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Kristy, FACS Caseworker

I first met Rachel early in her third pregnancy. She was anxious we would take her baby.
Rachel has faced enormous adversity and suffering in her life. She has Spina Bifida and is in a wheelchair. She also has a congenital brain condition which includes a mild intellectual disability, and has a shunt in her head to alleviate swelling. When she was a child her dad was in gaol and her mother struggled to care for her. Sadly her relationship with her mum broke down when Rachel was a teenager.

As a young woman Rachel married Ben. He was violent and controlling. He would lock her in the house, imprisoning her. She was terribly isolated. Rachel told me that during this time she used drugs as a way of coping with Ben’s violence.

Rachel and Ben had a little girl, Josie, who is now two years old. When Josie was still a baby she went to live with Ben’s mum. Rachel’s experience of this was that Ben’s mum stole Josie from her. Rachel went on to become pregnant again soon after. Tragically she lost her son, Harry, late in her pregnancy after Ben assaulted her, pushing her from her wheelchair.

Soon after the loss of Harry, Rachel became pregnant again. Then Rachel did the bravest thing a mother can do and left Ben. She took out an AVO to protect herself and her unborn baby. She was so motivated by this new baby. Rachel was living with her mum and having difficulty finding stable housing. Ben had smashed up their property and she was trying to pay off the repairs.

When I started working with Rachel we decided that it would be best to help her build a safety and support network, recreating her connections with the community after being so isolated. I became a coordinator of all the different services that came on board to support Rachel, but I was guided by her thoughts about what she needed. We found a range of supports for her medical needs, prenatal care, housing, social support and disability.

Sadie arrived six weeks early. She was born with Spina Bifida and the same congenital brain condition as her mum. This meant that Sadie needed to stay in the Special Care Nursery. In the first two weeks, we were getting some worrying information from hospital staff about how Rachel interacted with Sadie. I tried to think what might be holding her back? I knew she was anxious and I understood why. The last time she was in hospital her son was stillborn and being back there magnified this pain. It was hard to assess bonding in the Special Care Nursery, but what I was seeing in the relationship between Rachel and Sadie was positive.

The long stay in hospital gave us the space to get a picture of Rachel’s strengths and worries for Sadie when they moved home. Although there were positives, at times I felt frustrated and very worried because I was not seeing much change. We would talk to Rachel about what needed to happen, but when next week arrived, nothing had changed. Rachel didn’t remember what was agreed to or she would say that she had not agreed to it.

I spoke to my manager about my worries. We needed new ideas. At that time I felt like it was inevitable that Sadie would come into care. There were real risks for her. My manager suggested group supervision so I invited our psychologist, casework specialist, the Spina Bifida team, maternity social worker and the clinical nurse consultant to the meeting. This group of people meant we could share our variety of expertise and really get clear on what was happening for Rachel and Sadie. Group supervision really helped me to sit with the risk. When I was feeling stuck, together we were able to find new strategies to try. Our psychologist suggested that Rachel have a cognitive assessment, because of some of the challenges we were experiencing with her following through. This assessment turned out to be a real game changer. It helped us to understand Rachel’s level of functioning. It was clear we needed a different approach. We persevered and thought creatively. We stopped trying to change Rachel to fit in with us.

Before this, I believed Rachel was being resistant. I realised we just hadn’t helped her to really understand what we wanted. I got a better understanding of how to communicate with Rachel. I totally redesigned the assessment and case planning approach so that it met her needs. This change in approach kept Sadie safe with her mum, and we built in a plan for Rachel’s mum to live upstairs as extra support. I simplified the case plan so it was a reminder of the tasks Rachel had agreed to follow up. I laminated the case plan and stuck it on the wall along with a calendar with tasks and responsibilities. Rachel gave me some lovely photos of Sadie to stick on it as a motivator and reminder. At first I wasn’t sure if Rachel would use the calendar, but she did.

I came to appreciate just how hard it is for people with disabilities to navigate the service system and get real help. This was especially hard for Rachel because she did not have stable housing. Once she was settled into housing, everything started to fall into place.

My work and perception shifted from what she was or was not doing, to what we were doing. What we needed to do differently. After I changed my approach I started to see Rachel follow through and make changes.

Sadie is now nine months old. Rachel and Sadie have a lovely relationship and Sadie is thriving. This change could not have happened without giving Rachel the opportunity to see that she could trust me and the other workers involved. With the support of her mum, Rachel is now exploring her legal rights to have Josie returned to her care.

I am so thankful that I have a supervisor who is quietly confident. Who can slow things down so we have time to try new ways. She models openness, thinking out loud and considers how she may have got it wrong. This really helped me to name what I was worried about and manage uncertainty. This, in the end, was a key to helping Rachel.

Lianne, FACS Manager Casework

At different times we considered the need for Sadie to come into care. Rachel was so frightened of Sadie being taken that for considerable periods she avoided services. Rachel was also at high risk of post natal depression because she had suffered from depression in the past, and because of the deep loss and violence she had experienced. We were worried.

Being creative and tenacious was really important. A change in approach was needed and it was critical to keeping Sadie safe. And this is what we did, we changed our approach and it’s working. There is always something more you can do before the next, more intrusive option.

Reflection

Rachel's story is incredibly inspiring and I am in awe of her bravery! The challenges she has faced in her life are tragic and beyond the scope that many of us could even begin to understand. Kristy’s work with Rachel is also inspiring and demonstrates so clearly how much can be achieved when caseworkers can help parents find hope, reflect on their own practice and their client’s progress and work creatively.

It is very clear that Rachel and Kristy worked as a team to address Rachel capacity and needs and Kristy was able to change and adapt her practice as Rachel’s needs changed. It is also clear that the relationship Kristy had with her Manager helped her to overcome challenges she faced in her practice and demonstrates the importance great leadership and how it can help develop and support great practice.

This is a story I would love every new caseworker to read and to use as inspiration in their future work. Our clients need us to have hope for change, courage in managing risk and uncertainty and creativity how we approach our casework.

Lisa Charet
Executive Director, Western Sydney and Nepean Blue Mountains Districts

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Last updated: 19 Nov 2019