a young person they have got to know through their work. It aims to provide reassurance that what they are doing is for the benefit of the child and young person.  The guide discusses the fact that residential workers and foster carers can get very mixed message about keeping in touch once professional relationships end but also highlights that these relationships can also be essential lifelines.   Initially, after moving on, David would contact us because he missed us. Myself and Anne would visit him, take him for lunch or a coffee and have a general ‘catch up’. David began to realise that we valued him and that we would give up our time to meet him for no other reason than that we wanted to. David would also contact us in a crisis or when he needed support or advice. For example, when he needed to move from one homeless hostel to another and had no one to help him, or when he needed to open a bank account and did not know where to start. He would also contact us when he was under the influence and crying about missing his mum and contemplated ending his own life. We learned that David really did have no one else he felt he could ask for help and David learned that, as other care standards advocate, he could trust us, we were reliable, we were going to empower and respect him.  David shared that it had taken him a significant number of years to begin to accept that his own family do not have the capacity to provide him with the care and support that he now recognises he needed as a child and continues to need as a young adult. Over the years, also with the support of David’s throughcare worker, he established positive relationships with my parents, who took on an almost mentoring role. He has also met my gran, siblings and is recognised by the family dog. During the same conversation as discussed above David spoke about now feeling supported, respected, loved and cared for by my family, a family he feels part of. He discussed now having ambition, respect for himself, a Appropriate and inappropriate relationships: David’s story  142  sense of identity and belonging, a belief that he can achieve and a confidence that he has something of value to contribute to society that can be traced to the impact of these relationships.  However, regardless of the fact that I made a commitment to this young person and displayed what I feel was the moral courage to ‘go with’ my feelings, value the relationship we had built and embrace the body of theoretical evidence that advocates such practice, an ‘anonymous allegation’ was made to the Scottish Social Services Council (SSSC) about my ‘inappropriate’ relationship with David. As you can imagine, I was distraught at receiving notification of this allegation. The initial letter discussed possible consequences if misconduct was found, such as removal from the SSSC register. I have always been extremely conscientious in my work, so having my suitability to practise questioned was terrifying. Over the next two years I received three letters from the SSSC, the final letter advising that no further action would be taken against me.      It is important to highlight that during this investigation I was fully supported by my employer, no restriction was placed on my ability to practise. Yet, though the outcome was in my favour, the investigation process was extremely difficult, had a massive impact on my personal and work life, and left me feeling extremely vulnerable. Two years for them to reach this conclusion was an inordinate and unjustifiable time to live with the pressure of such an investigation hanging over me. I also felt that I was given the task of disproving any wrong doing, disproving that my relationship with David was anything other than a healthy one, without having anyone to access for support, advice or guidance. Although, I was relieved to hear that no misconduct was found, even now, any correspondence I receive from the SSSC such as annual renewal, newsletters, general emails evoke irrational feelings of anxiety in the pit of my stomach. This saddens me, as I have worked hard to get to where I am and I want to feel proud to be a member of a regulated profession and confident that the regulatory body would support and guide me as I progressed in my career.  A consequence of my experience, and more importantly, of having my practice scrutinised and my ability to continue working in my profession questioned, was that I reduced the contact I had with David over this period. David is now twenty years of age and is unaware of this investigation, but has on occasion made reference to the fact that he ‘missed me’ and ‘didn’t hear from [me] as much as [he] used to’. This has caused me immense guilt, as my care, support and if I’m being brave and honest, love, has on occasion provided David with an essential lifeline. Although theoretical, policy and political discussion is invaluable and essential to the development of practice the most powerful statement for me came from David during a recent conversation: ‘When you think about family sometimes blood isn’t thicker than water….who’d have thought you would still be around after all this time’.   Appropriate and inappropriate relationships: David’s story  143  I am proud to have been part of David’s journey so far but am saddened that someone viewed that investment as inappropriate and that this allegation was given credence by the SSSC, despite the fact that, in any rational system, what I was doing ought to have been considered to be good professional practice.  Discussion All of this leads me to conclude that much of what the SSSC might say about supporting relationships is empty rhetoric. The kind of practice it encourages through processes of the sort I encountered is borne out of suspicion and fear rather than care. The wider problem is that, in this legalistic world, when regulation is ‘handed to people who are asked to know nothing of … practice, a lacuna is created. In such a case no reason, no body of knowledge, no evidence, no discrete idea or philosophy underpins the “system” of regulation’ (Haney, 2012, p.9). This was certainly my experience.  Moreover, the SSSC’s position on matters of conduct flies in the face of the direction of the literature on professionalism. It reflects a particular technical/rational way of thinking, which privileges a legalistic and instrumental understanding of practice and which Bondi, Carr, Clark, and Clegg (2011) argue, is inappropriate for people professions. The approach is also inimical to the emerging literature on relational social work, which suggests that ‘adherence to professional guidelines can restrict the potential for connection and paradoxically, this may limit the effectiveness of our contribution to the client’s desired change’ (Alexander & Grant, 2009, p.6). So, we are left in the position whereby the body responsible for upholding professional standards seems to know little of the core tenets of the profession it seeks to regulate and cares less for those who work in it. What place love in a regulated world? References Alexander, C., & Grant, C. (2009). Caring, mutuality and reciprocity in social worker–client relationships: Rethinking principles of practice. Journal of social work 9 (1): 5–22. Bronfenbrenner, U. (1977, October 5). The Fracturing of the American Family, Washington University Daily.  Bondi, L., Carr, D., Clark, C., & Clegg, C. (2011). Towards professional wisdom: practical deliberation in the people professions. Farnham: Ashgate. Daly, E., & Rice, G. (2016). Walking the walk: The relationships matter story. IRISS, retrieved from: http://blogs.iriss.org.uk/relationships-matter/files/2014/07/rm-report.pdfWal (accessed 1st Nov 2016). Appropriate and inappropriate relationships: David’s story  144  The Bryn Melyn Group Foundation, The Charterhouse Group, The National Centre for Excellence in Residential Child Care and Voice. Good Practice Guide to Keeping in Touch. Leaflet. Retrieved from: https://secure.toolkitfiles.co.uk/clients/23786/sitedata/files/Good_Practice_Guide_to_kee.pdf.   Fowlie, A. (2015). There is no law against hugs. Professional social work Scotland. Also available at: http://ssscnews.uk.com/2015/11/16/law-hugs/.  Gilligan, R. (2008). Promoting resilience in young people in long-term care— the relevance of roles and relationships in the domains of recreation. Journal of social work practice, 22(1), 37–50. Haney, J. (2015). REGULATION IN ACTION: The health professions council fitness to practise hearing of Dr Malcolm Cross— analysis, history, and comment. Karnac Books Ltd: London. Macdonald, M.A. (2016). Reflections on the future of social work in Scotland. Ethics and social welfare, 10:3, 276-278. Ricks, F. (1992). A feminist view of caring. Journal of child and youth care, vol.7, no.2, 49-57. Scottish Executive (2008). The guide to getting it right for every child. Edinburgh: The Stationery Office.  SSSC Codes of Practice. Retrieved from: http://www.sssc.uk.com/about-the-sssc/multimedia-library/publications?task=document.viewdoc&id=239 (accessed 1st Nov 2016). Social Work Inspection Agency (2006). Extraordinary lives. Edinburgh: SWIA.  Whyte, B. (2016). Social work in Scotland: who calls the shots? Ethics and social welfare, 10:3, 267-275. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License    

Appropriate and inappropriate relationship: David's story

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Appropriate and inappropriate relationship: David's story

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