C NNECTIONS January 2018 | Volume 1, Issue 2
C NNECTIONS FALLING THROUGH THE CRACKS An Online Initiative Asks:
How Many More? — Page 24
ETHICS IN ACTION
“Sick Enough” for Help — Nova Scotia’s mental health care system needs a paradigm shift — Page 10
A RALLY CALL FOR SOCIAL WORKERS We need to recognize social work’s vital role in NS mental health care — Page 28 Laurel Walker and Todd Leader are calling for a client-centred approach to Nova Scotia’s mental health and addictions services.
2016 NSCSW Council
Guide the social work profession Submit your nomination for Council by March 23, 2018 Quicksand
As a member-driven organization, we rely heavily on our member volunteers to guide the social work profession’s future in our province. Council is our main governing body with elected representatives from 8 regions and appointed members representing various groups. We’re seeking nominations for the following positions: • President
• North Shore
• Cape Breton
• Fundy Shore
• Annapolis Valley
CONNECTIONS • Cumberland Interested in representing your profession? Montserrat
Submit your nomination for Council by March 23, 2018 by completing our online form.
C NNECTION C NNECTION view nomination form
C NNECTION C NNECTION
October 2017 | Volume 1, Issue 1
Published four times a year by the Nova Scotia College of Social Workers 1888 Brunswick Street, Suite 700 Halifax, NS B3J 3J8 Phone: 902.429.7799 Fax: 902.429.7650 Web: nscsw.org Connection is Â© Copyright 2018 by the Nova Scotia College of Social Workers, and also reserves copyright for all articles. Reproduction without written permission from the publisher is not allowed. Next issue: April 2018 Submission deadline: March 7th 2018
COVER PHOTOGRAPHY: Michelle Doucette CREATIVE DIRECTION & DESIGN: Brittany Pickrem, Branding & Design EDITORIAL COMMITTEE: Harold Beals (Retired member) Bessie Harris (Retired member) Shalyse Sangster Alec Stratford (RSW, College Staff) Annemieke Vink (RSW, College Staff) Collette Deschenes (Promotions Coordinator) ADVERTISING IN CONNECTION: To advertise please contact Collette Deschenes, Promotions Coordinator at email@example.com. See advertising rates at nscsw.org/advertise. CONNECT WITH THE COLLEGE: facebook.com/NSCSW @NSCSW
TABLE OF CONTENTS Volume 1, Issue 2
Shining light on Nova Scotia’s mental health care model
One Path to Justice
ETHICS IN ACTION
SOCIAL WORKER SPOTLIGHT
“Sick Enough” for Help — Nova Scotia’s mental health care system needs a paradigm shift
Framing Our Work: Cultural Safety and Critical Hope
Exploring private practice in NS
Professionalism in Practice
Creating a Space for Innovative Teaching, Learning and Service Delivery
Falling Through the Cracks
A Rally Call for Clinical Social Work
January 2018 | Connection 5
Shining light on Nova Scotia’s mental health care model
CONNECTIONS Mental health care issues continue to capture Nova Scotia’s headlines and headlines across the country. 1 in 5 Canadians will have a mental health care issue in any
Montserrat given year according to Nova Scotia’s Auditor General’s (AG) recent report on the province’s current mental health care.
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Our province’s social workers are well-versed in the medical model’s approach to mental health care. We have experienced its strengths and have witnessed its shortcomings. Our current medical model continually struggles to understand and operationalize the ability of preventive measures to maintain our overall mental wellness. Social workers understand the tools and possess the skills that are needed to provide a more holistic mental health care system. In this issue of Connection, you’ll gain further insight into social work’s role in mental health care and you’ll read stories that will challenge the dominant discourse of the medical model. This is call to action for our profession The College has a mandate to engage with Nova Scotia’s social work community to advocate for improvements to social policies and programs towards social justice. We can effect change in the mental health care system by challenging and providing a clear alternative to the medical model.
Alec Stratford, MSW, RSW Registrar/Executive Director
The College’s Social Justice Committee invites all social workers to help build the Guiding Principles for Mental Health this April 14, 2018. The principles developed will be used to guide the College’s advocacy to ensure we build a mental health system that puts clients fi rst. We hope this issue inspires you to further examine and challenge our mental health care system.
6 Connection | January 2018
Welcome new NSCSW members New Private Practitioners, Registered Social Workers and Social Worker Candidates OCTOBER 2017-DECEMBER 2017
PRIVATE PRACTITIONERS Judith MacCuish-Ryan Kendra Popwell Meghan Mulcahy Daniel Clairmont Cleveland Sauer Michelle Wheelhouse Marcy Daniels Jessica Heidebrecht
RSW DESIGNATION Joline Leblanc Jordan Bent Karen Ward Katelyn O’Reilly Lael Aucoin Laura Thomson Michelle Cameron Shelina Gordon Shelley Jones Thea Clark Pamela Secci
Brandy Gryshik Maryam Mosheni Maxine Mann
SOCIAL WORKER CANDIDATE – APPROVAL Andrea MacDonnell Andrew Clevland Carolyn McIntyre Cianna Mackeigan Edna Doucette Emileigh Van Dusen Eric Jonsson Erin Hickey Jacqueline Duggan Julia Bremner Kaitlyn Hines Katelynn MacLeod Katie Young Kelly Ford Lillian Bacon Lynn Boyce Lynn MacDonald
Mario Rolle Nicole Robson Rhonda Simon Shawn Wood Shelley Sigurdsson Victoria Dixon Maria Medioli Denyse Hines Kari Goodman Meghan Steele Michelle LeBrun Lynn Lecreux Delaney Collins Taylor Barei Susanne Williams Melissa Spencer Danielle Bates Chelsey Mokler Christie Keating Katherine Lusby Siena Richard Jennifer Huskilson Sherryanne Butler Tara Antle Marianne Colbourne
January 2018 | Connection 7
ONE PATH TO JUSTICE BY JIM MORTON, RSW
As a recently active member, I was excited to learn that social justice is high on the College’s agenda.
IF WE WANT CHANGE, WE NEED ACTION AND PROBABLY A LITTLE COURAGE.
YOU KNOW THE ISSUES.
Saul Alinsky wrote about this during the radical 1970’s. “Change means movement. Movement means friction. Only in the frictionless vacuum of a non-existent abstract world can movement occur without that abrasive friction of conflict.”2 As social workers we create movement to help folks overcome problems that oppress lives and extinguish hope.
Whether the priority turns out to be mental health, poverty, addressing the determinants of health or child welfare, our Code of Ethics is crystal clear that being leaders in the ‘pursuit of social justice’ is a core social work value. The Code of Ethics clarifies that social workers “promote social fairness and the equitable distribution of resources, and act to reduce barriers and expand choice for all persons, with special regard for those who are marginalized, disadvantaged, vulnerable or who have special needs.”1 Choosing and promoting our priorities is important, but I know from four decades of practice it’s not enough.
8 Connection | January 2018
The tools at our disposal include: empowerment, raising consciousness, normalizing (others also experience the problem), group work, reframing issues and dialogue3 interventions. If we’re serious about social justice, we need a plan and we need to stand together. I have a few thoughts about actions to take and I’m interested in your reactions.
Our College divides our membership into regional groups. What if we organized ourselves into eight regional social action units, each made up of at least three social workers, coordinated by our College’s social justice committee? Larger units would be helpful, of course, but a small group of committed leaders could make a surprising number of things happen. What could these social action units do? The possibilities are limitless, but let’s look at a few examples: Local study groups: If the College determines that income inequality is the priority, the units could examine poverty in its region by meeting with consumer groups, consulting expert colleagues, and familiarizing with the data. It’s always wise to look before leaping and focused study just might help bulk up professional development profiles. Armed with knowledge, there are many ways we can act. Write letters to the editor: An action unit could challenge itself to write five letters to regional media during a year. Imagine! Forty letters from social workers reaching readers and listeners would be a serious contribution. Organize demonstrations: Put 20 social workers in front of a community services building or MLA’s office and we’re certain to be noticed. Not everyone can commit to be an action unit member but some may find two or three hours for a specific project.
Jim Morton is a recently retired social worker with more than 40 years of practice experience as a family therapist, administrator and a long stint in electoral politics. Jim is an active member of the College located in Kentville who was also active with social work associations in New Brunswick and Saskatchewan.
Identify validators: Action units could lead the way by creating lists of articulate individuals who are well versed in the issues and ready to speak publicly. Community meetings: Town halls, bringing together groups of leaders and linking like-minded citizens could be used for learning, raising consciousness. Organize citizen coalitions: Change happens when a population takes charge of its own destiny. Imagine the effect of a skilled citizen’s group that decides to become a watchdog for quality access to mental health services in its community. Influencing power: Ultimately, it’s the people we elect who determine, through policy and funding, how our communities and our institutions function. Action units could help elect progressive allies to town councils, to Parliament, to the Provincial Legislature and school boards. “Effective Community life is the result of the combined action of the individuals of the community.”4 Social workers have the skills and the obligation to mobilize that action. What’s your thoughts on creating a network of social action units? What would you do differently? Are you ready to be part of a team in your region? Social work is committed to a just, equitable society, but achieving that end is ultimately a personal decision. “Whatever you do”, Todd Leader said recently, in the context of mental health reform, “Remember that if nobody advocates for this, we are guaranteed never to get it.”5
REFERENCES 1. Canadian Association of Social Workers Code of Ethics, as amended for NSASW (November 17, 2008). 2. Alinsky, Saul D. (1971) Rules for Radicals: A pragmatic Primer or Realistic Radicals. New York: Random House. 3. Mulalley, Robert (1993) Structural Social Work: Ideology, Theory, and Practice. Toronto: McClelland & Stewart, Inc. 4. Coady, Moses M. (1939) Masters Of Their Own Destiny. New York: Harper & Row. 5. Leader Todd (2016) It’s Not About Us: The Secret to Transforming the Mental Health and Addiction System in Canada. Halifax: Todd Leader.
January 2018 | Connection 9
CONNECTIONS “SICK ENOUGH” FOR HELP Nova Scotia’s mental health care system needs a paradigm shift
BY ALEC STRATFORD, MSW, RSW
About 1 in 5 Canadians will have a mental health issue in any
Montserrat given year according to Nova Scotia’s Auditor General’s (AG) recent report on the province’s current mental health care system.
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The report lists many crucial problems within the current system. The Nova Scotia Health Authority (NSHA) responded noting that their soon to be released strategy will address many of these issues. However, the AG’s analysis of our current mental health care system is problematic as it focuses on emergency service delivery issues and access to mental health professionals for individuals with identified problems.
10 Connection | January 2018
The report calls for better coordination and communication of services within our current delivery system. The problem with both the current system and with the analysis of the AG is that it creates a threshold for service in which you must be sick enough to receive services. It also calls for a broad standardization of services across Nova Scotia. Standardization approaches have a history of marginalizing those people who do not fit the model. This leads to deeper inequities for typically the most vulnerable in our society. In the media, and within the health authorities, we continue to hear the issues framed and focused on mental health service delivery. A lack of coordination, resources and attention for those who are severely ill.
At the end of the day, despite all their robust analysis, the strategy will prioritize and focus on treatments and approaches rooted in the medical model. It will do so because this is the model that the administration is embedded and most comfortable with.
This focuses on the medical model as the only and best solution for tackling mental illness.
Undoubtedly, our mental health system is in desperate need of a shift.
The NSHA and the IWK will soon release their strategy to transform our provinceâ€™s mental health and addiction services. The strategy report will have conducted a thorough analysis of the current issues with service delivery, indicating a lack of consistency in policies and procedure, treatment approaches and resource allocation. It will have examined population data to determine needs and populations at risks. It will have analyzed the impacts of the social determinants of health and the need to address social inequities. It will highlight the need for trauma informed practice, and cultural safety within services.
We cannot create a system that promotes positive mental health, when there is such clear inequality in our society.
At the end of the day, despite all their robust analysis, the strategy will prioritize and focus on treatments and approaches rooted in the medical model. It will do so because this is the model that the administration is embedded in and most comfortable with. The medical model is problematic because it is not rooted in an intersectional approach. Without an intersectional approach to treatment, the system will continue to try to standardize practice and put clients on a treatment assembly line. The system will deny the deeply rooted social inequities that exist, and will continue to focus on institutionalized approaches to treatment that stacks resources into emergency rooms and hospitals instead of communities. Most importantly, this approach will need Nova Scotians to be sick enough to receive services.
Our system needs to prioritize existing health inequities. We need a strategy that prioritizes resources to community based prevention, education and to addressing these inequities. We need a strategy that recognizes post-modern practices embedded in empathy, solidarity and that works towards liberation from our oppressive structures. We know mental health can be better treated before someone is in crisis. Our system needs to recognize this. Waiting until someone is sick enough before services are offered is regressive.
Alec Stratford is the NSCSWâ€™s Executive Director/Registrar. He has worked as a child protection social worker, school support counselor, community organizer wand as a sessional instructor. Alec has a passion and dedication for community development and believes that engaged informed communities can lead to transformative change. Alec brings a wealth of knowledge on adult and experiential learning and its connection to social change.
January 2018 | Connection 11
FRAMING OUR WORK
Janet Pothier presenting on cultural safety at the 2017 NSCSW Spring Conference
Cultural Safety and Critical Hope BY JANET POTHIER, RSW
My passion for the concept of cultural safety and its potential for transforming healthcare experiences for Mi’kmaq people is directly related to my experience working with Mi’kmaq communities as a health advisor. I was shown great generosity and kindness through this humbling experience as I was also consistently challenged to create congruency between my thoughts and actions.
Cultural safety is informed by an Indigenous world view that originated with the work of Irihapeti Ramsden3, a Maori nurse and activist. It is different than cultural competency and awareness training which focuses on the other and how to provide services to the other believing that by knowing about others cultural practices and beliefs we can practice competently.
I am member of settler society. A member of settler society is anyone whose people are not Indigenous to this place known as Canada. It is a political standpoint; it articulates my positionality and shapes my identity as a critical social worker.
Cultural safety shifts requires that we first focus inward before engaging with the other. It requires the practice of critical self-reflection and a deep understanding that we are all bearers of culture and have our own set of cultural beliefs, values, and assumptions that inform and shape our view of the world and how we come to understand the concepts of health, healing, wellbeing and relationships.
We are at a unique time in Canada’s history as the Truth and Reconciliation Commission’s (TRC) Call’s to Action1 have been offered to us, by Indigenous people as a gift and a responsibility. These actions offer guidance on how we need to move forward positively together to share in a future built on the painful and violent foundation of colonialism and marginalization of Indigenous people. It offers us pathways to healing. It requires us to learn from our past and actively co-create a future for Canada. Imagine how differently things would be if we, as members of settler society, had entered relationships with Indigenous people in Mi’kma’ki with humility and respect. It was with critical hope I began my journey of exploration into the Indigenous concept of cultural safety while in Dalhousie University’s bachelor of social work program and it is with critical hope that I write this article. Critical hope suggests that, for authentic change to occur, we must not only hope for change but we must be able to imagine it. We must create opportunities for change to happen and actively participate in the reimagining of society in ways that promote and sustain socially just systems and ways of being with one another and the world.2 Cultural safety embraces critical hope through education and reimagining relationships that respect Indigenous cultures and voices. It acknowledges their inherent right and dignity to access health services in meaningful and relevant ways and respects cultural beliefs, values, and languages, and Indigenous healing practices and traditions.
It also highlights our shared colonial past - and that while we may use the term shared - the experiences of this shared history are vastly different. For Indigenous people, it’s a history loss; of stolen land, lost cultures and languages, families and homes, dislocation from the land, the Indian Residential School system and the Indian Act.
Cultural safety highlights unexamined issues of power and privilege, and most importantly, it highlights a fundamental shift in how we understand service delivery. It clearly articulates that it’s the individual receiving services who determines if services received/care offered was culturally safe, not the service provider and not the system This is deeply rooted in understanding cultural differences as they relate to health and wellbeing. It acknowledges that historically Indigenous people have not received equitable access to health care and have suffered because of it. It is about addressing who has the right to determine what is helpful and not helpful.
January 2018 | Connection 13
As practitioners and policy makers, we say that we’re practicing in culturally safe and/or competent ways. This is not our determination to make. We can no longer check off cultural competency training as completed. Cultural safety is a life-long journey of unlearning and learning new ways of being with Indigenous people. In cultural safety workshops, settler people are asked to describe their cultural beliefs and values. Many struggle with this as we are generally always asking others to tell us about their cultural beliefs and values. In other words, we ask people to come in and teach us about them. We are not commonly asked to reflect on how we understand them which is through a lens of us. The dilemma is: what can we do to work in culturally safe ways If we cannot authentically know what it means to be from a different cultural background? Rose Dean asks us to become ‘informed not-knower’s4 to inhabit a space of curiosity and humility challenging a western dependence on the concept of expertise. This asks us to step back from what we think we know and be open to, and comfortable with, authentically learning from the people we work with. Cultural safety asks us to become these informed notknower’s, to be open to understanding differently and with humility. Cultural humility as a construct helps us understand and develop process oriented to working well across cultural differences5. Cultural humility focuses on the cultural needs of the people we’re working with while suspending our own cultural, values, beliefs and norms. It requires us to continuously engage in critical self-reflection and to challenge inherent power imbalances.
Janet Pothier is a social worker who is passionate about advancing social justice in equity in health care. Her field of practice currently focuses on advancing culturally safe practices in health care for Mi’kmaq and Aboriginal people in Nova Scotia. She teaches at the Dalhousie School of Social Work and has taught both the Advancing Social Justice Courses online and Cross Cultural Issues in Social Work Practice. Janet lives in Rines Creek with her partner and her grandchildren are her inspiration.
We cannot be working in culturally safe ways if we are unable to also embrace cultural humility. Social workers have a duty to embody our social work Code of Ethics. It is who we are. Imagine how critical social work practice can support the advancement of culturally safe practices in health care program and service delivery. We are trained to practice critical self-reflection, awareness and analysis, to respect the inherent dignity of individuals and groups, promote social justice, and to be the voice for marginalized people and groups. We can lead by respectfully grounding our work in culturally safe practices. We can acknowledge as social workers and, for many of us as settler people, that we have a responsibility to make culturally safe practices a priority in our work. Cultural safety requires deep courage, commitment, and laying down common beliefs about what it means to be Canadian. It may challenge our deeply rooted personal identities which can be frightening. Like all things, with challenge often comes great reward. I imagine a time when we gather to celebrate meeting and exceeding the actions outlined in the TRC’s Calls to Action Report. Maybe not in my lifetime but I believe ‘we’ will get there by maintaining critical hope. As I write this article, I acknowledge that I am on unceded Mi’kmaq territory.
REFERENCES 1. Truth and Reconciliation Commission of Canada: Calls to Action. Retrieved from: http://www.trc.ca/websites/trcinstitution/File/2015/Findings/Calls_to_Action_ English2.pdf 2. Campbell, C & Baikie, G. (2012) Beginning at the beginning: An exploration of critical social work. Critical Social Work, 13(1). Retrieved from http://www. uwindsor.ca/criticalsocialwork/beginning-at-the-beginning-an-exploration-ofcritical-social-work 3. Ramsden, Irihapeti. https://www.youtube.com/watch?v=n4rOBSRv6r8 4. Dean. R. (2001). The Myth of Cross-Cultural Competence. Families in Society: The Journal of Contemporary Human Services, Volume 82, No. 6 5. Tervalon, M. and Murray-Garcia, J. (1998). Cultural Humility versus cultural competence: Critical Distinctions in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved, May 9(2), pg 117.
14 Connection | January 2018
2017 NSCSW Spring Conference
Collaborate with your College Create a professional development opportunity in your community
In collaboration with our social work
We encourage members to seek and create
members, we hosted 11 professional
PD opportunities in their communities that
development (PD) events in addition to our
contribute to the field of social work and the
two conferences in 2017. A huge thank you to
quality of life for Nova Scotians.
our members who created and coordinated these events with help from the College!
College funding is available to support your community PD events.
C NNECTI C NNECTI
Bring an event to your community.
PRIVATE PRACTICE Exploring private practice in Nova Scotia from a regulatory perspective BY NSCSW STAFF
240 of our provinceâ€™s registered social workers are private practitioners. Private practice is a specialized area of social work that has separate regulatory requirements. Its also an amazing opportunity for social workers. It inspires many to launch their own organizations and set up their own business. Private practice is an opportunity to design your own schedule, ignite your entrepreneurial spirit and set your own direction for professional growth.
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Private practitioners do face challenges as they must promote their practice and ensure that the public is aware of their services. Private practitioners must promote their professional social work credentials and education to insurance companies who too often do not recognize social work as profession that can deliver mental health services. This was one of the driving forces behind the formation of the Collegeâ€™s Private Practice Committee.
In addition, the College’s Board of Examiners, and members applying for private practice status, expressed concerns with the College’s processes and criteria for approving private practice and asked these questions: • How do we verify that a social worker has the skills and training required? • What are other provinces doing? • What are the larger needs in the delivery of mental health services in Nova Scotia? • How can we better promote the skills, competence and ethical capacity of social workers to deliver private services in Nova Scotia? The College’s Private Practice Committee is addressing these questions. They’re reviewing the current process and criteria in place to approve social workers for private practice and are providing recommendations and guidance on areas of strengths, identified gaps and necessary changes.
• Social work regulatory jurisdictions are years behind on addressing e-services. How can we work with other jurisdictions for better mobility, so that private practitioners can deliver e-services in various provinces without having to be registered in every jurisdiction? • Overall, how can the College best protect the public to ensure they’re receiving services from skilled, competent ethical social workers in private practice? The challenge is how to align regulatory practices that best protect the public to ensure a high-standard of social work practice. Social workers empathically connect with clients, and work in solidarity to support meaningful change in their lives. They do so while working within communities, to liberate each other from oppressive social structures. These strengths reinforce social work’s strong fit for both private and public mental health service delivery.
How do we best articulate social work’s strengths
The committee will also review issues related to ongoing as a catalyst which enables us to show the Quicksand support/supervision of private practitioners, insurance deficiencies in the social structures and the coverage gaps and promoting private practice social work.
The committee’s areas of exploration could have a profound impact on the profession
impact these deficiencies have on an individual’s overall wellness?
Here are some areas the committee is exploring: • Nova Scotia is the only province with separate regulatory requirements for private practice. Should we keep this separate requirement?
Can we do this without losing the intersectional approach that social workers bring to this area of service delivery?
The Private Practice Committee has an ambitious agenda for the next year. They will be asking some tough philosophical questions and greatly looking forward to the challenge.
• Other Canadian jurisdictions, such as Alberta, British Columbia and now Saskatchewan, have successfully advocated to hold title protection for the title Registered Are you a social worker interested in contributing to the Clinical Social Worker. This was done to highlight the profession’s private practice? Are you willing to reflect and specific skills, competence and ethical capacity needed craft recommendations about the considerations raised here? to deliver clinical social work. Is this a pathway we There are still spots available on the committee. Contact Alec Montserrat should take? Stratford for further details. • These jurisdictions (Alberta, British Columbia and Saskatchewan) use the Association of Social Work Board’s Clinical Exam as measure of clinical social work expertise. Is this something we would support? If not an exam, how should we indicate and measure specific social work expertise?
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January 2018 | Connection 17
PROFESSIONALISM IN PRACTICE Spotlighting our future social workers This year eight of our student members received a $500 bursary from the College to support their social work education. We asked them:Â Why is professionalism in social work practice important to you?
KATIE FAULKNER Professionalism is vital for the profession. As social workers, we often work collaboratively with other health care professionals, community organizations, and government agencies. Professionalism holds privilege that we can use when working towards social justice.
JENN SMITH Professionalism represents integrity, which is imperative to me in both a personal and professional sense. I acknowledge that everyone makes mistakes through the learning process, but hope that if I go into things with genuine intentions and effort, my social worker identity will have a strong foundation to go on.
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MARIAN FARRELL Professionalism ensures the integrity of the profession, as well as provides a framework for navigating ethical dilemmas. Social workers meet with the most vulnerable people in society. When social workers act in professional ways, vulnerable clients receive proficient services, free from judgement, supportive and anti-oppressive service.
JESSICA MACLEAN As social workers, we work with vulnerable populations in a professional setting. It is important to be empathetic, engaged, and build a positive rapport, but assure that professional boundaries are in place. We also need to be mindful of professionalism outside of the workplace. We should be aware of our social media presence as we carry our reputation and name everywhere we go.
GABRIEL ENXUGA Professionalism in social work practice ensures that our clients receive competent and quality care. Some of the social work ethics for professional practice (as outlined by the NSCSW) include respect for the inherent dignity and worth of persons, pursuit of social justice, service to humanity, integrity, confidentiality and competence. These ethics are important because they not only provide a framework from which I can practice, but also create a means of ensuring that we, as social workers, are accountable to providing the best possible care to our clients. Professionalism, to me, means undertaking my work with a sense of duty and responsibility. As well as striving to be open to learning, feedback, and improvement, both within myself and the communities in which I work.
VICTORIA DUMBUYA As social workers, we have an obligation to use professionalism in our daily work. We are involved with people from all backgrounds and can be in the middle of legal and ethical issues in which professionalism will need to be exhibited. Professionalism to me means working accordingly and following through with the Canadian Association of Social Workers (CASW) Code of Ethics. Understanding and implementing the values and principles of the Code of Ethics in my professional practice will guide my conduct and hold me accountable to my professional role. Professionalism to me is also about trust. When we hold the title as Registered Social Workers, we should be committed to adhering to the expectations of practice and professionalism.
Social work has fought long and hard to be considered a profession. Having guidelines and ethics in place legitimizes the important yet, often underappreciated work social workers do to support marginalized individuals and communities.
Professional standards allow for a high level of conduct, monitoring, and evaluation. In the field of social work, it allows for resources to be better utilized, for service to be offered more compassionately, efficiently, and to a better benefit of communities.
Social work regulation ensures that service users and colleagues are treated in a fair and just manner.
Strong professional standards in social work practice also helps to avoid perpetuating or contributing to the same oppressive systems, institutions, and ideologies that marginalize critical communities.
January 2018 | Connection 19
CREATING A SPACE FOR INNOVATIVE TEACHING, LEARNING & SERVICE DELIVERY The Story of the Dalhousie Universityâ€™s School of Social Work Community Clinic
BY KARABANOW, J., HALL, C., MARTIN-CALERO, P., OULTON, S., TITUS, M., DAVIES, H., AND MURPHY, A.
IN THE EARLY SPRING OF 2014, A MEETING TOOK PLACE TO DISCUSS A SHARED DREAM. What would it look like to develop a community based service that could provide meaningful care to marginalized populations, supporting and supplementing existing resources, and providing a unique practice training space for university students in the health professions? Equally important, the vision involved all of this being done through a social justice lens.
competition, enrollment, and organizational fatigue. Sites that are explicit in their social justice work were (and continue to be) scarce. There were few community based agencies that had deep social justice/anti-oppressive practice (AOP) approaches for social work students to practice in. Lastly, most interprofessional placement opportunities were within hospital settings. The clinic was a possible way to bring different disciplines together in a community setting.
In many ways, this is our dream unfolding.
These observations and concerns regarding social work practice and related field education practicums are also found in current academic literature. Evidence shows that the current neo-liberal climate has led to limited time and quality of engagement between service providers and service users, bringing about increased marginalization of service users1. In addition, within this neoliberal agenda of reduced resources and increased caseloads, agencies are struggling to meet their daily functions and are more hesitant to take on student supervision2. Contrastingly, the World Health Organization has requested health professions to adopt a foundation in social accountability, as well as a focus on interprofessional education and care3
ENVISIONING SOMETHING DIFFERENT
As we shared and listened, we quickly realized
Three years later and the Dalhousie School of Social Work (SSW) Community Clinic is operating in Halifax’s north end. We have worked with over 400 clients, more than 30 organizations and have provided practice experiences to approximately 65 undergraduate and graduate students from social work, occupational therapy, nutrition and pharmacy. We’ve also had project based and service learning opportunities for medicine and management programs at Dalhousie University.
On that early spring day, Cyndi Hall, the Dalhousie SSW Quicksand
that we could attempt to mitigate these concerns
Field Education Coordinator and Jeff Karabanow, SSW full professor, met at the Dalhousie’s University Club to determine if we wanted to commit to starting a community clinic together.
CONNECTIONS by developing a community entity that could
provide meaningful supports to those in need
Jeff has co-created and continues to co-coordinate a community based emergency winter homeless shelter. He lamented there were few services to provide case management and supportive counselling in an unconditional, immediate fashion to those who are poor, marginalized, precariously housed or un-housed; individuals most often experiencing deep and unresolved trauma.
and, at the same time, develop a space for thoughtful, original and creative inter-professional student learning and teaching.
Cyndi shared her frustration around the increasing difficulty in securing quality student placements due to growing
We envisioned social work taking the lead and setting the foundation for case management practice and a culture of learning that embeds social justice values and principles. Once established, through development of policies and practices, relevant professions would be invited to participate in the work of the clinic in a collaborative and meaningful way.
Montserrat Opposite page: Clinic social workers Michelle Titus, Nikolas Harris and Sarah Oulton outside the clinic located at Veith House.
The seeds of the Dalhousie School of Social Work Community Clinic were born and ready to be planted.
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January 2018 | Connection 21
CONCLUSION The state of field education in Canada is reaching a crisis proportion, with service delivery structures overwhelmed, strained, financially fragile and with decreased capacity to provide services and offer field education. We are grateful to be part of the solution as we solidify our relevance in teaching, learning and serving community.
We do not want to simply become another community service with a charitable foundation – we must maintain our social justice lens and work with our communities to advocate for a more just and equitable society. We are diligent in our efforts to maintain our unique philosophy and offer transformative learning opportunities for students.
Many factors created the climate for us to be able to develop our clinic. The Dalhousie context was influential with changes in leadership and strategic planning that highlights community engagement and innovative teaching. Our own Faculty of Health embraced interprofessional learning and teaching. The climate of government and their increasing vigilance of professional schools created the opportunity to promote our approach to practice learning that significantly enhances readiness for practice. The Dalhousie School of Social Work, where both clinic directors are employed, supported the development financially and through flexible work deployment.
Dr. Jeff Karabanow is a Professor of Social Work at Dalhousie University in the Faculty of Health Professions and crossappointed with International Development Studies, College of Sustainability and The School of Health and Human Performance. He has worked with homeless young people in Toronto, Montreal, Halifax and Guatemala. His research focuses primarily upon housing stability, service delivery systems, street health, and homeless youth culture. He has completed a film documentary looking at the plight of street youth in Guatemala City and several animated shorts on Canadian street youth culture.
We have a lot to celebrate with this initiative – its community development roots, its social justice framework, its antioppressive emblems and its accompaniment philosophy. While indeed it is a work in progress, the clinic is a social work initiative that embraces an interprofessional lens and bridges between the worlds of community and university. The clinic focuses upon meeting the needs of our marginalized communities while providing thoughtful and meaningful training grounds for emerging health professionals.
Cyndi Hall holds both the BSW and MSW degrees from the Dalhousie School of Social Work. Her career includes work in the NGO world focused on mental health rehabilitation and 15 years with the Provincial Government as a career counsellor. Cyndi joined the School of Social Work staff 12 years ago as Field Education Coordinator. Cyndi has also co-produced and directed a documentary entitled “I Work For Change”, a film to celebrate the social work profession and dispel myths and stereotypes.
There are constraints as well, of course. We continue to seek consistent and sustainable funding to maintain the clinic’s operations and eventually expand to new offerings (e.g., drop in, therapeutic supports). We are also continually working to balance our service delivery platform with true community development and advocacy orientations of AOP.
REFERENCES 1. George, P., Moffatt, K., Barnoff, L., Coleman, B., & Paton, C. (2009). Image construction as a strategy of resistance by progressive community organizations. Nouvelles Pratiques Sociales, 22(1), 92-110. 2. Bogo, M. (2005). Field instruction in social work: A review of the research literature. Clinical Supervisor, 24 (1/2), 163-193. 3. Dugani, S., McGuire, R., & IMAGINE Working Group. (2011). Development of IMAGINE: a three-pillar student initiative to promote social accountability and interprofessional education. Journal of Interprofessional Care, 25(6), 454-456.
22 Connection | January 2018
NATIONAL SOCIAL WORK MONTH â€˘ MARCH 201 8
Bringing change to life Social workers make a real difference in the lives of people, families and communities across the country. Every year in March, Canada celebrates the important contributions of these social justice professionals.
Get involved in National Social Work Month: https://casw-acts.ca/en/March2018 #NationalSocialWorkMonth
FALLING THROUGH THE CRACKS
By providing a forum for people to share their stories, #HowManyNSHA-IWK is part of Laurel’s campaign for better mental health and addiction services.
An Online Initiative Asks: How Many More? BY KATHERINE BARRETT
Debi was diagnosed with borderline personality disorder at age 16. Now 27, she describes herself as a frequent user of the mental health system. When she has gone to the ER in crisis, however, Debi has been told she needs to “grow up” and “stop being childish.” She says: “I feel like no one believes that with the right therapy and skills in an intensive environment … I could get better and do better.” “Steve” is an officer with the Halifax Regional Police. He responds to many people in mental health crisis but finds this “difficult and stressful” because often those people don’t get the help they need. “It’s like the system is built only for the worst possible crisis,” he says. “Preventative care is needed, not reactive.” Amanda has struggled with trauma, depression and eating disorders since age eight. In college, she was referred to an eating disorder clinic but felt it did not provide the help she needed. Amanda asked for more intensive treatment, including out-of-province funding. She was denied. Amanda says that her team “never asked what I thought I needed, they just told me what … they thought would be best.” These are just three of sixty personal stories shared* on a Facebook forum called #HowManyNSHA-IWK. The forum is open to the public and posts news stories, reports and events. The sixty stories were one initiative of the forum called 60 Days, 60 Stories. All of the stories were posted in August through October of 2017. They came from youth, parents, community workers and professionals across the province. They came from people struggling with mental illness and from families who have lost love ones to suicide. The name of the forum is an open and urgent question: How many more people will fall through the cracks in Nova Scotia’s mental health and addictions services before the provincial bodies responsible for delivering those services—Nova Scotia Health Authority (NSHA) and the IWK Health Centre—make necessary changes? Both the #HowManyNSHA-IWK forum and 60 Days, 60 Stories initiative were established by Laurel Walker, a Halifax resident who knows first-hand how Nova Scotia’s current mental health and addictions services can fail those most in need.
In 2005, Laurel felt she was losing a long-term battle with depression and anxiety and had become suicidal. With her psychologist’s help, she was eventually admitted to the short-stay unit of the hospital. Upon release, Laurel began helping others in similar need. She founded the Halifax Walk for World Suicide Prevention Day, which has taken place every September 10 since 2007, and also became a peer support worker to assist those navigating the mental health system. But a short stay in the hospital did not address Laurel’s own challenges and by 2012 she needed intensive mental health services—services that were simply not available in Nova Scotia. Laurel was approved for out-of-province funding and spent eight weeks in an inpatient program in Ontario.
“I didn’t realize how sick I was until I got there,” Laurel says. Through a combination of therapies including art and horticultural therapy, and a review of her medications, Laurel began to get well. “After four weeks, I could see colours again. The leaves outside my window actually looked greener than I could remember.” Laurel says she is blessed to have strong family support and to have received the help she needed. Although she is still adjusting to life after the inpatient program, she also feels an intense responsibility to give back. “My situation was no more complicated than anyone who goes to the ER with a mental health crisis,” Laurel says. “I want to help others get the help they need and deserve —in Nova Scotia.” By providing a forum for people to share their stories, #HowManyNSHA-IWK is part of Laurel’s campaign for better mental health and addiction services. And while this type of community-building is a vital aspect of Laurel’s advocacy, she is also very specific about the kind of system-level changes required in Nova Scotia.
January 2018 | Connection 25
Mental health promotion and early intervention are crucial aspects of a clientcentre system. Not everyone requires or would benefit from intensive therapy from a psychiatrist, for example. This means that non-medical professionals, particularly counsellors and social workers, play a vital role. They are trained to look beyond the individual and beyond illness to see the whole context, including family, work and community.
“There needs to be a whole shift in how people in leadership view this issue. There are walls up. They aren’t seeing things. They aren’t listening,” Laurel says. “And professionals working in the system are burned out because they can’t do what they know is best for the client.” Do what’s best for the client. This is the heart of the change Laurel wants. It’s called a client-centred approach and while it might seem only sensible for any healthcare system to be client-centred, according to Laurel and many others on the forum, it is not how NSHA and IWK currently operate. Todd Leader literally wrote the book on client-centred approaches to mental health and addictions services. It’s Not About Us (Cathydia Press, 2016) advocates for an administrative system that puts clients needs first. In the current model, administrators are mandated and taught to manage systems. Their goal is to ensure those systems run efficiently and economically.
“If that means only scheduling appointments Monday to Friday, nine to five, so be it,” Todd says. “If it means standardizing to the lowest common level of service, so be it.”
26 Connection | January 2018
In contrast, a client-centred administration would look first at what clients need. What mental health and addictions services are necessary and sufficient to serve the public? And, Todd emphasizes, that means the whole public: Not only those people who are already sick but those who are at risk and those who are healthy too. Mental health promotion and early intervention are crucial aspects of a client-centre system. Not everyone requires or would benefit from intensive therapy from a psychiatrist, for example. This means that non-medical professionals, particularly social workers and counsellors, play a vital role. They are trained to look beyond the individual and beyond illness to see the whole context, including family, work and community. “Social workers play a huge role in our mental health and addictions system,” Todd says. “And they are essential to a client-centred approach.” Todd and Laurel first met at the Suicide Prevention Walk in Halifax. They quickly realized they were working for the same changes, if coming from different angles: Laurel as a client and frontline worker in the community; Todd as psychologist, social worker, teacher and former Director of Community Health Services with South Shore Health Authority. Todd currently runs a consulting business and is actively promoting the ideas in his book, but he also helps Laurel advance the #HowManyNSHA-IWK initiative by posting
Superheroes For Hire!
helping kids discover their greatness
news stories and events and fostering discussion among on NSHA and IWK to make specific changes that will move participants. The forum also has three administrative Nova Scotia to a client-centred system. members who run the site (in addition to Laurel), including a Quicksand new student placement from Saint Mary’s University. “But these initiatives are not about blame,” says Laurel. “They’re about working together to achieve system-wide changes.” That said, the proposals outlined in It’s Not About Us are not costly or complicated. With a receptive leadership that is open to change, they can be achieved.
#HowManyNSHA-IWK now has over 1,200 members and gains about ten new members each week. “It’s way bigger than I thought it would be,” Laurel says. Social media has worked well as a platform because it’s accessible, easy to manage and easy to share. The posts are public and Laurel believes openness and transparency are important. She has found that most people are very keen to speak out. “I think a lot of people were feeling hopeless,” she says. The forum provides the kind of support, compassion and camaraderie that people are not feeling when they deal with the healthcare system. “Speaking out is empowering,” Laurel emphasizes. “It helps people feel less afraid and less ashamed of their experience.”
“And we’re not stopping until they are,” Laurel says. “Whether it’s three months or six months or ten years. Until people stop falling through the cracks, the system is broken. So we’re not stopping until we see change.”
*Stories are paraphrased with permission from the #HowManyNSHA-IWK Facebook forum. Quotations are taken directly from the posted stories. “Steve” is a pseudonym.
Laurel is very busy these days, managing the forum, Katherine Barrett is a freelance writer and editor living in continuing the Suicide Prevention walk, speaking to the media, Lunenburg, NS. She is also the founder and editor in chief of Montserrat working full-time and taking care of her own health. But she Understorey Magazine. is dedicated to seeing change in Nova Scotia’s mental health and addictions services. In fact, she is gearing up for new initiative starting in early 2018. The project will launch via the katherinejbarrett.com #HowManyNSHA-IWK forum and will ask people put pressure
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January 2018 | Connection 27
A RALLY CALL FOR CLINICAL SOCIAL WORK We need to recognize social work’s vital role in NS mental health care BY TONYA GRANT MSW, RSW
Clinical social workers have provided competent, effective, and unique services in mental health care for over 100 years and counting.
and they can have varying levels of education focusing on generalist practice and/or specialization.
I never imagined 14 years ago, when I took on my role a clinical social worker working in mental health and addictions, and later in leadership positions, that I would need to spend so much time talking about clinical social work’s role in health and mental health care.
OUR PROFESSIONAL IDENTITY
Many times, over the years, I would need to explain that social workers work in many different practice areas and settings
28 Connection | January 2018
Social workers have struggled with a professional identity since the beginnings in the late 1800’s. Every decade there is a lively debate about whether our interventions should focus more on micro (individual) issues or if they should focus more on macro (societal) issues that target the root causes.1
Clinical social workers are trained to facilitate many models of interventions and focus on relationship-based work using a model or a combination of practices that are tailored to meet the individual’s needs. This intentional but highly flexible work may make clinical social work practice difficult to conceptualize as it can be considered both a science and an art. This area of social work has a rich history of working towards the betterment of people and communities in many diverse ways so, over time, I have come to enjoy the questions of “what we do” especially when the questions are fueled with openness and curiosity.
CLINICAL SOCIAL WORK’S CONTRIBUTIONS
multiple ways of thinking and multiple ways of solving problems. Clinical social workers are interested in looking at the whole picture and understanding the person in the context of their environment.4 This requires the flexibility to adjust to people’s changing needs and it does not always fit well with the medical model that favors standardization. There are major professional challenges facing social workers who work in the health care setting.
DEVALUED IN HEALTH CARE This past year, as co-chair of the College’s Board of Examiners, I heard from many clinical social workers across the province.
Over the last 100 years, numerous clinical social workers have made significant contributions in a variety of health and mental health related fields such as psychosocial casework, assessment, family therapy, solution-focused brief therapy interventions, and resiliency work.
These social workers described how their work stress is compounded by other professionals who misinterpret their work, make uninformed assumptions and even pronounce what they, as trained clinical social workers, can and cannot do in practice.
Social work has also consistently been at the forefront of the human rights movement and has helped to identify the detrimental impacts of the social determinants of health. During both World Wars, clinical social workers played a significant role in rehabilitation, trauma and family work.
Clinical social workers play such a vital role in Nova Scotian’s health and mental health care. It is worrisome to hear about social work’s essential work being misunderstood or devalued.
In the 1960’s, the Canadian Association of Social Workers (CASW) in solidarity with church groups, farmers and others community groups, advocated for and secured universal health care across Canada.2 3 Today clinical social workers continue to make significant contributions to areas such as psychotherapy, trauma work, psychosocial interventions, crisis work, rehabilitation, assessment, case management, policy development, education and research.2 3 4
PROFESSIONAL CHALLENGES As a mental health clinical social worker, my goal is to work collaboratively with people where they are at and how they want to work together to improve their mental wellness and overall functioning. In my experience, most clinical social workers want to work with people to better understand the meaning that they assign to their lives and to help them on a micro (personal), mezzo (interpersonal) and macro (societal) level. When I studied at Dalhousie’s School of Social Work we were encouraged to develop a postmodern world view that considers multiple perspectives, multiple ways of being,
In 1917, social work pioneer Mary Richmond wrote in her book “Social Diagnosis” that when other professions do not understand social work’s distinctive contributions, they then try to fit social work into their own worldview and practices.5 A century later this outdated way of thinking is sometimes still showing up in health care as other professionals are using their own measuring sticks to judge and misconceive social work practice. Social workers in health care are already vulnerable to stress and burnout.5 No one needs this extra layer of stress to contend with. Whether this is unconscious bias towards the practice of social work or professional elitism rearing its unjust head, this type of profession shaming is harmful on multiple levels. This needs to stop.
WE NEED THE SOCIAL WORK LENS Clinical social workers provide people-centered and relationship-based work that is interwoven with social justice principles and advocacy. These unique facets of our practice should not be silenced by other professions or systems that do not fully appreciate or value this type of work.
January 2018 | Connection 29
Social workers are trained to adopt a systemic worldview and to critique the very systems we work in. Clinical social workers provide strong mental health interventions such as assessment and psychotherapy as well as a critical analysis of structural barriers and institutional discrimination that impact on people’s health and wellness. These social workers also meet the diverse needs of Nova Scotians by providing holistic interventions through evidencebased practices and practice wisdom. This approach helps the system adapt to the needs of the person as opposed to the person having to adapt to the needs of the system. In my experience, when clinical social workers are engaged in advocacy they look at innovative ways to help solve complex health and mental health issues and consider intersectional perspectives at the micro, mezzo and macro levels. This creates opportunities for beneficial and meaningful health interventions and outcomes.
Tonya Grant MSW, RSW has over 25 years of experience in the human services field working with children, youth, adults and families from diverse backgrounds. Tonya has 14 years of experience working as a clinical social worker in community mental health & addictions, family therapy, residential mental health, complex case, clinical supervision and leadership. Tonya is trained in Solution -Focused Therapy, Cognitive Behavior Therapy, Family Systems Therapy and Trauma Informed Care. Tonya has a small private practice specializing in family therapy and teaches as a sessional Instructor at Dalhousie’s School of Social Work. She recently transitioned from her position of the Professional Practice Chief/Lead of Social Work at the IWK Health Centre to her new position as the Provincial Clinical Lead for Trauma informed Care.
30 Connection | January 2018
A social work lens is needed on health care teams as they focus on building strong alliances with clients with a well-founded emphasis on self-determination and understanding the person in the context of their environment. Mental health care services across the province are currently focusing on initiatives such as trauma informed care, patient and family centered care and cultural awareness which align with the College’s social work Code of Ethics and Standards of Practice. Clinical social workers are an essential part of Interprofessional health care teams as they continue to help people of all ages and from different backgrounds use their existing resiliencies to build healthy minds, bodies, relationships and communities.
REFERENCES 1. Jennissen, T. & Lundy, C. (2011). One hundred years of social work: A History of the Profession in English Canada, 1900–2000. Waterloo, Ontario: Wilfred Laurier Press. 2. Finkel, A. (2011). Social policy and practice in Canada: A History. Waterloo, Ontario: Wilfred Laurier Press. 3. Jennissen, T. & Lundy, C. (2011). One hundred years of social work: A History of the Profession in English Canada, 1900–2000. Waterloo, Ontario: Wilfred Laurier Press. 4. Regehr, C. & Glancy, G. (2014) The Context of Mental Health Social Work Practice in Canada in Mental Health Social Work Practice in Canada. Don Mills, Ontario: Oxford University Press 5. Richmond, M. (1917). Social Diagnosis. New York; Russell Sage Foundation 6. Cox, K. & Steiner, S. (2013). Self-Care in Social Work A guide for Practitioners, Supervisors, and Administrators. Washington D.C.: NASW Press.
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Shining light on the state of Nova Scotia's mental health care system.