The Social Work Department of The Queen Elizabeth Hospital in Adelaide, South Australia, developed a social work service for women presenting for elective termination of pregnancy. They used a high social risk identification and screening process and developed a protocol describing essential elements of the clinical social work practice. Program development was practice-based and empirical, using practice experience and drawing from relevant literature.
PIP: Attention to the psychosocial needs of women undergoing induced abortion can be as important as the procedure itself, especially among those at risk of postabortion emotional problems. Described is a high-risk screening and counseling program developed by the Obstetric Social Work Department at South Australia's Queen Elizabeth Hospital for public patients seeking pregnancy termination for psychosocial reasons. Referral for social work services was automatically effected in 3 scenarios: 1) age under 18 years, 2) termination of 2nd trimester pregnancies, and 3) women uncertain or ambivalent about the decision to abort. Patients who do no fall into these high-risk categories are informed about the option of social work services; about 20% accept. A protocol for each high-risk indicator has been developed to define potential themes for counseling, set clinical standards, and form the basis for the monitoring of consistency of service delivery among social workers. In the case of women who are ambivalent about the decision to abort, for example, the protocol sets the objectives of enabling the patient to take responsibility for the decision to abort and its consequences, encouraging her to discuss any aspects related to the pregnancy and abortion, assisting her to cope with associated psychosocial problems (e.g., relationship with partner), and ensuring she has access to the appropriate pregnancy service. Within this general framework, social workers can select from a range of treatment modalities, including crisis intervention, problem solving, psychoeducation, and bereavement theory. A quality assurance component of the program examines the issues of input, process, output, and access. The addition of a psychosocial element to the hospital's pregnancy termination clinic has both improved the credibility of the social work department within the hospital and reduced the occurrence of postabortion traumatic reactions.