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Assertive Engagement - Multco 2016

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tash shatz

on 1 November 2016

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Transcript of Assertive Engagement - Multco 2016

What is Assertive Engagement?
The Assertive Engagement Model
Traditional Models
- Inflexible appointments
- Low compliance = low service
- Exclusions from service for breaking rules or not following through
- Clients who are not patient or polite are excluded or punished
- Poor follow through is a sign of low client motivation

Three Sets of AE
Empathy vs. Sympathy
AE Practices
Skill set:
ask, offer, ask - what do they already know?
open ended questions, affirmations, and reflections
3 minutes of listening
identifying ambivalence
creativity and persistence
What works?
Assertive Engagement: "how" we do is Much more important than "what" we do
A social service approach to working with people that honors people as the experts in their own lives.
Recognizes that trauma and oppression may temporarily inhibit a person's capacity to make the changes they want.
Understands that each
individual's goals,
values, and motivations
are distinct.
Assertive Community Treatment:
studies since the 1970s have shown reduced time in psychiatric hospitals, better independent-living skills, enhanced work and social functioning, higher consumer satisfaction, and programmatic cost savings or no cost difference.
Motivational Interviewing:
in a meta-analysis of 72 clinical trials on substance use and health improvement, motivational interviewing had a significant effect in modifying behaviors in approximately 75% of the studies.
Strengths-based Practice:
studies found this consistently achieved more positive outcomes than programs using a deficit perspective. Improved parent/child engagement, increased confidence, higher parental satisfaction, and client ratings such as 95% usefulness for strengths-based program models.
Assertive Engagement
- Persistence and creativity at the core of being a provider
- Emphasis on clients identifying their own goals
- Understanding of why clients may struggle
- Belief in inherent abilities of clients

Heart set:
nurturing hope
make mistakes: real is better than perfect
clients as experts
Mind set:
treat clients as experts
be aware of your own judgements and values
resist the righting reflex
Weaves together Assertive Community Treatment, Motivational Interviewing, and Strengths-based Practices
Currently working with providers to adapt to a range of client populations
Multnomah County implemented AE with homeless youth system, homeless family system, anti-poverty work, and SUN programs over the past 3-4 years
AE = Assertive Engagement
Scenario 1
Scenario 2
What did you notice?
What did the doctor say that decreased connection and trust? What did she do to increase it?
In which scenario do you believe the patient might take action?
Where did you notice judgement come up for you?
How does this apply to your work?
Mind Set = How we think about the people we work with

Skill Set = How we do our work

Heart Set = How we feel about and how we treat the people we work with
Sources: The National Association of Mental Health Planning and Advisory Councils "Evidence Based Assertive Community Treatment;" American College of Obstetricians and Gynecologists Committee Opinion on Motivational Interviewing; UnitingCare Children, Young People, and Families Research Paper "Strengths-Based Practice: The Evidence"
Common Factors Theory
A summary of psychotherapy outcome research estimated that only 15% of client success is attributable to the techniques/models used.
Estimated 85% of factors identified for successful treatment come from client factors, hope, and the relationship between the provider and client.


Lambert, Michael J (1992). "Psychotherapy outcome research: implications for integrative and eclectic therapists". In Norcross, John C; Goldfried, Marvin R. Handbook of psychotherapy integration (1st ed.). New York: Basic Books. pp. 94–129.

Duncan, B., Miller, S., Wampold, B., & Hubble, M. 2nd Edition (2009) The Heart and Soul of Change: What Works in Therapy. 
Washington, DC: American Psychological Association

Moving Forward
What are you taking away from today's conversation?
What practices are you already using?
Where would you like to use more of these practices?
Mutnomah County AE content creation led by Seth Lyon, LCSW; Kenan Ginsberg, LSSW; Armin Tolentino; tash shatz. Inspired by content from Michael D. Clark, MSW, LMSW.

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