Social Work - Theses
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Item"There's more to care than just healing from incisions" Examining the health care experiences of gynaecology patients with a history of trauma( 2023-12)This qualitative study examined the health care experiences of fifteen gynaecology patients who have experienced traumatic life events. Semi-structured interviews were conducted, and data analysed using a trauma-informed lens. Current research suggests that hospitalisation can expose this patient group to re-traumatisation, however there is little research on their perspectives and care preferences. This study provides an original contribution to the knowledge of the care experience of gynaecology patients with a history of trauma, particularly those with endometriosis.
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ItemWomen’s Perspectives on the Impact of Trauma on Pregnancy, Substance Use and Parenting( 2021)There are few in-depth enquiries with pregnant women affected by substance use issues that have asked them about their past trauma experiences and the therapeutic interventions they think are required in an obstetric setting to address the implications of adverse events. Large-scale studies that have examined trauma histories in alcohol and other drug (AOD) services and in the wider population suggest a significant proportion of women affected by substance use have experienced trauma. However, prevalence studies tend to refer to post traumatic stress disorder (PTSD) to understand trauma and this may not be the most appropriate reference for research or clinical interventions for a pregnant substance using population. This is a qualitative research project that explored how 12 women from the Royal Women’s Hospital, Women’s Alcohol and Drug Service (WADS) understand the impact of past trauma on recovery from alcohol and other drug use (AOD), pregnancy, healthcare, and parenting. This research also examined what interventions pregnant women affected by AOD think could assist in their recovery from substance use and trauma and improve parenting capacity in the perinatal period. Constructivist theory is the overarching methodological approach chosen for this research, that is influenced by feminist theory. Data were collected through in-depth interviewing using a semi-structured interview and included obtaining basic demographic information. Thematic analysis was used to examine the data. This research suggests that pregnant women who have issues with substance abuse are likely to be affected by interpersonal trauma that commenced in childhood. Findings suggest that structural, systems and gender related violence can compound early childhood trauma and complicate recovery processes as these women mature. The multiple and enduring forms of trauma experienced by this population resulted in detrimental implications in a variety of psychosocial domains across the lifespan and in the perinatal period. Findings suggest that PTSD diagnostic criteria will not adequately capture the impact that adverse events have had on a pregnant substance using population. This research indicates that specialist obstetric services and clinical guidelines for pregnant women affected by AOD need to incorporate theory and practice approaches related to complex trauma, neurobiology, attachment, and betrayal trauma. Findings suggest that organisations which auspice clinical care to this population need to broaden their understanding of trauma, integrate this into policy and programming, and advocate for service systems change.
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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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ItemAn evaluation of an assertive community linkage intervention for patients presenting to the Sunshine Hospital Emergency Department with suicidal behaviours( 2017)According to much of suicide prevention literature the strongest risk factor predictive for suicide is previous suicide attempt or deliberate self-harm. While many assessed at Sunshine Hospital Emergency Department are deemed to be in the low to medium risk category upon discharge, longitudinal risk factors remain. In 2009 Mid West Area Mental Health Service (MWAMHS) management identified an opportunity for service development and funding was secured to employ a senior clinician to provide a post ED Assertive Linkage Service (ALS). A primarily phone based community linkage service was considered the most sustainable model. In an effort to evaluate the efficacy of the ALS intervention and ultimately inform the design of the service a program evaluation was undertaken which posed the question; Does an assertive linkage service intervention for clients presenting to the Sunshine Hospital Emergency department with deliberate self- harm improve service access, quality of life and client satisfaction? The aim of the Assertive Linkage Study was to conceptualise a social work intervention that involved assertive follow-up, support and therapeutic linkage for those who presented to the Sunshine Hospital emergency department with deliberate self-harm, suicidal ideation or suicide attempt. Demographic and clinical characteristics of patients in this cohort were identified and the impact of the intervention was measured. Many of the findings were consistent to those of other comparable studies. The sample population risk for repeat suicidal behaviours was significant and the ED representation rates were high. The needs profile of the ALS cohort was generally diverse and sometimes complex demanding a flexible and eclectic approach from the ALS clinician. Social work practice needed to be client-centred and the ALS clinician could not assume that all who presented would be receptive to or perceive the need for formal community-based support. On balance the ALS intervention appeared to have made a positive difference to the clients’ experience after their emergency department presentation. It also had a positive impact on emergency department representation rates, client satisfaction and quality of life outcomes.
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ItemAn exploratory study of the psychosocial experiences of parents of infants diagnosed with Infantile Spasms( 2017)Infantile Spasms is a severe form of infantile epilepsy with a variable, but typically poor, long-term prognosis. The lived experiences of parents of children with this condition have never previously been examined. However, it is well understood that parents of children with other paediatric conditions, such as health or developmental conditions diagnosed in infancy or paediatric epilepsy, experience a range of stressors. This thesis explores the lived experience of mothers who care for their child who has been diagnosed with Infantile Spasms. The qualitative study design, based upon principles of phenomenology, utilized semi-structured interviews with a small sample of mothers, in order to identify in-depth narratives via a process of thematic analysis. The study highlighted three major themes of experience for mothers of children with this condition. These themes were; the process of seeking and experiencing the diagnosis of Infantile Spasms, adjusting to the child’s prognosis from Infantile Spasms and living with and making meaning from a diagnosis of Infantile Spasms. Mothers described the distress and guilt associated with the diagnosis, particularly if it was delayed. Many mothers described communication by healthcare professionals at the point of diagnosis as important, and shared positive and negative examples of communication. Mothers related that adjusting to their child’s refractory seizures or developmental deficits from this condition was challenging, and many had limited supports to assist them in doing so. However, many mothers were determined to make positive meaning from the experience, by assisting others or contributing to research about the condition. This study is the first to outline the experience of mothers of children diagnosed with Infantile Spasms. Considerations for further research and clinical practice are outlined in the study.
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ItemEffective allied health teams in hospital emergency departments( 2016)While care coordination or allied health teams have been well established in emergency departments for well over a decade, there is little research evidence that identifies the unique characteristics or roles of these interdisciplinary teams that enhance patient care and contribute to the achievement of hospital targets. Most research has tended to focus exclusively on patient outcomes alone. Within this context, this study sought to examine the particular interdisciplinary model in place within the Allied Health Team within the Emergency Department of The Alfred. It explored whether the Emergency Department staff are satisfied with the resource and if they could identify the benefits of the team to both patient care and the efficiency of the emergency department (ED). The aim of the study was to consider this issue in comparison to literature relating to other similar types of services, teamwork and team characteristic. The research design incorporated a survey of 168 Emergency Department staff. The key areas examined in this staff survey were that of the Allied Health Team’s referral processes, communication and involvement in patient care, as well the benefits of having the resource and possible improvements. The findings indicate that there was a high satisfaction with this particular service and the interdisciplinary model used. In this way, the study contributes to the literature relating to these types of resources and best practice. Respondents highlighted a need for a seven-day a week service with all allied health disciplines available. The majority of the respondents reported that the impact of the team’s work improved patient care and discharge planning. Respondents commented on the positive impact on management of the Emergency Department workload. They saw that the Allied Health Team’s input was to improve patient care and discharge, freeing them to continue to address the specific medical issues at hand. This research provides an additional lens to view the contribution of these types of teams to health care efficacy and to consider service development, educational opportunities and further research in this area.
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ItemSupporting young people following the February 2009 Victorian bushfires: The views of professionals( 2015)The purpose of this research was to better understand professionals’ views of service and community support provided to young people following the February 2009 Victorian bushfires (‘the bushfires’). Currently there is little research focused specifically on young people and natural disasters. The aim of this research was to contribute to improved levels of support for young people in the event of any future natural disaster. Ten professionals were interviewed for the research project, all of whom had direct professional experience in supporting young people affected by the bushfires. The respondents provided their views on the main topic of the study – the service and community response to support young people following the bushfires. They also contributed to investigation of the secondary topic of the study, by discussing the problems with the response to young people following the bushfires. The findings highlight the importance of supporting young people’s family relationships and peer relationships. The study also concluded that services need a high level of creativity and flexibility when providing support to young people; external services entering a community for the first time should support existing community structures such as local schools, youth groups and community organisations. Many of the findings drawn from the study hold implications for future practice and future research in natural disasters. As natural disasters are increasing in frequency globally, young people and their communities will continue to be significantly affected and the need for this type of research will also increase.
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ItemAn exploratory study into the experience of healthcare professionals caring for adolescent and young adults (AYA) with cancer when cure is no longer the goal of care.( 2015)Adolescents and young adults (AYA) with cancer are a unique subgroup within oncology due to specific medical and psychosocial needs. Palliative care in AYA oncology is largely an under researched area. Much of the research to date in palliative care has focussed on the paediatric and older adult populations. However, recent research illustrates that clinicians caring for young people with incurable disease identify this work to be challenging, although the reasons for this, and whether there are differences across professional disciplines, remains unknown. This study aimed to provide an understanding of the experience, degree of knowledge, attitudes and practices of healthcare professionals caring for AYA patients with incurable cancer. The study was based at Peter MacCallum Cancer Centre, a specialist cancer centre in Melbourne. A practice based, qualitative research methodology was employed comprising two phases. Phase I involved focus groups. Phase II involved semi structured in-depth interviews. Results are described by professional discipline. They highlight the challenges and enablers to practice, reported by professionals. The main challenges faced were: a lack of age-appropriate knowledge, experience and communication skills and insufficient organisational prioritisation of appropriate care for AYAs. The main enablers of good clinical care for AYAs were: a multidisciplinary approach to practice; age-appropriate education and skills and; support for staff. Recommendations arising from this research include a multipronged approach to improving service delivery comprising three areas. First, targeted professional development, education and training in age-appropriate care and communication. Second, greater organisational commitment to clinician skill development, increasing multidisciplinary forums for care planning, formalising staff support and improving hospital wide age-appropriate resources. Third, the development of policies, procedures and guidelines for these key areas.