C NNECTIONS Fall 2018 | Volume 1, Issue 4
C NNECTIONS BUILDING STRONG BONDS How Kids in Action Program Assists Families in Rural Nova Scotia (page 29)
SOCIAL WORKER CHALLENGES Within Canadaâ€™s Troubled Child Welfare System (page 24)
PRIVATE PRACTITIONER CALLS FOR CHANGE To The Child Welfare System (page 17)
SAVE THE DATE 2019 NSCSW Spring Conference and Annual General Meeting Friday, May 24 & Saturday, May 25, 2019 Halifax, NS (location TBA) Mark your calendar for two days of learning, connection and growth at the Collegeâ€™s 2019 Spring Conference & Annual General Meeting. Call for conference proposals coming soon at nscsw.org/2019springconference Questions? Contact Annemieke Vink at email@example.com
C NNECTION C NNECTION
Fall 2018 | Volume 1, Issue 4
Published three times a year by the Nova Scotia College of Social Workers 1888 Brunswick Street, Suite 700 Halifax, NS B3J 3J8
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Phone: 902.429.7799 Fax: 902.429.7650
Bessie Harris (Associate, Retired) Laurie Ogilvie (Student) Shalyse Sangster (SWC)
Alec Stratford (RSW, College Staff) Linda Turner (RSW)
Connection is © Copyright 2018 by
Annemieke Vink (RSW, College Staff)
the Nova Scotia College of Social Workers, and also reserves copyright for all articles. Reproduction without written permission from the publisher is not allowed.
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TABLE OF CONTENTS Volume 1, Issue 4
WELCOME NEW NSCSW MEMBERS
April 2018 - August 2018
Two Incredible Journeys
ETHICS IN ACTION
College Committee Crafts MAID Guidelines
The Restorative Inquiry
Private Practitioner Calls for Change
2017 Award Recipients
Integrating the ‘Social’ in Primary Health Care
Report Highlights Social Worker Challenges
CHILD YOUTH ADVOCATE
Give Nova Scotia’s Children and Youth the Voice They Deserve
The IWK has Double Duty Dads Determined to Dig In
Building Strong Bonds
IN THE COMMUNITY
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Connecting Readers to the Current State of Child Protection in Nova Scotia In this fall issue of Connection, we’re taking a closer look at child protection in Nova Scotia and how social workers are going above and beyond their duties to try and hold the system together. We’re connecting readers to the recent report from the Canadian Association of Social Workers (CASW) (page 24), which captures the voices and struggles of child protection workers from across the country. In the article ‘Building Strong Bonds: How Kids Action Program Assists Families in Rural Nova Scotia’ (page 30) you’ll read the story of a community advocate who works on the ground to ensure that the best interest of children and families are respected. We’ll highlight new research on the impact of the Adverse Childhood Experiences on mental health and well-being in the article ‘Integrating the ‘Social’ in Primary Health Care’ (page 20). Readers will also learn about the crucial work of the Restorative Inquiry into the Home for Coloured Children in the article ‘The Restorative Inquiry: A Different Way Forward (page 12).
Alec Stratford, MSW, RSW Registrar/Executive Director
Social workers see firsthand how Nova Scotia’s vulnerable children and youth continue to fall through the cracks. They engage with the most vulnerable people in our province. With their knowledge and skills, they competently perform assessments, interventions, negotiations, mediations, advocacy, and evaluations. They are trained in inter-professional practice, community collaboration and teamwork. Currently, they do not have the resources and the tools needed to help keep children safe in their homes. Social workers also know that when the voices of the most vulnerable are raised up and given space that our society moves towards greater equality. That’s why it’s time to create a Child and Youth Advocate office in Nova Scotia. As you’ll read on page 26, we’re advocating to include the voices of our province’s children and youth at the forefront of the policies and programs that actively serve them. We encourage you to share this issue with your colleagues as we continue to advocate for policies that improve social conditions, challenge injustice and value diversity in our province.
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WELCOME NEW NSCSW MEMBERS New Registered Social Workers and Social Worker Candidates, April 2018-August 2018 REGISTERED SOCIAL WORKERS
Jenny Thornhill Stephanie Leblanc Jeremy Goodwin Sarah Slayter Sherri O’Quinn Nicole Warren Brendan Storey Samantha Molen Valerie Hewitt Jillian Hennick Cherlyn Layton Rebekah Dyck Samantha Thomas Matthew Primeau Shiela Ginnish
Amber Green Marian Farrell Larissa Verhoeven Cory Goodine Mary Margaret (Maggie) Surette Katelyn Craig (Bower) Beth Miller AnnMarie Walsh Lisa Wiggens Jennifer Moss Morgan MacLean Polly Joesph Theresa (Nicole) Long
Amy (Cate) Malone
Carly Sue Rioux
Sheila Jean Cann
Jillia Pritchett Melanie Barber Alanna Blanchard Donald Kennedy Courtney Crewe Janine Keagan Amanda Reid Marsha Stephens Afolake Awoyiga Keya Leahey Catherine Shears Elizabeth Beletic
SOCIAL WORK CANDIDATES Amanda Workman Jean MacGregor Matthew Brown Megan Turetzek-Windsor Heather Neilson Daniel Kalbhenn Mara Toombs Claudia Roberts Lisa Honeywell Diane Robicheau Jan Marshall Caroline Graham Elisha Walsh Shalyse Sangster
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TWO INCREDIBLE JOURNEYS BY CAROLYN CAMPBELL, RSW At the NSCSW’s annual Spring conference I gave a 45-minute talk titled An Unsettling Journey: Discovering the ‘truth’ of Truth and Reconciliation. I described the thoughts and feelings I experienced as I learned more about my ‘Settler’ identity and understood the roles and responsibilities of nonIndigenous people in the Truth and Reconciliation process. I’m building upon this presentation by describing two distinct but interconnected personal journeys. Both journeys were undertaken by choice but were quite different in form. Both touched my mind, my body, my heart, and my spirit. I learned valuable truths on each journey, some of them awe-inspiring and uplifting, others shocking and distressing. My travels have left me simultaneously proud, sad, content, humble, and unsettled.
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JOURNEY # 1: EMBRACING SETTLER IDENTITY This was an inward-looking journey exploring the colonial social and historical geography of Canada. I had many companions along the way. We read books, articles, and blogs, listened to newscasts and podcasts, watched videos, attended gatherings and ceremonies, and engaged in many, many conversations. We learned about the Doctrine of Discovery, a 1493 papal edict that authorized Spanish explorers to claim territories uninhabited by Christians. We became familiar with the idea of ‘terra nullius’, a Latin expression meaning ‘land belonging to no one’. This idea suggests that, if ‘discovered’ lands were not inhabited by Christians, they could be considered vacant and claimed by settlers.
JOURNEY # 2: CROSS CANADA 2018 This was an outward looking journey exploring the physical geography of Canada. I had one companion on this journey – my younger sister. We took 26 days to drive a 20 foot, 1983 camper, over 7000 kilometers from Nova Scotia to Vancouver. We camped, hiked, swam, star-gazed, bird watched and ended our travels visiting family in three different locations in British Columbia. During this journey, we marveled at the beauty of the Matapedia River; were awed by the magnificence of the St. Lawrence; were astounded by the tropical-like grotto on the shores of Lake Huron; marveled at the expansive horizons of the prairies; and were daunted by the massiveness of the Rockies. Some of the truths I discovered on this journey are that: • Canada is an amazingly vast and diverse landscape. • Culture and community are intricately linked with land. • I am welcomed across this country. • I ‘belong’ in the cultural and social geography of Canada. • I feel connected to Canada as my country, my home.
We learned that Canada is known as a ‘Dominion’ based on a biblical psalm asserting that ‘man shall have dominion from sea to sea.’ We learned that Indigenous peoples, the first peoples of this land, have been displaced to the extent that “Indian reserves account for just 0.2 per cent of our territory; Canada claims 99.8 percent of our land1.”
INTEGRATING THE TWO JOURNEYS The truths of the Settler journey were frequently in my mind during the Cross Canada journey. As the kilometers passed I was aware that:
Some of the truths I discovered on this journey are that:
• The common thread of both of my journeys is land.
• My presence on this land is based on racist, Christian doctrines and ideas.
• Filling our gas tank required the exploitation of Indigenous ways of knowing and being.
• My presence on this land is the result of land theft of massive proportions.
• My past and current family relationships were not ruptured by forced schooling and the apprehension of children.
• My country continues to deny land based economic benefits to Indigenous peoples.
• We could always find clean water to drink.
• I will always be a guest on this land.
• We had multiple types of insurance should we run into difficulties along the way.
• Until we deal with the land issue, reconciliation is recolonization
• We never worried that weTonya mightGrant encounter (left) racial Sherryslurs, Battiste (right) discrimination, or violence.
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of and been heavily influenced by white colonial settler ways of doing, being, knowing and relating.” Or, as Baikie4 tells us “Social work values, ethics, regulations, and professionalization are connected to colonizing practices.” While my 2018 cross Canada journey has ended, the Embracing Settler Identity journey must continue. While I am not sure where it will take me, I know that I must explore how I can be a good guest on this land, work with other Settlers to promote truth, justice, and reconciliation, learn in solidarity with Indigenous peoples and learn more about anti-colonial social work practice. This ongoing journey is a difficult one but I have hope that it can be joyful and rewarding. I find hope in our treaties, in fellow Settlers, in the generosity of Indigenous peoples as they offer their wisdom and share this land and in the resilience, renewal, and resurgence now evident within Indigenous communities. Given who we are, I also find hope in the fundamental values and principles of social work. I invite you to join me on this journey.
I struggled to merge my pride of this place I call home with my sorrow as to how it has become my home. Reconciling these two journeys is proving to be challenging. I live on a piece of land that feeds my soul and anchors my daily life. During my morning swim, I marvel at the stately pines that surround the lake. I nurture the Joe Pye weed that grows in my garden. I bask in the peace and contentment I derive from my connection to the earth, her creatures and her essence. But at the same time, I know that both my ancestral and current connections to this land come at a great cost to Indigenous peoples. Not just an economic cost as Lowman and Barker2 explain: Settler colonialism in Canada is not a clash between people who are connected to the land and a people who are not, but rather between a people who have always been connected to the land and a people whose connection to the land is premised on the displacement and destruction of Indigenous peoples’ pre-existing relationships to place. As social workers, we are beginning to recognize that our profession has been, and continues to be, intimately enmeshed with this displacement and destruction. As Carlson3 observes, social work “has originated out
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CAROLYN CAMPBELL is a social justice educator and community activist with experience in teaching, group facilitation, program planning, organizational leadership, and project development. Since retiring from a 25-year position with Dalhousie University’s School of Social Work, in 2016, Carolyn is expanding her engagement in citizenship education within her local community. She is particularly passionate about joining with other non-Indigenous people as they explore their roles and responsibilities in the truth and reconciliation process. Carolyn has Bachelors of Education Degree as well as a Master’s and a PhD in Social Work. As a Settler of British descent, she is privileged to live as a guest on unceded Mi’kmaq territory outside of Wolfville where she swims, boats, reads, gardens, plays with clay, and welcomes visitors.
REFERENCES 1. Manuel, A. (2017). The reconciliation manifesto: Recovering the land, rebuilding the economy. James Lorimer and Company, Toronto. 2. Lowman, E & Barker, A. (2015). Settler: Identity and colonialism in 21st century Canada. Fernwood Publishing, Halifax. 3. Carlson, E. (2016). Colonial settler epistemes in mainstream social work: Towards anti-colonial social work. In M.A. Hart, A. Burton, K. Hart (Eds.). International Indigenous Voices in Social Work (p. 169-186). Cambridge Scholars Publishing, Newcastle-upon-Tyne. 4. Baikie, G. (2019). Indigenous centered-social work. Theorizing a social work way- of- being. In R. Sinclair, M.A.Hart, and G. Bruyere (Eds.). Wicihitowin: Aboriginal social work in Canada (pp. 42-61). Winnipeg, MB: Fernwood.
COLLEGE COMMITTEE CRAFTS MAID GUIDELINES to Support Nova Scotia Social Workers
BY NSCSW PROFESSIONAL STANDARDS COMMITTEE
In June 2016, the federal government passed the legislation for medical assistance in dying (MAID). Canadian doctors and nurse practitioners can now provide medical assistance in dying (MAID). Social workers in the healthcare field play a key role as they help clients grapple with the complexities of exploring and requesting MAID.
See the NSHA Frequently Asked Questions at
When the option for maid was introduced, the College’s Professional Standards Committee was created as an evolving committee whose tasks and objectives fall within the College’s Standards of Practice and Code of Ethics.
approval in April 2018.
http://bit.ly/nshaMAID After over a year of research, planning and consulting, the Committee presented the College’s Guidelines for Social Workers on Medical Assistance in Dying to Council for
Regardless of a social worker’s specific role in MAID, the College’s Guidelines for Social Workers on Medical Assistance in Dying provides our members with an understanding of
Committee members went to work with the goal of establishing guidelines to support Nova Scotia social workers as they navigate helping clients who are exploring and requesting MAID.
their responsibility to be aware of the extent and parameters of their scope of practice. The guidelines are based on the College’s Standards of Practice & Code of Ethics and on the applicable legal and policy obligations. The College’s Guidelines for Social Workers on Medical Assistance in Dying highlights applicable values from the Code of Ethics and applicable standards from
To develop the guidelines, the Committee first reviewed the provincial legislation and MAID eligibility criteria and thoroughly reviewed the current Standards and guidelines of other Canadian regulatory social work bodies. The Committee connected with the Nova Scotia Health Authority (NSHA) as they developed their policy around access to MAID for Nova Scotians. This policy – to be released – will govern medical practitioners, including social workers, as they work with clients in the context of MAID.
the Standards of Practice in five sections: Respect, Self-Determination & Informed Consent, Social Justice, Competence in Professional Practice, Cultural Diversity and Appropriate Referrals. Read the full guidelines at http://nscsw.org/swguidelinesmaid/ Questions? Contact Sherry Battiste at email@example.com.
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THE RESTORATIVE INQUIRY A Different Way Forward BY CHAD LUCAS
As children within Nova Scotia’s care system, many former residents of the Nova Scotia Home for Colored Children grew up viewing social workers as an elusive group. “I never saw my social worker, because I wasn’t a problem child,” says Tony Smith, who spent most of his childhood either at the Home or in foster care. “It seemed like the kids who acted out were the only ones who received attention.” When Smith had a chance to share his experiences with a group of social workers as an adult, he was surprised—and encouraged—by their responses. “I had people tell me that they felt bad about that too, and they wished they could have spent more time with those quieter kids who flew under the radar,” says Smith, now the co-chair of the Nova Scotia Home for Colored Children Restorative Inquiry. He was even more pleased when he learned later that his story helped encourage a policy shift to ensure all children received more frequent check-ins.
That kind of approach to change—direct honest sharing, and responsive action— is how the Restorative Inquiry hopes to make a lasting difference for children in care now and in the future.
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Opened in 1921, the Home was for many years the only facility of its kind that cared for Black children in the Maritimes. Unfortunately, in an all-too-familiar scenario repeated in dozens of care institutions over the past century, many of its young residents endured multiple forms of abuse. In 2012, former residents joined together to form VOICES, the Victims of Institutional Child Exploitation Society. Two years later, VOICES reached a class-action settlement with the Home and the provincial government and secured the promise of a public inquiry from the province. That fall, Premier Stephen McNeil apologized to former residents and to the African Nova Scotian community for the province’s legacy of systemic racism. When the Premier asked former residents what they wanted in an inquiry, they decided the traditional method usually helmed by a commission or retired judge along with a hefty report with recommendations, was not the answer. They opted for a restorative process to bring affected parties together to make things better for kids in care today, and particularly to make a difference for African Nova Scotian children and their families. The inquiry is led by a Council made up of groups most affected, including former residents, African Nova Scotian community members, representatives from government and the Home, and legal advisors with expertise in restorative approaches. The inquiry’s work focuses on three central issues:
• Responses to institutionalized abuse • Experiences of children and youth in care of the province • Historic and ongoing impacts of systemic racism on African Nova Scotians Much of the work takes place in circle settings. Restorative Inquiry council and staff have met with former residents, with African Nova Scotian community members and organizations, and with public servants including representatives from the provincial departments of Community Services, Justice, Health and Wellness, and Education and Early Childhood Development. The deputy ministers of those departments, along with Communities, Culture and Heritage and Labour and Advanced Education, also sit on the inquiry’s Reflection and Action Task Group. That group helps government engage in the work of the inquiry and begin to make change in real time.
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“One of the unique features of this inquiry is we don’t have to wait until it’s over to make a difference,” says inquiry co-chair Pamela Williams, the Chief Judge of Nova Scotia’s provincial and family courts. “As we’re meeting with people, learning from them, and exploring the central issues, we can see what needs to be changed and begin to act on it now.” The inquiry continues to meet with partners and affected parties on the central issues, including a deeper examination of how children enter the care system, their experiences during care, and how they transition out of care. The inquiry’s mandate continues until March 2019. For more information, visit restorativeinquiry.ca
CHAD LUCAS is a communications lead with the Restorative Inquiry into the Nova Scotia Home for Colored Children
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RENEWAL SEASON IS HERE Thank you for your patience over the summer and early fall as we completed upgrades to our new member portal. We hope you find the new online portal intuitive and easy to use.
You can now complete your 2019 online registration renewal. To start the renewal process you must
first activate your new online member portal. Go to http://nscsw.org/memberportal-live/ to learn how.
To complete your online registration renewal:
After completing the online renewal process:
1. Visit our website at www.nscsw.org.
• Your registration will not be renewed until both the online form and payment have been received.
2. Click on the login button located on the top of the screen. 3. First enter your 2018 professional development activities – you cannot renew your registration until you have completed this step. 4. Complete the renewal form and ensure you’ve updated your current address, email and employer information and indicate if you would like to join a College committee. 5. Select a payment method. To pay online, select the pay now button and to pay later, select the Invoice Me button. 6. Once you submit your payment you can print your receipt, wallet card and certificate of registration.
• Once you have completed online renewal and you have submitted your payment you will be given the option to print your 2019 registration certificate and receipt. • Members who pay through payroll deductions, direct deposit/electronic transfer, or fees paid by employer must print off an invoice from their profile page and submit to the individual responsible for payment of your registration fees at your place of employment. We will only accept payments after you have completed your online renewal.
Please Note: To ensure adequate processing of cheques, we are unable to receive cheques after December 15, 2018.
Questions? Please contact the College’s Executive Assistant Nancy Viner at Nancy.Viner@NSCSW.org
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PRIVATE PRACTITIONER CALLS FOR CHANGE to the Child Welfare System BY ALYSSA DELENARDO, MSW
A social worker’s role is broadly understood as assisting individuals, families, and groups of people to overcome adversity. Jackie Barkley simplifies the complexities of a social worker’s primary role by stating it is “working in solidarity with clients”. Prior to entering the social work field, she was a factory worker. Her experience was humbling, providing space for her to understand privilege and a framework for her to solidify her passion for social justice activism.
“Standing in solidarity with clients doesn’t end at the end of the work day,” Jackie explains. “It becomes part of a social worker’s everyday life; it becomes part of them.”[sic]
it focuses on monetary gains as opposed to focusing on a client’s needs. This model has major implications on clients who experience system injustices as the system struggles to meet their complex needs. Jackie, using her knowledge and a social justice lens, suggests several changes to help reestablish the social work lens within the child welfare system: • On a micro level - Family and children services would provide family interventions that identifying and address childhood trauma. • On a mezzo level - Increase child protection worker resources by hiring an appropriate number of social workers that meet the workload demands. • On a macro level - Ensure parents are provided with
Jackie began her social work career working in the child welfare system. She still works with this system as a private practitioner who provides therapeutic counselling for clients through the province’s Department of Community Services (DCS). From Jackie’s perspective, there are many service gaps that need to be addressed in the child welfare system. In her opinion, the system has embraced a neoliberal model. A model that is creates challenges for social workers because
adequate funding so children and families can stay together & ensure the Nova Scotia child tax benefit is automatic.Lastly, Jackie suggests the creation of a complex service delivery system that acknowledges the cultural dynamics of families. Private practice social workers like Jackie are using their voices to call for changes to the child welfare system. She reminds social workers and Canadian citizens to stand in solidarity and help each other resist oppression.
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RECOGNIZING OUTSTANDING NOVA SCOTIA SOCIAL WORKERS At the College’s 2018 Spring Conference & AGM, we recognized the contributions of social workers in our province. Congratulations to all of 2017 award recipients!
2017 Award Recipients NANCY WRIGHT KEN BELANGER MEMORIAL AWARD Nancy Wright works at the IWK Health Centre with the Community Mental & Addictions program. Her nominator, Lisa Dauphinee-Muise, notes that she is one of the most caring, thoughtful, knowledgeable and skilled clinical social workers, dedicated to her clients and particularly dedicated to transgender youth. She is a strong advocate in the LGBTQ community and diligently and humbly supports and advocates for the youth to learn the skills they need to help improve their mental health and well-being. In 2008 Nancy and Dr. Suzanne Zinck (a child psychiatrist at IWK) formed the Transgender Health Clinic to address the needs of transgender youth.
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The clinic provides service to youth experiencing gender dysphoria and more. Nancy is now committed to building capacity amongst her peers by developing and providing training to ensure resources will continue to exist for transgender youth. Nancy has spent her career as a significant clinician, an ally for transgender youth and leader in securing training for those who follow in social work. The Ken Belanger Memorial Award accurately recognizes Nancy’s commitment to this disenfranchised community.
DAVID WILLIAM CONNORS AWARD
DIANE KAYS MEMORIAL AWARD
“As a former candidate under her supervision, I know that my own passion for working with teens and their families that are living with mental illness and addiction was sparked by her example,” says nominator Andrea Weyman-Hickman. As a clinician working in child and adolescent mental health, Lynn Billard repeatedly shows her strong commitment to the social work value of building competence in professional practice. Lynn worked together with her nominator Andrea Weyman-Hickman with teens and their families on the Intensive Community Based Treatment Team. During this time her colleagues watched her uphold all six social work values: Respect for Inherent Dignity and Worth of Persons, Pursuit of Social Justice, Service to Humanity, Integrity of Professional Practice, Confidentiality in Professional Practice and Competence in Professional Practice. Lynn continually demonstrates passion and enthusiasm for working with youth and families and has all the attributes that the David William Connors Memorial Award stands for.
Coleen Flynn is a Social Work Clinician with Children’s Intensive Services (CIS), Mental Health and Addictions Program at the IWK Health Centre. Coleen’s value to the CIS Team as well as clients and families they serve, is immense. She has a non-judgmental and accepting approach that is felt by the parents she continually advocates for within in the system. Coleen contributes to many areas of social work practice but specifically focuses on the care of women. She developed “The Mother’s Mental Health toolkit” and co-facilitated the Collaborative Problem-Solving Parenting Group. Coleen is instrumental to the growth of teams at the IWK in Team Lead capacity. She demonstrates ethical practice continually in all that she does. She also encourages critical thinking and reflection on social work practice as a supervisor and mentor for students at Dalhousie University’s School of Social Work. She significantly influences clients, families, team members and students with her clinical skills, advocacy, leadership, ethics, system improvement and education. Coleen shows her colleagues and clients the compassion and desire to build capacity that was so clear and evident in Diane Kays.
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RON STRATFORD MEMORIAL AWARD
CASW DISTINGUISHED SERVICE AWARD
Lana MacLean is a social work leader in Nova Scotia. She’s developed models for the provision of social and culturally competent assessments of African Nova Scotian clients involved in the criminal justice system and in the family court system. Lana’s detailed and comprehensive assessments have drawn the attention of judges and lawyers in the province who are increasingly interested in how cultural assessments can serve the needs of marginalized and racialized groups. She advocates for clients involved in the child protection system by articulating the challenges in current service delivery. She is also the chair of the African United Baptist Association social action committee where she is a powerful advocate for justice issues inside the church, and in the association’s outreach work.
The College’s Council awarded Wendy Keen with the 2017 CASW Distinguished Service Award at the 2018 Spring Conference & AGM. Throughout her years of service, Wendy demonstrated the best of social work practice. Her empathy, pursuit of social justice and dedication to social work lead her to many parts of Canada where she brought her talents for organizing and engaging organizations. She was the Executive Director of a women’s shelter and for Family and Children Services where she demonstrated her outstanding leadership abilities and commitment to her community. Wendy has contributed to the College since 1982 and served on College Council and the Board of Examiners. She continues to work tirelessly to promote the profession and to help ensure that the profession works to demonstrate strong ethical standards.
Lana’s raised the bar in so many ways. She deserves to be honoured and stand as a model for new social workers joining the field.
To nominate an outstanding social worker for a 2018 NSCSW award visit http://bit.ly/nominateaward
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INTEGRATING THE ‘SOCIAL’ IN PRIMARY HEALTH CARE Measuring Adverse Childhood Experiences, Current Health Challenges and Factors That Promote Resilience Among Patients of the Lunenburg Family Health Clinic BY NANCY ROSS, RSW
I came to academia following my lengthy history as a clinical therapist in addictions and mental health. I was motivated to conduct research that acknowledges the prevalence of trauma and childhood adversity among Nova Scotians and to further integrate the ‘social’ with healthcare. I was also motivated to learn more about what factors within our communities promote resilience and help mitigate the impacts of adversity and trauma. I hope that this research program, informed by a social justice mandate, will also contribute to policies that aim to prevent the occurrence of adverse and traumatic experiences.
In 2017 our team was successfully received funding from the Nova Scotia Health Research Foundation to measure Adverse Childhood Experiences (ACEs), current health challenges and factors that promote resilience among adult patients of the Lunenburg Family Health Clinic. Our team consists of mentors Dr. Sheila McDonald, lead researcher of the first Canadian ACE study in Alberta and Dr. Michael Ungar, co-director of the Resilience Research Centre. Other team members include myself as the principal investigator, co-principal investigator Dr. Sara Torres, associate Dr. Robert Gilbert, co-investigator Susan Savage, and research assistant Kevin Dugas.
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The Lunenburg Family Health Clinic, widely known as an innovative clinic, was willing to pilot this research.
They serve up to 150 patients daily who range in age from newborns to seniors in a collaborative clinic with 7 doctors, a nurse practitioner, a family practice nurse and a clinical therapist. TheÂ ACEs study is a longitudinal health outcome study that began in 1995 in California as a joint initiative of Kaiser PermanenteÂ and theÂ Centers for Disease Control and Prevention. The original study explored the relationship between ACEs and the development of health and social problems as adults. The results were profound as the study acknowledged first, the pervasiveness of ACEs among a sample of more than 17,000 patients (most were Caucasian and had completed a university
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degree) and second it recognized that negative health impacts were greater if patients experienced more than one ACE during their childhood. The ACE study considers ten categories of childhood adversity including: physical, sexual and emotional abuse; physical and emotional neglect; and five measures of household dysfunction that included domestic violence; parental mental illness and/or substance abuse; an incarcerated relative and separation/divorce. Today, a body of evidence builds on the original study to recognize further health and social impacts in adulthood (Anda et al., 2006; Douglas, et al. 2010; Dube et al. 2003; Edwards et al. 2001; Felitti et al., 1998; Logan-Greene, et al. 2014; McDonald et al. 2015; Poole et al. 2017). Included among these are physical health challenges (chronic stress, increased rates of heart disease, chronic pain and difficulty sleeping), unhealthy lifestyle behaviours (smoking, severe obesity, physical inactivity, a high lifetime number of sexual partners and a history of having a sexually transmitted disease), mental health challenges (depressed mood, anxiety,
suicide attempts, alcoholism, drug abuse), and social underachievement (lower educational achievement and economic productivity) (Felitti et al. 1998; Anda et al. 2009). This pilot project is the first ACE and resilience study to be conducted in Nova Scotia. Piloting this study within a medical practice represents an integrative health approach that will include recognizing lifestyle aspects that may serve as protective factors to mitigate potential negative social and health consequences of a high ACE score. There is a recent focus on combining the ACE study with resilience measures and this study will contribute to this growing body of literature by highlighting potential protective factors that are locally relevant.
Our preliminary data confirms what social
Our preliminary data confirms what social workers know, experiences of childhood adversity are high and impact physical and mental health in adulthood. Our team believes social workers are essential to primary health care and can play a pivotal role in screening for ACES to inform a more comprehensive health service.
workers know, experiences of childhood
Social workers have an essential role to play in motivating needed changes within health care. They can help recognize the links between ACEs and healthcare outcomes in adulthood to provide more holistic and integrated approaches.
care and can play a pivotal role in screening
adversity are high and impact physical and mental health in adulthood. Our team believes social workers are essential to primary health
for ACES to inform a more comprehensive health service.
They are a central part of the development and provision of counselling and treatment approaches that can mitigate the negative health impacts of ACEs and promote resilience and non-violent relationships. Social workers can work towards â€˜politicizing the personalâ€™ by recognizing the negative impact of grand narratives of capitalism, racism, colonialism and patriarchy in lived experience and continue to advocate for social change. A social work perspective brings a critical lens to ACE and resilience research that recognizes social justice is essential to a healthy life.
NANCY ROSS worked as a clinical therapist in addiction and mental health settings for many years before entering academia. She completed her PhD in International Development and Peace Studies at Bradford University, UK and is entering her sixth year teaching at the School of Social Work, Dalhousie University. She is on the Board of Directors for the Be the Peace Institute and is committed to work towards non-violence and peaceful relationships.
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CASW REPORT HIGHLIGHTS SOCIAL WORKER CHALLENGES Within Canada’s Troubled Child Welfare System This summer the Canadian Association of Social Workers (CASW), a federal partner of the Nova Scotia College of Social Workers (NSCSW), published a report which paints a troubling picture of Canada’s child welfare system. The report, Understanding Social Work and Child Welfare: Canadian Survey and Interviews with Child Welfare Experts, is a critical first step and a bird’s eye view of the social work profession in child welfare across Canada. This research further grounds our core areas for advocacy and validates what we gathered from our community consultation last spring. Some of the more concerning statistics indicate that: • 44 per cent of social workers have experienced threats or violence on the job; • 75 per cent have unmanageable workloads as a critical issue in their practice; • 45 per cent of social workers who left the field did so due to stress and/or vicarious trauma and;
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• 72 per cent say administrative responsibilities prevent them from spending adequate time with clients. The statistics reflect how demanding caseloads, the complexity of issues faced by families and an unsupportive work environment lead to vicarious trauma, greater burnout and turnover.
The report also indicates that the system is overrepresented by Indigenous families, children, and youth as well other visible minorities such as Black Canadian families. These are all issues facing Nova Scotia child protection social workers. Child protection social workers reported satisfaction with their opportunities to practice the essence of social work. Child protection can be a rewarding career as social workers build relationships and help clients along their journey to change. It
is also encouraging to note that 88 per cent of social workers say that their colleagues are their greatest source of support. The take away is that the child protection services would be strengthened in Nova Scotia if the Department of Community Services (DCS) placed greater value on social work knowledge and methods and prioritized a social worker’s need to have adequate time to spend with clients.
A respondent in the report stated “social work is all about relationships and if there is not enough time we cannot establish a relationship and, as a result, cannot adequately address
We know that the pathways to achieve these goals includes mentorship, training opportunities and manageable caseloads – not rigid bureaucratic processes focused on bottom lines. Nova Scotia needs a collective voice to advocate to change this system. We are asking for your support to help share the findings of this report. Visit the CASW website at casw-acts.ca to read the report and to share the video and infographics with your organization and through your social media platforms. Our goal is to continue to engage Nova Scotians in a critical conversation about the child welfare system.
risks to children.” The College raised these critical concerns with both the leadership and the DCS Minister as have many of our members working within the Child Youth and Family Services Division. The department responded that their goal is to empower front-line social workers but that transformation takes time. However, in the last provincial budget (2018-2019 budget) we saw minimal increases to the Child Youth and Family Supports Division full-time staff positions, a mere 5.3 positions. What remains unclear still is how DCS intends to change its current trajectory to adopt an empathetic view of the current situation within our child protection system, without putting more resources on the table. The report highlights five core recommendations made by social workers to address child protection services: 1. Address the disproportionality of Indigenous families and other visible minorities such as Black Canadian families involved with the child welfare system. 2. Improve working conditions for social workers by addressing workload. 3. Support organizations to improve staff retention and reduce turnover. 4. Support organizations to develop strategies to promote mental health and wellness and address post-traumatic stress experienced by social workers. 5. Raise the value organization place on social work knowledge and methods and the importance that social workers have adequate time to spend with clients.
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GIVE NOVA SCOTIA’S CHILDREN & YOUTH THE VOICE THEY DESERVE Social workers see firsthand how Nova Scotia’s vulnerable children and youth continue to fall through the cracks.
Child poverty remains stubbornly high and continues to be on the rise. The Canadian Centre for Policy Alternatives-Nova Scotia reported that child poverty increased from 18.1% in 1989 to 21.5% in 2016.
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The child protection system is over-represented by Indigenous and other minorities such as Black Canadian children and youth according to the Canadian Association of Social Workers (CASW) report Understanding Social Work and Child Welfare: Canadian Survey and Interviews with Child Welfare Experts. (Read the report at http://bit.ly/CASWReport) An NSCSW FOIPOP request last spring showed that applications to the provincial court’s Family Division under the Child and Family Services Act increased by 8% after the amended Act was implemented. This indicates that more intrusive child protection interventions are happening more often. This is not the intent of the province’s child protection services.
The time is right to create a Child and Youth Advocate office to ensure that the voices of our province’s children and youth are at forefront of the policies and programs that actively serve them.
Nova Scotia is one of only two provinces without a crucial Child and Youth Advocate office. In other provinces these offices are involved in rightbased public education, conflict resolution, conducting independent reviews and making recommendations to governments on programs and services delivered to children and youth. A Child and Youth Advocate office would prioritize the voices of these vulnerable children and youth combining individual advocacy with vibrant policy and systemic advocacy. In other provinces Child Youth advocates have advanced policies that led to more holistic and coordinated services for children and youth. Learn more in a backgrounder at http://bit.ly/ CYAOBackgrounder. That’s why we are launching a campaign calling on the provincial government to create a Child and Youth Advocate office to protect and promote the rights of Nova Scotia children and youth
A Raising Canada report (http://bit.ly/RaisingCanadaReport) paints a startling picture of the state of Canada’s children. It states that suicide is the second leading cause of death of Canadian children and youth. Over the last 10 years, there has been a 66% increase in emergency department visits, and a 55% increase in hospitalization, of children and youth due to mental health concerns. In Nova Scotia alone 806 children were hospitalized for mental health concerns in 2016. The statistics are striking, but not nearly as compelling as the stories that social workers bear witness to daily of children and youth who are struggling in Nova Scotia. Children and youth are struggling to have their stories heard, their rights acknowledged and their voices as part of the decision-making process on the systems and programs that impact them. Social workers know that when the voices of the vulnerable and marginalized are raised up and given space that our society moves towards greater equality.
An open letter on our campaign website (https:// childyouthadvocatens.org/) asks Premier Stephen McNeil to pass the legislation that would create a Child and Youth Advocate office. The legislation, An Act Respecting an Advocate for Children and Youth, was introduced by the NDP on Tuesday, September 11, 2018. Join us in supporting the creation of a Child and Youth Advocate office by: • Visiting & sharing the campaign website childyouthadvocateNS.org • Joining the conversation on Twitter and Facebook by using the hashtag #childyouthadvocatens • Writing a letter to Premier Stephen McNeil advocating for a Child and Youth Advocate office at: Office of the Premier, O. Box 726, Halifax, NS B3J 2T3 or email him at PREMIER@novascotia.ca. Let’s help give Nova Scotia’s children and youth the voice they deserve.
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THE IWK HAS DOUBLE DUTY DADS DETERMINED TO DIG IN BY ERIN LYNCH, IWK COMMUNICATIONS SPECIALIST “Often, the guys want to help, but don’t know exactly how to”, says James Whitehead, a dad whose baby was previously cared for at the IWK neonatal intensive care unit (NICU). “And they’re on double duty as they try to take care of their new baby and partner. So this was a perfect opportunity for previous NICU dads to share some tips and tricks of the trade with newer dads.” Whitehead is talking about a new initiative in the NICU where fathers of new preemies get together for snacks and a chat. Social worker Teresa Johnson, neonatologist Dr. Doug MacMillan, and NICU parent partner coordinator Leah Whitehead, put together the initial “dad’s night” and it has since taken on a life of its own. Leah Whitehead says dads were getting in touch with her for other things and she asked them if this would be something they would have interest in. “Five dads signed up right away, three dads from the unit who heard about it through word of mouth and came, and four other dads were sad they had missed it,” Whitehead says. “They’ve been so popular that it’s a regular occurrence now.”
Dr. Doug MacMillan jumped on-board immediately and asked how he could be involved. He facilitated the meetings, and says many dads who have babies in NICU experience a similar sense of loss of a parenting opportunity as do moms. “While there are some needs for the baby that dads cannot fulfill, for example breastfeeding, they can provide skin to skin care, feeding breastmilk by nasogastric tube, etc.,” says Dr. MacMillan says. “Moms and dads working together can have a better understanding of the processes affecting their baby (or babies) and how they can assist. These sessions will help provide Dads with better tools to help support their baby and their partner while peer support will be anticipated to help assist their own needs.” James Whitehead says there is a camaraderie being built among the men who know what it’s like being a dad on NICU. “The group provides the opportunity and permission to talk to other guys about tough stuff. These relationships allow the dads to move from an awkward nod given, not wanting to intrude, to having conversations and offering support. We are able to start saying things like ‘we’re having a good day, but I can see you’re having a bad day – want to have a coffee and chat?’” Next steps to help address family needs on NICU may include initiatives for grandparents, siblings and other family members. Teresa Johnson, the Professional Practice Lead for Social Work at the IWK, is thrilled that the program respects the emotional experience and many roles that dads have from the moments following birth through those days and weeks of supporting their baby and partner through often complex and traumatic situations.
“This type of practice fundamentally aligns with the positive social work practices & values of family integrated care, diversity and empowerment for the powerful parent role.”
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Building Strong Bonds:
HOW KIDS ACTION PROGRAM ASSISTS FAMILIES IN RURAL NOVA SCOTIA BY KATHERINE BARRETT
Ask Debbie Reimer what she needs—what one thing would help to achieve her dreams and goals—and she’ll answer without hesitation: an apartment building. “Yes, an apartment building!” she says. “One with programs, staff and social workers. A place for families to live. A place where we can get real work done.” The “we” in Debbie’s response is Kids Action Program, a nonprofit organization based in Kentville that assists families facing multiple challenges, including poverty, domestic
violence and addiction. Kids Action was founded in 1992; Debbie was hired in 1994 and has served as Executive Director since 2004. With such firm roots in the community, Debbie and her staff see the needs of families first-hand. “We know what people are struggling with,” Debbie says. The families Kids Action works with have basic, concrete needs such as transportation, food and a place to live. These are real barriers to keeping a job and keeping a family together. Real barriers that need real work. Hence, Debbie’s vision for an apartment building.
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Kids Action Program was launched in the wake of the federal government’s 1989 commitment to eliminate child poverty in Canada by 2000. This commitment, as well as federal agreements made at the 1990 United Nations World Summit for Children, yielded the Community Action Program for Children (CAPC), a program that funds community organizations to help vulnerable children in their jurisdiction.
Both federal funding programs, CAPC and CPNP, recognize that the kind of on-the-ground help families need may vary from community to community, family to family. Debbie confirms that requests to Kids Action are frequent and wide-ranging.
Kids Action has received CAPC funding since 1993. This money allows Debbie and her team to assist families with children up to six years old. While Debbie is grateful for the regularity of this funding, she is quick to point out that the amount of CAPC assistance has not increased in the intervening 25 years.
in need don’t come to us first, they certainly
In 1995, however, Kids Action began to receive annual funding for a second program under the Canada Prenatal Nutrition Program (CPNP). This initiative focuses on the well-being of mothers and children from conception until the child is six months old. With additional top-up funds from the Nova Scotia government, CAPC and CPNP form the core of Kids Action’s mandate. The funds allow the organization to maintain a staff of nine and assist in excess of 400 families a year in Hants and Kings counties.
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“I get cold calls every day,” she says. “If families
find us fast.” Parents might ask for help paying a power bill or finding a program for anger management. Sometimes the requests are more urgent: a mental health crisis or a desperate need to see a child that has been removed. Kids Action often works with families who are also involved with the Nova Scotia Department of Community Services. These situations are diverse, Debbie says, and very complex. As the only social worker on staff at Kids Action, Debbie takes the lead to assist families through oftendifficult government procedures. Her opinion is very clear: Community Services plays a vital role but the department and its staff are under strain. Kids Action works hard to relieve some of this pressure.
Debbie tells a story where this intervention proved pivotal. A child had been removed from the home and placed with a foster parent. The only constant in the child’s life at that point was the daycare. Kids Action was able to work through the daycare to build and maintain a sense of attachment between the child and the adults in her life. Subsequent assessment showed that the child had a very strong attachment indeed, and her father was later granted custody.
“I love my work and I believe in it,” she says. The organization is able to draw on this enthusiasm, as well as a professional staff and a large community-based network to help hundreds of families in rural Nova Scotia every year.
Debbie worries what might have happened to this child, and others, if Kids Action had not helped secure the ties among all important relationships: child, daycare, parents, foster parents and Community Services. In fact, attachment theory, the idea that strong emotional bonds are vital through disruption and trauma, forms the bedrock of Kids Action’s programs. All staff are trained in attachment theory and three staff members have extensive training such that the goal of maintaining positive emotional connections can direct the type of intervention Kids Action undertakes.
notes, 1993 funding amounts have almost 60%
While all parents and children need human connections, however, they often need more tangible items as well. Debbie recalls a situation where a mother and her children had to leave their house quickly due to an escalating mental health crisis with the father. Local transition houses were full and both Debbie and the mother knew that moving across the province to another transition house would only add more trauma. They had nowhere to go. Debbie remembers brainstorming with her staff: “What can we do?
More social workers on staff. More frequent repairs on their two very-well-used vans. And, according to Debbie, they need more safe places for families to live. They need to break ground on that apartment building.
On a daily basis, however, Debbie remains frustrated by the lack of resources. As she
less buying power today. This means that, in effect, Kids Action, along with other similar programs, have received funding reductions each year. They need more.
Through their extensive network in Hants and Kings counties, the team at Kids Action quickly found temporary, safe, comfortable accommodation for the family—then later found more permanent housing and a truck to help relocate. Throughout this process, Kids Action also assisted the father, visiting him at the hospital, attending doctor’s consultations and helping him understand the fast-moving and often-confusing swirl of events. This process of interpretation forms another pillar of Kids Action work. Particularly in situations involving child protection, parents may feel lost in a maze of processes and policies. They may not hear what’s being said. They may not know what information is important. And they may not understand what they have to do to get their child back. Whenever possible, Kids Action attends the families’ appointments with social workers, case workers, lawyers, doctors and schools. Debbie and her staff take notes and help interpret what is said and requested. For parents and children, this type of translation can make the difference between “I didn’t know” and “I understand.” Debbie speaks with a great passion about Kids Action.
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INTERNATIONAL SOCIAL SERVICE CANADA Protecting Children and Uniting Families Across Borders
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