Evidencing Social Work Practice in Health and Mental Health: an International Collaboration

Evidencing Social Work Practice in Health and Mental Health: An international collaboration

project 2018-19 5.10.2018

Introduction

Based on the previous audit undertaken in Victoria, Australia, a practice-research initiative is being undertaken collaboratively by the Universities of Helsinki and Melbourne in collaboration with HUS, the University of Tampere and TAYS, in conjunction with health and mental health service social workers in the two countries. We want to gain an evidence-informed global understanding of the current practices of social work practitioners in health and mental health services to contribute to debates about the future input and roles of social work in health.

The collaboration will generate internationally relevant data and expand the size of the dataset to enable more robust and generalised findings. The study aims to describe amongst other key functions, patient/consumer-specific clinical interventions, non-specific patient/consumer attributable activities, non-clinical interventions, and theoretical approaches and models informing interventions by social workers.

Health social workers believe that they make a positive difference to the lives of patients and their families. They feel they contribute to the health workforce in providing or ensuring good quality and effective care. Working with and challenging other professionals they see themselves as effectively contributing to patient well-being and improved economic outcomes for the health system. Social work has a long-standing, hundred-year history of engagement in health settings.

Aim

The aim of the study is to evidence current practice to quantify and clarify the contribution of health and mental social workers, as members of the health workforce, to improved outcomes for patients in the health service. This includes an exploration of the competencies demonstrated by social workers.

The findings from this project will help inform the future development of social work services in health and provide an evidence informed description of how services operate and their benefit for health service defined outcomes.

Objectives 1. To conduct a 24-hour audit of activities 2. To critically analyse key themes and findings to identify: • Interventions social workers perform; • Models and theories utilised by social workers 3. To make recommendations regarding future directions for workforce development for social work in health and mental health

A multi-site audit will be undertaken to evidence current social work practice in health and mental health settings. The audit is to be undertaken across health and mental health services in Helsinki and in Tampere in one day.

The original audit tool was developed in a practice research initiative between the University of Melbourne (UOM) (Professor Lynette Joubert) and St Vincent’s Hospital’s Department of Social Work (SVHM SW) (Sonia Posenelli). The practice research progressed in phases across multiple sites in Victoria involving over 15 sites and 532 social workers. The same tool will be translated in Finnish and applied for the data collection. We estimate that 240 social workers at Helsinki and HUS area and 40 social workers in the health care settings at Tampere will participate for gathering the data.

Next the study will now extend internationally in a collaboration with the University of Helsinki and the Heikki Waris Institute in conjunction with health services across Finland. The team of investigators from Helsinki and Melbourne aim to recruit a sample of 1000 social workers across health services internationally. In addition to the local social work profiles at Helsinki and Tampere, the data analysis will deliver a data driven classification of the social work profession irrespective of organisational and cultural contexts.

Principal Investigators

University of Helsinki & HUS University of Melbourne University of Tampere Dr. Laura Yliruka, The Heikki Waris Institute, Prof Lynette Joubert, Department of Social Socca, HUS Work, Melbourne School of Health Sciences Prof. Mirja Satka, Faculty of Social Sciences, Ms Lisa Braddy, Department of Social Work, University of Helsinki St Vincent’s Health, Melbourne MA Jenika Heinonen, The Heikki Waris Institute, Ms Catherine Ludbrooke, Peter Socca, HUS MacCallum Cancer Centre, Melbourne Dr. Anna Metteri, Faculty of Social Sciences, Dr Lyndal Hickey, Social Work Researcher, University of Tampere Department of Social Work, St Vincent’s Health

Chief Investigators and alumni researchers

Chief Investigator Organisation Position Miia Ståhle HUS Leading social worker Pirjo Holm HUS Leading social worker Kaija Kurkela HUS Leading social worker Ulla Väisänen HUS Leading social worker Leif Sundström HUS Leading social worker Sanna Ahonen HUS Social worker Aila Ronkanen Helsinki Manager of psychosocial work Sirpa Hornborg Helsinki Leading social worker Satu Tuomainen Helsinki Leading social worker Helsinki Leading social worker Seija Sistonen Helsinki Leading social worker PäiviMirella Savolainen Saari Helsinki Leading social worker Eevi Apponen Tampere Leading social worker Eeva-Liisa Lejon Tampere Leading social worker Mia Kanninen Tampere Leading social worker

2 Johanna Björkenheim Espoo Alumni researcher Sinikka Hiljanen Helsinki Alumni researcher

Ethical considerations

For the study a research permission will be applied via HUS and TAYS during the spring 2018. The Australian part has been screened as an observational/quality assurance study via the University of Melbourne, Departmental HEAG Committee. Anonymity of participants will be protected; they will not be required to provide their name or any identifying particulars and a study number will be allocated to each data collection tool. Due to the small sample size in some services, complete anonymity cannot be guaranteed as role description, site, and ward/service unit will be recorded on the spreadsheet and this needs to be managed in two ways: 1. Decisions by the manager as to the way in which the data will be presented in that organisation. 2. The Investigator team will ensure that no country or specific site is identified in any way as the purpose is to define and clarify a global understanding of health and mental health social work and its benefit to the health system.

The study design

The study design will comprise a prospective audit of usual social work practice. The data will be collected via a spreadsheet divided into 5-minute intervals. These will be populated with data codes from a coding sheet (attached). Social workers will be asked to describe the activities carried out on one working day, which will be nominated by their service. All Social Workers within the service have been invited to participate in this survey. If a designated audit day is not one of a particular social worker’s working days or they are engaged in an activity that can’t be regarded as ‘usual practice’, they will kindly complete the survey on their next working day. The coding sheet will be delivered for the social worker in the training events and the filled coding sheets will be brought directly to Socca to the principal investigators or send by post. The REDCap web-based application will be used for data entry and analysing (see REDCap manual as an attachment). The data will be destroyed after 5 years by the principal investigators.

The time schedule

Time schedule Task Main actors 6-9/2018 Translation of the data codes The research group form a coding sheet

9/2018 Preparing the data entry (Red Jenika Heinonen Cap)

9-11/2018 Training of the data collection, The research group Distribution of the data sheets to social workers 26.9.2018 Pilot data collection The research group & (Hyvinkää, HUS/Vantaa) social workers 24.10.2018 Main data collection in Helsinki area 20.11.2018 Main data collection in Tampere area

3 11.10.-10.12.2018 Coding Two social work students from the University of Helsinki 11/2018 Analysing The research group 12/2018 Jenika Heinonen 12/2018 Writing a report The research group, 1/2019 Jenika Heinonen

1-12/2019 Writing an international article Principal investigators Contact persons: Lynette Joubert ([email protected]) or Laura Yliruka ([email protected]).

Attachment 1. Appendix I Instructions to participants in each country

1. Complete the top box with basic demographic information requested: • total years experience in social work practice (rounded to the nearest number); • circle your gender M (male) or F (female); and • country of practice qualification (country where you obtained you first SW qualifying degree/diploma)

2. Also in this top box, complete: • the closest description of your primary professional role on the day (Variable A). • the code for the site of intervention (Variable B).

3. In the next box, complete: • your rostered hours for the day (eg 0830-1700) • Patient Count: this box is at the top of every page. Please count all unique patients you see across the day (one count per each patient). This patient count box will allow you to create a tally of the amount of unique patients you see on each page of the coding sheet. At the end of the day please add these up and place the number in the total box at the end of the form.

4. The main document requires codes (from the coding sheet) related to the time intervals on the spreadsheet. If you work outside the hours of 8.00am to 5.30pm, please change the times on the sheet to match your work / shift times. Record breaks rather than leave these times unaccounted for.

To complete the codes, decide whether your activity can be attributed to an individual patient with a unique patient identification or not.

If Yes In the ‘Activities attributable to patient/client’ section, provide one number only in each of columns C and D. Columns E, F, G and H must be completed if relevant to activity, but may have multiple numbers in the boxes. If you are using multiple numbers, please code in priority order, using the primary code first. Please use no more than three codes per column. Columns I and J are optional, only if appropriate to this individual and may have multiple numbers. You may use ditto marks (“) to indicate repeating the same code for the same or a different individual. (See example 1).

If your activity relates to more than one individual / mode of intervention within the 5 minutes, please use the primary activity only that you completed in this time.

If No If the activity is not related to a specific patient (i.e. unit meeting, group therapy, screening), please fill out column K. (See example 2). If the activity is non-clinical in nature complete column L. (See example 3 and 4). Multiple numbers are permitted in each column.

Attachment 2. Master Codes – will be translated into Finnish

Variable A Code Code for Role description Clinician 1 Senior Clinician 2 Clinical supervisor / Practice supervisor 3 Clinical Educator 4 Clinical Development 5 Care Coordinator/Case Manager 6 Manager (Program/department) 7 Researcher 8 Student co-ordinator 9 Senior social worker - Team Leader 10 Triage / Duty worker 11 Counsellor Advocate 12 Student – Placement 1 13 Student – Placement 2 14 Other (describe on spreadsheet) 15

Variable B Code Variable B Code Code for Site of Intervention Code for Site of Intervention Alfred Health Epworth Rehabilitation Alfred Acute Medical 1 Richmond 35 Caulfield Hospital 2 Hawthorn 36 Sandringham Hospital 3 Camberwell 37 Alfred Psychiatry Melbourne Health Alfred Adult Community Psychiatry 4 Royal Melbourne Hospital - city 38 Alfred Adult Inpatient Psychiatry 5 Royal Melbourne Hospital – Royal Park 39 Alfred CATT 6 Monash Health Alfred CYMHS 7 MMC Clayton 40 Alfred Psychiatric Rehabilitation 8 MMC Moorabbin 41 Headspace Elsternwick 9 Dandenong 42 Austin Health Casey 43 Austin Hospital 10 Kingston 44 Heidelberg Repatriation Hospital 11 North Western Mental Health Royal Talbot Rehabilitation Centre 12 CCU 45 Ballarat Health Services NWMH – City Campus 46 Ballarat Base Hospital 13 Moonee Ponds 47 Queen Elizabeth Centre 14 Parkville – OYH 48 Barwon Health Triage 49 Adult MH 15 PARC 50 Child & Youth MH 16 NWMH - Royal Park Campus 51 Acute inpatient 17 Broadmeadows Health Service 52 Rehab inpatient 18 Footscray - OYH 53 Outpatient/Community Based 19 Sunshine – OYH 54 Bendigo Health NAMHS – Northern Hospital 55 Bendigo Hospital 20 Sunshine Hospital 56 Anne Caudel Centre 21 Craigieburn Health Service 57 John Bomford Centre 22 BEC 58 Havlin Street East Complex 23 NAMHS – Darebin 59 Cabrini Hospital Sunshine Devonshire Rd 60 Malvern (acute) 24 Pascoe Vale South 61 Brighton (acute) 25 NAMHS - Preston 62 Palliative Care (inpatient) 26 Coburg 63 Palliative Care (community) 27 Peter MacCallum Rehabilitation 28 East Melbourne 64 Eastern Health Bendigo 65 Angliss 29 Box Hill 66 Box Hill 30 ONTrac 67 Maroondah 31 Moorabbin 68 Wantirna 32 Royal Women’s Hospital Peter James Centre 33 Social Work 69 Healesville 34 CASA 70 PAS 71 SACL 72 WADS 73 St Vincents STV Fitzroy 74 St George’s Kew 75 Caritas Christi Kew 76 Victorian Rehabilitation Centre 77 Western Health Footscray 78 Sunshine 79 Williamstown 80 IRS 81 CBR 82 ACAS 83

Variable B Code Code for Site of Intervention Monash Health Community Berwick 84 Cockatoo 85 Cranbourne 86 Dandenong (Thomas Street) 87 Pakenham 88 Springvale 89 Non-Monash Health Sites 90

Variable B Code Code for Site of Intervention Monash Health: Aged Persons Mental Health Service Middle South 91 Dandenong 92

Variable B Code Code for Site of Intervention Bendigo Health JLRU 93

Variable B Code Code for Site of Intervention La Trobe 94

Variable B Code Code for Site of Intervention Monash Health - Mental Health ELMHS (Early in Life Mental Health Service) 95 IRS (Intensive Rehabilitation Services) 96 CAPS (Community Access & Partnerships) 97 SEADS 98

Variable C Code Variable D Code for patient/client type Code for Primary Unit - ADULT Code Inpatient 1 Aged mental health 1 Outpatient 2 Aged acute 2 Community 3 Aged sub-acute 3 Residential 4 Assessment and Planning Units 4 Service User 5 Cardiac & Thoracic Surgery 5 Other (describe on spreadsheet) 6 Cardiology 6 CDAMS (Memory Clinic) 7 Chronic Disease Management 8 Dermatology 9 Developmental Disability Clinic 10 Eating Disorders 11 Emergency Department 12 ENT 13 Fertility Treatment 14 Gastroenterology 15 General Medicine 16

Gynaecology 17 Haematology (non-oncology) 18 ICU 19 Infectious diseases (HIV, meningococcal, 20 small pox) Major trauma 21 Minor trauma 22 Mental health 23 Neonatal medical issues 24 Neurology (stroke, MND, Parkinson’s) 25 Neurosurgery 26 Oncology 27 Orthopaedics 28 Pain Service 29 Palliative Care 30 Pregnancy care / Maternity / High risk 31 pregnancy Rehabilitation 32 Respiratory 33 Renal 34 Rheumatology 35 Sexual Assault 36 Surgery (general, acute, elective) 37 Termination of pregnancy 38 Transplant 39 Unplanned pregnancy 40 Urology 41 Vascular 42 Wound Service 43 Any other diagnosis for any category 44 (describe on spreadsheet)

Variable D Code Code for Primary Unit - PAEDIATRIC Adolescent Medical 44 Cardiology 45 Eating disorders 46 Emergency Department 47 Gastroenterology 48 General medicine (Endocrinology, 49 Dermatology) Surgery (general, acute, elective) 50 Infectious diseases (HIV, meningococcal, 51 measles, MRSA) Major Trauma (road traffic accident) 52 Minor Trauma (broken arm, wounds) 53 Mental Health 54 Neurology 55 NICU 56 Oncology 57 Orthopaedics 58 Palliative Care 59 Plastics 60 Rehabilitation 61 Renal 62 Respiratory 63 Special Care Nursery 64 Transplant 65 Any other diagnosis for any category 66 (describe on spreadsheet)

Variable D Code Code for Primary Unit – MENTAL HEALTH Adult Mental Health 67 Aged Mental Health 68 Youth Mental Health 69 Child Mental Health 70 Across the lifespan mental health 71 Psychiatry Rehabilitation 72 Any other diagnosis for any category 73 (describe on spreadsheet)

Variable D Code Code for Primary Unit – REHABILITATION Neuro Trauma 74 Ortho Trauma 75 ABI 76 Orthopaedic 77 Cardiac 78 Respiratory 79 Restorative 80

Any other diagnosis for any category 81 (describe on spreadsheet) Variable D Code Code for Primary Unit – ONCOLOGY

Paediatric 82 Lung 83 Breast 84 Gynaecology 85 Haematology 86 Gastro-intestinal (GIT) 87 Variable E Code Neurological 88 Code for Mode of Intervention Bone & soft tissue (sarcoma) (BST) 89 Face to face (patient/client) 1 Urology 90 Head & Neck 91 Face to face (group of patients/clients) 2 Skin & Melanoma 92 Face to face (significant other/s) 3 Lymphoma 93 Face to face (staff) 4 Late effects 94 Faxing/ emailing/ letters re patient 5 Day Chemo (Monash) 95 Faxing/ emailing/ letters to patient or 6 Any other diagnosis for any category 96 (describe on spreadsheet) significant other Social Media to or re patient (twitter, 7 facebook) Telephone (patient) 8 Telephone (significant other/s) 9 Telephone (service provider) 10 Telephone/ page (staff) 11 Non-contact (file, documentation, report) 12 Video-conferencing or tele-health 13 Other (Comment on spreadsheet) 14

Variable F Code Organ donation 56 Code for Issues impacting on Palliative Care / Advanced Care Planning 57 Intervention Parenting issues 58 Abuse / Child Protection issues 1 Patient/client primary carer for other 59 Accommodation 2 Perinatal loss/Termination 60 Acquired brain injury 3 Personality disorder/problems 61 Addiction 4 Poor compliance with treatment 62 Adjustment to condition 5 Pregnancy termination 63 Adjustment to hospital 6 Psychosis 64 Anxiety 7 Psych Disability 65 Asylum Seeker 8 Risk/impulsivity 66 Behavioural issues 9 Self esteem 67 Bereavement 10 Self-harm 68 Carer support 11 Sexual Assault 69 Child issues 12 Sexuality issues 70 Child protection 13 Social isolation 71 Communication issues 14 Stress management 72 Consent 15 Substance abuse 73 Cultural care for Aboriginal or Torres Strait 16 Suicidality 74 Islander patient/family TAC 75 Cultural or linguistic issues (CALD/NESB)/ 17 Interpreter Transition to RAC 76 Treatment resistance / Compliance issues 77 Death – sudden/unexpected 18 Unplanned pregnancy 78 Dementia 19 Veteran’s affairs 79 Depression 20 Work Cover 80 Disability - Intellectual 21 Other (comment on spreadsheet) 81 Disability - Physical 22 Disability - Sensory 23 Disability – Under 65 24 Disease progression 25 Elder abuse / Vulnerable older person 26 Emotion regulation 27 End of life / Withdrawal of treatment 28 Ethical dilemmas 29 Family/ relationship issues 30 Family violence issues 31 Financial issues 32 Funeral arrangements 33 Gambling 34 Guardianship issues 35 Administration of affairs 36 Hoarding 37 Homelessness 38 Identification of unknown patient 39 Intimate partner violence 40 Lack of emotional support 41 Legal issues (general) 42 Legal issues (Advanced care planning) 43 Legal issues (Medicare ineligible/ Visa 44 issues) Legal issues (NOK) 45 Legal issues (Superannuation/Insurance) 46 Legal issues (VCAT) 47 Literacy 48 Mental Health (Chronic) 49 Mental Health (Acute) 50 Moderate/ severe functional dependence 51 Multiple medical issues 52 Navigating the system 53 NDIA (Barwon) 54 Nutrition needs 55

Variable G Code Variable H Code for Patient-specific clinical Code for theoretical approach / model Code intervention type informing counselling / intervention Advocacy / negotiation 1 ACT 1 Attending VCAT hearing or similar 2 Behavioural approach / CBT 2 Bereavement Care 3 Behaviour modification (dementia) 3 Brief intervention / Single Session 4 CAT therapy 4 Care Planning 5 Couple counselling 5 Case conference 6 Crisis Intervention 6 Case Management 7 Developmental 7 Consultation/Secondary (patient related) 8 Systems / ecological 8 Counselling 9 Empowerment 9 Crisis intervention 10 Family meeting 10 Critical incident debriefing 11 Family therapy 11 Discharge Planning 12 Feminist theory 12 Complex Discharge Planning (Bendigo) 13 Grief and loss models 13 Intake 14 Humanist approach 14 Ecomapping 15 IPT 15 Education/ Information provision 16 Mindfulness 16 Family counselling/Family Work 17 Narrative approach 17 Family meeting 18 Psychodynamic approaches 18 Goal setting 19 Psychological first aid 19 Home visit 20 Risk framework 20 Liaison with community 21 Supportive care 21 Medication monitoring 22 Solution-focused / Task-centred practice 22 Mental state assessment 23 Strengths approach 23 Mini-mental state 24 Trauma interventions 24 Outcome measures 25 Other (Comment on spreadsheet) 25 Palliative care 26 Pregnancy options counselling 27 Psychometric testing 28 (Bio) Psychosocial Assessment 29 Reading medical file/ report/ database 30 Recording in medical file/ report/database 31 Referral 32 Resource provision 33 Review or follow-up of intervention 34 Risk assessment 35 Screening 36 Transferring deceased 37 Triage 38 Other (Comment on spreadsheet) 39

Variable I Code Variable L Code Code for Community Services Code for Non clinical interventions arranged by clinician (administration/ management) ACAS / TCP 1 Administration/ Manager tasks 1 Accommodation / Housing 2 Budget / Financial 2 Adoption / Permanent Care / Foster Care 3 Coordination 3 Carer respite 4 Consultation (not patient related) 4 - Centre Link / Income support 5 Education/training (preparation &/or delivery) 5 Case management 6 Group supervision/reflection 6 Community Aged Care Packages 7 Health promotion/community development 7 Community Counselling 8 Human Resources (administration) 8 Community Day Program - Aged 9 Human Resources (appraisal, 9 Community Day Program - Disability 10 performance management/ staff support) Community mental health agencies 11 Human Resources (recruitment) 10 Community support services (eg CCV, 12 Legal documentation 11 support groups, material aid provision) Mandatory Training/ OH&S 12 Community Rehab 13 Media 13 Day respite programs 14 Meetings (Staff, Committee etc.) 14 Financial Services / Budgeting Services 15 Mentoring/debrief (informal) provider 15 HARP 16 Mentoring/debrief (informal) receiver 16 Home Care / Home Help Services 17 Networking/Liaising 17 Legal Services 18 Operational (emails/phone calls not pt related) 18 Linkages - HACC 19 Planning 19 Meals 20 Policy review / development 20 Nursing Services 21 Professional Development (receipt of) 21 Personal Care 22 Project Management 22 Palliative Care 23 Quality Improvement activity 23 Post-acute Care / HITH 24 Report writing/ evaluation 24 Primary Care / General Practitioner 25 Research 25 Residential Care 26 Rostering 26 Other (Comment on spreadsheet) 27 Secondary consult/management – Senior 27 tutkimustoimikunta/hakuohje/Sivut/default.aspx staff Service Development 28 Variable J Code Statistics (clinical & non-clinical) 29 Code for Interdisciplinary Student support / Teaching (students) 30 Practice Supervision (formal) provider 31 Supervision (formal) receiver 32 Allied Health 1 Travel (includes walking) 33 Community Service Workers 2 Workload allocation 34 Consumers 3 Workforce development 35 Medical Practitioner 4 Other (Comment on spreadsheet) 36 Non-Clinical Staff (eg Admin) 5 Nursing 6 Other (Comment on spreadsheet) 7

Variable K Code Code for Non-specific patient attributable activity (no unique identifiers recorded) Group assessment 1 Group education 2 Group treatment 3 Handover (clinical) 4 Meeting (Ward, Unit, MDT) 5 Other (Comment on spreadsheet) 6