Kara M. Dean-Assael, LMSW Jayson Jones, LMSW Ruth Colón-Wagner, LMSW Yvette Kelly… ·...

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

Ruth Colón-Wagner, LMSW Yvette Kelly, LMHC

Welcome Introduction Language Engagement Defined Barriers ◦ Trauma History

The Engagement Process Initial Contact Role play

Our Introductions POLL QUESTION-Please share: ◦What role do you have in engaging participants in care? A. Director/Administrator B. Supervisor C. Clinician D.Administrative Support

Supervision is really about the quality of the relationship and is focused on: Addressing the emotional experience of human service work Improving the quality of interventions and staff decision-

making Enabling organizational accountability and effective line

management Identifying and addressing the issues related to cases,

caseloads, and workload management Encouraging the identification and achievement of personal

learning, career and development opportunities

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• A recognition of the essential elements of an effective supervisory alliance, high level of trust, collaborative style, emphasis on self-efficacy, direct communication style, etc.

• A commitment to providing a sufficient dose of supervision. • A process for direct observation of the work being

delivered; live observation or audio-video review. • Behaviorally specific written feedback from direct

observation activities. • Additional modeling of the skills/strategies to be

employed. • Ongoing opportunities for practice and feedback. • Plan for incorporating feedback and continued direct

observation.

Carver, D. (2014)

◦ The coaching and mentoring process begins before the intervention or service is provided. Discuss the service plan, the supervisees concerns and strategies. How the person will approach the work Provide helpful tips based on engagement best practices For practices with fidelity, review the fidelity indicators and identify which

indicators will be the focus of the work For direct observation, discuss how and why the supervisor will be introduced

◦ Always give supervisee the first opportunity to reflect on their work? ◦ Focus and emphasize on what the person did well ◦ Share your feedback in a way that doesn’t establish the supervisor as

the final expert on effective practice ◦ Offer concrete suggestions that are practical and can be applied at

the next available opportunity. ◦ Get feedback from supervisee about the helpfulness of the coaching

Provide participating organizations the

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

high standards of quality.

Initial participant engagement begins the participant-therapist relationship

Successful participant engagement practices can contribute to: ◦ Successful participant recovery ◦ Increased rates of attending initial face-to-face

appointment ◦ Increased rates of follow-up appointments

Supervisors are crucial in promoting engagement practices

Hope – Empowerment – Optimism Fostering Recovery

Building Hope Supporting Resiliency

Trauma informed

What Peers Do: • Acknowledge that everyone’s recovery is unique • Serve as role models by sharing their personal recovery stories, showing that recovery is possible • Teach goal setting, problem solving and symptom management skills • Empower others by helping them identify their strengths,

supports, resources and skills • Use recovery-oriented tools to help their peers address

challenges • Assist others to build their own self-directed wellness plans • Support peers in their decision-making by cultivating

others’ abilities to make informed, independent choices • Set up and sustain peer self-help and educational groups • Offer a sounding board and a shoulder to lean on • Advocate by working to eliminate stigma

Best Practices: Engagement

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

Engagement is about motivating and empowering participants to recognize

their own needs, strengths, and resources and to take an active role in

changing their life.

Engagement is essential in the provider-participant relationship from the moment a participant is considered

for treatment until they terminate or are discharged.

Engagement

Empower to Speak and be Heard

Policies and Practices

Creating Opportunities for

Involvement Capacity Building

Relationships

Strengths Based

Partnership

Addressing Needs of the Participant

Philosophy

Respect for Participant’s

Expertise

Addressing Barriers

Collaborative

N. Chovil, 2009

www. Th e Na ti on al Cou nc il . or g Engagement is the process by which

participants and service providers work together to achieve participant goals.

Participants are in control of their own treatment, including direct outcomes

• Person-centered treatment is essential for outcomes and engagement.

• Every aspect of treatment is in collaboration with the participant

• Impact of services can be magnified by participant involvement


STRONG PARTNERSHIPS WITH PARTICIPANTS AND PARTICIPATION IN TREATMENT ARE THE GOALS (YET ASSOCIATED WITH SERIOUS

CHALLENGES)TO INCREASE POSITIVE OUTCOMES FOR PARTICIPANTS

Program of services research based on core assumptions :

Collaboration with participants lead to services and prevention programs that potentially are:

•acceptable to participants •relevant to participant’s context, specific needs

and core values •potentially effective when… • implemented in “real world” settings by naturally

existing providers and resources (sustainable)


• Not all barriers are “equal.” • Perceptual barriers (e.g., stigma) and prior

negative experiences have been shown to have the greatest influence on initial and ongoing engagement

• Addressing perceptual barriers may be more important than focusing only on concrete obstacles


• Clients are satisfied with gains made within therapy Up to 45.5% (Todd et al, Roe et al)

• Dissatisfaction with therapist or therapy sessions Up to 34% (Todd et al, Hunsley et al) Sample client statements: Felt therapist was making treatment

worse, Weren’t confident in the therapist abilities . Did not like the therapist

• Circumstantial Barriers (Scheduling issues, child care conflicts, financial barriers) Approximately 32% (Hunsley et al, Roe et al)


• Approximately 29% believed that clients had successfully completed treatment goals

• Approximately 21% believed it was due to environmental factors Client relocated Lack of financial resources or insurance Therapist left the agency

• Approximately 23% believed that clients were no longer interest in therapy

• Only 3% of therapist believed that clients left due to dissatisfaction

Roe, D., Dekel, R., Harel, G., & Fennig, S. (2006)


These experiences may affect their participation in treatment and are most

important to consider in our engagement practices from the very

first encounter with a participant

www. Th e Na ti on al Cou nc il . or g Trauma refers to intense and overwhelming

experiences that involve serious loss, threat or harm to a person’s physical and/or emotional well being.

These experience may occur at any time in a person’ life. They may involve a single traumatic event or may be repeated over many years.

These trauma experiences often overwhelm the persons coping resources. This often leads the person to find a way of coping that may work in the short run but may cause serious harm in the long run.

How many of the participants in your organization have a history of trauma in their lives?

A. All of them B. Most of them C. Some of them D. A few of them E. None of them F. I don’t know


•Safety •Trustworthiness and Transparency •Collaboration and Mutuality •Empowerment •Voice and Choice (Fallot 2008)

What Hurts Interactions that are

humiliating, harsh, impersonal, disrespectful

critical, demanding, judgmental

What Helps Interactions that

express kindness, patience, reassurance, calm and acceptance and listening

Frequent use of words like PLEASE and THANK YOU

What hurts Congested areas that are noisy Poor signage that is confusing Uncomfortable furniture Separate bathrooms Cold non-inviting colors and

paintings/posters on the wall

What helps Treatment and waiting rooms

that are comfortable, calming and offers privacy

Furniture is clean and comfortable

No wrong door philosophy: we are all here to help

Integrated bathrooms (participants and staff)

Wall coverings, posters/pictures are pleasant and coveys a hopeful positive message

What hurts Rules that always seem to be broken (time to take a second look at these rules) Policies and Procedures that focus on organizational needs rather than on participant needs Documentation with minimal involvement of participants Many hoops to go through before a participant’s needs are met Language barriers

What helps Sensible and fair rules that are clearly explained (focus more on what you CAN DO rather than what you CAN’T DO) Transparency in documentation and service planning Materials and communication in the person’s language Continually seeking feedback from participants about their experience in the program

What hurts Asking questions that convey the idea that “there is something wrong with the person” Regarding a persons difficulties only as symptoms of a mental health, substance use or medical problem

What helps Asking questions for the

purpose of understanding what harmful events may contribute to current problems

Recognizing that symptoms may be a persons way of coping with trauma


Phone Based Engagement

Initial Phone Contact

Motivational Interviewing

Trauma Informed Care

Ongoing Phone Contact

Trauma Informed Care

In-Person Engagement

First Meeting

Discharge Planning

Ongoing Contact

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

Every point of contact is an opportunity for engagement!

Four Phases of the

Engagement Process

1. Initial Contact 2. Initial Interview/Meeting 3. Ongoing Services/ Retention 4. Terminating Services


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


Be sure caller has date and time of the appointment, as well as directions by car, bus, and subway (if applicable).

Be sure caller understands what he or she needs to bring (past reports, insurance card, identification, list of medications, etc.).

Explain timeline of first appointment (orientation to clinic, paperwork, questions/topics for first appointment, etc.).

Follow up with caller by phone or mail with an appointment reminder.


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.

• Despite appointment reminder calls, Jayson has missed his first two appointments. He called at the last minute on both occasions to reschedule.

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

• Jayson has a 4 year old son, who he shares custody with. • What would you tell Jayson when he explains his situation • How can you work with Jayson to ensures he gets the help he

needs and wants? • Would you use MI with Jayson? If so, How? • What engagement strategies would you use with Jayson?

www. Th e Na ti on al Cou nc il . or g What strategies can your agency/clinic use to

ensure that each of these objectives are addressed during the first phone contact and initial appointment with a participant? What obstacles may prevent your agency/clinic from implementing these objectives? What is one thing your agency/clinic can do starting tomorrow (Action Step)?

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

• Engagement Guides • Trauma Infograph • Motivational Interviewing

Information • ACE Survey • Brochure

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Schedule of Next Steps

Date Time Offering

February 23, 2015 11am – 12pm Webinar Training: Engagement Practices

March 16, 2015 for our LC

11am – 12pm Consultation Call

March 17, 2015 for broader CTAC audience

11am-12pm Consultation Call

April 6, 2015 for our LC

11am - 12pm Consultation Call

April 7, 2015 for broader CTAC audience

11am-12pm Consultation Call

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

Materials owned by ICL, Licensed by CTAC

Lydia Franco [email protected]

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 ACE Survey www.cdc.gov/ace/index.htm acestudy.org/home http://www.in-trac.co.uk/supervision-now-or-never/

http://www.mcsilver.org/

http://www.nyaprs.org/

http://www.ctacny.com/

http://www.thenationalcouncil.org/

http://www.cdc.gov/ace/index.htm

http://acestudy.org/home

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












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