Strategies for Engagement By Tammy Guest, MA Oregon Supported Employment Center for Excellence

It’s not unusual to find that people receiving mental health services (and people in general) can be difficult to engage at times.

Life Can Be Overwhelming! Imagine trying to handle all of this while also managing recovery from a mental illness!

Are we coming to the wrong conclusions? “Susie is late or doesn’t show up to a lot of our appointments. She seems picky about what hours she is able to work and sometimes brings her baby with her to our meetings! She presents as disheveled and unkempt. She doesn’t always return my calls. I think she just isn’t motivated to work.”

Dartmouth Website Recommendation Q : How do we work with an individual who repeatedly does not show up or will not engage with us? How much time should we spend trying to reach out to him? A : Rather than focusing on the length of time spent on providing outreach, focus on learning the reason that the person is not engaged.

Person A: Brand New Client ES Job: Vocational Profile, getting to know the client, establish rapport, develop job search plan, discuss disclosure, schedule benefits planner, develop resume & master application, refer to VR, visit a matching employer within first month. Person B: Actively Seeking Work ES Job: Continue meeting regularly with person for resume tailoring, cover letter development, interview practice, etc. while doing regular job development with matching employers. Also, begin planning for job follow along supports (address barriers to work that the person previously experienced.) Person C: Actively Working ES Job: Keep in regular contact with client and employer (with ROI), follow the FA plan and keep an eye out for potential repeats of previous problems with jobs (or new ones), active listening with the person re: the job, encourage the person to seek feedback from their employer, review “ways to shine as a new employee”, reinforce treatment modalities developed by clinician, check in with treatment team about progress. Person D: Not Engaging ES Job: Find out reasons for lack of engagement and identify ways to address the barriers to participation.

How to find the reasons for lack of engagement: 1.Look in the EHR/EMR and find out who the person is consistently meeting with (therapist, case manager, skills trainer, peer specialist, etc.) 2.Schedule a meeting with that person (and/or discuss in a treatment team meeting)and ask for insight into the lack of engagement (i.e.; are they aware of life challenges getting in the way, is the person reporting fears of losing benefits, is the person uncomfortable working with the ES, are the person’s symptoms increasing, memory problems, etc.) 3.Ask to join the next scheduled meeting that they have with the person. 4.Develop plan with the person and treatment team to address the barriers to engagement.

Finding reasons for lack of engagement cont… 5. If the person has not been showing up to meet with other treatment team members either, staff this at a treatment team meeting and: a. Call a family member or friend (w/ROI) b. Visit the person’s home (along with another treatment team member.) c. Visit areas of the community where the person tends to go (coffee shop, park, etc.) Be careful about approaching if the person is with other people, due to confidentiality. d. Visit or call the person’s employer, if employed and there is an ROI.

Ok, I’ve tried all of these things. Now what? 1.Make sure that all of your efforts have been fully documented and that you have kept the entire treatment team apprised of your efforts. 2.If treatment team members have success in meeting with the person, they are charged with finding out reasons for lack of engagement with clinic and/ or with IPS program. The team would develop a plan with the person to address the identified barriers. 3.If still no contact with the person, staff with your supervisor in weekly group or individual supervision. If you’ve had no contact for a certain period of time, then discuss whether closure to the program might be appropriate.

What NOT to do Client begins missing appointments: 1.Leave messages. 2.Mail letter giving __ # days to respond. 3.Close. OR 1. Do nothing for weeks- months just to see if the person calls on their own.