Social Work - Theses
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ItemFrom suspicion to intervention: improving responsiveness to abuse of the elderly in acute and sub-acute healthcare( 2017)Background: Elder abuse is a recognised form of family violence. It is an act of harm towards an older person by someone known to them - usually within their family network or trusted social environment. Because of the private nature of elder abuse, it remains a hidden problem. Hospitalisation has been identified as offering a “window of opportunity” (Joubert & Posenelli, 2009) to support older people at risk of abuse however very few health professionals have received any training alerting them to issues of elder abuse (Dow et al., 2013). For this reason, health professionals need to be equipped with the required knowledge to be both confident and competent in supporting older people at risk of abuse. Thesis Aims: This thesis is nested with an Australian Council Linkage Grant study - number LP0989536. The aims of the research are: • To identify the barriers to health professionals’ identifying and responding to suspected elder abuse • To examine current knowledge on elder abuse and to describe models, approaches and frameworks for identifying and/or responding to elder abuse, including the education and training of health professionals • To develop an evidence informed elder abuse training intervention for health professionals working with older people in an acute, sub-acute and Emergency Department setting • To implement the training intervention and evaluate its impact on the awareness, knowledge and confidence of health professionals working at the study site, in facilitating their responsiveness to suspected elder abuse Methodology: This research has applied a sequential, mixed methods design (Creswell, 2003); across four interrelated phases. The explanatory sequential design (Plano Clark, 2011) was fixed in that it was predetermined and planned at the commencement of the research to collect analyse, and interpret both quantitative and qualitative data in a single study to investigate the same underlying phenomenon (in this case elder abuse) and training targeted health professionals to identify and respond. Phase 1: involved an extensive examination of both peer reviewed and grey literature to scope key themes - elder abuse and the health context; theoretical perspectives, the models and frameworks in place in hospital contexts for responding to elder abuse as well as effective training strategies and approaches for health professionals. The phase involved further inquiry to identify the barriers to responding to elder abuse and how these might be addressed as part of this study. A descriptive design was used and included feedback from health professionals with different roles and years of experience at the study site to obtain their perspectives via a confidential online staff survey, focus groups and in-depth interviews (n =300). Phase 2: considered the key components needed for the training intervention – the content, the targeting or selection of trainees and effective strategies or methods for delivering the training. This phase entailed conceptualisation and decision-making in relation to the knowledge, ideas and insights generated by the findings of Phase 1 to inform the development of the training intervention. Phase 3: focused on application of the knowledge synthesis and decisions made in Phase 2 to inform development of the tools and products for the training package at the study site. In this phase, consideration was given to relevant features of the policy context. This phase describes the outcomes achieved at the study site which includes a governance framework relating to the protection of vulnerable older people which was developed and implemented to support the roll out of the training intervention as part of this study. Phase 4: applied a pre - post test to determine the effectiveness of the training intervention. The training intervention was evaluated by measuring changes in knowledge and confidence to act on suspected elder abuse in a hospital setting for a targeted group of experienced health professionals. This phase used a quasi – experimental design to test the effectiveness of the training intervention. Results: The outcomes of this study have resulted in identifying and analysing the perceptions, barriers and knowledge of health professionals regarding the problem of elder abuse. This has included targeted training through a competence based framework and the development of a governance framework, hospital wide policy and a model of care. The findings from the evaluation of the training intervention demonstrate that the training package which included an evidenced informed training DVD was successful in increasing the participants’ level of suspicion and the level of confidence to deal with suspected elder abuse cases. There have been several other unintended outcomes of this research. While the training package was developed to meet the aims of this study there have been significant changes in clinical practice at the study site. Training health professions in relation to indenting and responding to elder abuse has been embedded into practice and has resulted in significant systems change including ongoing data collection at the study site relating to cases of suspected elder abuse.
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ItemExperiences of anger following the 2009 Black Saturday bushfires: implications for post-disaster service provision( 2018)This study investigates the question “What are the experiences of anger post-disaster?” to better understand anger following disaster and establish service provision guidance. Theoretical anger conceptualisations typically engaged in disaster recovery environments are psychological and relate to psychopathology, particularly post-traumatic stress disorder (PTSD). This research engaged anger-related theory more broadly including both psychological and sociological theory. This qualitative research was a nested study within the Beyond Bushfires: Community, Resilience, Recovery research study. A total of 38 participants including both community members and service providers were interviewed individually and within focus groups to explore anger experiences. The service provider participants were from a range of roles: direct service providers, managers and senior disaster leaders. The breadth of work forces providing recovery services were also represented: three tiers of government, emergency services, community health, counsellors, case-managers, emergency responders and hub staff. Data were gathered and analysed utilising a discourse-based narrative approach called the ‘social interaction approach’ (SIA). Anger was found to be an active emotion post-disaster: immediate, intense, and frequent, extreme, prolonged, destructive, productive, justified and connected to other emotions. Anger was experienced differently post-disaster, nonetheless, triggers for anger are considered by service providers and community members to be about real events. Traditional gendered identities within regional areas and accompanying expectations of behaviour, seemed to influence experiences and expressions of anger including aggression, violence and family violence. Analysis of community member and service provider data highlighted factors influencing anger including: a sense of community control over recovery; methods of leadership including transparency and honesty and bottom-up processes; equity of provision of financial assistance, which was integral within and between communities; and expectation in terms of whether disaster responders established clarity around services that could be provided for communities. There were limitations with the research: the research was conducted with a culturally homogenous group following one disaster in one region of Australia limiting the scope of the data, and lack of a circular process for participants to review the conclusions drawn resulted in a lost opportunity to confirm conclusions. Numerous potential future research projects are recommended, including research developing an evidence-based framework of service intervention with anger, as well as understandings of anger, gender, violence or family violence and service provision. Ten recommendations for service provision are offered as guidance outlining the approaches that a service provider could take to engage with and respond to anger within a disaster recovery environment.
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ItemParenting after Black Saturday: lived experiences since the 2009 Victorian bushfires( 2018)In the aftermath of disasters, parenting is often recognised for its influence on children’s wellbeing and recovery. Research has also shown that the parental role has implications for parents’ post-disaster mental health as well. However, little is known about what the experience is like for parents themselves, particularly in Australia. In February 2009, catastrophic bushfires burned across the state of Victoria resulting in tragic loss of life, significant destruction of property and land, and disruption to communities. This study explored what it has been like to be a parent since the 2009 Black Saturday bushfires. Semi-structured interviews were conducted with 22 parents (19 mothers, 3 fathers) who, along with their dependent children, survived the Black Saturday bushfires. The interviews were conducted around 6-7 years following the fires, thus offering a longer-term perspective than much of the research in this area to date. An inductive thematic analysis was conducted to explore parental experiences over the years since the disaster. The findings provide insight into parents’ experience of adjusting to life after the fires as that of being forced into a new normal. Parenting after the bushfires stood out for many as being different and difficult. For some, the extent or nature of the changes were spoken about as a loss of a valued part of their identity. Some changes stood out as new situations, ones they had never expected to face as parents. There were also challenges they considered typical of parenting which were amplified after the disaster and now felt beyond parents’ control. This study identified five parenting challenges faced by participants in the aftermath of Black Saturday: (i) parenting flexibly and finding new strategies; (ii) sticking to their values; (iii) being present and available; (iv) being patient and tolerant; and, (v) negotiating differing needs. The challenges showed ways in which the post-disaster environment (e.g., the number of demands, changes within their communities), parental mental health (their own or their partner’s trauma and grief reactions) and their children’s mental health at times undermined their efforts to be the parents that they wanted to be. Parental experiences of supports and services showed the value and nuance of relationships and indicated ways in which formal services can facilitate or strengthen social support. Additionally, the importance of reinforcements with helping children cope as well as services to assist parents’ own coping was highlighted. The findings also speak to the critical significance of childcare (in particular the availability of safe and trusted places for children) and value in facilitating opportunities for time together as a family away from the onslaught of post-disaster demands. This study contributes to understanding the complexities of parenting and unique experiences of parents post-disaster. It has provided detailed insight into parental experiences following the Black Saturday bushfires offering an opportunity to acknowledge, normalize, and validate such challenges.
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ItemThe practice of evaluation in Australian child and family organisations( 2018)Despite reports that the demand for evaluation is at an all-time high, little is known about how child and family organisations in Australia are engaging with evaluation. Also unknown is what helps and hinders these organisations in their evaluation efforts, and how the professionals that comprise their workforce perceive evaluation. This research study surveyed 66 Chief Executive Officers, 46 internal evaluators, and 122 practitioners, to understand how child and family organisations practice evaluation, what acts as barriers and enablers to this practice, and what perceptions of evaluation are held by professionals. The study found that evaluation is understood differently by different professionals working in child and family organisations. Despite the majority of CEOs reporting clear purposes and internal motivations for their organisation’s engagement with evaluation, it was found that in some cases, the form of evaluation being undertaken and the type of data being collected may not meet that purpose. Overall, perceptions of evaluation were nevertheless mostly positive. From these findings, a critical elements framework for evaluation practice in child and family organisations has been proposed. It includes four domains: instilling a performance mindset for evaluation; assessing and communicating the purpose for evaluation; enabling the environment for evaluation; and optimising evaluation outcomes. Results of this PhD study can be used by child and family organisations across Australia to inform how they practice evaluation and how it can be used to optimise the outcomes of programs and services and, most importantly, for the beneficiaries they serve.
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ItemIdentifying the key factors shaping the construction of a social work identity in mental health( 2018)A social work identity is ‘difficult to grasp’. Relevant professional literature is scarce, though some authors have recently acknowledged that ‘Social work identity is a contested concept.’ (Mackay & Zufferey, 2015). The notion of a distinctive and unique social work identity is not well recognised or articulated by experienced practitioners, nor does it appear to be adequately emphasised in social work education and training programs. These considerations have significant implications for the profession as a whole. They become especially critical in mental health settings in which adherence to their profession’s well-established values, theories and practice standards may bring social workers into conflict with views, norms, and practices mandated by the prevailing biomedical status quo. There is limited research on social work identity in mental health settings and even less pertaining to students’ efforts to construct a professional identity in such paradigmatically unfamiliar environments. The primary objective of this research was to examine how students understand, experience, and articulate their developing professional identity and to identify specific factors influencing the ‘identity work’ of social work students immersed in mental health settings. Students from one Victorian university undertaking placements within mental health were invited to participate. The project utilised a qualitative methodology with focus groups held prior to placement and individual interviews towards the completion of participants’ 70-day (500 hour) placements. Inductive and deductive methods were used to identify key themes in the resulting data. The thesis presents findings from interviews with students at the end of 70-day placements in mental health settings. Key findings relate to what participants bring to the placement, what they observe, and what they do during the placement. Responses to specific questions about identity were considered. As participants rarely commented on their experience of supervision, reflective processes were also investigated. As services providing mental health care and treatment are paradigmatically unfamiliar to social work students, interviews were analysed for evidence of resistance to the dominant biomedical discourse. These themes were synthesised in an effort to identify key factors contributing to the construction of a social work identity in mental health settings. When asked to talk about their developing professional identity in relatively unstructured interviews students struggled to relate to the concept of a ‘social work identity’ and were unable to articulate what it might be or involve. Students were more at ease describing specific roles they had performed during their placement. However, analysis of their reflections on what they brought to placement, what they observed, and what they did during placement provided rich descriptions of a range of the factors which contributed to and influenced their developing social work identity. Interviewing students on mental health placement highlighted some of the difficulties they and others have relating to the concept of a social work identity. Further research will be required to gain greater insight into factors influencing social work identity development in these unfamiliar settings.
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ItemThe Victorian Centres Against Sexual Assault: responding to victim/survivors with intellectual disability or complex communication needs( 2018)Rates of sexual assault experienced by people with intellectual disabilities and complex communication needs are considered to be higher than for others in the community. In addition, people with disabilities can experience many barriers when trying to access support services in the aftermath of sexual assault. In the state of Victoria, Australia, the Centres Against Sexual Assault (CASAs) are funded by government to provide crisis support, counselling and advocacy to victim/survivors of sexual assault. Little information is available to guide CASA counsellor/advocates on the most helpful approaches to assist people with intellectual disabilities or complex communication needs in their recovery after sexual assault. In this exploratory study, counsellor/advocates from the fifteen Victorian CASAs were invited to participate, with 83 workers (29.4% of the workforce) completing an online survey. A mixture of quantitative and qualitative data was collected. The types of interventions used by counsellor/advocates, goals for counselling and advocacy, therapeutic approaches and adaptations, and use of counselling resources were investigated. Barriers to access were also explored. Statistically significant differences in counsellor/advocates’ training, experience, and confidence emerged from the data in relation to service provision to people with complex communication needs in comparison with victim/survivors with an intellectual disability. In addition, participants with experience in working with both groups had provided a service to a larger number of people, used a broader range of interventions, and reported a greater number of goals to have been met than those who had worked only with people with intellectual disabilities. Counsellor/advocates infrequently used a range of counselling and advocacy resources, however those who had used them found them helpful and expressed greater confidence in working with people with complex communication needs. Factors in successful interventions were described by respondents, and included making adaptations, utilising the person’s support network, being client-centred, having a positive therapeutic relationship, and taking time. Adaptations and adjustments to counselling used by counsellor/advocates were explored, with the most commonly used found to be those most easily accessible in the workplace. Findings provide direction for the CASAs in the enhancement of service provision for people with intellectual disabilities and complex communication needs, alongside highlighting the existing practice wisdom within the sector. Key recommendations for the CASAs from this study include drawing on the existing knowledge of experienced workers within each service to support and mentor fellow counsellor/advocates, along with building flexibility into the service model, to allow for adaptations and adjustments such as more sessions, outreach sessions, and more preparation time. Furthermore, working collaboratively with people with disabilities, disability advocacy groups, and disability organisations is needed to increase referrals and develop worker knowledge across the sector.
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ItemComplexity and service provision in the Royal Children's Hospital's Family Choice Program( 2017)Due to continued advancement in medical care and technology, the number of children living with complex medical care needs is increasing. Despite this, understandings of this group of children and the programs that support them are limited. This research aimed to understand the medical and psychosocial complexity of the children and families access the Royal Children’s Hospital, Family Choice Program (FCP) and how this complexity impacts on service provision, including respite and case management services. In doing this, the thesis uses an exploratory approach to understand the documented medical complexity of the children and the documented psychosocial complexity of their families. The thesis explores the service provided within the FCP, specifically the respite and case management services. The thesis considers the relationships between these variables to explore the relationship between medical and psychosocial complexity and the provision of service within the FCP. The study reviews the files of 65 children accessing the program over a six-month period (October 2014 – March 2015). A clinical data mining approach was used to collect the data, which involved collecting quantitative data from three program-based sources: The Family Choice Program Plan (FCPP), psychosocial assessment, and The Care Manager (TCM) a documentation system used by the program. The descriptive data were explored initially in three categories; medical complexity, psychosocial complexity, and service provision (incorporating respite and case management involvement). This descriptive data was then analysed further through a one-way repeated measures of analysis of variance (ANOVA) test to explore the differences between multiple variables to understand their impact on the dependent variable. Doing this meant it was possible to understand the impact of medical and psychosocial complexity of the provision of service within the FCP. The thesis provides new understandings and knowledge from an exploratory program-based perspective on the medical complexity of children; reviewing the type and frequency of the medical interventional care needs of the children accessing the FCP. It also provided information about the medical ‘vulnerability’ and/or ‘intensity’ of the child’s care needs in line with the program definitions. A review of the documented psychosocial complexity of the families of children with complex medical care needs found 27 documented stressors over ten psychosocial themes. The study also found how frequently these psychosocial stressors were documented for the group. Additionally, the study provides understanding of the service provision within the program; including respite and case management involvement. Respite was reviewed by considering the number of children accessing respite and the hours of respite allocated each week. Further, it explored the level of case management involvement provided to the families accessing the program. This study found a relationship between the documented medical complexity of the children, the psychosocial complexity of their families, the presence of respite and the level of case management involvement provided. This knowledge provided an understanding of how medical and psychosocial complexity impact on service provision within the program, also providing further understanding on children with complex medical care need internationally. The implication of these findings for program research and practice are considered.
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ItemArchitecture and the design of therapeutic environments: the case of self harm( 2017)This thesis finds that specific design interventions in the spaces providing therapy can improve therapeutic outcomes for those who self harm. Therapeutic interventions for this service user group typically involve various forms of talking therapy, and/or medications. However these service users are amongst the most clinically challenging to treat. The physical environments in which therapy takes place have not been thoroughly examined for their contribution to therapeutic outcomes. Despite a large body of literature affirming the links between good design practice and mental wellbeing, there is a paucity of research addressing specific environmental needs of service users who self harm. Further, existing design guidance is often generic in nature, describing broad principles to be achieved through design, but offering little tangible advice for the designer to integrate these principles into a realised built environment. The research involved an exploratory qualitative design that utilised a triangulated strategy; the method of data collection included three data collection methods: systematic literature review, multi-stakeholder interviews and case study observation. Key findings from the scoping review included the paucity of design guidance for therapeutic environments and counselling workspaces specifically, and that there is no published research examining the design of therapeutic spaces for individuals who self harm, specifically. Key findings from the semi-structured multi-stakeholder interviews included a deeper understanding of the perceptions of spatiality of individuals who self harm, aspects of therapeutic environments that are supportive or unsupportive and in what ways this occurs, and potential design strategies to assist therapeutic activities and psychological engagement. Analysing built therapeutic environments found that there is a limited inclusion or implementation of design recommendations uncovered in this research in existing built spaces. Through the analysis undertaken of the literature, interviews with service users, therapists/counsellors, carers, architects and design researchers, together with a case study examination of existing built therapeutic environments, a series of design recommendations were derived. These principles have been developed from environmental aspects which were commented on by those who self harm, and supported by other interview participant groups and observations in the field. The findings from this thesis are indicative that the design recommendations assist therapeutic outcomes. However, as indicated through the exploratory qualitative analysis undertaken, the built environment is a meaningful agent in therapy. What emerged from the study was the notion that for individuals who self harm, the built environment is not merely the housing of therapy, but an active participant in the therapeutic process. The counselling workspace may be a platform for therapy to unfold in a physical sense, providing aspects such as physical privacy and safety features, but offers many more psychological support mechanisms if designed/manifested in a particular way, including psychological safety and relief, negotiation of relationships, non-verbal communication opportunities, increased body awareness, reduced dissociation, increased sensory engagement and perception, and opportunities for the development of the self. The counselling workspace has active roles in therapy, including being a mediator between therapist and service user and helping to clarify and establish boundaries, being a vehicle for communication, and being a testing ground for the problem solving abilities and aspects of the self. When the built environment design initiatives outlined in this thesis are considered carefully and articulated through design and the curation of space, architects/designers may provide a platform of engagement through counselling workspaces, resulting in positive therapeutic effect. If the design recommendations were to be integrated into the built environments delivering mental health services to individuals who self harm, then the misgivings, difficulties or negative psychological interferences reported by the service users would be mollified and/or eliminated. Therefore, therapy and therapeutic outcomes would be assisted. In this situation, counter-productive stimuli are removed or reduced, assisting the service users to maximise the benefits of their therapy.
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ItemThe experiences of parents of children who have dyslexia in Victoria, Australia: a social justice perspective( 2017)This study aimed to shed light on the experiences of parents in Victoria, Australia with a school-aged child diagnosed with dyslexia. Utilising a mixed method research design, the study examined the experiences of parents as they navigated the pathway to their child’s diagnosis and attempted to gain support for their child’s learning disability post diagnosis. Applying a social work, social justice lens, this study examined the impact of the current social policy status of dyslexia on parents and their children as they sought recognition and support within the education system. Nancy Fraser’s theory of need recognition (1989) was utilised to provide a theoretical lens with which to analyse parents’ experiences and provide insight into the current status of the recognition of dyslexia in Victoria. The findings provided insight into the struggle by parents for the recognition of the needs of children who have dyslexia. The experiences of parents presented in the findings of this study illustrated the complex terrain parents traversed in order to have their child’s dyslexia identified and to obtain support for their child’s learning needs. The findings demonstrated that parents of children with dyslexia in Victoria navigated, largely unsupported, the domain of the educational system and were predominantly responsible for identifying early signs of their child’s dyslexia and funding resources to meet their additional learning needs. As parents encountered this landscape, they negotiated many professional terrains in a largely unregulated marketplace of services and resources. Despite the existence of the Disability Discrimination Act 1992 (Cwlth) and the Disability Standards for Education 2005, the findings demonstrate that neither the state, nor the Catholic nor the independent school sectors consistently recognised or addressed the needs of children with dyslexia. This was largely a consequence of the absence of a mandated overarching educational policy framework and the consequent lack of comprehensive provision of pre-service and in-service teacher training in relation to dyslexia and resources for the identification and remediation of dyslexia. The failure of the state to provide resources resulted in an over-reliance on parents to support their child’s learning needs. This contributed to social injustice in the form of inequity for children, as the provision of resources was dependent on factors associated with children’s family of origin, economic context and the extent to which the child’s school was prepared and able to allocate resources to children with dyslexia. This study demonstrates that the lack of structural recognition of dyslexia results in a paucity of knowledge relating to dyslexia which is exacerbated by the lack of allocation of consistent and comprehensive provisions and resources to accommodate the learning needs of children with dyslexia. These deficits lead to discrimination in relation to the provision of education to children with dyslexia. Recommendations from this study include policy recognition of dyslexia, mandated teacher education relating to dyslexia and the allocation of resources for the identification, remediation and accommodation of students with dyslexia in the education system.
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ItemExploring medical students' perceptions and experiences of bullying amongst hospital-based doctors( 2017)Historically, in Australia, the topic of bullying amongst doctors has been investigated sporadically. This has recently changed with an increase in research being conducted. However, the focus of this research is often on measuring and establishing the prevalence and impact of bullying in medicine, and is sometimes limited to a specialty, such as surgery, or a particular behaviour such as academic humiliation. Furthermore, both nationally and internationally, the settings for many investigations are educational rather than practice ones. Much research on medical students, and abrasive, bullying behaviours, focuses on gauging prevalence and impact, and often labels these behaviours as something other than bullying. To date, medical student perceptions and experiences of these bullying behaviours amongst hospital-based doctors have been overlooked. The aim of this study was to extend the current understanding of medical students’ perceptions and experiences of workplace bullying amongst hospital-based doctors. To achieve this aim, the research centred on three core questions, asking how medical students perceived and experienced bullying amongst hospital-based doctors, and how power and oppression dynamics might contribute, or extend, the current discourse on bullying and medical student insights and experiences. The sample targeted in the research were medical students who attended one of the medical schools in the State of Victoria, Australia. The participants did not necessarily need to identify as having experienced or witnessed bullying, rather recruitment was based on having insights on hostile or abrasive behaviours amongst hospital-based doctors, therefore based on having some clinical experience within a hospital setting. The research design was qualitative in nature. Sixteen medical students participated in semi-structured interviews. The findings of this study provide an expanded understanding of how medical students perceive and experience bullying amongst hospital-based doctors. New knowledge identifies that using theories, and an associated language of oppression, may assist in understanding further why some medical students report using criteria to define bullying behaviours that is different from that found in policies or legislation. In addition, these theories may explain why medical students will not report bullying behaviours even if they have experienced or witnessed the negative impact of it. Models of oppression can also assist in illuminating why some medical students suggested that bullying behaviours amongst doctors were inevitable or even, at times, reasonable. The individualistic focus of existing studies was also identified as a key issue. Medical students’ inability to explain contextual factors. and dynamics inherent to much bullying amongst doctors was also noted. This study has generated a number of implications for medical education and further research, including the observation that disciplines outside medicine may have unique potential for powerful contributions to the current conversation. The research confirms the complexity of the issue, and establishes the need to keep the subject of workplace bullying amongst doctors firmly on the agenda.
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