Clinical social work in Aotearoa New Zealand: Origins, practice, and future implications

Abstract

INTRODUCTION: Clinical social work is practised with individuals, groups and families in areas concerned with mental health and counselling for people’s wellbeing. As a field of practice, it has been insufficiently researched and often not understood in Aotearoa New Zealand. This article provides an overview of clinical social work in Aotearoa New Zealand.APPROACH: This is a theoretical article that discusses the development of social work, and clinical social work, in this country; attention is paid to professionalisation debates and registration. There is an overview of the social work training landscape and post-qualifying mental health specialisation options, with a brief discussion about the New Entry to Specialist Practice model for social workers. Theoretical underpinnings of clinical social work interventions are canvassed, including systemic models, recovery approaches, strengths-based models, indigenous models, narrative therapy, cognitive behavioural therapy and dialectical behaviour therapy. Four vignettes of clinical social work are presented, before a discussion about the future implications for clinical social work in Aotearoa New Zealand.CONCLUSION: Clinical social workers have a range of knowledge and skills to work with people in mental distress. A challenge is issued to clinical social workers to continue to uphold social work values within multidisciplinary mental health services. The development of a clinical scope of practice in the context of recent mandatory registration for social workers is recommended.

Full text

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CORRESPONDENCE TO:
Joanna Appleby
joanna.appleby@auckland.
ac.nz
AOTEAROA
NEW ZEALAND SOCIAL
WORK 32(4), 103–115.
Defining “what social work is” has often
presented challenges to the profession. At
the time of writing (2020), the Aotearoa
New Zealand Social Worker Registration
Board (SWRB) is working with various
stakeholders to consider defining an
initial broad scope of generalist social
work practice (SWRB, 2020). Within social
work there exist many fields of practice,
and also specialty areas of practice. In
this theoretical article, we will explore the
specialty of clinical social work, and what
makes it particularly unique in Aotearoa
New Zealand.
Our motivation in writing this article
comes from each of our own experiences of
practising clinical social work across a range
of mental health service settings in Aotearoa
New Zealand. We recognise that clinical
social work is not always well understood
within this country, and we have taken the
opportunity to present and discuss this field
of practice within the context of mandatory
Clinical social work in Aotearoa
New Zealand: Origins, practice, and future
implications
Joanna Appleby1, Barbara Staniforth1, Caroline Flanagan2 and Clarke Millar2
1 University of Auckland
2 Registered social workers
ABSTRACT
INTRODUCTION: Clinical social work is practised with individuals, groups and families in areas
concerned with mental health and counselling for people’s wellbeing. As a field of practice, it
has been insufficiently researched and often not understood in Aotearoa New Zealand. This
article provides an overview of clinical social work in Aotearoa New Zealand.
APPROACH: This is a theoretical article that discusses the development of social work,
and clinical social work, in this country; attention is paid to professionalisation debates and
registration. There is an overview of the social work training landscape and post-qualifying
mental health specialisation options, with a brief discussion about the New Entry to Specialist
Practice model for social workers. Theoretical underpinnings of clinical social work interventions
are canvassed, including systemic models, recovery approaches, strengths-based models,
indigenous models, narrative therapy, cognitive behavioural therapy and dialectical behaviour
therapy. Four vignettes of clinical social work are presented, before a discussion about the
future implications for clinical social work in Aotearoa New Zealand.
CONCLUSION: Clinical social workers have a range of knowledge and skills to work with
people in mental distress. A challenge is issued to clinical social workers to continue to uphold
social work values within multidisciplinary mental health services. The development of a
clinical scope of practice in the context of recent mandatory registration for social workers is
recommended.
KEYWORDS: Clinical social work; mental health; counselling; scope of practice

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registration and developing scope(s) of
practice.
We begin by discussing the historical
development of social work, the influence
of te ao Māori (Māori worldviews), and
the tensions that have influenced the
professionalisation project of social work
in this country. These have all shaped the
construction of perspectives and practice of
clinical social work. We then consider the
training context, major theories, models and
perspectives utilised in clinical social work.
We have each presented a vignette of clinical
social work practice from our practice
setting and conclude with the implications
and future focus for clinical social work in
Aotearoa New Zealand.
While many aspects of this article apply to all
social work practice, the particular focus here
will be on clinical social work. The authors
are all, or have been, employed within
clinical settings. While we acknowledge
that there has been a strong critique
levelled against clinical social work, over
its individualistic focus, its maintenance of
the status quo, the idea that it moves social
work away from its social justice function
and may support a neoliberal agenda (see for
example, Dalal, 2018; Payne, 2014; Specht &
Courtney, 1994), the focus of this article does
not lie in a critique of clinical social work, but
rather an initial exploration of the specialty
in Aotearoa New Zealand.
What is clinical social work?
There is not a strong history of clinical social
work in Aotearoa New Zealand, and at
times the term has not been well understood.
Clinical social workers often engage in more
generalist tasks, while many social workers
will engage in clinical skills. It is difficult to
definitively ringfence clinical social work.
Briggs and Cromie (2009) have discussed
clinical social work across both the
Australian and Aotearoa New Zealand
contexts, and note that it can also be difficult
to distinguish clinical social work from
other clinical roles within mental health
practice. However, they offer a definition
that clinical social work is “concerned about
the social context and social consequences of
mental health” with the purpose to “restore
individual, family and community well-
being, to promote the development of the
client’s power and control over their own
lives, and to promote the principles of social
justice” (Briggs & Cromie, 2009, p. 222).
Clinical social workers in Australia can
become Accredited Mental Health Social
Workers (AMHSWs), providing mental
health assessment and treatment through
Medicare Australia (Australian Association
of Social Workers, 2014). AMHSWs are
recognised by the Australian Federal
Government as an assessing authority of
specialist mental health expertise. They
are trained in a range of psychological
interventions, which are delivered in a
holistic manner that recognises the broader
implications of mental illness on a person in
their environment.
The National Association of Social Workers
(NASW, 2020) in the United States of
America (USA) defines clinical social work
as “a specialty practice area of social work
which focuses on the assessment, diagnosis,
treatment, and prevention of mental
illness, emotional, and other behavioral
disturbances”. Treatment modalities often
include individual, group and family
therapy and within the USA, clinical social
workers must be certified or licensed to
practice within a particular state.
The Council on Social Work Education
(CSWE) in the USA provided a
comprehensive definition of clinical social
work in 2009:
The practice of clinical social work
requires the application of advanced
clinical knowledge and clinical skills
in multidimensional assessment,
diagnosis, and treatment of psychosocial
dysfunction, disability, or impairment
including emotional, mental, and

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behavioral disorders, conditions,
and addictions. Clinical practice
interventions include case formulation
based on differential diagnosis and
assessment of risks and vulnerabilities
and those factors that produce and
constrain the strengths and resilience
found in the transactions among people,
their communities, and the larger social
environment. (CSWE, 2009, p. 2)
Clinical social workers in the USA must
usually hold a Master of Social Work degree
and Licensed Clinical Social Workers
(LCSW) must also undertake many hours of
supervised practice and often a clinical-level
board examination. Clinical social workers
can work in a number of different settings
such as in private practice, health settings,
community mental health centres (CMHCs),
primary care, and in drug and alcohol
treatment centres (NASW, 2020).
The USA Social Work Licensure (2020)
website distinguishes between clinical and
direct practice social work: “[t]he main
difference between clinical and direct social
workers is what each is legally allowed
to do. All social workers can connect
clients with resources and offer guidance
through difficult situations, but only clinical
social workers can provide counseling
treatments”. In Aotearoa New Zealand, the
understanding of clinical social work and the
associated legislation is less clear.
From previous definitions the authors
propose that clinical social workers in
Aotearoa New Zealand would be those
involved in the assessment and treatment
of mental distress, and/or involved in
counselling or engaging in therapeutic work
to enhance client wellbeing. Most clinical
social workers would be situated within
health settings, child and family counselling
settings or within a small field of private
practice. Much clinical social work practice
occurs within the context of the district
health board (DHB) public mental health
system, but there are also social workers
providing clinical roles in non-government
agencies, such as being engaged with Multi
Systemic Therapy within Youth Horizons
Trust, sexual offender treatment at SAFE
Network and family therapy and counselling
within agencies such as Family Works.
History and context
Social work and, in particular, clinical social
work, has been forged within the tensions
inherent within the history of Aotearoa New
Zealand. Professional social work training
in Aotearoa New Zealand did not begin
until 1950 with a two-year post graduate
diploma in social sciences offered through
Victoria University (Nash, 2001). Staffing
for this programme was, for the most part,
made up of academics from the United
Kingdom or those with American training.
They brought with them some knowledge of
casework, and early training at Victoria often
focused on individual or family treatment
(McCreary, 1971). With around 12 graduates
per year coming from this initial programme,
the growing social work workforce was
composed mainly of people who had
obtained their social work qualifications
overseas, or those without formal social
work qualifications.
A Māori renaissance in the 1970s and
1980s brought with it a strong protest
against colonising forces, which included
those present within social work training,
particularly its ‘casework function’. British
and American social work models were
criticised for responding to individualistic
western perspectives, for being racist and
aligned with the State in maintaining the
status quo (Ministerial Advisory Committee
on a Māori Perspective for the Development
of Social Welfare, 1986).
At the same time that this was occurring,
social workers in health were leading
the way in encouraging further
professionalisation. An ongoing debate
occurred within the then National
Association of Social Work (NASW), now
named Aotearoa New Zealand Association
of Social Work (ANZASW), about the

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benefits of formal social work registration.
While the debate about professionalisation
and regulation was complex (Hunt, 2017),
the two sides aligned generally between
the health social workers (most of whom
who had increasingly obtained academic
qualifications) and the rest of the social work
workforce. In that camp sat people who saw
professionalisation equated with elitism,
those who viewed professionalisation being
antithetical to Māori collectivist values, and
those who had no professional social work
qualifications (Staniforth, 2010a).
From 1978 until 1998, a number of motions
recommending that social workers require
formal social work training, and/or
registration were put forward at the NZASW
Annual General Meetings. All were defeated.
Throughout this time, there was also a
growing commitment to biculturalism for
social work, with the Association eventually
developing both Māori and Tauiwi (non-
Māori) caucuses, changing its name to
the Aotearoa New Zealand Association of
Social Work and developing a bilingual and
bicultural code of ethics (Beddoe & Randal,
1994; Fraser & Briggs, 2016; NZASW, 1993).
The availability of social work training
grew rapidly from the 1980s onward, with
a growing workforce of qualified social
workers. In response to earlier criticisms
about its colonial heritage, social work
programmes increasingly began to teach
indigenous perspectives, and Māori, many
who had previously been traumatised
within their earlier education (Wikaira,
participant contribution in Staniforth,
2010c), increasingly completed formal
training. While there were some factions
still opposed to registration, the notion of
registration of social work became more
palatable to several stakeholders, and in 2003
the voluntary Social Workers Registration
Act was passed (Hunt, 2017). Since that
time, the ANZASW, the Tangata Whenua
Social Work Association, the regulator (the
SWRB), and the Council of Social Work
Educators of Aotearoa New Zealand all
lobbied to make mandatory registration a
requirement of social workers, and to have
protection of the title ‘social worker’ (Hunt,
Staniforth, & Beddoe, 2019). In early 2019,
mandatory registration of social workers
was enacted through the Social Workers
Registration Legislation Act (2019). For the
first time, scopes of practice for social work
will be defined. The first scope of practice
will define a generalist social work practice
(SWRB, 2020), with more specialised scopes
of practice likely to follow over time.
Clinical social work in Aotearoa
New Zealand
This history is significant in understanding
the notion of clinical social work in Aotearoa
New Zealand. There are several factors
which have contributed to clinical social
work not developing widely as a field of
practice. There appears to be confusion about
what the term means, and the title “clinical
social worker” is not widely used by social
workers.
The professionalisation debate has taken
up much of the energy of the profession to
date (Daniels, participant contribution in
Staniforth, 2010c). Without a mandatory,
legislated requirement for social workers
to have a formal qualification, it has been
difficult to argue for increased specialisms
such as clinical social work. Additionally,
clinical social workers have been seen
as elitist, status-seeking, and involved
in maintaining people in positions of
oppression (Holden & Barker, 2018; Specht &
Courtney, 1994). With its focus on individual
treatment, it has also been criticised as
having a western focus and of minimal
relevance to Māori (Ministerial Advisory
Committee on a Māori Perspective for the
Development of Social Welfare, 1986).
As stated, there has been very little written
or researched about clinical social work as
a specific field of practice in Aotearoa New
Zealand. What has been written has been
more closely aligned with counselling in
social work, rather than clinical social work
(Booysen & Staniforth 2017; Staniforth,

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2010a, 2010b, 2010c). The concepts of
counselling and clinical social work are
sometimes seen as being interchangeable.
Education and training
Over the past 60 years the education
requirements for social work qualifications
have gone from a two-year diploma, to a
three-year degree, to a four-year degree, and
degrees have mostly sat at an undergraduate
level (Hunt et al., 2019). There is a two-
year first professional qualifying master’s
degree offered by some institutions, but
it is also required by the SWRB to have
a generalist orientation (Ballantyne et
al., 2019). Post-qualifying masters and
doctoral level qualifications have been
research focused, with the authors having
no knowledge of any social-work-specific
clinical programmes being offered within
the country. The majority of social workers
who do identify as clinical social workers
have either come from other countries with
a clinical tradition, such as the USA, Canada
or South Africa, have engaged in further
training in particular modalities, or obtained
further counselling qualifications (Booysen
& Staniforth, 2017).
Te Pou o te Whakaaro Nui (2020), the
national workforce development centre for
the mental health, addiction and disability
sectors in Aotearoa New Zealand, has
developed the New Entry to Specialist
Practice (NESP) programme for allied
health staff, including social workers, who
are entering the field of mental health. The
programme involves postgraduate study
in mental health, along with a capped
caseload, dedicated release time for study,
and mentoring from within the clinical
team. The course content includes mental
health assessment and diagnosis and clinical
interviewing skills. These programmes
have been developed in recognition of
the knowledge gap that exists between
generalist qualifications and the specialist
skills expected of social workers in the field
of mental health (Te Pou o te Whakaaro
Nui, 2020).
The recent report into enhancing the
readiness to practise (R2P) of newly
qualified social workers (NQSWs) in
Aotearoa New Zealand recommended
more support for newly qualified social
workers (NQSWs) (Ballantyne et al., 2019;
Hunt, Tregurtha, Kuruvila, Lowe, &
Smith, 2017). Recommendations around
reduced caseload and opportunities for
post-qualifying training fit well with the
NESP model. Mental health knowledge
was identified within the R2P project as a
common knowledge gap for NQSWs, and
the NESP programme was discussed by one
respondent as an effective learning model.
Some DHBs have NESP coordinators who
facilitate group supervision and additional
training (Staniforth & McNabb, 2004).
This is aligned to the R2P Report about
the importance of workplace induction,
supervision and peer support for NQSWs
(Ballantyne et al., 2019).
The NESP study programmes do not
include in-depth training in therapeutic
modalities, and are not social-work-specific.
NESP participants must be employed in a
setting where assessment, and therapeutic
‘treatment’ are undertaken, as the
programmes require consideration of case
studies and/or video feedback of real work
with clients. Whether a social worker does
complete the NESP programme is dependent
on their employer, funding, and capacity
within the service to support the NESP
learning.
Theoretical underpinnings,
approaches and models of practice
Clinical social workers bring a relational,
contextual, holistic and strengths-based
approach to mental health assessment and
intervention. Like all social workers, they use
a range of theories and models, including,
but not limited to, anti-discriminatory
theory, ecological theory, systemic models,
recovery approaches, strengths-based, and
indigenous models (NASW, 2020).
In addition to these skills, they will likely
have also undertaken training above their

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basic social work qualification in order
to provide ‘treatments’ such as narrative
therapy, cognitive behavioural therapy and
dialectical behaviour therapy (Booysen &
Staniforth, 2017).
Systemic approaches such as Gitterman and
Germain’s (2008) ecological systems theory,
provide a framework for understanding
individuals within their environments.
While systemic approaches are evident in
much of generalist social work practices,
Mendenhall and Frauenholtz (2013) argued
that clinical social workers work at the
micro, exo and macro levels in order to
increase mental health literacy. From
practice, we are aware of the Auckland
Liaison Education Adolescent Programme
(LEAP) programme, which was developed
by a clinical social worker to provide a
dedicated consultation, liaison and mental
health training service to schools. Systemic
approaches are also used by clinical social
workers involved in wraparound services.
In addition to the clinical functions of
assessment and treatment, child and
adolescent mental health services (CAMHS)
have developed wraparound teams for
work with families who have mental health
needs and concurrent child protection
agency involvement. Kirkwood (2014), a
Māori clinical social worker from a CAMHS
wraparound team, has discussed how the
wraparound approach is complementary
to the Treaty of Waitangi principles,
with a focus on culturally competent and
collaborative engagement with families.
Other systemic approaches applied by
clinical social workers include provision of
family therapy, couples counselling, and
multi-systemic therapy for families with
children with behavioural challenges.
Clinical social workers also bring recovery
and strengths-based approaches to
clinical settings, and aim to reduce power
inequality with clients, engaging in
collaborative assessment and goal setting.
They actively look for client strengths and
natural resources (Booysen, 2017). Within
multidisciplinary health settings, clinical
social workers have the additional role of
advocating recovery and strengths-based
approaches within the dominant medical
model. Consumer feedback has endorsed
recovery approaches, and the Ministry of
Health (2018) supports a recovery approach
to mental illness. Recovery approaches
are aligned with the social work values of
empowerment, respect and protection of
human rights.
There are a number of indigenous models
of wellbeing that have been put forward
in Aotearoa New Zealand. Māori models
are generally characterised by a holistic
approach and an understanding of the
impact of spirituality and collective identity
on wellbeing (Wratten-Stone, 2016). One of
the most widely known models is Te Whare
Tapa Whā, developed by Mason Durie
(1994). Translating to ‘the four-sided house’,
it is a holistic model that views wellbeing
as the collective strength and balance of
four sides of a house—taha tinana (physical
health), taha whānau (family health), taha
hinengaro (thoughts and feelings/mental
health) and taha wairua (spiritual health).
Kaupapa Māori theory has evolved from
a base of being Māori, of recognition and
validation of Māori cultural world views,
and challenging the dominance of western
knowledge bases (Smith, 1999). There are
some services in Aotearoa New Zealand
that have developed kaupapa Māori
services. These include a CAMHS team
(Elder et al., 2009), Māori adaptation of a
cognitive behavioural therapy intervention
(Mathieson, Mihaere, Collings, Dowell, &
Stanley, 2012), and a primary mental health
service using the Whare Tapa Whā model
(Abel, Marshall, Riki, & Luscombe, 2012).
Social workers have been involved in each of
these programmes.
International and Aotearoa New Zealand
trained clinical social workers have also
been influenced by narrative therapy
(Burack-Weiss, Lawrence, & Mijangos,
2017). David Epston and Michael White,
social workers from Aotearoa New Zealand

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and Australia respectively, published the
first text about narrative therapy (White
& Epston, 1990). The approach is based
on the assumption that people experience
problems when the stories of their lives,
as told by themselves or others, do not
represent their lived experience. The
therapeutic process is collaborative and
seeks to re-story the lives and experiences of
the person, thus co-creating a new narrative
(White & Epston, 1990).
In Aotearoa New Zealand, one of the
dominant psychological therapies offered in
mental health services and private therapy is
cognitive behavioural therapy (CBT). CBT is
based on the premise that a person’s thinking
affects their emotional and behavioural
responses (Beck, 2020). There are several
criticisms of CBT, including its place within
the positivist research paradigm, that it is
deficit focused, that it has an individualistic
approach that ignores social oppression
(Payne, 2014) and that it has been a tool
promoted by neoliberal forces (Dalal, 2018).
CBT is practised by clinical social workers
in Aotearoa New Zealand, although there
is a lack of research into the way in which it
is practised. Despite the multiple pressures
exerted by neoliberal paradigms within
agency settings, clinical social workers have
the capacity to be strengths-based, culturally
competent, and cognisant of the impact of
the environment upon a person, and so it is
hoped that CBT is practised in a way that
aligns to those values (Gonzalez-Prendes &
Brisebois, 2012; Padesky & Mooney, 2012).
Dialectical behaviour therapy (DBT) is a
psychotherapy that includes individual
therapy, skills group, and telephone
coaching for people with emotional
problems. Clinical social workers are
involved in delivering this programme in
mental health services and in a residential
DBT programme in Aotearoa New Zealand
(Cooper & Parsons, 2010). We are aware that
clinical social workers have been involved
in adaptations of the DBT programme,
including development of DBT-informed
skills groups for Māori young people in
secure youth justice facilities (Weenink,
2019), in secure care and protection
residences, and in the delivery of school-
based DBT in collaboration with school
teaching staff. Cooper and Parsons (2010)
have examined the social work values at play
in DBT. They have drawn links between core
social work skills and DBT strategies, such
as the use of empathy and adapting a non-
judgmental stance, and suggest that clinical
social workers who are trained in DBT are
highly skilled and provide effective services
in Aotearoa New Zealand.
Vignettes
We have provided four vignettes,
representative of our areas of clinical social
work practice. The first three are derived
from various cases to provide composite
vignettes. The final is a real case with a
pseudonym used. The woman provided
her permission to present this work. These
vignettes illustrate the use of different
therapeutic modalities in clinical social work,
including systemic, narrative and strengths-
based approaches, as well as CBT and DBT-
informed interventions.
Youth forensic service vignette
The first vignette is from Joanna Appleby,
a Pākehā social worker who completed her
BSW and MSW in Aotearoa New Zealand.
Jo has postgraduate qualifications in child
and adolescent mental health and CBT and
completed training in DBT. Her example
comes from a DHB-based youth forensic
service context.
Damon was a 15-year old Cook Island
boy who became involved in the youth
justice system. Damon ended up being
placed in a secure youth justice residence
due to his offending. Jo met with Damon
in the residence and formulated that his
poor distress tolerance was perpetuated
through difficulties with problem solving
and coping skills, partly due to poor role
modelling within his family and peer
group. When Damon became emotionally

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distressed, he became physically agitated,
experienced urges to kill himself, to
use methamphetamine, or to engage in
thrill-seeking offending. Jo worked with
Damon within the residence, using a
combination of CBT and DBT-informed
approaches. There was a focus on
increasing Damon’s awareness of his
own triggers, particularly loneliness,
and paying attention to the physical
sensations that accompanied those
feelings. Damon practised problem
solving, seeking social support, and
managing his urges to engage in
unhelpful behaviour. This work was
complemented with visual aids and
tangible reminders, given his poor verbal
skills. Prior to him returning home, Jo
worked with Damon’s mother to teach
the skills that Damon had learned, and
to make a plan to manage his suicide risk
with those skills. Further whole-family
support was provided once Damon
had returned home, and a multi-agency
risk management plan was developed,
including Oranga Tamariki and Youth
Horizons Trust.
Adult cognitive therapy centre
vignette
The second vignette is from Barbara
Staniforth, who completed her BSW and
MSW in Canada, and then undertook both
CBT and DBT training in Aotearoa New
Zealand. Barbara was seconded from a
CMHC team to a university-based specialist
cognitive therapy centre.
Kale was a 36-year-old man referred to
the CBT Centre by his CMHC for low
mood and suicidal ideation. Barbara
undertook an initial assessment with Kale
including a number of structured tools
such as the Beck Depression, Anxiety
and Hopelessness inventories (see
Beck, 2020). A careful consideration of
possible environmental factors that may
be contributing to Kale’s difficulties was
made, with no outstanding issues noted.
A tentative diagnosis of Major Depressive
Disorder was made. A safety plan
was developed to address the suicidal
ideation (with ongoing liaison with the
CMHC team) and psychoeducation
about CBT and depression was given.
Over the weeks, Barbara taught Kale a
range of CBT interventions including
behavioural skills such as breathing,
relaxation, exercise and diet and
engaging in meaningful activity. When
Kale’s mood had improved slightly,
cognitive interventions were provided
through a structured thought record
process. This revealed certain unhelpful
thinking patterns that Kale was engaging
in, and also some situations that he
wanted to change. A process of cognitive
restructuring was used to change
thinking patterns and structured problem
solving was used to change situations.
Kale reported an improvement in his
mood, and his Beck Depression Inventory
scores were significantly improved. A
relapse prevention plan was developed
and Kale was discharged back to the
CMHC after 12 weeks of treatment.
Child and adolescent mental health
service vignette
The third vignette is from Caroline Flanagan,
who completed her MSW in Scotland. She
has also completed postgraduate training
in child and adolescent mental health
and training in CBT in Aotearoa New
Zealand. Caroline’s example comes from
a DHB-based child and adolescent mental
health service.
Sophie was a 15-year-old Pākehā
girl living with her parents. She was
referred to the DHB CAMHS service by
her general practitioner with concerns
around self-harm by cutting, low
mood, suicidal thoughts and complete
school refusal. The clinical social work
intervention was based on a formulation
that Sophie’s presentation was based on
anxiety, both for her and her parents.
Caroline provided individual CBT for
anxiety with Sophie. The CBT included

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graded exposure with a gradual return to
school. Caroline also discussed practical
distress tolerance and mindfulness skills
with Sophie to minimise the self-harm.
Sophie’s suicidal thoughts resolved once
her stress reduced. Caroline worked with
Sophie’s parents around managing their
own anxiety and provided skills-based
family sessions. Important parts of work
with this family involved opening a
narrative around their shared experience
of anxiety, with a family systems
informed understanding of Sophie’s
difficulties. Caroline also worked with
the family to develop their understanding
and use of emotional language to help
them move from binary notions of ‘bad
behaviour’. The focus of the work was
on the whole family system, helping the
family to identify and utilise the skills
required to manage anxiety and distress
in helpful ways.
Maternal mental health service
vignette
The final vignette is from Clarke Millar,
who completed his Master of Applied Social
Work and postgraduate study in Discursive
Therapies in Aotearoa New Zealand.
Clarke’s example comes from a DHB-based
maternal mental health service.
A midwife referred a 39-year-old Māori
woman, Morgan, to the maternal mental
health service in the days following the
birth of her baby. This was Morgan’s
sixth baby; four of her older children
were in the custody of child-protective
services. Morgan was homeless, had an
impending court date for assault charges,
and her behaviour on the postnatal
ward appeared to staff as ‘psychotic’.
Morgan was diagnosed by the team
psychiatrist with a post-natal depressive
disorder, a resolving mild psychosis
with long-standing post-traumatic
stress disorder. The clinical social
work intervention involved individual
counselling with Morgan and a group-
based therapeutic intervention. This was
based on a trauma-informed formulation
of Morgan and her situation. Clarke
provided individual counselling to help
Morgan to process her trauma within a
strengths-based narrative framework.
Morgan also participated in the Circle
of Security parenting group, with an
emphasis on validating the feelings
of her children, as well as her own
feelings. Clarke also worked alongside
Morgan to reduce structural barriers. He
engaged in social work interventions of
addressing homelessness and advocating
for culturally responsive approaches,
including arranging for her Family Group
Conference to be held on a marae. Clarke
was also able to use his mental health
knowledge to clinically justify a service
response that was attuned to Morgan’s
relational needs in the context of her
post-traumatic stress. This included
advocating within the multidisciplinary
team for service flexibility in order to
provide continuity of care when Morgan
was moving between service geographic
boundaries.
These four vignettes demonstrate some of
the theories, approaches and models used
in working with individuals and their
families to improve emotional, behavioural
and mental wellbeing. While each of the
vignettes shows the use of specialised clinical
skills, the inherent holistic work with these
people and their families is consistent with
the overall ethos and aims of all social work
practice.
Future directions and challenges
It is an exciting time for clinical social
work in Aotearoa New Zealand, with an
opportunity for the profession (including
clinical social workers, health leaders,
educators and the regulator) to define this
area of practice. There are a number of
possible future directions for consideration.
These include continued commitment to the
Treaty of Waitangi, the impact of mandatory
registration and the opportunity to develop
a clinical social work scope of practice.

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These all have the possibility of impacting
the clinical social work role within multi-
disciplinary teams and other environments.
Clinical social work has been criticised in
Aotearoa New Zealand, given its roots in
western individualistic history. Its future,
therefore, must include a revisioning of
practice within a more collective framework
and a commitment to the Treaty of
Waitangi. The ANZASW bilingual and
bicultural Code of Ethics asserts that social
work practice is grounded in the articles
of the Treaty (ANZASW, 2019). The Social
Workers Registration Legislation Act (2019)
requires that all applicants for registration
are competent to practise social work with
Māori as well as other cultural and ethnic
groups. There is a challenge for all social
workers to be culturally competent to work
with Māori—within systems that may not
support this. The public health system in
Aotearoa New Zealand, where many clinical
social workers are employed, is sector
based, with siloed thinking and a medical
model that focuses primarily on individuals
(Government Inquiry into Mental Health and
Addiction, 2018). However, Māori thinking
can be characterised as asectoral and holistic
regarding wellbeing (Ahuriri-Driscoll, 2016).
Competence to work with Māori means that
clinical social workers have a responsibility
to shape services to be responsive to the
needs of those they serve. This necessitates
inclusion of whānau and Māori concepts of
health within mental health services.
True commitment to the Treaty means
that clinical social workers have a role in
enhancing Māori access to mental health
services that are culturally responsive.
Alongside advocating for improved access,
mental health services must be culturally
welcoming and safe for Māori, with inclusion
of Māori customs, explanatory models and
having space to discuss incorporation of
clinical and cultural interventions. All social
workers also have a role in promoting Māori
input into service delivery. The explicit
commitment of social workers to the Treaty
of Waitangi necessitates that these issues
should be forefront in the minds of social
workers in Aotearoa New Zealand.
As social work registration has just recently
become mandatory in Aotearoa New
Zealand (with a two-year phase-in period),
it is timely to attend to the issue of scopes
of practice, including the development of
a clinical scope of practice that reflects the
bicultural nature of this country. Scopes
of practice are not yet defined in Aotearoa
New Zealand, nor are the pathways to
eligibility. It is not yet clear if scopes will
require postgraduate study, or if there will
be a funding structure to enable mandatory
training. Specialist scopes are unlikely to be
developed until after the two-year transition
period for mandatory registration. This is
an opportunity for social work stakeholders
to participate in the defining of the roles,
actions and entry pathways for scopes of
practice.
A clinical scope of practice could help
address some current issues for mental
health social workers in Aotearoa New
Zealand. One particular issue is that there
is rarely a specific social work lens on
postgraduate mental health programmes or
within therapeutic training. For example,
while there are social workers who have
completed postgraduate training in CBT,
it is up to the individual social worker to
critically reflect on how to connect social
work values with the CBT model. A clinical
scope could assist in making explicit
the social work approaches to various
therapeutic modalities.
The Health Practitioners Competence
Assurance Act (2003) provides a mechanism
to ensure competence of health practitioners
in Aotearoa New Zealand. Professional
authorities must specify scopes of practice,
qualifications must be prescribed, and
professional registration is mandatory.
The Act provides generic terms to provide
a framework that can apply to all health
practitioners. However, the Act does not
cover social workers, as social work roles
are not limited to health social work, hence

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social workers have specific legislation.
With the advent of mandatory social work
registration and scopes of practice, there may
be regulatory parity with other disciplines
under the Health Practitioners Competence
Assurance Act (2003). It is hoped that this
will enhance the credibility of clinical
social work within the health field, which
was one of the first drivers for social work
registration.
In developing a clinical scope of practice,
the Australian and USA definitions could be
considered (Australian Association of Social
Workers, 2014; CSWE, 2009). Work done
by the National DHB Health Social Work
Leaders Council (2017) in association with
the ANZASW to develop a health scope of
practice, may also be beneficial in developing
a clinical social work scope of practice.
The authors propose that a clinical scope of
practice includes some of the features from
health social work colleagues, as well as
overseas examples. An understanding and
application of Māori models of wellbeing,
as well as understanding of cultural
explanatory models of mental health
will also be important. While not being
prescriptive about choice of therapeutic
models, it would be necessary for a
clinical social worker to have training and
continuing professional development in
a therapeutic modality, and be competent
to deliver therapeutic interventions to
individuals, families and groups. An
understanding of human growth and
development as well as an understanding
of basic psychological principles and brain
functioning would also be beneficial.
While some of these aspects are considered
within qualifying programmes, many social
workers have described feeling unprepared
for their counselling roles (Staniforth, 2010c).
Within a context of commitment to the Treaty
and increased professionalisation of social
workers, a further challenge is the promotion
of the clinical social work identity and voice
within multi-disciplinary mental health
teams. CMHCs in Aotearoa New Zealand
have a case management model with specific
disciplines, namely social work, nursing
and occupational therapy, undertaking
generic case management as key workers
for allocated service users (Briggs & Cromie,
2009). This model can result in loss of specific
professional identity. The work done on
developing a clinical scope of practice for
social workers could assist in defining a
social work role in mental health services.
There are challenges associated with
multi-disciplinary teams, with competing
frameworks and values (Frost, Robinson,
& Anning, 2005; Keen, 2016). Clinical
social workers have the opportunity to use
these environments to provide a critical
perspective, to challenge the medical
paradigm, and to advocate for service
reform. Clinical social workers bring a
holistic perspective to these teams, offering a
social justice perspective, and a social model
of mental health, alongside the dominant
medical model. Within this context, clinical
social workers also have a role in challenging
the rigidity of service exclusion criteria,
particularly when policies serve the needs of
the service over the needs of those who use
the service (Appleby, 2020). As mental health
and wellbeing service demand continues
to increase, there can tend to be a focus on
limiting service delivery and tightening
inclusion criteria as a solution. For clinical
social workers who are committed to social
justice and anti-discriminatory practice,
an alternative approach may include
macro-level advocacy for service funding,
in order to improve service flexibility and
responsivity.
Conclusion
We have attempted to provide an overview
of clinical social work in Aotearoa New
Zealand. A definition of clinical social work
was provided, along with a presentation of
the historical context of social work in this
country. We have considered the evolution
of education and theoretical underpinnings
of clinical social work and provided four
examples of clinical practice.

114 VOLUME 32 • NUMBER 4 • 2020 AOTEAROA NEW ZEALAND SOCIAL WORK
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Clinical social work in Aotearoa New
Zealand is an evolving field of practice.
There is more work to be done in defining
a clinical scope of practice and developing
social work clinical training pathways.
Clinical social workers have the opportunity
to shape these developments over the next
few years, and to continue to strengthen
social work’s influence within mental
health and wellbeing services in Aotearoa
New Zealand.
Accepted 9 October 2020
Published 15 December 2020
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