ENGAGEMENT MODEL:WHERE RECOVERY IS THE EXPECTATION!

S T E V E M I C C I O

Engagement and the Recovery Model

“How's That Working For ya?”

ASKING QUESTIONS

• When we come into contact with people that we serve, do these questions resonate?:

• “Are we asking the people we serve the right question(s)”• “What works with our engagement style?”• “What doesn’t work?”• “Do we invest in and embrace wellness

and does it show in how we engage others?”

•“How Do we Know?” and “How does our customer know?”

ENGAGEMENT

Engagement signifies that a person is involved in a process through which he/she harmonizes robust information and professional advice with his/her needs, preferences, and abilities in order to address health and/or mental health issues.

WHAT IS ENGAGEMENT?

• It is a partnership between you and the person served.

• It is a person being self determined to WANT to engage in services/help for all of the right reasons.

• It is mutual respect and dignity.• It is reflected in the “hope” that one shows

concerning a person’s ability to recover.• Engagement can deliver the message that

Recovery is the Expectation!

Build trust through genuine interest in a person’s welfare

Can improve recovery/all health outcomes as both parties focus on shared/partnered goals

Can decrease fear of “punitive” action/outcomes/behaviors

Foster self-determination to do something “different” (meaningful) that may provide a better outcome

WHAT CAN GOOD ENGAGEMENT DO?

COMPONENTS USED IN USEFUL AND SUCCESSFUL ENGAGEMENT

• Orientation• Environment• Language/Listening/

Communication

ORIENTATION

• How do we orient people to our services?• Who greets people as they enter your

facility?• Is it a trauma informed greeting? • How is/are your service(s) described?• Is the information required explained in a

dignified and respectful way?• Is the discussion of payment or finances

private and discreet?

ORIENTATION

• Is a tour given if people enter your office or facility?

• If in-take is needed, is the process transparently explained?

• If it is a long in-take process can it be broken up for the person?

• Is the treatment process or service explained clearly?

ORIENTATION

• Are expectations discussed?• Are people given an orientation packet

when first being introduced to the service (health home, Care Coordination)?

ENGAGEMENT QUESTIONS

When meeting people in community or at the office does it “feel” inviting and safe?

Is there a choice of where to engage where people “feel” safe and respected?

What is your engagement style when greeting someone that you serve?

• Do you say “hello”?• Shake hands, hug?• Are you genuine in your greeting?

LANGUAGE

LANGUAGE

What type of language style is used in your agency?

Using “I” Statements can help with successful engagement

“I feel confused; help me understand.” Rather than: “You’re not making any sense, you’re confusing me.”

Use Statements that Empower“What can I do to assist you in your recovery?” Rather than: “You need to take this medication and follow this treatment plan and you will feel better.”

LANGUAGEUse people first language

◦ “We serve people living with mental illness”

rather than

◦ “We work with mentally ill people or Bi- polars or Schizophrenics, etc.”

(Corrigan, 1998)

LANGUAGE… WHAT NOT TO SAY

“I know how you’re feeling”

“You shouldn’t feel that way”

“You should do this….”

“You don’t mean that”

“I know what’s wrong with you or what's wrong?”

“It’ll get better”

“If you would just follow the program…”

LANGUAGE… WHAT TO SAY

“It sounds like you feel …..”

“Please explain more and help me understand why you feel that way”

“What would you like to do?”

“Here is what I heard you say”

“Tell me what happened to you”

“What is helpful to you in this situation?”

NON-VERBAL

Research suggests that anywhere from 60% to 70% of communication is non-verbal.

(Engleberg, 2006)

Body language: Are you open, arms/legs uncrossed and inviting the person to talk. Lean in and let the guest know you are interested and not judgmental. Look at the person. They need to know you care.

Examples of what people report/observe: Rolling eyes Non-verbal critical body language to other staff Staff turning back towards person Ignoring person completely Threatening stance Staff talking about issues amongst one another disregarding the

person

NON-VERBAL

Does your body language communicate your values and beliefs toward recovery?

Do you exhibit fear or assume dangerousness of people served?

Is there a glass barrier, desk or some object between you and the person?

PARA VERBAL COMMUNICATION

Communication that encompasses intonation, cadence, volume, and pace of saying words.

When we are angry or excited, our speech tends to become more rapid and higher pitched.

When we are bored or feeling down, our speech tends to slow and take on a monotone quality.

When we are feeling defensive, our speech is often abrupt.

PARA VERBAL COMMUNICATION

ToneVolumeRate of speech “ I didn’t SAY you were lazy”“I didn’t say YOU were lazy”“I didn’t say you were LAZY”

PERSON CENTERED LISTENING

This is a term we use in our agency to describe our way of listening to one another through mutuality and the lived experience.

It’s active listening by being fully present and aware of what someone is saying, feeling, experiencing and how they are behaving.

It is void of distractions (Taken from McKay, Davis & Fanning, 1995)

LISTENING STYLES WE AVOID

Comparing: This refers to the constant self-dialogue that happens when the listener competes with the speaker. Essentially, listening is being hindered by how much a person is comparing him/herself to the speaker.

LISTENING (TAKEN FROM MCKAY, DAVIS & FANNING, 1995)

Mind-reading: This refers to the listener who cuts off the speaker in an attempt to speed up the process or get to the “truth of the matter.” The fact is we do not know what the speaker is going to say and we cut them off before they are done speaking thus not allowing the speaker’s message to fully come through.

LISTENING (TAKEN FROM MCKAY, DAVIS & FANNING, 1995)

Rehearsing: This is when we begin to review and create our response before another person is done speaking. When we do this we are not allowing the speaker’s full message to come through.

Filtering: This is when we only hear part of the message because we are listening for certain things. This gets in the way because, again, we do not hear the full message.

LISTENING (TAKEN FROM MCKAY, DAVIS & FANNING, 1995)

Judging: This refers to the act of putting labels or judging people before they speak or even during their comments. If we do not listen from a neutral standpoint we again miss the message.

Identifying: This refers to someone who is always referring back to one’s own experiences while someone is talking. While it is good behavior to do in order to relate with the person speaking, if you self-identify too much you completely miss how that person is feeling in his/her given situation and you ultimately think about how you felt.

LISTENING (TAKEN FROM MCKAY, DAVIS & FANNING, 1995)

•Advising: This refers to actively seeking to “solve” someone’s problems.

•Sparring and being right: This refers to arguing and debating with people based on your personal experiences

LISTENING (TAKEN FROM MCKAY, DAVIS & FANNING, 1995)

•Placating: This refers to agreeing with everything a person is saying so that you get approval of the speaker. If you constantly try to agree with them then you are not truly listening to them.

•Derailing: This refers to changing the subject being discussed to another topic because you are either bored or uncomfortable with the subject.

STRATEGIES FOR ACTIVE LISTENING

Maintain appropriate eye contact

Lean your body forward to show that you are listening

 

Avoid fidgeting or external distractions

STRATEGIES FOR ACTIVE LISTENING

Paraphrase the speaker when he or she is finished speaking

Ask questions to clarify (be genuinely curious)

Listen objectively and keep personal feelings aside

Expectations

EXPECTATIONS FOR ALL

• When engaging with a person that you serve do you offer a transparent approach to what they can expect from your service(s)?

• Do you discuss what you may expect from them while in your care?

EXPECTATIONS

What to expect from us What we expect from you

• Comprehensive Care Management

• Care Coordination and health promotion

• Comprehensive transitional care from in-patient to other settings, including appropriate follow up

• Individual and family support

• Referral to community and social support services

• Open and honest dialogue

• Open and honest dialogue • Self determined initiative• Making every attempt to

follow through on your care plan

• Informing us of challenges and successes based on your care plan

• Feedback on the quality of our services

• Good health and wellness

DECISION MAKING

Do you encourage people to brainstorm on possible solutions to an issue? (Motivational Interviewing)

Empowerment

Responsibility

Crisis Planning

Self Determination

Quality of lifeCenter on Adherence and Self-Determination:

http://www.adherenceandselfdetermination.org/

DECISION MAKING

Are you able to be transparent and share your fears, concerns and possible risks, yet allow the person to make the ultimate decision?

• What is your perception of Choice?

• Does your engagement influence choice unconsciously?

• Who really makes the choice(s)?

TRAUMA INFORMED CARE

Do you treat all people as possible victims of trauma?

Do you understand that some traditional methods of treatment may exacerbate the symptoms of people who have experienced trauma?

Are you conscious of Iatrogenic Treatment?

Do you understand that trauma can come from many sources?

http://mentalhealth.samhsa.gov/nctic/trauma.asp

HOPE

W H Y I S H O P E I M P O RTA N T ?

• H O P E I S T H E B E L I E F T H AT A P O S I T I V E O U TC O M E L I E S A H E A D

• H O P E I S A WAY O F T H I N K I N G , F E E L I N G A N D AC T I N G T H AT M AY H E L P O N E F I N D WAY S T O L I V E W I T H D I F F I C U LT S I T U AT I O N S

• H O P E I S F L E X I B L E A N D H O P E C H A N G E S A S O N E ’ S L I F E C H A N G E S

H O W D O I L E N D A V I S I O N O F H O P E ?

THANK YOU!

S T E V E M I C C I O , C E O

P E O P L E , I N C .

S T E V E M I C C I O @ P R O J E C T S T O E M P O W E R . O R G

W W W . P R O J E C T S T O E M P O W E R . O R G