Scope, context and intervention: an audit of 554 mental health and health social workers in Victoria, Australia.

Professor Lynette Joubert

Professor of Social Work in the Department of Social Work at the University of Melbourne.

Abstract:

Health and mental health social workers have a long-standing, hundred-year history of engagement in health settings. We will report on an innovative audit named the Evidencing Social Work in health and mental health study which has provided a comprehensive data source for current practice and its relevance to improving care.

The aim of this study was to provide evidence of the role of social workers from 17 health social work departments in Victoria, Australia. A dataset of over 10,000 items relating to social work practice was provided by 554 health and mental health social workers from both metropolitan and regional hospitals.

The Methodology adopted a practice research perspective and was developed as a co-created design with social work managers. The social workers audited their practice over a time-window of 24 hours.

The Results will be presented in relation to four primary areas ie workforce, scope of practice, context of service and competencies and skills management.

Social Work adds value to health systems though not only focusing on patient and family interventions but advocating for positive change and increased health literacy. Data from the audit undertaken for this study has informed a model of care for social work in health and mental health with defined professional competencies. In this audit, patients presented with 88 different types of issues and benefitted from 29 different types of interventions. The findings of this audit are relevant in relation to the professional position of social work in health and mental health.

Biography:

Lynette Joubert is a Professor of Social Work in the Department of Social Work at the University of Melbourne.  She is an honorary professor at the Peter McCallum Cancer Centre and senior social work academic at NorthWest Mental Health.  She is Chair of the Practice Research Unit in the Department of Social Work and has a particular interest in promoting practice research through academic practitioner partnerships.  Her national and international research focus is characterised by evidencing the contribution made by social work to better outcomes for service users in health and mental health.

Depressive symptoms post-stroke are independently associated with poorer perceived recovery outcomes within the first year

Miss Katherine Sewell1,2, Professor Leeanne Carey1,2, Dr Tamara Tse1

1La Trobe University, Melbourne, Australia, 2The Florey Institute of Neuroscience and Mental Health, Melbourne, Australia

Abstract:

Aim:
Our aim was to evaluate the independent association of depressive symptoms and stroke survivors’ perceived recovery outcomes within the first year post-stroke.

Method:
168 stroke survivors were assessed at baseline, three- and twelve-months post-stroke. Depressive symptoms were measured using the Montgomery-Åsberg Depression Rating Scale (MADRS) and perceived recovery was assessed using the Stroke Impact Scale’s Visual Analogue Scale (SIS-VAS). Quantile regressions were conducted for SIS-VAS at the .25, median and .75 quantiles. The model was adjusted for the covariates – age at stroke onset, sex of the individual and initial stroke severity.

Result:
The presence of depressive symptoms at 3 months post-stroke was significantly and negatively associated with perceived recovery at 3 months post-stroke at each quantile (p<0.00) and at 12 months post-stroke at the median (p=0.04) and .75 quantile (p=0.02). Similarly, depressive symptoms at 12 months post-stroke was significantly and negatively associated with perceived recovery at 12 months post-stroke at each quantile (p<0.00).

Significance of findings to allied health:
Post-stroke depression is known to negatively impact functional recovery outcomes, frequently determined by measures of disability and dependence. Our findings demonstrate the impact of depressive symptoms on perceived recovery post-stroke and highlight the importance of considering recovery beyond the conventional use of clinical measures of function and neurological examinations – where it currently appears to be embedded. Further, perceived recovery is of particular significance given the widely adopted healthcare approach of patient-centred care.

Biography:

Katherine Sewell is a PhD student at La Trobe University and an honorary student at the Florey Institute of Neuroscience and Mental Health.

Research interests include: stroke rehabilitation, stroke recovery outcomes, perceived health and post-stroke depression.

Katherine has a Master of Public Health (The University of Melbourne, 2016); a Graduate Diploma of Youth Mental Health (The University of Melbourne, 2014); a Bachelor in Psychological Sciences (La Trobe University, 2013) and a Bachelor of Occupational Therapy (La Trobe University, 2012).

The Pathways to Participation (P2P) program: A longitudinal evaluation

Dr Danielle Hitch1, Ms. Kate Lhuede1, Ms.  Sarah Palexas1

1North Western Mental Health, Coburg, Australia

Abstract:

Aims:
The aim of this study is to determine whether consumers who participate in the Pathways to Participation (P2P) program experience improved recovery (including self and clinician rated daily living needs, psychosocial health, time use, vocational activity and social participation) from mental illness at program end and three months post program. The P2P program is a hybrid of two pre-existing evidence based interventions – Action over Inertia and The Works.

Methods:
A longitudinal pre, post and follow up design was employed across four adult mental health services. Intervention effects were measured at baseline, post P2P program and 3 months post P2P program, using standardized outcome measures.

Results:
Sixteen consumers have participated in this study, and data collection is currently concluding. Preliminary findings have shown the majority of participants were female, and have co-morbidities including multiple mental and physical health diagnoses. A trend towards positive outcomes in regards to individual needs and recovery have been identified, and over 80% of consumers who have completed the program to date have reported tangible improvement in their recovery they attribute to the P2P program. However, there have been significant difficulties encountered around collecting data from clinicians, due to their existing heavy workloads.

Significance of the findings to allied health:
This study contribute to allied health understanding of interventions that directly address activity and participation for people with mental illness. While developed in occupational therapy, the P2P program can be delivered by other disciplines and is co-facilitated by peer support workers in its current form.

Biography:

Dani Hitch is the Allied Health Research and Translation Lead at Western Health, and a Senior Lecturer in Occupational Therapy at Deakin University. Her particular areas of interest include knowledge translation, occupational therapy and social justice

Mental Health First Aid for allied health clinical educators

Kristin Lo1, Mr Geoffrey Ahern2,3, Dr Alyssia Rosetto4,5, Dr Melanie Farlie6

1Monash University, Frankston, Australia, 2Deakin University, Burwood, Australia, 3Eastern Health/Victorian Police Mental Health and Police (MHaP) Response, Box Hill, Australia, 4University of Melbourne, Parkville, Australia, 5MHFA England, London, United Kingdom, 6Monash Health, Clayton, Australia

Abstract:

Aim:
To determine whether providing Mental Health First Aid (MHFA) training to clinical educators increases confidence to support students with mental health (MH) issues, helps recognise and support people with MH issues, and encourages participants to provide help by increasing MHFA knowledge.

Allied health clinical educators from a tertiary health service attended a 2-day MHFA course. Participants completed a pre and post workshop evaluation questionnaire. Quantitative data was analysed using independent t-tests with Welch correction and an alpha level of 0.05. Qualitative data was analysed using content analysis.

Twenty-four clinical educators attended. Pre (n=21) and post (n=23) surveys were completed. The confidence to manage students with MH issues increased significantly t(34.4)=5.868, p<0.0001. The difference in the MHFA management plan (A.L.G.E.E) score for the depression/suicide scenario was t(30.4)=5.39, p <0.0001 and for the post-traumatic stress disorder/anxiety scenario was t(30)=2.146, p=0.0401. The MH knowledge increased significantly t(24.8)=3.94, p=0.0006. The key behaviours that the participants were going to change as a result of this workshop were: continuing to have conversations with students about MH issues, stop being judgemental of people with MH issues and to start using A.L.G.E.E.

Significance of the findings to allied health:
MHFA increases clinical educator’s confidence to manage students with mental health issues, their ability to identify appropriate management strategies and encourages them to speak to students about MH issues.

Biography:

Dr Kristin Lo is a physiotherapist and has completed her PhD in strategies to support student fitness to practise (FTP) which includes mental / physical health, professionalism, clinical competency, communication and recognition of limits).

In her research she found that 1. a number of students presented with mental health issues that have potential to impact on their clinical placements and 2. Allied Health clinical educators were not confident in supporting students with mental health FTP issues. This was the impetus for the work.

Exploring social capital with older persons in the community presenting with mental health issues

Ms Helene Cowley1, Mr Eli Arbel1, Professor Lynette Joubert2, Ms  Lisa Hebel1, Ms  JoAnne  Bevilacqua1

1NorthWestern Mental Health, Melbourne Health, Melbourne, Australia, 2University of Melbourne, Melbourne, Australia

Abstract:

Background:
This practice based pilot is a collaboration between North Western Mental Health (Melbourne Health) and the University of Melbourne. Our study aimed to shed light on the role of social capital with older people (65+) experiencing mental health issues.

Aim:
To utilise Ecomaps, a social work intervention tool to facilitate discussions exploring a person’s current social networks and relationships. Based on these discussions with the client, specific goals were identified to improve social capital and to aim for a better mental health outcome.

Method:
A sample of aged participants were selected based on their suitability, which included cognitive capacity and clients who had not yet had social interventions as part of their treatment. The study involved a cross sectional design, and the use of a psychosocial questionnaire, previously developed  as part of practice research at Melbourne Health.

Results:
Initial results indicate that the use of Ecomaps is beneficial in supporting the identification of existing gaps within a consumers’ social capital, determining areas for development, and articulating what is most important to the client. Other benefits indicated include the value of a visual tool providing a macroscopic snapshot, and the process of engaging clients in an organic, reflective and narrative discussion that leads to problem-solving around social isolation.

Significance to Allied Health:
Previous practice-based research demonstrates a lack of focus on social capital when treating older patients with mental health issues. Given Australia’s growing ageing population, it is important to consider the role that social isolation plays in this population’s overall well-being.

Biography:

Helene Cowley is Chief Social with the Aged Persons Mental Health Program at NorthWestern Mental Health, Melbourne Health. Helene has over 25 years experience as a social worker, and has special interests in the mental health of older people, aged care, consumer and carer participation, community development, health promotion and health equity issues.

Eli Arbel is a social worker and key clinician with the NorthWestern Aged Psychiatry Assessment & Treatment Team (APATT). Eli’s interests are in mental health generally, and aged mental health specifically. Eli also has a a particular interest in social work research, particularly as it applies to social work clinical practice in mental health.

Adult mental health: Implications for dependent children’

Ms Lisa Hebel1

1 Senior Social Work Advisor, NorthWestern Mental Health

In 2015 a clinical data mining (CDM) project was carried out with 25 files of clients who were parents, randomly selected from 4 adult mental health services (100 in total). Each registered client of the adult mental health service was listed and randomly selected to see if the client had dependent children. This was done in each service separately until 25 clients with dependent children was reached.
The 26 question quantitative CDM tool focused on demographics, psychosocial needs as well as formal and informal supports.
Of those 25 files from each service, 10 were randomly selected (40 in total) for a more in-depth review, answering 10 specifically designed qualitative questions investigating the documented identification, assessment and interventions of the needs of the dependent children of registered clients. The selection of the 10 files was randomly generated and each file that was randomly selected was used.
Themes of social isolation, limited formal and informal social supports, poverty, violence and trauma were found. The impact on the clients’ ability to parent and have potential to cause direct or indirect harm to the children will be described.
Systemic responses to these situations and the children involved will also be briefly addressed.

Social media interventions for young adults living with suicidal ideation

Paul Dodemaide1, Dr Mark Merolli2, Dr Nicole Hill1, Professor Lynette Joubert1

1Social Work Department, Melbourne School of Health Sciences / University of Melbourne / Australia, Melbourne, Australia, 2Health and Biomedical Informatics Centre, Melbourne Medical School / University of Melbourne / Australia, Melbourne, Australia

Aim:

Understanding and responding to the lived experience of suicidal ideation (SI) continues to pose a great challenge and opportunity for health and mental health, advocates and clinicians.  Social media (SM) and their therapeutic affordances (TA) have proven to be effective in improving patient reported outcomes in the health and mental health fields, however similar evidence-based research surrounding SM and SI is in its infancy.  Methodologically a TA perspective has its foundations in ecological and behavioural psychology, here seeking to understand the mechanisms that connect a patient’s perceived actionable possibilities within SM to their reported outcomes.  This presentation reports on a scoping review of literature identifying SI outcomes from SM use, giving consideration to the conceptualisation of respective potential TA.

Method:

A literature search of seven databases, ASSIA, PsycINFO, MEDline, Academic Search Premier, CINAHL, Web of Science, and PubMed was conducted in November 2015.  Search terms (and derivatives) ‘suicidal ideation’ AND ‘social media’ AND ‘outcomes’ were used

Results:

Fifteen peer-reviewed articles were included.  Positive (n= 8) and negative (n= 3) suicidal ideation outcomes were reported.  Four articles explored motives and experiences of suicide-related SM users.  Attributable TA elicited and proposed include: narration, connection, information-seeking, collaboration, and introspection.

Significance of the findings to allied health:

SM and their TA are effective in reducing SI experiences among their users.  Adverse findings involved research broadly defining suicide-related internet use.  Further research is required to explore SM TA and patient reported outcomes in this consumer group.

 

Partnering mental health and primary health services

Ms Jo McElhinney1, Ms Stephanie Aalders1, Ms Elizabeth Wallace2

1Plenty Valley Community Health (PVCH), Epping, Australia, 2Community Team North, Northern Area Mental Health Service (NAMHS), Epping, Melbourne, Australia

Aim: To work collaboratively in reducing the impact of risk factors of physical health conditions  for clients with serious mental illness via a partnership between Northern Area Mental Health Service(NAMHS) and co-located Plenty Valley Community Health, Dietitian and Exercise Physiologist.

Method: Clients of NAMHS are screened through a continuous cycle of metabolic monitoring by NAMHS Physical Health Nurses and referred to Dietitian and Exercise Physiologist.  Before and after receiving services, objective measurements are taken.  These include: weight, BMI, waist-circumference, blood-pressure, lipids, fasting glucose, HbA1c, Vitamin D.  Dietetic and Exercise Physiology interventions are individualised based on assessments so clients can achieve optimal physical health outcomes.  Regular follow-up monitors progress and provides support.

Results:

  • Total clients: N=24.

 

  • AusDRisk-screen scores– 14 (58%) =high-risk, 4 (17%) =moderate risk, 6 have diagnosed diabetes (25%).

 

  • 17 lost weight (71%), between 1.0-14.8kg. Median number of Dietetics appointments: 5, EP appointments: 4.

 

  • 5 (21%) attended YMCA gym integration program– 3 completed the existing 8 week program (13%), 2 currently completing/attending (10%), 6 will begin the program (25%). 4 are ineligible and referred for further medical investigations (17%).

 

  • Waist circumference change–17 (71%) lost between 1cm-19cm, average loss: 6.6cm.

 

  • Qualitative– 4 referrals to Endocrinology (17%), 5 referred for investigation of cardiovascular issues (21%), 3 referred to DNE (13%), 2 referred to women’s health nurse (10%).

 

Significance of the findings to allied health:

Clients receiving services from a PVCH Dietitian and Exercise Physiologist through this innovative partnership with the NAMHS Physical Health team have improved health outcomes and reduced risk factors for chronic disease.

Psychosocial care needs of parents with incurable end stage cancer

Ms Vera Steiner1, Dr Anita Morris2, Professor Lynette Joubert1, Professor Aron Shlonsky1

1The University Of Melbourne, Melbourne, Australia, 2Western Health, Melbourne, Australia

Aim:

Explore current hospital-based supportive care interventions focused on addressing the psychosocial concerns and wellbeing of adults with incurable end-stage cancer who are parenting one or more children aged [0-18] years old.

Method:

This study comprised two phases:

1) A Rapid Evidence Assessment (REA) to review peer-reviewed evaluation studies of psychosocial intervention studies targeting adults with incurable end-stage cancer who were parenting one or more children aged [0-18] years.

2) A multi-site retrospective clinical data-mining study using mixed methodology to review psychosocial supportive care practices conducted with parents diagnosed with incurable end-stage cancer who received treatment at Western Health Sunshine Hospital and Radiation Therapy Centre, Melbourne (a partnership between Western Health and the Peter MacCallum Cancer Centre).

Results:

Parents with incurable end-stage cancer represent a patient group at high risk of psychosocial distress. They experience unique and multiple psychosocial stressors that impact on their wellbeing, parenting, family functioning and healthcare choices. Key themes revealed parents’ psychosocial stressors and current hospital-based psychosocial practices largely aligned with those reported in the intervention research literature. Additional findings will be discussed.

Significance of the findings to allied health

The brief nature of hospital-based interventions with parents with incurable end-stage cancer poses an ongoing challenge for health professionals focused on delivering brief evidence-informed supportive care interventions. This collaborative study provides a valuable insight into the supportive care needs of this patient population and the psychosocial services provided by hospital-based healthcare professionals to enhance their psychosocial wellbeing.

This research project was supported by an “Australian Government Research Training Program Scholarship”.