Family participation in co-design and co-delivery: a case study

Emerging Minds, Australia, November, 2020

Resource Summary

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This case study reviews Emerging Minds’ use of family participation (that is, the involvement of more than one member from a family, for example a mother and daughter) to advance the practices of co-design and co-delivery. It illustrates the value of family participation, explores the process, and highlights key learnings to ensure it is safe and beneficial for family partners, the organisation, and attendees.

Introduction

Co-design and collaboration with family partners is a cornerstone of Emerging Minds’ work. During these practices, the use of family participation, that is, the involvement of more than one member from a family, for example a father and son, was identified and undertaken.

In 2019, Emerging Minds collaborated with a group of child and family partners to co-design and co-deliver a workshop for staff of the National Workforce Centre for Child Mental Health (NWC). The aim of the workshop was to share knowledge, wisdom, experiences and strategies about how to undertake child and family partnership processes in a safe and effective way within the NWC.

The initial intention was to do this work in partnership with child and family partners from different families. However, as the process began, the possible use and benefits of family participation were identified. This case study seeks to illustrate our family participation process and learnings.

What did we do?

The NWC recognised a need for further discussions around what safe and effective child and family partnerships would look like across the various areas of work that were being undertaken. It was clear that these foundational discussions would require input from child and family partners from the start.

NWC staff approached a small working group of child and family partners to co-design and co-deliver the workshop.

These people were identified based on a number of factors:

  • They had a long-term relationship with the organisation and therefore had the organisational understanding required to undertake such a complicated task.
  • They had long-term experience as child and family partners and therefore had a wealth of knowledge and experiences to draw on to inform the workshop and participate in discussions.
  • They had strong, trusting relationships with NWC staff which would enable them to feel well supported and have honest conversations with staff if they felt unsafe or unsure about the process at any stage.

The working group developed the workshop based on a survey (Appendix 1) and verbal consultations with NWC staff about what they felt would be valuable. The workshop was co-delivered by four members of the working group. An evaluation was also undertaken, and this was reviewed by the working group with next steps identified.

Key learnings

  • Factors that were crucial to family members feeling safe and supported were:
    • strong, trusting relationships with staff
    • genuine and authentic engagement, listening and learning
    • shared control over design decisions.
  • Family participation is emotionally engaging work, parents and young people require detailed information and enough time to decide if being involved is the right thing for them and their family.
  • Staff need to provide adequate support, and family members, especially young people, shouldn’t be expected to bring any particular knowledge other than their own expertise of their life’s experiences.

The value of family participation

  • Many experiences of adversity occur in a family context, therefore having multiple family members present in the room (and in the co-design, co-delivery process) provides an important sharing of power and knowledge.
  • Family participation and co-delivery can enhance learnings for the organisation and attendees as well as be empowering for the family contributors.
  • Young people found that family participation provided an opportunity where they felt confident to share their perspectives and felt they were being heard.

Family participation in co-design and co-delivery

During the initial planning meeting, the group identified that the workshop would be an ideal opportunity to undertake family participation. Three of the parents in the group considered the pros and cons of this approach and then decided to ask their children if they would like to be involved in the process. In total, four young people ranging in ages from 16–26 participated in the planning of the workshop. Two of the four young people participated in the co-delivery and co-review of the workshop.

There were many unknowns with the family participation approach. But staff understood the value of having parents and children present in the room and the important paradigm shift and sharing of power and knowledge it would offer.

NWC staff felt confident with undertaking a family participation approach because:

  • Staff knew the family partners well and knew parents would only ask their children to be involved if they thought it would be of benefit to them.
  • Staff felt the parents had supportive relationships with their children and would be able to provide support to them as required, or alert NWC staff to their children requiring support if it were inadvertently missed.
  • We knew that the workshop attendees (NWC staff) would be supportive and respectful of the young people and their parents, thus significantly reducing the risk of harm.
  • There was no expectation on the family partners, particularly the young participants, to bring any specific knowledge other than their own expertise of their own life’s experiences.

Reflections from family members about family participation

Jaisen (father of Joshua)

Having worked with Emerging Minds in the past, I felt that this was a great opportunity to explore co-design and co-delivery in a safe and engaging environment. There’s something special in the way that a team can come together from different experiences and put together a workshop that is informative for the audience and satisfying and empowering for the family contributors.

Working with my son, Joshua, on this project meant that it gave us a project to work on together and spend time bonding over that period. Also, we got to discuss things that perhaps had been discussed before but had no application; or brought up things that had not been discussed but were healthy and relevant to the topic.

Working with Joshua was a chance to share experiences and learn from one another; and having that ear to bounce ideas off was another aspect that did not go unnoticed. Forming ideas and brainstorming was a great way to pinpoint ways in which we could apply these experiences to the project at hand.

I believe that this project only added to the strong connection I have with Joshua; it was a way of bonding and sharing, and these experiences are always welcome. Getting insight from your children is always enlightening and well worth the effort.

Doing this work is a wonderful experience, and one which I can utilise the best with support from my family. We are a tight-knit unit here, and everyone is always excited to learn when I have an Emerging Minds project to work on. Having been able to utilise our experiences to inform different projects is one of the positive drivers in doing the work. The children particularly enjoy giving their opinions and although most of them were too young to participate in this particular project, they have expressed their interest in future ones.

As my family is diverse in representing several areas including experiences in mental health, LGBTIQA+, living in adverse conditions and living in a regional area, we are all onboard to support one another and this project was no different.

As always, it’s difficult to leave the family behind when I travel, however this is only a small part of the project and there are benefits to dad going away to Adelaide or Melbourne. These include little trinkets and a reassurance that I will return with Krispy Kreme donuts.

I can honestly say that this project was well worth the time and effort, the preparation, the Zoom meetings, the flights, the workshop… It gave me a sense of accomplishment and hope. It is always nice to receive renumeration, but a lot of the value to me comes through knowing that the information, experiences, and knowledge that I possess are useful to someone.

Joshua (son of Jaisen)

I said yes to doing this work as I thought it would be a good opportunity to understand where the experts were sitting, what their perspectives were, how they approach these problems, and how that might differ to the perspective of the client/family.

Dad and I have often worked together before, so we’ve got pretty good chemistry. I get along really well with Dad, so I found the work fun and fulfilling. There weren’t any negative or unintended consequences.

I didn’t find it hard working with Dad; if anything it was probably a bit of a confidence booster to know that he was in the room with me, that I would be taken seriously and that there was someone on my side.

During the workshop I definitely felt safe and valued. I felt like the people in the room were open and seriously considering everything that was being said; everyone was there to listen and learn from each other. I had a lot of people approach me during the workshop and ask questions to try to get to know my thoughts and opinions on all sorts of things. I felt like I could always ask them questions too. There were people there who I was curious about; when I asked them about their work, they were eager to share their knowledge and experience with me.

Thinking about my family members who weren’t involved in the workshop and implications for them, I couldn’t say for sure but I do a lot of jobs at home to help, so me not being there to do that might have put more work on Mum and my older sibling. That’s the only impact I can think of.

I think that doing family participation gives family members the time and environment to discuss things that might have otherwise been awkward. Dad was there as a confidence booster. If it was just me on my own I might not have been taken as seriously, but having my Dad there who knows me well made me feel confident.

The other benefit of family participation was that the people at the workshop got to see Dad and I working together as part of a family, not just as separate people.

The process was definitely worth it. I was very pleased to have the opportunity to talk with professionals and understand processes and concerns that seem very far away from where I am as a layperson.

‘I didn’t find it hard working with Dad; if anything it was probably a bit of a confidence booster to know that he was in the room with me, that I would be taken seriously and that there was someone on my side.’

Kerry (mother of Amelia)

Conceptually, all forms of lived experience participation have been at an individual level, even the more contemporary forms of knowledge production such as co-production. Given that our experiences through adversity occurred as a family, it made sense to me that we explore and safely advance the practice of participation and co-production in a child and family organisation with this family participation approach. It hadn’t been done before and seemed like quite a blind spot in the sector’s knowledge and skill base. Family participation offered an exciting opportunity to build a foundation of collaboration between a family’s lived experience expertise and researchers and practitioners to build capability in services to respond to families’ needs, not perceived clinical individual needs.

It was so exciting doing this work with my daughter. I felt so privileged to have the opportunity to look back together on where we had been and where we were now, so proud of her in stepping so bravely and publicly into such a confronting and new experience, and doing something together, just the two of us. When she was little and through her teens, the enormous overwhelming circumstances of poverty of time and money, and really tough experiences, deprived me of doing things with her that most people take for granted. This opportunity was more precious than most people would realise unless they have had the same lived experience.

I was also aware of the impact that doing this work together might have on our other family members, both of being away from them for the duration of the workshop, and the messages they might have felt about why they weren’t included in the work. I made sure to talk with them about it before, during and after the workshop, made sure they had each other and things to do whilst we were away, and brought them back the usual small gifts after an absence so they knew this small temporary exclusion of them didn’t mean they were less important or mattered less. This may seem like an extremely overprotective approach, but again, unless you have been through so many terrifying experiences that isolate you, it’s difficult to fully understand the importance of security and inclusion.

The experience also gave me hope, in seeing the enthusiastic responses by so many of the participants in the workshop, that there is an appetite for innovative and excellence-oriented practice in the sector.

There’s no doubt that this kind of work is emotionally engaging. There’s usually a mattering differential between those of us who are doing this work because we want to reform and shake up a system that harmed us, and those who engage with this work as part of their paid work role. For me, it’s a visceral experience, based on so many times we were failed and wounded by unresponsive services and policies, and so it’s always challenging to hold down some of these feelings.

This time, I was aware of my daughter’s responses to some of these conversations in the same way, and feeling responsible for bringing her into this work in some way. It wasn’t a huge issue as I felt utterly supported and trusted the expertise of the lived experience partnership team at Emerging Minds. It was also a really good experience to work with another family as part of the workshop – extraordinarily validating. It was also really uplifting to see so many people dedicating their professional lives to working in child mental health from a co-production practice approach.

Reflecting on any negative impacts on me when doing this work, there wasn’t much. Occasionally there would be an outbreak of unreflective assertion of professional expertise that obviously was irritating, but not much. For my daughter, it reminded me again of some of the pain she was put through as a child, which was good to focus on again. But there was no significant impact.

I felt safe doing this work, because of the time we’d spent as a group creating the workshop. Being prepared, working with another family, and then working with Lydia, whom I’ve known for a long time since the children were little, meant there were no issues. The allocation of time to the process from the very beginning was important. Lydia is so good at creating spaces of shared power and intentionally ensuring everyone feels in control of every step of the process.

Reflecting on the impact on our other family members I think is really important. Our other members of the family were fine, although I think they would have liked to be involved. Because my two other children (who were involved in the planning but not the codelivery) were younger, they were very accepting of not being part of this process. Being away from family is also a big part of workshops when it involves travel, so I always make sure I bring back something special for the rest of the family when coming home … having been involved from the start thinking about it now it may have been nice to finish the process with another meeting with the other two children to discuss how the workshop went.

The project was really worth it, I feel like this could be such a valuable teaching aid – even just the role reversal of families as experts rather than in distress and recipients of a service offered was really valuable.

I think family participation brings the importance of roles in people’s lives into focus, and reinforces the existence of a family unit when considering practitioner approaches. I also think it provides safe opportunities for younger people to be involved than may not otherwise be. Having more than one perspective of a family member participating also provides opportunities for deeper discussions about families’ needs.

‘The project was really worth it, I feel like this could be such a valuable teaching aid – even just the role reversal of families as experts rather than in distress and recipients of a service offered was really valuable.’

Amelia (daughter of Kerry)

I agreed to participate as a family partner in this workshop because I was interested in understanding how mental health services are designed from the very beginning. The invitation to participate in a workshop designed to educate professionals on working with children and families intrigued me, as I was curious to know how professionals from different sectors might incorporate such partnerships into their work.

My mum has a professional and lived experience background, whereas I have just lived experience. As such, it was interesting to speak with her over a number of days about her reception of the workshop compared to mine. For example, for me it is obvious what aspects of services are lacking when I reflect on how I was impacted during a given time. My mum reflects this way too, but has a better understanding of how those obvious shortcomings might translate into implementable services. It was interesting to exchange ideas without the background noise of what is or isn’t feasible in a greater context. It was worth it alone to spend those days with my mum.

I felt the co-design work itself was a little open-ended and I wasn’t entirely sure what kinds of direct contributions I could make and how they might have any impact, though I suspect this is because Emerging Minds is already ahead of the game and had covered most of what I would have contributed. I felt a little out of place in the co-delivery, however I definitely found the workshop a valuable experience and was grateful to be invited to share and receive insight on how services are received and how they could be improved. I think it’s only obvious that if you are designing a service for a certain group of people, that they be consulted. I think having family partners present keeps professionals accountable. It was encouraging to be in a room with such passionate people and to hear their ideas.

It’s exciting to think that this workshop might have set off a chain reaction of people who are now eager to engage directly with family partners in their work and how impactful that could be!

Reflections from attendees

  • ‘I found it very useful to have the different perspectives of family members from the same family coming together. Often, child and family partnerships are conducted by speaking to each identity group separately whereas this format gave us the opportunity to explore the similarities, differences, challenges and strengths of each perspective simultaneously. It was also great for combatting binary/stereotypes of child vs family member in which these groups are pitted against each other – in the family participation format, we could see these groups working together, which sent a strengths-based message to the group.’

 

  • ‘Bringing families together in a workshop and around a shared lived experience highlights the reality of family life and relationships. Within families there can be shared perspectives and understandings. There are also many differences and disagreements that families continue to negotiate. Seeing this diversity in a workshop is fantastic. It also highlights something that members of family all seem to share – a desire to be heard, to be listened to and to contribute.’

 

  • ‘Seeing parents and their children working together brought the intergenerational nature of distress and impairment into my awareness. When parents struggle, children tend to struggle too. And when parents work to improve their lives, they also enrich the lives of their children. I know this to be true, yet still I often slip into an individualistic way of seeing, forgetting about the central importance of people’s family and social connections. Having young-adult children and their parents in the same room made such forgetting impossible.’

Conclusion

Our work at Emerging Minds is centred on the understanding that parental mental health adversity impacts children and families. As we strive to improve the mental health and wellbeing outcomes for children, parents and families, we understand that to do the best work in this space, it needs to be done in partnership with them.

Family participation is a useful tool and extension of the co-design and collaborative work we are doing. Family participation in co-design processes can be time consuming, can cost more money, and the resultant change families may wish to see in the real world can also be frustratingly slow. But what we experienced from this process was that it provided beneficial insights to both our family partners, NWC staff and workshop attendees. Insights that may not have been made visible in another format.

The family participation process also continued our ongoing learning in the child and family partnership space and has opened the door for more creative and authentic projects in the future.

No one does this work perfectly. However, family participation remains an important process for us to learn, to practice, and to eventually excel at.

 

Appendix 1

 

Survey for NWC staff that helped shape the content of the workshop

In March 2019 we will be running a cofacilitated session on Child and Family Partnerships. To help us codesign this session with a group of our partners, we invite you to complete this brief, anonymous survey. Your input into the session is highly valued and we intend for the day to be one of rich discussion, respect and shared learning.

  1. What do Child and Family Partnerships mean to you?
  2. What would you like to get from the one-day cofacilitated session on Child and Family Partnerships?
  3. What do you see as being the barriers for you in terms of undertaking Child and Family Partnerships?
  4. Do you have any concerns or reservations about undertaking Child and Family Partnerships?
  5. What value do you think Child and Family Partnerships could bring to your work?
  6. Do you have any other comments?
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