Chapter 17 – Lauren Bacon (D1SOP17)

Social care is a fine balancing act where you must simultaneously give and withhold the self when working with others. It is through the giving of self in everyday situations that you build and establish relationships with those you support. It is through withholding of self that you protect those you support from your own internal complexities, while also protecting yourself. This fine balancing act is managed through working in unison with the heart and head, each as essential as the other. There are times in social care where we must go into ‘neck up’ mode and use our head; education, the professional toolbox and the experience to make difficult decisions. However, we must never lose the heart and human connection within our work. By staying engaged with both, we can stand over our practice and justify our work and daily encounters. In times of difficulty, we must ask ourselves and reflect on the ‘why’ of our work. Keeping our ‘why’ at the forefront supports us to remain grounded and reflective throughout our work.

Personal Responsibility

As social care workers, we are personally responsible for the way we engage with others while exercising our professional duties of care and support. The Social Care Workers Registration Board Code of Professional Conduct and Ethics (SCWRB 2019) clearly outlines that it is the personal responsibility of social care workers ‘to act in the best interests of the service users’ (p. 8) by maintaining a ‘high standard of personal conduct and behaviour’ (p. 10). Workers must behave in a way that respects the dignity, privacy and confidentiality of the service user, without prejudice, discrimination, harm or abuse. Workers are personally responsible to ensure that they are mentally and physically fit for practice and are not under the influence of any substance. Understanding the principles of best practice, learning the codes of conduct and ethics and adopting an evidence- based approach will support you to maintain a high standard of personal conduct and practice.

Your personal code of conduct and ethics provides the foundation for your professional social care work toolbox (Lyons 2013). The social care toolbox is what you bring to work with you every day; it includes your values, attitudes and core beliefs. The key to harnessing this in order to positively influence your work lies in an active and purposeful engagement in self-awareness. Self-awareness relates to looking inwards and self-reflecting on your own values, views and core beliefs with the hope of improving yourself as a person and also as a social care worker (Lyons 2013). Lyons emphasises the importance of self-awareness, especially within a landscape that by its very nature will challenge our values, views and potential prejudices. Lyons states:

Therefore, practising reflection and being self-aware ensures that your social care toolbox remains in good working order in your daily practice, thus in turn contributing significantly to your ability and confidence in remaining accountable to your work and practice with service users.

Professional Accountability

Professional accountability in the social care sector can be a daunting challenge, especially for those working on the front line supporting our most vulnerable in society. Like most of our work, however, what is challenging can also be viewed as an opportunity, and a chance to break barriers and get positive outcomes for those we support. According to Kline and Preston-Shoot:

Professional accountability in the health and social care professions depends in no small measure on the quality of relationships between staff and service users, practitioners and managers, and teams of people in organisations. It rests on how well those involved manage and respond to certain uncertainty, the challenges and dilemmas that the work generates, the anxieties that practice and the management of practice create, the diversity that people bring and the disadvantages that impact on them (2012: 186).

Hearing phrases like ‘personal responsibility’, ‘professional accountability’ and ‘justifying professional decisions’ can sometimes induce feelings of self-protection. This is especially true in recent years within the ever-changing landscape of practice where accountability is now at the forefront. Working with people, especially vulnerable people, means that the stakes are often high, especially if anything goes wrong. We have seen this in recent years in media revelations of the concerning practices of some caring organisations. In day-to-day practice, many workers may fear legal repercussions, or internal investigations into the professional decisions they have made. These are real and genuine fears, and the reality is that things can go wrong when we are responsible for the care of the most vulnerable in society. It is imperative that professional accountability starts with accountability to service users by providing a safe and effective person-centred service. We do this by informing ourselves on best practice, learning the proficiencies and codes of ethical conduct for social care work, and reflecting on our encounters with others. In doing this, we can work without fear and get positive outcomes for those we support. We all have a personal responsibility to ensure that we promote open communication with colleagues, the individuals we support, and line management to ensure that we are not promoting a blame culture in our environment.

Running parallel to the importance of self monitoring is the onus on line management and those in supervisory positions to support social care workers to navigate through the challenges of professional accountability and personal responsibility. Regular and protected time for supervision and support meetings is crucial, as is the promotion of team and peer support. Sharing learning, reflective practices and open communication are key and should be promoted by line management in all social care settings. Different areas and sectors of social care work fall within many different remits. In order to remain accountable within your chosen area, it is essential that you are aware of what these remits are. These may be, for example: legal remits, organisational policies and procedures, regulations, codes of conduct, and so on. You are only accountable in your work if you are aware of what the boundaries and remits of your work are. Having this knowledge should alleviate the worries mentioned above and give you confidence to move forward and not be fearful.

If you can confidently answer these questions every day, you are maintaining professional accountability. If you can’t answer these questions, you may need to seek additional support. By using the Social Care Workers Registration Board Code of Professional Conduct and Ethics (SCWRB 2019) and following best practice principles in your daily work, you should gain confidence in your own practice and be able to justify the professional decisions you make.

Personal Accountability through Person-centred Practice

Professional accountability and personal responsibility go hand in hand in the social care profession. To be professionally accountable to your practice takes a skilled level of personal responsibility. As discussed above, professional accountability is being knowledgeable of the remits and boundaries of your chosen sector and working within them. Personal responsibility is ensuring that you inform yourself of these remits and what is best practice for your service users. It also means knowing your limits and when to seek support. Best practice in a social care context should always begin by focusing on the person using the service. As Kline and Preston-Shoot (2012) mention, the quality of the relationships with those we support contributes significantly to the achievement of a high standard of care.

Within practice, the need to justify the professional decisions made will most likely not come up during the more straightforward encounters. It is most likely to come up in more complex ‘what if’ situations. We will look at one of these encounters in the next section. These are the situations where a decision needs to be made and you find yourself juggling many factors which need to be considered, such as (but never limited to) a person’s will and preference, risk management, organisational policies and procedures, legal implications, professional codes, ethics and so on. The best starting point to tackle any situation or decision is by placing the person you are supporting at the centre, utilising a person-centred perspective. Person-centred practice means keeping the goals, wishes and aspirations of those you support at the centre of your work. A best practice organisation should have some sort of system in place which includes person-centred planning. This seeks to describe the person’s vision for his/her life as a full member of the community and society and to identify goals and actions to support him/her to move in the direction of that vision (NDA 2005). A social care worker is most often the key supporter of an individual’s person-centred plan.

Justify Professional Decisions Made

Above we looked at personal responsibility and professional accountability. Both are the active ingredients that, added together, support your ability to justify the professional decisions made. We will now look at a practice scenario to see an example of this.

Key worker 1:

Is a strong advocate for Sebastian and believes that Sebastian is an adult and his mother should hold no influence on his personal goals. Key worker 1 goes ahead with the goal. There is a plan put in place and key worker 1 uses a 10-week travel training programme that has been successfully used in the past with other key clients.

At Sebastian’s person-centred planning (PCP) meeting his mother is told that the training is taking place but is reassured that Sebastian will not be left alone. Key worker 1 discusses the plan with the staff team and drafts a staff support plan.

Key worker 1 is going through the practical travel training with Sebastian, which means accompanying Sebastian on the route. After doing this six times, key worker 1 decides without consulting family or the team to allow Sebastian to do a trial run. Key worker 1 walks with Sebastian to the bus stop and asks him if he would like to try the route alone. Sebastian is happy with this and agrees to give it a go. Key worker 1 leaves Sebastian and goes to the next bus stop, first informing Sebastian that she will be getting on at the next stop but will remain downstairs. When key worker 1 gets on at the next stop, Sebastian is visibly upset and becomes overwhelmed with the situation. Sebastian had become nervous at the stop when waiting for the bus and called his mother.

Key worker 1 returns to the service with Sebastian. Sebastian’s mother is very upset that he was left alone, and that she was not informed of the plan. A formal complaint has been made. Key worker 1 will need to meet with her manager and explain what happened. Key worker 1’s manager had not been informed of the plan to progress the travel training to a mock run. The result is as above and the goal of travelling independently to the service is now cancelled.

Key worker 2:

Is a strong advocate for Sebastian and believes that Sebastian is an adult and is entitled to set goals that are meaningful to him. However, key worker 2 understands that Sebastian’s mother is a vital social support to Sebastian and her input is needed to make the goal a success. Key worker 2 supports Sebastian to progress his goal.

Key worker 2 reflects on what has worked well for Sebastian in the past, such as his goal of going to the shops independently. From Sebastian’s person-centred plan (PCP), key worker 2 knows how important his relationship with his mother is and knows that her support is a key ingredient for success.

Key worker 2 and Sebastian devise a plan which is broken down into very small achievable steps over a period of a year. Key worker 2 links in with the manager to risk assess any potential stumbling blocks.

Sebastian shares his plan with his mother at his PCP meeting and her feedback is recorded. Each step of the plan is documented and clear dates and goals are set. Some of the steps are delegated to Sebastian to work on at home with support from his mother. The plan is in picture format so that Sebastian can see what is coming next. A support plan is also devised for the team. Sebastian is the owner of the goal and plan and is involved in every step including planning and organising.

Key worker 2 is going through the practical travel training with Sebastian, which involves accompanying Sebastian on the route. After several weeks, the next step of the plan is for Sebastian to do a trial run. Sebastian and his mother prepare for this step the night before, using his picture schedule.

The day arrives and key worker 2 walks with Sebastian to the bus stop and clarifies with him that he is comfortable to go ahead with the trial run. Sebastian is happy with this and the plan goes ahead. Key worker 2 leaves Sebastian and goes to the next bus stop, first informing Sebastian that she will be getting on at the next stop but will remain downstairs. When key worker 2 gets on at the next stop, Sebastian is visibly upset and becomes overwhelmed with the situation.

Keyworker 2 reassures Sebastian and returns to the unit. Sebastian has a cup of tea and they chat about how it all went. Sebastian is praised for what was achieved – he got on the bus, used the bus pass successfully and made his way to a seat. Sebastian explains that a small child on the bus shouted unexpectedly, which gave him a fright, causing him to become overwhelmed.

Sebastian calls his mother and tells her how it all went. Sebastian’s mother reassures him and praises him for his efforts. Sebastian continues with the travel training, and key worker 2 adds to his supports to ensure that he has coping strategies to help him self-regulate if a similar situation should occur.

The progress on the goal is documented regularly and stumbling blocks are used as learning going forward. In the meantime, as part of the training, Sebastian now gets the bus home on Fridays with staff shadowing for support.

Learning and Reflection

Let’s remind ourselves of the proficiency here:

‘Recognise personal responsibility and professional accountability for one’s actions and be able to justify professional decisions made’

Key worker 2 can be used as an example of best practice in this particular situation. While key worker 1 did follow some elements of best practice, ultimately they could not justify some of the professional decisions made.

• Kept Sebastian at the core of all decisions.
• Recognised from Sebastian’s PCP (evidence base) that the support and encouragement from his mother would be crucial to achieve success.
• Used past successes to inform supports; for example, knowledge gained from his previous goal determined that this plan would need a prolonged period of time.
• Ensured the information and plan was accessible to Sebastian – using a picture format with clear timelines.
• Involved his mother in the plan so that Sebastian could work on the goal at home, thus utilising his circle of support and increasing his confidence through encouragement.
• Linked in with the unit manager to risk assess any potential stumbling blocks.
• Reflected on every step with Sebastian and amended the plan when different needs arose.

The risks in both situations are the same; however, the professional approach used by both workers had different implications, both positive and negative. What is important here is not so much in the outcome but the process. While the ultimate result may be that the goal is unsuccessful, key worker 2 can justify the decisions made and can present all the steps taken to support the person. The approach used by key worker 2 will ensure learning even if the goal is not a success; and there will be no damaged trust between Sebastian, the service and his family supports.

It is crucial that we allow those we support to take positive risks. It is through risk-taking that we make mistakes and it is through mistakes that we often learn the best life lessons. Key workers 1 and 2 both promoted positive risk-taking here. Empowerment versus protection will always be a fine balancing act in your work as a social care worker. By using all the tools available to you, as key worker 2 did, you can continue to challenge those you support and get the best outcomes for them.

While key worker 1’s approach did not yield a positive outcome for Sebastian, all is not lost. There is learning in all practice. Reflective practice is an important element in ensuring professional accountability, especially at times when we may have not followed best practice and have had negative outcomes for those we support.

Complete the task below from the perspective of key worker 1 and/or as a team reflection.

Use Gibbs’ reflective cycle to reflect on the practice of key worker 1’s actions and steps and how they contributed towards their own professional accountability and personal responsibility.

Reflect as a team. Team accountability is as important as the actions of one key worker. How could the team have done things differently to ensure team accountability and team responsibility?

Kline, R. and Preston-Shoot, M. (2012) Professional Accountability in Social Care and Health: Challenging Unacceptable Practice and its Management. London: Sage.

Lyons, D. (2013) ‘Learn about Your “Self’ Before You Work with Others’ in K. Lalor and P. Share (eds), Applied Social Care: An Introduction for Students in Ireland (3rd edn) (pp. 98-108). Dublin: Gill & Macmillan.

NDA (National Disability Authority) (2005) Person Centred Planning in Ireland for People who have Disabilities. Available at <http://nda.ie/nda-files/person-centred-planning.pdf> [accessed November 2020].

RTÉ (2014) Inside Bungalow 3, December. Available at <https://www.rte.ie/news/ player/2014/1209/20694826-inside-bungalow-3/> [accessed February 2021].

Social Care Workers Registration Board (2019) Social Care Workers Registration Board code of professional conduct and ethics. Dublin: CORU Health and Social Care Regulator. Available at https://coru.ie/files-codes-of-conduct/scwrb-code-of-professional-conduct-and-ethics-for- social-care-workers.pdf