Helping families in crisis

Professor Jennifer McIntosh AM, from the College of Science, Health and Engineering, has led a study to understand family trauma during COVID-19 and its impact on the Victorian public health services workforce

Jennifer McIntosh was twenty-one. It was her first day at her first job. The psychology graduate could hardly believe that she had landed a research officer position at the Children’s Protection Society. Neither could her supervisor, Wendy O’Brien. “Are you sure you are only twenty-one? Really?” O’Brien remarked during the interview, scrutinising McIntosh, her CV, and then McIntosh again. The young candidate was, after all, quite unique. She had spent her undergraduate years submerged in attachment theory and development psychopathology, and now lived to understand “new ways of knowing, for the sheer love of it.” McIntosh may have been “completely green and wet behind the ears,” but O’Brien saw her potential and offered her the job.

On the morning of that first day, O’Brien rushed past McIntosh’s office. “Come on, quick, we need to get to the car,” she said briskly. Their destination: a domestic violence incident in West Heidelberg. McIntosh began to prepare herself as best she could. ‘Take a deep breath, stay calm, remain focused, follow O’Brien, do your job.’ From the curb, she could see that almost every window in the house had been broken. Inside, a woman lay slumped against a wall, in a corner, a gash stretching across her neck. And under a table, a small child sobbed uncontrollably, seeking refuge from the violence he had just witnessed, in his home, among his family.

“That day, and that job, changed my life,” says McIntosh. “From then on, something became deeply embedded in me. I wanted to understand the devastating impact of growing up in these environments, and what we can do in terms of prevention.”

McIntosh made that her mandate, devoting her career to family trauma and transition. A clinical and developmental psychologist, family therapist and researcher, she has worked in every clinical setting imaginable: from inpatient and outpatient teams in child adolescent and mental health services, to her own private practice for children in foster care. After a decade in child protection, McIntosh moved into high conflict family law settings, where she developed child-inclusive mediation counselling: “An approach that involves consulting with a child directly and helping the parents to understand what their child needs,” she explains. That model was adopted by family courts and family services worldwide. Later, McIntosh worked with Professor Craig Olsen to embed attachment theory into the Australian Temperament Project Generation Three, Victoria’s largest longitudinal study of families and their social and emotional bonds. It all led to McIntosh being awarded a Member of the Order of Australia (AM) in 2019.

“This time last year, I thought my career was set,” she says. “I was doing what I love and working on some extraordinary research. Then along came the advertisement for the inaugural Professor of Systemic Practice and Family Therapy at the Bouverie Centre.” The position, supported by the Department of Health and Human Services (DHHS), realised Director Jeff Young’s long-held dream to make the Bouverie Centre – the only publicly-funded specialist family service in Australia and part of La Trobe University since 1996 – a fully integrated practice-research centre. “We needed a person with an exquisite mix of practice sensitivity in family therapy and systemic approaches, research expertise, and the ability to translate findings into real world impact,” relates Young. “Jenn has all these qualities, along with an acute intelligence, a capacity to drive innovation and change, and an inexhaustible commitment to making the world a better place.”

McIntosh was appointed in January. While her working life is not as she anticipated due to COVID-19 restrictions, McIntosh is already making headway in reimagining Bouverie’s place in the practice-research world. Her new study with Dr Sian McLean focuses on family violence during the pandemic and its impact on the Victorian public health services workforce. Funded by The Bouverie Centre and supported by the DHHS Family Violence Advisory Group on COVID-19, the study surveyed four public mental health and allied health sectors to capture the workforce experience. “My interest lies in helping vulnerable families quickly,” says McIntosh. “But a lot of that depends on the workforce, on helping the helpers. We set out to get an understanding of what is happening at the coalface. We received 446 responses from practitioners, who reported on more than 10,000 family related cases seen during the month of May. It confirmed what we suspected: the combined stresses of working with COVID-related restrictions, while seeing increasing numbers of clients experiencing family violence, is impacting practitioners’ own mental health and physical health.”

The findings are sobering. Fifty-four percent of all practitioners reported an increase in client family violence rates in April-June 2020. Of the 330 practitioners who had direct client contact, 58% reported that working with increased numbers of clients experiencing family violence had caused a significant increase in their workplace stress. The highest reports of increased family violence-related work stress came from the child and adolescent mental health workforce, where 79% reported frequent stress, and 72% reported a decline in their own mental health. “Practitioners experiencing high COVID-19-related stress had significantly more sleep problems, more headaches, and more gastrointestinal symptoms than practitioners experiencing lower stress,” notes McIntosh.

The younger the practitioner, the higher the stress reported. “Practitioners develop their capacities for coping with complexity across a lifetime, and it is hard for people new to the field to also cope with COVID,” she says. “They are likely to be young parents themselves, perhaps they are not financially established, and so there is a lot going on. We need to be aware of accumulating stress and what I describe as compound fractures.”

McIntosh believes that forewarned is forearmed. “It’s really important to pick this up now. If this pandemic is going to be with us in the longer term, then we need to prioritise taking care of the health of our workforces that are supporting families in crisis.” What’s needed? McIntosh believes that supportive management and policies that enable practitioners to do the complicated work and “go home at the end of the day better able to sleep” are key: things like more time with clients (maternal and child health service practitioners have just fifteen minutes with a client to identify risk and check complexity), more supervision and debriefing time will “make a big difference in this tough work of helping families.”

“It’s about training practitioners to cope with complexity,” adds McIntosh. “I have been in the game for 34 years, and there’s not much I haven’t seen. I have sat with murderers and I have sat with children dying of neglect. You clock up a lot of experience in this field, but it takes time, and the anxieties you carry home at the end of the day can be very heavy.”

“This study is a positive step forward. Right now, we need to help our workforce to better cope with complexity, so that they can be supported and equipped to help families through this pandemic.”

Discover more research from the College of Science, Health and Engineering on LinkedIn and Instagram.