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Remember to walk a mile in his moccasins: revealing the person behind the 'problem'

by Eleanor Tallon, 04 August 2023.

'Just for a moment, slip into his mind and traditions and see the world through his spirit and eyes before you cast a stone or falsely judge his conditions.'

(Mary T. Lathrap, 1895)

The words in this poem optimise the true value of Social Work practice and similarly, they reflect the essence of the MCA 2005. This is what we should all hold as our mantra when intervening within the unique lives and the humanity of the people we serve.

So let me tell you a story, a human story.

One which encapsulates the interconnectedness of the person who is receiving the service (I will call him Robert), and the person behind the professional agent who briefly touches upon his life (my name is Eleanor).

Robert's story:

Robert loves tractors and KFC. He also likes yellow shoes, washing machines and the Beatles.

Robert lives in a care home with 8 other residents. He likes his carers, but he isn't so keen on other residents, especially the ones who are noisy and come too close into his space. That makes him anxious, and he screams and curls up into a ball, biting and scratching himself to calm down.

Sometimes there is just too much to process and at those times he likes to squeeze himself into a small space, shut away from the outside world. Safe, in his cocoon, where he has control.

For six months, Robert has stayed in his own little sanctuary and does not want to come out of it.

The problem?

Robert has a diagnosis of Autism, learning disability, and a sensory condition which causes him to perceive the world in a different way to other people. He prefers to be naked as this helps him to self-regulate. His behaviour can be challenging for others, and the care home are struggling to support him and have served him notice.

The professionals involved decide that due to the risks (which include aggressive behaviours and a previous psychiatric admission), he will require sedation and restraint to move him to a new setting.

My story

I am a Social Worker and Best Interest Assessor with 15 years of experience in varied specialist and community teams, including learning disability, integrated care, DoLS and rehabilitation case management.

I am also a devoted mother, and I worked part time for the first 6 years of my son’s life (since 2016) ultimately putting my career secondary to the responsibility of being a lone parent. This meant I veered away from climbing the corporate statutory ladder, instead focusing on roles which allowed me a flexible working pattern alongside a stable income.

I hadn’t originally planned to become a business manager, but I came across the opportunity to work privately, having connected with other independent Social Workers (ISWs) over Linked in.

Little did I know that these marvellous ISWs (they know who they are) would become the mentors and comrades that have inspired by professional journey as an independent expert in the Court of Protection.

A meeting of minds

So, it was to be that Robert’s neuro-divergent world, and my own collided. I encountered his perturbing situation first-hand back in November 2022, when I initially went to visit him. The risks of self-harm (and harm from others) were prevalent.

Essentially, I had been instructed to give views to the court, on what placement would be in Robert’s best interests, how he would be best supported whilst remaining in his current setting and what would promote his well-being through the transition process.

Robert has limited verbal communication, but I spent several hours across two visits, interacting with him and gaining observational and secondary information from the carers and the records. Most significantly, I sat on the floor near where he was, I spent time ingratiating myself to him and he allowed me closer into his space. We looked at a book that I had brought about tractors, we chatted about various things that he liked, I spoke a little about myself, and he told me I was a nice lady.

Although it was only a snapshot into his life, I was able to gain a sense of the unique person behind the ‘problem’, and it was clear that the problem was not Robert. His behaviour was a response to the unpredictable environment and the lack of appropriate stimulation and communication. His sensory needs were not being met and he was expressing himself in the only way he could.

The solution

Within my assessment, I drew upon my professional training, incorporating the social model of disability and human rights approaches. In line with the Care Act 2014, I assessed Robert’s needs and strengths holistically, focusing on his cognitive, social, behavioural, environmental, and physical health needs. I highlighted the significance of prevention, safeguarding and effective risk assessments (which were not in place).

I also made recommendations which were founded upon my clinical experience of working with people with LD, Autism, and sensory impairments. These included the requirement for a comprehensive positive behaviour plan, person-centred visual communication, and sensory therapies, to support his mood and encourage him to leave his safe space more regularly.

Further to this, I followed the best interest checklist (section 4, MCA 2005) and referred to the case of Aintree v James (2013) which highlights that the primary focus when considering best interests is to see things from the person’s perspective.

Remember to walk a mile in his moccasins.

I attempted to consider how the external world may be subjectively experienced by Robert and gave views that a bespoke single occupancy home environment (adapted to his sensory needs) would be in his best interests. I suggested a slow and integrated transition with a new team of workers gradually familiarising with Robert in his current setting.

The care teams facilitated the suggestions made around using picture boards to give him choices and control over activities and outings. This was then progressed to him having ‘drive by’ visits with the new carers to his new setting. I recommended that this was done at his own pace, where he was able to remain in the vehicle and view the new home externally, thus allowing him to become desensitised to the changes and new surroundings before any requests were made for him to leave the vehicle and enter the property.

The transfer date was set for April. Prior to this, social stories were introduced to explain to Robert that he would be moving to the new home, where he would be supported by his new care team (who he had already built rapport with). However, there were still contingencies in place involving the use of a secure vehicle with a specialist team trained in restraint practices, should Robert refuse to go to his new home and become a risk to self or others.

I was absolutely delighted to hear that, following the hard work and collaboration of the professionals and care teams involved, on moving day Robert willingly engaged. He walked independently into his new home with no restraint or sedation necessary.

This was an amazing outcome when considering the implications of what could have occurred.

I hope Robert remains happy in his own domain, doing things he enjoys (like being naked) with minimal restrictions on his personal space and freedom as possible.

Recognising my worth as an ISW

I contributed three expert reports during the proceedings. The first of which was my initiation into expert witness work. Despite my years of experience, I have no reservations in saying it was daunting, the very fact I was referred to as an ‘expert’ was enough to afflict an acute case of imposter syndrome!

Yet I leaned into this and grew stronger with it.

When liaising with the other professionals involved, I had to stand my professional ground as a Social Worker. This is something I have become accustomed to within multi-disciplinary team meetings, given the common misrepresentations of what Social Work is, and the diversity of remits and expertise within the discipline.

Without full knowledge of the spectrum of Social Work tasks, other professionals can undervalue Social Workers. Using the terminology of Dr Lucy Series, a Social Worker (in particular, a Best Interest Assessor) can be classed as an ‘empowerment entrepreneur’. I think this is a fitting title.

Social Workers are adept at managing risk, coordinating complex support plans and transitions whilst simultaneously advocating the needs, the autonomy and the strengths of the individuals who are often marginalised and face multifaceted barriers within society. Social Workers are trained to recognise power structures and challenge them, Thompson’s PCS model and anti-discriminatory practice being a core component of the Social Work repertoire.

However, rights-based practice is also positioned within a climate of austerity and the role of the state is subverted to prioritise those at greatest need. ‘Various conflicts were also identified in the research between rights-based social work practice and the policy agendas and associated resource pressures’ (Meadows, K. and Moran, N. 2022), therefore Social Work is often a juggling act, with competing demands.

But a good Social Worker will capably synthesise the human story within their assessment, and weave this into the applicable legal frameworks promoting well-being and safety. Fundamental to the role of the Social Worker is to create space for self-actualisation, where the person is enabled to maximise and occupy their personal power, to contribute meaningfully according to their own goals.

We are alive to complex human dilemmas, we recognise the impact of traumas, we understand the value of systemic networks and we are skilled communicators.

People are not problems to be fixed, and they are not just a diagnosis. The medical model invariably takes precedence, but people lives are enacted in the real world, not in a randomised controlled trial.

Social Workers delve into the stories, and those qualitative details are key to achieving the outcome which is as closely aligned to the person’s will and preferences, as is possible. Respecting a person’s rights, will and preferences is integral to the UN Convention on the Rights of Persons with Disabilities (CRPD) which we all must seek to reconcile our practice with (Martin, W. et al, 2016).

The journey

Over the last nine months of my work in the Court of Protection (CoP), I have witnessed some harrowing stories, and not all have a positive outcome like Robert’s. By virtue of the complexities, the cases which escalate to the CoP are challenging and often very messy. But this is by no means unfamiliar to Social Work practice.

As an ISW I offer valuable expertise and I utilise my professional skills to connect with the people I assess, and the families and professionals surrounding them. As a Social Worker I am attuned to the plethora of conflicts and navigate them with sensitivity, empathy, and compassion.

Each person is on a journey through life, and all their experiences, their difficulties, their interpersonal influences, their responses to state intervention, their culture, values, and beliefs; are valid.

We are all human.

My professional journey as an ISW is ongoing and my story is still unfolding. I hope to keep walking this path for years to come, but to do so I know I need to take care of myself, be reflective and balance my personal and professional life to avoid burn out. Or worse still, become dehumanised.

After all, to keep walking the professional path with integrity, I must remember to walk a mile in my personal moccasins.

Eleanor Tallon is an Independent Social Worker and Best Interest Assessor. She can be contacted via her website and found on LinkedIn. She also Tweets @Eleanor_Tallon

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