Social Work - Theses
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Illuminating skills and knowledges of women who have lost a male partner to suicide: A feminist insider narrative practice research project
Abstract This qualitative exploratory study, from a feminist insider position, uses narrative practice to privilege the insider knowledge of widows , and to contribute new knowledge about how women respond to the suicide of a male partner. Narrative therapy, co-developed by Michael White and David Epston (1990), is a non-pathologising practice that situates experiences of hardship in their historical and social contexts. It supports people to free themselves from stigmas generated by contemporary attitudes and to craft preferred identities. Narrative practices arose specifically to counter discourses that marginalise and stigmatise people, and is thus particularly suited to assisting those bereaved by suicide as they are subject to significant stigmatisation. Feminist-informed qualitative research is underpinned by a reflexivity in relation to one’s own positioning, interests, values and knowledges. It ‘generates problematics from the perspective of women’s experiences’ (Harding, 1987, p. 6). In this project, I drew on my own lived experience of bereavement, which came about through the suicide of my husband and father of my children 16 years ago. Influenced by Wilkinson and Kitzinger (2013), this study does not minimise or maximise insider experience; rather it uses it in transparent ways. Seventeen women were interviewed from Australia, the United States and Canada. These women brought expertise, commitment and care to the project. The women’s rigorous contributions were thematically analysed using Braun and Clarke’s (2006) six phases of reflexive thematic analysis in a manner consistent with narrative practice and feminist understandings. The exploration of widows’ grief following the death of a spouse by suicide has been given little attention in bereavement research (Flake Ford, 2016; Miers et al., 2012). The literature that exists has not considered suicide bereavement in its specific social, political, ethical and historical contexts, and has forsaken considerations of power. This poststructuralist study questions socially constructed norms of contemporary Western culture in relation to suicide, provides openings for fresh thinking and argues for the recognition and application of insider knowledges. In this research, responses to suffering and loss are honoured and explored. Such responses have been absent or thinly described in previous studies. The ways in which women actively negotiate and break through the embodied stigma and taboo that often accompany losing a partner to suicide, and the skills and knowledges that women deemed helpful in their transition from ‘partnerhood’ to ‘widowhood’, are richly documented, witnessed and shared (see Leahy et al., 2012; Speedy, 2004). Based on the analysis of widows’ responses, this thesis offers new understandings to the field of suicide bereavement, and provides recommendations to first responders, practitioners and service providers on more supportive and less stigmatising practice responses to suicide.
Women’s Perspectives on the Impact of Trauma on Pregnancy, Substance Use and Parenting
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.
Shared understanding of knowledge translation in a domestic violence research network
Background: Despite significant growth in knowledge translation research, there remains a gap in our understanding of the connection between knowledge translation, domestic violence research and research networks. Knowledge translation is crucial as it creates the connection between those that produce the research and those that use the research. However, despite efforts, there is still a disconnect between researchers, practitioners and policymakers, suggesting a need to further explore this critical area of research. One framework, Integrated Knowledge Translation, offers the potential to bridge these gaps. Aims: Given the paucity of existing literature, this study explored the shared understanding of knowledge translation of a domestic violence research network. The study answered the following questions: What is the shared understanding of knowledge translation and activity in a domestic violence research network? How is a shared understanding of knowledge translation developed in a domestic violence research network? Method: The study utilised several methodological approaches, including participatory action research and realist research. The three phases of data collection included an online scoping survey; a realist informed systematic review and deliberative dialogue. Results: The scoping survey completed by 49/65 researchers found a focus on practitioners when sharing results from research with considerable gaps that included policymakers and survivors. A systematic literature review of 50 studies using a realist lens identified mechanisms of change that support knowledge translation. The synthesis of the included studies identified five potential program theories. A deliberative dialogue explored these mechanisms further and identified four key actions 1) agreement on a knowledge translation approach; 2) active promotion of dedicated leadership within an authorising environment; 3) development of sustainable partnerships through capacity building and collaboration particularly with survivors; and 4) employment of multiple strategies applying different kinds of evidence for diverse purposes and emerging populations. Conclusion: This study adds to our understanding of the meaning of shared knowledge translation by exploring the knowledge translation activity of a research network. Moreover, the mechanisms of change identified will support the knowledge translation of future research networks. The use of the deliberative dialogue has uncovered specific factors required for the successful knowledge translation of domestic violence research. These factors have been added to the Integrated Knowledge Translation capacity framework to enhance its application for domestic violence research. Future research could explore these individual, professional organisational and network factors further by evaluating them in practice. Forthcoming research could also explore these factors with input from survivors.
The needs of foster and kinship carers and the mental health and wellbeing of children
Children and young people in foster and kinship care are far more likely to experience mental health problems than their mainstream peers (Baker, Kurland, Curtis, Alexander & Papa-Lentini, 2007; Milburn, Lynch & Jackson, 2008; Teggart & Menary, 2010; Ford, Vostanis, Meltzer & Goodman, 2011), with more than half of this cohort demonstrating a measureable need for mental health services (Tarren-Sweeney & Vetere, 2013). The input of carers has been found to be a key determinant in the outcomes for the children in their care (Blythe, Wilkes & Halcomb, 2014). This thesis seeks to build on the existing literature through three primary research questions: what is the nature and extent of the relationship between the role of carers and the mental health of children in foster and kinship care?; what unmet needs do foster and kinship carers experience, and how do these unmet needs impact on their caregiving role?; and what opportunities exist to better support carers to meet the mental health needs of children? The study utilises a mixed methodology, including a scoping review of available literature and two phases of data collection. In phase one, structured focus groups and interviews were conducted with thirty-one foster and kinship carers. In phase two, the carer version of the Carers’ and Users’ Expectation of Services survey was used to guide a further sixty-eight interviews with carers. Results were partially published in three peer-reviewed journal articles, detailing findings including a lack of systemic support for foster and kinship carers and a range of barriers which affect their ability to promote the mental health and wellbeing of children and young people in their care (Fergeus, Humphreys, Harvey & Herrman, 2018). These barriers may include insufficient resources and training, and a lack of understanding of the carer role. The study makes a substantial contribution to the understanding of the complexities of the carer-child relationship through the examination of the needs of foster and kinship carers and an analysis of how unmet needs may impact on the ability of carers to effectively discharge their role (Fergeus, Humphreys, Harvey & Herrman, 2019). Key implications for practice are discussed including the need to recognise and respond to the critical nature of the role of the carer in realising positive outcomes for children and young people in care through ensuring timely and appropriate support for carers.
Social work education in Aotearoa New Zealand: Advancing an equity agenda through democratising and decolonising policy, programmes and practice
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.
Implementation frameworks – their usability and limitations within child, youth and family services
Purpose This thesis is located at the nexus of research-supported interventions (RSIs) in child and family services, evidence-based practice and implementation science. Within the context of Australian child and family services, it focuses on the implementation problem, i.e. the sector’s persistent problems with integrating evidence in routine practice. Its overarching goal is to examine how implementation frameworks have been and can be used to understand efforts to implement RSIs in this sector, and how these frameworks, and potentially any other implementation science concept, may be more effectively moved into routine child and family services in the future. Methods This research builds on a mixed-methods design and was conducted in three phases. During phase one, the scoping review method was used to identify studies conducted within child and family services and explore how implementation frameworks were used in the sector. In phase two, one particular implementation framework, the Consolidated Framework for Implementation Research, was applied to understand the barriers to the Australian implementation of multiple RSIs developed in the United States. The examination of the failed implementation of Multisystemic Therapy-Emerging Adults in New South Wales built on a case study design, whereas the early implementation of multiple US-based RSIs in Victoria was evaluated using mixed methods. Finally, during phase three, in developing a proposal for how to better bridge the implementation research-practice divide, the systematic integrative review method was instrumental for the development of a program logic for the role of implementation support practitioners. Results The use of implementation frameworks in child and family services studies has been cursory, and limited guidance is available on how to operationalize them in contexts of routine practice. The Australian experience with implementing US-based RSIs reflects that implementation frameworks insufficiently mirror the implementation challenges these interventions impose on stakeholders. While frameworks map implementation as a tidy and linear collection of determinants, real-world implementation occurs as a dynamic, both concurrent and recurrent interaction between multiple implementation factors. Particularly limited are the insights that frameworks provide to understand the role of the outer setting, containing, for example, policy dynamics, in an implementation. The role of implementation support practitioners may be a relevant strategy for integrating implementation research in routine child and family services, but the evidence surrounding their work and effectiveness is scarce and will require further consolidation. A first program logic outlining how ISPs may build implementation capacity in child and family services is presented. Conclusion To solve the implementation problem, strategies are needed that can help to create a new normal. One in which research-minded decisionmakers, operating in the child and family services sector, constantly request and use evidence in their daily routines, and practice-minded scientists work to spur this use in all areas of policy and practice. Implementation support practitioners may be one such strategy. To better understand the characteristics, activities, and contexts required for this role to be effective will be a key task for the decade ahead – both for the child and family services sector and the field of implementation science.
Parenting while dying: Hospital-based supportive care of parents with advanced cancer
Every year in Australia thousands of parents raising minor-aged children are dying from cancer. Parenting with incurable end-stage cancer (IESC) gives rise to unique multidimensional stressors that can greatly affect the psychosocial wellbeing of parents and their children. Research shows that parenting concerns are commonly experienced and can impact on healthcare decision-making. Surprisingly, however, parenting-related support needs are not routinely addressed as part of hospital-based healthcare services. This dissertation contributes the first Australian series of interconnected studies exploring hospital-based interdisciplinary service responses to patients’ and co-parents’ parenting support needs, offered as part of routine palliative cancer care. A mixed methods exploratory design comprising three sequential linked study phases underpinned the research project. The first phase entailed data mining the hospital medical records of 74 adult patients diagnosed with IESC (27–75 years, M = 47; 61% female; received hospital palliative cancer care between September 2013–December 2015) and parenting minor-aged children. Documented clinical, sociodemographic, psychosocial and hospital-based interdisciplinary parenting support response data were collected and analysed using descriptive statistics. Using qualitative methodologies, the second and third phase studies explored multidisciplinary health professional (HP) and parent perspectives on patient/co-parent parenting supportive care needs and experiences, and factors influencing hospital-based parenting supportive care utilisation and provision. Semi-structured interviews (1 focus group, 2 individual interviews) with 12 multidisciplinary HPs working at an Australian metropolitan general hospital (8 disciplines, M = 19.7 years of HP experience) were conducted in August 2017. Following, semi-structured interviews with 12 parents (8 patients, 4 co-parents) were conducted (October–December 2017). Each phase was analysed individually using thematic analysis. Individual findings from each phase were synthesised to explore overall project findings. Analysis revealed multidimensional parenting-related support needs were experienced by a diverse sociodemographic cohort of adult patients (aged 27–75 years old; 62% female). Parenthood was largely challenging—insights into the dynamic and unique nature of parenting concerns throughout the IESC phase were provided—from IESC diagnosis to bereavement. Support needs varied in nature and timing across the IESC treatment phase for individual families. The complex psychosocial context within which parenting occurred was indicated by the broad array of pressing psychosocial issues voiced. A tailored, patient-centred, family-focused, trauma-informed, interdisciplinary approach to hospital-based parenting support was deemed optimal. However, in practice it was not always achievable, resulting in parents experiencing unmet needs. Parents and HPs viewed multisystem factors as influencing parenting support provision and utilisation. Key facilitating factors were hospital-wide systemised parenting practice procedures (e.g., parenting status screening, needs assessments and interventions), adequate clinical resourcing, targeted HP training, collaborative communication, professional supervision and a child-friendly, culturally safe hospital environment. Multidimensional psychosocial factors including emotional and psychological readiness, personality, and beliefs about death and dying impacted on parents’ engagement with parenting-related support. Using these insights, multilevel system approaches for strengthening hospital-based parenting supportive care to parents facing IESC alongside treatment are discussed. Findings together with existing parental cancer research may assist hospital management and interdisciplinary HPs engaged in policy decisions and intervention delivery to develop and implement new initiatives targeting parenting-related psychosocial distress.
Informing NDIS market stewardship through consumers’ information preferences: An exploratory study
Australia’s policies have historically seen many people with disability (PWD) confined to institutions, abused, neglected and systemically denied the right to self-determination (Barnes & Sheldon, 2010; Oliver, 1992). It follows that many PWD have typically lacked choice over which services are involved in their lives. An ideology of choice has emerged in the context of publicly funded disability services, influenced by ideas associated with neoliberalism and new public management (Fotaki et al., 2008). Some welfare-state services have been “personalised” (Needham, 2011), such as Australia’s National Disability Insurance Scheme (NDIS), which uses a marketplace model to offer consumers choice about what support to purchase (Fawcett & Plath, 2014). The NDIS is not a conventional market in a neoclassical sense – it is a quasi-market, seeking a way to manage considerations of both efficiency and equity. Within this context, there is an important role for “market stewardship” to balance these tensions (Carey, Reeders, et al., 2018). Choice can create not only self-determination for consumers, but a burden (Glendinning, 2008), and information is required to support the process of NDIS decision-making. However, there is limited evidence about what information is required. In this regard, a significant gap exists in the market stewardship literature, especially around knowledge that is driven by consumer preferences rather than provider or government priorities. This research explores what information is required for NDIS consumers to feel informed when choosing service providers. It is a social work practice research study, examining a problem identified through practice with the aim of addressing it (Sim et al., 2018). Data was collected in two phases. The first utilised semi-structured interviews (n=23) to explore informational issues in depth while gathering data to inform the construction of a survey. This survey comprises the second phase, extending the sample to test the generalisability of the results (n=201). Results show that word of mouth information from trusted interpersonal relationships is valued, as is information from and about professionals. This suggests that decades of oppression of PWD and professionalisation of service navigation have resulted in consumers’ mistrust regarding information from service providers and government (Walsh, Wilson, Baines, & Martin, 2012), which is compounded by the complexity of the new NDIS system (Malbon, Carey, & Reeders, 2018). Participants therefore rely on trusted peers and professionals for reliable information. This reliance is problematic because it stalls capacity building for both consumers and providers and decreases the urgency to implement market stewardship interventions. Furthermore, it can lead to riskier decision-making and poorer outcomes (Hakansson & Witmer, 2015; Schul & Peri, 2015) and relies on consumers having strong social networks, which puts equity outcomes at risk as well as the success of the insurance scheme. This thesis contributes new knowledge to the market stewardship literature and also to practice. Academic findings are described above. Practical recommendations include deprofessionalising service navigation in order to decrease the information asymmetry that exists; using peer advisors to distribute information throughout the sector; helping providers create trustworthy information through their marketing collateral; creating sector-wide metrics; investing in shared digital solutions in order to collate and distribute information; and localising NDIS governance so as to create rich local information.
Enduring anorexia: A multi-storied counter document of living and coping with anorexia over time
It has been well-documented that anorexia (nervosa) often endures in people’s lives, yet very limited research attention has been given to the perspectives of adults who have lived with its influence and effects over time. What studies do exist have engaged participation through specialist services, potentially skewing representation, and participants’ experiences, knowledge and capabilities have tended to either go unrecorded or else are dominated by bleak narratives and/or deficit-based portrayals written from clinical perspectives. The Enduring anorexia project addresses these issues by inviting more inclusive participation via social media and by employing the theoretical lens of narrative practice. This hopeful lens centres lived experience perspectives, acknowledges personal agency and seeks entry points into alternative storylines of preferred identity that can lead to new possibilities and understandings. Since social workers Michael White and David Epston first co-created narrative practice as a respectful and non-blaming approach to counselling and community work that recognises people as separate to problems and intentional in responding to difficulties, the field has been characterised by innovation and diverse application. The Enduring anorexia project extends this application, innovation and practice stance into conducting academic research in the realms of longer-term experience of living and coping with anorexia, demonstrating what opportunities arise as a consequence. A two-step format of online survey and optional interview gathered stories of experience, response, and ideas about ways forward from 96 participants across 13 countries. Their generous and insightful contributions were thematically analysed congruently with narrative practice’s theoretical bases of poststructuralist, feminist and critical thought. This reflexive process generated 12 themes describing complex and multi-storied experiences of living with anorexia over time. Some themes highlighted the capacity for anorexia’s ongoing influence to create profound and extensive difficulties in people’s lives; accumulating consequences for physical, psychological and social wellbeing were compounded by multiple psychiatric and societal discourses that created obstacles and confounded attempts at seeking support or creating change. Other themes illuminated the meaningful ways participants engaged with their circumstances to purposively manage both their lives and anorexia’s influence in it in order to overcome barriers, to reclaim all or part of their lives, and to live meaningfully and consistently with their values, beliefs and hopes. In a realm where there is considerable professional uncertainty about how best to proceed or help, the Enduring anorexia project points to a need for - professional attitudes that view people as separate from problems and privilege ‘insider’ over ‘expert’ perspectives; - therapeutic approaches that attend to the politics of experience, and double-listen for skills, knowledges and entry points into alternative storylines; - support services that are available, accessible and intentionally inclusive; - research lenses and directions that focus on response, inclusion, opening space for possibility, and reporting respectfully; - a re-conceptualisation of what has been considered a problem of the individual, to invite wider societal responses. Throughout, narrative practice is shown to be an effective lens/tool for conducting inclusive, non-blaming, hopeful and generative research. The Enduring anorexia project incorporates reflections on academic research processes, written from the perspective of an insider-practitioner-researcher.
Population dynamics modelling of child protection populations in Australia
Growing service demand is a perennial challenge for child protection systems in Australia, with the number of children involved in child protection (CP) investigations and admitted to out-of-home care (OOHC) increasing across Australian states and territories in the last decades. Since OOHC is costly and its effects on outcomes for children and youth are ambiguous, such a demand growth has attracted much scrutiny. While factors influencing involvement in CP and placement in OOHC have been studied extensively, a review of existing research literature shows that no study has applied mathematical formulations of population dynamics to model CP population structures and trends. This study intends to fill the gap by asking the research question, "How can we use population dynamics modelling to study the macro-dynamical structures of CP populations across Australian states and territories?" Two population dynamics models of a generic child protection system were constructed, one with four sub-populations and the other with three sub-populations. The models describe how the sub-populations evolve with time, simulate their interactions, and elucidate effects such as "churn" – repeated involvement with CP, both in terms of CP investigations and OOHC admissions. Analytical solutions of the system differential equations were obtained. Applying the model solutions together with annual aggregate new and repeat client data from 2015-16 to 2017-18 to all Australian states and territories, this study obtained estimations of the investigation rates and OOHC admission rates for the sub-populations, trends of the sub-populations, as well as cross-sectional prevalence and lifetime prevalence of involvement in CP. The results show that both the investigation rates and OOHC admission rates for repeat clients were much higher than those for new clients across the states and territories. It was estimated that if the current rate scenarios persist, OOHC populations across the states and territories will approach asymptotic values significantly higher than the current values. How CP sub-populations response to changes in the CP process rates have also been investigated using hypothetical scenarios. This study contributes to CP population research in three dimensions. Theoretically and methodologically, this is the first application of population dynamics models to study the macro structure and trends of CP populations. Empirically, the models allow us to estimate CP prevalence and rates. Practically, the models allow us to estimate future trends of CP populations and to study how CP populations react to rate scenario changes which in turn, may result from practice or policy changes. As in all modelling efforts, there are limitations and caveats. These include making the assumption that there is no system capacity limit in OOHC, thus making the models linear; not considering age structure; not considering socio-economic conditions and ethnic differences; and last but not least, having very limited data which are essential to such kind of modelling efforts. While future works have already been planned to address some of these limitations, any further progress will depend on the availability of high frequency data, from which conditions related to model limitations can be better understood and models can be better constrained.
Socio-legal collaborations in Australia - models of service provision and the influence on practice
Interdisciplinary collaborations between legal and social services have emerged as a growing framework for assisting clients with high degrees of disadvantage, vulnerability and complexity. World-wide developments in the social determinants of health and access to justice have demonstrated the need for integrated approaches which break down professional silos and work with intertwined legal and social issues. The promotion of collaboration, however, has not generated a unique program or intervention structure, rather a wide diversity of forms has developed organically, be it with the common goal of assisting those in need in holistic and integrated ways. This study has mapped the nature of these collaborations across Australia, their forms and staff, and explored the influence collaborating professions are having on each other’s practice. While lawyers and social workers would seem to have a natural synergy for these programs, the study examined which professions are actually involved, how they went about collaboration and the professional practice being delivered, collective details of which have until this study remained limited. The study presented is a mixed methods project using online surveys and semi-structured interviews to explore these programs and the experiences of staff within them. Results suggest that social work practice and social workers take up a significant role in these interdisciplinary collaborations and are central to a model of effective collaboration between legal and social service professions. Social work was found to be not only the most common form of social service practice found in these collaborations but also one of the most influential upon other professions and professional practice including law. From these findings an evidence-based model of socio-legal collaborations was developed, alongside a socio-legal collaboration health check, translating the theoretical model into practical guidance for program reform and sector development. A call for social work leadership in these socio-legal settings is also made, with the results of the study demonstrating the need for social work to understand and promote their critical contribution to collaborations and to the other professional practices and client outcomes which result.
From suspicion to intervention: improving responsiveness to abuse of the elderly in acute and sub-acute healthcare
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.