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 ModelOsher and Kofoed’s Four Stages Pre-contemplationEngagement/early persuasion ContemplationEarly persuasion PreparationLate persuasion ActionActive Treatment MaintenanceRelapse 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