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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ItemSocial work education in Aotearoa New Zealand: Advancing an equity agenda through democratising and decolonising policy, programmes and practice( 2020)Purpose The profession of social work has a long-standing commitment to addressing issues of equity and disadvantage. Giving effect to democratising and decolonising practices in social work education has nevertheless presented challenges for the discipline. An integrated three-part qualitative study was undertaken to consider how social work education in Aotearoa New Zealand operationalises its commitment to an equity agenda particularly through democratising and decolonising practices across three influencing domains: policies, programmes and practices. Methods Three mixed-method, qualitative waves of research were undertaken. A document analysis of the global, Aotearoa and Australian sets of social work education standards formed the first wave. This analysis raised questions about how the equity-based agenda, conceptualised in the twin themes of democratising and decolonising practices, was being operationalised in programmes and in teaching. In the second wave of research, interviews were undertaken with social work education leaders to examine how these two themes were being operationalised across programmes of social work education in Aotearoa. In the third wave of research, focus groups and interviews were undertaken with social work educators more broadly to examine how the equity themes were being operationalised in teaching practices in tertiary institutions in Aotearoa. Findings The findings from the first wave of research identified a number of equity themes, in particular: service user and student participation, student representativeness, indigenous rights and political action, gender and cultural equity, and equitable access for students. The findings from the document analysis specifically relating to democratising and decolonising practices informed Waves 2 and 3 of the research. In Wave 2, leaders identified opportunities for advancing democratising and decolonising practices across three spheres: first, by supporting students, including engaging with the student voice, maintaining systems of representation and creating a diverse student cohort; second, by recruiting, maintaining and supporting a diverse workforce and, in particular, developing an equity-focused workforce strategy to support these aims; and third, by using leadership to advance an equity-focused social work education. In Wave 3, social work educators highlighted the challenges in operationalising democratising and decolonising teaching and learning practices. In particular, they identified the importance of addressing issues of privilege: understanding settler and White privilege and the responsibility for addressing it in the classroom context; broader issues of privilege, including racism, sexism, classism, heterosexism, ableism and ageism, and the value of an intersectional approach; the relationship between regulation and privilege; and the importance of developing decolonising frameworks for practice. Conclusion This thesis highlights both the challenges and the opportunities for developing democratising and decolonising programmes and practices in social work education in Aotearoa. In giving effect to positive change, the findings of the thesis reinforce the importance of values-based policies and practices, particularly when exploring the complexities of navigating a bicultural social work education. A number of frameworks for action are presented, including a leadership framework identifying key enabling elements that are important to the creation of equity-based programmes, and a framework supporting teaching practices that are decolonising and Treaty based. The importance of advancing policy, programme and practice equity through positive activism is reinforced.
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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 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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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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ItemChanging paradigms in social work field education: an exploration of a team-based rotation model of field education( 2016)Workforce shortages across the Australian health services sector have resulted in government incentives to increase capacity for clinical placements for allied health professions, including social work. The injection of government funds in 2010 enabled an investment in trialling innovative approaches to field education. The overall objective was to optimise capacity for the provision of quality student education. These developments set the scene for strengthened partnerships across education and health services sectors. The University of Melbourne joined together with five major hospital networks to explore a team-based rotation model focused on optimising capacity for growth in social work clinical placements, whilst maintaining the overall quality of practice learning for the social work profession. The model was trialled in the participating organisations over three years, 2011-2013. The aim of this study was to explore how a fundamental change in the placement model could impact and the experiences and outcomes of field education; from the perspective of students, agency educators, agency managers and university staff. The study adopted a mixed methods design and was conducted from an insider-research stance. Four online surveys were used during the fourteen-week placement block in each year of the trial. Post-placement individual and group interviews then followed these surveys each year. The thesis captures the research journey and reports on the findings across the three years. The findings show a sustained growth in placement capacity with the implementation of the model. However, the views of participant groups on the quality of the teaching and learning experience are mixed. Ultimately, the study highlights the complexity of field education and points to a set of foundational factors influencing the quality of the learning experience regardless of the education model in place.
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ItemThe predominance of American influences on the establishment of social work education at the University of Melbourne 1920-1960( 2015)This dissertation examines the period 1920-1960 during which social work education in Melbourne, the capital city of Victoria , was first established outside its local university, the University of Melbourne, then later adopted by the University when judged to have reached a suitable academic standard. It explores the extent to which its founders drew on British and American expertise using Everett Rogers' theory of diffusion of innovations through communication in networks as its theoretical underpinning. There is a widely held belief , among older social work alumni, that the course at the University of Melbourne originated from British medical social work. An examination of archival material both in the city of Melbourne and internationally has found that from the outset Victoria's social work proponents actively chose to follow American social work educational models, while drawing to a lesser degree on British expertise. The dissertation traces the emergence of social work education in America and Britain and discusses the reasons for their divergence in the early twentieth century. It outlines the parallel development of social work education in three Australian capital cities, Sydney, Melbourne and Adelaide in all of which social work education commenced outside the local universities. The influence of the traditional precursors of social work education, particularly the Charity Organisation Society, are investigated. The role of Jocelyn Hyslop, the founding Director of the Melbourne social work programme (which began outside the University in 1933) and her Melbourne employers and supporters who achieved success in 1940 in having the University take over social work education from the inaugural voluntary management committee is documented. The dissertation then traces the Department of Social Studies' fortunes throughout World War II and the period of post-war reconstruction tracking the way in which the standards of the course were guarded and an increasingly American approach was adopted. It shows how despite the subsequent University of Melbourne course losing some impetus in the 1950s the establishment of a range of national Australian networks and the emergence of new opinion leaders saw social work education continue to flourish. This American influenced Melbourne course made a crucial contribution to the establishment of social work education in Melbourne and nationally.
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ItemSafety and resiliency at home: voices of children from a primary care population( 2015)Almost one quarter of Australian children experience family violence perpetrated by their father or step father which has significant health outcomes across the lifespan. However, some children who experience family violence are thought to be resilient. Children lack opportunities to have their voices heard, therefore children’s own understandings of their safety and resilience are often missing. As a site of early intervention, primary care is well placed to respond to these children. The aim of the research was to hear children’s voices about their safety and resilience in the context of family violence, and to determine an appropriate primary care response. Qualitative methodologies underpinned the research which involved semi-structured interviews and focus groups with 23 children and 18 mothers from primary care settings, all of whom had experienced family violence. I developed a child-centred approach utilising ethical and safe methods. A theoretical framework of ethics of care and dialogical ethics informed the research. Hermeneutic phenomenological analysis revealed that children and mothers understood children’s safety in the context of: awareness of family violence; whether the violence was named and by whom; who provided care and protection; and children’s sense of trust in relationships. Resilience was understood differently by children and mothers. Children understood their resilience according to social recognition of their achievements and talents. The children’s meaning was independent of adversity and aligned with the concept of relational self-worth. Mothers however, only understood children’s resilience with reference to the adversity their child had experienced. This was underpinned by the mother’s sense of responsibility for the adversity and the child’s apparent resilience despite this adversity. Understandings of safety and resiliency were further analysed to reveal the key finding that children required agency to negotiate their safety in the context of family violence and post-separation. A ‘model of children’s agency’ was developed to reflect the four factors that facilitated children’s agency: physical and emotional distance from the perpetrator; awareness of disruption or danger in the parental relationship; modelling of safety in relationships by non-violent adults; and the child’s sense of co-constructing family resiliency. To inform an appropriate primary care response, I also sought children’s and mothers’ understandings of primary care. Their insights focused on: questioning the role of primary care to respond to children experiencing family violence; the importance of knowing and modelling within the child-mother-health practitioner relationship; and the expectation that the health practitioner would facilitate communication about family violence. Using these insights, I proposed an approach based on collaboration, relationship and shared language, an ‘informed trialogue’ within the child-mother-health practitioner triad to foster children’s agency in the primary care consultation. The ‘informed trialogue’ guides the health practitioner to encourage and impart the ‘model of children’s agency’ by advocating physical and emotional distance from the perpetrator; building child awareness of family violence; supporting the modelling of safety in trusted relationships and demystifying family resiliency. The ‘model of children’s agency’ and the ‘informed trialogue’ bring children’s voices to the fore to inform primary care and those that work with children experiencing family violence.
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ItemConsumer centred care in nephrology social work: understanding the psychosocial experiences of adult patients living with chronic kidney disease and their carer( 2015)Introduction Chronic Kidney Disease (CKD) imposes a substantial burden on individuals and communities. It can have a profound impact on the wellbeing and quality of life of the individual diagnosed with the disease and also on their family. CKD is associated with complex psychosocial problems in both patients and their primary carer. Individual quality of life can be compromised through the experience of anxiety and depression, a reduced sense of hope, limited coping strategies and reduced social supports. The complex nature of CKD can result in a reduction in quality of life and can affect dyadic adjustment and lead to the development of learned helplessness in both the patient and their carer. Aim The aim of this longitudinal study was to explore the contextual and complex nature of the psychosocial experiences and implications of illness on both adult patients experiencing CKD and their carers. This was done to provide insight and understanding into the individual patient’s experience of CKD including the impact on their quality of life and the psychological experiences of the disease including hope, depression and anxiety, social support, coping. It also aimed to provide insight into the implications of the illness on dyadic adjustment and learned helplessness and into the psychosocial impact of CKD on carers. Method This is a case series study exploring a number of identified issues relevant to the renal population. It used previously validated tools over a 12 month period to explore the research questions presented in the thesis. "Controls" were not used as the published data already showed what the “norm” was or what the expected responses would be within a similar underlying population. The goal was to compare the current group of participants against the established norms and the patient scores against their carer’s scores. The number of participants were chosen by looking at other published studies exploring a similar question in a similar population. To support this methodology, minimal clinically important differences (MCID) were reported for the tools where a pre-established MCID had been reported in the literature. Findings This study has shown that: • Quality of life was compromised in the current patient participants. In particular the symptoms and problems of kidney disease, effects of kidney disease and physical component summary subscales of the KDQoL were the most compromised subscales in this population. These results are reflective of those previously reported in the literature. • In relation to carer perceptions of quality of life in patients, there was a lack of agreement between patient and carer perceptions of the patient’s quality of life. • In the overall participants, hope was not significant and did not correspond to high levels of quality of life. The participants reporting high levels of hope, however, also reported above average quality of life scores. • Anxiety and depression were not significant factors for the overall population, although higher levels of anxiety were reported by both patients and carers when compared to depression. This finding contradicts the previously reported literature. • The participants in this study used more emotion-focused coping strategies and fewer problem-focused coping strategies and this assisted them to develop coping strategies for dealing with illness intrusiveness. • Social support was high in the participants and in particular perceived support from family and significant others were the most frequently reported sources of social support. This high degree of support was reflected in normal to mild anxiety and depression scores for both patients and carers, thus supporting a limited number of studies in the literature. • Learned helplessness was not significant in the current study participants. Depression and anxiety were not significant in the minimal number of patients and carers who reported high levels of learned helplessness. • Dyadic adjustment was reported in fifty percent of the participating dyads in this study. Overall dyadic adjustment and in particular dyadic cohesion and affectional expression resulted in lower incidence of depression and anxiety and higher reported levels of hope. Conclusion In conclusion, this thesis offers a comprehensive, detailed and deeper understanding about the psychosocial experiences of patients across all stages of CKD and their nominated carer from an Australian perspective. CKD has a profound impact on patients’ and caregivers’ physical, mental and emotional wellbeing, relationships with family and friends, lifestyle, and roles and responsibilities. Despite facing the continuous and overwhelming challenges of CKD, the patients and caregivers in this study used an array of emotion-focused coping strategies, and formal and informal social supports to maintain a reasonable quality of life. Suggestions for future research and implications for social work practice are made.
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ItemYoung men speak: a study of mid-adolescence and masculinity( 1999)This study investigated the effect of dominant notions of masculinity in the lives of mid-adolescent males. A qualitative research design, based on the analysis of transcripts of in-depth interviews with eight sixteen and seventeen year-old young men, confirmed the existence of a harsh masculine culture that impinged significantly on their behaviour and attitudes. The findings are identified a possible turning point in young men’s lives, where they begin to develop highly valued close relationships with a small group of friends or mates, with whom they share and emotional bond, and around whom they feel less pressure to prove their manliness. While they described the possibility of sharing thoughts, and feelings and experiences, there were nevertheless limits to what was allowed to be spoken even between the closest of friends. These restrictions were attributable to the sanctions that operated to maintain an environment significantly influenced by dominant notion of masculinity, and in which these friendship groups were embedded. The young men conformed to the tacit restrictions on intimacy, from fear of exposing themselves as weak or poorly skilled. Nevertheless, participants demonstrated a developmental readiness for intimacy, and were beginning to experience emotional engagement with male or female peers. The study suggests the need for a new concept that values and acknowledges a sense of emotional connectedness in the absence of sharing verbalised thoughts and feelings. With intimacy constrained, and little discussion of personal issues, young men had inadequate knowledge of the complexity of problems that might confront them, and few models of coping strategies. Consequently, they risked feeling isolated and unresourced in times of stress. Similarly, while they recognised signs of stress in others, they had few helping skills. In any case, dominant masculinity required that young men handle their own problems, without showing any vulnerability. Counselling was seen as an ultimate failure of manliness. There were indications of intergender rivalry, and despite attempts to be fair and equitable, an underlying belief that men should be in control in families and relationships. Rock music was clearly a potent positive element in the lives of young men, and served a variety of purposes. Alcohol gave individual and group release from the debilitating restrictions of masculinity, removing the need for self-control and allowing greater intimacy. The young men showed they were able to discriminate between “real life” and media or sporting images of masculinity, and had independently identified personal role models from within their own family or friendships circles. This study has shown the importance of understanding the adolescent male world from his own perspective. In particular, it demonstrates the degree to which masculinity impacts on the adolescent behaviour and attitudes, and highlights the necessity for Social Work practitioners to factor the masculine code of behaviour into case and programme planning. Moreover, it is suggested that Social Workers take a proactive approach to teaching young men the language and skills to understand masculinity, and to pursue identity formation and the establishment of positive relationships despite its impact on their lives.