1. PRACTICE SHAPERS – A CONTEXT FOR SOCIAL WORK IN CENTRELINK

2. A Context For Social Work in Centrelink Jill Garratt AASW Conference 2009

3. Elements Personal Personal Professional Professional Organisational Organisational Community Community

4. Personal personal qualities personal qualities knowledge knowledge beliefs, values beliefs, values personal ethics personal ethics life experience life experience history history world view world view personal interests and skills personal interests and skills

5. Professional education education practice knowledge practice knowledge skills skills values values ethics ethics practice wisdom practice wisdom Professional practice model Professional practice model theory theory

6. Organisational legislation/Policy/Service agreement legislation/Policy/Service agreement mandate mandate organisational purpose organisational purpose role/Duty statement role/Duty statement code of conduct code of conduct accountability Requirements accountability Requirements organisational Training organisational Training technology technology delegations delegations

7. Community ‘Because of the emphasis placed on working in context, social work is a profession, perhaps more than any other, which is shaped by its many contexts – material, social, political, economic and cultural’ Fook, J, 2002,Social Work, Critical Theory and Practice, Sage, London

8. ‘The purchaser provider split’ has also become one of the main organising features of service provision under a globalised economy.’ Under this principle, the ‘purchaser’ (eg the government) buys specific services from ‘providers (for example community based, non- government, private or business organisations), who compete for service provision contracts Fook, 2002

9. Community systems systems politics politics funding funding public opinion public opinion environment environment values values law law client expectations client expectations

10. Context for Practice

11. Transferrable The elements of this model for understanding practice can be applied in any practice setting The elements of this model for understanding practice can be applied in any practice setting

12. Thank you for your interest Jill Garratt AASW Qld Conference 2009

13. A PAYMENT PLAN TO CRISIS INTERVENTION IN 30 SECONDS How did that happen? Clinical Social Work within vocational education in the far north

14. A Payment Plan to Crisis Intervention in 30 seconds- How did that happen? Clinical Social Work within Vocational Education in the Far North Marci Gryffyn-Spicer BSW Hons, Grad Cert Edu, Cert IV TAA, MAASW (Acc) Counsellor, Student Support Services Tropical North Queensland Institute of TAFE Cairns and Far North Queensland

15. Research Questions: Why in the #!%* am I doing this? Is this Social Work?

16. Background TNQIT is the ONLY institute in TAFE QLD where Counsellors assess students’ eligibility for payment plans This goes back 10+ years In other TAFE’s, Counsellors only get involved if there is financial hardship It has never been listed in the Position Description In peak enrolment times (Jan-Mar & Jun-Aug) we do an average of 45 a week per staff

18. Stats Total geographic area covered: 286,000 Square Km Total Student Population over all area 2009: almost 15,000 Total Indigenous Student Population over all area: approximately 40% 300 Training programs over 8 campus’s as well as job specific locations

19. Ethics Social work aims to maximise the development of human potential and the fulfilment of human needs* Social work operates at the interface between people and their environments* Social workers promote distributive justice and social fairness, acting to reduce barriers and expand choice and potential for all persons* Social workers will respect the right of individuals to make informed decisions about their well-being and about service and resource alternatives* When the social worker’s ethical responsibilities conflict with the interests of other professionals, groups of professionals, agency policies/procedures or legislative requirements* When the employer’s interests or instructions conflict with ethical practice considerations, social workers should make this clear to the employing authority and attempt to negotiate a solution, protecting the best interests of clients where these are involved.* *Source: AASW Code of Ethics

20. Pirata Ethos About the year 1640 the pirates formed a kind of democratic confraternity. It was in fact the social contract of the expedition. It was always signed by the whole ship's company before any departure when the elected Captain and the officers prepared a charter-party. Every decision of importance was discussed, followed by a vote. 1. Ye spoil taken from a captured ship is to be distributed in equal portion. 2. Ye supplies and rations are to be shared equally. 3. If one Brother steals from another, his nose or ears are to be cut off. If he sins again, he is to be given a musket, bullets, lead and a bottle of water and marooned on an island. 4. Quarrels between several Brothers whilst aboard ye ship shall be settled ashore with pistol and sword. He that draws first blood shall be the victor. No striking another whilst aboard ye ship. 5. If ye introduce on board a woman in disguise, ye shall be punished to death.

21. How did a payment plan become crisis intervention? “I am really sorry I was late for my payment plan appointment, but I _______” Got raped a couple days ago Just came from the funeral of my husband Ran my car off the Kuranda range road and had to wait for a ride

22. A Maelstrom of Change…

23. Complete overhaul of the payment plan system – social and financial Implementing & facilitation of change across all Faculties and geographic areas of the “new way” Addition of a modified Psychosocial Ax form A paradigm shift for staff & students

25. Research Questions: Why in the #!%* am I doing this? Answers: Because……. Is this Social Work? Yes, as I have embraced the humble Payment Plan & use it as an early intervention tool

26. Ready For Anything Pirate Social Worker To the Rescue Thank you For Attending Contact Details: marcella.gryffynspicer@deta.qld.gov.au Tel (07) 4042-2518 Questions

27. WHY WE UNDERTAKE VIEWINGS OF DECEASED PERSONS IN HOSPITALS

28. Why we Undertake Viewings of Deceased Persons in Hospitals Presented by: Phill Capra Cairns Base Hospital

29. The role of undertaking viewings of deceased persons in the hospital setting has been identified as a task of social workers. Death in the last few decades has become more sanitised and exposure to deceased persons less common. There is little empirical evidence to suggest that viewing of deceased persons “improve” grief outcomes, or decrease incidence of depression related to grief (database search on terms “viewing”, “bereavement”, “deceased, “death”, “depression”, “grief” in various combinations used on database searches including (SocIndex, Emerald & PsychInfo). However intuitively and morally social workers are aware of the importance of families viewing their deceased relative. Social Workers are also aware that this process may assist in bereavement. In an outcome driven health industry, consideration of evidence and theory in practice in validating this essential service is required.

30. Why Research? Personal interest, validate personal experience and perceived practice wisdom both at an individual and collective level To ensure that we are not in fact doing harm To validate an intervention To ensure the continuation of viewings within the hospital system To seek best practice

31. Literature Very little research into benefits or outcomes of viewings Research relates more to the area of trauma Theory and ideas about viewings and grief, with limited or no documented evidence. Often descriptive of viewing process. Funerals and death rituals have been researched extensively in multiple fields Bereavement and grief extensively researched Field of thanatology is growing, but research still more focused on bereavement, grief, funeral rituals

32. History Since circa 1900 increase in hospitalisation, death in facility and not in the home. Since 1920 life expectancy has increased by over 30 years Less exposure to death as dying becomes more medical and people hospitalised Death rituals performed within the family or close community have become lost skills Many people have not seen a dead body Increase in the reliance of health professionals and Funeral Directors in regards to the practical aspects of death Slight evidence this trend is reversing thanks in part to hospice and community palliative care movements

33. Theory Historically viewings are beneficial as they assist family & friends; to ensure the deceased is dead, to ensure the deceased stays dead, to provide an opportunity for individuals to reflect/mourn/say goodbye to physical form. Viewing ensures “reality” of the death, in particular in sudden and unexpected death (McKissock, 1992) Provides an opportunity to “speak” with the deceased. Note: Also some theory in regards to PTSD, or suggestions could impact on grief process in trauma situations.

34. What is Happening Currently Benchmarking exercise in 2006, of various hospitals showed many similarities. Preference for ward viewings, during business hours, coronial processes. Social Workers utilising viewing process as described by McKissock, usually learnt on the job. Push to encourage viewings to occur at Funeral Directors Viewings at Funeral Directors can cost hundreds of dollars, and some FDs do not offer viewings

35. Evidence From the Trauma Field Need to re-establish sense of control (self-determination) Regret and remorse, people are more likely to regret not viewing (Mowll, 2005; McKissock, 2002*) Need to view deceased to see death has occurred (Goodall, 2000*) Most beneficial intervention in a sudden and unexpected death, (Li, Carmen & Lee, 2002; Fanslow, 1983; Ashdown, 1985) People who viewed had improved physical and mental health outcomes, compared to those who hadn’t post-disaster, Granville train crash 1981 & Zeebrughe ferry disaster (Singh, Raphael, 1981; Hodgkinson, 1995)

36. Evidence Importance of ritual and creativity (Glassock, 2001; Bolton & Camp, 1989; Hyland & Morse, 1995) Concept of post-mortem harm, psychological harm to the bereaved, as a result of actual or perceived harm to the deceased body (Tomansini, 2009; Scanlon,1998) Importance of individualising grief therapy, client focused (Neimeyer, 2000). Cultural appropriateness

37. Problem with Evidence Alone In considering grief outcomes, the primary measure is depression. Too many variables Funding source Ethics Simplification of complex emotions and processes Researcher bias

38. Art Building of relationships most important thing we contribute (Duncan, Miller & Hubble, 1999) Social Workers best placed to advocate for individuals and families in the health system Power of empathy Doing what is right, respect for the individual. Empowering/ Enabling/ Facilitating a process that is likely to help. Being aware of science/ evidence and utilising this

39. The Future Unknown? Decrease in hospital viewings, as push to view at Funeral Directors? Core business of social work verse core business of pathology? Is there a need to prove outcomes? Please email phillip.capra@health.qld.gov.au for full list of referencesphillip.capra@health.qld.gov.au

40. SOCIAL WORK ASSESSMENT PROCESSES AND MANAGING ANXIETY GROUP PROGRAM

41. SOCIAL WORK ASSESSMENT PROCESSES Presented by: Lynda Watson & Vicki Fleming, Sunshine Coast & Wide Bay Health Service District, November 2009

42. No Time to Reflect

43. Discomfort

44. Social Work Practice Reflection on Social Work: Ethics Values Principles

45. Evidence Base Practice Evidence Based ‘Users’ Those who accept the evidence of others Evidence Based ‘Practitioners’ Those who critically appraise evidence of others

47. Looking for Guidance

48. Direct Service Standard 1.4 “The social work assessment and the intervention taken is appropriate to the client’s situation, in keeping with ethical and legislative requirements and directed towards appropriate outcomes reached in agreement with the client, wherever possible.” “Practice Standards for Social workers: Achieving Outcomes”, AASW 2003, p. 7.

49. Critical Appraisal Scrutiny of: ‘How’ tools impact on the gathering of information What and why information is collected What is the format

50. Critical Appraisal Scrutiny of: The impact on the therapeutic alliance between worker and client. Ensuring the values and principles of the Social Work underpin all social work tasks and duties.

51. Evidence Based Practioner Well Researched Interventions Social Work Ethics & Values Practioner Experience Client Preferences & Culture Practioner Tools and Techniques

53. THE INTERFACE BETWEEN SOCIAL WORK AND LAW Hospital social work and decision making capacity

54. Who Decides That They Can’t? Leading the challenge of assessing decision- making capacity in the hospital setting. Melissa D’Or Director Social Work Fraser Coast Health Service Sunshine Coast-Wide Bay Health Service District

55. Context Ageing population Life expectancy continues to increase. Prevalence of cognitive impairment steadily increases with age. Increasing rates of elder abuse, particularly financial abuse. Very few Australians plan for incapacity.

56. Legal Capacity Key Concepts: Legal construct Presumption of capacity Specific capacity has replaced notion of global capacity. Domain specific, decision specific & time specific. Can this person make this decision? Valid trigger must be present.

57. Decision Making Capacity A person with decision making capacity is able to: Understand the nature and effect of the decision; Freely and voluntarily make the decision; Communicate the decision in some way. Impaired decision making is the inability to go through the process of making a decision and putting it into effect.

58. Darzins, Molloy & Strang 2000 “In performing assessments of decision-making capacity, practitioners should really be looking for evidence of incapacity. If they do not find evidence of incapacity the presumption of capacity is allowed to stand”.

59. Incapacity is not: Ignorance Eccentricity Different ethical views Cultural diversity Poor communication Poor judgment Poor decision making

61. Elements of Capacity Understanding: basic understanding of the facts involved in the decision. Appreciation: understanding of the nature and significance of the decision & nature & meaning of potential alternatives. Reasoning: ability to derive conclusions from the information presented. Choice: ability to express a choice. Values: weighing risks & benefits of various options and choosing one over another, requires values.

62. Assessment of Capacity No widely accepted standardised assessment for measuring capacity. Substantial variability between assessments. Tools for assessing intelligence have been used for assessing capacity. Is intelligence the same as capacity? MMSE is only a screening tool and should be used as an indicator that further assessment is required.

63. Significance in a Primary Health Care Setting Patients need to make decisions about their healthcare, including discharge plans. Consent is required for medical procedures/treatment. Health professionals have a “duty of care” to their patients. Vulnerability of those who lack capacity.

64. 1.Medical investigations: CT scan, MRI, blood and urine testing. 2.Cognitive screening: MOCA, MMSE. 3.Assessment of independent living skills. 4.Psychosocial assessment. 5.Purpose-built capacity test eg. Six step capacity assessment process. 6.Consultation with Geriatrician. 7.Multi-disciplinary team consultation and decision- making. Assessing Decision-Making Capacity Framework

65. The Six Step Capacity Assessment Process Darzins, Molloy & Strang, 2000, Memory Press 1.Ensure a valid trigger is present. 2.Engage those being assessed. 3.Information gathering. 4.Education. 5.Capacity Assessment. 6.Act on results.

66. The Challenges for Social Work Who is responsible for assessing capacity? Lack of specific training for professionals. Lack of specific skills to assess capacity. Lack of understanding by patients, relatives and other health professionals. Pressure for beds results in the need for timely discharge. Assessment of a patient’s capacity takes time. Competing demands.

67. Challenges for Social Work contd Impact of patient not having capacity: what action is required? Increasing numbers of socially isolated persons, elder abuse, & patients with complex social circumstances. Role of families & significant others in a patient’s decision making process. Those being assessed are often unwell and in an unfamiliar environment.

68. The Future: Social Work Leading the Way. Social Work can play a pivotal role in the assessment of capacity: Our profession is underpinned by a strong ethical base with an emphasis on social justice. Expertise in Psychosocial assessment. Wholistic approach: the profession straddles the medical, psychosocial and practical spectrums. Social Workers possess the knowledge.

69. The Future contd What more is required? Access to ongoing and relevant professional development. Greater resourcing: increased staffing levels. Prioritising of this work: balancing workplace demands to ensure this is a priority for SW. Multidisciplinary decision making: setting up processes/pathways to facilitate this. Identification of “experts” within the profession.