Why is engaging important?
Engagement with practitioners and services has a direct influence on treatment retention, outcomes and the quality of the experience for clients. Evidence suggests that young people who remain in treatment do better than those who drop out, regardless of the seriousness of the issues (Gilvarry, 2000).
Engaging is especially significant for young people who are less proactive in seeking help for health concerns (Sawyer & Patton, 2000). More specifically it has been observed that adolescents rarely perceive a need for treatment of AOD problems. Further, young people experiencing the most disadvantage and life complexity have been found to have low rates of access to AOD and mental health services relative to need (Busen & Engebretson, 2008; Barry, Ensign, & Lippek, 2002; Rosenthal, Mallett, Milburn, & Rotheram-Borus, 2008; Waldron et al., 2007). This can be because disadvantaged young people with AOD issues often:
- Have fraught relationships parents or carers, who are not in a position to advocate for necessary services (Statham 2004)
- Have limited resources and diminished power in adult-centred systems (Meade and Slesnick, 2002)
- Mistrust professionals and lack the confidence or interpersonal skills to negotiate access (Karabanow & Clement, 2004) or advocate for themselves (Barry et al., 2002).
Clients who are engaged effectively are more likely to raise and work through any issues with practitioners that might jeopardise their involvement in treatment or with a service.
Where a robust connection is established with a client, Youth AOD practitioners are in a position to facilitate their engagement with other key services and social institutions such as schools.
Considerations for different practice contexts when engaging
The modalities through which youth AOD practitioners engage young people and either deliver interventions or facilitate the delivery of interventions are:
- Clinic based settings
- Outreach / casework
- Day programs
- Short-term residential units with a focus on respite and withdrawal
- Long-term residential services that provide supported accommodation and rehabilitation
Each of these modalities provides a context that shapes the process of engaging young people and families.
Clinic based settings are contained environments. The services and interventions delivered within clinical settings are generally consultation based and involve counselling. In practice this means each occasion of service involves young people and families attending for a short, defined period. This could be a single session or be repeated on a regular basis. While there might be time to build engagement over time, the foundations for engagement need to be laid in the first session and geared toward the client feeling motivated to come back for another. Also, the engaging will need to be done as part of formal contact as there is very little unstructured time to bond with a young person or family in a clinical setting.
Outreach is a vehicle for engagement with demonstrated effectiveness, particularly for those young people considered ‘especially vulnerable’ (United Nations, 2004) and ‘hard to reach’ (Gleghorn, 1997; WHO, 2004). Through outreach, practitioners have the opportunity to be proactive in locating and connecting with young people and families in environments where they feel comfortable. Outreach also offers practitioners more scope for flexibility and creativity in devising suitable methods to engage young people and families. For example, offering to take a young person to an appointment or to participate in a mutually agreed activity.
Day programs offer young people safe, contained and often fun spaces in which to participate and access services. Day programs vary both in purpose and in the services and/or resources that are offered but generally provide a blend of structured activities, direct care and an opportunity for unstructured participation. This affords practitioners a range of opportunities to build rapport and engage with clients. As young people attend at their own discretion and in their own time, they are also more likely to be open to makinga connection as they have more control over the engagement process. Day Programs can also provide a place for practitioners from other agencies to engage with young people.
Residential services have young people residing with them 24 hours a day. This can both facilitate engagement and also act as a constraint. Further, these opportunities and constraints differ between short-term residential units with a focus on respite and withdrawal and longer term residential rehabilitation services.
In all residential services the pre-admission period offers an opportunity to begin the process of engaging young people, their families and other service providers that are involved in their care.
Young people have decided to take up a residential option are generally aware that the service needs to know how best provide support and care for them during their placement. This affords practitioners in residential services more scope to be direct in gathering information about clients in the pre-admission and intake period. Assessment and information gathering may need to be handled more delicately and require more time in other settings. This means that residential practitioners very quickly gain a lot of information about a young person and their life circumstances. This combined with the continuous 24 hour contact means that practitioners should take care not to force or rush the process of engagement. Practitioners can take advantage of both the formal (structured programming) and informal (meal times, down time at night) opportunities to engage young people.
Practitioners in residential withdrawal services should also be mindful that each young person’s stay is built around short term goals. This highlights the need to facilitate young people’s engagement with other helpful services and constructive relationships that will support them post the residential stay.
Aims of this module
This module has been developed to strengthen the existing capacity of youth AOD practitioners and agencies to engage eligible young people and families effectively. Twelve key aspects of engaging young are identified and a range of related evidence informed practices explored.