Engagement in help-seeking of dual diagnosed mothers at a low-threshold service: grasping life through co-created opportunities

Abstract

Purpose Mothers with a dual diagnosis (mental ill health and substance use) have delays in accessing services, or their care may be interrupted prior to therapeutic relationships being formed. The purpose of this paper is to explore and describe how engagement merges in the context of mothers with a dual diagnosis. Design/methodology/approach This is a qualitative, focused ethnographic study at a low-threshold service for substance abusing families. The data contain interviews, observations, field notes, and reflections. The analysis followed several systematic steps. Findings Engagement is the co-creation of possibilities between workplace staff and the client in different interfaces. It is not a single act, emotion, or verbal communication, but a complex intertwined system of events that can awaken or enable the client to get a grasp on life. The sensitivity of the worker is one tool for engaging the client in manifold ways in different interfaces: even the smallest events with connection are viewed as valuable. Engagement involves the intentional client in the process of interaction: the client needs to participate and become an acting and sensing part of the change, which occurs on an experiential level. The process is described with the metaphor of a seed. Originality/value Engagement as inner involvement challenges the current working methods, and requires sensitivity, because the mothers with a dual diagnosis may not have verbalisable goals when arriving to the services.

Qualitative description of outreach and engagement in perinatal substance treatment in Finland

“…According to our results, skilled staff need to demonstrate greater sensitivity in approaching women with problematic substance use or SUD-for instance, need to avoid confrontation-and instead cultivate trust. The women in our study also bene ted from a gender-sensitive approach (1,4,8,18,20), which helped to create connections and engagement (38,39).…”

“…A personalized approach that promotes a feeling of being valued may enhance active engagement (38). Engagement can mean commitment to using services (34,38) or it can be de ned as a process, where an inner experienced level of engagement emerges (39). This study will focus on describing and analyzing specialized outreach and low threshold service practices for the women with problem substance use.…”

Carriers of pain: Vulnerable meetings between staff and clients with a dual diagnosis

“…Either can create barriers, which would cause non-understanding. Obstacles or misunderstanding may occur if clients do not have the words to express their needs and problems, 2,22 whereas staff may look at verbal expressions as a prerequisite to facilitate participation with in-depth discussions and exploration of their worldviews. 12 Both the client and staff have control over factors that will increase or decrease the rate and level of involvement on both parts.…”

“…26 Staff have to strive to build relationships, and simultaneously they have to endure and coexperience emotional pain and suffering. 23 In this setting the opportunities for change are co-created, 22 and the main goal is that the client becomes more and more intertwined with her own life opportunities. In practice the cultural phenomenon at this site was approval towards the clients.…”

“…In practice, after individual interviewee-level analysis, these data were compared, and contrasted to the field notes with observations and reflections, which is a form of validation. 13 After vulnerability had appeared as a key concept, 22 a decision was made to study connecting and vulnerability in more detail, and go through the same rich data again. In this specific study the process started from a new pre-understanding, 20,21 and by new thematization.…”