A gentle rebel: an interview with the Pathfinder’s new patron, Sarah Mason

The Birmingham Pathfinder is proud to be an approach to family support which has been conceived and built from the bottom up by frontline workers; and that is rooted in working class experience.

Our people are our greatest asset, and today we are celebrating one of the Pathfinder’s founders, Sarah Mason, as she becomes our patron. In this interview we discuss her life, and how it led to her role in setting up the Pathfinder, and changing things from the frontline.

Q. You’re a very warm and gentle person Sarah but there must be quite a big rebellious streak. Where did that come from?

We were quite poor as a family when I was a child, but we were very loved. And I always felt passionately that it was a shame that everyone didn’t have that.

I had a friend who lived in the same street. Her dad and mom both had alcohol issues. Her mom often had injuries, and she would say, ‘Oh, don’t let Sarah come in, because I’ve got a black eye’. Every year, we used to plan what we wanted for Christmas, like roller skates, or whatever it was. My friend was always promised the same as me, but she never, ever had them.

So, I think even from a small child, there was an awareness of disparity.

And so I wanted to work with young people in residential care. And I saw kids living in residential care homes with ripped sofas, and the bed linen wasn’t very nice, and the wallpaper was ripped, and I was like ‘Why can’t we decorate the rooms?’ Why can’t they have a nicer sofa?’ Because I just thought it should be like home. The children were there through no fault of their own. For example – one child, their dad had murdered their mom. So mom was dead, and dad was in prison. The last thing they needed was to be in a very regimented, sparse, crumbly sort of place.

It wasn’t really expensive stuff they needed. They had to ask if they wanted a bath once a week; they had to be given sanitary towels out of the office door one at a time. It was just unnecessarily cruel.

I felt it wasn’t right, but I was very young, aged 20, and I had no voice. I’ve never had a voice in terms of my job – I’ve always done jobs where I didn’t really have one. But I was there right on the frontline, seeing how things operate.

The least people deserve is kindness and empathy.

And then I had my own children, and I felt very much ‘that could be my child’. I felt aligned with any kid who, by the luck of the stars, ended up in that situation.

Q. So what were the next steps towards the start of the Pathfinder?

I went back to work when my children were that little bit older. I had been a full-time social services advisor for 15 years and had taken time out with my young children, one of whom had special needs, being profoundly deaf.  I began working 15 hours a week in term time as a school nurse assistant in an SEMH (social, emotional and mental health) special school.  That’s all I could manage.

The children were extremely disadvantaged. I was doing their heights and weights, and I was just thinking, why are we doing this, what’s the point? I can see physically they’re okay but they are clearly traumatised.

I think because I was paid so little, I knew I could stack shelves in Tesco if I had to. That realisation gives you some freedom.

So, I was always asking what are we going to do about this? And they were like, ‘if you want to be a nurse, be a nurse’. And I said ‘I don’t want to be a nurse, I want children’s emotional wellbeing looked after. I don’t want to just do their heights and weights – they need looking after emotionally’.

Q. What did you witness?

So many things that got my adrenaline going. Professional neglect, institutional neglect.

I’d read very old clinic letters that would say a child needed further treatment but they hadn’t been followed up due to their parent’s inability to attend appointments and the child would have been discharged as a result.

When I organised children’s records, as part of my job, I noticed that we’d have children who’d moved around lots of different properties and different areas, with huge thick records.

I would never just read the last notes. I used to read all the notes. Wherever they’d come from. I read them all from start to finish. I was fascinated by the life journey that had led them to be in a SEMH special school aged 11.

Q. So you would know more about those children than almost anyone…

Yes, almost anybody. I would write a timeline for the front of their records with key events in their life. This was then available to their Special School Nurse and Community Paediatrician.

I remember there was a child who, at the start of their health records, was described as a boy and by the end of the records was a girl. So clearly, that child had either gone missing, been replaced or something horrendous had happened, and all you could do is flag it and say something, is not right here.

There were children with notes from years ago querying their hearing – saying this child didn’t hear very well in the hearing test. It was never raised again.

There was medical neglect. Children being neglected professionally as a result of families moving address several times with no robust system of monitoring children.

Q. What did you do?

In meetings, I could appear quite difficult. There were always issues of staffing levels. You couldn’t shout too loud because there really just weren’t enough staff.  If there was a shortage, all the staff always had to descend upon the schools where the children had a physical disability, because clearly in some cases they were physically keeping those children alive.

The children in the SEMH schools were considered a lower priority. I didn’t agree with this. They had equal importance.

There was also very much a stigma about school nursing in the SEMH schools. No one ever wanted to do nursing cover in those schools.

People didn’t really think our children were deserving. There was an undercurrent – an assumption; they’re kind of just naughty children; disruptive and sometimes displaying challenging behaviours in medical appointments.  Their parents don’t turn up to appointments because they’re lazy or disinterested in their child’s well-being. One member of staff used to lock the office door in case one of the kids came in. Some staff felt frightened of the children’s behaviour. They didn’t want to walk across the school site in case they came face to face to face with one of the kids.

I felt that those kids could probably see that in people’s faces and that would make them tougher against the system because they felt that distaste. It was shaming, and shame is a very powerful, destructive emotion.

Not good enough is it?

You’re fighting a system that is not there for those children. You’re just firefighting all the time. That’s as much as you can do and people get burnt out.

Q. So when did you meet Rob?

It was after I started work as a Special School Nurse Assistant at Lindsworth SEMH School. I was aware of Rob’s work, but we never crossed paths.

One day we had a chat about ‘new to school’ reviews. When the children were starting school in year seven, I would do their heights, weights and hearing tests in one room and Rob would do assessments for his service, with the same group of children, in an adjacent room. At the end we decided to compare assessment notes. We realised, ‘Wow, this looks like two different children according to their two separate electronic records of school health and social care’.

I was accessing their medical records; anything that had been recorded by health visitors, school nurses or paediatricians, vaccination records and A and E attendances. I’d have access to all that information but no access to their social care or school records at all.

Rob had access to the children’s social care and youth justice records but no access to their health records. As a result, we thought we’d do some joint home visits for this group of new Year 7 children as a more holistic approach.

Q. Were you supposed to do that? Or did you just do it?

Honestly, I think we just did it. School nurses were so short-staffed and over-stretched with their mandatory work.

What you read about a child in their records is only a very small part of what’s happening in their life. The actual makeup of the family – who’s living there, and what parents are dealing with themselves, broadens the picture considerably.

We went out to see families in their homes. We’re both quite empathetic and we were eager to learn about the bigger picture of the family’s lives.  Parents would say ‘no one’s ever asked us how we are before’. Usually it’s like, ‘well, your child has stopped coming to school. What are you doing about it?’

It was as if people just overflowed with gratitude, and also needed to offload. It was like, ‘well, let me tell you, my husband used to rape me as a punishment’ and things that you would never expect someone to say on the first meeting. It was as if they’d been holding on for so long for someone to care enough without judgement.

We left after about an hour or so at the family’s home and used to pool our thoughts and notes to build a more complete picture of their family system.

This was a completely different practice for school nursing, as I was now including the other family members in the records. The special school nursing manager was very supportive of what was to become Birmingham Pathfinder and created a new electronic caseload for me. This allowed me to record information on the other household family members for a more complete family picture. They also paid for me to attend a 12-month Systemic Family Therapy course to support this new way of working.

When a family has a child with any kind of special need – ADHD, autism, behavioural challenges – it impacts every family member in some way.

We needed to better understand, build a clearer picture, be curious and remember that the parents had been someone’s children once. They’d had their own challenges and gone through similar difficulties as their own children were going through now and they were often ill-equipped to support them.

Parents often reached out or were referred to social care for support, and social care would perhaps would put them on a six-week programme of family support or a parenting course. It was never enough to make any meaningful or sustainable changes.

Q. So at this point, then you’ve formed a working alliance with Rob. How did it feel?

For the first time in my life, I felt I was doing what I should be doing and what I wanted to do.

I just thought at last I’ve found a kindred spirit. Someone else who’s belief was ‘this isn’t right, is it?’ and doesn’t just want to play by the rules in order to do a job and go home. Hallelujah – this is actually the first person I’ve ever met in 20+ years in the system who thinks like me.

And I thought, if I get sacked, it doesn’t matter. I’ll still do it voluntarily, because I finally realise that this is what people need.

Q. You’re doing something really unusual by this point – lots of people in the system are caring and see the need for change but feel powerless so they either do what they can within the parameters, or they leave. There are very few people who actually try and change things. And that’s what you two start to do. How did it feel?

It just felt like the right thing to do. We both felt very much that it was so important.

I’m thinking about one mom in particular – people stick in your mind. She was very thin and fragile, and she was struggling with three little boys. Her husband worked long hours. One of her young sons had already been excluded from his primary school as a result of his behaviours and sent to a Pupil Referral Unit. Her other two boys continued to attend their mainstream primary. She was having to take two children to their primary school and stand in the playground with the young son who had been excluded from that school, with the judgemental looks from the other parents, then take him on a bus to the PRU. People would shout at her on the bus “Control that kid. What kind of parent are you?”

We supported her to have her three sons assessed and established that all three boys were in fact autistic and their needs were not being met.  If mom’s wider family story had been explored they would have realised that her two older brothers had both been diagnosed with autism and it would have led medical professionals to explore this as a possible diagnosis much earlier. She wouldn’t have been led to believe that she was just a bad Mom and her son to believe he was just ‘naughty’. For many months these beliefs had eroded their self-confidence.

This was at a time where everyone was talking about ‘joined- up working’ and information- sharing. The Khyra Ishaq serious case review had come out saying people were working with individual children in families and nobody was looking at the whole picture. At the same time, I got into trouble for writing about a mom’s mental health on a child’s notes, when it was hugely relevant – the child didn’t want to go to school because her mom had attempted suicide many times and she felt her mom could die while she was at school… It’s just so obvious.

Q. So you are going beyond trying to survive within the system or do little bits of kindness, important though that is. You’re starting to enlarge the space for something different…

Rob’s position in systems was senior enough for him to have a voice. That was important. If we had both been healthcare assistants it wouldn’t have gone anywhere because I was constantly reminded of my position. I was experienced; I’d worked in multi-agency teams in the community where I was a social services adviser. But the system is so hierarchical, as a healthcare assistant, no one listened to me.

Rob was able to pitch a different tripartite [health/education/children’s social care] approach, and I was able to back him up and say, yes, this is what’s needed.

Q. Then what happened?

I think there were obstacles in as much as people, I think, agreed with the reports Rob had written, but they knew that funding would be needed.

If you are saying that all those children in an SEMH school are going to either be victims or perpetrators of youth violence or adult violence, you’re saying an influx of funding is needed and that’s not there – though actually all the funds are going into the crisis end of things – nothingness.

No one wants to say, okay, let’s stop and redo it.

I think all we were able to do was just keep pushing and advocating on the level that we had the capacity for – with parents who would just be dismissed ordinarily. We might go and pick a kid up and take them to a paediatrician appointment or get their eyes tested and glasses prescribed. Little things that were never done. Families trusted us and shared their difficulties. If you think you are not going to get blamed by the person you’re telling, you will be more open about what is going on.

The majority of parents are frightened of the establishment and are hiding away from it. They fear that they’re going to be blamed and there’s no time to build trust. One family we worked with recalled having 36 social workers during their lifetime as a child and adult.

We started to enlist teaching assistants from within schools to be upskilled to Pathfinder workers. Rob developed partnerships with agencies; Department for Work and Pensions for benefits advice, Aquarius for substance misuse support, St Basils for psychological input. The partnerships grew and a multi-agency team was developing.  Rob managed to persuade schools to release members of staff to support identified families in the Pathfinder model.

We met some members of the team who are still with us now.

I always say people have got Pathfinder written through them. You can kind of see it. It’s an empathy that you can see and it’s the things they’ve noticed and recognised.

When we met Gemma Cooney Folk we knew straight away. She was sitting outside what is known as a ‘quiet room’ in a PRU. She was one of the Teaching Assistants, under recognised but with a wealth of experience. It’s a small empty room that primary aged children are taken to calm down when excluded from the classroom. Gemma shared that often during these times she had her glasses smashed, was being punched and kicked and whatever but nothing therapeutic was really on offer. So Gemma was one of the first people to become a Pathfinder worker in her PRU.  She took us to visit a family she felt were most needing Pathfinder support.

That’s when we met a couple who had two little boys who attended her PRU. Visiting them at home meant we found out so much more, such as their 16-year-old sister was upstairs in her bedroom. She had not long come out of hospital from self-harming. So in ordinary circumstances, she would have been completely invisible.  Her mom had learning disabilities and the step-dad was controlling.

When you’ve visited families at home, in an informal way, you kind of get the vibe, you get more of a feeling about what the whole atmosphere is like.

Q. At what point does the Pathfinder’s first home at the fire station come into the picture?

The fire service were at that point taking on responsibility for community safety. So they said, you might as well use an empty part of the station.  So Rob took the keys and we walked in.

We couldn’t believe it. Up to that point, we’d literally just have to go to Sainsbury’s for a cup of coffee, and sit and write our notes together and then go back to our respective jobs.

I should say, the good thing was that my manager ‘got’ Rob and understood what we were trying to do. She really should get credit for releasing me from my job. This way of working became the Pathfinder model.

It was unconventional, because it didn’t sit under any particular bit of the hierarchy. It wasn’t part of the system. It was a little enclave.

It had to be at the level of the healthcare assistant or teaching assistant. The nurse who is band six couldn’t do what we did because she’d have so much mandatory work to do. The level of bureaucracy she would have to complete as part of a legal function, all the vaccinations, etc, etc, there would be nothing left.

Q. By now you’ve got settled at the fire station. What was that like?

It was fantastic. It was just me and Rob and two desks looking at each other thinking this is amazing – we can form a hub here, and we can start getting the Pathfinder workers to come in to learn from the multi-agency staff.

It was difficult and there were tensions – especially about releasing staff from schools to come to the fire station. The bigger picture was it was really wonderful for their staff to be upskilled,

Rob did a fantastic job of getting everybody on board.

Q. Thinking now about someone in a similar position to you, when you were a healthcare assistant, who’s feeling those feelings of frustration and anger, what would your advice be?

One of the difficulties is in a lot of roles you’re very much on your own. When I was a social service advisor, there were four of us and we used to come together to share our thoughts.

I think it’s useful to think of having a peer group to discuss how you could practically make one step towards encouraging or influencing things to be done differently. I think it will always stay the same unless people do that because it’s in everyone’s interests to keep everything the same.

I was a bit of a thorn in their side. Nobody wants to have a member of staff who is always saying ‘I’m not really sure if that’s okay’. I could see I was really annoying people

Q. That’s really hard on you as well – to be the one who is always saying those things…

Yes, I think that’s why my line manager, during a staff meeting, shouted at me ‘Sarah Mason, if you want to do things differently just go and train to be a nurse’. She didn’t want to have to shift or change things or do anything different and I didn’t need to be a nurse to work differently.

I remember saying in one meeting, ‘I need you to minute that I’m telling you that the staff shortages are detrimental to the children’s well-being and safety. I want it recorded that I’ve stated my concerns, because I’m not happy with the reduced service to SEMH children’.

That doesn’t make you popular.

The other thing I think can be helpful to frontline staff is a buddy system; two people who can check in with each other from time to time for their emotional well-being. It’s nice to know that you can offload sometimes outside of professional supervision.

Q. What are the key things that you think are essential in this journey of promoting change?

I think to read a lot. I read a lot. I researched a lot. I read all the serious case reviews. I was always looking for information that would reinforce and legitimise my belief system, so I would know that the route I was thinking about was right.

Don’t ever think that you’ve got to change the whole world, that’s too overwhelming. It’s like, how do you eat an elephant one bite at a time?

What small changes can you do in your practice? What small changes can you let other people see you doing? Social rehearsals that people can see.  They see it and think, ‘Oh, actually, there’s a different way to talk to people’.

And I think if you treat others how you’d like to be treated yourself, and you treat other people’s children how you’d like yours to be treated, then you can’t go far wrong.