I really like Schwartz Rounds. I know when you undertake a scientific evaluation of something, you are supposed be carefully neutral, to avoid the suggestion of bias or that you might have pre-empted the outcome. But I am only human, and I have to be honest. I liked the idea of Schwartz Rounds before we embarked on a 24-month trial of whether they ‘work’ in children’s services or not. And – even after all the ups and downs of a long project, and despite being interrupted by a global pandemic (had you noticed?) – I like them still.
Which is not to say that we didn’t evaluate them as rigorously as possible. Indeed, the whole point of using a randomised controlled trial design is to minimise the impact of bias. In practice, social workers and other members of staff were randomly invited to attend the Rounds or not. And when doing our data analysis, we were effectively blind to whether the respondents had attended or not.
With that said, and my personal feelings made clear, what are Schwartz Rounds and what did we find?
No-one needs me to tell them that working in children’s services can be immensely rewarding, but also incredibly difficult and stressful at times. Schwartz Rounds are an intervention designed to help all members of staff cope better with the emotional and social strains of such work, to help build collaborative relationships between colleagues, to support staff to remain empathic with families and ultimately to ensure a healthier working environment.
They involve groups of staff, from all levels and parts of the organisation, meeting together once a month, and sharing food and telling stories about the social and emotional impact of their work. At the start of each session, a group of three or four people will each talk for five minutes in relation to a theme – for example, about a child or family I will never forget. The other attendees listen and once the stories are finished, are invited to reflect on what they have heard and if they want, to share stories of their own. Trained facilitators make sure the focus is kept on the social and emotional impact, and does not deviate to include problem-solving, administration or management oversight. From my own experience of attending Rounds, they are unlike any other kind of local authority meeting I’ve been to.
During one memorable example, a child protection conference minute-taker shared her story about a child she would never forget, which involved a child that she had never actually met. For conference after conference, she listened as parents and professionals spoke about the most horrendous examples of criminal and sexual exploitation. There seemed nothing that anyone could do to keep her safe. As the minute-taker shared her story, she spoke about feeling powerless, and how little support she received. She felt like a cog in a machine, not fully human or fully involved. Afterwards, the social worker of the child was able to acknowledge that she had not seen it from this perspective before, and they shared a hug and a promise to take better care of each other in future. This small but powerful example encapsulates the potential of Schwartz Rounds to make a real and tangible difference for those working in this often-difficult area.
This does not mean that Schwartz Rounds provide a kind of magic solution to all the problems in children’s social care – far from it. As we found in our evaluation, some people attended and did not find them helpful. Some people found them upsetting. One of our most important recommendations is that attendance must always be voluntary, and follow-up support should be available for anyone who needs it.
That being said, we found clear signs of promise that regular attendance (six times a year, or more) was associated with lower levels of psychological distress and fewer days absent from work. We also found that Schwartz Rounds were either cost-neutral, or in some cases provided a small cost-saving.
Overall, we have recommended that local authorities can continue providing Schwartz Rounds or should consider introducing them.
- The Point of Care Foundation can provide training and ongoing support for local authorities to introduce Schwartz Rounds. They should not be introduced without their involvement.
- You can read the full evaluation report here , and watch a ten-minute video of a Schwartz Round from a healthcare setting here.