Module 10: Engagement

Objectives

• To be able to define engagement phase

• To be able to identify what helps and hinders engagement

Dual Diagnosis Capabilities

• Role Legitimacy: Recognise and accept that working with people with dual diagnosis is a routine part of ones role. Dual Diagnosis capability 1 level 2

• Non-Judgemental Attitude: Be aware of ones own attitudes and values in relation to dual diagnosis and be able to suspend judgement when working with service users, and carers. Challenge others’ attitudes in an appropriate and useful manner. Dual Diagnosis Capability 4 level 2

• Engagement: Be able to develop an effective therapeutic relationship and be able to work flexibly with this client group. Dual Diagnosis Capability 6 level 2.

Transtheoretical Model Osher and Kofoed’s Four Stages

Pre-contemplation Engagement/early persuasion

Contemplation Early persuasion

Preparation Late persuasion

Action Active Treatment

Maintenance Relapse prevention

Engagement Stage defined as:

• Lack of working alliance between worker and client.

• Sporadic/chaotic use of services.

• Lack of trust (from service user and worker).

• High levels of resistance.

• Non-adherence to treatment proposed.

• Treatment failure.

Interventions for Engagement

• Outreach.• Befriending/ low key.• Creative and flexible approach• Therapeutic optimism.• Practical assistance and crisis intervention- be perceived

as helpful.• Stabilisation of psychiatric symptoms (? admission to

hospital; medication management)• Sensitivity to client’s life, choices and viewpoint.• Typically not addressing substance use.• Utilise strategies to reduce resistance.• Support and exploring alternate social networks.

Exercise

In your experience….

• What things hinder engagement process

• What things aid engagement process

Discuss small groups: 15 minutes