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Forensic Medicine Social Work Model of Care 2020
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Executive Summary Every year approximately 6500 deaths are reported to NSW Coroners.
Each death reported to a NSW Coroner means there is an individual, a family or a community suddenly bereaved and who may be directly involved in the coronial pathway.
Families involved in the coronial pathway, during a period of grief and loss, may suffer repeated trauma and are at high-risk of poor health, psychological, social and economic outcomes.
The Forensic Medicine Social Work Team provides care coordination and case management activities across a care continuum to support bereaved families accessing the coronial pathway and is a crucial service for NSW.
The NSW Forensic Medicine Social Work Team contributes to the timely access to information, supports families to be able to express their grief in a safe environment and contributes to the commencement of the restoration of health and wellbeing following the death event.
NSW Health Pathology greatly values the crucial service provided by this team of highly dedicated Social Workers and is committed to ensure continued effective and
sustainable Forensic Medicine Social Work services for the NSW community into the future.
In 2018/19 utilising the Agency for Clinical Innovation Healthcare Redesign methodology, a project team was mobilised to identify key service issues, improvement opportunities and to document the service model.
This report represents the cumulative redesign work and outlines the current service model, the redesign findings, sets the priorities of the service and summarises on-going improvement opportunities.
Dr Isabel Brouwer
Chief Forensic Pathologist, Clinical Director – Forensic Medicine NSW Health Pathology
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Contents Executive Summary 2
Acknowledgement 4
Glossary 5
NSW Health Pathology Values and Strategy 6
Introduction 7
NSW Health Context 9
Forensic Medicine Social Work Context and Practice 9
Forensic Medicine Care Continuum & Service Integration 15
The Coronial Pathway in NSW 18
Social Work Scope of Practice 22
Governance 26
Ethics 30
Statutory and Policy Context 30
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Acknowledgement The Forensic Medicine service would like to acknowledge the generosity of bereaved families who shared their experiences and participated in the counselling pilot in order to inform the service changes. At a time of grief and loss they were able to make a positive contribution to the future of this important service.
Contributors Documentation of the Forensic Medicine Social Work Model of Care (MoC) has been guided by the following people.
Redesign Project Team: Angela Morgan, NSWHP Redesign Lead Colleen Fitzpatrick, Team Lead, Sydney Forensic Medicine Social Work Service Danny Nugus, Team Lead, Newcastle Forensic Medicine Social Work Service Kimanh Fok, FASS Quality Officer Consultation: Forensic Medicine Social Workers; Newcastle, Wollongong and Sydney Local Members for Parliament Project Sponsor: Dr Isabel Brouwer Chief Forensic Pathologist, Clinical Director - Forensic Medicine Meredith Caelli Manager Audit and Risk, NSW Health Pathology Phuong-Loan (Juliet) Nguyen Performance and Reporting Officer, Forensic & Analytical Science Service Leadership Group: Michael Symonds Executive Director, Forensic & Analytical Science Service Rebecca Gigli Chief Operating Officer, Forensic Medicine Alex Bird Deputy Operating Officer, Forensic Medicine Roslyn Wilson Quality Manager, Forensic & Analytical Science Service
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Glossary AASW Australian Association of Social Workers
ACI Agency for Clinical Innovation
CC Coroners Certificate
CCMU Coronial Case Management Unit (Sydney)
CISP Coronial Information and Support Program (state-wide, based in Sydney)
CNC Clinical Nurse Consultant
CSU Coronial Support Unit
CST Coronial Support Team
FM Forensic Medicine
FMLT Forensic Medicine Leadership Team
DC Death Certificate
DOJ Department of Justice
DVI Disaster Victim Identification
FASS Forensic and Analytical Science Service
FMCCC Forensic Medicine & Coroners Court Complex
FMSW Forensic Medicine Social Work
FP Forensic Pathologist
ICOD Interim Cause of Death
IHI Institute for Healthcare Improvement
MOC Model of Care
NATA National Association of Testing Authorities
NSWHP NSW Health Pathology
OIC Officer in Charge
PM Post Mortem
P79a Police report of death to the Coroner
RTC Regional Triage Centre (Newcastle)
SASP Support After Suicide Program
SUDI Sudden Unexpected Death of an Infant
SNOK Senior Next of Kin
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NSW Health Pathology Values and Strategy The Forensic Medicine Social Work Service displays the NSWHP RITE values:
Respect We acknowledge and value the opinions, skills and abilities of others and treat everyone with dignity and respect.
Integrity We act professionally, honestly and consistently and are accountable for our decisions and actions.
Teamwork We recognise the contributions of others, value diversity and collaborate with others to achieve our goals.
Excellence We strive to exceed expectations by delivering innovative, quality services and outcomes.
The work that Forensic Medicine performs is guided by the NSW State Health Plan: Towards 2021 and NSW Health Pathology Strategic Plan: Towards 2025.
Forensic Medicine aligns with NSW Health Strategic Direction 2: Providing World-Class Clinical Care. Forensic Medicine seeks to drive better clinical performance, whilst maintaining a continued focus on quality and safety in all aspects.
The Forensic Medicine Social Work Service contributes to the NSW Health Pathology Strategic Plan: Towards 2025 and directly addresses three of the strategic directions:
Strategy One: Keep People Healthy and Safe The Forensic Medicine Social Work team improves the health of the community by working with bereaved people to promote the health, safety and welfare of individuals and families exposed to the Coronial system.
Strategy Two: Integrate Systems to Deliver Truly Integrated Care The Forensic Medicine Social Work team supports the needs of families by integrating with our Justice and Police partners to improve access to information and support services for people across service domains.
Strategy Three: Develop and Support People and Culture Forensic Medicine Social Work team actively promote a commitment to diversity in the workplace and seek to be inclusive of all people. Social Workers ensure families can express their cultural and spiritual practices in a respectful, supportive environment.
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Introduction Forensic Medicine is responsible for conducting post-mortem examinations on behalf of the NSW Coroner as part of investigations into reportable deaths under the NSW Coroners Act (2009).
There are approximately 6000 reportable deaths per annum. This includes unexplained and unexpected deaths, and deaths of a suspicious nature.
Forensic Medicine is part of a state-wide service, under NSW Health Pathology’s Forensic and Analytical Science Service (FASS), with three facilities (Sydney, Newcastle, and Wollongong).
The scope of work conducted by Forensic Medicine includes, but not limited to:
• Providing information to the judicial system to assist in criminal investigations
• Providing expert testimony on all aspects of Forensic Pathology
• Attending crime scenes to provide in-field expertise
• Supporting mass casualty disaster victim identification
• Providing pivotal input and assistance to help identify unclaimed and unidentified bodies
• Provide teaching and training for medical students as well as health, emergency and law enforcement professionals
• Other specialist services such as anthropological examination of skeletal remains and Forensic Odontology services
The three FM sites across NSW provide a Forensic Medicine Social Work (FMSW) service within multi-disciplinary teams. FMSW is a conduit between Forensic Medicine, families, communities, partner agencies and external stakeholders in the coronial system, providing a vital service in response to approximately 6000 Coroner-reported deaths in NSW each year.
There is significant cost to individuals, families and communities as a result of sudden, unexplained and traumatic deaths. Families and individuals faced with sudden bereavement are highly vulnerable and can develop poor long-term physical health, psychological health, economic and social outcomes.
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Navigating the coronial pathway adds to the emotional, social and financial burden experienced by some families. The work of FMSWs improves the experience of families, their health, social and financial outcomes through timely access to relevant information and emotional support.
The sudden death of a family member is distressing, there is chaos and I felt like I was in a constant state of helplessness.
(What I needed was) easy and timely access to the medical information, and communication and explanation of the process.” (Client of the Forensic Medicine Social Work service)
FMSWs in the coronial and Forensic Medicine context help support and improve the experience and outcomes of families suddenly bereaved. FMSWs are grief and loss specialists due to their professional training, ethical framework (AASW Code of Ethics), and unique understanding of and ability to advocate and intervene within the health and legal systems.
‘Clients have expressed that access to timely, accurate information in a safe and supported way is a crucial factor that helps them cope with the fear, anxiety and trauma associated with the death. This allows them to make meaning of what has happened, be able to express their grief and not feel powerless in a complex environment.’ (Senior Forensic Medicine Social Worker)
Due to the complex environment in which FMSWs operate, having a clear clinical framework and service model is an important factor. The service model aims to bring together the cumulative understanding of the role of the service within a care continuum, set the direction for the service and articulate where the gaps and opportunities are for improvement.
The content of this document is multi-dimensional and describes the state-wide service model for FMSW including a description of the people who may need this service, how services are delivered and the environment in which it operates.
The model of care aims to increase the transparency in the context the service operates, how this directs service activities and the way services are delivered for the people of NSW.
It is based on the best available evidence in relation to social work practice in the area of grief and bereavement with an appreciation that there is currently limited evidence or research into social work services in the context of the coronial pathway. The model is family-centred, supports an integrated approach to the care continuum, demonstrates efficient use of resources and is safe and effective for people of NSW.
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NSW Health Context NSW Health is committed to delivering outcomes and experiences that matter to patients and the community through a value-based healthcare approach. In NSW, value-based healthcare means continually striving to deliver care that improves:
• health outcomes that matter to patients
• experiences of receiving care
• experiences of providing care
• effectiveness and efficiency of care.
These four essentials of value are also known as the quadruple aim.
Forensic Medicine Social Work Context and Practice The FMSW team provides a service to NSW Health Pathology and more broadly NSW Health.
NSW Health Pathology works in partnership with the NSW Department of Communities and Justice and NSW Police to provide a forensic medicine service across the state. The state-wide service operates across the Sydney, Wollongong and Newcastle sites.
Forensic Medicine Social Work teams work with the Senior Next of Kin (SNOK) of deceased persons when a death is reported to the NSW Coroner.
The Forensic Medicine Social Work Service provides:
• individual and family information
• education and support in the immediate days following the death
• care coordination and case management activities
• a conduit to enable access to on-going community support services.
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Forensic Social Work Key Principles Service principles to describe key principles that are important to clients of the Forensic Social Work team have been identified through consultation. The principles are translated into services and activities to ensure families and individuals receive the care they value.
Service principle Description Related activities
Access Proactive telephone contact to introduce access to FMSW service to guide and support families through coronial FM pathway. Skilled and sensitive conversations.
Clarifying and helping to resolve legal and procedural complexities to ensure smooth functioning of coronial pathway, that families’ voice is heard, and SNOK can access service.
The environment is comfortable and welcoming for bereaved families and the cultural and spiritual needs are considered.
FMSW will work with families to identify the type of support required and provide alternate referral options.
The SNOK will be contacted on the next business day of admission / notification of the death (P79a) and a plan of contact discussed to meet the expressed need of families
Person & family centred
Care provided recognises individual family complexity and varying needs following a sudden bereavement.
Care is conducted in a culturally and spiritually sensitive manner.
Care is provided within a framework that responds to the social, emotional and cultural context of the individual.
The FMSW support plan includes an assessment of family complexity, risk factors, and needs
Cultural and spiritual needs are noted and escalated to all stakeholders to ensure cultural requirements are understood and met.
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Collaboration, Integration and continuity of care
FMSW team provide an integrated approach along the care continuum.
Partnerships and linkages are developed to ensure families are not disempowered by the complexity of the coronial pathway.
FMSW participate in cross sector care planning and service delivery
FMSW maintains key partnerships with aligned service to ensure families can access the type of care they require
FMSW works with the Forensic Medicine and interagency teams to ensure the needs of families are represented.
Trauma informed practice and individual focused care
Recognition of the impact of trauma is considered in the service plan and approach to care.
Understanding that each individual will react differently to sudden bereavement and trauma and will require individualised approaches.
The service will promote informed and supported choices to responsibly manage exposure and access to potentially distressing or confronting information that a person’s individual needs require
Care is focused on building the individual’s understanding of the Coronial Pathway, their rights, responsibilities, choices and options to empower and promote autonomy and identify and mobile internal and external resources.
FMSW will assess the individual and family context of the traumatic event and incorporate this into the plan of care
Forensic Individuals will be supported by a Social Worker when viewing the deceased or accessing information relating to the death
The SNOK will be provided with relevant and personalised information relating to the Coronial Pathway
Individuals and families will be referred for long term bereavement services where required.
Safety and quality
The service is based upon the best available evidence and is constantly evolving to meet the community’s needs.
Clinical and operational governance systems are in place
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Staff work within their scope of practice, have meaningful development opportunities and are appropriately supported to work within the Coronial context.
Quality improvement activities are conducted to continuously evolve the service
Staff have access to clinical supervision, professional development and support services
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Evidence base The model of care for FMSW includes an application of available evidence to support the social work interventions. The FMSW Service incorporates a range of contemporary grief and loss models and theories to provide a targeted, holistic and individualised response to people’s divergent, pervasive and complex needs.
Therapeutic strengths-based, narrative, trauma-informed, and person-centred counselling approaches are embedded into the role and functions of the FMSWs. It is recognised that there is no ‘one-size fits all’ approach. A medicalised diagnosis and treatment model of therapeutic intervention is not adequate, applicable or practical for a dynamic and responsive service designed to inform, support, advocate for, and empower families through the coronial and forensic systems.
The evidence relating to families’ needs post disaster and social work strategies in Disaster Victim Identification (DVI) is relevant to FMSW intervention. The needs and responses identified in post disaster literature include: clear, accurate and sensitive information; honest and open explanation of process; confirmation of death and location of body; support to view and access to body/remains; knowledge of what happened, i.e. how they died, did they suffer; practical, financial, emotional support; ongoing information with supported access to PM / DVI results, reports and photographs; peer support with other families; proactive ongoing support and access to counselling at a later time if required with trusted professional.
An examination of the existing evidence base was conducted by a service consultant in 2015 to determine if the service offerings were in-line with effective models. A summary of the key literature review findings relevant to the context of forensic social work service provision, grouped under three themes, is as follows:
1. Current social work practice
• There is very little national or international literature relating to best practice models specifically for forensic counselling services
• The main practice models in the Australian context documented includes services within coronial or forensic medicine organisations
• Australian documented practice models include social work provision of legal and medical information and grief and bereavement support in the initial days following a death. Forensic Social Workers are described as being skilled in emotional support, knowledgeable of the legal and investigative processes and able to assist equalise the power imbalance between families and the legal and medical systems
• Longer-term counselling is not available in documented Australian models.
• International social work practice models documented mainly consisted of services provided in the USA. Social Workers work within the Office of the Chief Medical Examiner and have a main focus on crisis intervention, follow-up
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bereavement support and referral assessment. Some additional social work led programs are documented including those aimed at reducing the impact of trauma on children, families of homicide victims, and families where a child has died.
2. Grief and loss theory, crisis support, models of social work grief counselling, support and intervention
• The impact of the sudden and traumatic nature of Coroner-reported deaths, and the additional complexities of the coronial process, can compound and exacerbate people’s grief and associated needs, requiring specialised immediate and longer-term interventions
• Effective crisis support aims to stabilise acute distress, manage the upsurge in distress and help the individual obtain function and provide links to ongoing interventions and care. Early crisis support improves an individual’s long term psychological outcomes.
• Crisis support: normalising grief reactions has a protective mechanism in the development of significant psychological problems
• Facilitation of body viewing: all viewings that are facilitated by a Social Worker for support provides the relatives with the opportunity to begin processing the death event and receive information and support regarding the Coronial and forensic processes. The presence of social workers is effective in reducing the confronting clinical environment for individuals and facilitates and opens the space for the construction of meaning and the expression of loss
• All forms of bereavement are associated with potentially deleterious health and social outcomes for bereaved children and adults. Risk and identified need can vary depending on individual risk and protective factors. The suddenness and additional and prolonged complexities surrounding the death can increase risks for people bereaved following sudden or unexplained deaths. Some research highlights increased risk and vulnerability for parents of deceased children, bereaved children, and people bereaved by suicide.
3. Vicarious trauma
• Evidence demonstrates that vicarious trauma occurs through empathetic engagement with trauma survivors and exposure to traumatic materials and is a foreseeable outcome for social workers working in the area of grief, loss, sudden death and trauma
• The effects of vicarious trauma are cumulative and, without appropriate preventative and management strategies, can permanently change a social worker’s inner experience, for example: intrusive imagery, increased safety fears, avoidance of violent stimuli, emotional numbing and poor emotional and physical health.
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Research NSW Health Pathology is dedicated to supporting and promoting high quality research by developing a research environment where ongoing education, learning and improvement is encouraged. Research in the coronial context will provide a basis for further service improvement and refinement of the model of care.
Research activities should be considered and developed in the future Forensic Medicine FASS-wide initiatives and research findings translated into new clinical care practices for the benefit of the community of NSW
Forensic Medicine Care Continuum & Service Integration The Forensic Medicine Social Work service supports a continuum of care involving multi-disciplinary specialist support teams of Forensic Pathologists, Post Mortem Technicians, Radiographers, Radiologists, Clinical Nurses and Administrative staff. Within the coronial context the continuum of care is interdependent across aligned providers including the Department of Justice (DOJ), Police, and Local Health Districts and internally across FASS. Each agency has specific roles and responsibilities.
In the delivery of services to NSW, the Forensic Medicine Social Work team develops key partnerships with Local Health Districts and government and non-government agencies to support the continuum of care to NSW families.
FMSW is a part of this system and has a specific focus on providing case management and care coordination across the continuum. FMSWs are integrated within the Coronial Case Management Unit (CCMU; Sydney) and the Regional Triage Centre (RTC; Newcastle).
Integration of FMSW staff with other internal FM disciplines/teams supports the development of an inter-disciplinary model of service delivery that aims to ameliorate the complexities within the health and Coronial Pathway.
Deceased and family care continuum
Autopsy & medical
examination SW Services
Transport services
Funeral services
On-going social
and psychological
welfare services
Coronial investigation
SW & Court
Services
Death investigation
Death
notification
Acute/post acute care
health services
Funeral industry
Social welfare agencies
Coroner
Police
Forensic Medicine
Local Health Districts
Non-government agencies
Department of Justice
NSW Health
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Timeline of Service Activities The provision of Forensic Medicine Social Work services occurs in the immediate days following a death that has been reported to a NSW Coroner and commencement of the Coronial Pathway. Initial contact occurs on next business day following admission.
Follow up occurs when coronial directions are received or when clients call the service requesting social work support. Further contact occurs when discharging a coroner’s certificate, following the post mortem examination to provide interim findings and to confirm release details.
In the continuum of care Forensic Medicine Social Work services extend beyond the initial referral period to post finalisation of the autopsy report to the Coroner.
This additional contact is in support of the care plan and provision of advocacy, case planning/referrals, provision of information, support with medical reports, suicide notes and referral to appropriate supports. On-going counselling, social, financial or psychological support is referred to external agencies.
The service model delivers short term care coordination, acute care to families and individuals and in the medium-term case management and follow up in support of the above.
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This timeline aims to reflect the planned approach to Social Work contact depending on each individual family’s needs. Due to the nature of reportable deaths, unpredictable admission rates, complex death investigations and staff availability, this timeline may not represent actual timeframes in some cases
Social Work objectives and time lines
At SNOK request
3-12 months Post 12months
Day 4 -7 Day 2 - 3 24 hrs
Assess: On-going grief response, education and information requirements
Need for on- going supports
Provide: Support to obtain and understand medical reports
Evaluate: Referrals, advocacy and case management activities
Provide: Interim COD and medical investigations carried out
Information: Legal and court contacts Organ retention Body release timeframes
On-going education and emotional support
Referral to on- going support services or SASP
Assess: Need for on- going support
Provide: Progress update
Information & support for grief response
Information how to access on- going support services
Case Planning: Advocacy and coordination of family requests
Provide: Care coordination and case management activities
Referrals Advocacy Priority reports
Support: Court, family and Coronial communications
Clarify: On-going objections and disputes, unblocked tissue
Assess:
support and educational needs
Provide: Support for grief response, information and education
Notify: Coronial direction Examination plan Transport plan
Clarify: Requests for viewings
Prepare: Arrange viewing with mortuary and family
Provide: Prepare family for viewing Support family memory making
Support grief response
Clarify: Care & treatment SNOK disputes
Assess: Immediate level of distress Cultural and spiritual requests
Provide: Emotional first- aid, normalisation of grief response
Information relating to location of deceased and plan
Resolution contact
Discharge contact
Follow-up contact
In-direct activities
Progress contact
Supported viewing
Initial contact
Stage 5 – Case Management
Stage 3 – Examination & Investigation Stage 4 – Coronial Findings Stage 5 – Case Management
Stage 2 Mobilize and Report & Stage 5: Case Management
Stage 2 Mobile & Report
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High-level representation of service integration approach
FM Sydney FM Newcastle
Coronial Case Management Unit Regional Triage Centre
Duty Coroner
Duty Pathologist
Coronial Support
TeamClinical Nurse
ConsultantSocial
Worker – Family liaison
Radiographer
Registry Officer
CCMU Coordinator
CCMU
Police Local Area
Commands
NSW Police
State Coroner (Sydney)
Regional Coroners
Department of Justice
FM Wollongong
Duty Pathologist
Social Worker – family liason
AdminIstration Officer
Case Coordinator
RTC
Clinical Nurse Consultant
Radiographer
The Coronial Pathway in NSW The coronial pathway begins on notification of an unexplained/unexpected death by the Police to a NSW Coroner and concludes once all Police, legal and medical investigations have been completed and the Coroner makes a determination on the cause, manner and time of death and any medical, legal or criminal implications for individuals or the community.
There are two pathways through the coronial pathway: pathway one results in the issuing of a Coroners Certificate (by the Coroner) or Death Certificate (by the GP or treating Doctor); pathway two results in an autopsy.
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Pathway One
Pathway Two
Police investigation
Coronial notificationDeath
Coronial order
Autopsy required?
No
Yes
Coroners Certificate
Medical Certificate Cause of
Death
Autopsy
Police
Health
Coroner
Application of the coronial pathway across NSW agencies Across NSW, coronial reportable death notifications are triaged between the Sydney CCMU and the Newcastle RTC. Geographical referral lines are distinguished through the Police Area Commands and associated court of jurisdiction.
Each case progresses through the coronial pathway dependent on the context of the death and available information. The interventions carried out across the agencies to support the referral to progress to outcome operate within the same framework.
Key principles in this process include minimisation of transportation of deceased people, minimisation of disruption of bereavement, acknowledgement of religious/cultural needs and support of the NSW Coroners Act 2009 to determine the cause of death using the least invasive procedure.
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High-level representation of the Coronial Pathway in Sydney catchment areas
Death Death notification
Police investigation
Reportable death?
Funeral Director
No Yes
FMSydney
Collate case documents
Imaging\upon admission where no objection
Remote triage Direct admission
Collate case documents
Body admission
CCMU
CSU(Police Sergeants)
Quality review P79a
Coordinating identification
Obtain & review of
medical history & case notes
FMDuty Path & CNC
Arrange viewings
FMSW Family Liason
Initial contactPathway 2
CISP
Contact SNOK re: objections
Initial & follow-up contact
pathway 1
Contact SNOK re: organ retention
Medical opinion to Coroner
Court info & inquest support
Police Health Coroner
No Yes
Issue Coroners Certificate
Duty Coroner(of Court)
Coronial order
PM required?
Review all case information
Pathway 1
Autopsy Medical report
Pathway 2
CCMU Coordinator
Communicate with GP:
Death Cert
Producing orders
Synopsis for Coroner
Pathway 2
Initial contact
Supported viewings
Final PM report
Contact SNOK re: unblocked
tissue
Discharge contact
Progress contact
Follow-up contact
FMSocial Workers
Non-admitted cases in regional sites
Coordinating identification Court briefing
Destitute application
PoliceOIC
Morning ward round
Funeral Director
Funeral Director
Case/care coordination
Support open disclosure
Contact SNOK re: Coroners Certificates
Coronial disposal/transport
order
Coronial decision to dispense of
matter
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High-level representation of the Coronial Pathway in NSW regional catchment areas (this denotes all rural/regional coronial referrals to the Newcastle & Wollongong facilities)
Non-admitted cases in regional sites
Death Death notification
Police investigation
Reportable death?
Funeral Director
No Yes
FMNewcastle
Collate case documents
Imaging\upon admission where no objection
Remote triage Direct admission
Collate case documents
Body admission
RTC
Obtain & review of
medical history & case notes
FMDuty Path & CNC
Communicate with GP re:
Death Certificate
Initial contact
FMSW Family Liason
Medical opinion to Coroner
Police Health CoronerIssue Coroners
Certificate
Administration
Receipt doc’s from agencies
Data entry
Communicate progress to
agencies
Initial contact
Clarify SNOK & objection
status
Liaise with OIC P79a updates
Retrieve information
from OIC
No
Funeral Director
Yes
Duty Coroner(of court)
Coronial order
PM required?
Review all case information
Initial contact
Progress contact
Supported viewings
FMSocial Workers
Contact SNOK: re: unblocked
tissue
Discharge contact
Case/care coordination
Follow-up contact
Autopsy Medical report
Contact SNOK re: Coroners Certificates
Pathway 1 & 2
Funeral Director
Case Cordinator
Chief Pathologist & Operations Manager
Morning ward round
Destitute, ID’s, skeletal remains,
monitoring case progress
Support open disclosure
Coronial disposal/transport
order
Coronial decision to dispense of
matter
Final PM report
Contact SNOK re: objections
Contact SNOK re: organ retention
Court info & inquest support
CISPSydney
Coordinating identification Court briefingDestitute
application
PoliceOIC
CSU SydneyPolice Seargents
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Social Work Scope of Practice Forensic Medicine Social Workers possess extensive specialist knowledge, advanced reasoning skills and operate autonomously with minimal direct supervision.
Key professional capacity requirements to be demonstrated by a FMSW include:
• Provide care to clients in the context of complex circumstances and apply professional knowledge and judgement to complex or critical tasks
• Exercise independent professional judgement in solving problems and managing cases
• Provide clinical supervision, be involved in service improvement activities, service reporting, research and provide a consultative role within their area of expertise.
In addition, the FMSW Team Leads provide:
• Consultancy for the clinical area across a geographical region or clinical network • Provide advice to service managers on clinical service delivery, practice, redesign
and the development of clinical services in response to demand and client needs • Contribute to education activities in their area of expertise
The work of FMSWs within the Coronial context is focused on case management and care coordination across a continuum.
FMSWs approach each client or family in a collaborative manner to assess their needs. They then arrange, monitor or advocate for a package of services or activities across multiple service domains to provide consistency of care.
Forensic Medicine Social Work team representatives
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Aim of Forensic Social Work Interventions within the Coronial Pathway Social Work interventions are designed to support the needs of individuals and families throughout the Coronial Pathway with a key focus on psychosocial support and trauma experience.
Families can seek all information available to make meaning of the death event and to understand their loss and the potential health, financial and social impacts. Forensic Medicine Social Workers provide families with information and support in order to:
• help them to make sense of the death
• be guided with safety and expert care through the initial days and weeks
• experience compassion, humanity, choices and some control and comfort through the Coronial and Forensic Medicine processes
• provide assistance to guide and access initial and on-going health, social, financial, emotional, practical and community supports
Due to the multi-agency coronial pathway, the process can be complex for families to understand and navigate.
Medical, legal and technical information can be confronting; therefore, Forensic Medicine Social Worker support plays an integral role in case management and care coordination activities in order to de-fragment care, respond to expressed requests for support, and provide accurate and timely information and choices with the aim to empower families.
The case management and care coordination principles referred to in the scope of practice for Forensic Medicine Social Work are applied across a spectrum of case acuity and individual needs with key interdependencies managed across agencies during the coronial pathway.
Social Work Activity The broad range of activities provided by the FMSW service are described below. The activities may be interchangeable depending on the individual case, complexity and availability of information. The main service activities are broadly grouped and includes: Care Coordination, Case Management, DVI, SASP and facilitated identifications and viewings.
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Care coordination
• Engaging individuals and families in the Coronial Pathway • Development of supportive and empathetic relationships • Engage families in collaborative decision making • Development a plan of case management activities that meet
families expressed needs; telephone, email, and some face-to-face support
• Provide cross-discipline/agency support to families psychological, religious and cultural needs
• Provide intra-agency advocacy for families’ emotional, practical, legal, religious and cultural needs, liaise with court and police for increased access to information for families
• Advocate for families re: priority reports, certificates and court issued information and documentation
• Support families during open disclosure
Case management
• Review P79a, contact SNOK, confirm admission to FM facility and if relevant, seek further information on GP or Specialist details, care and treatment concerns, updates on coronial processes, discuss release expectations and escalate priority requests as appropriate.
• Communication; obtain medical information to expedite communication to families, any organ retention issues identified, manage communication of critical health impacts e.g. genetic referrals and manage specific cultural and spiritual requests
• Provide timely and accurate information to SNOK e.g. confirm admission/location of deceased person, convey any permissible information available, convey the plan for the deceased person, advise Coronial direction and plan/timeframes for examination
• Assess the immediate level of distress and trauma experience of impacted individuals and provide emotional first-aid and evidence-based strategies to assist with grief and bereavement, additional needs (e.g. memory collation, viewings, mediate family conflict, manage risk, response re specific needs of children) and referral to on-going supports (e.g. Red Nose, Homicide Victims Support Group)
• Documentation of contact outcomes in case files and relevant data in appropriate information systems
• Provide information regarding outcomes of clinical reviews, CT, medical record reviews, coronial directions.
• Discuss information with families relating to the medical investigation that may be requested, this may include: Interim Cause of Death (ICOD), tests results, timeframes for medical reports or organ retention (liaise with Court and CISP)
• Assist access to funeral providers or destitute funeral arrangements
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• Support SNOK to obtain information required e.g. Coronial process, brief of evidence, applying for the final PM report, certificates etc.
• Provide psychoeducation, practical strategies, resources and advocate for needs to be bet (e.g. care of children experiencing trauma or grief)
• Provision of resources and information to assist with longer-term needs, including appropriate support services (if / where they exist)
Viewings and identifications
• Respond to requests for viewings or formal police identifications • Obtain and familiarise with all available case information available
e.g. P79a, internal information systems, hand-over from mortuary staff, body condition or location to facilitate the viewing or identification
• Provide support to families with the police identification process (visual identification of the deceased). Support Police to complete visual identification. Additional information sought from families to assist with non-visual I.D. (e.g. dental records, identifying features)
• Support the needs of families if they request to view the deceased, this may include facilitating a viewing at the FM facility
• Completing the memory making process for deceased children including foot/hand prints and locks of hair
DVI • Responsible for supporting families of victims involved in major disasters including the ante-mortem identification of victims, participation in DVI planning and training activities
Management of Forensic Social Worker Wellbeing Social work staff working in the context of Forensic Medicine may experience vicarious trauma, burnout or compassion fatigue due to the nature of the work.
Working within a Forensic Medicine context constantly exposes Social Workers to traumatic information and imagery, deceased bodies in various states of decomposition and/or injury and emotionally vulnerable, distressed, disempowered and grieving people attempting to navigate a complex coronial system.
The effects of vicarious trauma are cumulative and without appropriate management staff can experience significant distress, feelings that they are overwhelmed or it may lead to a permanent psychological injury.
Managing vicarious trauma is difficult, however work-based and personal strategies are available to reduce exposure to trauma and manage the known effects, and to promote
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sustainable practice. Effective strategies to reduce exposure to vicarious trauma and reduce the cumulative effects have been adopted include:
• Ongoing peer support
• Regular review of caseloads
• recognition and value of work undertaken
• A supportive and safe team and work environment and culture
• Internal and external supervision (individual and group based)
• Support for Continuing Professional Development (CPD), education and training
• Implementation of flexible work workplace arrangements
Governance NSW Health Pathology has a well-established governance system that is designed to ensure the business is safe, effective and manages resources responsibly.
Governance systems including; ethics, risk management, compliance, policy, administration and levels of accountability provides the framework to attain the vision and values of NSW Health Pathology.
Operational governance is provided to the three Forensic Medicine Social Work teams via the Forensic Medicine Leadership Team. Daily management of team activity is provided by the service Team Leads.
The Team Leads have a dual clinical and management role and provide operational and clinical governance to their teams, the Sydney Team Leader also provides these responsibilities to the Forensic Medicine Social Worker based at Wollongong.
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Enterprise Risk Management NSW Health Pathology has an Enterprise Risk Management Framework that documents the key processes and tools for effective risk management. The Enterprise Risk Management Framework is designed to support the achievement of NSWHP lead strategies and operational objectives detailed in our Strategic and Operational Plans.
The Framework states that every NSWHP employee has a responsibility to identify, assess and mitigate risks in the workplace and understand and adhere to reporting processes.
The Framework outlines the risk management roles and responsibilities of NSW Health Pathology employees through all levels in the organisation including all staff and contractors, managers, committees and the Chief Executive and Board members.
For Forensic Medicine specific risk management responsibilities include;
Executive Director FASS: • Responsible for the management of risk in line with NSW Health Pathology Risk
Appetite Statement
• Ensure staff in their business units comply with the risk management policy and procedures and fosters a culture where risks can be identified and escalated
• Continually monitors their areas of responsibility to ensure that risks are identified and managed
Chief Pathologist, Chief Operating Officer, Deputy Operating Officer:
• Accountable for compliance with risk management procedures and fosters a culture where risks can be identified and escalated
• Responsible for the identification and management of risk within their areas of responsibility
Team Leads (Risk Champions):
• Assist managers to implement risk management strategies and facilitates risk assessments within their individual business unit
• Manage day to day operational risk in-line with approved protocols
• Report risks to management
All staff: • Familiarise themselves with policies and procedures concerning the management of
risk relevant to their workplace activities
• Adhere to relevant legislation and their compliance obligations
• Incorporate risk management practices into their workplace activities
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• Report and escalate risks to their line manager
• Look for opportunities to improve operational efficiencies and optimise outcomes
NSW Health Pathology risk escalation matrix
Clinical Governance NSWHP, managers and clinicians are accountable for effective clinical governance systems. Clinical governance ensures treatments are effective, evidenced-based, risks are actively managed, and staff are appropriately credentialed and experienced to provide care.
System clinical governance is provided by NSWHP Corporate Clinical Governance, supported through the Quality team of FASS. Direct clinical governance is provided to the Forensic Medicine Social Work teams by the FMLT comprising of the Executive Director of FASS, the Chief Forensic Pathologist/Clinical Director, Chief Operating Officer and the Deputy Operating Officer.
The Chief Operating Officer and Deputy Operating Officer provide local support to the local site who, together, with the Team Leads are responsible for ensuring local systems are in place to maintain and improve the safety and quality of care. This includes ensuring all incidents, complaints and clinical issues are reported and mitigation activity conducted in-line with NSWHP clinical governance framework and NSW Health policy.
The Team Leader is also responsible for ensuring all policies, guidelines and practices are implemented to optimise safe and effective clinical care for Social Workers and clients of the service. This also includes elements of service operation management and may include; roster management, following up on service risks and issues, mitigation of grievances and service communications,
Forensic Medicine facilities and services also participate in an accreditation process that includes the following;
• ISO 15189 Medical Laboratories – Requirements for quality and competence
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• National Pathology Accreditation Advisory Council (NPAAC) Requirements for the Facilities and Operation of Mortuaries
• The Royal College of Pathologists of Australasia (RCPA) – Accreditation of sites for Training Programs, Forensic Pathology
Ethics
Forensic Medicine Social Workers acknowledge their ethical responsibilities as outlined in the Australian Association of Social Work; Code of Ethics and uses these principles guide individual behaviour in the workplace.
Statutory and Policy Context Forensic Medicine is a service of NSW Health and as such, is accountable to adhere to relevant NSW Health policy and procedures along with local NSWHP policies and procedures. As Forensic Medicine is a key agency providing services to the NSW Coroner, all staff are required to work within the relevant Acts and legislation.
The FM Social Workers are required to have an understanding of statutory documents and policy that relates to the Coronial process and more broadly the work of NSW Health.
Current legislation and policy relevant to the role of FM Social Workers:
NSW Legislation1
Anatomy Act 1977 (No 126) Children and Young Persons (Care and Protection) Act 1998 (No 157) Coroners Act 2009 (No 41) Health Records and Information Privacy Act 2002 (No 71) Health Services Act 1997 (No 154) Human Tissue Act 1983 No 164 Public Health Act 2010 (No 127) Poisons and Therapeutic Goods Act 1966 (No 31) Radiation Control Act 1990 (No 13) State Records Act 1998 (No 17)
NSW Health2 Coroners Cases and the Coroners Act 2009
1 https://www.legislation.nsw.gov.au/#/search 2 https://www1.health.nsw.gov.au/pds/Pages/pdslanding.aspx
Respect for persons
The FMSW respects the inherent dignity, worth and autonomy of every person.
Social justice
The FMSW promotes protection by acting to reduce barriers and to expand choice for all people especially for those who are disadvantaged, vulnerable or have special needs.
Professional integrity
The FMSW makes considered and ethically accountable professional decisions and ensures ongoing professional competence by participation in life-long learning.
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Child Wellbeing and Child protection Policy and procedures for NSW Health Clinical Handover – Standard Key Principles Destitute Persons Cremation or Burial 2008 Death - Management of Sudden and Unexpected Death in Infancy Forensic Pathology Practice and Performance Standards in NSW 2012 Health Care Records – Documentation and Management NSW Health Code of Conduct Open Disclosure Policy
FMSWs are also required to have knowledge of the following legislation and policies in order to assist families during the Coronial process.
NSW Legislation
Government Information (Public Access) Act 2009 Births, Deaths and Marriages Act 1995 No 62 Crimes (Forensic Procedures) Act 2000 No 59 Motor Accidents Compensation ACT 1999 No 41
*Not all NSW Health policies have been listed within the model, as NSW Health Social Workers are required to adhere to NSW Health policy.
FMSWs also are responsible to comply with the requirements of the Australian Association of Social Workers Code of Ethics and Practice Standards 2010.
