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Although much is known about psychopathology such as post-traumatic stress disorder (PTSD) and depression following bushfire (also known as wildfire), little is known about prevalence, trajectory and impacts for those experiencing general adjustment difficulties following exposure to these now-common events.
Aims
This was an exploratory analysis of a large cohort study that examined the prevalence, trajectory and risk factors of probable adjustment disorder over a 10-year period following bushfire exposure.
Method
The Beyond Bushfires study assessed individuals exposed to a large and deadly bushfire across three time points spanning 10 years. Self-report survey data from participants from areas with moderate and high levels of fire-affectedness were analysed: n = 802 participants at Wave 1 (3–4 years post-fires), n = 596 at Wave 2 (5 years post-fires) and n = 436 at Wave 3 (10 years post-fires). Surveys indexed fire-related experiences and post-fire stressors, and comprised the six-item Kessler Psychological Distress Scale (probable adjustment disorder index), four-item Posttraumatic Stress Disorder Checklist (probable fire-related PTSD) and nine-item Patient Health Questionnaire (probable major depressive episode).
Results
Prevalence of probable adjustment disorder was 16% (Wave 1), 15% (Wave 2) and 19% (Wave 3). Probable adjustment disorder at 3–4 years post-fires predicted a five-fold increase in risk for escalating to severe psychiatric disorder (i.e. probable fire-related PTSD/major depressive episode) at 10 years post-fires, and was associated with post-fire income and relationship stressors.
Conclusions
Adjustment difficulties are prevalent post-disaster, many of which are maintained and exacerbated over time, resulting in increased risk for later disorder and adaptation difficulties. Psychosocial interventions supporting survivors with adjustment difficulties may prevent progression to more severe disorder.
In the last of our metaphorical distinctions, we turn to the group of theories and perspectives within social work that seek to eliminate disadvantage and empower people to realise their hopes and aspirations. Over time, these theories have been described in many ways: as activist, progressive, structuralist, political, radical, anti-oppressive, decolonising and emancipatory, to name just a few. In a sense, they apply ‘mountain-moving’ effort to create a more equal society. Mountain-moving theories stretch this effort, conceptually and practically, across individual, family, community and societal concerns. Understanding the nature of injustice and social inequality is of critical importance, and changing structures, systems and processes to increase their responsiveness to these concerns is a key practical activity in reducing disadvantage. Nevertheless, as we look at the development of these theoretical ideas over time, we will see the complexity of incorporating a social action reform agenda within contemporary practice environments.
Social workers practise across a wide range of settings, with all kinds of different people who have diverse cultural experiences. Some work primarily with individuals, whereas others work with families or groups of people in therapeutic or community contexts. Some social workers focus on community advocacy, community action and social change. In such diverse practice contexts, the notion of theoretically informed practice can seem complicated. Yet social workers do draw upon a range of theoretical perspectives in their work, using theory to help understand and make sense of what is, in reality, a complex human world. Many theories used by social workers can also be found influencing the practices of allied professionals: counsellors, psychologists and others working within health and human services. We would argue that theory applied in social work has a disciplinary character that distinguishes it from the application of the same theories across allied disciplines. This is because knowledge and theory in practice are critically influenced by disciplinary attachments and the underpinning values and nature of the profession itself.
To suggest that social work theory and empirical research necessarily inform and strengthen practice under-estimates the difficulties involved in bringing together conceptual and practical endeavours. Building linkages between theory, research and practice has been a long-standing challenge in social work. Busy practitioners have little opportunity to keep abreast of new research, and the higher-order nature of some theories and perspectives means that they lack the capacity for straightforward translation into practice. As a consequence, models of practice have emerged from theoretical ideas. These function as bridges between broader theoretical ideas and intervention strategies used in daily practice. For example, empowerment perspectives (see Chapter 8) do not provide a tractable practice pathway, yet the family group conference is a good example of a practice model that can trace its roots to the empowerment tradition. This is an example of a practice model that has emerged from theoretical concepts and ideas. When theory, knowledge and practice come together in this way, the result becomes part of a rich and continually evolving intellectual tradition within social work.
Throughout this book, we have explored the ways in which we bring theory to our practice as social workers. This process is a complex and continuing one. As theoretical understandings change and develop over time, and as service systems change, we develop our understandings, practice wisdom and insights. Social work as a profession has been strong in emphasising both the need for more formalised reflective practice and the opportunities that social work supervision presents to consider how practice can be improved through processes of critical reflection. In this chapter, we look at the skills involved in critical reflection and how social work as a profession benefits from engaging in reflective and reflexive, theoretically informed practice. So, we explore the elements of successful supervisory relationships, as well as some ways of thinking about supervision within the client, worker, agency and community system. Then we return to the importance of the cultural lens in supervision – ensuring culturally responsive supervisory practices as one vital way of supporting optimal practice.
Social workers will often say that they use systems theories in their practice. People are inextricably linked to their environments, and theories that call on systems of experience and interaction tend to make logical and practical sense to workers in daily practice. Systems theories help us to think about these interactions between people and their social and physical environments, and they also help us to understand how change can occur through the use of ecosystem interventions.In this chapter, we will explore the development of systems theory and how some key thinkers in the systems theory approach have informed social work practice. An examination of some of the key systemic thinkers and their understandings of systems theories will serve to illustrate how these theories have evolved, and how they have shaped practice in different and significant ways. Finally we will explore contemporary systemic adaptations, and in particular, how a broader systems analysis informs service navigation.
Stories become powerful narratives that influence human well-being and identity. In the same way as these life narratives create meaning for us, story-telling theories in social work focus on the stories we live by, as individuals, families and communities. By listening to our own internalised stories and others stories, we can begin to understand both their meaning and the influence they have on the ways that people live their lives. Story-telling theories are critically interested in this, and in the ways that stories can be reauthored to enable more positive and rewarding life outcomes. Story-telling as a therapeutic process has been most fully articulated in narrative therapy. Throughout this chapter, we explore how narrative work enables people to cope more effectively with adversity and difficulty. Stories can also transform communities and societies, and we will look at how giving voice to these stories can transform marginalised, silenced and oppressed people and communities. But before we explore narrative ways of working, we will first look at a broader influence that has supported narratives of strength and resilience: the strengths perspective in social work practice.
In this chapter, we look at behavioural approaches, and the more recent cognitive behaviour approaches, that provide a lens of change on how people think, feel and behave. In the second half of this chapter, we look at mindfulness approaches, and how they build on some of the core tenets of cognitive behavioural approaches as well as spiritual and cultural approaches. The chapter concludes by examining critically the strengths and limitations of these approaches.
We have used the metaphor of onion-peeling to describe the characteristics of insight-focused theories because they seek to peel back layers of experience to reach understanding. Like an onion, human experience reflects a layering: layer upon layer, it builds up around us and influences our lives, sometimes in complex and repetitive ways. Awareness and insight lead to change and optimal functioning. The onion-peeling metaphor is relevant to several key theoretical approaches. In this chapter, we explore two that have been particularly influential in the development of social work thinking: psychodynamic and person-centred approaches. As with the ecosystem collection of theories, both psychodynamic and person-centred approaches have extensive histories and traditions. In this chapter, we draw together core ideas from the psychodynamic and person-centred theories that we think best capture the essence of the onion-peeling tradition.