Kara M. Dean-Assael, LMSW Jayson Jones, LMSW Ruth Colón ... · cost-benefit analysis of partnering...

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Kara M. Dean-Assael, LMSW Jayson Jones, LMSW

Ruth Colón-Wagner, LMSW Yvette Kelly, LMHC

February 23, 2015

Welcome Introductions Today’s objectives The Engagement Process Review of engagement at first contact Engagement at the first few meetings Ongoing Engagement Role play Next Steps Questions/Concerns

Provide participating organizations the

opportunity to improve the knowledge and skills of engagement practices that meet

high standards of quality. Today, we’ll focus on engagement skills

during the first meetings and retention.

Many organizations are increasing their use of engagement practices for financial AND quality issues

Effectively engaging participants is not easy and prone to numerous pitfalls

It takes specific skills and knowledge to effectively engage participants

Many individuals engaging participants have had little training in these competencies/skills

Ongoing engagement and attendance is often a challenge

Consistent and effective best practices in engagement with participants is a serious challenge

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Best Practices: Engagement

www. Th e Na ti on al Cou nc il . or g

Phone Based Engagement

First Phone Contact

Motivational Interviewing

Trauma Informed Care

Ongoing Phone Contact

Trauma Informed Care

In-Person Engagement

First Contact First Meetings

Discharge Planning

Ongoing Contact

R.O.P.E.S. Action Steps

Every point of contact is an opportunity for engagement!

A. Very First Contact B. First Meetings C. Ongoing Engagement

Four Phases of the

Engagement Process

1. First Contact 2. First Meetings 3. Ongoing Services/ Retention 4. Terminating Services


Summary of Phase One:

Engagement at First Contact


Objectives: Be welcoming Validate the caller Express empathy and understanding Assess for urgency Clarify the need Confirm the next appointment and problem solve

any presenting barriers

Do you have any questions from our last webinar?

Did anyone make any changes in their first contacts since the last webinar?


Phase Two: Engagement at First

Meetings


Objectives: Remember the ARCH principles Focus on immediate concerns and needs Help participants make informed decisions about

treatment and clarify the helping process Encourage shared decision-making in treatment:

set the foundation for a collaborative working relationship

Instill hope, reinforce strength, and foster resilience

Attend to participant’s past experiences with mental health services and problem solve around barriers

Create an opportunity for participants to ask questions and contract for future services


Acceptance, Respect, Curiosity, and Honesty Micucci, Joseph A. (2009)

Be ready to schedule another appointment sooner than the following week. Participants often need help negotiating with

other “systems” (healthcare, substance abuse providers, etc.). Responding to participants’ concerns provide

an opportunity for provider to demonstrate their commitment and potential capacity for help.

Provide a clear overview of first meetings Clarify the helping process…

Carefully introduce self, agency intake process, and possible service options.

Discuss what is expected of participant and what they should expect from the intake process

Clarify the need for mental health care- establish the felt need

Set the foundation for a collaborative working relationship. Explain roles and responsibilities with

the focus on ‘shared’ goals “We” begins to be created


Empower participants by: • Providing positive feedback • Instilling hope • Reinforcing strengths • Fostering Resilience • Helping to identify barriers to implementing change within their

day-to-day life and help problem-solve around those barriers

Validate participant and take time to understand participant’s perspective

• Participants may have concerns about privacy and confidentiality • Participants who do not trust the provider or feel the information

shared will not be held in confidence are also at a greater risk for dropout

• Cultural and racial differences between the provider and participant can lead to misunderstanding

Identify and problem-solve around barriers to help seeking First meetings are most helpful if there is an exploration

of potential barriers to obtaining ongoing services Specific obstacles, such as time and transportation must

be addressed. Other types of barriers include previous negative

experiences with helping professionals; discouragement by others to seek professional help; differences in race or ethnicity between the interviewer and the participant; trauma history


• Create a space for participants to feel comfortable to express their concerns and ask questions

• Contract for future services


Phase Three: Ongoing Engagement


Objectives: Validate and identify strengths Express empathy and understanding Encourage shared decision-making Build hope and foster resilience Continue to problem-solve around concrete and

perceptual barriers Helpful Techniques to Consider: R.O.P.E.S.


• Despite dropping out of services, participants that do so often require further services, but are less likely to seek mental health services in the future

• Getting participants to initially engage is good but not sufficient to produce change.

McKay, Harrison, Gonzales, Kim, & Quintana, 2002; Harrison, McKay, & Bannon, 2004; Kazdin, 1996; Prinz &Miller, 1994; Stanton & Shadish,1997;

McKay, 2000; Deane, Wilson, & Ciarrochi, 2000

Build a trusting relationship ◦ Provider needs to establish

trust by acknowledging the power dynamics that have existed in traditional service delivery models with providers having control.

◦ Providers must be transformed from the dominant provider to a coach or mentor helping individuals to develop skills and grow.

Expert Coach/Mentor

Inform participants of the cost-benefit analysis of partnering with you to meet their goals ◦ Discuss expected duration and

modality of treatment ◦ Inform participants that services

will be customized according to their needs and change as necessary

◦ Explain your role as coach to help guide them through their learning.

Information is a record Information is

shared

Treatment negotiation ◦ Negotiate an

agreement on the nature of the patient’s problem and the manner in which it should be addressed in therapy

Professional Autonomy Choice

Participant Empowerment ◦ Incorporate their

therapy preferences. ◦ Instill general hope

about the process.

Deficit Focused Strength

Focused


R eview_____ O verview___ P resentation____

Tell Show

E xercise________ Do

S ummary__________ END

BEGINNING

MIDDLE


>Review >Overview >P >E >S


Designed to promote: • Continuity and follow up from the previous meeting • The process of engaging, orienting and motivating

learners about the current meeting • Promote involvement and acknowledge strengths

STEP 1: Review of important points from previous meeting STEP 2: Review of Action Step

STEP 3: Overview of the agenda


Presentation part of the ROPES format begins a focus on the current meeting:

Important Information

Personalized Discussion •Helpful to identify strengths and areas to consider improving

Discussion points •A suggested starting point to stimulate interaction


An invitation to participants to: •continue their learning •apply their learning between meetings

A twist on homework assignments - the action step

•Not required •Not given by the “teacher” •The person chooses to give him/herself a homework assignment •High value placed on identifying areas of interest and using it to set the agenda in meetings


The ending of a meeting corresponds to the Summary component of a R.O.P.E.S. teaching process

What is it? • A very quick review of what was discussed in

the session

Why is it important? • It reinforces learning, assesses participants’

understanding and gathers important feedback from participants

www. Th e Na ti on al Cou nc il . or g Engagement Practices- Role Play Vignette

• Jayson is a 28-year-old man presenting with substance abuse issues and depression. He is currently unemployed and looking for work.

• He has missed his first two appointments, first calling in to reschedule because he was “feeling under the weather,” then forgetting to show for the follow-up.

• Jayson lives 20 miles away and usually uses his cousin’s car whenever he can.

• Otherwise, he would have to take a bus and a train to get to the clinic. • Jayson has a 4 year old son, who he shares custody with. • Jayson comes in for his second session with Ruth

• What is your feedback?

Plan

Act

Check

Do

Inpu

t

Plan – define organizational plan for quality tied to customer needs.

Do – improve organizational performance on key indicators.

Check/Study – assess how well the services delivered in “DO” phase accomplished the objectives in “PLAN” phase.

Act – evaluate and refine quality plan.

The diagnosis Have we assessed the problem correctly? Do we have the complete picture? Have we fully assessed the strengths of the participant? Have we fully assessed and addressed practical barriers

that disrupt the treatment process? The problem of practitioner-participant

misalignment Has their been a successful engagement process? Is there a discrepancy between the treatment plan aims

and the felt need of the participant? Are their cultural values, beliefs, and preferences that

have not been taken into account?

Dosage and Duration (e.g., attendance and progress tracking) ◦ Missed appointments ◦ Lack of “homework”/ “Action Plans”

Order of intervention strategies (e.g., treatment planner)

Fidelity to the intervention

Adaptation of the intervention in a way that maintains the active ingredients ◦ Variation vs Deviation

Review the diagnosis thoroughly How was the diagnosis made? Who was involved in contributing to the final diagnosis?

Review the core clinical problem that has been the focus of treatment

How was this determined? Is this core clinical problem area that the practitioner has

been addressing endorsed by the participant? Review the interventions and approaches

What interventions have already been tried? Is there a way to measure progress on the critical clinical

problem(s)? Are we consumed by the crisis of the week? Have we been

able to stay focused or do we meander from one crisis or problem to another?

Use the progress tracking, treatment planner and session planner to identify problem area, adjust, and get back on track

Communicate with participant and get feedback as to what they would like to do

Collaboration!

www. Th e Na ti on al Cou nc il . or g Engagement Checklist

Engagement Guides Feedback Form Feedback Article Treatment Planner Session Planner Action Planner

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1) What strategies can your agency/clinic use to ensure that these objectives are addressed with participants?

2) What obstacles may prevent your agency/clinic from implementing these objectives?

3) What is one thing your agency/clinic can do starting tomorrow?

Date Time Offering

March 16, 2015 for our LC

11am – 12pm Consultation webinar

March 17, 2015 for broader CTAC audience

11am-12pm Consultation webinar

April 6, 2015 for our LC

11am - 12pm Consultation webinar

April 7, 2015 for broader CTAC audience

11am-12pm Consultation webinar

May 4, 2015 11am-12pm Final Webinar: Lessons Learned and Sustainability

June Follow-up Survey for our LC

Materials owned by ICL, Licensed by CTAC

Kara M. Dean-Assael Jayson Jones [email protected] [email protected] Ruth Colón-Wagner Yvette Kelly [email protected] [email protected]

Materials owned by ICL, Licensed by CTAC

mailto:[email protected]






McSilver Institute for Poverty, Policy, & Research www.mcsilver.org New York Association of Psychiatric Rehabilitation

Services www.nyaprs.org/ Clinic Technical Assistance Center (CTAC) www.ctacny.com The National Council for Behavioral Health www.thenationalcouncil.org http://www.in-trac.co.uk/supervision-now-or-

never/ http://www.scottdmiller.com/

http://www.mcsilver.org/

http://www.nyaprs.org/

http://www.ctacny.com/

http://www.thenationalcouncil.org/

http://www.in-trac.co.uk/supervision-now-or-never/



http://www.scottdmiller.com/

http://www.scottdmiller.com/

Kara M. Dean-Assael, LMSW Jayson Jones, LMSW Ruth Colón ... · cost-benefit analysis of partnering...

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