Treatment engagement is defined as:
the individual and environmental factors that influence someone’s continuation of treatment, adherence to recommendations, attitudes toward treatment, and collaboration with providers.
In addiction treatment, engagement matters because it influences participation, retention, achievement of goals, treatment satisfaction and outcomes.
So what influences engagement levels? Research indicates that several factors can help clients feel more engaged and involved in their treatment process. These factors include:
- Creating a welcoming environment
- Using motivational interviewing
- Building a collaborative relationship
- Asking for feedback
- Applying a multidimensional, individualized approach
Creating a welcoming environment
A client’s experience early in treatment – starting from when they call your office or walk through your doors for the first time – strongly influences engagement and retention. Details matter at this stage, including:
- Reducing barriers and creating easy access to your facility for individuals with disabilities
- Creating a clean, friendly waiting area – with a water source, accessible restroom, culturally diverse imagery on the wall, friendly and responsive staff, and helpful, engaging literature – like Interactive Journals – available in prominent areas
- Establishing a friendly and supportive intake process – waiting to do lengthy assessments until subsequent sessions
Using motivational interviewing
Motivational interviewing is a client-centered, goal-oriented communication style that promotes positive behavior change by strengthening client motivation. Across three decades of research, motivational interviewing has been found significantly effective for enhancing engagement across a range of populations and settings. The motivational interviewing style includes asking open-ended questions, providing affirmations, offering reflections, and responding with empathy and genuineness in client interactions.
Building a collaborative relationship
One of the biggest indicators of client engagement is having a strong alliance with the practitioner. An alliance includes collaborative goal setting and giving clients a sense of ownership in their treatment process. It also includes establishing trust and rapport through empathic, supportive interactions over time.
Asking for feedback
Seeking feedback on patient progress can improve client symptoms and reduce dropout by 20 percent. Instruments like the Session Rating Scale (SRS) provide brief opportunities to check in with clients and understand their unique needs using questions about the client-practitioner relationship, goals and topics covered, the approach or method used, and an overall rating. Similarly, the Outcome Rating Scale (ORS) is a four-instrument questionnaire that assesses client well-being. Both instruments take less than a minute to administer, score and interpret collaboratively with the client.
Applying a multidimensional, individualized approach
Combining interventions and approaches to meet the unique needs of your clients is the most effective way to increase engagement. Motivational enhancement, a welcoming environment, a collaborative relationship and feedback measures can lead you to interventions that meet their specific needs. These might include digital treatment modalities, Interactive Journaling®, culturally humble or trauma-sensitive practices, certain types of therapy, harm reduction models, or other interventions relevant to the needs and life experiences of your clients.
Additional resources
International Center for Clinical Excellence
Effective Psychotherapists: Clinical Skills that Improve Client Outcomes
Treatment Improvement Protocol (TIP) Series, No. 47: Treatment Entry and Engagement
Motivational Interviewing Staff Training