Not Just for Clients: A Model for Organizational Relationship-Based Practice

Background & Purpose:

Relationship-based practice is at the heart of social work (Weatherstone & Tableman, 2015). Long recognized as a key mechanism for change, relationship-based practice requires explicit attention to the clinician-client relationship (Melmed et. al., 2009). The vast literature on relationship-based practice, however, often examines client-clinician relationships outside of the organizational settings where most clinical work occurs. We identify strategies for creating an organizational parallel process for relationship-based social work. In doing so, we seek to bridge clinical practice principles with organizational ones, highlighting their intersection and interdependence in social work.

Methods:

This work is based on ethnographic observation of and semi-structured interviews (N=73) about the implementation of The In-Home Recovery Program (IHRP) in New Jersey. IHRP is an intensive, in-home program that combines substance use disorder (SUD) and individual treatment, parent-child dyadic therapy, case management, and group treatment for parents with children under the age of 72 months in the child protection system. Data analysis utilized a rapid analysis approach, triangulating between data sources (Hamilton, 2013; Taylor et al. 2018). A domain summary template containing categories inductively derived from interview guides and field notes was developed first. Additional domains were added as they emerged and from this work a code book template was created. Two analysts coded a total of ten transcripts to test the developed template. Discrepancies were resolved using a consensus coding process. We then analyzed the full data set using the domain template.

Results:

As a relationship-based model, IHRP is premised on the idea that safe, and secure relationships are one mechanism by which client change takes place. Close attention to building relationships across all stakeholders has been a key part of implementation and represents a parallel process by which the core tenets of the intervention are upheld and modeled. Multiple formal processes have been enacted to create relationship-based practice at the organizational level. These processes include: 1) regular meeting structures involving different constellations of stakeholders and partners; 2) integrated training in the intervention across organizations and roles; 3) explicit attention to points of relational stress or disagreement in monthly case conferences; 4) continuous quality improvement through a mixed-method evaluation that provides quarterly opportunities for formal reflection and; 5) clinical consultation and reflective supervision that considers relationships between team members, partners, and organizations to be as important as clinical processes with clients.

Conclusion & Implications:

The IHRP program is being implemented using a relationship-based organizational process that facilitates the delivery of the intervention. How organizations implement relationship-based interventions can offer a powerful model for clinical staff that can fuel investment in client relationships. The managerial turn in social work has resulted in a deemphasis of the elements of practice that are central to effective relationship-based intervention (Mosley & Rathgrab Smith, 2018). In this context, it is not enough to simply offer relationship-based services, organizations themselves must attend to relationship-based principles within their own practices and procedures. The design and implementation of IHRP represent one model for organizational relationship-based practice.