Walking the tight rope: Women`s health social work, maintaining the

Walking the tight
rope: Women's
health social work,
maintaining the
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
• 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
Maintaining the balance…constructing the
safety net
Assessing and
responding to the
child protection
risks pregnant
women are
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
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
Evidence (what did you read?)
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
attitude and
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
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,
• Knowledge of social disadvantage and its
• 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
• 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
• 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”
• 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
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
Establishing and
maintaining the
now and into
the future
• Personal, professional factors & organisational factors
• The human touch, relationship based practice, culturally
• 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
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
Wheatly, M. (2010) Perseverance.
Thank you
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