Consumer Engagement

1. Consumer Engagement Deborah G. Haskins, Ph.D., LCPC, NCGC-II, BACC

2. Consumer Engagement • How Do We Engage Consumers? • What are tips to increase consumer’s participation in treatment and prevention?

3. Consumer Illustrations • Joe calls the Gambling Hotline for help. He wants to work with a problem gambling counselor but is unemployed and has no health insurance or money to pay for treatment • Mikel is an African American male. He has never been in counseling before and is having trouble connecting with his European American problem gambling counselor • Sam is a Syrian middle aged sports better. He just began treatment. When he comes to the agency, he states he doesn’t feel comfortable: “I don’t see people like me or images anywhere there like me.”

4. Consumer Illustrations • Karen is a 40 year old gambler and began playing the slots machine after feeling lonely in her marriage. She tried GA but doesn’t’ feel comfortable. She says, “I feel like the men are cocky and harsh like my husband was all our marriage.” • Linda is a parent of a young adult college student who gambles online. They are a religious family and question whether seeking problem gambling treatment is going to work better than if “we pray about this.”

5. Mental Health Consumer (Wikipedia, 2009) • A mental health consumer is a person who is under treatment for a psychiatric illness or disorder. The term was coined in an attempt to empower those with mental health issues, usually considered a marginalized segment of society. The term suggests that those persons have a choice in their treatment and that without them there could not exist mental health providers. • Consumer theory was developed to interpret the special relationship between a service provider and service user in the context of mental health.

6. Tips • Consider the whole issue of empowerment. Establish a strengths-focus relationship and treatment process where consumers can be empowered in their recovery process (Smith, E. J., 2006) “What strengths has person used to deal with? “ • “Gift” the client in every session. Dr. Stanley Sue says “treat each session as if it can be the client’s last.” What can client learn or take away that helps him/her feel they got something out of the session.

7. Tips • Therapeutic Relationship? How does this influence consumer engagement? Smith, Thomas, & Jackson (2004) stated: “The quality of the patient’s participation in therapy stands out alone as the most important determinant of outcome. The therapeutic bond, especially as perceived by the patient, is importantly involved in mediating the process-outcome link….These consistent process-outcome relations, based on literally hundreds of empirical findings can be considered facts established by 40 plus years of research in psychotherapy…

8. Tips • Engage Right Away within first 48 hours: • Make the first contact yourself, when possible • Identify the scope of their understanding of the impact that gambling has had • Make yourself available with 48 hours, 24 hours when possible.

9. Tips • Engage and provide therapy . Paperwork that is only necessary should wait until the end. • What is most important to them: • Legal issue • Financial devastation • Loss of supports (spouse, family, friends) • Loss of job (Notice many counselors don’t know resources or have skills to assist in this area) • Not wanting to stop gambling

10. Tips • Use Motivational Theory: What is consumer’s motivation to change? Target interventions and prevention based on the level (note voluntary or involuntary help-seeking) (DiClemente, C. C. & Prochaska, J. O., 1988) • Abstinence or Harm-Reduction? : Harm reduction can be an interim step towards an abstinence model. (Dickson, L., Deverensky, J., & Gupta, R., 2004) • Be sure to focus on a holistic recovery plan • Deal with the emotional issues which contributed to the etiology of pathological and problem gambling

11. Tips • Be more available, but set boundaries, if client is really struggling. (e.g., telephone check, double-up sessions) • Include couple/family focus consistently: Notice counselors are not consistent . Standardize your process to assess partners/family’s role and supports and include them right from the start. Be creative in how you involve them • Recommend medication.

12. Tips • Help should be provided in a cultural context: Many clients disengage because services are not offered in a cultural context they understand or value (Boyd-Franklin, 2003; Helms & Cook, 1999; Gamst, Der-Karabetian, & Dana, 2008; Hays, 2008) • Don’t rush the process. Take your time. Remember when consumer is in crisis, if we create a “parallel process ,” then we will push them out the door.