Peer Workers START COURSE Transition Support Project logo Description This online training module is an introduction to utilising peer workers and is intended to complement the staff induction training provided by your organisation. Every organisation does things differently and has different policies and guidelines. Please interpret the content in this module with your organisation in mind and discuss any discrepancies with your line manager. Duration: Approximately 45 minutes (you can close the training and pick up where you left off at a later date). Language used in this training module is based on the following national standards: - National practice standards for the mental health workforce (2013) - National framework for recovery-oriented mental health services (2013) Last updated: October 2021 Content and links in this training were correct at the time of publication. We check these regularly; however, if you find broken links or errors please contact
Training objectives Lesson 1 of 6 raining objectives This module is for people who want to learn more about peer workers. By the end of this module you will: • Understand the definition of peer work • Understand the definition of co-production • Understand the benefits of using peer workers • Understand how peer workers are trained • Understand the barriers faced by the peer workforce and how these can be addressed • Understand the strategies and processes to get the most out of the peer workforce • Understand the evidence for incorporating peer workers into your organisation • Explore links between peer work and NDIS recovery coaching Image of an open book Assumed knowledge This module is for people who want to learn more about peer workers. We have other training modules that cover NDIS topics which may be relevant to this module, particularly Psychoscoial Recovery Coaching, which can be found on the training page of our website. There is no assumed knowledge for this module.
Introducing peer work and co-production Lesson 2 of 6 What is peer work? Peers are people with a common interest or lived experience of mental illness. Peers can support each other by sharing advice and solving problems together. They draw on their experiences to help and support others in similar circumstances. The lived experience of peer workers enables them to connect in a meaningful way with the people they support and provide a greater level of understanding and support. Peer workers help to support, inspire and educate their clients. They assist in building confidence and resilience for people who are struggling, providing them with examples from their life and showing them that personal challenges can be overcome. Peer workers can also sometimes be called consumer workers, carer workers or lived experience workers. Peer workers are most often employed in either formal peer support roles as mental health peer workers, working directly with consumers or carers, or as peer advocates, advocating for consumers or carers on an individual level and/or for system improvement. Importantly, unlike other professional supportive relationships, peer workers are not solely at a distance, but perform the role of both mentor and carer. Peer workers perform a needed role in the healthcare community. Their stories and experiences can be a powerful shared connection with others. Peer work is a professional role that is distinguished from other forms of peer support by the intentionality, skills, knowledge and experience that peer workers bring to their role. They are employed as professional subject matter experts who can be key conduits between consumers, their carers and other support people, and services. The NSW Mental Health Commission has produced a video to explain what peer work is. This video by the Council for Intellectual Disability also discusses peer support. “Every time I use my lived experience to help someone else, I heal a little bit more.” - Peer worker Short quiz: The peer workforce and the mental health sector Continue What is co-production? The notion of co-production is key to peer work. The New Economics Foundation (NEF) describes co-production as: "A relationship where professionals and citizens share power to plan and deliver support together, recognising that both partners have vital contributions to make in order to improve quality of life for people and communities." NEF's full literature review on co-production in mental health (2013) is available online. Their principles of co-production are unpacked below. Principles of co-production According to NEF, there are six principles which form the foundation of co-production: Flip cards Card 1: front Taking an assets-based approach Card 1: back This involves transforming the perception of people, so that they are not seen as passive recipients of services and burdens on the system, but rather as equal partners in designing and delivering services. Card 2: front Building on people’s existing capabilities Card 2: back This means altering the delivery model of public services from a deficit approach to one that provides opportunities to recognise and grow people’s capabilities. This process involves encouraging people to put their individual talents to use at an individual and community level. Card 3: front Applying values of reciprocity and mutuality Card 3: back This means offering people a range of incentives to work in reciprocal relationships with professional and with each other, where there are mutual responsibilities and expectations. Card 4: front Engaging peer support networks Card 4: back This involves engaging peer and personal networks alongside professional networks to help transfer knowledge. Card 5: front Blurring distinctions Card 5: back This means removing the distinction between ‘professionals’ and ‘recipients’. It also means removing the distinction between ‘service providers’ and ‘consumers’. By eliminating old paradigms, the way in which services are developed and delivered can be reconfigured for greater, mutual benefit. Card 6: front Facilitating rather than ‘delivering’ Card 6: back This means enabling public service agencies to become catalysts of sustainable change rather than the sole drivers of change. Image: Alternative Ladder of Participation How does co-production differ from engagement and consultation? Genuine co-production is about more than just consulting those with a lived experience. Co-production involves working with participants as equal partners and actively applying their input at every step of service creation and delivery. The figure to the left illustrates an Alternative Ladder of Participation, highlighting the differences between the concepts of 'doing to', 'doing for' and 'doing with'. This is explored further below. A deeper dive into 'Ladder of Participation' concepts Image of a face Where there is a lack of consumer participation, service providers are viewed as "doing to": This means that the person with a lived experience of mental illness is not invited to be involved in the design or delivery of a service. The expectation is that the person will be compliant and let the service 'happen to them'. Image of a person looking down, wearing a T-shirt with “Mental Health Matters” printed on it The next level of consumer participation involves "doing for": This means that services are designed by service providers, but the person with a lived experience of mental illness may be informed and asked to provide their opinion through consultation. They are given an opportunity to share their views, but these are not necessarily actioned and do not shape the service. Image of people having lunch behind glass The highest level of consumer participation is genuine co-production, or "doing with": This means that the person with a lived experience of mental illness is involved in all aspects of the service design, including delivery (e.g. through peer support or mentoring). In this case, service providers and participants are equal, and people's voices are heard and actioned.
Peer workers: benefits and barriers Lesson 3 of 6 Why peer work? There is a growing body of evidence that supports peer work as playing a unique and central role in the delivery of recovery-oriented mental health services. Read more about the National Standards for Mental Health Services and the National Framework for Recovery-Oriented Mental Health Services. Health Workforce Australia has produced a peer workforce literature scan. This video by the NSW Mental Health Commission discusses the benefits of peer workers and the benefits and challenges associated with incorporating peer work into the workplace. There is also a video depicting peer work in action, and how to support someone with a lived experience in the workplace. Peer work can also engage hard-to-reach populations, by fostering trust, communication and empathy. How do peer workers benefit people who use mental health services? The benefits of peer work in disability are well-known. We often look to our peers for ideas or advice and to share concerns. People with disability and their families who have good peer support networks have been shown to be happier, more resilient and better informed. Peer workers can: • reduce feelings of social isolation • break down service barriers • help improve a person's social functioning • help make a person feel more accepted and less stigmatised • increase feelings of hope Peer work improves recovery outcomes Research shows that peer support can improve recovery outcomes for people. It can: • improve hope • develop a recovery-oriented perspective • support the development of important life skills • increase self-esteem • support a personal sense of empowerment • improve advocacy skills • support a sense of connection and belonging • reduce clinical symptoms Image of people seated talking How do peer workers benefit organisations? Peer support in mental health has recently gained significant attention and has being shown to be an important factor in people’s recovery. There is now substantial evidence that the quality of life of those experiencing mental illness can be substantially enhanced when peer support is an integral part of their treatment and/or interventions. Peer workers can improve a service or organisation’s culture and enhance its recovery focus. Working with peer workers helps other mental health staff understand that the people they care for can and do recover; improving empathy and understanding towards the consumers and carers they support. Peer workers accomplish this by role modelling hope and recovery, and the visibility of peer workers as designated lived experience staff helps to reduce stigma. Peer workers can also deliver training to staff and provide the consumer or carer perspective on committees, and policy and project teams. Peer workers can: • develop and sustain a culture based on recovery practices • bridge gaps between supports provided by other professionals • reduce hospital admission rates • access hard-to-reach clients • reduce the load on other workers Read more about National Mental Health Statistics on peer work. This video by NSW Mental Health Commission explains the importance of peer work to teams. For person with a lived experience of mental ill health, a career in peer work can: • provide an opportunity for a person's lived experience to be used purposefully • turn the experience of mental ill health into a platform for further growth and development • generate high levels of personal and professional reward by using the experience of mental ill health to help others Read some stories shared by peer workers about the benefit peer work had on their recovery journey. “Peer support is not like clinical support, and it is more than just being friends. In peer support we understand each other because we’ve ‘been there’ ,shared similar experiences and can model for each other a willingness to learn and grow. We come together with the intention of changing unhelpful patterns, getting out of ‘stuck’ places, and building relationships that are respectful, mutually responsible, and, potentially, mutually transforming. This allows us to try out new behaviours with one another and move beyond the ‘illness culture’, where we are defined as sick and disabled, into a culture of health and ability.” - Mead and Copeland, 2004 Mind's peer work framework Knowing when and how to disclose purposefully is one of the most important aspects of the peer worker role. This includes being aware of the purpose for each disclosure and what the possible and preferred outcomes are. This is especially important when sharing possibly traumatic or adverse experiences. Purposeful disclosure also includes making the decision not to share. Peer workers employ the same skills in effective communication as other community mental health practitioners. This includes being aware of body language, developing and maintaining connection, avoiding problem solving or giving advice, being curious, listening to learn, and using the same language the person does. Read more about the peer work framework developed by Mind. CONTINUE How are peer workers trained? Image of face The National Mental Health Commission has funded the Mental Health Peer Work Qualification Development Project and the Champions of Mental Health Peer Work Initiative, both of which have been coordinated by the Mental Health Coordinating Council on behalf of Community Mental Health Australia. These projects were established to develop and support a nationally recognised qualification for peer workers (Certificate 4 in Mental Health Peer Work). It is hoped that this certification will facilitate a broader utilisation of peer workers in mental health services across Australia, and ensure a consistent level of training for the role. Where are peer workers employed? Peer workers are most often employed in admitted settings, public community mental health services, community managed organisations, and disability services to provide peer support and advocacy to people experiencing mental health issues (consumer peer workers) or their carers (carer peer workers). They are specifically employed for the expertise developed from their personal lived experience of mental illness and recovery or their experience as a mental health carer. Image of person looking away Barriers faced by the peer workforce Health Workforce Australia has identified the following barriers to successful peer work: Poorly defined jobs Roles and responsibilities of peer workers can be vague, as can be the reporting and supervision structure. Pay rates can often be less than other workers in the team. Negative attitudes and stigma There continues to be stigma around peer work in the mental health workforce from other mental health staff. Some workers have preconceived ideas about the usefulness and value of peer workers to the team. Role conflict and confusion Peers have a constant requirement to balance their lived experience expertise with other roles and duties included in their paid employment as a mental health worker. Lack of clarity regarding confidentiality A lack of clarity around disclosure of personal information from peers to others poses a potential barrier for peer workers. Limited opportunity for networking and support Peers are often the only peers in their team, or part of a small team. This can result in peer workers feeling isolated and unsupported. Strategies to overcome barriers Factors affecting peer integration -Workplace strategies that promote integration, including inclusive workplace strategies and processes, cohesive team culture and understanding the benefits and value of peer work for clients. Attitudes towards recovery - Clear recovery position in mission statement - Leadership committed to recovery - Peer position viewed as essential rather than add-on Role conflict and confusion - Well defined recruitment strategies - Consistent application of workforce policies to peer and non-peer staff - Written job applications for all staff including peers - Supervision to ensure that actual job expectations are the same as written job expectations - Training to staff and clients to provide understanding of roles - Formal orientation for new employees Lack of confidentiality - Neutral job titles that do not disclose peer status - Implement a formal disclosure process for peers - Keep previous treatment records of internally recruited peers in confidential files - Do not allow peers to receive services where they are employed - Training on policies and practices related to confidentiality - Establish a formal process for sharing work-related information to peer and non-peer staff Job structure - Accepts experience in lieu of formal credentials as HR policy - Peer positions are permanent - Peer positions have a clear path for promotion - Apply the same performance standards to peers and non-peers - Compensate peers and non-peers equally in comparable positions - Provide benefits counselling to help inform the peer's decision on hours to work Social support - Opportunities for interaction in agency life (team meetings) - Include peer input in treatment planning and case notes - Offer peers training to learn language of the workplace - Supervision Peer support is not: Informal support Peer work is not a form of ‘informal support’, which means it should be freely given and provide mutual benefit. Friendship Peer work is not the same thing as friendship; it can and should have limits/boundaries (though sometimes people do become friends). Giving advice Peer work is not giving advice, it is sharing experiences and listening to the experiences of others. Given by people without lived experience Peer work is not given from people who don’t have the same personal or lived experiences that are the basis for the peer support. Image of a person smiling Values associated with peer work Flip cards Card 1: Front Hope Card 1: back Maintaining a positive and optimistic outlook; valuing hope, courage and perseverance; knowing that people do recover from mental health challenges. Card 2: front Mutuality Card 2: back Building relationships which minimise power imbalances and build connection and trust, and empathising. The ability to take the perspective of another and feel what they feel. Card 3: front Respect Card 3: back Considering the rights, values, beliefs and property of all people. Card 4: front Integrity Card 4: back Acting with honesty and accountability. Card 5: Front Making a difference Card 5: back Working towards social justice, respect for people’s rights and fostering the inclusion of consumers in community life. Expand the sections to learn more about peer practice principles: Purposeful disclosure Purposeful disclosure means sharing personal lived experience in a way that is both safe and appropriate. Purposeful disclosure can help the peer worker to build connection or establish rapport, to support the person in their lived reality, to validate their experiences, to reduce stigma, to inspire hope and to demonstrate empathy. Recovery-orientated practice Peer workers use their lived experience of recovery when holding hope for someone who may not have hope for themselves and incorporate their lived perspectives to support recovery-orientated practice. Trauma-informed practice By drawing on their lived experience, peer workers understand the impact trauma can have on all aspects of people's lives, and take this into account in their practice. Self-care Self-care is different for everyone and includes mental, physical and spiritual health. Peer workers practice self-care as well as encouraging these behaviours with consumers, carers and fellow staff. Making meaning Peer workers know that understanding experiences, behaviours, and beliefs is key to the process of recovery. Effective communication Effective communication includes being aware of body language, developing and maintaining connection, avoiding problem solving or giving advice, being curious, listening to learn, and using the same language as the person. Peer workers tend to use everyday language as opposed to diagnostic or clinical language as the latter can be detrimental. Mutuality and advocacy Peer workers have unique skills in building relationships that both acknowledge and minimise power imbalances and build connection and trust based on empathy. Influence Peer workers draw on their lived experience, knowledge base and peer work values to contribute to a positive culture within teams.
Peer work informing recovery coaching Lesson 4 of 6 Peer work and recovery coach work The concepts of peer work inform the role of psychosocial recovery coach. The psychosocial recovery coach is a service item under the NDIS for people whose primary disability is psychosocial. Recovery coaches can have lived or learned experience and require Certificate 4 training or equivalent experience. Most recovery coaches will have tertiary qualifications in peer work or mental health and experience in mental health related fields. This is a new opportunity for qualified mental health peer workers. It is helpful to think about the recovery coach as a specialist life coach for NDIS participants who have mental illness. Recovery coaching is a contemporary way of working with people with a psychosocial disability. In line with a peer work approach, recovery coaches work collaboratively with participants, their families, carers and other services to design, plan and implement a recovery plan; and assist with the coordination of NDIS supports and other mental health specific supports within the community. Image of people having coffee. For more information We have developed a psychosocial recovery coach training module. Access it here for a more in-depth exploration of recovery coaching.
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