Transcript: Families as peer workers in early childhood intervention

The work of Plumtree, an Australian not-for-profit organisation that provides support for young children from birth to 8 years old with a developmental delay or disability and their families.

Podcast Episode: Families as peer workers in early childhood intervention

Category: Early years 

What follows is a transcription of the audio recording. Due to differences between spoken and written English, the transcript may contain quirks of grammar and syntax.

SM - Sylvana Mahmic
MH - Melanie Hayworth

SM Hi, I’m Sylvana Mahmic the CEO of Plumtree. I’m also mother to Karim who’s twenty eight and has a disability and he’s been using self-manage funding for the last ten years or so.

MH And I’m Dr Melanie Hayworth. I’m a Peer Worker at Plumtree Children’s Services which is an early childhood intervention service in Australia and I have recently project managed a new project that we did with funding from the Australian Government around how peer work can be used in early childhood intervention, or ECI and the ways that families can be used to make peer work, work for ECI. So the project was funded by what was called the Innovative Workforce Fund which, in Australia fairly recently we’ve had the roll out of what was called the National Disability Insurance Scheme which gives individualised funding packages to individuals with disabilities and as part of that roll out quite a large sector of our workforce had, the disability sector workforce has been impacted by the roll out of this very large innovative package and we know that there just is not the workforce capability to keep up with the new demand that’s come alongside the roll out of the NDIS, the National Disability Insurance Scheme and the Federal Government was interested in working out different ways that we could innovate within the sector to increase our workforce and look at the ways that we’re addressing workforce capacity and capability across the sector. So since 2015 Plumtree has been employing peer workers to facilitate what is a unique capacity building programme for families called Now and Next but over that time Sylvana and Plumtree have recognised that peer work and employing parents as peer workers within an ECI context has actually very broad benefits for both the peer workers themselves and the families that access the ECI service, and so the project was around documenting what we are doing in Plumtree and understanding what the benefits are for all stakeholders for the organisation, for the staff who work, the existing staff, the traditional Allied Health and Early Childhood Intervention Educated Psychology Social Work staff as well as for the peer workers and of course for the families and the children with whom we work. So we wanted to document our experiences and we also wanted to look at the Mental Health Sector and see what’s happening in peer work in the Mental Health Sector because those, in the Mental Health Sector peer work has been part of the Mental Health Sector in a recovery framework for many decades and we wouldn’t want to “reinvent the wheel” so to speak, we wanted to be able to use the lessons that the Mental Health Sector has already learnt to increase the benefits to all our stakeholders and relegate some of the challenges associated with integrating and implementing a peer workforce in ECI.

SM Just for our listeners ECI is Early Child Intervention and Plumtree offers services to children birth to eight years old, so our organisation is seeing families at very earliest possible stage of their lives. Melanie just out of this ten month project, could you just tell our listeners what the deliverables of the project were?

MH So we had five key deliverables and one was a very substantial literature view which started off looking mostly at the Mental Health Sector. As I said we were keen to learn the lessons and to understand what had happened in Mental Health that has allowed peer work there in that sector to be so successful and we know that in Scotland there is a lot of excellent research coming out and a lot of my research within the literature view in fact, came from the Scottish context because the National Recovery framework is so important within the Scottish context, but as well as that we were looking at what other sorts of peer interventions are available in the disability sector and there are a number of parenting types of, or a few, parenting types of interventions that allow parents to connect with other parents but most of these are on a fairly ad hoc basis or on a support voluntary basis, so it’s peer support rather than paid peer workers. What Plumtree is really interested in is how we can pay families to support other families to increase family leadership and capacity. So the literature review was looking at what’s happening currently in the disability and ECI sectors and really substantially looking at what’s gone before in the Mental Health Sector to help us to inform our best practise. So that was one deliverable although we contracted out to a University, the University of Sidney has a Centre for Disability Studies and we used their researchers to help us to conduct focus groups within our Organisation to understand better the perspectives of the different stakeholders in our Organisation, and they wrote a report around what they found, that they talked to families, families who had access peer workers within Plumtree but also the peer workers themselves and how, I am a peer worker at Plumtree, and how we find it working as peer workers and peer facilitators, and also the staff, the existing staff who were here before peer workers and how they perceived peer workers, the challenges that they’d found and any benefits that they were feeling from having peer workers working within their Organisation. So, the research report that the CDS, the Centre for Disability Studies, published as part of that gave us an overview of that research in the focus groups with some recommendations and some analysis of that data that they collected for us. From that, from that research in the literature review as well as in the focus groups and that said, yes, research. We then developed a tool kit which is really aimed at other ECI Organisations talking about, “What are the benefits” and sort of marketing peer work, so to speak, but looking at, “What are the conditions for a successful implementation of peer work”, what we’ve found was that whilst peer workers found that there were many benefits for themselves whilst families thought that there were many benefits of working with peer workers, the staff had many concerns that we hadn’t necessarily proactively addressed. So the way that peer work had rolled out at Plumtree over the last number of years was a very organic experience, it sort of evolved which is ironic and say more about them. I can but it was an evolution rather than something that was proactively set about as a strategy, would you agree Sylvana?

SM Oh sure.

MH So we, some of the things that we know particularly now from the Mental Health Sector is that proactive communication with staff, job descriptions, job roles, clarity around employment conditions, those kinds of things if they are proactively addressed before the integrational implementation of the peer workforce in an existing organisation, that those kind of things really help with how non-peer workers perceive peer workers, and we’ve used non-peer workers even though it’s not one hundred percent satisfactory as a sort of catch or because of the diverse nature of the staff that most ECI services employ. We have Allied Health, we have Educators, we have Psychologist, Social Workers, Therapists, you know, Occupational Therapists, Speech Therapists, so but those people, whilst they may have a lived experience of disability, whether their own or their children or a family member, they generally don’t draw on that lived experience, that personal lived experience of disability in their work with families and there is a perceived distance between families and non-peer workers, whereas what makes a peer worker unique is that we draw on our lived experience with disability, that becomes part of the reason why we’re working with families, we explicitly draw on that experience. And so we use non-peer just to kind of articulate that there is a very broad diversity of workers who are not drawing on their lived experience in ECI. So those non-peer workers certainly felt that there were challenges involved in implementing peer work. So the toolkit that we made, that we put together, has part of the deliverables for the project. It was really around, “How can we maximise potential benefits and minimalise the potential challenges or barriers to successful implementation. So that was another deliverable. We also understand that best practise says that we need to have some way of translating our research into some knowledge translation so that we can have an action pathway for greatest impact. And so we developed an knowledge translation strategy and action plan which basically outlines the ways in which we want to translate the knowledge that we’ve now amassed and the experiences we’ve had to the broader ECI and disability sectors both nationally in Australia and globally and internationally as well and as part of that one of the very few ways that we’ve talked about that is by sector development and sector development often happens at that more academic level so we have written an academic article which has been submitted for peer review, that would be one way of marking to one particular set of stakeholders so that kind of, the sector development in terms of policy makers, researchers and those kind of things, but we would like, we have a lot of other work to do. We also understand that there are multiple stakeholders in this including families and the staff themselves.

SM Thanks, Melanie. So in summary there are five outputs of the project that you’ve been managing over the past year, a literature review, a research report, the families as peer workers toolkit, an academic article submitted to a journal and also the knowledge translation plan.

MH That’s right, and we, there were many other little things, we have a wonderful, we’re developing an animation for families that will educate families as to the benefits of peer workers for them so that they can start, we firmly believe that knowledge translation and research impact comes when stakeholders on all levels are invested in changing so if families are not, particularly in Australia where families will have to pay for peer workers eventually from their children’s individualised funding packages, we need to make sure that families understand why using peer workers is so important to them, what it will do for them. So we’re developing, currently developing an animation that will help families to understand what peer workers might give to them, might offer them in terms of the benefits.

SM So Melanie, I think we were a little bit cheeky when we went off to do that an animation hard draft and our storyboard because the project itself was really about documenting, researching and developing resources for the Early Childhood Intervention sector but we just couldn’t resist, as time went on, could we in terms of…

MH Overachievers…

SM Overachievers but also I think in this context we recognised how important it was for our sector to understand the potential value for connecting families to other knowledgeable and trained parents in that earliest possible point in their experience, but also the flipside of that was preparing families for understanding the value of all of that so I think that, that was when we, I think, snuck that last bit in, yes, but we have to do some work about that in the future.

MH Absolutely.

SM So how does peer work, work in practice, here at Plumtree which is an Early Childhood Intervention Organisation? A couple of years ago we developed a programme which we called Now and Next that was developing the capacity of families and building the decision making supports and in the beginning that programme was developed by our professionals initially and also delivered by professionals. Once we decided to take that into a group format we had feedback from families and also we felt intuitively ourselves that this was the right thing to do, was that the programme should be run by families for families and so the Now and Next programme in the last two years has been delivered by families for families. So we have been training and employing, supervising and coaching families who are families of children with disabilities themselves, very young children, and they have been delivering this programme to now over three hundred families who have done Now and Next already in the last few years. So what we were doing during that time, we were introducing a new workforce without realising exactly what we were doing. We were doing it on a sort of ad hoc basis. We were learning as we went. We didn’t have a plan when we set out but we just knew that this programme was needed for families and needed to be run by them. So it’s been a learning process throughout this period. In addition to learning as we were going we were learning using an action based framework. I was also looking, as the CEO, at how we could incorporate the peer workers into our team and the research that Melanie has done showed, with Sidney University, showed that our experiences have very closely mirrored the experience of peer work in the Mental Health Sector so some of the ups and downs, the strengths and the challenges of our experience were very closely, we experienced them and are the same as have been experience in the Mental Health Sector. I guess from my perspective as a CEO I’ve learnt that peer workers bring an awesome amount of energy, enthusiasm, insight into our Organisation. The benefits are, for me I see them as having been bringing the voice of the consumer into our Organisation in a more regular way, our peer workers, we’ve trained up to twenty now, not all of them work with us at exactly the same time, they also perform very different roles now and not just facilitating the workshop, but for me I think what I’ve seen is that they bring the voice into the Organisation, they’re around all the time so they keep telling me the things that they like and the things that they don’t like and having those voices here on a regular basis really forces myself and the Senior Team here to keep looking at, “What are we providing and how are we providing that?” And checking in with the peer workers because we trust them and they trust us enough to have a conversation to tell us where we’re doing things well and where we’re not doing things well or where we could be improving. So that’s one particular perspective that I feel that it has sort of worked in practice in terms of helping us to do our work better. The other thing that I’d like to say in terms of how it works in practice is that I think my learning has been that we’ve learnt that peer workers are a workforce like any other workforce and just as I would support, you know, induct, train, supervise, encourage, recognise the skill sets and the contribution of the team members who are the non-peer workers it’s exactly the same with the peer workforce and that was a bit of an insight. Whilst they’ve got an awesome set of capabilities that are previously untapped by our Organisation and by our sector generally I’d like to say, ultimately we have to treat them with the same respect as we do with other employees and they’re employees of the Organisation, I think that was, that was obvious but very big learning. There have been some ups and downs which again are mirrored in the Mental Health space with their experience with the peer workforce and our team has been on the ups and downs of some days it works, some days it doesn’t work. We’ve got, we’ve reassured our team here that we’ve got a culture where everybody can really express what they feel concerned about and we’ll work through a lot of those issues and capture them in the research and we hope that those will be future learnings for other organisations in the Early Intervention sector so that they can introduce, or consider introducing peer work into their organisations but not have to start from scratch. So that’s how it works in practise at Plumtree. Melanie, for the next question, what do you think that this project has achieved, what are the kind of key research messages?

MH So despite having hundreds of thousands of words in the end worth of writing we’ve really got three key research messages that we would like to get out to the sector. The first one is probably the most important is that peer workers offer unique benefits to families of young children with disability and developmental delay that are not really available through existing early childhood intervention organisations, but which are complimentary to them and a lot of that is around family capacity building. We know as a sector that we need our families to recognise that they have a role in their children’s development, that they have a very, very profound and important role in the relationships that they have with the professionals with whom they work for their children but we also know that it can be a real challenge to develop and build family leadership and capacity and feelings of agency in families. Often families are very reliant on the expert model that ECI uses in many parts, but peer work is one way that we can counterbalance that. We know from our research that peer work provides families with feelings of leadership and capacity of agency. We are able to do work with families in a way that’s just not available to many professionals, and just to finish that thought, some of the things that are quite pervasive for young, for families of young children with developmental delay and disability, Mental Health outcomes, social isolation. Peer work we know now does quite a lot to counter those sorts of, particularly say social isolation. Parents feel more connected. They feel like they have a community when they’re working with peer workers so that the adverse Mental Health outcomes that come along with social isolation which is a lived reality of many families, those things are decreased when peer workers are introduced so there are some really vital benefits to families and to children that need to be explored further. So that was the first major research message that we came across. The second one is, as Sylvana mentioned, our experiences in ECI here at Plumtree very closely parallel many of the documented experiences in the Mental Health Sector in terms of benefits and in terms of challenges and the real impact of that once we recognise how closely our experiences are paralleling or mirroring the Mental Health sector is that we don’t have to relearn, we don’t have to re-research, we can maximise the benefits in the disability sector, we can minimise the disadvantages or the barriers and the challenges in the disability sector by learning what the Mental Health sector has put decades of research into learning and we can do it in a way that is cost effective and quick because we can take out things that have already been learnt and evidenced in another sector, so that cross sector intersectionality is really important because it puts us on the front foot for implementing peer work quickly and with maximum benefit and minimum challenges, which is not to say there won’t be challenges but that we can really learn substantially from those Mental Health experiences. And the final thing we learnt was that obviously the implementation of peer workforce into any existing organisation is going to face challenges and barriers and they shouldn’t be understated or underestimated. It isn’t a straightforward, it’s a complex process. Having said that we also are now coming to understand that those challenges and barriers can be mitigated by pre-emptive organisational action so things, as I said, thinking about employment conditions, about physical space, addressing staff concerns, job descriptions, employment conditions, in Australia we are mandatory reporters for child protection and those kinds of things how does that impact on your peer workforce. Addressing all of these things before peer workforce implementation mitigates many of the challenges and barriers, so does sector development and the education of the community and all stakeholders on the benefits of peer work. So, knowing those three prongs are ways of mitigating those challenges and barriers. So those are sort of the three main messages we came to in our research, in our work.

SM Melanie I’d just also like to add a couple of challenges that we experienced as an organisation, just a tip was that communicating with your team and really exploring up front in terms of a cultural fit with your organisation is peer work for your organisation, is this going to be a right fit and then communicating really closely and carefully with your team in an environment of trust and honesty so that people can talk about some of the ups and downs really openly, and then those can be addressed, and being prepared, I think that the resource kit that you’ve put together based on the evidence that also trialled with one of our partners’ organisations in the Hunter which is a couple of hours drive from Sidney and then the other, and the other tip, I think, in terms of mitigating some of the challenges is to look within your team, if you’ve got a reasonable sized team, is to look for the champions within the team because once we started bringing in peer workers there was definitely some ups and downs in terms of what the team overall thought but they were definitely, you know from the outset, some team members who just understood the potential value of peer workers and incorporating them into an organisation that provides supports for very young children and their families and those people, you know, are helping them to become champions and working with other team members and helping them to understand, let’s say they were a couple of other tips from us.

MH I think the organisational, cultural assessment is key, which we learnt from our own experience partly because Sylvana is too humble to say so, but she is both the innovator and also highly, just so deeply committed to family centred practises and to respecting the voices of families and that’s obviously going to be key to, particularly in the early intervention space, being able to respect and accept that your families have so much to offer, is key to how successful that will be in your organisation and Sylvana is a champion herself of families and their voices and what we, and our expertise and our children … and harnessing our passions which run deep. So absolutely and things that come out of the Mental Health sector around supervision and training up also really key as well and things like making sure that job descriptions are, you know, developed with existing staff so that, and recruitment which needs to be sensitive to the fact that many of your parents and many of the families will not have had the standard career development because their careers might, you know, be paused as they’ve stopped to look after their children, or things like that. So sensitive recruitment processes are really important but incorporating your staff into thinking about who might be appropriate as a peer worker also gives them an ownership and an agency in the decision making as well. So there are lots of tips, I think, that we’ve tried to capture to help other organisations do this in a way that’s really proactive in implementing that peer workforce so that staff feel like they’ve had ownership over this decision and that it becomes natural and beneficial to them as well.

SM Melanie I guess that the project in a nut shell really presents peer workers a new and untapped workforce in early childhood intervention and I think that your research also and the resources present an argument for greater use of this workforce in the disability sector more generally, so I hope that in the future some of the work that you’ve done as part of this project and experimenting with that here in Australia will influence people to start thinking about the potential for peer work to be used in their organisations and hopefully using the evidence based in the resources and tools that have been developed as part of the project to start up conversations within your teams, within your organisations, your Board, you know your Management Teams and start thinking about whether or not this is for you, if you’re already doing it there might even be a few things that you think that we’ve added in there or we’d love to actually hear from you guys if you guys from Scotland want to send us some awesome materials and resources…

MH Absolutely.

SM …that you’re using over there or have developed, we want to hear about them. If you’d like to hear a little bit more about what we’ve been talking about today in a bit more depth, the deliverables that Melanie took you through a little earlier on are available as a blog post on our website, the Plumtree website, under the blog post tab, and the blog post is entitled Families as Peer Workers in Early Childhood Intervention and we hope that you’ll check those resources out and those research tools out and thank you very much for the opportunity to speak to Scotland today we really..

MH Thank you.

SM …really welcome your interest.

MH Thank you and we hope to be in touch at some point.

SM Email us if you’re interested. We’d love to chat about this issue.

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