Social Work Spotlight - Episode 33: Grahame

Episode Date: June 25, 2021

In this episode I speak with Dr Grahame Simpson who has 30 years of experience as a practitioner and clinical researcher in the field of traumatic brain injury. He is recognised internationally for his work in conducting epidemiological, clinical and psychometric, intervention and translation-based research in suicide prevention, positive sexual adjustment, the community-based management of challenging behaviours and family resilience in the field of traumatic brain injury.Links to resources mentioned in this week’s episode:Family Violence Multi-Agency Risk Assessment and Management Framework - https://www.vic.gov.au/sites/default/files/2019-02/MARAM-policy-framework-24-09-2018.pdfBrain Injury Australia’s report Australia’s first research into family violence and brain injury - https://www.braininjuryaustralia.org.au/download-bias-report-on-australias-first-research-into-family-violence-and-brain-injury/Beck Hopelessness Scale - https://www.pearsonclinical.com.au/products/view/42Beck Scale for Suicide Ideation - https://www.pearsonclinical.com.au/products/view/44Contemporary Perspectives on Social Work in Acquired Brain Injury (Introduction by Grahame Simpson & Francis Yuen) - https://www.researchgate.net/publication/306068907_Contemporary_Perspectives_on_Social_Work_in_Acquired_Brain_Injury_An_IntroductionUS military personnel Window to Hope program - https://msrc.fsu.edu/funded-research/window-hopeStrength2Strength program at Royal Rehab - https://royalrehab.com.au/event/strength2strength-program-for-brain-injury-3/No to Violence NSW - https://ntv.org.au/International Network for Social Workers in Acquired Brain Injury - https://www.inswabi.org/The UK Brain Injury Social Work Group - https://www.biswg.co.uk/This episode's transcript can be viewed here:https://docs.google.com/document/d/1Zj4DEb-LQKGC5dN-F0mqrZihyKuStxIopertaH1ndoY/edit?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, Yasnaine McKee Wright, and today's guest is Dr. Graham Simpson. Graham holds an academic position within the University of Sydney's John Walsh Center for Rehabilitation Research, as well as a clinical position as social worker and clinical specialist at the Liverpool Brain Injury Rehabilitation Unit. He has 30 years experience as a practitioner and clinical researcher in the field of traumatic brain injury. He is recognized internationally for his work in conducting epidemiological, clinical, psychometric, intervention and translation-based research in suicide prevention, positive sexual adjustment, the community-based management of challenging behaviours,

and family resilience in the field of traumatic brain injury. So thank you so much, Graham, for coming on to the podcast. It's really lovely to have you here. That's fine. Can I ask firstly when you started as a social, worker and what brought you to the profession? So I started as a social worker. Well, I finished my degree back in 1984. I graduated. I think I just always had an interest in people and I really enjoyed interacting with people and social work is, if anything else, a people profession and I guess a

sympathy when people were struggling or, you know, sort of up against the odds, things like that. My mother claims that she was the one who suggested to me. I have no memory of this. And of course, growing up, you know, middle class family, going to a boys private school, I had really never encountered a social worker at all in my life. and I completed an arts degree at the University of Sydney, but I was struggling to think about what direction that would take me in. And it was during that time, I came to a point of sort of thinking that social work would be a good direction to go.

So I then moved across from the arts degree into a social work degree. And you also studied psychology. Why were you interested in that? and did you study one much later than the other? For instance, did you do social work and then later in life come back to psychology? Many social work degrees include psychology subjects as a part of the degree. But after I'd been working for a few years, I wanted to do a master's. This was in the late 80s.

I was interested in doing a clinical master's, but none of the schools of social work at that time were offering a clinical master's. And so just using the psychology subjects that I had as a part of my social work degree, I was able to enroll in a Masters of Counseling. I had to do a qualifying year through the School of Behavioral Sciences at Macquarie University. And that Masters of Counseling then counted as five years towards registration as a psychologist. So I then just did the extra year of supervision after the master's. degree. So I sort of call myself an accidental psychologist. And, you know, subsequent to that time, universities like University of New South Wales now offer masters of couple and family counselling or counselling. So if those options had been available, I might never have ended up

taking that kind of psychology part. The only type of masters that was really available at that time was kind of like a generic masters of social work, and it really had no subjects that were of particular relevance to the sorts of things I was doing or interested in. There were no subjects on disability, no clinical subjects. You know, there was often courses in like social administration or things like that. So that's why I chose that path. And in a sense, it was a fortunate thing as well, because that's when I first started to engage with three. research as well through that, which then became a very important part of my subsequent career. Yeah. And have you then worked as a clinical psychologist or is that mainly something that's

informed your research later? The master's I did was of counselling. So I would qualify as a counselling psychologist, I'm not a clinical psychologist. So I'm a registered psychologist. So after I completed that 60, I did an additional year and also joined a, the Australian Psychological Society, so I'm a member of that. But I never joined the College of Counselling Psychology because I was already paying registration for ASW, APS, the Psychology Board, which is now APRA. Yeah, so by that stage also, I was very much involved in research. But I think what I learned, I certainly learned additional clinical skills through the, Masters of Psychology, which I still use, and most importantly, the research.

That was the start of, I think, my interest in engagement in research. But I have always felt that I'm a social worker, and I like the broader sociological framework that social work brings to understanding where people are located in the challenges that people face. so never felt that I should change and become a psychologist. Yeah. And did you delve straight into working with acquired brain injury or did you have other experience before that? When I graduated, I didn't even, you know,

I didn't have a lot of confidence that I could even be a social worker or do social work. So I worked for three years as a youth worker with developmentally disabled state wards who were, in an institution. This was during the 80s. So during the period that I worked there, it was a period about three years,

it was actually a process of de-institutionalisation from the sort of the residents into homes in the community. And so it was after those three years that then I thought, oh, you know, it would be good to aim for a social work job. And it was really just random sort of the job. in brain injury. So it was basically it was a position that was being advertised at Lickham Hospital in the head injury unit. And as far as I can, I think my supervisor said I was the only person who applied for it. So if you've got the right person, you only need one person applying. But

my background with developmental disability gave me some knowledge that was useful and could be transferred into a quiet brain injury. And what is your current? And what is your current? role, you're working over two different areas at the moment. What does that involve? Yes, in fact, it's the same job, but just with two different employers is the way. So I worked clinically at the brain injury unit for 13 years on the community rehabilitation team. And I was the social worker and then eventually the social work team leader for the brain injury unit. I'd done my master's in the early 90s. And during that decade, I was getting a special work. I was getting a more and more involved in research.

And so around 2000 or so, I enrolled in my PhD. The brain injury unit where I was working at had a research officer position, and that position became vacant around that time. And so my unit director suggested because I was so involved in research that I moved into that position. So I'm still on a social work award, but since 2000 up to current, I was in this research officer position. I've been in full-time research.

And then in June of last year, I applied, it was successful applying for a position as associate professor in the John Walsh Centre for Rehabilitation Research at the University of Sydney. It's in the Faculty of Medicine and Health. Once again, it's a research-only position, so there's no teaching involved. And my job is really to run a research program

on severe traumatic brain engine. That's really what I'm doing out at Liverpool. So in fact, I'm still running the same research program that I've been doing. And just the university gives us some opportunities to continue to build and expand that program. So I just reduced my number of hours. So I was working with the local health district employed through southwestern Sydney, local health district. Okay.

And given that at Sydney University, you're employed through the medicine and health faculty, Is there a different approach there as opposed to if you were employed by the social work faculty? Is the teaching different? Are the approaches different? So one of the, I guess, issues in terms of the social work curriculum nationally is the disability of struggles or even health struggles to get into the undergraduate curriculum. And Chris Bigby, who's the professor of social work at La Trobe, has written and talked about this in many different places. One of the things that will give the profession impact is if we have specialisation in areas, so we have sustained programmes of work.

And so in Australia, the two leading departments in terms of disability and rehabilitation is La Trobe, led by Chris Beatt and at Griffith. So one of the things that I've done is that I've also happened to a position as adjunct professor at Griffith University in the School of Human Services and Social Work, because the school of social work at University of Sydney kind of has a focus on different areas. But once again, my role's not a teaching role. It's a full-time research.

And this is, I guess, where I also have the psychology part and the research part. But I did my PhD actually at the John Walsh Centre for Rehabilitation Research, because that's where my supervisor was located. So you need to find a school that specialises in the area that you're sort of interested in or working in, if at all possible. The program of research that I run is a multidisciplinary, so it's not specific to social work.

However, just by virtue of the fact that I'm a social worker, there's a stronger psychosocial element in that program, than there would be if the person running it was an OT or a physiotherapist or something else like that. So it's sort of not as easy as kind of that. I'm based in a medical research institute, so the Ingham Institute for Applied Medical Research, but the research program that I run is really where the research arm

of the brain injury unit, and we're just across the road from Liverpool Hospital. But following your question more, at the John Welfth Centre. So rehabilitation kind of is a little bit different to other areas of medicine. It kind of covers lots of areas of medicine. So you can have cancer rehabilitation, rehabilitation for the amputees, rehabilitation after trauma and things like that. So it's not diagnostic specific. It's kind of more of a discipline in a sense. So it's kind of in that sense slightly less medically oriented than, so if you're doing research in cardio, you know,

a lot of that is at a biological level or a cellular level or genomics, you know, there's a whole range of different types of that. Rehabilitation as a discipline, along with psychiatry, isn't as focus on that. It does have a broader type of framework. So you're not just thinking about people's physical well-being, but their functional abilities and that. However, I think social work have a broader perspective again to bring the field of rehabilitation and the larger frameworks that we have. But, you know, there are many of my colleagues in other professions who, for example, are concerned about Indigenous disadvantage or sort of young people in nursing homes or that.

So social work doesn't have a mortgage on social justice, but I think the difference when our profession and the others is that for us it's kind of like our core central value. So in terms of when I come into the John Walsh Centre, and I'm taking over from a psychologist, I kind of have a slightly broader agenda of research that our program is delivering. So, yeah, so I think it's interesting being in a faculty of medicine and health. Health inequalities has now become a significant factor

that many schools of medicine also address. So, you know, there are areas of intersection, I think, between sociology, social work and medicine in terms of thinking about health. Yeah. Given that a lot of your work has been around family care, giving support and adjustment and TBI and spirituality and suicidality, how do you feel working in that multidisciplinary team has,

affected or added to the existing knowledge and understanding within other disciplines? So one of the interesting things, and this is an interesting thing about the organisation of knowledge and the structure of disciplines. So in terms of the research that I've done in the area of suicidality, that came out of my clinical experience when I was working on the community rehab team. And I both had clients who died by suicide and clients I was working with who went through periods of significant suicidal distress. So one of the things that you then kind of do is that you start to look around to see,

well, what sort of resources or information is available to kind of help me in the practice that I'm doing in this area. And there really was virtually nothing. And so research then is a fantastic way to then start exploring. So when I was doing my Master's of Counseling, I actually did a file review of the eight clients from our service from the first thousand clients who died by suicide. And when that was published a few years ago, it was really one of the first papers internationally that documented the issue of suicidality after brain injury. But even though you had clinical psychology and neuropsychology, no one in those fields had really been researching this area in a systematic way.

you know and I think there were kind of reasons why that was so I then continued on so my doctoral research was also in the area of suicidality and as part of my postdoc I developed a program called the Window to Hope a psychological program that's storing my psychology side of things and it was a 10-week intervention to help to reduce hopelessness after traumatic brain injury There are many reasons why people experience hopelessness. They may not be able to return to work. They may have physical disabilities. They may have relationship breakdowns. There's a lot of stigma about brain injury, so in terms of an identity.

And people can't see a way out. And so they develop this chronic sense of hopelessness about their lives. So the whole idea about Window to Hope was to kind of reduce that because hopelessness then chronic hopelessness is one of the strongest risk factors for eventual suicide. So we kind of aimed to tackle that. So I did a trial of the program, which was successful in reducing the level of hopelessness that people were experiencing. And then this becomes a case of how things can then springboard, because I then was contacted by someone who's now a good colleague of mine from the US who was working with military veterans

who had a traumatic brain injury. They were facing the same problem over there. And my program is the only program in the world that kind of tackled that. So we then got funding from the United States Department of Defense. And I went over there and trained up the therapist in the program. And we delivered the program over there. and once again it was successful and we reported the results of that in 2018.

But it's kind of why, as a researcher, I like being in the clinical context because one can be developing novel programs, novel interventions, and sometimes if they're unique, they can become both nationally or internationally sort of significant. Then I guess I also work a lot with the social workers around the family work you're mentioning

the family work. So we've been doing some leading research around resilience amongst families and family members providing support to people both with a traumatic brain injury and spinal cord injury. So we've been working with social workers from rehabilitation centres across Sydney and also regional New South Wales and Queensland and trialling a program that we developed forward strength to strength. And once again, this really came out of social work practice. There was a group of social work practitioners from the different centres who work together with myself and we developed the program. We had funding from eye care in New South Wales. And that's also worked out very well. So now Icare actually fund us to deliver it to families supporting clean participants who have a brain

injury or a spinal cord injury. So it's one of the frontline treatments that the government uses for that. But then once again, we've got an American trial of that program as well, from a different centre in the US. And once again, this was a novel program that nobody else had done. So we got funding this time from the National Institute of Disability, Independent Living and Rehabilitation Research in the US. And I had to travel over to Detroit to train the therapists there and how to deliver the Strength for Strength Program and that trial is still ongoing. But that came out of a group of social work practitioners

working together in New South Wales, basically Sydney and that. So I think that kind of combination of practice and research, then if we kind of go to the theoretical level, there's quite a debate about resilience and whether resilience is a conservative construct which enables governments to offload the responsibility of care to families. And I think that on the other side, then, you have a competing paradigm, which is about

moving the focus from deficits-based to strength-based focus in the way that we think about families and supportive care. So informal care, it's a critical issue because we know from Careers Australia, Access Economics has done a report that estimates that the value of informal care delivered by Australian families to all people with disabilities or chronic health issues is valued at something like $40 to $60 billion per year across the countries. So it's a substantial factor to be looking at the informal care that families make. We feel that if one is defining resilience, resilience is around the capacity. It's not just about an individual's ability to persevere,

but important dimensions of resilience also relate to the ability to mobilize the needed social and economic resources to make a challenge manageable, such as providing care to a person with a disability. And the other thing is, I think, that we're also careful not to label family members as carers. Some family members do want to adopt that role and use that terminology. but many family members want to return to work and so we would see part of resilience and adaptation the ability of families to resume their work life and many of the other areas of the life

that they may have been living before the injury and that sort of contributes to the sustainability I guess of providing the longer-term support. That's not as easy with family members who have really high levels of disability but many people with traumatic brain injury only have moderate or lower levels of disability. So don't require physical care and really just requiring more structure around cognitive impairments or things like that. So part of my job is around kind of developing my own.

But then I'm also able to work with social workers. So we have a social worker in our unit who's been running a program for children who, who have a parent who's on the ward with a significant brain injury. And we know at an international level that there's been almost no focus on the needs of these children. And she had developed this, who had been running this sort of seminar in the holidays. It was kind of like a two and a half hour, three hour symposium, I guess, or learning experience for children at age between six and 12 or six and 13. and she's been running this over three of the last four years.

And at the end of the session, she gets the children to fill out an evaluation form. And so we've got these evaluation forms from 40 children who've attended the workshops over the three years. So we're currently writing that up for publication. I don't have a lot of experience in pediatrics. So one of my previous research assistants is now working in a different family and child research program. So we've involved her in it as well and we're collaborating with it. And this will be something that we'll be able to publish because it's a unique intervention and there's been a number of papers talking about the gaps in support for children.

And, you know, once again, this is a novel program developed by social work at a local level, which, you know, I think will have a great deal of interest internationally. And I guess it's interesting what you're saying about an assumption that a carer is a family member, but also that a care is an adult. And a lot of what we know is that younger people and children are often relied upon to provide a lot of informal support. And that's why things like the Wee Care Program exists. The basis behind it is strength and resilience, but also just allowing a bit of education for younger people around this is the effect of the brain injury for this specific loved one. This is how you can support them. Here are some

resources you can turn to because often they must feel as though this is my responsibility, this is my burden to bear, whereas there are so many community supports and formal options as well that can support them. And what you were saying about having your foot in many areas in terms of the research informing clinical and vice versa is something so important to point out and so important to keep grounded in that sense where you can actually see the outcomes benefiting the population that you're targeting. So that must feel good to. It's one of the things that I like most about the job. So I've been very involved in or trying to contribute to building capacity in social work around research.

So I was on the editorial board of Australian Social Work for almost a decade. I just stood down last year. So that's the National Journal of the Australian Association of Social Work. And I also served for nine years on the National Research Committee of the AASW. and the last four years of that I was the convener of the National Research Committee. And one of the issues in working in the health setting and in a multidisciplinary setting, many of our colleagues in other allied health, you know, sort of have very strong research culture as a part of their profession.

And I think it's been a challenge for social work to be able to build our capabilities in the field. And I think that, you know, there are a number of important reasons, both in demonstrating the value and the effectiveness of what we do, but also because we have a unique perspective to bring that, as with the suicidality and things like that, that other professions weren't touching sexuality is another big area that kind of is really underplayed within rehabilitation. And, you know, this is an area that social work is often involved in intimate partner violence. child protection. And because social workers haven't been systematically researching in these areas, there's kind of nobody else who's doing it. And so you then have these significant gaps. And, you know, so, and it's very exciting now. There are colleagues in Canada who, over the last few years, have started a very substantial program of research into intimate partner violence in the context of brain injury. and that falls on both sides of that situation because people can sustain brain injury as a victim of family violence,

but then you can also have perpetrators of family violence who have a brain injury. So we're kind of dealing with both sides. So then I have the opportunity to work with no to violence in New South Wales and Maram in Victoria around the area of family violence. and the brain injury Australia did a major report just in the last three years, which was part of the funding from Victoria around domestic violence. So as a broader issue, but the role of disability in that area hadn't received a lot of attention. So I think social work have a lot of areas that we're familiar with in a number of other contexts, but which are relevant expertise in the context of disability and brain injury.

And so the whole idea of practice research, which is a very strong social work-developed approach, is around this identifying issues in the practice setting and then undertaking research, which then gets fed back into clinical practice. And so, for example, with the children's group that Tina's been doing, you know, I was then talking to a colleague up in Queensland, you know, who's, you know, sort of saying, oh, you know, we've got a network of social workers in rehab. They'd be really interested in that program as well. So, you know, we can start to, and if we can do that, then we actually have large enough numbers.

We can then start to do another higher level of evaluation of that program. And when I was much younger, of course, the catchphrase was think globally, act locally. But we're really now in an era where you can turn that on its head and that you can kind of act locally and what you do at a local level can then actually spread globally. With the Strength to Strength Program, when we were developing that,

I'll say to the people, let's just kind of keep it, let's not embed it in New South Wales, you know, in terms of talking about New South Wales services or things like that. And when we took it to America, they said, look, we can just run with, this as it is. You know, we didn't need to make any changes of it. And that was because I was

already thinking about the possibility when we were developing it at the local level, that it could have much greater things. Now, the issue is, of course, with a lot of these sorts of developments, the applicability of these to lower middle-income countries may not be as move. So they certainly work for higher-income countries where, you know, there's kind of a greater cultural matching. So one wouldn't necessarily automatically assume, all right, well, the programs that we develop in this context will automatically transfer to lower middle-income countries. And one then might be having to think about, you know, different sorts of ways of working

or approaching there. But certainly in that band of countries that are higher-income countries, it certainly seems to have applicability there. Yeah. I was actually speaking with Candace for another episode, episode 20, if anyone wants to go back and have a listen, but she was talking about the development of the Strength to Strength Programme, and I seemed to remember she was talking about rolling it out in Adelaide. Is there a reason why other states haven't picked it up yet, do you think?

So once again, when I was at university, one of the things that one was always taught was the number of government reports or reports for government that ended up, just sitting on a shelf gathering dust. What I didn't realize, of course, at that time, but as researchers we know, there's so much research that ends up sitting on a shelf, gathering dust, and doesn't get picked up. My research colleagues are often amazed at how much pick up that we have.

And in research languages, this is called translation. When you take research and you translate it, so it starts to change practice and, you know, sort of evolved practice. So we've done really well with strength to strength. And within brain injury, brain injuries are relatively small world. So we have good connections with social workers at the key statewide unit in Queensland, which is at Princess Alexandra, and over at Adelaide, which is the Hampstead rehab. And that's what Candace was referring to. We went over and trained there. In Brisbane, in Queensland, they're also at Princess Alexandra, they're also running the program.

Candace and I went up there and trained them up there. So the exciting thing, though, with Adelaide is for the first time we're actually training other people to do the training. Hobart or Tethmone doesn't have as large a brain injury presence. It's a much smaller state. One of the things that really helps these things to stick is when you have people who are working in the field for long periods of time. So it's been more difficult. We had some good relationships with social workers at one of the units in Victoria and then within a period of six months, the two leading people left. Yeah, so I think one of the challenges also is that the production of knowledge is now kind of like exponential. If you look at research output over the last 400 years, it's like an exponential graph.

So it kind of starts in the year 1600, and it kind of just is running kind of just so flat, 1700s, the 1800s, the 1800s, it starts to come up, the 1900s, and then the 20th century, and boom, it just goes like up almost vertical. So there's this enormous production of knowledge. And so then what this means in a clinical thing is that theoretically, we can be evolving our practice or almost every five years or every 10 years. And so you can't just, oh, I've done my training at university.

I can now do this work for the next 40 years. So it takes a particular type of, I think, orientation to be willing to be in a continuous state of evolution and that's not comfortable. And it's easier, I guess, if we can just continue to do the things that we know. Now, one has to also be careful about this, though, of course, because there are underlying factors. So, for example, despite all of that knowledge, we know that things like establishing a therapeutic alliance with a client

is kind of a core element that will lead to the efficacy of almost any type of clinical interaction. So it doesn't matter if you're doing third wave cognitive therapies or second wave cognitive behavioral staff or sort of supportive counseling or anything. any of those sorts of modalities, if you don't have the basic capacity to establish a therapeutic alliance and empathy, none of those things are going to work particularly well. So there are certain poor things. And I think this is around some of the universals of human

experience. So, you know, before you go back in history, 3,000 years and look at early writings and that, we still see things like the love of parents for their children, you know, sort of these things are kind of universal in human experience. I think some of those things don't change. So, but I do think just that orientation or our ability to adapt or integrate the research that's being generated into practice is a significant challenge. And other than that translation of research knowledge and making change, especially when there are staffing turnovers, is there anything else that you personally? find difficult about what you're doing or challenging about the work?

Oh, well, there's never enough research funding, I think, is one thing. I think continuing to build capability within social work to participate in research. And so one of the very exciting things there, Professor Claire Tilbury, who's in the School of Social Work at Griffith, Mark Hughes, who's Professor of Social Work at Southern Cross, and Chris Bigby, who got funding from the Australian Research. Council three years ago to actually look at the impact of social work research in the Australian context. And so that's been a wonderful and the most comprehensive, I guess, examination of how we as a

profession are actually forming in research. And there's both good news and areas that we could do better, as one might imagine. But I think building that capability, finding pathways for social workers. And I think one of the challenges is that historically social workers, in the Australian context, because the association between research and the profession is different in other parts of the world. But in the Australian context, quand you want to brace the sort of the more humanistic approach to social work, which kind of emphasises the uniqueness of the individual. and the phenomenology of experience,

and then also at a policy level or at a, you know, a societal level around a critique of social conditions, social values. And so that kind of has led us into really putting a lot of our eggs into a limited range of research methodologies that kind of embody those kinds of values and frameworks. And so one of our challenges is a professional, profession is that, you know, we need to be able to broaden our base. But because many people come into social work, because it doesn't kind of have a scientific paradigm, it doesn't have a,

it hasn't traditionally been easy to then engage or interest, social workers in research. And I think that's changing and that's evolving in the Australian context. And, you know, I certainly, you know, my experience has always been in the health context. And we, we, found that social workers have a really sort of very attuned to research because health is such a high level of research done in the health context more broadly. Yeah, I remember a long time ago, I actually had someone say to me, social workers don't do RCTs. I feel like just because we tend to adopt qualitative approaches to research, it doesn't mean that we can't be instrumental in designing robust quantitative studies. So it is about that rethinking, reframing, having a different idea of

where we fit and what our contribution might be and going from there instead of dealing with the same sorts of approaches that, yes, they produce outcomes, but are they really what we're trying to achieve? Well, I think there's no one research method that will answer all research questions. And so qualitative research is critical for a whole range of different reasons and areas. Quantitative research tells us, you know, a different set of information. So, for example, clinical epidemiology gives us a lot of data about health inequalities, and that's quantitative data. You're not going to get the impact from interviewing a dozen or 20 people if you're wanting to talk about the state level, you know, of health conditions of.

indigenous people or something like that. So, however, it's critical to also have those individual lived experiences. So you need them working hand in hand. Randomised control trials can certainly demonstrate effectiveness of particular sorts of interventions in different settings. And I think they're perfectly viable like the window to hope. That was a randomised control trial that we did. but they are valuable for some things.

We've just been completing another major study looking at employment and vocational rehabilitation for people with traumatic brain injury in terms of helping to get people back to work. And that's what would be classed as a complex intervention, but there was no way logistically that we could have run that as a randomised control trial. But we're still able to do it as a controlled trial where we had a match group of people who just received the normal services

and then a group of people who received the vocational intervention program. So I think it's about identifying the appropriate research design for the particular research question. Lots of research these days are mixed methods. So within quantitative researchers, there's a much greater, I think, acknowledgement or acceptance of the importance of qualitative research as a complementary area of work and qualitative research has significantly grown in strength as well

and in the impact that it can have, which has also been very important. So I kind of, within our research program, we use all of these different types of research methods. And given that you've been awarded, I think I read somewhere over $14 million in research funding and obviously had a very successful research career, what would you recommend? recommend for people who were interested in getting into research? I think one of the really important things, I was just talking about this with Claire Tilbury just a couple of days ago, is that it's good to kind of be trying to start from where one is, I guess, and that's not always an easy thing to do.

This was one of the things that when I was working with the National Research Committee that we kind of sort of struggled with. But there are pathways that people can take into research and there can be, I would be starting by saying to people about looking for local opportunities around where you are. If one can find a mentor or somebody who is working in research that one can link into, that that's a really kind of good place to start. And I think that sort of mentoring or doing with others is kind of like the most efficient way to start to build up a kind of, or to start someone on, I guess, on a research journey. I was very fortunate.

I really hadn't pictured research if you'd asked me. I was really just interested in being a good social worker, I think. But the unit that I was working in was a place where research was done. So that was then how I sort of then got introduced to it. I guess. But not all environments are like that. I know in New South Wales Health, so in the Southwestern Sydney Local Health District, we now have two chairs of Allied Health, one from Western Sydney University of Sydney, one from the University of Sydney, whose job it is to mentor. There's about a thousand Allied Health staff who work within South Western Sydney,

including social work. So creating these opportunities for people so that they can start to engage with research and have those experiences of it. And, you know, my wife is a social worker and she has no real interest in research. So it's not an area of interest for everyone, but I think it provides some really exciting ways for social work to magnify the roles and the contributions that we make. You know, there's lots of other ways as well. But, yeah. And I imagine if you're not working in a clinical role, you wouldn't have direct exposure with, say, grief

counseling or adjustment challenges with people. But there would be all sorts of exposure to that through reading research outcomes or even reading transcripts from interviews. How do you manage that? Do you have support when things come up for you that are perhaps a little bit emotional? Well, one of the things that I guess I like about being a researcher but located in the health service rather than the university is that you can still have that face-to-face connection with clients, with families and things like that. And I've tried to tackle issues that are emotionally challenging. And I think that's part of what social work does as a profession. We often deal with areas that many other professions find, you know, sort of difficult or tend to avoid, which is why things like child protection or intimate partner violence historically within the field of brain injury rehab.

At an international level, have received so little attention. So I think at a personal level, peer support, I think, is really the major issue. So if I've been in a sort of a situation, where there's been something that's been distressing or clinically challenging, I would want to debrief with a senior colleague. Now that I'm in my position, I tend to be doing the debriefing rather than receiving it. But I certainly have a spiritual life or a spiritual dimension to my life, and I think that plays a highly significant role as well.

So I think those would be, and I think sort of social support, I think those would be the three different things that, for me, would help me deal with those challenging things. We kind of need to kind of try and take these things on, and I think that they are difficult, but, you know, they're important parts of people's lives and part of our responsibility, but you kind of need to know what you're doing. That's the really critical thing. And part of ethical practice in social work is not working with things that are outside

one's level of training or expertise. So it's then about if we're kind of confronted by things where we don't have the training, we're then linking people into other services or other supports that will mean that they do get that sort of expertise. Yeah, absolutely. Have you noticed differences between the patient or family experience between, say, traumatic brain injury and stroke, which would be more of an acquired brain injury? There certainly can be. I mean, one of the interesting, so at an age level, traumatic brain injury has two peaks. So one is in the 18 to 25, and that's often a lot of young men who get involved in fights

or in motor vehicle accidents and things like that. The second peak for traumatic brain injury is over 70, and that's people who have falls, is the principal factor for that. And then if we think about stroke, about a quarter of people with stroke, have those under the age of 65, but then, of course, three quarters are in that more elderly and then frail-aged kind of category. So I think the age of the person makes a difference.

So younger stroke may, I think, present with a greater level of similarities to traumatic brain injury. that can be partly because of the sex, because of the age. The type of injury itself or the mechanisms of injury do make a difference. So with a traumatic brain injury, the prefrontal cortex, which is kind of the frontal areas of the frontal lobes, and then also the frontal areas of the temporal lobes, which sit under the frontal lobes,

play a significant role in executive function, behavior, monitoring, self-monitoring, behavioral regulation, social connection. And so because of that mechanism of injury, you get a certain sort of presentation for people, the brain injury, lots of cognitive challenges, behavioral, discontrol with stroke. And the nature of stroke, and depends on where in the brain the stroke occurs. A lot of the strokes occur within the middle cerebral artery because it's the most extensive of the three major arteries that carry blood to the brain. And that supplies areas like the motor region of the frontal lobes. And so we see much larger proportions of hemipleger or hemipreasis in stroke.

Aphasia, because the areas associated with speech in the temporal and back regions of the frontal lobes are also very vulnerable to stroke. So there isn't quite the same levels necessarily of disinhibition and dysregulation in stroke that you get in traumatic brain injury, and particularly when you're looking at the more elderly people who have stroke. So however, you know, there are a lot of the same cognitive problems. There are certainly physical care needs. Post-stroke depression is a significant challenge. And, you know, screening for depression in strokes are really important thing to do.

So I think that there are very, very important. but it depends on what parts of the brain are damage and also people's sort of age. Yeah, you've just reminded me, I meant to ask, with the study that was looking at hopelessness following trauma, how do you measure that? How do you understand someone's level of hopelessness and how that might improve or decrease over time? Yeah, so we used standardised psychological measures for the outcome. So specifically, we use the Beck hopelessness scale, which is probably the most widely used measure of hopelessness internationally. And then we also use the Beck scale for suicide ideation.

So they were our primary outcome measures. And then we had some standardised measures of problem solving, depression. And yeah, so we also then had some secondary measures. But yes, we used standardised measures for that. And given that a lot of your research, been around the client experiences in rehab, what changes, you've had the fortunate opportunity to be part of, I guess, many decades of research, both in social work and in other areas of health. What changes have you seen in these fields over time and where do you see social work continuing

to make an impact or what changes might be possible from both a research and clinical perspective? I think the biggest game changer at the moment is the NDIS. and the introduction of the NDIS. When I first started working, there was kind of one specialist unit, which was the unit that I was at. We had that sort of specialised in traumatic brain injury. So there was very few specialist services.

In the 90s, New South Wales Health introduced the New South Wales brain injury network. So suddenly we had a network of 12 to 15 services across New South Wales, a decentralised level. So suddenly it was creating significant improvements in access. Then with the introduction of the motor accident scheme, there was then once people were kind of discharged because rain injury can be like a lifelong challenge for people,

there was a lifetime support scheme for people with brain injury who were injured as a result of motor vehicle accidents. Ten years after that was introduced, it then became no fault. but there was still then this gap for people who weren't injured in motor vehicle accidents. And so then with the NDIS coming in, suddenly there's a pathway for everyone. And, you know, of course, the NDIS is still in its formative stages. And, you know, there's lots of rocky or challenging elements about it.

But when I talk to my colleagues overseas and say, we have this extraordinary continuum of rehabilitation and support that's lifetime that everyone can access. It's an extraordinary situation to be in. As I said, we're still to see how the NDIS shapes up, but we have this extraordinary potential. So when I started, there was like a single unit, you know, and now there's this network of 15 units.

There's the eye care system, there's the NDIS system. So it's kind of been a revolution. I mean, I still remember we did a follow-up of the first 100 clients. This wasn't something that I was involved in personally who had been admitted to the unit during the years 1970s, 6 to 1981. And this was a 20-year follow-up of them. And after the research had been done, we held a half-day symposium where we invited the families

and the people of the brain injury to come along and sort of present the results to them and discuss that. And as a part of that, we had a couple of current clients through a presentation, and the families were just blown away to listen to what the people were saying. And, you know, once again, this was kind of in the sort of being, like the early 2000s, you know, just with how much more services

and support and resources there were. So from the service system perspective, it's just been an extraordinary development. And now the other thing then is that brain injury now is being recognised also in other clinical populations, so in homelessness, in prisoners, in intimate family violence. So just a fantastic kind of growth and development from that. So what does that mean for social work? I think that social work in New South Wales is uniquely privileged because we have the largest

concentration anywhere in the world of social workers in specialist CBI positions. because we have this network of 15 services because many of them have social workers as part of the multidisciplinary teams, part of the way health services are structured within the Australian context, particularly within the public health sector, not so much the private sector.

And so I always say to my colleagues, we have this enormous responsibility to the profession in terms of a leadership role. I think that there will always be a significant, role for social work and in terms of the complex psychosocial issues that our clients face, one of the things that we're doing as part of the international network for social workers in acquired brain injuries. We're currently developing a psychosocial assessment framework that social workers could use in working in TVI. So we surveyed colleagues from many different countries

and for the first time we're building this documentation of the range of issues of social workers are addressing, which once again has been really documented. So I think we need to be demonstrating what it is that we're doing because a lot of other professions don't really understand what social work does. Just the physios see someone cry, say, that's kind of as deep as their analysis goes. So I think that in terms of the psychosocial dimensions, the interface with complex government and bureaucratic systems for accessing resources, insurance systems, legal systems. And these things are really critical for people in terms of their future well-being, in terms of income, in terms of accommodation, in terms of support.

So I think that there will always be a strong role for social work. And I think as we start to use the research to take the things that we're doing in terms of innovation in these areas that we're practicing, documenting the sorts of needs and challenges that people are facing and publishing those, it kind of then broadens out the view from a biomedical functional view of the process of rehabilitation and recovery from an injury and kind of makes it a much broader set of challenges that people have to navigate. Are there any other programs or projects that you're part of or working on? you mentioned the international network of social workers for acquired brain injury.

We developed or established back in the early 90s, the Social Workers in Brain Injury Group in New South Wales as a special interest group. And once again, it's kind of easy to do that because we kind of had the critical mass of social workers working in the field within New South Wales. And Swivey continues to operate to this day as a registered special interest group with the AASW. After our first 10 years or so, we started to look around to see if there were any similar groups in other countries. And the only group that we could find, and it took a number of years of looking, because this was back before the internet was really a thing, of course.

So it was the brain injury social work group in the UK. And so what we then did was that we partnered to create an international network. One of the issues for traumatic brain injury is that in the health context, it's a relatively niche kind of field. It's a small area of specialisation. So it's not an area of practice that, for example, is going to be on the radar of the AASW. Chris Bigby says, you know, we're not even getting disability, you know, onto curricula.

So something like traumatic brain injury, which is a very small size of disability, it's not going to be something that's really on the horizons of academic social work departments. And so if we're looking at how do we develop a whole research program, how do we develop practice and that, that's a much bigger issue than one social worker or two social workers can do. And some countries like New Zealand or Singapore, they might only have six or eight social workers in the whole country that are kind of working in this area. And so this is where networks are just a fantastic way to mobilize the resources of a profession to address areas of practice. And so that's in a sense what the international network of social work in the ABI. We kind of modelled it on.

There was a health inequalities network that was developed in the UK that was an international network. The Americans have a very strong social working oncology network. And so we kind of modelled a bit on that. We launched it at the international conference, the social work and mental health in Hong Kong in 2006. And it really was about, I guess, promoting a better practice within the profession, within the field of brain injury. And you kind of, you don't know whether or not you, how long things are going to last.

You know, sometimes things last one year. But in 2010, we were still going and growing as a network. So we met at the next international conference for Social Work and Health and Mental Health, which was in Dublin in 2010. And so we established an executive committee there. and that committee still regularly meets. One of the really important developments that we then did, we developed a family outcome measure,

which involve social workers from the network from 14 different sites across four countries to develop a family outcome measure. We've developed resources, pediatric resources. This was done by social workers at the National Rehabilitation Hospital in Dublin, in Ireland. But in terms of contemporary society, you really have to be visible online.

And so we established a website. I think it's been running two years now. And we've sort of almost doubled our membership after the website. So we're now up to about 200 members across 10 countries. And it works. So it provides a mechanism. We did a systematic review of all social work authored papers in the field of brain injury, published in the journal.

And we're currently working on the psychosocial assessment training. work. But alongside the research, probably the most frequent use of the network is for peer consultation. So, you know, someone will be saying in Australia, oh, I've got a client who's coming back to England, north of England, does anyone know, services there, or they're wanting to start a new service, you know, sort of what number of hours of social work? Should I be recommending that that service has the inpatient service or things like that? So, you know, it can be clinical questions, service development questions, a whole range. of different sorts of things.

And it's a bit like Sense of the Strings. It's a surprise, but it's a very delightful surprise that the thing keeps going. But then you have the critical mass to actually undertake substantial projects. Like with the psychosocial assessment framework, you know, we have colleagues in Australia, the US and the UK, you know, who are working on that, you know, and then at the later stage we'll involve our colleague from India to look at how it might work in, you know, sort of a country that's at a different stage of development and where social conditions are very different. Yeah, so what we're doing is what we've always been talked

to do, which has changed from the bottom up. Yeah. And then I guess you have even more of an opportunity to network at conferences and those sorts of things. So we continue to meet. And so this has been where technology, plays a very important role because the International Committee we meet twice a year in real time. So our American colleague, it's like 4.30 in the morning for her. And our colleague in Auckland, it's 10.30 at night. So we have colleagues on the executive committee from the US, Canada, Ireland, England, Sweden, India, Australia and New Zealand. But we can meet in real time using Zoom.

So these kind of things just wouldn't have been possible 10 or 15 years ago to do this. But we try to meet then face-to-face, have a face-to-face meeting of the executive at each of the conferences, the international conferences, the social and health and mental health. So the one in York in 2019 was the last one. And then every three years we look at who wants another term, you know, sort of who wants to require. So what we then have been able to do is to develop a stream of presentations around social work and ABI, which we then run as a part of the international conference for

social work and health and mental health. So, you know, sort of colleagues in different countries who are part of the network who are doing research or wanting to present, you know, and we can provide people with support in developing abstracts and submitting abstracts. But then we'll liaise with the conference organisers so that we kind of have this stream of social work presentations. We'll have a dinner for the Inswabi group, we'll have the face-to-face meeting, and members get the chance to interact with other social workers and other countries working in the field. So it's been really important to be able to apply it to that conference,

but then some of the members would also meet at things like the Global Brain Injury Congress, which in our particular field is one of the headline international events. So apart from that particular conference that we've tied the network to, have other opportunities to meet at other conferences as well. Where would you suggest people go if they wanted to learn more about social work in this area? Well, I think the website, our website, is a really good starting point, which is www. www.enswabi.org, and that provides a whole lot of resources and information about it. We published a book two years ago called Contemporary Perspectives of Social Work in ABI.

It's kind of like the first book dedicated to social work practice in the field. And the introduction chapter of that, which was written by myself and Francis Ewan, kind of provides like a good introduction to the field. The brain injury social work group in the UK have a website as well, and they have some resources on that, which are also, I think, wall to access. So I think those would be some of the places that one could go as a starting point. So often I watch things and there's such a caricature of people with a brain injury. Are there any things you can think of where people seem to really get it right and represent

people with a brain injury appropriately? I think there are, but I couldn't tell them to you off the top of my head. I have to go away and check that. There's a beautiful article that was published in the British Medical Journal about coma as represented in soap, TV soaps. And it's just absolutely hilarious in documenting how badly wrong these things can be. It was a movie called While You Were Sleeping and the guy's in the coma and she gets adopted by the family. And he kind of eventually emerges from the coma and they're all in the room. And he's immediately lucid and recognized everyone except for her. her. And they're all safe. It's the main dream, of course, it's because in fact he doesn't know her.

But that kind of emergence from Toma isn't a realistic depiction of what actually happens in real life. So it's kind of just one example of what this article was looking at in terms of how things like that are misrepresented. But there are some really good representations in many, very accurate ones. It's just unfortunately I can't think of them off the top of my head, but I could certainly fire that up and let you know. Yeah, thank you. And any other resources that you can think of, I'll put them in the show notes so that people can go off and do their own reading or viewing if they're interested. You've touched on quite a few really important points. Firstly, aspects of positive adjustment following a brain injury or traumatic injury and just the fact that social work covers such a wide area. So even though you're working in a very specific field, you cover things like mental health, employment, family relationships, sexual health, community participation. So yes, it is a very niche field, but no, it's not unique,

in a sense. You need to know a lot about quite a few things. But also, I love what you said about rehab not being disciplined specific. It's kind of its own discipline. And social workers have an important and diverse role to play in developing those disciplines and developing knowledge and understanding across those fields. And for me, it also further demonstrates the role of social work in research and in brain injury and how important it is. And the more we talk about it, the more people will understand what we do. I think that's a very nice summary. Thank you so much, Graham, again, for the time. I've loved having you on here and hearing about your perspectives and just your diverse research experience. It's quite inspirational to hear about. A pleasure. Thank you so much.

Thanks for joining me this week. If you would like to continue this discussion or ask anything of either myself or Graham, 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 Spotlight Podcast 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. This episode's guest is Eileen, a senior social worker who started her career in child protection before transferring to health. She has worked in the spinal and rehabilitation fields across acute, sub-acute and community areas, worked in medical oncology, and currently works as a case manager at the National Center for Veterans Healthcare,

an outpatient clinic at Concord Hospital. I release a new episode every two weeks. Please subscribe to my podcast so you'll notify when this next episode is available. See you next time.