Engaging Individuals in Counseling: Results of Initiating an Engagement Group in a Community Mental Health Center

Background and significance: A failure to engage clients seeking mental health services is a serious problem for both providers and individuals in need of treatment, making the identification of ways to improve access to care an important part of the agenda of both service providers and services researchers. We determined that up to 60% of individuals asking for treatment did not attend their initial assessment in FSWP's outpatient division, a problem that contributes significant costs to the running of a community mental health center. Even those in need mental health services who attend once or twice do not get enough treatment to benefit significantly. This is a major public mental health problem that negatively impacts the morale and mental health of the individual or family requesting counseling, the functioning of the agency and the morale of the clinician. Improving initial engagement was thus identified as a core shared content interest at the inception of our academic/agency collaboration, and we developed an active program of research in this area. Five mixed methods projects have been completed, involving interview studies of clinicians and people seeking services, and three analyses of innovative approaches to improve engagement developed by the outpatient staff, one of which is described below. Methods. Therapists noted that incongruity between client and therapist expectations for treatment frequently led to lack of engagement. Clinicians and supervisors developed an engagement group to prepare clients for use of treatment by minimizing barriers to treatment and reframing negative expectations. Forty-one people who missed their initial assessment or two therapy appointments attended a one-hour Engagement Group. These individuals also completed pre-post knowledge tests about “What Is Therapy”. Results: Attendance analyses were conducted separately for people missing two appointments and people missing initial assessments. Analysis 1 examined 27 people referred for missing two appointments. For these people, attendance patterns were examined in the 20 weeks before and after group attendance. Attendance increased from 2.3 to 3.6 sessions, [t (df =26) = 2.30, p <.05], and “no shows” decreased from 2.8 to 1.7 sessions [t (df =26) = 3.00, p < .01]. In Analysis 2, each of the 14 people referred for missing an initial assessment was matched to two similar clients who attended their initial assessment. Attendance patterns for engagement group attendees and matched comparisons were identical [3.4, versus 3.2 sessions, t (df=37) = .19, NS]. Pre-post knowledge tests also showed significant improvement in scores. Conclusions and implications: The data reported here provides an illustration of the joint program of engagement research designed to bridge the “rigor/relevance” gap. These efforts have led to the identification of some important quality improvement areas for the agency. The engagement interventions undertaken by the clinic, such as the one illustrated here, each had a positive impact on engagement. A variety of techniques can be jointly developed, successfully implemented, and demonstrated to effectively address this pressing problem.