Models of engagement

Having joined the Beyond the Streets team in November 2018 as a Women’s Support Worker at Door of Hope, Lara Hibbs reflects on what she’s learnt about engagement with women so far.
One of the main challenges of our daytime support work of Door of Hope is establishing and maintaining engagement with clients. To some extent this issue is inseparable from our client group, who face social exclusion and find engaging with services difficult for a number of good reasons. However, it has also led us to consider how the way that we plan our project could lead to shifts both in level of engagement and client group make-up.
Engagement models for optional services are on a spectrum between outreach-based, where the service reaches out to find the client, and client-led, where the client initiates and maintains the relationship. Generally speaking there tends to be a relationship between the engagement model and both the perceived benefit of using the service to the client, and the level of action and buy-in required from the client to use it. For example, vaccination programmes or HIV testing services are often outreach based, and an effective intervention can be completed in a short, one-off interaction. This is represented by the green diamond on the left of the graph below In contrast, our excellent local homeless centre offers longer-term courses involving more commitment from the t over multiple meetings, and engagement is initiated by the client. This correlation is intuitive as it stems from the natural action arising from the existing motivation of potential clients.
Our Beyond Support telephone call-back service is represented by the green diamond on the right of the graph, as using the service involves several telephone meetings over a long term period, but is initiated by clients.
Our daytime support service, represented here by the red star, is an outlier to this relationship in that engagement is outreach-based, but using the service typically involves having several meetings with a support worker and the focus may well be tackling a considerable task, for example starting drug recovery, or a housing application. In other words, a large amount of dedication and input is needed from the client.
This natural line of best fit describing engagement in various services, as already mentioned, stems from the natural actions arising from client motivation, as well as the need for efficiency in services. One response to this relationship is to deliberately align ourselves to this line of best fit, and focus on working with self-referrals for daytime support work. This would have the benefit of having clients with a level of motivation which is likely to be higher, and would be likely to be a more efficient way of running the service. Another response is to accept the inefficiency which this model necessarily concedes, with the main advantage of recognising that in our client group the chain of ‘natural actions arising from client motivation’ may be broken by the effects of addiction, past failure, or controlling relationships. One client who we see sporadically told us about how she can be in two or three minds about how much she wants to have a meeting with us, depending on her state of mind and heroin use. Another client would love to have her own place to live, but every housing meeting we set up is sabotaged by her partner.
It is not obvious to us that there is a right response out of these two to the issue of how we engage clients. We do not want to be another service that sacrifices the left-behind on the altar of efficiency. On the other hand, we do not exist outside of a system of limited resources, and we are determined to remain woman-led and not to become a controlling or harassing force to our clients. That is, the woman is the agent of change in her own life, and if that motivation is absent we will not replace it with our own.
Happily, there are multiple potentially adjustable variables affecting engagement, for example ‘perceived benefit’ to potential clients may increase over time with reputation of our service, amount of service-user input required may go down as our pathways, for example, into housing, are smoothed out. However, the dilemma of a good engagement model remains.