Engagement, Community Rehabilitation Companies and Lockdown

Melanie Rivera works with 3SC on our justice delivery through her company healthy4Living and she has seen first-hand some of the challenges faced by clients during the current crisis. Pre-COVID-19, Mel delivered face to face with service users but due to current restrictions this has now moved to intervention over the phone. Workbooks which are completed at each session are either emailed by the Community Rehabilitation Company (CRC) Case Manager to the service user or sent to their address so this can be completed over the phone with them.

Mel works with service users who lack confidence and struggle with anxiety and feels that the currently delivery method helps with service user engagement as they are not having to meet Mel in crowded offices and having to travel for the meetings. Mel has received 7 referrals in May 2020 which is 2 more than the previous 4 months. This showcases how her delivery has grown by adapting her intervention to give Case Managers the opportunity to continue to refer during the COVID-19 period.

Melanie had this to share with us;

“As a small service provider who has been delivering my service to the CRC for a number of years now, I would like to share some of my best practice ideas in continuing to deliver my service during such a challenging time. Over the past few months our country has had to pull together, during this COVID-19 pandemic, in lockdown. I adapted my business and service delivery in order to continue delivering my programme and do the rewarding work that I do with vulnerable service users. The results have been great, because I have found new ways to grow, and build my relationships with all my team as well as service users, Case Managers, and my 3SC Contract Performance Manager, who kindly promoted my service. I have since had new Case Managers referring their cases to me on my integrity course.

I believe there is a continued need for this type of delivery, and perhaps not just during the pandemic.  Delivering sessions by telephone is another way to communicate and I personally think sessions can be just as effective as face to face work with lots of unique advantages including:

• Able to reach out to more people, including the ones that are more isolated.
• Less travel time means more service users can be reached in different areas.
• Possibly less DNAs (did not attend), and no cost for travel or room bookings for the sessions.

I have found the following approaches and strategies really helpful for effective telephone sessions and keeping the service users involved, even though we are not face to face.

1) Staying with person-centered and collaborative ways of working

I am a huge advocate of ensuring that vulnerable CRC service user, feel valued and respected as human beings. This does not mean dismissing that they have done wrong. It simply means hearing them and empathizing with the adversity they face in life. This tends to create a trusting alliance and they feel safe enough to connect with their thoughts and actions and explore how they might change their behaviour and ultimately their direction in life.

Fairness and transparency ensure equality of opportunity to all. Engaging service users in what they want to get out of each session can ensure that there is a good balance of structure and collaboration, the topics can they draw out what relevance and meaning the material has for them personally. This means actively listening to what service users say, communicating honestly, and relating to each person as an individual. Through acknowledging different parts of their identity and focusing on what they can do, rather than what they cannot do.

Steering away from overt advice-giving; Instead, hearing their own change talk and bringing it out. Evidence-based information provides sound knowledge that supports them to make their own informed decisions, based on what is available to them. Providing service users with a sense of purpose and valuing them as ‘experts by experience’ also helps them make a legitimate contribution, O’Shea, A. et, al (2017), cited in Wilson, A. (2019). Open questions involve them in topic discussions.

2) Applying the Social Model

Seeing individuals, from a social perspective, means understanding the whole person; in practice, this means going beyond labels and stereotypes. Recognising service users’ social worlds, relationships, power structures and cultural norms, and how this influences their personal experience of health, illness and their resilience for maintaining wellbeing (Wilson. A, with MacKian, S. 2019).

3) Picking up on possible barriers, and finding ways to overcome them

a) Internal

People with health and wellbeing problems are more likely to have less social support and social contact than other people, who are not experiencing problems. Personal barriers are; low confidence, embarrassment, low self-esteem feeling depressed and difficulties trusting people.

b) External

 

Many service users’ living conditions (such as income, housing and employment), create barriers in choosing a healthy lifestyle. Any efforts in changing lifestyle, are unlikely to succeed, without a strong foundation of economic and social support. The Black Report on Inequalities in Health (Department of Health and Social Security, 1980) cited in Lucassen, M. et.al. (2019).

 

c) Stigma and Equality Issues

 

Engaging with BAME and LGBT service users in ways that respect their culture, sexuality and differences. Cultural awareness means respecting peoples background, ways of relating, and sense of self.  Many barriers may be overcome through the type of trusting relationship, built through person-centered and the social model approach. These approaches allow partnerships and more citizen control, because they hear the voice of the individual and respect human rights. Moving beyond tokenism, which just pays lip service. Sharing information about other services, and resources so they have support with specific barriers.

d) Some service users have learning difficulties or can’t read.

 

Different needs require some adjustments, in order to engage well. I have managed this by switching materials so that it is more visual. For example, instead of sending them a workbook, I have opted for a postcard/vision board with photos that reflect the theme of the session. I also find the use of metaphor is good for explaining ideas. Making adjustments for people with long-term illness, or physical disabilities, also means ensuring they feel comfortable and understand.

4), Evidence-based information

I support service users in their own self-help, with general health and wellbeing. In addition to my workbooks, I suggest links to further information that may be able to help them. For e.g. Mental Health Foundation, has particularly good resources, available.”

To find out more about 3SC’s work managing justice contracts please visit https://www.3sc.org/justice/

Gareth Snaith, Contract Performance Manager, 3SC