Social Work Spotlight - Episode 2: Dana

Episode Date: May 2, 2020

In this episode, Dana and I discuss her experience working both in Australia and the USA in a variety of settings, but particularly her strong interest in rehabilitation medicine. We discuss her passion for supporting adjustment to disability and finding that new ‘normal’ with clients. We also touch on the role of case management in a hospital rehabilitation setting and the value and impact of social work in this context.Links to resources and topics mentioned in this week’s episode: Guardian ad Litem - http://www.gal.justice.nsw.gov.au/Pages/Gal_what_is_gal.aspx icare - https://www.icare.nsw.gov.au/ National Disability Insurance Scheme - https://www.ndis.gov.au/ Centrelink and Medicare (Services Australia) - https://www.servicesaustralia.gov.au/individuals/contact-us Australian Association of Social Workers - https://www.aasw.asn.au/ National Association of Social Workers - https://www.socialworkers.org/ Podsocs - https://podsocs.com/ Agency for Clinical Innovation (rehabilitation resources) - https://www.aci.health.nsw.gov.au/resources/rehabilitationSynapse, Australia’s Brain Injury Organisation - https://synapse.org.au/ International Network of Social Work Acquired Brain Injury - https://www.inswabi.org/This episode's transcript can be viewed here:https://drive.google.com/file/d/13PXX_mOeA8xaXlQUJTGA44qAYwhpgvyh/view?usp=sharingThanks to Kevin Macleod of incompetech.com for our theme music.

Hi and welcome to social work spotlight where I showcase different areas of the profession each episode. I'm your host, Yasmin McKee Wright, and today's guest is Dana. Dana has been working as a clinical social worker for 13 years in the USA and Australia. She has worked in both community agencies and hospital settings, with experience in children and adolescents, aged care, burns, stroke, and briefly in palliative care. The majority of her social work experience, however, has been in rehabilitation medicine as part of a full multidisciplinary team. Dana currently works in a brain injury rehab unit in Sydney

and has a strong interest in adjustment to disability and finding that new normal with clients. She practices holistic interventions and advocates in the best interest of the client. Outside of work, she enjoys spending time with family, going on walks, meeting with friends, and getting stuck in a good historic fiction novel. Dana, thank you so much for joining me. I'm really glad that you could be part of this interview, this podcast, and I'm really excited to see you after such a long time. We used to work together.

Going back to your history as a social worker, I'm keen to know a little bit more about how you started in social work. And what did you study? Did you go straight into social work or did you study something else? Well, thanks, Yasmy, for asking to interview me. It's great to see you too. It's been a long time. So I did my bachelor's in psychology and during that time I felt that I wanted to broaden my, I guess, horizon and after working for about a year with children that suffered from autism, I decided to go back and do my master's in social work and I felt that social work might give me that kind of broader sense of how people are impacted by their environment, by the community they live in, their culture, you know, their upbringing and how all of that combined influences a person's,

you know, journey through life. And so I went and did a master's in social work at Boston College. I'm originally from the States. And yeah, so that's, I guess I kind of jumped into it after four years doing a bachelor's and then working part-time and realizing I wanted to explore further what my options were and so yeah so it wasn't until you had that experience with the children with autism that you kind of felt you wanted to do something similar but maybe not specializing in psychology yeah I just wanted to see I understood at that time that social work there are a lot of different types of hats or role social workers I can have and I wanted to learn more about that in addition my uncle he was actually a social worker in a hospital back home

where I grew up in Pennsylvania, and he was a social worker and drug and alcohol. And I found that very fascinating in some of the cases he had and the interventions he used. And so I guess that kind of prompted my thinking. And I tossed back and forth between psychology and social work, knowing that first let's just focus on psychology and see where that brings me. And was that something you discussed with him at the time, the thought process? No, I didn't. I didn't. I should have at that time. But as a young person when you're with adults, yeah, it wasn't something that I remember him telling me information and just cases he might have had. And I just piqued my curiosity. And I might have had a few questions back then. But I felt like I wanted to travel my own path.

Like I was happy to take an information. But I just thought, no, this is what I'm doing. And that was great conversation that we had. But this is the path I'm taking. And sure enough, I ended up going into social work. And where did you first work after you graduated? After my master's, I took a job with a fee-for-service company in Brockton, which was outside of Boston. And that was working with families.

So family work, working with children as well as families that were having. family breakdowns, marriage breakdowns, and also looking at families that were going through custody disputes. So the other part of my job, I was a guardian ad litem. And so I was meeting with families who were court, I was basically court appointed to sit down with them and get the facts from them and write a report, submit that to the judge. So the judge can make a decision what's in the best interest of the child or children in regards to living with mom, living with dad, and where are the issues, how can we best support this family? So it was a lot of writing. And so that, I did that for about a year and a half. And then following that, I actually moved overseas and lived in Europe,

for about, how long was it? About 10 years. Yeah. And when you're working in the court, who was your client was it both parents was it one parent so it was it was basically I was interviewing the whole family so it wasn't just one specific family one sorry one specific member of the family right so it was something that was required from the courts in order to make a decision what's in the best interest of the child and who they should live with and it's just it was more fact-finding and assessment writing and making recommendations to the courts what would be in the best interest of the child. It was really a heavy job. Yeah, for your first

I know, I know. I had a fantastic supervisor at the time and she was very supportive and read through all my reports before I submitted them, thankfully. So I did that. Yeah, so that job with the fee for service work and the counseling and the guardian ad litem work that was for about, I did that for about a year, maybe a year and a half. Yeah. And I know working with involuntary clients is really difficult because they would have all had to go through that process whether they felt they needed support or not. Yeah, most of them were quite agreeable because they knew it was to hopefully have time with their kids. I think the hardest part though was I only had a chance to meet with them one time. So if the interview didn't go well or if they felt they didn't give enough information or if

they were having a bad day, I mean, whatever. was reported, it was reflected in the reports that I wrote. Yeah, that's tough. It was, yeah, yeah. And sometimes they just, you know, the judge didn't necessarily take my recommendations. Yeah. You could have just thrown them out the window. But, and I'm sure families would have disputed, I never got any calls or anything.

So, but then soon after I went to Europe. Sure. Did you have any aha moments as a young social worker of this is really what I think, I was cut out to do or this is something I'm really passionate about because as your first role, that's a hard one. It can be hard to find, not even a win, just a moment where you think, you know, this is where I'm supposed to be. Yeah. I think at that time I knew I wanted to work with people who were disadvantaged and of minority, advocating for them, just finding their voice and empowering them.

I think the aha moment was different than maybe what you're looking for. The aha moment for me was this is, you know, working with children, family, adolescence. It's challenging. You're working with so many different personalities and developmental stages and it made me realize that if this is something I'm going to do,

I have to really, you know, I have to really dig deep to work out if this is really for me. And I think that time working in that setting made me realize I'm not quite sure. Yeah, if this is the role I want to have. Sure. Long term. However, the experience was incredible.

Yeah. Yeah. And challenging. And, yeah, don't regret any of it. And there were some lovely moments, especially working one-on-one with some of the children. Yeah. So, and that was quite rewarding. So, again, with social work, it made me realize that, all right, I'm not quite sure if that's the population I want to work with.

What else is, you know, on offer? Yeah. And that, I guess, came at a time when you immigrated and had babies and all that stuff. So you would have been quite busy. I don't think you worked in that time, did you? No, I didn't. I didn't work in social work. I did teach English as a second language to young children in primary schools part-time.

So that was lovely. But then I didn't go back into the social work field until I moved to Australia. Yeah. And culturally, I guess you would have brought something new. to an Australian context, having had experience in all different places. I think that would have been a really interesting perspective for everyone to have. Yeah, no, it was. And considering I didn't work for a certain block of time and then coming to a different country

and also working in the health system, which I had a little bit of experience in the States working in a, I worked with adolescents in a psychiatric inpatient unit, not as a social worker, but as a support person. So the healthcare system is a lot different here. So it was a huge learning curve. But having said that, you know, it's, I think every job you take has its challenges and has its learning curve. So, yeah. Well, good segue.

Can you tell me about what you're working at at the moment? What is your current role? What's the normal day like for you? So currently I'm working in. in a brain injury unit. It's a rehab in Sydney. And I work as a social worker and case manager. And that role is multifaceted.

So there's lots of parts to the role. A good bulk of it is a lot of case management, paperwork forms, dealing with different organizations NDIS, which is the National Disability Insurance Scheme. And that's for people who, if they meet the criteria, can benefit from supports. to live independently. There's, you know, also eye care.

So a lot of the clients we have who have suffered a brain injury due to motor vehicle accident that can be covered under eye care if they're eligible. So it's navigating those systems and it's a big learning curve. Here we go again,

on big learning curve again. Because it's something that I haven't, I've done bits and pieces up but I haven't had the full, I guess gamut of working with eye care and DIS to this extent with clients in rehab. So and when you're when you're working with clients in rehab, you're there from in the time they're admitted to the time they go home. So you want to ensure that when they go home, it's a safe discharge. So just, yeah, getting back to a typical day, what it looks like.

A lot of meetings. We have case conferences. We review cases. Different clients. Different clients. clients and we look at their discharge plan, we look at their psychosocial part, we look at their function, communication. So we work within a multidisciplinary team and it's quite comprehensive. You have a speech pathologist, you have an occupational therapist who assists with function and doing, you know, everyday activities, toileting, showering, just daily care. We have a physio that works with people's mobility transfers. You have your psychologist on the team, your neuropsychologist who looks at capacity and cognitive impairments.

We have a recreational therapist who looks at clients who have an interest in recreational activities, which could be dance. It could be fishing. It could be, you know, bowling. So she focuses on their interests. And you've got the regular like dietitians and nurses. Dietitians and doctors, absolutely, nursing, all of that.

So we work together as a team, and when we have these case conferences, we go through each client and we discuss where they're at, you know, how they've been progressing. And with each client, we're always focusing on their discharge. It's not to say they're discharging the next day, but the idea is that they have some sort of a discharge plan location, potentially how long are they going to be in hospital. What are the challenges, you know, how can we best support them?

So, yeah, so that's, so, yeah, so meetings, case management duties, obviously there's the social work aspect of it and the psychosocial, emotional support you provide, not just to the clients, but also the families. So a lot of these families are, you know, they've been through horrific moments of, you know, learning that their loved one or their friend went through an accident and some of them maybe almost losing their lives to now on a rehab ward and making progress. And it's a real journey for the family. And it's that unknown, that uncertainty, you know, what's going to happen. And, you know, they may not return to their previous life and what that was before. They may not be able to work

in the field they were working. They may not be able to drive. They may not be able to walk. And so it's the unknown and it's, you know, finding what the new normal is going to look like. So that's the social work part that I really love. And how do you calculate how long someone might be in the hospital? That's a good question. So we look at the progress that they're making. And if they have goals and they're attaining these goals, we continue the rehab process.

Some of the weight, I think a majority of the weight, as a lot of the clients, they're reaching their goals, they may have long-term goals that they could do in the community. And having said that, they might be ready for discharge from clinical perspective and medical perspective, but a lot of times these clients are held back and aren't able to discharge when we'd like to discharge them due to funding for services, support, cares, NDIS,

It can take a long time to put together a plan for them and to get the funding and having planning meetings and reviews. So it can take a really long time. And if that's the social worker's role to pull all that together and have a good understanding of those resources, it can come back to you. How do you struggle and how do you manage with that when there's so much pressure on you? I think for me, as long as I know, I'm making some progress on each of my clients and I can report to the team during case conferences or discharge planning.

meetings. I feel as long as I feel there's progress being made, I'm doing everything. Yeah, I'm doing everything I can. And it's just, I think the most important thing is transparency to the team, communication, this is where I'm at. If I feel that I'm struggling a bit or I feel that I need a bit of, you know, support, I'll, you know, I'll speak to my social work colleagues. I'll speak to my supervisor. You know, how could I do this better? How could I improve this? And everyone is fantastic in the rehab and very supportive. And I think everyone's under the same pressure. And the doctors get it.

You know, they get it. Of course, you know, everyone has a certain goal. Like, obviously, it's all client-centered and there's certain goals that we're trying to attain with our clients. And some are, you know, everyone has their goal that they're shooting for and everyone has their own challenges

and just bringing that all. It's almost like a symphony, just bringing that all together till the crescendo and what that's going to look like. It's a challenge, but we all try to work together. And what do you necessarily mean by a person-centered in this context? So person-centered is, so each client that comes in, we assess them to see where they're at

and the potential that they have to return back into the community. And we assess that by reports that we received, but as well as sitting down with the client and finding out if you're if you're able to have that discussion with them find out what do they want to get out of their rehab what are their rehab goals do they you know a lot of times some of these clients who are working age our population is quite young they want to return to work so a goal could be returning to work and looking out those goals one of the goals for one of our clients recently was she wanted just to resume her normal

everyday activities and be a mom and to be able to look after her daughter. So, you know, it's focusing on what their aim is and what's going to help them feel normal again. Yeah. And it sounds as though you need to know quite a lot about the services, not only to explain it to the patient and to the families, but to your own team so that they understand where the roadblocks might be and the challenges that you're facing. No, we definitely have to be transparent and let the team know, you know, what's keeping a discharge from going ahead.

And a lot of times it's a waiting game for services to come through. And, you know, it's a big process also, just writing the report and gathering all that information from the team. So you have to get the input from the OT, from the physio, and the neuropsychologist and getting reports and it's full on. So like I said, it's multifaceted.

Yeah, but you're needing to know what to gather in the first place. Well, that's just it. Yeah. And this current job, I'm relatively new. So luckily with social work, our skills are quite transfer, transferable. And that's the beauty of the field. But having said that, when you go into a more specialized area, which was my long-term goal is to be in a more specialized social work role.

Certain areas have their structure and their processes, and you're working more closely with those services that are going to provide clients, that independence that they're striving for. And do you find working with those other disciplines is any different in the rehab unit than it was in your other roles? Right, yeah. So my last role, I was in an acute. setting in a Sydney hospital and also did rehab but it was more of a short-term rehab program

and the difference between acute and rehab I guess acute sub-acute is with acute there's a faster turnover so not only are you seeing your clients or patients as we say in the acute setting you see them maybe not you don't have them as a patient as long same goes with the team you're not you're working with your team closely but the turnover of patients is so quick that if you have a client that you're working for a long time with, you really get to understand their style. So, and I think the communication in rehab compared to acute, you work more closely with the different team members as well,

because there's so many parts that you have to put together because the disability that a lot of these clients are facing is so complex. have to work closely with the team whereas in Q'd it's not necessarily the case they may be in just for a respiratory issue or they may be in not just but you know it may not be as complex as a brain injury so you may not you may only work with the physio or you may only work with the OT briefly but when you're in a rehab setting it's a full multidisciplinary team approach it's a holistic approach and every part of the team is important and if one of the you know wheels come off, it could be detrimental to the client.

Everything comes to a halt. Yeah. Yeah. I remember in the acute setting, in sort of the hospital setting where everything's really new, the person is still really medically unwell. There are a lot of times when you just can't find the patient. You can't find the client because they're off at some test or they're off doing other things where it sounds as though you have a lot more time to spend with them and develop

those relationships in the subacute or in the, it's still an inpatient unit. but it's separated from a main hospital. Yeah, that's the one thing I love about rehab is you really get to know your clients. You get to know their families. You get to know, you know, their little quirks. Now, we're one client, you know, who is up early morning, and you know when you walk in that morning, he's going to be in the dining area having his breakfast. And you know what he's going to be eating because, you know, his likes and dislikes.

And, you know, and these patients or clients, I'm sorry. Sometimes I say patients, sometimes I say patients. They're intangible. Yeah, because in the acute we said patients and yeah, and subacute we've been saying clients. Look, they're there a long time and it's kind of a second home, even for the family. So you walk into some of their rooms. Some of these clients have been there for three, four, five months, some even a year. Wow.

So their room is their... Their room. Yeah, and it's, you know, family bring photos in and signs and they bring their own, you you know, linens in and blankets and pillows and music and you name it, it doesn't look like a hospital room. Yeah. So that's their home for now. They're so unsettled, especially if they, like they might not live in Sydney.

They might be from somewhere else. And so even the family members having to come and visit all the time. Yeah. Yeah, exactly. How do you support them if they're out of town? Yeah. So some of the clients, luckily, are supported by eye care. and I'm one particular client who's under lifetime care and support and the family live up north

and they provide funding for an apartment for the family to stay in when they come down to visit. And it's fantastic because it's so important, again, it's client-centered. Having family there to support clients in the situation is so important for their recovery. It's monument. So we encourage that. And when you can see a difference in some of the clients, mood when family is there, and also when they know family is leaving and they become really low. So it's anticipating that as well.

So it's never a dull day. And what would be the difference between? You said there's a clear segregation or an expectation with your time of social work versus case manager. How do you see the two roles as being different? Right. So with the case management role, I'd say it's basically managing that client's case in everything that revolves around their journey and their discharge plan. So it's setting up family meetings and when it would be appropriate to have a family meeting. Normally we'll have family meetings a few weeks after admission just to give the family and the client an opportunity.

to see the progress the client has made and the goals we have in terms of discharge planning and what that's going to look like. It's a lot of the paperwork that needs to be done. So within the rehab I'm in now, there's lots of processes and structures in place. So it's putting together goals, action plans, getting ready for case conferences. There's discharge planning. There's report writing and also expectations from I-Care and NDEL. BIS, even CenterLink, Medicare, New Start. So these are all entitlements that people could be eligible for, and it's navigating that system.

So there's a lot of emailing, there's a lot of explaining to clients what you're doing and why. And during those times, I try to take that opportunity to use my social work skills to support them through it. And I think that's where you can try to maintain somewhat of a balance, but it's hard. It's difficult because some of the paperwork overtakes the social work role. So that's a big challenge. Yeah.

Well, there's that meme that something like social workers are changing the world one progress note at a time. Oh, gosh. Tell me about it, yeah. But I guess we can't really communicate what we're doing as effectively if we can't demonstrate it. So we have to for whatever funding bodies or even some of the information might not stick if, let's say you have to provide information to a family member and they're just completely overwhelmed and they're not going to absorb it. Having it in writing is sometimes really helpful.

So being able to clearly communicate, which it sounds as though you developed as a very young social worker, that ability to concisely get information down is invaluable. And I think one important thing I know for me is, just don't pop in. I mean, I guess you can pop in and have a chat, but it's good to have a purpose. And so whenever I have some paperwork, I need to show a client,

I kind of make a list of what I need to go through with them, but also I ask myself and reflect, what is my purpose? Where are they at? You know, check in with them. How are they traveling? They've been in rehab now two weeks. What's that been like for them?

And it gives you an opportunity to, it's kind of that case management stuff as a segue into checking in with them and really providing that support and intervention and how they're managing and navigating being in rehab and being away from family and far from home and just letting them know and validating their, you know, what their struggles might be. Yeah, which comes back to that person-centered approach. Absolutely, yeah, yeah, it's important. Do you do case management for community or just for the inpatient?

Just impatient at the moment. Okay. So who then takes over from you? So then we have a community team that we then hand over to. And so that's another process and putting a referral. So we're responsible to do the referral for the team as a case manager. So it's finding out from every team member what they're recommending for that patient in the community, if there's a referral from that discipline.

So it may be that someone doesn't have any issues with their mobility and they're managing fine with that. So they may not need a physio referral. So, but it may be that they require equipment. And so what does the OT recommend? So I need to put that all together. We send that referral to the community a few weeks before discharge. And go to the discharge planning meeting. So that's within our own community team.

Okay. Yeah. And do you ever get to follow up people that have been discharged? I have. Again, I'm relatively new in the role and I've had a few follow-ups and a few photos sent to me. Oh, that's so lovely. how well this particular client is doing and how excited it is that she's finally home. Which really demonstrates the impact that you had as an inpatient.

Yeah. And it's funny because you, and this is where boundaries come in because you kind of, you get these emails and how she's doing and you're curious. You think, oh, I wonder how this went. I wonder how that went. And you know that you've handed over to that community social worker case manager. And it's in their hands now. And it's important to be aware of those professional.

boundaries. I think personally, I'm very curious, but professionally, you trust that the handover was successful. And if there's any issues, obviously that community, social work or case manager can come back to me and speak to me. But yeah, but I think it's also a bit cathartic for the client to be able to check back with their previous therapists and say, look at me. Look what I'm doing. And I'm, you know, I'm succeeding. And of course, responding with another email and saying, yeah, well done. And, you know, thanks for sharing and just giving that confirmation validation. So, but yeah, it's so nice to get updates.

Yeah. Yeah. And it means to them that they're connecting with something that they're comfortable with and familiar with. Yeah. I guess it gives us a therapist validation too if they're reconnecting with us and letting us know how they're doing. Oh, that's so lovely.

Do you ever have any issues with family members or? or what you might see as conflicting priorities. I believe when someone sustains such a severe disability, whether it's brain injury, spinal or just a multi-trauma injury, first initially there's this shock and everyone wants to be there in support and that's fantastic. But there is a burden and I think if someone is in hospital

for a very long time, months, if not over a year or even longer, I think there's a real strain on the family and I think that's when some differences may arise and conflict. And so there's a bit of conflict management sometimes within the role of social work. And just managing those, like you said, different opinions. And it's almost being a mediator and mediating that and encouraging communication. So I'm actually in a situation like that right now with the family. So two completely different views. And our intervention is to sit down with the family and just put everything on the table

and to find out how can we best support the communication, what end to remember. It's client-centered. Yeah. Come back to that goal. Come back to that. Yeah. And what, especially if you've had goal planning or, sorry, goal-setting with the client, you know, they make a list of goals.

This is what they want to do and referring back to that. So some families. want to have their own agenda and it's hard just really hard because you can only you can't tell them what to do you can guide them and support them and encourage them but at the end of the day they they have to sort it out within the family but just trying to provide that support as a social as a team the best we can that's probably yeah the best support they can get at that time. And do you think any of that changes based on the mechanism of the accident,

so how the person came about their injury in terms of how the family might approach it? Yeah, I think in terms of, I would say in terms of cognition, so if the actual client doesn't have capacity to make decisions or insightful decisions, and a family member has made the guardian to make. some, whether it's medical decisions, you know, health decision services, you know, care, accommodation, it may be challenging for the other family member. So I think it might depend on the severity, yeah, of the injury and how much capacity the client has to make decisions for themselves. Okay. I'm not sure if I answered your question. Yeah, no, I think you have. I think,

well, if I'm thinking back on it, it's probably a two-fold question. So one, One would be the impact of the injury on the person's ability and who they are now if they have different personality or different capacity, as you suggested. But also, a lot of the people that you would support would be potentially risk takers in their life pre-accident. And if they've had, say, a road accident, is there an element of blame and of having difficulty with acceptance following the accident? I think they very well can be, especially people who have this, they would be experiencing grief and loss of their previous life, but also they could very well just be stuck in the blaming, you know, whose fault was it? And not if they're stuck in that state of blame and unable to accept, they have trouble moving forward. So it's also assisting the family and the client

with that and where they're at and asking them, why is it that this is, why is it such a challenge for you? And, you know, asking them, just putting the blame on someone, does it really help you in this situation? And how can you, you know, how can we explore it further to help them accept it? Sometimes it just takes time and just supporting through that. You can't talk a person out of where they're at. It's part of the grieving process, and it might take someone a long time. Others, they may get stuck or frozen,

and it's that ambiguous, I guess, loss, that ambiguous grief. Yeah. Not knowing where to go, how to move on, when to move on, because they're still stuck in that non-examined. acceptance phase, I guess you could call it. Yeah. Yeah. And are you the only social worker case manager in the team?

No. No, there's three of us. Okay. Which is fantastic. So it's good to be able to bounce ideas and thoughts off of each other. So it's good to have, it's good to work not just within a multidisciplinary team, but within your own discipline. Yeah.

So within our team in brain injury, a lot of the disciplines have more than one. So they're able to kind of support. each other as a core team. It seems like a good way of going about it. So what do you think it is about your profession or your skills or experience that make you a better case manager when compared to, say, an occupational therapist or a physiotherapist who is one of the case managers? I think it's so important to have good organizational skills and the ability to prioritize and

communicate what your needs are to know to support that patient and really seeing the big picture so I guess in terms of experience of the social worker we come from I guess a practice a model of you're looking at the whole person holistically and that's big picture stuff so I guess applying that to case management would be the same because you're looking at you know where are they discharging to? When are they discharging to? What about their home environment? And obviously

that's OT, but we have to think about that as a case manager as well because they may need certain supports in there that doesn't fall under OT, but may fall under the case management role. So, you know, returning to work, what does that look like in terms of getting them work ready? How are they getting to places? You know, what type of support do they need their medical appointments, things like that. So I guess it's the big picture stuff that you need to understand, I guess, to be a case manager and understanding that patient. And again, coming back to the client-centered approach and what their needs are and what their wishes are and short-term, mid-term, long-term. And how do you get your referrals? I'm curious as to whether you are allocated a new client

based on the fact that you're a social worker case manager or whether it happens just because you have capacity? It happens just because you have capacity. So the unit I work in has 16 beds. And so I work four days a week. I carry five clients. And the full timer carries six. And then the other part timer is also five.

So if one of my clients discharged first, I take the next one that comes in. I guess there are exceptions, but so far that's how it's been working. Yeah. How do you use supervision? How do you see that as integral to your practice? Yeah, well, before this job, I used supervision at that time, how I could get the most out of the role I was in and also looking at projects and things like that. I find with this new job, the supervision is a lot around the clients.

And I go through most of my, not all of them, but three to four clients that I may have lots of questions about or just, again, looking at them with a holistic, I guess, view and them going home and how to best understand them. And if there's any complex matters that I'm struggling with, I will bring that to supervision. So in regards to the supervision I have now within the brain injury unit, some of the issues are around case management. But a lot of it is also brain injury and how to best support someone as the client within the unit and the stress they may be having.

and some of them may be having a lot of stress around loss of memory and understanding and they may have difficulties communicating and they may communicate using, instead of saying I want to drink water, they may say, I want to drink a flower, you know, so it's this communication impairments that they have and the stress around that and supporting them. So a lot of the supervision, yes, is about my cases, but all. also how to best support someone who sustained a brain injury as well as the family and looking at the grief and loss and the change, the adjustment, the acceptance. And having a bit of, I guess, professional education within my supervision.

No, my supervisor is great in that respect because she has so much experience and is able to point me in the right direction with resources and things like that. What would be a normal trajectory for you career-wise, having a way? worked in rehab. So what do people normally in that field then progress to? Oh, that's a good question. Perhaps they would move on to another specialty, another type of rehab role, perhaps research, study, lecturing, could be program management. Yeah, I think there's, I think there could be lots of opportunities. It just depends on the individual. I think, with some social workers are quite happy within the clinical role, case management role,

and quite content. And others may want to strive for the next level, which could be management level. Could be as a professional leader. It could be, you know, someone who manages, you know, quite a large, you know, group of social workers. It could be someone who manages allied health therapists as well. Yeah. You mentioned you were interested in specialising.

What sort of thing are you interested in? Right now, brain injury. Yeah. Yeah. So since I've been three months in the role, just trying to educate myself as much as possible how brain injury affects a person. For example, what's PTA, which is post-traumatic amnesia?

How is that screened? And how long do they test it for? And what does it mean if there are so many days in PTA? and what kind of outlook do they have? And so just understand, I guess, the mechanics and the medical part of brain injury, but also looking at down the road, how does that affect them within their community, within their normal, you know, living environment and their activities of daily living, how does that affect them?

And, you know, how can we best support them returning home to this home that they know, but in different capacity. Yeah. You know, and preparing for that, anticipating that. And I've seen recently a client who's had a number of panic attacks, just very nervous about returning home. Yeah.

It's been in hospitals for such a long time and managing that and helping clients with coping and looking at strategies to deal with that anxiety. And identifying the reasons for it or the triggers. The triggers. absolutely, you know, and, you know, is it, is it the, this particular client reports pain when he's having this anxiety, and is the anxiety causing the pain? Is there pain that's causing anxiety? You know, what's the trigger? And so I'm working that out. You mentioned your part-time,

where you are. How do you manage your time? Because it must be difficult not being there all the time. Do people find that difficult to understand that you're not full-time? No, it's, so I work four days a week, so I have one day off. No, I'm like, again, I'm transparent about everyone. It's always the same day off. The team knows, you know, in emails, they get an automatic response. I let clients know. So, for example, I was working with a client the other day, and we were working on her new start application.

And I needed to contact her sister. And I said, I'm going to send her an email. but just to remind you I won't be back until you know in two days and if she has any questions she'll just have to wait until then she's like oh that's right that's right that's your day off so so a lot of the clients that have been there a long time they know my day what my day off is yeah so it's hard though I must admit because you miss a whole day so it's a lot of catching up emails and you know the progress notes and where all your clients are at and something you might, you know, your client that you have, might have had a crisis on the day you've had off

and just picking up the pieces and finding out what that's all about. But look, I've been part time for a long time, so I've been able to manage that. It's harder to be part time than full time. Okay. Yeah, because, because of that inconsistency, not inconsistency, right word, but you're there one day, not there the next day, and it's the risk of missing out or the day. The day I chose to have off though there aren't a lot of meetings which is a good thing but occasionally a meeting does come up and sometimes I'll swap okay yeah to it so I can attend a certain meeting or event but for the most part I honor my day off and team has they learn to respect that and I'm not the only part-timer yeah within the multidisciplinary team so it's actually quite flexible and they're yeah they're open to it

great how do you juggle family life and outside life in amongst all that Yeah, I think you have to be purposeful in terms of self-care. I think at the end of the day, it's important to leave on time. I'm not the best follower of that. I mean, it's important to leave on time. I can't say I commit to that 100%. Sometimes I feel that it's good to get certain work done then and there because you're in that moment.

However, having said that if I do work late, I tend to come in a little bit later than the next day. So our manager is really flexible with that. And I'll communicate to my team. You know, I'm coming in a little bit late today. So it's a bit of give and take. Yeah, yeah. Absolutely.

And yeah. So I like to balance that with, you know, home life, spending time with family, doing activities, and just really leaving work at work. Yeah. And I think that's a skill. Experience has taught me that it's important to leave work at work. If you're at home worrying about something, there's nothing you can do. Especially if it's a weekend, it's best to leave work at work.

And I think for me, it took a number of years to develop that skill. And I know that you've only been in your current role for a few months, but you've worked in rehab before that. So I'm curious to know what you think of being changes or developments in the field in that time. Within rehab? Within rehab. I think within rehab, there's, seems to be a growing trend of different types of rehab happening. So it's not just sub-acute rehab anymore.

There's day hospitals. There's outreach. There's outreach. There's community. There's in-reach. So I think there's different aspects of rehab and that's what I've seen change over the last decade that I've been working in Australia and most of the work has been in rehab are these different kind of sub subacute programs and it's supporting patients to focus on what their goals are and not to just get them home but to get them home so they're supported enough to be able to do the things they do every day and giving them resources and support so going from acute subacute and then into the community where they're still being supported by a community team, that's all rehab.

So following them through, if they would just go from acute and then home, the recidivism rate could easily increase because they're not being supported in the community. So just having that ongoing support and then slowly, I guess, waning them off is a really great approach. Yeah. Yeah. Have you noticed a difference in resources between the private? sector in public? I think for the current clients because of their injuries are so complex, they have more access to supports because they meet criteria to get those supports. Like you said earlier in the acute

setting, a lot of times they're very medically unwell and they may not be in a position to speak about what the resources are. For example, I know within the acute setting if someone has had a traumatic injury and they've been in acute for a week or two. There's always the hope that they're going to recover to the way they were before to say to them if they have a spinal injury or if they have a brain injury and they have capacity to understand to tell them, oh, we have this national disability insurance scheme. That's confronting disability. What do you mean disability? I was just, you know, skiing the other month, you know? They're not ready to hear it. They're not ready to to hear it so it's that whole timing you know when when are they as a social worker assessing

when we think they're ready to to hear that information or to let them know that this support is here and I think one approach is maybe kind of generalizing we have supports for people who are in a situation that if they're soon discharging home and they may need a little bit of help with shopping or getting places we have some services we can put into place um and and But without going into the whole elaboration of this is NDIS and it requires X, Y, Z. And so it's kind of slowly easing them into the system. Otherwise, I find because of the anxiety, they're already experiencing from the trauma as well as the unknown after discharge. It could be really upsetting.

So depending on the complexity of the injury, there might be more resources available to them. And the timing since injury. Yeah. Because with brain injuries, if you haven't been in PTA for long enough, you can't possibly suggest to someone that they're eligible. So you don't have all of the information that you need at that real crisis stage. You don't. But you've kept it vague enough that they know that you're here as a social worker to provide support.

They don't need to know necessarily what the support is. They just feel reassured that there is something there. and by the time you get around to your ninth or your 50th conversation, perhaps then they're ready and they've got questions that they come to you. Right. Or just, I've always been keen to give clients resources as well that they can read, that they can take away because there's so much information coming in while they're in hospital. You know, they're dealing with pain.

They're dealing with confusion. They're dealing with, you know, anxiety and just where am I? What does this all mean for me? telling them, giving them information, how much are they going to really retain? So by putting it in a brochure or writing it down and just say, just have a look at this when you're ready. You know, that's kind of the approach I use when I worked in acute setting. Sometimes I just put a bunch of little pamphlets in an envelope and close it up

and just when you're ready, have a look at it. Many social work care package. You could say that. Yeah. Have you noticed or heard about it? any developments that we might see in the future that will help this particular cohort. Just facilitated communication in regard, using technology is just a, just been a huge push, just different ways to use technology.

So that's definitely changing. And you see it in rehab and some of the type of devices that they're using. And whether it's timetabling and helping people manage. schedule or personal care alarm. So clients who might be returning home, but might need a bit of support during the night. They may not have a care overnight. How are they going to respond to an emergency? They may have a watch where if there's emergency, they tap it and they can talk to someone on the watch. So there's lots of advances and that is definitely something that's changed since I've been working in rehab. Yeah. And do you use,

electronic records? We do. We use electronic records. Yes, we do. I never got to that. That would have been interesting. Oh, you left before everything. Just in terms of how you manage your file noting and how you communicate with everyone around you.

Yeah. Yeah. So where I work, there's different ways of communicating. It's not necessarily just medical notes. It could be a group email. It's seeing people in the corridor and passing on information. We also use iPads. So on my iPad or my list, my to-do lists for each client, my calendar's on there.

I can access email. And that's great because you can carry that everywhere with you and it just cuts down on paper. Yeah. Paper trails. Absolutely. Eco social work. Equal social work. Yeah, absolutely.

Is there any form of social work that just has never been of interest to you? I've never really been interest in the, I guess, the juvenile system incarceration, working with prisoners. It's never been an interest of mine. There's a fascination there. I'm curious, but I don't think I'm cut out for that kind of work. I did find working with children and adolescents challenging on one level. But having said that, in terms of your social work values and work.

morals and your consciousness of vulnerable young people, you want to ensure their safety. And I think that's the part of child and adolescent that the main reason I went into it is to ensure that they're safe. In terms of areas, yeah, there's definitely areas of social work out there that suit some people and may not suit others. I have a previous colleague. She worked in the juvenile system and loved it and came to acute and still works in child and adolescent but it's just her thing whereas she could never imagine working in aged care. Whereas I really enjoy aged care and I enjoy working with older people and hearing their stories and learning from them and just all the wisdom that they have and experiences and it's golden. You mentioned projects. Is there

anything particular you're working on at the moment? So there is, there is a resilience program that is put on by the brain injury unit and so I've been to the facilitator training for that. So at some point, hopefully in the near future I'll be observing and taking part in facilitating. It's for family members to help them looking at their own strengths and building from the strengths that they have and building on resilience and also allowing those families to meet other people who are in similar situations so that shared experience and facilitating that. So it's not my project, it's already established, but it's taking part in leading those groups. Yeah. So I'm looking forward to that. Taking you back to your experience with groups. Yes. Yeah. Yeah. So I really,

I really enjoy that group work and looking at. It's the shared experience. It's facilitating that and allowing people to give them a space and some time to share where they're at. And they could be at a different part in the journey compared to someone else. And that might be helpful for someone who's new to brain injury or spinal injury or whatever the disability might be. and watching groups connect and build this cohesiveness, you know, week after week. So it's a real pleasure and honor to be within groups like that and looking at how they fit together.

And there's obviously challenges within groups as well, but facilitating that is very rewarding. So if people are interested in reading or finding out a little bit more about this area of social work or any other results, where might you point them? A helpful resource for people who are curious about social work, the field of social work, what the opportunities are for them. I would recommend just looking at the local, I guess, chapter or local Australian organizations,

so ASW, so the Australian Association for Social Workers, as well as NASW, which is in the US, that's a National Association for Social Workers. There's lots of great resources there. what social workers are doing, what projects, research they're doing, case studies, as well as how the social work field is changing, looking at different themes or trends in age care, in child protection, within rehab as well, different disabilities, adjustment coping. I think if listeners would access that website, ASW or NASW, that would be one resource they could look at.

There's also a great podcast called Pod Sox, and I think it's put on by Griffith University in Queensland. That's in Queensland. And so there's lots of really good talks about different areas of social work, and that could give people some. insight into the different roles social workers have within government or private NGOs, working in GP offices. And as well as just contacting local universities that provide education degrees in social work. So that's what I would recommend looking at.

And anything particular to rehab? In the Agency of Clinical Innovation, there's a section, current research that they're doing in regards to rehab. It's quite, I think it's more general. And that's interdisciplinary, isn't it? Yeah. I guess just also Googling journal articles, rehab journal articles as well. It's certainly a field that is never dull. There's never a dull day in the world of social work. And I think it's the type of profession that has so many opportunities to experience and your skills can be so transferable between different areas that there's many many different roles one can take within the field so yeah I encourage anyone to look further yeah

I think it's going to be so helpful for people to see the diversity within social work but also within a particular field like rehab and the the skills and the support that you bring to that and make it uniquely yours. It's really interesting. So thank you so much for sharing. I really, really, really appreciate you're taking the time. It's been wonderful chatting. And yeah, and I'll leave links and other information in the show notes so that people can do more reading if they're interested and ask me questions. Sounds great. Yeah. Thank you. Yeah, thank you, Yasme. If you would like to continue this discussion or ask anything of either myself or Dana, please visit my anchor page at anchor.fm.fm slash social work spotlight.

You can find me on Facebook at social work spotlight podcast, Instagram at social work spotlight underscore podcast, Twitter at SW SpotlightPod, or you can email SW Spotlightpodcast at gmail.com. I'd love to hear from you. Please also let me know if there is a particular topic you'd like discussed, or if you or another person you know would like to be featured on the show. And finally, a quick thank you to anchor.fm for hosting this podcast.

Next week's guest is Paul, who works in a busy inner city hospital, and we discuss his clinical work, varied experiences over his career, and how he has come full circle to support social workers and provide placement opportunities and education to students. I release a new episode every two weeks. Please subscribe to my podcast so you are notified whenever this next episode is available. See you next time. Thank you.