Embedding a specialist family violence social worker in an Emergency Department: Sustaining knowledge to improve the early identification and health response to victim/survivors

Family violence has serious, long lasting health impacts and accounts for substantial repeat health presentations (Cowan et al., 2020). Healthcare practitioners play a vital role in identifying and responding to victim survivors of family violence. There is compelling evidence that training alone is insufficient in producing a holistic healthcare response to family violence (Hegarty et al., 2020).

In response to the increased frequency, complexity, and severity of family violence presentations, Canberra Health Services (CHS) Strengthening Health Responses to Family Violence (SHRFV) program implemented the Clinical Lead – Family Violence initiative embedded in the Emergency Department (ED). This role, held by a skilled senior Social Worker, is designed to nurture a skilled and confident workforce in ED and respond to family violence as a health issue. The Clinical Lead is a clinical support role providing advice, consultation, training, and reflective practice to staff to implement a sustained practice change.

The aim of this study is to determine whether, and in what ways the embedded Clinical Lead – Family Violence position has assisted ED staff to:

• embed a shared understanding of family violence in practice
• change practice behaviours to adopt Sensitive Practice/sensitive enquiry in their response to suspected family violence presentation, including knowledge/confidence of referral pathways.

This grant will fund time and resources for Principal Researcher, Renata Kiss and the Co-Principal Researchers Fiona Holihan, Anna McLeod, and Dr. Amelia Wheeler to undertake qualitative interviews with ED staff and community agencies and undertake data extraction and analysis from the program documentation.

Principal Researcher:

Renata Kiss, Clinical Lead – Family Violence, Strengthening Health Responses to Family Violence, Canberra Health Services

e: [email protected]

Co-Principal Researcher:

Anna McLeod, Manager – Strengthening Health Responses to Family Violence, Canberra Health Services

e: [email protected]

Co-Principal Researcher:
Fiona Holihan, Senior Manager – Child Health Targeted Support Services, Canberra Health Services
e: [email protected]

Co-Principal Researcher / Research Mentor:
Dr. Amelia Wheeler, Lecturer in Social Work, Australian Catholic University
e: [email protected]

Women’s wellbeing camps as a means of HTLV-1 health promotion:

A pilot study with a remote community in Central Australia

The human T cell leukaemia virus 1 (HTLV-1) is a neglected blood-borne virus and sexually transmissible infection that is highly endemic to remote Aboriginal populations in Central Australia. HTLV-1 is the cause of an aggressive leukaemia (adult T cell leukaemia, ATL) and neurodegenerative disease (HTLV-1 associated myelopathy, HAM), and is associated with a range of inflammatory diseases that can shorten a person’s lifespan. Transmitted sexually, through blood contact and maternally via prolonged breastfeeding, infection with HTLV-1 and progression to associated diseases is preventable, and the necessary prevention initiatives therefore require the direct involvement of women, their families and communities.

The 2021/2022 Practitioner Research Grant provided the funding to pilot an HTLV-1 wellbeing camp with women in a community that has a high prevalence of HTLV-1. This community had participated in a previous study with the principal researcher, in which a camp was suggested by community members as a means of HTLV-1 health promotion (Fowler & Einsiedel 2021).

The primary ambition of the camp was to understand what mitigation strategies are envisioned by women at high risk of HTLV-1 infection when they are provided with basic

biomedical information about HTLV-1. A second aim was to ascertain the effectiveness and cultural appropriateness of a wellbeing camp as a method for addressing such questions. Further sub-objectives, such as raising general awareness about HTLV-1, promoting cultural safety in health, and honouring the sexual and reproductive rights of women belonging to a population at risk of HTLV-1, were included in these broader aims.

The camp took place over two days/nights in October 2022 on homelands nominated by the women. It offered a blend of cultural activities, information sharing and focussed reflection as per the agenda specified by participants during two co-design workshops that occurred in the community prior to the camp. Audio recordings were made during two focus groups, and further data were collected via observation, informal discussion, photos and art activities.

An emphasis on shifting the custodianship of HTLV-1 knowledges to affected communities was and is a key component of this study’s imperative, providing a contribution to reconciliatory praxis and to the social justice aims of emerging research trajectories in Central Australia. The study is expected to assist the progression of an HTLV-1 public health initiative that is gender sensitive and culturally informed. It may also provide insights into the cultural fitness of a wellbeing camp as a forum for HTLV-1 knowledge transfer and sharing, a method which could be extended to male cohorts, to other remote settings, or to regions where HTLV-1 is endemic outside of Australia.

The project, specifically data analysis and publication, is currently on hold while the principal researcher is on maternity leave and will resume in October 2023.

Listening to young people project: Involving young people as co-researchers in addressing their needs at TAIHS Lighthouse and beyond.

In this project we seek to prioritise the voices of young people to help inform future service delivery at Townsville Aboriginal and Islander Health Service (TAIHS) Lighthouse. Literature has identified the importance of listening to marginalised young people, and the positive effects that their increased inclusion can bring to service delivery. In order to inform our future service delivery, young people will be invited to become co-researchers and will work to identify the needs of young people who are at risk of becoming involved, or who may currently be involved in juvenile justice systems. The Australian Institute of Health and Welfare (AIHW, 2019) identifies that 5,513 young people aged 10 and over were under youth justice supervision on an average day in 2017-18. Queensland and New South Wales had the largest groups of young people under supervision (Qld 29%; NSW 25%, AIHW, 2019). While approximately only 5% of young people in Australia are Indigenous, almost half (49%) of those under youth justice supervision in 2017-18 were Indigenous (AIHW, 2019).

The grant will be used to support the proposed Participatory Action research including group meetings; recompense for young people’s attendance; an Indigenous research assistant; transcribing of interviews; mentoring; and a contribution towards presentation of the findings at a national conference. This research project is a result of a research collaboration between practitioners at TAIHS, Sara O’Reilly and Nikkola Savuro, and the academic Social Work Group at James Cook University, Associate Professor Susan Gair and Dr Ines Zuchowski.

24-Hour Snapshot: Evidencing Social Work Practice in Hospital Emergency Departments

Emergency Departments (EDs) are the ‘front door’ of a health facility and, for many people, form their primary contact with the health care system, providing an important interface between the community and health facilities (Australasian College for Emergency Medicine, 2009). Social Work (SW) is one of the three key professions (alongside medical and nursing) that work in an ED. Yet there is little documented evidence about the scope of social work practice in hospital Emergency Departments in Australia.

This project aims to document the scope and conduct of social work practice within two Queensland ED’s at the Princess Alexandra Hospital (PAH) and Toowoomba Base Hospital (TBH), using a comprehensive audit tool. The validated audit tool had previously been used to conduct a 24 hour practice audit of 550 social workers across 14 hospitals and mental health services in Victoria (Joubert, 2017).

The grant funds would enable Ms. Rebecca McKimmie, Senior Social Worker – ED at PAH, to have time off line to coordinate Steps 1-3 and play a role in the data extraction and dissemination component of Step 4.

Step 1: Organise a consensus conference with the Victorian researchers, PAH and TBH participants to adapt the tool to the ED context; identify the mechanisms required to support the participating SWs in audit data collection; and coordinate their training in the use of the audit tool.

Step 2: In the week prior to the snapshot, undertake any of the preparatory work to ensure that support systems are in place for the data collection.

Step 3: Coordinate and support the participating Social Workers on the day of the 24 hour ED snapshot.

Step 4: Extract demographic data from the patient electronic medical record to combine with the audit data, interview the social workers about their experience, analyse results and then disseminate the results.

Step 5: Review feasibility data collected in relation to the 24 hour snapshot approach.

The team has scoped the literature, and is in the final stages of submitting an ethics application.

References:
Australasian College for Emergency Medicine. March; 2009. www.acem.org.au/Standards-Publications/Policies-Guidelines.aspx
Joubert, L. (2017). A report for stakeholders. Melbourne, University of Melbourne.

Social Work Interventions in Cancer Care

The practitioner research grant for 2018/2019 has been awarded to an academic and practitioner partnership researching social work practice in cancer care. The aims of the study are to identify the reasons for referring cancer patients and carers to social work and the types of interventions undertaken by social workers. By understanding more about social work practice in this area, more can be learned about those with whom we practice.

Social workers in health settings are often at the forefront of psychosocial support in cancer care however there have been few studies that have explored the types of social work interventions undertaken with cancer patients in Australia. Social work practice in the health field is intrinsically contextualised by the social determinants of health and health inequalities.

Individuals, groups and communities that experience higher mortality rates from all cancers combined, and poor or variable psychosocial outcomes are often from communities experiencing impoverished and inequitable access to appropriate services particularly in rural and regional centres and in Indigenous communities.

The multi-state, multi-site study is using clinical data-mining methodology and is being conducted in health care settings in metropolitan, regional and rural centres in New South Wales, Victoria and Queensland.

Dr Rosalie Pockett
Sydney School of Education and Social Work
The University of Sydney
Email: [email protected]

Mr Ray Araullo
Deputy Director, Social Work Department
Royal North Shore Hospital St Leonards, NSW 
Email: [email protected]

Ms Kim Hobbs
Clinical Specialist Social Worker
Westmead Hospital, Westmead NSW

The strengths and challenges of embedding trauma informed care in child and family service delivery: A Grampians Region case study

This project sought to address a gap in the literature on how trauma informed care is implemented in practice within child and family services in the Australian context. Researchers are social work academics from Federation University and a social work practitioner from Berry Street ‘s Grampians regional office, based in Ballarat. Berry Street is a non-government agency providing child and family services across Victoria.

Using a framework provided by Miseler and Myer (2013) Practical steps to get from trauma aware to trauma informed while creating a healthy, safe and secure environment for children, through 15 qualitative interviews, this research explores practitioners’ perceptions of trauma-informed case management service delivery for children and families in the Grampians Region in Western Victoria. It examines the materials used in Berry Streets’ trauma informed practice, and explores how Berry Street practitioners integrate and embed trauma informed practice in their service delivery. It also identifies barriers to case management within trauma informed care.

Research outcomes will be used to assist Berry Street to plan improvements to trauma informed case management service delivery and to develop research-informed practice frameworks. The AASW grant is enabling a research assistant to assist in data collection, and to support other research processes such as interview transcription and conference attendance.

Kerryn Bagley, Isaac Moses and Tejaswini Patil
Federation University and Berry Street, Vic
Email: k[email protected]

Assault and Brain Injuries (AaBI) Project: Exploring the psychosocial needs of families and caregivers who experience a Traumatic Brain Injury (TBI) as the result of an assault or an alleged assault

While other violent crimes within Australia are decreasing, the number of assaults is increasing (Bricknell, 2008). Severe assault-related Traumatic Brain Injuries form approximately 12 per cent of admissions to hospitals (Morisse et al., 2014) and the financial costs associated with this type of injury are significant (Piccenna et al., 2014). There is minimal research evidence regarding how family members or informal carers support a person who has this type of injury navigate the health and criminal justice systems.

This research project was part of a larger study that includes quantitative and retrospective data collection. This exploratory research investigated the psychosocial stressors on family members caring for a person who has sustained a traumatic brain injury because of an assault.

The AASW grant enabled a Senior Social Worker at the Princess Alexandra Hospital’s Brain Injury Rehabilitation Unit, to have time off-line to complete 7 qualitative interviews with informal carers, transcription of the interviews and commencement of the data analysis.

Dr Annerley Bates
Princess Alexandra Hospital
Queensland Health and Griffith University, QLD

A child’s perspective: Hearing the views of children who have experienced reunification

The aims of the research project were to capture children’s feedback on the child-friendly practices used in Wanslea’s reunification practice in order to:

1. Inform and progress reunification practice at Wanslea and in the sector
2. Expand the evidence-base of reunification practice
3. Expand the evidence-base for child-aware approaches to practice
4. Expand the evidence base and experience of child participation in research
5. Develop child-friendly tools that can be used to inform children of the meaning of participating in a reunification program

However, this was not where the key learning came! Following approval from the Department for Children Protection and Family Support (CPFS), recruitment efforts commenced. The research population was determined to be children who had participated in the Reunification program since its inception in 2009, and who were aged over 5 at the time of intervention. The sample population comprised of 53 children in 26 families. There were multiple layers of consent required.

The key findings and outcomes of this project relate to learning about the gap between a commitment to child participation in research and the implementation of that commitment in practice. Barriers to implementation included multiple gatekeepers, issues of timing, the limits of written communication, engaging families with statutory involvement as research participants, and accessing children’s consent through layers of adult consents. Strategies to address these barriers were identified, including multiple communication strategies, engaging research champions, recruiting at close of intervention, and being clear about why particular children were to be included. These strategies will be implemented in a different iteration of this project. The process of applying for this grant prompted Wanslea to form its own Research Ethics Consultation group, given the volume and nature of the research work in which we engage.

Jenny Terry, Sarah Mitchell and Katrina Stratton
Wanslea Family Services, WA
Email: [email protected]

Developing Australian Practice and Competency Standards for Social Workers in the End of Life and Palliative Care

This research was into the social work role when working with people who had palliative care needs. The action research project also looked at the synergy between the identified needs of people requiring palliative care, the needs of their family members and care givers and the skills and competencies of social workers working with them across different care settings.

Significant findings in relation to the role of social work included the dominance of the medical model on structures and the provision of therapeutic interventions, which for many social workers created tension with their values and knowledge base; that social work is integral to the development and maintenance of the multidisciplinary team; that the breadth of knowledge and scope of practice of social workers is poorly understood by other medical and allied health care professionals and that there is very poor integration of mental health assessment or delivery of appropriate and timely interventions into the palliative care pathway.

This research made an important contribution to getting a Commonwealth Palliative Care Grant that enabled the delivery of training for social workers and other health care professionals in understanding the bio-psychosocial and existential needs of this cohort and evidence based interventions that can make a positive impact on the lives of people at a very vulnerable time and often difficult time. This research has also helped form a foundation document for the development of Practice Standards and Clinical Practice Guidelines to guide social workers in this field of practice and across care settings.

Julianne Whyte
Amaranth Foundation
Email: [email protected]

Lost Contact: The impact on grandparents’ health and wellbeing of being separated from or denied access to their grandchildren. Implications for social work practice

For both Indigenous and non-Indigenous peoples, the critical importance of maintaining family contact and intergenerational relationships for ongoing health and wellbeing is known. Equally, the psychological damage caused by severed family relationships is well documented. Through this community-university partnership research project, the lived experiences, narratives and perspectives of Queensland grandparents who had been separated from, had lost contact with, or were denied ongoing relationships with their grandchildren were explored. In this qualitative, exploratory study, the lived experiences of 21 Queensland grandparents were documented through in-depth interviews. The findings identified that disrupted or lost contact with grandchildren impacted grandparents’ health, mental health and wellbeing, and that some grandparents’ actions to safeguard grandchildren had resulted in damaged relationships with their adult children and denied contact with grandchildren. Further, a cycle of unpredictable lost and regained contact occurred for some families, including when grandparents had been carers for grandchildren. Grandparents in this study recommended that relationships between grandparents and grandchildren need to be highly valued and upheld, particularly after grandchildren came to the attention of child protection services. The findings were presented to peers, have been published in peer review journals, and have informed further research.

Susan Gair
James Cook University

Learning to Practice: An evaluation of the social work student learning module at Southern Health

Development of the skill of integrating theory and practice, a vital part of social work students’ education, is facilitated largely by fieldwork supervisors. Monash Health had developed a social work student education module to complement the student learning experience during field placement. The “Learning to Practice” research project evaluated the benefits of this module, with particular attention to potential differences between Bachelor and Masters (Qualifying) students.

A qualitative study was undertaken with two cohorts of students at Monash Health in 2011. Students’ learning needs and goals were explored in pre- and post-placement surveys. Focus groups were also conducted with students, fieldwork supervisors and university liaison staff to provide more detailed insights, and then transcribed and coded thematically for analysis.

Significant themes emerged relating to the support students deem important in the learning process; engagement with their own learning; and reinforcement that exposure to the practical skills and knowledge of clinicians appears to promote links between theory and practice. Differences between Bachelor and Masters students were explored but were not notable. In our current political climate it is timely to evaluate the ways in which we educate and prepare increasing numbers of students for readiness for the health workforce. This research resulted in new insights into providing improved student learning opportunities and proficiencies.

Kerridge and F. McDermott
Southern Health and Monash Health, Vic
e: [email protected]

The Experiences of Aboriginal and Torres Strait Islander Students in Social Work Field Placement

The Experiences of Aboriginal and Torres Strait Islander Students in Social Work Field Placement. Entering the profession of social work may be a controversial path for Aboriginal and Torres Strait Islander people. Recurring themes in the literature highlight the profession’s complicity in forcibly removing children from their family, culture and country; in disregarding Aboriginal experience and cultural ways of helping; and in perpetuating the unchallenged influence of Eurocentrism in social work practice and education. Yet attracting more Aboriginal and Torres Strait Island people to the profession is an important response to these complex issues. To date the inclusion of Aboriginal and Torres Strait Islander people, knowledge and skills in social work practice and education is fraught at best.

This research was a collaborative research project which explored field education experiences with Aboriginal and Torres Strait Islander social work students and graduates. During individual interviews and focus groups, participants described experiences of subtle and overt, personal, organisational and cultural racism as every day features of their field education placements. These findings were examined through a lens informed by ‘whiteness’ perspectives and highlighted significant implications for social work education units and agencies involved in supporting Indigenous social work students on field placement.

Debra Miles, Dorothy Savage, Susan Gair and Ines Zuchowski
James Cook University

Exploring social workers’ experiences of working with bushfire affected families

Following the devastating Victorian bushfires in February 2009, social workers engaged with people affected by this event in a variety of roles, including Bushfire Case Manager, Counsellor and Community Development Worker. This research explored the experiences of social workers who worked with bushfire affected families in order to understand their role and the context in which they practised. It described the personal impact of disaster recovery work. Secondly, by drawing on the knowledge and experiences of these social workers, this investigation identified skills and personal qualities that can be used to inform the preparation and support of social workers responding in future disaster events or emergency recovery situations.

The research design featured a mixed methodology including an anonymous on-line survey completed by 22 participants and interviews with six social workers. Narrative data analysis was performed to identify themes. A key finding of the study was that, while social workers frequently work in contexts of uncertainty, the demands placed on practice were exacerbated by the lack of familiarity with geography, social networks and resources, as well as by higher levels of uncertainty and lack of clarity and detail relating to the event itself.

This grant was my first research funding. It meant I could pay someone to transcribe the qualitative interviews but the real value was that someone believed in me enough to support this project. The research was published in Australian Social Work (Hickson & Lehmann, 2014) and findings were presented at Rural Social Work, Australian and New Zealand Disaster and Emergency Management, and National Allied Health conferences.

Dr Helen Hickson
Email: [email protected]