We're working to develop a shared understanding of what makes a care system truly relational. By learning from those within and directly impacted by the out-of-home care system, this article outlines the shifts that the system urgently needs to make to put relationships at the centre.
15 May 2024
We’ve had many discussions with people across the care sector about what makes a care system truly “relational” (also referred to as “relationship-based”). There are many definitions of relationship-based practice, and no single group has a monopoly on what is or isn't relational.Notwithstanding this, to help advance a shared understanding of what we mean by a relationship-based care system, here’s our conceptualisation:
- Relationships are at the centre. An essential outcome is for all children and young people to have meaningful, enduring, genuine relationships with the adults who are raising them. This deceptively simple goal has been assumed - but is missing - in existing care systems.
- People and organisations who offer support to children, young people and their families, prioritise building positive, sustainable relationships, above all else. This provides the foundation for effective support.
- The wider system is designed to support relationships as its highest priority. Approaches that prioritise and strengthen relationships are incentivised, and barriers to building relationships are removed. The methodology to evaluate programs focuses on child and family wellbeing, and the quality of the child’s relationships.
Context matters
For children to thrive, primary caregivers must provide enduring relational security (the centre point in the diagram above). This means being willing to remain unconditionally available physically and emotionally for children when they most need it. That is, when children feel the most unsafe and are often hardest to live with.
For children in statutory care, whether they are cared for by kin, carers or any other model, the overriding task is therefore to identify and support appropriate adults who are able to offer meaningful connections. The child needs strong emotional bonds with the adult raising them (attachment), a connection to culture, and a safe and supportive environment to heal.
In addition to primary caregivers, a child and their family will ideally have positive relationships within their communities, which may include their extended families, sports coaches, teachers, volunteer organisations and so on.
Professional supporting relationships (the middle ring of the diagram above) may include caseworkers, medical and mental health practitioners, and other care service providers.
These extended relationships will differ in terms of boundaries, depth and longevity – which is appropriate and necessary.
Take for example, a social worker in a hospital. The social worker can promote the common aim of seeing children connected and loved. The social worker can provide a service that is informed by relationships, even if they are not going to play a key role in raising the child long term. They can be genuine in their responses and interactions, provide support that fosters meaningful connections outside of their service, and ultimately help broaden and deepen the child’s relationships once discharged from hospital. This is likely to have a great influence on how the service feels for children and families, who do not have a choice about engaging with professionals who are always, at best, well-intentioned strangers.
We need a range of services in society, and all can be enhanced by an understanding of the centrality of relationships. We need genuine connections, with boundaries that are informed by the purpose and actions of each service involved.
Healthy versus unhealthy relationships
It can be argued that all interpersonal actions occur in context of the relationship between those involved. Even avoidant interactions can be understood through a relational lens – for example, you are still communicating even when deliberately not speaking.
A group home or hotel using shift workers is also using a type of relational practice. But it’s one of anxiety and unpredictability, not one that is aligned with healthy childhood development. When we refer to relationship-based practice or a relational approach, we mean approaches that promote informed, attuned and healthy connections.
Case studies
Here are some examples of what a relational approach can look like in the care system:
Family by Family
Family by Family is a unique, peer-to-peer family support program that aims to reduce family stress and demand for crisis services.
A family going through tough times (a ‘Seeking’ family) is matched with a family that has been through tough times and come out the other side (a ‘Sharing’ family). Sharing Families are supported and coached in their work by trained professionals.
The model exemplifies the relational approach of walking alongside families and supporting them to build their own capabilities and solve their own problems:
- Family Coaches guide families through three clear stages, starting with Seeking and Sharing Families getting to know each other so they can build relationships of trust, chatting, sharing stories and doing fun activities together (the relationship-building stage).
- Then both families begin to work on the Seeking Family’s goals, encouraging, helping and celebrating the small wins, with side-by-side support and role modelling happening along the way (the ‘doing with’ stage). The families may connect through things like sporting clubs, voluntary work, coffee clubs, playgroups, local libraries and services, depending on the Seeking Family’s goals.
- Finally, the Sharing family encourages the Seeking family to try things on their own, giving feedback, reflecting and planning for the future (the ‘doing without’ stage).
Family by Family is grounded in social theory and evidence-based practice, and has been running in Australia for ten years with over 1,500 families receiving support. External evaluations of Family by Family have demonstrated a range of positive outcomes including reduced Child Protection notifications and breaking cycles of disadvantage.
Find out more about Family by Family
Professional Individualised Care
Professional Individualised Care (PIC) is an innovative model in out-of-home care that has embedded relationship-based practice across all levels of its operations.
PIC engages professional therapeutic carers with recognised qualifications and specialised skills, such as social workers and psychologists. Unlike traditional foster care, PIC’s carers are supported to devote themselves comprehensively to their roles, receiving a compensatory full-time income and a generous allowance to cover the needs of the child or young person.
At its core, PIC emphasises relational connection first and foremost, in whatever manner best suits the child and carer. With an understanding that genuine relationships require time and dedication, PIC prioritises building trust and connection between coordinators, carers and children. This includes a relationship-focused authorisation process, and ongoing supervision and support for carers. Carers are trusted as the primary decision-maker, due to their expertise and close relationship with their child.
Compared to other out-of-home care arrangements like Alternative Care Arrangements, which often result in isolation and poor outcomes, PIC stands out for its effectiveness and cost-efficiency. Evaluation by Lateral Economics revealed that PIC typically costs 50% less than other options while producing significantly better lifetime holistic wellbeing outcomes for children and young people.
Find out more about Professional Individualised Care
Why is relational practice so important?
There’s a distinction between being friendly and building rapport, versus having a genuine connection. The Centre for Relational Care is guided by people with extensive experience in the care sector, including psychologists, social workers and care providers who engage with the sector every day. They tell us that children and families feel this difference profoundly.
Also, children are only able to engage, adapt and heal when they have a meaningful relationship with the adults trying to help them do so. Psychology refers to this as ‘connecting’ before ‘correcting’.
On a wider scale, the evidence for the critical role of relationships in individual and societal health and wellbeing is extensive and growing. Here are recent examples:
The 85-year Harvard Study of Adult Development - the longest running scientific study of adult life ever conducted - found that “the people who stayed healthiest and lived longest were the people who had the strongest connections to others.” >> Read more
The US Surgeon General recently reported on an “epidemic of loneliness and isolation” as an urgent public health issue. He points to scientific evidence showing that loneliness is associated with a greater risk of cardiovascular disease, dementia, stroke, depression, anxiety, and premature death. Turning this around “will require reimagining the structures, policies, and programs that shape a community to best support the development of healthy relationships.” >> Read the report
Your thoughts?
If you would like to share your thoughts on relationship-based care, please contact us.