Strategies for Effective Peer (Lived Experience) Employment within Multidisciplinary Organizations: Model for Best Practice

What is best practice in employing Lived Experience workers? 

Byrne, L., Roennfeldt, H., & Wolf, J., Linfoot, A., Foolesong, D., Davidson, L & Bellamy, C. (2021). Effective peer employment within multidisciplinary organizations: Model for best practice. Administration and Policy in Mental Health and Mental Health Services Research. doi: 10.1007/s10488-021-01162-2

Take Home Messages
  • Best practice in employing Lived Experience workers involves a whole of organisation approach. 

  • Senior leadership of the organisation need to understand and value the work and demonstrate this valuing.

  • Best practice requires organisational commitment which is long-term and provides adequate financial support.

  • Best practice requires an organisational culture that values and supports Lived Experience workers as well as mutual respect and collaboration. 

  • Organisational strategies support effective employment of Lived Experience workers, such as Lived Experience workers in senior roles, Lived Experience led supervision and whole of workplace training on the value and role of Lived Experience. 

  • Best practice approaches support authentic Lived Experience work that contributes to more recovery-oriented and person-driven services. 

Aim

To get a clearer understanding of what organisations do to support effective Lived Experience employment.

Method

We interviewed and held focus groups with 132 people, including designated Lived Experience and non-designated workers (including senior and executive management as well as clinicians and HR professionals) employed in multi-disciplinary organisations in the US that delivered both mental health and alcohol and other drugs services. The organisations were nominated by a group of peer experts as demonstrating commitment to effective employment of peer/Lived Experience workers. 


We then used this information to develop a model for best practice for peer/Lived Experience employment.

Why is this Research Important?

Employment in a work environment that does not understand, value or collaborate with Lived Experience workers is damaging to the workers and limits the potential benefits of Lived Experience work.

Results

There is a relationship between organisational commitment, culture and strategies that contribute to best practice. 

Effective employment of Lived Experience workers begins with organisational commitment to authentic Lived Experience Work. Organisational commitment begins with Senior leadership being exposed to Lived Experience work and concepts, understanding the uniqueness and value of the work and taking action to support the development of the work. The attitudes and understanding of the Senior Leadership of the organisation then need to be communicated and taken up throughout all levels of the organisation. This leads to meaningful, sustainable, financial and philosophical commitment to the work throughout the organisation.

Participant Quotes Relating to Organisational Commitment

Peer work is valued and seen as essential

"So, it's [peer work is] a given. It is a founding tenet of this clinic to make sure that peer support was included."

Site 1 Focus Group Peers

Organisational Culture that contributed to effective Lived Experience employment was described as transparent, open to change, fostering mutual respect and meaningful collaboration, and demonstrating a commitment to learning through challenges.

Transparency

"It’s being open, transparent and that's also what helps us to maintain recovery, is that honesty and the willingness to talk about the problems and talk about the successes."

Site 1. Interview: Peer Manager

Participant Quotes Relating to Organisational Culture
Organisational Strategies

Several strategies were identified to facilitate a supportive workplace culture and overcome professional defensiveness. These included the employment of senior peer roles in positions of authority and with the ability to impact change, workplace preparation and training, recruitment strategies, policies and procedures, peer led supervision and peer specific training. 

Organisational/workplace culture

  • Workplace preparation and training for all staff to understand and value the work

  • Exposure to Lived Experience concepts from orientation

  • Mutual understanding & respect 

  • Role of HR in embedding peer work, including appropriate policies and processes

Demonstrated valuing of peer work

  • Included in mission statement & organisational policies

  • Championing at all levels of the organisation: top down and bottom up support

  • Sufficient numbers of peers to non peers

Senior peer roles

  • Peer leadership roles help to preserve role clarity and authenticity of designated roles

  • Promote and guide peer workforce development

  • Provide career pathway

Addressing and ensuring role clarity

  • Understanding and maintaining the authenticity of the roles 

  • Appropriate peer-led supervision

  • Effective recruitment

  • Training for peers in Lived Experience discipline and concepts

Additional Challenges

Additional challenges such as funding and a lack of diversity could also impact the effective employment of Lived Experience workers. 

Potential Challenges

Funding

  • Funding being cut

  • Funding guidelines that inhibit authentic peer work

  • Funding opportunities being exploited by those without authentic peer understanding

Workplace culture (inadequately addressed)

  • Training as a ‘once off’ - needing to be revisited annually

  • Poor collaboration, understanding and respect across roles

Lack of diversity

  • Language/communication barriers

  • Need to understand and embrace diverse cultures

  • Lack of leadership roles for people from diverse cultures and perspectives

Peers seen as optional

  • Peers seen as optional rather than ‘central to business’ and Lived Experience not included in policies/mission

  • Inadequate or inappropriate HR policies and processes and inadequate supervision

Insufficient numbers of peers to non-peers

  • Not enough peer roles to non designated staff

  • Lack of peers in senior roles

  • Lack of career pathways

  • Limited access to peer led supervision

Conclusions and Suggestions for the Lived Experience Workforce
  • There is a need for financial investment in Lived Experience workforce development. Organisations need to employ sufficient numbers of Lived Experience workers to influence workplace culture.

  • A philosophical commitment includes Lived Experience values and concepts as part of policy and practice, including within the organisation mission statement and this commitment needs to be referred to often.  

  • Organisations need to be willing to take risks, be open to change and learn through challenges. 

  • There is a need to ensure a supportive workplace culture by investing in workplace preparation and whole of workplace training (preferably before employing Lived Experience workers) to reduce assumptions and defensiveness towards Lived Experience workers.

  • Senior Lived Experience roles and greater numbers of Lived Experience workers are needed in leadership roles with Lived Experience workers employed at all levels of organisations.

  • There is a need for Lived Experience supervision for role clarity and protecting role authenticity.

  • Need for professional development and Lived Experience specific networks and other Lived Experience-led supports. 

  • There is a lack of cultural inclusion and diversity in the Lived Experience workforce and greater diversity and equity in employment as well as whole-of-organization training in cultural capacity building. 

  • Funding challenges can undermine the effective Lived Experience approaches.  Educating funding bodies about Lived Experience principles and practice to assist in funding that supports Lived Experience work. This could include having Lived Experience workers within funding body decision-making, funding design and allocation.

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