SWITCH Research Group
Social Work Innovation, Transformation and Collaboration in Health (SWITCH) Research Group is located within Monash University, Faculty of Medicine, Nursing and Health Sciences.
The Group Director is Associate Professor Melissa Petrakis, Senior Lecturer in the Department of Social Work, School of Primary and Allied Health Care (SPAHC), at Caulfield Campus. Dr Petrakis commenced the research group Tuesday 19th March 2019 – on World Social Work Day. For 2019 the global theme for social workers is Promoting the Importance of Human Relationships. It was a fitting day to formalise research relationships that have taken shape over the last 5 years.
The research group brings together 12 industry-partnership research studies, being carried out over the next 5 years led by Chief Investigator Dr Melissa Petrakis. The studies include exceptional practice-based research in health and mental health services and sectors, including Senior Clinician co-researchers and partnership organisations. The studies being undertaken under SWITCH include the involvement of 4 health networks, 3 universities, 2 mental health community support services, 12 research students and 12 practitioners.
Partners include:
- St Vincent’s Hospital (Melbourne), Mental Health Service,
- Nexus Dual Diagnosis Advisory Service, a program of the Victorian Dual Diagnosis Initiative,
- Neami National,
- Wellways Australia,
- University of Newcastle, Potential Enabling Program Participant Research (PEPPR) register,
- Eastern Health, Mental Health Service,
- Epworth HealthCare, Epworth Monash Rehabilitation Medicine Unit.
Enquiries about the work of the group, individual studies, and interest from prospective Masters and PhD students, in the first instance please contact melissa.petrakis@monash.edu
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| Photo: Dr Melissa Petrakis with Senior Clinician and Monash practice-based PhD researcher Kevan Myers at the World Social Work Day 2019 event at St Vincent’s Hospital, Melbourne | |
Research studies being conducted within SWITCH:
Family Intervention in Early Psychosis
Abstract
Background: The role played by friends and family members in the recovery of individuals with early psychosis is extremely important. There is a growing body of literature that reflects this and puts forward a number of ways that mental health services can support friends and family members in this role and enable them to meet their full potential as a core component in recovery. It has not yet been established how mental health services can best do this, or how family intervention practices can be embedded into early psychosis programs.
Aims: This project included two aims and therefore two phases of research:
- To locate, synthesise and analyse the recent literature regarding approaches to engagement of, and intervention with, family members of people experiencing their first episode of psychosis; and
- To evaluate the outcomes of a recent family group program intervention in an early psychosis service, and compare it to a high-efficacy group program delivered in the same service six years earlier to see whether promising interventions are replicable and sustainable over time and with different staff.
Methodology: The research took a practice-based approach, and employed both a pragmatic approach to the design and a mixed methods approach to data collection. Publication 1 provided background to the study. For Publication 2 a systematised literature review was undertaken, and for Publication 3 a pre- and post- intervention questionnaire that used a four-point Likert scale for six questions and also collected qualitative data on a further three questions was utilised. The quantitative data was analysed using an independent samples t-test and a thematic analysis of the qualitative data was conducted.
Results: The published literature review results suggest that the delivery of family intervention in early psychosis settings supports family and friends to play an active role in supporting recovery, and that services deliver family intervention in a variety of ways. Group interventions in particular were found to have a number of benefits. The review also illustrates the use of practice-based research in this area as a means of evaluating and supporting family intervention. The published outcomes paper was based on seventeen participants who engaged in a family intervention group and completed a questionnaire. The group program was found to continue to deliver highly significant improvements in friends’ and family members’ understanding of recovery, medications, relapse prevention, and substance co-morbidities. Quantitative data re-affirmed that participants highly value group peer support and that this reduces feelings of isolation and the experience of stigma.
Implications: The research supports the use of family group interventions in early psychosis. Further, the study demonstrates that this type of intervention can be embedded into an early psychosis service and that this can produce positive outcomes over time.
Practice-based Researcher and Senior Clinician
Katharine (Kate) Day is a post-graduate student at the Department of Social Work, Monash University (Australia) and Senior Clinician at St Vincent's Mental Health Services Early Psychosis Program. Kate has a background of extensive experience in mental health, and alcohol and other drug service delivery and development with a focus on supporting families. Kate engages in research practice based research into mental health social work interventions and has a particular interest in family intervention and early psychosis. For the last five years she has been particularly involved in capacity building in early psychosis in public mental health, and in the use of strengths-based practice as standard care.
Publications
Day, K. & Petrakis M. (2018). Early Intervention in Mental Health: Opportunities and challenges, in M. Petrakis (ed.), Social Work Practice in Health: an introduction to contexts theories and skills, Allen & Unwin, Sydney.
Day, K., Starbuck, R & Petrakis, M. (2017). Family group interventions in an early psychosis program: A re-evaluation of practice after 10 years of service delivery. International Journal of Social Psychiatry, 63, 5, 433-8.
Day, K. & Petrakis, M. (2016). Family interventions in early psychosis service delivery: A systematized review. Social Work in Mental Health, 15, 6, 632-50.
Self-as-mother: maternal identity and wellbeing in the early years of parenting
Self-as-mother: the role of a relational self in the development and support of maternal identity and wellbeing in the early years of parenting
Abstract
In the first twelve months after giving birth, one in seven mothers in Australia is diagnosed with postpartum depression. Support for new mothers in the first year is offered chiefly via new parent groups which have been beneficial for some but potentially isolating for others. Much of the research on maternal mental health and wellbeing and the formal supports offered to mothers focuses on the initial twelve months following birth. However, mothers most commonly experience depressive symptoms when their child is four years old.
Mothering and motherhood are inherently gendered due to the biology of childbirth. Research into gender and wellbeing indicates that a relational self-construal, how one defines oneself in relation to close others, may influence the processes by which mothers maintain and enrich their wellbeing. This exploratory study looked to examine the role of a relational self in the development and support of maternal identity and wellbeing at the pivotal four-year mark.
This research contains five publications, each contributing to the primary research question: Do mothers of preschool-aged children who incorporate close others into their definition of self experience greater wellbeing?
This study used a mixed method case study approach with a homogenous sample. Respondents were recruited through preschools in metropolitan Melbourne, Australia. Eight mothers completed the Relational-Interdependent Self-Construal Scale (RISC), the Relational Self-Esteem Scale (RSE) and the Satisfaction with Life Scale (SWLS) and took part in semi-structured interviews. The 24 items from the three scales provided 192 pieces of data for analysis. Interpretive Phenomenological Analysis of the interview data provided triangulation.
Respondents incorporated family and close others into their self, more than friends, despite feeling empathetic towards friends. Relational self-esteem could be a potential moderator between a relational self-construal and satisfaction with life. This finding suggests that mothers with a high relational self-construal who maintain and enhance their self-esteem through their relationships with others may experience greater life satisfaction.
The data identified four themes that contributed to the emergence of the self-as-mother: becoming a mother as a journey of self-discovery, the biological imperatives of becoming a mother, remothering and the continued challenges of the emerging mother role.
This study provides the basis for further research into the support provided to mothers when their child is in preschool. Mothers benefit from different kinds of support, with family support being of equal importance as social supports. This research upholds the idea that relationships offer women better resilience. The participants who reported the highest satisfaction with their friendships engaged in ‘growth-fostering relationships’ in both groups, or tribes, and in individual friendships. Offering mothers a variety of opportunities to socialise may ensure that all mothers have access to the support they need during this challenging life stage.
Industry-engaged Researcher and Lecturer
Lauren Hansen (formerly Wills) is an educator, researcher and welfare practitioner. She has worked directly with clients in a variety of practice settings including family violence, family support services, early parenting and private practice. Lauren has recently submitted her PhD thesis at Monash University. Her research interest is the development of the maternal self and how this affects wellbeing across the lifespan. Lauren has a Master of Social Work from Monash University and is an International Coach Federation Certified Life Coach. Lauren is currently a Senior Lecturer, Learning Futures at Deakin University where she is responsible for embedding career education and employability into a number of courses within the Faculty of Health.
Publications
Hansen, L. (2020). The self-as-mother in the preschool years: an interpretive phenomenological analysis. Children Australia, 45(1), 48-53.
Hansen, L. (2019). Motherhood muzzled: The challenges in recruiting mothers of preschool-aged children. Methodological Innovations, 12(3), 2059799119889576.
Wills, L. (2018). The wellbeing of Australia’s mothers’. In M. Petrakis, Social Work Practice in Health, Melbourne: Allen & Unwin.
Wills, L. & Petrakis, M. (2018). The self in motherhood: A systematised review of relational self-construal and wellbeing in mothers. Advances in Mental Health, 17(1), 72-84.
Cultural Humility Training in Mental Health Service Provision
Abstract
Addressing implicit racial bias has the potential to promote equity and social inclusion in organizational processes and policies. It may enhance the accuracy of psychiatric assessments and diagnoses, leading to more appropriate treatments; and improve therapeutic engagement, trust and rapport resulting in improved medication compliance. It may alleviate triggering depression and anxiety common with implicit racial bias or setting-specific racism (Paradies et. al. 2015). This may enhance consumer and service provider satisfaction, attending to cultural influences in recovery, reducing negative cultural assumptions and stereotypes (Ascoli, Palinski, Owiti, De Jongh, & Bhui 2012).
In Australia there has been growing attention toward addressing race and the manifestation of racism in direct practice (Eley et al. 2007; Paradies 2006; Victoria Police 2013). Conceptual shifts from cultural competence and cultural responsiveness to cultural safety and cultural humility, aim to address lingering covert power imbalances, whilst promoting inclusiveness, greater self-reflection, and an ongoing commitment to this process (VTMH 2015; Tervalon & Murray-Garcia 1998). Helms (2015a & b) describes the importance of understanding the influence of both culture and race, its dynamic impact on mental health services, and shared responsibility between client and service provider.
The values and ethics of social work, and mental health practice more broadly, are frequently cited by students and practitioners as affirming and why they choose this discipline and/or profession. Social work education and mental health professional workforce development need an approach that recognizes the marginalization of some students and practitioners and supports their integration into peer group and disciplines. A secondary gain is better preparing all students and practitioner colleagues for empathic, skilled work with minorities. A process that is internal and not external to student and practitioners will enhance consciousness raising. A USA approach has been trialed in an Australian context in the current study, both with a social work student cohort and in a broader mental health workforce development initiative in the field.
Practice-based Researcher and Senior Clinician
Mayio Konidaris has extensive experience in the public mental health field as a social worker and family therapist over the past 28 years. She is particularly committed to the needs of families of CALD backgrounds living with mental illness and is currently undertaking PhD studies in the field of cultural humility training in mental health service provision. Mayio has worked in the family relationship sector and maintained working with individuals and families in private practice dealing with a range of complex issues, including a university counselling service. In recent years Mayio has concurrently worked in the fields of Aged Psychiatry and Child and Youth Mental Health. Mayio has been an accredited MHFA instructor for over 8 years and facilitated training with financial counsellors, contributed to the old age mental health first aid training, including the tertiary education sector, to staff, students, and students in leadership roles. Mayio is available to tailor this training to meet the specific organisational needs.
Publications
Konidaris, M., & Petrakis, M. (2020). Developing Self-Reflexivity in Students Regarding Awareness of Racial Inequalities in Mental Health Service Provision. In The Palgrave Handbook of Global Social Work Education (pp. 923-936). Palgrave Macmillan, Cham.
Konidaris, M., & Petrakis, M. (2018). Cultural Humility Training in Mental Health Service Provision. New Paradigm: The Australian Journal of Psychosocial Rehabilitation (Summer 2017/2018 Special Issue Research into Practice), 30-33.
Compassion: The Perception of Common Humanity
“Investigating the relationship between the perception of common humanity and compassion in healthcare workers”
Abstract
Compassion is a core value in healthcare. Research is now showing that compassion is a positive state of mind, leads to feelings of warmth, concern, reward and affiliation, promotes helping behaviours towards others and can be trained. However, the central mechanisms of compassion are still not well understood. There is an absence of studies that have attempted to isolate the core components of compassion. Several researchers have hypothesised that the perception of common humanity is the foundation of compassion. Common humanity involves recognising that all humans share the same basic needs. Human vulnerabilities and frailties are common to all. The perspective of common humanity appears to be a prerequisite for unbiased universal compassion.
This research explored the relationship between the perception of common humanity and compassion in healthcare workers. The Sequential-Relational Model of Compassion was developed to explain the compassion process. A pre/post intervention was undertaken to investigate the impact of viewing common humanity scenarios on healthcare workers’ level of compassion. Healthcare workers completed validated scales on perspective taking, common humanity and compassion. There was a statistically significant increase in healthcare workers’ level of compassion after viewing the common humanity scenarios. There was evidence to suggest that perspective taking influences compassion, mediated by common humanity.
A compassion training session emphasising common humanity was also trialled and evaluated. The quantitative and qualitative data lent support to the hypothesis that the perception of common humanity is a prerequisite for compassion. This research has implications for health professions education and the content of compassion training courses.
Debbie Ling is a Lecturer in the Department of Social Work, Monash University, Research Fellow in the Epworth Monash Rehabilitation Medicine Unit and a Senior Clinician Social Worker at Epworth HealthCare. She completed her doctoral research in 2019. Debbie is regularly asked to deliver compassion and common humanity training to healthcare workers. Debbie is also an Accredited Mental Health Social Worker in private practice.
Debbie sits on the Australian Compassion Council, Charter for Compassion Australia and the Australia21 Mindful Futures Network Advisory Group.
Publications
Ling, D., Petrakis, M., & Olver, J. H. (2021). The use of common humanity scenarios to promote compassion in healthcare workers. Australian Social Work, 74(1), 110-121.
Ling, D., Olver, J., & Petrakis, M. (2020). Investigating how viewing common humanity scenarios impacts compassion: a novel approach. The British Journal of Social Work, 50(6), 1724-1742.
Ling, D., Olver, J., & Petrakis, M. (2018). Outcomes from a Compassion Training Intervention for Health Care Workers. Czech & Slovak Social Work/Sociální Práce/Sociálna Práca, 18(4).
Dual diagnosis interventions in mental health community support services
Dual diagnosis interventions in mental health community support services: Outcomes from a national trial to enhance skills in direct practice staff
Abstract
The Reasons for Use Package (RFUP), a dual diagnosis resource, was developed by Nexus, a Melbourne metropolitan dual diagnosis advisory service. This was a response to an identified need to enhance staff capacity with a structure for therapeutic conversations with consumers. State and Federal government policy around dual diagnosis had led to numerous services doing a multitude of various dual diagnosis professional development activities including screening. Despite the number and type of activities being undertaken in this area there was still a seeming lack of confidence in how to engage and structure appropriate interventions. Whilst there were pockets of confident dual diagnosis practice within organisations this tended to be individual staff rather than service wide. The impact was that organisational capacity fluctuated as it rested on those individuals. This undermined consistent hopeful recovery orientated practice and reduced the ability for the growth of practice wisdom. Potentially this could weaken future efforts to build capacity. Having mentoring embedded within the RFUP was needed to more fully implement dual diagnosis practice.
Over a two year period a large national mental health community support service – Neami National – implemented a dual diagnosis package with an embedded mentoring component. Consultation with consumers and carers occurred in designing the RFUP, design of evaluation methodology and developing organisational implementation.
There was a successful management endorsed trial of the RFUP involving a small group of staff from both a publicly funded clinical mental health service and a mental health community support service. Staff and consumers involved found the structure of the RFUP beneficial. Staff requested management commence a further roll out. A case comparison evaluation was completed with a large national Mental Health Community Support Service to inform implementation.
The RFUP includes a specific “spirit” guiding the desired approach. This entails a collaborative and supportive process between staff and consumer using the RFUP as a doorway to conversation about dual diagnosis through exploration of issues not interrogation of the consumer.
The mentoring model was designed to mirror the spirit of the RFUP so that the mentor mentee sessions reflected the desired collaborative explorative style of the consumer staff interaction. This congruence between the consumer experience and mentoring enhances implementation, as individual staff feel supported in exploring their practice and are thus able to move into mentoring colleagues by following a structure based on facilitation rather than the perceived need for expert knowledge. The RFUP Mentoring model is a crucial aspect in assisting the development of individual staff and organisational dual diagnosis capacity.
Practice-based Researcher and Senior Clinician
Kevan Myers qualified and worked as a social worker in the United Kingdom prior to emigrating to Australia in 1991. He is currently team leader at Nexus Dual Diagnosis Service, St Vincent’s Hospital Melbourne where he has been based for ten years. Nexus has a capacity building brief with a range of health and welfare services. Kevan is also a member of the international body MINT (Motivational Interviewing Network of Trainers). Kevan is passionate about working with dual diagnosis consumers and carers to improve outcomes contributing to organisational change and workforce development.
Publications
Myers, K., Kroes, S., O’Connor, S., & Petrakis, M. (2020). Reasons for Use Package: Outcomes From a Case Comparison Evaluation. Research on Social Work Practice, 30(7), 783-790.
Kroes, S., Myers, K., Officer, S., O’Connor, S., & Petrakis, M. (2019). Dual diagnosis assessment: A case study implementing the reasons for use package to engage a marginalised service user. Cogent Medicine, 6(1), 1630097.
Myers, K., Kroes, S. & Petrakis, M. (2018). A foundation for dual diagnosis practice: wisdom, tools and resources. Chapter 9 in Melissa Petrakis (Ed.) Social Work Practice in Health: An introduction to contexts, theories and skills. Sydney: Allen & Unwin.
Petrakis, M., Robinson, R., Myers, K., Kroes, S., & O'Connor, S. (2018). Dual diagnosis competencies: A systematic review of staff training literature. Addictive Behaviors Reports, 7, 53-57.
Myers, K., Kroes, S., O’Connor, S. & Petrakis, M. (2018). The Reasons for Use Package: how mentoring aids implementation of dual diagnosis practice. New Paradigm: the journal of the Psychiatric and Disability Support Services, 25-29. Melbourne: VICSERV.
Morrison, B., Kroes, S., Owens, C., Fairclough, J., Myers, K. & Petrakis, M. (2018). Before During After: A New Harm Reduction Tool. In Robertson, S, Dunbar, L, Cassaniti, M, Tooth, B, Kellehear, K, Prowse, L, Garan, N, Suttie, S. Embracing Change: Through Innovation and Lived Experience Contemporary TheMHS in Mental Health Services, Sydney Conference Proceedings 2017, TheMHS Conference, Sydney, Australia.
Myers, K., O’Connor, S., Petrakis, M. & Kroes, S. (2017). The Reasons for Use Package: Development research and implementation lessons for the field. 26th Contemporary TheMHS in Mental Health Services, ‘People: Authenticity starts in the heart’ 23-26 August 2016, Auckland New Zealand. 2016 TheMHS Conference Proceedings, Australia.
Opportunities for change: non-traditional students enroling in higher education
Opportunities for change: What factors influence non-traditional students to enrol in higher education
Abstract
In recent years the Australian Federal government has sought to increase the diversity of students attending the higher education sector through supporting students that have traditionally been under represented. This is due to a perception that the attainment of a higher education can enhance a graduate’s life as they have greater access to professional positions, which may also lead to higher wages and better career stability. Most of the current research is focused on the student’s process of deciding to enrol, and how to support students to succeed once they are enrolled, but fails to explore in-depth narratives of students’ stated reasons of why they enrol, and if they consider these preconceptions to have been met or challenged.
The current research adds to knowledge by investigating factors that lead students to enrol in higher education. The study aimed to examine how the Australian Federal Government's Widening Participation agenda has affected Australians’ perception of higher education. It is important to examine how enrolment of non-traditional students has changed throughout the last fifty years, whether and how the widening participation agenda influenced enrolment of students, and student’s perceptions of the factors that led to their enrolment post completion of an enabling program.
Industry-engaged Researcher and Counsellor
Deanna McCall currently works at the University of Newcastle, as a Student Counsellor/Clinical Social Worker. Prior to this position Deanna was employed at the Hunter New England Local District Health Department in the Mental Health Unit. Deanna’s interest is in developing strategies to assist students to develop their emotional and psychological wellbeing, to enable them to live full lives and achieve their academic aspirations. Her research seeks to explore if access to Higher Education can enhance the lives of individual’s, who may traditionally have been underrepresented in the higher education sector, and how, if at all, this impacts on broader society.
In 2014 Deanna was nominated for and awarded a Citation for Outstanding Contributions to Student Learning in the Australian Awards for University Teaching (AAUT). The awards are designed to recognise quality teaching practice and outstanding contributions to student learning. Deanna was recognised in the Academic Division for developing an outstanding and innovative online orientation which has significantly enhanced the engagement and experience of students commencing an online enabling program with the ‘Week Zero Team’. Her Higher Degree by Research project has directly progressed from this initial work that was highly regarded nationally.
Publications
Crawford N., Lisciandro J., Jones A., Jaceglav M., McCall D., Bunn R., Cameron H.E., Westacott M. & Andersen S. (2016). Models of support for student wellbeing in enabling programs: comparisons, contrasts and commonalities at four Australian universities. Proceedings of the 2016 FABENZ Conference, UNITEC Auckland, New Zealand, 01 Dec 2016 - 02 Dec 2016. FABENZ. 1-17.
McCall, D. & Relf, B. (2015). A GPS for Group work: Providing the best route to a successful group work experience for enabling students. STARS Students Transitions Achievement Retention & Success 2015, Melbourne, 01 Jul 2015 - 04 Jul 2015. STARS 2015 Handbook & Proceedings. STARS. 5 pages.
Breaking Bad News on Social Media: an exploratory study in the trauma hospital
Breaking Bad News on Social Media: an exploratory study of the implications of the use of social networking sites in the trauma hospital environment
Abstract
Social media is increasingly being used to communicate about highly emotional and traumatic situations. For example, after the London Bridge terrorist attack in May 2017 (Titcomb, 2017). The use of social networking sites to communicate about an emergent hospital admission has also become a normal and important way for people to reach out and engage with supports; however as social media is still a relatively new and evolving phenomenon and unique compared to other forms of communication, the potential positive and negative consequences of its use are mostly unknown. The goal of a current PhD research study is to increase awareness of the consequences of patients, families and friends using social networking sites to communicate about a crisis or traumatic emergent hospital admission.
Aims: By analysing reflections of social workers employed in the trauma emergency hospital environment, this research aims to identify a range of positive roles and potentially problematic issues occurring when social networking sites are used to communicate about a sudden and unexpected hospital admission. This project aims to create new knowledge in order to inform staff, patients and families of its benefits and potential issues, so social networking sites can be used in an informed way, respectfully, at a time of stress, crisis and trauma, and to avoid potentially distressing experiences.
Social Work is becoming increasingly aware of the various ways the use of social media can further impact upon the stress people are under due to a traumatic hospital admission. This can be especially so for families already struggling with stressors, or with complex family dynamics; and for patients, especially those intubated and sedated, where the use of social networking sites may be used without their consent, with them having no control over what is written or posted. Communication during traumatic incidents is imperative to reducing stress, and stated as one of the factors of providing psychological first aid is “helping people connect to information, services and social supports” WHO (2014).
One role of a hospital social worker, through the process of holistic bio-psychosocial assessment is to identify and “address the social and emotional issues that are impacting on the patient and their family/carer’s health, wellbeing, adjustment and recovery” including the “external issues that may be negatively affecting it” AASW (2016). Social Workers are in a unique position to develop awareness of the various stressors and dynamics impacting on individuals. This research will investigate how best to intervene and educate at times when the crisis at hand may cloud the decision-making of those involved in terms of use of social networking sites.
Practice-based Researcher and Mental Health Clinician
Margaret (Margi) Cowgill has over fourteen years of experience as a social worker in public health. Margaret is currently employed as a social worker in the Mental Health Service of Peninsula Health in Melbourne. She has previously worked in various departments with the Alfred Hospital – in the trauma specialty – between the Alfred’s three campuses for over eight years. Margaret began her social work career in in the United Kingdom where she worked in community support teams in various areas of health including HIV, learning disabilities, physical disability and age care; and also in hospital-based roles such as emergency department, orthopaedic/trauma, general medicine, neurological rehabilitation, aged and complex care rehabilitation. Margaret studied her undergraduate social work degree at the University of Tasmania, she obtained her Masters of Social Work from Monash University where she is currently studying her PhD in social work research.
Publications
Cowgill, M., & Knol, R. (2022). 5 Trauma-Informed Practices in Health Social Work. Social Work Practice in Health: An Introduction to Contexts, Theories and Skills. (pp. 49-62). Routledge.Social Work Practice in Health: An Introduction to Contexts, Theories and Skills. (pp. 49-62). Routledge.
Cowgill, M. & Petrakis, M. (2018). Hospital-based trauma social work. Chapter 4. in Melissa Petrakis (Ed.) Social Work Practice in Health: An introduction to contexts, theories and skills. Sydney: Allen & Unwin.
Evidence-based treatments (EBTs) in dual diagnosis practice
The Utility of Innovative Dual Diagnosis Tools for the Mental Health Workforce
Abstract
There has been a steady recognition, since the 1990s, of the observed links between substance use disorders and a variety of other negative outcomes for those mental health patients – now community residents - with dual diagnoses (Drake & Brunette, 1998). Evidence, from both retrospective and prospective studies, indicates that co-occurring substance use and abuse is associated with relapse and re-hospitalisation, violence, family discord and problems, homelessness, decreases in functional status, HIV infection, and medication non-compliance (Drake & Wallach, 2000).
Aims: This exploratory and descriptive study has four main aims:
1. To discern the most robust approaches to training and workforce development in dual diagnosis evidence-based treatments (EBTs).
2. To trial an EBT – the BDA Harm Reduction tool and associated capacity building package – in a CCU setting.
3. To determine strengths and weaknesses in this tool and its implementation.
4. To examine factors which facilitate or inhibit uptake of EBT approaches to dual diagnosis practice in routine care in a community care unit setting.
Research Question: The main Research Question is:
How does the use of the BDA tool and associated implementation package enhance dual diagnosis practice in a community care unit?
Practice-based Researcher and Senior Clinician
Simon Kroes is a dual diagnosis senior clinician at Nexus Dual Diagnosis Service, in the mental health department at St Vincent’s Hospital Melbourne. Simon has worked in various other settings including disability, crisis services, aboriginal and community health. He has a keen interest in developing practical resources for health and welfare staff, consumers and carers. In 2011 he developed the initial concept and prototype of the Reasons for Use package (RFUP) which he developed further with colleague Kevan Myers. In November 2016 he won a commendation from Tandem (the Victorian state-wide peak body for families and carers of people experiencing mental ill health) for his work on the Carers Can Ask resource, which aims to assist carers in having more meaningful conversations with service providers. He is currently researching a harm reduction treatment panning tool he developed that has been implemented at numerous services. Simon is also the chairperson of the North East Dual Diagnosis Youth Network which aims to develop best practice integrated care for young people who have dual diagnosis issues.
Publications
Myers, K., Kroes, S., O’Connor, S., & Petrakis, M. (2020). Reasons for Use Package: Outcomes From a Case Comparison Evaluation. Research on Social Work Practice, 30(7), 783-790.
Kroes, S., Myers, K., Officer, S., O’Connor, S., & Petrakis, M. (2019). Dual diagnosis assessment: A case study implementing the reasons for use package to engage a marginalised service user. Cogent Medicine, 6(1), 1630097.
Morrison, B., Kroes, S., Owens, C., Fairclough, J., Myers, K. & Petrakis, M. (2018). Before During After: A New Harm Reduction Tool. In Robertson, S, Dunbar, L, Cassaniti, M, Tooth, B, Kellehear, K, Prowse, L, Garan, N, Suttie, S. Embracing Change: Through Innovation and Lived Experience Contemporary TheMHS in Mental Health Services, Sydney Conference Proceedings 2017, TheMHS Conference, Sydney, Australia.
Myers, K., Kroes, S. & Petrakis, M. (2018). A foundation for dual diagnosis practice: wisdom, tools and resources. Chapter 9 in Melissa Petrakis (Ed.) Social Work Practice in Health: An introduction to contexts, theories and skills. Sydney: Allen & Unwin.
Petrakis, M., Robinson, R., Myers, K., Kroes, S., & O'Connor, S. (2018). Dual diagnosis competencies: A systematic review of staff training literature. Addictive Behaviors Reports, 7, 53-57.
Myers, K., Kroes, S., O’Connor, S. & Petrakis, M. (2018). The Reasons for Use Package: how mentoring aids implementation of dual diagnosis practice. New Paradigm: the journal of the Psychiatric and Disability Support Services, 25-29. Melbourne: VICSERV.
Myers, K., O’Connor, S., Petrakis, M. & Kroes, S. (2017). The Reasons for Use Package: Development research and implementation lessons for the field. 26th Contemporary TheMHS in Mental Health Services, ‘People: Authenticity starts in the heart’ 23-26 August 2016, Auckland New Zealand. 2016 TheMHS Conference Proceedings, Australia.
Views of Peer Workers and Clinicians implementing Recovery-Oriented Practice
Views of Peer Workers and Clinical Staff regarding the implementation of Recovery-Oriented Practice in a public mental health service
Abstract
Background: Commonwealth and state policy have mandated the implementation of recovery-oriented practice (ROP). Its implementation has been different for the various public Area Mental Health Services. For the purposes of the present research, the implementation of ROP at Eastern Health was of interest because it was in its infancy and was imminent.
Aims: To achieve a better understanding of the perspectives of peer workers and clinical staff about ROP prior to the implementation of the Collaborative Recovery Model into a public area mental health service.
Method: The research design was exploratory and social constructivist. The first methodology was a focus group of peer workforce, using semi-structured questions, conducted in a public mental health service. The data collected was qualitative, and was analysed for themes and content. The second methodology was a survey of clinical staff throughout the mental health service programs, prior to ROP implementation.
Results: To date, data from the peer worker focus group has been analysed. Seven participants (six females) attended and contributed to the findings. Recruited participants were consumer peer workers (5) and carer (2) representatives. The results demonstrated that peer roles are potentially valuable in the implementation of ROP in mental health services. The results showed peer workers add lived experience and can potentially contribute to clinician uptake and practice of ROP. Some barriers to implementation were identified that should assist the service to meet its aims in ROP implementation.
Conclusions: The current focus group study contributes to the growing evidence that investigates the inclusion of peer workers in mental health services. It suggests that the role of peer workers in the implementation of ROP is advantageous as their views provide vital indications of how mental health services might successfully implement ROP.
Practice-based Researcher and Mental Health Clinician
Janice (Jaz) Chisholm is a Social Work Clinician working with Mental Health Triage and the Crisis Assessment & Treatment Team at Eastern Health in Victoria. Prior to this Jaz worked as a case manager with an Area Mental Health Service for four years. She has completed a Master of Mental Health Science (Research) and is currently a PhD Candidate. Her research is in the area of peer worker and clinician views on the implementation of recovery-oriented practice, and will next extend to include consumer views. She presented her research at the TheMHS conference in 2018 in Adelaide, and will present at the 9th International Conference on Social Work in Health and Mental Health in York, England in July 2019. The approach Jaz takes in her research is informed by both her professional training and a lived experience of mental illness.
Publications
Chisholm, J., & Petrakis, M. (2022). Clinician perspectives and sense of efficacy about the implementation of recovery-oriented practice in mental health. The British Journal of Social Work, 52(3), 1380-1397.
Chisholm, J., & Petrakis, M. (2022). Peer Worker Perspectives on Barriers and Facilitators: Implementation of Recovery-Oriented Practice in a Public Mental Health Service. Journal of Evidence-Based Social Work, 1-14.
Chisholm, J., & Petrakis, M. (2022). Clinician perspectives about working alongside mental health peer workers in service teams. Advances in Mental Health, 20(1), 51-63.
Chisholm, J., & Petrakis, M. (2021). Clinician perspectives and sense of efficacy about the implementation of recovery-oriented practice in mental health. The British Journal of Social Work.
Chisholm, J., & Petrakis, M. (2020). Peer worker perspectives on their potential role in the success of implementing recovery-oriented practice in a clinical mental health setting. Journal of Evidence-Based Social Work, 17(3), 300-316.
Enhancing LGBTIQ+ Responsiveness in Mental Health Services
Abstract
This project aims to achieve the Government-endorsed Rainbow Tick Accreditation for St Vincent’s Mental Health, the Emergency Department (ED) and De Paul House. This is with the aim to improve existing programs within St Vincent’s Hospital (Melbourne), and to establish new projects as adjuncts to existing service structures with the support of Monash University, Department of Social Work to strengthen an evidence-based approach. These innovation projects are in the form of:
- workforce training and development on clinical best practice
- community health promotion and literacy about LGBTQIA+ issues and mental health
- building sustainable partnerships with relevant stakeholders
- policy development, and
- building the reputation of St Vincent’s Hospital (Melbourne) as one which provides excellent, inclusive care to consumers who identify as gender and/or sexually diverse.
The project committee, four of whom have undergone the Rainbow Tick Accreditation training through Gay and Lesbian Health Victoria (GLHV), and La Trobe University, intend for patient outcomes to improve through stronger staff and clinician expertise in engaging with these consumers. We anticipate that increased clinician confidence to discuss the nuances of mental health and LGBTQIA+ identity will enhance clinical intake and assessment, case formulation, collaborative treatment planning, risk management, family and carer engagement, and smoother discharge processes through referrals to specialised services and supports in the community.
The increased ability to provide psychoeducation, health literacy, and links to community organisations will enhance patient and consumer outcomes by meeting their outstanding needs resulting from psychosocial disadvantage due to LGBTQIA+ identity.
In order to embody the Rainbow Tick standards, we will need to be able to demonstrate that each of the six standards is embedded in the organisational systems of St Vincent’s Mental Health, ED and De Paul House, as per the Rainbow Tick Guide to LGBTI Inclusive practice, (Second Edition) (La Trobe University, 2016):
- Organisational Capability
- Work Force Development
- Consumer Participation
- A Welcoming and Accessible Organisation
- Disclosure and Documentation
- Culturally Safe and Acceptable Services
The LGBTQIA+ Steering Committee has established collaborative relationships and has received training from experts in this area. Four staff members undertook the How2 training for achieving National Rainbow Tick Accreditation for LGBTQIA+ inclusiveness and best practice, which is delivered by GLHV and La Trobe University. The Steering Committee also sits on the North Western Primary Health Network (NWPHN) Steering Group for the new region-wide Suicide Prevention Strategy for LGBTQI+ Victorians. This group is led by the NWPHN and includes providers of mental health care and those leading research in this field.
Additionally, St Vincent’s Mental Health has been invited to join the Victorian Mental Health Inter-professional Leadership Network (VMHIL) – a collaboration of Victorian mental health services supported by DHHS. It works to build a culture of innovation by supporting new and creative ways of thinking, building a community to facilitate knowledge exchange, drive practice change, and service development in critical areas including recovery-oriented practice and supported decision making. One of the four staff on this project will be a lived-experience representative, as co-production of services is a core priority in St Vincent’s Mental Health. We subscribe to the value of “nothing about us without us” which drives the philosophy of developing policies and services in tandem with consumer and carer participants, to ensure a truly person centred model. We will be prioritising the LGBTQIA+ Rainbow Tick through our involvement in this VMHIL project, and will partner with St Vincent’s ED and De Paul House in these pursuits.
Moreover, two members of the St Vincent’s Mental Health LGBTQIA+ Steering Committee were invited to deliver a presentation at the Australia and New Zealand ‘The Mental Health Services’ Conference (TheMHS) to an international audience of mental health colleagues. This is part of the Conference’s section on ‘Celebrating Diversity’ in mental health practice. We have also been accepted to publish an article in the St Vincent’s Font Newsletter on this topic.
These collaborations and partnerships have laid the foundation for developing and co-delivering new services to this niche population, utilising existing services through stronger referral pathways, and has opened doors for St Vincent’s Mental Health to seek and share resources and training opportunities as part of this proposed Quality Improvement project. This can be used to provide more inclusive patient care by gaining new expertise through consultations, developing diversity responsive policies, and through linking consumers and families to existing support systems that they currently may be missing out on.
Practice-based Researcher and Senior Clinician
Jan Kilicaslan is a Senior Social Worker employed at St Vincent's Hospital Melbourne, in the Mental Health Service Development Unit as a Project Officer. Since 2007, she has held an eclectic range of roles in areas including clinical mental health, youth and family work, community development, and human rights advocacy. With Bachelor Degrees in Psychology, Social Work (Hons), and a Graduate Certificate in Youth Mental Health, Jan transitioned from studying a Master's Degree to commencing a PhD Including Published Works (Professional Doctorate) at Monash University in 2017. She has presented at Australian as well as international conferences and has engaged in research and evaluation as part of her roles in the mental health field.
Jan's current PhD research explores the current state of LGBTIQ+ responsive practice in mainstream mental health services in Melbourne, Australia, and opportunities to enhance clinical care for gender, sexuality and bodily diverse consumers and patients of these services. This topic became a key point of focus in Jan's practice and research after building collaborative professional working relationships with colleagues in LGBTIQ+ specific mental health services and learning of the ongoing gaps in service experienced by LGBTIQ+ individuals. Her objective is to carry out evidence-based-practice and practice-based-research in her work and studies in the interest of supporting the minimisation of discrepancies between service delivery and service-user needs in the field of clinical mental health.
Publications
Kilicaslan, J., & Petrakis, M. (2019). Heteronormative models of health-care delivery: investigating staff knowledge and confidence to meet the needs of LGBTIQ+ people. Social work in health care, 58(6), 612-632.
Hanratty, D., Kilicaslan, J., Wilding, H., & Castle, D. (2019). A systematic review of efficacy of Collaborative Assessment and Management of Suicidality (CAMS) in managing suicide risk and deliberate self-harm in adult populations. Australasian psychiatry, 27(6), 559-564.
Kilicaslan, J., & Petrakis, M. (2019). Heteronormative models of health-care delivery: investigating staff knowledge and confidence to meet the needs of LGBTIQ+ people. Social work in health care, 1-21.
Kilicaslan, J., Bell, M., & Petrakis, M. (2018). Gender diversity and mental health at St Vincent’s Hospital Melbourne: A move towards LGBTQ+ inclusive practice. In Robertson, S, Dunbar, L, Cassaniti, M, Tooth, B, Kellehear, K, Prowse, L, Garan, N, Suttie, S. Embracing Change: Through Innovation and Lived Experience Contemporary TheMHS in Mental Health Services, Sydney Conference Proceedings 2017, TheMHS Conference, Sydney, Australia.
Personal Recovery in sub-acute mental health services
Abstract
Recovery-oriented practices and the lived experience of service users in sub-acute mental health programs is under-researched. A scoping review of the literature explores current recovery research and frameworks. It investigates whether people with mental illness experience both clinical and personal recovery improvement while in such programs, to clarify whether evidence-based practices are being utilised. Service user perspectives were sought. The review examines the measures used to evaluate this area to date, and the extent to which they are fit-for-purpose. There is a paucity of research in this area. At present there have only been three studies into sub-acute Prevention and Recovery Care (PARC) facilities in Victoria. The limited studies available conclude that sub-acute programs are a promising innovation and that they aid personal recovery.
This model is of considerable interest to the government as it is repeatedly being mentioned as a promising way forward during the Mental Health Royal Commission Community Consultation processes in the first half of 2019.
Practice-based Researcher and Mental Health Clinician
Anna Lanyon is a Social Worker employed at St Vincent's Hospital Melbourne, in the Secure Extended Care (SECU) Diversion & Complex Care Program. She commenced a research study during the establishment phase of the North Fitzroy PARC – a 10 bed sub-acute step up/step down facility bridging inpatient and community mental health care – in 2015-2016. The Minister for Mental Health officially opened the North Fitzroy PARC on the 8th September 2015. The PARC is operated in a partnership between Wellways [formerly Mental Illness Fellowship (MIF) of Victoria] and St Vincent’s Mental Health Service. St Vincent’s provides clinical treatment through an in-reach model and subcontracts provision of residential accommodation, recovery programs and practical support to Wellways.
Publications
Lanyon, A., Petrakis, M., & Ross, B. (2021). Writing case notes on placement. In Writing Skills for Social Work Students. Red Globe Press.
Engaging Families in Mental Health Reform: The Value of Participatory Methods
Abstract
The Royal Commission into Victoria’s Mental Health System established, by the Governor of the State of Victoria on advice from the Victorian Government, in February 2019 is a once in a generation opportunity for reform to improve the experiences of service users, their families and supporters. Submissions to the Royal Commission by families and supporters reported feelings of being unheard, excluded from the treatment of their loved one, as well as their own experiences of distress, anxiety and disconnection. Further to this, despite the Royal Commission’s Report recognising that families, carers and supporters “have much to contribute to a future mental health and wellbeing system” and that most consumers have relationships of support and care, which remain an important part of recovery and wellbeing, family and supporters often experienced difficulties in gaining access to information to assist them in their support roles or to understand how to navigate the system. The Mental Health Act 2014 designed to create greater inclusion of family and supporters had failed and in many cases led to further exclusion.
Empowerment theory recognises that individuals and communities may experience direct power blocks through social institutions discriminating against or blocking access to services. With many families, carers and supporters experiencing exclusion, poor access to information, trauma, loss of confidence and disempowerment in their interactions with the mental health system, appropriate approaches to enhance empowerment need to be identified to ensure that engagement methods build knowledge and skills for social action and system reform.
One of the aims of the Royal Commission was to rebalance the relationship between the system and families and supporters by making the system more accountable and ensuring the involvement of families, carers and supporters in care and recovery becomes standard practice. Building on the work of the Royal Commission this project aims to answer the research question: What processes enable a family-led approach to mental health reform?
The project will undertake three studies to answer the research question, including systematically mapping international evidence which prioritizes the views of carers, on the interventions and service responses that best support the needs of carers and establish trends that exist in the evidence on carer support. A second study will review legal reform to understand the impacts on family, carers and supporters of people with mental health challenges. Building on the first two studies the third study will investigate participatory methodologies to empower family engagement in system reform.
Practice-based Researcher and Senior Family Adviser
Caroline Walters is a post-graduate student and teaching associate at the Department of Social Work, Monash University (Australia). In her role as Senior Advisor at Tandem (the Victorian peak body representing family and friends supporting people living with mental health challenges), Caroline engages in Mental Health System advocacy through supporting and promoting the voice of family and carers of people with mental health challenges. With a strong belief in relational and inclusive family practice within mental health, Caroline is interested in participatory methods of research and system reform that centres and promotes the voice of family and supporters and the people they support. Caroline is both a social worker and a registered nurse, with 10 years of research experience calling on a diverse practice of research methodologies to encourage inclusion and fair evaluation of programs.
Publications
Walters, C., & Petrakis, M. (2022). A Systematic Mapping Review of Family Perspectives About Received Mental Health Interventions. Research on Social Work Practice, 32(1), 61-72.
Walters, C., & Petrakis, M. (2021). A Systematic Mapping Review of Family Perspectives about Received Mental Health Interventions. Research on Social Work Practice. doi:10.1177/10497315211010950
SWITCH research partners
