Social Work - Theses

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    Client-Involved E-Collaboration for Better Access (CIEBA) to Allied Mental Health
    Hadges, Monica Deborah ( 2023-10)
    Almost 12 percent of Australians received a Medicare-subsidised, focused psychological strategy (FPS) service in private practices during 2016–17. This jumped to 18% during 2019–20, coinciding with COVID-19 (Australian Institute of Health and Welfare, 2021). Australia’s private allied mental health workforces comprise psychologists, accredited mental health social workers (AMHSW) and occupational therapists. Care coordination is complicated by interprofessional silos between allied health disciplines and medical providers involved in mental health. This AMHSW study investigates a prototype system of practice, Mi Team Mental Health (Trade Mark), to obtain stakeholder perceptions about the suitability, perceived barriers and tailored information and communication technology (ICT) functionality for client-involved e-collaboration between providers for Better Access (BA) mental health services. Although it has wider implications and aligns with current policy and practice reforms, digital care coordination has not yet prioritised client involvement as fundamental. This exploratory mixed-method research recruited a purposive sample of adult mental health consumers (N = 13) and private allied mental health therapist participants (N = 13) in Queensland and Victoria. Data obtained from semi-structured interviews were thematically analysed, merged with data from a survey of all participants and compared to existing telemental health literature specific to client-involved non-recorded videoconferencing tools in clinical practice. Even though data were collected in 2018/19, before COVID-19 dramatically increased the use of telemental health service delivery in Australia, most consumer and professional participants could see the potential of this client-centred ICT-enabled practice, noting increased transparency, choices, enhanced recovery-focused language and real-time efficacies. In Australia’s BA context of care, involving clients and bringing in providers in real-time is seen as particularly pertinent when done for reviews of mental health care plans. The most unexpected finding was that of the recovery language coevolution practice change. If consumers were involved in pre-negotiated clinical reviews via structured e-collaboration meetings, then interprofessional sensitivity to the choice of language would inherently change and become simpler. They were potentially helping all relevant providers collaborating on the screen to become inherently person-centred and better informed of other recommendations, discipline opinions or progress. This person-centred approach to collaborative multidisciplinary practice shifts the ‘expert’ stance to involve clients as essential team members. It can unite fragmented and siloed disciplines. This research advances collaborative models of digital service delivery for more sustainable shared care in Australia’s private mental health landscape. The conceptual contribution, client-involved e-collaboration for Better Access (CIEBA), offers a process for how tailored ICT systems can facilitate and structure human factor pre-screen, on-screen and post-screen practice behaviours and can be further developed to better include client voice in real time. Hybrid consulting is the new normal, with greater community acceptance, familiarity and ease of access. Within tailored e-collaboration technologies, human behaviours remain the greatest enablers (or limiters) of client involvement. This study contributes to the ecosystem culture shift needed for new FPS practices that emphasise lived experiences and encourage client involvement in care planning. Further research that includes medical disciplines operating in Australia’s BA context would help inform future CIEBA care coordination knowledge and practice.
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    Psychosocial care for families during paediatric emergencies: Development of an evidence-informed model of care
    Manguy, Alys-Marie Margedd ( 2023-10)
    The presence of parents during paediatric resuscitation and healthcare emergencies is now accepted practice in paediatric emergency departments internationally. The benefits to children, families and staff of having parents present during paediatric health care emergencies have been documented over the last three decades. However, there is limited guidance for clinicians who support families through these critical events, and scant literature on psychosocial care models or interventions for use specifically in paediatric emergency departments. The aim of this study was to develop an evidence-informed, preventive and therapeutic model of acute psychosocial care for use in paediatric emergencies. This study was undertaken within a pragmatist paradigm, using a mixed methodology including both quantitative and qualitative approaches. This included a scoping literature review, a retrospective clinical audit of the presenting population and psychosocial service response, and interviews with the parents of children who had received resuscitative care. A synthesis of these data informed the proposal of a model of care. The study adhered to the ethical requirements of The University of Melbourne and The Royal Children’s Hospital Melbourne Human Research Ethics Committees. Each phase of this study generated new evidence. The scoping review provided an overview of available models and frameworks; the clinical audit illustrated details about the presenting population and their service usage, while identifying key variables associated with parent distress; and the interviews highlighted parents’ experiences, generating important themes to consider when caring for families during paediatric emergencies. At the study's conclusion, a model for the acute psychosocial care of families during paediatric emergencies was proposed.
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    The accounts of men in an Aboriginal-controlled Alcohol and other Drug Recovery Service: contributions to relationally-informed practice
    Smith, Gregory John ( 2023-04)
    This thesis documents the experiences and knowledges of men at an Aboriginal-controlled alcohol and other drug service. The men participated in the project in the hope that their accounts would be helpful for others. The contributions of the men supported new ways of thinking about the delivery of respectful AoD (alcohol and other drug) services to Aboriginal peoples by ‘universal’ services, and for all peoples irrespective of culture and the kinds of services involved. A framework of relational theory is proposed, drawing on social construction and related contributions. This framework reflects the role of culture in determining identity, knowledge, meaning and lived-experience. The framework provided the theoretical basis underpinning the project. The men provided access to transcripts of narrative therapy counselling and groupwork sessions, which were then examined using a narrative inquiry methodology. The men described the importance to them of identities as Aboriginal men, fathers, family and community members. They gave accounts of how the service had contributed to significant developments in these identities. Key themes included the Aboriginal-managed nature of the service, providing an environment free from judgment, supporting recovery, healing and re-connection with culture. Relationships with staff differed from those experienced by the men in other services: including respect for culture, being ‘on the same level’, sharing of experiences and different approaches to role boundaries. The thesis draws on these accounts and literature to propose implications for universal services seeking to provide culturally-respectful and responsive support to Aboriginal men. Attention is then directed at implications for all services, irrespective of the particular sector or cultural context. Drawing on a range of literature, it is argued that all practice and research should be assumed to be ‘cross-cultural.’ Theory and practice frameworks are proposed to support this approach. A schema for a ‘borderlands’ concept of practice is proposed, drawing on Anzaldúa (1999), Bhabha (2004), Baltra-Uloa (2013) and others. In this schema, practitioners would draw on Western and Indigenous relational understandings. The schema is also applied to social research, drawing on Chilisa (2020). Both schemas include the Journey of the Self proposed by Bennett et al. (2011), as a metaphor for the progressive development of self-awareness and decolonisation of methodologies, irrespective of the cultural setting. The thesis brings attention to the limited explorations in literature of the contributions of the ‘therapeutic relationship’ to therapy and casework. It is also argued that contributions of peoples subject to therapy, casework and research to the professional and personal lives of practitioners are under-acknowledged. Frameworks proposed in the thesis could be used to explore these important areas of practice and research. Training materials prepared in association with the project are included in Appendices.
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    The Michael White Archive: New learnings from White’s therapeutic practice in the realms of abuse and trauma
    Semeschuk, Kelsi Frances ( 2022)
    This research focuses on the video archive of Michael White, an Australian social worker whose development of narrative therapy (with David Epston) has profoundly influenced counselling practice internationally. The main objective of this study was to extrapolate aspects of White’s work that were not fully articulated in his published writings. Specifically, the focus was on White’s practice with people with experiences of abuse and associated trauma. This informed the guiding research question: In Michael White’s video archive, what therapeutic practices and ideas did he demonstrate in responding to experiences of abuse and trauma that were not fully articulated in his published writings on narrative therapy? This research employed a theory-building qualitative poststructuralist feminist archival methodology to investigate not only the archive (the past), but also to directly influence contemporary practice (the present). Hence the following sub-questions also informed the study: How can the therapeutic practice of contemporary narrative therapists be influenced by engagements with Michael White’s video archive? What changes in narrative therapists’ practice become possible through their engagement with Michael White’s video archive? A further sub-question related to: How can feminist research be undertaken on the archive of a senior man who is no longer alive? With these research questions as guides, 21 videos were selected, reviewed, transcribed and analysed. Through this process, the researcher produced four ‘Domain’ documents that articulated her learnings/findings from her engagements with the video sample. The structure of the Domains comprised an interweaving of de-identified excerpts of transcripts from Michael White’s video archive, the researcher’s own therapeutic practice, her own discussions with practitioners, and narrative therapy literature. Informed by the aims of engaging in research that was collective, practice-based and reflective of a diversity of contemporary voices, the Domains were shared with participants in practitioner focus groups, which were made up of 45 narrative practitioners from 10 different countries. The findings from the focus groups resulted in four findings chapters in relation to: (1) narrative practice at times when the therapist is more centred; (2) narrative practice and memory; (3) narrative practice as a way of linking emotion with meaning and action; (4) narrative practice as a way of attending to gender politics and a refusal to separate practices of abuse/violence from power. Finally, in accordance with a feminist ethic, the researcher wrote five first-person commentaries to convey her own subjective learnings throughout the project. This thesis provides multiple contributions to knowledge in the field of narrative therapy and community work, including: methodological innovations that enable ethical collective engagement with the archive (and other archives) to influence practice in the present, identification of richer descriptions and multiple new concepts to aid narrative therapists in responding to those subjected to abuse and trauma, documentation of 42 ways in which the practice of counsellors in 10 countries has been changed as a result of participation in this research.
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    Clinical Supervision in Australian Youth Cancer Services
    Thompson, Katherine ( 2022)
    This thesis explores the clinical supervision within Australian Youth Cancer Services. The study uses a two-phase exploratory sequential mixed-method design to investigate the role clinical supervision plays in supporting the delivery of youth-friendly cancer care, the practice of clinical supervision within the interprofessional team environment and the factors identified as influencing the effectiveness of clinical supervision in the specialist setting. In Phase 1, qualitative data were collected from national focus groups with healthcare professionals. Following analysis, data from the focus groups informed the subsequent development of an online survey administered in Phase 2, to a larger national sample of healthcare professionals working in the sector. The results highlight the complex and demanding nature of working with young people in an oncology setting. Most participants recognised the value of clinical supervision and how it could support delivering developmentally appropriate cancer care. Only half of the participants received clinical supervision when this research was undertaken, with significant variations in its understanding and practice across professional disciplines and jurisdictions. Using these findings, in conjunction with existing clinical supervision literature and consultation with key stakeholders, a clinical supervision framework has been developed to guide its practice across Australian Youth Cancer Services.
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    A strength-based, mixed-methods, explorative approach employing the Tree of Life as an intervention to enhance respectful relationships and challenge bullying
    Stevens, Jennifer Evelyn ( 2022)
    ABSTRACT What is bullying? Bullying is a behaviour intended to intimidate or persecute someone. Although bullying generally consists of a series of encounters in which a targeted person is subjected to some kind of abuse against which he or she cannot adequately defend themselves, it would be wrong to assume that we can exclude the possibility of bullying occurring on a single occasion. Manifestly, a person can be bullied, once only, by another person or group, with traumatising results (Rigby, 2008, p. 24). Bullying is a problem regularly found among children who attend institutions of schooling. Longitudinal studies of bullying behaviours indicate that there are prevailing and damaging consequences for both victims and bullies (Hornby, 2016; Goodstein, 2013; Hymel & Swearer, 2015). In essence, there are four aspects to bullying: it is a deliberate behaviour; it is not typically a one-off incident; it involves a power imbalance; and it is harmful (Hornby, 2016, p. 2). The study employed a mixed methods approach to evaluate the ‘Tree of Life’ as a narrative intervention to address bullying in primary schools. The aim of the study was to explore whether the Tree of Life intervention could be adapted to a mainstream school setting to respond to bullying in schools and engender positive peer relationships. The design utilised semi-structured, whole class interviews to explore the nature of peer relationships. The strength-based intervention enabled the researcher to document students’ collective values and beliefs about their relationships. Pre-and post-intervention, quantitative data were gathered to measure the effectiveness of the intervention. Qualitative analysis was applied to identify the relationship between students’ value systems and their relationships with each other, both within the classroom and in the playground. The study was implemented in a Reception to Year 9 college in South Australia. Two classes of students aged 10 and 11 years of age were invited to participate in the study. The findings of this study indicate that, within a peer ecology, a personal sense of identity and collective shared understandings contributed significantly to a sense of belonging and wellbeing for students. Commensurate with the students’ sense of wellbeing and belonging within the peer ecology, there was a reduction in bullying incidents reported in the post-intervention Peer Relations Surveys.
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    Young and Positive: Young People Living With HIV in Contemporary Australia
    Wojciechowski, Lisa Marie ( 2022)
    The scientific, political and community response to HIV has changed significantly over the last 40 years of the pandemic and, with it, the lived experience of people with HIV in Australia. Young people diagnosed with HIV today receive their diagnosis in a very different context than those diagnosed in previous generations. Biomedical advances in treatment have led to U=U (i.e., undetectable viral load = untransmissible virus through sex or breastfeeding) and pre-exposure prophylaxis and rendered HIV a chronic condition. However, despite these advances in the biomedical aspects of the virus, stigmas persist. The successes of the Australian HIV response mean that relatively few young people aged 18–29 are living with HIV in Australia. While young people aged 18–29 are considered ‘adults’ in existing health and HIV services, evidence increasingly defines this age group as being distinct from the broader adult population in important ways. This means that the needs of young people living with HIV risk being overlooked in the context of health promotion and service design and delivery. The changing nature of what it means to be young—and HIV positive—in Australia today raises questions about whether the HIV service infrastructure is catering for the needs of all people living with HIV. However, very little research has explored how young people with HIV in Australia feel connected to and access HIV services and support; this is a missed opportunity to ensure they are being meaningfully recognised and supported. The Young + Positive study used a convergent parallel mixed-method design underpinned by a multidimensional theoretical approach to address this gap. Survey data (n = 60) and qualitative interviews (n = 25) were gathered between 2017 and 2019. Data were analysed using descriptive statistics and thematic analysis to explore how young people aged 18–29 understand HIV and their connection, capacity and willingness to access care and support, and aimed to identify opportunities for improving engagement around their HIV support needs. The implications of the research findings suggest that young people see themselves as a distinct cohort with specific needs in relation to their HIV and that opportunities exist to integrate young people more meaningfully into existing HIV service systems to better meet their support needs.
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    How do we understand and measure the role of attitudes in violence against women?
    Webster, Kim ( 2022)
    Men’s violence against women (MVAW) is a prevalent problem with serious health, social and economic consequences. Government policy and academic literature concerned with preventing and improving responses to this violence commonly propose changing attitudes as a key strategy. Data on attitudes measured at the individual level are also identified as indicators to plan action to prevent the problem, to monitor progress, evaluate intervention effectiveness and as a partial test of explanatory theories. Although there is a large body of literature pertaining to attitudes towards MVAW, a theoretically informed examination of their role and significance remains a gap in the literature (Pease & Flood, 2008). Specifically, there is a need to better understand the role of attitudes in different aspects of the problem. Understanding the covariates of attitudes towards MVAW is important as this can help to illuminate factors shaping attitudes as well as targeting and planning of actions to achieve change in them. The extant literature suggests that gender ideology is an influential covariate, but this has yet to be confirmed in scholarly research at a population-level in Australia. Further, there is no existing research examining the relative influence of theoretically relevant dimensions of gender ideology on attitudes towards MVAW. The Australian National Community Attitudes Towards Violence Against Women Survey is the longest running periodic survey of its kind in the world, having its origins in 1987. Some conceptual and theoretical work was undertaken prior to the 2006 wave of the survey by researchers Pease and Flood (2009). Since this time the survey has undergone substantial redevelopment and there have been further waves involving large national samples. This thesis with publication contributes to addressing the gaps identified above. First it draws on the extant theoretical literature to explore the role and significance of attitudes in the problem of MVAW. This is followed by two studies. In the first, the covariates of attitudes to MVAW are explored using data from the 2013 wave of the survey (Study 1; N= 17,517). This national probability study confirms that gender ideology has a stronger influence on attitudes to MVAW than demographic factors. It suggests the need for a more comprehensive and conceptually informed measure of gender ideology, and to investigate whether it is possible to identify domains within this broader construct. A tentative conceptual model is developed to identify key theoretical pathways between gender subordination and MVAW. In the second study, data from the 2017 wave of the survey (national probability sample N=17,542), were used, along with a new multi-dimensional measure of gender ideology, to assess the relative importance of selected theoretical domains in the Australian population, and the relative strength of the relationship between the domains and attitudes towards MVAW. Implications for further conceptual development, research and practice are discussed.
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    “What do you do that’s so special, anyway?”: A critical realist examination of the mechanisms of change in feminist-informed sexual assault counselling
    Weizenegger, Bree ( 2022)
    Abstract This research examines what is causative of positive change for victim/survivors of sexual assault when they engage in feminist-informed sexual assault counselling. Research was conducted at two, publicly-funded Centres Against Sexual Assault (CASA) in Melbourne, Australia. CASAs are grounded in a gendered analysis of violence against women, and utilise traditional feminist counselling principles. To date, the majority of research regarding recovery from the impacts of sexual violence occurs in the field of psychology, and focuses on whether a reduction of post-traumatic stress symptoms has taken place. This is, however, a reductionist perspective on the impact of sexual violence, and misses a wide range of impacts that survivors can experience. Additionally, a focus on post-traumatic stress symptoms absents the social context within which sexual violence occurs, and the place that wider socio-political forces have in shaping a victim/survivor’s experience of, and recovery from, sexual violence. Feminist counselling has historically included a focus on both the wider impacts of sexual violence and also the social context within which sexual violence occurs. However, there has been no specific research at the Victorian CASAs – and very little research at international sexual assault counselling centres – to determine what happens in feminist-informed sexual violence counselling that supports the change process for victim/survivors. This research therefore seeks to answer the question: What are the mechanisms that cause positive change in feminist-informed sexual assault counselling? To answer this primary research question, the philosophy of critical realism was utilised to conceptualise the research, and guide methodology. Critical realism has not been widely adopted within the counselling research field, and few applied examples exist within feminist research. Therefore, this thesis sought to answer a second research question in relation to the adoption of critical realism: Does critical realism represent a viable philosophy to use in the research of feminist counselling mechanisms? This research employed a qualitative design. Semi-structured interviews were conducted with 21 participants recruited via two CASAs, comprising both counsellor/advocates and victim/survivors. The data were analysed following a critical realist model of scientific activity, primarily utilising the inferences of abduction and retroduction to identify causal mechanisms. Three primary mechanisms of change were identified: 1) the counsellor’s active recognition of the victim/survivor as having value as both a human being and legal subject; 2) a shift in the victim/survivor’s false consciousness regarding who is responsible for the sexual violence perpetrated against them, and; 3) a sense of perceived control over the counselling process for victim/survivors. The findings of this research contribute to the significant knowledge gap regarding the interventions, change mechanisms, and outcomes that a feminist-informed approach to sexual violence counselling provides. The research indicates that feminist-informed counselling activates mechanisms of change that are not conceptualised or theorised in existing evidence-based treatments for survivors of sexual violence. Therefore, this research offers counsellors additional interventions to support the change process in their work with victim/survivors. The findings of this research also demonstrate that critical realism is a viable and beneficial philosophy to utilise when conducting research in both feminist- and counselling-related research.
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    Journeys of connecting: Understanding cultural connection for First Nations children and young people in out-of-home care in Victoria, Australia
    Krakouer, Jacynta Marie ( 2022)
    On the continent now known as Australia, European colonisation has greatly affected First Nations families’ lives. As in other colonised contexts, there has been enormous cultural loss experienced by Aboriginal and Torres Strait Islander peoples over time, in part because of child removal practices. In Australia, these practices resulted in the ‘Stolen Generations’, whereby 10–30% of all First Nations children were forcibly removed from their families, communities, Countries—and, by extension, cultures (Wilson, 1997). Today, recognition of this cultural loss and the importance of Indigenous children’s rights to culture is reflected in international law (United Nations, 1989, 2007) and in contemporary out-of-home-care (OOHC) policy and practice. While cultural rights are recognised and protected, it remains that cultural connection is poorly understood and inconsistently supported in Australian OOHC systems. This thesis makes a critical contribution to better understanding how cultural connection is understood, and experienced in OOHC contexts by Aboriginal and Torres Strait Islander community members, including Aboriginal young people who have lived in OOHC, in Victoria, Australia. Using a mixed-methods approach, underpinned by Indigenous Standpoint Theory, the findings highlight the complex nature of cultural connection as a process of culturally connecting, which intertwines identity and culture. It demonstrates the importance of reconceptualising cultural connection as a journey of culturally connecting, experienced over time. The findings highlight how journeys of culturally connecting are best supported by Indigenous peoples, in accordance with Indigenous relationality, to impart knowledges of mob and ancestry that are pertinent to belonging, identity and the practice of mob-specific culture. This thesis shows that it is possible to better support cultural connection in OOHC where cultural disconnection has already occurred. However, there are no easy set of solutions to realise cultural connection for Aboriginal and Torres Strait Islander children and young people within a system that produces cultural disconnection by design. The best way to support cultural connection is to prevent First Nations children and young people from entering OOHC in the first place. Our self-determination, as First Nations peoples, is paramount to this venture.