In March 2020 our world changed in ways we had not imagined with the emergence of Covid 19 sending the UK into a national lockdown. For services that were primarily set up as face to face this positioned us in a much harder to reach place for the children, young people and families (CYP&F) in Fife.
We had been discussing an enquiry line prior to this in relation to creating access and early intervention & prevention opportunities for the population (Ready to Act 2015); Covid however created a greater urgency and drive. We wanted this to work for the CYP&F but also for all our requestors. We also wanted to be able to evidence that this had
- The desired outcome for our requesters that we hoped
- A positive impact for the services providing it
- The drive to create services at a pre-request level.
We were fortunate to be offered support from the “Children & Young People’s Improvement Collaborative” to guide our project using Quality Improvement methodology (the impact of this deserves a blog in itself) and to lead us to a place where we systematically rolled out the enquiry line measuring as we went.
This gave us the “hard data tools” to measure aims, but what about the “relational and reasoning skills”? This is not a simple task of “just answering call”; this involves AHP’s to be having collaborative conversations from a less proximal position than before. We need to be able to understand risk and foreseeable harm, and coproduce outcomes without having the initial conversation or sliding into assessment mode. As we once discussed in Care Aims training, how do we separate the swallows (low risk) from the eagles (high risk) from such a distance? They look the same.
AHP’s and other healthcare professions often like to “do” and “fix”, so how do we create a space during this call to pause and understand in a relatively short time frame?
Our conversations throughout this journey focused on our ability to pause the solution focused thinking we naturally do and contain ourselves in a place of “collective enquiry”. The skill of being in this place allows for much more to be “heard” than the words. This focus and interest allows you to pick up on the human need of the caller. What is not being met for this person? The anxiety, frustration, hopes and sometimes resignation comes through in the voice when you truly listen. Approaching a call with empathy, curiosity and compassion provides a strong foundation to create a collaborative outcome.
Being people who like to talk and ask questions, this can be a real challenge. Allowing people to be heard and understood is integral to providing a good service. When we listen, understand and validate a caller we can never underestimate the power of professional reassurance.
We must be vigilant to avoid saying we “just” provided advice, signposting or information as the skill of being able to do this from such a proximal position takes years of experience and is a skill set in its self. This is a valuable intervention. Not only are we empowering the callers to manage the concern and enable self-help, we are also providing valuable information on what risk looks like and when to contact the service again. When we enter a call in a place of truly listening “real magic” can happen. When using asset focused conversations and when we suspend solution focused enquiry, mutually agreed outcomes are more readily achievable.
This has been evidenced in the call but also in follow up evaluation 3 months after the call. The positive impact for the child or young person, the caller, their CPD and transferability of what was discussed in the call came through strongly from our education colleagues.
Moving forward as we extend our enquiry line and we include more staff, these conversations will be crucial to maintain the quality and efficacy of this universal service. These concepts need to sit at the core of training and reflections and become as natural as breathing to therapists. At times this is challenging but what better way to meet the needs and achieve great outcomes for the children and families we work with in Fife than through truly listening to their story and empowering them to re-write it.
Tracey Ratcliffe & Fiona Mudie
Fife’s Children & Young People’s Occupational Therapy Service