Social Work Spotlight - Episode 24: Lara

Episode Date: February 19, 2021

In this episode I speak with Lara, whose interest in Social Work began with volunteering for the Dublin AIDS Helpline in 1990, working with non-Government organisations in an administration role, training in welfare in the late '90s and commencing as a case manager for a women's refuge.  Lara completed her social work degree in 2010 while working as a Housing Support Officer for ACON and is now the social work team leader for the Western Sydney Sexual Health Centre.Links to resources mentioned in this week’s episode:ACON - https://www.acon.org.au/ Adahps (formally the AIDS Dementia and HIV Psychiatry Service, providing a range of services to assist people who have HIV related cognitive impairment and complex health needs) -  https://www.health.nsw.gov.au/adahps/Pages/contacts.aspxBobby Goldsmith Foundation - https://www.bgf.org.au/Melbourne Sexual Health Clinic - https://www.mshc.org.au/AboutUs/ClinicalServices/tabid/98/Default.aspx#.X_o-ntgzZPYNSW STI Programs Unit - https://stipu.nsw.gov.au/Play Safe (NSW Health) - https://playsafe.health.nsw.gov.au/ Sexual Health Counsellors Association of NSW - https://stipu.nsw.gov.au/sexual-health-counsellors-association-of-nsw-scan/Sexual Health Info Link - https://www.shil.nsw.gov.au/ Sex Workers Outreach Project - https://swop.org.au/This episode's transcript can be viewed here:https://drive.google.com/file/d/1mc332ESIYnhikAVtlImh_YcUs7J4N17O/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, Yasamine McKee Wright, and today's guest is Lara. Originally from Ireland, Lara's interest in social work began with volunteering for the Dublin AIDS Helpline back in 1990, working with non-government organisations in an administrative role, training in welfare in the late 90s, and commencing work in the field at a women's refuge as a case manager. Working as a housing support officer in ACON, Lara started her studies in social work and graduated in 2010 from UNSW. In 2011, she started working part-time at Western Sydney Sexual Health Centre and is now the full-time team leader of social work at the centre. Thank you so much, Lara, for coming onto the podcast. It's wonderful being able to speak with you about the work that you're doing.

No problem. So when did you start as a social work? and what led you to this profession? Well, it's actually 10 years since I started working as a social worker. It's literally my 10 year anniversary this month. So it's quite significant. I was always drawn to social justice, and even as a teenager, sort of stood up for people,

you know, was always on the side of people who were also. people who were ostracized just naturally I can remember arguing with people about you know discrimination or racism so it was always in me a little bit but I didn't recognize it then back then and then as I got older I was drawn to working in NGOs so this was back in Ireland so I grew up in Ireland and again it was sort of community-based work and also working in education education, I did work for the HIV helpline back in Dublin, which I've kind of come full circle from that. So at the time, that's when HIV was very scary and people were dying. And so that, at the time, I just wanted a volunteer. So when I moved to Australia, I continued to work in

NGOs. And then I finally decided I should move from admin, which is what I was doing into welfare work. I did welfare work for, I don't know, I think it was from 1999 till about 24 in between having children and moving overseas and coming back. Yeah, so I, social work was, I think it's always been a part of me. I just didn't know what it was years ago. And even now, a lot of people, as you would now, struggle to understand what social work means. but I think coming into sexual health was sort of the closing off of what I first started doing as a volunteer back in Dublin. I don't know if I was necessarily completely attracted to sexual health.

It just was a natural flow. I used to work in Acon, which is a community organisation, which supports LGBTIQ, and now focuses a bit more on sexual health and other health issues for that communities. And I think you were in the housing support program at ACON. What sort of issues would come up for you with that particular group of people? Well, often when we met with those people, so there was myself and two of the people on the team, when we met with people that were coming into the service, we were often the first point of contact.

So they would disclose a lot of very important issues. It could be meant to have drug and alcohol or any of those concerns that are, high up there in needs. And even though we were housing offices, we tended to do a lot more than that so case management and indirect counselling or accidental counselling. So again, that's sort of all nurtured what I really wanted to do, which was to, you know, gain some more skills and be able to help people from their community and other people a bit more. That position no longer exists in ACON, which is a bit of a shame because they still have needs. I mean, the HIV's changed, but it still needs. However, they do have social workers at ACON, which they didn't have before.

And what has created that shift? Was it a policy thing or a funding thing? Yeah, that was funding at the time. Now, I mean, they're still, they have moved out and diversified from just HIV to much broader. So I think the funding then got drawn into the different pathways they've now pursued. So they've got an amazing transgender program and that kind of thing. So that wasn't around when I was first on ACOM. Okay. So they've diversified a little bit and they've not necessarily gotten any more funding. They've just needed to make the existing funding stretch a little bit further. Yes. And I suppose keep up with the times because HIV is no longer alive.

threatening illness. So there's aging in HIV that became a huge focus and they moved into the other communities, not just men who identify as gay or MSM, but other people within those communities as well. So it's a lot broader and I think it's better for it because it's a great organization, but they've broadened their reach. Okay. And you've undertaken some more study recently. Can you tell me about that? Yes, I'm still undertaking it because I had a break during COVID pandemic because I work within sort of the infectious diseases branch of Westmead as well as sexual health. So we were on standby in case we were needed. So I sort of pulled out momentarily, but I'm back into it literally two weeks ago. So I'm doing a post-grad in psychology and I'm also trying because it's a little bit

hard to navigate and you might already know about this, but licensed to mental health social worker within the ASW, but their setup is a little bit difficult to navigate for me, so I'm trying to get my head round how to do it. But it's only 50 years, CPD and supervision and case studies, so it's very manageable. So by June of next year, I hope to be finished both of those. Okay, it's funny you mention that because my last guest, so just the last episode, was with someone who assist people and mentors people who are trying to gain their accreditation for mental health social work. So I'll have to put you in touch. That would be good, yes. No, I really want to do it because there's a need of work

and I'm sort of unofficially do it anyway. So I thought if I had the accreditation behind me, then it allows me to see clients who are very specialised. needs at work. I see them anyway, but I can offer more. And is that your interest in undertaking psychology training? Is that you do a lot of that counselling and use a lot of those treatments or modalities as part of your work anyway? Yeah, a high proportion of our work is counselling because the clients that come to the clinic that I work in, they're very diverse. So when they come through and they see nurses and doctors and in their initial assessment for STI screening, which is our focus. They will come to me and the other two social workers. If it's identified

that there's mental health issues, drug and alcohol, homelessness, they could be refugees, there might be legal issues, you name it really, we do it. So we see everyone who those other clinicians would deem need to see us. And we can see them long term, but we can certainly do crisis intervention and make sure that they've got strong referral pathways. People with HIV, we do case-manage long-term because they're coming regularly to the clinic. And then other people who might identify as transgender or MSM, we would also do a lot of work with them, whether it be counselling or casework.

if they're a priority group, which those categories I mentioned, they do fit into the priority groups, then we can see them a bit longer than we would. Just someone who comes in for an STI screen identifies they're depressed, but they're in the heterosexual community. We refer them out. And do you have an opportunity to do much preventative health versus acute or crisis work? Yes, we do. So we do see quite a lot of young clients coming through.

So we could say probably from the age of 13 to 25. We have people that young coming in up to 25. But in the younger age groups from 13 to 20 say that's a good time to provide education and discuss any issues they have around sexuality or identity and equip them a bit more. So I would hope that in those councils, counselling, advice or education sessions, that social work provides that we allow them to learn how to manage their sex life and healthily and how to predominantly if it's a gay man or a man who's having sex with men or

transgender male to female then we would be looking at preventing HIV as a very core part of our service. I'm in the western suburbs and our community, there's higher sort of rates of HIV there. So it's a little bit hidden because the people that live in that, and those suburbs are not maybe as educated as other people, not because they're from the western suburbs, but because they're coming from all over the world. And the levels of health literacy differ incredibly. So we have to kind of, you know, we have everyone from Indian, Chinese, Lebanese, white Australian, Aboriginal, not so many Aboriginal, but we do have some coming in. So it's very diverse and we have to kind of gear our levels of teaching, I suppose, to whoever's coming in the door.

But there is a lot of preventative and we worry for the age groups who are very vulnerable, which tend to be somewhere in the range between 20 and 30 is quite a vulnerable age group for getting HIV and other STIs. Anyone can get it. But that age groups tends to be a bit more vulnerable. So we try and zone in on those people and make sure that. clinicians are referring them to social work so we can get into a bit more of a conversation with them around safe sex and knowledge so that they're equipped to go back out. Okay. Do you find then that the cultural differences or cultural issues affect someone's access

to the service or perhaps their willingness to come forward to access? Yes, so both. So a lot of People from culturally diverse backgrounds are not aware that they can attend sexual health clinics without a Medicare card. And that's a huge thing because it means, and I'm so glad that we do that because that means we can see a lot of people who get off the plane or come over on a boat and may have needs that are not being met. And often they find out accidentally and then they turn up to us. They might get referred through asylum seekers or somewhere else, but it's not. not very clear because people who come through are still surprised they don't have to pay. Like we provide, if someone's diagnosed with HIV and they have fan out, they've got HIV through a screening program, they are allowed to access compassionate care through our

clinic. So we access that medication through pharmaceutical companies. And a lot of people aren't aware of that, but that's a thing. But other than that, we can see anyone. They don't have to have Medicare. They can come in and use a pseudonym if they want. There are cultural barriers, which is one of the things you were sort of implying. Yes, so, for example, African communities are very scared about HIV and not just HIV,

but other sexually transmitted infections and being known to have them. Now, obviously, we practice very strict confidentiality and ethically, you know, that would never happened that that information would be passed on but through 10 years working in my clinic the afric community have told me many of the clients i see have said that they're very worried that someone else is going to find out that they're coming or that they'll gossip about them and are we going to share the information so it is a huge barrier to even step over the door and come in some people have come in in in disguises and or don't want it they have to be taken into a room because they're very concerned or they don't want to see clinicians who are African.

So I'm just using that community, but it happens across communities. I mean, this is not just African-based. But it can be a very big issue and then we have to really work on the trust. Sometimes it takes years. I've had one Chinese lady who every time she came to see me, she would say, oh, you're not going to tell anyone that I've got HIV and I'd be like, like obviously trying to reassure her and explain how we operate in Australia. And she was saying, but it's really important to me that nobody knows. And it took actually about two years.

And then one day she finally came in and said, I get it now, Lara. So I trust you and it too. But that was a long time. So but then I'm not from the community. So you have to put yourself in their place really impetus and kind of try and understand what the health systems like in other countries and what it might be like in their community. So it's quite a challenge and health resource-wise we don't have everything translated into other languages either. Yeah, I guess that further points to the ongoing stigma or shame that's

associated with just talking about sex in general but also sexually transmitted diseases. So it's hard enough for someone who grew up here at times to talk about it. Yeah, definitely. It's not easy. I mean, the systems are not ideal, as you probably know, yes, but they're not. They don't facilitate a lot of the work we try to do in. It's like putting your head off a wall when you really want to help someone and you're restricted by, for example, laws around refugees here in Australia and trying to tell someone, oh, you're not going to be able to get a visa, but you're trying to still help them with

their sexual health needs and but you can't pretend that something's going to happen when it doesn't and I I always try and be transparent with clients because I don't see the point in trying to hide the reality from them but it can be difficult because they're really their hope is in this country so even though our main focus is sexual health there's a lot of other things going on in the background that often take over from the sexual health needs. needs, I guess. Absolutely. It's just one aspect of their lives. You mentioned COVID impacting on the work that you do. How has COVID affected the people that you support in terms of, they're probably terrified anyway just with contact and sexual relationships and some who might be pregnant and how that

all works within a pandemic? Look, it's been really hard. So there's different cohorts who come to the clinic that it's affected in different ways. And I knew that, it would take a bit of time to sort of come to light. So in the beginning, we just restricted our services like everyone else has, you know, tried to go to telehealth more. And we had less people coming to the clinic. There was a lot of education done through different services. So places like ACON, places like SWAP,

which is the Sex Workers Outreach Project, in terms of how they would operate their work practices in COVID. and refugees again, there was a lot of work done on that. There's an organisation called Scan, which is sort of, it's a peer-based group, and we do advocacy as well, but it's sexual health and counselling and psychologists who come together, they're all based in sexual health clinics, and we try and advocate and try and put together resources and work together as a group. but it was a bit of a struggle because the government was just introducing services slowly

and perhaps too slowly for some people. So that was very hard because we could say, oh, we can support you in this way, but we can't in another way. And sex workers, the group that I mentioned, because their work is one-on-one and unfortunately a lot of sex workers, they're forced into work. in the sense that a lot of the people that we see are students who are really struggling to keep their head above water and their sex working to earn money. That source of income was taken away from them. For a while, I mean, it's all sort of gone back to normal now, but there was a period of time when they couldn't work and the brothels closed down and people were trying to be resourceful, but it really impacted on a lot of our clients.

and it manifested as basically been financially struggling, like in a big way, not being able to pay rent, food. So not just, you know, the luxuries of life, but trying to survive. Now, swap were amazing. They came up with lots of resources. They raised money for them. They put together. They've got a dashboard, which is probably still up there on their website, which has got all this information. So that was great.

but I've got a particular client who's not a resident of Australia who's a student and she wasn't able to get work so she had to drop out of her studies if you drop out of your studies you lose your visa she's in a domestic violence situation she came through the clinic because she was sexually assaulted so her life is really traumatic she's had a lot of trauma and the resources available are very very difficult so she's suicide now and you know really depressed and this is sort of the fallout from COVID so even though there was issues to begin with it's exacerbated and magnified issues for people made it worse and it's it's actually as a social worker yourself you would know like with the resources available for certain types of groups but there isn't many or they just fall in the

whole and trying to get something it's virtually impossible. Western suburbs isn't that grey either for supportive surfaces. So I think in the city it's a little bit better. But for us we don't have, considering we've got such a diverse group of people, we don't have access to much. Yeah, so you've got a lot of people who, it sounds like, struggled to engage with mainstream health services in the first place and then thankfully being able to access your services, but that might mean that you're doing things that you wouldn't normally do or supporting them with things that you wouldn't normally. How do you manage those boundaries and making sure that you're still able to look after yourself within that? I think I'm pretty good

at boundaries. I mean, the rest of my team are also quite good at boundaries. I mean, we're very supportive of each other. So in terms of trying to work out the clients, we can see. and manage and provide care for. It's very much a team effort, so I think the three of us would come together and discuss particularly difficult clients. The actual multidisciplinary team I'm in is also very supportive, so the doctors, nurses, admin, everyone puts their two cents in it, and that really helps because having such a supportive environment means that you can then support those clients who have really difficult cases a bit more.

There is autonomy in the sense that we can, there are priority groups that would be the people we should be seeing. However, for example, some of these clients, they might be on a waiting list for sexual assault service, for example, and we're not just going to say, see you later. We will try and provide what we can in the time frame leading up to when they get accepted onto the waiting list or start counselling, for example, but just clarify with them that we're not. counsellors per se and that we can't possibly provide the level of care they need but sometimes where they're only option so those people who don't have many care and things are there are no money they will keep coming back to the clinic but we would never say to someone you have to go now and that's it I mean if they have money and they've got a job they're an Australian citizen and they're reasonably

managing okay financially and mentally then we would say okay this You need to find a psychologist, get a mental health plan, that sort of thing. But it's a very specialised, like the area of sexual health is very interesting because your focus is sexual health. However, it's so much more than that because it just covers everything. It's sort of the, it's like a tree, the branches all come out from it. And then we've got to pick the branch that we need to focus on. So they might be coming in because they've got chlamydia, but they're.

then it turns out, no, I mean, this really awful domestic violence situation. How can you help me? I'm a refugee. I don't have Medicare. I can't access these services. I don't work. I've had some people who've told me horrifyingly to me because we live in a privileged society that are most of us do, that they were living on a pot of soup for one month

in a family of three. And I mean, this is an actual story that I heard not that long ago. about a year and a half ago. And I couldn't believe like this client is a lovely woman. I was horrified. She said it's fine and I'm thinking inside it's not fine. This is not fine. So those kind of things.

We get a lot of trauma coming into the clinic. Yeah, and I guess you've created this safe environment where they feel as though they can discuss these things with you. So they might come to you for something as you suggested and then bring up other things because they feel. safe? Yeah, I think so. I mean, in terms of keeping going ourselves, we have regular supervision, but I think it's

more the ad hoc discussions, conversations, the team meetings that have to go through all that. We also have regular meetings about people with HIV who are complex. So the whole team will be in on that and give advice or we make a plan. that kind of thing. But I think it's the informal support really that helps us to manage it. I don't tend to take things home. I'm quite resilient, I think, luckily.

But I don't think you can be a social worker really if you're going to take it home because it would drive you mad. I mean, there's an odd client I will take home and that's not good. But sometimes, as you know, if they hit on a vulnerable spot with you and use a person and then you tend to think about them. But I always think we try and do what we can, and most of us are really passionate about our job and really are in it for the right reasons.

And so you know you're doing your best and even one small thing is going to help get someone on the right path in terms of better health for them or get them into a safer place or protect them from getting HIV or whatever it is, but you only need one small thing. So I don't take it home. Yeah.

It seems really clear from what you've said about the team, the importance of working closely and collaboratively with other disciplines. And I would suggest that also extends even to the frontline staff. So your reception and people who they first come in contact with and having them feel as though they're welcome in that space. Yeah, definitely. We do have, I mean, it's not a very big clinic, but we've got a small admin team at the front and obviously without them, we'd all fall apart because they don't necessarily vet people

who are coming in, but they will ring us and say there's a distress client or so-and-so is here and they want to see you and we can't see them because we're in a meet session. They actually have to do a lot of placating and reassuring clients that, Because many clients who are in distress will think that we can sort of just come out of the room and see them. And I wish we could, but it doesn't always happen that way. So they're actually key to making sure that the workspace works properly. So that we're seeing clients when we show that they're booked in on time or we can call them back or they wait. Sometimes if there is an extremely distressed client who's expressing suicidal thoughts and,

They're usually with the triage nurse at this point. But then I do. We have had times when we've had to say to regular clients. I'm sorry, there's an emergency we need to. Our clients are amazing, but they're very understanding. I mean, there's the odd one who isn't understanding, but I quite enjoy that challenge. That's why I'm doing my life is mental health

because I want to be better equipped to handle difficult situations. But yeah, I think once you find that connection with someone, and it doesn't matter what's going on for them. You just need to get past the sort of assumptions about me as a social worker or how do you connect with this person? So I think the admin are sort of the in-between connections, so they connect that person to us before they even get across the door or through the door. Yeah, and what would you say is your favourite part about your job?

Oh, I've been there for 10 years, and it still surprises me the things I hear. here, some of which are highly amusing and some of which are terrible. But it's very diverse work. So I enjoy that. I like a busy atmosphere and I'm not someone who, I'm not policy driven and it's not my thing. I like direct clinical work. And there's a lot of it. So there's no shortage of that.

I tend to get involved, as do the other social workers, and a lot of things that may be other social workers might not if they're in a different sort of role. But for example, because of we're autonomous within our role, we can go to court with clients, we can go to housing, we can go to Centlink. I've been to every court you can imagine. I've been to divorce, criminal, civil court, immigration, tenancy, all of them. And I love that. It's very interesting and challenging.

and I think one of my favourite parts of my role is advocacy and because I'm driven by that social justice that I mentioned earlier that is a big thing for me. I'm not interested in organisations saying to me, no, we can't do that or they don't really read the application for whatever it might be or they say, no, we're not taking that person. But I'm the person that will go, I'm challenging that. I think I end up having smoke coming out my ears because I just feel strongly about the,

I hate lack of justice. And I mean, I had an African client once who went into a bank and he's got HIV and he's, you know, he's got some other disabilities. But when he went up to the counter, the person said, oh, I don't know how we can help you sort of people. And I was just horrified. I was like, what do you mean? But he's highly educated at this client.

So he gave them what for But not everybody can And I've gone in with other clients So I've had to go up to the counter and say What do you mean you're not going to help this person? What are you talking about? Yeah no advocacy would be a big driving force for me And for anyone who comes into the clinic

Whatever position they're in Most of people come in And they're very vulnerable, they're embarrassed If they're not, if they've never been to a sexual health clinic They feel like everyone's looking at them and they know why they're there and they're horrified that they're there. Many of them think of themselves as being dirty. These are words that are used by clients, not me.

I'm dirty. I'm ashamed. I don't know why I did that. So that's the other part that I like about my work is being able to normalise sexual health and a sexual life and say everyone has sex. Reassure them that's normal. And if you get an STI, it's really not different than getting another sort of infection. And it's just that it's stigmatized through various different mediums.

And I really like that part of the work. By the time they come through the amazing staff that we had, the nurses, doctors, front desk, whoever it is, and they come to me. We might be the last people to see them. But by the time they leave, I'm hoping that most of them feel comfortable. or a degree of comfort that it's okay. Nobody's looking at me or judging me. And I feel like I understand a bit more about what's happening to me,

whatever it might be. So that's a very rewarding part of the job because it isn't fun going to a sexual health clinic. Nobody wants to go in there unless they're regular and then they get used to it. But even some of them don't want to come in if they're regular. Do you have the capacity to see people outside of the clinic? or if they're just completely averse to coming into the clinic in the first place?

Not unless they're registered clients saying that there has been a couple of times when someone's not mobile or is a complex client complex being there's lots of different issues and there might be an STI as well. I've mentioned HIV a lot, but we know we also manage people with hepatitis and syphilis too when syphilis can be problematic for people if it's got into their brain and that kind of thing. So we do that as well. But if clients are immobile or can't attend the clinic, we will go out and visit them, but we're not a community outreach team as such. Some of the other areas within Sydney have outreach teams, but we don't. And I'm working on that because I really want one, but that I can't believe we don't have one

because we really need it. But we do work with Bobby Goldsmith and ADAPS, which are both services that come to the area and provide some outreach. So we try and do complex case management with them. That would be primarily focused on people living with HIV. Hepatitis B and syphilis, that wouldn't be so much of a thing. But we do. I don't think I could ever say we don't do something

because we try and adapt to the situation and do the best we can. I mean, the capacity isn't high enough with three of us, two of us are full-time, the other social workers part-time, but we're always booked out. I mean, social workers are not always booked out, but we try and allow some free appointments for walk across the corridor kind of thing. So, yeah, the capacity to go out and visit clients and communities is a bit limited. Yeah, but I think something we do so well is advocate for people, and I think in your role, you'd have to have a really good understanding of the systems,

in order to tailor your argument or your report to the correct audience. So it's kind of picking your battle. Yeah, it's true. I'm curious to know, actually, you mentioned you've worked in the HIV setting in Ireland. Is there much difference between the two countries in terms of policy and how the services themselves are run? Well, that was many years ago, so that was in the 1990s. So it was quite different back then.

And I think then they had, it was just the helpline, so they were just answered, they had a team of trained volunteers, me being one, and then they had, you know, the manager of that service that was just providing information about how to access medicine and what to do, but I think at that time they didn't have anything. And Ireland was always very behind, but they caught up and then started to progress. you know, they brought in the same-sex marriage and all of that before Australia and before other countries, which is very surprising to me because they're Catholic and predominantly were Catholic. Nowadays, they have HIV clinics or sexual health clinics like here. So

I have had one client who moved back to Ireland and we linked him up with a service back there and he said they were really great. So that kind of says to me that they would provide similar sort of services because if there was anything different he would have reported it back and i do have a friend who's worked in an styi clinic in ireland and she also describes it as being quite similar so i'm not sure about people without pay related social insurance or whatever it is but medicine in ireland you have to pay for normally so i'm not sure about refugees and that kind of thing. I think it's pretty unique that they can get services without Medicare. Yeah, it's really great. You mentioned one of the challenges of working in this area is different people's health literacy,

as well as maybe access to translated resources. What are some other challenges that you come across? I think there's a lot of misconception about sexual health. So many people think that we're a sex therapy, service for example but we're not we don't do that at all I mean we try and refer people out for the service and people may not come to us thinking that what's there for me or a fear fear is a big barrier so they don't want to know they have something or we've had like in in different cultural groups we've had it's a very much of a learning experience so you know how our perception like I grew up in Ireland, but then I spent a lot of my adult life in Australia, so it's this mixture of the two cultures, but it's still predominantly white and sort of the sort of education and knowledge

around sexual health. I would say for me, it was very poor in Ireland because I went to a convent. Nuns don't talk about anything. Nobody has sex. So, but I had liberal parents, so that made the difference. And then coming out here, it wasn't much of a culture shock, but I think that the culture shock for other people from non-Engish speaking background is huge. And then for me, I was going to say the learning experience around what to expect with different cultures. I thought, oh yeah, they'll just have a different system and they may not have any services. There might be stigma. But it's much more than that. For example, I learned that Chinese clients are very medically focused and we've got a Chinese staff worker who explained this to us that when they come in,

they just want to cure. They're not interested in therapy or counselling and they find it a bit challenging. Yeah, there's always the exception, but culturally that's sort of the makeup and we're hearing it from a person who is from that background. So it's not me saying it. We're taught by sort of culturally appropriate peers or people who understand their countries. And we have a sister clinic in another area in the western suburbs where we get a lot of Aboriginal clients but many of them won't like it's very hard to connect with social workers due to the history and that can be a big challenge we're trying we're working on that now but then it's just that misconception of what a social worker is is she going to take about my kids I mean it's still

persists for me anyway I've found it like I've had there was one lady that I did connect with that came to Paramada, sorry, came to Mount Druitt and then came to me and I was like, I was so happy that we connected because it's rare and I was able to assist her with some housing issues. And it took a while and I met all of her extended family and I felt quite privileged because I don't know, it was somewhere along the way we found a connection and she was able to then and she was calling me sister, which I understand is a high privilege. But it wasn't about that for me. It was more about that I was able to help, and she kept coming back

because inevitably most of our Aboriginal and Torres Strait Island or clients don't come back due to barriers around understanding or assuming that we're not going to help them or whatever it is. So that's really difficult, and I can't believe that in 2020, almost 21, that we're still having to make clients from those backgrounds feel safe and they obviously don't feel safe or accepted. We are working hard and then some of our other clinicians are have projects on the goal where we're trying to engage people a bit more and but we don't have staff that are Aboriginal identified so

for example that's a problem because we need it so yeah there are many boundaries there's also language boundaries or barriers even with interpreters because we're able to access the hospital interpreters but with sexual health sexual health is a barrier itself so then if you add language to it becomes a whole other ballgame and sometimes they think people who are interpreting might know who they are so that can be very difficult and I mean other STIs are we use the name HIV and we use the name syphilis but apparently in some cultures, some words mean the same thing.

So a syphilis and HIV might mean the same thing. And then someone thinks they have HIV. It's happened like with a client where we've said you've got syphilis and they thought they've had HIV and nearly had a breakdown. But it was to do with the terminology of the language. So that's things that I've learned along the way. And I feel I've been there a long time, but I'm still learning because where you can never stop learning, I guess.

Well, you're learning externally through university courses, but you're also learning from the people that you work with as well as the people that you're supporting. Yeah, and I mean, the knowledge you get from clients is invaluable. I mean, that's really what anecdotally and in supervision and peer groups and that kind of thing, the knowledge from the clients is really useful, because that's what allows us to then improve the service and make sure that we're meeting the needs.

So there's a lot of gaps. I wish there wasn't, but yeah, it's hard. I imagine the health disparities for people who are, say, gender and sexually diverse, or even culturally diverse would be quite apparent to you. How do you see that play out? Yeah, so I mean, a good example might be people who identify as transgender. We are seeing more people who identify as transgender and that's been really rewarding as in they're starting to feel more comfortable and we've had some connections from people in

organisations who work with us or next to us and are encouraging people to visit sexual health clinics and become a bit more involved. Now historically outcomes for people who identify as transgender are not great mental health wise but I think it's changing very very slowly and if we as a sexual health clinic position ourselves as transgender friendly which we are then I'm hoping that that will improve health outcomes for that group of people it takes a while because they've got to know that the service is welcoming that there's staff members there that are educated, that we use the right pronouns, that if we don't use them, we're open to that, that we will listen and ask rather than just sit there like idiots and not question

and say what you want me to call you or what you prefer. But I have some lovely transgender clients. Again, they're not all Australian. We've got a few from overseas who are refugees or trying to gain refugee status and that's another challenge in itself. Levels of health literacy in that group can vary a lot. So it really depends because they've got so much to deal with otherwise, it might get put to the side. And it's only a bit later on as they get into their adulthood and maybe mid-20s that they get a bit more health literacy. And it's not for want of knowing or not being exposed to it, but there's just too much going on with mental health, transitioning, hormones, possibly, whatever they're doing. But there's a lot. So it's just one aspect.

Sex workers would be sort of similar in health outcomes because sex workers who choose that work and they're very confident and they're just there to earn money. There's other sex workers who have no choice but to work in that and they sometimes unfortunately have bad. They don't have good managers, people who don't treat them well. There's a big mix, but I suppose within the sex worker group, there's an amount of people who are very vulnerable. And again, sexual health literacy would be very low because they're just trying to survive. They're doing what they're told. They possibly maybe from other countries where they don't speak English at all. They're offered a job.

They're going to take a job because they need to survive. I find a lot of students, which I mentioned students earlier, but that's probably a hidden cohort of people who sex work because I think we assume as Australians that they come here because they've got money but often their parents might send them here to pay for the course but then they're expected to work. COVID happens or some other thing happens like some of my clients have got really bad depression and they're unable to work. Suddenly they don't have like normal mainstream work where they have to be in an office doing admin or whatever it is or they can't get a job, so they'll turn to sex work just as a means to get by.

But they don't understand condom use. They don't know about HIV. They don't know how you get a sexually transmitted infection. They don't know about contraception. We just assume we being mainstream, but assume that people know this stuff, but they don't. And sometimes their beliefs are quite bizarre. Like, so someone said something to them along the way or they learn to do. in their country of origin or a client if they're a sex workers told them something.

I had a client with their customer told them, oh, condoms will give you cancer. And she believed it. Because they didn't want to use condoms. So that's the kind of thing we're trying to contend with them that someone comes in. Oh, but this is what I was told. And the health outcomes could be quite poor if they didn't come into the health care. I'm not saying that we're going to change everything, but I'm hoping that we would at least give them basic knowledge, even if they came just one. They will have some understanding that you should use and try to drum in use condoms if nothing else.

Just use them to protect against pregnancy or STI's and both. Yeah, so those people that I've mentioned, there can be students, sex workers, transgender, culturally diverse clients, people from poor socio-economic backgrounds. We do get people who live on the streets coming into the clinic. They usually come in because they have symptoms. generally they probably wouldn't come in unless something physical propels them in. But even then that snapshot of seeing them because often people who are on this morning come back because they're transient and they've moved out of the area,

even that one time seeing them, I'm hoping, makes some impact. I might protect them from getting something or falling pregnant or whatever it is, but just allowing them some freedom around their understanding. Yeah. I'm particularly interested not only because I work in this area, but also there have been some more conversations around NDIS and access to sex work and that sort of thing. Do you see many people who have a disability and require sexual health supports? Yeah, we actually see quite a lot. It would be more intellectual disability, I think, than physical. We've had some physical disability in the clinic, but it's interesting because I wouldn't consider myself to be necessarily skilled enough to work with people living with a disability. However, if you focus in on the sexual health aspect of it, then it doesn't matter. You take away.

It doesn't matter. They still have sexual needs. So like anyone, when they come in and they're coming in because they might have had sex or they want to talk about it. Like often clients with a disability, for example, we've had some clients. coming in with autism where their care will come in with them. The care could be a parent or might be a support worker. And it's actually being great because they've never had sex, but they come in because they want to find out.

And it's very refreshing because they don't have the same boundaries as other people do. And my son has got autism so I can speak from the heart about this so that like there's no quams. oh, what do we do here? And what do you, what happens? Why is the penis hard? Like there's no, there's no shyness, really. So sort of in one way.

Sounds like a perfect client, really. Yeah, it can be a little bit easier to work with clients and with a disability. But then there's the challenge of how do I meet people, will someone want me? Surprisingly and refreshingly, most of our clients with an intellectual disability have no problem getting partners. Surprisingly, not to me, because I've seen many of them now, but I mean it might be for the general public, it might be surprising to know that.

And it's great because it means I can say to a client who comes in who's got a disability and has never had a sexual partner. Oh, don't worry, you know, I have many of my clients, you know, they feel the same as you, but they've actually successfully met someone. It might take a bit longer, or it might be not through conventional methods. we have seen a couple of people who've seen sex workers to, I don't know if it was true

the NDIS but they had been to sex workers. I mean the NDIS I think with that it's not that old like it's not been around that long and so I haven't actually referred anyone to that service but that means for me that and for the social work team that our clients coming through with disabilities have successfully managed to meet someone without having to go to a sex worker and it's fine if they're They want to do that, but nobody's actually requested that so far. It can be harder because there's questions of consent and understanding and informed consent and maybe not quite getting it.

You know, they're like anyone else. We all want to be attractive to people and we want to find a partner generally for most people. And most of the clients I see are very aware that they've got a disability. They'll talk about it and say, you know, but people don't understand because I'll say this or they've got to understand that I don't comprehend or whatever it is and then trying to work that into a healthy sex life can be quite challenging but I love those kinds there they're a breath of fresh air really they've just got an extra layer of struggle on top of everything

else but they're really good once once they find out that it's a safe place and they can come in there and we're not going to judge them they'll come in and that's what we want We want everyone, not just people with disability, to feel like they can come back and, you know, get that support and sometimes it's challenging. It really depends on the person. Yeah, we see quite a few. I mean, we refer people sometimes to planning because they've got a bit more expertise with regards to people with disability.

But yeah, we have our fair share actually. More, more I would say now in the last three years or so. I don't know why particularly. I wonder if it's that NDIS thing where there's been more of a push towards choice and control and person-centered practice. And that's not new, but there's a bit more of a language around it and perhaps people are asking the question a little bit more. Yeah, possibly. Yeah. You've already mentioned you would love to be able to set up additional services like, say, an outreach service in your area.

but where do you see social work making an impact in this area? What are your hopes for the future of the service? Well, we're really trying to open up our sexual health service, so to reach more people who are not necessarily accessing us. And that's by going out to other suburbs within the western suburbs who are like, for example, Blacktown, trying to draw in clients who don't necessarily, we're not even on their radar.

Social work, I would see them playing a huge role in that because we've got to provide the psychosocial background to any clients who want an STI test, for example. Apart from the actual community outreach, trying to increase things like peer support groups within the Western suburbs too, again, that's a bit of an area that's a bit blank. And I mean, obviously COVID's interfered with face-to-face, but I don't think Zoom and telehealth and all that works very well for our people.

I really don't. I don't know the Western. So there are too much barriers. They don't have access to internet or they don't have privacy or there's a language barrier. So if someone is speaking English, but they've got an accent, as you would know, it's even harder on the phone. Like it just sort of becomes magnified and you can't. It's distorted. Yeah. But yeah, social work would really like to increase peer support and around different groups. So for example, the HIV clients, yes, from all over the world, but Middle Eastern men who identify as MSM or men who have sex with men, transgender, all of that.

But it's going to take a lot like, I mean, the resources are limited. So trying to how to work it so that we can provide those kind of services, maybe start the up and then they're driven by the people who actually are part of the group. I mean that would be the ideal thing, but getting to that point and crossing all the walls that we have to get through or over, it's difficult. We're also the social work team are looking at groups of clients who we consider to be complex who may not have an STI but are very vulnerable and that could be across everyone. So the groups that I've mentioned already, but they're, how do we?

manage those people do we try and get them to attend more social work sessions or try and how do we make it more welcoming the clinic's a little bit old-fashioned so we're looking at improving the sort of welcoming aspects of it and we've recently had strategic planning sessions which is looking at next year so moving into a more welcoming space and even if we stay where we are that we actually have flags up and things like that. But the social work team have different interests. So we're trying to bring them together and then work on the little projects within the team. But it's all about creating client. It's client focused. I mean, in the end, our passions

are client focused. So it's all about making it more relaxing. It might not be the right word, but just more welcoming really and safe. They're not feeling judged. That makes sense. Yeah. I know you've worked in this area for many years and you're looking at developing your counselling skills and mental health social work accreditation, but are there any other areas of social work that interest you

that you'd be keen to try? I was looking at EAP's employment assistance program, like working across, there's a lot of employment assistance programs, but I'm quite interested in providing trauma. based counselling, so on-site disasters or places where there's been a suicide in the company or within families. I was drawn to that, but I'm not sure now I'd like, I don't know, I'd like to have my own practice, I think, but I don't know what sort of group because I'd like to diversify,

I don't know, I think I'd like to draw in sexual health, mental health. all the welfare work I've done as well. I used to work in women's refuges and that kind of so. Just draw it all together and then practice myself. I'm not really sure of the future. I had a few ideas. One of them was EAP but I thought about women and family health as well or emergency because I work well in crisis so I was looking at I think again all the skills that I have and that I'm looking at getting would combine quite well in an emergency department. I don't know, I'm getting old, Yasmin, so I don't want to be challenging myself too much. I guess it's also different if you've got a young family to think about,

you can't sort of diversify too much or stretch yourself too thinly. No, but I want to be the role model as well. So just, yeah. Well, my kids aren't young. I've got a 16 and an 18-year-old. So one of them's got special needs, which I've mentioned. So that can be the young one, so that that can be a bit challenging. But I think that's helped my social work.

That's another thing. So it's contributed to my understanding of people. Are there any areas of social work that have never interested you? Yes. Aged care and child like facts. No way. I couldn't do it. I mean, it's too traumatising.

Age care just doesn't interest me. I don't want to work with elderly people. I like working with. adult sort of mainstream, but because in the clinic we do see young people. I wasn't sure that I'd like working with teenagers. I wouldn't pick it, but when they come in, I'm fine with it. It's just, you know, some, that one of the social workers loves working with young people and she puts her hand up when they come in.

But I'm not that person. I put my hand up when someone comes in who's argumentative at the front desk. That's the person I want to see. I like that. I want to get the connection with them. Working with younger people, it's not your focus, but it's something that you've obviously developed good skills in. Well, I hope so.

I mean, I just try and talk with people at their own level and try and connect there. And I think once you do that, then it's easier to start talking about the nitty, gritty and intimate things. That makes sense. Where would you direct people if they were interested in knowing a little bit more about social work in this field? any good resources or organisations they should check out. Yeah, there's some really good websites. I mean, I would encourage any social work student

to look at a placement in a sexual health clinic because it will definitely change your life because you're not going to... It just exposes people to a lot of different stories and challenges for people from all over the world that we might not even think about. So no matter what you did after that, it's going to stand you in good stead. But apart from that, I would recommend the Stipu website,

which is the New South Wales Sexual Transmitted Infection Unit. And they have a really brilliant resource on it called PlaySafe, which is a website for sexual health, but it's based. It's sort of aimed at young people, but anyone could look at it. It's very factual, fun and sort of informative. plus the actual Stipu website itself has loaded resources on different STIs and different things about those STI's and health resources. There's the sexual health info line which also has lots of resources on STIs but HIV as well

and then talks about what to do if you have one. How do you tell Parano's, that kind of thing. Acon, I would always go back to them. if I'm talking to people about HIV, whether they're newly diagnosed or whether they are worried about getting HIV, there's lots of good resources on there and they also have the transgender hub that I mentioned. I can't remember the name of it, but it's on there that's really, really great. Plus other resources around drugs and alcohol and mental health for LGBT. They'd be the main sort of ones I'd look at, I mean, there's lots of different resources, I suppose,

for if you're in the field, but if before you even get to the field, that's what I'd be looking at rather than going to the more sort of hardcore stuff might be off-putting if you start looking at antibiotics and how you treat things and stuff, but there's lots of stuff really.

Yeah, all the sexual health clinics have their own websites too and outside of New South Wales, Melbourne's Sexual Health Clinic has a really good website. They've either got really good funding or a good designer, but they've settled up really well. But I would say to anyone who wants to get into the field that there's probably not that many jobs in it because there's not that many sexual health clinics. So if you want to do it, your best bet would be to try and get a placement. This job was advertised when I finished Yumi, so I qualified the year before.

This job was advertised. It was a two day a week job at the time, which fitted in with my childcare because the kids were much younger then. And because I've worked in ACON, I already had a flavour like of sort of that, but I wanted to do more than ACON I wanted. And at that time, ACOM wasn't as diversified. It was still more focused on HIV, but now it's changed. But yeah, I got into this and never looked back really. Now I'm full time. So it took a while to get from two to five days.

but yeah social work students should give it a go really yeah is there anything else that you wanted to say before we wrap up about the work that you do any final thoughts no i think sexual health is something that's still a little bit stigmatized or a lot stigmatized depending on where you come from so it's a work in progress i mean we've got a long way to go before stigma is no longer used in the sense of sexual health and anything to do with sexual health is no different than having it cold or something else like that. And I would love to see that happen because it's a natural part of people's lives. And I think as social workers, we're trying to work at the very core of someone's being.

Like intimacy is such a big part of people's lives. And yet it's so through lots of different reasons has become this thing that's not talked about or whispered about. So I'd like that to change. So there's a lot of advocacy to be done around that. you're working on the cold face, basically. You don't have much time for the big advocacy. You advocate with the clients, but I suppose all the changes will come through gradually

by speaking to people and normalising it. So I think that's very important for us in sexual health. Sure. I think I always have a perception of health and sexual health as being universal, but there are so many layers to it and so many barriers exist to people. accessing supports and that includes cultural influences in accessing support but you're still

even though you're working in a very defined area you're still working with other issues like housing and immigration and violence so sounds like the role is being really good experience to take you to other areas that you might be interested in in future so you really develop your skills there's a diversity of the work and exposing you to different challenges as you mentioned earlier. Yeah, no, definitely. So much to think about and learn. You know, there's endless courses.

I mean, you're never going to get bored. It's just, yeah, and because things change all the time and they take a while to filter through as well, there's a lot of finding out. I find there's a lot of detective work going on in the social work role. So that, you know, when you're not case managing and you're not counseling, you're not advocating, then you're finding out what's going on.

on elsewhere to try and link up people with the right services and I'm still a standard that sometimes I don't know some things there and I'm thinking why don't I know like why have they not contacted us because it's constantly changing yeah changing but also are we still a bit invisible so I didn't know that was sexual helicinics when I first came to Australia and I was a young person in the 20s like you know after I'd been here for a while I didn't know about them so and they were here back then so that's interesting because I think it's kind of still the same.

It's such a valuable area of social work as well. You can really see where it fits and where the importance is. But as you said, there's not enough funding, not enough support. It's not visible. And hopefully that's something that over time we can change. I hope so. Thank you so, so much for coming on to the podcast. It's been lovely having the discussion.

I had so many things I wanted to chat with you about. And I'm glad that I had the opportunity. and I think a lot of other people can learn from this as well. Thanks, Yasmin. Thanks for giving me the opportunity as well. Thanks for joining me this week. If you would like to continue this discussion or ask anything of either myself or Lara,

please visit my anchor page at anchor.fm slash social work spotlight. You can find me on Facebook, Instagram and Twitter, 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. My next episode is going to be a first time for the podcast. I've invited two guests, Belinda and Rabina,

to speak with me about their work in the Disability and Sexual Violence team at the New South Wales Health Education Centre Against Violence. This portfolio funding has come out of the Royal Commission into responses to abuse in institutionalised settings to improve responses to people with disability who have experienced sexual violence, as well as for children and young people who are using problematic and harmful sexualised behaviour. They have both had incredible careers, demonstrating an ongoing commitment to furthering an intersectional understanding

of structural and interpersonal forms of violence and inequalities while trying to cultivate reflective, trauma-informed, and socially just responses in direct practice and advocacy. They believe providing education and training is a crucial part of social work practice, as well as social work clinicians being involved in lobbying for structural change. I release a new episode every two weeks. Please subscribe to my podcast so you will notify when this next episode is available. See you next time.