Walking the tight rope: Women's health social work, maintaining the balance Striving for cultural responsiveness in a multiagency world ACCAN 2015 Linda Haultain PhD, PGDSSS; RSW Hannah Frost, BSW, RSW Shireen Moodley, BSW Establishing the context – team • Work with women who are pregnant with high social needs and their associated risks • Home, clinic and ward visits during pregnancy and six weeks post partum • Early referrals welcome • Referrals primarily received from Midwives • Multidisciplinary and multiagency in nature • Social workers, Practice Supervisors, Team Leader, Professional Leader Context - need • Maori and Pasifica women are over represented in Reports of Concern (ROC) to CYF • Mandatory responsibility to notify ‘significant risk of harm’ to our statutory colleagues • Significant numbers of ROC are made to CYF from the Women’s Health Service • Health Social Workers undertake 65% of all ROC Maintaining the balance…constructing the safety net Assessing and responding to the child protection risks pregnant women are experiencing Establishing and maintaining the relationship now and into the future Practice based research – adopting a critical best practice approach • PhD research (qualitative and quantitative data 2011) • Clinical audit 2014 • Critically reflective conversations 2015 • Making explicit links with the literature Cultural responsiveness • Assess and respond to specific cultural needs to assist patient and family engagement • Indentify cultural support for patient and/or family members • Facilitate effective family meetings • Works effectively with an interpreter Audit tool example Effective practice domain Evidence (what did you read?) Outcome 1.1 establish trust and rapport 1. consent given 2. significant information gained to inform initial assessment 3. evidence of ongoing engagement and relationship 1. quality information to inform assessment 2. continued engagement 3. collaborative plans addressed key issues 1.2 maintain a non-judgmental attitude and approach 1. in the face of multiple high 1. continued engagement risks, HSW continued to 2. alerts removed support families goals 3. open disclosures by 2. women given choices & women supported sound supported to be safe even safety planning when poor choices were made (returning to abusive partner during pregnancy) 1. Interpersonal family violence Maintaining the balance…constructing the safety net Assessing and responding to the child protection risks pregnant women are experiencing Establishing and maintaining the relationship now and into the future the critically reflective question When you reflect on working with pregnant women who are experiencing significant child protection risks, what are the personal, professional and organisational qualities you believe have a bearing on the capacity you have to maintain this balance? Personal values and beliefs that help support the balance • Feminism, cultural awareness, social justice, equity • Knowledge of social disadvantage and its impact • A fundamental belief in each persons innate value, strength, capacity This supported particular ways of being with women • “Its about connection – not collusion” • Empathy, generosity, gentleness, kindness, compassion, fairness, patience • Not wanting to add to the disadvantage • Supporting self determination “Willingness to hear her whole story but knowing I can’t know her whole story” Valuing of women “Women have value, even when they are unable to step into the space we offer and hold, we still offer that space, and continue to offer it” “My position as someone from an ethnic minority, it helps me to be empathic, to be aware of pakeha models, the medical model and ways of thinking, it helps me to have a strong voice, to advocate for women from minorities” Professional – an attitude of empathy and investment that shapes practice • Holding a broader view and a longer view • Acknowledging and supporting women and their families hopes, goals and dreams • Looking backwards and looking forwards – its not just about the now • A desire to not add to the suffering Professional ‘models’ • Women centered and family centered practice • Cultural responsiveness, including bi-cultural practice • Strengths based practice • Narrative therapy • Trauma informed practice • Attachment, knowledge and understanding • Empowerment model • Social model of health Professional - skills • • • • Risk assessment Facilitation skills Experience working with conflict Compassionate listening, rapport and relationship • Multi-professional and multi-agency working • Rigorous use of consultation and supervision Supervision – feeling safe in the reflective space • The reflective space, “me being curious about my own practice, asking myself the how and the why questions” • Feeling safe, they (PS) have the skills, knowledge and understanding, they offer the care and support • “They are the bigger, stronger, kinder person, they hold that space for us and that enables us to do that space for others” Supervision • There is permission giving – I am allowed to make mistakes, to innovate, to explore and to extend practice • It is not risk adverse – we make decisions together and we hold risk together • Reflective practice – its about honestly and safely exploring the tensions, its an inquiry • Supervision, its competent, safe, informed, it’s a high trust environment Organisational investment • Supervision • Workload management • Multiple child protection forum (multiagency and multiprofessional) • MOU between CYF, Police and ADHB • Policy; social work assessment, including bi-cultural and broader cultural expectations, child protection, family violence, including alerts, informed consent • Investment in right recruitment, meaningful performance appraisal, audit of notes and live observation/ supervision of practice, supervision logs, CPD logs • Investment in training, journal club, time for reflection • Learning from errors by undertaking root cause analysis reviews Te Tiriti o Waitangi – evidencing bi-cultural social work practice • Partnership; providing women information and choices, informed consent, working with cultural colleagues, using hui, listening to women, making plans together, keeping women in the centre (relationally) in order to keep babies in the centre (safety and wellbeing) • Participation; advocacy, explaining, communicating, sharing decision making, planning, transparency, including fathers and wider whanau • Protection, babies all born in hospital, cultural advocacy and support provided, greater protection /safety of women and their pepe by engaging in robust safety assessments & planning, of other members of the team, keeping mother and pepe together, breast milk, cultural practices, memory making The safety net in review Assessing and responding to the child protection risks pregnant women are experiencing Establishing and maintaining the relationship now and into the future • Personal, professional factors & organisational factors • The human touch, relationship based practice, culturally responsive • Informed by theories and models that reflect a commitment to social justice and take account of women’s complex histories and their impact and robust risk assessment and safety planning • Supervision, leadership, workforce investment • Holding risk together References • • • • • • • De Boer, C. & Coady, N. (2007) Good helping relationships in child welfare: learning from stories of success. Child and family social work, 12, pp 32-41 Epstein, I. (2010) Clinical data-mining. Oxford University Press Ferguson, H. (2001) Promoting child protection, welfare and healing: the case for developing best practice. Child and family social work, 6, pp 1-22 Ferguson, H. (2003) Outline of critical best practice perspective on social work and social care. British journal of social work. Vol 33. page 1005-1024. Morrison, T. 1996. Partnership and collaboration: rhetoric and reality. Child Abuse & Neglect 20 (2): 127-140 Munroe, E. (2011) The Munroe review of child protection. Interim report: The child’s journey ttp://www.education.gov.uk/munroreview/downloads/Munrointerimreport.pdf Wheatly, M. (2010) Perseverance. Thank you Questions? Contact: lindah@adhb.govt.nz