Children, families and practitioners – they all have a voice, and the right to agency in decisions that affect their lives. When they’re asked and listened to, children often have very clear ideas about their engagements with professionals and other adults who are trying to help them.
Within the mental health context, there are myriad aspects of service delivery which can be designed in consultation with the participants, or which can be improved by conversations with these people about how to best meet their needs. How sessions are booked, how they’re structured, how they’re documented; practice approaches, strategies, environments, follow-up appointments, advocacy, referral processes … When considering these issues, the challenge for service organisations is to engage with the key stakeholders – children, families and practitioners – to prioritise their voices in service co-design, then turn their feedback into reality.
Services designed collaboratively with children, families and practitioners tend to be more effective, more acceptable to the individuals and families participating, and more relevant to their local context. Actively seeking input from these participants, either formally or informally, is an approach that can be used to improve outcomes for children and their families (Moore, McDonald, McHugh-Dillon, & West, 2016) – and which can add great value to an organisation.
Partnering with children and families to prioritise their ideas and concerns is particularly important in disadvantaged communities.
The following Emerging Minds video (2 min, 16 sec) explores some of the ideas behind giving a voice to child and family partners, improving practice and delivering better mental health outcomes for children.
Engaging children as partners in practice is helpful for children in many different ways. These engagements show children that their voices are important, and create contexts in which children can:
- have a say in matters that affect their lives
- recognise their own skills and know-how
- see themselves in a different light, not overshadowed by problems
- have their skills, knowledge, values and hopes recognised and valued by others
- gain an increased sense of their own agency to influence their life; and
- contribute to other people’s lives, including those facing similar challenges.
The following are some of the things children have said about partnerships and engagement, and having their voices heard: (Carson, Dunstan, Dunstan, & Roopani, 2018; Australian Human Rights Commission, 2018; Moore, 2017; Griffiths-Cook & Fenn, 2018)
- Opportunities to participate: Children want opportunities to effectively participate in conversations and decisions that affect their lives.
- Feeling heard and respected: Children want to not only have a voice but to have their views and experiences heard, acknowledged, considered and respected.
- Taking time: For children it can take time – more than one meeting – to build a relationship of trust and rapport with a professional.
- Waiting for the right time: Children like adults to know when it is the right time, and for how long, to talk about challenging topics.
- Being interested and encouraging: Children like adults to be interested in what they are into, what they need, and how they respond when things happen in their life. They like adults to be positive and encouraging.
- Listening without interrupting: Children would prefer to meet with professionals whose listening in characterised by respect, being focused on the conversation, and considering and responding to the child’s comments and perspectives without interrupting.
- Checking understanding: Children would prefer to meet with professionals who take the time and effort to build trust by checking their understanding of the child’s perspectives, asking about and acknowledging their feelings, and by being down-to-earth and personable.
- Recognising capabilities and ideas: Children like adults to recognise that they are capable and have ideas they would like to explore to work things out for themselves. They also find it helpful to hear ideas and suggestions from adults.
- Following through: Children would prefer to meet with professionals who follow through on what they say they’ll do, as well as provide feedback and keep them informed of recent and relevant developments.
Building respectful partnerships shines a light on stories of strength, struggle, hope and resilience – as well as the challenges within children’s and families’ lived experience. For service organisations, committing to these partnerships helps build a platform – an informed base from which processes and strategies can be developed, enabling people to share their stories in ways that are valued, respected and supported. However, these partnerships can only be mutually beneficial and provide children, families and practitioners with a genuine voice when:
- they are supported by a whole-of-organisation approach, guided by robust policies and procedures
- the intent, purpose and limitations of every partnership are clearly explained, transparent and reviewed
- the contribution of child and family partners is consistently recognised through remuneration, reimbursement and/or other appropriate ways
- power differences are diligently considered through careful planning to ensure the respect, safety and wellbeing of participants
- children and young people are recognised and respected for their unique insights, ideas and solutions, and for the role they can play in ensuring services, organisations, policies and other outcomes are relevant and appropriate for them
- diversity is ensured through the recruitment of child and family partners with a range of experiences and backgrounds, including Aboriginal and Torres Strait Islander partners; and
- an ongoing commitment to evaluation leads to continual improvement in outcomes, for practitioners, organisations, children and families.
Beyond the more focused, intimate relationships between practitioners, children and families, the process of engaging, listening and following-through in service design can be elevated to a broader community level. When services take this ‘big picture’ approach, engagement systems can be designed to:
- proactively seek-out community values, concerns and aspirations
- incorporate these values, concerns and aspirations into decision-making processes; and
- establish ongoing partnerships with communities to ensure that community priorities and values continue to shape mental health service delivery (Moore, McDonald, McHugh-Dillon, & West, 2016).
Seeking to honour community values is particularly relevant to service delivery within culturally and linguistically diverse (CALD) communities, where social norms, family structures and community expectations may be very different to those in more mainstream contexts. At an organisational level, this ‘honouring’ can be a focus in the design and delivery of mental health services, supporting practitioners to engage with a high level of cultural awareness.
This approach also applies to non-Indigenous practitioners who engage with Aboriginal and Torres Strait Islander children and families. For individual practitioners, it is essential to understand how connections to Community, Country, culture, spirituality, and family underpin all aspects of an Aboriginal and Torres Strait Islander child’s development and social and emotional wellbeing. At an organisational level, this understanding can be applied in the design and delivery of mental health services, to support non-Indigenous practitioners in their engagements with First Nations communities.
In addition to enhancing services and respecting community values, listening to children’s voices is in keeping with the principles of children’s rights. As a signatory to the United Nations Convention on the Rights of the Child (CRoC; United Nations, 1990), Australia has a responsibility to ensure that children’s best interests are reflected in policy and program planning, and that children are widely supported to participate in the decisions that affect their lives.
Giving children opportunities to be involved in decision-making processes and to freely express their needs can empower them, increasing the likelihood that they will access and trust in service systems (Moore, 2017). Having child-centred processes in place can also enhance decision-makers’ understandings of children’s experiences, foster more positive attitudes towards children, and ultimately improve service responses (Moore, 2017; Osborn, & Bromfield, 2007).
So how do we achieve all of the above? The method by which partnerships can be built, voices can be heard, and practice processes developed is called co-design. This methodology is structured to include people with relevant lived experience – such as those living with a mental health condition – as equal partners with practitioners in the conceptualisation, design and development of organisational processes. Co-design ensures that all critical stakeholders, from experts to end users, are given the chance to participate equally in service design (NSW Council of Social Services, 2017; Tyndale, Amos, & Price-Robertson, 2020).
In the co-design process, power is shared. Children and families with lived experience often begin service engagement with the sense that there’s a power imbalance between practitioners and themselves. Professionals must make explicit efforts to address these inequities in power, knowledge and resources – both real and perceived. These efforts require high levels of staff expertise and organisational commitment … and plenty of time.
Another central tenet of co-design is that all participants attempt to relinquish control of the outcome, trusting instead in the collaborative process. This process-focused stance allows for the possibility of new and unexpected ideas and outcomes to emerge.
When it’s done well, co-design can ensure that all participants enjoy true participation, not tokenistic or exploitative involvement (Tyndale, Amos, & Price-Robertson, 2020) – and that the voices of children, families and practitioners can be heard and honoured.
In the following video (three minutes, three seconds), Emerging Minds practitioners and child and family partners discuss organisational support and the benefits of co-design to honour children’s and families’ voices.
Australian Human Rights Commission. (2018). Australian Children’s Commissioners and Guardians Joint Participation Paper 2018. Sydney: Australian Human Rights Commission.
Carson, R., Dunstan, E., Dunstan, J., & Roopani, D. (2018). Children and young people in separated families: Family law system experiences and needs. Melbourne: Australian Institute of Family Studies.
Griffiths-Cook, J. & Fenn, L. (2018). Kids have big thoughts too. Life Transitions: what children say about change. Canberra: ACT Human Rights Commission.
Head, B. (2011). Why not ask them? Mapping and promoting youth participation. Children and Youth Services Review, 33(4).
Moore, T. (2017). Protection through participation: Involving children in child-safe organisations (CFCA Practitioner Resource). Melbourne: Australian Institute of Family Studies.
Moore, T., McDonald, M., McHugh-Dillon, H., & West, S. (2016). Community engagement: A key strategy for improving outcomes for Australian families (CFCA Paper 39). Melbourne: Australian Institute of Family Studies.
NSW Council of Social Services. (2017). Principles of co-design. Sydney: NCOSS.
Osborn, A., & Bromfield, L. (2007). Participation of children and young people in care in decisions affecting their lives (NCPC Brief 6). Melbourne: Australian Institute of Family Studies.
Tyndale, J., Amos, J., & Price-Robertson, R. (2020). Supporting children and families: How does co-design invite us to think differently? Adelaide: Emerging Minds.
United Nations. (1990). United Nations Convention on the Rights of the Child. New York: United Nations.