“Sometimes What They Think is Helpful is Not Really Helpful”: Understanding Engagement in the Program of Assertive Community Treatment (PACT)

George, Miriam; Manuel, Jennifer I.; Gandy-Guedes, Megan E.; McCray, Shenee; Negatu, Dina

doi:10.1007/s10597-015-9934-9

Cited by 20 publications

(41 citation statements)

References 19 publications

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“…Despite the focus of the assertive community treatment model on treatment engagement, little is known about which specific elements promote engagement, particularly among homeless individuals. A recent qualitative study with assertive community treatment staff, not focused on those who are homeless, identified the following as primary elements for engaging clients: therapeutic alliance between staff and clients, persistence and consistency, the provision of practical assistance and support rather than a sole focus on medications, the team decision making process, acceptance of clients as they are, and flexibility. A British study of engagement in assertive community treatment compared to community mental health teams, again not specific to homeless individuals, found that the small caseloads and team approach of assertive community treatment facilitated treatment engagement.…”

Section: “Difficult To Engage” Populationsmentioning

confidence: 99%

Treatment engagement of individuals experiencing mental illness: review and update

Dixon

Holoshitz

Nossel³

2016

World Psychiatry

426

326

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Individuals living with serious mental illness are often difficult to engage in ongoing treatment, with high dropout rates. Poor engagement may lead to worse clinical outcomes, with symptom relapse and rehospitalization. Numerous variables may affect level of treatment engagement, including therapeutic alliance, accessibility of care, and a client's trust that the treatment will address his/her own unique goals. As such, we have found that the concept of recovery-oriented care, which prioritizes autonomy, empowerment and respect for the person receiving services, is a helpful framework in which to view tools and techniques to enhance treatment engagement. Specifically, person-centered care, including shared decision making, is a treatment approach that focuses on an individual's unique goals and life circumstances. Use of personcentered care in mental health treatment models has promising outcomes for engagement. Particular populations of people have historically been difficult to engage, such as young adults experiencing a first episode of psychosis, individuals with coexisting psychotic and substance use disorders, and those who are homeless. We review these populations and outline how various evidence-based, recovery-oriented treatment techniques have been shown to enhance engagement. Our review then turns to emerging treatment strategies that may improve engagement. We focus on use of electronics and Internet, involvement of peer providers in mental health treatment, and incorporation of the Cultural Formulation Interview to provide culturally competent, person-centered care. Treatment engagement is complex and multifaceted, but optimizing recovery-oriented skills and attitudes is essential in delivery of services to those with serious mental illness.

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Section: “Difficult To Engage” Populationsmentioning

confidence: 99%

Treatment engagement of individuals experiencing mental illness: review and update

Dixon

Holoshitz

Nossel³

2016

World Psychiatry

426

326

View full text Add to dashboard Cite

show abstract

“…Client engagement is described both as a client-owned concept (Wild et al, 2006) as well as a social worker-related construct (George et al, 2015;Petriwskyj et al, 2015).…”

Section: Engagement Theorymentioning

confidence: 99%

“…Other contradictions could lie within each of the activity systems, such as different cultural backgrounds of actor A and actor B; different institutional logics (rules and regulations of the service provider vs family values / 'rules'). Moreover, there could be a reluctance to co-create certain types of services with actor B or to engage with the service provider in the first place (George et al, 2015). Additionally, a past negative experience may have created barriers to further engagement (Higgins and Scholer, 2009).…”

Section: Actor B's Activity Systemmentioning

confidence: 99%

“…The client is the focal actor in the client activity system. Clients appear to have different levels of engagement (psychological component; Higgins and Scholer, 2009;Brodie et al, 2011;George et al, 2015) during the interactions with the social workers, dependent on the co-creative activity, as expressed by one client:…”

Section: Engagement In the Client Activity Systemmentioning

confidence: 99%

“…But, definitively being in a [group], listening to other people's way of dealing with things is more beneficial than someone just telling you the answer" (Māori male, 27 years). This client's initial reluctance to engage (Higgins and Scholer, 2009;George et al, 2015) changed when interacting with other actors, i.e. other clients in group sessions at He Waka Tapu.…”

Section: Engagement In the Client Activity Systemmentioning

confidence: 99%

See 2 more Smart Citations

An integrative transformative service framework to improve engagement in a social service ecosystem: the case of He Waka Tapu

Hepi

Foote

Finsterwalder

et al. 2017

JSM

112

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The home visit communication skills inventory: Piloting a tool to measure community health worker fidelity to training in rural South Africa

Laurenzi

Gordon

Skeen

et al. 2019

Research in Nursing & Health

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Community-based home visiting programs using community health workers (CHWs) have become popular modes of delivering health care services, especially in settings where health workers are overburdened and resources are limited. Yet, little is known about the processes that shape effective implementation in low-resource settings, and whether these processes adhere to home visitors' training. This study used the newly-developed Home Visit Communication Skills Inventory (HCSI) to explore the delivery of a CHW program in rural South Africa. Routine home visits from CHWs to their maternal care clients were audio-recorded with consent, and later transcribed and translated into English. The HCSI, devised and piloted using existing frameworks and program-specific training components, consisted of 21 items covering domains related to active listening, active delivery, and active connecting, and was used to score English transcripts of the home visits. The HCSI was used to generate general frequencies and aggregate scores for each CHW. Eighty-four home visits by 14 CHWs showed a diverse application of communication skills. Active listening and active delivery were common, with fewer instances of active connecting observed. Practices disaggregated by CHW showcased varying strengths by an individual. In reviewing visit characteristics, longer average visit duration was significantly correlated with the presence of multiple types of active connecting skills.While technical skills were widely observed, fewer CHWs engaged in more complex "connecting" skills. The HCSI is a feasible, low-cost, and practical way to describe home visit fidelity among CHWs. Audio-based checklists can be used to describe fidelity to a model in the absence of additional supervisory resources. K E Y W O R D S communication skills, checklist development, community health workers (CHWs), home visiting, rural health, South Africa

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“Sometimes What They Think is Helpful is Not Really Helpful”: Understanding Engagement in the Program of Assertive Community Treatment (PACT)

Cited by 20 publications

References 19 publications

Treatment engagement of individuals experiencing mental illness: review and update

Treatment engagement of individuals experiencing mental illness: review and update

An integrative transformative service framework to improve engagement in a social service ecosystem: the case of He Waka Tapu

The home visit communication skills inventory: Piloting a tool to measure community health worker fidelity to training in rural South Africa

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