In our previous column, we discussed the benefits of adding peer employees to the behavioral health workforce. For the most part, our focus has been on adult systems, but in this column we share an example of “parent partners” who work with families in a system of care for children. We are thrilled that in many systems for both adults and children, parents finally are being given the opportunity to share their experiences and hard-learned expertise with families in the process of recovering from mental illnesses. This is consistent with one of the fundamental goals in the final report of the President's New Freedom Commission on Mental Health: to involve people receiving services and their families in the planning and delivery of services in order to promote recovery.
Like most peer employees, parent partners have personal experiences that match those of the families they work with. Hired as paid employees, parent partners work directly with other parents and support them in their efforts to advocate for their children in schools, access community services, and create healthy home environments. Parent partners share their own experiences with other families as a way of extending hope for recovery.
Earlier this year we had the privilege of being part of one of the most interesting examples of this concept when we trained a group of parent partners in Riverside County, California. The county first hired parent partners for children's programs in the mid 1990s. Once the parent partners began working with families, an interesting shift took place in the overall relationship between the clinical staff and the parents of children using services. The parent partners were building bridges between the staff and families, which produced better processes and outcomes. The parent partners provided clinicians with the parents' perspective on services, allowing staff to adjust service delivery methods and create a better connection with parents.
The parent partners developed an orientation class for parents entering the system so they knew what to expect. Parents expressed very positive feelings about the parent partners' work. Parent partners were “naturals” at engaging fellow parents early in the service delivery process, and the support and information they provided reduced the no-show rate.
Families in Riverside County were learning a lot from talking to other parents who had faced similar problems. They were learning how to approach the system to receive better assistance and support for their children. They were becoming credible advocates for their families. They no longer felt alone as they faced the challenges of obtaining appropriate services for their children.
These positive outcomes convinced Donna Dahl, program chief of the county's mental health department, along with Erlys Daily, the manager of children's programs, and Renee Becker, family liaison, to forge ahead with plans to expand the program and make it available to more struggling families. With funding from California's Mental Health Services Act (Proposition 63), they had the opportunity to add 17 parent partners to their existing workforce of 11.
This was not as easy as it sounds, though. If you are familiar with the civil service system, which is fraught with enough obstructions to stop almost any innovative idea in its tracks, you may be wondering how it was possible to hire parent partners in the first place, let alone add more. What we learned from Donna and her team is the value of endurance— sometimes you just have to outlast the resistance, especially when trying something new. Donna and her team were able to explain the value of adding parent partners to those who manage the larger aspects of county operations, first in the mid 1990s when the job descriptions initially were established, and again this year when they had the funds to expand the project.
We were honored to recently train the parent partners about a recovery-oriented approach to working with families. We adapted our Peer Employment Training (PET) to match the parent partners' needs, who have slightly different issues than those of peer employees. To do this, we had to back up, squint, and develop a new perspective and sensitivity for the needs of parents with minor-age children.
We realized that the parent partners needed to develop some advanced communication skills. They needed to be able to share their own personal experiences with other parents in ways that inspired hope that their children could recover. They needed skills to work with clinical teams in ways that allowed them to join as strong contributors to the healing process. They needed skills in becoming credible advocates, as well as on how to voice concerns to upper management. Since the parent partners worked with parents not only individually but also in groups, they needed group facilitation skills.
The following key points will help you establish parent partners in your own programs, and we are convinced you will be pleased with the results.
Anything you can do to reduce stigma and discrimination will strengthen each family's ability to address its stressors. Parents experience stigma too, although for them it's more like what Corrigan and Miller call “courtesy stigma,”1 negative responses extended to those closely associated with people who have mental health diagnoses. One parent partner related a story of having been identified as the mother of a child with mental illness at a social event, and then being regarded with shock and morbid curiosity by other parents, who previously had shown her kindness and respect as the mother of other “normal” children.
As with all peer training programs, it's important to provide top-notch training to parent partners before they join the workforce. In our PET classes, we emphasize the importance of focusing on strengths to facilitate the recovery process. One parent partner remarked that in the past she had almost forgotten that her child was still a beautiful human being, and that she hadn't realized how little providers and teachers spoke of hope and her son's recovery.
Like most peer employees, parent partners often experience resistance from the professional teams they are hired to join, so they need support from management. Professional team members often voice concerns about parent partners' professionalism, competency, and lack of formal behavioral health education. Thus, parent partners have to work diligently at creating a space for themselves. Training professional staff about the benefits of parent partners will help alleviate this resistance. Strong support from immediate supervisors and top leadership is a key to success. It's important to link the parent partners' work to the organization's overall vision.
Don't be discouraged by civil service requirements. If your organization is part of a governmental entity bound by civil service requirements, take heart! If Riverside County was able to work within this structure to set up job descriptions for this class of employment, you might be able to do it too (you can reach Donna at DDAHL@co.riverside.ca.us). If, however, you are exhausted by the thought of working through this process, think about adding parent partners at contracted provider agencies. They have much more latitude when it comes to setting up employment opportunities for new job classifications. Once parent partners are hired by a contracted provider, they could work at your sites on your teams even though they are employed elsewhere.
Adding parents to the workforce, as with other peer programs, is a great idea. It's a way to increase the effectiveness of services, right from the beginning when the engagement process begins. Probably the most important aspect of adding parents to the workforce, or any peers for that matter, is a solid training program that instills the importance of a recovery-based approach that focuses on strengths and self-determination. Laying the groundwork for a successful integration is also important, and it should encourage professional staff to embrace parent partners so they can create a strong partnership.Lori Ashcraft, PhD, directs the Recovery Education Center at Recovery Innovations, Inc. (formerly META Services) in Phoenix. William A. Anthony, PhD, is Director of the Center for Psychiatric Rehabilitation at Boston University. Ellen Dayan is a Recovery Services Instructor at Recovery Innovations.
- Corrigan P, Miller F. Shame, blame, and contamination: A review of the impact of mental illness stigma on family members. J Mental Health 2004; 13 (6): 537–48.