Guidelines for Social Work Practice in Medicare Locals

Transcription

1 Guidelines for Social Work Practice in Medicare Locals Dr Deborah Absler

2 Acknowledgements I would like to acknowledge the Australian Association of Social Workers (AASW) for commissioning this report and the Department of Health for providing the funding, the AASW for managing and overseeing the Project and the Guidelines Project Reference Group members who provided strategic guidance and direction to the project. The Members included: Anne Dwyer, Ranse McLean and Louise Vause, Mental Health Services Branch, Department of Health and Ageing; Jennie Parham and Craig Hodges, Australian Medicare Local Alliance; Professor Robert Bland and Vicki Cowling, AASW National Mental Health Committee; Stephen Brand, AASW Senior Manager Social Policy and Mental Health and Kerril Williams, AASW Mental Health Administration Officer. I would like to particularly thank Stephen Brand for his leadership and participation in all aspects of the project and Kerril Williams and Elizabeth Sommerville for their contribution and support in conducting this Review. AASW Branch staff and members in Queensland, South Australia and Victoria are acknowledged for their assistance. A sincere thank you is expressed to the Medicare Local representatives and to the many social workers across Australia, who generously provided their time, experience and expertise in shaping this report. Your openness and contribution was invaluable. Dr Deborah Absler Consultant to AASW Australian Association of Social Workers Published November 2013 National Office Canberra Level 4, Ainslie Place CANBERRA CITY ACT 2600 PO Box 4956 KINGSTON ACT 2604 T F E advocacy@aasw.asn.au Enquiries regarding this submission can be directed to: Senior Manager, Social Policy and Mental Health: Stephen Brand E stephen.brand@aasw.asn.au T AASW Chief Executive Officer: Glenys Wilkinson E ceo@aasw.asn.au This document is available on the AASW website: 2

3 Contents Acknowledgements 2 EXECUTIVE SUMMARY 4 1. Introduction 6 2. Guidelines Document Methodology 7 3. National Context Medicare Locals ATAPS Program 8 4. The ATAPS Allied Health Workforce The Social Work Profession Accredited Mental Health Social Workers Specialist Mental Health Practice AMHSWs Accreditation Requirements AMHSWs Profile ATAPS Purchasing Guidelines Standards and Accredited Mental Health Social Workers Qualifications Legal and Professional Status Adherence to Ethical Standards Expertise and Experience Clinical Practice Expertise and Experience Continuing Professional Development Social Work Practice Standards Capacity to Provide Services in all Geographic Regions Clinical Mental Health Practice The View from Medicare Locals: Social Work Contribution to ATAPS CONCLUSION 26 References 28 3

4 EXECUTIVE SUMMARY This Report outlines the core and specialised contribution made by Accredited Mental Health Social Workers (AMHSWs) to Medicare Local s mental health programs, in particular the Access to Allied Psychological Services (ATAPS). The Project was commissioned by the Australian Association of Social Workers (AASW) on behalf of the Department of Health and Ageing (DoHA) to ensure a multidisciplinary employment strategy is incorporated into Medicare Locals mental health programs by addressing misunderstandings regarding social work s professional education and knowledge base and the profession s skill set and practice domain. The social work domain in mental health offers a particular gestalt of skills, knowledge and values that approaches the individual ATAPS clients with a commitment to restore their individual, family and community wellbeing, to promote their recovery, to enhance the individual s sense of empowerment over their life and to advance principles of social justice. This report confirms that AMHSWs make a core and specific contribution to the ATAPS multidisciplinary model of care, and by extension to the entire primary health care model. They are a qualified and highly experienced profession with extensive relevant experience with the ATAPS client group and able to deliver quality clinical services that incorporate Focused Psychological Strategies (FPS) delivered within a psychosocial perspective. They are employed as private providers and employees within the range of Medicare Local mental health programs as clinicians, team leaders and management. Their involvement complements and enhances the multidisciplinary focus and creates opportunities for clients to receive integrated quality service delivery. This report outlines that the cohort of social workers eligible to provide ATAPS, are a highly experienced, educated and accredited workforce in clinical mental health practice and in related fields relevant to the ATAPS client group. They are registered providers with Medicare Australia and are well able to meet the requirements of providing skilled clinical mental health therapeutic outcomes. AMHSWs have been assessed as having specialist mental health expertise based on a rigorous assessment process. They are approved to provide the same evidencebased FPS as other allied health providers. The report highlights that social work is a tertiary-qualified recognised national and international profession. AMHSWs are a well-qualified and experienced workforce. In addition to their foundation social work university qualifications (four year undergraduate or masters qualifying); many have completed postgraduate social work and specialist clinical and mental health training. They have extensive experience in a range of public organisations and as clinical private 4

5 practitioners providing targeted mental health assessment and treatment options with measurable outcomes with the ATAPS client group. They are experienced members and leaders of multidisciplinary teams involved in the provision of primary mental health care. The social work contribution to the ATAPS multidisciplinary model of care provides a skilled and valued additional clinical service, responsive to the specific needs of the ATAPS target client populations. They offer theoretical and practice expertise in a range of evidencebased therapeutic approaches (including FPS) to engage with persons across the life span. The comprehensive social work approach incorporates a clinical and systemic perspective, including a range of well-researched approaches to inform and complement FPS. This involves AMHSWs undertaking a comprehensive assessment that acknowledges that the individual client s own psychological presentation must be understood within their particular context and circumstances. This includes addressing their psychological response to their illness but also enquires about their broader circumstances including their family circumstances, their social, cultural and community context and their existing linkages with professionals. Their capacity to address the person s psychological, social, physical and spiritual domains within a holistic systemic perspective, their contribution and participation in a multidisciplinary service model and expertise working in partnership and collaboration, provides an essential contribution and dimension to integrated responsive primary mental health care. [When Medicare Locals employ AMHSWs to deliver ATAPS] clients attend, get better, get good outcomes. (South Australian Metro/Regional Medicare Local) 5

6 1. Introduction This Report outlines the core and specialised contribution made by Accredited Mental Health Social Workers (AMHSWs) to Medicare Local s mental health programs, in particular the Access to Allied Psychological Services (ATAPS). ATAPS is a program of the Better Outcomes in Mental Health Care initiative that provides access to short-term, low-cost treatment for people with high prevalence mental health disorders. This Report was commissioned by the Australian Association of Social Workers (AASW) on behalf of the Department of Health and Ageing (DoHA) to ensure a multidisciplinary employment strategy is incorporated into Medicare Local mental health programs by addressing misunderstandings regarding social work s professional education and knowledge base and the lack of knowledge about the profession s skill set and practice domain. It outlines that the cohort of social workers eligible to provide ATAPS are a highly experienced, educated and accredited workforce in clinical mental health practice and in related fields relevant to the ATAPS client group. They are registered providers with Medicare Australia well able to meet the requirements of providing skilled clinical mental health therapeutic outcomes. Since ATAPS establishment, AMHSWs have been employed as individual private providers and in clinical positions within Divisions of General Practice and now Medicare Locals. They provide Focused Psychological Strategies (FPS), perform clinical duties such as triage consultants and hold team leader positions supervising and training Allied Health ATAPS professional staff. They hold a range of management roles providing clinical leadership and policy and service development. They are employed across metropolitan, rural, regional and remote locations to all ATAPS Tier One and Tier Two program areas. The social work contribution to the ATAPS multidisciplinary model of care provides a skilled and valued additional clinical service responsive to the ATAPS client populations specific needs. They offer theoretical and practice expertise in a range of therapeutic approaches (including FPS) to engage with persons across the life span. Their specialised capacity to address the person s psychological, social, physical and spiritual domains within a holistic systemic perspective, their contribution and participation in a multidisciplinary service model and expertise working in partnership and collaboration, provides an essential contribution and dimension to integrated responsive primary mental health care. This Report outlines the benefits of their inclusion as part of the multidisciplinary ATAPS workforce for clients, General Practitioners (GPs), Allied Health colleagues, Medicare Locals and the broader service system. If you don t employ a social worker you are missing out on potential skills in your staff. (Western Australia Rural/Remote Medicare Local) 6

7 2. Guidelines Document Methodology The Report was informed by the following data collection methods. A Reference Group with membership from the DoHA Mental Health Services Branch, the Australian Medicare Local Alliance (AMLA),the AASW, Mental Health Committee and the AASW management provided guidance to the project. An extensive analysis of relevant literature and documentation. An extensive Consultation process with: Eight Medicare Locals: Interviews were conducted with 14 personnel (a CEO, Mental Health Managers, Team Leaders, Managers from related programs and Senior Clinicians) from Medicare Locals situated in Western Australia, South Australia, Victoria, New South Wales and Queensland across metropolitan, regional and rural and remote sites. Key stakeholders: Interviews were conducted with:»» AMLA Field Officers and a Senior Consultant.»» DoHA Mental Health Programs, Director, Assistant Director and Project Officer.»» AASW: The Senior Manager, Social Policy and Mental Health, and AASW Mental Health Team. Social workers:»» 56 social workers 1 attended three focus groups conducted in Queensland (26 participants), South Australia (17 participants) and Victoria (13 participants).»» 67 AMHSWs completed a specifically designed survey were registered to deliver Tier 1 and Tier 2 ATAPS services (and other mental health programs) as private contractors, Medicare Local employees, and employees of contracted organisations in a number of metropolitan, rural and regional and remote settings across Western Australia, South Australia, Victoria, New South Wales and Queensland.»» Additional telephone and direct interviews and communication were also conducted with private contractors and employed staff in clinician and team leader positions from regional, rural and remote locations in Victoria, New South Wales, Queensland and Western Australia metropolitan. 1 The majority of those who attended were Accredited Mental Health Social Workers 2 Most of the surveys were completed on-line with some provided in written form. Some participants attended focus groups and completed the survey. 7

8 3. National Context 3.1 Medicare Locals Social Workers help Medicare Locals connect to other relevant organisations. They are good at identifying gaps in services and needs to assist in service development and planning. They make good leaders and managers. (Western Australian Remote Medicare Local) Social workers understand social determinants of health. (Queensland Metro Medicare Local) Medicare Locals were established in as the principal body to structure and coordinate primary health care services across 61 geographically varied locations throughout the country. Evolving from the former Divisions of General Practice, Medicare Locals have been established as independent legal entities, with the role of co-ordinating general practice and the broader primary health care sector to improve access to services, drive integration, and address primary health care inequities. Medicare Locals have become a key vehicle through which primary mental health care services are delivered. Central to their suite of services, is the ATAPS program. 3.2 ATAPS Program Social workers are very good at working with the people who fall into all the ATAPS groups. (Victorian Regional Medicare Local) Developed in 2002, the ATAPS is a program of the Better Outcomes in Mental Health Care initiative that provides access to short-term, low or no cost treatment for people with high prevalence mental health disorders who may not otherwise be able to access services. It complements the Better Access Initiative by targeting hard-to-reach population groups and those on limited incomes to improve community access to quality primary care mental health services [and] to address barriers to the early identification and treatment of mental disorders. 3 Medicare Locals utilise different business models to deliver their ATAPS Program. 4 Models tend to vary among States and between metropolitan, regional, rural and remote locations related to organisational preferences, local needs and workforce availability. The most frequent model has consisted of a subcontracting model, employing private providers or private group practices and in some situations organisations to deliver ATAPS. Other Medicare Locals have adopted a direct employment model, employing providers to deliver services from the Medicare Local and/or from external sites such as GP practices and community agencies. In addition Medicare Locals have utilised a hybrid model with combinations of both models for different program elements or regional areas. Both the hybrid model and direct employment has become increasingly more popular. 5 3 Martin, J. (2013), Accredited Mental Health Social Work in Australia: A reality check, Australian Social Work, Vol. 66, No. 2, , p Australian General Practice Network, (November 2011) ATAPS Workforce Mapping Report 5 Australian General Practice Network, (2011), ATAPS Workforce Mapping Report 8

9 ATAPS services are divided into the Tier One Core Program and Tier Two special purpose funding, which was introduced in Specialist streams and service responses were developed for: women with peri-natal depression; people at risk of suicide or self-harm; people who are homeless or at risk of homelessness; people impacted upon by extreme climatic events; people in rural and remote locations; Aboriginal and Torres Strait Islander people and children with mental disorders 6. Individuals are assessed by a GP through their Mental Health Treatment Plan as having a clinical diagnosis of mental illness. They are referred to the relevant Medicare Local, (or subcontracted organisation) who co-ordinate the delivery of the ATAPS program. Eligible people can access up to twelve individual mental health services in a calendar year. In addition, the referring practitioner may consider that in exceptional circumstances the person may require an additional six individual FPS services above those already provided (up to a maximum total of 18 individual services per client per calendar year). In addition to individual sessions, up to 12 separate services within a calendar year are also available for group therapy services. When a person completes their first 6 sessions the GP will consider the need for further services before a further 6 sessions are accessed (if required). The authorised allied health provider professions who deliver ATAPS services include psychologists, social workers, mental health nurses, occupational therapists, Aboriginal and Torres Strait Islander Health Workers and student, intern and probationary psychologists (under supervision). 7 Thus, from the outset, the ATAPS service involves a collaborative team approach involving the consumer, their GP, the Medicare Local (or authorising organisation) and the allied health provider. Social workers understand the complexity of issues experienced by ATAPS clients, the layers of complexity. They can deal with a range of multiple issues and help sort multiple settings. They know about the range of issues clients are dealing with e.g. domestic violence, children being in care. (Queensland Metro Medicare Local) 6 Australian Government, Department of Health and Ageing: Operational Guidelines for the ATAPS Initiative (January 2012). 7 A definition of allied health providers states that Allied Health is an umbrella term used to describe individuals who are trained to work individually or with others to support individuals achieve optimal health, Australian Medicare Local Alliance (2013), Guide to Allied Health in the Primary Care Setting, ACT, p

10 4. The ATAPS Allied Health Workforce It works well to have a multidisciplinary team because the different professional s specific skills work together and therefore address different elements of mental health and mental illness. It gives the Medicare Local an opportunity to have choice based on the particular client s issues and what intervention might work best, to work out with the referrer what is needed what is the best fit between the client and the different team members. (Victorian Rural Medicare Local) Utilisation of a multidisciplinary team approach for the provision of ATAPS services is specified within The ATAPS Program Operational Guidelines 8 and was confirmed by the 2010 Commonwealth Government s Review findings as the appropriate workforce to continue delivery of evidence based psychological therapies under ATAPS. 9 The impact and benefits of utilising a multidisciplinary workforce to deliver primary mental health care is well established in the mental health literature. It offers improved access to clients, more flexible service provisionincluding an enhanced capacity to provide services to more disadvantaged groups, a broader skill set and a more targeted approach to service delivery and allows for case reviews, supervision and better support systems. 10 In the eleven years of ATAPS operation, the ATAPS allied health professional workforce profile has changed. Whilst psychologists remain the largest professional provider group, increased numbers of social workers, as well as mental health nurses and occupational therapists now deliver ATAPS psychological services. 11 Social workers constitute 7.6% of the ATAPS workforce, the second professional group after psychologists (88.5%) followed by mental health nurses (2.9%), occupational therapists (.09%) and Aboriginal and Torres Strait Islander Health Workers (0.1%). 12 The ATAPS allied health provider workforce composition within the main business models has also shifted. Within the categories of those directly employed by Medicare Locals or by a subcontracted agency to deliver ATAPS psychological services a more even spread across the disciplines have emerged. However, it is noted that the involvement of social workers and other allied health providers in ATAPS and other Medicare Local s mental health programs remains variable and under-utilised Australian Government, Department of Health and Ageing: Operational Guidelines for the ATAPS Initiative, January Australian Government Department of Health and Ageing, (February 2010) Outcomes and proposed next steps: Review of the Access to Allied Psychological Services Component of the Better Outcomes in Mental Health Care Program, (p. 13). 10 Australian General Practice Network, (2011), ATAPS Workforce Mapping Report. 11 Australian General Practice Network, (2011), ATAPS Workforce Mapping Report. 12 Department of Health and Ageing, (January 2013) Access to Allied Psychological Services: Increasing Efficiency for ATAPS Tier 1 services an efficiency model Consultation Paper, p14. It would be expected that those figures would have increased since that research was undertaken. 13 Australian General Practice Network, (2011), ATAPS Workforce Mapping Report, November

11 5. The Social Work Profession Social workers demonstrate evidence of specialist skills and knowledge. (Victorian Rural Medicare Local) Social work is a tertiary-qualified recognised national and international profession. The Australian social work profession adheres to the definition of social work jointly agreed by the International Federation of Social Workers and the International Association of Schools of Social Work: The social work profession promotes social change, problem solving in human relationships and the empowerment and liberation of people to enhance wellbeing. Utilising theories of human behaviour and social systems, social work intervenes at the points where people interact with their environments. Principles of human rights and social justice are fundamental to social work. 14 Social work s unique contribution is an understanding of, and capacity to respond to the specific psychological and emotional needs of individuals and to build on individual strengths to empower people to exercise more direction over their life. Of particular relevance to ATAPS service users, they also focus on the interface between the individual and the environment and recognise the impact of social, economic and cultural factors on individual and societal mental health and wellbeing. 16 Social workers provide evidence-based professional interventions for individuals, groups and communities. They work with individuals to address situations of personal distress and crisis. This is achieved by working with individuals towards the realisation of their intellectual, physical and emotional potential 15 utilising a number of practice modalities including clinical interventions and therapies, casework, case management and community development. 14 AASW, (2010) Code of Ethics, Canberra. 15 AASW, Australian Social Work Education and Accreditation Standards (ASWEAS), (2012), ACT. 16 AASW, (September 2012) Social Work and Mental Health Position Paper, ACT, p

12 6. Accredited Mental Health Social Workers Social worker s skills are equally applicable across Tier One and Tier Two. We targeted a social worker to develop and deliver the Child Mental Health Program because they know how to identify the target population, they knew about the range of services. They bring with them the capacity to and knowledge about mapping, analysis, the problems within a region, the population health perspective and applying the social determinants of health. (Queensland Metro Medicare Local) The specific cohort of social workers who provide ATAPS specialist clinical mental health services are AMHSWs. They have been assessed by the AASW as having specialist mental health expertise. 6.1 Specialist Mental Health Practice The social work profession has a longstanding and recognised tradition of specialist mental health practice within the field of public mental health services and in clinical private practice. These speciality areas were one of the first established within the social work profession. 17 The focus of the mental health policy context in the past decade at the Federal and State levels has further promoted the expansion of the role of social workers in mental health as both providers of public and private services. 18 From 2006 accredited private practice Mental Health Social Workers became eligible to register as Medicare providers and supply claimable therapeutic sessions for people with mild to moderate mental health problems under the Better Access Initiative. 19 Social workers comprise a large and integral proportion of the mental health workforce. 20 They constitute a third of the allied health workforce for public mental health services and are identified as one of the five key mental health disciplines. 21 In a multidisciplinary team they bring skills in networking, they don t think as a solo practitioner but as a member of a team because they are used to that. (Western Australia Rural/Remote Medicare Local) The first social workers were employed in public mental health services in 1944 (Martin, 2013) and mental health has been a traditional field of specialist social work practice. Bland, Renouf & Tullgren, (2009), Social work practice in mental health, NSW: Allen and Unwin, p Martin, (2013), p AASW, (September 2012) Social Work and Mental Health Position Paper, ACT, p Ziguras S, Henley K, Conron W, Catford N., (1999) Social work in mental health services: A survey of the field. Australian Social Work, 52: Department of Health and Ageing, (2010) National Mental Health Report 2010: Summary of Fifteen Years of Reform in Australia s Mental Health Services under the National Mental Health Strategy Canberra: Commonwealth of Australia, Australian Health Ministers (1992), National Mental Health Policy, AGPS.

13 6.2 AMHSWs Accreditation Requirements AMHSWs have satisfactorily achieved two stages of accreditation. They have proved their eligibility to be a member of the AASW and have been assessed by the AASW as having specialist mental health expertise based on the following assessment criteria: 1. They hold current membership of the AASW, 2. They demonstrate having at least two years post-qualifying social work practice experience in the mental health or related field and provide evidence of how this experience meets the AASW Practice Standards for Mental Health Social Workers (2008), 3. They have received at least two years postqualifying supervision in mental health or related field, 4. They meet AASW Advanced Accredited Continuing Professional Development (CPD) requirements, 5. They provide a written statement that outlines how their Clinical Social Work Practice utilises the evidence-based FPS approaches 6. A referee statement from an employer or supervisor is provided. At the time of this report there are 1500 AMHSWs in Australia. Although there is no accurate current data collected recording the number providing ATAPS, the 2011 ATAPS Workforce Mapping Report indicated that 213 AMHSWs were providing ATAPS at that time, 163 of whom were employed as private contractors and 50 were directly employed by Divisions of General Practice or a subcontracted organisation. 22 In a 2010 survey, 20% of the 566 AMHSWs who participated in the survey reported that they provided ATAPS services Australian General Practice Network, ATAPS Workforce Mapping Report, (November 2011), p. 9. It was noted that this is likely to be an underrepresentation of the actual numbers of ATAPS providers due to the lack of reliable data available. 23 At this time there were 1,142 registered Accredited Mental Health Social Workers (Martin 2013) 6.3 AMHSWs Profile Social workers are used to working with vulnerable people. They are a good fit with the work being done through ATAPS. (Queensland Metro Medicare Local) The profile of the AMHSWs who participated in this project provides a valuable snapshot of their level of participation and contribution to primary mental health care service delivery. A large number were active providers within the Better Access Initiative. Fifty-one were currently involved in delivering mental health services for Medicare Locals, 46 in ATAPS services. Many more were interested in providing ATAPS but reported that they had been unsuccessful in registering with their Medicare Locals due to the Medicare Local s policy of either not employing or applying strict quotas to the employment of social workers. The AMHSWs interviewed were also involved in delivering the Rural Primary Health Program, the Shared Care program (SA), Mental Health Services in Rural and Remote Australia (MHSRRA) and in Headspace centres. They are registered with Medicare Locals located in Queensland, New South Wales, Victoria, South Australia and Western Australia, in metropolitan, rural, regional and remote settings as private providers, directly employed and employed by an external agency subcontracted to provide ATAPS programs. Some were involved with providing ATAPS for only one Medicare Local whilst others were registered with two or three Medicare Locals. Some were both private providers for one Medicare Local and employees with another. Within the private providers, they ranged from working as sole practitioners, employed or co-located within a GP or specialist medical practice and in a group practice with other allied health providers. Some had been involved with providing ATAPS since its establishment in Their referral rates differed from only having received a small number to having received hundreds of referrals, from working part-time to full-time as ATAPS providers. As well as being employed to provide clinical services, a number were 13

14 also employed as triage clinicians, team leaders and in service development and management positions. Almost all delivered ATAPS Tier One services, with a number also providing Tier Two services across the following: specialist suicide prevention; child services; perinatal; indigenous and homeless programs. Within a number of States in metropolitan and regional locations AMHSWs had been employed to design, establish and deliver the Medicare Local s Children Mental Health Service, to establish, lead and deliver perinatal services, and to develop and deliver the Aboriginal and Torres Strait Islander Service. In these roles they were either co-located with a range of different services, in private practices or delivered the program from the Medicare Local. Others had been approached by Medicare Locals to develop specific services, for example, working specifically with Culturally and Linguistically Diverse (CALD) clients and refugees in a regional Victorian setting and providing a service response from an indigenous school. A number were employed to provide clinical supervision to multidisciplinary ATAPS clinicians. Some had also been involved in service development and project and policy development for the Medicare Locals within ATAPS and related mental health programs. A proportion of the AMHSWs were also involved on Medicare Local Strategic Design Committees, Medicare Local Mental Health Reference Groups and Steering Committees, Medicare Local Allied Health Advisory Committee and National Working Parties. 14

15 7. ATAPS Purchasing Guidelines Standards and Accredited Mental Health Social Workers Positive outcomes [for patients experiencing mental illness and psychological distress] are best achieved through referral to and collaboration with health professionals specifically trained in psychological therapies including both psychologists and social workers. When one sees their patients return with improved mental health, one appreciates that invaluable resource of establishing a working relationship with a local therapist or social worker. (GP) 24 The standards outlined in the ATAPS Purchasing Guidelines (Australian Government, 2012) state that all allied health providers must be credentialed in the field of mental health and meet a number of required qualifications, standards and skills to provide the specified therapies. The following sections outline how AMHSWs meet (and in many categories exceed) these required standards. 7.1 Qualifications It is a misconception that social workers are less qualified they have clinical expertise and bring other skills to the role. (Queensland Metro Medicare Local) AMHSWs are required to be appropriately qualified according to the requirements of their profession: AMHSWs have undertaken two levels of accreditation. They have achieved eligibility to be members of their professional body, the AASW, and they have also been assessed by the AASW as having specialist mental health expertise. The AASW is the key professional body representing social workers in Australia. Graduates of AASW-accredited social work university programs are eligible for membership of the AASW. The academic qualifications that applicants are required to hold on completion of an AASW-accredited course in order to gain entry to the profession of social work are a Bachelor of Social Work, Bachelor of Social Work with Honours or a Social Work Master s degree (Qualifying Master of Social Work). These academic programs are accredited when they meet the requirements of the Australian Social Work Education and Accreditation Standards. 24 AASW, (May 2008), Better Access Initiative. Post Implementation Review of Medicare Items. AASW Response, Canberra 15

16 Bachelor degree programs combine an academic social science program (studies of society and studies of the individual) with social work specific education. They are full-time courses of four years duration or two years duration following completion of a relevant three year degree. 25 The goal of social work education is to provide a rigorous program which results in graduates who are competent, effective, skilled, knowledgeable, ethical and confident practitioners. (AASW, 2012, p. 6). Social work practice is informed by professional education based on an analysis and understanding of human behaviour and of complex social processes. It accepts a commitment to working within a stated value position and code of ethics. (AASW, 2012, p. 3). 26 The curriculum provides entry-level professional social work education providing education, knowledge, skills and values that can be applied across the diverse range of practice settings, fields of practice and methods of social work practice utilised. An extensive period of field education (placements in social work practice settings) assists the integration of theory and practice. Professional social work education gives primacy to the development of reflective and reflexive practice, structural analysis, critical thinking and ethical professional behaviour (AASW, 2012, p. 4) which equips social work practitioners to enter practice across a range of social work settings. The content delivered in professional social work education recognises that social work operates at the interface between individuals and their social, cultural, spiritual and physical environments. illness including psychiatric classifications, major syndromes, theories and knowledge of aetiology and theories and knowledge of a range of interventions and treatment approaches in mental health and the evidence base for these interventions. 27 In addition, essential core curriculum content includes an understanding of individuals and of society within a framework that situates the person in their environment. Specific knowledge development is addressed in relation to human behaviour and development, personality development, life-cycle stages, family and social networks, physical health and ill-health, mental health problems and mental disorder, ability/disability, vulnerability and resilience. The core curriculum also addresses the theoretical knowledge, counselling theories and skills required in the application of practice methods used when working with individuals, groups, families and communities. This includes clinical counselling, group work, practice skills in effective communication and interpersonal skills with individuals, groups, families and communities. The curriculum also extends to the practice skills required for assessment and analysis, data collection and management, case noting and report writing and how these are applied when working within a range of different fields of practice, settings, client groups and geographical locations. As will be outlined in further sections in addition to these foundation social work university qualifications, many AMHSW s complete postgraduate social work and specialist clinical and mental health training. Mental health is one of the four essential core curriculum content required in all Bachelor of Social Work and Qualifying Masters of Social Work degrees. This consists of curriculum related to knowledge of mental health and 25 As a considerable proportion of social work graduates are mature age they have frequently had extensive previous work experience and other qualifications prior to their entry into a Social Work degree. 26 AASW, Australian Social Work Education and Accreditation Standards (ASWEAS), (2012), ACT. 27 Bland, Renouf and Tullgren, (2009); AASW, (2008) Practice Standards for Mental Health Social Workers, ACT. 16

17 7.2 Legal and Professional Status Don t see them as second class to other professions. They can tick all the boxes. They are well rounded professionals with a diverse range of skills, their work with clients is great, they manage partnerships well and I want other allied health providers to learn from them. (NSW rural and regional Medicare Local) To be registered by an appropriate State or national authority to practise or where the profession does not have registration: The profession of social work is regulated by the AASW, which sets standards for social work practice, ethics and education. Social work is currently not a registered profession in any State of Australia. 28 Eligibility for membership of the AASW is the benchmark for qualified practice in Australia. As noted by the AMLA the majority of allied health professions are self regulated and.self-regulated professions offer a high standard of unique skills in the primary care setting (2013, p. 22). 7.3 Adherence to Ethical Standards Social workers have a commitment to ethics and providing quality services. They are accountable committed to receiving supervision and ongoing professional development. (Victorian Rural Medicare Local) The AASW meets the requirements of having a comprehensive Code of Ethics which includes an ethical and professional guidelines structure and accountability and disciplinary procedures for dealing with malpractice, incompetence and unethical behaviour. All AASW members are required to agree to abide by the AASW s Code of Ethics. 28 This is an area which the AASW has taken an active role. 7.4 Expertise and Experience To be adequately experienced in the field of mental health: Social workers are very competent in working with people with mental health presentations in a range of ways. They never lose sight of the person. (Western Australian Metro Medicare Local) The operational standards require that AMHSWs have at least two years post qualifying social work practice experience in mental health or a related field. A 2008 study reported that the level of professional experience of current AMHSWs far exceeded this minimum requirement. 47% had over 15 years experience in the mental health field while 73% had over 10 years experience. 29 The findings of this research also support this profile. The nature of AMHSWs prior mental health experience includes the provision of specialist clinical services at the mental health clinician, team leader and management positions across adult mental health community and hospital services, infant, child and adolescent mental health, aged mental health, forensic mental health, early psychosis services and with specific population groups such indigenous Australians and ethnic communities. Social workers frequently have previous relevant experience - done FPS in the past and previous experience with the same group of people, therefore familiar with this population and don t baulk. They are a good fit with the client group. (South Australian Metro/Regional Medicare Local.) 29 AASW, (May 2008), Better Access Initiative. Post Implementation Review of Medicare Items. AASW Response, Canberra, p

18 In these positions they undertake mental health assessment (including mental state examinations) and provide the required clinical treatment for a range of mental health presentations including: depression and other mood disorders; anxiety disorders; psychosis; suicidal presentations; personality disorders; trauma and abuse. They provide: individual clinical counselling and therapy; family therapy; group therapy; psycho-social interventions and education and training. An integral component of all social work mental health practice involves liaison, development and promotion of collaborative networks and delivery of integrated mental health care with their medical and allied health colleagues and with external agencies and health and social providers. Social workers are good at facilitating relationships with other professionals, ensure coordination occurs. Feedback from GPs is that social workers do more liaison, linking, bring people together, collaboration. (Queensland Metro Medicare Local) Across all mental health service settings, social workers participate as members (and often team leaders) of the treating multidisciplinary teams (Martin 2013, p281). They participate in and provide intake and triage services, case discussions and professional and service development activities and family and community supports. Social workers are good intake clinicians because they are skilled at conducting a mental health assessment, they have previous experience providing or working with triage, have a broad knowledge of referral pathways and options. (Victorian Rural Medicare Local) 7.5 Clinical Practice Expertise and Experience Social workers have clinical expertise. (Queensland Metro Medicare Local) To be currently or recently engaged in clinical practice in that field: They can work across a continuum, with individuals, families, groups, organisations. They can work in all the specialist teams with children, homeless, peri-natal, indigenous. (South Australian Metro/Regional Medicare Local.) The required skills to deliver ATAPS include appropriate knowledge, skills and experience. Knowledge is required in psychopathology, psychological theory and in evidence based practice; effective interventions for specific mental health problems and the theoretical basis of treatment and skills involved. They are experienced workers, highly trained, highly skilled. (South Australian Metro/Regional Medicare Local) AMHSWs are a well-qualified and experienced workforce. 30 Studies in both 2008 and 2013 identified that 84% of AMHSWs had over 10 years experience as a social worker and 63% had over 15 years experience over 10 years experience in the mental health field and 47% had over 15 years experience. 31 In addition to holding a Bachelor of Social Work qualification, the 2013 study reported that 59% possessed post graduate qualifications including certificates, diplomas, Masters or PhD qualifications in both social work and specialist clinical qualifications including family therapy, individual adult and child psychotherapy, group therapy, child development, behavioural science; attachment theory; effects of trauma, relational dynamics Prior, (2010), Martin (2013). 31 AASW, (May 2008). 32 Martin, (2013), p

19 Both Martin s (2013) study and the research undertaken for this project highlighted the breadth of AMHSWs experiences in a range of public organisations and as clinical private practitioners with extensive experience providing targeted mental health assessment and treatment options with measurable outcomes. The location of social worker s organisational experiences, in addition to the mental health field are across the breadth of health, government and non-government agencies including alcohol and drug services, homeless services, relationship counselling and therapy services, child and family services, sexual abuse and domestic violence centres, forensic services, migrant and indigenous services. Within these settings their core client group are those with multiple, co-existing and complex presentations alongside those with specific areas of difficulty. Thus the clients eligible for ATAPS both in the Tier One and Tier Two categories are those who social workers have familiarity with and extensive knowledge of and experience with engagement and effective interventions for these client groups in a number of service settings. AMHSWs operate their own individual private practices, in group practices with other allied health providers, are co-located in GP and other medical practices and in community agencies. In addition to delivering ATAPS services, AMHSWs are core providers of the Medicare Better Access to Mental Health Care program and provide services to a number of Commonwealth and State based mental health and other related programs including Chronic Diseases Management (Enhanced Primary Care) programs, Employee Assistance Programs, the Department of Veterans Affairs, Victims of Crime, Work Cover, the Transport Accident Commission, the Family Court as well as general clinical services for individuals and families across the age span. They also provide supervision, consultation, professional development and training for a range of government and nongovernment agencies, professional groups including General Practitioners and other Allied Health professionals. Their direct clinical practice experience includes assessment, intervention in clinical counselling, psychotherapy and case management with individuals, couples, families and groups. The range of psychological services provided includes relationship counselling, loss and grief counselling addressing violence and abuse, addictive behaviours including gambling, drug and alcohol use, mediation, youth conferencing, palliative care, family dispute resolution. 33 Social workers broaden psychological strategies. They identify client s individual needs but also their networks, systems, families, schools and how to pull it together. They take an overall holistic view. What is needed for this client in this situation in this location? They use a different framework and work differently they explore a holistic assessment of multiple factors and how they link together. They know how to put things together and make linkages. They think about the next stages needed liaison. They look outside the square, are more flexible, they pull in wider resources. They do more liaison; make phone calls to ensure continuity of care, follow-through on what needs to be done. (Queensland Metro ML) AMHSWs are approved to and provide the same evidence-based FPS as other allied health providers; psycho-education, motivational interviewing, cognitive behavioural therapy, relaxation strategies, skills training, interpersonal therapy and narrative therapy. Studies undertaken in 2007, 2008 and 2013 indicated that the four most frequently used interventions by AMHSWs were: interpersonal therapy (81% in the 2007 study and 46% in the 2013 study and also noted in the 2007 study), cognitive behaviour therapy, (43% in the 2013 study), psycho-education (including motivational 33 Martin, (2013). 19

20 interviewing) (33% in the 2013 study), relaxation strategies (26% in the 2013 study), skills training (23% in the 2013 study), and narrative therapy (19% in the 2013 study). An Environmental Scan conducted in a 2007 survey identified that AMHSWs were the professional group most likely to offer narrative therapy to Aboriginal and Torres Strait Islander people. 34 We employ social workers because of their clinical therapeutic approach. They bring a different dimension to FPS; They are good at engaging clients, They start where the client is, They look at the holistic picture, They are able to work from the position of the client s information, They develop a goal based strategy of what is achievable, They work within the ATAPS guidelines (Adelaide Metro Medicare Local). 7.6 Continuing Professional Development To have continuing involvement in relevant professional development: The degree gets you in the door but it is the experience and training since qualification that is important. Don t employ people based on their qualification it is not that black and white it is based more on their background, interests, qualification, experience, personality, training they have done post qualification, that they have worked in a specific area. (Western Australia Rural/Remote Medicare Local) AMHSWs are required to attain 50 hours of Continuing Professional Development (CPD) each 12 month CPD cycle. Twenty of these 34 Mental Health Professional s Association (2007), (MHPA) Project; AASW, (May 2008), Better Access Initiative. Post Implementation Review of Medicare Items. AASW Response, Canberra, p3. hours must be activities specifically related/ relevant to mental health; 10 hours must be focused on consolidating and expanding their information and knowledge on FPS. A 2010 analysis of AMHSWs Continuing Professional Education activity 35 revealed that AMHSWs devoted 84% of their CPE activities to meet this requirement, engaging in a range of activities including workshop and seminar attendance and choice of professional publications. Examples of their attendance included workshops on trauma and recovery focused treatment and clinical responses to working with depression and grief. 7.7 Social Work Practice Standards I have had very positive patient feedback and outcomes and I feel confident referring to social workers for that reason. In 5 years I have not had one instance of negative feedback from a patient (which is a very atypical pattern!). (Queensland GP) To satisfy all standards outlined in their profession s relevant practice standards or competency standards documents: AMHSWs demonstrate competency in accordance with the AASW Practice Standards for Mental Health Social Workers (2008) which relate to direct practice, service management, organisational development and systems change, policy, research and evaluation and education and professional development. In the area of direct practice they demonstrate competencies across nine standards. Those particularly relevant for delivering ATAPS include: The capacity to establish respectful and empathic working relationships with the client, Social workers have good skills with ATAPS clients, they are good at relationship building make them feel safe, 35 Prior, W. (June 2010), Report to the Australian Association of Social Workers, Mental Health Continuing Professional Education Project. Canberra. 20

21 help them connect to others. They are good at promoting social connectedness, family relationships, empowering clients, advocacy. (WA Remote Medicare Local) The capacity to develop a comprehensive bio-psycho-social assessment addressing the physical, psychological and social aspects of the client and their situation (which may include undertaking a Mental State Examination) and other assessments of clinical functioning. It is also expected that to maintain the required standards AMHSW s will undertake additional training as necessary in specialised interventions. They are also expected to maintain professional standards of records of activity. The capacity to develop and implement the required interventions to achieve specific therapeutic outcomes. These interventions are evidence based and include a range of psychological modalities including FPS. The capacity to enhance purposeful communication among relevant stakeholders involved with the client. They are good at relationship building, liaison and partnerships with other professionals and with organisations and co-working if this is required, good at making connections, developing trust, understanding the cultural issues e.g. with the indigenous community. They communicate well with GP s send letters, explain clearly what has been done. (Western Australia Remote Medicare Local) Practices as a member of a multidisciplinary team including contributing a social work perspective to team deliberations around clinical activities and applies a range of skills in problem solving, education and conflict resolution to the management of the multidisciplinary team. When social workers are involved in a multidisciplinary team you see the difference regarding how clients are assessed, what assessment tools are used and how clients are referred. They have transferable skills from other areas. They deliver and provide more scope. (NSW Rural and Regional Medicare Local) AMHSWs compliance with these standards is monitored by the AASW Mental Health Team as part of their ongoing accreditation status. A 2008 Survey demonstrated that AMHSWs have a high rate of compliance with the referral and communication and administrative requirements including providing reports to GPs following the 6 th and 12 th review appointments. Also, 60% provided additional reports when indicated after the initial consultation. In addition, a majority supplemented this communication with telephone contact, face-to-face meetings, correspondence and formal case conferencing Capacity to Provide Services in all Geographic Regions Social workers have good skills with clients make them feel safe, help them connect to others. Clients seen by social workers are referred more to other services, they link them in well to other services. (WA Remote Medicare Local). To be available to provide services within an agreed geographic region: Social workers are located across all Australian States and territories. A 2008 survey identified that 37% of AMHSW are practicing in regional, rural and remote areas of Australia AASW, (May 2008), Better Access Initiative. Post Implementation Review of Medicare Items. AASW Response, Canberra, p AASW, (May 2008), Better Access Initiative. Post Implementation Review of Medicare Items. AASW Response, Canberra, p

22 8. Clinical Mental Health Practice Social workers are capable of delivering FPS, have the same goals to address the concerns and deliver the same tools but bring in their own flavour which is the social work framework, a holistic view of wellbeing, looking at the big picture. They have the capacity for flexibility in delivering services when it is needed and are flexible in their approach. (Western Australia Remote Medicare Local) The social work domain in mental health offers a particular gestalt of skills, knowledge and values that approaches the individual ATAPS clients with a commitment to restore their individual, family and community wellbeing, to promote their recovery, to enhance the individual s sense of empowerment over their life and to advance principles of social justice. Social workers bring to their direct (clinical) practice an invaluable understanding of how the social environment shapes a person s experience of mental illness, and how that illness impacts on the individual, family, and community. 38 Thus AMHSWs embrace a commitment to the individual, to their social context and social consequences of their mental health experience. 39 Two key themes that are core to Mental Health Social Work practice: are the importance of the lived experience of mental illness and the importance of relationships as a basis for change. 40 Social workers work well with clients. They are very respectful with people. They take a client focus what is important to the client. They are good at finding the language that engages clients and get into their frame of reference. They are good at helping 38 Armstrong, G., Blashki, G., Joubert, L., Bland, R., Moulding, R., Gunn, J. and Naccarella, L. (2010), p AASW, (2008) Practice Standards for Mental Health Social Workers, ACT, p Bland, Renouf and Tullgren, (2009), p. 7 people problem solve, developing coping strategies for people who are not used to planning. (Queensland Metro Medicare Local) AMHSWs delivering ATAPS and other Medicare Local mental health programs draw on a range of well-researched approaches to inform and complement FPS. Thus, while they deliver shared tasks and treatment approaches with their allied health colleagues, they also utilise a holistic approach that focuses on strengths, recognising the social, emotional, physical and spiritual aspects of wellbeing (Martin, 2013, p. 292). Social workers do the same Focused Psychological Strategies work as (other allied health providers). They are better at picking up where the client is at and then addressing these issues, better at looking at the bigger picture and what s needed for that person, they know about other resources. Social workers have a broadness of approach and a range of skills see individuals, run a range of groups e.g. psycho-education. (WA Remote Medicare Local) This perspective and lens incorporates a range of individual mental health frameworks and theories, psycho-social support, family psycho-education, group work and community development, research and policy development (Bland, Renouf and Tullgren, 2009) gained from their foundation social work professional education, and further consolidated through additional professional education. In practice this involves AMHSWs undertaking a comprehensive assessment that acknowledges that the individual client s own psychological presentation must be understood within 22

23 their particular context and circumstances that includes addressing their psychological response to their illness but also enquires about their broader circumstances including their family circumstances, their social, cultural and community context and their existing linkages with professionals. The comprehensive social work approach incorporates a clinical and systemic perspective. Therefore, AMHSWs deliver FPS informed by a strongly held commitment to, and extensive involvement with the importance of incorporating the consumer s voice and experience into their treatment, respecting the lived experience of people living with mental illness and their families and supporting them on their recovery journeys. Social workers have pioneered and championed the participation of consumers and carers and families in all aspects of their mental health care. intervention, practice-based research, history and philosophy melded with mental health specific knowledge, application of evidencebased treatment methods blended with a range of extensive employment experiences in mental health and related domains. I believe that social workers with appropriate training and experience offer an important resource for GP s in providing clinical counselling for their patients. (Queensland GP) AMHSWs kit bag to engage ATAPS clients consists of a composite of social work s own knowledge base, which includes theories of 23