Words that make me go hmmm: Strengths-based

Some of the words and phrases I’ve written about in this series of blog posts literally make me cringe when I hear or read them. ‘Strengths-based’ is different though. It’s a term that genuinely does make me go hmmm, and I’ve known for some time that the only way to fully understand – and explain – why, was to write this blog.

First though, a disclaimer. I’m all for the shift away from the paternalistic, deficit-based, transactional care management approach, with its focus on problems and labels and tick boxes, on assessments for services and one-size fits all solutions, on doing to and fixing. I wholeheartedly believe in the key elements of strengths-based practice [1]. In the vital importance of recognising and responding to people as unique, whole, human beings, as the experts in their lives, and in the context of their whole lives. Of listening hard – with no assumptions or judgement, to understand what matters to people. Of flexibility, proportionality, collaboration, and trust. Of identifying, and responding to, the capabilities and aspirations and potential of individuals and families and communities. Of creativity and possibility. And – above all – of relationships.

But.

I’m uneasy about some of the stated ambitions of a strengths-based approach – or at least our common interpretation of them.

And I think we throw the term strengths-based around, drop it in to our narrative too easily to put a new shine on our practice, without realizing very many of those key elements, without changing very much behind the scenes. A “new softer-sounding language adding a coating of irony to unyielding bureaucracies.” [2] Glossy wallpaper covering up the cracks in a wall built on crumbling foundations.

Let me explain, by briefly unpicking some of the language associated with the term. Each word is worthy of its own blog (I’ll get there!) but collectively I think they illustrate what’s wrong, not what’s strong – and why it’s time to stop talking about ‘strengths-based’ practice.

1. Independence

The strengths-based approach is about reducing dependency and challenging ‘prescription culture’. Crucially, it is about protecting and promoting the person’s independence, resilience, choice and wellbeing.”

Social Care Institute for Excellence [3]

Supporting people to live as independently as possible, for as long as possible, is a guiding principle of the Care Act 2014 [4], but while the statutory guidance refers to “the key components of independent living, as expressed in the UN Convention on the Rights of People with Disabilities (in particular, Article 19 of the Convention)”, it dismisses the term ‘independent living’ as “relatively abstract”, suggesting the focus on wellbeing and the “outcomes that truly matter to people” is clearer.

However, by not explicitly defining independence, the term is widely interpreted in line with the dictionary definition of “not relying on other people or needing help or money from anyone else” [5]. As people ‘taking care of themselves’ and being self-sufficient.

Strengths-based approaches are frequently defined as aiming to ‘reduce dependency’. In this narrative, reliance on other people is seen as a negative, undesirable state, and there’s a relentless focus on ‘reablement’ to ‘get people back on their feet’ and ‘regain or retain skills to enable them to manage with minimal or no support’ [6].

These ambitions, however, are far from the Article 19 definition of independent living and its focus on equal rights, equal choices, inclusion, and participation.

Relying on care and support from other people doesn’t prevent independence, it allows it. We all depend on other people. None of us functions in complete isolation, and we know we need each other to thrive.

We need to flip the widely misinterpreted narrative of independence, and talk instead of the importance of relationships, connection, and inclusion. Value and celebrate dependence in terms of continuity, stability, safety and belonging… a place to call home, people we love, communities where we look out for one another. And recognise and uphold people’s rights to choice and control, and to the care and support we all need to live ordinary, interdependent lives.

2. Resilience

“Strength-based practice is a social work practice theory that emphasizes people’s self-determination and strengths. It is a philosophy and a way of viewing clients as resourceful and resilient in the face of adversity.”

Wayne McCashen [7]

Dictionaries define resilience as “the capacity to recover quickly from difficulties”, “the ability to become strong, healthy, or successful again after something bad happens”, the “ability of something to return to its original shape after it has been pulled, stretched, pressed, bent, etc.” [8] [9] “People and things that are resilient are able to recover easily and quickly from unpleasant or damaging events.” “Something that is resilient is strong and not easily damaged by being hit, stretched, or squeezed.”[10]

Resilience is the process of adapting in the face of trauma. Being able to ‘bounce back’ when times are hard. Coping. Surviving.

The strengths-based narrative suggests that “maximising activity” in terms of people’s personal resources, support networks and community resources “helps create, develop and support ‘resilient individuals’ – people who can manage independently even when their needs may be increasing.” [11]

Hmmm… sounds a little like fixing to me? Changing people, rather than addressing the causes of stress and trauma. Absolving our collective responsibility, rather than challenging the behaviours and environments and structural inequalities that are causing harm.

Instead of ‘creating’ “resilient individuals”, who ‘manage’, ‘cope’ and survive, let’s turn our attention to creating compassionate, welcoming and accepting ecosystems of support, where everyone is able to thrive.

3. Empowerment

“Strengths and asset based approaches are ways of working to empower and support people to lead good quality and fulfilled lives.”

Skills for Care [12]

“We empower our customers to take care of themselves”

“We empower our service users to make positive decisions”

“We empower our patients to live a fulfilling life”

“We empower our service users to maximise their independence”

Argh.

Our ‘customers’. Our ‘patients’. Our ‘service users’. Remind me again where the power lies?

Our use of the term ‘empowerment’ suggests people don’t already have power, and it’s our actions that give them power. So, who has the choice and control here?

We’ve turned empowerment into a transaction. A service. We give people power. It is our gift to (choose to) give (and take) away. How benevolent of us. How kind.

For all of us to have genuine power, we must address the politics and policies and prejudices that remove people’s choice and control. Devolve decision-making, shift resources and responsibility out from the institutional core, and work alongside people and families and communities as equals.

4. Signposting

“Strengths-based approach/practice is NOT about signposting and providing less support.”

Department of Health and Social Care [13]

Strengths-based practice is NOT about signposting. Except it is, in many local authorities that have invested in their ‘front-door’ under the guise of a strengths-based approach, to ‘manage demand’ and redirect people seeking support elsewhere… either a website or – usually – The Community. That abundant, welcoming, accepting alternative to services, brimming with opportunity. The pot of gold at the end of the signpost.

We view increases in the number of calls ‘signposted to other services’ as an indicator of success.

We wave people off from our front door with a cheery “come back to us if things get worse.”

Good luck out there.

We need to stop signposting and start connecting. Introduce instead of refer.

To do this, we need to be based within communities, know (and be known in) communities, and above everything – invest in communities.

5. Assessment

“There is increasing interest in ‘strengths-based’ approaches to assessment – where the focus is not on what the person can’t do, but on where their strengths lie and the supports they have around them in their family and the community”.

Ruth Hardy [14]

Ahh… the paradox of the strengths-based assessment

We ‘start with what’s strong’, but our assessment only begins because something’s wrong.

We focus on capabilities, aspirations and potential, then determine eligibility for support on levels of need and ‘outcomes’ that people are unable to achieve.

“Like so many others in my position, now that I have secured the level of support that I need, I don’t want to do anything that will threaten this. And so I have learnt to only talk about what I can’t do; I have learnt not to mention my skills, my experience and my abilities. I have learnt not to mention my dreams, my ambitions and my intentions. More than that, I try to make sure that those who assess me have no idea that these dreams aspiration and intentions even exist.”

Jan Sutton [15]

We consider how family and friends can help, then – despite strengths-based practice NOT being about “shifting responsibilities to carers and family/friends” [16] – where carers are able and willing to continue, we reduce or remove personal budgets accordingly.

“The quickest way to be denied or lose support is to offer to do the caring yourself.”

Alex Fox [17]

We view the person as ‘the expert in their life’, but decisions about their future are made in panels about them, without them.

We ‘empower’ people to have choice and control about their support, then prescribe from a limited menu of traditional services, or offer a Direct Payment we don’t trust people to spend.

We talk of people and families as equals, but a strengths-based assessment is still an assessment, and any kind of assessment is a test. Tests have right and wrong answers. You can pass or fail. One party is the judge, the other – the judged.

And when we get round to reviews, if things are a bit better and support is working well, the threat of cuts to budgets is never far away.

“Got email to say time for my #socialcare review. Feel terrified. Having PAs allows me to live independently, but I always feel like I’m begging not to have my hours cut. I’ve spoken at national conferences about social care but this makes me feel sick & powerless. Silly but true.”

Anna Severwright [18]

6. Outcomes

“Local authorities should identify the individual’s strengths – personal, community and social networks – and maximise those strengths to enable them to achieve their desired outcomes, thereby meeting their needs and improving or maintaining their wellbeing.

Social Care Institute for Excellence [19]

Outcomes is a lovely bit of social care jargon, isn’t it? Who beyond ‘serviceland’ thinks or talks about their outcomes? I have plans and hopes and daydreams and endless to do lists – and maybe the odd New Year’s resolution I make and promptly forget about, but if someone asked me what outcomes I wanted to achieve (those ‘where do you see yourself in 5 years’ time?’ type questions) I’d just feel stressed and judged and inadequate.

But strengths-based working is all about outcomes – and when we say outcomes, we don’t mean any old, vague ambitions, or pipe dreams, or wild fantasies. Outcomes must be personal, and measurable, and – even better – ‘SMART’ (Specific, Measurable, Achievable, Realistic and Time Limited).

Just whose outcomes are we talking about here?

“Why do learning disabled people always have to be working towards an outcome? Why do learning disabled people’s lives have to be in a permanent state of being measured? Why do learning disabled people have to succumb to professionals deciding whether they’ve achieved something?”

Mark Neary [20]

7. Training

“A strengths-based approach to care is a collaborative process that draws upon an individual’s strengths and assets and those within their community. Learn how to put this approach into practice and maximise an individual’s independence”.

Social Care Institute for Excellence [21]

Ahh, training. A half day here, a full day there. Let’s ‘roll out’ mandatory strengths-based training and change the world… or at least change our practice. Just. Like. That.

Easy.

Except of course it’s not.

This isn’t about training. It’s about liberating workers from the processes and forms and bureaucracy that has smothered values, crushed hope, and stifled curiosity. Freeing workers up to explore communities, make connections, build relationships, uphold rights. It’s about permission to try. Be creative. Make mistakes. Try again. It’s about unlearning one way of working and learning another way – not in a classroom or in front of a computer but by being alongside people and families and communities and colleagues to agree what good looks like, and how we can work together to achieve it.

Focusing on strengths-based training also absolves organisations of any responsibility for systemic change. Which is why it won’t work.

“We tried in vain to explain that more money was not needed, nor were new professionals required. What was needed was permission to free those at the front line to work in new ways – ways in which they want to work.”

Hilary Cottam [22]

“Our communities don’t need to be trained to help each other, because that’s a human thing – that’s a very human thing.”

Karen, People Focused Group [23]

Conclusion

As I said at the start, the term ‘strengths-based’ makes me go hmmm.

It’s too widely misinterpreted. Too easily misused.

We talk about ‘what matters to you’ but we’re still doing what matters to us. We’re still concentrating on doing things right, not on doing the right things. We’ve added layer upon layer of complexity and jargon to describe good practice. We have handbooks and models and theories and policies to help shape and improve what we do and how we do it, but somewhere along the way we’ve lost sight of why we’re here.

We don’t need more glossy wallpaper. We need to acknowledge the cracks, dismantle the wall(s) and rebuild the foundations.

As Hilary Cottam writes, “to create change we need a guiding vision, and the vision we must aim for is good lives well lived.” [24]

If ‘good lives well lived’ is our ‘why’, then good practice really all comes down to one simple question.

One question, that encapsulates listening, curiosity, meaning, purpose, hope, ambition, relationships, inclusion, choice, control, connection, and collaboration.

What does a good life look like for you and your family, and how can we work together to achieve it?

Does it really need to be any more complicated than that?


References

[1] Strengths-based social work: practice framework and handbook, Department of Health and Social Care, 12 February 2019

[2] A new health and care system, Alex Fox, 2018

[3] Care Act guidance on strengths-based approaches, Social Care Institute for Excellence, March 2015

[4] Care and support statutory guidance, Department of Health and Social Care, August 2021

[5] Independence, Independent, Collins Dictionary

[6] Reablement, Social Care Institute for Excellence

[7] Quoted in Strengths-based social work: practice framework and handbook, Department of Health and Social Care, 12 February 2019

[8] Resilience, Oxford Languages

[9] Resilience, Merriam Webster

[10] Resilience, Collins Dictionary

[11] Developing a wellbeing and strengths-based approach to social work practice: Changing culture, Think Local Act Personal, 2016

[12] Person-centred and community based working (strength-based approach), Skills for Care

[13] Strengths-based social work: practice framework and handbook, Department of Health and Social Care, 12 February 2019

[14] Strengths-based questions for social work assessments, Ruth Hardy, Community Care, 27 November 2017

[15] Striving: a right, a responsibility and a risk, Jan Sutton, Authors of our lives, 19 February 2014

[16] Strengths-based social work: practice framework and handbook, Department of Health and Social Care, 12 February 2019

[17] A new health and care system, Alex Fox, 2018

[18] Got email to say… Anna Severwright, Twitter, 8 August 2019

[19] Care Act guidance on Strengths-based approaches, Social Care Institute for Excellence, March 2015

[20] Measurable outcomes, Mark Neary, Love, Belief and Balls, 1 January 2016

[21] Strengths-based approach training course, Social Care Institute for Excellence

[22] Radical help, Hilary Cottam, 2018

[23] Webinar: Developing strengths-based places – the next steps for strengths-based practice, Social Care Institute for Excellence (SCIE), Recorded 15 June 2021

[24] Radical help, Hilary Cottam, 2018

4 thoughts on “Words that make me go hmmm: Strengths-based

  1. Very thought provoking. Then the phone rings and a plea is heard for a respite stay as dad has “got worse” and the family is stressed all to hell and please can you sort this asap and when he comes home we need the carers four time a day…

    A lot of the time we respond to other people’s narratives and our own would seem like a distraction. “What does a good life look like for you?”? It has a place of course and we need to let people know that we think further, can offer and do more, but that’s not a question the caller would expect, welcome or consider useful.

    Making a better case for what our work involves is one more place it has to start and yes, the rubbish language has no place there. But more voices from the people we support are needed to get the balance right between exploration and response.

    Liked by 1 person

    1. Thanks for your comments Jason. I completely agree that the views and wishes of people we support need to be at the heart of what we do – at an individual conversation level and at a strategic and operational decision making level too. I think that’s essentially what the ‘what does a good life look like to you’ question is all about. I don’t mean we should ask it explicitly, but ‘what matters to you?’ should always be the starting point, whether in terms of an initial conversation, crisis response or a conversation about longer term support, and the ‘how can we work together’ part emphasises that the response should be about the right mix of relationships and support for that person and their family to get on with living their lives, not just getting a service.

      Like

  2. Context is critically important. For people with intellectual disabilities and/or autistic people, they face various forms of institutionalization and second-class citizenship. So abandoning a rights-based perspective is problematic (in my neck of the woods the term “strength-based” is not something that has taken over in my experience, more commonly there’s a lot of chatter about “person-centred” and “choice” that has been watered down or co-opted, which I think is similar to what you are talking about).

    But back to context – it really is much more complicated than “What does a good life look like for you and your family, and how can we work together to achieve it?” because most individuals and their families have been groomed, victimized, traumatized, conditioned by segregated institutional models – probably right through the school years an into adulthood. So in answering that question, individuals and families often answer within the context of their own trauma and conditioning – so from the front lines to senior staff to board members we need to be actively aware of that institutional, segregated, second-class citizenship reality and work very hard to frame opportunities and support choices that are not just a perpetuation of all of that systemic discrimination. The first answer to that question might be “A group home with good staff and a day program so I have something to do.” If we take that at face value and that’s what we strive to deliver on, we are just continuing the same degrading institutional pattern.

    The proof is certainly in the results, not in the language, and I think that’s where the “does it need to be more complicated” question works well – most people want their own apartment, a real job and/or other authentic belonging and contribution alongside others, some close authentic relationships (friends and romantic) and a broader network of welcoming relationships. That is more or less what most humans want and that includes those with intellectual disabilities and/or autistic person – but only if they have been supported to escape the bonds of the institutionalization they have suffered – and typically are still suffering to some degree or another – when they come to us for support.

    If we operated with some basic concrete assumptions about a “good life” – apartment, job, friends – that would be huge progress as compared to the changes in language I’ve observed over the past 30 years that has gotten us to where we are still having these same conversations, and some 80% of public resources are going to the delivery of group homes and group programs, because none of these language or policy changes came with expectations or accountability for delivering real change in people’s lives.

    Liked by 1 person

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