Professional Curiosity

Professional Curiosity and Critical Evaluation

Professional Curiosity is the capacity and communication skill to explore and understand what is happening within a family (or an organisational setting) rather than making assumptions, accepting things at face value, or allowing your personal values or possible unconscious bias to influence the way that that you see and interpret risk. 

This has been described as the need for practitioners to practice ‘respectful uncertainty’ in applying Critical Evaluation to any information they receive, or ‘thinking the unthinkable’.

Watch this YouTube Video: The journey from reflection towards reflexivity (relevant for all practitioners).

The following factors highlight the need to improve professional curiosity:

• The views and feelings of some adults can be very difficult to ascertain.
• Practitioners do not always listen to adults who try to speak on behalf of another adult and who may have important information to contribute.
• Carers can prevent practitioners from seeing and listening to an adult.
• Practitioners can be misinformed with stories they want to believe are true.
• Effective multi-agency work needs to be coordinated.
• Challenging carers and other professionals requires expertise, confidence, time and a considerable amount of emotional energy.

 The key to effective safeguarding practice is to ask the right questions, including: 

1. Would I live here, and if not, why not?
2. Would I be happy with this standard of care for a member of my family?
3. What does good look like?
4. Is there anything else going on in this person’s life which might be causing harm, or the potential for adult abuse or neglect?

Barriers to professional curiosity

It is important to note that when a lack of professional curiosity is cited as a factor in any safeguarding enquiry or review that this does not automatically mean that blame should be apportioned. It is widely recognised that there are many barriers to being professionally curious, some of which are set out below:

The ‘rule of optimism’.
Risk enablement is about a strengths-based approach, but this does not mean that new or escalating risks should not be treated seriously. The ‘rule of optimism’ is a well-known dynamic in which professionals can tend to rationalise away new or escalating risks despite clear evidence to the contrary.

Accumulating risk – seeing the whole picture.
Reviews repeatedly demonstrate that professionals tend to respond to each situation or new risk discretely, rather than assessing the new information within the context of the whole person, or looking at the cumulative effect of a series of incidents and information.

Normalisation.
This refers to social processes through which ideas and actions come to be seen as 'normal' and become taken-for-granted or 'natural' in everyday life. Because they are seen as ‘normal’ they cease to be questioned and are therefore not recognised as potential risks or assessed as such.

Professional deference.
Workers who have most contact with the individual are in a good position to recognise when the risks to the person are escalating. However, there can be a tendency to defer to the opinion of a ‘higher status’ professional who has limited contact with the person but who views the risk as less significant. Be confident in your own judgement and always outline your observations and concerns to other professionals, be courageous and challenge their opinion of risk if it varies from your own. Escalate ongoing concerns through your manager and by using more formal procedures if necessary.

Confirmation bias.
This is when we look for evidence that supports or confirms our pre-held view, and ignores contrary information that refutes them. It occurs when we filter out potentially useful facts and opinions that don't coincide with our preconceived ideas.

‘Knowing but not knowing’.
This is about having a sense that something is not right but not knowing exactly what, so it is difficult to grasp the problem and take action.

Confidence in managing tension.
Disagreement, disruption and aggression from families or others, can undermine confidence and divert meetings away from topics the practitioner wants to explore and back to the family’s own agenda.

Dealing with uncertainty.
Contested accounts, vague or retracted disclosures, deception and inconclusive medical evidence are common in safeguarding practice. Practitioners are often presented with concerns which are impossible to substantiate. In such situations, ‘there is a temptation to discount concerns that cannot be proved’. A person-centred approach requires practitioners to remain mindful of the original concern and be professionally curious:

• ‘Unsubstantiated’ concerns and inconclusive medical evidence should not lead to case closure without further assessment.
• Retracted allegations still need to be investigated wherever possible.
• The use of risk assessment tools can reduce uncertainty, but they are not a substitute for professional judgement, and results need to be collated with observations and other sources of information.
• Social care practitioners are responsible for triangulating information such as, seeking independent confirmation of information, and weighing up information from a range of practitioners, particularly when there are differing accounts, and considering different theories/ research to understand the situation.

Other barriers to professional curiosity.
Poor supervision, complexity and pressure of work, changes of case worker leading to repeatedly ‘starting again’ in casework, closing cases too quickly, fixed thinking/preconceived ideas and values, and a lack of openness to new knowledge are also barriers to a professionally curious approach.

Disguised Compliance

Disguised Compliance involves carers giving the appearance of co-operating with agencies to avoid raising suspicions and allay concerns.

There is a continuum of behaviours from carers on a sliding scale, with full co-operation at one end of the scale, and planned and effective resistance at the other. Showing your best side or ‘saving face’ may be viewed as ‘normal’ behaviour and therefore we can expect a degree of Disguised Compliance in all families; but at its worst superficial cooperation may be to conceal deliberate abuse, and professionals can sometimes delay or avoid interventions due to Disguised Compliance.

The following principles will help front line practitioner’s deal with Disguised Compliance more effectively:

• Focus on the needs, voice and lived experience of the adult.
• Avoid being encouraged to focus too extensively on the needs and presentation of the carers, whether aggressive, argumentative or apparently compliant.
• Think carefully about the engagement of the carers and the impact of this behaviour on the practitioner’s view of risk.
• Focus on change in the family dynamic and the impact this will have on the life and well-being of the adult. This is a more reliable measure than the agreement of carers in the professionals plan.
• There is some evidence that an empathetic approach by professionals may result in an increased level of trust and a more open family response leading to greater disclosure by adults.
• Practitioners need to build close partnership style relationships with families whilst being constantly aware of the adult’s needs and the degree to which they are met.
• There is no magic way of spotting Disguised Compliance other than the discrepancy between a carer’s account and observations of the needs and account of the adult. The latter must always take precedent.
• Practitioners should aim to ‘triangulate’ and cross-reference the information they have received to confirm or refute the facts that have been presented.

Professional Challenge - having different perspectives

Having different professional perspectives within safeguarding practice is a sign of healthy and well-functioning inter-agency partnerships. These differences of opinion are usually resolved by discussion and negotiation between the practitioners concerned, but it is essential that they do not adversely affect outcomes for adults and are resolved in a constructive manner.

If you have a difference of opinion with another practitioner, remember:

• Professional differences and disagreements can help find better ways to improve outcomes for adults and families.
• All professionals are responsible for their own actions in relation to case work.
• Differences and disagreements should be resolved as simply and quickly as possible, in the first instance by individual practitioners and /or their line managers.
• All practitioners should respect the views of others whatever the level of experience – remember that challenging more senior or experienced practitioners can be hard.
• Expect to be challenged; working together effectively depends on an open approach and honest relationships between agencies and professionals.
• Differences are reduced by clarity about roles and responsibilities, the ability to discuss and share problems, and by effectively networking.

Also see this briefing from the Somerset Safeguarding Adults Board: Mendip House Practice Briefing

Cultural Competence

Culturally competent safeguarding practice is essential in achieving the right outcomes, and for improving the well-being of adults from Black, Asian and Minority Ethnic (BAME) communities.

Lack of cultural awareness among practitioners can impact on their ability to effectively work with and support adults, and therefore deal with abuse and neglect appropriately. This can also result in poor practice or interventions, which in turn can reduce trust in statutory agencies and create barriers for engagement with and from minority ethnic communities.   

It is important therefore that practitioners are sensitive to differing family patterns and lifestyles that vary across different racial, ethnic and cultural groups. At the same time they must be clear that abuse or neglect cannot be condoned for religious or cultural reasons.

All practitioners working with adults at risk and their carers whose faith, culture, nationality and recent history differs significantly from that of the majority culture, must be professionally curious and take personal responsibility for informing their work with sufficient knowledge (or seeking advice) on the particular culture and/or faith by which the adult and their family or carers live their daily lives.

Practitioners should be curious about situations or information arising in the course of their work, allowing the family to give their account as well as researching such things by discussion with other practitioners, or by researching the evidence base. Examples of this might be around attitudes towards, and acceptance of, services e.g. health and dietary choices.

In some instances reluctance to access support stems from a desire to keep family life private. In many communities there is a prevalent fear that social work practitioners will negatively interfere, and there may be a poor view of support services arising from initial contact through the immigration system, and, for some communities – particularly those with insecure immigration status – an instinctive distrust of the state arising from experiences in their country of origin.

Practitioners must take personal responsibility for utilising specialist services. Knowing about and using services available locally to provide relevant cultural and faith-related input to prevention, support and rehabilitation services for adults (and their family) will help support practice.

This includes:

• Knowing which agencies are available to access locally (and nationally).
• Having contact details to hand.
• Timing requests for expert support and information appropriately to ensure that assessments, care planning and review are sound and holistic.

Often for BAME communities, accessing appropriate services is a consistent barrier to them fully participating in society, increasing their exclusion and potential for victimisation.

Social Graces

The term ‘Social Graces’ is a mnemonic to help us remember some of the key features that influence personal and social identity. This helps to prompt a professional to have discussions with an adult in a more inclusive way, which in turn may help to improve their understanding of that person's life circumstances and risks they may be facing:

G Gender and Geography

R Race and Religion

A Age, Accent, Appearance and Ability 

C Class and Culture

E Ethnicity, Education and Employment 

S Sexual Orientation and Spirituality

Read here for more information: Social Graces: A practical tool to address inequality www.basw.co.uk