Stories of change

Community support workers team, Southland District Health Board

"It did help to make that role into a very user friendly role for the client, but it also made me, the clinician, free up my time because ... sometimes we just don't get enough time to service our clients because they need to be helped in a better, more rounded way."
Joseph Oxley, team manager, drug and alcohol specialist service.

The profile

Southland District Health Board (SDHB) is the second largest DHB by geographical area in New Zealand. The catchment area includes population of about 107 000 people and encompasses Invercargill City, Queenstown, Gore and rural Southland. Currently 3000 people access mental health services in Southland. The Invercargill community mental health service (CMHS) provides secondary care to about 400 service users living in the SDHB area. CMHS consists of two multidisciplinary teams - East and West and includes forensic services and community support workers (CSW).

CSWs provide a short-term support (from six to eight weeks) to service users who are under the care of CMHS and have recently been discharged from hospital. Longer-term support is arranged on a case-by-case basis depending on individual needs. In some cases CSWs provide social support to clients of non-government organisations (NGOs).

The CMHS employ two community support workers - Doug Alderson and Gay Elliott. Doug‘s core business is forensic mental health, but he also works across the West CMHS and the Gore community mental health team. His position is funded by the forensic mental health team budget. Gay works across both West and East CMHS, including maternal mental health and eating disorders. Her position is funded by the Invercargill community mental health team budget. Each CSW's case load averages at about 17 individuals.

According to the Health Workforce Information Programme (District Health Boards New Zealand), in March 2008 CSWs represented just over three per cent of mental health support workers. Gay and Doug presented a paper about the support work role and their own professional development at the 2008 TheMHS conference in Auckland and the support workers summit in Wellington in March 2009.

"Gay [Elliott] was part of the inspiration for me to carry on working in mental health."
Val Dockerty, consumer advisor.

Gay and Doug at the Southern Institute of Technology

The beginnings

The seedlings of community support work began in SDHB in the early 1990s. At the time there was no specialised training on how to support service users. The multidisciplinary team approach was in its infancy. The mental health team then consisted of two nurses and a social worker.

In the late 1990s the SDHB consulted with the Southland NGO sector about developing a support worker role. The aim of this role was to ensure consistency and provide adequate support to service users transitioning back to the community following discharge. Strong drivers were the consumer movement in early to mid-1990s, as well as the shift away from the medical to the strengths model, in which community support is assigned an important role.

The first community support worker to be employed by SDHB was the late Gaye Padget who started working in 1999. She pioneered the position on how a non-clinical role could be a part of a multidisciplinary team. Gaye provided social support to service users, including activities in the community. Her colleagues and the people she supported perceived her as vivacious and amazing. Gaye set the bar very high for CSW personal qualities such as compassion, empathy, flexibility and problem solving abilities.

After 2000 the role of CSWs evolved further. It now incorporates social support and short therapeutic interventions and training institutions offer relevant certificate and/or diploma in community support. Gay and Doug now hold Diplomas in Mental Health Support Work and are trained in motivational interviewing. Both are also trained in providing supervision to non-clinical staff.

"...in the DHB sector ... you're working alongside your ... multi-disciplinary colleagues... It just makes the seamless service so much easier to provide." Douglas Alderson, community support worker.

The process

SDHB mental health services recognised the need for intensive service user support in the first six to eight weeks following discharge from inpatient care. To achieve a smooth transition, service users are referred to the CSWs by the community recovery team.

The process of referral varies. At times the support that a person needs is identified at the initial assessment. At other times the referral to CSWs is made as part of the recovery plan. Decisions for the referrals are based on clinical review, needs assessments and communication with the local NGO.

Doug and Gay have different preferences for making first contact. Doug contacts a new service user by phone and arranges a time to visit. The first meeting lasts between 30 and 60 minutes. At this visit Doug introduces himself, starts building rapport, and briefly discusses the collaborative work. For Doug it is important service users do not feel too pressured by a new person coming into their environment.

Gay prefers to visit the person with their case manager as they have usually established rapport with the individual and their family/whanau. Gay and the case manager discuss with the service user their roles, who does what, and professional boundaries. From then on Gay sees the person on her own but will meet with the case manager and service user at least once a month to assess progress and establish further goals.

The frequency and intensity of support varies from once a week to sometimes four times a week. Support can increase or decrease over time depending on individual needs. Within the SDHB the level of involvement of CSWs with the people they support is flexible. The CSWs contribute to multidisciplinary team clinical reviews.

CSWs provide support in different areas of a person's life. One is liaising with Work and Income New Zealand to ensure people get the benefits and allowances they are entitled to. CSWs also help service users in getting good accommodation that is comfortable, warm and meets their mental and physical health requirements. CSWs work closely with training and employment consultants to address relevant needs. Additionally, CSWs aid the NGO needs assessment process that is a part of transitioning the service users from secondary to primary care.

CSWs support service users to engage in structured community-based activities, such as day activity centres developed by the SDHB. There service users attend programmes where they develop knowledge about their condition, practice social skills, and get training in applied areas such as woodwork and craft. Taking part in structured community-based activities helps individuals to normalise the experience of mental illness and develop better awareness of their abilities to manage their condition. CSWs are trained in motivational interviewing and brief interventions for problem solving and are able to use these talking therapies in their work.

CSWs are employed across a number of mental health services and this reflects on the variety of areas of support Doug and Gay offer to people. For example, this can be role modelling to forensic service users how to work with Work and Income New Zealand case managers and how to avoid confrontation, or talking about healthy alternatives to drug and alcohol charged social environments to people with addiction problems. The support involves assessing personal needs, encouraging the individual to develop and practice social skills and engage in daily activities. The aim is reintegration in the community.

"It's been such a nice process to watch, to see people moving on the chain,
getting back into their lives again.", Douglas Alderson, community support worker.

The unique approach

• CSWs are part of multidisciplinary teams in secondary mental health services, who support clients by visiting them at home. 
• Both Gay and Doug have obtained Diplomas in Mental Health Support Work. They are trained in motivational interviewing and brief interventions for problem solving. 
• Doug plays an invaluable destigmatising role. He works with the forensic team and complements their rehabilitation work. 
• CSWs are involved in the daily operational management of their teams and are included in the non-emergency duty rosters. 
• They provide supervision to other non-clinical staff.

"... it's about cutting out all the red tape and actually getting people connected with the community again.", Douglas Alderson, community support worker.

Invercargill Mayor Tim Shadbolt with Gay and Doug

The results

The effect of CSW's work has not been formally evaluated, but anecdotal evidence from service users and staff members highlights their contribution to the process of service users' recovery and re-engaging with the community.

CSWs are very well connected with the community. They know the local services and agencies and have a friendly and engaging approach that makes the ongoing interaction seamless and effective.

More clients have returned to part-time work than in previous years. CSWs provide ongoing encouragement to service users, while attending training and employment programmes. This involves not only practical skills development, but also discovering the recreational and meaningful side of obtaining and holding a job.

In a forensic setting the involvement of CSW in multidisciplinary team opens up new avenues and paves the way to recovery. For example, a forensic service user, who previously wasn't accepted to work due to her history, became a volunteer in a specialised aged residential facility.

The lessons learnt

• The formal training of CSWs has increased their effectiveness in working with service users and efficiency in supervising non-clinical staff. 
• A supportive team environment is critical for CSW positions in secondary mental health care.
• The ability of CSWs to communicate with team members, management and the community is and essential skill supporting service users.
• CSWs skills can be successfully used in working with family/whanau. 
• Community support work is about taking a chance and taking on new career paths.

"I think the important thing that both Doug and I realise is our boundaries around what
we can actually do and what we can't." Gay Elliott, community support worker.

More information

Contact

• Douglas Alderson at douglas.alderson@sdhb.govt.nz, or phone 03 214 5786, extension 8194.
• Gay Elliot at gay.elliot@sdhb.govt.nz ,or phone 03 214 5786, extension 8173.

Website

• Southland District Health Board

Documents/links

• Community support workers - enabling change in the mental health workforce (PDF, 86KB). A paper by Gay Elliot and Douglas Anderson, presented at TheMHS conference, Auckland, September 2008.
• Skills Matter providing information about different training in mental health services, including community support.
• Aotearoa mental health and addiction support workers , a social networking website.
  

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Community support workers team, Southland District Health Board (PDF)

 

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Page last updated: 7 November 2008