Key Worker – My journey from clueless to passionate
In 2009 I returned to Australia after a year of working as a paediatric physiotherapist in London. I knew I wanted to continue working with children and found myself sitting in an interview for a Key Worker position. Key Worker? I had never heard of this before! However, I was drawn to working with young children. It was an interesting interview – instead of being bombarded with questions, much of the interview was spent explaining the role to me.
I would be assigned to families as their Key Worker, working with them on all aspects of development rather than just their mobility or physiotherapy goals. I would have support from other therapists in my team (speech pathologists and occupational therapists) to help me support the children and families that I would be working with.
To me, this made sense. After all, when I’m at the playground with a parent and their child who wants to be able to use the slide with their friends without needing help to climb the stairs, we are going to communicate with each other. We are going to discuss whether we go down the slide again or have a go on the swing. Perhaps we are going to tell a joke while we catch our breath. What better time for us to work on this child’s communication goals?
And I say us: the child, the parent and myself because my role isn’t to work one on one with the child. It isn’t me that will be successful in helping the child to achieve their goals. It is what the child and parent (and other significant people in the child’s life) do between sessions that will lead to success. This is because the time between therapy sessions allows greater opportunities to practice the skills and have a greater impact on a child’s progress than a therapy session alone. It makes more sense to practice a skill when the opportunity arises during the course of the day rather than trying to create an opportunity in a therapy session. Research tells us that when a parent uses a strategy with their own child it is 3 times more effective than when used by a practitioner (Dunst 2007). As a Key Worker, it’s not my role to tell the parent what they should be doing, but to coach the parent to identify what will work for their child, for them and their family. Often, I will provide information or guide a family to source the information that they need to make an informed decision. My role may be to give ideas or show a parent what they could do. We then discuss if this will work for them and their child, we might practice doing it or discuss what would work for them to work on that skill with their child during their day-to-day life.
Working as a Key Worker was a very steep learning curve initially. It often wasn’t easy, but I knew that working this way made a difference. Parents report that having one main contact person who knows them well and understands their child and family is important to them and makes it easier for them, rather than having numerous professionals coming and going, each potentially adding things to practice between visits without knowing what else is going on for this family (Moore 2013, Drennan 2005). It is satisfying to work with families to identify what their main priorities are and to support them in these areas. After all, it’s often not possible, or effective, to try to work on everything at once. When the child and family require support from another discipline, that support is provided, it might be a joint visit or a series of visits, or even some information that is provided and then I as the Key Worker would continue to support that child and family to continue to embed those strategies into their life.
Fast forward a number of years and Key Worker continues to be recognised as best practice, including by the NDIS. It makes sense because the principles that the Key Worker model is based on are what leads to meaningful outcomes for children and their families.
These principles include:
- Identification of functional goals that are important to the child and family.
- Working with families to build their capacity to support their child to achieve these goals.
- Working with children and families in natural environments, the places where they spend their time.
- Working collaboratively with families and other members of the child’s team with family permission. This could be educators, other therapists, or medical professionals.
It is important to acknowledge that for the Key Worker to be successful in supporting children and families they themselves need to be well supported. This means Key Workers being a part of a stable team where they build rapport and trust with each other, where therapists from other disciplines are available to support the child and family when required, and where Key Workers are supported to learn and grow, in their discipline-specific skills, in all areas of child development as well as in skills related to service delivery, such as coaching.
Drennan, A., Wagner, T. & Rosenbaum, P. (2005). The ‘Key Worker’ Model of Service Delivery. Keeping Current #1-2005. Hamilton, Ontario: CanChild Centre for Disability Research. Retrieved from https://www.canchild.ca/en/resources/85-the-key-worker-model-of-service-delivery
Moore, T.G. (2013). Teamwork in early childhood intervention services: Recommended practices. Briefing paper prepared for Early Childhood Intervention Australia (Victorian Chapter). Parkville, Vic.: Centre for Community Child Health, Murdoch Children’s Research Institute, The Royal Children’s Hospital.
About the author
Eva is the Early Childhood Clinical Excellence Lead at KEO Care. Eva started her career as a physiotherapist working in a rehabilitation hospital before moving into paediatrics, working in a special school and then spending some time working in community paediatrics in the UK. Since 2009, Eva has worked as a transdisciplinary Key Worker and is passionate about supporting families to achieve the best outcomes for their children. In her role at KEO Care, Eva trains and supports Key Workers to ensure that they satisfied and proficient in their role and that the children and families they are supporting get the benefits of a well functioning transdisciplinary Key Worker service.